A full voice evaluation contains a combination of formal and informal instrumentation, perceptual evaluation, acoustic measures, aerodynamic assessment, and videostroboscopy.
Formal and Informal Instrumentation & Perceptual Evaluation
his can include a combination of the Vocal Handicap Index (VHI), Singing VHI, Reflux Symptom Index (RSI), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and other informal measures. The examiner may also conduct stimulability testing as well as rating the voice on the Vanderbilt FITQ scale and palpating for laryngeal tension.
This can include measuring one's fundamental frequency (F0) as well as Cepstral Peak. The examiner may have the client sustain a number of vowels, speak sentences and read paragraphs to capture the sound in a variety of contexts.
This is a laryngeal function study. The examiner calculates the patient's vital capacity using a spirometer. Vital capacity, maximum phonation time, phonation quotient and estimated mean flow rate are all calculated to determine if the data falls out of the range of normal.
Videostroboscopy is how Speech Language Pathologists view a patient's vocal cords. This is to determine if there is a structural or anatomical cause to a patient's complaints. Our vocal folds vibrate in our larynx so fast that they can't be seen in motion with a normal light shining on them. This technology utilizes a strobe light source to emit light pulses at a slower rate than the vibrating vocal folds causing them to appear as though they are in slow motion. Normal, healthy vibratory dynamics include white symmetrical vocal folds with normal amplitude, periodicity, mucosal wave and closure.
Any patient who is recommended for voice therapy should be evaluated with this exam prior to receiving any skilled intervention. This is to make sure there are not contraindications for therapy. This exam may reveal changes in the look of the tissue surrounding your vocal cords, indicating you may have acid reflux. It may discover that you have a polyp, like Adele. It may reveal that you are overcompensating with your muscles after an upper respiratory infection. Whatever the concern, Speech Language Pathologists use this exam because it allows us to see what the naked eye cannot: vocal cord motion.
The camera is attached to a metal rod with a 70 degree angled lens and will simply rest on your tongue. The Speech Language Pathologist will have you sit on the edge of your chair, lean forward, and stick your tongue out. You will say the vowel "eeeee" and a series of other tasks with the scope in your mouth. The Speech Language Pathologist will hold your tongue with gauze, warm the tip of the scope in warm water to prevent fogging of the camera, and gently rest the scope on your tongue.
Sometimes, a topical anesthetic will be sprayed onto the back of your throat to diminish any reactions you may have to the presence of the scope in your mouth. This allows for a quick and thorough examination. Most patients, however, do not require this.
Imagine you are a mountain climber and you have climbed into your own mouth, crawled along your tongue and are now peeking over the edge into your throat. You look up and there is your uvula. You look down and you see two white V shaped muscles. These are your vocal cords.
A bedside swallow evaluation involves testing a variety of food textures and liquids and a skilled examination of your oral structures. This is different from a Modified Barium Swallow Study, and often times this will be performed outside our office prior to this evaluation.
Bedside Swallow Evaluation
A patient arrives with either food brought from home or food provided. The Speech Language Pathologist will perform an oral-motor evaluation to observe cranial nerve functions. Food and liquid trials are next, as the SLP observes how the patient manages thin or thickened liquids as well as puree, mechanical soft and regular solid foods.
Sources: Laryngeal Evaluation by Kendall & Leonard; Thoughtful friends who have so graciously allowed me to use pictures of their vocal cords.