- Many people use their voices extensively and exuberantly. They are more susceptible to vocal fold damage and dysphonia if they have poor vocal skills.
- Psychological distress leads to dysphonia through various mechanisms but the two most common are (a) increased muscle tension in the larynx, jaw, tongue, neck, and/or respiratory system and (b) suppression or repression of negative emotion.
- Gastro-esophageal reflux may produce symptoms in 10% of the general population. It increases pharyngeal-laryngeal muscle tension and is accompanied by chronic laryngeal inflammation. We have demonstrated that there is an increase in thyroarytenoid muscle activity when the lower esophagus is stimulated. (Gill & Morrison, 1997) The resultant increase in laryngeal muscle tension aggravates any coexistent dysphonia, and treatment of the reflux may be all that is needed for the voice problem to resolve. Reflux amplifies the manifestations of vocal misuse and abuse, therefore a voice therapy program will be more effective when reflux is controlled.
In all individuals with voice disorders, dysphonia is built on a platform made up of the four components. Each component affects the dysphonia to some degree, and while one or two may receive the most attention, all four will need to be considered in the treatment plan. Further pathological processes may overlie the platform components and contribute to the voice disorder. These usually come from one of two broad groups: neurological diseases and structural changes to the vocal folds. They will be considered later.
Dysphonia Platform Component Assessment
Technique and Vocal Skill
Assess and grade the level of vocal technical ability. You will need to:
- observe general posture; head, neck and shoulder alignment; and movement
- note jaw position and freedom of movement
- observe strap muscle activity, especially omohyoid action with breathing and speech
- watch and feel respiratory action during speech, singing, and other relevant vocal activities. Note abnormal speech breathing patterns, particularly absence of abdominal distension, exaggerated thoracic movement, and large lung volumes on inhalation
- listen for inappropriate pitch, loudness and quality, and note resonance focus
- note rate of speech, phrasing patterns, fluency
- palpate suprahyoid, thyrohyoid, cricothyroid, and inferior constrictor muscles
- observe voice improvement with appropriate diagnostic therapy techniques
  
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