Perceptual Analysis of voice:

Samples- 2 female, 2 male & 1 child

GRBASI scale
Gender Age Grade Roughness Breathines Asthenia Strain Instability Impression
s
Male
40 0 0 0 0 0 0 Normal

Male
42 2 2 1 1 2 1 Moderate
dysphonia
with
roughness
and strain

35 2 0 2 0 0 0 Breathy
Female Voice

30 3 3 2 2 3 2 Severe
Female dysphonia
with
roughness
and strain

08 1 1 1 0 1 1 Mild
Child dysphonia
with
breathiness

MPD ( Maximum phonation duration)

Gender Age A I u Average a Average i Average u

Female 10 14 15
30 20 16 16 16.8 16.4 16.2
20.4 19 18
13 12
35 14 14.6 14.2 14.0
Female 14 14 14
16 16 16
22
22 22 22.8
Male 40 23 24 23 23.6 23.2
26 24 23

21 20 20 20.6
Male 42 21 21 21 21.4 21.0

22 22 21

Child 10 09
09 10.2 9.8 9.6
08 10 10
10
11 10 10

S/Z ratio
Gender Age S z S/Z
Female 30 98 100 0.98
Female 35 100 99 0.99
Male 40 97 100 0.97
Male 42 100 98 0.98
Child 08 96 100 0.96

Acoustic analysis of voice

Age F0 (Hz) I0 (dB) Rise time (ms) Fall time (ms)

Speake
 r

Male 1 40 120 75 10 15

Male 2 42 110 80 12 18

Female 30 200 70 8 10
1

Female 35 210 72 7 9
2

Child 08 300 65 5 7

parameter Male 1 Male 2 Female 1 Female 2 Child 1 Child 2

Soft Intensity: 65 Intensity: 55 Intensity: 50 Intensity: 60 Intensity: 45 Intensity: 55
phonation dB dB dB dB dB dB
Pitch: 110 Hz Pitch: 95 Hz Pitch: 230 Hz Pitch: 210 Hz Pitch: 320 Pitch: 300 Hz
Hz
Loud Intensity: 85 Intensity: 80 Intensity: 75 Intensity: 85 Intensity: 75 Intensity: 80
phonation dB dB dB dB dB dB
Pitch: 85 Hz Pitch: 100 Hz Pitch: 190 Hz Pitch: 200 Hz Pitch: 280 Pitch: 270 Hz
Hz
Pitch Average pitch: Average pitch: Average pitch: Average Average Average pitch:
110 Hz 97 Hz 220 Hz pitch: 205 Hz pitch: 310 Hz 290 Hz
Glide Pitch glide: 90- Pitch glide: 80- Pitch glide: Pitch glide: Pitch glide: Pitch glide:
110 Hz 110 Hz 200-240 Hz 190-220 Hz 300-330 Hz 280-310 Hz
Speech Speech rate: Speech rate: Speech rate: Speech rate: Speech rate: Speech rate:
160 wpm 150 wpm 180 wpm 170 wpm 130 wpm 140 wpm
Pause duration: Pause duration: Pause duration: Pause Pause Pause
0.4 sec 0.5 sec 0.3 sec duration: 0.4 duration: 0.6 duration: 0.5
sec sec sec
Vowel |a| F1: 480 Hz F1: 520 Hz F1: 700 Hz F1: 680 Hz F1: 880 Hz F1: 850 Hz
F2: 1450 Hz F2: 1600 Hz F2: 1950 Hz F2: 1800 Hz F2: 2400 Hz F2: 2300 Hz
Duration: 210 Duration: 190 Duration: 180 Duration: 200 Duration: Duration: 220
ms ms ms ms 240 ms ms
Intercepted | Duration: 45 Duration: 55 Duration: 35 Duration: 40 Duration: 50 Duration: 45
a| ms ms ms ms ms ms
Pitch drop: 15 Pitch drop: 18 Pitch drop: 12 Pitch drop: 15 Pitch drop: Pitch drop: 18
Hz Hz Hz Hz 20 Hz Hz
Intensity drop: Intensity drop: Intensity drop: Intensity Intensity Intensity drop:
4 dB 5 dB 3 dB drop: 4 dB drop: 5 dB 4 dB
Vocal Tract Visualization and Imaging

Introduction: Vocal tract visualization and imaging is the collection of procedures for
performing a detailed visual examination of the vocal tract and laryngeal and velopharyngeal
structures and gross function, including vocal fold vibration. These procedures enable a speech-
language pathologist (SLP) to further assess and plan treatment strategies for

 voice,
 deglutition, and
 resonance disorders.

