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Voice Disorder Therapy
A voice disorder occurs when there is any alteration in vocal fold vibration or ability to vibrate causing voice symptoms such as hoarseness, loss of range, pitch changes, breathy voice, vocal effort and vocal fatigue.
Voice disorders are categorized as follows:
- Organic — voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms.
- Structural — organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)
- Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)
- Functional — voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal.
Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple, Glaze, & Klaben, 2010).
I work with many different physicians and value the team approach.
Inflammation of your voice box (larynx) from overuse, misuse, irritation or infection.
Muscle Tension Dysphonia
A pattern of improper use of laryngeal and extrinsic muscles of the larynx and neck that can develop during laryngitis from an upper respiratory illness and remain even after swelling of the vocal cords has resided. It can also be caused by stress, vocal misuse and abuse and can occur as a secondary condition to other disorders of the vocal cords.
Vocal Fold Nodules, Polyps and Cysts
Benign (noncancerous) growths on the vocal folds. All can cause hoarseness and are typically associated with vocal overuse or vocal cord trauma.
Occurs when blood has leaked into the vocal fold from a ruptured blood vessel. This usually happens as a result of forceful or incorrect use of the voice.
Vocal Fold Scarring
Scar tissue has formed on the layer of the vocal cord that vibrates. The area where the scar is located is “stiffer” than the surrounding area, thus resulting in altered vocal fold vibration.
Also called “polypoid corditis”, is a swelling of the entire layer of the superficial lamina propria (or Reinke’s layer), a structure crucial to normal voice function. It occurs almost exclusively in smokers.
Wart-like growths in the airway passages caused by the human papilloma virus; these growths usually form on the vocal folds, causing a voice disorder.
Vocal Fold Granuloma
Occurs when the lining on the cartilage in the back of the larynx is injured. When the lining is injured, it results in the cartilage being exposed to air, food, and acid reflux. When this happens, the cartilage becomes irritated. Rather than allowing that irritation to spread, the body creates a granuloma around that area of injured lining.
The most common ways for the lining to be injured and result in exposed cartilage are:
- Intubation for surgery (breathing tube placed during all general anesthesia)
- Intubation for illness (breathing tube placed during hospitalizations, for example, head injuries, lung infections, etc)
Forceful voice use, including:
- singing aggressive styles (i.e., gospel, rock, etc)
- singing incorrectly (i.e., poor technique, when unwell)
- singing in poor environments (i.e., poor amplification, poor monitors, loud environment, etc)
- throat clearing
Vocal Fold Paresis
A vocal fold with weak or impaired motion because the nerve in the muscles of the vocal fold is damaged. Most commonly, this happens as a result of a routine viral infection like a cold, although any surgery that can cause vocal fold paralysis can also cause paresis.
Vocal Chord Paralysis
Bilateral Vocal Fold Paralysis
Complete loss of nerve function to the voice box muscles resulting in abnormal vocal fold function and can affect the ability to speak and sing and, in some cases, also breathe and swallow.
There are different types of vocal cord paralysis. Bilateral vocal cord paralysis involves both vocal cords becoming stuck halfway between open and closed and not moving either way. This condition often requires a tracheotomy (an opening made in the neck to provide an airway) to protect the airway when the person eats.
Unilateral vocal cord paralysis
When only one side of the vocal cords is paralyzed or has very limited movement. It is more common than bilateral involvement. The paralyzed vocal cord does not move to vibrate with the other cord but vibrates abnormally or does not vibrate at all.
Voice Dysfunction in Neurological Disorders (Dysarthria)
Occur as part of an underlying neurologic condition such as Parkinson's disease, multiple sclerosis, myasthenia gravis, or ALS. They can also happen as the result of a stroke. These disorders can affect the strength of the muscles of the voice box resulting in a lack of vocal control, and they can also affect respiration and articulation which impact both voice and speech.
Neurological voice disorders can make a person difficult to understand. That can make communication with loved ones and caregivers difficult or complicated, which can lead to depression in the patient, and missing important signs of disease progression.
Spasmodic Dysphonia (SD)
A type of dystonia resulting in involuntary movements, or spasms, or the vocal cords. There are three types of SD - Adductor, Abductor and Mixed.
Adductor SD (Ad-SD)
Spasms in muscles that close vocal folds, which interrupt speech and cause strained or strangled voice breaks
May be the result of vocal overuse, misuse, poor vocal hygiene, or the result of an underlying medical issue. When you are experiencing chronic hoarseness that lasts longer than six weeks, it is best to seek the advice of an ear nose and throat (ENT) doctor to determine the cause of the problem.
An involuntary and rhythmic movement of the vocal cords. Tremor may occur alone or in combination with other neurologic conditions, particularly laryngeal dystonia. The tremor can range from mild to severe.
May be the result of vocal overuse, inappropriate/ injurous vocal practices, or the result of an underlying medical issue. When you are experiencing chronic hoarseness that lasts longer than six weeks, it is best to seek the advice of an ear nose and throat (ENT) doctor to determine the cause of the problem.
A common complaint among those who use their voices professionally. These individuals often include actors, singers, teachers, speakers, broadcasters, lawyers etc. Professional voice users tend to have substantially higher vocal demands than others. The vocal demands of this group all too often lead to vocal misuse and abuse, even among those with voice training.
Patients who experience vocal fatigue are often dismissed because their vocal folds look normal; since their symptoms cannot be explained by any physical findings, they’re told there is no problem.
Vocal fatigue can result from many causes, but when the vocal folds appear normal, fatigue is most often due to muscle tension dysphonia (MTD). MTD is the improper use of laryngeal and extrinsic muscles of the larynx and neck.