Voice Disorders Class 05/21/2025

need direct visualization (medical clearance) before starting voice therapy

same voice symptoms can come from many different things

Voice and Related Disorders

Introduction

• Heather Anderson, Ed.D., CCC-SLP

Normal Voice Capabilities

• A normal voice can:

  • Convey emotion- you can tell how they are feeling based on their vocal pitch and quality.

  • Adapt to multiple contexts- adapt to be projected for theater, presentations, etc.

  • Change pitch, volume, loudness, and quality voluntarily (volume and loudness are the same thing)

  • Contribute to survival- how? by being able to yell for help, also babies rely on this obviously

  • Compensate for change- as the body changes like with puberty, males mostly, males can compensate and still talk and adapt while their voice changes

  • Provide clues to an individual’s physical, emotional, psychological, and medical status

Agenda

• Syllabus & course requirements

• Overview

• Anatomy & Physiology (if time permits)

Course Content and Requirements- slide 4

• Purpose:

  • Exam preparation

  • Competency

  • Lifelong learning

• Syllabus

• Organizational considerations

• Practice with physical, instrumental, perceptual assessment

• Case study presentation

What is a Voice Disorder?

a voice disorder is related to an articulation disorder if someone has a cleft palate

voice disorders are related to fluency bc….

voice disorders are related to diagnostics bc you’ll have to evaluate them like a diagnostics exam

• Definition: A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location.

• A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant.

• ex: older child who sounds like a little kid; paralyzed type of voice without seeing any obvious paralysis

• voice disorders that are organic or physiological will result from alteratioons in respiratory, laryngeal or vocal tract mechanisms. structural changes in the mechanism itself like aging. neurogenic means no actual. legion or swelling, but there is a problem with a neuro event. functional means it came from something that is not visible; psychogenic; or inefficient use of vocal mechanism when the. physical structure is normal= diplophonia, vocal fatigue, ventricular phonation. functional is different from psychogenic; psycho= psych stressors lead to maladaptive voice disorders or a psychogenic conversion or changes from major events.

• References:

  • Aronson & Bless, 2009

  • Boone, McFarlane, Von Berg, & Zraik, 2010

  • Lee, Stemple, Glaze, & Kelchner, 2004

  • American Speech-Language-Hearing Association [ASHA], 1993

  • Colton & Casper, 1996

  • Stemple, Glaze, & Klaben, 2010

  • Verdolini & Ramig, 2001

  • (https://www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/)

Relationship to Other Courses

• How are voice disorders related to:

  • Articulation disorders?

  • Fluency disorders?

  • Diagnosis and evaluation?

  • Motor speech disorders?

  • Other related fields?

Voice Disorder Types

aphonia= no voice like from surgery, tracheostomy '

disphonia= voice disorder

• Organic

  • Structural

  • Neurogenic

• Functional

• Psychogenic/Psychogenic conversion

• Related disorders

  • Resonance

  • Structure and function

  • Relationship between sound and structure

  • Relationship between medical diagnoses and dysphonia

  • Importance of referral and collaboration

- Perceptual Signs and Symptoms (ASHA, 2023)- slide 6

see handout she gave us, this explains all vocal qualities!

• Rough vocal quality (raspy, audible aperiodicity in sound)

• Breathy vocal quality (audible air escape in the sound signal or bursts of breathiness)

• Strained vocal quality (increased effort; tense or harsh)

• Strangled vocal quality (as if talking with breath held)

• Abnormal pitch (too high, too low, pitch breaks, decreased pitch range)

• Abnormal loudness/volume (too high, too low, decreased range, unsteady volume)

• Abnormal resonance (hypernasal, hyponasal, cul-de-sac resonance)

• Aphonia (loss of voice)

• Phonation breaks

• Asthenia (weak voice)

• Gurgly/wet-sounding voice

• Pulsed voice (fry register, audible creaks or pulses in sound)

• Shrill voice (high, piercing sound, as if stifling a scream)

• Tremorous voice (shaky voice; rhythmic pitch and loudness undulations)

Other Signs and Symptoms- slide 10

• Increased vocal effort associated with speaking

• Decreased vocal endurance or onset of fatigue with prolonged voice use

• Variable vocal quality throughout the day or during speaking= normal to some extent but not if it happens a lot

• Running out of breath quickly= ALS, motor or respiratory problem

• Frequent coughing or throat clearing (may worsen with increased voice use)= can be a factor in development of a benign lesion, but lesion causes the tickle

• Excessive throat or laryngeal tension/pain/tenderness

• fundamental frequency makes pitch= number of times per second vocal folds adduct and abduct, controls vocal pitch

Describing Phonation and Resonance- handout you already have!

