SPAUD Chapter 6: Voice Disorders

what are the primary causes of voice disorders

abuse/misuse - screaming, excessive use, untrained singing

medical - cancer, nervous system damage

psychogenic - emotional stress, unresolved psychological issues

vocal problems

edema - swelling of the vocal folds

atrophy - reduction of tissue

hyper function - increased muscle activity

hypo function - decreased muscle activity

vocal qualities

aphonia - loss of voice

harsh voice - excessive muscle tension

breathy voice - particle whisper (glottal)

hoarse - bth breathy and harsh (vibrating in an irregular way)

psychogenic voice disorders 

conversion aphonia/dysphonia

puberphonia - mutational falsetto 

muscle tension dysphonia 

conversion aphonia/dysphonia

psychogenic problem

normal phonation in vegetative settings (couch and throat clearing)

Puberphonia - mutational falsetto

high pitch voice by post pubertal male

easily corrected (learned behavior)

muscle tension dysphonia

simultaneous contractions of adductors and abductors 

caused by stress

type a personality 

weak and hoarse voice 

Medical Voice Disorders

paralysis, spasmodic dysphonia

Paralysis

recurrent laryngeal nerve of the vagus damage

unilateral paralysis

move the affect fold closer to midline

spasmodic dysphonia

rare - 1-2 people per 10,000

basal ganglia is affected 

adductor - strangle voice quality (come together uncontrollably)

Botox injections at 3-6 month intervals

Abductions - moments of breathiness 

contact ulcers

ulcers on the vocal processes of the arytenoids 

excessive slamming during low pitch, nonproductive throat cleaning/coughing, gastric reflux, and intubation

back glottal fry

ex. singer, teachers, and preachers

nodules

callus-like growths

20% of patients with voice problems

most common form

male children, adult females

form in pairs - greatest amplitude of vibration

polyps

10% patients with voice disorders

Blister-like growth

unilateral

can impede full closure of the coal cords during phonation

vibrating at different frequency than the other one

papillomas

hpv

wart-like growth

usually go away without treatment 

if too large, they may compromise the airway

Carcinoma

12,500 new patients every year

75% are on the vocal cords themselves 

exposure to inhaled smoke - smoking + drinking = increased risk 

15-20% require a laryngectomy

voice evaluation 

best managed by teams

patient interview

judgement of quality

instrumental evaluation

best managed by teams

collaboration between SLP and ENT - who should take the case

Patient interview

talks with patients about voice concerns, history, and medical lifestyle

judgment of quality

perceptual - observe voice quality, severity, and fluency

instrumental evaluation

endoscopy, stroboscopy, and visiPitch

Laryngectomy

surgical removal of the larynx due to cancer

trachea redirected to stoma 

protective function of nose gone - cover stoma 

tracheoesophageal speech- (TEP) 

voice therapy

counseling (preoperatively too)

ear training (what does a normal voice sound like)

feedback (computerized programs)

altering loudness

yawn-sigh (vocal fold apart-sigh-come together controlled)

open mouth

respiration training 

treatment for laryngectomy 

esophageal speech - air released near neoglottis

electrolarynx - handheld battery operated device that makes a mechanically sounding voice