KEAN UNIVERSITY



Fall 2009

KEAN UNIVERSITY

Union, New Jersey

DISORDERS OF VOICE

Course Number: CDD 5262

Semester Hours Three

Prerequisite: Permission of Program Coordinator

Limitation on Enrollment: 25

Required or Elective: Required

Catalogue Description:

Anatomy and physiology of laryngeal mechanism; effects on voice production; clinical management for voice disorders.

N.B. In order to ensure full class participation, any student with a disabling condition requiring special accommodations (e.g. tape recorders, special adaptive equipment, special not-taking or test-taking procedures) will be strongly encouraged to contact the professor at the beginning of the course. For the student’s convenience, the professor’s office hours, telephone number and email address will be listed on the syllabus.

KEAN UNIVERSITY

Union, New Jersey

DISORDERS OF VOICE

I. Course Objectives:

Students will become informed effective clinical professionals demonstrating knowledge of the voice and voice disorders, and skill in diagnosing and treating persons with disorders of voice. They will also demonstrate an understanding of the ethics and human values involved in treating voice disorders. Students will:

A. diagram and demonstrate knowledge of the anatomy, physiology, neurology and histology of normal voice production. (K)

B. identify the acoustic characteristics of voice and resonance disorders. (K)

C. describe and classify the voice disorders associated with trauma to the vocal mechanism, neuropathologies, organic and psychological disabilities, cleft palate and resonance problems, laryngectomy, tracheostomy, and geriatric physiology; correlate classifications with acoustic and physiological data. (K,S)

D. select, administer, and interpret appropriate instrumental and non-instrumental evaluations of voice production and resonance. (K,S)

E. acknowledge the roles of other professionals in the team approach to evaluation and intervention for persons with voice and resonance disorders. (K,S,D)

F. compare and contrast the surgical and medical interventions for voice disorders and their impact on the therapeutic work of the speech-language pathologist. (K,D)

G. design and implement effective intervention programs for persons with voice and resonance disorders. (K, S, D)

II. Course Content:

A. Anatomy, physiology, neurology and histology of the normal voice (K)

1. Structures and function of laryngeal cartilages and muscles

2. Structures and functions of velopharyngeal, oral and nasal areas

3. Basic neurology of larynx and phonation

4. Basic histology of larynx and vocal folds

B. Acoustic correlates of voice disorders. (K)

1. Measures of vocal frequency: pitch, pitch range, jitter

2. Measures of vocal intensity: amplitude, shimmer

3. Measures of vocal quality and resonance: spectrum, nasality, noise factors

C. Voice disorders and their correlation with physiological and acoustic data.

1. Types of vocal misuse and abuse (phonotrauma) and their effects on the vocal mechanism. (K, S)

a. medications, steroids, smoking, and toxins

b. prolonged or abusive use

c. excessive loudness

d. infection

e. trauma: blunt, penetrating, inhalation, thermal

f. other

2. Voice problems associated with nervous system involvement.

a. pyramidal and extra-pyramidal disorders: pseudobulbar palsy, Parkinson disease, ALS, Huntington disease. . .

b. cerebellar disorders: ataxia, Arnold-Chiari malformation

c. lower motor neuron and myoneural junction disorders: spasmodic dysphonia, essential tremor, myasthenia gravis, vocal fold paralysis

d. generalized central nervous system damage: multiple sclerosis, Tourette syndrome

3. Voice problems associated with organic problems:

a. benign lesions: keratosis, granulomas, papilloma

b. vascular disorders: hemorrhage, varix

c. webbing, granuloma, bowing

d. carcinoma

4. Voice problems associated with psychological disabilities: conversion aphonia, puberphonia, etc.

5. Voice and resonance disorders associated with cleft palate

6. Characteristics of partial and total laryngectomy

7. Voicing problems of tracheostomy and ventilator-dependent patients

D. Instrumental and non-instrumental evaluations of voice production. (K, S)

1. Instruments of acoustic measurement:

a. instruments to measure pitch and amplitude: visipitch, keyboards, CSL

b. voice imaging: spectrograph, waveform analysis

2. Instruments to examine laryngeal function

a. fiberoptic endoscopy/ laryngoscopy

b. stroboscopy

3. Non-instrumental voice evaluation techniques

a. Case history, questionnaires

b. voice measurement: s/z ratio, perceptual scaling, pitch matching

E. The team approach to evaluation and intervention. (K, S, D)

1. Roles of various professionals working with persons with voice problems:

a. otolaryngologist

b. other professionals: primary care physician, radiologists, neurolaryngologists, psychotherapists, voice scientists, teachers of singing and speaking.

