Materiały źródłowe

• #1 Voice Disorders

  https://www.asha.org/practice-portal/clinical-topics/voice-disorders/?srsltid=AfmBOor8SgtLdbsAgXv8fn3VfVkw9p2dPSdhx5lAEtRDkymg9G3RtfZJ

  A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individuals age, gender, cultural background, or geographic location (Aronson Bless, 2009; Boone et al., 2010; Lee et al., 2004). […] Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple et al., 2010). […] The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor (Stemple et al., 2014; Verdolini et al., 2006). For example, vocal fold nodules may result from behavioral voice misuse (functional etiology). However, the voice misuse results in repeated trauma to the vocal folds, which may then lead to structural (organic) changes to the vocal fold tissue.

• #1 Three Ways to Treat Voice Disorders | Suffolk Center for Speech

  https://www.lispeech.com/three-ways-treat-voice-disorders/

  Voice disorders are changes to either the structure and/or function of the laryngeal mechanism. This causes the larynx to differ in terms of voice quality, pitch, and loudness compared to those of individuals from a similar age, gender, and cultural background. […] A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs even if others do not perceive it as different or deviant. […] These are a series of systematic voice manipulations designed to facilitate return to healthy voice function by strengthening and coordinating laryngeal musculature and improving the relationship among airflow, vocal fold vibration, and phonation.

• #1 DYSPHONIA – Office Instructions – Ear, Nose and Throat Physicians of North MS PA

  https://ehr.wrshealth.com/live/patient_v2/instructions.php?id=2427145&iid=6033

  Functional voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation). Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia. These voice disorders are rare. The etiology of nodules is functional, as they result from behavioral voice misuse. The voice misuse results in repeated trauma to the vocal folds, which may then lead to structural (organic) changes to the vocal fold tissue. Normal voice production depends on power and airflow supplied by the respiratory system; laryngeal muscle strength, balance, coordination, and stamina; and coordination among these and the supraglottic resonatory structures (pharynx, oral cavity, nasal cavity). A disturbance in one of the three subsystems of voice production (i.e., respiratory, laryngeal, and subglottal vocal tract) or in the physiological balance among the systems may lead to a voice disturbance. Disruptions can be due to organic, functional, and/or psychogenic causes. Organic causes include vocal fold abnormalities (e.g., vocal nodules, edema, glottal stenosis, recurrent respiratory papilloma, sarcopenia [muscle atrophy associated with aging). Inflammation of the larynx (e.g., arthritis of the cricoarytenoid or cricothyroid, laryngitis, laryngopharyngeal reflux) Trauma to the larynx (e.g., from intubation, chemical exposure, or external trauma). The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor.

• #1 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  The sound source of a voice is produced by the self-excited oscillation of the vocal folds. […] In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. […] The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. […] Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds. […] The self-excited oscillation of the vocal folds located at the larynx produces the major sound source of a voice.

• #1 Voice Disorders

  https://www.asha.org/practice-portal/clinical-topics/voice-disorders/?srsltid=AfmBOor8SgtLdbsAgXv8fn3VfVkw9p2dPSdhx5lAEtRDkymg9G3RtfZJ

  A disturbance in one of these subsystems or in the physiological balance among the systems may lead to or contribute to a voice disorder. Disruptions can be due to organic, functional, and/or psychogenic causes. […] Organic causes include the following: structural vocal fold abnormalities such as vocal nodules, cysts, or polyps, edema, glottal stenosis, recurrent respiratory papilloma, sarcopenia (muscle atrophy associated with aging). […] Functional causes include the following: phonotrauma such as yelling, screaming, excessive throat clearing/coughing, speaking in too high or too low pitch. […] Psychogenic causes include the following: chronic stress disorders, anxiety, depression, conversion reaction such as conversion aphonia, conversion dysphonia. […] Recognizing associations among these factors, along with patient history, may help in identifying the possible causes of the voice disorder. Even when an obvious cause is identified and treated, the voice problem may persist. For example, an upper respiratory infection could be the cause of the dysphonia, but poor or inefficient compensatory techniques may cause dysphonia to persist, even when the infection has been successfully treated.

• #1 DYSPHONIA – Office Instructions – Ear, Nose and Throat Physicians of North MS PA

  https://ehr.wrshealth.com/live/patient_v2/instructions.php?id=2427145&iid=6033

  Dysphonia is a descriptive medical term meaning disorder (dys- ) of voice (-phonia). A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location. A number of different systems are used for classifying voice disorders. For the purposes of this document, voice disorders are categorized as follows: Organic voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms […] Structural organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging) […] Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds)

• #1 Voice Disorders and Voice Health | Midwest Ear, Nose & Throat Specialists | Blog

  https://mwent.net/voice-disorders-voice-health/

  Organic voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms […] Structural organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging) […] Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds) […] Functional voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)

• #1 Speech Therapy Treatments For Voice Disorders | District Speech and Language Therapy | Speech Therapy Clinic in Washington DC

  https://districtspeech.com/speech-therapy-treatments-for-voice-disorders/

  Structural causes include: Cleft lip and cleft palate, Vocal fold nodules and polyps, Cysts, Edema, Inflammation of the larynx, Laryngitis, Other trauma to the larynx, Chemical exposure. […] Neurological cause include: Parkinson’s disease, Multiple sclerosis, Pseudobulbar palsy. […] Functional causes include: Frequent yelling or screaming, Excessive throat clearing or coughing, Speaking in too high or too low pitch, Vocal fatigue due to overexertion. […] Psychogenic causes include: Chronic stress disorders, Anxiety, Depression. […] Even if an obvious cause is identified, your speech therapist may still examine your medical history to identify any comorbid conditions. In these cases, voice disorders often remain even after the cause is identified. […] A good example is when a voice disorder develops from an upper respiratory infection, which is fairly easy to treat, but the voice issues continue even after the infection is gone. This can happen due to the improper use of speech techniques that only an experienced therapist can assist you with.

