1. SPPA 6400 Voice Disorders Stephen M. Tasko SPPA 6400 Voice Disorders: Tasko

2. Introduction SPPA 6400 Voice Disorders: Tasko

3. Some Questions What is a voice disorder? How does it differ from speech disorder? How does if differ from a resonance disorder? How common are voice disorders? Who gets a voice disorder? Why might someone have a voice disorder? How do you know if someone has a voice disorder? SPPA 6400 Voice Disorders: Tasko

4. Voice Production Basics Colton, Casper & Leonard (2011) SPPA 6400 Voice Disorders: Tasko

5. Vocal Fold Oscillation SPPA 6400 Voice Disorders: Tasko

6. Ways to think about voice disorders? Etiologic Correlates of Vocal Dysfunction Vocal misuse – Vocal Abuse – Inappropriate Function of Vocal Components Medically related etiologies – Direct Surgery – Indirect Surgery – Chronic Illness and Disorder Primary disorder etiologies – Cleft palate – VP Insufficiency – Cerebral Palsy and other neurologic disorders – Trauma Personality-related etiologies – Environmental Stress – Identity Conflict SPPA 6400 Voice Disorders: Tasko Stemple, et al. (2014)

7. Classification of Pathologies and Disorders The overly simplistic approach – Organic Voice Disorders – Neurogenic Voice Disorders – Functional Voice Disorders SPPA 6400 Voice Disorders: Tasko

8. Classification of Pathologies and Disorders I. Structural Pathologies of the Vocal Fold A.Malignant Epithelial Dysplasia (a.k.a cancer) B.Benign Epithelial and LP Abnormalities C.Congenital and Maturational Changes II. Inflammatory Conditions of the Larynx A.Cricoarytenoid and Cricothryoid Arthritis B.Acute Laryngitis C.Laryngopharyngeal Reflux D.Chemical Sensitivity/Irritable larynx Syndrome SPPA 6400 Voice Disorders: Tasko Verdolini et al. (2006) The more thorough approach

9. Classification of Pathologies and Disorders III. Trauma or Injury of the Larynx A.Internal Laryngeal Trauma B.External Laryngeal Trauma and Arytenoid Dislocation IV. Systemic Conditions Affecting Voice A.Endocrine Disorders B.Immunologic Disorders SPPA 6400 Voice Disorders: Tasko Verdolini et al. (2006)

10. Classification of Pathologies and Disorders V. Nonlaryngeal Aerodigestive Disorders Affecting Voice A.Respiratory Disease B.Gastroesophageal Reflux Disease (GERD) C.Infectious Diseases of the Aerodigestive Tract VI. Psychiatric & Psychological Disorders Affecting Voice A.Psychogenic Conversion Aphonia and Dysphonia B.Factitious Disorders or Malingering C.Gender Dysphoria or Gender Reassignment SPPA 6400 Voice Disorders: Tasko Verdolini et al. (2006)

11. Classification of Pathologies and Disorders VII. Neurologic Conditions Affecting Voice A.Peripheral Nervous System Pathology B.Movement Disorders Affecting the Larynx C.Central Neurologic Disorders Affecting Voice VIII. Other Disorders of Voice Use A.Vocal abuse, misuse, and Phonotrauma B.Vocal Fatigue C.Muscle Tension Dysphonia (Primary & Secondary) D.Ventricular Phonation E.Paradoxical Vocal Fold Motion SPPA 6400 Voice Disorders: Tasko Verdolini et al. (2006)

12. Occurrence Rates of Voice Disorders SPPA 6400 Voice Disorders: Tasko Source: Manitoba Centre for Health Policy

13. Occurrence Rates of Voice Disorders SPPA 6400 Voice Disorders: Tasko Roy et. al (2004) JSLHR 47 281-93.

14. Occurrence Rates of Voice Disorders SPPA 6400 Voice Disorders: Tasko Roy et al. (2004)

15. Occurrence Rates of Voice Disorders Common Problems^ Males – edema – polyps – Granuloma – papilloma Females – nodules – edema – polyps – psychogenic dysphonia SPPA 6400 Voice Disorders: Tasko *Roy et al. (2007) ^Coyle et al. (2001) *

16. What about the young and the old? Elderly (65-94 years)* Lifetime prevalence: 47% Current problem: 29% Negative quality of life Largest treatment seeking group Common problems – Vocal fold paralysis – Cancer – Presbyphonia Children^ Current problem: 6-23% Most common problems – Vocal nodules – Vocal fold paralysis – Subglottic stenosis – Laryngomalacia – Functional voice problems SPPA 6400 Voice Disorders: Tasko *Roy et al. (2007) ^ multiple sources