Copyright © 2008 Delmar. All rights reserved. Unit Seven Voice Disorders

Copyright © 2008 Delmar. All rights reserved.

Unit Seven

Voice Disorders


Chapter 27

Anatomy and Physiology

of the Respiratory

and Phonatory Systems


3

The Respiratory System

• Driving support of voice production

• Intricate balance between respiration (inhalation and exhalation) and phonation


4

Supportive Structures of Respiration

• Bones in the chest provide framework and protection of the respiratory system

• Thorax– Contains the lungs and the heart


5

Muscles of Respiration

• Diaphragm– Primary muscle

• Internal and external intercostals

• Pectoralis major and minor muscles

• Rectus abdominis muscles


6

Trachea

• Extends from larynx down to the lungs

• Composed of cartilaginous rings


7

Respiratory Process

• Diaphragm lowers and rib cage expands

• Space in thoracic cavity increases

• Air pressure decreases in lungs

• Air flows down trachea into lungs

• Alveolar sacs and chest relax and air is forced from lungs


8

Phonation

• Larynx is the organ of phonation

• Sits at top of trachea and below root of tongue


9

Framework of Larynx

• Cricoid cartilage

• Thyroid cartilage

• Two arytenoid cartilages

• Epiglottis


10

The Vocal Folds

• Biological function– To prevent food/liquid entering the trachea

• Overlaid function of true vocal folds is to produce voice


11

Vocal Folds

• Glottis– Space between open vocal folds

• Posteriorly– Vocal folds attach to the arytenoids


12

Vocal Fold Vibration

• Vocal folds must open and close to produce voice

• Vocal folds are open when breathing


13

Vocal Fold Vibration

• To produce voice– Folds close

• Air pressure beneath the folds increases and forces folds to open

• Elasticity and Bernoulli’s law causes folds to close

• Subglottic air pressure builds up and forces folds to open again


14

Maximum Phonation Time (MPT)

• Length of time a person can sustain a tone or sound on one expiration

• Varies based on gender, age, physical characteristics, health


15

Frequency

• Frequency – Number of cycles of opening and closing

the vocal folds per second– Measured in Hertz (Hz)

• Fundamental frequency – Rate of vocal fold vibration


16

Pitch

• Psychological sensation of the frequency of a sound

• Pitch changes based on vocal fold:– Tension– Mass– Length


17

Loudness

• Perceptual correlate of intensity of a sound– Intensity measured in decibels (dB)

• Relates to the force with which vocal folds open and close and the amount of air that escapes


18

Voice Quality

• Judgments of voice quality are subjective

• Quality is affected by:– Adequate vocal fold closure– Efficient timing of closure– Amount of tonicity within the folds


Chapter 28

Voice Disorders

in Children and Adults


20

Voice Disorder

• A deviation of loudness, pitch, or quality out of the range of a person’s age, gender, or geographical background


21

Classification of Voice Disorders

• Functional – Faulty use of mechanism

• Neurological– Related to muscle control and innervation

of muscles

• Organic – Related to physical changes in larynx


22

Functional Voice Disorders

• Hyperfunctional – Excess tension or forcing in larynx

• Hypofunctional– Decreased or inadequate tension or

reduced vocal capacity


23

Laryngitis

• Inflammation of vocal folds

• Voice is associated with lowered pitch and phonation breaks

• Vocal quality is hoarseness


24

Chronic Laryngitis

• Laryngitis lasting longer than 10 days

• Causes may include:– Traumatic laryngitis– Allergies– Singing excessively at damaging intensity

levels– Smoking


25

Vocal Nodules

• Most common benign lesions in children and adults

• Typically bilateral

• Occur at juncture of anterior and middle one third of vocal folds


26

Vocal Nodules

• Caused by continuous abuse/misuse of voice– Screaming, coughing, singing in abusive

manner

• Voice quality is hoarseness


27

Vocal Polyps

• Benign vocal fold lesions

• Frequently unilateral

• Occur at juncture of anterior and middle one-third of vocal folds



28

Functional Dysphonia

• May be hyperfunctional or hypofunctional

• No medical or surgical treatment

• SLP works to improve intensity, pitch, quality

• Psychological support may be beneficial


29

Functional Aphonia

• Hyperfunctional voice disorder

• Voice is typically whispered

• Most causes are psychological


30

Falsetto

• High-pitched breathy voice

• Produced by vibration of anterior one-third of the vocal folds


31

Organic Voice Disorders

• Papillomas

• Contact ulcers

• Trauma

• Cancer


32

Papillomas

• Soft wart-like growths

• Viral in origin

• Occur mainly in children– 4-6 years


• Treatment is surgical removal


33

Contact Ulcers

• Small ulcers at juncture of middle and posterior one third of folds

• Can be caused by:– Persistent and excessive slamming of

arytenoids and hard glottal attacks– Gastroesophageal reflux– Intubation for surgery


