Voice Disorders, part II

View part I.

World Voice Day is approaching on April 16th, and we continue our posts about voice disorders.  If you have any questions or comments, please feel free to leave them below.  The voice is an amazing instrument.  How is yours working for you?   

Normal human vocal cords (or vocal folds) consist of two infoldings of tissue situated horizontally across the larynx, or voice box, at the top of the windpipe. Vibrations, caused by air from the lungs moving past adducted vocal cords, produce the sound of the voice. The sound of each individual voice is determined by the size and shape of a person’s vocal cords, throat, nose and mouth, as well as environmental, behavioral, emotional, psychological and other physiological factors.

Voice disorders range widely in their vocal impairment, severity, causes and treatments. Nerve damage, acid reflux, smoking, an over- or under-active thyroid, stress and a person’s psychiatric and physical health can all create or worsen a voice disorder. Some voice disorders are caused simply by vocal misuse, like speaking or singing with poor technique, and overuse, such as excessive singing, talking, coughing or yelling.

Some common disorders appear below. See a laryngologist if you experience vocal discomfort or unexplained loss of voice that lasts longer than two weeks.
Laryngopharyngeal Reflux–inflammation of the larynx caused by gastric acid.
Symptoms: Decreased vocal performance, increased effort upon voicing;  may or may not include “heartburn” or indigestion.   Lifestyle changes are recommended, such as avoiding spicy and acidic foods, especially late in the day.  Medications that decrease acid production or level are a common treatment.
Causes: Reflux, specifically a back flow of stomach contents through the esophagus which spills over into the larynx and pharynx (i.e. throat)  that results in swelling and irritation of the laryngeal and pharyngeal tissue.

Vocal Fold Bowing–a small gap in the middle of the vocal folds develops and causes incomplete vocal fold closure, commonly seen in older adults. May improve through strength and flexibility exercises.
Symptoms: Less than optimal voice, weakness, breathiness, hoarseness, or a strained voice.  Treatment options include voice therapy to strengthen the voice and injections into the vocal folds to “bulk them up”. 
Causes: Age and atrophy of the larynx, inactivity of the vocal folds.

Vocal Fold Cyst–a fluid-filled lesion that can occur at any location on the vocal folds, and which interferes with vibration and fold closure at times. Usually appears on one side, but may cause swelling on the opposite side due to irritation.
Two types of cysts: 1. Mucus retention cysts occur when a glandular duct is blocked and unable to secrete; 2. Epidermoid cysts result from congenital defects or trauma.
Symptoms: diplophonia, a voice quality in which the vocal cords produce multiple tones at the same time; dysphonia an impaired quality of voice typically involving hoarseness or a breathy sound. Treatment involves voice therapy and medical interventions including surgery if necessary.
Causes: An upper-respiratory infection combined with vocal overuse, or trauma, which makes tissue prone to developing cysts. Females are more likely than males to be effected.

Spasmodic Dysphonia–inovoluntary movement of the vocal folds during speech resulting in irregular voice breaks and interruptions of phonation (sound). Most common in females between the ages of 20 and 50.
Depending on type of SD, the vocal folds may slam together and stiffen cutting off words or making it difficult to start; or spasms can cause the vocal folds to open allowing air to escape from the lungs during speech. A mix of these types may also be present.  Injecting Botox into the spasming laryngeal muscles causes temporary paralysis of those muscles and usually results in improved voice.
Symptoms: Tight/strained voice; choppy voice similar to stuttering; strained or strangled and full of effort; weak, quiet and breathy or whispery voice. Spasms are usually absent during activities such as laughing or singing.
Causes: Believed to be neurologic in nature with stress and other environmental factors exacerbating symptoms.

Muscle Tension Dysphonia–(sometimes referred to as muscle misuse dysphonia or vocal hyperfunction) a cluster of abnormal patterns of vocal muscle activation, most commonly excessive or unequal muscle tension due to inappropriate use while speaking or singing. Ranges from mild to severe.
Symptoms: In severe cases, voice is extremely breathy or tight/strangled and high-pitched. Treatment involves abdominal-diaphragmatic breathing, relaxation, muscle control, and voice placement exercises guided by a speech pathologist.
Causes: Theories point to incomplete relaxation of the muscle responsible for opening the vocal folds, excessive contraction of certain muscle groups, and incoordination of laryngeal muscle contraction with air pressure and airflow timing. 

View part I.

Posted on 13 April 2009 | Category: General, Voice


Voice Disorders, part I

View Part II.

Voice disorders range widely in their vocal impairment, severity, causes and treatments. Causes can vary from trauma, inflammation or structural changes to immunological, neurological or behavioral factors that result in less-than-ideal voice production.

