Overview

A classic work, now in its fourth edition, Clinical Voice Pathology is a distillation of the authors’ many years of experience gained in a multitude of settings, across a huge range of disorders in populations through the life spectrum, and represents etiologies arising from medical, environmental, social, psychological, occupational, and even idiopathic threats to vocal health.

Whether typical voice user, occupational voice user, elite vocal performer, head and neck cancer client, or anyone who has lost the ability to communicate competently and confidently due to detrimental voice change, each patient presents a unique diagnostic dilemma: how best to return the voice to optimal condition?

In answering this question, the authors assert that voice pathologists must apply knowledge of anatomy and physiology, etiologic correlates, laryngeal pathologies, and differential diagnosis to conduct an accurate evaluation. Traditional clinical management requires well-developed skills in the interpersonal interview, behavioral observation and modification, and task selection and elicitation. The contemporary voice assessment no longer relies solely on audio-perceptual voice quality judgments, but also demands technical expertise in using voice laboratory instruments for acoustic analysis, aerodynamic measures, and laryngeal imaging to help inform the management plan. Finally, we can only succeed when we have educated our patients to understand and self-monitor voice production behaviors independently and accurately.

Thus, this book organizes, explains, and illustrates the comprehensive hierarchy of knowledge necessary to manage voice disorders by:

• Opening with an entertaining history of voice disorders from its ancient foundations to the present, so clarifying the role of speech-language pathologists in the care of voice disordered patients, and introducing the interdisciplinary background that has proved essential in attaining success in voice therapy.

• Detailing the anatomy and physiology of voice production to provide an understanding of the structure and function of the laryngeal mechanism as an essential basis for evaluating phonatory function, examining the larynx and vocal folds, and recognizing the impact of abnormal changes or adaptations on voice production.

• Providing a thorough update on the etiologies of voice disorders (including misuse, medically-related factors, primary disorders, and personality-related influences) by discussing the common factors associated with the cause and maintenance of voice disorders in order to understand best options for treatment planning.

• Presenting the pathologies of the laryngeal mechanism, organized according to ASHA’s Classification Manual for Voice Disorders-I in eight major groups: Structural pathologies; Inflammatory conditions; Trauma or injury; Systemic conditions affecting voice; Aerodigestive conditions affecting voice; Psychiatric or psychological disorders affecting voice; Neurologic voice disorders; Other disorders of voice. The text illustrates many of the pathologies with color plates.

• Discussing the objectives and procedures of a systematic diagnostic voice evaluation, introducing traditional evaluation techniques, including the patient interview, audio-perceptual judgments, patient self-assessment, determining the cause(s) and maintaining factor(s) of the voice disorder, and educating the patient about these findings to establish a collaborative management plan based on these clinical data.

• Reviewing the instrumental measures that comprise a comprehensive voice assessment, including the scientific principles that underlie their development, application, and interpretation. In addition to standard measures of acoustics, aerodynamics, electromyography, and stroboscopy, this edition explains the utility of high speed digital imaging and videokymography tools. The appendix includes instrumental measurement norms and a helpful glossary of terms.

• Exploring an array of voice therapy approaches following the orientations of hygienic, symptomatic, psychogenic, physiologic, and eclectic treatments.

• Using frequent case examples to illustrate major insights about voice treatment gathered from the authors’ thirty-plus years of clinical experience, and orienting the reader to the theories, selection criteria, and clinical methods for specific voice management principles.

• Delivering a treatment framework that is appropriate for common, yet diverse complaints due to nodules, laryngopharyngeal reflux, paralysis, and vocal fold dysfunction, as well as infrequent disorders such as papilloma, mutational falsetto, and transgendered voice.

• Highlighting the current clinical evidence that either supports or refutes popular treatments used in voice therapy.

