Dysphonia - current state of the problem and treatment methods

Dysphonia is a voice formation disorder in which the quality of the voice (pitch, strength, timbre) is impaired, as a result of which it becomes defective - weak, poorly modulated, hoarse, and so on. Occurs as a result of organic or functional disorders of central or peripheral origin. The complete absence of voice, in which only whispered speech can be preserved, is called aphonia.

Main manifestations

An increase or decrease in tone in the vocal folds, incomplete closure of the glottis, tonic muscle spasm of the larynx and convulsive approach of tense vocal folds, discoordination in the work of the external and internal muscles of the larynx, vibrating voice, confusion of speech breathing, discomfort in the throat.

The heterogeneity of forms of voice disorders determines the diversity of their clinical manifestations. The differences between them are due primarily to the nature of the disorder (organic or functional, congenital or acquired); location and size of the lesion. The specifics of voice dysfunction in each form of Dysphonia (hypotonic, hypertonic, hypo-hypertonic, mutational, spastic) are also determined by: duration of the disorder (short-term or persistent changes), degree of severity (severe, moderate, mild), stage of the disease (early or late recovery ), pathogenetic mechanisms (nature of the disorder).

Voice disorders. Dysphonia, Aphonia, Phonosthenia.

After working with a psychiatrist, preparation for breathing work begins. If the laryngeal nerve is damaged during paralysis, then it will be almost impossible to restore its motor function. In other cases, functional training is required. The exercises will increase the mobility of the healthy part of the larynx, and in case of paralysis, they will partially restore the mobility of the vocal fold.

The next step is to normalize physiological breathing and phonation. Classes should be aimed at normalizing breathing and begin with “blowing into a harmonica.” You need to blow slowly, inhaling and exhaling on the same note. Healthy children should start training with 1 minute 10 times a day, gradually increasing the time to 2 minutes and 15 repetitions per day. If you feel dizzy, you should reduce the exercise time to 15-20 seconds.

This activity lengthens the exhalation, and the uniform movements of inhaled and exhaled air massage the larynx, thereby increasing the mobility of the healthy part of the larynx and activating the paralyzed part. In combination with “blowing into a harmonica,” breathing exercises are recommended that train extended exhalation:

Complex A. Sit straight in a chair or stand up:

1) Take a quick shallow breath and then a long exhale;

2) Inhale through your nose and exhale through your mouth;

3) Inhale through your mouth, exhale through your nose;

4) Inhale and exhale with only one half of your nose, then the other;

5) Inhale through one half of your nose and exhale through the other;

6) Inhale through your nose and then exhale slowly with increasing force at the end;

7) Inhale through your nose, exhale through loosely pursed lips;

Inhale through your nose, exhale through your nose while holding your breath.

Do not start doing breathing practices and exercises right away so as not to overload the patient. Do breathing exercises for about a week, and then add exercises for the muscles of the neck and larynx.

Complex B. To perform the exercises described below, you need to sit up straight:

1) Place your hands in a lock at the back of your head, tilt your head back and apply slight resistance with your hands;

2) Clench your hands into a fist and rest your hands on your chin, then tilt your head forward, providing resistance with your hands;

3) Cover your ears with your palms, then tilt your head towards your shoulders with resistance from your hands;

4) Squeeze your jaws, and then move your lower jaw down, to the sides, forward;

5) Puff out your cheeks;

6) Use the tip of your tongue to reach the roof of your mouth;

7) Raise your palate when you yawn.

The above workouts are very easy to do. It is recommended to perform them 6 times during the day, repeating each approximately 5 times.

When combining exercises with a speech therapist and classes to establish diaphragmatic breathing, the reflex cough will disappear, exhalation will significantly lengthen and weak oscillatory movements of the paralyzed part of the larynx will appear. The next step is exercises for voice coordination. The essence of these exercises is that the vibrations of sound affect the mechanism of voice formation. With regular practice, the correct acoustic effect is achieved, which is what voice production consists of.

The correction begins with the pronunciation of the letter {m}, which allows you to establish the correct phonation.

