Phoniatrician. Treatment of the vocal apparatus in Yekaterinburg

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Phoniatrics is a branch of otorhinolaryngology that studies the pathology of the vocal apparatus, methods of treatment and prevention of voice disorders. The functioning of the vocal apparatus involves the vocal folds, oral cavity, nose, lungs, abdominal muscles, and diaphragm.

What diseases does a phoniatrist treat?

A phoniatrist must have basic knowledge of the diagnosis and treatment of organs involved in voice formation.
He specializes in pathological changes in the vocal apparatus and voice restoration. The phoniatrist treats the following conditions:

vocal fold cyst, acute or chronic laryngitis in the acute stage, papillomatosis or paralysis of the larynx, nodules, polyps, paresis.
functional dysphonia (spastic, hypotonic, hypertonic, etc.);
neoplasms in the larynx, in the folds;
deals with voice restoration after surgical treatment of laryngeal diseases.

Production of sounds

The process of sound and voice formation has been well studied over the past decades. The acoustic component of speech arises as a result of the work of the muscles of the peripheral apparatus. It works like this. When starting a conversation, a person unconsciously exhales slowly. The air flow from the lungs enters the larynx, the ligaments of which are in a certain position corresponding to the required sound. In addition, the tongue, lips and lower jaw also take the necessary position. The vibration of the vocal cords in the larynx during the passage of air flow creates a sound that is corrected by the organs of the oral cavity.

Speech is a complex process in which several dozen anatomical structures are involved. Organic or functional disorders in any of them will lead to a change in voice or the appearance of speech defects of varying severity.

Signs of ligament pathology

Physiologically, there are no nerve endings in the vocal folds, so pathological changes do not cause pain.
But there are a number of symptoms and manifestations that require seeking medical help. It is necessary to pay attention to the following manifestations:

“loss” of voice after an infectious disease (if more than a week has passed after recovery);
loss of voice after injury, overexertion, as a result of stress;
hoarseness, change in smoothness or loss of expressiveness of the voice, hoarseness;
feeling of a lump in the throat, the need to clear your throat before speaking;
shortness of breath, feeling of shortness of breath during a conversation;
pain when swallowing;
feeling tired after using your voice for a long time;
prolonged mutation in adolescents.

Structural components of speech

Responsible for speech function:

The sensory speech center is the perception of speech sounds, based on the sound discrimination system of the language; Wernicke's area in the left hemisphere of the brain is responsible for this process.
The center of motor speech - Broca's area is responsible for it, thanks to it it is possible to reproduce sounds, words and phrases.

In this regard, in clinical psychology there is the concept of impressive speech, in other words, the understanding and presentation of oral and written speech. There is also the concept of expressive speech - that which is spoken out loud accompanied by a certain tempo, rhythm, and emotions.

In the process of speech formation, each person should have a clear understanding of the following subsystems of their native language:

phonetics (what syllables, sound combinations can be, their correct structure and combination);
syntax (understanding exactly how the relationships and combinations between words occur);
vocabulary (knowledge of the vocabulary of the language)
semantics (the ability to understand the meaning of words long before acquiring pronunciation skills);
pragmatics (relationships between sign systems and those who use them).

The phonological component of a language means knowledge of the semantic units of the language (phonemes). Physically, speech sounds can be divided into noises (consonants) and tones (vowels). Any language is based on a certain distinctive feature; if you change one of them, the meaning of the word will change dramatically. The main semantic distinguishing features include deafness and sonority, softness and hardness, as well as stress and unstress. It is these features that act as the basis of the phonemes of the language system. Each language has a different number of semantic units, usually from 11 to 141.

The Russian language involves the use of 42 phonemes, in particular, 6 vowels and 36 consonants.

It has been scientifically proven that any healthy infant in the first year of life has the ability to reproduce 75 different shortest sound units, in other words, can learn any language. But, most often, children at the initial stages of their development are in only one language environment, so over time they lose the ability to reproduce sounds that do not belong to their native Russian language.

Lost voice: diagnostics

Diagnostic methods:

Patient interview.
Examination of the patient, oropharyngoscopy, laryngoscopy, rhinoscopy, videolaryngoscopy (examination of the larynx with an endoscope at high magnification), videostroboscopy. Using video stroboscopic equipment, the specialist receives an enlarged image of the larynx. This method makes it possible to examine a hard-to-reach area to diagnose pathological changes at an early stage.
Instrumental studies (ultrasound, MRI, CT).
Laboratory diagnostics.

