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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

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Cd 508 l.jpg

CD 508

VOICE & VOICE DISORDERS


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Chapter 3

Voice Disorders


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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


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FUNCTIONAL

Falsetto

Phonation breaks

Pitch breaks

--> Organic

Nodules

Polyps

Traumatic laryngitis

NEUROLOGICAL

Essential tremor

Spastic dysphonia

Vocal fold paralysis

ORGANIC

Contact ulcer

Leukoplakia

Webbing

Etiologies


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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


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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.


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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


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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


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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

  • 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


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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


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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

  • 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


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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


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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


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Reinke’s Space - see superficial layer


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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


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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


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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


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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


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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

Contact Ulcers


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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


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