Overview

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Written by leading specialists in voice, this book captures the science and art of clinical voice. A necessary book for every graduate student in the field of speech language pathology, this text provides a level of detail needed to assess and treat those with voice disorders. Supplemented with case studies and video examples relevant to the study of clinical voice pathology, this edition provides supplemental material for the educator as well as pragmatic tools for the student and clinician.

An accompanying workbook, sold separately, is an excellent supplement, allowing students to review chapter material and quiz themselves in an efficient manner.

Review

• Bernard Rousseau, PhD, CCC-SLP (Vanderbilt University School of Medicine), Doody's Review Service, (2009):
  "This is an exceptionally informative book.... An excellent resource of current information on the assessment and management of patients with dysphonia... A must read for graduate students in speech-language pathology."

Audience

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

• Preface
• Acknowledgments
• Dedication
• Chapter 1. Respiratory Anatomy and Physiology
  • Lungs
  • The Trachea
  • The Bronchi
  • The Thorax
  • The Ribs
  • The Diaphragm
  • The Abdominal Wall
  • Sternum
  • Clavicle
  • Driving Forces of the Respiratory System
  • How Does the Human Body Generate These Respiratory Forces?
  • Passive and Active Forces of the Respiratory System
  • The Respiratory System and Voice Production
    Relaxation Pressure Curve
  • Therapeutic Considerations
    Pulmonary Function Testing: Important to Make the Right Referral
    Interpreting the Results of the Flow-Volume Loop
  • Using the Right Terminology
  • Biofeedback Techniques
  • Summary
  • References
• Chapter 2. Laryngeal Anatomy and Physiology
  • Laryngeal Anatomy
    Basic Structure and Function
    Biological Functions of the Larynx
    Nonbiological Functions of the Larynx
  • Laryngeal Structure: Pieces and Parts
    The Hyoid Bone
    Thyroid Cartilage
    Cricoid Cartilage
    Arytenoid Cartilage
    Corniculate Cartilage
    Cuneiform Cartilages
    Epiglottis
  • Laryngeal Muscles
    Intrinsic Laryngeal Muscles
    Ventricular Vocal Folds
  • What Are the Vocal Folds Made of, Exactly?
    Epithelium
    Superficial Layer of the Lamina Propria
    Intermediate Layer of the Lamina Propria
    Deep Layer of the Lamina Propria
    Thyrovocalis Muscle
    Vocal Fold Architecture
    The Extracellular Matrix (ECM)
    Hyaluronic Acid (HA)
    Extrinsic Laryngeal Muscles
    Suprahyoid Muscles
    Infrahyoid Muscles
  • Laryngeal Ligaments and Membranes
    Mucous Membrane
  • Extrinsic Membranes
    Thyrohyoid Membrane
  • Intrinsic Membranes
    Quadrangular Membrane
    Conus Elasticus
  • Ligaments
  • Aryepiglottic Folds
  • Cavities
  • Arterial Supply of the Larynx
  • Laryngeal Nerve Supply
    The Recurrent Laryngeal Nerve
    The Superior Laryngeal Nerve
    Sensation from the Larynx
  • Laryngeal Development (Infancy to Adulthood)
  • Adult Male and Female Differences in Laryngeal Anatomy
  • Age Effects on Laryngeal Anatomy
  • Phonation
    Myoelastic Theory of Voice Production
  • Mechanisms for Changing Pitch
  • What Is a Vocal Register?
  • Mechanism for Changing Loudness
  • Summary
  • References
• Chapter 3. Vocal Health
  • Phonotrauma
  • Basic Issues Related to Vocal Health
  • Recovery Process
  • Contributors to Poor Vocal Health
    Nonprescriptive Drug Use
    Cigarette Smoking
    Marijuana Use
    Chewing Tobacco
    Coughing and Throat Clearing
    Alcohol Intake
    Caffeine Intake
    Sleep Deprivation
    Vocal Load and Vocal Fatigue
    Talking Too Loudly
    Poor Nutrition
    Obesity
    Dehydration
    Use of Herbals
    Allergies
    Acute Sinusitis
    Summary
    References
• Chapter 4. Evaluation
  • The Specialty of Otolaryngology
  • Case History
  • The Physical Examination
    Oral Peripheral and Cranial Nerve Examination
  • Visual Examination
  • Laryngoscopic Techniques
    Oral Rigid Laryngoscopy
    Transnasal Flexible Laryngoscopy
  • Instrumental Assessment
  • Imaging
    Digital Laryngostroboscopy
    Videokymography
  • Aerodynamics
    General Methods for Collection of Aerodynamic Signals
    Average Airflow
    Estimated Subglottal Pressure
    Estimated Laryngeal Airway Resistance
    Inverse Filtering
  • Laryngeal Aerodynamic Variations
    Laryngeal Aerodynamics of the Developing Larynx
    Laryngeal Aerodynamics as a Function of Aging
    Laryngeal Aerodynamics Differences as a Function of Sex
  • Using Aerodynamics for Examination of Voice Disorders
  • Acoustic Analysis of Voice
  • Goals of Acoustic Analysis
    Recording Voice For Acoustic Analysis
  • Acoustic Analysis of Voice
    Spectrograms
    Fundamental Frequency
    Intensity
    Voice Range Profile
    Short-Term Perturbation
    Relative Noise Level
    Spectral Measures
    Fast Fourier Transform (FFT)
    Vowel Spectrum
  • Auditory-Based Measures of Voice Quality
  • Perceptual Rating Scales
    Voice Handicap Scales and Quality of Life Scales
    Voice Handicap Index
    Voice-Related Quality of Life Scale
    Pediatric Voice-Related Quality of Life Scale
  • Summary
  • References
    Appendix 4-1
    Appendix 4-2
    Appendix 4-3
    Appendix 4-4
• Chapter 5. Vocal Pathology
  • Etiology of Voiced Disorders
  • Pathology Classifications
  • Incidence of Voice Disorders
  • Vocal Pathologies
    Vocal Fold Nodules
    Vocal Fold Polyps
