voice and speech disorders ppt

Speech is Beautiful

Free Professional Development Teachers And Voice Disorders

Education · Tips · Vlog

I shared this PowerPoint in a video a long time ago, but I wanted to remind you guys in my new video  Video: Free Professional Development Voice Disorders  since you may be planning ahead for a staff meeting this spring. Grab my free PowerPoint presentation geared for an audience of teachers, who are professional voice users disproportionally impacted by voice disorders. And I talk a little at the end of the video about my son’s voice disorder too (I’m going to have to do a separate video about that…)

Teaching Leads to Voice Disorders

Teaching is a job with significant voice use — and overuse. Jobs like musical performance also fall into this same category because you need your voice to work. Additionally, you need to project your voice to a crowd. That’s how teachers can strain their voices, which leads to hoarseness and more seriously to voice disorders.

Yelling is Vocal Abuse

I don’t know if you knew this but yelling is vocal abuse. That’s because it puts strain on the delicate muscles inside the “voice box.” Try to stop yelling and if you feel like you cannot, considering wearing a microphone or some type of amplification device in the classroom. It will save your voice, which you want to do. You need your voice to be there for you for years to come.

Vocal Hygiene

Vocal hygiene refers to what you do with your voice to save it. If you are at risk for a voice disorder, here are some things you can do to help your voice:

• Stay hydrated. The muscles in your voice and the membranes covering them need water to move optimally.
• Reduce consumption of liquids that dry out your voice. Reduce drinking coffee and alcohol.
• Do not visit smoky places. Avoid breathing smoke, which irritates your voice box.
• Period of vocal rest. Have times of the day where you do not talk, especially after a day of heavy vocal use.
• Don’t yell. As a mentioned before, it is vocal abuse.
• Don’t whisper. Whispering puts a strain on your vocal folds or muscles of the voice box. If you do become hoarse, talk normally even if your voice quality is off. It’s actually better than whispering.
• Don’t clear your throat. When you clear your throat, you rub those vocal folds together and it’s tough on them. If you feel something stuck in there, do a quick, forceful cough.

Free Professional Development Teachers Need

Teachers need to know that their profession causes more voice disorders than virtually any other (beside singing). That’s where this free Powerpoint comes in. Share it with staff so that they learn how to protect their voices and avoid having to see a doctor.

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• Voice disorders

People develop a voice disorder for many reasons. A voice disorder is a change in how the voice sounds. Health care providers trained in ear, nose and throat illnesses and speech-language pathologists diagnose and treat voice issues.

Treatment depends on what's causing the voice change. Treatment can include voice therapy, drugs, shots or surgery.

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The voice box, also called the larynx, is made of a smooth covering, muscle and soft, moist areas. The voice box sits at the top of the windpipe, also known as the trachea, and the base of the tongue. The vocal cords vibrate to create sound.

Air moving through the voice box causes the vocal cords to vibrate and brings them closer together. The vocal cords also help close the voice box during swallowing to stop you from breathing in food or liquid.

If vocal cords become swollen, or inflamed, develop growths or can't move as they should, they can't work properly. Any of these might cause a voice disorder.

Some common voice disorders include:

• Voice changes related to the brain and nervous system, known as spasmodic dysphonia (spaz-MOD-ki dis-FOE-nee-uh)
• Polyps, nodules or cysts on the vocal cords — growths that aren't cancer
• Precancerous and cancerous growths
• Vocal cord paralysis or weakness
• White patches, also known as leukoplakia (loo-koh-PLAY-key-uh)

Risk factors

Many factors can lead to a voice disorder, such as:

• Alcohol use
• Conditions related to the brain and nervous system, such as Parkinson's disease or a stroke
• Gastroesophageal reflux disease (GERD)
• Illnesses, such as colds or upper respiratory infections
• Scarring from neck surgery or from trauma to the front of the neck
• Throat cancer
• Throat dehydration
• Thyroid problems
• Voice misuse or overuse

