Communication Disorders
Voice Disorders

A voice is termed "disordered" when the vocal quality of an individual is altered/changed in such a way that it is thought to be abnormal to the listener. The onset and development of these disorders can be "sudden" or "slow.

Singers, teachers, actors, call center executive ,doctors, lawyers, nurses, sales people, corporate leader, political leader, public speakers are among those who make great demands on their voices. Unfortunately, these individuals are most prone to experiencing voice problems.

Some of these disorders can be avoided by taking care of your voice by learning vocal hygiene technique and technique of voice projection with least effort by speech language pathologist/Speech therapist. Consult a Speech Language Pathologist/Otolaryngologist if you have any voice problem for more than 15 days.

An Introduction to different kinds voice disorders:

Puberphonia:

Definition: A male speaks in high pitch voice (female like) even after the age of 14 years. Many times people on phone confused that they are talking to a female.

Etiology: During puberty in males the mass and length of the vocal fold increase and the pitch decreases. Few of the people although having the appropriate vocal fold mass and length after the puberty, but they are not able to switch to the new low pitch voice (male like). Its reason can be usually long time habits from childhood, speaking into a high pitch voice.

Treatment: It can be very easily treated by voice therapy (vocal exercises).Speech language pathologists/speech therapists are the professionals who are trained for voice therapy. Duration mostly can be 1-2 week.

Functional Aphonia:

Definition: absence of voice

Etiology: (1) acute stress to vocal folds (2) laryngeal pathology or other disease

Symptoms: no voice present

Treatment: Voice therapy by speech language pathologist/speech therapist

Spasmodic Dysphonia:

Definition: a disorder described as both functional/organic bases that is a rare condition with a neurological basis

Etiology: (a) psychological influence (b) unknown cause

Symptoms: strained struggled effortful voice which is hoarse with tremors, jerky voice onset, intermittent voice breaks, breathy spasms, hypernasality, failure to maintain voice

Treatment: Voice therapy by speech language pathologist/speech therapist

Q. I recently read about an experimental voice cord injection technique to help patients with spastic dysphonia. Does it work?

A. You are referring to an experimental procedure used in some hospitals, whereby the patient's vocal cord is injected with botulinum, an invasive toxic substance. Botulinum is a diluted form the deadly botulism. The downside and side effects affecting the body, as well as the vocal cord, are not fully known. The procedure causes a temporary parasis or paralysis rather than a permanent paralysis of the vocal cord and generally involves repeated doses for life. It was orignally thought that the injection would last nine months, but the period may be reduced to six months, three months, or six weeks.

In the December, 1999 National Spasmodic Dysphonia Association Newsletter, page 7, Dr. Gerald Berke, Chairman of UCLA Head and Neck Division reports regarding Botox (botulinum toxin): "...there are some obvious drawbacks. It requires lifelong visits from 4 to 10 times per year for repeat injections. The injections are not inexpensive. The interval between post injection breathiness, good voice, and the return of symptoms may not be very long in some patienst. Hypersensitivity and antibody formation have been shown to produce some long term structural changes in muscle cells."

Ventricular Dysphonia:

Definition: a condition in which the false vocal folds, the ventricular bands adduct together over the true vocal folds below

Etiology: (1) pathology may be unknown (2) may occur due to true vocal fold disease

Symptoms: monotonous voice, low pitched

Treatment: Voice therapy by speech language pathologist/speech therapist

Hoarse Voice:

It can be the result of vocal nodule, vocal polyp, Hyperkeratosis, Leukoplakia (Keratosis), contact ulcer, Vocal fold paralysis. Any of these medical problems should always be followed by voice therapy with the medico surgical management, otherwise it can reoccur .Because voice therapy not only work on present problem but also work to remove the reason of the occurrence of these disorders..

Vocal Nodules:

Definition: localized benign growths on the vocal folds that are usually thought to be a result of vocal abuse.

Etiology: due to vocal abuse when the tissues are under constant stress induced by frequent, hard oppositional movement of vocal folds

Symptoms: soreness or pain in neck, sensation of something in throat, hoarseness, and breathiness

Treatment: Mostly voice therapy if the size is small in some cases surgery is needed and that should be always followed with the voice therapy otherwise it can reoccur even after surgery as the voice therapy work on the reason of occurrence of the vocal nodule and other voice problems.

Vocal Polyps:

Definition: soft fluid filled bulges located at the front region of the vocal fold

Etiology: vocal abuse

Symptoms: hoarseness, shortness of breath, audible inhalation

Treatment: Medico surgical and voice therapy

Hyperkeratosis:

Definition: a mass of accumulated keratin (a scleroproteinous pigmented spot or covering) which may grow on the inner glottal margins which may occasionally develop into malignancy

Etiology: smoking, alcohol use, environmental pollution and other factors

Symptoms: pronounced hoarseness

Treatment: Medico surgical and voice therapy

Leukoplakia (Keratosis):

Definition: a disease characterized by a whitish patchy thickening of the epithelium of a mucous membrane. A precancerous lesion develops on the tongue or the inside of the cheek as a response to chronic irritation.

Etiology: Chronic smoking or tobacco use.

Symptoms: hoarseness, roughness

Treatment: Medico surgical and voice therapy

Contact Ulcers:

Definition: A small ulceration that develops on the medial surface of the vocal processes of the arytenoid cartilages. Laryngoscopically, a contact ulcer will be visible as a buildup of pink or pinkish-white tissue on one of the vocal processes of the arytenoids.

Etiology: (1) predominantly in males average age of 50 who engage in a great deal of aggressive speaking or so called type A personality. (2) constant throat clearing that is secondary to irritation of mucosa due to gastroesophageal reflux or regurgitation of peptic acid.

Symptoms: constant throat clearing, vocal fatigue, and breathy voice with some hoarseness accompanied by discomfort or even stabbing pain

Treatment: Medico surgical and voice therapy

Vocal fold paralysis:

Definition: a unilateral or bilateral paralysis of the vocal folds occurs when conduction of nerve impulses is temporary blocked, the axons of the nerve section, or the nerve fibers are entirely cut which disturbs glottal closure due to lack of adduction of the affected vocal fold.

Etiology: (1) peripheral lesions of Vagus nerve (2) neuritis (3) neoplasm's in neck, bronchi, and chest (3) acute external trauma to neck (4) surgery (5) idiopathic causes (6) birth trauma (7) central nervous system disease

Symptoms: breathiness, hoarseness, diplophonia, and aphonia

Treatment: Medico surgical and voice therapy

Few Tips to Prevent Voice Problems

  • Limit your intake of drinks that include alcohol or caffeine. These act as diuretics (substances that increase urination) and cause the body to lose water. This loss of fluids dries out the voice. Alcohol also irritates the mucous membranes that line the throat.
  • Drink plenty of water. Six to eight glasses a day is recommended
  • Don't smoke and avoid second-hand smoke. Cancer of the vocal folds is seen most often in individuals who smoke.
  • Practice good breathing techniques when singing or talking. It is important to support your voice with deep breaths from the diaphragm, the wall that separates your chest and abdomen. Singers and speakers are often taught exercises that improve this breath control. Talking from the throat, without supporting breath, puts a great strain on the voice.
  • Consult speech language Pathologist to learn vocal hygiene.
 
 

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