A voice is termed "disordered" when the vocal quality of an individual is altered/changed in such a way that it is thought to be abnormal to the listener. The onset and development of these disorders can be "sudden" or "slow." Examples of characteristics of sudden onset may be: trauma, infection, CVA, injurious inhalation, intubation, conversion reaction, or a severe allergic reaction. Degenerative neurologic disease, musculo-skeletal tension, vocal abuse and misuse, growths of folds, gastro-esophageal reflux, and chronic allergies may characterize slow onset.

All disorders do not have known etiologies, and some may occur as a result of numerous etiologies. Very few disorders are attributed to one known cause. It is our purpose to classify the existing disorders into two major categories Functional Voice Disorders and Organic Voice Disorders, each of which will contain several subcategories. It should be noted that some disorders might appear in both categories as a result of multiple etiologies.

Functional disorders encompass all disorders that result in physical change, but do not have a known cause. They are typically hyperfunctional voice disorders (e.g., abuse or misuse), however we are also subcategorizing them as Voice Disorders Resulting From Abuse (i.e., other than hyperfunctional), Psychogenic Voice Disorders, Voice Disorders with No Indication of Pathology, and Manifestations of Voice Disorders.

Contact Ulcers:

Definition: A small ulceration that develops on the medial surface of the vocal processes of the arytenoid cartilages. Laryngoscopically, a contact ulcer will be visible as a buildup of pink or pinkish-white tissue on one of the vocal processes of the arytenoids.

Etiology: (1) predominantly in males average age of 50 who engage in a great deal of aggressive speaking or so called type A personality. (2) constant throat clearing that is secondary to irritation of mucosa due to gastroesophageal reflux or regurgitation of peptic acid.

Symptoms: constant throat clearing, vocal fatigue, and breathy voice with some hoarseness accompanied by discomfort or even stabbing pain

(Voice Therapies Page)

Vocal Nodules:

Definition: localized benign growths on the vocal folds that are usually thought to be a result of vocal abuse.

Etiology: due to vocal abuse when the tissues are under constant stress induced by frequent, hard oppositional movement of vocal folds

Symptoms: soreness or pain in neck, sensation of something in throat, hoarseness, and breathiness

(Voice Therapies Page)

Vocal Polyps:

Definition: soft fluid filled bulges located at the front region of the vocal fold

Etiology: vocal abuse

Symptoms: hoarseness, shortness of breath, audible inhalation

(Voice Therapies Page)

Hyperkeratosis:

Definition: a mass of accumulated keratin (a scleroproteinous pigmented spot or covering) which may grow on the inner glottal margins which may occasionally develop into malignancy

Etiology: smoking, alcohol use, environmental pollution and other factors

Symptoms: pronounced hoarseness

(Voice Therapies Page)

Leukoplakia (Keratosis):

Definition: a disease characterized by a whitish patchy thickening of the epithelium of a mucous membrane. A precancerous lesion develops on the tongue or the inside of the cheek as a response to chronic irritation.

Etiology: Chronic smoking or tobacco use.

Symptoms: hoarseness, roughness

(Voice Therapies Page)

Functional Aphonia:

Definition: absence of voice

Etiology: (1) acute stress to vocal folds (2) laryngeal pathology or other disease

Symptoms: no voice present

(Voice Therapies Page)

Spasmodic Dysphonia:

Definition: a disorder described as both functional/organic basis that is a rare condition with a neurological basis

Etiology: (a) psychological influence (b) unknown cause

Symptoms: strained struggled effortful voice which is hoarse with tremors, jerky voice onset, intermittent voice breaks, breathy spasms, hypernasality, failure to maintain voice

(Voice Therapies Page)

Ventricular Dysphonia:

Definition: a condition in which the false vocal folds, the ventricular bands adduct together over the true vocal folds below

Etiology: (1) pathology may be unknown (2) may occur due to true vocal fold disease

Symptoms: monotonous voice, low pitched

(Voice Therapies Page)

