CD 508

VOICE & VOICE DISORDERS

Chapter 3

Voice Disorders

Functional vs. Organic

◗ Functional - caused by faulty use of the vocal mechanism• Misuse may lead to organic change

◗ Organic - related to some physical abnormality in structure at various sites on the vocal tract• Change in structure of vocal mechanism• Neurological

Etiologies

◗ FUNCTIONAL◗ Falsetto◗ Phonation breaks◗ Pitch breaks◗ --> Organic◗ Nodules◗ Polyps◗ Traumatic laryngitis

◗ NEUROLOGICAL◗ Essential tremor◗ Spastic dysphonia◗ Vocal fold paralysis◗ ORGANIC◗ Contact ulcer◗ Leukoplakia◗ Webbing

Falsetto

◗ AKA puberphonia, mutational falsetto, and incomplete mutation of voice

◗ High-pitched, breathy quality with frequent downward pitch breaks

◗ Only anterior portions of vocal folds vibrate, with posterior gap

◗ Folds approx. in ‘thin vocal lips’ which do not completely touch in midline

Falsetto - 2

◗ --> Voice that is too high for speaker and calls attention to itself

◗ --> perception of immature speaker◗ Inappropriate except for some singing◗ Becomes a voice disorder when used as

major mode of vibration◗ Tx: lower pitch and increase quality◗ e.g. via digital manipulation, glottal fry, massage,

etc.

Functional Aphonia

◗ Speak via whisper◗ Often described as a conversion

disorder◗ Hx of temporary loss before it becomes

permanent◗ Onset often related to trauma/disease,

but continued once healed

Functional Aphonia - 2

◗ Most recover via voice therapy alone◗ Tx: use vegetative adduction to extend

to phonation, e.g. cough, clear, inhalation phonation

◗ Behavior modification and counseling

Functional Dysphonia

◗ 1) Approximate folds in lax manner --> breathiness

◗ 2) Approximate folds tightly --> harshness or tightness

◗ 3) Close off voice via tight adduction of ventricular or aryepiglottic folds AKA ‘supraglottal shutoff’ --> muted horn

◗ Functional/organic cannot be determined by perceptual features

Functional Dysphonia - 2

◗ Boone recommends that SLP also attempt to visualize vocal folds

◗ Tx: • Appropriate pitch & volume;• Relaxation/increased effort to increase

quality• Change configuration of vocal tract• Increase efficiency

Muscle Tension Dysphonia

◗ Voice adversely affected by excess muscle tension

◗ May cause• Partial closure of ventricular folds• Shortened vocal folds• Sphincter-like closure of supraglottal area• Tx: relaxation and manual manipulation

Why do we need voice therapy if the problem is organic?◗ Laryngeal pathology caused by vocal misuse

and/or abuse is likely to recur after surgery unless the patient eliminates the original source of the problem.

◗ This is analogous to surgically removing a bunion or callous, then putting on the same shoes that caused the problem in the first place.

Diplophonia◗ Means ‘double voice’◗ Produced with two distinct sound

sources, voicing simultaneously• Each vocal fold vibrating at different rate• Laryngeal web• Ventricular fold vibration, etc

◗ Treatment• Eliminate source of second voice• Surgical removal of mass• Reduce hyperfunction/laryngeal tension

Vocal Fold Thickening

◗ Enlargement along glottal margin of vocal folds

◗ Results from continuous vocal abuse, endocrine imbalance, chronic URI, surgery, etc.

◗ Treatment --> vocal hygiene• Eliminate sources of misuse/abuse• Surgical removal - note: problem will recurr if

source not eliminated

Reinke’s Edema

◗ Fluid accumulates under vocal fold cover in Reinke’s space - acts like a blister

◗ Caused by chronic abuse/irritation, e.g. smoking or vocal misuse/abuse

◗ Characterized by “dry, strained hoarseness”

◗ Tx: eliminate abuse/irritant

Reinke’s Space - see superficial layer

Vocal Polyps◗ Occur at anterior mid-third site on cords◗ Lesion is soft, usually fluid filled,

occuring on inner margin of one fold• Sessile - broad based• Pedunculated - on a narrow-necked stem

◗ Often precipitated by a single event◗ Tx:

• Microflap surgery• Vocal hygiene therapy

Vocal Nodules◗ Caused by continuous misuse/abuse of

the voice◗ Benign, typically bilateral lesions at the

anterior mid third of the vocal folds• ranges from soft and pliable to fibrotic

◗ --> open chink --> breathiness ◗ --> increased effort to approximate

folds --> hoarseness◗ Quality deteriorates with use◗ Tx: vocal hygiene

Phonation Breaks: Abductor Spasms

◗ Temporary loss of voice occurring for only part of an utterance, usually after prolonged hyperfunction

◗ Tx: reduce hyperfunction• Eliminate misuse/abuse• Reduce stress

Pitch Breaks

◗ Caused by• Pubertal growth of larynx• Prolonged vocal hyperfunction• Fatigue

◗ Tx:• Avoid demands of formal singing during puberty

(until larynx is stable)• Voice rest• Reduce hyperfunction

Contact Ulcers

◗ Ulceration along the posterior one-third of the vocal margin

◗ Caused by • Excessive slamming

of arytenoids together

• Frequent throat-clearing/coughing

• Gastric reflux

◗ Symptoms• Vocal fatigue• Pain in larynx (or

lateralized to one ear)

• Hoarseness◗ Tx:

• Vocal hygiene• Reflux precautions• Medications

CD Audio Files◗ Note: you should have received a CD with your

textbook. You can play this on your audio system, or on your computer (if equipped with speakers)

◗ Listen to tracts◗ # 6 & 13 - functional aphonia◗ # 9 - functional dysphonia◗ # 3 & 9 - muscle tension dysphonia◗ # 7 - diplophonia, thickening◗ # 2 - polyps◗ # 4 & 10 - vocal nodules◗ # 3 & 8 - phonation & pitch breaks