• Introducing the factors that influence clinical management approaches for the performing voice, such as personality, temperament, performance routines and schedule, and other special considerations needed for care and treatment, as well as defining the roles of a necessarily expanded interdisciplinary team, and identifying the affiliate organizations that represent and support voice performers. In addition to traditional voice therapy considerations, non-traditional alternative treatments that are popular with this population are also considered.

• Providing what is effectively a stand-alone manual on the management and rehabilitation of the laryngectomized patient, reflecting the current ‘best practice’ in voice rehabilitation or restoration in head and neck cancer patients, and outlining the complementary roles of the interdisciplinary treatment team as a means to understanding the multiple management goals: cure the disease, select optimal communication methods, ensure safe swallowing, and address any associated physical, social, and emotional changes that affect each patient

Packed with a vast amount of entirely new artwork, redrawn and historical images, full color illustrations, replete with case examples, multimedia images of pathologies, and fully revised and updated, Clinical Voice Pathology maintains and improves on the standards set by its predecessors and is set to enjoy the same worldwide adulation.

In the authors’ words “Over the past four decades, our chosen specialty of clinical voice pathology has expanded greatly within the field of communication disorders. Nonetheless, this fourth edition of our text retains its original purpose: to provide students and clinicians with a strong foundation of basic voice science infused with a deep clinical understanding of the best methods for assessing and treating voice disorders. As we prepared this edition, we challenged ourselves to revise every chapter thoroughly, by referencing the latest relevant published research, infusing clinical treatment evidence, and sharing lessons learned from our ever-broadening experience, whenever possible. The effort was both illuminating and rewarding. Consequently, we hope that you, the reader, will find this text clear, informative, and a worthwhile addition to your professional library.”

Reviews

• Thomas Murry, PhD, (2009):
  "This book brings together the science of voice assessment and the art of voice therapy in a superbly written text...(A) necessary resource in understanding normal and abnormal vocal function, diagnosing voice disorders, and treating the patient using a comprehensive plan of therapy."

• Adrienne B. Hancock, PhD (George Washington University), Doody's Review Service, (2010):
  "I am glad to have this book on my shelf. I have referred my students to the treatment descriptions in this book because they are so clearly written and include a rationale for when each technique would be used in the description."

• #, Doody's, (2013):
  ""Named to Doody's Core Titles in the Health Sciences 2013 list""

Audience

Primary Subject: Voice
Secondary Subject: Speech and Language Pathology / Voice and Voice Therapy
Audience Level: Textbook - Desk Copy

