Dysphonia
Dysphonia refers to a disorder characterized by abnormal voice production due to issues with the vocal folds in the larynx. It can affect both children and adults, but it is more prevalent among adult females and individuals whose professions require extensive voice use, such as teachers and singers. The vocal folds play a crucial role in speech by adducting and abducting to facilitate airflow, and any disruption in this process can lead to symptoms of dysphonia, including hoarseness, breathiness, and intermittent voice breaks.
Common causes of dysphonia include vocal misuse and abuse, often resulting in conditions like laryngitis, vocal nodules, or polyps. Other contributing factors may involve biological conditions such as neuromuscular diseases or neoplastic growths. Treatment options for dysphonia typically depend on the underlying cause and can include voice therapy, injections to increase vocal fold mass, or surgical interventions when less invasive methods are ineffective. Overall, understanding and addressing dysphonia involves recognizing the importance of proper vocal health and the impact of various factors on voice quality.
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Dysphonia
Type of psychology: Biological bases of human behavior; Clinical; Counseling; Developmental; Neuropsychological; School
Voicing is produced when the lungs, diaphragm, abdominal and chest muscles, and ribs create airflow that is pushed through the larynx. In the larynx, the vocal folds vibrate and create a tone. This tone is then passed through the throat, oral cavity, and nasal cavity, where the tone is adapted to produce different speech sounds. A disturbance in the anatomy or physiology of the vocal folds within the laryngeal cavity causes dysphonia, or voice disorder. Dysphonia may be caused by masses on the vocal folds, changes in the consistency of the vocal folds, or changes in the way the vocal folds move. These changes in vocal fold anatomy and physiology become evident through vocal quality.
Background
A voice is created when air from the lungs pushes through the vibrating vocal folds in the larynx and up through the nose and mouth. Any disorder or abnormality in this process is known as dysphonia. Dysphonia may occur in both children and adults. However, voice disorders occur more often in adult females and professionals who frequently use their voice in loud environments such as teachers, coaches, actors, and singers.
The larynx and vocal folds serve a variety of speech and nonspeech functions. The vocal folds adduct, or close, to protect the airway when swallowing. The vocal folds must abduct, or open, in order for air to flow from the lungs and up through the nose and mouth. The vocal folds may quickly adduct and then abduct to protect the airway from foreign materials by coughing. Finally, the vocal folds vibrate at varying speeds and frequencies to produce voicing necessary for speech. A disturbance in the ability for the vocal folds to adduct and abduct will result in an inability to appropriately produce sounds for speech and manifest in dysphonia.
Etiology
The most common cause of dysphonia is vocal misuse and abuse. Laryngitis, or an inflammation of the larynx, may result from vocal abuse. A virus such as a cold or flu, allergies, bacterial infections, or acid reflux may cause laryngitis.
Vocal misuse and abuse can lead to masses such as nodules or polyps to form on one or both vocal folds. Vocal fold nodules are callous-like tissue formations on the outer layer of the vocal folds. They arise from excessive yelling, screaming, or coughing. Nodules often decrease in size or disappear completely with vocal rest. However, surgical intervention can be necessary if nodules remain.
In the same way, polyps are also caused by vocal misuse and abuse. Polyps are blister-like masses that appear on one or both vocal folds. Most polyps are larger than nodules and may require surgical intervention.
Biological factors such as neuromuscular diseases and neoplastic growths impact vocal fold function as well and can lead to dysphonia. Malignant and benign neoplastic growths or tumors present in a similar fashion as a polyp or nodule and may cause pain during phonation. Degenerative diseases such as Parkinson’s disease and dysarthria can lead to weak or paralyzed vocal folds. As the vocal folds weaken or paralyze, they are unable to make contact to produce vibrations needed to formulate a tone.
Presentation
Voice disorders present themselves in the way a speaker’s voice sounds to a listener. Changes to the vocal folds can cause the speaker to produce a lower pitch. Masses on the vocal folds prevent the complete closure that is necessary for phonation. The resulting spaces between vocal folds cause air to pass through and produce a breathy vocal quality. These masses may also lead to irregular vocal fold movements and result in a hoarse voice. Diseases that cause stiffness of the vocal folds will require the speaker to use more effort and pressure when pushing air from the lungs and will manifest in a strident vocal quality. This increase in pressure can also cause abrupt initiations in speech. A change in the structure of the vocal folds, either by mass or stiffness, may also cause intermittent voice breaks or aphonia.
Treatment
Courses of treatment for dysphonia are largely dependent on the source of the problem. There are three major types of intervention for voice disorders: injections, voice therapy, and surgery. Unilateral vocal fold paralysis may be treated by collagen or TeflonTM injections to the paralyzed vocal fold. Injections to the site of immobility will not aid in vocal fold movement but will increase the mass of the vocal fold and allow the functioning vocal fold to make contact for phonation.
Voice therapy with a speech-language pathologist is the least invasive method of treatment for dysphonia. Voice therapy techniques vary based on diagnosis and symptoms but in general will aim to minimize symptoms of dysphonia and implement techniques for appropriate voice production. This form of intervention may also involve lifestyle changes such as periods of vocal rest, decreasing overuse of voice, decreasing excessive throat clearing, eliminating smoking, reducing alcohol intake, and increasing fluid intake.
Surgical intervention is typically the course taken when vocal rest and voice therapy are unsuccessful. Intervention may be recommended in order to remove a mass or tissue, repair laryngeal anatomy, or to reposition the vocal folds.
Bibliography
Amer. Speech-Language-Hearing Assn. “Voice Disorders.” ASHA.org. Amer. Speech-Language-Hearing Assn., 1997–2016. Web. 29 June 2016.
Colton, R.H., Casper, J.K., and Leonard, R. (1996). Understanding Voice Problems ( 3rd ed.). Philadelphia Lippincott Williams & Wilkins.
Kacker, Ashutosh. “Hoarseness.” MedlinePlus. NIH, US Natl. Lib. of Medicine, 24 Nov. 2014. Web. 29 June 2016.
Stinchfield Hawk, Sara. Speech Disorders: A Psychological Study of the Various Defects of Speech. Hoboken: Taylor, 2013. Digital file.
“Voice Disorders.” MedlinePlus. NIH, US Natl. Lib. of Medicine, 20 Apr. 2016. Web. 29 June 2016.