Voice disorders for students2..... (2).ppt

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1. Voice disorders
Dr Firas Al-Hameed
M.B.Ch.B C.A.B.S MRCS (ENT) (England)
Thi-Qar Medical School

2. Voice production
•A power source (lungs)
•A vibrating source (vocal folds, or larynx)
•Anatomy to modify the sound (throat, mouth, nasal passages, tongue, soft palate, lips and teeth)
•The resonators produce a person’s recognizable voice.
•The articulators produce recognizable words.

3. •Functional voice disorders
•Organic voice disorders
•Neurogenic voice disorders
Voice disorders

4. •Voice disorders that are characterized as dysphonia in the
setting of normal vocal fold anatomy and movement.
•Puts too much effort” into his or her voice as a result of physical
or emotional stress or as a compensation for laryngitis.
•Muscle tension dysphonia
•Psychogenic voice disorders
Functional voice disorder

5. •Persistent dysphonia
•Results from excessive laryngeal and related musculoskeletal
tension and associated hyperfunctional true and/or false vocal
fold vibratory patterns
•More common in females
•Pain is often reported in the neck, jaw, and shoulders
Muscle Tension Dysphonia (MTD)

6. Dysphonia plicae
ventricularis
Phonation using false vocal
fold vibration rather than
true vocal fold vibration.
•MTD most commonly

•Occasionally may be an
appropriate compensation
for profound true vocal fold
dysfunction.
Ventricular dysphonia
Low-pitch
Monotonous
Quite hoarse and may also be breathy.
Diplophonia ( hear two voices at once)

7. •Inappropriate persistence of higher-pitched prepubertal voice long
after puberty and normal voice change.
•Males
•Unknown etiology
•Emotional stress
•Delayed development of secondary sexual characters
•Non fusion of thyroid lamina
•Psychogenic
Puberphonia
(mutational falsetto)

8. •Patient speaks in a whisper but continues speaking with the same
rhythm .
•Vocal cords movement with:
•Ah
•Cough
•Swallowing
Functional Aphonia

9. Organic voice disorders

10. Vocal Fold Nodules
•Aetiology:
•Sub-epithelial thickening gives rise to swellings.
•long-term vocal abuse. children and amateur actors and
singers
•Position: The junction of the anterior third and the
posterior two-thirds. Why?
•Features:
•The voice to sound rough and breathy in quality. They
may start the day with fairly good voices that become
increasingly dysphonic with continuous vocal usage.
•Treatment: speech therapy
Surgery

11. Vocal cord polyps
•Aetiology:
•Physical trauma (voice abuse, chronic cough), Sudden onset
of hoarseness after single episode of voice abuse
•Chemical trauma (laryngopharyngeal reflux, smoking and
alcohol)
•Infection and inflammations
•Allergy
•Features:
•Hoarseness with vocal strain and sore throat
•Hemorrhagic with evidence of recent hematoma formation.
•Sessile or pedunculated
• maybe difficult to see because they sometimes hang down
on their stalk to sit below the cords
•Treatment:
•Microphonosurgery.

12. Vocal cord granuloma
•Aetiology:
•Inflammation of the arytenoid cartilage
(perichondritis)
•Intubation trauma or excessive
coughing
•Features:
•Throat irritation, unilateral laryngeal pain
•Quite a minimal effect on the voice.
•Unilateral
•Reflux is a commonly associated feature.
•Treatment
•Speech therapy
•Treatment of acid reflux
•Surgical excision

13. Reinke’s Oedema (Polypoid Degeneration)
•Aetiology:
•Chronic exposure to cigarette smoke can result in an
accumulation of thick fluid in Reinke’s space.
•Features:
•Rough voice and low pitch.
•Female patients are frequently mistaken for men on
the telephone.
•Treatment:
•Cessation of smoking is mandatory
•Voice therapy
•Surgery is reserved for late cases.
•Recurrence

14. Laryngeal papillomatosis (recurrent respiratory
papillomatosis)
•Aetiology:
•Caused by Human Papilloma Virus
(HPV) types 6 and 11.
•Features:
•Hoarseness due to irregularity of
the vocal fold surfaces
•Airway compromise
•Treatment:
•Repeated excision, but the
papillomata invariably recur.
Risk of malignant transformation
(1-4%) , HPV 16 & 18

15. Laryngopharyngeal reflux (LPR)
•Typical reflux symptoms of dyspepsia, heartburn , belching, throat
clearing, feeling of something in the throat, dysphagia, voice change,
and cough. Sudden coughing or chocking spasm at night
•Treatment:
•Reduce intake of dairy products; acidic, spicy or fried food; and fizzy drinks.
•Proton pump inhibitors (PPIs)
•Alginates: reduce nonacid reflux (e.g., pepsin).

16. Infective Laryngitis
•Signs and symptoms
•Hoarse voice
•Pain on speaking and swallowing
•Malaise
•Slight pyrexia
•Reddened and swollen vocal cords.
•Viral : hoarseness and pain that lasts for a few days
•Bacterial: more pronounced and longer-lasting symptoms
Treatment:
•Self-limiting
•Supportive therapy :
•voice rest simple analgesia steam inhalations
•well hydration avoid alcoholic beverages Reduce intake of tea and coffee
•Simple cough suppressants

17. Fungal laryngitis:
•Features:
•Painless voice change; laryngeal examination will usually show plaques (or
scattered small deposits) of Candida around the larynx
•Risk factors:
•Steroid inhalers (advise patients to gargle after using their inhalers)
•Systemic steroids
•Immunodeficiency
•Treatment:
•Short course of antifungals

18. •Mucosal white patch that cannot
be easily scraped off.
•Leukoplakia of vocal cord
represents a chronic inflammation
or exposure to
•Has a malignant transformation
tendency
•Symptoms:
•Hoarseness
•Throat discomfort
•Sore throat
•Irritating cough
The vocal fold leukoplakia/ erythroplakia

19. •Spasmodic dysphonia
•Vocal cord paralysis/ paresis
•Stroke
•Traumatic brain injury
•Parkinson, multiple sclerosis, mysthenia gravis,….
Neurogenic voice disorders

20. Neuromuscular Conditions
•Spasmodic Dysphonia
•Focal dystonia affecting muscle groups of the larynx supplied by the RLN.
•Adductor spasmodic dysphonia (ADSD) is the most common variety and is
characterized by strained and strangulated voice, abrupt cessations in the
flow of speech
•Abductor SD: The flow of the voice is broken up by breathy pauses.
•Treatment: injections of botulinum toxin can give relief from symptoms for a
few months