Chapter 6 (Voice)

To protect the lungs

• 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

• How we say something-not the words we say
• Changes in loudness, pitch, voice quality, reasonance and phrasing

Changes in pitch, loudness, and vocal quality. Important to stay in shape physically.

• Loud enough
• Flexible - not a monotone
• Pleasant sounding
• Produced with ease
• Representative of the speaker

• 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

Monoloudness - may be indication of neurological impairment, part of the individual's personality or psychogenic in cause.

• 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

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.

• 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

• -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

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.

• -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

Gastroesophageal Reflux Disease

• -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

• -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

Establishes a permanent tracheostoma at the base of the neck for breathing.

• -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

-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.

• 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.