Clinical Voice Pathology: Theory and Management

Includes 200+ audio and/or audio-video cases illustrating the range and variety of voice- and upper-airway related disorders, as well as techniques employed in their assessment and management!

Clinical Voice Pathology: Theory and Management, a classic text now in its seventh edition, is a comprehensive resource that addresses the history, anatomy, physiology, etiologies, pathologies, and contemporary issues related to the assessment and management of the voice and related disorders. While continuing to provide the graduate speech-language pathology student with the knowledge necessary to evaluate and treat an impressive array of voice disorders, the text now includes two new chapters that focus on the expanding role of the speech-language pathologist in (1) upper airway disorders (including chronic refractory cough as well as inducible- and exercise-induced laryngeal obstruction), and (2) gender-affirming voice and communication training. With a foundation rooted in science, combined with the vast clinical and research expertise of the authors, students and practicing clinicians will be equipped with the knowledge necessary to effectively assess and manage not only a wide range of voice and upper airway disorders, but also individuals who seek gender-affirming voice care.

Individuals with diverse voice and airway related issues, such as professional voice users, performers, patients with laryngeal cancer, or who are tracheostomy and ventilator-dependent are often complex and demand a clinician who possesses an extraordinary depth and breadth of knowledge. To facilitate the acquisition of this knowledge, this text offers a wealth of visual aids, including artwork, case studies, and a companion website with extensive audiovisual instructional materials. These features not only maintain the high standards set by previous editions but further enhance the learning experience. 

New to the Seventh Edition

• A new chapter describing the SLP’s roles and responsibilities in the assessment and management of upper airway disorders including chronic refractory cough (CRC), inducible laryngeal obstruction (ILO) and exercise-induced laryngeal obstruction (EILO). 
• A new chapter on gender-affirming voice and communication training for transgender and gender-diverse individuals including approaches to gender-affirming health care. 
• Additional extensive audio and video examples of clinical cases and related treatment outcomes. 
• Instructional “how-to” videos demonstrating important procedural aspects of assessment (eg, focal laryngeal palpation, voice stimulability testing) and specific evidence-based voice therapies including manual laryngeal reposturing, circumlaryngeal massage, vocal function exercises, and resonant voice therapy.  
• Continued focus on enhancements to instruction and learning, including use of “Call-Out” boxes to highlight cases and encourage additional discussion.
• Updated references throughout the text to reflect the current state of clinical research and practice.

Key Features

• New Chapters on (i) Upper airway disorders and (ii) Gender-affirming voice care
• Full-color text and images
• Numerous Call Out boxes
• Multiple helpful appendices

PluralPlus Online Ancillaries

For instructors: PowerPoint Slides, Image Bank
For students: Videos, Audios

Preface 
Contributors

Chapter 1. Voice: A Historical Perspective
Introduction
    Definition of a Voice Disorder
    Role and Skills of the Speech-Language Pathologist
Ancient History
    Folklore Remedies
    Egyptian Papyri
    Hindu Writings
    Hippocrates
    Aristotle
    Claudius Galenus
The Renaissance
The 17th to 19th Centuries
The Laryngeal Mirror
Further Advancements
Voice Therapy
Clinical Voice Pathology
    Artistic and Scientific Ingredients of Voice Pathology
Summary and Concluding Remarks
References

Chapter 2. Anatomy and Physiology
Overview
Anatomy
    The Laryngeal Valve
    Respiration for Phonation
Vocal Tract Resonance
Structural Support for the Larynx
    Hyoid Bone
    Laryngeal Cartilages
Muscles
    Muscles for Respiration: Inspiration and Exhalation
    Laryngeal Muscles 
True Folds, Ventricular (False) Folds, and Ventricle 
Vocal Fold Microstructure
    Epithelium
    Basement Membrane Zone
    Lamina Propria
    Vocalis Muscle 
Blood Supply and Secretions
Neurologic Supply
    Central Nervous System Control
    Peripheral Innervation
Laryngeal Reflexes
Developmental Changes
Vocal Folds in Older Adults
DNA Microarray Gene Expression Analysis
Physiology of Phonation
    Theories of Vibration
    Fundamental Frequency Control
    Intensity Control
    Phonation Modes and Voice Quality Control 
Summary
References

Chapter 3. Etiologies of Voice Disorders 
Etiologies of Phonotrauma
    Phonotrauma
    Inappropriate Vocal Components 
Medically Related Etiologies
    Direct Surgery
    Indirect Surgery
    Chronic Illnesses and Disorders
Primary Disorder Etiologies
Personality-Related Etiologies
    Environmental/Life Stress    
Summary
References