These procedures use either a constant or a stroboscopic light source for indirect
laryngoscopy, rigid fiberoptic oral endoscopy (RFOE), or flexible fiberoptic
nasendoscopy (FFN). Images and/or videos can be made using any of these techniques and can
be stored on digital media. Physicians are the only professionals qualified and licensed to render
medical diagnoses related to the identification of laryngeal pathology as it affects voice. Imaging
should be viewed and interpreted by an otolaryngologist with training in this procedure when
used for medical diagnostic purposes. SLPs trained in stroboscopy view and interpret imaging
for SLP diagnosis (e.g., dysphagia) and to establish/modify treatment plans. Videofluoroscopy,
ultrasound, and video images can also be used to view all or part of the vocal tract and oral
structures.

LARYNGOSCOPY
Examination of the internal structures of the larynx, including the vocal folds, is called
laryngoscopy.

Laryngoscopy is of two types:

1) Indirect laryngoscopy
2) Direct laryngoscopy

Indirect Laryngoscopy
 The technique developed after Manuel Garcia visualised the intact larynx for the first
time in 1854 using a dental mirror.
 It derives its name from the technique of viewing the interior of the larynx indirectly via a
mirror or some other optical instrument rather than with naked eye.
 The physician faces the upright patient, wraps the tongue in gauze to protect the frenum
from the lower incisors, and, with thumb and middle finger, draws the tongue out of the
mouth.
 The mirror, slightly warmed and tested against the dorsum of the tongue, is introduced
into the mouth, the examiner carefully avoiding contact with the tongue.
 The mirror, guided posteriorly by pushing the uvula upward and backward, is positioned
in the oropharynx.
 Gagging can be inhibited by encouraging the patient to breathe through the mouth and to
keep the eyes open. Otherwise, a topical anesthetic agent is sprayed into the oropharynx.
 With the laryngeal mirror properly positioned, the clinician reflects a light beam off a
head mirror onto the laryngeal mirror to see the laryngeal interior.

 With the mirror, the laryngologist inspects the base of the tongue, the anterio anterior
surface of the epiglottis, the valleculae, the pharyngeal walls, the pyriform sinuses, the
posterior border of the epiglottis, the aryepiglottic folds, and the mucosa of the posterior
commissure.
 The vocal folds are viewed during quiet breathing and while the patient sustains the
vowel /e/ or /i/. The effort to produce these vowels causes the larynx to rise in the neck,
affording a clearer view of the vocal folds.
 The examiner searches for symmetry of glottal opening and closing, normalcy of color,
presence or absence of mass lesions, or inflammation.
Advantages Disadvantages

 Quick overview  Poorly tolerated

 No pain or trauma  If a gag reflex is present, this

procedure cannot be performed.

 Anatomical variations frequently

make it difficult to visualize the
larynx.
Direct laryngoscopy
1. Rigid laryngoscopy
2. Flexible Laryngoscopy

Rigid laryngoscopy

Instrumentation:

Rigid laryngoscope

Procedure:
 It is a non-flexible instrument.
 Superior to indirect laryngoscopy. It can be adopted for the photography and can be used
as an observation tube and can be connected to closed circuit television with video tape
recording.
 This examination provides the clearest magnified view of the larynx.
  The patient has to lie on the back during this procedure.
 The examiner then holds the patient's tongue while viewing the voice box.
 Images are usually recorded on video.
 It facilitates visualisation of the larynx, hypo pharynx, base of the tongue, nasopharynx,
and nasal surface of the palate.