• #1

  https://www.ijhns.com/abstractArticleContentBrowse/IJHNS/8/13/1/28089/abstractArticle/Article

  Aim: To provide an overview of neurological disorders affecting the larynx, either primarily or as part of a systemic disease process. In this review, we first present an overview of the approach to diagnosis and treatment of neurological diseases of the larynx, and then move on to discuss individual conditions in more detail. […] Neurological voice disorders can be divided into three categories: those that originate from the central nervous system, those that originate from the peripheral nervous system, and those that are functional or behavioral in nature. Several central nervous system disorders have manifestations in the larynx the disorders most commonly seen by otolaryngologists are: dystonia, essential tremor, Parkinson’s disease, and stroke. Laryngeal disorders originating from the peripheral nervous system include vocal fold paresis/paralysis and myasthenia gravis. Functional voice disorders include muscle tension dysphonia and paradoxical vocal fold motion.

• #1 Functional Disorders | Medical School

  https://med.umn.edu/ent/patient-care/lions-voice-clinic/treatments/specific-voice-disorders/functional-disorders

  One of the most common voice disorders we treat is muscle tension dysphonia (MTD). MTD is known as a functional disorder; that is, there is nothing structurally wrong with the voice. Rather, the muscles do not function properly, which causes poor sound, discomfort, or a sensation of increased effort. […] The onset of MTD can be very subtle. The individual is usually unaware of the extra effort, but this extra effort typically recruits muscles that are not part of the larynx itself. The result may or may not be a stronger voice, but it can be the start of a vicious cycle where more and more effort is required. This cycle may continue for months or even years before the individual becomes aware that his or her voice is abnormal. The reason why some individuals adapt one style of muscle tension over another is unknown.

• #1 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  Structural causes include vocal fold lesion, larynx inflammation, and larynx trauma. […] Neurogenic causes include paralysis of the nerve supplying the larynx (recurrent laryngeal nerve), spasmodic dysphonia of larynx muscle, Parkinson’s disease, and multiple sclerosis. […] Functional causes include trauma from yelling and screaming, excessive throat clearing and coughing, and speaking in too high or too low pitch. […] Psychogenic causes include chronic stress and anxiety, and depression. […] There are a variety of speech therapy techniques that can be considered according to the underlying disorder, therefore, identification of the underlying cause of voice abnormality is the essential initial step to guide the management.5 […] Voice therapy is most effective in treating the most common cause of voice disorders: voice misuse.

• #1 Acute Laryngitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/864671-overview

  Although acute laryngitis is usually not a result of vocal abuse, vocal abuse is often a result of acute laryngitis. The underlying infection or inflammation results in a hoarse voice. […] Acute laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3 weeks. When the etiology of acute laryngitis is infectious, white blood cells remove microorganisms during the healing process. The vocal folds then become more edematous, and vibration is adversely affected. […] The phonation threshold pressure may increase to a degree that generating adequate phonation pressures in a normal fashion becomes difficult, thus eliciting hoarseness. […] The membranous covering of the vocal folds is usually red and swollen. […] Some authors believe that the vocal fold stiffens rather than thickens.

• #1 Acute Laryngitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/864671-overview

  The deficient voice production in patients with acute laryngitis may result in application of a greater adduction force or tension to compensate for the incomplete glottic closure during an acute laryngitic episode. […] This tension further strains the vocal folds and decreases voice production, ultimately delaying return of normal phonation. […] Patients with acute laryngitis have an increased open quotient value. This indicates that the patient’s vocal folds are open longer, and less time is spent in the closed position, which contributes to the hoarseness and breathiness of the voice.

• #1 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  Spasmodic dysphonia (SD) is currently understood to be a focal dystonia that affects laryngeal muscle control during speech. Dystonia refers to a syndrome of sustained muscle contractions. Focal dystonias involve abnormal activity in only a few muscles. Dystonic movements are aggravated or become manifest during voluntary movement and worsen with fatigue or physical and emotional stress. Dystonia may be focal, segmental, multifocal, or generalized. Although spasmodic dysphonia (SD) is considered a focal dystonia, it may present as a segmental or multifocal dystonia. […] The preponderance of evidence suggests that idiopathic dystonias are due to an abnormality of neurotransmitters in the basal ganglia (putamen, head of caudate, and upper brainstem). Zweig et al suggested that the putamen and the striatopallidothalamocortical circuit are disrupted in patients with focal dystonias.

• #1 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  A study by Khosravani et al using electroencephalographic analysis indicated that compared with healthy controls, persons with spasmodic dysphonia (SD) demonstrate, during voice production, a reduced movement-related desynchronization of motor cortical networks and an excessively large synchronization between left somatosensory and premotor cortical areas. […] A study by Simonyan et al suggests that the pathophysiology of spasmodic dysphonia (SD) may be related to specific brain abnormalities. […] Evidence from both diffusion tensing imaging and neuropathological data show specific white matter changes along the corticobulbar and corticospinal tracts and in the brain regions contributing to them. […] Postmortem histopathology also confirmed reduced axonal course and myelin content in the right genu of the internal capsule.

• #1 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  The changes in the CBT/CST suggest deficiency in connection between the cortical and subcortical regions, which are essential for voluntary voice production. […] Interestingly, botulinum toxin therapy resulted in a reversal of sensory hypoactivity 3-4 weeks after injection. […] Using the Newcastle Laryngeal Hypersensitivity Questionnaire, a study by Vanderaa and Vinney reported that adductor spasmodic dysphonia (SD) and mixed (adductor/abductor) SD are significantly associated with laryngeal hypersensitivity.