    Generalized Edema/Reinke’s Edema/Polypoid Degeneration/Diffuse Polyposis
    Laryngitis
    Contact Ulcers/Granulomas
    Cysts
    Candida
    Laryngeal Papilloma
    Granular Cell Tumor
    Laryngeal Web
    Sulcus Vocalis
    Presbylaryngis
    Leukoplakia/Hyperkeratosis
    Dysplasia and Laryngeal Cancer
    Laryngeal Trauma
    Ankylosis of the Cricoarytenoid Joint
    Subglottic Stenosis
    Laryngomalacia
    Laryngeal Cleft
  • Vascular Lesions
    Varix and Ecstasia
    Vocal Fold Hemorrhage
  • Functional Voice Disorders
    Puberphonia
    Ventricular Phonation
    Muscle Tension Dysphonia (MTD)
    Transgender/Transsexual Voice Transition
    Conversion Aphonia
  • Idiopathic
    Paradoxic Vocal Fold Dysfunction
  • Summary
  • References
• Chapter 6. Neurologically Based Voice Disorders
  • Neurologic Voice Disorders
    Unilateral True Vocal Fold Paralysis
    Bilateral True Vocal Fold Paralysis
    Superior Laryngeal Nerve Paralysis
    Spasmodic Dysphonia
    Essential Voice Tremor
    Myasthenia Gravis
  • Hypophonia Associated with Parkinson’s Disease
    Description and Etiology
    Multiple Sclerosis
    Amyotrophic Lateral Sclerosis
    Huntington’s Disease/Chorea
    Progressive Supranuclear Palsy
    Multiple System Atrophy (MSA)
  • Other Neurologic Cases
    Management of Voice in CVA
  • Summary
  • References
    Appendix 6-1
• Chapter 7. Vocal Rehabilitation
  • Voice Therapy
  • The Evolving Process of Voice Therapy
  • Goals of Voice Therapy
  • Initial Steps in the Therapy Process
  • Definition of Treatment Efficacy
  • Who Is the Target Population of Voice Therapy?
    Accurate Diagnosis Guides Treatment Planning
  • Factors Contributing to Successful Therapy Outcome
  • Factors Related to Therapy Outcomes: Prognostic Indicators
  • Voice Therapy Approaches: What Are They?
    Complete Voice Rest Versus Modified Voice Rest
  • Hygienic
    Symptomatic
    Psychogenic
    Physiologic
    Eclectic
    Combined Modality
    Physiologic Therapy Approaches
  • Special Cases
    Management of Paradoxic Vocal Fold Dysfunction
    Management of Abductor Spasmodic Dysphonia
    Management of Adductor Spasmodic Dysphonia
    Voice Therapy for School-Age Children with Voice Disorders **Biofeedback Techniques
  • Defining a Voice Outcome
  • Criteria for Termination of Therapy
    Definition of Treatment Effectiveness
  • Summary
  • References
    Appendix 7-1
• Chapter 8. Management: Phonosurgery
  • Surgical Treatment of Dysphonia
  • Office-Based Procedures
    Indirect Laryngoscopy
  • General Considerations in the Surgical Approach to the Larynx
    Microlaryngoscopy with Nodule Removal
    Microflap Dissection
    Laser Laryngoscopy
    Laryngeal Microdebrider Dissection
    Injection Augmentation
    Laryngeal Framework Surgery
  • Selected Clinical Cases
  • Suggested Readings
    Appendix 8-1
• Chapter 9. Management of Head and Neck Cancer
  • Head and Neck Cancer Statistics
  • Causes of Head and Neck Cancer
  • Mechanisms and Sites of Laryngeal Cancer
  • Multidisciplinary Team
    Team Members
  • Primary Symptoms Associated with Head and Neck Cancer
  • Head and Neck Cancer Sites
  • Head and Neck Cancer Types
  • Staging of Head and Neck Cancers
    Defining the TNM System
    Staging Supraglottic Cancer
    Staging Glottic Cancer
    Staging of Subglottic Cancer
    Definition of Regional Lymph Nodes (N)
    Defining Distant Metastasis (M)
  • American Joint Committee on Cancer Staging (AJCC)
  • Treatment Options for Head and Neck Cancers
    Organ Preservation Options
  • Surgical Options for Laryngeal Cancer
    Laryngectomy Types
  • Role of the Voice Pathologist
    Presurgical Counseling
    Postsurgical Counseling and Management
    Offering Modes of Communication Following Total Laryngectomy
  • Developing a System to Track Outcomes with the Head and Neck Cancer Population
  • Summary
  • References
    Appendix 9-1
• Chapter 10. Vocal Performance
  • The Singing Voice
  • The Voice Care Team
  • Performer Classifications
    Vocal Performer
    High-Risk Performers
    Vocal Percussionists
  • Etiology of Dysphonia in Vocal Performers
  • Compensatory/Cover Techniques Used by Vocal Performers
  • Singers and “Support”
  • Clinical Assessment of Vocal Performers
    The Medical, Social, and Singing History
    Speaking Voice Assessment
    Singing Voice Assessment
  • Training and Techniques Specific to Performance Voice
    The Alexander Technique
    Feldenkrais Method
  • Professional Associations
    NATS
    VASTA
    The Voice Foundation
  • Case Studies
    Case 1: Touring Performer
    Case 2: Theme Park Performer—Street Theater
    Case 3: Adolescent Singer/Aspiring Performer
  • Summary
  • References
    Appendix 10-1
• Chapter 11. Drug Types and Effects on Voice
  • Drug Interactions
  • Patient-Specific Factors
  • Pharmacokinetics
  • Drug Administration
  • Drug Classes
    Antihistamines
    Mucolytic Agents
    Corticosteroids
    Antihypertensive Agents
    Antibiotics
    Antivirals
    Analgesics
    Hormones
    Gastroenterologic Medications
    Psychoactive Medications
  • Neurologic Medications
  • Drug Compliance
  • Effects of Nutrients on Absorption of Drugs
  • Herbal Supplements/Alternative Medicines
    Anti-inflammatories
    Antimicrobials
    Antispasmodics
    Astringents
    Bitters
    Demulcents
  • Special Populations
    Drug Dosing for the Pediatric and Geriatric Populations
  • Drug Treatment for Spasmodic Dysphonia
  • Drugs That Can Cause Dysphagia
  • Summary
  • Recommended Readings
  • References
    Appendix 11-1
• Glossary
• Index