Exercise 1 . Pronounce the sound slowly and briefly, directing it so that it “hits” the roof of your mouth, thereby causing resonance. After a couple of training sessions, the phonations will become longer and the voice will sound clearer. When the exercises no longer cause difficulties, proceed to the pronunciation of open syllables.

Exercise 2 . First, pronounce one sound {m}, then alternate vowels with this sound, for example: ma, mo, mu, me, we. At the same time, sharply lower your lower jaw. To consolidate the result, after a couple of lessons, you need to pronounce the syllables, with the emphasis on the second word.

Exercise 3. Pronounce the following syllables: - ma-ma na-na; - ma-mo na-no; - ma-moo na-well and so on.

Exercise 4 . Say the following syllables: mom-mama-mama; nana-nana-nanana and so on.

When the syllables sound loud and full, you can move on to the next task. Exercise 5. Say the sound {th} in combination with vowels

Repeating vowels on a hard attack has a positive effect on the closure of the vocal folds. Pronounce the vowels briefly and firmly, and the sound {th} for a long time: ay... yai..., oh... her..., uh... yu..., hey... her...

After the above activities, coordination of breathing and voice production is necessary. To achieve this, pronounce vowel sounds in one exhalation. Exercise 6 . Pronounce syllables with vowels, for example: a, ao, ay, ae, ai, aou, aoe, aoi, aouei, aoui, etc.

The child must repeat the syllables, first after the speech therapist, then independently.

Pronouncing the combinations easily and without complaints, you can move on to the next stages of treatment - working on the restored voice. To work it out, the following syllables are rehearsed: ma, mo, mu, me, we. Gradually starting phrasal speech and reading.

When working with speech material, it is recommended to practice vocals. Exercises will help strengthen your voice and increase sonority. You can sing triads, melodies without sharp transitions or scales.

When the voice is restored, it sounds loud, accompanied by organized breathing, and there is no unpleasant sensation in the throat. During the examination, the vocal folds close, and their vibrations are visible on the affected part of the larynx.

The duration of rehabilitation work lasts up to 4 months, the duration of treatment depends on the severity of the disorder and the time of start of classes.

Is it possible to restore voice function with Dysphonia?

To restore voice function, the help of a speech therapist is needed. During a diagnostic examination, a specialist determines which aspects of voice-forming activity are impaired; draws up an individual recovery program; conducts individual classes (procedures), including breathing exercises, speech and vocal exercises, speech therapy massage, vibration stimulation of speech and neck muscles. If necessary, initiates drug therapy (consultations with a neurologist, psychotherapist). The methodology and duration of classes are determined individually.

The sooner the patient is referred to a specialist for help, the sooner he will reach the maximum level of social functioning, thus improving the quality of life.

Speech therapy service of the State Clinical Hospital named after. S.S. Yudina

GBOU "NIKIO im. L.I. Sverzhevsky" of the Moscow Department of Health

Functional dysphonia is a violation of vocal function, characterized by a violation of the closure of the vocal cords in the absence of pathological changes in the larynx.

The causes of a functional voice disorder can be constitutional, anatomical, congenital features of the vocal apparatus, voice overstrain, traumatic factors, previous respiratory diseases, asthenic syndrome of any etiology. Hypotonic disorders can also develop against the background of prolonged silence, as well as after surgical interventions on the larynx or with atrophy of the vocal folds. Anxiety and depressive disorders can contribute to the development of functional dysphonia. Hormonal disorders, most often thyroid diseases, play a significant role in the occurrence of functional dysphonia. Other causes are neurological diseases such as Parkinson's disease and myasthenia gravis, traumatic brain injury, cerebrovascular accident, etc.

Functional changes are reversible, but in some cases they can lead to organic changes in the larynx.

The clinical picture of functional dysphonia is caused by a violation of the vocal function of varying degrees of severity.

Hypotonic dysphonia is a violation of vocal function caused by a decrease in the tone of the vocal folds and other muscles involved in voicing. Rapid voice fatigue and aspirated hoarseness are noted.

Hypertonic dysphonia is a violation of vocal function caused by increased tone of the vocal folds. Phonation is carried out with tension in the neck muscles, the voice is sharp, and hoarseness is pronounced.