2. Role of speech-language pathologist in interacting with other specialists

3. Models of teams working with persons with voice disorders

F. Surgical and medical interventions for voice disorders and their impact on the speech-language pathologist. (K, D)

1. Medications for voice disorders: Botox, dopamine

2. Basic concepts of “phonosurgery”.

3. Standard techniques in phonosurgery

G. Effective intervention programs for persons with voice disorders. (K, S, D)

1. Goals and outcomes of voice therapy

2. Obstacles to successful management of voice disorders

3. Techniques for treating phonotrauma

a. vocal rest

b. vocal hygiene

c. tension-reducing techniques:

i. confidential voice

ii. chewing

iii. airflow techniques

iv. relaxation exercises

v. yawn-sigh, etc.

d. biofeedback, digital manipulation and massage

e. hydration

4. techniques for neurogenic disorders

a. LSVT for Parkinson’s disease

b. Botox for spasmodic dysphonia

c. Others

5. Techniques for psychogenic disorders

6. Techniques for disorders of vocal resonance

7. Techniques for establishing voice after laryngectomy and tracheostomy

a. voice with ventilator and Passy/Muir valves

b. pseudolarynges

c. tracheo-esophageal punctures

d. esophageal speech

III. Methods of Instruction:

A. Lecture

B. Observations of and participation in voice evaluations and therapy

C. Guest speakers demonstrating disorders

D. Case studies

E. Internet problem-solving, voice list-serve

F. Computer/Visipitch self-analysis of voice

Methods of Evaluation

A. Written examinations (K)

B. Voice disorders chart (K)

C. Presentations of Case Study observations (K,S,D)

D. Small group projects (K,S)

E. Independent diagnoses of living clients (K,S,D)

F. Presentation of intervention plans (K,S,D)

Suggested Texts

Recommended Text(s):

Boone, D. R., McFarlane, S. C., & Von Berg, S. L. (2009) Voice and voice therapy, 8th ed.). Boston: Allyn and Bacon.

Colton, R.H., Casper, J. K., & Leonard, R. (2006). Understanding voice problems: A physiological perspective for diagnosis and treatment (3rd ed.) Baltimore:Lippincott, Williams & Wilkins.

Sapienza, C. & Ruddy, B. H. (2009) Voice Disorders. San Diego: Plural Publishing

Bibliography:

AAO-HNS: American Academy of Otolaryngology-Head and Neck Surgery. (2008). What is an Otolaryngologist? http:healthinfo/about/otolaryngologist.cfm

American Speech-Language and Hearing Association. (2008) The roles of otolaryngologists and speech-language pathologists in the performance and interpretation of strobe-videolaryngoscopy. http:docs/html/RP1998-00132.html

Adler, C., Bansberg, S., Hentz, J., Ramig, L., Witt, K., Edwards, B., Krein-Jones, K., & Caviness, J. (2004). Botulinum toxin type A for treating voice tremor, Archives o f Neurology,61,1416-1420.

Adler, S., Hirsch & Mordaunt, M. (Eds). (2006). Voice and communication therapy for the transgender/transsexual client: A comprehensive clinical guide. San Diego: Plural Publishing.

Altman, K.W., Atkinson, C., & Lazarus, C. (2005). Current and emerging concepts in muscle tension dysphonia: A 30-month review. Journal of Voice, 19(2), 261-267.

Baylor, C.R., Yorkston, K. M., Eadie, T. L. & Maronian, N. C. (2007). The psychosocial consequences of Botox injections for spasmodic dysphonia: a qualitative study of patients’ experiences. Journal of Voice, 21(2), 231-247.

Behrman, A. (2007). Speech and Voice Science. San Diego: Plural Publishing.

Behrman, A., Sulica, L., & He, T. (2004). Factors predicting patient perception of dysphonia caused by benign vocal fold lesions. The Laryngoscope, 114, 1693-1700.

Behrman, A., Rutledge, J., Hembree, A., & Sheridan, S. (2008). Vocal hygiene education, voice production therapy, and the role of patient adherence: A treatment effectiveness study in women with phonotrauma. Journal of Speech-Language and Hearing Research, 51(2), 350-366.