About The Authors

Christine Sapienza, Ph.D.

Christine Sapienza, Ph.D., is a Professor and Chair in the Department of Speech, Language, and Hearing Sciences at the University of Florida, Gainesville, Florida. She also is a research career health scientist at the Malcom Randall VA in Gainesville, Florida, with the Brain Rehabilitation Research Center.

Dr. Sapienza received her Ph.D. from the State University of New York at Buffalo in 1993 in speech and voice science, and her current research interests are disordered voice production, treatment of neuromotor disorders, defining outcomes of strength training paradigms, and integrating basic physiological techniques to study rehabilitation strategies.

Her most recent work focuses on the use of strength training paradigms in multiple populations, including Parkinson’s disease, voice disorders, spinal cord injury, and multiple sclerosis. She maintains an active research laboratory with four current Ph.D. students. She has several active grants, including an NIH/NCMMR R21 and a VA Merit Review. She has over 100 publications and 150 lectures, presentations, and workshops to date.

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Bari Ruddy, Ph.D.

Dr. Hoffman Ruddy is an associate professor in the Department of Communication Sciences and Disorders at the University of Central Florida, Orlando. She also serves as the Director of the Voice Care Center at the Ear Nose & Throat Surgical Associates, Orlando, Florida, and has worked clinically in this center for over twelve years. Hoffman Ruddy received her Ph.D. from the University of Florida in 2001. Her clinical work and research focus on the physiologic study of voice production in pediatric, professional, and neurogenic populations.

Her current research interests involve the application of computer simulation training of voice therapy with children and adults, as well as 3D computer modeling of upper and lower airway function in patients with malignant lesions. She actively publishes and lectures in these clinical areas.

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