Voice disorders care at Mayo Clinic

• Bruch JM, et al. Hoarseness in adults. https://www.uptodate.com/contents/search. Accessed Aug. 30, 2022.
• Vocal fold paralysis. National Institute on Deafness and Other Communication Disorders. https://www.nidcd.nih.gov/health/vocal-fold-paralysis. Accessed Aug. 28, 2022.
• Learn more about your voice. American Academy of Otolaryngology — Head and Neck Surgery. https://www.enthealth.org/be_ent_smart/learn-more-about-your-voice/. Accessed Aug. 28, 2022.
• Kost KM, et al. Voice disorders in the elderly. Clinical Geriatric Medicine. 2018; doi:10.1016/j.cger.2018.01.010.
• What causes hoarseness? American Academy of Otolaryngology — Head and Neck Surgery. https://www.enthealth.org/conditions/hoarseness/. Accessed Aug. 28, 2022.
• Ma J, et al. A 532-nm KTP laser for vocal fold polyps: Efficacy and relative factors. Ear, Nose & Throat Journal. 2021;  doi:10.1177/0145561320946153.
• Ami T. Allscripts EPSi. Mayo Clinic; Sept. 19, 2022.

News from Mayo Clinic

• Science Saturday: Bioengineering vocal cords Feb. 18, 2023, 12:00 p.m. CDT
• Minnesota man takes shot at getting his voice back Aug. 17, 2022, 04:30 p.m. CDT
• Science Saturday: Regenerating damaged vocal cords April 23, 2022, 11:00 a.m. CDT
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Here’s how voice assisted ai technology can give people a voice again.

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Dutch Whispp app user, Ruud, uses the app to speak clearly with friends.

Johns Hopkins defines stuttering as a voice speech disorder. Stuttering affects more than 80 million people worldwide, and in the United States, more than one million Americans stutter.

A voice disorder is a problem with pitch, volume, tone, and other qualities of your voice that occurs when vocal cords don't vibrate normally. There are several types of voice disorders classified as organic, which include structural and neurological (caused by a neurological disorder like Parkinson's or Alzheimer's), functional (muscle dysfunction), and psychogenic disorders.

A Dutch start-up has created an app designed to give a voice to people with voice disorders or speech disorders, such as stuttering.

Using artificial intelligence (AI), the Whispp app enables them to make understandable and relaxed phone and video calls.

"The app has a real-time assistive voice technology that converts voiceless/vocal cord-impaired speech or whispered speech (speech that does not have a clear pitch) into natural and voiced speech," said Joris Castermans, CEO of Whispp. "People who stutter severely, for example, can reduce their stuttering frequency by an average of 85% while whispering. Additionally, people who suffer from spasmodic dysphonia or recurrent respiratory papillomatosis speak much more relaxed and fluently when they whisper."

In an email interview, Castermans said the Whispp enables users to express themselves better and easier, enhancing their quality of life and allowing them to participate more fully in society.

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"Communication is a fundamental aspect of human existence that presents a daily challenge for people who suffer from a voice disability or stutter severely," said Castermans. "The inability to communicate can lead to social isolation and, in many cases, feelings of inadequacy and depression."

With their own AI models for Whispp, the AI is audio-to-audio based with no textual intermediate, so the company doesn't use language models.

"With this, Whisper converts non-voiced speech with a very low latency," said Castermans. "Whispp's AI converts every 20 milliseconds of audio into a real-time stream.

Whispp uses real-time, audio-to-audio-based assistive voice AI to create real-time speech conversion and accommodates a range of voice types — from whispers to rough esophageal speech. This allows the app to create a tailored solution for several voice conditions.

For example, Castermans says people who stutter severely speak fluently and are relaxed when they whisper. "This is because of a neurological change that occurs while they are speaking; aside from this, people who stutter severely didn't 'learn' to be anxious while whispering."

Castermans says that big tech and assistive speech tech companies predominantly focus on Automatic Speech Recognition, known as speech-to-text (STT), for non-standard speech. "This is very helpful for patients with reduced articulation (ALS, MS, stroke and Parkinson's Disease) who can use text-to-speech to synthesize their speech."

