2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Chandrasekhar et al

Table 5. Preoperative voice assessment chart.

1. PATIENT SELF-REPORT a. Voice Handicap Index 75 b. Ask the patient if their voice has changed in: i. Pitch

1. During conversation (eg, higher or lower than typical) 2. Range 3. During singing ii. Loudness 1. During conversation 2. Range 3. Ability to speak over background noise (eg, reduced endurance or ability) iii. Quality 1. During conversation 2. During singing

3. During different times of day 4. With longer durations of talking 2. AUDITORY-PERCEPTUAL ASSESSMENT

a. GRBAS (Grade, Roughness, Breathiness,Asthenia, and Strain) 87 b. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) 88 c. Surgeon subjective opinion or rating of overall degree of voice aberrance can be recorded in the chart.An example of such a rating might be: i. Normal = The patient’s voice sounds clear and of expected pitch and loudness level ii. Mild abnormality = minimal, but noticeable abnormality in voice quality iii. Moderately abnormal = noticeable abnormality in voice quality that is sometimes distracting iv. Severely abnormal = obviously abnormal voice that is distracting 3. AUDIO RECORDING OFTHE PATIENT’SVOICE a. Referral to a speech-language pathologist with voice expertise is preferable for optimal voice recording b. At the minimum, a HIPAA-compliant voice recording using a smartphone or other audio recording device may be adequate c. Recording suggestions i. A quiet environment is important ii. Place the microphone near the patient’s mouth (eg, within 4 cm) iii. Record a variety of speaking tasks such as 1. Sustained voicing of “ah” and “ee” for 3 to 5 seconds each 2. Standard sentences or passages : a. Read or repeat the following sentences aloud i. The blue spot is on the key again

ii. How hard did he hit him? iii. We were away a year ago. iv. We eat eggs every Easter. v. My mama makes lemon muffins. vi. Peter will keep at the peak.

b. Alternatively, ask the patient to read “The Rainbow Passage” (From Fairbanks G. Voice and Articulation Drillbook . 2nd ed. New York: Harper & Row; 1960: 124-139.) or other standard passages such as found at the website: http://www.d.umn.edu/~cspiller/ readingpassages.html 3. Conversational recording :Ask the patient to describe how their voice is functioning or talk about a favorite vacation for 30 seconds to 1 minute duration.

The CAPE-V was also shown to have concurrent validity. 89 These instruments were designed for use by professionals with expertise and training in audio-perceptual aspects of voice. For individuals without such training and expertise, a simple method for acquiring preoperative auditory-perceptual judg- ments of the patient’s voice can be achieved by completing an audio recording of the patient’s voice while they sustain a vowel sound such as “ah” or “ee” for 3 to 5 seconds and then while

they read standard sentences or spontaneously converse for 30 seconds to 1 minute. The audio recording should be made in an environment with minimal background noise and with a high- quality microphone placed in optimal proximity to the speaker if possible. 90 With advancements in technology, audio record- ing devices are now more common and widely available. Although not ideal, many smartphones (which are readily avail- able to most practitioners) contain a recording application that

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