CMD201 EXAM #4 Voice Disorders

• Voice is the basic sound source produced by vocal fold vibration
• Resonance - sound that is amplified and modified by the vocal tract resonators (the throat, mouth cavity, and nasal passages)
• Articulation - vocal tract articulators (the tongue, soft palate, and lips) modify the voiced sound
• How many Etiologies are there?

  5
• What are the 5 Etiologies?

  Vocal Misuse/Abuse, Neurogenic, Local irritation, Neoplastic, Psychogenic
• 1. Vocal Misuse/Abuse is damage to the vocal cords, secondary to voice misuse/overuse
• 2. Neurogenic : UMN/LMN damage secondary to stroke, ALS, Parkinson's
• 3. Local irritation: Secondary to GERD (inhaling irritants like smoke)
• 4. Neoplastic: Unwanted guest that make the vocal folds hard to vibrate, cancer & tumors
• 5. Psychogenic: Voice disorders that result from an emotional or psychological event
• What is the fuel for voice?

  Breath
• What are Perceptual Characteristis

  Pitch, Loudness, Phonatory quality
• Dyspohina - Umbrella term for disordered voice
• Aphonia - Lack of voice, no voice at all
• Hypofunction - vocal folds that are under functioning
• Hyperfunction - vocal folds that are too tight/strained
• Diplophonia - "double pitched", hearing 2 pitches at the same time
• (Vocal Misuse/Abuse) - List abusive behaviors

  Yelling/screaming/cheering, spending time in smoky environments, using caffeine products, giving lectures or speeches
• (Vocal Misuse/Abuse) - what forms with vocal abuse?

  Vocal nodules (bi lateral), contact ulcers/granulomas, vocal polyps
• (Vocal Misuse/Abuse) - Vocal nodules are bilateral, small, soft lumps (acute) that develop on the vocal folds and can harden over time (chronic)
• (Vocal Misuse/Abuse) - Vocal nodules, vocal symptoms are...

  Hoarseness, decreased pitch, breathiness, decreased pitch range
• (Vocal Misuse/Abuse) - Vocal Polyps are unilateral and vascular (have blood supply)
• (Vocal Misuse/Abuse) - Contact Ulcers

  Inflamed lesions that are developed on the arytenoid cartilages
• (Neurogenic) - from illness, damage, or disease to the neurological systems associated with vocal production
• (Neurogenic) - Diagnoses associated with voice disorders

  Amyotrophic lateral sclerosis (ALS) & Parkinson's disease
• Parkinson's disease


  • Progressive degenerative disease caused by dopamine depletion
  • Voice: weak and breathy secondary to weakened respiratory system/breath support; can also be hoarse and monotone
• (Psychogenic) - Result from an emotional or psychological event

  • Brain is overwhelmed and can affect the larynx EVEN THOUGH there is nothing physically wrong with the system
• (Psychogenic) - Is a Conversion Disorder, a psychological disturbance in which an individual exhibits symptoms of a physical disorder or disease
• (Psychogenic) - Caused by stress, anxiety, depression
• dysphagia(Neoplastic) - caused by smoking and alcohol

  Symptoms: hoarseness and dyspagia
• Characteristics of Voice Disorders: Impacts one or more...

  Resonance, Pitch, Loudness, Phonatory Quality
• Tubing can cause ulcers and/or granulomas
• what part of the vocal folds do ulcers/granulomas form?

  Back part of the vocal folds
• Vocal polyps are unilateral and vascular
• Laryngeal Cancer is caused by smoking and alcohol
• Resonance Disorders are issues with the VP (velopharyngeal) port, affecting sounds made when air is coming through the nose, mouth, and throat
• Resonance Disorders

  • Hypernasality : port remains open, too much resonance
  • Hyponasality : port remains closed, too little resonance
• What are the goals in treatment for Voice Disorders?

  Behavior
• What are specific goals for treatment in Voice Disorders?

  1. To teach a vocal behavior that is absent
  2. To substitute an appropriate vocal behavior for an inappropriate one
  3. To strengthen vocal behaviors that are weak or inconsistent
  4. To educate re: risk factors/exposures/behaviors that could assist with prevention of return of voice disorder
• What are the common causes in voice Disorders in adults...

  • Vocal nodules-20%
  • Edema/swelling- 14%
  • Polyps- 11%
  • Carcinoma- 10%
  • Vocal Fold Paralysis- 8%