Hypo-hypertonic dysphonia (vestibular-fold voice) is a violation of vocal function due to a decrease in the tone of the vocal folds with the formation of phonation at the level of the vestibular folds with the subsequent development of their hypertrophy.

Aphonia is the lack of sonority of the voice while maintaining whispered speech.

Psychogenic dysphonia or aphonia is a disorder of vocal function, the leading etiological factor of which is considered psychogenic.

Mutational dysphonia is a voice disorder that occurs during the period of mutation.

Spasmodic dysphonia is a voice disorder characterized by tense and compressed intermittent phonation, tremors, hoarseness, and impaired speech intelligibility. There are abductor and adductor forms. During speech, twitching of the diaphragm is noted. Articulation disorders and changes in the psycho-emotional sphere are diagnosed. Clinical and neurological examination reveals organic pathology in the form of dystonic syndromes (such as writer's and blepharospasm, torticollis, etc.).

In the process of diagnosing and treating voice function disorders, a multidisciplinary approach is required with the involvement of a neurologist, endocrinologist, psychiatrist and phonopedist in the rehabilitation process.

Treatment of functional dysphonia

The approach to the treatment of functional dysphonia should be comprehensive. It is necessary to influence etiopathogenetic factors: treatment of general somatic diseases, somatomorphic disorders, sanitation of foci of chronic infection.

The prognosis for functional dysphonia is often favorable. Persistent impairment of vocal function and a long-term course lead to a deterioration in the patient’s communication.

Prevention of vocal function disorders consists, first of all, in maintaining vocal hygiene, developing correct phonation skills, and developing the speaking and singing voice, especially in people of voice-speech professions. Timely diagnosis and treatment of general somatic diseases leading to the development of dysphonia are of great importance.

Self-medication

Self-medication often leads to complications that may require surgery. Traditional medicine can only complement therapy aimed at suppressing the parasite. Along with this, the patient is prescribed a diet. It consists of eliminating foods from the diet that irritate the mucous membrane. This list can include all salty, peppery and spicy dishes that are served hot.

You can restore your voice in the absence of an inflammatory process on your own. Plant extracts that have a sedative effect (valerian solution or motherwort decoction) will help relieve nervous tension.

In case of vocal cord dysfunction, for example, after a football match, their rehabilitation will be facilitated by raspberry or blackberry juice and eggnog with the addition of a tablespoon of cognac. After taking them, it is recommended to remain silent so as not to strain the ligaments. Speaking in a whisper is not recommended, as this puts additional stress on the muscles of the larynx, which can only worsen the situation. If talking cannot be completely avoided, you should speak more slowly than usual. All words must be pronounced clearly.

Treatment

Dysphonia is treated by a pediatrician, therapist and speech therapist. It is important to strictly observe the vocal regime and in no case overstrain the vocal cords. Treatment of voice loss involves the following activities:

• diagnosis and treatment of ailments that could provoke such a disorder;
• the use of drug therapy, as well as physiotherapy;
• carrying out correction of neurological disorders;
• sessions with a psychologist;
• Surgical intervention is carried out strictly according to indications (in case of ineffective therapy or in the presence of neoplasms).

Why does dysphonia occur?

The causes of dysphonia in children can be congenital: it is a defect of the larynx , in which there is abnormal development of the cartilage of the larynx. As a result, morphological features lead to the child constantly exhibiting noisy breathing. Congenital anomalies of the larynx associated with the formation of vascular tumors - angiomas . Sometimes the causes of dysphonia in children are also associated with developmental disorders of the vocal folds. If we are talking about congenital dysphonia associated with dysfunction of the vocal folds, then the symptoms of dysphonia may be similar to manifestations of bronchial asthma : these are periodic wheezing and attacks of shortness of breath.

The causes of organic type dysphonia are acute or chronic diseases of different parts of the larynx and lower respiratory tract. These may be inflammatory processes, allergic reactions, neurological or oncological diseases, as a result of which a narrowing of the airway lumen occurs or other changes that lead to changes in speech due to impaired breathing and voice.

