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

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Invest in Your Voice

In a time of economic instability, an investment in your voice is one that’s guaranteed to yield high return for years to come.

We don’t normally think of our voice as needing maintenance or special attention, though a healthy and effective voice is a vital asset. Your voice is one of your most valuable tools in your personal and professional life, especially with an increasing emphasis on voicemail, teleconferencing and face-to-face communication. Your voice contributes as strongly toward making a good impression as your appearance or handshake.

That’s why the theme for this year’s World Voice Day is “Invest in your Voice”. Investing in your voice means treating it right by avoiding smoking, limiting heavy screaming or shouting, and by staying hydrated and recognizing when your voice needs a break.

You should also warm up your voice, like you would other muscles, before periods of extended use. Warm-ups are not just for vocal professionals, but also benefit teachers, public speakers, or preachers, to name a few.

If you think you have a voice disorder or you want to improve your voice projection or quality, don’t wait to seek help.  Speak to a speech pathologist who has expertise in the vocal mechanism.  See a laryngologist if a disorder is suspected.  Different diagnoses require very different care, so it is important to be seen by a highly qualified professional.  

The Sound Center will feature information about the importance of your voice and tips on how to keep it in peak condition as part of its count down to WVD 2009.

World Voice Day began in Brazil in 1999 as a day of awareness, recognition, and celebration of the human voice, and is now commemorated worldwide each year on April 16. WVD strives to inform people of the importance of the human voice and the need for preventative care.

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Posted on 6 April 2009 | Category: Communication, General, Voice

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