How is sound formed / How is the human voice formed?
For a sound to occur, vibratory motion is necessary. Vibration is the back and forth movement of an object. In order for the human voice to be formed, a vibration must occur.
While exhaling, the air coming from the lungs vibrates the vocal cords in our larynx and creates the raw sound. The vocal cords vibrate 180-210 times per second in men, 210-240 times in women and 400 times in babies. This raw sound is shaped in the throat, nose and mouth cavities to form the tone of voice that is unique to each person. This unique sound is then transformed into the sound of speech as our oral organs (tongue, teeth, lips, palate, soft palate) assume various positions.
The human voice is formed in three stages. These are: Respiration, i.e. the respiration stage; Phonation , i.e. the vibration stage of the vocal cords; and Resonance, i.e. the stage in which the raw sound takes a shape and the tone of voice that is unique to each person is formed. Speech is realized when articulation, the production of speech sounds, is added to this stage.
Our vocal system consists of lungs, trachea, larynx, nose and mouth. In order for a healthy voice to be formed, all organs in the vocal system must work in a healthy and harmonious way. All behaviors aimed at protecting the vocal system are called vocal hygiene.
What is Voice Therapy?
Voice therapy consists of the following topics: (1) Vocal hygiene, how to take care of the vocal cords by keeping them moist and away from irritants. (2) Voice production exercises, how to produce the best sound without damaging the vocal cords. The vocal cords are also muscles. Like other muscles in our body, vocal cords are strengthened with the right exercises and damaged with the wrong exercises. It involves strengthening the vocal cords against trauma by exercising them.
The items to be considered in vocal hygiene are listed below. We call all behaviors aimed at protecting the vocal system "Voice Hygiene".
- Proper breathing is important for the vocal cords to vibrate without damage. The correct breath for speaking is diaphragmatic breathing. In order to use diaphragmatic breathing, the correct posture, that is, standing upright, is important.
- Frequent and violent throat clearing, frequent and violent coughing will irritate the vocal cords, so these behaviors should be avoided.
- Hydration of the vocal cords is important. Drink at least two liters of caffeine-free and theine-free fluids a day. Caffeine, theine (tea, coffee, cola), alcohol, dairy products cause damage to the vocal cords as they dry the water in the cells and cause an increase in phlegm.
- Do not speak too loudly, shout or scream, as speaking loudly can irritate the vocal cords. Instead of sending your voice far away, go there yourself.
- Do not speak in dry, dusty, smoky, air-conditioned and noisy places.
- Do not smoke, as smoking irritates the vocal cords.
- Get treatment if you have acid reflux. The beginning of the esophagus is located just behind our vocal cords. Treatment of reflux is important as stomach acid coming up the esophagus will irritate our vocal cords.
- Use diuretics under the supervision of a doctor; these drugs can cause drying of the vocal cords.
- Drink herbal teas in moderation, as many herbal teas also have a diuretic effect.
- If you have allergies, sinusitis, pharyngitis, pharyngitis, otitis, nasal congestion and lung disease, be sure to have them treated. All kinds of diseases and problems in your body will negatively affect your voice; so resolve all your health problems.
- Get enough sleep every day.
- Pay attention to the head-neck position while talking on the phone.
- The vocal cords are also muscles. For these muscles to work strongly and regularly, do the vocal exercises recommended by the "Expert Speech and Language Therapist" regularly.
- If you have hearing loss, make sure you get it treated. Due to hearing loss; you will feel the need to speak by shouting all the time.
- Always consult an ENT physician before using medicines with hormonal effects. Some hormones can cause permanent thickening of your voice, while birth control pills narrow the dynamic range of your voice.
Vocal hygiene: how to take care of the vocal cords by keeping them moist and free from irritants. Moisturizing treatment is used for almost all vocal disorders. Humidified vocal cords vibrate with minimal effort or are forced by the lungs. In addition, the humidity protects the vocal cords from damage and prevents the vocal cords from being damaged again. However, moisturizing treatment may be contraindicated for some patients due to the medications they are taking. Patients with heart or kidney disease who retain fluid in the body should not consume large amounts of fluid in moisturizing treatment. Again, patients with mold allergy should not be in humid environments. Moisturizing treatment generally includes two or three types of methods. One of these methods is to moisturize the cells from the inside by drinking plenty of fluids and avoiding substances that dry out the internal structure of the body such as caffeine, alcohol and diuretic drugs if not medically necessary. The second method is to externally moisturize the surface of the vocal cords with water vapor or steam under the supervision of a doctor. The third method involves taking medications that fluidize body secretions under the supervision of a doctor.
