CD 508

1. CD 508 VOICE & VOICE DISORDERS

2. Chapter 3 Voice Disorders

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. Reinke’s Space - see superficial layer

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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