"The disadvantage of this approach, however, is the high latency of two to three seconds, which creates barriers to natural conversation," said Castermans. "As a result, current AI speech technology solutions do not provide an adequate solution for people with voice disorders who have lost their voice but still have good articulation."

The Whispp app is available on Android and IoS.

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Voice Disorders

Sep 08, 2014

650 likes | 1.34k Views

Voice Disorders. Balasubramanian Thiagarajan. Introduction. Normal voice is difficult to interpret Voice disorders should be classifiable Voice disorders should be objectively quantifiable. Normal voice - Pre-requisites. Normal range of vocal fold mobility

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• mucosal wave
• glottic closure
• glottic closure patterns
• vocal fold vibratory cycle

Presentation Transcript

Voice Disorders Balasubramanian Thiagarajan

Introduction Normal voice is difficult to interpret Voice disorders should be classifiable Voice disorders should be objectively quantifiable

Normal voice - Pre-requisites • Normal range of vocal fold mobility • Normal mobility of mucosa on deep layers • Optimal co-aptation of vocal fold edges • Optimal motor force at glottic closure • Optimal pulmonary support • Optimal timing of the glottic closure in relation to the onset of phonatory expiration • Optimal tuning of vocal fold tension

Phonatory expiration • This occurs when the person is attempting to speak • Vocal folds on both sides approximate along their entire antero-posterior dimension • This can be tested by asking the patient to say (eeee) while performing laryngoscopic examination • In non phonatory expiration vocal folds are gently abducted Non phonatory expiration

Glottal cycle • Opening phase • Closing phase • Closed phase

Opening phase • Vocal fold gets blown upwards by increasing subglottic pressure • Undulating wave moves on the medial margin from the lower part to upper part.

Closing phase • After the width of the glottis reaches the maximum, subglottic air pressure reduces and elastic recoil of vocal folds draw them towards midline. Closure occurs from below upwards • The lower lip of vocal folds close first followed by the upper

Closed phase • Glottis closes completely when the upper lip of both vocal folds come together. • This phase lasts till the subglottic pressure overcomes the glottic closure

Characteristics of voice disorder Voice disorder Discomfort Pain on phonation Easy fatiguability Not appropriate for age and sex Unable to fullfil Liguistic/ paralingusitic functions Not audible Not clear Not stable

Definitions • Dysphonia - Voice impairment / difficulty in speaking • Dysarthria - Articulation difficulties due to impairment of speech muscles • Dysarthrophonia - Dysphonia + Dysarthria CNS causes like motor neuron disorders • Dysphasia - Impairment of comprehension of spoken / written language. • Hoarseness - harsh breathy voice

Voice disorders - diagnostic problems • Aetiology (Multifactorial) • Pts develop compensatory mechanisms in order to communicate effectively, this could mask the primary disorder • Pts may have more than one condition contributing to voice disorders

Voice disorders - causes • Inflammatory • Structural / neoplastic • Neuromuscular • Muscle tension imbalance

History • Nature & chronicity • Exacerbating / releiving factors • Life style / dietary / hydration issues • Medical conditions / trt effects • Pts voice use / voice requirements • Impact on quality of life • Pts expectations

Complaints • Voice quality changes - (hoarseness, roughness and breathiness) • In appropriate pitch - age and sex • Poor voice control (break in pitch) • Inability to raise voice to be heard in noisy environment • Difficulty in singing • Voice tiring

Complaints - contd • Throat related symptoms • Reduced ability to communicate • Difficulties in using voice at different times of the day • Emotional effects due to voice changes

Examination • Oral cavity • Oropharynx • Nasal cavity • Lower cranial nerves • Cervical adenopathy • Signs of increased muscle tension • Laryngeal position • Breathing pattern

Direct laryngocopy - pitfalls • Small view • Brief duration of visibility • Mucosal wave cannot be appreciated (100 cycles / sec. Retina can perceive only 5 cycles / sec)

Stroboscopy • Depends on Talobot's law (persistence of vision) • This is an optical illusion caused by fusion of various phases of glottic cycle • The frequency of flashing light should be equal to that of vocal fold vibratory cycle

