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Speech Exam

Voice Quality



    • 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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