Dept of Audiology & Speech Language Pathology

SRM Medical College Hospital & Research Centre

Voice Disorders & Preservation of voice

A guide to the teachers
Voice disorders are the occupational hazard of every teacher

Balakrishnan D
BSc MBBS MS DLO PhD
ENT Surgeon, HOD of Audiology & Speech Language Pathology
 Voice Disorders & Preservation of Voice

Dept of Audiology & Speech Language Pathology

‘If all my possessions were taken from me with one exception,

I would keep the power of communication,
for by it, I would soon repair all the rest’
Daniel Webster
 Voice Disorders & Preservation of Voice

OUT LINE

Production of voice
Clinical conditions, which require an ENT consult
Characteristics of an Ideal voice
Assessment of the voice of an individual
Voice Therapy / speech therapy
Preservation of Voice quality

Balakrishnan D Usha A Dalvi Ambethkar S

BSc, MBBS, MS(ENT), DLO, PhD MSc (SP & Hg), PhD M. ASLP
 Voice Disorders & Preservation of Voice
HUMAN VOICE IS AN AIR INSTRUMENT

The length of the air column decides the pitch. The place and manner of
articulation can be altered in every wind instrument, including the human voice.
Voice Disorders & Preservation of Voice
PRODUCTION OF VOICE - MECHANISM

The lungs produce the air stream.

The vocal cords cut the stream into discrete
column packets. The parts above, mould the
packets into distinct sounds.
.

When there is a derangement in any of these,

due to any reason, the voice will alter.
 Articulation simply means ‘getting together of
various stations upstream from the glottis e.g.
Glottis = /h/ /-/
Lips – both = /p/ /b/
Tongue - = /t/ /d/
Palate = /k/ /g/

When the nose is closed, the phoneme is described as Oral consonant. When the air
goes through the nose, it is called nasal consonant. Sometimes, due to a structural
deficit, an oral consonant leaks through the nose - nasalization.
When air escapes through the nose, it is called nasal emission.
A nasal emission may be audible, or may not be so.
Voicing
 When the tongue articulates with the palate, a
resonating chamber is created posterior to that.
When the articulation (obstruction) is partial, air
hisses out slowly. They are christened fricatives.
Examples of such sibilant phonemes are
/s/ /sh/ Rose, Pressure
/z/ /zh/ Zebra, Pleasure

When the pressure build up is total, and when it is

gradually released, affricates are produced.
Examples of such affricates are
/ch/ /j/ Church, Judge

When the air pressure does not build up at all , due to the palatal cleft, the phoneme
is simply skipped and not produced at all. Instead, the glottis produces a stop.
When the air pressure does not build up , due to the palatal cleft, that
particular phoneme is simply skipped and not produced at all.
Instead, the glottis produces a stop.
 Voice Disorders & Preservation of Voice

VOICE DISORDERS CAN RESULT FROM THE FOLLOWING

Anatomical defects Movement dynamics

Voice overuse
 Voice Disorders & Preservation of Voice

USUALLY, ALL THREE COALESCE TOGETHER INTO A GREY AREA

ALSO, MANY PATIENTS PRESENT WITH SEQUENTIAL ISSUES
 Voice Disorders & Preservation of Voice

MORE COMMONLY, WE GET ANOTHER ADDITIONAL CONUNDRUM

.
AN ALL ENCOMPASSING BAD LIFE STYLE HABITS
 Voice Disorders & Preservation of Voice

MORE COMMONLY, WE GET ANOTHER ADDITIONAL CONUNDRUM

.
AN ALL ENCOMPASSING BAD LIFE STYLE HABITS

a b use
e
Voic h bits
a
)
(bad
 Voice Disorders & Preservation of Voice

PATIENTS DO NOT PRESENT WITH A DIAGNOSTIC LABEL

WE HAVE TO UNRAVEL THESE CIRCLES

WHICH HAS CAUSED WHICH ?

YOU MUST BECOME A
SHERLOCK HOLMES
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Chronic Obstructive Pulmonary Disease,

Malignancy, other repiratory failure,
Pneumonitis, TB, Even plain cold, Smoking
The bellows
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

The Chronic Obstructive Pulmonary Disease,

Malignancy, other repiratory failure,
Pneumonitis, TB, Even plain cold, Smoking
The reeds
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Moulding

Cleft lip, cleft palate, macroglossia, ulcers in the

tongue and cheeks, mal-aligned teeth, Tonsils
and adenoids, cysts, malignancies …

Plain thirst, drying due to lack of adequate water

intake, betel nuts, Chewing tobacco (paan),
smoking …
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
 Voice Disorders & Preservation of Voice

MEDICAL CONDITIONS WHICH AFFECT VOICE

Resonators

Nasal block, Septal deviation, enlarged

conchae, nasal allergy, nasal polyp, mass, Even
plain cold can block the nose. Result: cul de sac
resonance - Rhinolalia clausa
The lower set
of phonemes
are voiced
In a cleft palate, all phonemes
get nasalized. And, the oral
consonants could not be
articulated properly. Hence,
one phoneme gets
substituted by another nasal
consonant i.e.
/m/ /n/ /ng/
All children have incompetence of the Pharyngo-tympanic tube and they
present with secretory otitis and its consequences; also CSOM.

The children with SOM, do not hear well.

Hence, they learn many phonemes wrongly.
Additionally, during corrective therapy, they
have difficulty in discerning and vocalising
Clinical ENT made easy 2014 phonemes, properly.
Balakrishnan D, Jaypee Medical Publishers
New Delhi, Philadelphia.
 Simple otoscopy
TM bulging

Retracted TM

Grommet

Secretory Otitis Media

Easy to identify & simple to treat
Hearing aid
Let us learn a few Basic terms used in Phonetics
Phon aka Phone
[p]
[p]
[pa] [n] = PAN
[pa] [l] = PAL
[pa] [t] = PAT
This is a … … Phoneme
/p/
 When the air stream goes unimpeded, the
phoneme is called a Vowel. When the air
stream gets obstructed, the stream produces
Consonants. Such occlusions are called the
Articulation.
Thank you for your patient listening
Balakrishnan D