• #1 Hyperfunctional Dysphonia | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/hyperfunctional-dysphonia

  Hyperfunctional dysphonia is one of the most common conditions associated with the voice. […] Also referred to as muscle tension dysphonia (MTD) or vocal hyper function, hyperfunctional dysphonia is the constriction and overexertion of the muscles around the larynx (voice box). […] There are a number of factors that can lead to hyperfunctional dysphonia, such as: Long-term misuse of the voice, Acid reflux, Sudden changes in the voice due to an infection or stress. […] It is worth noting that hyperfunctional dysphonia can be brought on by one or more of these causes. […] Proper diagnosis of hyperfunctional dysphonia is only possible through the examination of the larynx. An otolaryngologist will evaluate the larynx during voice production to identify the underlying cause(s) of the problem. […] Depending on the diagnosis, treatment for hyperfunctional dysphonia may vary.

• #1 Voice | Department of Otolaryngology–Head & Neck Surgery

  https://www.otolaryngology.pitt.edu/research/voice

  Additionally, we found that consistent with prior literature, individuals with muscle tension dysphonia (MTD) score higher on a measure of perceived stress. Stress and stress-reactivity are implicated in the pathogenesis and maintenance of functional voice disorders (like MTD) in both the Trait Theory of Voice Disorders, as well as the Psychobiological Framework of Voice and Stress. […] This novel finding lays the foundation for a more rigorous investigation of stress-manifestation in the body and how this phenomenon relates to functional voice disorders, like MTD.

• #1

  https://link.springer.com/article/10.1007/s00455-024-10693-3

  The majority of patients with Parkinsons disease (PD) develop swallowing, speech, and voice (SSV) disorders. […] A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. […] SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. […] This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. […] Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.

• #1 Types of Voice Disorders – Advanced Head & Neck Rehabilitation Center of Texas

  https://www.hnrehabcenteroftx.com/types-of-voice-disorders.html

  A neurogenic voice disorder refers to a disruption in the nerves controlling the larynx. Common examples of this include complete or partial vocal cord paralysis. There can also be spasms in the laryngeal musculature that interfere with the ability to produce a voice. […] A functional voice disorder refers to a problem with the manner in which a voice is produced and can be affected on many different levels. Voicing, or how we produce a voice, does not require conscious thought or effort. This is because a signal is sent from the brain that automatically results in the coordinated pattern/event we call voicing. For various reasons, however, this pattern can become altered, resulting in behaviors that are interfering with the production of a clear voice. […] In some cases, a functional disorder may arise as a result of an organic disorder. For example, if a vocal cord cyst is interfering with the closure of the vocal cords, there may (unconsciously) be more force or effort to close the vocal cords in light of the obstruction. This extra muscle effort can result in a functional disorder, especially if it is continued over an extended period of time. […] Although there may be a degree of variability noted in organic voice disorders, this dysphonia tends to be more consistent.

• #1 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

• #1 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  This self-excitation is caused by the flow-structure interaction between respiratory airflow and vocal fold tissue. […] The vocal fold closure ensures a requirement for self-excitation, i.e., a continuous energy transfer from the flow to the vocal folds. […] The myoelastic-aerodynamic theory is not applicable to such oscillations without complete glottal closure. […] The main body of each fold, which consists of the thyroarytenoid muscle, is more or less relaxed in falsetto. […] The pull of the tissue by the cricothyroid muscle activation thins the vocal folds. […] Therefore, only the ligamentous superficial layers of the vocal folds enter into vibration, possibly resulting in a negligible mucosal wave. […] The mucosal wave theory has been the cornerstone of nearly all subsequent theoretical developments of voice mechanics.

• #1 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  However, recent experimental and theoretical studies have demonstrated that the pressure distribution along the glottis essentially differs from that in a static condition in a range of high but realistic voice fundamental frequencies. […] The Strouhal number should not be negligible in the high vocal frequency range. […] The critical subglottal pressure and volume flow are expressed as functions of vocal fold biomechanical properties, geometry, and voice fundamental frequency. […] The threshold subglottal pressure and volume flow for flutter are explicitly described. […] The critical subglottal pressure described by Equation (24) is interpreted as the minimum lung pressure required for vocal fold oscillation onset. […] Such a critical lung pressure is in general called the phonation threshold pressure (PTP) and is potentially useful in diagnosis to noninvasively evaluate vocal fold stiffness and quantify the ease of phonation.

• #1 Types Of Voice Disorders | Charlotte, Monroe, Indian Land

  https://cornerstoneent.com/voice-and-throat/voice-disorders

  Each year millions of people are affected by voice disorders. For those who rely on their voice to make a living, such as teachers, doctors, actors, singers, and public speakers, problems like chronic hoarseness and vocal fatigue can be devastating. There are many causes of vocal disorders and the underlying problem with many patients is often multifactorial. Vocal overuse, acid reflux, tobacco use, and chronic allergies are a few of the many potential causes of vocal dysfunction. In addition, any patient with persistent hoarseness should be evaluated to rule out laryngeal cancer, a condition where hoarseness is often the first symptom. Proper diagnosis of the disorder is crucial for appropriate treatment. […] Voice disorders fall into a few main categories: Structural, neurogenic, functional, and psychogenic. Often, a patients disorder may fit more than one category and the challenge lies in determining the primary cause.

• #1 Voice Disorders | Conditions & Treatments | UR Medicine

  https://www.urmc.rochester.edu/conditions-and-treatments/voice-disorders

  Prior to the initiation of voice therapy, a laryngeal examination must be completed in order to identify the etiology of your individual voice problem and determine the most appropriate course of treatment. […] We identify the root of your voice disorder, treat it quickly and effectively, and improve your overall vocal health.

