Chapter 6 (Voice)
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What is the biological function of the larynx?
To protect the lungs
What is the emotional function of the larynx?
- Voice can sound happy, mad, or afraid
- Hear emotions in the voice
- Babies use vocal shadings
- "The voice is the mirror of the soul"
- Voice is our primary means of expression
What is the linguistic function of the voice?
- How we say something-not the words we say
- Changes in loudness, pitch, voice quality, reasonance and phrasing
How does voice change at the age of 60?
Changes in pitch, loudness, and vocal quality. Important to stay in shape physically.
We expect a voice to be:
- Loud enough
- Flexible - not a monotone
- Pleasant sounding
- Produced with ease
- Representative of the speaker
Disorders of pitch
- Monotone - may be indication of neurological impairment, part of the individual's personality, or psychogenic in cause
- Inappropriate pitch - outside of range for age, gender, body size
- Pitch breaks - for exmaple young men going through puberty
Disorders of loudness
Monoloudness - may be indication of neurological impairment, part of the individual's personality or psychogenic in cause.
Disorders of voice quality
- Hoarse voice - may be temporary due to a cold or the flu, overuse at a party/sporting event
- Breathiness - air escaping between the vocal folds while talking - indicates that the vocal cords are not coming together
- Vocal tremor
- Strain or struggle
Two kinds of voice disorders
Organic - involves structural deviation of the laryngeal mechanism which will in turn affect how the vocal folds vibrate. Primary treatment: medical, dental, surgical that may be followed by speech therapy. It involves respiration, phonation, resonation, and articulation.
Functional - no weakness, paralysis or other neurological disease of the vocal folds and no nodules, cysts, polyps. Treated with counseling or psychotherapy.
Voice disorders associated with vocal misuse or abuse
- Vocal nodules-misuse or phonotrauma
- Contact ulcers-painful; related to GERD
- Vocal polyps-fluid filled lesions
- Acute of chronic laryngitis-folds get red and ugly
- -Referral from a physician
- -Extensive case history
- -Evaluation: videoendoscopy with or without stroboscopy
- -Recommendation from physician
- -The patient must be internally motivated to follow the recommendations of all professional involved
- -Mandatory to follow the vocal hygine program
Paradoxical Vocal Fold Movement: A "nonorganic" disorder of the upper airway with both true and false vocal folds exhibiting paradoxical function of closure on inspiration, expiration, or a combination of both. PVFM have a history of abuse. More females than males.
- -Not just about the voice-it is overall communication style
- -See far more males than females
- -Process takes time, patience, money and couseling-psychosocial crucial to success
- -Altered lexicon (mars and venus)
- -Facial expression
- -Pitch and pitch flexibility
- -Rate volume and loudness
- -Voice is the greatest challange for male to female patients/clients
Gastroesophageal Reflux Disease
What are some of the ways to protect your voice?
- -Do not smoke
- -Drink lots of water
- -Humidify the environment
- -Avoid Caffeine, alchohol, and carbonated beverages
- -Eliminate habitual and frequent throat clearing
- -Avoid very hot and/or very cold beverages - No ice
- -Avoid chocolate and nuts
- -Avoid mint, menthol, and eucaplytus
- -Be careful with medicated/drugs
- -Conserve (rest) your voice whenever possible - "If you are not getting paid to use it...DO NOT USE IT"
- -Control and limit vocal loudness
- -Avoid talking in loud settings
- -Give in to laryngitis
- -Learn to use your voice correctly
- -Pay attention to how your voice sounds and feels
- -Be aware the symptoms of GERD/LPR (laryngopharyngeal refux)
- -Do not converse during strenuous physical exercise
- -Learn to manage stress
Laryngectomy: the Diagnosis
- -Often delayed (excuses for sore throat, practitioner didn't refer to ENT, tumor difficult to visualize, patient ignores and fears the worst.
- -Medical procedures and tests
- -Variety of specialists
- -Decision as to chemotherapy, radiation, surgery
- -Patient and family faced with changes
Laryngetomty: the surgery
Establishes a permanent tracheostoma at the base of the neck for breathing.
- -Focus on wound healing and recovery from the procedure
- -Patient and family members are taught how to care for the wound and hygiene of the stoma
- -Chemo and/or radiation may complicate and/or prolong the recovery.
- -Make sure the patient and family members have alternative ways to communicate
- -Understand how the patient feels and find different ways to communicate
-Loss of warming, humidifying, and filtering that leads to respiratory ailments such as excessive mucus production, coughing, crusting of the stoma, and sensory fuctions of taste and smell are altered.
-Patient must prevent the inhalation or aspiration of foreigh bodies into the lungs.
3. Tracheoesophageal speech (TEP):
- 1. Esophageal speech: Individual learns to trap air in the upper esophagus and release it in a "belch-like" maneuver to produce vibration of the throat for generating a voice. ADVANTAGES: No additional surgery, no equipment repair, maintenance, both hands are free. DISADVANTAGES: High failure rate (75%), generally requieres time and money.
- 2. Artifical larynx: on the neck, intraoral. It is mechanical. Battery-powered device is positioned against the neck or in the mouth. ADVANTAGES: easy to master, volume control adjustable, highly intelligible over the phone. DISADVANTAGES: visual distraction and auditory (mechanical buzzing or noise), hand held.
Preferred by many patients, patients find it easier to master-closest thing to normal speech.
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