Voice Disorders Flashcards
Frequency
- An acoustic phenomena
- The vibration of the folds is directly related to the frequency and quality of the sound of the person’s voice
- The number of times per second that the vocal folds vibrate a cycle is the frequency of vibration (not completely consistent) (mucosal wave)
- The average frequency on which a person speaks is the *fundamental frequency *
Pitch
- Perceptual phenomena (cannot be measured physically)
- The avg. adult male’s fundamental frequency is ~130 HZ, the avg. adult female’s fundamental is ~230 Hz
- in geriatric populations, male’s tend to rise slightly and female’s drop slightly
- Theoretically, the vocal folds should vibrate relatively the same from period to period; but, their periodicity (cycle to cycle) is not perfect
- These periodic changes in vocal fold vibrations are called frequency perturbation or jitter (never 0)
Amplitude
- Intensity is an acoustic phenomena,
- Loudness is a perceptual phenomena
- Amplitude (amount of displacement is the vocal folds when they vibrate)
- There are small amplitude changes (frequency pertubation and amplitude perturbation) from cycle to cycle; periodicity is not perfect
- Higher perturbation would correlate to poorer quality;
- Lower perturbation should correlate to better quality
- Cycle to cycle changes will result in increased perturbation scores and changes in quality
- Changed pitch related to a more consistent change in the vocal folds
- The avg. person is able to vary his/her pitch by about two octaves (16 whole notes)
How are voice disorders classified?
- Etiologic
- Kinesiologic
- Perceptual
Etiologic Voice Disorders
- Medical model
- Deals w/ the causes of the disorder, typically discussed relative to organic or nonorganic
- Structural issue = organic problem
- Functional = nonorganic
Kinesiologic
- Has to do with movement of the vocal folds; how they vibrate
- Usually described as either hypofunctional or hyperfunctional
- Medially compression (not enough – breathy; too much – harsh)
Perceptual
- Based on what you hear:
- Quality
- Resonance
- Loudness
- Pitch
Perceptual Qualities of Pitch in Voice Disorders
- Monopitch
- Inappropriate pitch
- Pitch breaks
- Reduced pitch range
Monopitch
Lacks variation during speech or other vocal activities; may relate to an organic/nonorganic problem
Inappropriate Pitch
Relative to age and gender, exceeding the range considered appropriate – either too high or too low
Pitch Breaks
Unexpected and sudden shifts in pitch, upward/downward; common in puberty but can also be observed with organic/neurological etiologies
Reduced Pitch Range
We tend to be able to vocalize about 2 octaves; usually it’s the upper range that is reduced
Perceptual Qualities of Loudness in Voice Disorders
- Monoloudness
- Loudness variation
- Reduced loudness range
Monoloudness
A reduction in the ability to vary the vocal loudness; unrelated to how loudness level of the voice
Loudness Variation
Opposite of monoloudness; either too loud or too soft, it be related to hearing impairment, personality/habit, neurologic, or respiratory problems
Reduced Loudness Range
In a single patient, this is often observed along with reduced pitch range
Perceptual Qualities of Quality in Voice Disorders
- Breathy
- Rough
- Hoarse
- Harsh
- Tremor
- Strain/struggle
- Diplophonia
- Glottal fry
- Wet
- Stidor
- Throat clearing
- Cough
Breathy
Air escaping through the glottis during phonation because of inadequate glottal closure; because of this the voice is often somewhat weak; a severe form of breathiness is called aphonia (no voicing)
- Consistent (aphonia)
- Episodic (aphonia)
Rough
A lack of periodicity in the voice (without accompanying breathiness); there is a perceived irregularity in the voice
Hoarse
- Most common characteristic of voice problems.
- There is aperiodic vibration of the folds along with leakage of the air through the glottis.
- Some would characterize it as a cross between breathiness and roughness.
- Related to perturbation with considerable noise in the spectrum
Harsh
- The opposite of breathy
- Related to “roughness” with aperiodicity in the voice.
- The folds are too tightly adducted, often described as tense.
- Could see hard glottal attacks and tension in the head and neck.
Tremor
- A regular, rhythmic variation and pitch and loudness that are not under voluntary control
- Perceived as unsteady or quivering. Usually relates to CNS damage
Stain/Struggle
Usually seen as difficulty in initiating or maintaining phonation; minimal periods of aphonia or voice stoppages may be observed
Diplophonia
- Means “double voice.”
- There are two distinct fundamental frequencies heard at the same time; this may be observed in either the true or false vocal folds (or both)
Glottal Fry
- Extremely low pitched phonation, has a rough vocal quality, except this is periodic.
- May be observed normally when a person dips into the pulse register usually at the end of an utterance and often when the person is speaking near the bottom of their pitch range.
- Not considered abnormal, unless the person typically speaks within the pulse register
- People who consistently utilize it may also increase glottal tension to accomplish communicative needs.
Wet
A liquid sounding voice quality, often accompanied with a hoarse quality; certainly may be observed in a patient who is silently aspirating or has drainage issues
Stridor
A term that refers to noisy breathing that can accompany inspiration, expiration, or both; it is indicative of a narrowing of the airway; may be structural, neurologic, or psychologic in etiology
Throat Clearing
May relate to clearing mucous from the folds or a feeling of “something in the throat” (globus sensation); it is less damaging to the folds than coughing but with similar physiology
Cough
Triggered by reflexes below the level of the folds; concern would relate to the etiology and frequency of the cough; can be damaging
Causes of Organic Voice Disorders
- Changes in the mass/tension of the vocal folds due to physical changes in the folds, and
- Changes in the neurologic innervation to the vocal folds.
- Some structural changes to the folds are such because of vocal abuse or misuse issues; in this sense, the etiology is clearly behavioral but has created a structural or organic disorder
Changes in Mass/Tension
- Laryngeal Web
- Palpilloma
- Keratosis/Leukoplakia
- Cysts
- Nodules
- Polyps
Laryngeal Web
- Congenital, a web of tissue covers part or all of the glottis (or at some other location within the larynx)
- Congenital webbing is caused by failure of the glottis to separate in the embryo
- Acquired webs can occur due to trauma. Inhalatory stridor is likely
Papilloma
- The most common laryngeal tumor in childhood, may also be seen in adults.
- Lesions are benign and effect the epithelium,thought to be caused by a virus.
- Due to proliferation, surgical excision is typical, however, they can reoccur
- You would likely observe aperiodic vf vibration and accompanying perceptual problems related, observe stridor, if the lesions are large enough
Keratosis/Leukoplakia
- A thickening of the epithelial lining (can be seen wherever there is epithelium).
- Benign but can be pre-cancerous.
- Smoking, pollutants, and other factors are often thought to be causes, getting rid of the irritant is the best treatment.
Cysts
- A sac of tissue containing a liquid or semi-solid substance on the superficial layer of the Lamina Propria, etiology is unknown.
- Cysts tend to produce a stiffer and more asymmetrical vibratory pattern compared to nodules and polyps.
- Vocally, the patient will present with hoarseness
Nodules
- Most common vocal fold lesion in adults and children.
- Small, densely packed collection of cells, often bilateral, commonly found along the free margin of the fold at the midpoint of the foldthey are caused by vocal abuse/misuse
- Begin as edema, becoming fibrous: the submucosal edema loosens the mucosa from the vocal ligament, and the nodule appears within the superficial layer of the LP.
- Become more fibrous and firm, compared to polyps, if the edema doesn’t become fibrous, it may degenerate into a polyp
- Voice will be likely hoarse and breathy. A reduced pitch range is seen with many speakers/singers
