Voice Disorders

Christine Sapienza, PhD, CCC-SLP, serves as the Dean of the Jacksonville University, Brooks Rehabilitation College of Healthcare Sciences. Previously, Dr. Sapienza was a longstanding tenured professor and chair of the Department of Communication Sciences and Disorders at the University of Florida, as well as a research career scientist at the Brain Rehabilitation Research Center at the Malcom Randall Veterans Administration Hospital. As a principal investigator of National Institutes of Health grants, VA Research Rehabilitation Research and Development Awards, and a M.J. Fox Foundation grant, Dr. Sapienza has provided extensive mentoring to 16 doctoral students, all of whom have contributed back to academics and clinical service. She has built a strong national and international reputation for expertise in the design and implementation of larger scale randomized clinical trials examining treatments as well as the careful reporting of peer-reviewed outcomes from these studies. Dr. Sapienza methodically disseminates this information to the scientific community at large in the form of invited presentations, workshops, and clinical teaching platforms. Through writing, she works to integrate research findings in journal articles, textbooks, and clinical manuals. As a frequent contributor to patient support groups she aspires to assist patients and caregivers as they navigate available treatments and emerging science. Most recently, Dr. Sapienza was selected as Jacksonville's Women of Influence.+++++++++++++++++++++++++++++++++++++++++++++Bari Hoffman, PhD, CCC-SLP, is an Associate Professor in the Department of Communication Sciences and Disorders and jointly appointed as Associate Professor, Internal Medicine at the University of Central Florida. Dr. Hoffman serves as research partner to the Florida Hospital Cancer Institute and Director of the Center for Voice Care and Swallowing Disorders at the Ear Nose Throat and Plastic Surgery Associates. She has worked clinically in this setting for more than 18 years treating individuals with voice and upper airway disorders specializing in pediatric, professional and neurogenic populations, along with individuals undergoing treatment for head and neck cancer. Dr. Hoffman received her doctoral degree from the University of Florida in 2001. Her current research involves studying novel treatment technologies and biomechanical mechanisms for disorders of laryngeal function while defining the high impact on quality of life factors. She implements 3-D computer modeling of upper and lower airway function, coping strategies of individuals with dysphonia and respiratory muscle strength paradigms in a variety of patient groups. Dr. Hoffman has a significant record of peer-reviewed publications, authorship of multiple textbooks, and actively lectures across the country on these topics. In recognition of her contributions to teaching, research, and service, she has received numerous awards within her University and state association.

Foreword by Thomas Murry, PhD

Preface

Acknowledgments

Contributors

Companion Website



Chapter 1. Respiratory Anatomy and Physiology

The Lungs

The Trachea

The Bronchi

The Thorax

The Ribs

The Diaphragm

The Abdominal Wall

Sternum

Clavicle

Driving Forces of the Respiratory System

How Does the Human Body Generate These Respiratory Forces?

Passive and Active Forces of the Respiratory System

The Respiratory System and Voice Production

Relaxation Pressure Curve

Using the Right Terminology

Biofeedback Techniques

Summary

References



Chapter 2. Laryngeal Anatomy and Physiology

Laryngeal Anatomy

Laryngeal Structure: Pieces and Parts

Laryngeal Muscles

What Are the Vocal Folds Made of, Exactly?

Laryngeal Ligaments and Membranes

Extrinsic Membranes

Intrinsic Membranes

Ligaments

Aryepiglottic Folds

Cavities

Arterial Supply of the Larynx

Laryngeal Nerve Supply

Laryngeal Development (Infancy to Adulthood)

Adult Male and Female Differences in Laryngeal Anatomy

Age Effects on Laryngeal Anatomy

Phonation

Mechanisms for Changing Pitch

What Is a Vocal Register?

Mechanism for Changing Loudness

Summary

References



Chapter 3. Vocal Health

Phonotrauma

Basic Issues Related to Vocal Health

Recovery Process

Contributors to Poor Vocal Health

Summary

References



Chapter 4. Evaluation

The Specialty of Otolaryngology

Case History

The Physical Examination

Laryngoscopic Techniques

Instrumental Assessment

Imaging

Digital Laryngostroboscopy

Videokymography

Aerodynamics

Classic Methods for Collection of Aerodynamic Signals

Laryngeal Aerodynamic Variations

Laryngeal Aerodynamics as a Function of Aging

Laryngeal Aerodynamic Differences as a Function of Sex

Laryngeal Aerodynamic Changes as a Function of Speech Task

Using Aerodynamics for Examination of Voice Disorders

Acoustic Analysis of Voice

Intensity

Voice Range Profile

Short-Term Perturbation

Relative Noise Level

Spectral Measures

Fast Fourier Transform (FFT)

Vowel Spectrum

Long-Term Average Spectrum

Cepstral Peak

Electroglottography

Electromyography

Auditory-Based Measures of Voice Quality

Indices Obtained by Combining Measurements

Perceptual Rating Scales

Voice Handicap Scales and Quality-of-Life Scales

Voice Handicap Index

Voice-Related Quality-of-Life Scale

Hygiene and Safety of Equipment

Summary

References

Appendix 4-1. Case History Form - Voice

Appendix 4-2. Videostroboscopy Rating Form

Appendix 4-3. Position Statement: Evidence-Based Practice in Communication Disorders