Stroboscopic examination • Amplitude of vibration • Mucosal wave • Symmetry • Periodicity • Glottic closure patterns - including its phase and configuration • Non vibrating portions • Ventricular vibrations

Amplitude of vibration • It is the extent of vocal fold movement in the horizontal plane • Usually it is one half of the width of the visible part of the vocal fold • Amplitude decreases when the pitch increases • Amplitude increases with increasing loudness of phonation

Amplitude of vibration - Rating • 0 - No observable horizontal excursions • 1 - Diminished amplitude of excursion • 2 - Normal amplitude of excursion • 3 - Greater amplitude of excursion

Decreased vocal fold vibration amplitude • Vocal fold stiffness • Reduced subglottic pressure • Sulcus vocalis increases stiffness of the vocal folds • Tight glottic closure - Hyperfunctional dysphonia

Increased amplitude of vocal fold vibration • Reinke's odemea - There is a consious increase of subglottic pressure in these patients to move the increasingly bulky cord • Decreased laryngeal muscular tone - vocal fold paralysis (appears like flag fluttering in the wind)

Mucosal wave • This is a normal wavy motion of vocal fold mucosa travelling both in vertical and horizontal planes • Normally it travels across in the vertical plane of the vocal folds and then rolls laterally across atleast 50% of the width of the visible part of vocal fold • It is affected by the mucosa and the underlying muscle layers • Normally it decreases with rising pitch of phonation • It increases with increasing loudness of phonation

Mucosal wave - grading • 0 - No observable travelling wave • 1 - Restricted mucosal wave • 2 - Normal mucosal wave • 3 - Greater mucosal wave

Decreased mucosal wave - causes • Increased stiffness due to mucosal changes - Polyp, sulcus vocalis and vocal fold dysplasia • Increased muscle tension leading to tight glottic closure (Hyperfunctional dysphonia; it leaves a long closed phase) • Decreased muscle tone causes weak glottic closure pattern (Hypofunctional dysphonia with long open and short closed phase)

Mucosal wave absence • Stroboscopic fixation (synonym) • Malignant neoplasm • Vocal fold scarring • Recurrent laryngeal nerve paralysis

Increased mucosal wave • Reinke's oedema • This is due to elevated subglottic pressure

Symmetry • Both vocal cords are normally symmetrical • They mirror each other in timing / phase and amplitude

Symmetry (Contd) • A - displays normal amplitude and timing. Upper curve represents right cord and lower curve represents left cord movements • B - Asymmetry. The range of excursion of left cord is less than that of the right fold • C - Extreme asymmetry. Left vocal fold opens while the right vocal fold closes • D - Asymmetry both in phase and amplitude

Periodicity • This is regularity of successive glottic cycles • Aperiodicity between successive cycles could be either in amplitude or timing or in both. • To access this the strobe light setting should be set to auto so that the light flashes are executed at the same frequency as that of vocal fold vibrations • Normally laryngeal image will be static • In aperiodicity the flashes will not coincide with glottal cycle. This causes hazy shivering of laryngeal image

Periodicity - (Contd) • A - Normal glottic wave form • B - Aperiodicity in timing between successive cycles • C - Aperiodicity in amplitude • D - Aperiodicity in timing and amplitude

Aperiodicity - causes • Inadequate expiratory air during phonation • Disrupted laryngeal muscle tension • Imbalance of neuromuscular control of larynx • Disrupted mechanical properties of vocal folds

Glottic closure patterns • The timing of opening phase, closing phase and closed phase are more or less equal normally • Opening phase dominates with increasing pitch / decreasing loudness during phonation • Closed phase predominates with rising loudness of phonation

Pathological changes of glottic closure • Predominance of opening phase - decreased laryngeal muscle tension (hypofunctional dysphonia) • Predominance of closing phase - Due to increased glottal resistance / hyperfunctional dysphonia

Glottic closure shape • Normal - Complete closure. Small triangular posterior chink + females • Hour glass phonatory gap - vocal nodules • Slit shape phonatory gap in hyperfunctional dysphonia

Glottic closure shape - (contd) • Oval shape phonatory gap - Hypofunctional dysphonia • Irregular phonatory gap - Growth vocal folds • No closure - Bilateral vocal fold paralysis

