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Vocal nodules - Essay Example

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The human voice is a way to project our individuality, a means of communication, articulation and expression of our thoughts and feelings. It is used extensively in all walks of life and by nearly all people. And yet voice disorders are not entirely uncommon in the population…
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Vocal nodules
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Explain how a mass like a vocal nodule on the glottal margin of a vocal fold might reduce the person's ability to speak loudly The human voice is away to project our individuality, a means of communication, articulation and expression of our thoughts and feelings. It is used extensively in all walks of life and by nearly all people. And yet voice disorders are not entirely uncommon in the population. These disorders may have different manifestations, one of which is the vocal nodule (Benign vocal lesions 2005).
Vocal nodules are primarily benign growth on the vocal folds which arises due to vocal misuse and abuse. Persistent abuse can result in these benign lesions gradually developing on the glottal margin of each vocal fold which may result in lowering of the pitch of the voice. However in order to fully appreciate the mechanism involved in this process an understanding of speech mechanism with respect to the role of vocal fold nodules is required. This is discussed below;
The larynx or the voice box has a twin infolding of mucous membranes (vocal folds) stretched across the larynx. During speech or phonation, the air flow (originating from the lungs) is modulated by these membrane vibrations. Increased air flow/air pressure in the lungs causes the folds to open and once the pressure recedes after the air flows out the fold close again. These folds vibrate when closed due to internal air pressure. (Cumming 2005) In effect, the loudness of speech or what is best termed as the pitch of the voice is determined by resonance frequency of the vocal folds and is measured in hertz. Fundamental frequency of vocal fold vibration correlates with changes in vocal fold tension and subglottal pressure and hence vocal fold mass, stiffness, and viscosityis the main predictor of the pitch of the voice (Hirano 1987).
Vibrations of the vocal folds that are too forceful or prolonged result in vascular congestion. If persistent they will eventually result in hyalinization of superficial lamina propria and eventually this is likely to lead to the formation of nodules. Nodules are commonly bilateral in occurrence with a classic location at the junction of the anterior and middle third of the vocal fold (Dikkers 1995). Phonotrauma or vocal cord insults are indeed itntricately linked with the formation of nodules. Most importantly clinical and phenotypic expression/appearance of benign vocal fold lesions is most commonly associated with a voice change. A plausible explanation for this could be that nodules if found on the glottal margin interfere with the vibratory patterns of the vocal fold by increasing the mass and reducing the pliability of the overlying cover (ie, cover/body theory of vocal fold vibration). In addition they restrict adequate closure of the membranous folds throughout the glottic cycle. The fundamental frequency of vocal fold vibration is also altered since the nodules affect frequency at the mechanical level and hydration of the vocal folds. Overall voice quality and ease of voice production and hence the pitch of the voice is severly affected or significantly lowered.
Given the importance of voice in everyday life, it is only natural that voice disorders receive much attention. In addition we need to ensure that we do not knowingly cause phonological trauma. Knowing the mechanism of voice insults is defintely a step ahead in this direction!
Sources
Benign Vocal Lesions - Nodules, Polyps, Cysts. The Center for Voice at Northwestern University.
Cummings, CW. Laryngeal and Pharyngeal Function. Otolaryngology - Head and Neck Surgery 4th edition. Pennsylvania. 2005. 1963 - 1974.
Dikkers FG, Nikkels PG: Benign lesions of the vocal folds: histopathology and phonotrauma. Ann Otol Rhinol Laryngol 1995 Sep; 104(9 Pt 1): 698-703
Hirano M Anatomy and behavior of the vocal process. Laryngeal function in phonation and respiration. Boaton. 1987 Read More
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