Flexible fiberoptic laryngoscope/transnasal fiberoptic laryngoscopy

• First introduced by Swashima and Hirose, 1968.
• Fiberoptic scope/ nasopharyngoscope requires a powerful light source.
• A television monitor and recorder can be attached for viewing and videotaping
purposes.
• The curved part of the scope is a flexible fiberoptic cable that can be passed
through the nose and through the pharynx until it gives a view of the vocal folds.

The instrument shown above is a nasopharyngoscope. The curved part of the scope is a
flexible fiberoptic cable that can be passed through the nose and through the pharynx
until it gives a view of the vocal folds.

 The flexible scope causes very little gagging and is actually quite comfortable.
 Using this flexible endoscope, the larynx can be examined during normal speech.
Videostroboscopy
 Stroboscopy is a technique used to observe motion in cases where the movement is so
quick that the human visual system cannot capture and process the image.
 Stroboscopy is a special method used to visualize vocal fold vibration.. This "slow
motion picture" is an illusion, as the speed of actual vocal fold vibration is not changed
by stroboscopy.

Principle:
 The light source of the stroboscope emits intermittent flashes of light which are
synchronous with the vibratory cycles.
 The source of the trigger signal for the light flashes is the waveform of the subject's
voice.
 When the flashes are emitted at the same frequency as that of the vocal fold vibration, a
sharp and a clear image of the vocal folds is observed, assuming that the reappearance of
the waveform is maintained constant. When the flashes are emitted at frequencies slightly
less than the frequency of vocal fold vibration, giving rise to a systematic phase delay of
the consecutive light flashes, a slow motion effect is produced.

Apparatus
 It consists of a microphone, a light source, an electronic control unit and a pedal.

Parameters to be observed
 Pathology
 Closure
 Symmetry
 Regularity (Periodicity)
 Amplitude
 Mucosal wave
 Non vibrating portion
 Ventricular hyper adduction
 Other findings
Procedure
 The microphone is attached to the subject's neck near the thyroid cartilage with an elastic
band to make contact with the larynx.
 The camera is attached to a fiber-optic endoscope that is used to view the VFs.
 Instead of viewing the larynx under steady light, this procedure uses rapid flashes of light
to view vocal folds.
 These light flashes are synchronous with the vibratory cycles.
 When the subject phonates, the fundamental frequency of phonation is determined and
the stroboscope light is pulsed at approximately the same frequency.
 When the frequency of flash coincides exactly with frequency of vibration of the vocal
fold (synchronisation), the vocal fold seems motionless.
 When a rapidly moving object (represented by the high frequency waveform) is strobed
by flashes at a lower frequency, the rapidly moving object appears to move more slowly
 There are the following general tendencies:
 As the fundamental frequency increases, the amplitude of vibration and the mucosal
wave decrease and the closed phase becomes relatively shorter, assuming that the vocal
effort is roughly constant.
 As the vocal intensity increases, the amplitude and the mucosal wave increase and the
closed phase becomes relatively longer.
 In falsetto, the amplitude is small, the mucosal wave is hardly found, and the glottis is not
completely closed.

Advantages
 extensive body of information
relative to the effect of pathology
on the process of voicing
 potential for providing information
about the neuromuscular and
physiological integrity of the vocal
folds and supraglottic structures
Disadvantages
 patient discomfort related to the
use of FFN or RFOE
 image restricted to isolated vowel
production when the strobe light is
used
 highly subjective (Roy et al.,
2013)

Candidacy for VLS:

According to the American Laryngological Association, some indications for performing VLS
videolaryngoscopy and stroboscopy are:

