Voice disorders are a group of voice disorders characterized by partial or complete absence of phonation. Voice disorders are more common in persons of vocal-speech professions (teachers, lecturers, actors, singers, etc.) who experience a large speech load, in adolescents in puberty, children and adults with various speech pathologies ( rhinolalia , dysarthria, stuttering ). Thus, about 60% of teachers, 6-24% of adolescents during the mutation period and 41% of children with speech problems suffer from voice disorders. In turn, voice disorders hinder the full development of speech and communication, worsen the neuropsychic state, impose restrictions on the choice of profession.

Voice disorders are a medical and social problem, therefore they are studied by medical and pedagogical disciplines – otolaryngology (and its highly specialized section – phoniatrics), neurology, psychiatry, speech therapy (and its highly specialized area – phonopedics).

Organic causes

Central organic voice disorders are associated with paralysis and paresis of the vocal cords, caused by damage to the trunk or cerebral cortex, conducting nerve pathways. Central organic voice disorders are found in children with cerebral palsy .

The causes of peripheral organic voice disorders are various inflammatory diseases or anatomical changes in the vocal apparatus. Among them:

• chronic laryngitis ;
• burns and injuries to the larynx;
• peripheral paresis and paralysis (with damage to the recurrent nerve);
• ” Singing knots “;
• tumors ( papillomatosis ) of the larynx;
• postoperative scars and stenosis of the larynx ;
• condition after resection of the larynx or laryngectomy.

Functional reasons

With functional disorders of the voice, the activity of the vocal apparatus is impaired in the absence of organic damage. Central functional disorders of the voice ( psychogenic aphonia ) is a consequence of an acute traumatic situation. More often occurs in women prone to neurotic reactions.

Peripheral functional voice disorders of the phonasthenia type can be caused by excessive voice loads, non-observance of the voice mode in respiratory diseases. Pathological mutation of the voice in adolescents can be caused by endocrine disorders, early smoking, overload of the vocal apparatus during this period.

Hypotonic dysphonia and aphonia are most often caused by bilateral myopathic paresis (paresis of the internal muscles of the larynx) caused by ARVI , diphtheria , influenza , and strong voice tension. The development of hypertonic (spastic) dysphonia and aphonia is usually associated with excessive voice forcing.

According to the degree of phonation disorder, dysphonia (partial violation of the strength, pitch and timbre of the voice) and aphonia (lack of voice) are distinguished. With dysphonia, the voice becomes deaf, hoarse, hoarse, unmodulated, breaking off, quickly drying out, and sometimes nasalized. Aphonia is characterized by a complete absence of voice sound and the ability to speak only in a whisper. For the reasons and mechanisms of phonation disorders, there are:

1. Functional disorders of the voice:

• central (psychogenic aphonia or hysterical mutism)
• peripheral (phonasthenia, hypotonic and hypertonic dysphonia or aphonia, pathological mutation)

2. Organic voice disorders:

• central (dysphonia and aphonia with dysarthria and anarthria)
• peripheral (dysphonia and aphonia in diseases of the larynx; rhinophonia ).

Organic voice disorders

Voice disorders in chronic laryngitis are caused by damage to the neuromuscular apparatus of the larynx and non-closure of the vocal folds. A voice defect is expressed by the loss of normal sounding, severe fatigue, and sometimes the inability to perform a voice load. Characterized by unpleasant subjective sensations in the throat – scratching, tickling , rawness, the feeling of “lump”, pain, pressure.

In the case of peripheral paralysis and paresis of the larynx, the voice may be completely absent or have a hoarse sound. Violation of the voice is accompanied by severe speech fatigue, reflex cough, choking, and respiratory distress. Discoordination of phonation and respiration significantly aggravates the defect.

Voice disorders associated with benign and malignant tumors of the larynx develop gradually, as the formations grow. After any, even sparing surgery , transient vocal disturbances occur in the larynx. When the larynx is removed, a person completely loses his voice; at the same time, the respiratory function is sharply disrupted, since there is a separation of the trachea and pharynx.