• Chapter 1: Voice: A Historical Perspective
  • Ancient History
  • The Renaissance
  • The 17th to 19th Centuries
  • The Laryngeal Mirror
  • Further Advancements
  • Voice Therapy
  • Clinical Voice Pathology
  • References
• Chapter 2: Anatomy and Physiology
  • Anatomy
  • The Laryngeal Valve
  • Respiration and Phonation
  • Vocal Tract Resonance
  • Structural Support of the Larynx
    Hyoid bone
    Laryngeal cartilages
  • Muscles
    Muscles for Respiration: Inspiration and Exhalation
    Laryngeal Muscles
    Extrinsic Laryngeal Muscles
    Intrinsic Laryngeal Muscles
  • Vocal Fold Microstructure
    Epithelium
    Basement Membrane Zone
    Lamina Propria
    Connective Tissue
    Vocal Muscle
  • Blood Supply and Secretions
  • Neurologic Supply
  • Central Nervous System Control
  • Peripheral Innervation
  • Laryngeal Reflexes
  • Developmental Changes
  • Geriatric Vocal Folds
  • DNA Microarray Gene Expression Analysis
  • Physiology of Phonation
    Theories of Vibration
    Fundamental Frequency Control
    Intensity Control
    Phonation Modes and Voice Quality Control
  • References
• Chapter 3: Some Etiologic Correlates
  • Etiologies of Vocal Misuse
    Voice abuse
    Inappropriate vocal properties
  • Medically-Related Etiologies
    Direct surgeries
    Indirect surgeries
    Chronic illnesses/disorders
    Primary Disorder Etiologies
  • Personality-Related Disorders
  • References
• Chapter 4: Pathologies of the Laryngeal Mechanism
  • Incidence of Voice Disorders
  • Pathology Classifications
    Structural Pathologies of the Vocal Fold
    Malignant Epithelial Dysplasia of the Larynx
    Benign Epithelial and Lamina Propria Abnormalities of the Vocal Fold
  • Vocal nodules
  • Vocal fold polyps
  • Vocal fold cysts
  • Reactive vocal fold lesion
  • Reinke’s edema and Polypoid degeneration
  • Vocal fold scarring
  • Vocal fold sulcus/Sulcus vocalis
  • Vocal fold granuloma and Contact ulcer
  • Keratosis, Leukoplakia, and Erythroplasia
  • Recurrent Respiratory Papilloma (RRP)
  • Subglottic and Laryngeal/Glottic Stenosis and Acquired Anterior Glottic Web
  • Vascular Lesions: Vocal Fold Hemorrhage, Hematoma, Varix and Ectasia
    Congenital and Maturational Changes Affecting Voice
    Congenital Webs (Synechia)
    Laryngomalacia
    Puberphonia: Mutational Falsetto and Juvenile Voice
    Presbyphonia or Presbylaryngeus
    Inflammatory Conditions of the Larynx
    Cricoarytenoid and Cricothyroid Arthritis
    Acute Laryngitis
    Laryngopharyngeal Reflux
    Chemical Sensitivity / Irritable Larynx Syndrome
    Trauma or injury
    Internal Laryngeal Trauma: Thermal & Chemical Exposure; Intubation/Extubation Injury
    External Trauma and Arytenoid Dislocation
    Systemic conditions affecting voice
    Endocrine disorders
  • Hypothyroidism & Hyperthyroidism
  • Sexual Hormonal Imbalances
  • Growth Hormone Abnormalities (Hyperpituitarism)
    Immunologic disorders
  • Systemic Lupus Erythematosus (SLE)
  • Sjogren’s Syndrome
  • Scleroderma
  • Fibromyalgia
    Allergies
    Non-Laryngeal Aerodigestive Disorders Affecting Voice
    Respiratory Diseases
  • Asthma & Chronic Obstructive Pulmonary Disease
  • Gastroesophageal Reflux Disease (GERD)
  • Infectious Diseases of the Aerodigestive Tract
    Laryngotracheobronchitis (Croup)
    Mycotic (Fungal) Infections: Candida
    Psychiatric or psychological disorders affecting voice
    Psychogenic Conversion Aphonia and Dysphonia
    Factitious Disorders or Malingering
    Gender Dysphoria or Gender Reassignment
    Neurologic voice disorders
    Peripheral Nervous System Pathology
  • Superior Laryngeal Nerve Paralysis: Unilateral or Bilateral
  • Recurrent Laryngeal Nerve Paralysis: Unilateral
  • Recurrent Laryngeal Nerve Paralysis: Bilateral
  • Superior Laryngeal Nerve (SLN) or Recurrent Laryngeal Nerve (RLN) Paresis