 Persistent or recurrent hoarseness or dysphonia

 Vocal fatigue or strain
 Voice changes after surgery or trauma
 Difficulty swallowing or breathing
 Throat pain or discomfort
 Vocal cord paralysis or paresis
 Vocal cord nodules, polyps, cysts, or tumors
 Laryngeal cancer or precancerous lesions
 Spasmodic dysphonia or other neurological voice disorders
 Professional voice users who need vocal assessment or optimization
Videostroboscopy is used to assess the following (Patel et al., 2018):

 amplitude of excursion (lateral movement of the vocal fold medial plane)

 symmetrical
 normal/reduced/absent
 each fold can be rated separately as a percentage

 vertical level—level difference in the vertical plane between vocal folds during the
maximum closed phase of the glottic cycle

 on-plane
 off-plane

 periodicity of vocal fold movement

 always/usually/sometimes/never periodic
 segments of the vocal fold that are aperiodic

 vocal fold mucosal wave (independent lateral movement of mucosa over the vocal fold)

 normal/diminished/great/symmetrical/absent

 glottal closure pattern—glottal configuration at maximum closure

 complete
 incomplete
 posterior glottal gap
 anterior glottal gap
 hourglass
 incomplete
 irregular
 spindle-shaped/bowing

 phase closure—relative proportion of the glottal cycle in which the glottis is closed
versus open

 open phase
 closed phase

 vocal fold appearance

 malposition
 excrescence (abnormal projection/outgrowth)
  edema
 erythema

 vocal fold edge appearance

 smooth
 straight
 bowed
 convex
 concave
 irregular
 rough

 subglottal appearance

 erythema
 edema

 supraglottal behavior

 medial compression
 anterior–posterior compression

 mild/moderate/severe

 arytenoid movement

 normal or impaired mobility

 bilateral
 unilateral

 velopharynx

 contact between the soft palate and the posterior pharyngeal wall as well
as lateral pharyngeal wall movement with
 sustained fricatives such as /s/,
 syllable repetition,
 multisyllabic words,
 phrases with pressure-loaded consonants, and
 sentence or spontaneous speech

 secretions

 amount
 consistency
Interpretation

 amplitude asymmetry—mass, compliance, neurogenic difference, scarring, granuloma

 function of the velopharynx—degree of closure, context relevant behaviors
 inadequate closure—intervening mass, neurogenic disorder (paralysis), hypofunctional
disorder
 mucosal wave adynamic segment—cover scarring, intracordal cyst, fibrosis, neurogenic
disorder, edema
 phase asymmetry—mass, compliance, neurogenic difference
 supraglottic compression—hyperfunction, compensatory hyperfunction
 voice quality abnormal, larynx normal—behavioral disorder

Precautions and Risks

Before undertaking these procedures, practitioners consider the following precautions:

1. Check with state licensure board(s), where appropriate, to determine whether there are
limitations on the scope of SLP practice that restrict the performance of these procedures.
2. Follow universal precautions, including personal protective equipment (PPE) as
appropriate, to prevent the risk of disease transmission from blood/airborne pathogens.
3. Have immediate emergency medical assistance available when using topical anesthesia or
FFN.
4. Hold a current Basic Life Support Certificate if performing FFN or using topical
anesthesia.
5. Recommend that the patient remains NPO until anesthetic wears off.

Practitioners also educate patients on risks associated with imaging, obtain the patient's informed
consent, and maintain documentation when performing FFN or when using topical anesthesia.
Risks may include the following:

1. vasovagal response
2. adverse/allergic reaction to topical anesthesia
3. nasal irritation
Picture of common voice disorders:

Vocal nodules

Reinke’s edema

Vocal polyp
Vocal cyst
 Leukoplakia

Vocal cord cancer

Laryngitis

Vocal cord paralysis

Vocal granuloma
Aerodynamic:
INTRODUCTION
Aerodynamic in voice production refers to the study of how air flows and interacts with the vocal
folds and other structures involved in producing sound.

 The sounds of speech are a product of careful and precise use of the air
pressure generated by the respiratory system.
 It is useful to know what the air pressure is at a given region in the vocal
tract with respect to another region within the same.
 It is also important to observe changes in air pressure values that result
from speech activity.

