Joseph R. Anticaglia MD
Medical Advisory Board
One of the things we take for granted is a good voice, one that is strong, easily understood and of good quality. We have a problem when a voice disorder interferes with our ability to communicate personally, with family or friends – or professionally, to earn a living.
The voice of professional broadcasters, singers, and actors is essential for their livelihood. A relatively minor voice disorder may have minimal to no effect on a construction worker. However, that same problem in a professional voice user can wreck a career.
The person who uses his voice in occupations or professions such as teachers, courtroom lawyers, clergy and others are also at risk for serious consequences from difficulties with their voice.
Mary Jane, a 45 y/o high school science teacher, complains of a recurrent problem. “For the past two years, during the first or second week of March my voice starts to give out. I have trouble projecting it, my throat feels achy and it gets harder and harder for me to speak. I doubt if I can complete this school year and whether I should continue teaching.”
The larynx (voice box) is located behind the Adam’s Apple and is composed of cartilage, muscle and mucosa. Ordinarily, human voice production consists of four parts and there is a skillful, coordinated interaction between the brain and the following parts of the vocal tract – Generator, Oscillator, Resonator and Articulator.
Vocal Tract
Generator:
The pulmonary system includes the lungs, muscles of respiration and trachea (windpipe). It generates and sends “air power” upwards towards the undersurface of the larynx.
Oscillator:
The air stream from the lungs causes the true vocal folds of the larynx to open and close rapidly (oscillate). This action produces “puffs of air” above the vocal folds towards the resonators which result in a buzzing sound, not speech.
This action is kind of like rapid hand clapping. They have also been compared to the sound that can be produced by blowing into the mouthpiece of a trumpet. The vocal folds do not vibrate like the strings of a violin.
Resonator:
Next, the sound travels upwards from the vocal folds into the resonators, namely, the back of the throat, the back of the mouth and behind nose. It continues towards the articulators.
Articulators:
Finally, the articulators, made up of the tongue, palate, cheeks, teeth and lips shape the sound – modified by the resonators – into speech. It’s a remarkable system, where air is transformed into sound and finally shaped into speech or song.
Many disorders can impact the vocal tract and affect the quality and production of speech. Chronic Obstructive Pulmonary Disease, (COPD) might reduce the power of the pulmonary air stream causing a shaky, weak voice that easily tires. Benign and cancerous laryngeal lesions can disrupt the movement of the vocal folds causing a raspy voice.
Cleft palate, nasal obstruction (e.g. pinch your nose and speak) can cause the voice to have a nasal quality depriving it of its unique richness and timbre. Certain tongue lesions can interfere with the clarity of speech. What we take for granted about the workings of the voice has not always been the case.
Brief History
Surprisingly, we knew very little about the workings of the voice for thousands of years. Centuries ago, the voice was thought to have sacred or magical properties. Egyptians and others prayed to voice gods and other healing divinities. Hoarseness or other diseases were attributed to demons or God’s punishment for a person’s sinful ways. (1)
It wasn’t until the nineteenth century before anyone had ever visualized the larynx in a wide-awake person.
In 1854, Manual Garcia placed a dental mirror in the back of his throat, and used sunlight to reflect the image of his larynx onto a hand held mirror. This revolutionary discovery of visualizing the movement of a person’s larynx with the “naked eye” was a remarkable benchmark for voice science. (Garcia died when he was a hundred years old and still was receiving accolades and appreciation for his innovative work.)
More than a hundred years after M. Garcia describe the “macro,” eyeball visualization of the larynx, Minora Hirano, in 1975, described in detail the “micro,’” the microscopic architecture of the vocal folds. His ground-breaking work laid the foundation for surgeons to precisely remove laryngeal lesions with a minimum of damage to underlying structures.
The use of certain instruments is another huge advance that makes throat specialists better able to visualize, evaluate and treat patients with voice problems. (2)
Back to Mary Jane: Using advances in medical care, up-to-date instrumentation, speech therapy, and counseling to diagnose and treat her vocal abuse and misuse, M.J. returned to full time teaching.
It’s extraordinary how puffs of air are remodeled into speech and song can convey “complex thought and subtle emotion.” (1) Just as we turn on a light switch without thinking about it, we usually don’t think about how speech and song come about. With better understanding of how the voice works, hopefully, this knowledge will translate into better care for patients
References
(1) Hans von Leden; A Cultural History of the Larynx and Voice; In Professional Voice, Sataloff, Robert T.; Singular Publishing Group, Inc., San Diego, London.
(2) Microscope, Endoscope and Stroboscope.
Sataloff, Robert Thayer; The Human Voice; Scientific America, December, 1992
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options