Organic voice disorders arise as a result of structural changes in the organs involved in phonation: the larynx, soft and hard palate, resonator cavities. Found in all age groups. In childhood, organic dysphonia is more often associated with congenital malformations and acute inflammatory processes, in adults – with chronic inflammation and neoplasms of the larynx. In practical speech therapy, organic dysphonia accompanies the clinic of various forms of dysarthria (pseudobulbar, bulbar, subcortical, cerebellar), open and closed rhinolalia , aphasia.

Various anatomical disorders in the vocal apparatus lead to the development of organic dysphonia. The phonation mechanism can suffer as a result of congenital, infectious-inflammatory, tumor diseases, trauma to the organs of voice formation. The main causes of organic dysphonia:

• Malformations of ENT organs. Violation of voice formation in early childhood is facilitated by congenital dysplasia of the larynx ( laryngomalacia , membranes of the glottis, laryngotracheoesophageal fissure ) and maxillofacial region ( palatine clefts , Gothic palate ). In these cases, dysphonia is defined from birth in the form of an altered, painful cry of the infant.
• Paresis and paralysis of the larynx . Central paralysis is observed in cerebral palsy and other neurological pathologies ( stroke , CNS malformations, encephalitis , syringomyelia ). Peripheral paralysis and paresis are the result of damage to the fibers of the laryngeal nerve with neck injuries, infectious diseases ( influenza , diphtheria ). Disorders of innervation cause unilateral or bilateral paralysis of the vocal folds, leading to a violation of the phonatory function.
• Neoplasms. Organic dysphonia of tumor etiology can occur against the background of laryngeal papillomatosis , adenoid enlargements, and throat cancer . The resonator function is impaired in the presence of nasal polyps , tumors of the accessory sinuses, and the tracheobronchial tree.
• Inflammatory processes. In the structure of inflammatory diseases of the throat associated with organic dysphonia, acute and chronic laryngitis , nodules of the vocal folds prevail . Less common causes are laryngopharyngeal reflux , stenosing laryngotracheitis , and mutational laryngitis .
• Injuries. Dysphonic disorders can be the result of foreign bodies , burns of the larynx, surgical operations. The acoustic characteristics of the voice change as a result of cicatricial stenosis that developed after injury to the neck organs, prolonged tracheal intubation , and wearing a tracheostomy tube.
• Hearing loss . Persistent hearing loss of varying degrees of severity entails insufficient acoustic control over one’s own speech. The consequence of this is a change in the nature of vocalization.

The pathogenesis of phonation disorders in organic forms of dysphonia can be associated with various mechanisms: a change in the mobility of the vocal folds, a violation of their closure, discoordination of voice formation and respiration. Sometimes several mechanisms are involved in the development of pathology.

Arrhythmia and asynchrony of oscillations, a decrease in the amplitude of movements of the vocal folds causes dysphonia in trauma, laryngeal paresis. Incomplete closure of the vocal folds is noted in chronic hypertrophic laryngitis , tumor processes. Complete non-closure develops after chordectomy.

Discoordination disorders are often accompanied by damage to the neuromuscular apparatus, congenital inferiority of the structural components of the larynx. So, the incompetence of the muscles of the palatopharyngeal ring leads to air leakage and the appearance of a nasal shade.

According to the severity of the defect, voice disorders are divided into dysphonia (partial disorder) and aphonia (complete loss of voice). Taking into account the level of damage, organic dysphonia can be of two types:

• Peripheral . They arise when anatomical changes are localized at the level of the peripheral part of the vocal apparatus: the larynx with vocal folds, resonator cavities.
• Central . They develop as a result of damage to the links of the central nervous system that are part of the phonatory nervous arc: the cerebral cortex, pons pons, subcortical nuclei and cranial nerves.

The leading clinical criterion is a change in the acoustic characteristics of a voice: pitch, sonority, sound intensity, timbre, modulation. The patient with aphonia speaks in a whisper, the sound of the voice is absent even when coughing and crying. Organic dysphonia symptoms classification

With organic dysphonia, the voice is stifled, deaf, hoarse. In the process of speech, voice fatigue quickly sets in, the voice “fades”. Hypo- or hypernasalization is often noted. Prosodic speech components suffer: the voice becomes monotonous, there are no modulations in it. The rate of speech slows down, logical pauses and accents are violated. Unpleasant subjective sensations in the throat are noted: a feeling of a foreign body , perspiration , a constant desire to cough up.

Certain nosologies associated with organic dysphonia have their own distinctive symptoms. With facial clefts, nasal nasal occurs – rhinophonia. Laryngeal paresis, along with gross voice defects, occur with phonation breathing disorders, dysphagia , and articulation difficulties. Progressive hoarseness and asthma attacks may indicate obstruction of the airways by a foreign body or neoplasm.

