Click on a voice disorder title to watch a video about the pathology.
Spasmonic DysphoniaDescription and Etiology
-A neurological voice disorder -A focal laryngeal dystonia of unknown origin. (Laryngeal dystonia refers to abnormal muscle tone that display jerking movements of the laryngeal area.) -There are three types of SD: -Abductor SD uncontrollable opening (abduction) of the vocal folds when voice is used results in an excessively breathy and irregular voice quality -Adductor SD frequent and irregular closure of the vocal folds results in a strained or strangled voice quality -Mixed SD when individuals experience both types of SD -Nearly 80% of females are diagnosed with SD typically in their 40s. **Etiology is unknown. Perceptual Signs and Symptoms -Abductor SD voice quality is weak and breathy with spasms during abduction -sounds like voice is being stopped, typically heard when a sound is prolonged -Adductor SD voice quality is strained with spasms during adduction -sounds like voice is being stopped, typically heard when a sound is prolonged -Delayed onset of voicing can also display these characteristics. -SD may affect overall speech intelligibility and communication effectiveness. Visual Assessment -Abductor SD -The spasms in the laryngeal area move the vocal folds to an opened position when they should be in a closed position. -Adductor SD -The spasms in the laryngeal area move the vocal folds to a closed position when they should be in an opened position. The spasms only occurring when voicing is happening, they are not observed when the vocal folds are at rest. Management Botulinum Toxin -Botox injection into the laryngeal muscles -For adductor SD, Botox is injected unilaterally or bilaterally into the muscle that is primarily associated with voice spams in the adductor phases of the vocal folds. -The unilateral technique is beneficial in minimizing side effects of ADSD such as breathiness and hoarseness of the voice. -The injection of Botox stops the release of a chemical called acetylcholine into the nerve supply of the muscle, which reduces the ADSD symptoms. Voice Therapy -Low risk and low-cost treatment for SD. -Behavioral treatments help in the management of ADSD. -Typically resulted in improvement of vocal symptoms through voicing behaviors such as, whispering, use of breathy voice, coughing, throat clearing, singing, humming, or changing pitch. |
Vocal Fold EdemaDescription and Etiology -Buildup of fluid in the outermost (superficial) layer of the vocal fold. -Reinke’s edema is also known as polypoid degeneration, diffuse polyposis, or polypoid degeneration. -The superficial layer is filled with thick fluid that is due to frequent trauma, exposure to cigarette smoke, or stomach acids as a results of laryngopharyngeal reflux. -The extreme form of edema is often called polypoid degeneration. Perceptual Signs and Symptoms -Gravelly, lowered pitch and different degrees of hoarseness are observed. -Characteristics may be due to an increase in vocal fold mass. -Most noticeable in women and may be overlooked in males because lower pitched voices are more common amongst males. -Reinke’s edema can become large enough to cause dyspnea, which is breathlessness caused by the impairment of the opening of the airway. -Dyspnea also occurs during vigorous exercise activities, but also affects breathing at rest, contributing to sleep apnea. Visual Assessment -Swelling in both vocal folds along the entire length, can also be seen on one side only. -Stiffness of the vocal fold can be seen. -Vibratory movement patterns of the vocal fold are affected. -Left vs. right vocal fold movements do not match -Glottal closure is complete. -Horizontal vibratory amplitude is reduced. -Looks like a water balloon on the vocal fold. Management -If edema were due to smoking, the first step would be to quit smoking. -Depending on the individual, smoking may be reduced or decreased per day rather than quitting cold-turkey to help implement a strict vocal hygiene program. -Advanced cases will often not respond to these strategies. -phonosurgical treatment -individual should stop smoking prior to the surgery. -phonosurgical procedures include: -longitudinal incision -removal of edema by using suction -resection of surplus vocal fold mucosa -phonosurgical treatment is a highly significant procedure that leads to a good prognosis for individuals with edema. -Behavioral Therapies and Vocal Hygiene Education, used to teach patients to use thier voices safely, are also highly benefical |
Vocal Fold HemorrhageDescription and Etiology
-Damage to vocal folds caused by exposure to blood from small blood vessels Perceptual Signs and Symptoms -This can have a wide range of effects on voice quality, ranging from aphonia (no voice) to dysphonia (characterized by a hoarseness). Causes: -Trauma from medial procedures and surgery -Extended periods of high intensity voice use -Excessive crying -Some blood thinners may increase risk of vocal fold hemorrhages occurring Visual assessments will typically show: -Patchy areas of redness on the vocal folds -Impaired vibration of the vocal folds Management -Rest your voice (vocal rest) -Surgery -Behavioral Therapy -Vocal Hygiene Education |
NodulesDescription and Etiology -Nodules are the most common vocal fold pathology -They are benign lesions -Common in women, children, singers, teachers, and other individual’s who often use their voice for extended periods of time Perceptual Signs and Symptoms -Raspy voice -Breathy voice -Increased respiratory effort Causes: -Yelling/screaming -Throat clearing -Coughing -Talking too much -Talking too loud Visual assessments will typically show: -Inflammation -Both right and left vocal folds may be affected -Hourglass shaped glottal closure pattern -Increase in mass of vocal folds -Increase in stiffness of vocal folds Types: -Acute –Acute nodules are gelatinous in appearance and typically caused by over use of the vocal folds or a traumatic event. -Chronic – Chronic nodules appear callous-like and firm. -Reactive nodular change – A reactive nodular change occurs when an individual has had a previous lesion (such as a vocal polyp) that affects the vocal fold and leads into a nodule. How to manage the disorder: -Behavioral voice therapy -Medical therapy -Surgery (as a last resort) |
Sapienza, C., & Hoffman, R.B. (2009). Voice Disorders. San Diego, CA: Plural Publishing, Inc.