• #1 Voice Disorders | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/condition/v/voice-disorders

  Voice disorders can occur due to many different factors. Any voice condition that interferes with vocal fold movement or vibration can result in voice quality changes, leading to an abnormal voice that does not meet daily needs. […] Many different disorders can affect your voice, ranging from lumps and bumps on your vocal folds, tension in the muscles surrounding your vocal folds, and neurologic voice conditions. Voice problems may also arise due to functional changes resulting from overuse and misuse of the vocal system. […] In most cases, a more detailed examination of the voice box called video laryngostroboscopy is required to identify the cause or causes of voice disorders. […] Symptoms of a voice disorder, also known as dysphonia, may include: Hoarseness/raspiness, Pitch that is higher or lower than normal, Change in volume/loudness, Increased effort associated with speaking or singing, Voice fatigues easily, Voice loss, Throat discomfort, Chronic throat clearing.

• #1 Vocal Hyperfunction/Muscle Tension Dysphonia | BIDMC of Boston

  https://www.bidmc.org/conditions-and-treatments/ear-nose-throat-and-mouth/vocal-hyperfunction-muscle-tension-dysphonia

  Vocal hyperfunction occurs when the muscles of the larynx work too hard when speaking. The condition can be brought on by stress, reflux or other conditions. […] Vocal hyperfunction/muscle tension dysphonia is diagnosed often by laryngovideostroboscopy, a non-invasive procedure to examine your vocal fold vibration and vocal fold closure. […] Through practice, the body learns to make the small changes required for effective voice activation and for a smoother, easier voice. Regular practice helps to make these changes automatic so that eventually they come naturally.

• #1 Voice Disorders | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/voice-disorders

  Voice disorders are vocal differences that can impact your childs daily communication needs. […] A combination of two or more factors can cause your child to experience a voice disorder: […] Structural or physical changes to your child’s vocal mechanism […] Changes with the nerves that help with movement of the vocal mechanism (vocal cord paralysis) […] Misuse or overuse of the voice (with normal structure) […] Psychological (mental or emotional) stressors. […] Treatment for voice disorders may include therapy, medical management (like medication or dietary modification) and/or surgical procedures. […] Our SLPs provide voice therapy. […] Long-term goals of voice therapy may include: […] Short-term goals of therapy may include our SLPs teaching your child strategies like: […] At CHOP, our goal is to identify and treat voice disorders so your child can have the best communication outcomes.

• #1 Hoarseness in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1201/p720.html

  Spasmodic dysphonia (or laryngeal dystonia) is the episodic, uncontrolled contraction of laryngeal intrinsic muscles to create a halting, strangled voice. […] Less commonly, hoarseness occurs secondary to systemic illnesses. Autoimmune diseases, such as inflammatory arthritis and lupus, can affect the cricoarytenoid joints. Endocrine disorders, including hypothyroidism and acromegaly, can cause hoarseness. […] Voice therapy, or voice training, is strongly recommended for patients with hoarseness who have significantly impaired vocal quality of life, especially those with dysphonia of nonorganic origins, benign vocal fold lesions, or age-related vocal atrophy. […] Surgical intervention is needed for dysplastic or malignant lesions, airway obstruction, or benign lesions (e.g., nodules, polyps, cysts) that do not respond to conservative therapies.

• #1

  https://care2communicate.com.au/voice

  Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds) […] Functional voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation). […] Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple, Glaze, Klaben, 2010). […] Direct approaches focus on manipulating the voice-producing mechanisms (e.g., phonation, respiration, and musculoskeletal function) in order to modify vocal behaviors and establishing healthy voice production (Colton Casper, 1996; Stemple, 2000).

• #1

  https://care2communicate.com.au/voice

  Indirect approaches modify the cognitive, behavioral, psychological, and physical environments in which voicing occurs (Roy, et al., 2001; Thomas Stemple, 2007). Indirect approaches include the following two components: […] Patient education discussing normal physiology of voice production and the impact of voice disorders on function; providing information about the impact of vocal misuse and strategies for maintaining vocal health (vocal hygiene) […] Counselling identifying and implementing strategies such as stress management to modify psychosocial factors that negatively affect vocal health (Van Stan, Roy, Awan, Stemple, Hillman, 2015).

• #1 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  Structured exercises to strengthen and coordinate muscles of the larynx, Outcome studies have found that vocal function exercises are effective in enhancing vocal function in individuals with normal voices and in patients with disordered voices. […] According to the underlying cause, a combination of speech therapy with medical or surgical approaches may be required.

• #1 Voice Disorders | Laryngologists, Voice Therapists

  https://www.dukehealth.org/treatments/voice-disorders

  We diagnose and treat the full spectrum of voice disorders, from laryngitis and voice strain to more complex problems such as atrophy, hemorrhage, scarring of the vocal cords, vocal tremor, and laryngeal papilloma. […] If you have other medical conditions that may contribute to your voice disorder — such as allergies, asthma, or acid reflux — we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team. […] Depending on your diagnosis, medical management and voice therapy can often correct a voice problem. […] We use a range of surgical approaches to treat the root cause of your voice disorders, including benign lesions, cancer, and vocal cord paralysis. […] Their ongoing research ensures you receive the best, most up-to-date care for your voice disorder.

• #1 Types Of Voice Disorders | Charlotte, Monroe, Indian Land

  https://cornerstoneent.com/voice-and-throat/voice-disorders

  It is rare for a psychological disorder to be the sole cause for a voice problem, but a psychogenic component is often present because of the emotional impact a voice disorder can have. In such cases, correct identification can be challenging, but recognition is important to ensure that mental health professionals can be involved in any treatment approach. […] Cancer of the larynx or any part of the throat is not considered a voice disorder. However, unexplained hoarseness is one of the warning signs of cancer, and anyone with persistent hoarseness that does not resolve after 2 weeks should be evaluated by an ENT physician. […] There are a variety of treatment options available depending on the patients specific condition. In many cases, treatment of underlying causes of laryngeal inflammation such as acid reflux and postnasal drainage are initiated. In patients who do not respond to conservative management, microscopic vocal cord surgery can be performed to address structural lesions of the vocal cords. Voice therapy with a speech pathologist is also an important part of the treatment protocol for both surgical and nonsurgical patients to improve vocal technique and prevent recurrence of their symptoms. […] Anyone with persistent hoarseness that does not get better after 2 weeks should be evaluated by an ENT physician.

