Signs and symptoms of voice disorders

Question 1

What is a voice disorder?

Answer 1

A voice disorder exists when quality, pitch, loudness, or flexibility differs from the voices of others of similar age, sex, & cultural group

Question 2

Prevalence of voice disorders

Answer 2

Most common are vocal nodule (21%) and oedema (14%) and polyps (11.4%)
More common in older groups.
More common in young females than males.
Early adulthood - nodules and oedema
Males under 14 - nodules
Females 25-44 nodules
More common in teachers, singers, managers, nurses, secreteries

Question 3

Sign VS symptoms

Answer 3

Symtoms:
Reported by the patient.
Subjective experiences
Represent a departure from normal function
Not measured
May be misleading

Signs:
Objective indication of some fact or characteristic detected by the clinician.
Observed or tested

Both represent abnormal function and are relevent!

Question 4

Symptoms of VD

Answer 4

Vocal fatigue
Hoarseness
Breathiness
Reduced phonational range
Aphonia
Pitch breaks
Strangled voice
Tremor
Pain and other sensations

Question 5

Four areas of signs

Answer 5

Perceptual
Acousitc
Laryngoscopic
Physiological

Question 6

Perceptual signs:

Answer 6

Pitch - monopitch, inappropriat pitch, pitch breaks, reduced pitch range
Loudness - monoloudness, inappropriate loudness, Quality - hoarseness (reduced clarity, more noise), breathiness, tension, tremor, strain/struggle behaviour, sudden interruptions, diplophonia
Other behaviours - stridor, excessive throat clearning
Aphonia - consistent (perceived as whisper) and episodic (involuntary)

Question 7

Acoustic signs

Answer 7

Abnormal frequency:
- Fo males 100-150Hz and females 180-250Hz
- Frequency variability (SD of Fo)
- phonational range
- Perturbation - jitter (irreg. vibration of VF)
Inappropirate amplitude:
- Strength of tone produced by VF (SLP convo level 75-80dB)
- Amplitude variability - SD of dB
Dynamic range - range of ludness
- Pertubation - shimmer (amplitude variation)
Spectral noise:
- Signal-to-noise ratio (normal is low noise)
- Random aperiodic energy in voice
Abnormal rise and fall times:
- Ability of VF to start and stop vibrating
- Rise time - time to produce tone full amplitude
- Fall time - time to stop producing tone
Maximum phonatory duration
- Reuced in relation to norms
- s/z ratio (phonating /s/ vs /z/) - normal is 0.4 - 2.0
- Vocal pathology s/z ratio of >1.4
Voice tremor
- Regular vibration in Fo or amplitude
- 3-5 Hz around mean Fo
- Associated with CNS problem
- Presence of longer voice stoppages
- Observed in spectogram
- Frequency breaks - sudden shifts of Fo

Question 8

Physiological signs

Answer 8

Abnormal aerodynamics
- Airflow - normal is 0.5 - 2.0 1/sec
- Subglottal pressure- normal is 2-9cm H2O
- Abnormal vibratory patterns
- info re: opening and closing phases of vibratory cycles
Muscle activity
- Electrical activity - severe high or low background activity
- slow to turn on or off
- sudden upexpected bursts

Question 9

Laryngoscopic signs

Answer 9

• Impaired vocal fold approximation
• Abnormal VF movement
• Tissue changes
• Abnormal dimensions
• Use of ventricular folds
• Anatomical abnoramlities
• Abnormal layngeal position
• Involuntary laryngeal activity

Question 10

Aetiology of voice disorders (3 general conditions)

Answer 10

1. Structural abnormalities
2. Structure normal but function abnormal
3. Normal structure and function

Question 11

Structural abnormalites in VF- description and causes

Answer 11

As VF are vunerable to stresses it can result in tissue reactions or changes.
Uneven vibrating edges on the VFs leads to adduction, air wastage and poor quality.
Causes:
- Inappropriate voice use
- Infection
- Physical trauma
- Substance irritants

Question 12

Structure normal but function abnormal - causes

Answer 12

Disorders of CNS eg. dysarthria

Disorders of PNS eg. RLN paralysis

Question 13

Normal structure and functioning - causes

Answer 13

Dysphonia - functional, psychogenic
Hearing loss - potential for normal voice, poor auditory feedback
Transsexualism - mismatch between

Question 14

Why is the classification of VD difficult/important? What are the three areas of classification?

Answer 14

Useful for communicating among professionals and patients.
Dilemma due to predisposing, precipitating and maintaining factors.
Diverse teminology
Useful for planning management - need to identify cause.
Classifications:
Functional
Organic
Neurological

Question 15

What is a functional voice disorder?

Answer 15

Caused by misuse and abuse, personality disorder and faulty habits of vocal use.
Examples:
Functional dysphonia
Muscle tension dysphonia
VF thickening
Nodules, polyps, reinke's oedema
Chronia laryngitis
Ventricular dysphonia

Question 16

What is an organic voice disorder?

Answer 16

A structural abnormality in the vocal tract.
Examples:
Vocal process granuloma (contact
ulcer)
Intubation granuloma
Leukoplakia
Cancer
Infectious laryngitis
Endocrine changes
Papilloma
Laryngeal web
Vocal fold cyst

Question 17

What is a neurological voice disorder?

Answer 17

An imbalance in the coordination and neurological structures and processes involved in normal voice.
2 types
1. Neurological problems of VF adduction e.g. VF paralysis, spasmodic dysphonia
2. Voice problems associated with neurological disease e.g. PD, MS, ALS, CVA, HD

Question 18

What are the limitations of classifying a VD as functional or organic?

Answer 18

Possibility of both features to be present
The way structures are USED may change the structures themselves
Some laryngeal structures place constraints on voice use
No complete differentiation between two - can be complex interaction