Transcript Chapter 11: Voice Disorders

Chapter 11:
Voice Disorders
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.1
Focus Questions
• What is a voice disorder?
• How are voice disorders classified?
• What are the defining characteristics of
voice disorders?
• How are voice disorders identified?
• How are voice disorders treated?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.2
Introduction – A Brief History
• 16th century – the larynx studied on human
cadavers – did not permit to see larynx at work
• 1600 – first book on laryngeal structures
• 18th century – well-developed understanding
how the vocal folds produce the voice
• 1829 – glottiscope: crude glimpses of the
laryngeal cavity
• 1854 – laryngoscope: vast improvement in
technology to examine the larynx
• Today, advanced technology (endoscopy,
stroboscopy) allow examination of the vocal
folds live in action
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.3
Overview of Voice Disorders
• Individual’s vocal quality is in some way
compromised
• For some, disorder is mild, transient, and
requires no treatment
• For others, disorder is severe, persistent,
and requires ongoing treatment
• Most serious cases, larynx is removed for
reasons such as cancer, and alternative
methods of producing voice are necessary
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.4
Case Study #1: Kate
• 46-year old trauma surgeon and mother of
four
– two years ago was in a car accident, suffered
a spinal cord injury and became a paraplegic
– Unable to breathe and ventilator-dependent
• Did not speak at all until a year after her
surgery, SLP has been working with her to
increase her speech output and set up a
voice-activated computer
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.5
Case Study #1 Questions
• What community activities might be
possible for Dr. Mitchell now that she uses
her voice?
• How might Dr. Mitchell be involved with
her profession in the future as a
quadriplegic?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.6
Case Study #2: Anton
• 68-year old veteran diagnosed with
laryngeal cancer six years ago
• Had his larynx removed two years ago,
tried unsuccessfully to learn esophageal
speech, now uses an artificial larynx
• Is interested in helping other
laryngectomees
• Is interested in possibility of a laryngeal
transplant
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.7
Case Study #2 Questions
• Given that Anton already has a way to
produce speech via the artificial larynx,
why would he desire a laryngeal
transplant?
• Anton’s hobby after his laryngectomy was
to counsel other laryngectomees. In what
ways might Anton’s counseling be superior
to that of a clinical professional, like a
psychologist?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.8
Case Study #3: Ms. Chin
• 42-year old television personality (coanchor of news show)
• Experiencing intermittent problems with
her voice in which it seems to start and
stop and feels strangled
• Went to otolaryngologist, who gave her a
preliminary diagnosis of spasmodic
dysphonia
• Ms. Chin’s producer suggested she take
disability leave until her voice is resolved
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.9
Case Study #3 Questions
• Do you agree with Ms. Chin’s producer
that she should be “off the air” until her
voice problems are resolved?
• Ms. Chin has an appointment soon with an
SLP who may not be skilled in treating
spasmodic dysphonia. How important is it
to see a clinician who has worked with this
condition before?
• What other professionals should be
involved with Ms. Chin’s voice treatment?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.10
I. What is Voice?
• Vocal fold vibration that provides sound source
for spoken language
• Phonation: humans set their vocal folds into a
vibratory pattern (say “oooo”)
– Vocal folds are adducted (closed), air is exhaled
upwards and blows apart the vocal folds setting
them into a rapid vibratory pattern
• Voice is further modified by the processes of
resonation and articulation
• Three vocal characteristics: frequency,
intensity, and phonatory quality
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.11
Frequency
• Rate of vocal fold vibration (pitch)
• Fundamental frequency (F0) – basic
vibratory rate of the vocal folds (in Hertz)
– Kindergarten girls and boys = 250 Hz
– Adult women = 180 – 220 Hz
– Adult men = 120 – 140 Hz
• F0 relates to three characteristics:
– Vocal fold length, mass, and tension
• Fundamental frequency changes as we
age, especially between birth and puberty
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.12
Intensity
• Sound pressure reported in decibels
(loudness)
• Relates to two features of vocal production:
– Amount of airflow from the lungs
– Amount of resistance to the airflow by the vocal
folds (which contributes to their excursion, or
how far apart the vocal folds move and come
back together)
• Every person has a baseline intensity level
that characterizes his/her conversational
speech
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.13
Phonatory Quality
• How well the two vocal folds work together
during the vibratory cycle
– If vocal folds work symmetrically and
harmoniously, voice is pleasant and clear
– If compromised in some way (e.g., growth on
one of the folds), phonatory quality is affected
• Also influenced by the resonation of the
voice into the oral and nasal cavities (e.g.,
nasal voice quality)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.14
What is a Voice Disorder?
