The Voice and Voice Therapy

Daniel R. Boone celebrates his 55th year as a speech-language pathologist with the publishing of this eighth edition of The Voice and Voice Therapy. Dr. Boone has held professorships over the years at Case Western Reserve University, University of Kansas Medical Center, University of Denver, and the University of Arizona (where he is now a professor emeritus).

Dr. Boone is a former president of the American Speech-Language-Hearing As-sociation and holds both a fellowship and the honors of that organization. He is the author of over 100 publications and is well known nationally and interna-tionally for his many lecture and workshop presentations. Perhaps Dr. Boone is best known for his love of his students and turning them on to the excitement of clinical voice practice.

Stephen C. McFarlane is a professor emeritus at the School of Medicine at the University of Nevada, Reno. He received ASHA honors in 1999. He received both his

B.S. and M.S. from Portland State University and his Ph.D. from the University of Washington. Dr. McFarlane has a long history of research interests in the area of voice disorders. Study of the outcomes from voice therapy and the development of new treatment techniques is of particular interest. He has been published in dozens of books and journals, among them Seminars in Speech and Language; American Journal of Speech Language Pathology, Phonoscope, and Current Opinion in Otolaryngology & Head and Neck Surgery.

Shelley L. Von Berg teaches, practices, and researches in the areas of voice, dysphagia, and motor speech disorders in adults and children at the Department of Communication Sciences and Disorders at California State University, Chico. She earned her M.S. and Ph.D. from the School of Medicine at the University of Nevada, Reno. She has presented on the assessment and intervention of neurogenic speech-language disorders nationally and abroad. Dr. Von Berg has been published in the ASHA Leader Series; Unmasking Voice Disorders; Language, Speech, and Hearing Services in Schools; Current Opinion in Otolaryngology & Head and Neck Surgery; and Cleft Palate-Craniofacial Journal.  

Richard I. Zraick is an associate professor in the Department of Audiology and Speech Pathology at the University of Arkansas for Medical Sciences and the University of Arkansas at Little Rock. His research interests include voice disorders, neurologically-based communication disorders, adult speech disorders, and clinical skills training for speech-language pathology students.