• #1 Voice disorders – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/voice-disorders/

  People develop a voice disorder for many reasons. A voice disorder is a change in how the voice sounds. Treatment depends on whats causing the voice change. If vocal cords become swollen, or inflamed, develop growths or cant move as they should, they cant work properly. Any of these might cause a voice disorder. Many factors can lead to a voice disorder, such as aging, alcohol use, allergies, conditions related to the brain and nervous system, such as Parkinsons disease or a stroke, gastroesophageal reflux disease (GERD), illnesses, such as colds or upper respiratory infections, scarring from neck surgery or from trauma to the front of the neck, screaming, smoking, throat cancer, throat dehydration, thyroid problems, voice misuse or overuse. Medicine can be taken by mouth, injected into the vocal cords or applied to the surface of the vocal cords during surgery. KTP laser treatment is a state-of-the-art therapy that treats lesions on the vocal cords by cutting off the blood supply to the growth. This allows removal of the growth while leaving intact the most underlying tissue. Shots of tiny amounts of purified botulinum toxin into the skin of the neck can help stop muscle spasms or unusual movements. This drug treats a movement issue related to the brain and nervous system. This condition, called spasmodic dysphonia, affects the vocal muscles of the larynx. Sometimes one vocal cord cant move. One paralyzed vocal cord can cause hoarseness. It also can cause choking when drinking liquids. But it rarely causes trouble when swallowing solid foods. Sometimes the problem goes away with time. If the problem doesnt go away, one of two procedures can push the paralyzed vocal cord closer to the middle of the windpipe. Either procedure allows the vocal cords to meet and vibrate closer together. This improves the voice and allows the larynx to close when swallowing.

• #1 Voice | Language & Learning

  https://www.langandlearn.com/sessions/voice-disorders/

  If a voice disorder is suspected, the first step is to visit an otolaryngologist (also known as an ENT), which is a doctor specializing in ear, nose, and throat disorders. […] Following determination of areas of weakness and underlying causes, stimulability for enhanced vocal quality using a variety of techniques will be implemented.

• #1 Voice Disorders – Sensible Rehab – Occupational & Speech Therapy

  https://sensiblespeech.com/services/speech-therapy-services/voice-disorders/

  An evaluation by a licensed Speech-Language Pathologist (SLP) is recommended for any individual who is experiencing a disruption to their normal speaking voice. The SLP will provide a thorough assessment of vocal quality and make recommendations for a therapy program and/or further instrumental assessment by an Otolaryngologist (ENT). […] The specific kind of voice therapy a person receives varies as every persons voice is different! At Sensible Speech Language Pathology Inc. we have SLPs who are certified to provide LSVT LOUD therapy, vocal hygiene programs, vocal function exercises, and more. Your healthy voice is our top priority!

• #2

  https://care2communicate.com.au/voice

  A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individuals age, gender, cultural background, or geographic location (Aronson Bless, 2009; Boone, McFarlane, Von Berg, Zraik, 2010; Lee, Stemple, Glaze, Kelchner, 2004). […] A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton Casper, 1996; Stemple, Glaze, Klaben, 2010; Verdolini Ramig, 2001). […] Organic voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms […] Structural organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging)

• #2 Voice Disorders

  https://www.asha.org/practice-portal/clinical-topics/voice-disorders/?srsltid=AfmBOor8SgtLdbsAgXv8fn3VfVkw9p2dPSdhx5lAEtRDkymg9G3RtfZJ

  A disturbance in one of these subsystems or in the physiological balance among the systems may lead to or contribute to a voice disorder. Disruptions can be due to organic, functional, and/or psychogenic causes. […] Organic causes include the following: structural vocal fold abnormalities such as vocal nodules, cysts, or polyps, edema, glottal stenosis, recurrent respiratory papilloma, sarcopenia (muscle atrophy associated with aging). […] Functional causes include the following: phonotrauma such as yelling, screaming, excessive throat clearing/coughing, speaking in too high or too low pitch. […] Psychogenic causes include the following: chronic stress disorders, anxiety, depression, conversion reaction such as conversion aphonia, conversion dysphonia. […] Recognizing associations among these factors, along with patient history, may help in identifying the possible causes of the voice disorder. Even when an obvious cause is identified and treated, the voice problem may persist. For example, an upper respiratory infection could be the cause of the dysphonia, but poor or inefficient compensatory techniques may cause dysphonia to persist, even when the infection has been successfully treated.

• #2 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  This self-excitation is caused by the flow-structure interaction between respiratory airflow and vocal fold tissue. […] The vocal fold closure ensures a requirement for self-excitation, i.e., a continuous energy transfer from the flow to the vocal folds. […] The myoelastic-aerodynamic theory is not applicable to such oscillations without complete glottal closure. […] The main body of each fold, which consists of the thyroarytenoid muscle, is more or less relaxed in falsetto. […] The pull of the tissue by the cricothyroid muscle activation thins the vocal folds. […] Therefore, only the ligamentous superficial layers of the vocal folds enter into vibration, possibly resulting in a negligible mucosal wave. […] The mucosal wave theory has been the cornerstone of nearly all subsequent theoretical developments of voice mechanics.

• #2 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  The voice is the sound produced when the air is forced out of the lung and passes between the vocal cords of the larynx (voice box), the vibration of these vocal cords produces sounds we call voice, which are shaped to produce speech.1 […] A voice disorder is defined as any deviation affecting the voice that adversely affects the speaker or the listener, interfering with communication. This deviation could affect the pitch, loudness, or quality of the voice.2 […] Disrupting one of these systems or the coordination between them may lead to a voice disorder. Disruptions can be organic, functional, or psychogenic. […] Organic voice disorders are further classified into structural and neurogenic. […] Results from changes affecting the voice production mechanism, in its respiratory, laryngeal, or vocal tract part.

