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Functional and Organic Voice Disorders

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What is a functional voice disorder?
Caused by faulty use of healthy mechanism
What is an organic voice disorder?
Caused by physical abnormality in structure of vocal tract
Is there always a clear cut difference between functional and organic voice disorders?
No! This can be tricky, they can overlap or be indistinguishable.

EX. a tumor can be caused by cancer from smoking (functional), but is organic because it is an abnormality in structure
EX. aphonia can be organic (vocal fold paralysis) or functional aphonia when they speak in a whisper/have no voice because of emotional trauma (somatization of an emotional disorder), this is also referred to as conversion disorder
What causes pitch breaks and fluctuations?
insufficient airflow, changes in mass, size, and tension of VFs
Functional Disorders: Falsetto
-this is puberphonia, which is mutational, incomplete mutation of voice
-high-pitch and breathy
-upper end of range that is used all of the time
-endocrine?
What is functional aphonia or dysphonia characterized by?
-observed normal mechanism
-vague description of symptoms by patient
-may be "conversion" disorder (emotional cause)
-Therapy= focus on awareness, symptomatic approach, psychotherapy support
-normal phonation is usually restored using minimal voice therapy
What is muscle tension dysphonia?
-functional dysphonia characterized by excess muscle tension
-3 types: ventricular phonation, vf shortened, and sphincterlike
-there is also non adducted type
What is diplophonia?
-double voice
-two sources of vibration
-Therapy= sometimes surgery, reduce hyper function
Thickening of VF?
-inflammation, irritation, or misuse
-Can be an early sign or indicative of advanced stage of damage
-trial therapy before surgery
-when swelling is caused by fluid under VF cover it is probably 1)Reinke's edema (thin, watery) or 2)polypoid degeneration= thicker, jelly like
Vocal Polyps
-unilateral
-can occur after one event (ex. sporting event, night at the bar) which produces hemorrhaging
-usually treated by surgery and vocal re-training
-may be either sessile (broad based) or pedunculated (narrow necked on a stem)
Vocal Nodules
-bilateral
-caused by misuse/abuse over time
-whitish, glottal margin causing "hourglass" closure
-may be anywhere, any size, more than one
-good success when treated with therapy
Cysts
-benign lesions
-either will be filled with mucous or a fibrous mass
Functional/Traumatic Laryngitis
-glottal edge of VF swollen and thick, irritated and may have increased blood flow (creating edema)
-treat this by eliminating causal behavior (ex. yelling, chronic coughing, habitual throat clearing, and forceful singing)
-chronic laryngitis may develop if problem is unattended to
Vocal Fold Hemmorhage
-extreme vocal trauma
-use of aspirin (blood clotting medicine)
-ex. steven tyler video
Ventricular Dysphonia
-this needs to be observed visually
1) False VFs vibrating: this is often a compensation for a true VF problem, although this may be trained if true VFs are paralyzed or removed
2)False VFs are impinging on true VF vibrations

*the ventricular voice is usually low pitched because of the large mass of vibrating tissue (false folds have more mass than true folds), which causes little pitch variability and monotone
*the false folds often don't make an approximation of their entire length, so voice is hoarse and breathy
Paradoxical Vocal Fold Dysfunction (PVFD)
-Vfs adduct during inhalation
-patient has tightness/choked feeling, this is scary, and can be triggered by strenuous exercise
-complex-unclear etiology
Phonation Break
-suddenly no voice temporarily that may occur for only part of a word, or sentence
-usually happens after prolonged hyperfunction
Pitch Breaks
1) caused by boys experiencing pubertal growth of larynx
2)hyperfunction: result of prolonged hyper function
3) Vocal Fatigue, ex. actors after long performance
Sulcus Vocalis
-bilateral, groove-like lesion parallel with glottis
-abuse and reflux may contribute
-incomplete glottal closure, interrupted mucosal wave
*organic
Contact Ulcers
*organic
-medial aspect of arytenoid process
-ulcer= small irritation
-granulated tissue= over the ulcer
-Causes:
1)abusive use
2)laryngopharyngeal reflux (LPR)
3)esophageal reflux

*vocal fatigue, laryngeal pain, hoarseness
Granuloma/Hemangioma
granuloma=firm granulated sac
hemangioma= soft, pliable blood filled sac

Causes:

1)intubation
2)abuse/misuse
3)LPR
Cancer
-oral, pharyngeal, laryngeal
-smoking, tobacco, infections, herpes, trauma, leukoplakia
Laryngectomy
-total removal of larynx
-tracheostomy (opening in trachea)
-esophageal speech, electrolarynx, passy-muir one-way valve
Congenital Abnormalities
-Laryngomalacia: epiglottis that is too pliable and collapses in the airway, failure of cartilage to stiffen, cause of stridor

-Subglottal Stenosis: narrowing of subglottic space. If severe, tracheostomy may be necessary

-Tracheoesophageal and Esophageal Atresia: abnormal occlusion of the esophagus , treated by surgery, and voice and feeding therapy
Leukoplakia
-benign tumors, pre-cancerous
-under tongue, no VF
-Smoking is most common cause
-added mass on vf, random size and place
Endocrine changes
-normally causes change in pitch
-pituitary, adrenal, thyroid, puberty, birth control pills, PMS, menopause
Hyperkeratosis
-pinkish, rough lesion-nonmalignat/precancerous
-result of continued tissue irritation
Infectious laryngitis
-some people are more prone to it
-usually viral, sometimes bacteria
Papilloma
-viral, wart like growths
-usually in children under age 6
Reflux
-GERD= gastric juices from stomach into esophagus
-LPR= continue up past esophageal sphincter into pharynx
Reflux meds
-antacids (neutralize acid= tums, rolaids
-H2 blockers (reduce acid)= pepcid, zantac
-proton pump inhibitors (reduce acid)= nexium, prevacid, prilosec

*if using an over the counter for longer than 2 weeks and heartburn persists, see MD or ENT
Reflux treatment
-consult MD or ENT about meds
-small frequent meals
-avoid fatty/fried foods, caffeine, cigarettes, tomato, citrus, spicy, mint, air filled foods (carbonation, whipped cream)
-sit or stand after eating, no food 3 hours before bedtime
-raise head of bed
-lose weight if overweight
Webbing
-congenital or acquired
-inhibits vibration