Berg, E., Hapner, E., Klein, A., & Johns, M. (2006). Voice therapy improves quality of life in age-related dysphonia: A case-control study. Journal of Voice, 22(1), 70-74.

Branski, R., Verdolini, K., Sandulache, V., Rosen, C., & Hebda, P. (2006). Vocal fold wound healing: A review for clinicians. Journal of Voice, 20(3), 432-442.

D’Alatri, L., Galla, S., Rigante, M., Antonelli, O., Buldrini, S., & Marchese, M. (2007). The role of early voice therapy in patients affected by unilateral vocal fold paralysis, Journal of Laryngology and Otology, 24, 1-6.

Duff, M., & Proctor, A. (2004). Prevalence of voice disorders in African American and European American preschoolers. Journal of Voice, 18, 348-353.

Finck, C. (2005). Vocal fold structure and speech pathologies. Review of Laryngology Otology and Rhinology, 1265, 295-300.

Franco, R., & Andrus, J. (2007). Common diagnoses and treatments in professional voice users. Otolaryngologic Clinics of North America, 40(5), 1025-1061.

Gonzalez-Rothi, L., Musson, N., rosenbek, J., & Sapienza, C.(2008) Neuroplasticity and rehabilitation research for speech, language, and swallowing disorders. Journal of Speech-Language and Hearing Research, 51(1), 222-224.

Laukkanen, A.M., Ilomaki, I., Leppanen, K., & Vilkman, E. (2008). Acoustic measures and self-reports of vocal fatigue by female teachers. Journal of Voice, 22 (3), 283-289

Lee, E. K., & Son, Y. I. (2005). Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy. International Journal of Pediatric Otorhinolaryngology, 697, 911-917.

Liu, H., & Ng, M. (2007) Electrolarynx in voice rehabilitation. Auris Nasus Larynx, 34(3), 327-332.

Morgan, J., Zraick, R., Griffin, A., Bowen, T., & Johnson, F. (2007). Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis. Laryngoscope, 117(11), 2068-2074.

Paluska, S.A., & Lansford, C. D. (2008). Laryngeal trauma in sport. Current Sports Medicine Rehabilitation, 7(1), 16-21.

Plant, R. L. (2005). Aerodynamics of the human larynx during vocal fold vibration. Laryngoscope, 115(12), 2087-2100.

Rosen, C., Lee, A., Osborne, J., Zullo, T., Murry, T. (2004) Development and validation of the voice handicap index-10. Laryngoscope, 114, 1549-1556.

Roy, N., Holt, K., Redmond, S., & Muntz, H. (2007). Behavioral characteristics of children with vocal fold nodules. Journal of Voice, 21(2), 157-168.

Sapir, S., Spielman, J., Ramig, L., Story, B., & Fox, C. (2007). Effects of an extended version of the Lee Silverman Voice Treatment (LSVT) on voice and speech in Parkinson’s disease. American Journal of Speech Language Pathology, 16(2), 95-107.

Sataloff, R. (2006). Vocal health and pedagogy: Advanced assessment and treatment 2nd ed. San Diego: Plural Publishing.

Stajner-Katusic, S., Horga, D., Musura, M., & Globlek, D. (2006). Voice and speech after laryngectomy. Clinical Linguistics and Phonology, 20(2-3), 195-203.

Van der Merwe, A. (2004). The voice use reduction program. American Journal of Speech-Language Pathology, 13, 208-219.

Wenke, R. J., Theodoros, D., & Cornwell, P. (2008). The short-and long-term effectiveness of the LSVT-R for dysarthria following TBI and stroke. Brain Injury, 22(4), 339-352.

Wingate, J., Ruddy, B., Lundy, D., Lehman, J., Casiano, R., Collins, S. (2005). Voice handicap index results for older patients with adductor spasmodic dysphonia. Journal of Voice, 19(1), 124-131.

Woodson, G. (2008). Evolving concepts of laryngeal paralysis. Journal of Laryngology and Otology, 122(5), 437-441.

Zur, K. B., Cotton, S., Kelchner, L., Baker, S., Weinrich, B., & Lee, L. (2007). Pediatric voice handicap index (pVHI): A new tool for evaluating pediatric dysphonia. International Journal of Pediatric Otorhinolaryngology, 7(1), 77-82.

Seminal and Supplemental:

Texts:

Andrews, M. (1999). Manual of voice treatment: Pediatrics to geriatrics, Clifton Park: Delmar Learning.

