The Profession of Speech Pathology: Voice Disorder - Essay Example

Voice work The awareness and acceptance of voice disorder as a disease has seen remarkable recognition in the present time, compared to any other period of medical history. This results in timely and more comprehensive evaluation and treatment. The research and information has encouraged good aetiological investigations which would lead to the origin and the cause of the disorder more effectively. The profession of speech pathology is remarkably high on demand and is filled with the challenge of correct diagnosis differential diagnosis and accurate therapeutic management. Medically the fields have come closer to arrive at more accurate decision based on aetiology, resulting in otolaryngology and neurolaryngoloy factors as the source of the disorder. Even there has been connection established between psychological factor. "Our alliance with psychology and psychiatry continues to grow as well because of mutual recognition of the effects of life stress, interpersonal conflict and psychoneurosis on voice. What in fact, does one need to know and how deeply should one delve is closer to finding the answers because of the clarification of our responsibilities to our selves, to our patient and to the medicine." (Aronson,A.E.,1990,p.preface.9 or ix ). It would be important for clinician to consider evaluation of the voice disorder by taking into consideration evaluation based on three fields in medical science otolaryngology, neurology and psychiatry. As a voice therapist my first step would be to evaluate the three patients with proper diagnosis and accurate case history. I would focus on the causes underlying the symptoms observed medically and also to take into account the psychosocial factors, which would help determine the extent and the nature of the voice disorder. I would be specific about my evaluation from the point of view whether it is physiologic, acoustic and perceptual(Aronson,1990). I would have the patients fill out a detailed case history questionnaire which would have specific information regarding date of birth, sex, professional and marital status, detailed descriptin of the problem and the causes, information related to voice disorder, previous history of voice disorders, events associated with the onset and description of vocal use, lifestyle information, medical and surgical history( Boone & McFarlane,1988; Dworkin & Meleca, 1997). I would make a perceptual analysis of the voice using evaluation and assessment techniques, where the voice is recorded with high quality acoustic recorder in order to make accurate acoustic measurement(Lee,2007). There are different components to evaluate a recorded voice such as: monologue, reading of standard passage, counting, study of voiceless expiration time matching the typical phonation time, study of the pitch, measure of the loudness, cough. I would make a critical observation of the peripheral mechanism by observing the posture and respiratory patterns of the patient while engaged in talking, singing or silence, with special attention to the signs of symptoms around the neck area which reveal the functioning of the larynx and respiratory systems. Then I would move to the third step in the evaluation physiological analysis which would confirm and verify the perceptual and observational finding. This is done by laryngeal endoscopy. The last but not the least is the acoustic analysis, which would involve phonatogram, visipitch and pneumotachograph. The symptoms of the disorder can be the result of impaired vocal fold adduction, cricothyroid muscle, psychological muscle misuse and organic aetiologies. . I will also investigate into the reasons for abnormal voice, if it is from mass lesion of the vocal folds or it is the result of the diseases from the central and peripheral nervous system (Lee, 2007, Rammage & Morrison, 1994). Psychogenic aspect of the voice disorder is very significant in the right diagnosis. "Voice as an indicator of personality, of transient emotional states, and as sign of chronic stress and psychopathology". (Aronson,A.E.,1990,p,preface 10 or x) The relationship between emotions and vocal pathology is very deeply connected. Almost every patient who develops a voice disorder, regardless of aetiology, emotions and psychological factors play a significant role The first patient with the history of long term voice trouble, seems to be suffering from vocal nodules and ventricular dysphonia. This is characteristic of a person who constantly misuses his/her voice. The muscle tension caused by the abuse of voice can result in vocal folds and ventricular folds, causing the problem with the voice. This could be caused by various factor related to individuals personality emotional, medical, professional, social and familial background (Dworkin & Meleca, 1997). The therapeutic management of this patient will require voice therapy: awareness of the problem, explanation of the vocal mechanism, biofeedback, and musculoskeletal tension reduction for physiological symptoms and counseling for ventricular dysphonia. "The mechanics of speech requires integration