  • Myasthenia Gravis
    Movement disorders affecting the voice
    Spasmodic Dysphonia
  • Adductor Spasmodic Dysphonia (ADSD)
  • Abductor Spasmodic Dysphonia (ABSD)
  • Mixed Adductor and Abductor Spasmodic Dysphonia
  • Essential Vocal Tremor
    Central Neurological Disorders Affecting Voice
    Amyotrophic Lateral Sclerosis
    Parkinson Disease
    Multiple Sclerosis
    Huntington’s Chorea
    Other disorders of voice
    Vocal Abuse, Misuse, and Phonotrauma
    Vocal Fatigue
    Muscle Tension Dysphonia (Primary and Secondary)
    Ventricular Phonation (Plica Ventricularis)
    Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction) or Episodic Dyspnea
  • References
• Chapter 5: The Diagnostic Voice Evaluation
  • The Players
  • Patient Profile
  • Referral Sources
  • Medical Examination
  • Voice Pathology Evaluation
  • Diagnostic Voice Evaluation
    Referral
    Reason for the referral
    History of the problem
    Medical history
    Social history
    Oral-peripheral examination
    Auditory perceptual voice assessment
    Impressions
    Prognosis
    Recommendations
    Patient self-analysis of the voice disorder
  • References
  • Appendix 5.1 Sample Report
  • Appendix 5.2 Consensus Auditory Perceptual Evaluation of Voice
  • Appendix 5.3 The Rainbow Passage
  • Appendix 5.4 Vocal Component Checklist
  • Appendix 5.5 Voice Handicap Index
• Chapter 6: Instrumental Measurement of Voice
  • Clinical Utility
  • Basics of Technical Instruments
  • Microphones and Recording Environment
  • Digital Signal Processing
  • Acoustic Measurements
    Pitch Detection Algorithm
    Fundamental Frequency
    Intensity
    Voice Range Profile, Phonetogram, and Physiological Frequency Range of Phonation
    Perturbation Measures
    Signal (or Harmonic)-to-Noise Ratios
    Spectral Analysis
    Aerodynamic Measurements
    Calibration
    Pressure, Flow, Resistance and Ohm’s Law
    Airflow Equipment
    Flow Measurement
    Subglottal Air Pressure Measurement
    Phonation Threshold Pressure
    Laryngeal Resistance
    Inverse Filter
  • Laryngeal Imaging
    Endoscopy
    Stroboscopy
    High Speed Digital Imaging
    Kymography
    Criteria for Laryngeal Imaging
    Endoscopic Imaging Techniques
    Rigid Scope
    Flexible endoscope
    Patient Comfort
  • Recording Protocol
    Visual Perceptual Judgments
    Structural appearance of the entire larynx
    Glottic closure pattern
    Supraglottic hyperfunction
    Mucosal wave
    Amplitude
    Symmetry
    Periodicity
  • Electroglottography (EGG)
  • Laryngeal Electromyography (LEMG)
  • Normative Information
  • Electrical Safety
  • Hygienic Safety
  • The Clinical Voice Laboratory
  • Glossary
  • References
  • Appendix 6.1 Joint Statement: ASHA and AAO-HNS
  • Appendix 6.2 Vocal Tract Visualization and Imaging: Position Statement
• Chapter 7: Survey of Voice Management
  • Voice Therapy Orientations
    Hygienic Voice Therapy
    Evidence
    Symptomatic Voice Therapy
    Evidence
    Psychogenic Voice Therapy
    Evidence
    Physiologic Voice Therapy
    Evidence
    Eclectic Voice Therapy
    Case Study Illustrating Voice Therapy Orientations
  • Hygienic Voice Therapy
    Treatment Strategies for Voice Abuse and Misuse
    Vocal Hygiene Therapy Approaches
    The Homemaker
    The Noisy Job Environment
    The Public Speaker
    Voice Abuse or Misuse in Children
    Can We Always Expect Success?
    Hydration
    Confidential Voice
  • Symptomatic Voice Therapy
    Therapy Approaches for Respiration
    Therapy Approaches for Phonation
    Therapy Approaches for Resonance
    Therapy Approaches for Pitch
    Therapy Approaches for Loudness
    Therapy Approaches for Rate
    Treatment Approaches for Laryngeal Area Muscle Tension
  • Psychogenic Voice Therapy
    Functional Aphonia/Dysphonia