34

Contact Ulcers

• Voice quality is hoarseness

• Voice therapy is usually successful


35

Traumas

• Various traumas can compromise the airway and affect the larynx

• Voice therapy will focus on helping clients achieve their most functional voice


36

Cancer

• Requires surgical and medical treatment


37

Neurological Voice Disorders

• Hypoadduction– Difficulty getting the vocal folds together– Vocal fold paralysis

• Hyperadduction– Vocal folds close too tightly or for too long


38

Vocal Fold Paresis and Paralysis

• Unilateral paralysis – Vocal quality is breathy– Has low intensity– Diplophonia


39

Spasmodic Dysphonia

• Strained, strangled, harsh vocal quality

• Affects females more than male

• Onset on average at 45 years of age

• Treatment involves voice therapy and medical-surgical approach (Botox)


Chapter 29

Voice

Evaluation and Therapy


41

Examination

• Indirect laryngoscopy– Place a laryngeal mirror into back of mouth– Direct light onto mirror to shine on the

vocal folds


42

Examination

• Endoscope placed intraorally or transnasally

• Can be videotaped (videoendoscopy)– Or observed with a strobe light

(videostroboscopy)


43

Voice Screening

• Screenings of voice will determine if a complete evaluation is needed

• Screening tasks include:– Count 1 to 10– Conversation– Phonating vowels


44

Voice Evaluation

• Case history

• Assessment of voice– Perceptual, acoustic, physiologic

• Instrumental evaluations

• Self-perception


45

Instrumental Evaluations

• Aerodynamic

• Electroglottography

• Electromyographic assessment

• Photoglottography


46

Voice Therapy

• Multifaceted approach is required

• Specific voice therapy will depend on age of client, type, and severity of disorder


47

Hygienic Voice Therapy

• First step in many therapy programs

• Focus on instilling healthy vocal behaviors in habitual speech patterns– Determine misuse– Become aware of these behaviors– Eliminate damaging behaviors


48

Symptomatic Voice Therapy

• Reduce/eliminate abuse and misuse of voice through facilitating techniques– Auditory feedback– Change of loudness– Counseling


49

Psychogenic Voice Therapy

• Identify and modify the emotional and psychosocial behavioral reasons that cause a voice disorder


50

Physiological Voice Therapy

• Directly alter or modify the physiology of the vocal mechanism


51

Eclectic/Holistic Voice Therapy

• Combination of any or all of the orientations and approaches of voice therapy


52

Laryngectomy

• Surgical removal of the larynx

• Surgical approach to treating laryngeal cancer


53

Before a Laryngectomy

• Establish immediate means of communication after surgery

• Discuss choices of voice production– Tracheoesophageal puncture (TEP)– Esophageal speech– Electrolarynx


54

Tracheoesophageal Puncture (TEP)

• Incision made into trachea

• Valve directs air from trachea into esophagus


55

Esophageal Speech

• Compressing air and injecting into esophagus

• Expel air from esophagus causing it to vibrate upper esophageal valve


56

Electrolarynx

• Neck devices with vibrating source that produces sound


Chapter 30

Emotional and Social

Effects of Voice Disorders


58

Emotional and Social Effects

• The voice reflects our personality

• It is an indicator of emotions and attitudes


59

The Voice

• The voice is the mirror of the person

• The voice reflects our personality

• The voice is an indicator of emotions and attitudes


60

Voice

• In a social context, the voice will convey:– Semantic content– Emotional state– Personality characteristics


61

Young Children

• Many children are unaware or unconcerned with a hyperfunctional voice disorder

• Voice therapy may not begin until kindergarten

• Parents are counseled on how to encourage less abusive voice use by their children


62

Children

• As children get older, they become aware of their voice and are better candidates to participate in voice therapy


63

Adolescents

• Adolescents with chronic voice problems are typically motivated to participate in a voice therapy program

• Adolescents with falsetto voices can experience significant social penalties – especially boys


64

Adults

• Twenty-five percent of adults are displeased with the sound of their voices

• A holistic approach to treatment views the whole person when determining the best therapy program for an adult with a voice disorder

Documents

Copyright © 2008 Delmar. All rights reserved. Unit Seven Voice Disorders