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Voice Therapy

What is a Voice Disorder?

Every time we use our voices to vocalize, speak, or sing, our vocal cords (made of muscle tissue) are coming together in a vibratory manner. Since we use our vocal cords daily, it is common that these muscles may become injured or strained. Like other muscles in our bodies, our vocal cords may not adequately function if they are injured, thus creating a voice disorder. If we are experiencing a problem with our voice, it is possible that we are causing "vocal abuse" to our cords without being aware of it.


Voice Therapy

Vocal Abuse

Vocal abuse may cause bruising or swelling of one or both vocal folds. It occurs when we injure or improperly use our vocal cords. Possible incidents may include excessive talking, screaming, yelling, whispering, throat clearing and use of improper vocal pitch. This can relate to children as well as adults. Additionally, abuse may be caused by smoking or inhaling irritants, excessive intake of alcohol or caffeine, or not addressing issues of acid reflux.

Polyps and Nodules

The bruising and swelling created by vocal abuse can result in polyps or nodules. Vocal cord nodules are noncancerous callous-like growths on both vocal cords that may become larger and stiffer over time as long as the vocal abuse continues. Polyps are similar to but different from nodules. They are typically present on one vocal cord and look like blisters or bumps.

Nodules and polyps can cause pain, irritation, and excess phlegm to build up on the vocal cords, resulting in frequent throat clearing and coughing. Nodules can cause the voice to sound raspy, hoarse, harsh, breathy, aphonic (without voice) or may reduce vocal pitch range. Additionally, vocal cords are susceptible to infections, viruses, cancer, and other diseases that can cause various vocal pathologies. 

Vocal Cord Paralysis

Vocal cord paralysis occurs when one or both of the vocal cords are unable to move. This directly affects the function of the voice and has the potential to cause breathing and/or swallowing problems. Paralysis can occur bilaterally or unilaterally. Bilateral vocal cord paralysis occurs when the two vocal cords are unable to move in either direction and are stationary between the open and closed or "paramedian" position. Becuase the vocal cords are unable to vibrate against each other; the result is aphonia or no voicing. A person with bilateral vocal cord paralysis, however, may be able to use their false vocal folds to create a whispering sound. Unilateral vocal cord paralysis is more prevalent than bilateral. This occurs when only one vocal cord is paralyzed or limited in mobility with an abnormal vibration pattern. The result is reduced vocal volume, clarity, and air pressure for adequate speech.

Paradoxical Vocal Fold Movement(PVFM)

This vocal fold movement is episodic in nature. A patient with paradoxical vocal fold movement will experience typical vocal fold movement for adequate speech and then a sudden spasm-like closure of their vocal cords. This vocal cord closure will occur when they should be in an open position, for example when breathing. The result of this vocal cord movement is a loss of ability to breathe or speak for a short period. This can sometimes lead to anxiety, panic attacks, or fainting.

Spasmodic Dysphonia

This chronic voice disorder causes the vocal cords to vibrate against each other in forceful spasms that continuously pervade the flow of speech. Short durations of alternating aphonia or vocal spasms may occur, resulting in a choppy, jerky, quivery voice which sometimes sounds as though a person is groaning and straining to speak. Speech therapy for spasmodic dysphonia addresses the behavioral aspects of this voice disorder along with proper breath support for optimal voicing, amongst various other treatment techniques.


Citations

"Vocal Cord Nodules and Polyps." Vocal Cord Nodules and Polyps. Accessed April 17, 2015. http://www.asha.org/public/speech/disorders/NodulesPolyps/#a.

"Voice Disorders." Voice Disorders. Accessed April 17, 2015. http://www.asha.org/public/speech/disorders/voice/.

"Vocal Cord Paralysis." Vocal Cord Paralysis. Accessed April 17, 2015. http://www.asha.org/public/speech/disorders/vfparalysis/#_ga=1.40459431

"Voice Disorders." Voice Disorders. Accessed April 17, 2015. http://www.asha.org/public/speech/disorders/voice/.

"Voice Disorders: MedlinePlus." U.S National Library of Medicine. Accessed April 17, 2015. http://www.nlm.nih.gov/medlineplus/voicedisorders.html.