Contents to the DVD xi

Preface xii

1 The Voice and Voice Therapy 1

The Biological Function of the Larynx 2

The Emotional Function of the Larynx 3

The Linguistic Function of the Voice 4

Voice Disorders in the Normal Population 5

Kinds of Voice Disorders 6

2 The Normal Voice 14

Normal Aspects of Voice 15

Normal Processes of Voice Production 15

Respiration 16

Anatomy of Phonation 25

Principles of Phonation 41

Resonance 48

Structures of Resonance 48

Mechanism of Resonance 49

Summary 53

Thought Questions 53

Organic Voice Disorders 8

Neurogenic Voice Disorders 8

Psychogenic Voice Disorders 9

Muscle Tension Dysphonia 9

Management and Therapy for Voice Disorders 10

Summary 13

Thought Questions 13

3 Organic Voice Disorders 54

Cancer 56

Congenital Abnormalities 56

Laryngomalacia 56

Subglottal Stenosis 57

Tracheoesophageal Fistulas and Esophageal Atresia 57

Contact Ulcers (Granulomas) 58

Cysts 61

Endocrine Changes 61

Hemangioma 63

Hyperkeratosis 63

Infectious Laryngitis 64

Laryngectomy 64

Leukoplakia 65

Papilloma 66

Pubertal Changes 68

Reflux 69

Sulcus Vocalis 71

Webbing 73

Summary 74

Thought Questions 74

4 Neurogenic Voice Disorders 76

A Working View of the Nervous System 77

The Central Nervous System (CNS), the Cortex, and Its Projections 77

Pyramidal and Extrapyramidal Tracts 78

The Peripheral Nervous System (PNS) 82

Flaccid Dysarthria 87

Vocal Fold Paralysis 87

Myasthenia Gravis 92

Guillain—Barré 93

Unilateral Upper Motor Neuron Dysarthria (UUMND) 93

Spastic Dysarthria 94

Hypokinetic Dysarthria 95

Parkinson’s Disease 95

Hyperkinetic Dysarthria 97

Spasmodic Dysphonia 98

Essential Tremor 104

Differences among Spasmodic Dysphonia, Essential Tremor, and Vocal

Hyperfunction 105

Huntington’s Disease 106

Ataxic Dysarthria 107

Mixed Dysarthria 108

Amyotrophic Lateral Sclerosis (ALS) 108

Multiple Sclerosis (MS) 109

Traumatic Brain Injury 110

Summary 111

Thought Questions 112

5 Functional Voice Disorders 113

Psychogenic Voice Disorders 114

Falsetto 114

Functional Aphonia 116

Functional Dysphonia 118

Somatization Dysphonia (Briquet’s Dysphonia) 120

Excessive Muscle Tension Disorders 120

Muscle Tension Dysphonia 120

Reinke’s Edema 122

Vocal Fold Nodules 123

Vocal Fold Polyps 125

Traumatic Laryngitis 126

Ventricular Dysphonia 127

Diplophonia 130

Phonation Breaks 130

Pitch Breaks 131

Summary 132

Thought Questions 132

6 Voice Evaluation 133

Screening for Voice Disorders 134

Medical Evaluation for Voice Disorders 135

Assessment, Evaluation, and Diagnosis of Voice Disorders

by the Clinician 138

Review of Auditory and Visual Status 142

Case History 142

Noninstrumental Assessment 146

Instrumental Assessment 150

The Clinical Voice Laboratory 161

Clinical Instrumentation for Acoustic Analysis 162

Clinical Instrumentation for Aerodynamic Analysis 168

Three Case Studies Comparing Noninstrumental and Instrumental

Assessment Approaches 171

Summary 178

Thought Questions 179

7 Voice Therapy 180

Voice Management and Therapy for Children 181

Voice Therapy for Adolescents and Adults 184

Voice Therapy Facilitating Techniques 185

1. Auditory Feedback 186

2. Change of Loudness 189

3. Chant—Talk 192

4. Chewing 194

5. Confidential Voice 196

6. Counseling (Explanation of Problem) 198

7. Digital Manipulation 200

8. Elimination of Abuses 203

9. Establishing a New Pitch 205

10. Focus 207

11. Glottal Fry 211

12. Head Positioning 213

13. Hierarchy Analysis 215

14. Inhalation Phonation 218

15. Laryngeal Massage 220

16. Masking 222

17. Nasal/Glide Stimulation 224

18. Open-Mouth Approach 226

19. Pitch Inflections 228

20. Redirected Phonation 230

21. Relaxation 233

22. Respiration Training 236

23. Tongue Protrusion /i/ 239

24. Visual Feedback 241

25. Yawn—Sigh 243

Summary 246

Thought Questions 246

8 Management and Therapy

for Special Problems 247

Management—Voice Therapy for Particular Populations 248

The Aging Voice 248

Deaf and Hard of Hearing 252

Pediatric Voice Problems 255

Professional Voice Users 256

Transgender (Transsexual) 259

Management—Voice Therapy for Respiratory-Based

Voice Problems 261

Airway Obstructions 261

Asthma 262

Emphysema 263

Faulty Breath Control 264

Paradoxical Vocal Fold Movement 265

Tracheostomy 266

Management—Voice Therapy Following Laryngeal Cancer 266

Facilitating Techniques 270

Laryngectomy 270

Counseling and Communication Options 270

The Electrolarynx 272

Traditional Esophageal Speech 272

Tracheoesophageal Puncture Shunt (TEP) 273

Summary 275

Thought Questions 275

9 Therapy for Resonance Disorders 276

Nasal Resonance Problems 277

Hypernasality 277

Hyponasality 278

Assimilative Nasality 278

Evaluation of Nasal Resonance Disorders 279

The Oral Examination 283

Laboratory Instrumentation 284

Treatment of Nasal Resonance Disorders 290

Therapy for Oral—Pharyngeal Resonance Problems 301

Summary 306

Thought Questions 306

References 307

Index 335

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