• Pitch, loudness, or phonatory quality
differs significantly from persons of a
similar age, gender, cultural background,
and racial and/or ethnic group, and
• Vocal quality detracts from the ability to
function and achieve in society
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.15
Describing Voice Quality
• Dysphonia: umbrella term for a voice that
is disordered in some way
• Aphonia: total loss or lack of voice
• Many other, mostly subjective terms…
– Pitch and frequency: jitter or diplophonic
– Loudness and intensity: pressed or strident
– Resonance: nasal or ringing
– Phonatory quality: flutter or creak
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.16
Describing Vocal Fold Functioning
• Hypofunction: vocal folds are underfunctioning and have inadequate tension,
so air escapes through
– Breathiness or hoarseness, or no voice at all
• Hyperfunction: vocal folds are overly tense
and compress too tightly together
– Too loud, too high, and/or too strained
– Sometimes spasticity of the voice
• Diplophonia: vocal folds produce two
different pitches simultaneously
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.17
Voice without a Larynx
• Laryngectomy: surgically removing the
larynx
• Two primary reasons:
– laryngeal cancer: removed to stop spreading
– laryngeal trauma: removed if too damaged to
protect respiratory system or impede
breathing
• Alaryngeal communication: an alternative
way to produce speech
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.18
Prevalence and Incidence:
Voice Disorders in Adults
• Prevalence = 29%, Incidence = 6%
• Higher prevalence for women, peak ages of 4060 years
• Higher prevalence among people with frequent
allergies, asthma, colds, and sinus infections
• Higher prevalence among professions reliant on
voice
• Common causes: vocal nodules,
edema/swelling, polyps, carcinoma, and vocal
fold paralysis
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.19
Prevalence and Incidence:
Voice Disorders in Children
• 25% of children exhibit significant vocal
problems, with 40% of these cases
ongoing, not transient, problems
• For some it is a congenital problem, but
most cases result from overuse or misuse
of voice
• Most common cause: vocal nodules that
impede smooth meeting of folds, resulting
in breathy or hoarse voice
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.20
Prevalence and Treatment
• Rate of voice disorders for both children
and adults is relatively high, but many
cases go undiagnosed and/or untreated
• Several reasons for this:
– Treatment access: e.g., disorder not
considered to impact educational
performance in school
– Knowledge: e.g., person may believe that
voice problem will disappear spontaneously
– Social perception: e.g., the disordered voice
(e.g., a breathy, hoarse voice) brings positive
social attention
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
11.21
II. How are Voice Disorders
Classified?
• Voice disorders are grouped based on
their cause, an etiological classification
• Four different categories:
A. Vocal abuse
B. Neurogenic disorders
C. Psychogenic disorders
D. Alaryngeal communication
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.22
A. Vocal Abuse
• Chronic or intermittent overuse or misuse
of the vocal apparatus
• Vocally abusive behaviors:
– Talking in noisy environments
– Frequent coughing or clearing of the throat
– Using caffeine products
– Yelling, screaming, and cheering
– Giving speeches or lectures
– Spending time in smoky environments
• Two common conditions: vocal nodules
and contact ulcers and granuloma
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.23
Vocal Nodules
• Small bilateral protuberances or calloused
growths on the inner edge of the vocal
folds
• Acute nodules are similar to bruises on the
vocal folds, but these can harden and
thicken over time, which becomes a
chronic condition
• Most prevalent in children and adults who
engage in vocal misuse and abuse
• Additional factors: temperament and
general health
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.24
Contact Ulcers and Granuloma
• Contact ulcers: inflamed lesions that
develop on the cartilage in the larynx
• Granuloma: a mass of tissue generated by
the body’s healing process at the site of
the contact ulcer
• Mostly results from vocal abuse, but also
from acidic irritation due to chronic reflux
or tubal intubation (during surgery)
• Low, breathy voice quality
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.25
B. Neurogenic Disorders
• Result from illness, damage, or disease to
the neurological systems associated with
voice production
• One of the most important nerves: vagus
nerve in peripheral nervous system
– runs from cranium down around the heart, but
has several branches that innervate the
pharynx and larynx
• Pharyngeal nerve
• Superior laryngeal nerve
• Recurrent laryngeal nerve
• If any of these nerves are disrupted, a
voice disorder may result
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.26
Vagus Nerve Lesions
• Can occur due to surgical damage, trauma,
and viral infections
• Most serious outcome: vocal fold paralysis
• Mostly unilateral paralysis:
– Abduction paralysis: one of the vocal folds cannot
open, voice is not usually affected, but breathing
may be difficult
– Adduction paralysis: one of the vocal folds cannot
close, so they cannot meet together, causing
hoarse or breathy voice quality
• Complete paralysis: both vocal folds
paralyzed, completely blocking airway –
tracheostomy is necessary
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.27
Spasmodic Dysphonia
• Affects motor control of larynx, results in
intermittent voice stoppages
• Jerky, grunting, squeezed, groaning, and
stuttering-like voice quality
• Ranges from mild to severe
• Adductor type: most common, voice is
strangled, strained, and squeezing
• Abductor type: less common, voice is
breathy and open
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.28
Amyotrophic Lateral Sclerosis
• Also called Lou Gehrig’s Disease –
progressive, degenerative, neuromuscular
disease
• Cause is unknown, impact is significant, and
most survive less than 10 year after
diagnosis
• Voice is soft, breathy, low in pitch and
loudness, limited variability, and hypernasal
