[An overview of the symptoms and signs of voice disorders and the pathophysiology of hoarseness].
Voice disorders are due to organic and functional disturbances of the voice generator, activator and resonator. They appear as a consequence of different factors which lead to the development of hoarseness, and may as well be the result of disturbed phonatory patterns. Phonatory patterns refer primarily to the muscular activity of the vocal system, which is delicately balanced within the voice generator, activator and resonator. PATHOPHYSIOLOGY OF HOARSENESS: Basic causes of hoarseness are insufficient glottic closure during phonation (glottal gap), changes in the vocal fold stiffness and imbalance in mechanical properties between the two folds. Glottal gap leads to the excessive air leakage during phonalion and insufficient conversion of the expiratory air into pulses. Turbulence of the expiratory air particles is increased, leading to the development of noise. Excessively stiff or tax vocal folds, both disturb the vibration process and lead to the development of noise and hoarseness. Imbalance in tension between the two folds, and especially in their mass, may lead to the glottal gap, with the consecutive noise and hoarseness. PHONATORY PATTERNS: Phonatory patterns refer to habitual movements of the vocal organs during phonation and speech, which are acquired during the process of learning phonation and speech. This is primarily the muscular activity of generator, activator and resonator of the voice, which is so balanced to produce the optimal voice quality with the least effort and fatigue. The activity of the phonatory organs is not well balanced in cases of voice disorders. That is the primary cause of functional voice disorders, and a very frequent consequence of organic voice disturbances. Hyperkinetic dysphonia is the most common type of disturbed phonatory patterns, characterized by excessive vocal effort, while hypokinetic dysphonia is rarely seen. The third type of functional disorders of the phonatory patterns is an incorrect placement of the voice (imposlatio falsa), which is characterized by an imbalanced muscular activity of the vocal organs, but within the normal limits concerning the overall amount of activity.
Milutinović
Z
Z
Department of Otorhinolaryngology, Maxillofacial and Cervical Pathology, Zemun Clinical and Hospital Centre, Belgrade.
D006685:Hoarseness / Q000503:physiopathology*; D006801:Humans; D014832:Voice Disorders / Q000175:diagnosis*