Voice Disorders

Question 1

Support for voice production

Answer 1

Support for voice production
* Balance between respiration (inhalation and exhalation) and phonation.
* Respiratory system (trachea, lungs, diaphragm, ribs, intercoastal muscles, pectoralis
major, rectus abdominis muscles)

• Larynx:
  – Valve to protect the airway and lungs.
  – Vocal folds open to allow breathing
  – Close during swallowing to prevent food from entering lungs
• Phonation:
  – Larynx, on top of trachea;
• cricoid cartilage, thyroid cartilage, 2 arytenoid cartilages, epiglottis
  – Vocal folds

Question 2

Phonation

Answer 2

Phonation
* Production of voice
– Lungs blow air against vocal folds in the nearly-closed position
– Air pushes through the very small space between them and makes the
covering of the vocal folds vibrate (mucosa)
– Repeating undulation (mucosal wave)
– Regularity of the mucosal wave is essential to the production of good voice.
* Normal voice production [Sean Parker Institute for the Voice]
* Normal pitch glide [Sean Parker Institute for the Voice]

Question 3

Parameters

Answer 3

Parameters
* Maximum Phonation Time
– Length of time a person can sustain a tone or sound on one expiration
– Varies based on gender, age, physical characteristics, health

• Pitch
  – Perceptual correlate of Frequency [# of cycles of opening and closing the vocal folds /sec]
  – Frequency measured in Hertz (Hz)
• Loudness
  – Perceptual correlate of intensity of a sound
  – Intensity measured in decibels (dB)
• Voice quality
  – Subjective judgement

Question 4

Voice disorders

Answer 4

Voice disorders
* Deviation of loudness, pitch, or quality out of the range of a
person’s age, gender, or geographical background (ASHA)
* Classification:
– Functional [inefficient use of the voice when the physical structure is
normal, such as vocal fatigue and vocal tension]
– Organic [result of structural or neurologic damage]
– Psychogenic [manifest after emotional stress or trauma]

Question 5

Some characteristics of voice disorders

Answer 5

Some characteristics of voice disorders
* Breathy vocal quality
* Change in pitch or pitch range
* Chronic cough or excessive throat clearing
* Difficulty with breathing during speech
* Discomfort or pain with voice use
* Hoarse voice
* Inability to speak loudly or abnormal loudness
* Loss of voice
* Tremulous voice
* Vocal strain or tension

Question 6

Laryngitis

Answer 6

Laryngitis
* CHARACTERISTICS
– Inflammation of vocal folds
– Lowered pitch and phonation breaks
– Hoarseness
– Chronic: more than 10 days
– Teachers, attorneys, clergymen, school children
* TREATMENT
– Medications : anti-acid, anti-inflammatory …
– Vocal hygiene

Question 7

What is vocal hygiene?

Answer 7

What is vocal hygiene?
* Nourishing, hydrating and protecting vocal tract
– Avoid yelling and screaming
– Avoid smoking
– Healthy diet
– Limiting caffeine, sugar replacements and acid intake
– Control coughing and throat clearing
– Hydration program

Question 8

Parkinson’s Disease

Answer 8

Parkinson’s Disease
* CHARACTERISTICS
– Lower volume, lower energy, and rapid rate of speech in persons with Parkinson’s disease
* TREATMENT
– Lee Silverman Voice Treatment Method (Dromey et al., 1995; Fox et al., 2006)
– Patients learn to “recalibrate” their perceptions so they know how loud or soft they sound
to other people and can feel comfortable using a stronger voice at a normal loudness level
– LSVT LOUD Insights From Bob

Question 9

Polyps and Nodules

Answer 9

Polyps and Nodules
* CHARACTERISTICS
– Hoarseness, breathiness, “rough” voice, “scratchy” voice, harsh-
sounding voice
– shooting pain from ear to ear
– feeling of “lump in your throat”
– neck pain
– less ability to change pitch
– voice and body tiredness

Question 10

Polyps and Nodules
* INTERVENTION

Answer 10

Polyps and Nodules
* INTERVENTION
– Voice therapy
* Vocal hygiene
* Behavioral voice intervention: vocal exercises, speaker awareness
and proper postures and alignment when using the voice.
– Microsurgery
– Medical management of cough, reflux, allergies

Question 11

Functional Aphonia

Answer 11

Functional Aphonia
* CHARACTERISTICS
– Whispered voice
– Most causes are psychological
– Links with anxiety and need to maintain self-assertion
* TREATMENT
– Counseling about psycho-social trigger
– Achieve “light-bulb “moment

Question 12

Transgender voice therapy

Answer 12

Transgender voice therapy
* Pitch [most important factor in gender identification]
– Average female pitch : 225Hz
– Average male pitch : 125Hz
– Gender neutral pitch: 155-185Hz
* Intonation or variability in pitch
* Intensity (loudness)
* Hormonal and surgical interventions