    Functional Falsetto
    Vocal Cord Dysfunction (VCD)
  • Physiologic Voice Therapy
    Laryngeal Muscle Imbalance
    The Post-Surgical Patient
    The Geriatric Voice
    Vocal Function Exercises (VFE)
    Resonant Voice Therapy (RVT)
    Accent Method of Voice Therapy
    Lee Silverman Voice Treatment (LSVT)
  • Team Management of Specific Laryngeal Pathologies
    Vocal Fold Cover Lesions
    Laryngopharyngeal Reflux (LPR) and Gastroesophageal Reflux Disease (GERD)
    Unilateral Vocal Fold Paralysis
    Spasmodic Dysphonia
  • Successful Voice Therapy
  • References
  • Appendix 7-1. Phrases and Sentences Graduated In Length
• Chapter 8: The Professional Voice
  • The Professional Voice User
  • History
  • The “At-Risk” Status
  • Professional Roles
    The Otolaryngologist
    The Voice Pathologist
    The Producer
    The Agent of Manager
  • Clinical Pathways
    Otolaryngology-Voice Pathology-Voice Pedagogy
    Voice Pedagogy-Otolaryngologist-Voice Pathology
    Voice Pedagogy-Voice Pathology-Otolaryngology
    Otolaryngology-Voice Pedagogy
    Voice Pathologist-Voice Pedagogy
  • Common Etiologic Factors
    Personality Factors
    Phonotrauma
    Drugs
    Hydration
  • Common Pathologies
    Acute and Chronic Non-infectious Laryngitis
    Vocal Nodules
    Contact Ulcers and Granulomas
    Gastroesophageal Reflux Disease (GERD)/Laryngoesophageal Reflux (LPR)
    Voice Fatigue
    Vocal Fold Hemorrhage and Vascular Pathologies
  • Supportive Training and Techniques
    Alexander Technique
    The Linklater Method
    The Feldenkrais Method
    The Lessac System
    Estill Voice Training™
  • Summary
  • Glossary of Terms
  • References
• Chapter 9: Rehabilitation of the Laryngectomized Patient
  • Incidence of Laryngeal Cancer
  • Etiology
  • Symptoms of Laryngeal Cancer
  • Medical Evaluation
    Staging and TNM Classification
    Lymph Node Distribution
  • Treatment Options
    Conservation
    Combined Treatments
    Radiation Therapy
    Surgery
    Concurrent Chemoradiotherapy
  • Methods of Reconstruction
    Myocutaneous Flaps
    Free Flaps
    Jejunal Free Flap
    Gastric Pull-Up
  • Need for Follow-Up Treatment
  • Multidisciplinary Rehabilitation Team
    Head and Neck Surgeon
    Plastic and Reconstructive Surgeon
    Radiation Oncologist
    Medical Oncologist
    Speech-Language Pathologist
    Oncology Nurse
    Dietician
    Radiologist
    Physical Therapist
    Dentist and/or Prosthodontist
    Psychologist
    Audiologist
    The Laryngectomized Visitor
    Special Concerns of the Laryngectomized Patient
  • Communication
  • Physical Concerns
    Respiration
    Coughing and Sneezing
    Tracheal Tubes and Tracheostoma Vents
    Swallowing
    Smell and Taste
    Safety
    Lifting
  • Psycho-Social Concerns
  • Speech Rehabilitation
    Artificial larynx
    Esophageal speech
    Surgical prosthetics
  • Helpful Web Sites on Head and Neck Cancers
  • References

About The Authors

Joseph Stemple, PhD

Dr. Stemple is a Professor of Communication Sciences and Disorders in the College of Health Sciences at the University of Kentucky.

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Leslie Glaze, PhD, CCC-S

Leslie Glaze is a speech-language pathologist specializing in voice disorders, cleft palate, and alaryngeal speech. She is an Adjunct Assistant Professor and Instructor in the Department of Speech-Language-Hearing Sciences at the University of Minnesota in Minneapolis, Minnesota, where she was formerly the Director of Clinical Programs.

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Bernice Klaben, PhD, CCC-SLP, BRS-S

Dr. Klaben is an Associate Professor in the Department of Otolaryngology – Head and Neck Surgery at the University of Cincinnati Medical Center.

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