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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 © 2009 Bastian Voice Institute.
Vibrato:
In the voice, a pulsating effect produced by small variations
of pitch, typically occurring 5 or 6 times per second. The
opposite of singing with vibrato is to sing with straight
tone.
Videoendoscopy:
The coupling of video-documenting technology to an endoscope,
so that the examination of larynx, trachea,
or esophagus, as the case
may be, is recorded on a permanent medium for later review
and possible comparison with prior endoscopy examinations.
Videostroboscopy (of
the larynx): See stroboscopy.
*Vocal capabilities:
The full extent of the voice’s abilities in terms of
loudness, range, steadiness and control, rapid repetitive
sound-making, high soft singing, and so forth. Understanding
of any voice’s capabilities (and limitations) requires
much elicitation by the examiner.
Also required is an understanding of expected capabilities
for sex and age, so that an individual’s capabilities
can be compared with what is expected.
*Vocal capability
battery (VCB): A variable set of vocal
tasks that the clinician elicits
from the patient in order to understand the individual’s
vocal capabilities and vocal
limitations. During the VCB, the clinician might
assess average/anchor pitch,
maximum range, ability to
add loudness,
sustained phonation (for
stability), swelling tests of mucosal
injury, maximum phonation
time, and response to brief trial
therapy.
Vocal fold bowing:
A descriptive term referring to the appearance of vocal folds
that are somewhat atrophied, often with some concomitant flaccidity.
When the individual phonates, or puts the vocal folds together
to produce voice, instead of the vocal
folds matching in a straight line with a very small
gap between them, a long, wider elliptical opening is seen
between them. Correlates with a voice that tends to fade with
use, is fuzzy and soft-edged, and sometimes is a little higher
in pitch than normal.
Vocal fold dysfunction
(VFD), aka vocal cord dysfunction (VCD): A nonorganic
laryngeal disorder that manifests as breathing difficulty.
Typically the individual with this disorder has failed to
respond appropriately to asthma and other medicines. He or
she continues to make noises that are primarily or exclusively
inspiratory, in contrast to asthma. Not infrequently, individuals
with VFD are treated for years as having asthma before the
diagnosis of VFD is finally made.
Vocal fold paralysis,
bilateral: A neurological disorder in which the
nerve supply to both vocal folds is not working. This may
be as the result of injury through external trauma, thyroid
surgery, or blunt or penetrating trauma to the neck. Sometimes
vocal fold immobility due to scarring, for instance from an
endotracheal tube, is mistaken
for vocal fold paralysis, though the distinction is usually
easy to determine, provided that an appropriately intense
and directed workup is done.
Vocal fold paralysis,
unilateral: Neurogenic inability of one vocal
fold to move. Unilateral paralysis is associated with weak
voice of a degree that can vary between individuals. Symptoms
may include one or more of the following: weak, air-wasting
dysphonia, inability to be heard in noisy locations,
a tendency of the voice to be somewhat stronger in the morning
but to “fade” with use, and a tendency to cough
when drinking thin liquids.
Vocal fry:
The name given to a quality of sound produced at low pitch
(generally below 70 Hertz, or around E2 or F2 in musical notation).
Vocal fry is produced in what some call pulse
register, as compared with chest and falsetto
registers. Once defined with the help of audible
examples, most individuals can readily identify vocal fry
quality. Vocal fry may be heard in poorly produced voices;
in other cases, it is used intentionally as a training technique,
particularly for air-wasting
dysphonia that has a functional cause.
Vocal hygiene:
Loosely defined, this means the constellation of both good
and bad habits that affect the voice positively and negatively.
At BVI, the wrap-up discussion at the conclusion of the initial
diagnostic process as well
as the initial therapy session with a speech
pathologist contains a concise summary of vocal hygiene,
with special emphases relevant to the individual. Examples
of vocal hygiene tips include instructions on hydration, smoking
cessation, spaced – rather than massed – voice
use, and so forth.
*Vocal limitations:
Description or cataloguing of expected capabilities that the
individual has lost. Via elicitation,
the examiner seeks to answer the question: “What can’t
this voice do that it should be able to do?” The set
of incapacities of an individual voice, as compared with what
would be expected, if that voice were entirely normal for
age and sex. Vocal limitations may not be understood by clinicians
who: (1) do not have a complete understanding of normal capabilities,
often derived through thorough knowledge of singing voice
capabilities; (2) can’t or don’t elicit a complete
vocal capability battery,
with necessary modeling of
various vocal tasks, particularly
at the extremes of vocal capability.
