dysphonia: Definition from Answers.com

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Dysphonia
ICD-10	R 49
ICD-9	784.42
MeSH	D055154

Dysphonia is the medical term for disorders of the voice: an impairment in the ability to produce voice sounds using the vocal organs (it is distinct from dysarthria which means disorders of speech, that is, an impairment in the ability to produce spoken words). Thus, dysphonia is a phonation disorder. The dysphonic voice can be hoarse or excessively breathy, harsh, or rough, but some kind of phonation is still possible (contrasted with the more severe aphonia where phonation is impossible).

Dysphonia has either organic or functional causes due to impairment of any one of the vocal organs. However, typically it is caused by some kind of interruption of the ability of the vocal folds to vibrate normally during exhalation. Thus, it is most often observed in the production of vowel sounds. For example, during typical normal phonation, the vocal folds come together to vibrate in a simple open/closed cycle modulating the airflow from the lungs. Weakness (paresis) of one side of the larynx can prevent simple cyclic vibration and lead to irregular movement in one or both sides of the glottis. This irregular motion is heard as roughness. This is quite common in vocal fold paresis.^[1]

Contents

1 Common types of dysphonia
2 Associated conditions (incomplete list)
3 Clinical measurement
4 When should a patient seek treatment?
5 How is dysphonia treated?
6 See also
7 References
8 External links

Common types of dysphonia

Organic dysphonia
- Laryngitis (Acute: viral / bacterial) - (Chronic: smoking / GERD / LPR (Laryngopharyngeal Reflux) ).
- Neoplasm (Premalignant: dysplasia) - (Malignant: Squamous cell carcinoma).
- Trauma (Iatrogenic: surgery / intubation) - (Accidental: blunt / penetrating / thermal).
- Endocrine (Hypothyroidism / hypogonadism).
- Haematological (Amyloidosis).
- Iatrogenic (inhaled corticosteroids)

Functional dysphonia
- Psychogenic
- Vocal misuse
- Idiopathic

Associated conditions (incomplete list)

Voice disorders
- Laryngitis
- Chorditis
- Vocal cord nodules
- Vocal fold cyst
- Reinke's Edema (Mostly caused by smoking)
- Laryngeal papillomatosis
Gastroesophageal reflux disease: When there is a clinical suspicion for GERD as the cause of the dysphonia, an Esophageal pH Monitoring is required to confirm the diagnosis and establish the relationship between GERD and dysphonia.

Clinical measurement

Dysphonia is measured using a variety of examination tools that allow the clinician to see the pattern of vibration of the vocal folds, principally laryngeal videostroboscopy. Acoustic examination is also common, obtained by recording the sounds made during sustained phonation or whilst speaking. Another tool is electroglottography.

Subjective measurement of the severity of dysphonia is carried out by trained clinical staff. The GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale or the Oates Perceptual Profile are widely used for this purpose. Objective measurement of the severity of dysphonia typically requires signal processing algorithms applied to acoustic or electroglottographic recordings. These include algorithms such as jitter, shimmer and noise-to-harmonics ratios, but these have been shown to have some critical limitations, particularly for severe dysphonia. Recent advances in signal processing theory have led to more robust algorithms.^[2]

When should a patient seek treatment?

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Any person who has been hoarse for four weeks or more should seek medical attention from their family doctor. They may require to be seen by an ear, nose and throat specialist for further examination including inspection of the larynx. This can be done quite easily (by the specialist) using an angled mirror, or flexible fibre-optic 'telescope'. Persistent hoarseness, difficulty in swallowing, sore throat, choking when swallowing (especially fluids), persistent earache, coughing up blood, weight loss and loss of appetite may indicate a more serious condition and should always be taken seriously.

How is dysphonia treated?

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Each condition has its own specific treatment, and the treatment should also be tailor-made to each individual. The general principles of management are described below. Conservative therapy Every attempt should be made to identify and eliminate causative factors such as stress, smoking, and alcohol. Drink plenty of clear fluid to avoid a dry throat. Rest the voice completely for two to three days. No talking or whispering is allowed. Communicate to others by writing everything down on a note pad. Speech therapy The speech therapist plays an important role in the assessment and treatment of patients with voice disorders, e.g. Reinke’s oedema, vocal cord nodules and voice misuse. The therapy will take some weeks or months before any improvements are noticed and so the patient must be highly motivated. Medical therapy Upper respiratory tract infections, e.g. acute laryngitis, are commonly caused by viral infections. Bed rest, regular paracetamol and saline or soluble aspirin gargles are often adequate. Antibiotics are only indicated when there is bacterial infection. Nasal sprays such as Beconase are used to treat patients who suffer from chronic inflammation of the sinuses and nasal lining and who get catarrh dripping down the back of the throat. Medications to reduce acid secretion by the stomach are used to treat patients with gastro-oesophageal reflux. Surgery Surgery is indicated for diagnosis (e.g. tissue biopsies) and treatment (e.g. removal of tumours and laser surgery). The operation is performed with a fibre-optic viewing ‘telescope’ (endoscope) under general anaesthesia. The view of the larynx is magnified with a microscope so that delicate operations can be carried out. The procedure is known as ‘microlaryngoscopy’ or ‘endolaryngeal microsurgery’. Surgical management of non-cancerous causes of voice disorders is only indicated when all the other measures have failed.

References

^ Little, M.A. et al. (2009). Objective dysphonia quantification in vocal fold paralysis: comparing nonlinear with classical measures. Journal of Voice (in press).
^ Little, M.A. et al. (2007). Exploiting nonlinear recurrence and fractal scaling properties for voice disorder detection. Biomed Eng Online, 6:23.

External links

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dysphonia

dys·pho·ni·a