Voice & Resonance Disorders LIN381 Fall 2024 PDF

Voice & Resonance Disorders LIN381 Fall 2024 Ch.9 Normal voice and resonance production Vocal Pitch Fundamental frequency (perceived as vocal pitch, Hz) Modify length and tension of vocal folds to produce pitch changes Vocal Loudness Perceptual correlate of...

Voice & Resonance Disorders LIN381 Fall 2024 Ch.9 Normal voice and resonance production Vocal Pitch Fundamental frequency (perceived as vocal pitch, Hz) Modify length and tension of vocal folds to produce pitch changes Vocal Loudness Perceptual correlate of intensity (dB) resulting from alveolar pressure from lungs onto the vocal folds Most conversational speech averages around 60dB Voice Quality Unique characteristics of an individual’s voice related to laryngeal anatomy and learned behaviors Age- and hormone-related changes to performance of vocal folds; atrophy of laryngeal muscles; physical changes in the vocal folds; cartilage ossification Presbyphonia: age-related disorder caused by changes in pitch, loudness and quality Resonance Velopharyngeal structures and closures shape the sound coming out Disorders of voice and resonance Result of disordered laryngeal, respiratory, and or vocal tract functioning 7.7% adult prevalence; but only 10% will seek treatment 6% prevalence rate in children, with boys more affected than girls Certain occupations may have higher rate of voice disorders: teachers, singers Can be associated with vocal misuse or abuse, neurological disorders, psychological conditions, or combination Cleft palate: 1 in 700 births When an individual is seeking voice treatment services for gender-affirming or transgender care, it is not considered a voice disorder…rather it is a voice difference. Organic disorders (underlying physical or neurological basis) Vocal nodules: (hoarseness/breathiness) growths on one or both vocal folds (resulting from vocal misuse/abuse); over time, the nodules become hard and vibrous, interfering with vocal fold vibration Vocal polyps: (hoarseness/breathiness/sudden voice breaks, diplophonia (perception of two different pitches during phonation) fluid-filled lesion resulting from ruptured-swelling blood vessels in vocal folds; tend to be unilateral, larger, prone to hemorrhage; caused by trauma (even a singular yelling incident) Contact ulcers and granulomas (hoarseness/breathiness) Small ulcerations; painful. As they heal, replaced by granulated tissue “granuloma”; tend to reappear Gastroesophageal reflux disease (GERD) is a significant contributing factor (stomach acids irritating vocal fold tissue, repeated throat clearing) Sometimes contact ulcers caused by surgical intubation Laryngitis (chronic/acute: mild hoarseness, lowered pitch, effortful speaking, vocal fatigue) Inflammation of the vocal folds (smoking, allergies, GERD, vocal abuse) Organic disorders (underlying physical or neurological basis) Papillomas (hoarseness) Small, typically benign growths caused by human papillomavirus (HPV). High rate of recurrence; can obstruct airway; which can cause surgical scarring Webs (shortness of breath, hoarseness, aphonia) Connective tissue growth between the vocal folds, obstructing airway Congenital or result of trauma or infection Cancer (hoarseness, difficulty breathing) Linked to smoking, excessive use of alcohol HPV infection Obesity, Poor nutrition, family history, GERD, chemical exposure Requires surgical procedures, maybe even larynx removal, stoma opening to trachea for breathing Also, may involve radiation therapy Neurologic Voice Disorders Damage to CNS or PNS that serves the muscles responsible for speech, causing dysarthrias Table 9.3 shows voice characteristics associated with neurological damage or disease Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS) https://blog.lsvtglobal.com/lsvt-loud-speech-therapy-for-parkins on-disease-2/ Voice Banking https://www.youtube.com/watch?v=0yvm2ZNK4Pk Functional voice disorders (result of misuse or abuse; or psychological factors such as stress) Muscle tension dysphonia (hoarseness) Abnormal muscle activity Conversion dysphonia (involuntary whispering, loss of voice) Psychogenic voice disorder believed be result of converting stress, anxiety, depression into physical symptoms Functional mutism (mouthing words without voice, or nonspeaking) May occur in schizophrenia, severe depression or other psychiatric conditions Vocal fold adduction still working (based on ability to cough) Resonance disorders Disruption of normal balance of oral and nasal resonance Can be caused by structural abnormalities (e.g., cleft palate) or blockage in nasopharynx Velopharyngeal Dysfunction (VPD): limitations in partitioning between oral/nasal cavity resulting in too much air escaping through nasal cavity (“nasal turbulence”, hypernasality) or insufficient air (hyponasality, which sounds like a bad head cold) Cleft Palate Cleft palate or lip is caused by a failure of structures to fuse or merge correctly during embryonic development (4th-7th week of pregnancy) Results in not being able to seal the nasal cavity from the oral cavity Opening can also create a loss of pressure for sucking (contributing to feeding problems) Surgery for cleft palate/lip recommended before age 1 Images from CDC Speech patterns related to atypical shape of oral/nasal cavity and how air flows https://acpacares.org/speech-samples/ Atypical consonant production Pressure consonants (stops, fricatives, affricates) Atypical nasal resonance and nasal airflow Hyponasality or Hypernasality VPD: incompletely closed velopharyngeal valve Dysphonia (hoarseness, low voice intensity) Evaluation Otolaryngologist (ENT) Resonance disorders may also be evaluated by cleft palate or craniofacial team. Endoscope/nasoendoscope (video stroboscopy): camera+light that can view the laryngeal or nasal structures, including vocal fold vibration, while the patient is producing sounds https://www.youtube.com/watch?v=9Tlpkdq8a8c Case history (including medical procedures) & quality of life measures Evaluation Evaluation of pitch, loudness and voice quality through recording and rating speech examples; also can create spectrograms Pneumotachometer can measure air flow and air pressure around vocal folds Nasometer can measure acoustic energy flowing through nose and mouth Electropalatography (visualizes tongue-palate interactions) In a hospital, may have access to xray & MRI imaging technologies to visualize the velopharyngeal system https://www.youtube.com/watch?v=uTOhDqhCKQs Sample sentences to evaluate resonance https://acpacares.org/speech-samples/ How are you? (voiced sounds) Mom made lemonade (nasality) Sissy sees the sun in the sky (high pressure consonants) Management of Voice/Resonance disorders Vocal function exercises Resonant voice therapy (breath and vibratory sensations) LSVT (Lee Silverman Voice Treatment) works to increase vocal loudness (e.g. Parkinson’s patients) Mindfulness, relaxation techniques Yawn-sigh technique; phonation through a straw to increase air pressure through vocal folds Surgical intervention (e.g., cleft palate); likely need intervention after surgery to re-learn articulatory movements Enhanced Milieu Teaching (EMT) integrates therapeutic practices within home/everyday setting Change vocally-abusive behaviors If larynx has been removed, patient may learn to use esophageal speech; may use prosthetic device to support voicing (e.g. electrolarynx …when placed on lateral aspect of neck, it excites air in the vocal tract) https://www.youtube.com/watch?v=riHLUOXt1Aw