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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

CD 508

VOICE & VOICE DISORDERS

chapter 3

Chapter 3

Voice Disorders

functional vs organic
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
etiologies
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
falsetto
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
falsetto 2
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.
functional aphonia
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
functional aphonia 2
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
functional dysphonia
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
functional dysphonia 2
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
muscle tension dysphonia
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
why do we need voice therapy if the problem is organic
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.
diplophonia
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
vocal fold thickening
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
reinke s edema
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
vocal polyps
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
vocal nodules
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
phonation breaks abductor spasms
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
pitch breaks
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
contact ulcers
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
cd audio files
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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