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Voice disorders are frequently seen in the pediatric population. They can have significant impact on the patient. Voice disorders may result from aberrations in the speech mechanism. The salient features of four common voice disorders and their clinical relevance are discussed.
Voice disorders are commonly seen in general medical practice. In some cases voice disorders represent the presenting symptom for serious underlying disease. It is important for clinicians from internal medicine, pediatrics, and family practice to be able to identify those factors in the history or observed vocal symptoms which suggest need for referral for comprehensive voice evaluation as well as to understand the distinct but complementary roles of the specific disciplines (otolaryngology and speech-language pathology) involved in diagnosis and treatment of patients with voice disorders.
Voice disorders are common among children, estimated to range from 6% to 23% in school-aged children. The various causes of voice disorders are presented in this article in addition to a discussion of normal laryngeal voice and development. Also presented are the causes of abnormal voice and brief discussion of a framework for multidisciplinary assessment and treatment of pediatric voice disorder.
Functional voice disorders (FVDs) are common. The diagnostic criteria for six types of FVD and the results of treatment in a large series of patients are reported. Voice therapy was effective in 69% of the patients. Failure of voice therapy usually correlated with continued tobacco use, noncompliance with therapy, or premature termination of therapy.
Forty consecutive patients with psychogenic voice disorder were studied prospectively to shed light on some problems of differential diagnosis met by the otolaryngologist. The females (n = 35) were on average younger than males (n = 5) (mean age 34.5 vs 51.8 years, respectively). Although an upper respiratory tract infection preceding the voice disorder was reported by no more than 25% of the patients, as many as 40% had been treated with antibiotics on one or more occasions. Other treatment and voice rest had been prescribed to a further 20% of the patients. The frequency rate of reported asthma/allergy-like symptoms (37.5) exceeded the incidence of asthma/allergy in the normal Swedish adult population. Minor laryngeal abnormalities found in 10 patients could be rejected as causative since they were inconsistent with the voice disturbance. In most of the patients (n = 27), vocal function returned to normal or improved after voice therapy combined with counselling. Vocal abnormalities remained unchanged in three patients. The patients who required multiple therapy sessions (n = 10) were older (mean age 48.8 years) and seemed to have more profound personal problems than the average. The findings suggest that psychogenic voice disorder may often be misdiagnosed as acute laryngitis or asthma/allergy. Restricted use of antibiotics and other drugs is to be recommended in the treatment of benign voice disorders.
This study examined the effect of voice disorders on judgments of personality and appearance. One-hundred-and-five college students evaluated the personality and appearance characteristics of 12 speakers, four with normal voice quality, four with harsh-breathy voice quality, and four with hypernasal voice quality. A semantic differential procedure was employed to obtain ratings on 12 bipolar adjectives. Results indicate a significant difference between the normal and disordered voices. Voice disorders elicit more negative responses on judgments of personality and appearance of the speaker. These findings indicate that voice disorders warrant correction.
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Only a few psychological papers deal with functional dysphonia. Even fewer empirical studies are concerned with the importance of variations in personality and neurotic behavioural patterns that are typical of functional dysphonia. The enumeration of other functional disorders is important. We suggest that difficulties in self-confidence, social competence, and social fear as well as an increase in control of emotions contribute to the genesis of functional dysphonia. In order to reveal the psychological factors in the diagnosis of dysphonia, every phoniatric diagnosis must be supplemented by a clinical and psychological one.
In phoniatrics the differential diagnosis of functional voice disorders is mainly based on the medical history of the patient, laryngoscopic and stroboscopic findings. On the one hand the typical laryngoscopic picture must be stressed, on the other hand the central significance of stroboscopy for the functional diagnosis of the larynx has to be mentioned. Only the detailed assessment of the stroboscopic signs and symptoms described by Schönhärl allows a therapy-relevant differentiation between cause-related diagnosis and compensatory secondary symptoms with a necessary distinction of psychosomatic disorders.
The purpose of this investigation was to compare adolescents' perceptions of the nonspeech characteristics of voice-disordered and normal speakers. Recordings of six three-word phrases produced by 16 speakers, eight voice-disordered and eight normal-speaking children, were presented to 19 adolescent students for judgments of nonspeech characteristics on a semantic differential scale containing 22 bipolar adjective pairs. Results of their ratings indicated that for 15 of the 22 pairs (68.2%) the normal speakers were judged more positively than the voice-disordered speakers. Moreover, for 9 of the 22 pairs (40.9%) the differences in listeners' ratings between the two speaker groups were statistically significant. Implications of these findings concerning developmental trends in the perception of voice disorders and their potential impact on mainstreaming in schools are discussed.
It is very difficult to give a valid classification of functional voice disorders. Many patients with voice disorder initially consult an ENT specialist. Important aspects of differential diagnosis are presented based on a study of the literature which should help the ENT specialist discriminate between hyperfunctional and hypofunctional dysphonia, which is very important for therapy. An early tentative diagnosis should be followed by a phoniatric examination.
The clinical designation of the psychogenic voice disorder is discussed. "Psychogenic" is aetiologically by no means an apposite, or adjective, to organic diseases, for the occurrence of factors that can be defined as psychopathological (either primary or secondary) is always practically and clinically important--especially if these factors are of general psychosocial relevance, or of a latent depressive and neurotic nature. Hence, biographical anamnesis can be obligatory, supplying information that is essential for a therapeutic approach.
Voice disorders due to hormonal contraceptives in twenty-six patients are reported. All patients are working in occupations with a strong use for their voices especially of the singing voice. The disorders are primarily caused by norsteroid containing preparations (Non-Ovlon). Therefore these preparations should not be applied for patients in voice professions. With regard to good prophylactic measures and an early diagnosis a regular joint gynaecological and phoniatric examination is recommended.
The author's approach to patients with voice disorders emphasizes the value of a multidisciplinary voice team, including an otolaryngologist, a speech pathologist, and a neurologist.
In a mass screening of children ages 6-10 in a rural school division, 203 children were identified as showing a voice deviation. One year later a retesting of 178 of these children showed that 39.9% still showed a voice disorder. Four years later 50 of these children were still available in the same school system; 38% of them still showed a voice disorder. Virtually none of these children were referred to the otolaryngologist for an ENT evaluation or to the speech-language pathologist for voice rehabilitation. Results indicate that, for many of these children, the voice disorders do not "clear up" through maturation alone.
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