Vocal nodules: Small swellings
or elevations found at the junction of the middle and anterior
thirds of the vocal fold. They form in response to vibratory
trauma, as when an individual abuses or overuses the voice.
Some resolve with rest and voice therapy alone; others are
proven to be irreversible over time and may raise the option
of vocal fold microsurgery.
*Vocal overdoers
syndrome (VOS): A term coined by Dr. Anat Cedar
and Dr. Bastian to designate an individual whose amount and
manner of voice use can be considered excessive and to thereby
put the person at risk of mucosal injury.
Typically, the VOS is comprised of two parts: innate talkativeness,
and a life circumstance (occupation, performance, family,
hobby, social) that permits, invites, or demands much voice
use.
*Vocal phenomenology:
Description of the phenomena that are observed in an individual’s
voice production. Of most interest is the vocal phenomenology
elicited at the extremes
of an individual’s expected vocal
capabilities. Many diagnoses are associated with
highly specific, even diagnostic, vocal phenomenology, provided
one knows how to elicit and
is singing voice qualified.
Vocal polyp:
A general and somewhat imprecise term used to describe or
“name” a swelling originating in the vocal fold
mucosa. Such a mass is commonly
unilateral, benign, and the result, at least in part, of vibratory
trauma. A polyp may be referred to as hemorrhagic,
pedunculated, smoking-related,
and so forth. A vocal polyp interferes with the voice’s
clarity and other capabilities by interfering with accurate
approximation of the folds during phonation.
A polyp may also add mass to the vocal fold, thereby dropping
the pitch range available to the voice.
Vocal task:
A specific voice production, typically modeled
by the clinician, with a request that the patient imitate
that task. Example: swelling tests,
sustained phonation, and
other components of the vocal capability
battery.
Vocal tremor:
A regular, wavering quality of voice, analogous with a singer’s
vibrato but occurring, to an individual’s distress,
during speaking, not just during singing. May occur as a sole
abnormality in essential voice tremor,
or in combination with spasmodic dysphonia.
*Vocal under doer syndrome (VUS):
A term coined by Dr. Anat Cedar and Dr. Bastian to designate
an individual whose amount and manner of voice use can be
considered inadequate to keep the mechanism in good condition.
Typically, the VUS is comprised of two parts – innate
introversion/taciturnity and a life circumstance that permits,
invites, or demands very little voice use.
*Voice building:
The process of adding strength to the voice by utilizing a
variety of tasks that tax its strength capabilities. The idea
is that over time the larynx will rise to the challenge and
adapt to increased demands, much as might happen to the arms
as a result of a weight-lifting regimen. Sometimes the voice
building regimen is very simple and “do-it-yourself”;
other times it is more sophisticated and requires the assistance
of a speech pathologist who
is singing voice qualified.
Voice evaluation:
Can refer to the second part of the integrative
diagnostic model as performed by the laryngologist,
or to an initial assessment of the vocal
capabilities and vocal limitations
as carried out by the speech pathologist.
Should be distinguished from other things that are sometimes
confused with laryngeal examination and also from “objective”
measures.
Voice fatigue syndrome:
A clinical scenario that, when seen, almost always accompanies
the vocal under doer syndrome.
Typically such individuals report that with any significant
amount of voice use, the voice seems effortful and tight;
they may also complain of paralaryngeal discomfort. Most often
seen in vocal under doers whose job requirements for voice
use have increased due to a promotion to a management level.
Voice production:
Refers to the act of making voice, and the details of the
use of breathing (power supply), larynx (sound source), and
resonators (mouth and throat) to create a specific voice quality.
Using different strategies of voice production, the same person
may bring forth various voices: one may be clear and normal-sounding;
another may be harsh and unpleasant; a third may be air-wasting,
or breathy.
Voice therapy:
As delivered by a speech pathologist, this is a comprehensive
process that includes teaching the patient concerning the
diagnosis; review of occupational and other life demands and
problems posed by a voice deficit; and establishing and implementing
a comprehensive plan for remediation. A significant component
of voice therapy may include work on voice
production.
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