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Vocal Pathology Overview for Better Understanding and Management

Explore common voice disorders, laryngeal pathology, vocal fold dynamics, and nerve control in speech with expert insights. Learn about medications, benign lesions, and treatment options.

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Vocal Pathology Overview for Better Understanding and Management

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  1. Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University

  2. The “Plan” • RELAX!!! • Be comfortable • Ask questions • Get answers • Go home with new information • Take with you material that you can use

  3. Common Terms • Voice Disorder • Hyperfunction • Hypofunction • Aphonia • Dysphonia • Laryngeal Pathology • Vocal Pathology :{ )

  4. Speech Dynamics • Speech on exhalation from lungs • Activates the vocal folds • Voiced sound (phonation) passes through the pharynx and oral cavity • Articulators modulate

  5. Prosection of the Larynx • 9 cartilages; 1 bone • 5 intrinsic laryngeal muscles to regulate mass, length and tension of the vocal fold • It is a VALVE; it’s binary

  6. TVF = true vocal fold • FVF = false vocal fold • Trachea = “windpipe”

  7. Coronal Section of the Larynx • TVF and FVF • TVF shape and histology

  8. Valve Functions of the Larynx • Abduct: Posterior cricoarytenoid m. • Adduct: Lateral Cricoarytenoid m. (and the Transverse and Oblique Arytenoid muscles. • “Open” at rest

  9. Vocal Fold Activity • Closed-Open-Closed • Medial Compression • Vocal “cord”, ligament and fold • Frequency, Amplitude and Waveform • Perturbation values: jitter and shimmer

  10. 1 cycle of vocal fold vibration • “closed-open-closed” • Aerodynamic process • Myoelastic process • Frequency perceived as “pitch”

  11. Vocal Fold Movement • Closed-Open-Closed • Stroboscopic view • Medial compression • Male Frequency Range: 118-150 Hz • Female Frequency Range: 180-240 Hz

  12. Speech is a MOTOR act • Nerves activate and fire • Muscles are “moved” by the nerve impulse • Cranial nerves that control speech: Trigeminal, Facial, Hypoglossal, Vagus, and Accessory

  13. Recurrent Laryngeal Nerve • Asymmetrical branch of CX • “Feeds” the intrinsic laryngeal muscles • PCA • LCA • OA/TA • TA

  14. Nerve Damage • CX: The Vagus • Recurrent Laryngeal Nerve • Image of unilateral cord paralysis • Dec’d pitch • Respiration for speech is inefficient

  15. Medications • Coordination and proprioception (stimulants, sedatives,nervousness, tremors, pain masking) • Airflow (bronchodilators, constrictors, nervousness, tremor) • Fluid balance (decongestants,---”rebound effect”--edema, sedating, decreased energy

  16. Medications, cont. • URT secretions--(antihistamines, dryness, sedation) • Hormonal (androgens, increasing vocal mass) • Gastrointestinal Reflux Disorder: GERD---OTC medications, diet.

  17. Laryngeal Pathology • An ANATOMICAL CHANGE in the size, structure or shape of the larynx • A pathology is a deviation in the normal structure caused by disease or other systemic variation

  18. Benign Lesions • Vocal Nodules • Vocal Polyps: Sessile Peducunlated • Contact Ulcers • Granuloma • Papilloma

  19. Added Mass • Top view: vocal nodules (bilateral) • Bottom view: vocal polyp (sessile)

  20. Swelling • Reinke’s Edema • Increased mass, decreased pitch (frequency) • Atypical perturbation values

  21. Plicae Ventricularis • False vocal fold vibration • Decreased pitch and decreased frequency (< 90 Hz) • Limited Pitch e.g., “Monopitch”

  22. “Bowed Vocal Cords” • Chronic Laryngitis • Presbylaryngis • Fatigue/Overuse • Symptoms: • decreased intensity • decreased respiratory control • decreased pitch range

  23. Granuloma • Associated with physical irritation; abrasion of the mucous cover of the vocal fold • Adds mass: decreases pitch (frequency), increases perturbation values

  24. Intracordal cyst • Note left side of body (slide right!) • Added mass • Incomplete medial compression of true vocal fold • Result: increased mass and air escape

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