Lecture 5

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Instrumental Assessment & Report Writing

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Laryngeal examination indirect laryngoscopy direct laryngoscopy fiberoptic laryngoscopy -flexible -rigid stroboscopy high speed imaging
Indirect laryngoscopy procedure: mirror inserted into oropharynx, position to relfect VF, mirror warmed, tongue pulled forward. quick, minimal pain/trauma. limitations: gag, view may be difficult, P cant speak normally
Direct laryngoscopy procedure: hospitalisation, anesthesia, endoscope inserted directly into oropharynx and close to larynx. Advantages: detailed exam, biopsies, enable manipulation of structures. Limitations: invasive, costly, unable to observe laryngeal function
Fiberoscopic (rigid) procedure: rigid tube inserted into oropharynx, tongue pulled forward, limitations: limits speech and laryngeal activity, restricted access to laryngeal cavity
Fiberoscopic (flexible) procedure: passed through nasal cavity over soft palate, local anesthetic required, scope positioned slightly above epiglottis. advantages: flexibility, zoom lens, P able to speak and sing, all ages, overcomes gag
Stroboscopy procedure: stroboscropic light source (rigid or flexible), enables detailed view of vibratory behaviour of VF, strobe light emits rapid pulses at rate controlled by examiner. basic principle: light pulse=vocal frequency (static image), slow motion image. parameters: symmetry, regularity, closure, amplitude, mucosal wave, lesions and effects
High speed imaging imaging of VF up to 2000 frames per second allows clearer examination of VF vibration costly for research purposes
Physiological Examination electro-glottography (EGG) laryngeal aerodynamics electro-myography (EMG) respiratory function
EGG 2 electrodes placed externally on thyroid cartilage, small electrical current passes through. VF ab - no current passes through VF ad - current passes through changes in flow=glottal cycle - Lx waveform Laryngograph normal (sharp closure, gradual open) breathy (too long open phase) harsh (too short open phase) limitations: electrode placement, P movement
Laryngeal Aerodynamics parameters: airflow rate, subglottal pressure, SPL, laryngeal resistance, ad/ab rate of VF instrumentation: aeroplane ll (Kay Elementrics
EMG measures electrical activity of muscles direct - electrodes inserted indirect - surface electrodes parameters: onset and offset activity, pattern, amplitude, abnormal. uses: diagnosis, predictions, guiding botox injections
Respiratory Function Spirometry: vital capacity and forced (expiratory) vital capacity. (FEV1)=FEV in 1st sec of FVC. Kinematic Ax: recodeing of changes in circumference of RC and AB, determines presence of asynchronous or arrhythmic repiratory behavious. instrumentation=respitrace interpretation= normal (equal contribution of RC and AB to lung volume reduction) also measures: freq. paradoxing, mean syllables/breath, max phonation time, speaking rate
Acoustic Analysis visipitch computerised speech lab phonetogram/voice range profile praat
Visipitch real time delay of Fo and energy of voice parameters: average Fo and range, average intensity and range, frequency perturbation (shimmer), noise-to-harmonic ratio
CSL similar parameters to Visipitch more sophisticated spectrograms - reflex properties of VF vibration and vocal tract
Voice Range Profile measures the max phonational pitch and intensity range, 2D visual, graphical representation, intensity plotted against frequency, profile area=max phonational capacity of individual
Praat acoustic analysis freeware purpose: assess voice quality using acoustic analysis, extract energy info using spectrographic frequency and pertubation methods. 2 data methods: acoustic signal typing using spectrogram, voice report
report writing background info, results of evaluation, clinical impressions, recommendations
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