What is voice and how is it formed?
Everything that can be perceived through hearing is described as sound, so the phenomenon of sound is also valued by the presence of a well-heard ear. Voice (or vocalization) is the sound produced by human body. The voice in humans is formed by the work of 3 different systems.
- Lung system that allows the movement of air molecules
- Vibrator / vibration provider system (vocal cords and connected structures-larynx)
- Resonator system (mouth, nose and sinus cavities)
Our lungs fill with the air we breathe, and after giving oxygen to the blood and replacing it with carbon dioxide, it becomes waste air and is thrown out in the same way. This waste air is used in voice formation. The waste air is wetter and heavier than the air outside. It is slightly denser due to the water molecules. While this air is thrown, it passes through our vocal cords and activates the surface layer (covering layer) of this tissue. It then transmits the air to the resonator system as air currents in a regular frequency range, providing wave formation. The moving and stationary structures in our resonator system shape this air movement, providing it to spread to the environment as human-specific voices. The vocal cords are two structures at the top of the windpipe, right and left. While breathing, it moves away from each other and opens the airway; During swallowing and making voice, they approach each other and close. As both vocal folds approach each other and air passes through them, vibration occurs, cutting and opening the air flow periodically. Thus, a certain frequency voice is formed. This is called the fundamental frequency. The fundamental frequency in men is lower than that of women and children, so the male voice is thicker and the average is 120 Hz (105-140 Hz). Women and children have high fundamental frequency values; in women, an average of 210 Hz (180-240 Hz), in children, an average of 240 Hz depending on age and gender.
How does hoarseness occur and which voice disorders do we see most frequently?
As a perception in society, when hoarseness is called, laryngeal diseases associated with the vocal cords come to mind mostly. But any problems that may occur in these 3 different systems that create the voice mentioned above can disrupt the quality of the voice. Lung-related diseases (such as bronchial asthma), nasal diseases (allergic rhinitis or other causes obstructing the nose) can impair the quality of the voice. However, diseases related to the vocal cords are more frequent. We can classify hoarseness in 3 separate groups as structurally, neurologically and behaviorally:
Structural Voice Disorders: It refers to pathological changes on the vocal cords, and most of them are mistakenly called calluses (nodules) among the public. In fact, although nodules are seen as the most common pathologies, there are also many different disease definitions like polyps, granuloma, papilloma, laryngitis, cyst, reinke edema (polypoid degeneration), sulcus vocalis. Different treatment approaches may be required for each of them. We can classify all these diseases as benign vocal cord changes.
Hoarseness appears as a leading symptom in cancer or a group of diseases that predispose to cancer. These diseases also are included in structural voice disorders.
Neurological Voice Disorders: Vocal cord paralysis (may occur for many different reasons, especially thyroid surgeries), Spasmodic dysphonia (vibration disorder in the vocal cords), Voice problems due to Parkinson’s disease
Behavioral Voice Disorders: Mutational Falsetto / Puberphonia (Fine voice structure developing especially in boys during adolescence and after), Muscle Tension Dysphonia (More pronounced hoarseness in tension-stress situations), Conversion Aphonia (psychologically based hoarseness)
How are voice disorders diagnosed?
The basis in the diagnostic evaluation of voice problems is to reveal some of the causes of voice disorders and to create a treatment plan for each patient and disease in the light of the findings we have obtained. For the diagnosis of voice disorders, it is necessary to have information about the structure and working system of the larynx, and to know which diseases affect the voice. Hoarseness may manifest itself in the patient as vocal fatigue, breathless voice, decrease in voice range, aphonia (complete loss of voice), pitch disorder, tremor, pain and strain.
The causes of voice disorders, as noted above, can be varied, and sometimes more than one cause can contribute to hoarseness. In the examination of these patients, in addition to objective methods such as videolaryngoscopic examination, stroboscopic evaluation, aerodynamic and acoustic voice analysis, perceptual evaluations made by the ENT physician and subjective evaluations made by the patient himself are used.
How should the voice disorders be treated?
Ensuring voice hygiene is actually a package of suggestions that will contribute positively to the correction of all voice problems. In many diseases involving the vocal cords, voice therapy appropriate to the characteristics of the disease and performed by relevant specialists can resolve many problems. In addition, with the methods we call microlaryngeal surgical interventions in many diseases, we can eliminate the problematic structure in that area and restore the voice to its former power. Again in this cases, voice therapy is also very important in terms of preventing the recurrence of problems such as nodules.
What is vocal hygiene and what should be considered in vocal hygiene?
Voice hygiene, that is, voice care, is an important part of voice therapy. It includes regulations to protect the vocal cord tissue to improve the quality of the voice and to avoid abusive behavior. Prohibition of smoking; an average of 2 liters of water consumption per day; ensuring adequate humidity in the living environment; use of antireflux treatments if there are reflux complaints and signs; limiting the consumption of spicy, fatty, acidic foods and beverages, tea and coffee; abandoning frequent throat clearing habits; Avoiding shouting, screaming, loud cheering, and loud talking are behaviors that need attention for vocal hygiene. In addition, situations such as stress, tension, insomnia, irregular working hours are factors that negatively affect voice quality.
What is the purpose of voice therapy?
Although patient-specific goals are set, the overall goal of voice therapy is to produce the best possible voice for the patient. Since it is not always possible to know the patient’s normal voice characteristics, comparison may not be made after hoarseness. With the therapy, it is aimed to make the voice suitable for the gender, age and social status of the patient. Although many different techniques have been defined for voice therapy, regardless of the technique, the purpose is; It is to educate the patient about how to use the patient’s voice more effectively and how to prevent the occurrence of repetition or pathology.
How is the surgical treatment of voice disorders?
Surgery for the treatment of voice disorders is called voice surgery, phonosurgery, or microlaryngeal surgery. In this type of surgery, the aim may be to straighten the tension, shape and function of the vocal cords, to remove pathological tissues in the vocal cords, to correct deformities or abnormalities in the structure of the larynx, to fill the vocal cords (such as oil injection and hyaluronic acid injections), or to apply botox. Depending on the type of disease, one or more of these methods are preferred.
