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Glossary
Note: Within a definition, words in italics are defined elsewhere in the glossary. Words beginning 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. Please note that we may be adding terms to this list from time to time. Copyright © 2008 Bastian Voice Institute.
Secondary gain: Advantage
gained from holding on longer than necessary to an illness—be
it organic or nonorganic. At BVI, the phenomenon of secondary
gain is most commonly seen in nonorganic voice and breathing
disorders. An example might be that a person consciously or
subconsciously maintains “laryngitis” after the
initial organic infection has resolved, for the secondary
gain of being excused from school or work. In this case the
loss of voice is “worth it” as compared with the
“gain” achieved. The secondary gain may have to
do with attention, avoiding a responsibility, punishing or
controlling another person, or possibly other issues.
SD: Abbreviation
for spasmodic dysphonia.
Sedation: A state of reduced
excitement or anxiety induced by the administration of sedative
agents such as lorazepam (Ativan) and diazepam (Valium). At
BVI, we occasionally administer lorazepam, given orally a
couple of hours before a procedure, to allay anxiety.
*Sensory neuropathic
cough: A peculiar kind of coughing of unknown
cause, but thought to be neurogenic. An individual attack
of coughing is typically though not always triggered by an
abrupt, intense, and unexplained tickle low in the neck. In
the usual scenario, coughing attacks may vary in severity,
but at least some percentage of them is of the dramatic sort.
Individuals may have been misdiagnosed for years with cough-variant
asthma or acid reflux.
Sessile:
Attached completely at the base and without an intervening
stalk; the opposite of pedunculated.
*Shattered vibration:
A chaotic kind of vibration in which there may be several
independent segments vibrating erratically to create a characteristic
sound quality. May be seen, for example, in an individual
who has vocal folds that are not symmetrical with respect
to vocal fold mass, flaccidity, and tension, and that are
not “of one piece” within themselves, so that
a fold may have two different vibratory patterns within itself.
Shimmer:
The cycle-to-cycle variability of the period amplitude of
vocal fold vibration. Shimmer is used as one of the measures
for the micro-instability of vocal fold vibrations. Given
that shimmer may vary dramatically with changes of voice production
within the same voice, and also that a given shimmer measurement
is non-specific to any particular voice disorder, this measure
considered superfluous to the integrative
diagnostic method. Shimmer is therefore not used
routinely at Bastian Voice Institute.
Silastic:
This term comes from the combination of the words silicone
and plastic. Silastic is a highly inert silicone rubber that
has wide use for medical applications. Laryngologists
commonly place silastic implants into flaccid, paralyzed
vocal folds in order to plump and firm them up so
that they can serve as better partners to the non-paralyzed
fold.
*Singing voice qualified:
When used to refer to a speech pathologist or physician, this
means that the clinician has personal knowledge of the expected
phenomenology and capabilities of the voice, including those
only encountered in the singing voice. Typically, this kind
of qualification comes from personal voice training and singing
experience on the part of the clinician.
Single modality treatment:
Refers to a situation in which only one treatment modality
is chosen from among several options available for that disease
process. This is in contrast to combined
modality treatment or even multi-modality
treatment.
Smoker’s polyps:
See polypoid degeneration.
Spasmodic dysphonia:
A benign neurological voice disorder caused by laryngeal
dystonia. Abductory SD interferes with smooth flow
of the voice by choking off the sound of the voice. During
running speech, abductory
SD, by contrast, causes the voice to momentarily
drop off to a whisper. Also called intermittent
whisper phonation. Comprises about 10% of cases of
spasmodic dysphonia.
Speech pathologist:
See speech-language pathologist.
Speech-language pathologist:
An individual who has a graduate degree (master’s or
doctorate) in speech/language pathology. After successful
completion of the CFY (clinical fellowship year), a speech
pathologist may work behaviorally with a wide variety of conditions
that affect breathing, voice, and swallowing. Some speech
pathologists are generalists, potentially working within the
same day with: a child whose speech is not clear; a person
who is trying to recover clear speech after a stroke; a singer
with vocal nodules; and an
elderly person who is aspirating when she swallows. A speech
pathologist’s activities may be divided between evaluation
(including by use of the videofluoroscopic swallowing study
or videostroboscopy to assess
the voice) and therapy or treatment – teaching and coaching
the patient in ways that improve their voice, breathing, and
swallowing. At BVI, our speech pathologist is singing
voice qualified, working nearly exclusively with
voice and breathing disorders. Adjunct speech pathologists
from Good Samaritan Hospital are typically involved with our
patients who have swallowing disorders.
Spirometry: Measurement
of the breathing capacity of the lungs using an instrument
that measures expired lung volumes and flow-volume curves.
*Squeezedown (of
the voice): A vocal phenomenology
term coined to refer to adductory
spasms that do not “complete” all the way to a
phonatory arrest. Virtually
exclusively a manifestation of spasmodic dysphonia.
