Communication Disorders - Voice Disorders

Voice Disorders

Voice is generated by airflow from the lungs as the vocal folds are brought close together. The vocal folds vibrate when air is pushed past them with sufficient pressure. Without normal vibration of the vocal folds in the larynx (voice box), the sound of speech is absent. To produce a whisper, the vocal folds need to be partially separated. A voice disorder is characterized by a non typical, and unpleasant quality of voice. It can be excessively harsh, breathy, hoarse, or abnormal pitch, or loudness, given age and gender.

There are many reasons why children and adults have voice disorders. One of the most common causes of vocal problems is called "vocal abuse." Prolonged vocal abuse can result in "vocal nodules" which is a growth on the vocal chords. Some children have allergies, sinus, and adenoid problems which affect their vocal quality. While decongestants and antihistamines can dry out the vocal chords, they can also cause voice problems in children.

Shouting is the primary way in which children abuse their voices. Typically, children yell from room to room in the house and scream to each other on the playground. At times, they make funny noises or imitations of character voices. Children who are excessive talkers may experience inadequate breath supply and support, causing them to push down harder on the vocal folds to complete lengthy utterances. All of these behaviors — shouting, screaming, yelling, excessive talking — are used by children to get the attention of playmates, siblings, parents and teachers. However, these behaviors can result in serious vocal abuse problems.

A voice is considered normal when its loudness, pitch and quality suit a particular person and meet his or her communication needs. Voice problems arise when the loudness, pitch or quality of the voice overshadows what the person is saying. Pain or discomfort while speaking or singing may also signal a voice problem. The vocal fold may become paralyzed as the result of an injury. Improper breathing patterns may also cause voice problems, as can excessive smoking.

Causes

Some of the causes of voice disorders are:

Juvenile Papilloma is the most common childhood disease of the larynx. Wart-like growths can grow on the vocal folds or elsewhere in the airway. They must be surgically removed if they interfere with breathing or voice production.
Vocal Nodules are caused by abuse of the vocal folds and are the result of a thickening at a specific spot. When a node develops on one fold, there is often an irritation at the same site on the other vocal fold. As the nodes thicken, the person's pitch becomes lower. The voice may also be breathy or hoarse. Most vocal nodules will disappear with proper voice therapy, but in some cases surgery is necessary.
Laryngeal Webbing is a membrane that can grow between the vocal folds. This not only affects how a person speaks, but it can also block the airway. Patients with laryngeal webbing may exhibit shortness of breath and hoarseness. Their voices also may become more higher pitched than usual. The webbing must be surgically removed, followed by voice therapy.
Granuloma is a growth that occurs as a result of trauma to the vocal area. For example, if a tube is inserted into a patient's throat, the surrounding membranes of the vocal folds may become torn. The damaged tissue can then become a large growth, which may cause problems with breathing. These growths should be surgically removed.
Trauma to the cartilage in the larynx may cause it to be fractured or displaced, requiring surgical reconstruction. Although the first priority is to clear the airway, the voice also will need attention and therapy will most likely be necessary. The voice from the newly reconstructed larynx will typically be low pitched with a breathy quality.
Nasality may be caused by a structural or functional problem with the roof of the mouth, or palate. Nasality may result from clefts of the palate; related craniofacial anomalies, such as Pierre-Robin and Treacher Collins syndromes; neurological diseases, such as cerebral palsy; or simple functional problems. Denasality may result from the blockage of air through the nasal passages.