Aerodynamic measures:

Lung volumes and capacities

Air pressure

Airflow

Volume and capacity:

Volume is the quantity of three Capacity is the maximum amount

dimensional space enclosed by that can be held, absorbed or
some closed boundary. produced.
 Tidal
volume

Inspiratory
Residual
reserve Volumes volume
volume

Expiratory
reserve
volume

TIDAL VOLUME: (VT)

 It is the volume of air entering and leaving the nose or mouth per breath.
 It is determined by the activity of the respiratory control centers in the brain as they effect
the respiratory muscles and by the mechanics of the lung & the chest wall.
 Tidal volume is one of the components of lung volumes and capacities, which are the
measurements of the different aspects of lung function
 Tidal volume can vary depending on the level of physical activity, the posture, the
breathing pattern, and the emotional state of the person
 During normal, quiet breathing the VT of a 70kg adult is about 500ml per breath.
 INSPIRATORY RESERVE VOLUME: (IRV)
• It is the volume of air that is inhaled into the lungs during a maximal forced inspiration,
starting at the end of a normal tidal inspiration.
• It is determined by the strength of contraction of the inspiratory muscles, the inward
elastic recoil of the lung and the chest wall.
• The IRV of a normal 70 kg adult is about 2.5lt.

EXPIRATORY RESERVE VOLUME: (ERV)

 It is the volume of air that is expelled from the lungs during a maximal forced expiration
that starts at the end of a normal tidal expiration.
 It is therefore determined by the difference between the FRC and the RV.
 ERV is one of the four lung volumes that are measured by spirometry, a test that
evaluates how well your lungs work.
 ERV is part of your vital capacity, which is the total amount of air that you can breathe in
and out of your lungs.
 The ERV is about 1.5lt in a healthy 70 kg adult.
RESIDUAL VOLUME: (RV)
 It is the volume of gas left in the lungs after a maximal forced expiration.
 It is determined by the force generated by the muscles of expiration and the inward
elastic recoil of the lungs as they oppose the outward elastic recoil of the chest wall.
 The RV of a healthy 70kg adult is about 1.5 Lt.
 RV is important to a healthy person because it prevents the lungs from collapsing at very
low lung volumes.

Volume Males females

Tidal volume At rest 750 cc 285-393

Inspiratory reserve 1500-2500 cc 1500-2500 cc

volume

Expiratory reserve 1000-2000 cc 1000-2000 cc

volume

Residual volume 1000-1500 cc 1000-1500 cc

Dead space air 150 cc 150 cc

Inspiratory

Capacity

Functional
Vital residual
Capacities
capacity capacity

Total lung
capacity
TOTAL LUNG CAPACITY: (TLC)
 It is the volume of air in the lungs after a maximal inspiratory effort.
 It is determined by the strength of contraction of the inspiratory muscles and the inward
elastic recoil of the lungs and the chest wall.
 The TLC consists of all four lung volumes: the RV, the VT, the IRV & the ERV.
 The TLC is about 6L in a healthy adult.

INSPIRATORY CAPACITY: (IC)

 It is the volume of air that can be inhaled into the lungs during a maximal inspiratory
effort that begins at the end of a normal tidal expiration.
 It is therefore equal to the VT + IRV
 The IC of a normal healthy adult is about 3L.

FUNCTIONAL RESIDUAL CAPACITY: (FRC)

• It is the volume of air remaining in the lungs at the end of a normal tidal expiration.

• FRC is usually considered to represent the balance point between the inward elastic recoil
of the lungs and the outward elastic recoil of the chest wall.

• The IC of a normal healthy adult is about 3L.

AIR PRESSURE
 Pressures of the respiratory system
 During inhalation, the diaphragm and the intercostal muscles contract,
increasing the volume of the thoracic cavity and decreasing the intrapleural
pressure, which is the pressure within the space between the lungs and the
chest wall
 During exhalation, the diaphragm and the intercostal muscles relax,
decreasing the volume of the thoracic cavity and increasing the intrapleural
pressure. This causes the lungs to recoil, creating a positive alveolar pressure,
which forces air out of the lungs, until the alveolar pressure equals the
atmospheric pressure

ALVEOLAR PRESSURE
 The pressure within the lungs is called the pulmonic or alveolar pressure.
 Alveolar pressure determines whether air will flow into or out of the lungs.
 When alveolar pressure is negative, as is the case during inspiration, air flows from the
higher pressure at the mouth down the lungs into the lower pressure in the alveoli.
 When alveolar pressure is positive, which is the case during expiration, air flows out.

