Practical Strategies for Treatment of Common Voice Disorders - PowerPoint PPT Presentation

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Practical Strategies for Treatment of Common Voice Disorders

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Practical Strategies for Treatment of Common Voice Disorders Carol Krusemark, M.A., CCC-SLP Voice Pathologist/Singing Voice Specialist – PowerPoint PPT presentation

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Title: Practical Strategies for Treatment of Common Voice Disorders


1
Practical Strategies for Treatment of Common
Voice Disorders
  • Carol Krusemark, M.A., CCC-SLP
  • Voice Pathologist/Singing Voice Specialist
  • MGH Center for Laryngeal Surgery and Voice
    Rehabilitation

2
Common Voice Disorders
  • Muscle Tension Dysphonia
  • Primary
  • Secondary
  • Vocal pathology associated with abuse/misuse
  • Nodules
  • Vocal scarring or loss of vibratory layer

3
Primary Muscle Tension Dysphonia
  • a posterior glottic chink caused by
    simultaneous activation of vocal fold closers
    and openers
  • Can be normal in females

4
Primary Muscle Tension Dysphonia
  • False vocal fold approximation medio-lateral
    supraglottic compression

5
Primary Muscle Tension Dysphonia
  • Supraglottic compression in the anterior to
    posterior axis

6
Primary Muscle Tension Dysphonia
  • Compression from both the A-P and medio- lateral
    directions

7
Vocal Nodules
  • Reactive fibrovascular lesions formed at the site
    of greatest vocal fold contact

8
Scar or loss of vibratory layer
  • Loss of superficial lamina propria, resulting in
    reduced musocal wave

9
Treatment modalities
  • Facilitating Strategies
  • Reduction of vocal fold and supraglottic
    hyperfunction
  • Type I posterior glottic chink
  • Glottal fry
  • Inhalation phonation
  • Types II-IV Supraglottic compression
  • Semi-occluded vocal tract tasks

10
Type I
  • Glottal fry phonation
  • Low subglottal driving pressure
  • Reduced tension of the muscle within the vocal
    folds (thyroarytenoid)
  • Vocal folds are short and thick
  • Increased interarytenoid activity
  • Complete vocal fold closure front to back
  • Eliminating posterior chink
  • Isolation/syllables/words/etc.

11
MTD Posterior glottic gap
  • Inhalation Phonation
  • Phonation during inspiratory phase
  • Results in improved vocal fold closure along
    entire length
  • Vocal tract adjustment can assist with transition
    from inspiratory to expiratory phonation
  • Hierarchy of tasks

12
MTD Compression
  • Goals
  • Reduce supraglottic compression
  • Reduce vocal fold medial compression
  • Task requirements
  • Complete closure of the vocal folds along their
    length (coordination of closers)
  • Adduction to a just barely touching position

13
Semi-occluded vocal tract tasks
  • Lowers phonation threshold pressure
  • Decreases medial compression
  • Reduces laryngeal muscular tension
  • Improves laryngeal muscular coordination
  • squares up vocal fold edges for efficient
    vibration
  • Phonation through a straw (small is better)
  • Sustained phonation of voiced fricative
    consonants
  • Lip bubbles/trills
  • Tongue trills
  • Rolled /r/
  • Humming
  • Fringe benefit highlights oral resonance

14
Straw phonation
  • Daily exercises program (2-3 times)
  • Three Principles
  • Lips around straw
  • Sound through straw only
  • Vibratory feeling at the lips
  • Four tasks
  • One long, slow slide from low to high and back
    again
  • A series of slow slides on a single breath
  • A series of accented slides (revving)
  • Song phonation

15
From straw to speech
  • Assure correct production through straw
  • Practice phrases before and after straw
  • Note auditory and ideally kinesthetic contrast
  • Maintenance of kinesthetic similarity Make it
    feel like it did after you used the straw
  • Gradually fade straw use

16
Circumlaryngeal massage
  • Addresses paralaryngeal resting muscle tension
  • Massage and manipulation of the supporting
    muscular sling
  • Focuses on muscular attachments to the thyroid
    cartilage and hyoid bone
  • Muscle relaxation encourages inferior movement of
    the thyroid cartilage

17
Circumlaryngeal Massage/Evidence
  • Significant changes in patient severity ratings
    (Roy, 1993) and acoustic voice measures (Roy,
    1997) after one session
  • 93 able to maintain improvement for a week
    without further treatment (Roy, 1993)
  • Improved voice was maintained for up to 5 months
    for 72 of patients (Roy 1997)

18
Circumlaryngeal Massage/Evidence
  • Professional voice users with moderate to severed
    muscle tension dysphonia
  • 25 sessions
  • Improvements in acoustic measurements
  • Strain
  • Highest frequency
  • Average fundamental frequency
  • Jitter and shimmer
  • Improvements in Dysphonia Severity Index

19
Structure identification
20
Muscles of the anterior neck
  • Suprahyoid
  • Digastric
  • Mylohyoid
  • Geniohyoid
  • Stylohyoid
  • Infrahyoid
  • Thyrohyoid
  • Sternohyoid
  • Omohyoid
  • Sternthyroid

21
Circumlaryngeal Massage
  • Using small circles, massage in the thyrohyoid
    space, moving horizontally through the space

22
Circumlaryngeal Massage
  • Use larger circles to massage from the thyrohyoid
    space to above the hyoid bone and back

23
Circumlaryngeal Massage
  • Massage in the thyrohyoid space moving from back
    to front

24
Circumlaryngeal Massage
  • Massage up and down in a C shape from the
    thyrohyoid space to the cricoid cartilage and back

25
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