Age Related Dysphonia Case Study

Hearing loss is one of the most common ailments faced by American seniors. In fact, nearly 36 million seniors have at least some hearing loss, with the majority of those individuals being more than 65 years of age. On the surface, the consequences of hearing loss may seem to be about the loss of a physical sense. In reality, the actual loss of hearing is the least of a senior's concerns.

For example, students were asked to sing a glissando up and down the scale, intone “Ah” for as long as possible, practice diaphragmatic breathing, and other vocal exercises (see Appendix B for an example of directed exercises). Although students were initially reluctant to use their voices, the justification for these activities was that the clinician must demonstrate a procedure or task for the client so that the client understands what is required. If the clinician is tentative in using his or her voice or if the clinician’s model is flawed, the client will also behave tentatively and the output will be equally flawed. Practice produced proficiency so that students were able to provide an efficient model for the voice client. Moreover, students were counseled to learn to love their voices. This was necessary because an informal survey on session one of the class revealed that every student, without exception, did not like the sound of their voice. To be a potential voice specialist, students needed to be unashamed of their voices and to behave as if they were performance artists. This appeared to have a positive effect on their voice use in class and in the clinical settings. Many students reported that they were more comfortable working with voice

The speech-language pathologists (SLPs) at Martin Health System (MHS) evaluate, diagnose, and treat a diverse patient population who present with a myriad of medical issues, the most common of which is a condition known as dysphagia. More than 80% of patients referred to an SLP at our facility present with this diagnosis. Broadly characterized by trouble swallowing, dysphagia includes everything from painful swallows, to coughing or choking while eating and drinking, or even a sensation of a lump in throat, . Complications of dysphagia can lead to dehydration, malnutrition, and respiratory problems such as aspiration pneumonia, fatigue, cognitive confusion, decreased quality of life, or even death.

In 2006 it had been estimated that around 19% of Speech-Language Pathologist’s caseloads are comprised of geriatric clients with communication disorders (Zraick, Gregg, & Whitehouse, 2006). Due to the influx of the baby boomer generation reaching old age within recent years, this percentage is sure to have increased. It is imperative that Speech-Language Pathologists become highly familiar with the aging process as it relates to speech production for both healthy and disordered speakers. Strong knowledge of this area will enable a Speech-Language Pathologist to determine if the changes a client undergoes are the result of the normal course of aging, or if they are indicative of a disorder. Aging effects various aspects of speech and all

Speech therapy covers a wide range of different tasks to preform and individuals to help, existing to improve lives and have a deep understanding of communication.

It is common for people with vocal fold nodules to improve without the need for surgery (Simpson B al., et 2008). Speech-Language Pathologists have to be mindful of using evidence-based practices

An interview was conducted in which the client’s mother stated that she feels that Tommy’s voice quality is becoming progressively worse. Tommy has also begun to perceive the difference compared to his peers. He stated, “I sound different from all of my friends at school. They say ‘Tommy, what’s wrong with you? Why do you sound like that?’” In response to his friends’ inquisitiveness about his voice, Mrs. Callahan stated that Tommy is becoming less talkative. During the interview, a connected speech sample was taken whereby Tommy was asked to read the Limpy standard reading passage aloud. Low pitch and hoarseness were evident during the

CAPE-V is an auditory method of evaluating voice quality. The CAPE-V was created to provide a consistent scale and consistent parameters for professionals evaluating the voice while also allowing clinicians to identity differences among a client’s voice (Nagle, 2016, 47). Clinicians determine if a person has a voice disorder or if a person has a normal voice. Six voice qualities are specifically examined when a CAPE-V is used; however, the evaluation includes blank lines to allow a clinician to write additional voice features he or she perceives that are not originally listed on the CAPE-V form. Qualities examined by a professional utilizing a CAPE-V are overall severity, roughness, breathiness, pitch, and loudness. A tick mark is placed on a visual analog scale to denote the severity of each vocal quality; the left portion of the scale signifies a normal vocal quality, while the right portion of the scale represents an extreme deviance in voice parameters. The assessment requires the client sustain vowels /a/ and /i/, read six sentences, and speak in a conversational manner to the statement, “Tell me about your voice.” Prolonged vowels enable a clinical to hear a client’s voice with no articulatory influences, speaking the sentences permits a professional to evaluate specific voice qualities, and conversational speech allows a clinician to further assess a client’s voice for abnormalities (Kempster et al., 2009, pp. 126-127). Clinicians agree that

