Transcript CD 508_VoiceDisorders

CD 508
VOICE & VOICE DISORDERS
Chapter 3
Voice Disorders
Functional vs. Organic
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Functional - caused by faulty use of
the vocal mechanism
• Misuse may lead to organic change
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Organic - related to some physical
abnormality in structure at various sites
on the vocal tract
• Change in structure of vocal mechanism
• Neurological
Etiologies
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FUNCTIONAL
Falsetto
Phonation breaks
Pitch breaks
--> Organic
Nodules
Polyps
Traumatic laryngitis
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NEUROLOGICAL
Essential tremor
Spastic dysphonia
Vocal fold paralysis
ORGANIC
Contact ulcer
Leukoplakia
Webbing
Falsetto
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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
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--> 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
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e.g. via digital manipulation, glottal fry, massage, etc.
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Functional Aphonia
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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
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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
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Functional Dysphonia - 2
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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
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Voice adversely affected by excess
muscle tension
May cause
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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.
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Diplophonia
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Means ‘double voice’
Produced with two distinct sound
sources, voicing simultaneously
• Each vocal fold vibrating at different rate
• Laryngeal web
• Ventricular fold vibration, etc
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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
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• Eliminate sources of misuse/abuse
• Surgical removal - note: problem will recurr if
source not eliminated
Reinke’s Edema
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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
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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
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Often precipitated by a single event
Tx:
• Microflap surgery
• Vocal hygiene therapy
Vocal Nodules
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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
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--> open chink --> breathiness
--> increased effort to approximate
folds --> hoarseness
Quality deteriorates with use
Tx: vocal hygiene
Phonation Breaks: Abductor
Spasms
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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
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Caused by
• Pubertal growth of larynx
• Prolonged vocal hyperfunction
• Fatigue
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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
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• Excessive slamming
of arytenoids
together
• Frequent throatclearing/coughing
• Gastric reflux
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Symptoms
• Vocal fatigue
• Pain in larynx (or
lateralized to one
ear)
• Hoarseness
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Tx:
• Vocal hygiene
• Reflux precautions
• Medications
CD Audio Files
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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)
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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
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