Some conditions heal on their own, but others require voice therapy and medical management. Nerve damage, acid reflux, smoking, an over- or under-active thyroid, stress and a person’s psychiatric and physical health can all create or worsen a voice disorder. Some voice disorders are caused simply by vocal misuse, like speaking or singing with poor technique, and overuse, such as excessive singing, talking, coughing or yelling.

The tissue of the vocal folds, or vocal cords, sometimes become swollen or injured due to illness, heavy use, exposure to irritants, etc. Sometimes the muscles of the larynx, or voice box, do not work properly due to nerve damage, behavior patterns, or other problems. Common disorders include the development of growths such as nodules or polyps, swelling as in laryngitis, laryngopharyngeal reflux and vocal cord paralysis. 

Laryngitis–inflammation of the vocal cords.
Symptoms: Raspy, hoarse voice. May be low- or high-pitched, depending on how the vocal cords are affected in terms of mass and mobility.
Causes: Excessive use of voice, infections, inhaled irritants, acute laryngopharyngeal reflux.

Vocal Nodules or Nodes–small, callous-like benign growths on vocal cords, which usually occur in pairs and can be a problem for professional voice users. Typically can be reduced or eliminated with proper voice care.
Symptoms: Hoarse, low and breathy voice. Vocal fatigue.
Causes: Vocal misuse and overuse.  Also, dehydration, smoking, drinking alcohol, certain medications, drug use,  laryngopharygeal reflux and environmental factors can precipitate and aggravate the condition. 

Vocal Polyps–soft, blister-like benign growth on a vocal cord, which usually occur unilaterally (on one vocal cord).
Symptoms: Hoarse, low and breathy voice. Vocal fatigue. Severity depends on location and size of lesion.
Causes: As with vocal fold nodules, polyps are associated with heavy voice use, and may be precipitated or aggravated by dehydration, environmental factors, hormones, medications, drug use and allergies.

Vocal Cord Paresis or Paralysis–weakness or immobility of one or both vocal folds causing them to not open or close properly. Cases range from relatively mild to life threatening as paralysis can allow food or liquid to enter the lungs. May require therapy or surgery, although no action may be necessary.
Symptoms: Depending on the exact location of the insult and the position of the immobile vocal fold, the voice may be weak and breathy; there can be stridor during inhalation; and swallowing and coughing can be difficult.
Causes: Mechanical trauma (e.g., head/neck/chest surgery or injury), tumor, certain disease processes, viral infections, hereditary neoplasms and idiopathic.

Voice therapy involves collaborating with your laryngologist (one can be recommended), identifying your vocal demands and habits, and working with you to develop a way of speaking that is optimal for you. The goal is a voice that has endurance and meets your needs.

Posted on 9 April 2009 | Category: General, Voice


A Call for Questions

I would love to use this blog as a place to answer any questions related to communication.  If I can’t answer them, I will do my best to find the answer and invite feedback from you.  So go ahead, ask away!  Here are some ideas to get you started:

  • VOICE:  Would you like to know something about how your voice works?  What people prefer to hear in a voice?  Voices people dislike?  Can a voice be changed?
  • ACCENT:  Perhaps you want to know something about accents, like what is the American accent?  Why are some accents harder to understand than others?  Is it discriminatory to require an employee to receive accent modification training?
  • PRESENTATION:  How about presentation in the business world?  How much should a person use gestures?  Should a presentation incorporate visual aids like PowerPoint?

These are just a few ideas.  Use them or brainstorm your own and ask.  I love this stuff!

Posted on 1 April 2009 | Category: Accent, Communication, Presentation, Voice


Chicago a cappella – Voices extraordinaire!

Ah, the human voice!  In the business world, a persuasive, informative, confident sound is key.  But it’s Friday…take a break from the boardroom and consider indulging in an “intimate taste of the vocal arts,” as Chicago a cappella’s 9-voice ensemble was described in the Chicago Tribune by Michael Cameron (April 21, 2008).

This group is near and dear to my heart.  They sing innovative programs and have extremely high musical standards.  I serve on the Board, and The Sound Center is a sponsor of the upcoming Black and Red Ball on May 22nd.  I would like to extend a warm invitation to this event.  If you would like to taste the vocal arts and delicious cuisine, join us at Park West.

If you can’t attend, please give yourself the opportunity to hear them!  Sample their sound here or buy a CD.  Download their music at itunes.  Catch a performance in the ‘08-’09 season.  They perform in Chicago, Oak Park, Evanston, and Naperville.

You can also buy some raffle tickets and be entered to win a Desert Resort and Spa Getaway for Two!  Check it out!

Posted on 9 May 2008 | Category: Voice