Hoarseness of Voice and voice disorders 1 HOARSENESS

Hoarseness of Voice and voice disorders 1

HOARSENESS • ROUGHNESS OF VOICE RESULTING FROM VARIATIONS OF PERODICITY AND/OR INTENSITY OF CONSECUTIVE SOUND WAVES 2

HOARSENESS • NORMAL VOICE 1. VOCAL CORDS(VC) SHOULD BE ABLE TO APROXIMATE PROPERLY WITH EACH OTHER 2. PROPER SIZE AND STIFFNESS 3. ABILITY TO VIBRATE REGULARLY IN RESPONSE TO AIR COLUMN 3

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LOSS OF APPROXIMATION SIZE STIFFNESS VC PARALYSIS ODEMA PARALYSIS VC FIXITY FIBROSIS FUNC TUMOR FIBROSIS SURGICAL EXCISION 5

AETIOLOGY 1. INFLAMATION-ACUTE/CHRONIC 2. CONGENITAL 3. TUMORS/TUMORLIKE 4. FIXATION OF CORDS 5. TRAUMA 6. PARALYSIS 7. MISC. LIKE MYXOEDEMA 8. FUNCTIONAL 6

DIAGNOSIS HISTORY NECK EXMINATION /ILS CVS /RS/CNS LAB+RADIOLOGY DLS +/- MLS BRONCHOSCOPY OESOPHAGOSCOPY 7

DYSPHONIA PLICA VENTRICULARIS (VENTRICULAR DYSPHONIA) • VOICE IS PRODUCED BY VENTRICULAR FOLDS • VOICE IS ROUGH , LOW PITCHED AND UNPLEASANT • SECONDARY TO IMPAIRED FUNCTION OF THE TRUE CORD OR FUNCTIONAL 8

DIAGNOSIS • ON ILS/FLEXIBLE SCOPY FALSE CORDS APPROXIMATE OBSCURING THE VIEW OF TRUE CORDS 9

TREATMENT TREAT THE CAUSE VOICE THERAPY PSYCHOLOGICAL COUNCELLING 10

FUNCTIONAL APHONIA FUNCTIONAL DISORDER SEEN IN EMOTIONALLY LABILE FEMALES AGE 15 -30 SUDDEN ONSET WITHOUT ANY OTHER LARYNGEAL COMPLAINTS • COMMUNICATES WITH WISPER • • 11

ON EXAMINATION • VOCAL CORDS ARE SEEN IN ABDUCTED POSITION AND FAIL TO ADDUCT ON PHONATION • ADDUCTION CAN BE SEEN WHEN PT COUGHS – INDICATES (N) ADDUCTOR FUNCTION 12

TREATMENT • REASSURE • PSYCHOTHERAPY 13

PUBERPHONIA (Mutational Falsetto voice) • IN MALES AT PUBERTY THE VC LENGTHEN AND VOICE CHANGES TO LOWER PITCH • FAILURE OF THIS CHANGE LEADS TO PERSISTENCE OF CHILDHOOD HIGH PITCHED VOICE. 14

CLINICAL FEATURES • SEEN IN BOYS WHO ARE EMOTIONALLY IMMATURE • FEEL INSECURE AND SHOW EXCESSIVE FIXATION TO THEIR MOTHERS • PSYCHOLOGICALLY THEY SHUN TO ASSUME MALE RESPONSIBILITIES • (N) PHYSICAL –SEXUAL MATURITY 15

TREATMENT • VOICE TRAINING –TO PRODUCE LOW PITCHED VOICE • PRESSING THE THYROID IN BACKWARD AND DOWNWARD DIRECTION RELAXES THE STRECHED CORD. (GUTZMANN’S PRESSURE TEST) • PROGNOSIS IS GOOD. 16

PHONASTHENIA • WEAKNESS OF VOICE DUE TO FATIGUE OF PHONATORY MUSCLES • THYROARYTENOID AND INTER ARYTENOID AFFECTED • SEEN IN ABUSE OR MISUSE OF VOICE • EASY FATIGUABILITY OF VOICE 17

TYPES & TREATMENT • Elliptical space- thyroarytenoid weakness. • Triangular gap near posterior commissureinterarytenoid. • Key hole app- Both thyroid and interarytenoid. • Rx-Voice rest , vocal hygiene. 18

Hyponasality (Rhinolalia Clausa) • Lack of nasal resonance for words like m, n, ng. • Due to blockage of nose / nasopharynx. • Common cold, nasal allergy, nasal polypi, nasal growth, adenoids, nasopharyngeal mass, habitual. 19

Hypernasality (Rhinolalia Aperta) • Words with little nasal resonance are resonated through nose. • Failure of nasopharynx to cut off from oropharynx / abnormal communication b/w oral & nasal cavities. • Velopharyngeal insufficiency, cleft palate, paralysis of soft palate, post-adenoidectomy, oronasal fistula, habitual 20

Stuttering • Disorder of fluency of speech - hesitation to start, repetitions, prolongations or blocks in the flow of speech • Well-established- may develop secondary mannerisms - facial grimacing, eye blink and abnormal head movements. 21

• Too much attention/ child reprimanded by parents & peers- behaviour pattern may become fixed - may develop into an adult stutterer. • Education of parents- not to overreact to child's dysfluency in early stages of speech development. 22

Treatment • Speech therapy and Psychotherapy- improve his image as a speaker and reduce his fear of dysfluency. 23

THANK YOU 24