• Difficulty clearly articulating speech sounds
because cannot strongly coordinate motor
processes
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.29
Parkinson’s Disease
• Progressive, degenerative neurological
disease caused by depletion of dopamine
• Unable to produce a strong voice because
of a weakened respiratory system
• Rigid muscular tone restricting movements
of larynx; produces hoarseness and a
monotonic pitch
• Lee Silverman Voice Treatment program –
effective for improving voices of persons
with Parkinson’s
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.30
C. Psychogenic Disorders
• Nonorganic disorders, resulting from
emotional or psychological characteristics
• Our voices carry messages about our
emotional or psychological state
• The voices of individuals who experience
significant personality or psychological
health disorders may be negatively
impacted
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.31
Psychological or Emotional
Triggers
• After someone recovers from a vocal
injury because of overuse or misuse of the
voice, may experience a sense of
vulnerability and anxiety about using voice
• Other traumatic experiences, like cancer,
being robbed or raped, and having surgery
of the throat, can have the same effect
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.32
Psychopathology
1. Stress, Anxiety, and Depression
• Acute stress disorder: within one month of
having a traumatic experience,
exaggerated startle responses, motor
restlessness; can be reflected in the voice
• Generalized anxiety and anxiety disorder:
muscle tension, trembling, twitching; may
lead to vocal tremors and voice breakages
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.33
2. Conversion Disorder
• Physical symptoms or deficits result from
severe anxiety or stress
• Can result in a loss or disordered voice as
one variety of conversion disorder
3. Vocal tics and Tourette’s Disorder
• Vocal tics produce sudden, rapid,
recurrent vocalizations
• Tourette’s: vocal tics occuring
simultaneously with other motor tics
affecting the head, torso, and extremities
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.34
Mutational Falsetto and
Juvenile Voice
• Vocal characteristics are not consistent
with age and gender
• Mutational falsetto: male child or
adolescent exhibits inappropriately high
voice
– Voice therapy and medical treatment are
effective
• Juvenile voice: female companion to
mutational falsetto, women maintain a
child-like voice into adulthood
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.35
D. Alaryngeal Communication
• Producing voice without a larynx
• Two most common reasons:
– Larynx is not available because of a
tracheostomy
– Larynx has been completely removed in a
larnygectomy
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.36
Trachestomy
• When respiratory system is compromised,
mechanical ventilation and respiration is
needed
– tracheostomy tube is inserted through the
neck to direct air into the lungs
• Unable to talk because air is not going
over vocal folds
• Passy-Muir Tracheostomy Speaking
Valve: allows adults and children to speak
even while ventilated
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.37
Laryngectomy
• Etiology: Laryngeal cancer is linked to tobacco
and alcohol use, nutritional inadequacies and
occupational exposures; affects African-American
older males at the highest rates
• Symptoms: most consistent symptom is
hoarseness
– Any person exhibiting hoarseness should seek medical
attention if persists for more than two weeks
• Treatment: Rid the body of the malignancy
– most oncologists use conservation approaches, and
prefer to only remove part of the larynx if possible
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.38
III. Defining Characteristics of
Voice Disorders
• Voice disorders impact one or more of the
following perceptual characteristics of
voice:
A. Resonance
B. Loudness and pitch
C. Phonatory quality
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.39
A. Resonance
• Velopharyngeal port controls the extent to
which exhaled air enters the nasal and
oral cavities
• The port typically rests in an open position,
but when we speak, it is almost always
closed (airflow channeled into the oral
cavity)
• Voice disorders of resonance result from
problems with control of port, called
velopharyngeal inadequacy
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.40
Velopharyngeal Inadequacy
• Common causes:
– Cleft palate and cranio-facial abnormalities
– Iatrogenic (problems resulting from surgery)
– Allergies
– Neuromuscular impairment
• Results in either:
– Hypernasality: port remains open to allow too
much resonance and nasal emissions during
speech
– Hyponasality: too little nasal resonance, voice
may sound stuffy and congested
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.41
B. Pitch and Loudness
• Pitch: frequency
• Loudness: intensity
• Too much or too little tension in voice
production can cause abnormal pitch or
loudness
• Of pitch and loudness, pitch changes are
more common symptoms of voice
disorders
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.42
Pitch
• Important concepts:
– Habitual pitch: pitch one uses normally
– Optimal pitch: best pitch voice can produce
– Basal pitch: lowest pitch one can produce
– Ceiling pitch: highest pitch one can produce
– Vocal range: difference between basal and
ceiling
• Disordered pitch:
– Habitual pitch differs significantly from optimal
– Extremely limited vocal range
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.43
Loudness
• Over-loudness: air pressure builds up
under vocal folds and produces wide
excursion of folds
• Under-loudness: lack of respiratory force
because of…
– Neurological injury and disease
– Social or psychogenic factors
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.44
C. Phonatory Quality
• When vocal folds do not work
harmoniously, impairment in general
quality of the voice
• Common types of impaired phonation:
– Hard glottal attack
– Glottal fry
– Breathy phonation
– Spasticity
– Hoarseness
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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11.45
IV. How are Voice Disorders
Identified?
