by GalWave

Created on: February 04, 2007   Last Updated: April 18, 2007

This letter will try to put some light upon
Voice disorders that come from respiratory distress:

An organic malfunction inside the lungs, like emphysema, bronchial asthma or cardiovascular disease will reduce the lungs capacity and thus will have a reducing effect on the exhalation volume.
Vocal pseudo asthenia is yet another organic vocal disorder that will appear in hyperthyroidism. Outside of the lungs, there may be other organic disorders that will take place inside the vocal tract, like enlargement of the Thyroid gland, which will have the same effect of respiration distress.

At the glottis (the vocal-folds layout) itself, any edema, paresis or palsy can disturb the inhalation-exhalation process in two main ways:
A. When one vocal cord is paralyzed in the abduction (open) position the glottis is unable to close for phonation (voice production) and we will hear hoarseness because most of the air will run out before it can be used for voice production. A possible solution will be pushing-physiotherapy from a certified speech pathologist.
B. When there is a bi-fold paralysis in the Median position (in the middle) the vocal cords are in constant position of good voice production while the voice is very good the inhalation process is very disturbed and Hypoxia ( chronic Oxygen insufficiency) is inevitable , leading the heart to work much harder in order to supply oxygen and causing expected heart disease. Also, any infection upon the vocal cords will cause an emergency situation of possible suffocation. The preferred solution will be surgery by an ENT.

Above the level of the glottis, any respiration problem will be causing an articulation disorder and not a voice disorder.
To add more, upon these peripheral disorders, there are CNS disorders like cerebral palsy or extra pyramidal diseases like PD (Parkinson's disease). More frequently we will see functional disorders in the coordination of respiration, since the respiratory centers are under influence from higher brain centers like the thalamus or the cortex. For instance, any emotional disturbance or physical excitement will be impacting our respiration.
""The voice is the mirror of our soul":
Most psychogenic voice disorders (not from an organic source) will then impact the respiration method for speech only. Let me concentrate in two examples of that:
A. Psychoneurotic disorder: The vocal cords do not open well so in silent respiration we will hear a squeaking sound. In phonation, the voice will be hoarse due to insufficient closing. In fact, the patient is doing the opposite of the normal respiratory pattern; he is narrowing the glottis for inhalation and opens it for phonation (talking).
B. Stuttering: The patient has a tendency towards the opposite respiratory pattern as well, He will use the inhalatory air for phonation, while the speech onset will be so much delayed as most of the expiatory air is out before the actual phonation start. Stuttering in essence is a failure to coordinate the onset of articulation with the exhalation for speech production.

In short, a good rule of thumb might be: While an organic disorder of the respiratory system will affect both silent respiration as well as respiration in phonation just the same While a psychogenic disorder will leave the silent respiration unaffected while disturbing only the respiratory pattern for speech production.

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