SPPA 6400 Voice Disorders: Tasko

SPPA 6400 Voice Disorders

Stephen M. Tasko

SPPA 6400 Voice Disorders: Tasko

Introduction

SPPA 6400 Voice Disorders: Tasko

Some Questions

• What is a voice disorder?• How does it differ from speech disorder?• How does if differ from a resonance disorder?• How common are voice disorders?• Who gets a voice disorder?• Why might someone have a voice disorder?• How do you know if someone has a voice

disorder?

SPPA 6400 Voice Disorders: Tasko

Voice Production Basics

Colton, Casper & Leonard (2011)

SPPA 6400 Voice Disorders: Tasko

Vocal Fold Oscillation

SPPA 6400 Voice Disorders: Tasko

Ways to think about voice disorders?

Etiologic Correlates of Vocal Dysfunction• Vocal misuse

– Vocal Abuse– Inappropriate Function of

Vocal Components

• Medically related etiologies– Direct Surgery– Indirect Surgery– Chronic Illness and Disorder

• Primary disorder etiologies– Cleft palate– VP Insufficiency– Cerebral Palsy and other

neurologic disorders– Trauma

• Personality-related etiologies– Environmental Stress– Identity Conflict

Stemple, et al. (2014)

SPPA 6400 Voice Disorders: Tasko

Classification of Pathologies and Disorders

• The overly simplistic approach– Organic Voice Disorders– Neurogenic Voice Disorders– Functional Voice Disorders

SPPA 6400 Voice Disorders: Tasko

Classification of Pathologies and Disorders

I. Structural Pathologies of the Vocal Fold

A. Malignant Epithelial Dysplasia (a.k.a cancer)

B. Benign Epithelial and LP Abnormalities

C. Congenital and Maturational Changes

II. Inflammatory Conditions of the Larynx

A. Cricoarytenoid and Cricothryoid Arthritis

B. Acute LaryngitisC. Laryngopharyngeal RefluxD. Chemical

Sensitivity/Irritable larynx Syndrome

Verdolini et al. (2006)

The more thorough approach

SPPA 6400 Voice Disorders: Tasko

Classification of Pathologies and Disorders

III. Trauma or Injury of the LarynxA. Internal Laryngeal TraumaB. External Laryngeal Trauma

and Arytenoid Dislocation

IV. Systemic Conditions Affecting VoiceA. Endocrine DisordersB. Immunologic Disorders

Verdolini et al. (2006)

SPPA 6400 Voice Disorders: Tasko

Classification of Pathologies and Disorders

V. Nonlaryngeal Aerodigestive Disorders Affecting Voice

A. Respiratory DiseaseB. Gastroesophageal Reflux

Disease (GERD)C. Infectious Diseases of the

Aerodigestive Tract

VI. Psychiatric & Psychological Disorders Affecting Voice

A. Psychogenic Conversion Aphonia and Dysphonia

B. Factitious Disorders or Malingering

C. Gender Dysphoria or Gender Reassignment

Verdolini et al. (2006)

SPPA 6400 Voice Disorders: Tasko

Classification of Pathologies and Disorders

VII. Neurologic Conditions Affecting Voice

A. Peripheral Nervous System Pathology

B. Movement Disorders Affecting the Larynx

C. Central Neurologic Disorders Affecting Voice

VIII. Other Disorders of Voice Use

A. Vocal abuse, misuse, and Phonotrauma

B. Vocal FatigueC. Muscle Tension Dysphonia

(Primary & Secondary)D. Ventricular PhonationE. Paradoxical Vocal Fold

Motion

Verdolini et al. (2006)

SPPA 6400 Voice Disorders: Tasko

Occurrence Rates of Voice Disorders

Source: Manitoba Centre for Health Policy

SPPA 6400 Voice Disorders: Tasko

Occurrence Rates of Voice Disorders

Roy et. al (2004) JSLHR 47 281-93.

SPPA 6400 Voice Disorders: Tasko

Occurrence Rates of Voice Disorders

Roy et al. (2004)

SPPA 6400 Voice Disorders: Tasko

Occurrence Rates of Voice Disorders

Common Problems^• Males

– edema– polyps– Granuloma– papilloma

• Females– nodules– edema– polyps– psychogenic dysphonia

*Roy et al. (2007)^Coyle et al. (2001)

*

SPPA 6400 Voice Disorders: Tasko

What about the young and the old?

Elderly (65-94 years)*• Lifetime prevalence: 47%• Current problem: 29%• Negative quality of life • Largest treatment seeking

group • Common problems

– Vocal fold paralysis– Cancer– Presbyphonia

Children^• Current problem: 6-23%• Most common problems

– Vocal nodules– Vocal fold paralysis– Subglottic stenosis– Laryngomalacia– Functional voice problems

*Roy et al. (2007)^ multiple sources