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What is the biological function of the larynx?
To protect the lungs
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What is the emotional function of the larynx?
- Voice can sound happy, mad, or afraid
- Hear emotions in the voice
- Babies use vocal shadings
- "The voice is the mirror of the soul"
- Voice is our primary means of expression
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What is the linguistic function of the voice?
- How we say something-not the words we say
- Changes in loudness, pitch, voice quality, reasonance and phrasing
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How does voice change at the age of 60?
Changes in pitch, loudness, and vocal quality. Important to stay in shape physically.
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We expect a voice to be:
- Loud enough
- Flexible - not a monotone
- Pleasant sounding
- Produced with ease
- Representative of the speaker
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Disorders of pitch
- Monotone - may be indication of neurological impairment, part of the individual's personality, or psychogenic in cause
- Inappropriate pitch - outside of range for age, gender, body size
- Pitch breaks - for exmaple young men going through puberty
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Disorders of loudness
Monoloudness - may be indication of neurological impairment, part of the individual's personality or psychogenic in cause.
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Disorders of voice quality
- Hoarse voice - may be temporary due to a cold or the flu, overuse at a party/sporting event
- Breathiness - air escaping between the vocal folds while talking - indicates that the vocal cords are not coming together
- Vocal tremor
- Strain or struggle
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Two kinds of voice disorders
Organic - involves structural deviation of the laryngeal mechanism which will in turn affect how the vocal folds vibrate. Primary treatment: medical, dental, surgical that may be followed by speech therapy. It involves respiration, phonation, resonation, and articulation.
Functional - no weakness, paralysis or other neurological disease of the vocal folds and no nodules, cysts, polyps. Treated with counseling or psychotherapy.
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Voice disorders associated with vocal misuse or abuse
- Vocal nodules-misuse or phonotrauma
- Contact ulcers-painful; related to GERD
- Vocal polyps-fluid filled lesions
- Acute of chronic laryngitis-folds get red and ugly
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Voice Evaluation
- -Referral from a physician
- -Extensive case history
- -Evaluation: videoendoscopy with or without stroboscopy
- -Recommendation from physician
- -The patient must be internally motivated to follow the recommendations of all professional involved
- -Mandatory to follow the vocal hygine program
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PVFM
Paradoxical Vocal Fold Movement: A "nonorganic" disorder of the upper airway with both true and false vocal folds exhibiting paradoxical function of closure on inspiration, expiration, or a combination of both. PVFM have a history of abuse. More females than males.
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Transgender
- -Not just about the voice-it is overall communication style
- -See far more males than females
- -Process takes time, patience, money and couseling-psychosocial crucial to success
- -Altered lexicon (mars and venus)
- -Breathiness
- -Facial expression
- -Gestures
- -Intonation
- -Pitch and pitch flexibility
- -Rate volume and loudness
- -Voice is the greatest challange for male to female patients/clients
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GERD
Gastroesophageal Reflux Disease
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What are some of the ways to protect your voice?
- -Do not smoke
- -Drink lots of water
- -Humidify the environment
- -Avoid Caffeine, alchohol, and carbonated beverages
- -Eliminate habitual and frequent throat clearing
- -Avoid very hot and/or very cold beverages - No ice
- -Avoid chocolate and nuts
- -Avoid mint, menthol, and eucaplytus
- -Be careful with medicated/drugs
- -Conserve (rest) your voice whenever possible - "If you are not getting paid to use it...DO NOT USE IT"
- -Control and limit vocal loudness
- -Avoid talking in loud settings
- -Give in to laryngitis
- -Learn to use your voice correctly
- -Pay attention to how your voice sounds and feels
- -Be aware the symptoms of GERD/LPR (laryngopharyngeal refux)
- -Do not converse during strenuous physical exercise
- -Learn to manage stress
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Laryngectomy: the Diagnosis
- -Often delayed (excuses for sore throat, practitioner didn't refer to ENT, tumor difficult to visualize, patient ignores and fears the worst.
- -Medical procedures and tests
- -Variety of specialists
- -Decision as to chemotherapy, radiation, surgery
- -Patient and family faced with changes
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Laryngetomty: the surgery
Establishes a permanent tracheostoma at the base of the neck for breathing.
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Laryngectomy: aftercare
- -Focus on wound healing and recovery from the procedure
- -Patient and family members are taught how to care for the wound and hygiene of the stoma
- -Chemo and/or radiation may complicate and/or prolong the recovery.
- -Make sure the patient and family members have alternative ways to communicate
- -Understand how the patient feels and find different ways to communicate
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Laryngectomy: Breathing
-Loss of warming, humidifying, and filtering that leads to respiratory ailments such as excessive mucus production, coughing, crusting of the stoma, and sensory fuctions of taste and smell are altered.
-Patient must prevent the inhalation or aspiration of foreigh bodies into the lungs.
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Laryngectomy: Speaking
- 1. Esophageal speech: Individual learns to trap air in the upper esophagus and release it in a "belch-like" maneuver to produce vibration of the throat for generating a voice. ADVANTAGES: No additional surgery, no equipment repair, maintenance, both hands are free. DISADVANTAGES: High failure rate (75%), generally requieres time and money.
- 2. Artifical larynx:
on the neck, intraoral. It is mechanical. Battery-powered device is positioned against the neck or in the mouth. ADVANTAGES: easy to master, volume control adjustable, highly intelligible over the phone. DISADVANTAGES: visual distraction and auditory (mechanical buzzing or noise), hand held.
3. Tracheoesophageal speech (TEP): Preferred by many patients, patients find it easier to master-closest thing to normal speech.
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