MERF INSTITUTE OF SPEECH & HEARING (P) LTD

(In association with Madras ENT Research Foundation (P) LTD)

(ARliated to The Tamilnadu Dr. M.G.R. Medical University &Approved by Rehabiftation Counci! of India)
CIN: U85100TN2017PTC119973
MERF- ISH
Academic Unit (For All Communications): Old No.172 New No.212, Royapettah High Road, Royapettah, Chennai -600 014.
Clinical Unlt: Old No.162/2 New No.191, Royapettah High Road, Mylapore, Chennai -600 004.
Tel: 044 -24622403, 24939143 E-mail : merf isth@[Link] Website : [Link]

VOICE &SWALLOW EVALäATION REPORT

Name : Mrs. Girija Raman Date :15.04.2024
Age/Sex :72 years /Female IM No :078818
Referral : Dr. Kiran Natarajan Profession: Rtd DGM of BSNL
(ENT Consultant, MERF Hospital)

Brief history:
Mrs. Girija Raman reported to the department of Speech Language Pathology with the
concern of change in voice quality in the past one month. The onset of the problem was reported
to be gradual and progressive in nature. It was reported that the patient was working as a Deputy
General Manager of BSNL for more than 20 years and had concerns with her voice quality
which was reported to be resolved with voice rest. Currently, the change in voice was reported to
be persistent for which she had underwent ENT Consultation and was advised for voice rest and
voice intervention. She was reported to have been practicing singing for the past 10 years
however not a professional singer. The patient's voice was perceived to be of hoarse voice
quality with notable roughness with prolonged voice usage.

ENT Findings:
Video Laryngoscopy (VLS) performed at 'MERF ENT Hospital ', Chennai
On 24.03.2024 revealed Bilateral vocal cord nodules. She was reported to be under voice
rest for a week upon medical advise.
On 01.04.2024 revealed Right vocalnodule with presence of LaryngopharyngealReflex.

Other Medical History:

" She was reported to have been under pharmacological intervention for Laryngopharyngeal
Reflex, however currently she is not under any medication.
" HOsinusitis from the past I year and was reported to beunder Ayurvedic treatment for the 4
5 months.
Is under medication for Hypertension for the past 2 years
" K/C/OOsteoporosis and is undertaking calcium supplements for the same.
Vocal and Non V0cal Habits:
The following vocal and non-vocal behaviors were reported
 hours
by the patient before voice rest. Currently l-2
" 3 hours of voice usage per day reported
of voice usage per day as reported.
" History of taking in noisy environments.
" It was reported that she is an untrained
singer and was practicing classical singing tor more
at
a week), However, she is under voice rest
than 5 years for half an hour (alternate davs in
present.
improved to 2 liters per day in the past 2
Reduced intake of water- 1liter per day which was
weeks,as reported.
reported. Upon advise it was reported to have
History of intake of coffee 3 times a day was
swapped with intake of tea two times a day.
Occasional intake of spicy food was reported
morning meals
" Irregular diet patternreported- delay in taking
structurally
Examination (OPME): All the articulators are
Oral Peripheral Mechanism
normal and functionally adequate for speech production.

Evaluation of Speech Subsystems

Respiratory assessment:
:Abdominal breathing
Breathing Pattern for speech activities
:Thoracic breathing
Breathing Patternfor non-speech activities words/breath)
Respiratory support for speech :Inadequate (6-7

Maximum Phonation Duration (MPD)

lal: 12 seconds
/:10 seconds
fu/: 10seconds

Impression: Reduced MPD

S/Z ratio:
/s/: 8 seconds
Izl: 8.3 seconds
s/z: 0.96
respiratorylaryngealpathology
Impression: No indication of
analysis)
Phonation: (Voice profile-Perceptual
Pitch pitch drop perceived)
Pitch :Appropriate (however, age related
Pitch variability Present
Absent
Pitch breaks
 Diplophonia Absent
Pitch range Inadequate
Loudness
Loudness Appropriate
Loudness variability :Present
Loudness range Inadequate

Quality
Quality Hoarse voice quality
Tremors :Absent
Voice breaks :Absent
Endurance :Fair

Articulation & Resonance:

Diadachokinesis Rate (DDK):
Alternating Motion Rate:
/pa-5 syllables per second
/ta -4-5 syllables per second
ka - 4-5 syllables per second