INTRAPLEURAL PRESSURE
 It is the pressure measured between the parietal and visceral pleurae.
  Intrapleural pressure changes during the phases of breathing. It becomes more negative
during inspiration, as the chest wall expands and the lungs follow. It becomes less
negative during expiration, as the chest wall recoils and the lungs contract2.
 Intrapleural pressure is affected by the volume of the pleural cavity and the elasticity of
the lungs and the chest wall. Conditions that alter these factors, such as pneumothorax,
pleural effusion, or fibrosis, can impair the normal breathing process3.

SUB-GLOTTAL PRESSURE
 It is the pressure developed below the vocal folds.
 This pressure can be used to determine if the speaker has weaker respiratory system.
 During normal respiration with the vocal fold open, it is assumed that the subglottal and
the intraoral pressure are equal to the alveolar pressure.
 A minimum subglottal pressure is needed to set the vocal fold into vibration, this varies
with fundamental frequency.
 It could range from 3cm to 6cm of H₂O.
 It is the major determinant of vocal intensity.

INTRAORAL PRESSURE
 It is the level of air that is impounded behind an articulatory obstruction in the oral
cavity.
 It can be measured to determine the effectiveness of velopharyngeal function for oral
consonants.
 To determine if the lungs have delivered sufficient air pressure for speech articulation.
 It is often measured for pressure consonants.

AIRFLOW
 Laminar flow

-It occurs when the passage or tube of airflow has no constriction (vowels).
  Turbulent flow

-It is produced when the surface is rough or turbulent (fricatives).

 Orifice flow

-It develops as constrictions from within the vocal tract during the phonation.

 Transitional flow

-A mixture of laminar and turbulent flow.

Airflow based on its location of action is of three types

 Transglottal airflow: it is the airflow through the glottis. It is one of the index of
efficiency of phonation.
 Oral airflow: it is the airflow through the oral cavity.
 Nasal airflow: airflow through nasal cavity, recorded at the nares. It is the index of
nasalization or nasal emission. In normal speech it is seen only with nasal breathing or
with production of nasal sounds.

Types of methods to evaluate the voice function:

1. Subjective
2. objective

Subjective evaluation
 MPD
 S/Z ratio
OBJECTIVE MEASURES

SPIROMETER
Spirometry (spy-ROM-uh-tree) is a common office test used to assess how well your lungs work
by measuring how much air you inhale, how much you exhale and how quickly you exhale.

Why it's done

Your doctor may suggest a spirometry test if he or she suspects your signs or symptoms may be
caused by a chronic lung condition such as:

 Asthma
 COPD
 Chronic bronchitis
 Emphysema
 Pulmonary fibrosis
If you've already been diagnosed with a chronic lung disorder, spirometry may be used
periodically to check how well your medications are working and whether your breathing
problems are under control. Spirometry may be ordered before a planned surgery to check if your
lung function is adequate for the rigors of an operation. Additionally, spirometry may be used to
screen for occupational-related lung disorders.

Types
There are two types of spirometer they are:

 Wet spirometer.
 Dry spirometer

Wet spirometer
 The classic instrument for the evaluation of air volumes is the wet spirometer which is an
extremely simple device.
 It consists of an air collecting “bell” inverted in a vessel of water.
  At the start of the test, water fills the bell but air from the patient is channeled into it and
the water is displaced.
 This causes the bell to float so that its height is directly proportional to the amount of air
in it.
 A pointer linked to bell indicates the volume of air.
 This device include a chamber containing water and a bell that floats inside the chamber.
 Volume displaced into and out of the bell causes it to rise and fall, respectively.
 The height of the bell being directly proportional to the volume of the air in the
spirometer.
 A pen fixed to the bell makes a record of volume change on a paper attached to a rotating
drum.
 It uses the principle of displacement to measure the amount of air the lungs can hold.
 Result : The distance the indicator travels represents the lung volume. The scale is
calibrated in liters.
 Uses: Bronchitis and asthma are two lung disorders that can be diagnosed using a wet
spirometer. Patients will have a decreased ability to exhale air through the breathing tube.

