CETP VOICE DISORDERS KEY EXAM SCRIPT
2026 FULL QUESTIONS AND CORRECT
ANSWERS
◉ Subjective Ax of loudness. Answer: To assess loudness, SLPs make
subjective judgments re:
- Parameters like harshness, breathiness, hoarseness (harsh +
breathy), and vocal tension
- Is loudness appropriate for their daily situations
- Is the client's voice too loud or too soft d/t possible physical factors
(e.g., hearing loss or asthma)
◉ Subjective Ax of resonance. Answer: Clinician subjectively judges
the presence of:
- Hyponasality (too little nasal resonance on nasal sounds)
- Hypernasality (too much nasal resonance on non-nasal sounds)
◉ Subjective Ax of respiration. Answer: Clinicians note the type of
breathing:
- Clavicular breathing occurs when the patient inhales and the
shoulders/sternum elevate; strain and tension may be present.
Clavicular breathing = inefficient (think: panting)
- Thoracic breathing is chest breathing
,- Costal breathing = lower lateral ribcage; easiest to feel if a patient
is hunched over
- Diaphragmatic-abdominal (or costo-abdominal) breathing is
appropriate, efficient breathing, using the abdominal region and the
lower thoracic cavity; little to no chest or shoulder movement. Ideal
for professional voice users (singers, teachers, public speakers). This
is the most physiological/desirable type of breathing
◉ Subjective Ax of Phonation. Answer: Clinician assessed the
patient's ability to sustain phonation, using simple measures like:
- MPT (ability to sustain phonation in one exhalation); generally
given 2-3 trials, which are then averaged and compared to MPT
norms. MPT enables clinicians to measure adequacy of respiration,
glottal efficiency, and possible presence of vocal pathology (e.g.,
nodules)
- s/z ratio, which helps to determine if there is laryngeal pathology
present. Pt is asked to produce two long /s/ phonemes and two long
/z/ phonemes. The clinician divides the longest /s/ by the longest
/z/. Voiced z requires phonation (VF vibration). Ideally, the ratio is 1.
A ratio of more than 1.4 indicates possible laryngeal pathology (i.e.,
you're not able to phonate a /z/ for as long as the /s/)
◉ Voice disorders of resonance include.... Answer: 1) Absence of
desired resonance (hyponasality)
2) Too much resonance (hypernasality)
2) Inadequate resonance (cul-de-sac)
,3) Inappropriate resonance on neighboring sounds (assimilative)
◉ T/F: Appropriate resonance (or lack thereof) is based in part on
cultural/linguistic norms. Answer: T: Certain cultures have a lower
tolerance for hypernasality, while others involve more nasality
◉ Hypernasality
(AKA Excessive nasality). Answer: - Occurs when the velopharyngeal
mechanism doesn't close the opening to the nasal passage, during
the production of non-nasal/oral sounds; air and sound escape
through the nose, adding unnecessary nasal resonance
- These patients speak w/ decreased/insufficient intraoral pressure,
which affects production of fricatives, affricates, and plosives; these
sounds are then produced "weakly"
- Most common resonance disorder
- Sounds like they're speaking through their nose
◉ Cause of hypernasality. Answer: - Functional: no physical reason
for hypernasality; the patient has made a habit of talking through
their nose (e.g., many deaf people, who have adequate VP
mechanisms, but are unable hear the sound of their own voices)
- Organic: physical problems that often require surgical correction
(e.g., cleft palate and pts w/ inadequate cleft repairs)
, ◉ Submucous cleft (of hard or soft palate). Answer: - An additional
cause of hypernasality
- Associated w/ bifid uvula
◉ Velopharyngeal inadequacy/insufficiency (VPI). Answer: - Cause
of hypernasality, where the VP mechanism is inadequate to achieve
closure. Thus, nasal cavity isn't sealed off appropriately from the
oral cavity
- Etiology of VPI is heterogenous (may be neurological, structural, or
learned)
◉ Major causes of VPI. Answer: - Decreased muscle mass of the
velum; not enough velar tissue to achieve closure
- Adenoidectomy or Tonsillectomy; often occurs when a child's VP
mechanism initially did not have sufficient muscle mass. Adenoids
and tonsils are masses that help compensate for an otherwise
inadequate VP mechanism. Thus, when these masses are surgically
removed, the basic VPI becomes apparent
- Paresis (weakness) of the velum; reduces velar mobility, so it's
unable to assist in adequate closure (Note: velar paresis/paralysis
occur secondarily to CP, stroke, head injuries, PD, and other
neuropathologies)
◉ Hyponasality
2026 FULL QUESTIONS AND CORRECT
ANSWERS
◉ Subjective Ax of loudness. Answer: To assess loudness, SLPs make
subjective judgments re:
- Parameters like harshness, breathiness, hoarseness (harsh +
breathy), and vocal tension
- Is loudness appropriate for their daily situations
- Is the client's voice too loud or too soft d/t possible physical factors
(e.g., hearing loss or asthma)
◉ Subjective Ax of resonance. Answer: Clinician subjectively judges
the presence of:
- Hyponasality (too little nasal resonance on nasal sounds)
- Hypernasality (too much nasal resonance on non-nasal sounds)
◉ Subjective Ax of respiration. Answer: Clinicians note the type of
breathing:
- Clavicular breathing occurs when the patient inhales and the
shoulders/sternum elevate; strain and tension may be present.
