Voice Disorders
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Vocal abuse is any behavior or occurrence that strains or injures the vocal
folds (or vocal cords). This may include excessive talking, throat clearing,
coughing, inhaling irritants, smoking, screaming, or yelling. Vocal misuse
is improper voice usage such as speaking too loudly or at an abnormally high
or low pitch. Frequent vocal abuse and misuse can damage the vocal folds
and cause temporary or permanent changes in vocal function, voice quality,
and possible loss of voice.
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Voice is produced by vibration of the vocal folds. The vocal folds are two
bands of smooth muscle tissue that lie opposite each other. They are located
in the larynx or voice box. The larynx is positioned between the base of
the tongue and the top of the trachea (windpipe), the passageway to the lungs.
When at rest, the vocal folds are open to allow an individual to breathe.
To produce voice, the brain precisely coordinates a series of events. First,
the folds come together in a firm but relaxed way. Once the folds are closed,
air from the lungs passes through them, causing vibration and thus making
sound. The sound from this vibration then travels through the throat, nose,
and mouth (resonating cavities). The size and shape of these cavities, along
with the size and shape of the vocal folds, help to determine voice quality.
Variety within an individual voice is the result of lengthening or shortening,
tensing or relaxing the vocal folds. Moving the cartilages, or soft, flexible
bone-like tissues to which the folds are attached, makes these adjustments
possible. For example, shortening and relaxing the vocal folds makes a deep
voice; lengthening and tensing them produces a high-pitched voice.
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Disorders of vocal abuse and misuse are the most prevalent and preventable
of the types of voice disorders. Anyone, from infants to the elderly, who
uses his or her voice excessively may develop a disorder related to vocal
abuse. Lawyers, teachers, clergy, cheerleaders, and professional voice users
such as singers and actors often develop these types of voice disorders.
Much of the chronic hoarseness experienced by children is caused by vocal
abuse or misuse.
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The most common disorders resulting from vocal abuse and misuse are laryngitis,
vocal nodules, vocal polyps, and contact ulcers. Health professionals who
have training in voice and voice disorders often refer to these conditions
as "hyperfunctional voice disorders."
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Anyone who experiences vocal change or hoarseness for more than 2 weeks
should be examined by a physician, preferably an otolaryngologist (a physician/surgeon
who specializes in diseases of the ears, nose, throat, and head and neck).
While hoarseness is a common symptom of vocal abuse or misuse, it is also
one of the first signs of cancer of the larynx. A physician's visit is especially
important for people who smoke cigarettes, because smoking is closely associated
with laryngeal cancer. The otolaryngologist will examine the individual's
vocal folds and determine if a medical condition is causing the voice problem.
As part of the voice examination, the otolaryngologist will often look directly
at the vocal folds. This may be done by inserting a tiny mirror into the
mouth to the back of the throat (laryngoscopy). The otolaryngologist may
also examine the vocal folds by passing a small camera and light through
the mouth or nose and into the throat (fiberoptic laryngoscopy). This method
is often preferred because it allows viewing of vocal cord movement during
speech.
Following an examination, the otolaryngologist may refer the individual
to a speech-language pathologist, a health professional trained to evaluate
and treat people who have voice, speech, language, or swallowing disorders
that affect their ability to communicate. The speech-language pathologist
will evaluate the pitch, loudness, and quality of the person's voice, and
will also assess vocal techniques such as breathing and style of voicing.
A voice recording is often made, and trial therapy techniques may be used
to test their effectiveness at improving the voice.
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Most disorders of vocal abuse and misuse are reversible. The best treatment
is to identify and eliminate the vocal behavior that created the voice disorder.
In many cases, a brief period of voice therapy is helpful so that the individual
can learn good vocal techniques such as proper breath support for speech
or eliminating forceful voicing.
In some instances, eliminating the abuse or misuse and voice therapy are
not enough. In these cases, medication to block the production of stomach
acid may be helpful. In some cases, an operation may be necessary to remove
growths from the vocal folds. Since most disorders of vocal abuse and misuse
easily recur following surgery if the vocal misuse continues, another period
of voice therapy by a speech-language pathologist after surgery may help
prevent recurrence of the problem.
Children with disorders of vocal abuse and misuse are often the most difficult
to treat because it is not easy for them to change their vocal behaviors.
Fortunately, most children outgrow these disorders by the time they are teenagers.
For these reasons, many surgeons do not operate on children who have disorders
of vocal abuse or misuse. A period of voice therapy, however, may help the
child to learn proper voice behaviors.
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Scientists are examining a multitude of issues related to vocal abuse and
misuse. They are conducting in-depth studies of the tissues of the vocal
folds to determine how various types of stress affect these delicate tissues.
Scientists are especially interested in determining why vocal behaviors in
some individuals lead to vocal nodules while similar behaviors in other individuals
may lead to mild laryngitis, vocal polyps, or little or no voice change.
They are also examining the tissue changes necessary for the development
of laryngeal growths such as nodules and polyps, as well as laryngeal cancer,
and how various treatments reverse those tissue changes. Speech-language
pathologists are studying the effectiveness of behavioral techniques including
use of machines to help people relearn proper vocal techniques such as good
breath support or efficient use of the larynx. Studies that will improve
the treatment of hyperfunctional voice disorders in children are also in
progress. Of special interest is the long-term impact of various treatments,
especially medical and surgical treatments.
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American Academy of Otolaryngology-Head
and Neck Surgery (AAO-HNS)
American Laryngological
Association (for professionals)
American Speech-Language-HearingAssociation
Voice Foundation
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