If the problem arose due to concomitant diseases, the phoniatrist may recommend consultation with a related (subspecialty) specialist.

What treatments are used

Treatment of benign neoplasms of the vocal cords is surgical. The goal of surgery is complete removal of the affected tissue. Overgrown tissue is excised endolaryngeally (through the oropharynx), using an endoscope and microsurgical instruments. The possibilities of ultrasound, laser and radio wave surgery are actively used. When treating papillomas, concomitant antiviral and immunocorrective treatment is prescribed.

Endolaryngeal microsurgery provides targeted excision of the tumor along with the growth zone, without damaging the surrounding healthy tissue of the laryngeal mucosa. A gentle approach prevents the occurrence of surgical scars, and complete removal of damaged tissue eliminates relapse of the disease. The operation is performed under general or local anesthesia. In most cases, hospitalization is not required and the patient can go home within a few hours.

What if the problem is not just in the larynx and vocal folds?

The number of people with pathological changes in the vocal apparatus of a functional nature is growing.
The problem is not associated with anatomical changes and is usually temporary. The causes of functional pathology are endocrinological diseases, increased stress on the human psyche, neurotic reactions, vocal fatigue. The disease makes communication difficult, affects performance, and may pose a risk of professional unsuitability. With functional changes, patients note the appearance of hoarseness, a decrease in the sonority and melody of the voice, and its loss. When performing laryngoscopy in some patients, the doctor may not detect changes in the structure of the larynx, but it is possible to determine a violation of the mobility of the laryngeal muscles and folds.

Classification of functional disorders:

Hypotonic dysphonia is a decrease in muscle tone of the folds and is one of the most common functional disorders. The disorder is more common in females.
Hypertonic dysphonia is a disorder caused by increased muscle tone of the folds. More typical for men, especially those in leadership positions.
Phonasthenia is a change that occurs due to a lack of coordination between the breathing process and voice formation against the background of neurotic disorders.
Functional aphonia is a disease in which the patient does not have a sonorous voice, but is able to use whispered speech. Most often, this pathology appears as a result of psychotrauma, after emotional stress. Women are more susceptible to changes. Laughter and coughing with sound may persist (diagnostic sign).

Speech apparatus and defects

The degree of development of the speech apparatus determines the quality of pronunciation of sounds. Diseases of any of the departments are manifested by a deterioration in sound pronunciation and change the characteristics of a person’s voice. The task of speech therapists and doctors when identifying phoniatric symptoms is to identify the causes of their occurrence and select methods to eliminate the defects.

Due to the complexity of the structure of the speech apparatus, there are many possible causes of impaired sound pronunciation. Diagnostic measures should always be comprehensive and selected individually for each person. There are several reasons for the development of speech defects, which occur most often:

organic disturbances in the structure of individual structures;
their functional immaturity, which causes incorrect movements during the conversation;
neurological disorders in those parts of the central and peripheral nervous system that are involved in the formation and formation of sounds.

With these defects, a person often notices problems with breathing, swallowing food and liquids. Such symptoms gradually lead to a decrease in the level of quality of life and can cause impaired adaptation in society, depression and other negative consequences. If you have delayed speech development or other defects, you should always seek professional help from doctors or a speech therapist. Specialists will conduct the necessary examinations and select corrective measures to eliminate the organic or functional defect.

The human vocal apparatus has a complex structure and consists of three main parts: respiratory, vocal and articulatory, or sound-pronouncing. All structural departments act in concert, determining not only a person’s voice, but also the formation and pronunciation of all sounds and words. The regulation of the speech process is carried out by the central nervous system, namely the cerebral cortex, subcortical extrapyramidal systems and the nuclei of the cranial nerves. Knowledge of anatomy allows you to promptly identify changes in the speech organs, primarily located in the oral cavity.

Examination and diagnosis by a phoniatrist

The examination of the patient begins with an assessment of his condition, evaluation of complaints and voice characteristics.
The doctor must collect a history of the disease, allergic status, concomitant diseases, what medications the patient is taking, hormonal levels, and previous surgeries. Diagnostic methods:

indirect laryngoscopy – examination of the larynx using mirrors;
videofibrolaryngoscopy – examination of the larynx with a flexible endoscope through the nose, allows examination at any age (from 0 to 99+), in patients with a pronounced gag reflex;
video stroboscopy - examination with a device that allows you to obtain a multiply enlarged image of the larynx, examine hard-to-reach areas, evaluate the oscillatory movements of the vocal folds and make a video recording

The specialist can use additional instrumental diagnostic methods - X-ray, ultrasound, CT, MRI. To clarify the diagnosis, the specialist prescribes laboratory diagnostic methods - a swab from the throat, larynx for microflora and sensitivity to antibacterial drugs, a blood test.