• #2 Voice Disorders and Voice Health | Midwest Ear, Nose & Throat Specialists | Blog

  https://mwent.net/voice-disorders-voice-health/

  Organic voice disorders that are physiological in nature and result from alterations in respiratory, laryngeal, or vocal tract mechanisms […] Structural organic voice disorders that result from physical changes in the voice mechanism (e.g., alterations in vocal fold tissues such as edema or vocal nodules; structural changes in the larynx due to aging) […] Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds) […] Functional voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation)

• #2 Speech Therapy Treatments For Voice Disorders | District Speech and Language Therapy | Speech Therapy Clinic in Washington DC

  https://districtspeech.com/speech-therapy-treatments-for-voice-disorders/

  People with voice disorders usually differ in voice quality, pitch, and loudness compared to their peers of the same age, gender, and cultural background. […] An organic voice disorder is a voice disorder with a physiological cause. That means it’s the result of abnormalities in respiratory, laryngeal, or vocal tract mechanisms. […] A structural voice disorder is actually kind of organic voice disorder. These result from structural changes, such as the alteration of vocal fold tissues caused by inflammation or vocal nodules for example. […] This is another kind of organic voice disorder. It results from issues with the central or peripheral nervous system in the larynx that affects the vocal mechanism. This can cause vocal tremors and vocal fold paralysis. […] Our ability to make sounds and speak depends on the respiratory system, laryngeal muscle activation and other vocal mechanisms connected to internal structures such as the pharynx, the oral cavity, etc. Any disturbance in these mechanisms can cause a voice disorder and as mentioned previously, the causes can be organic, functional, and/or psychogenic.

• #2

  https://care2communicate.com.au/voice

  Neurogenic organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism (e.g., vocal tremor, spasmodic dysphonia, or paralysis of vocal folds) […] Functional voice disorders that result from improper or inefficient use of the vocal mechanism when the physical structure is normal (e.g., vocal fatigue; muscle tension dysphonia or aphonia; diplophonia; ventricular phonation). […] Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple, Glaze, Klaben, 2010). […] Direct approaches focus on manipulating the voice-producing mechanisms (e.g., phonation, respiration, and musculoskeletal function) in order to modify vocal behaviors and establishing healthy voice production (Colton Casper, 1996; Stemple, 2000).

• #2 Speech Therapy Treatments For Voice Disorders | District Speech and Language Therapy | Speech Therapy Clinic in Washington DC

  https://districtspeech.com/speech-therapy-treatments-for-voice-disorders/

  Structural causes include: Cleft lip and cleft palate, Vocal fold nodules and polyps, Cysts, Edema, Inflammation of the larynx, Laryngitis, Other trauma to the larynx, Chemical exposure. […] Neurological cause include: Parkinson’s disease, Multiple sclerosis, Pseudobulbar palsy. […] Functional causes include: Frequent yelling or screaming, Excessive throat clearing or coughing, Speaking in too high or too low pitch, Vocal fatigue due to overexertion. […] Psychogenic causes include: Chronic stress disorders, Anxiety, Depression. […] Even if an obvious cause is identified, your speech therapist may still examine your medical history to identify any comorbid conditions. In these cases, voice disorders often remain even after the cause is identified. […] A good example is when a voice disorder develops from an upper respiratory infection, which is fairly easy to treat, but the voice issues continue even after the infection is gone. This can happen due to the improper use of speech techniques that only an experienced therapist can assist you with.

• #2 Acute Laryngitis: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/864671-overview

  Although acute laryngitis is usually not a result of vocal abuse, vocal abuse is often a result of acute laryngitis. The underlying infection or inflammation results in a hoarse voice. […] Acute laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3 weeks. When the etiology of acute laryngitis is infectious, white blood cells remove microorganisms during the healing process. The vocal folds then become more edematous, and vibration is adversely affected. […] The phonation threshold pressure may increase to a degree that generating adequate phonation pressures in a normal fashion becomes difficult, thus eliciting hoarseness. […] The membranous covering of the vocal folds is usually red and swollen. […] Some authors believe that the vocal fold stiffens rather than thickens.

• #2 Treating Functional Voice Disorders and Maintaining Good Vocal Health

  https://www.expressable.com/learning-center/voice/treating-functional-voice-disorders-and-maintaining-good-vocal-health

  Functional voice disorders are often caused by overuse and abuse. Many professions rely on the voice all day long. Teachers and coaches often have functional voice disorders due to the strain of having to yell all day. Those who work in a loud environment such as a factory often develop functional voice disorders from having to make their voices heard over competing sounds. Even children can develop a functional voice disorder from too much shouting. […] If left untreated, functional voice disorders can lead to an organic voice disorder, such as vocal nodules or polyps. Nodules are benign growths that form on the vocal folds due to abuse and appear like hard calluses. These develop over time and are often preventable. Abuse of the voice can also lead to vocal fold swelling. Over a period of time, this can cause spots to form and become larger and callous, especially with continued overuse. Polyps are typically larger than a nodule and appear to look more like a blister on the vocal folds. However, both can be attributed to vocal abuse. […] While this can sound scary, again, functional voice disorders are typically preventable and treatable.

• #2 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  Spasmodic dysphonia (SD) is currently understood to be a focal dystonia that affects laryngeal muscle control during speech. Dystonia refers to a syndrome of sustained muscle contractions. Focal dystonias involve abnormal activity in only a few muscles. Dystonic movements are aggravated or become manifest during voluntary movement and worsen with fatigue or physical and emotional stress. Dystonia may be focal, segmental, multifocal, or generalized. Although spasmodic dysphonia (SD) is considered a focal dystonia, it may present as a segmental or multifocal dystonia. […] The preponderance of evidence suggests that idiopathic dystonias are due to an abnormality of neurotransmitters in the basal ganglia (putamen, head of caudate, and upper brainstem). Zweig et al suggested that the putamen and the striatopallidothalamocortical circuit are disrupted in patients with focal dystonias.