A. The Voice Care Team
• Close collaboration of a variety of
professionals
• Medical professionals: primary care
physician (PCP), otolayrngologist
• Allied health professionals: speechlanguage pathologist, psychologist or
psychiatrist
• Possibly educators or voice coaches also
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.46
B. The Assessment Process
• Identification of warning signs
• Assessment Protocol:
– Case history and interview
– Oral-motor examination
– Clinical voice observation
– Instrumental voice observation
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.47
Warning Signs for Voice Disorders
• Children and adolescents:
– Vocally abusive behaviors
– Underlying medical condition
– Psychological well-being
• Adults:
– Change in phonatory quality for more than two
weeks, consult physician
• Referrals: PCP will likely make at least two
referrals:
– Otolaryngologist
– Speech-language pathologist
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.48
Assessment Protocol
• Speech-language pathologist’s goals:
– Characterize the general features of the voice
– Establish if any of these features differ from
the norm
– If disorder is present:
• Identify cause
• Identify intervention approach that will be the most
beneficial to improving the voice
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.49
Case History and Interview
• Interview with the client to learn more
about:
– Medical history
– Chronological history of problem
– Symptoms and possible etiology of problem
– Way in which client uses voice for daily living
activities
– Client’s motivation for seeking help
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.50
Oral-Motor Examination
• Identify conditions of structures involved
with producing voice
• Study amount of tension and sensation
involved in speech and voicing
• Examine possible swallowing problems
• Study the appearance and functioning of
the velum
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.51
Clinical Observation
• Perceptual observation of characteristics
of voice during a variety of speaking and
vocal activities
• Example activities: counting from 1 to 40
softly then loudly, sustaining a vowel
sound for as long as possible, engaging in
normal conversation
• Also studies systems that support vocal
production, like respiration
• Relies heavily on the listener, so need to
be properly trained and experienced
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Communication Sciences and Disorders: An Introduction
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11.52
Instrumental Observation
• Objective measures of vocal functioning:
– Acoustic assessment: measures frequency,
intensity, and resonance characteristics
– Aerodynamic assessment: measures airflow,
air pressure, and vocal fold resistance
– Electroglottography: measures vocal fold
contact during voicing
– Videostroboscopy: examines laryngeal
system and measures vocal fold movement
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.53
V. How are Voice Disorders
Treated?
• Elimination of the cause of the disorder (e.g.,
vocally abusive behavior)
• Compensation for a disorder (cause cannot
be eliminated)
• Three possible goals:
– Teach a vocal behavior that is absent
– Substitute vocal behavior for inappropriate one
– Strengthen vocal behaviors that are weak or
inconsistent
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.54
A. Treatment for Vocal Abuse
Several options:
•
•
•
•
Surgery (e.g., removal of vocal nodules)
Vocal hygiene programs
Voice therapies
Computer programs
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.55
B. Treatment for Neurogenic
Disorders
• Combination of medical interventions and
voice therapies
• Medical interventions:
– Phonosurgery: improvement, alteration, or
restoration of the voice (e.g., thyroplasty)
– Injections into the vocal folds (e.g., Teflon,
botox)
• Voice therapies:
– e.g., Lee Silverman Voice Treatment program
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Communication Sciences and Disorders: An Introduction
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11.56
C. Treatment of Psychogenic
Disorders
• Multidisciplinary approach including
speech-language pathologist and mental
health professionals
• Goal: determine emotional or psychosocial
cause of voice disturbance
• Therapy usually focus on reducing
tension, counseling, and eliminating any
voice abuses or misuses
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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11.57
D. Treatment of Alaryngeal
Communication
• Communication counseling: explore all
alternative options for producing voice
– Artificial larynx: vibrating power source placed
against the neck, often mechanical sounding
voice
– Esophageal speech: learn to trap air in the
esophagus and then use that for voice, often
very difficult for most people
– Tracheoesophageal speech: surgical puncture
between the trachea and esophagus provides
an air source for speaking
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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