• Refer to file:///C:/Users/hka001/OneDrive%20-%20LSU%20Health%20Shreveport/Voice%20quality%20handout.pdf

Resources

• Preferred practice patterns (ASHA, 2004): http://www.asha.org/policy/RP1993-00208/

• ASHA Practice Portal Clinical Topics: asha.org

• National Center for Voice and Speech: http://www.ncvs.org

• Voice Foundation: THE VOICE FOUNDATION – Advancing understanding of the voice through interdisciplinary scientific research & education

• Voice Simulations: Voice Disorders: Simulations Home Page (wisc.edu)

• Online Textbook materials

• Simucase

Public Health Significance- slide 13

prevalence= ppl who had it during a time period

incidence= rate of ppl who develop a condition, how many incidents did we have

• Estimate: 3-9% of U.S. population

• Point prevalence of 0.98% in treatment-seeking population

• Gender

  • Adult ratio: female to male 1.5:1.0

  • Child ratio: more prevalent in males

• Age

  • Higher in elderly adults - prevalence 4.8-29.1%

  • Pediatric population – prevalence 1.4-6.0%

• Occupations with the most common incidents of voice disorders

  • Teachers, manufacturing/factory workers, sales, singers, ministers, actors, PE teachers, lawyers, auctioneers

  • 55.7% of teachers have a case of dysphonia

Public Health (Titze & Abbott, 2012)

• Significant occupational limitation; approximately 1/4 require critical role of voice

  • Teaching

    • 5.8% of employee population (8 million)

    • 11-38% estimated to have voice disorder

    • Prevalence 57.7% - at least one occurrence of dysphonia (Roy et al., 2004)

    • Subject areas

    • Predominance of women

    • High voice demands (6-7 hours/day)

    • "Non-trivial" consequences

Public Health - Other occupations

• Actors

• Singers

• Caretakers of children

• Salespeople

• Auctioneers

• Aerobic instructors

• Stock graders

• Counselors

• Lawyers

• Ministers

• Public speakers

• Others

Public Health - Voice Disorders in Children (Ramig & Verdolini, 1998)

• Developmental and behavioral problems

• Impact on communication skills

• Participation in the classroom

• Social interactions

• Psychosocial function

• Similar issues in adults with movement disorders (More restrictive than mobility limitations)

Historical Focus of Vocology - slide 17

Historical Focus of Vocology

old timey remedies for voice/ sore throats: crab juice, centipede liniment, ashes of a burned swallow (bird), gargling honey, vinegar, cow pee

Socrates was the first to realize the larynx is the part that sound comes from

laryngeal mirror brought in the modern age. like a dentist mirror but smaller

• Vocology History

  • Term coined in 1992 by Dr. Ingo Titze

    • “The science and practice of voice habilitation.”

  • Prior to the 1990s, voice was within the purview of:

    • Otolaryngology (ENT)

    • Speech-Language Pathology

    • Voice teachers/coaches

    • Singing teachers

    • Actors

Vocology Today- slide 20

• Goals

  • Prevention of voice disorders

  • Voice maintenance

  • Voice enhancement

  • Vocal artistry

    • how to sing high without hurting self, how to get past a vocal injury

• Broad base of influence

  • Medicine

  • Science

  • Pedagogy

    • Pedagogy: method and practice of voice teaching, especially as an academic subject or theoretical concept.

  • Performance

Laryngology- slide 21

• Branch of medicine that deals with diseases and disorders of the larynx

  • Focus on structure and function of the larynx

    • Diseases

    • Traumas

    • Defects

    • Benign lesions

  • Primarily concerned with the medical and surgical treatment

Speech-Language Pathology- slide 22

• Focus is on the evaluation and treatment of speech, language, voice, and swallowing disorders

  • Voice = the primary focus for vocology

• SLPs address vocal

  • Hygiene

  • Health

  • Rehabilitation

    • what happens after you take the tumor off the vocal fold

slide 25- renaissance continued

slide 27- modern age of voice pathology: ASHA; added laryngeal videotroboscopy, acoustic analysis, and aerodynamic analysis of vocal function

slide 28- involvement of SLPs in voice care: Van Riper approach, 1939 book about speech correction, this started Speech pathology.

voice problems are sometimes related to lifestyle

slide 29-30: ingredients of the artistic and scientific nature of voice care

32-34: dependents of normal voicing: 1937, 1980, today

early tools of voice analysis: tape recorder, stop watch, laryngeal mirror

Voice Assessment (ASHA): provided to evaluate vocal structuire and function, including ID of impairments, associated activity and participation limitations, and contact barriers and facilitators.

37: Outcomes of Voice Assessment: