Phonation is the process of sound production by the interaction of airflow through the glottis and the opening and closing of the vocal cords of the larynx. Voice loudness is proportional to the air pressure below the glottis;pitch is related to this pressure and to the length of the vocal cords. Voice quality may change when there is interference with the vocal cords or pharyngeal cavity vibration (i.e., resonance).
A voice disorder may be related to an enlarged vocal cord, a laryngeal mass, or a neurologic or psychologic problem. A voice disorder is defined as the presence of a voice that is different in pitch, quality, loudness, or flexibility in comparison with the voices of other persons of similar age, sex, and ethnic group. An abnormal voice may be a symptom or sign of illness, and its cause should be determined.
In a study of a school-aged population, voice disorders were found in up to 23% of children. Most of these disorders were related to voice abuse and not to organic problems. In another study, 7% of men and 5% of women from 18 to 82 years of age were found to have voice disorders. Most of these disorders were related to organic problems.
Many patients with organic speech disorders are rejected by other people. Their speech may be high-pitched or nasal and a cause of embarrassment. Their self-esteem is low. They are rejected by others because their voice patterns are objectionable.
Just as a voice disorder has an impact on a person, a person can use his or her voice to have an impact on others. The manner in which a person speaks—the quality, pitch, loudness, stress patterns, rate—reflects his or her personality. Psychogenic voice disorders are functional disorders that are manifestations of psychologic imbalance. Voice is a useful indicator of affective disorders, such as depression, manic states, and mood swings, as well as of schizophrenia.
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