• #2 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  A study by Khosravani et al using electroencephalographic analysis indicated that compared with healthy controls, persons with spasmodic dysphonia (SD) demonstrate, during voice production, a reduced movement-related desynchronization of motor cortical networks and an excessively large synchronization between left somatosensory and premotor cortical areas. […] A study by Simonyan et al suggests that the pathophysiology of spasmodic dysphonia (SD) may be related to specific brain abnormalities. […] Evidence from both diffusion tensing imaging and neuropathological data show specific white matter changes along the corticobulbar and corticospinal tracts and in the brain regions contributing to them. […] Postmortem histopathology also confirmed reduced axonal course and myelin content in the right genu of the internal capsule.

• #2 Hyperfunctional Dysphonia | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/conditions/hyperfunctional-dysphonia

  Hyperfunctional dysphonia is one of the most common conditions associated with the voice. […] Also referred to as muscle tension dysphonia (MTD) or vocal hyper function, hyperfunctional dysphonia is the constriction and overexertion of the muscles around the larynx (voice box). […] There are a number of factors that can lead to hyperfunctional dysphonia, such as: Long-term misuse of the voice, Acid reflux, Sudden changes in the voice due to an infection or stress. […] It is worth noting that hyperfunctional dysphonia can be brought on by one or more of these causes. […] Proper diagnosis of hyperfunctional dysphonia is only possible through the examination of the larynx. An otolaryngologist will evaluate the larynx during voice production to identify the underlying cause(s) of the problem. […] Depending on the diagnosis, treatment for hyperfunctional dysphonia may vary.

• #2

  https://link.springer.com/article/10.1007/s00455-024-10693-3

  The majority of patients with Parkinsons disease (PD) develop swallowing, speech, and voice (SSV) disorders. […] A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. […] SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. […] This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. […] Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.

• #2 Voice Disorders

  https://www.asha.org/practice-portal/clinical-topics/voice-disorders/?srsltid=AfmBOor8SgtLdbsAgXv8fn3VfVkw9p2dPSdhx5lAEtRDkymg9G3RtfZJ

  A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individuals age, gender, cultural background, or geographic location (Aronson Bless, 2009; Boone et al., 2010; Lee et al., 2004). […] Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple et al., 2010). […] The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor (Stemple et al., 2014; Verdolini et al., 2006). For example, vocal fold nodules may result from behavioral voice misuse (functional etiology). However, the voice misuse results in repeated trauma to the vocal folds, which may then lead to structural (organic) changes to the vocal fold tissue.

• #2 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

• #2 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  The sound source of a voice is produced by the self-excited oscillation of the vocal folds. […] In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. […] The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. […] Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds. […] The self-excited oscillation of the vocal folds located at the larynx produces the major sound source of a voice.

• #2 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  However, recent experimental and theoretical studies have demonstrated that the pressure distribution along the glottis essentially differs from that in a static condition in a range of high but realistic voice fundamental frequencies. […] The Strouhal number should not be negligible in the high vocal frequency range. […] The critical subglottal pressure and volume flow are expressed as functions of vocal fold biomechanical properties, geometry, and voice fundamental frequency. […] The threshold subglottal pressure and volume flow for flutter are explicitly described. […] The critical subglottal pressure described by Equation (24) is interpreted as the minimum lung pressure required for vocal fold oscillation onset. […] Such a critical lung pressure is in general called the phonation threshold pressure (PTP) and is potentially useful in diagnosis to noninvasively evaluate vocal fold stiffness and quantify the ease of phonation.

• #2 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  Structural causes include vocal fold lesion, larynx inflammation, and larynx trauma. […] Neurogenic causes include paralysis of the nerve supplying the larynx (recurrent laryngeal nerve), spasmodic dysphonia of larynx muscle, Parkinson’s disease, and multiple sclerosis. […] Functional causes include trauma from yelling and screaming, excessive throat clearing and coughing, and speaking in too high or too low pitch. […] Psychogenic causes include chronic stress and anxiety, and depression. […] There are a variety of speech therapy techniques that can be considered according to the underlying disorder, therefore, identification of the underlying cause of voice abnormality is the essential initial step to guide the management.5 […] Voice therapy is most effective in treating the most common cause of voice disorders: voice misuse.

• #2 Types Of Voice Disorders | Charlotte, Monroe, Indian Land

  https://cornerstoneent.com/voice-and-throat/voice-disorders

  It is rare for a psychological disorder to be the sole cause for a voice problem, but a psychogenic component is often present because of the emotional impact a voice disorder can have. In such cases, correct identification can be challenging, but recognition is important to ensure that mental health professionals can be involved in any treatment approach. […] Cancer of the larynx or any part of the throat is not considered a voice disorder. However, unexplained hoarseness is one of the warning signs of cancer, and anyone with persistent hoarseness that does not resolve after 2 weeks should be evaluated by an ENT physician. […] There are a variety of treatment options available depending on the patients specific condition. In many cases, treatment of underlying causes of laryngeal inflammation such as acid reflux and postnasal drainage are initiated. In patients who do not respond to conservative management, microscopic vocal cord surgery can be performed to address structural lesions of the vocal cords. Voice therapy with a speech pathologist is also an important part of the treatment protocol for both surgical and nonsurgical patients to improve vocal technique and prevent recurrence of their symptoms. […] Anyone with persistent hoarseness that does not get better after 2 weeks should be evaluated by an ENT physician.

