This document discusses various disorders of voice and speech. It defines phonation and its components, and describes different types of speech and language disorders including fluency disorders like stuttering, articulation disorders, and voice disorders affecting pitch, quality and loudness. It then examines specific voice disorders in more detail such as hoarseness, dysphonia, puberphonia, spasmodic dysphonia, and their causes, evaluations, and treatments.
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Disorders of voice, dr.sithanandha kumar, 19.09.2016
1. Disorders of voice
Dr .Sithananda kumar @ venkatesan . R
Assistant Professor
Department of ENT
MGMC&RI
2. Definition
•Vocalization means producing sound, preferably
on an emotional level
•Phonation is sound production with the aim of
communicating by speech or singing
•Voice production involves interaction between
the respiratory system, larynx, vocal tract,
articulatory organs, and cerebral coordination
3. Components of phonatory
apparatus
• Activator( power source) - lungs and respiratory muscles
• Generator ( of voice)– vocal cords
• Resonator – vocal tract( supraglottic , pharyngeal passages)
• Articulator – palate , tongue , lips , teeth
• The coordination of phonation originates in two centers
in the brain—the limbic system and the primary motor
area of cortex
22. Hoarseness
• Any change in voice quality from harsh, rough or raspy voice to
weak voice is usually referred as hoarseness
• Hoarseness results from variations of periodicity and/or
intensity of consecutive sound waves
• For production of normal voice, vocal cords should:
a. Be able to approximate properly with each other.
b. Have a proper size and stiffness.
c. Have an ability to vibrate regularly in response to air
column.
23. Causes of hoarseness
Loss of approximation
Increase / decrease in size/ thickness of the cord
Increase / decrease in Stiffness
25. Dysphonia Plica ventricularis
• voice production by ventricular folds (false cords)
• False cords take over the function of true cords
• Voice is rough, low-pitched and unpleasant
• Ventricular voice may be secondary to impaired
function of the true cord such as paralysis, fixation,
surgical excision or tumors
• Ventricular bands in these situations try to compensate
or assume phonatory function of true cords.
26. • Functional type of ventricular dysphonia
occurs in normal larynx
• psychogenic
• In this type, voice begins normally but soon
becomes rough when false cords usurp the
function of true cords
• Treatment – speech therapy
27. Puberphonia
• Also called mutational falsetto voice
• Failure in the change of childhood high-pitched voice
to low- pitched male voice after puberty in boys is
called puberphonia
• The boy’s physical and sexual development is normal
• Seen in boys who are emotionally immature, feel
insecure and show excessive fixation to their mother
28. • Until puberty, the larynx of male and female have
identical dimensions
• Childhood voice has higher pitch.
• After puberty, male larynx grows rapidly with
increase in length of Rima glottides
• The vocal cords lengthen which brings change in
character of male voice (voice becomes lower
pitch).
29. • Gutzmann’s pressure test-Pressing the
thyroid prominence in a backward and
downward direction relaxes the
overstretched cords and low tone voice can
be produced
• Treatment – speech therapy
30. Phonaesthenia
• Weakness of voice
• Fatigue of phonatory muscles
• Thyroarytenoid and interarytenoids or both may be
affected
• Seen in abuse or misuse of voice or following
laryngitis. Patient complains of easy fatigability of
voice
32. Functional aphonia
• Also called hysterical aphonia
• Functional disorder is usually seen in emotionally
labile young females.
• Sudden onset aphonia
• Not associated with other laryngeal symptoms.
• Patient is usually able to whisper
33. • Vocal cords are seen in abducted position and fail
to adduct on phonation
• Adduction of vocal cords can be seen on
coughing, indicating normal adductor function
• Sound of cough is good
• Treatment given is to reassure the patient of
normal laryngeal function and psychotherapy
34. Spasmodic dysphonia
• Neurologic disorder of unknown origin that
causes vocal fold spasms during speech
• The spasms result in either excessive glottal
closure or prolonged lateralization of the vocal
folds, causing vocal breaks
• The disease was first described by Traube in
1871
• Three types-adductor, abductor and mixed
35. • Spasmodic dysphonia are focal dystonia that affects
laryngeal muscle control during speech
• Dystonia refers to a syndrome of sustained muscle
contraction
• Focal dystonia involve abnormal activity in only a few
localized muscles
36. • More common in females
• Common between 2nd
to 9th
decade
• The typical age at onset is 39 to 45 years
• Adductor SD occurs in 82%of patients,
whereas 17%have abductor SD
37. • Stuttering can be prevented by proper education
of the parents, not to overreact to child’s
dysfluency in early stages of speech development
• Treatment of an established stutterer is speech
therapy and psychotherapy to improve his image
as a speaker and reduce his fear of dysfluency.
38. Adductor spasmodic dysphonia
• Voice breaks are due to spasmodic hyper
adduction of the vocal folds that interrupt
phonation
• Vocal fold closure interrupts phonation, causing a
strained or strangled vocal quality with
intermittent vocal break
• In adductor SD, the Thyroarytenoid and lateral
cricoarytenoid muscle spasm predominate
39. Abductor spasmodic dysphonia
• Voice breaks are due to spasmodic hyper abduction
of the vocal folds that interrupt phonation
• Patients have prolonged breathy voiceless breaks
• Pitch changes and uncontrolled rises in vowel
fundamental frequency may make them sound as if
they are on the verge of crying
• In abductor SD, the posterior cricoarytenoid muscles
predominate
41. Treatment
• Botulinum toxin injections are the current
treatment of choice
• Their effect is temporary ( onset of action in
72hrs)and injections must be repeated
approximately every 3 months
• Contra indicated in pregnancy , along with
aminoglycosides and neurological disorders like
myasthenia gravis
42.
43. • Botulinum toxin is produced by Clostridium
Botulinum
• Causes a chemical denervation by splicing
fusion proteins (SNAP [soluble NSF attachment
protein]-25, syntaxin, synaptobrevin) and
blocking the release of acetylcholine at the
synaptic junction
• Botulinum toxin must be injected directly into the
muscle, the Thyroarytenoid for adductor SD and
the posterior cricoarytenoid for abductor SD
44.
45. STUTTERING
• Disorder of fluency of speech
• Consists of hesitation to start, repetitions, prolongations or
blocks in the flow of speech
• Stutterer may develop secondary mannerisms such as
facial grimacing, eye blink and abnormal head
movements
• Normally, most of the children have dysfluency of speech
between 2 and 4 years
46. Rhinolalia clausa
• Hyponasal voice
• Lack of nasal resonance for words which
are resonated in the nasal cavity, e.g. m, n,
ng
• Due to blockage of the nose or
nasopharynx
47. Rhinolalia aperta
• Hyper nasal voice
• words which have little nasal resonance
are resonated through nose
• The defect is in failure of the nasopharynx
to cut off from oropharynx or abnormal
communication between the oral and nasal
cavities.
48.
49. Hot potato voice
• Also called muffed voice
• Due to obstruction in the glottal tract above the
level of vocal cords
• Peritonsillitis/ abscess
• Hypertrophied lingual tonsil / lingual thyroid
• Growth posterior one third of tongue
• Vallecular cyst
• Acute epiglottitis / epiglottic malignancy
• Retropharyngeal abscess
50. Mogiphonia
• Phonic spasm
• Professional neuroses seen in singers ,teachers and
clergyman
• Initially the voice is normal but soon the vocal cords get
adducted and the person cannot speak
• The treatment is vocal rest, speech therapy
• Treatment of the underlying psychoneurotic problem.