Advantages:
 Simple device
 Easy to use
 Can evaluate air volume (tidal volume and vital capacity mainly)

Disadvantages:
 Unable to observe small rapid volume changes
  Since it is mechanical device, there is a significant resistance that must be overcome
before the bell displacement is achieved.
 Responses are sluggish.

Dry spirometer
 Hand held or dry spirometers are compact and portable device that does not depend on
the displacement of water from a bell.

 Dry spirometers measure the volume of air expired by the lungs and the volume of air in
the lungs.
 Dry spirometers can be used to perform basic pulmonary function tests (PFTs), such as
measuring the forced vital capacity (FVC) and the forced expiratory volume in one
second (FEV1).
 Dry spirometers have an indicator that moves along a scale as the air is exhaled, showing
the amount of air in milliliters or liters.
 Dry spirometers are easy to use and do not require water or electricity. They are also less
prone to infection and contamination than wet spirometers.
 Dry spirometers may have some disadvantages, such as inaccurate measurements due to
air leakage, temperature changes, or mechanical friction.
 Advantages:

 They are simple, portable, and inexpensive.

 They do not require electricity or calibration.
 They can measure vital capacity, forced vital capacity, and forced expiratory volume.

Disadvantages:

 They are less accurate and sensitive than electronic spirometers.

 They are affected by temperature, humidity, and air leakage.
 They cannot measure inspiratory flow or lung volumes that cannot be exhaled

U tube manometer
 It is a very simple device with a 'u' shaped tube.
 The tube is filled to half its height with water to which a very small amount of detergent
is added to reduce surface tension effects.
 Care must be taken to avoid trapping air bubbles in the tube during the filling operation.
 The sensing tube is attached to one arm and the device is ready for use.
 The functioning of the u-tube manometer rests on fundamental physical principles, it is
therefore inherently calibrated.
 Readings are taken of the difference between the heights of the liquid in the two arms of
the tube.
  The applied pressure can be described in terms of the height of the column of liquid it is
supporting, which is the vertical distance between the 2 liquid levels.
 Due to surface tension the fluid level surfaces are not flat, but instead concave. The fluid
level is measured at the bottom of the concavity, called the meniscus, in each arm of the u
tube.

Pneumotachograph
A device that measures airflow quantitatively by detecting flow of respiratory gases and
comparing it to the pressure drop against a small resistive field.

 Pneumotachographs are used to perform spirometry, a test of lung function that

can diagnose and monitor respiratory diseases.
 Pneumotachographs can measure the rate of the respiratory function, such as
forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC).
 Pneumotachographs use a fine wire mesh screen or a series of screens with low
resistance to air flow. Flow is calculated by measuring the pressure differential
across the screen or screens.
 Pneumotachographs are very accurate and stable, but they require regular
calibration and cleaning.
 Pneumotachographs are one of the most widely used pulmonary function systems
 Aerophone II
 The Aerophone II is designed to measure vocal and respiratory functions.
 It records data by means of hardware transducers from which the system's software
documents these results.
 The software can then calculate parameters which measure air-flow, air pressure, sound
pressure level, and their interrelationships

Results
Key spirometry measurements include the following:

 Forced vital capacity (FVC). This is the largest amount of air that you can forcefully
exhale after breathing in as deeply as you can. A lower than normal FVC reading indicates
restricted breathing.
 Forced expiratory volume (FEV). This is how much air you can force from your lungs in
one second. This reading helps your doctor assess the severity of your breathing problems.
Lower FEV-1 readings indicate more significant obstruction.