After a complete examination, the doctor prescribes a therapeutic course. Therapy can be conservative or surgical. Conservative therapy includes medication, physiotherapy, and phonopedia. Surgery is prescribed for tumors in the larynx or vocal folds.

Benefits of treatment at GMS Hospital

At the GMS Hospital Surgery Center, operations for vocal fold tumors are performed by experienced otorhinolaryngologists with many years of practice. The main advantages of treatment in our center include:

the use of modern diagnostic equipment to detect neoplasms at an early stage;
use of advanced microsurgical techniques aimed at rapid recovery;
conducting histological analysis of the removed formation immediately after surgery;
successful treatment of complicated and advanced tumors;
medical support in the postoperative period, right up to recovery;
absence of surgical complications;
no need for hospitalization.

Surgical interventions are performed under the visual control of an endoscope, which ensures targeted removal of the tumor without damaging surrounding healthy tissue. You can make an appointment for a consultation with a GMS Hospital specialist around the clock - on the website or by phone.

How to save your voice?

The human voice is a delicate instrument that requires delicate handling.
Smoking, alcohol, telephone conversations, working in dusty rooms, loud speech - this is a list of factors that negatively affect the vocal apparatus. Prevention measures:

observe the vocal load regime. In case of overexertion, you need rest, complete silence (6-12 hours are necessary for recovery);
do not lie down immediately after eating to prevent reflux of the food bolus and entry through the esophagus into the larynx;
balanced diet. Elimination of carbonated drinks, spicy, too hot foods;
giving up alcohol and smoking;
rest, stress reduction;
breathe through your nose. This protects the respiratory tract from dust, viruses, and infections;
control the level of humidity in the room;
drink enough water per day.

Representatives of voice-speech professions are recommended to consult a phoniatrist at least once every six months.

What is sound and voice from a physics point of view?

Let's start with what sound and voice are from a physics point of view. Sound is a physical phenomenon that is the propagation of mechanical wave vibrations .

From a physics point of view, sound has three properties :

height;
force;
sound spectrum.

The height depends on the vibration frequency . Oscillations occur with a certain periodicity and are measured in hertz. Hertz is a unit of frequency for periodic processes in the International System of Units, as well as in the CGS and ICGSS units.

The strength of sound (aka volume) depends on the amplitude of vibrations . Greater amplitude means stronger sound. The unit of sound intensity is decibel (dB). For example: the rustling of leaves is about 10 dB, and a loud conversation is up to 90 dB.

The sound spectrum is a set of additional vibrations or overtones that arise along with the main frequency. This can be observed especially clearly in music or singing. Overtones increase the fundamental tone in multiple ratios (overtone: over, tone) and give the sound additional color, i.e. timbre.

Sounds with periodic (identical and evenly repeating) wave vibrations are called musical tones . Sound vibrations of non-periodic repetition are not musical tones. These are, for example, creaking, crackling and other sounds.

We will talk about the power of sound and sound spectra in the following lessons, but now let's return to the pitch of sound.

Types of sound by height:

Wave vibrations perceived by the human ear, i.e. in the range of 16-20,000 Hz (hertz).
Ultrasound is sound waves with frequencies higher than those perceived by the human ear, i.e. above 20,000 Hz.
Infrasound is sound vibrations having frequencies lower than those perceived by the human ear, i.e. below 16 Hz.

Thus, the higher the vibration frequency, the higher the sound . In the context of our course on voice development, we are interested in the audible range, i.e. 16-20,000 Hz. In the lower part of the range, the sound is subjectively perceived as dull and bassy, in the upper part - as thinner and sonorous. The entire audible range of sounds is distributed along the so-called note-octave scale (see Fig. 1a), built on the basis of a binary system.

The fact is that sounds whose frequencies differ by 2 times (2 times higher or lower) are perceived by ear as similar. This table is well known to musicians, but it is presented to everyone else to understand how great the capabilities of human hearing and, accordingly, the voice are. You don’t have to delve into the designations of notes and octaves for now. We will touch on this topic when we talk about the development of the singing voice.

