Voice, Resonance, and Fluency Disorders
This domain tests perceptual and instrumental evaluation of voice, resonance, and fluency, and the selection of appropriate intervention.
Core rules
- Voice assessment includes case history, perceptual rating (for example GRBAS), acoustic measures, aerodynamic measures, and laryngeal visualization when indicated. Red flags such as progressive hoarseness, stridor, or unilateral vocal fold paralysis require medical referral.
- Resonance disorders include hypernasality, hyponasality, and cul-de-sac resonance. Hypernasality often reflects velopharyngeal insufficiency after cleft palate repair or neurologic disease; assess nasal emission and velopharyngeal function.
- Fluency disorders include stuttering and cluttering. Stuttering involves core behaviors, secondary behaviors, and avoidance; cluttering involves rapid, disorganized speech and reduced intelligibility. Neurogenic stuttering can follow stroke or trauma.
Worked example
A 7-year-old with repaired cleft palate is hypernasal, has nasal emission on pressure consonants, and is less intelligible in connected speech. Voice quality is otherwise normal. The priority is velopharyngeal assessment, not trial voice exercises alone. Speech therapy targets oral pressure, placement, and resonance awareness while the cleft team evaluates structural and functional velopharyngeal status. If the child also stutters, treat fluency separately rather than attributing all difficulty to resonance.
Traps that cost marks
- Treating hypernasality with voice therapy alone when velopharyngeal insufficiency is suspected.
- Missing medical red flags in adult voice cases.
- Confusing cluttering with stuttering and using the wrong fluency goals.
- Judging fluency only from a structured repetition task.