Functional dysphonia can develop in a person against the background of diseases of the internal organs (lungs, heart, blood vessels), the endocrine system (thyroid gland, adrenal glands, gonads). This type of dysphonia can manifest itself against the background of obstruction of the upper respiratory tract due to foreign bodies entering there or taking anabolic steroids. Quite often, dysphonia treatment is required for those who use their voice professionally, that is, they practice vocals and constantly speak loudly due to their profession. Dysphonia can manifest itself as a result of anemia , vitamin deficiency , diseases of the cervical spine, neurological and mental disorders.

Speech changes of this type may also appear after surgical interventions, which may damage the organs of the vocal apparatus of the larynx. Sometimes dysphonia occurs under the influence of severe stress, taking certain medications, or as a result of previous infectious diseases.

Voice disorder occurs as a result of constant exposure to a room with increased dampness, a lot of dust, or a microclimate that is too cold or too hot. Changes in speech can also be associated with production factors - inhalation of harmful substances, dust, etc.

Another factor that can negatively affect the condition of the vocal apparatus is frequent consumption of alcoholic beverages . Under the influence of alcohol, there is an increased rush of blood to the pharynx and larynx, which leads to dry mucous membranes. Voice quality also deteriorates in smokers. Tobacco smoke provokes chronic inflammation of the larynx, bronchi, and trachea. In addition, tobacco smoke contains a large amount of harmful substances that contribute to the development of serious diseases, including cancer. There is no need to overuse spicy foods that irritate the mucous membrane. The voice may also change due to drinking very cold drinks. It is especially harmful to alternate between drinking too cold and hot drinks or foods.

Etiology

The causes of voice loss in children are as follows:

• constant imitation of car or steam locomotive whistles;
• overstrain of the vocal cords during screaming;
• hypertrophy of adenoid tissue;
• imitation of the voices of fairy-tale characters.

Factors contributing to the development of functional dysphonia:

• laryngitis in acute form, especially recurring;
• systematic overstrain of the vocal cords;
• disruption of the innervation of the muscular structures of the larynx in various pathologies of the nervous system.

Factors in the development of organic dysphonia:

• tumor-like formations in the lung tissues, which can put pressure on the laryngeal nerve fiber;
• papillomas;
• laryngitis that has become chronic;
• traumatization of the larynx during surgical intervention in this area;
• benign and malignant laryngeal tumors.

Diagnostics

In case of voice disorder, a comprehensive examination of the patient is necessary. First, you should contact an otolaryngologist, who, depending on the symptoms, will refer you for a consultation with a neurologist or endocrinologist. The examination includes the following methods:

• Endoscopy of the larynx. Using a laryngoscope, the doctor identifies the absence of pathologies of an organic nature and dysfunction of the folds. Their tight contact and swelling indicate hypertonic dysphonia. In the case when the folds do not close and are partially motionless, hypotonic dysphonia is diagnosed. The spastic form of voice disorder is characterized by convulsive contraction of the muscles of the larynx.
• AAG – acoustic voice analysis. Deviations are judged by a sudden reduction in the time of maximum phonation (an indicator of ligament closure, level of phonation breathing), a significant narrowing of the frequency range, a negative dysphonia index, and a decrease in the frequency of the fundamental tone of the voice.
• Electrophysiological methods. The following studies are carried out using the devices:

– the electroglottograph demonstrates vibrations of the vocal folds during hyperkinesis or hypokinesis;

– an electromyograph reveals a paretic or spastic state of the laryngeal muscles.

Instrumental indicators confirm the data of endoscopic examination.

• Consultation with a phonopedist. At an appointment with a highly specialized doctor, the timbre, strength, attack of sound, as well as the intonation characteristics of speech and the parameters of speech and physiological breathing are assessed. This data will become the basis for drawing up a treatment plan.

Causes of hypotonic dysphonia

The reasons for this type of voice disorder are different. The most common is VSD, the so-called vegetative-vascular dystonia, incorrect vocal technique, vocal stress, osteochondrosis, hypothyroidism. Therefore, it is necessary to look for the cause of the formation of hypotonic dysphonia. After determining the cause of the disease, the doctor will prescribe individual treatment, including drug therapy, physical therapy and pedagogical correction. Teachers, i.e. phonopedists work very seriously on voice correction as part of the treatment process.