Stenosis:
Means abnormal narrowing of a passageway in the body. At BVI,
this typically refers to narrowing in the breathing passage,
such as for stenosis in the glottic,
subglottic, or tracheal
areas. Stenosis in the airway can be the result of a breathing
tube, external trauma, prior tracheotomy,
surgical resection of part of the airway for tumor, or other
causes. Persons with airway stenosis will note a reduced capacity
for exercise. Often the clinician hears noisy breathing on
inhalation, especially when the patient is asked to fill the
lungs quickly. Esophageal stenosis gives symptoms of difficulty
swallowing solids more so than liquids.
Straight tone:
Refers to sustaining the voice on a steady pitch and loudness,
without any vibrato. In the vocal capability battery, straight
tone is elicited during a sustained tone to assess the stability
of the voice, and to discover whether or not there are any
neurogenic findings of lack of control, “involuntary
glitches,” tremor, or the like.
Stridor:
A harsh, wheezy, or rough respiratory sound most often heard
on inspiration to indicate laryngeal, subglottic,
or tracheal partial obstruction
or stenosis. Compare with
involuntary inspiratory phonation.
Stripping (of vocal fold(s)):
An older term in the lexicon of laryngology, now passing out
of use. The idea of stripping is to grasp the mucosa superficially,
and then to “peel” it, along with whatever pathology
might be present. The thought was that the mucosa would re-grow
and be more normal. With more modern concepts of the crucial
importance of the mucosa and particularly the need for it
to be loosely attached to underlying layers of the folds,
the practice of stripping has been discredited in favor of
more precise removal of otherwise irreversible lesions.
Stroboscopy:
Means to look at something using strobe rather than continuous
illumination. At BVI, we use strobe light to allow apparent
slow motion videodocumentation of the vibration of the vocal
folds. Middle C on the piano is the pitch one hears when the
vocal folds vibrate at 252 hertz,
or cycles, per second. Under ordinary illumination, the vocal
folds are a blur due to the rapidity of vibration. Under a
common setting for the stroboscope, the vocal folds appear
to be vibrating at 2 cycles per second, regardless of the
actual rate of vibration, so that vibratory dynamics may be
understood.
Subglottis: The lower
part of the larynx, from just below the free margin of the
vocal fold to the upper end of the trachea.
Superior laryngeal
nerve (SLN) paralysis: Paralysis of one of four
main nerves serving the larynx, and two of the four if the
paralysis is bilateral. SLN paralysis may be idiopathic
or perhaps the result of neck surgery. The SLN internal branch
supplies sensation to the interior of the upper part of the
larynx; the external branch supplies motor innervation to
the cricothyroid muscle. Individuals with SLN paralysis, whether
unilateral or bilateral, seem to compensate for the sensory
deficits, provided that motor swallowing abilities are intact.
On the other hand, they have symptoms of loss of upper voice
and poor vocal projection. These two symptoms are easily verified
by clinician elicitation and
judgment of response.
Supportive treatment:
Treatment aimed at providing comfort or reducing the problem,
but not necessarily curing it.
Supraglottis: The upper
part of the larynx, from just above the vocal fold to the
tip of the epiglottis.
Sustained phonation:
A part of the vocal capability battery
in which the patient is asked to sustain a sung tone as steadily
as possible, so as to detect tremor, or other kinds of vocal
instability.
*Swelling tests:
Vocal tasks that reveal the vocal phenomenology of mucosal
disturbances such as vocal nodules,
vocal polyps, vocal cysts
(see epidermoid cyst and mucus
retention cyst), and so forth. These tasks incorporate
high frequency (pitch), very low intensity (loudness), and
sometimes rapid onset/offset of the voice. The two swelling
tests used at Bastian Voice Institute almost exclusively are
the first phrase of “Happy Birthday,” and a five-note
descending staccato. In both cases the individual should produce
the voice in a tiny “boy soprano pianissimo” kind
of production; this tiny dynamic is insisted on because getting
even a little louder tends to conceal the problem. Women should
focus on the C5-C6 octave. Signs of swelling test positivity
include onset delay, breathiness
that gets worse as one ascends the scale, and loss of expected
upper range, as understood by a singing
voice qualified clinician. Note that a small gap
between the vocal folds can also cause onset
delay and breathiness,
but differences in performance between the two can help to
indicate whether the problem is swelling, or gap.
*Symptom complex:
The aggregate of symptoms associated with a diagnosis, in
the case of BVI patients, relating to a voice, swallowing,
or airway disorder. Certain symptom complexes are virtually
diagnostic for the disorder involved. Example: The symptom
complex of vocal fold paralysis
often includes air-wasting,
coughing on liquids, difficulty coughing up sputum (due to
the non-percussive nature of the cough), and generalized fatigue
experienced as a result of sustained voice use.
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