Ancillary Tests

• Videostroboscopy: examine vocal fold mucosa for general health (coloration, thickness, atrophy, etc), vocal fold anatomical defects (masses, glottal chinks, etc), vocal fold biomechanical disturbances (immobility or hypomobility, tremors, spasmodic or muscle-tension disorders), and vocal fold mucosal wave dynamics

• Acoustic Analysis: measures of fundamental frequency, pitch period fluctuations or jitter (normal = 0.40%), amplitude fluctuations or shimmer (normal = 0.50 dB), and harmonic-to-noise ratio (normal = 11 dB)

• Speech Aerodynamic Studies: measures of mean transglottal airflow rate (normal = 100 cc/sec), glottal resistance (normal = 30—50 cm H2O/lps), subglottal pressure (normal 6—8 cm H2O)

• Perceptual Testing: qualitative rating of voice features, utilizes numeric scoring system (1 = normal to 7 = most deviant from normal); GRBAS scale individually rates Grade of hoarseness, Roughness, Breathiness, Asthenic, and Strained quality of voice (0 = normal to 3 = severe)

• Laryngeal EMG: see Vocal Fold Paralysis, p. 115

• Glottography: measures light translumination during vibration and degree of vocal fold contact (eg, open quotient [duration vocal folds are open over the length of the glottic cycle], speed quotient [duration of glottal opening over glottal closure], and shift quotient [time of peak opening over duration of glottal opening])

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