Voice aetiology, signs and symptoms Flashcards
Who are particularly at risk of voice disorders? (4)
- Teachers: excessive use, loud speech, talking over background noise, often frequent but short-lived issues
- Singers: excessive use, loud speech,
- Children: excessive use, loud speech, yelling, harsh ‘sound effects’
- Elderly: associated with ageing, medications, most commonly laryngitis, nonspecific dysphonia and benign VF lesions
‘Prolonged vocal use’ ‘Increased vocal load’
Why is there a higher rate of voice disorders in females than males? (3)
- Shorter vocal folds and produce a higher f0
- Less tissue mass to dampen vibratory force
- Less hyaluronic acid in SLLP, role in wound repair
Conditions associated with increased incidence of voice disorders (6)
- Sinus infections
- Oesophageal reflux
- Recurrent upper respiratory infections
- Asthma
- Respiratory allergies
- Multiple chemical exposures
Attitudes towards people with voice disorders
- Considered rigid, dishonest, passive
- Children with voice disorders could be disadvantaged in oral assessments
- Deviant voice could lead to listener’s false estimations of a child’s non-speech characteristics
When do we treat voice disorders?
- Just because we perceive an impairment doesn’t mean anything needs to be done
- Weight up signs (observable) vs symptoms (complaints)
Primary symptoms of voice problems (9)
- Roughness
- Vocal fatigue
- Breathy voice
- Reduced phonatory range
- Aphonia
- Pitch breaks/inappropriately high pitch
- Strained/strangled
- Tremor
- Pain/other sensations
Voice roughness (2)
Complaint:
- Raspy
- Hoarse
Vocal fatigue (4)
Complaint:
- Tired after prolong vocalisation
- Continuing to talk is effortful
- Occasional hoarseness
- Worse at end of day
Breathiness (2)
Complaint:
- May be unable to say complete sentences without running out of air
- Difficulty being heard over noise
Reduced phonation range (3)
Complaint:
- Difficulty reaching higher pitches
- May experience tiredness or sore throat
- Usually associated with singers
Aphonia (3)
Complaint:
- Absence of voice
- Speakers in a whisper
- Variety of symptoms including dry throat, soreness, effortful
Pitch breaks/inappropriately high pitch (2)
Complaint:
- Periodic squeakiness or cracks in voice
- Often in male adolescents
Strained/strangled voice (5)
- Difficulty phonating, inc inability to start or maintain
- Tension/effort apparent
- Can be easily fatigued
- Hyperfunction of neck muscles
- Entire larynx may compress
Tremor (3)
- Wobbly or shaky
- Unable to voluntarily produce sustained vowel
- Usually regular vibration
Pain/other sensations (5)
- Pain with voice production
- Pain in neck
- Lump in throat
- Tension
- Dryness
Perceptual signs of voice (5)
- Pitch
- Loudness
- Quality/clarity
- Other behaviours
- Aphonia
Features of voice pitch (4)
Perceptual correlate of f0
- Monopitch
- Inappropriately high/low pitch
- Pitch breaks
- Reduced pitch range
Features of voice loudness (3)
Perceptual correlate of intensity
- Monoloudness
- Excessive loudness variation
- Reduced loudness range
Features of voice quality (7)
- Rough: noisiness, lack clarity, often with breathiness/strain/tension
- Breathiness: audible air escaping, lacks clarity, inadequate glottal closure
- Strain: tension/effort, difficulty initiating/maintaining, increased muscle constriction
- Tension: hard edge, muscle tension, can be combined with hard glottal attacks, often related to hyperfunctional use or compensatory behaviours
- Tremor: rhythmic variations in pitch/loud, wobbly, typical in CNS dysfunction
- Sudden interruption to voicing: unexpected changed quality/loud, sudden involuntary abduction or delayed abduction, usually neurological origin
- Diplophonia: double voice, each VF functioning under diff levels of tension/mass, each vibrates at diff frequency
Features of stridor
- Noisy breathing, in or out
- Potential blockage of airway
Features of excessive throat clearing
- Often accompanies voice disorder
- Natural behaviour but considered a perceptual sign of voice disorder when consistent
- May be attempt to clear mucus or something from throat
Features of aphonia - consistent and inconsistent
Consistent aphonia:
- Usually perceived as whispering
- Can result from bilateral VF paralysis
- May be psychogenic
Inconsistent aphonia:
- Can be unpredictable involuntary breaks (secs long)
- Or can last longer periods (mins/hrs/days)
- Or gradual fading
- May be psychogenic or CNS based
Common aetiologies of voice disorders (6)
- Phonotrauma
- Psychological stress
- Laryngeal surgery
- Other non-laryngeal surgery
- Drug side effects
- Acute and chronic illness
What is phonotrauma?
- Coughing and throat clearing: vigorous adduction causing irritation/damage, associated with respiratory diseases/medication side effects
- Prolonged voice use (increased vocal load)
How phonotrauma affects voice
- Coughing and throat clearing: vigorous adduction causing irritation/damage, associated with respiratory diseases/medication side effects
- Prolonged voice use (increased vocal load)
- Shouting/screaming
- Loud talking
- Vocal noises, eg. growling
Laryngeal surgeries affecting voice
Direct
- Laryngectomy (total, hemi, supraglottic)
- Glossectomy
- Mandibulectomy
Indirect
- Thyroid
- Cardiac
- Carotid arteries
- Lung
Intubation
- Trauma to mucosa of VF
- Constant pressure on VF can cause necrosis
- Nerve damage can lead to paralysis
- Arytenoid tissue scarring
Acute and chronic illnesses affecting voice
- Sinusitis
- Respiratory illness
- Medications
- GI disorder
- Endocrine disorder
- Cardiac disease
- Arthritis
Medications affecting voice
- Eg. antihistamines: reduced laryngeal secretions, mucosal drying
- Eg. bronchial inhalers: irritant
