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The spectrum of voice disorders – presentation
Published in Stephanie Martin, Working with Voice Disorders, 2020
Polyps may require a combination of surgery and voice intervention depending on the site and type of polyp. Similarly, the disturbance to vocal fold vibration may be considerable or insignificant. Characteristically the voice is rough and breathy, with pitch and voice breaks as in vocal nodules, sometimes also with diplophonia.
Tumours of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Vinidh Paleri, Stuart Winter, Hannah Fox, Nachi Palaniappan
Again, early symptoms can be vague, with a feeling of ‘globus’ or foreign body sensation in the throat. Any involvement of the glottis or recurrent laryngeal nerves results in hoarseness. With paralysis, diplophonia may occur with a shortened maximum phonation time. Therefore, this diagnosis should always be considered in the possible differential causes of ‘idiopathic’ cord paralysis, especially in high-risk cases. Circumferential progression leads to progressive dyspnoea and stridor, with markedly shortened maximum phonation times and rapid vocal fatigue. Direct extension into the thyroid may mimic a thyroid isthmus lesion.
Vocal fold paralysis
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
The presentation of a UVFP arises from glottal incompetency. Failure of complete glottal closure causes air leakage through the glottis presenting as breathy dysphonia, reduced volume/projection, reduced vocal stamina, diplophonia and aspiration. This creates mild vocal fatigue with prolonged voice use, from moderate dysphonia to totally disabling aphonia. Aspiration with/without pneumonia can result from both glottal incompetency and a significant sensory deficit. The presence of a weak or ineffective cough must be noted. In a high vagal lesion, dysphagia for solids may also be reported.
Walking the thin white line – managing voice in the older adult
Published in Speech, Language and Hearing, 2019
For atrophic and bowed vocal folds, much in the same way as treating a paralyzed vocal fold, surgical options to achieve better glottal contact consist of augmenting and/or medializing the affected vocal fold. A variety of substances and techniques are described including injection laryngoplasty with patient-harvested fat, commercially prepared injectable implants including collagen, methylcellulose, hyaluronic acid gels (Figure 4) or external-approach medialization in the style of Isshiki type 1 thyroplasty (Johns et al., 2011). Implants used most commonly in external transcervical approaches are Gore-tex™ and silastic carved or preformed implants. Typically in age-related glottal atrophy (the presbyphonic larynx), vocal folds are still mobile and symmetric. This contrasts with unilateral vocal fold paralysis where one fold is hypomobile or immobile and often de-tensioned. Therefore surgical correction of age-related glottal insufficiency or degeneration requires careful consideration. Over-filling the vocal fold with injectable implant will increase phonation onset pressure and give rise to a sensation of strain when voicing, and if the folds are asymmetric it is likely the patient will exhibit diplophonia and be dissatisfied with the perceptual quality of the voice (Anderson & Sataloff, 2004). Similarly, injection of filler into the superficial lamina propria, instead of the paraglottic space, may impair vibratory function, negatively impacting phonatory quality.
Diagnosis and management of laryngotracheal stenosis
Published in Expert Review of Respiratory Medicine, 2018
Matthew M Smith, Robin T Cotton
A number of factors are associated with intubation that can exacerbate the initial injury. Enteral feeding via a naso/orogastric tube is common while a patient is intubated. The presence of a naso/orogastric tube stents open the lower and upper esophageal sphincters. This can lead to acidic irritation of the larynx and trachea, resulting in scarring and stenosis. Another difficulty with prolonged intubation is maintaining adequate patient sedation. If the patient is having difficulty being sedated, this can lead to repeated movement of the endotracheal tube, which results in friction between the tube and the mucosal lining and thus mucosal injury [5]. The glottis and its associated structures are also vulnerable to injury. Similar to other synovial joints, the cricoarytenoid joint is susceptible to scar and fixation when injury is followed by fixation (endotracheal intubation) [6,7]. This can lead to posterior glottic stenosis, in which the vocal folds become fixed and immobile [8]. Vocal fold paralysis is another problem that can lead to a lack of voluntary vocal fold movement and glottic narrowing. This can be secondary to birth trauma, congenital anomalies of the larynx, central nervous system abnormalities, adverse effects of medications, cardiovascular abnormalities, upper respiratory infections, malignancy, genetic causes, or iatrogenic causes. A patient with unilateral vocal fold paralysis can present with dysphonia, breathiness, diplophonia, or dysphagia with aspiration. If bilateral vocal fold paralysis is present, then stridulous breathing along with respiratory distress and dysphagia are typically present.
Is children’s listening effort in background noise influenced by the speaker’s voice quality?
Published in Logopedics Phoniatrics Vocology, 2018
Birgitta Sahlén, Magnus Haake, Heike von Lochow, Lucas Holm, Tobias Kastberg, K. Jonas Brännström, Viveka Lyberg-Åhlander
To verify the authenticity of the voice qualities, two experienced voice clinicians, both SLPs, assessed examples from both voice conditions. Six randomly selected sentences, three from each voice condition, were assessed on a Visual Analogue Scale (VAS, 0 = no deviance, 10 = max deviance) using the Stockholm Voice Evaluation Approach (SVEA) protocol (the SVEA covers assessments of aphonia, hyper-/hypofunction, breathiness, voca fry, glottal attacks, roughness, high pitched roughness (‘scrape’), instability of register and pitch, diplophonia and voice breaks) (34). The VAS was a pen-and-paper version: a 10 m unmarked line with endpoints. The SLP drew a line across a separate VAS-line to mark the rating of each parameter. The sentences were played over a loudspeaker (Fostex SPA 12, Fostex Corporation, Tokyo, Japan), to make a consensus judgment possible. When verifying the voice qualities, the two SLPs were allowed to listen to the sentences as many times as needed and in any sequence they wished. The SLPs were asked to make independent judgments and where judgements differed, consensus was to be reached through discussion. The SLPs were requested to mark on the protocol if agreement was not possible to reach. However, the SLPs did not indicate any difficulties in agreeing on any voice excerpt. Both voice qualities were judged to be authentic and the typical voice aligned with expected voice characteristics when reading or talking in competing noise (Table 3).