Chapter 4. Pathologies of the Laryngeal Mechanism
Prevalence of Voice Disorders
Pathology Classifications
    Structural Pathologies of the Vocal Fold
Congenital and Maturational Changes Affecting Voice
    Congenital Webs (Synechia)
Inflammatory Conditions of the Larynx    
            Cricoarytenoid and Cricothyroid Arthritis
Trauma or Injury of the Larynx 
Systemic Conditions Affecting Voice
Endocrine Disorders
    Hypothyroidism and Hyperthyroidism
Immunologic Disorders
Allergies
Nonlaryngeal Aerodigestive Disorders Affecting Voice
    Respiratory Diseases
Psychiatric and Psychological Disorders Affecting Voice
Neurologic Disorders Affecting Voice
Movement Disorders Affecting the Larynx
    Spasmodic Dysphonia
Central Neurologic Disorders Affecting Voice
    Amyotrophic Lateral Sclerosis (ALS)
Other Disorders of Voice Use
Summary
References

Chapter 5. The Diagnostic Voice Evaluation
The Management Team
Patient Profile
Referral Sources
Medical Evaluation
Voice Pathology Evaluation
Diagnostic Voice Evaluation
    Referral
    Reason for the Referral
    History of the Problem
    Oral-Peripheral Examination
    Auditory-Perceptual Voice Assessment
    Focal Palpation of the Paralaryngeal Region
    Voice Stimulability Testing/Assessment (Diagnostic Probes)
    Patient Self-Assessment of the Voice Disorder
    Impressions
    Prognosis
    Recommendations
    Additional Considerations
Summary
References
Appendix 5-A. Sample Report
Appendix 5-B. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)
Appendix 5-C. The Rainbow Passage
Appendix 5-D. Vocal Component Checklist
Appendix 5-E. Voice Handicap Index (VHI), Henry Ford Hospital

Chapter 6. Instrumental Measurement of Voice
Clinical Utility
Basics of Technical Instruments
Microphones and Recording Environment
Digital Signal Processing
Acoustic Measures
    Pitch Detection Algorithm
    Fundamental Frequency
    Intensity
    Voice Range Profile, Phonetogram, and Physiologic Frequency Range of Phonation
    Perturbation Measures
    Signal (or Harmonic)-to-Noise Ratios
    Spectral Analysis
Aerodynamic Measures
    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
    Recording Protocol
    Visual-Perceptual Judgments
Electroglottography (EGG)
Laryngeal Electromyography (LEMG)
Normative Information
Electrical Safety
Hygienic Safety
The Clinical Voice Laboratory
Caveats and Additional Considerations
Glossary
    Acoustics
    Aerodynamics
    Imaging
References
Appendix 6-A.     Joint Statement: ASHA and AAO-HNS
Appendix 6-B. Vocal Tract Visualization and Imaging: Position Statement

Chapter 7. Survey of Voice Management
Voice Therapy Orientations
    Hygienic Voice Therapy
    Symptomatic Voice Therapy
    Psychogenic Voice Therapy
    Physiologic Voice Therapy
    Eclectic Voice Therapy
    Case Study 1: Representing Voice Therapy Orientations
Hygienic Voice Therapy
    Treatment Strategies for Vocally Traumatic Behavior
    Vocal Hygiene Therapy Approaches
    Case Study 2: The Homemaker
    Case Study 3: The Noisy Job Environment
    Case Study 4: The Public Speaker
    Case Study 5: Phonotrauma in Children
    Case Study 6: 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
    Case Study 7: The Pseudoauthoritative Voice
    Case Study 8: The Voice Saver
    Case Study 9: Emotional Voice Changes
    Therapy Approaches for Loudness Modification
    Therapy Approaches for Rate Modification
    Treatment Approaches for Paralaryngeal Muscle Tension
    Case Study 10: Ventricular Phonation
Psychogenic Voice Therapy
    Functional Aphonia/Dysphonia
    Functional Falsetto
Physiologic Voice Therapy
    Case Study 11: Laryngeal Muscle Imbalance
    Case Study 12: The Postsurgical Patient
    Case Study 13: The Aging Voice
    The Semioccluded Vocal Tract
    Speech-Based SOVT Therapy
    Accent Method of Voice Therapy
    Flow Phonation
    Lee Silverman Voice Treatment (LSVT)™
    Phonation Resistance Training Exercise (PhoRTETM)
    Conversation Training Therapy (CTT)
Team Management of Specific Laryngeal Pathologies
    Vocal Fold Cover Lesions
    Laryngopharyngeal Reflux (LPR) and Gastroesophageal Reflux Disease (GERD)
    Unilateral Vocal Fold Paralysis
    Case Study 14: Unilateral Vocal Fold Paralysis
    Spasmodic Dysphonia 
    Essential Tremor
Successful Voice Therapy
References
Appendix 7-A. Phrases and Sentences Graduated in Length

