Chapter 13: Voice Disorders in Children & Adults

• Dysphonias = voice disorders
• 6% of 8 year olds have voice disorders
• 33% of people aged 60+ have voice disorder
• Polypoid Degeneration (Reinke's edema): Swelling of vocal folds as a result of fluid collection (edema) in superficial layers of epithelial tissue
• Hyperfunction: a pervasive pattern of excessive effort and tension that affects phonatory/respiratory/articulatory/resonatory systems. Results in tense-sounding voice & hard glottal attacks
• Functional Voice Disorders = caused by faulty use of normal vocal mechanism
• Neurological Voice Disorders = related to muscle tone & control of the muscles used for respiration & phonation
• Organic Voice Disorders = related to some physical abnormality in the larynx
• Hard Glottal Attacks = forceful approximation (closing) of vocal folds during initiation of phonation
• Hypofunction = inadequate muscle tone in laryngeal mechanism & associated structures. Signs include breathiness bc of inadequate closure of vocal folds, weak vocal power & reduced vocal endurance
• Vocal Nodules: a benign vocal fold growth that tends to be bilateral caused by continuous vocal fold hyperfunction
• Vocal abuse (phonotrauma): harmful acute or chronic vocal behaviors such as excessive screaming, cheering, coughing, or hard glottal attacks that are damaging
• Vocal misuse: harmful chronic behaviors that may have a cumulative damaging effect on structure & functioning of laryngeal mechanisms caused by chronic inappropriate loudness or pitch, singing beyond range of vocal mechanism, etc
• Hoarseness: common dysphonia that is a combination of breathiness & harshness that may affect loudness, pitch & quality
• Acute: Intense & of short duration
• Chronic: of long duration w/ slow progress
• FUNCTIONAL: Laryngitis: an acute or chronic inflammation of the mucous membranes of the larynx that often results in hoarseness or loss of voice
• Harshness: a "rough" sounding vocal quality
• Breathiness: incomplete closure of vocal folds that results in excessive unvibrated air escaping
• FUNCTIONAL: Acute laryngitis (traumatic laryngitis): an abrupt, intense, and brief inflammation of mucous membrane lining in larynx accompanied by edema of vocal folds w/ hoarseness & loss of voice often caused by vocal abuse
• FUNCTIONAL: edema: accumulation of excessive fluid in tissue that is associated with inflammatory conditions & results in swelling of tissue
• FUNCTIONAL: chronic laryngitis: persistant laryngitis lasting more than 10 days
• otolaryngologist (ENT) physician: ear, nose, throat doctor
• lesions: a wound, injury or area of pathological change in tissue
• FUNCTIONAL: Vocal hygiene: behaviors that are helpful to achieve and maintain a healthy vocal mechanism and prevent vocal pathologies (includes eliminating phonotrauma, speaking in appropriate pitch, turning radio or TV down when talking, using amplification, singing within optimal pitch range).
• FUNCTIONAL: Vocal polyps: benign vocal fold growth that is similar to a vocal nodule but is softer and more like a blister than a callous. Caused by vocal abuse/misuse, results in vocal hoarseness.
• FUNCTIONAL: Contact ulcer: benign vocal fold ulceration at junction of middle one-third and posterior one-third of a fold that is caused by excessive vocal hyperfunction. Common in hard-driving adults who experience reflux, coughing, throat clearing.
• FUNCTIONAL: Vocal fold cyst - enclosed, sac-like structures in the vocal folds
• FUNCTIONAL: Functional Dysphonia: voice disorder that is either hyper- or hypo-functional and has no organic, physical, or neurological cause. Heard in patients w/ extreme tension in laryngeal and sypralaryngeal structures. Voice can have hyper- or hypo- qualities
• FUNCTIONAL: Muscle tension dysphonia (MTD): hyperfunctional voice disorder caused by excessive muscle tension. Results in weak voice, low endurance, rough, hoarse, etc.
• FUNCTIONAL: Functional aphonia - hyperfunctional voice disorder in which person speaks in a whisper but is able to use a normal voice when laughing, coughing, clearing the throat, and humming. Often associated with psychological stressors or conflicts
• FUNCTIONAL: Conversion reaction (Disorder): ego defense mechanism in which intrapsychic conflict is expressed symbolically through physical symptoms (including voice disorders) to gain empathy or to get out of difficult situation
• FUNCTIONAL: Mutational Falsetto (Puberphonia): high-pitched, breathy voice produced by vibration of anterior one-third of vocal folds w/posterior two-thirds held tightly in slightly open position or so tightly adducted that little or no posterior vibration occurs
• ORGANIC: Papilloma (laryngeal papillomatosis): soft, wartlike, benign growths on vocal folds of children w/ viral origin and can grow to size that obstructs airway
• ORGANIC: Cancer (carcinoma): a malignant new growth (or neoplasm) characterized by uncontrolled growth of cells that invade surrounding tissue and spread
• Malignant: neoplasm with uncontrollable growth that invades & destroys neighboring tissues
• ORGANIC: Presbyphonia: age-related dysphonia associated with normal aging
• NEURO: Hypoadduction: difficulty making the vocal folds close strongly enough for normal phonation to occur that results in weak, breathy voice
• NEURO: Hyperadduction: difficulty with vocal folds closing too tightly or for too long causing the voice to sound tense & strained
• NEURO: Vocal Fold Paralysis: loss of laryngeal movements (vocal fold opening & closing) that may be caused by damage to the brainstem, resulting in weak, breathy voice, or difficulty breathing