In patients with permanent tracheostomy, a peculiar pharyngeal voice is formed: due to the occlusion of the palate and the posterior wall of the pharynx, speech acquires a “croaking” sound, the articulation of consonants becomes exaggerated.

Organic dysphonia, which arose at an early age, leaves an imprint on the entire course of a child’s speech ontogenesis. The accumulation of vocabulary, the formation of grammar is slowed down, phonemic perception and sound pronunciation are distorted. Children can be diagnosed with delayed speech development , different degrees of OHP . Subsequently, the difficulties of verbal communication and schooling are added.

Persistent organic voice defects are difficult for adult patients. This may be due to the inability to continue professional activities, long-term treatment and its lack of effectiveness. Against the background of such experiences, neurotic disorders arise .

Examination of patients with organic dysphonia is the responsibility of otolaryngologists and phoniatrists . It includes a subjective assessment of voice function and a number of instrumental studies that make it possible to objectify the clinical picture: Organic dysphonia symptoms classification

• Inspection . As part of the initial appointment, complaints and anamnesis of the patient are clarified, an acoustic analysis of the voice, and a study of phonation breathing are carried out. The head and neck, ENT organs are examined ( rhinoscopy , pharyngoscopy , otoscopy ). The data obtained make it possible to determine the direction of further diagnostic search for dysphonia.
• Endoscopy. In order to identify the organic pathology of the larynx, an indirect laryngoscopy or fibrolaryngoscopy is performed . For a detailed visual examination of the vocal folds and their function assessment, stroboscopy is indicated . When neoplasms are detected, their biopsy and histological examination are carried out.
• Electrophysiological studies. The function of the laryngeal muscles is assessed using electromyography , the function of the vocal folds in dynamics – using electroglottography . With hearing loss, a study of evoked potentials , otoacoustic emission is carried out .
• Radiological diagnostics. As clarifying methods for dysphonia, Rg-graphy of the nasopharynx and paranasal sinuses, CT of the paranasal sinuses can be prescribed . To determine the lesion focus of the central nervous system, MRI of the brain is informative .

Differential diagnosis of organic forms of voice disorders is carried out with functional dysphonia , which is characterized by the absence of morphostructural damage to the vocal apparatus and the brain. The distinction between the forms of dysphonia is a determining factor in determining the directions of medical and psychological-pedagogical correction.

Conservative therapy

Overcoming organic dysphonia is directly related to the elimination of the etiological factor. During treatment, patients are assigned voice rest. With laryngitis, a course of anti-inflammatory drug treatment, therapeutic manipulations (intra-laryngeal infusions), physiotherapy ( inhalation , electrophoresis , UHF ) are carried out .

Central and peripheral paresis of the larynx require differentiated etiotropic treatment (vascular drugs, nootropics – for stroke, detoxification, antibacterial therapy – for infectious processes). In order to activate neuromuscular transmission, electrical stimulation of the laryngeal muscles, acupuncture are performed .

Surgery

The nature and volume of the surgical aid depends on the underlying pathology that caused the organic dysphonia. Laryngeal foreign bodies are removed endoscopically. With concomitant respiratory failure, an emergency temporary tracheostomy may be required . Cleft palate is repaired by uranoplasty .

Postoperative scars limiting phonation are excised. Nasal polyps, adenoids, papillomas are subject to surgical treatment. In malignant neoplasms of the larynx, the scope of intervention can vary from chordectomy to total laryngectomy . Organic dysphonia symptoms classification

Aphonia is an inevitable consequence of extirpation of the larynx. In this case, the restoration of voice formation is possible only with the help of replacement mechanisms (development of the esophageal voice) or surgical methods ( implantation of a voice prosthesis , tracheoesophageal bypass grafting).

Speech therapy correction

After the end of conservative etiopathogenetic or surgical treatment, the signs of dysphonia do not always disappear on their own. In this case, the help of a phonopedist is required to restore the phonator function . The immediate content of the work depends on the causes of organic dysphonia, the results of treatment, the safety of the structures of the larynx, the requirements for the quality of the voice. Correction directions:

• Rational psychotherapy . At the preparatory stage, it is important to form the patient’s correct motivational attitudes, faith in the success of rehabilitation treatment. For this purpose, autogenic training, conversations, demonstration of examples of phonation restoration in patients with similar problems are used.
• Training of physiological and phonation breathing . Complexes of exercise therapy are prescribed, special breathing exercises are carried out . Blowing into the harmonica is an effective exercise for functional training of the vocal apparatus.
• Articulation and vocal exercises . Articulatory gymnastics is first performed silently, then with phonation. Cause the voice by pronouncing the sound “m” first in isolation, then in combination with vowels. Gradually increase the strength and pitch of the voice, develop coordination of phonation and articulation.
• Automation of skills. The developed strong sonorous voice is fixed in words, phrases. Vocal training contributes to the expansion of the range. Literary material (poetry, prose) is used to work on the expressiveness of the voice.  Organic dysphonia symptoms classification