Steps In a Voice Assessment
Step 1:
Often the first step in any evaluation process, especially for voice disorders, is to collect an extensive case history on the patient. This is so the SLP can pinpoint any exacerbating factors for the voice disorder, or pinpoint any behaviors which may have caused the voice disorder in the first place. Many personal questions may be asked such as medical history, your feelings about your voice disorder, and lifestyle questions, among other things. For this step, you, as a patient, may be required to fill out questionnaires and case history forms, and participate in a one-on-one interview with the SLP.
http://www.nwchiropractic.co.uk/Images/11/ChiropracticCaseHistory.jpg
Often the first step in any evaluation process, especially for voice disorders, is to collect an extensive case history on the patient. This is so the SLP can pinpoint any exacerbating factors for the voice disorder, or pinpoint any behaviors which may have caused the voice disorder in the first place. Many personal questions may be asked such as medical history, your feelings about your voice disorder, and lifestyle questions, among other things. For this step, you, as a patient, may be required to fill out questionnaires and case history forms, and participate in a one-on-one interview with the SLP.
http://www.nwchiropractic.co.uk/Images/11/ChiropracticCaseHistory.jpg
Step 2:
The next step in the evaluation of a potential voice disorder is the physical examination of the head/neck an orofacial regions, such as the nose and mouth. The otolaryngologist (or ENT) may perform these tasks to determine if there are any structural or tension related issues which may be causeing the voice disorders. These examinations are usually done visually and physically, by touching areas around the head and neck areas. This examination is usually not uncomfortable for the patient and is not overally invasive.
http://www3.mdanderson.org/calendar/image/head_image_orange_905.png
The next step in the evaluation of a potential voice disorder is the physical examination of the head/neck an orofacial regions, such as the nose and mouth. The otolaryngologist (or ENT) may perform these tasks to determine if there are any structural or tension related issues which may be causeing the voice disorders. These examinations are usually done visually and physically, by touching areas around the head and neck areas. This examination is usually not uncomfortable for the patient and is not overally invasive.
http://www3.mdanderson.org/calendar/image/head_image_orange_905.png
Step 3:
The next step generally involves the collection of acoustic voice signals from the patient in order to determine voice quality of the patient. This step is also not invasive, and simply requires the patient to speak into a microphone attached to computer monitoring equipment. The patient may be asked to read a few sentences and/or prolong some vowel sounds.
http://comdis.truman.edu/New_Photos/resized/visipitchSmall.JPG
The next step generally involves the collection of acoustic voice signals from the patient in order to determine voice quality of the patient. This step is also not invasive, and simply requires the patient to speak into a microphone attached to computer monitoring equipment. The patient may be asked to read a few sentences and/or prolong some vowel sounds.
http://comdis.truman.edu/New_Photos/resized/visipitchSmall.JPG
Step 4:
The next step for the SLP or ENT is to gain a visual picture of the vocal folds. This is done by either an oral rigid laryngoscope, or by a flexible nasal laryngoscope (both as seen below). These procedures are more invasive and often are the cause of anxiety for many patients during a voice evaluation. However, these procedures, although they may be uncomfortable and induce the gag reflex, they are by no means painful and should not be feared.
Other procedures may also be completed to assess what may be causing the voice disorder if other complications arise. Keep in mind there are many people who can be involved in a patient’s voice care team other than an SLP or ENT. These can include neurologists, pulmonologists, allergists and even psychologists depending on the cause of the vocal disorder. Each specialist may have their own assessment techniques.
http://www.health.utah.edu/csd/images/Stroboscope.jpg
The next step for the SLP or ENT is to gain a visual picture of the vocal folds. This is done by either an oral rigid laryngoscope, or by a flexible nasal laryngoscope (both as seen below). These procedures are more invasive and often are the cause of anxiety for many patients during a voice evaluation. However, these procedures, although they may be uncomfortable and induce the gag reflex, they are by no means painful and should not be feared.
Other procedures may also be completed to assess what may be causing the voice disorder if other complications arise. Keep in mind there are many people who can be involved in a patient’s voice care team other than an SLP or ENT. These can include neurologists, pulmonologists, allergists and even psychologists depending on the cause of the vocal disorder. Each specialist may have their own assessment techniques.
http://www.health.utah.edu/csd/images/Stroboscope.jpg
Oral Rigid LaryngoscopeAn oral rigid laryngoscope, also pictured below, is simply a long, rigid, tube like instrument which passes into the mouth and stops at the base of the tongue where the camera angles down and allows for a view of the vocal folds. This procedure may be uncomfortable to the patient, but is by no means painful. The patient is simply required to hold open their mouth for a long period of time while making sustained vowel sounds.
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Flexible Nasal LaryngoscopeA flexible nasal laryngoscope, as seen below, goes through the nose in order for the SLP or ENT to gain a good visual picture of the vocal folds during connected speech. The nasal passage ways are usually numbed to reduce any discomfort the patient may feel during the procedure.
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Sapienza, C., & Hoffman, R.B. (2009). Voice Disorders. San Diego, CA: Plural Publishing, Inc.