Baken, R., & Orlikoff, R. (2000). Clinical measurement of speech and voice, Clifton Park: Delmar Learning.

Case, J. (2005) Clinical Management of Voice Disorders, 3rd Edition, Austin: Pro-ed.

Deem, J. & Miller, L. (2000) Manual of Voice Therapy; Second Edition. Austin: Pro-ed.

Sataloff, R.(1998). Professional voice: The science and art of clinical care, Clifton Park: Delmar Learning.

Stemple, J. (2000). Voice therapy: Clinical case studies, Clifton Park: Delmar Learning.

Articles:

Behrman, A., & Orlikoff, R. (1997). Instrumentation in voice assessment and treatment: What’s the use? American Journal of Speech-language Pathology, 6, 9-16.

Dromy, C., Ramig, L., & Johnson, A. (1995). Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: A case study. Journal of Speech and Hearing Research, 38, 751-764.

Jacobson, B., Johnson, A., Grywalski, C., Silbergleit, A., Jacobson, G., Benninger, M. & Newman, C. (1997). The voice handicap index (VHI): Development and validation. American Journal of Speech-Language Pathology, 6, 66-79.

Belafsky, P., Postma, G., Reulbach, T., Holland, B., & Koufman, J. (2002). Muscle tension dysphonia as a sign of underlying glottal insufficiency, Otolaryngology—Head and Neck Surgery, 127, 448-451.

Mashima, P., Birkmire-Peters, D., Syms, M., Holtel, M., Burgess, L., & Peters, L. (2003). Telehealth: voice therapy using telecommunications technology. American Journal of Speech-Language Pathology, 12,432-440.

Mirza, N., Ruiz, C., Baum, E., & Staab, J. (2003). The prevalence of major psychiatric pathologies in patients with voice disorders, Ear, Nose, and Throat Journal, 82, 808-810.

Pannbacker, M. (1998). Voice treatment techniques: A review and recommendations for outcomes studies. American Journal of Speech-Language Pathology, 7, 49-64.

Perry, A. (1997). The role of the speech and language therapist in voice restoration after total laryngectomy. Journal of Laryngology and Otology, 1111, 4-7.

Sapir, S. (1995). Psychogenic spasmodic dysphonia: A case study with expert opinions.

Journal of Voice, 9,270-281.

Sapir, S., Spielman, J., Ramig, L., Hinds, S., Countryman, S., & Fox, C. (2003). Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]). American Journal of Speech-Language Pathology, 12, 387-399.

Schneider, B., Wendler, J., & Seidner, W. (2002). The relevance of stroboscopy in functional dysphonias. Logopaedica, 54, 387-399.

Sharkawi, A., Ramig, L., Logemann, J., Pauloski, B., Rademaker, A., Smith, C., Pawlas, A., Paum, S., & Werner, C. (2002). Swallowing and voice effects of Lee Silverman Voice Treatment: a pilot study. Journal of Neurology, Neurosurgery, and Psychiatry, 72, 31-36.

Szabo, A., Hammarberg, B., Granqvist, S., & Sodersten, M. (2003). Methods to study pre-school teachers’ voice at work: Simultaneous recordings with a voice accumulator and a DAT recorder. Logopedics, Phoniatrics, Vocology ,28, 29-39.

Non-print:

Department collection of DVDs, videotapes and CDs demonstrating signs and symptoms of voice disorders and methodologies for treating them.

Demonstration videotapes and DVDs:

Kay Elemetrics: Sono-speech, Visipitch and computerized speech lab

Passy-Muir: Passy Muir valve

Blom-Singer: tracheo-esophageal puncture and Blom-Singer voice prosthesis

Blue tree video graphics--laryngology

Internet sites:

ASHA Special Interest Division #3, Voice Disorders Listserve:

Sid3voice@pmsys.public_health.uiowa.edu.

The Voice Disorders website of Dr. Celia Hooper at the University of North Carolina, Chapel Hill:unc.edu/~chooper/clases/voice/

The Wake forest atlas of anatomical pictures of voice disorders,

bgsm.edu/voice/gallery.html/

Teachers: Take Care of Your Voice [NIDCD Health Information] nidcd.health/education/news/

Voice Disorders - Site map. sitemap.html

Voice Institute for laryngectomee and International Association of

Laryngectomee.

University of Pittsburgh Voice Center.

upmc.eduupcmvoice/default.htm

Voice Center at Eastern Virginia Medical School.

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