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Speech Exam

Voice Quality

November 5th, 2019


  • Signs of Dysphonia

  • Hoarse voice
  • Bovine cough
  • Causes of Dysphonia

  • Neurological

  • Trauma - vagus / recurrent laryngeal nerve
  • Small-vessel ischaemia
  • Infection  - meningitis, diptheria
  • Tumour
  • Multiple sclerosis
  • Parkinson's disease
  • Neuromuscular / Muscular

  • Myasthenia gravis
  • Spasmodic dysphonia
  • Upper Respiratory

  • Irritation - alcohol, tobacco, reflux, pollutants, inhaled chemicals
  • Laryngitis - viral, bacterial, fungal
  • Vocal cord trauma - direct trauma, chronic cough, vocal abuse
  • Vocal cord mass - nodules, polyps, cyst, tumour
  • Medications - ACE inhibitors, antihistamines, inhaled steroids
  • Other

  • Psychogenic


  • Listen For

  • Softness of speech.
  • Significance

  • Hypophonia is classically suggestive of Parkinsonism.

Hypernasal Speech

  • Listen For

  • Speech that is excessively nasal in quality, particularly on articulating vowels. Nasal emissions (air escaping through the nose) may occur on articulating consonants.
  • Significance

  • Hypernasal speech is associated with flaccid dysarthria, due to a lower motor neuron lesion.

Harsh Speech

  • Listen For

  • Speech that is strained or strangled in quality.
  • Significance

  • Harsh speech is associated with spastic dysarthria, due to an upper motor neuron lesion.
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