Voice Resonance Week 5: Functional Voice Disorders

What are functional voice disorders?

The structure is intact, but the functions are compromised in the absence of any organic/neurological pathology.

What is muscle tension dysphonia/vocal hyperfunction?

Broader umbrella term used to describe all functional voice disorders.

What kind of disorder is MTD? Why?

Behaviorally based disorder; there is an imbalance with laryngeal or perilaryngeal muscle activity that involves VF hyper-function and laryngeal constriction. 

Phono-Traumatic versus Non-Phono-Traumatic MTD

Phono-Traumatic: Leads to a structural disorder

Non: Does not cause a mass to form

(the outcome is what defines which it is)

Causes of Phono-Traumatic MTD

• Extraversion 

• Altered biomechanics 

• Vulnerability 

What types of tension is the laryngeal musculature is there? 

Anterior-posterior compression 

Lateral-medial compression

Supra-glottal compression (everything above the VF are squeezed) 

Primary MTD

Stand-alone functional problem; person is using their voice too much, inappropriately, etc.

Secondary MTD

Person is trying to compensate for another problem, like VF paralysis, thus trying to use another muscle, such as the FVF, to compensate for the loss of the VF.

What does MTD sound like perceptually?

No pattern in pitch, loudness, quality; could be high, low, unvaried. 

What are the aerodynamics of MTD?

• MAFR: varies; could be too much or too little airflow

• VC: normal 

What are the acoustics of MTD?

Quality is low!

• Frequency/intensity could be anything 

• NHR: higher because of poor mucosal wave 

• Shimmer/jitter: higher 

• CPP/CSID: lower 

Prevalence of MTD

• 90% of MTD in women 

• Professional voice users 

Treatment for MTD

Responds to voice therapy, but varies in response

Typical complaints from people with MTD

• Change in voice quality 

• Fatigue

• Strain 

• Pain 

• Poor projection 

• Loss of pitch/loudness ranges 

Different forms of MTD

• Hard-glottal attack 

• Elevated laryngeal position 

• Ventricular dysphonia 

• Puberphonia/mutational falsetto 

Hard-Glottal Attack

Rapid adduction of the VF usually seen just before a vowel sound; increased sub-glottal pressure is required to overcome the adductive forces which produces sudden explosive sounds. 

Elevated Laryngeal Position

Accompanied by pitch increase; untrained singers tend to use it as a strategy to increase pitch, which can be detrimental to voice. 

Ventricular Dysphonia

Vibration of the false VF by itself or with the true VF; usually secondary to a VF disease where the false VF compensate for the impaired true VF vibration. 

What does ventricular dysphonia do to the voice?

• Low in pitch due to increased mass of the ventricular folds

• Reduced loudness due to poor pressure below the false VF

What is diplophonia?

2 voices/pitches you can hear at the same time in the same individual.

Puberphonia/Mutational Falsetto 

Unusually high pitch in a male that persists beyond puberty

Androphonia

Higher pitch than normal for women; childlike voice 

Symptoms of Puberphonia 

• Hoarseness

• Breathiness

• Pitch breaks

• Inadequate resonance

• Shallow breathing

• Muscle tension

• Lack of variability 

Common causes of puberphonia

• Desire to no “grow up”

• Over identification of a male with his mother

• Social immaturity

• Desire to maintain soprano singing voice