Non vibrating portions • Laryngeal scarring • Dysplastic patches • Mucosal fixation

Stroboscopy - uses • Detection of early glottic cancers • Determine changes to vocal folds not normally visible to naked eye • Pre and post treatment comparison

Vocal hygiene • Smoking cessation • Avoidence of dust and fumes • Reflux prophylaxis • Avoid eating late in the night • Avoidance of voice strain

Specific voice disorders (common) • Tension dysphonia • Laryngitis • LPR • Vocal nodules • Vocal fold cysts • Vocal fold paralysis • Arytenoid granuloma

Voice disorders (Less frequent) • Sulci / mucosal bridges • Spasmodic dysphonia • Papillomatosis • laryngeal trauma • Hyperkeratosis / Malignancy • Endocrine causes • Amyloid

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Child-friendly app helps correct speech sound disorders in young children

New innovator: kate beckett’s ultimate speech sounds is the only such app to offer a voice with an irish accent.

Kate Beckett is the founder of Ultimate Speech Sounds, a soon-to-be launched app that helps correct speech sound disorders in children.

Specialist speech and language therapist Kate Beckett is the founder of Ultimate Speech Sounds, a soon-to-be launched app that helps correct speech sound disorders in children.

Sound errors often occur when a child is acquiring their language skills and most mistakes will disappear as they get older. What the app is tackling, however, are the errors that persist after a child’s peers have stopped making similar mistakes.

It’s at this point that speech therapists typically enter the frame and Beckett’s app is designed as a resource for them to use in their practices. It also enables them to interact with the child’s parents, as doing the prescribed remedial exercises consistently and correctly at home is central to correcting any disorder.

“The app allows both the parent and child to have an animated visual tool to guide home practice rather than the parent trying to remember what the therapist told them to do,” Beckett says.

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“Tracking home practice allows the therapist to tailor strategies as the child progresses and provides an incentive to the parents who can see the results of their efforts. Engaging the parents is crucial as only 16 per cent of the correction is done in the clinic. The rest is done at home.”

Beckett has worked as a speech therapist in the UK, New Zealand and Ireland and found that similar sound disorders crop up wherever children are learning English. There are apps out there to help but none offer a voice with an Irish accent. It was this deficit that inspired Beckett to think about developing an alternative.

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“During the Covid lockdown, I was trying to teach children to speak using a model with an American accent when it was an Irish accent I needed,” she says. “Existing options only teach with British and American accents so I could see the potential to broaden the app to cover other regions. My app teaches phonics (speech sounds) in seven different English-speaking country accents, including Australian, Canadian, New Zealand and South African.”

Ultimate Speech Sounds is built around a child avatar called Dara (digitised automated realistic articulator), but unlike other apps Dara shows the avatar’s full face. This makes it easier for the child to see how sounds are formed.

Most existing apps show a floating mouth and tongue and young children have difficulty associating what they’re seeing with their own anatomy. With Dara, the child can see how the avatar is forming the sound from a front and a side view. They also hear the sounds spoken correctly and copy the position of the avatar’s mouth to improve their pronunciation.

Beckett has put a lot of effort into ensuring that Dara has superior graphics with strong visual appeal for kids while the fact that it’s a child talking to a child makes the whole experience more user friendly.

However, as this is a child-oriented app with shared information, one of the issues Beckett had to cover off was child safeguarding GDPR. To this end, she has been working with a company specialising in the protection of children’s data and it has been overseeing the app’s development at each stage to ensure it is internationally compliant.

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The Ultimate Speech Sounds app will be launched in the early part of next year with the minimum viable product on schedule to be finished and trialled with a group of 40 Irish and British speech therapists this summer.

The revenue model is an annual subscription paid by therapists using the app but Beckett says the cost per patient will be modest.

So far, Beckett estimates start-up costs at about €25,000 with support from Enterprise Ireland and Wicklow LEO. Her next step is to raise €750,000 to build her team and launch the app on international markets, with particular emphasis on the US as it holds the greatest potential in terms of scale.

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