Voice and Resonance Disorders

Voice disorders include raspy voice, nodules on the vocal chords and any other issue concerning how one’s voice sounds.  Resonance disorders are those issues affecting how air flows through the mouth and nose and affects the sound of a person’s voice including consistently sounding like they have a stuffy nose, having a nasal quality to the voice or issues due to congenital formations such as cleft palate.

Voice Disorders

Voice disorders include impaired ability to produce voice (dysphonia) and inability to produce voice (aphonia). Normal voice is produced by the vibration of the vocal folds (vocal cords), two small muscles in the larynx (voice box). Anything that disrupts the vibration of these vocal folds will cause changes in voice quality.

One cause of voice disorders is unilateral (one-sided) or bilateral (two-sided) weakness or paralysis of the vocal cords due to nerve damage from neurological diseases, injuries, or other causes. Growths on the vocal cords (nodules or polyps) that interfere with their complete closure can cause a hoarse and breathy sounding voice. These growths are often caused by vocal abuse such as excessive loud talking, singing, yelling, or crying; frequent coughing or throat clearing; or tense throat/neck muscles during speaking or singing. Smoking, heavy intake of caffeine or alcohol, acid reflux, and allergies can also contribute to these growths. Spasmodic dysphonia is a chronic type of voice disorder that causes a harsh, strained sounding voice due to tremors or abnormal muscle tone in the vocal cords. Voice disorders also frequently occur with Parkinson’s disease.

Symptoms of Voice Disorders

Symptoms may range from mild to severe. If they are severe enough, they may make speech hard to hear or understand. They include:

  • Hoarse, scratchy, breathy, strained, or strangled sounding voice
  • Discomfort when using the voice
  • Overly high or low pitch
  • Restricted range of pitch and/or loudness
  • Voice that quickly fatigues

Assessing and Treating Voice Disorders

Initial evaluations for voice disorders are typically conducted by an ear, nose, and throat doctor (ENT) and sometimes a neurologist. The evaluation with determine the structural conditions of the vocal mechanisms often by using a scope (thin tube with a camera) that is inserted through the nose to look at the larynx and the movement of the vocal folds.

The speech-language pathologist (SLP) may then take a thorough medical history, including questions about voice habits and other social habits such as smoking and drinking alcohol. She will have the client complete various speech tasks to assess voice quality, pitch, loudness, and duration. The SLP may use specialized instruments to measure the acoustic features of the voice.

Treatments for voice disorders will depend upon the diagnosis. The SLP may train the client in vocal hygiene techniques – ways to avoid vocal abuse and promote good health of the larynx and vocal folds. The client may do exercises to strengthen the movements of the vocal folds, increase breath support, or promote relaxation of tense throat and larynx muscles. Special instruments and computer programs can be used to provide visual feedback about a client’s voice output, so she can learn to make adjustments. A therapy program called Lee Silverman Voice Therapy (LSVT®) that focuses on louder and clearer voice production may be provided for clients with Parkinson’s or other neurological voice problems.

Sometimes the ENT will determine that medical treatments are necessary. These may include: injections to relax the vocal folds for spasmodic dysphonia; medications to treat allergies, reflux, or thyroid problems; surgeries to remove growths; or surgeries to move or enlarge a paralyzed vocal cord.

Resonance Disorders

Resonance refers to the way that air is shaped as it passes through the mouth and nose while speaking. The air for m, n, and ‘ng sounds should be directed through the nose. For all other sounds, the soft palate (in the back of the roof of the mouth) moves up and back to close off the nasal cavity so that air is directed through the mouth. If this closure, called the velopharyngeal valve, is impaired in any way, resonance disorders may result. Incomplete closure (also called velopharyngeal insufficiency or VPI) may occur because of structural abnormalities; for example, openings due to cleft palate, obstructions due to enlarged adenoids or swollen nasal passages, or a short palate. It may also occur when there are problems with palatal movement, such as weakness, paralysis, or incoordination caused by neuromuscular diseases or injuries.

Symptoms of Resonance Disorders

Symptoms range from mild to severe. If they are severe enough, they may make speech hard to understand. They include:

  • An overly nasal sounding voice (hypernasality)
  • Air audibly leaking through the nose during speech (nasal emission)
  • A voice that sounds less nasal than usual (hyponasality or denasal), similar to when one has a severe cold (e.g., My nose is stuffy sounds like By doze is stuffy.)

Assessing and Treating Resonance Disorders

An ear, nose, and throat doctor (ENT) and sometimes a neurologist, should complete an exam in addition to the speech-language pathologist’s (SLP) evaluation. The ENT will determine the structural integrity of the nasal, oral, and laryngeal cavities. A scope (thin tube with a camera) may be inserted through the nose to look at the movement of the soft palate and walls of the throat.

The SLP will first take a thorough medical history, including questions about allergies, throat and ear infections, and injuries. She will assess resonance as the client says different sounds, words, and phrases. The SLP may use specialized devices to take quantitative measures of resonance or nasal emission.

Treatments for resonance disorders will depend upon the diagnosis. The SLP may give exercises to improve strength or coordination of the movements of the palate and walls of the throat. The client may practice sensing the position of the palate and adjusting its movement during various speech tasks. Special instruments and computer programs can provide visual feedback about resonance output for this same purpose.

Sometimes medical treatments by a doctor are necessary. These include medications to treat allergies, surgeries to repair cleft palate or soft palates that are too short, surgeries to remove enlarged adenoids, and fitting of prosthetic devices worn in the mouth to help close off the opening between the nose and throat.