Client X is a college student referred to the clinic by a music professor due to concerns of possible vocal nodules. During vocal juries, X’s professor commented that her voice became very airy, especially when using her high register. Client has also described her voice as husky, breathy, tense, and hoarse.

After listening to this individual’s voice, one could infer that this individual has an overall severe voice problem. I determined this because of voices I have heard on a daily basis. This individual’s voice seemed very rough and there was a lot of strain. This individual’s sounded exhausted and forced when they tried to produce

For Commissure advancement, a center strip of the anterior commissure is cut from the thyroid cartilage. The vocal cords are then “detached in the subperichondrial plane, and the cartilage strip is advanced and secured using a metal splint” (American, 2003). A successful surgery tightens and increases tension in the vocal folds. Commissure advancement and endolaryngeal shortening can increase one’s fundamental frequency by 40 to 50 Hz (American,

How can our daily lives be if we only whispered? What about having a breathy or strained voice? For many, these questions do not come across when communicating. Yet, several do not realize the different types of voice problems that individuals have. Day by day numerous people are being diagnosed with Spasmodic Dysphonia. The majority do not understand what it is or how it can be treated. Researchers have begun conducting studies to identify brainstem functions with patients with Spasmodic Dysphonia, determine the risks, and develop the best recovery treatment for this disorder.

Expected results: Typically, females have a fundamental frequency ranging between G3 (196 Hz) and A3 (220 Hz). Ms. Noid’s MSF result will demonstrate an inconsistent pitch due her paralyzed vocal fold. Her vocal fold pathology impairs the left vocal fold to lengthen and decrease its mass and stiffness (impairment of Thyroarytenoid and Cricothyroid). Consequently, Ms. Noid’s vocal folds might vibrate at different frequencies (diplophonia); have a decreased MSF measure, disrupted vocal fold vibration, and inadequate glottal closure, which would cause a decrease in subglottic pressure. Ms. Noid’s fundamental frequency would be affected (perceptual correlate of pitch), therefore, reducing her flexibility, and changing her vocal

For others, learning how to support the voice is a process that takes many years. Montserrat Caballe spent her “first year at the Conservatoire learning how to breathe.” She went on to call this her “respiratory gymnastics.” “Her breathing exercises were aimed at building a big solid wall around the diaphragm by using and controlling all those muscles under and behind the abdomen which support the diaphragm and the back. She wanted to strengthen them to the point where the diaphragm does need to work but only to support the breath. The actual work of pushing up the air is done by the abdominal muscles.” Dramatic Soprano and Professor of Voice at New England Conservatory, Jane Eaglen shares Caballe’s beliefs on the sheer physicality required to achieve sufficient breathe support for a large voice. She states “Making the voice seamlessly supported throughout its entire range takes a lot of physical strength. Not stamina, but sheer physical strength. The strength to use your muscles, and the diaphragm, and the rest of the body in the right way—never the throat. There must never be an inkling of tension in the throat. I very much use all of my body to sing. I use my legs, bottom, everything. So the whole body was ready by then: the cords were ready, the voice was ready and the muscles were ready. A voice should always be like that – seamless. But this just took time. It came through good teaching and my being

The last option is surgical voice restoration which was introduced by Singer & Blom in 1980(Blom,1995) Not all patients are suitable for this however, It involves a tracheoesophageal speaking valve, a small fistula is surgically created through the tracheal wall into the oesophagus. A small, one way valve is inserted into the fistula and it allows air to be shunted from the trachea to the oesophagus and up through the pharyngo-oesophageal segment creating an acoustic wave form and voice. A longer flow of voice can be achieved as pulmonary air is used as the initiator for voice.