of respiratory, phonatory, resonatory and articulatory musculature" (Aronson,A.E.,1990,p.3) . Human voice is essential for survival. "Larynx has very close connection with the quality of voice. Larynx is an important escape valve for the emotions-anger, grief and affection-which are essential for the maintenance of the psychologic equilibrium" (Aronson,A.E.,1990,p.4). The second patient has undergone surgery recently, which would have weakened his/her immune system and might have affected one of the RLNS resultingig in recurrent laryngeal nerve paralysis. This has resulted in the complete or partial lack of intervention of the involved ipsilateral muscles(i.e. thyroarytenoid, lateral cricoarytenoid, posterior cricoarytenoid and interarytenoid) causing loss of vocal fold mass, abduction and leading to glottic incompetenc. This is the cause of her breathy voice resulting from large volumes of air lost during phonation, with reduction in loudness, pitch range, and possible diplophonic. The increased air turbulence reduces the maximum phonation time resulting in fatigue(Crumley,1994). The therapeutic management of this patient will require voice therapy: symptomatic voice therapy for six months (Mathieson & Green,2001) and phonosurgery: medialisation laryngoplasty to move the paralyzed vocal chords towards the midline(Mathieson & Green,2001) surgical reinnervation (Crumley,1994). The trauma of surgery may have also unsettled her emotional equilibrium and stress related to surgery may have made it worse. So after critical evaluation of her symptoms and psychological state, I would use combination of voice therapy, phonosurgery, injected implants and counseling. My third patient seems trickier than the other two. She has had intermittent vocal difficulties over several years i.e. presence of stridor, degree of breathiness and vocal effort / tension. Her symptoms are very clearly organic. Her clinical symptoms confirm neurologic spasmodic dusphonia and psycogenic spasmodic dysphonia. The evaluation reveals that her larynx is normal at rest, her disorder is focused on voice production, which indicates that patient probably has spastic/spasmodic dysphonia with neurological and psychogenic underlying causes. The therapeutic management would strongly require consideration of treating the underlying causes.(Mathieson&Greene,2001) The neurologic spasmodic dysphonia will require adoptin of Botox and voice therapy(Murrey and Woodson,1995). The psychogenic spasmodic dysphonia will require symptomatic therapy(i.e. inhalation phonation, sound prolongation, easy voice onset/ breathy voice, forward resonance focus/humming), biofeedback (EMG videolaryngoscopy, EGG aerodynamic monitoring), holistic techniques (i.e. yawn- sigh approach, chewing approach, progressive relaxation)(Morrison & Rammage, 1994). He/She would strongly need psychiatric intervention to attend to the emotional and psychological factors, which would make him/her more stable and in control the emotional aspect having positive impact on the physical symptoms. Though on surface the three cases appear very similar, these are very different upon in-depth evaluation and diagnosis. A very different style of treatment has to be created for all three of them based on their history and background information and the emotional state. Though interviewing and counseling, would be a common thread tying the three cases together besides the similarity in their surface symptoms. The most effective method of treating any voice disorder would be to have an alert eye for details related to clinical symptoms, backed by sound reasoning and skillful problem solving technique (Aronson,A.E.,1990,p.preface.10 or x). It requires a holistic view of the whole patient her symptoms, her psyche, her background information and her emotion. Voice disorders are reflection of physical malfunction as well as psychogenic malfunction. Treatment has to be organic as well as psychogenic."Voice is more than a mechanical and acoustic phenomena. It is a mirror of personality, a carrier of moods and emotions, a key to neurotic and psychotic tendencies". Brodnitz (Aronson,A.E.,1990,p117). Works Cited Aronson, Arnold.E Google Book Search. Retrieved March 19, 2007, from Clinical Voice Disorders Web site: books.google.com/bookshl=en&lr=&id=NHNhj4dE1rwC&oi=fnd&pg=PA1&s g=twvVM0_3dYiNDZxlpouCy0rAY34&dq=%22Aronson%22+%22Clinical+V ice+Disorders:+An+Interdisciplinary+Approach%22+#PPP1,M1 (Aronson,A.E.,1990,p ) Aronson, A.E. (1990) Clinical voice disorders: an interdisciplinary approach. New York: Brian C. Decker (3rd ed,) Boone, D.R., McFarlane, S.C (1994) The voice and voice therapy.New Jersey: Prentice-Hall (5th edition) Crumley, R.L (1994) Unilateral recurrent laryngeal nerve paralysis. Journal of Voice, 8, 79-80. Greene,M.C.L.,&Mathieson,L.(2001)The voice and its disorders(6th edition) Whirr Publishers.London Lee M. (2006), Voice and Laryngectomy handbook. City University Morrison, M. & Rammage L. (1994) The management of voice disorders. San Diego: Singular. Reilly, S., Douglas, J., Oates J. (2004)Evidence based practice in speech pathology. Whirr Publishers :London Read More