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Safia Nazeer Khan
Clinical Psychologist
RBT/ABA Certified
Voice disorders are conditions that affect the production or quality of voice, including changes in pitch, volume, or quality of sound. They can result from a variety of causes, including vocal misuse or abuse, neurological conditions, structural abnormalities, or psychological factors.
There are several types of voice disorders, each with its own unique characteristics and causes.
Dysphonia: This is a broad term that refers to any disorder
that affects the quality of voice. Dysphonia can result from vocal cord
nodules, polyps, or other structural abnormalities, as well as neurological
conditions, such as Parkinson's disease or multiple sclerosis.
Vocal cord paralysis: This occurs when the nerves that
control the vocal cords are damaged, resulting in weakened or paralyzed vocal
cords. This can cause difficulty speaking, breathiness, and hoarseness.
Spasmodic Dysphonia: This is a neurological disorder that
causes involuntary spasms of the vocal cords, resulting in a strained or
strangled-sounding voice.
Laryngitis: This is an inflammation of the larynx (voice
box) that can cause hoarseness, difficulty speaking, and sometimes a complete
loss of voice.
Puberphonia: This is a disorder in which an adult male
continues to speak with a high-pitched voice, similar to that of a prepubescent
boy. It is usually caused by a failure to develop a deeper voice during
puberty.
Muscle tension dysphonia: This occurs when the muscles used
for speaking become tense or strained, resulting in a strained or hoarse voice.
This can be caused by vocal misuse or abuse, such as yelling or singing
incorrectly.
Benign vocal cord lesions: This refers to non-cancerous
growths on the vocal cords, such as nodules, polyps, or cysts. These can cause
hoarseness, breathiness, and difficulty speaking.
Assessing Voice Disorder
Voice Disorders Assessment
Case History: A comprehensive case history is an essential
part of assessing a voice disorder. It includes gathering information about the
patient's medical history, vocal habits, and current voice use. It also
includes information about the onset, duration, and progression of the voice
disorder.
Perceptual Assessment: A perceptual assessment of voice
quality involves listening to the patient speak and rating the voice quality based on several parameters such as hoarseness, breathiness, strain, and
pitch breaks. This assessment can be done by a speech-language pathologist,
otolaryngologist, or voice specialist.
Acoustic Analysis: An acoustic analysis of the patient's voice can provide objective voice quality measurements. This analysis involves recording the patient's voice and using specialized software to measure several parameters, such as fundamental frequency, jitter, shimmer intensity, and spectral characteristics of their voice
Aerodynamic Assessment: An aerodynamic assessment involves
measuring the pressure and airflow during speech. This assessment can help
determine if there are any underlying respiratory problems that are
contributing to the voice disorder.
Imaging Studies: Imaging studies such as laryngoscopy, video stroboscopy, or CT scan of the larynx may be performed to visualize the
vocal cords and assess any structural abnormalities, such as nodules, polyps,
or tumors.
Patient Self-Assessment: Patients can provide valuable insights into their own voice and the impact of their voice disorder on their quality of life. Self-assessment tools such as the Voice Handicap Index can be used to evaluate the patient's perception of their voice and how it affects their daily activities.
Vocal Fold Assessment
2. Palpation: The examiner uses their fingers to feel the patient's thyroid cartilage and cricoid cartilage for any masses or nodules. They may also palpate the patient's larynx and trachea for any tenderness or masses.
3. Phonation: The patient is asked to speak or sing to assess the quality of their voice. The examiner may also use a tuning fork to assess the patient's voice.
4. Laryngeal Manipulation: The examiner uses a laryngeal mirror or fiberoptic scope to visualize the patient's vocal folds. They may also use a strobe light to observe the movement of the vocal folds during speech or singing.
5. Acoustic Analysis: The patient's speech or singing may be recorded and analyzed to assess the fundamental frequency, intensity, and spectral characteristics of their voice.
6. Aerodynamic Analysis: The examiner may use a pressure transducer to measure the airflow and pressure during speech or singing. This can help to assess the patient's glottal closure and vocal fold vibration.
7. Special Tests: Additional tests such as video stroboscopy, capillary microscopy, or laryngeal electromyography may be performed if necessary.
8. Diagnosis and Treatment: After the examination, the examiner will provide a diagnosis and recommend appropriate treatment options, which may include speech therapy, medication, or surgery.
Conclusion
Assessing and treating voice disorders requires a multidisciplinary approach that involves a team of specialists, including otolaryngologists, speech-language pathologists, and voice specialists. By conducting a thorough assessment and diagnosis, clinicians can develop an individualized treatment plan to help patients improve their voice quality and overall quality of life.
Treatment for voice disorders depends on the underlying cause and severity of the condition. In some cases, simple changes in vocal technique, such as speaking more slowly or taking breaks during speaking, can improve symptoms. In other cases, surgery or medication may be necessary.
It is important to seek treatment for voice disorders, as untreated conditions can lead to further complications, including chronic hoarseness, vocal fatigue, and even loss of voice. If you are experiencing any changes in your voice, such as hoarseness, breathiness, or difficulty speaking, it is important to consult with a healthcare professional who specializes in voice disorders.
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