CD 508 VOICE & VOICE DISORDERS

Chapter 3 Voice Disorders

Functional vs. Organic w Functional - caused by faulty use of the vocal mechanism Misuse may lead to organic change w Organic - related to some physical abnormality in structure at various sites on the vocal tract Change in structure of vocal mechanism Neurological

Etiologies w FUNCTIONAL w Falsetto w Phonation breaks w Pitch breaks w --> Organic w Nodules w Polyps w Traumatic laryngitis w NEUROLOGICAL w Essential tremor w Spastic dysphonia w Vocal fold paralysis w ORGANIC w Contact ulcer w Leukoplakia w Webbing

Falsetto w AKA puberphonia, mutational falsetto, and incomplete mutation of voice w High-pitched, breathy quality with frequent downward pitch breaks w Only anterior portions of vocal folds vibrate, with posterior gap w Folds approx. in ‘thin vocal lips’ which do not completely touch in midline

Falsetto - 2 w --> Voice that is too high for speaker and calls attention to itself w --> perception of immature speaker w Inappropriate except for some singing w Becomes a voice disorder when used as major mode of vibration w Tx: lower pitch and increase quality w e.g. via digital manipulation, glottal fry, massage, etc.

Functional Aphonia w Speak via whisper w Often described as a conversion disorder w Hx of temporary loss before it becomes permanent w Onset often related to trauma/disease, but continued once healed

Functional Aphonia - 2 w Most recover via voice therapy alone w Tx: use vegetative adduction to extend to phonation, e.g. cough, clear, inhalation phonation w Behavior modification and counseling

Functional Dysphonia w 1) Approximate folds in lax manner --> breathiness w 2) Approximate folds tightly --> harshness or tightness w 3) Close off voice via tight adduction of ventricular or aryepiglottic folds AKA ‘supraglottal shutoff’ --> muted horn w Functional/organic cannot be determined by perceptual features

Functional Dysphonia - 2 w Boone recommends that SLP also attempt to visualize vocal folds w Tx: Appropriate pitch & volume; Relaxation/increased effort to increase quality Change configuration of vocal tract Increase efficiency

Muscle Tension Dysphonia w Voice adversely affected by excess muscle tension w 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? w 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. w 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 w Means ‘double voice’ w Produced with two distinct sound sources, voicing simultaneously Each vocal fold vibrating at different rate Laryngeal web Ventricular fold vibration, etc w Treatment Eliminate source of second voice Surgical removal of mass Reduce hyperfunction/laryngeal tension

Vocal Fold Thickening w Enlargement along glottal margin of vocal folds w Results from continuous vocal abuse, endocrine imbalance, chronic URI, surgery, etc. w Treatment --> vocal hygiene Eliminate sources of misuse/abuse Surgical removal - note: problem will recurr if source not eliminated

Reinke’s Edema w Fluid accumulates under vocal fold cover in Reinke’s space - acts like a blister w Caused by chronic abuse/irritation, e.g. smoking or vocal misuse/abuse w Characterized by “dry, strained hoarseness” w Tx: eliminate abuse/irritant

Reinke’s Space - see superficial layer

Vocal Polyps w Occur at anterior mid-third site on cords w Lesion is soft, usually fluid filled, occuring on inner margin of one fold Sessile - broad based Pedunculated - on a narrow-necked stem w Often precipitated by a single event w Tx: Microflap surgery Vocal hygiene therapy

Vocal Nodules w Caused by continuous misuse/abuse of the voice w Benign, typically bilateral lesions at the anterior mid third of the vocal folds ranges from soft and pliable to fibrotic w --> open chink --> breathiness w --> increased effort to approximate folds --> hoarseness w Quality deteriorates with use w Tx: vocal hygiene

Phonation Breaks: Abductor Spasms w Temporary loss of voice occurring for only part of an utterance, usually after prolonged hyperfunction w Tx: reduce hyperfunction Eliminate misuse/abuse Reduce stress

Pitch Breaks w Caused by Pubertal growth of larynx Prolonged vocal hyperfunction Fatigue w Tx: Avoid demands of formal singing during puberty (until larynx is stable) Voice rest Reduce hyperfunction

Contact Ulcers w Ulceration along the posterior one-third of the vocal margin w Caused by Excessive slamming of arytenoids together Frequent throat- clearing/coughing Gastric reflux w Symptoms Vocal fatigue Pain in larynx (or lateralized to one ear) Hoarseness w Tx: Vocal hygiene Reflux precautions Medications

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