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DISORDERS OF VOICE

Hoarseness of voice
Causes of hoarseness

LARYNGEAL
Congenital :
Web,cyst,tumour

Traumatic:
Injury,radiation,intubation,voice abuse

Infection:
Acute,chronic

Tumours:
Benign,malignant
Laryngeal oedema

Functional aphonia

Recurrent nerve palsy

Laryngocoele

OESOPHAGEAL
Malignancy

CERVICAL & MEDIASTINAL

Mass

GENERAL
Myxoedema
Diabetes
Syphilis
Lead poisoning
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Investigations
X Ray Chest:to r/o mediastinal mass,aortic aneurysm,LAH.

Ba swallow:to r/o CA oesophagus

ESR,VDRL,Blood sugar.

Panendoscopy:to r/o malignancy

Cardiovascular investigations:to r/o aortic aneurysm,mitral stenosis

CT scan:to r/o SOL in brain,thorax.

Thyroid function tests

Direct laryngoscopy/Microlaryngoscopy

Treatment
SPECIFIC : Treatment of cause

GENERAL:

*Voice rest

*Steam inhalations

*Antibiotics

*Anti inflammatory drugs

*Speech therapy

*Direct laryngoscopy/Microsurgery.
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Functional aphonia
(Psychogenic aphonia,Hysterical aphonia)

Functional paralysis of the adductors

Young females,18 to 34 years

Emotionally unstable individuals

Onset & recovery are sudden

Sometimes aphonia is complete;more often voice reduced to a whisper

Cords fail to meet on attempted phonation

Cough is normal

Speech therapy;persuasion;treatment of underlying psychogenic cause.

Dysphonia plicae ventricularis

(Ventricular band voice)
Aetiology
Usually found in persons who shout(street vendors).
Produced by apposition of false cords
May be secondary to impaired function of true cords
Commonly,the condition is psychogenic

Diagnosis: by IDL

Clinical features
Voice is low,gruff,unpleasant

Treatment
Voice rest & speech therapy.
Prognosis is poor.
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Puberphonia/Pubophonia/Maturational falsetto
Not of organic origin.
Voice has weak quality & small dynamic range.The falsetto voice is
different from the voice of a young boy.
Normal sexual development has been followed by abnormal functional
adaptation.
Most cases can be treated by speech therapy alone.
Intractable cases require psychiatric help.

Phonasthenia

Weakness of voice due to fatigue of phonatory muscles.

Thyroarytenoid and/or interarytenoids may be affected

Easy fatiguability following abuse of voice

IDL shows :
(a)Elliptical space between the cords in thyroarytenoid weakness
(b)Triangular gap near the post commissure in interaytenoid
weakness
(c)Keyhole glottis when both are affected

Treatment is voice rest

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Stuttering(Stammering)

Disorder of fluency .
Inhibition or interruption of speech fluency that is independent
of the will of the stutterer.

Types
Clonic : repetition of words & syllables
Tonic : dysfluent blocks due to straining at the start of word
or sentence.

Etiology

Theories:
Hereditary
Neurosis- emotionally triggered.
Neglect or overprotectiveness
*CNS abnormalities-incomplete cerebral
dominance (it is associated with left-handedness or forced
right-handedness)
*Impaired auditory &/or other feedback
systems for speech
*Learning theory-an anticipation of certain words produces
anxiety leading to an abnormal approach to the situation.

Treatment

Speech therapy
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Rhinolalia aperta
Production of speech sounds with predominantly nasal resonance

Etiology: Velopharyngeal insufficiency

Congenitally short soft palate
Submucous palate
Cleft of soft palate
Paralysis of soft palate
Post adenoidectomy
Oronasal fistula
Habitual speech pattern

Rhinolalia clausa
Inability to produce the resonants m,n,ng.
Lack of nasal resonance due to blockage of nose
Etiology:
URTI
Nasal allergy
Nasal polyp/mass
Adenoids
Rhinolalia mixta
Combination of clausa & aperta