With central paresis and paralysis of the larynx, observed with dysarthria and anarthria, the voice becomes weak, quiet, intermittent, deaf, monotonous, often with a nasal tinge.

Organic voice disorders that have arisen in a young child are accompanied by a lag in speech development , a delay in the accumulation of vocabulary and the development of grammatical structures, impaired sound pronunciation, communication difficulties and limited social contacts. Voice disorders that develop during adulthood can contribute to occupational disability.

Functional voice disorders

As a peripheral functional disorder of the voice, phonasthenia is an occupational “disease” of persons of vocal-speech professions. The manifestations of phonasthenia include the inability to arbitrarily regulate the sound of the voice, (to strengthen or weaken), interruption (misfires) and rapid fatigability of the voice, hoarseness. In the acute period of phonasthenia, the voice may disappear completely. In most cases, phonasthenia does not require treatment; the voice recovers on its own after a period of rest.

With hypotonic dysphonia, due to paresis of the internal muscles of the larynx, non-closure of the vocal folds develops, which is manifested by hoarseness of the voice , vocal fatigue, pain in the muscles of the neck and occiput; in severe cases, only whispering is possible. With hypertonic dysphonia caused by tonic spasm of the laryngeal muscles, the voice is distorted, becomes deaf, rough; with aphonia, it does not arise at all.

A pathological mutation can be expressed in the preservation of a high sounding voice after the end of puberty, voice instability (alternating low and high tones), dysphonic sound, etc.

A functional impairment of the voice of a central nature (hysterical mutism, psychogenic aphonia) is characterized by a complete instantaneous loss of voice, the impossibility of whispering, but at the same time a sounding laughter and cough. An important differential feature is the variability of the form of non-closure of the vocal folds. The course of psychogenic voice disturbance is long-term, repeated relapses are possible after voice restoration.

Establishing the causes of voice disorders is carried out by an otolaryngologist , phoniatrist , neurologist ; study of the main characteristics of the voice – speech therapist . The survey algorithm includes:

1. ENT diagnostics. Laryngoscopy is performed to detect anatomical or inflammatory changes in the vocal apparatus ; in order to assess the function of the vocal folds – stroboscopy . In the diagnosis of tumor lesions, X-ray and MSCT of the larynx are irreplaceable . To obtain information about the function of the muscles of the larynx, electromyography is performed . With the help of electroglottography, changes in the vocal apparatus are assessed in dynamics.
2. Speech therapy examination . Includes an assessment of anamnesis, complaints, voice characteristics, the nature of voice formation and voice attack, physiological and phonation respiration, tempo-rhythmic and intonational characteristics of speech; determination of the time of maximum phonation.

Medical events

The content of medical work for various voice disorders depends on the causes and nature of the phonation disorder. So, in case of functional disorders of the voice, decisive importance is attached to general strengthening treatment, massage of the anterior surface of the neck, exercise therapy, physiotherapy, adherence to the voice regime. In case of organic voice disorders, general and local drug therapy is carried out ( endolaryngeal administration of drugs, inhalations ), according to indications – surgical treatment of ENT pathology (removal of excess tissue of the vocal folds, laryngeal resection, laryngectomy , etc.).

Speech therapy correction

Speech therapy work to restore voice disorders should be started as early as possible in order to prevent the fixation of pathological voice supply, achieve better results, and prevent the development of neurotic reactions to the defect. The main areas of corrective work include psychotherapy , breathing correction, the development of phonation and articulation coordination, the automation of the achieved skills and the introduction of the voice into free speech communication.

In speech therapy classes for the correction of dysphonia , breathing and articulatory gymnastics , phonopedic exercises are used. In patients after extirpation of the larynx, work is carried out on the formation of the esophageal voice.

A loud voice is considered restored with correct speech breathing, absence of fatigue and unpleasant subjective sensations. The approximate terms of speech therapy work with voice disorders are 2-4 months.