Clavicular breathing = inefficient (think: panting)
- Thoracic breathing is chest breathing
,- Costal breathing = lower lateral ribcage; easiest to feel if a patient
is hunched over
- Diaphragmatic-abdominal (or costo-abdominal) breathing is
appropriate, efficient breathing, using the abdominal region and the
lower thoracic cavity; little to no chest or shoulder movement. Ideal
for professional voice users (singers, teachers, public speakers). This
is the most physiological/desirable type of breathing
◉ Subjective Ax of Phonation. Answer: Clinician assessed the
patient's ability to sustain phonation, using simple measures like:
- MPT (ability to sustain phonation in one exhalation); generally
given 2-3 trials, which are then averaged and compared to MPT
norms. MPT enables clinicians to measure adequacy of respiration,
glottal efficiency, and possible presence of vocal pathology (e.g.,
nodules)
- s/z ratio, which helps to determine if there is laryngeal pathology
present. Pt is asked to produce two long /s/ phonemes and two long
/z/ phonemes. The clinician divides the longest /s/ by the longest
/z/. Voiced z requires phonation (VF vibration). Ideally, the ratio is 1.
A ratio of more than 1.4 indicates possible laryngeal pathology (i.e.,
you're not able to phonate a /z/ for as long as the /s/)
◉ Voice disorders of resonance include.... Answer: 1) Absence of
desired resonance (hyponasality)
2) Too much resonance (hypernasality)
2) Inadequate resonance (cul-de-sac)
,3) Inappropriate resonance on neighboring sounds (assimilative)
◉ T/F: Appropriate resonance (or lack thereof) is based in part on
cultural/linguistic norms. Answer: T: Certain cultures have a lower
tolerance for hypernasality, while others involve more nasality
◉ Hypernasality
(AKA Excessive nasality). Answer: - Occurs when the velopharyngeal
mechanism doesn't close the opening to the nasal passage, during
the production of non-nasal/oral sounds; air and sound escape
through the nose, adding unnecessary nasal resonance
- These patients speak w/ decreased/insufficient intraoral pressure,
which affects production of fricatives, affricates, and plosives; these
sounds are then produced "weakly"
- Most common resonance disorder
- Sounds like they're speaking through their nose
◉ Cause of hypernasality. Answer: - Functional: no physical reason
for hypernasality; the patient has made a habit of talking through
their nose (e.g., many deaf people, who have adequate VP
mechanisms, but are unable hear the sound of their own voices)
- Organic: physical problems that often require surgical correction
(e.g., cleft palate and pts w/ inadequate cleft repairs)
, ◉ Submucous cleft (of hard or soft palate). Answer: - An additional
cause of hypernasality
- Associated w/ bifid uvula
◉ Velopharyngeal inadequacy/insufficiency (VPI). Answer: - Cause
of hypernasality, where the VP mechanism is inadequate to achieve
closure. Thus, nasal cavity isn't sealed off appropriately from the
oral cavity
- Etiology of VPI is heterogenous (may be neurological, structural, or
learned)
◉ Major causes of VPI. Answer: - Decreased muscle mass of the
velum; not enough velar tissue to achieve closure
- Adenoidectomy or Tonsillectomy; often occurs when a child's VP
mechanism initially did not have sufficient muscle mass. Adenoids
and tonsils are masses that help compensate for an otherwise
inadequate VP mechanism. Thus, when these masses are surgically
removed, the basic VPI becomes apparent
- Paresis (weakness) of the velum; reduces velar mobility, so it's
unable to assist in adequate closure (Note: velar paresis/paralysis
occur secondarily to CP, stroke, head injuries, PD, and other
neuropathologies)
◉ Hyponasality