Definiton: temporary but complete cessation of phonation

Etiology: occurs after prolonged hyperfunction

Symptoms: breaks in phonation; complains of vocal fatigue and need to increase vocal effort to speak

(Voice Therapies Page)

Pitch Breaks:

Definition: unexpected and uncontrolled sudden shifts of pitch in either an upward or downward direction are readily perceived even by an untrained listener

Etiology: (1) frequently associated with the changing voice of the adolescent male and are usually a temporary stage that changes with time (2) may occur as a result of laryngeal pathology or as an accompaniment to conditions that involve some loss of neural control of phonation

Symptoms: inappropriate pitch level, pitch breaks, increased fundamental frequency, restricted phonation range, reduced maximal phonation time

treatment

Thickening of Vocal Folds:

Definition: a disorder that occurs when vocal folds become too thick or massive

Etiology: unknown; alcohol/smoking may contribute; GERD

Symptoms: abnormal vibratory patterns of vocal folds

treatment

Definition: A perceptually distinguishable motor speech disorder produced by injury or malfunction of one or more of the cranial or spinal nerves. It may be manifested in any or all of the respiratory, phonatory, resonatory and articulatory components of speech and reflects problems in the nuclei, axons, or neuromuscular junctions that make up the motor units of the final common pathway

Etiology: (1) surgery (2) trauma from accidents (3) muscle disease (4) tumor (5) stroke (6) infections (7) degenerative and demyelinating diseases (8) anatomic malformations

Symptoms: hypernasality, breathiness, nasal emissions, audible inspiration, short phrases, imprecise consonants, monopitch, harsh vocal quality, monoloudness

(Voice Therapies Page)

Hyperkinetic Dysarthria:

Definition: a motor speech disorder where involuntary movements and variable muscle tone are present as a result of damage to basal ganglia

Etiology: (1) Huntington's Disease (2) vascular trauma (3) infections (4) neoplastic and metabolic factors

Symptoms: inappropriate loudness, slow rate, inappropriate interruption of phonation, voice tremor, strained voice, voice stoppage, vocal noise, harsh voice, hypernasality

(Voice Therapies Page)

Hypokinetic Dysarthria:

Definition: a motor speech disorder caused by damage to the basal ganglia

Etiology: (1) degenerative diseases (Parkinson's, Alzheimer's, PICK's) (2) stroke (3) trauma (4) inflammation (5) tumor (6) drug toxicity (7) normal pressure hydrocephalus

Symptoms: monopitch, monoloudness, harsh voice, breathy voice, low pitch, reduced stress, variable rate, resonance disorders, mild hypernasality

(Voice Therapies Page)

Ataxic Dysarthria:

Definition: a motor speech disorder caused by a widespread disturbances in timing, synergy, speed, movement range, control of dysmetria, and coordinated and alternating forcing functions of the muscles of the speech and respiratory mechanism

Etiology: (1) stroke (2) tumor (3) infection (4) ataxic cerebral palsy

Symptoms: hoarse breathy coarse voice with tremors, monopitch, monoloudness, and explosive pitch outburst

(Voice Therapies Page)

Spastic Dysarthria:

Definition: a disorder resulting from disturbances in muscular control over the speech mechanism due to damage of the central (brain) or peripheral (spinal cord) nervous system

Etiology: (1) stroke (2) accident/trauma (3) tumor

Symptoms: harsh vocal quality, low pitch voice

(Voice Therapies Page)

Vocal fold paralysis:

Definition: a unilateral or bilateral paralysis of the vocal folds occurs when conduction of nerve impulses is temporary blocked, the axons of the nerve section, or the nerve fibers are entirely cut which disturbs glottal closure due to lack of adduction of the affected vocal fold.

Etiology: (1) peripheral lesions of Vagus nerve (2) neuritis (3) neoplasm's in neck, bronchi, and chest (3) acute external trauma to neck (4) surgery (5) idiopathic causes (6) birth trauma (7) central nervous system disease

Symptoms: breathiness, hoarseness, diplophonia, and aphonia

(Voice Therapies Page)

Definition: a band of tissue varying in size that extends across the glottis between the two vocal folds. Congenital webs results as the glottal membrane fails to separate in the embryonic development. Acquired web result from injury to the vocal folds.

