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Data Base Recording and Report Generation Voice Clinic

last modified on: Mon, 11/20/2023 - 09:26

Last update: 2017

Diagnosis and documentation of voice disorders and their laryngeal correlates involve a multifaceted protocol. The sample protocol is provided on Figure IC-1, a data-entry form used for voice/laryngeal evaluations at the University of Iowa Department of Otolaryngology--Head and Neck Surgery. The following is a description of the various components of this protocol.

HISTORY AND PATIENT RATINGS OF VOCAL FUNCTION

The data entry form shown in Figure IC-2, (PDF icon database2.pdf) includes data fields for recording the history of the disorder and possible contributing health and/or lifestyle variables (such as smoking, alcohol use, allergies, gastroesophageal reflux disease, and vocal abuse). Also included are patient ratings of dysphonia severity, impact of dysphonia on the patient's life, and vocal effort.

LARYNGEAL FUNCTION STUDIES

A concise set of objective laryngeal function measures are obtained to document adequacy of vocal fold valving for voice and the range of vocal function. Maximum phonation time and S/Z ratio have been shown to correlate well with glottal incompetence. Measures of maximum and minimum phonational frequency describes the range of vibratory rates the patient is capable of producing. Mean habitual fundamental frequency, jitter, shimmer, and harmonics/noise ratio are measured from three sustained a phonations (also used for measuring maximum phonation time).

CLINICIAN'S PERCEPTUAL JUDGMENTS OF VOICE

The speech-language pathologist performing the examination provides a rating of dysphonia using the GRBAS system described by Hirano (1984) where G = grade or severity of dysphonia, R = severity of roughness, B = severity of breathiness, A = severity of asthenia (vocal weakness), and S = severity of vocal strain. Each variable is rated from 0 = normal to 3 = severe. Judgments of habitual pitch adequacy, pitch range, frequency of pitch breaks, and respiratory support are also recorded. When indicated, diagnostic therapy probes are used to assess the patient's stimulability and possible suitability for voice therapy.

SURGICAL DATES

If the patient has had laryngeal surgery, the date and type of surgery are recorded. The number of days between the date of surgery and the current evaluation are calculated and recorded.

ELECTROGLOTTOGRAPHY

Electroglottographic recordings are useful for documenting the adequacy of vocal fold contact area during phonation. These recordings are obtained during the videostroboscopic examination (described below) and are rated for amplitude, open quotient, and waveshape.

VIDEOSTROBOSCOPIC ASSESSMENT

Videostroboscopy is performed according to standardized techniques described by Karnell (1995). Type of endoscope, type of examination, and quality of examination are recorded as an indication of the adequacy and intent of the examination. Vocal fold vibratory function is assessed by recording adequacy of glottal closure, presence of supraglottic compression, adequacy of mucosal wave, amplitude symmetry, and phase asymmetry. The condition of the edges of the vocal folds are recorded as well as the presence of adynamic segments.

DIAGNOSIS

When the videostroboscopic evaluation is complete, preliminary primary and secondary diagnoses are recorded. The speech-language pathologist and attending physician discuss these in detail as they review together all of the findings of the assessment. A final diagnosis is recorded based on the outcome of the data review.

RECOMMENDATIONS

The recommendations for treatment are also determined through interdisciplinary discussion and agreement. These are recorded and discussed with the patient. If voice therapy is recommended, an attempt is made to locate a speech-language pathologist who specializes in voice and practices near the patient's home. Information (phone, address) about the "local" clinician is provided to the patient before the patient leaves. Additional descriptions of what is meant by "vocal conservation" (see Figure IC-3)(PDF icon Vocal Conservation Instruction Sheet.pdf), minimizing "esophageal reflux" (see Figure IC-4)(PDF icon Esophageal Reflux Instruction Sheet.pdf), and using "optimal breathing" (see Figure IC-5)(PDF icon Optimal Breathing Instruction Sheet.pdf) are provided in written form for the patient when indicated.

REPORT

The report generated from the evaluation includes a written description of each of the observations coded in the data-entry form described above as well as a photograph showing select relevant images from the videostroboscopic examination. The report is formatted as a memo from the speech-language pathologist to the referring attending physician. An example based on the data shown in Figure I-C2 (PDF icon Example of Laryngeal Function Report.pdf) is represented in Figure IC-6 (PDF icon Voice Clinic Report example.pdf).

References

Karnell MP. Nasometric discrimination of hypernasality and turbulent nasal airflow. Cleft Palate Craniofac J. 1995 Mar;32(2):145-8. doi: 10.1597/1545-1569_1995_032_0145_ndohat_2.3.co_2. PMID: 7748876.

Karnell MP, Hall KD, Landahl KL. Comparison of fundamental frequency and perturbation measurements among three analysis systems. J Voice. 1995 Dec;9(4):383-93. doi: 10.1016/s0892-1997(05)80200-0. PMID: 8574304.

Seaver EJ, Karnell MP, Gasparaitis A, Corey J. Acoustic rhinometric measurements of changes in velar positioning. Cleft Palate Craniofac J. 1995 Jan;32(1):49-54. doi: 10.1597/1545-1569_1995_032_0049_armoci_2.3.co_2. PMID: 7727487.

Karnell MP, Melton SD, Childes JM, Coleman TC, Dailey SA, Hoffman HT. Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders. J Voice. 2007 Sep;21(5):576-90. doi: 10.1016/j.jvoice.2006.05.001. Epub 2006 Jul 5. PMID: 16822648.