see also: Voice Rest - Vocal Conservation as a Management Strategy (Non-operative and Post-op); 

Teaching Vocal Heath as Music Educator -- Music and Medicine on Monday

From Previous Lectures
H Hoffman MD
Dept of Otolaryngology

Learning Objectives:

1. To understand the basis of voice and speech production
2. To understand the key functions of the larynx
3. To identify common voice disorders and their significance
4. To learn the management of common voice disorders.

Take Home Points:

1. The combination of adequate breath support (lungs) and appropriate vocal cord vibration are needed for normal phonation.
2. The function of normal vocal cords (a competent glottic valve) converts the DC current of air streaming upward from the lung into an AC current.
3. Impaired function of the glottic valve results in an abnormal voice and can also impair swallowing and breathing.
4. The most superficial layer of the vocal cord is fluid. It overlies the mucosal surface of the vocal cord which also contains muscle and ligament. Normal voicing requires this fluid layer to be present – underscoring key components to the treatment of voice disorders: humidification and hydration.
5. Passive vibration of the vocal cords rather than active movement by muscle contraction results in voice - this concept explains how a patient with bilateral vocal cord paralysis may have a normal voice.
6. Voice disorders may be managed by physicians who are not capable of examining the vocal cords when the presumptive diagnosis is laryngitis through
           a. voice rest
           b. humidification
           c. hydration
           d. management of associated symptoms (such as cough).
7. Laryngitis is inflammation of the larynx and can be caused by
           a. Infection: viral/bacterial/fungal
           b. Trauma: vocal overuse/intubation
           c. Exposure to irritants: smoke/GE reflux/inhalants
8. Referral to an Otolaryngologist is indicated when
           a. there is clinical suspicion that the voice disorder is not a self-limited laryngitis
           b. the voice problem persists longer than two to three weeks;
           c. there are associated symptoms such as swallowing or breathing impairment
9. Methods to image the larynx include:
             indirect mirror examination
             flexible fiberoptic transnasal exam of the larynx
             direct laryngoscopy (usually done in the operating room)
             videostroboscopic exam of the larynx (see: A Singers First Look at Her Vocal Cords - Transoral Videostroboscopy - How to Look at the Larynx)
10. Important voice disorders include infectious, neurogenic, traumatic, psychogenic, and neoplastic causes
11. Medications with adverse effects on the voice include:
                   Drying effect (antihistamines, diuretics, tricyclic antidepressants)
                   Laryngeal irritants (inhaled propellants)
                   Factors increasing bleeding risk (aspirin, anticoagulants)
12. Medications with favorable effects on the voice:
                Antitussives: codeine/dextromethorphan/benzonatate (Tessalon perles)
                Mucolytics: guaifenesin
                Water: H20 (humidification and hydration)           
                Anti-reflux medications (H2 blockers e.g. Zantac /PPI e.g. Prilosec/Omeprazole)
                Replacement therapy: (thyroid; and hormone therapy - controversial)
13. Speech pathologists manage voice disorders by:
                Assessing vocal behavior
                Modifying vocal behavior
                Maximizing vocal potential