Chapter 8. The Professional Voice
Overview
The Professional Voice User
History    
The “At-Risk” Status
Professional Roles
The Otolaryngologist    
The Voice Pathologist
The Producer
The Agent or Manager
Clinical Pathways
    Otolaryngology-Voice Pathology-Voice Pedagogy
Voice Pedagogy-Otolaryngology-Voice Pathology
    Voice Pedagogy-Voice Pathology-Otolaryngology
    Otolaryngology-Voice Pedagogy
    Voice Pathology-Voice Pedagogy
Vocal Types and Vocal Range
Categories of Singers
Vocal Registers
Common Etiology Factors
    Personality Factors
    Phonotrauma
    Drugs
    Hydration
Common Pathologies
    Acute and Chronic Noninfectious Laryngitis
    Vocal Nodules
    Contact Ulcers and Granulomas
    Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux
    Voice Fatigue
    Vocal Fold Hemorrhage and Vascular Pathologies
Clinical Assessment of the Vocal Performer
Supportive Training and Techniques
Summary
Glossary of Terms Used in Singing
References

Chapter 9. Rehabilitation of the Laryngectomized Patient
Overview
Incidence of Laryngeal Cancer
Etiology
Symptoms of Laryngeal Cancer
Medical Evaluation
Staging and Tumor-Node-Metastasis Classifications
Lymph Node Distribution
Treatment Options
    Conservation
    Combined Treatments
    Radiation Therapy
    Surgery
    Concurrent Chemoradiotherapy
Methods of Reconstruction
Multidisciplinary Rehabilitation Team
Special Concerns of the Laryngectomized Patient
    Communication
    Physical Concerns
    Psychosocial Concerns
Speech Rehabilitation
    Artificial Larynges
    Esophageal Speech
    Surgical Prosthetics
Role of the Speech-Language Pathologist and Surgical Prosthetics
    Patient Evaluation
    Patient Fitting
    Independent Care
    Maximizing Communication
    Hands-Free Speaking Valve
Summary
Helpful Websites on Head and Neck Cancers
Major Medical Suppliers for Laryngectomees
References

Chapter 10. Artificial Airway and Mechanical Ventilation
Tammy L. Wigginton and Mark R. Finfrock
Introduction
Artificial Airway
    Nasopharyngeal Airway
    Oropharyngeal Airway
    Laryngeal Mask Airway
    Endotracheal Intubation
Tracheotomy
    Tracheostomy Complications
    Communication Options for Patients With a Tracheostomy
Mechanical Ventilation
    Mechanical Ventilation Terminology
    Strategies for Restoring Verbal Communication for Ventilator-Dependent Patients
    Noninvasive Ventilation Speech Challenges
    Invasive Ventilation Speech Challenges
Summary
References

Chapter 11. Upper Airway Disorders: Chronic Refractory Cough and Inducible Laryngeal Obstruction
Overview
Chronic Refractory Cough (CRC)
    Neurophysiology of Cough
Assessment and Diagnosis
    Cough Assessment Measures
    Cough-Related Quality of Life Measures 
    Transnasal Flexible Laryngoscopy 
Treatments for Chronic Refractory Cough
    Neuromodulator Medications
Behavioral Cough Suppression Therapy
1.    Education
2.    Training in Active Cough Suppression and/or Cough Replacement Techniques
3.    Reducing Laryngeal Irritation
4.    Psychoeducational Counseling
    Evidence to Support Speech-Language Pathology Treatment
Laryngeal Procedures for CRC 
Inducible Laryngeal Obstruction (ILO)
    Assessment and Diagnosis of ILO    
    Features That Distinguish ILO Versus Asthma
    Differences Between ILO and Asthma on Pulmonary Function Tests 
    Transnasal Flexible Laryngoscopy    
    TFL With Provocation Testing
    ILO-Related Quality of Life Measures
Management of ILO 
Evidence to Support Treatment
Exercise-Induced Laryngeal Obstruction (EILO)
    Evaluation of EILO
Management of EILO
References
Glossary of Term

Chapter 12. Gender-Affirming Voice Care
Brett R. Myers
Overview
Background and Terminology
Interdisciplinary Care of the Voice
    Hormone Therapy
    Laryngeal Surgery
    Surgical Techniques for Feminization
    Surgical Techniques for Masculinization
    Importance of Interdisciplinary Care
Gender-Affirming Voice Assessment
    Case History
    Patient-Reported Outcome Measures
    Perceptual Assessment 
    Acoustic Assessment
Behavioral Voice Treatment
    Counseling
    Voice Training Techniques
    Considerations for Young People
    Telepractice
    Group Training
    Singing Voice
Summary
References
Appendix 12-A. Trans Woman Voice Questionnaire (TWVQ)
Appendix 12-B. Utah Gender Presentation Scale for Communication (U-GPS) 
    
Index