Appendix 4-4. Relevant Paper: The Roles of Otolaryngologists and Speech-Language Pathologists in the Performance and Interpretation of Strobovideolaryngoscopy

Appendix 4-5. Voice Handicap Index

Appendix 4-6. Voice-Related Quality of Life Measure

Appendix 4-7. Recommended Protocols



Chapter 5. Vocal Pathology

Etiology of Voice Disorders

Vocal Lesions

Pathology Classifications

Incidence of Voice Disorders

Structural Pathologies of the Vocal Folds

Vascular Lesions

Functional Voice Disorders

Idiopathic

Autoimmune

Summary

References



Chapter 6. Neurologically Based Voice Disorders

Neurologic Voice Disorders

Other Neurologic Cases

Summary

References



Chapter 7. Vocal Rehabilitation

Addressing Patient Diversity in Vocal Rehabilitation

Clinical Competence

The Road to Therapy

Communication Strategies

Adherence

Voice Therapy

The Evolving Process of Voice Therapy

Goals of Voice Therapy

Definition of Treatment Efficacy

Voice Therapy Approaches: What Are They?

Specific Treatments for Other Populations

Special Considerations for Gender-Affirming Voice and Communication Therapy

Voice Therapy for School-Age Children With Voice Disorders

Technology and Gaming in Voice Therapy

Biofeedback Techniques

Alternative Voice Management

Defining a Voice Outcome

Criteria for Termination of Therapy

Telehealth Options

Definition of Treatment Effectiveness

Summary

References

Appendix 7-1. Voice Stimuli



Chapter 8. Management: Phonosurgery

Surgical Treatment of Dysphonia

Awake Procedures

General Considerations in the Surgical Approach to the Larynx

Microlaryngoscopy With Nodule Removal

Microflap Dissection

Laser Laryngoscopy

Laryngeal Microdebrider Dissection

Injection Augmentation

Laryngeal Framework Surgery

Selected Clinical Cases

Suggested References for Reading

Appendix 8-1. Postoperative Instructions for Surgery of Vocal Fold Lesions



Chapter 9. Team Management of Head and Neck Cancer

Introduction

Head and Neck Cancer Statistics

Head and Neck Cancer Sites

Head and Neck Cancer Types

Head and Neck Squamous Cell Cancers

General Cancer Staging

Primary Tumor Staging

Cancer Spread

Surgical Options for Treating Head and Neck Cancer

Organ Preservation Through Radiation and Chemotherapy

Combined Management Approaches

Multidisciplinary Clinical and Research Team

Surgical Options for Laryngeal Cancer

The Role of the Speech-Language Pathologist Prior to Laryngectomy

The Role of the Speech-Language Pathologist Following Laryngectomy

Types of Partial Laryngectomy Procedures

Postoperative Strategies

Communication Following Total Laryngectomy

Developing a System to Track Outcomes With the HNC Population

Future Directions

Conclusions

Useful Websites

References

Appendix 9-1. Case Example: Management of SCCA In Situ in a Professional Performer: An Interdisciplinary Approach

Appendix 9-2. Case Example: Management of Recurrent Laryngeal Cancer Spanning 10 Years

Appendix 9-3. Voicing Practice Exercises: Handout for the Laryngectomized Patient



Chapter 10. Vocal Performance

What Constitutes Singing Voice Intervention?

The Singing Voice

The Voice Care Team

Performer Classifications and Vocal Registers

Etiology of Dysphonia in Vocal Performers

Compensatory and Cover Techniques Used by Vocal Performers

Singers and Support

Clinical Assessment of Vocal Performers

The Medical, Social, and Singing History

Speaking Voice Assessment

Vocal Load

Vocal Pacing and Budgeting

Singing Voice Assessment

Training and Techniques Specific to Performance Voice

Case Examples

Singing Health

Professional Associations

Case Studies

Summary

References

Appendix 10-1. Singer's History Form

Appendix 10-2. Singing Voice Handicap Index (S-VHI)

Appendix 10-3. Evaluation of the Ability to Sing Easily (EASE)

Appendix 10-4. Glossary of Singing Terms



Chapter 11. Drug Types and Effects on Voice

Drug Interactions

Patient-Specific Factors

Drug Administration

Drug Classes

Psychoactive Medications

Drug Compliance

Herbal Supplements and Alternative Medicines

Special Populations

Summary

Recommended Readings

References

Appendix 11-1. Chapter 11 Glossary



Chapter 12. Immune System Response to Diseases and Its Impact on Laryngeal Function

Introduction

Innate Immunity and Wound Healing

Adaptive Immunity

Fibroblasts' Immune Functions

Immunologic Barriers to Treatment

Biomaterials

Cell-Based Therapies

Conclusions

References



Chapter 13. Laryngeal Reflexes

Sensory Receptors

Free Nerve-Ending Receptors

Encapsulated Nerve Endings

Pathway of Sensory Information

Laryngeal Reflexes

Upregulation of Sensory Afferents

Down Regulation of Sensory Afferents

References



Glossary

Index