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Glossary

Note: For a more complete reference than this glossary, see our new standalone educational website, Bastian Medical Media for Laryngology. Within this glossary, entry titles ending with * were coined or brought into the language of voice disorders by Dr. Bastian, or to our knowledge are used primarily by BVI physicians and Bastian-trained fellows. © 2013 Bastian Voice Institute.

Abductory spasmodic dysphonia (AB-SD)

A benign neurological voice disorder caused by laryngeal dystonia. Abductory SD interferes with smooth flow of the voice as follows: During running speech, the voice intermittently drops out to a whisper. AB-SD is also called intermittent whisper phonation, and comprises about 10% of all cases of spasmodic dysphonia. See also tonic variant spasmodic dysphonia.

Achalasia

Failure of a ring of muscle, such as the lower esophageal sphincter (LES), to relax appropriately. This muscular non-relaxation creates a functional obstruction, interfering with normal passage of food into the stomach. This term is most commonly used in relation to the LES, but may also be used in reference to the upper esophageal sphincter (UES) or even anus.

Acid reflux

The backwards flow (reflux) of acid from stomach upwards into the esophagus and even farther up, to the level of the laryngopharynx. Symptoms may be esophageal, laryngopharyngeal, or both. Esophageal symptoms include heartburn, indigestion, acid belching. Laryngopharynx symptoms tend to include dry throat, husky (especially morning) voice, frequent morning throat clearing, excessive mucus, mildly sore throat.

Acoustic analysis of voice

The measurement and /or graphing of acoustic (sound) information such as fundamental frequency, formant pattern and energies, decibel level (roughly, the loudness), signal-to-noise ratio, jitter, shimmer, and the like from the voice. At present it is difficult to find unique diagnostic information from any set of acoustic measures. Hence, acoustic analysis is arguably justified for now in the realm of voice research and when used as a feedback tool in the therapy room. Although this may change in the future, at present acoustic analysis is superfluous to the diagnostic process, and specifically to the integrative diagnostic model or method.

Addition of loudness

Refers to the ability to increase the loudness of the voice. An individual may be either apparently or due to physical limitation unable to add loudness because of vocal fold paralysis, a nonorganic disorder, or vocal fold bowing – although the phenomenology observed when three individuals representing these three diagnoses try to add loudness differs markedly.

Adductory spasmodic dysphonia (AD-SD)

A benign neurological voice disorder caused by laryngeal dystonia. Typically, during running speech, the voice is interrupted by sudden choking off of the voice, and there may be an underlying more continuous “tight” sound to the voice as well. Also called strain-strangle phonation. AD-SD comprises about 90% of cases of spasmodic dysphonia. Also exists in the less common tonic variant spasmodic dysphonia.

Aerodynamic analysis of voice

Refers to instrument analysis of the power supply for voice pulmonary air. Can include spirometry, which assesses various capacities and capabilities of the respiratory system, apart from phonation. Also allows determination of the pressure and flow through the vocal folds during phonation. BVI clinicians believe that aerodynamic analysis of voice has yet to earn a place as part of the routine diagnostic workup. See integrative diagnostic model, as well as BIV’s diagnostic model/method for voice disorders. Aerodynamic analysis of voice, however, may be of interest for voice research and when the equipment is used as a biofeedback tool in the therapy room.

Air-wasting dysphonia*

A kind of hoarseness that refers to the breathiness (see Breathy dysphonia) that one is hearing. Typically, the length of time a person can sustain voice without taking a new breath (maximum phonation time, or MPT) is decreased. The voice may be described as whispery or foggy or fuzzy. Among other things, possible causes include vocal fold paralysis or paresis, vocal fold bowing and atrophy, or functional (especially nonorganic) voice problems.

Amyloid

A waxy, translucent protein substance deposited into tissue in response either to unknown local factors, or as a manifestation of systemic disease, such as multiple myeloma. Treatment is generally directed at improving function, for example via local (laser) excision.

Ankylosis

Immobility and fusion of a joint due to disease, injury, or a surgical procedure. Ankylosis of the cricoarytenoid joint may be seen after traumatic dislocation, or in rare instances of the disease rheumatoid arthritis.

Aspiration

The sucking into the airways of foreign material, when one breathes in. Aspirated material may be saliva, ingested liquid or food, or refluxed gastric contents.

Atypical spasmodic dysphonia*

A benign neurological voice disorder caused by laryngeal dystonia. Atypical cases of SD may be challenging to diagnose, even by clinicians with some experience with the disorder. Examples of reasons that this may be so: In the atypical case, contrary to what is usually seen, singing may be more affected than talking; falsetto/head voice may be more affected than chest voice, and so forth. There may also be no phonatory arrests in the less common tonic variant spasmodic dysphonia.

Auditory perceptual evaluation of voice

Auditory perception in essence is the sense of hearing applied to assessment of the voice. In some locations this refers primarily to characteristics of the patient’s spontaneous speaking voice, and sometimes very basic additional elicitations. In clinics where the integrative diagnostic model has been mastered, the clinician’s auditory perception has been informed by extensive knowledge and experience of normal and abnormal vocal capabilities and vocal limitations. This knowledge, along with his or her own voice used for modeling and elicitation, are the tools used during vocal capability battery administration. It is auditory perceptual evaluation of elicited vocalizations at the extremes of normal capability that provide powerful diagnostic information about the voice, as distinct from the larynx.

Average/anchor frequency*

The term used at BVI to designate the pitch (and by extension, fundamental frequency) that an individual is using during spontaneous, running speech, as determined via auditory perception. We use both “average” and “anchor” together, because some persons speak in a perceptually monotone voice, at which point we consider the pitch extracted via auditory perception to be virtually synonymous with “average” fundamental frequency (Fo). (Proven to be the case in informal study comparing Fo extracted by auditory perception vs. by machine measures.) Other individuals speak with a great deal of pitch inflection. In this latter case we listen for the lowest common pitch to which the voice seems to be “anchored.” When highly inflected speakers become generally fatigued or “depressed,” they tend to default to this pitch, which then becomes more of an “average” pitch for them. Of course, using machine measures of fundamental frequency (primarily using equipment for acoustic analysis), a formal average fundamental frequency can be determined. The ability to determine average / anchor pitch via auditory perception during the vocal capability battery can be learned by clinicians with good pitch perception.