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Intro to voice+ disorders (2) (Voice quality (Subjective but concerned…
Intro to voice+ disorders (2)
Intensity control
Sound pressure lvl of acoustic output (dB)=loudness
Determined by
Increasing subglottal pressure=increased loudness bcos longer vibratory phase closure pattern (in mucosal wave), larger amplitude of vibration
VF vibratory phase
Transglottal flow=amt of air, rate of airflow b/w VF
Supraglottic vocal tract tuning=how all structures above VF manipulate sound produced eg. lips, tongue, resonators, soft palate
Voice quality
Subjective but concerned about healthiness
Affected by integrity of VF vibration
Filtering char of supraglottic tract will enhance (SP's role), detract from perceived VQ
Defn: Compliant, symmetric biomechanic properties of VFs + enough, consistent subglottic pressure, flow source + appropriate vocal tract tuning chars, need requisite respiratory vol.
Incidence of voice disorders
Age, gender
More common in older ages
Young females > males
Vocal nodules, oedema more common in early adulthood
Nodules
More freq in males <14 y/o bcos of rowdy play
More common in mothers bcos yelling
Occupation
Teachers, singers, nurses, fitness instructors
Examples (most to least common)
Vocal nodules, oedema, polyps, carcinoma, VF paralysis, dysphonia w/o pathollogy (anat normal but voice X)
Aetiology of voice disorders
VF show structural abnormalities
VFs delicate bcos vulnerable to stress
Uneven vibrating edges on VF (bcos of tumour, polyps, cyst) --> poor adduction VF --> air wastage, poor quality (breathiness, hoarseness)
Causes
Inappropriate voice use eg. habitual, non-productive throat clearing (continue coughing as habit after laryngitis), shouting, strange vocal noises
Infection, disease eg. papillomatosis, laryngitis, GI reflux (mucosal, structural change to VF)
Systemic changes eg. dehydration, pharmaco agents, hormones
Congenital eg. cleft palate, laryngeal web
Physical trauma eg. intubation injury (rubbing, ulceration, granulation VF), penetrating trauma
Surface irritation eg. smoking
Structure normal, fn abnormal
Disorders of CNS eg. dysarthria
Disorders of PNS (nerves, ganglia) eg. RLN paralysis, VF paralysis
Hyperfunctional disorders eg. muscle tension dysphonia
Normal structure & fn
Hearing loss, poor auditory feedback- affects perception of vol, pitch, articulation
Mismatch b/w modal range, gender eg. transgender men, women
Classification of voice disorders
Functional (Primary)
Psychogenic, muscle tension--> cause problem in voice fn
Caused by psychoneuroses, personality disorder, faulty habits of voice use, using voice in unhealthy way
Phonotrauma, psychological causes
Eg. functional dysphonia, muscle tension dysphonia, VF thickening, vocal nodules, poylps, Reinke's oedema, chronic laryngitis, ventricular dysphonia
Organic (Secondary)
Body producing this w/o your control
Structural abnormality in vocal tract
Eg. vocal process granuloma (contact ulcer), intubation granuloma, leukoplakia, cancer, laryngeal web, infectious laryngitis, papillomatosis, VF cyst
Neurological
Neurological problems of VF adduction eg. VF paralysis, spasmodic dysphonia
Voice problems associated w neurological disease eg. Parkinson's' disease (reduced vol), multiple sclerosis, stroke, Huntington's disease, motor neuron disease
Defn: imbalance in coordination of neurological structures, processes invl in normal voice
Limitations w classification
May have one/several causes
Eg. vocal abuse
repeated impact of tense VF that causes observable changes in VF mucosa
Growth of vocal nodules--> Prevent full adduction VF--> air wastage, hoarseness--> change VQ--> anxious--> more tension-->compensate for breathy voice w more vocal effort--> worsen organic condition
Starts as organic but becomes fnal bcos of vocal misuse