Reflux Treatment is also an important stage of vocal hygiene. It has been understood that many vocal diseases occur as a result of stomach acid irritating the larynx. The beginning of the esophagus is located just behind our vocal cords. Reflux treatment is important because stomach acid coming up the esophagus will irritate our vocal cords. Reflux treatment is in three ways. The first method is the most preferred behavioral method. This method involves avoiding spicy foods, alcohol and caffeinated drinks and fatty foods. Patients sleep with their heads up to prevent stomach contents from coming up and irritating the larynx and airway. They should stop eating at least 4 hours before bedtime. If the patient has a weight problem, they may be asked to lose weight. The second method is medication under the supervision of a doctor. The third method is a surgical method called fundoplication applied for reflux conditions that do not improve with behavioral or medications.
What are Voice Disorders?
Voice disorders consist of four different causes: organic, psychological, neurogenic and functional. Nodules, polyps, reinke's edema, muscle tension dysphonia, spasmodic dysphonia, vocal cord paralysis, cysts, hemorrhage, sulcus vocalis, arching, granulomas, paradoxical vocal cord movement, puberphonia or some neurogenic diseases such as Parkinson's and ALS are accompanied by many voice disorders.
The quality of the sound we produce is closely related to how easily (or with effort) the vocal cords move. If the vocal cords vibrate synchronously, the sound is pleasant to the ear. However, if they come together harshly and forcefully, the sound is not only unpleasant, but the vocal cords can be permanently damaged.
If you have been experiencing hoarseness, changes in your voice or a feeling of discomfort in the larynx for more than 10 days without a cause such as a cold or allergy, you should consult an Ear, Nose and Throat Doctor as soon as possible. Your doctor will determine whether you may need the professional help of a Speech and Language Therapist to resolve the problem.
Nodules and Polyps
Definition
Nodules and polyps are the most common benign formations in the middle part of the vocal cords. Nodules are callous structures formed on the vocal cords. Polyps are fluid-filled formations compared to nodules. They can be fed by invisible blood vessels. A hoarse voice, strained voice and rapid fatigue are typical symptoms of both nodules and polyps.
Cause
Both nodules and polyps are caused by vocal cord trauma during speaking or singing. Factors such as smoking and alcohol use, caffeine, allergies, reflux, exposure to harmful chemicals are also effective in the formation of nodules and polyps.
Treatment
In nodule treatment, voice therapy constitutes the first stage of treatment. In addition to vocal hygiene recommendations, resonance voice therapy and vocal function exercises are used.
Cysts
Definition
Cysts that form on the vocal cords are the same as cysts that form anywhere else in the body. They are sacs filled with fluid and surrounded by skin. Unilateral cysts occur in the middle region of the vocal cords, which vibrates the most.
Cause
The real cause of vocal cord cysts is not known exactly. It is thought to be effective in the formation of voice use because it occurs in the middle point of the vocal cords that vibrate the most.
Treatment
Treatment of cysts is by surgical method. After surgical intervention, voice therapy is applied.
Reinke's Edema (Polypoid Degeneration)
Definition
Reinke's edema is a balloon-like swelling along the vocal cords. It is a symptom of excessively low-pitched speech (especially in women).
Cause
It is seen in people who use their voice too much, smoking, chemicals, excessive alcohol, reflux.
Treatment
Treatment is based on the needs of the patient and the degree of the problem. If the swelling is such that it blocks the airway, then surgical intervention is required. If the swelling is mild, then voice therapy is preferred first.
Muscle Tension Dysphonia
Definition
Muscle Tension Dysphonia (MTD) is the feeling of fatigue and discomfort in the voice as a result of overuse of one or more muscles. Although KGD usually occurs on its own, in some cases it can be accompanied by organic problems.
Cause
KGD is caused by overactivity of the laryngeal muscles. The overactivity is usually not due to an organic cause and can be modified by voice therapy.
Treatment
Voice therapy is the treatment of choice for CGD. Different therapy approaches can be used. Laryngeal massage and soft phonation are effective methods.