So we come to what voice is and how it differs from sound. Sound is a broader concept. In the context of our course, sound is absolutely everything we can hear . This is the singing of birds, the rustling of grass, the splash of water, the roar of a motor, the hum of a printer, the clink of glasses and, of course, the human voice.

The voice is the result of the work of the vocal apparatus and sound production organs (we will talk about their structure from an anatomical point of view later). The capabilities of the voice are somewhat less than the capabilities of the human ear, in the sense that even record holders cannot cover the entire gamut of sounds with their voices in the range of 16-20,000 Hz. True, some of them may go beyond the audible range.

Record-breaking voices from the Guinness Book of Records:

The highest vocal note among men, “F sharp” of the 5th octave (5,989 Hz), was taken by Amirhossein Molai in Tehran (Iran) on July 31, 2021 [Guinness World Records, 2019].
The highest note among women, “G” of the 7th octave (25,087 Hz), was taken by Brazilian singer Georgia Brown in 2004. Technically this note is not musical. Georgia Brown also holds the world record for the widest vocal range among women. Its range extends from the “G” of the major octave (98 Hz) to the “G” of the 7th octave (total 8 octaves) [Guinness World Records, 2004].
The lowest vocal note among a woman was 57.9 Hz, which is slightly higher than the A note of the counteroctave. It was taken by Maryana Pavlova (UK) in Wallington, Greater London, UK, June 3, 2021 [Guinness World Records, 2019].
The lowest vocal note produced by a man is G-7 (0.189 Hz), achieved by singer and songwriter Tim Storms (USA) at Citywalk Studios in Branson, Missouri, USA, on March 30, 2012. The frequency output of Timothy's voice was measured using Bruel & Kjaer equipment (low-frequency microphone, precision audio analyzer and post-analysis laptop) [Guinness World Records, 2012].

By the way, in music it is customary to use not the entire audible range. You can easily verify this by looking at the piano keys. All 88 keys (36 black and 52 white) cover the range from subcontractive A (27.5 Hz) to 5th octave C (4,186 Hz). This is completely sufficient to reproduce any piece of music that is comfortable for the human ear and the way we hear sounds.

You can check the capabilities of your own voice by downloading Pano Tuner and allowing the application access to the microphone. Try to play the highest and lowest note currently available to you, but do not do more than three attempts in a row, because this can lead to overstrain of the vocal apparatus. Record the result and repeat the experience after completing our course. If you have never trained your voice or worked on expanding your range before, you may be able to do so now that you have studied the anatomy of the voice and techniques that help with sound production.

There are options available online without first downloading apps. For example, the Vocal Max service. To start, click on the “Start” button, select the note that is most convenient for you to start with, and play it. As soon as you hit it, it will change color, and the next step will only be possible on any of the adjacent notes, both up and down. If you are not yet familiar with notes, try playing the note “C” of the 1st octave - it is in the range of almost every person. After studying the previous illustration, you can easily find it yourself.

As you play each of the subsequent notes, they will also change color. When you exhaust your range, click “Finish” and save the result, say, as a screenshot. Most likely, after 1-2 months of training, your range will become wider.

And finally, the speech. Speech is a joint result of the work of the vocal apparatus and thinking . If in order to make simple sounds (screaming, crying, moaning and others), we only need to use the vocal apparatus, for speech we need a preliminary understanding of what you want to say. For speech, a smaller vocal range is used than for various types of sounds - screaming, crying, moaning and others.

There is a distinction between internal and external speech, but in the context of our course we are interested, first of all, in the development of external speech, where the organs of sound production are involved. At the same time, beautiful external speech is impossible without the development of internal speech, i.e. planning and control “in the mind” of speech actions, internal pronunciation of planned phrases.

By the way, in our course you will learn that sound production can also be planned! “In your mind” you can rehearse not only the text of the future message, but also its emotional intensity, volume, and pitch. A meaningful approach to sound production, knowledge of the anatomy of the voice and an understanding of how certain movements and positions of the sound production organs affect your voice and your speech will help with this.

Prevention

Prevention of tumor processes of the speech apparatus consists primarily of timely treatment of infectious and inflammatory diseases of the larynx and giving up bad habits. It is necessary to observe the voice mode - avoid high speech loads. In hazardous industries, it is imperative to use protective equipment to prevent inhalation of irritating agents (hot or caustic fumes, polluted air). At the first alarming symptoms, contact an otolaryngologist. You can make an appointment with GMS Hospital specialists online or by phone.