The professional voice: Part II. Physical examination

doi:10.1016/S0892-1997(87)80045-0

Journal of Voice

Volume 1, Issue 2, 1987, Pages 191-201

https://doi.org/10.1016/S0892-1997(87)80045-0 Get rights and content

Summary

Physical examination of professional voice users should incorporate not only a complete otolaryngologic evaluation and appropriate general physical examination, but also special studies. Evaluation of the patient during actual singing or projected speaking is important. Special instrumention including strobovideolaryngoscopy is invaluable, and objective measures of voice function add much to diagnosis and analysis of treatment results.

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Cited by (24)

Automatic diagnosis of vocal fold paresis by employing phonovibrogram features and machine learning methods
2010, Computer Methods and Programs in Biomedicine
The clinical diagnosis of voice disorders is based on examination of the rapidly moving vocal folds during phonation (f0: 80–300 Hz) with state-of-the-art endoscopic high-speed cameras. Commonly, analysis is performed in a subjective and time-consuming manner via slow-motion video playback and exhibits low inter- and intra-rater reliability. In this study an objective method to overcome this drawback is presented being based on Phonovibrography, a novel image analysis technique. For a collective of 45 normophonic and paralytic voices the laryngeal dynamics were captured by specialized Phonovibrogram features and analyzed with different machine learning algorithms. Classification accuracies reached 93% for 2-class and 73% for 3-class discrimination. The results were validated by subjective expert ratings given the same diagnostic criteria. The automatic Phonovibrogram analysis approach exceeded the experienced raters’ classifications by 9%. The presented method holds a lot of potential for providing reliable vocal fold diagnosis support in the future.
Physical Examination of Voice Professionals
2007, Otolaryngologic Clinics of North America
Citation Excerpt :
This examination also gives the physician an opportunity to observe any dramatic differences between the qualities and ranges of the patient's speaking voice and the singing voice. A physical examination summary form has proven helpful in organization and documentation [3]. Remembering the admonition not to exceed his or her expertise, the physician who examines many singers can often glean valuable information from a brief attempt to modify an obvious technical error.
Comprehensive physical examination is essential when evaluating patients. Often it includes objective voice assessment and measures along with strobovideolaryngoscopy. In all cases physical examination involves a thorough examination of the ears, nose, throat, neck, posture, cranial nerve function (usually), and assessment of the patient's general (systemic) physical condition. Performance assessment usually should be included for professional voice.
The Value of Laryngeal Electromyography in the Evaluation of Laryngeal Motion Abnormalities
2006, Journal of Voice
Citation Excerpt :
With severe muscle tension dysphonia, the apparent tremor is present with fatigue only and usually lacks the same reliable periodicity. The last components of the neurolaryngeal examination include isolation, repetition, and opposition testing.11,12 Phonatory tasks that allow one to isolate the abductor, adductor, and tensor muscle groups of the larynx while eliminating supraglottic hyperfunction allow the examiner to detect mild vocal fold hypomobility and differentiate paresis and/or paralysis form cricoarytenoid joint hypomobility.
Laryngeal electromyography (EMG) functions routinely as a prognostic tool in the evaluation of vocal fold paralysis, as a guide for therapeutic injections into the laryngeal muscles, and more recently as an assessment tool in the evaluation of vocal fold paresis. This study investigates the clinical utility of laryngeal EMG as a diagnostic aid in the evaluation of movement disorders of the larynx in patients complaining of dysphonia. A retrospective chart review of all laryngeal EMGs performed at a tertiary laryngology referral center over a 13-month period was performed. All laryngeal EMGs were performed to evaluate laryngeal motion abnormalities in dysphonic patients. Thirty-seven laryngeal EMGs were completed during this study period. Analysis of the data revealed that the medical treatment plan changed as a result of findings on laryngeal EMG in 10/37 patients (27.0%); laryngeal EMG guided and/or confirmed the course of treatment in 12/37 patients (32.4%) and did not change the treatment plan in 15/37 patients (40.5%). Laryngeal EMG is a useful diagnostic tool that, in this study, contributed significantly to and helped guide the evaluation and management of motion disorders in the larynx of dysphonic patients.
Mild Vocal Fold Paresis: Understanding Clinical Presentation and Electromyographic Findings
2006, Journal of Voice
Citation Excerpt :