Sequential Motion Rate:

/pataka/ -6 syllables per second

Impression: Good Oral Agility

oriented speech, her speech can be
Articulation: No articulatory errors noted. In a context YJINIHH) scale
Intelligibility rating (SIR-A
understood without effort(score 1) based on Speech
Resonance: Normal oro-nasal coupling

Subjective Evaluation:
2-Moderate, 3-Severe)
1. GRBASI scale (0-Normal, 1-Mild,
Phonation Conversation

Grade
1
Roughness
Breathiness
0
Asthenia
Strain 0

Instability
Impression: \tild horNeness In oe

2 Consensus Auditory Perceptual Evluation of Voice (CAPE-V}:

Parameters Scoring Impression
Overallsevernty Mild deviangy
Roughness 25 Mild deviancy
Breathiness Mild deviancy
Strain No deviancy
Pitch No deviancqy
Loudness No deviancy

3. Voice Handicap Index (VHD): Emotional Total

Functional Physical

Impression: Mild impact on patient 's quality of life

4. Reflux Symptom Scale (RSI):
Score
Relar
Impression : No indication of Larngophanngeal

Objective evaluation: voice

Voice was performed using PRAAT software which revealed Type-I
Acoustic Analysis of
revealed Slight dysphonia
was calculated which
signal. Dysphonia severnity index (DS)
Sample Analysis Interpretation

Identify Signal Type

Sample eligible for further
Signal Type: IIIIII Type I analvsis

Frequency Measures
168.613 Hz
Inappropriate for gender
Fo in phonation (Hz) (could be attributedto age
162.781 Hz
related puch drop)
Fo in speaking (Hz) Perceptually appropnate
17.916 Hz
SD of Fo (Hz) in spontaneous speech
153.93Hz
Low Fo (Hz) Pitch range - Inadequate
259.74 Hz
High Fo (Hz)
Maximum Phonation Frequency Range 9.056

Intensity Measures
 Increased loudness on
lo (dBSPL) 63.704 dBSPI
general conversation
Average Intens1ty in spcaking (dBSPL) 60,097 dBSPL (perceptually appropriate)
Low lo (dBSPL) 6168 dBSPL
Restricted Loudness
High lo (dBSPL) 79.77 dBSPL
range
Dynamic Range (dBSPL) 18,09 dBSPL
Quality Measures
Jiter () in phonation tasks 0.24% Inappropriate
Sh1mmer (dB) in phonation tasks 0.31 dB Appropriate

RIsc time (msec) Interrupted phonation 57 ms

Fall time (msec) Interrupted phonation 52 ms

Harmonic to Noise Ratio in phonation 20.897 dB

Harmonicto Noise Ratio in specch 10,038 dB

Dysphonia Severity Index (DSI):

Score :-0,.98
Impression: Slight dysphonia

Provisional Diagnosis:

llyperfunctlonal voice Disorder- lloarse voice quality

Recommendation:
Voice intervention
" To follow vocal hygicne strategies
Conservative voice usage JAYALAMSHMIP.8
" Follow up RCLRO:Ai01/0

Sivadharini
llanna Elizabeth Ms. Ja Lakshmi P B
Student Clinician Speech lLanguage Pathologist

Plense ful (ree to contuct us for any further queries regurding the ubove information.
 VOSPECTOR 2024/04/18

Oirlja Raman, 1982 /07 /21 # 134

RFCORD

Iregularity
Mean FO (Hz) 164.37
4.56
o77
SD FO [Hz
191.74 Noise
Max FO [Hz]
Min FO [Hz) 92.65 0 19

Jitter [%] 0.10

Overall Severnty
0 150 20
Shimmer (%] 343
GNE
10
0.94 o79
delts 180m
4E4

00
0 80

0e0
0 40

0 20

0 20

0 40

0 60

3009 3800 4200 4990 E400 e090 7080

e00 1200 1800 2499
delta 7080 ms Tme (ms)
Spectrogram (1024 /Hamming
3elts 390 3ms

220
20 0

18

14 0

120

00 00 030 0901 899 09 02 T09 09 03 00 0004 00 00 08 490 00 06 300 00 97 080

ceits 7089ms Time (in sec ms)

90 23 1 12 20

lingWAVES V3.2.7
AYA LAKSHMIPB

ept