Etiology: prolonged infection or trauma

Symptoms: varying degrees of breathing problems, diplophonia, and dysphonia

(Voice Therapies Page)

Papilloma:

Definition: is a common benign tumor that starts in the epithelium that interfere with glottal closure depending on the extent of the lesion which causes increased stiffness

Etiology: caused by a virus of the papovavirus group

Symptoms: low pitch level

(Voice Therapies Page)

Traumatic Laryngitis:

Definition: a minor inflammation of the larynx and surrounding tissues causing temporary hoarseness.

Etiology: (1) viruses (2) bacteria (3) Allergies (4) excessive use of voice (5) electrolyte disturbances (6) tumors (7) changes in production of hormones by endocrine glands

Symptoms: hoarseness or loss of voice, sore throat, sensation of lump in throat, slight fever, swallowing difficulty (rare), tiredness

(Voice Therapies Page)

Granuloma:

Definition: area of thickened irregular tissue on vocal folds caused by irritation

Etiology: (1) complication of intubation (2) contact (3) gastroesophageal reflux

Symptoms: breathiness, hoarseness, phonation breaks

(Voice Therapies Page)

Vocal fold paralysis:

Definition: a unilateral or bilateral paralysis of the vocal folds occurs when conduction of nerve impulses is temporary blocked, the axons of the nerve section, or the nerve fibers are entirely cut which disturbs glottal closure due to lack of adduction of the affected vocal fold.

Etiology: (1) peripheral lesions of Vagus nerve (2) neuritis (3) neoplasm's in neck, bronchi, and chest (3) acute external trauma to neck (4) surgery (5) idiopathic causes (6) birth trauma (7) central nervous system disease

Symptoms: breathiness, hoarseness, diplophonia, and aphonia

(Voice Therapies Page)

Laryngeal Webbing:

Definition: a band of tissue varying in size that extends across the glottis between the two vocal folds. Congenital webs results as the glottal membrane fails to separate in the embryonic development. Acquired web result from injury to the vocal folds.

Etiology: prolonged infection or trauma

Symptoms: varying degrees of breathing problems, diplophonia, and dysphonia

(Voice Therapies Page)

Puberphonia:

Definition: a high-pitched adolescent voice that occurs passed the age of puberty

Etiology: difficult to determine the physical or psychological factors

Symptoms: high pitch

(Voice Therapies Page)

Spasmodic Dysphonia:

Definition: a disorder described as both functional/organic basis that is a rare condition with a neurological basis

Etiology: (a) psychological influence (b) unknown cause

Symptoms: strained struggled effortful voice which is hoarse with tremors, jerky voice onset, intermittent voice breaks, breathy spasms, hypernasality, failure to maintain voice

(Voice Therapies Page)

Thickening of Vocal Folds:

Definition: a disorder that occurs when vocal folds become too thick or massive

Etiology: unknown; alcohol/smoking may contribute; GERD

Symptoms: abnormal vibratory patterns of vocal folds

(Voice Therapies Page)

Carcinoma:

Definition: cancer is a disease that may affect the structures of the oral cavity, pharynx, and larynx. Most carcinomas of the vocal fold are squamous cell carcinomas. The lesion begins unilateral, but can extend to the contralateral side. The vocal fold tissue is asymmetrical and glottic closure is usually bothered. The mass and the stiffness of the cover are increased.

Etiology: (1) smoking (2) environmental irritants (3) chemical or other contaminants (3) metabolic disturbances (4) unknown causes

Symptoms: hoarseness, lump in neck, broadening of larynx, tenderness in neck

(Voice Therapies Page)

Hemangioma:

Definition: a blood sac that usually occurs in the head and neck region. It is the most common benign tumor in infants

Etiology: unknown

Symptoms: inspiratory stridors, hoarseness, excessive coughing, and dysphagia

(Voice Therapies Page)