All patients with a laryngeal examination that revealed evidence of mild hypomobility of one or both vocal folds in adduction, abduction, and/or longitudinal stretch and who underwent laryngeal electromyography were included in the study. Our technique for assessing mobility of the vocal folds involves assessment of vocal fold mobility, coordination, and use of accessory muscles of phonation.17,19,20 The neurolaryngeal evaluation is performed with a flexible laryngoscope to prevent distortion of the larynx and muscle forces in the larynx that can result from holding the tongue forward for indirect and rigid stroboscopic examinations.
The implications of mild vocal fold hypomobility are incompletely understood. This study describes the clinical, electromyographic, and probable etiologic findings in patients who presented with complaints of dysphonia and whose physical examination revealed vocal fold paresis as a factor possibly contributing to their voice complaints. A retrospective chart review of all patients who presented to a tertiary laryngology referral center over a 13-month period, who had a clinical diagnosis of mild vocal fold hypomobility and who underwent laryngeal electromyography, were included in the study. A total of 22 patients completed the medical evaluation of their voice complaint. Of these patients, 19 (86.4%) were found to have evidence of neuropathy on laryngeal electromyography. The clinical picture indicated the following probable origins for the vocal fold paresis: goiter/thyroiditis (7/22 or 31.8%), idiopathic (4/22 or 18.2%), viral neuritis (4/22 or 18.2%), trauma (3/22 or 13.6%), and Lyme's disease (1/22 or 4.5%). This article describes the clinical entity of mild vocal fold hypomobility and associated flexible laryngoscopic, rigid strobovideolaryngoscopic, and laryngeal electromyographic findings.
Determining the Etiology of Mild Vocal Fold Hypomobility
2003, Journal of Voice
The prevalence of mild vocal fold hypomobility is unknown. In a study by Heman-Ackah et al, vocal fold hypomobility in a population of singing teachers was found to be associated more frequently with vocal complaints than was the presence of vocal fold masses.¹ The etiology of mild vocal fold hypomobility has not been previously explored. In the present study, a retrospective chart review was performed of 134 patients who presented to a tertiary laryngology referral center over a 6-month period for evaluation of vocal complaints. Of the 134 patients, 61 (46%) were found to have mild vocal fold hypomobility previously undiagnosed by the referring otolaryngologist. Imaging studies and laboratory tests to evaluate for structural, metabolic, and infectious causes of the decreased mobility had been ordered. Forty-nine patients completed the work-up. Of these, 41 out of 49 (84%) were found to have imaging or laboratory findings that could explain the hypomobility. Thyroid abnormalities were found to be associated with vocal fold hypomobility in 21 out of 49 (43%) of those with a complete evaluation. Other causes of vocal fold hypomobility included idiopathic (8 of 49, 16%), viral neuritis (5 of 49, 10%), central nervous system abnormality (4 of 49, 8%), neural tumor (3 of 49, 6%), joint dysfunction (3 of 49, 6%), iatrogenic nerve injury (2 of 49, 4%), myopathy (2 of 49, 4%), and noniatrogenic traumatic nerve injury (1 of 49, 2%), This study shows that unilateral vocal fold hypomobility often is associated with a physiologic process, and a complete investigation to determine the etiology is warranted in all cases.
Strobovideolaryngoscopic findings in singing teachers
2002, Journal of Voice
Professional voice users often present to otolaryngologists and laryngologists with specific voice complaints. The contributions of pathologic lesions to the patients' vocal complaints are not always clear on examination, and often, premorbid examinations of the larynx are not available for review. This study examines the incidence of laryngeal pathology among singing teachers. At a national convention of singing teachers, volunteers were recruited for a “free strobovideolaryngoscopic examination.” All volunteers completed a detailed questionnaire of their vocal and medical history and underwent strobovideolaryngoscopic examination. Strobovideolaryngoscopic examinations were completed in 20 volunteers, 7 of whom had voice complaints and 13 of whom perceived their voices to be normal. Vocal fold masses were common among the asymptomatic singing teachers. Evidence of reflux laryngitis was a common finding among both symptomatic and asymptomatic singing teachers. Asymmetries in vocal fold hypomobility were more common among those with voice complaints than was the presence of vocal fold masses in the population studied.

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The professional voice: Part II. Physical examination

Summary

Am J Otol

J Voice

A technique for stroboscopic examination of the vocal folds using fiberoptics

Arch Otolaryngol

Stereo-fiberoptic laryngeal observation

J Acoust Soc Am

Phonosurgery

Basic and clinical investigations

Otologia (Fukuoka)

Electroglottography and its relation to glottal activity

Folia Phoniatr

Clinical examination of the voice

Fundamental frequency-sound pressure level profiles of adult male and female voices

J Speech Hear Res