Puberphonia
Definition
It is the insistence on using the voice of adolescence after puberty, without any organic cause. It is more common in males who use a high-pitched voice. Sometimes, it is also seen in women who use a high-pitched voice like a child's voice.
Cause
There is no systematic study on the cause of puberphonia.
Treatment
Treatment with voice therapy is possible. The most typical approach is laryngeal massage, but the important point is that the patient accepts and uses the new adult voice.
Paradoxical Vocal Cord Movement
Definition
Paradoxical vocal cord movement (PSTH) is not a voice disorder; however, it can be associated with voice disorders. PSTH occasionally causes breathing difficulties as the vocal cords tend to close during inhalation and/or exhalation, thus preventing air from entering and leaving the lower respiratory system freely. Patients panic and are sometimes hospitalized due to breathing difficulties. PSTH problems are mostly behavioral and can be easily treated with breathing exercises.
Cause
Although there is no known cause of PSTH, it can be triggered by exercise, reflux, cough and/or panic.
Treatment
In addition to medication to address physiological "triggers", behavioral therapy by a speech-language pathologist and, in some cases, psychological or psychiatric support for anxiety are effective treatments for PSTH.
Sulcus Vocalis
Definition
Vocal cord sulcus are grooves along the vocal cord tissue. It causes serious voice impairment. Common sulcus symptoms are weakness, fatigue and a high-pitched voice.
Cause
The cause of vocal cord sulcus remains controversial. In some cases, it is seen in cases where a cyst has been removed. In other cases, it may be congenital.
Treatment
Although voice therapy helps to eliminate some symptoms, it does not completely eliminate them. Surgical intervention is often required.
Granulomas
Definition
Granulomas are vascularized tissues that form in the larynx. They often form at the back of the vocal cords.
Cause
Many granulomas are caused by stomach acid irritating the back of the larynx. Granulomas can also be caused by diseases such as tuberculosis or HIV+. Low-pitched voice production and overuse of the back of the larynx are also thought to cause granulomas.
Treatment
The most important part of treatment is reflux therapy. If the lesion is very large and there is no response to medication, micro-surgery or voice therapy or both can be performed.
Vocal Cord Paralysis
Definition
Vocal cord paralysis is a condition in which one or more nerves leading to the vocal cords function poorly and the vocal cords cannot move or return to normal. In many cases, the vocal cords cannot close completely or at all. At the same time, the vocal cords do not elongate as they should to produce fine-toned sounds. Very rarely, the vocal cords do not open. In this case, the patient's breathing becomes difficult.
Cause
Vocal cord paralysis can be caused by many things. The most common cause is viral: The patient gets the flu or an upper respiratory tract infection and consequently laryngitis and there is no return. Other causes are surgical interventions (chest, neck or shoulder), heart problems and, rarely, tumors or brain damage.
Treatment
Voice therapy is used to improve the closure quality of the vocal cords. In some cases, surgical intervention is performed to ensure that the vocal cords close during vocalization and swallowing.
Spasmodic Dysphonia
Definition
In Spasmodic Dysphonia (SD), the vocal cords suddenly contract at different times during speech, causing the voice to suddenly stop. While the voice is affected in SD, vegetative functions such as coughing, laughing and even singing may be normal
Why?
It is not known what causes SD. In some cases, however, the cause is attributed to a minor abnormal nerve or brain condition that cannot be attributed to any other disorder. This unusual condition does not cause any problems other than speech. For AD-SD, it is thought to occur as a reaction to stimulation of the nerves of the vocal cords.
Treatment
The main treatment for SD is the injection of a small amount of "botolinum toxin" (botox) into one or both vocal cords or the muscles close to them. These injections weaken the treated vocal cord and reduce contractions.
Hemorrhage
Definition
These are bleeding inside the vocal cord tissue. Extensive bleeding causes the blood to fill the tissue.
Cause.
One of the causes of hemorrhages in the vocal cords is excessively loud voice use (e.g. shouting). Other vocal misuse conditions can cause vascular fractures in the vocal cords.
Treatment
The treatment of vocal cord hemorrhage depends on the cause. If the bleeding is recent and widespread, complete vocal rest for a few days or weeks or medication to absorb the blood may be prescribed. Surgical intervention is performed if necessary.
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