• #2 Spasmodic Dysphonia: Practice Essentials, History of the Procedure, Epidemiology

  https://emedicine.medscape.com/article/864079-overview

  The changes in the CBT/CST suggest deficiency in connection between the cortical and subcortical regions, which are essential for voluntary voice production. […] Interestingly, botulinum toxin therapy resulted in a reversal of sensory hypoactivity 3-4 weeks after injection. […] Using the Newcastle Laryngeal Hypersensitivity Questionnaire, a study by Vanderaa and Vinney reported that adductor spasmodic dysphonia (SD) and mixed (adductor/abductor) SD are significantly associated with laryngeal hypersensitivity.

• #2 Hoarseness in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1201/p720.html

  Spasmodic dysphonia (or laryngeal dystonia) is the episodic, uncontrolled contraction of laryngeal intrinsic muscles to create a halting, strangled voice. […] Less commonly, hoarseness occurs secondary to systemic illnesses. Autoimmune diseases, such as inflammatory arthritis and lupus, can affect the cricoarytenoid joints. Endocrine disorders, including hypothyroidism and acromegaly, can cause hoarseness. […] Voice therapy, or voice training, is strongly recommended for patients with hoarseness who have significantly impaired vocal quality of life, especially those with dysphonia of nonorganic origins, benign vocal fold lesions, or age-related vocal atrophy. […] Surgical intervention is needed for dysplastic or malignant lesions, airway obstruction, or benign lesions (e.g., nodules, polyps, cysts) that do not respond to conservative therapies.

• #2 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  Structured exercises to strengthen and coordinate muscles of the larynx, Outcome studies have found that vocal function exercises are effective in enhancing vocal function in individuals with normal voices and in patients with disordered voices. […] According to the underlying cause, a combination of speech therapy with medical or surgical approaches may be required.

• #2 Voice Disorders | Laryngologists, Voice Therapists

  https://www.dukehealth.org/treatments/voice-disorders

  We diagnose and treat the full spectrum of voice disorders, from laryngitis and voice strain to more complex problems such as atrophy, hemorrhage, scarring of the vocal cords, vocal tremor, and laryngeal papilloma. […] If you have other medical conditions that may contribute to your voice disorder — such as allergies, asthma, or acid reflux — we will work with your other providers throughout Duke Health to ensure you receive the best care from an integrated team. […] Depending on your diagnosis, medical management and voice therapy can often correct a voice problem. […] We use a range of surgical approaches to treat the root cause of your voice disorders, including benign lesions, cancer, and vocal cord paralysis. […] Their ongoing research ensures you receive the best, most up-to-date care for your voice disorder.

• #3 Treating Functional Voice Disorders and Maintaining Good Vocal Health

  https://www.expressable.com/learning-center/voice/treating-functional-voice-disorders-and-maintaining-good-vocal-health

  Functional voice disorders are often caused by overuse and abuse. Many professions rely on the voice all day long. Teachers and coaches often have functional voice disorders due to the strain of having to yell all day. Those who work in a loud environment such as a factory often develop functional voice disorders from having to make their voices heard over competing sounds. Even children can develop a functional voice disorder from too much shouting. […] If left untreated, functional voice disorders can lead to an organic voice disorder, such as vocal nodules or polyps. Nodules are benign growths that form on the vocal folds due to abuse and appear like hard calluses. These develop over time and are often preventable. Abuse of the voice can also lead to vocal fold swelling. Over a period of time, this can cause spots to form and become larger and callous, especially with continued overuse. Polyps are typically larger than a nodule and appear to look more like a blister on the vocal folds. However, both can be attributed to vocal abuse. […] While this can sound scary, again, functional voice disorders are typically preventable and treatable.

• #3

  https://link.springer.com/article/10.1007/s00455-024-10693-3

  The majority of patients with Parkinsons disease (PD) develop swallowing, speech, and voice (SSV) disorders. […] A large gap in our knowledge is that the mechanisms of SSV disorders in PD are poorly understood. […] SSV disorders were thought to be caused by the same dopaminergic problem as those causing impaired limb movement; however, there is little evidence to support this. […] This review aims to provide an overview on the neuromuscular organization patterns, functions of the UA structures, clinical features of SSV disorders, and gaps in knowledge regarding the pathophysiology underlying SSV disorders in PD, and evidence supporting the hypothesis that SSV disorders in PD could be associated, at least in part, with PAS damage to the peripheral nervous system controlling the UA structures. […] Determining the presence and distribution of PAS lesions in the pharynx, larynx, and tongue will facilitate the identification of peripheral therapeutic targets and set a foundation for the development of new therapies to treat SSV disorders in PD.

• #3 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

• #3 Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0017503

  The sound source of a voice is produced by the self-excited oscillation of the vocal folds. […] In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. […] The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. […] Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds. […] The self-excited oscillation of the vocal folds located at the larynx produces the major sound source of a voice.

• #3 Speech Therapy For Voice Disorders – Klarity Health Library

  https://my.klarity.health/speech-therapy-for-voice-disorders/

  Structured exercises to strengthen and coordinate muscles of the larynx, Outcome studies have found that vocal function exercises are effective in enhancing vocal function in individuals with normal voices and in patients with disordered voices. […] According to the underlying cause, a combination of speech therapy with medical or surgical approaches may be required.

• #4 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

• #5 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

• #6 Phonotraumatic behaviors and voice disorders » Laboratory for the Study of Upper Airway Dysfunction » College of Public Health and Health Professions » University of Florida

  https://uad-lab.slhs.phhp.ufl.edu/2021/04/02/phonotraumatic-behaviors-and-voice-disorders/

  When patients come to a speech-language pathologist (SLP) complaining of a hoarse voice, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. […] Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are typically bilaterally symmetrical and are among the most common vocal fold pathologies caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from repetitive trauma of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found within the lamina propria and commonly seen in occupational groups with a high vocal stress (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a persons voice.

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