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NOTICE TO THE READER

Care has been taken to confirm the accuracy of the indications, procedures, drug dosages, and diagnosis and remediation protocols presented in this book and to ensure that they conform to the practices of the general medical and health services communities. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. The diagnostic and remediation protocols and the medications described do not necessarily have specific approval by the Food and Drug administration for use in the disorders and/or diseases and dosages for which they are recommended. Application of this information in a particular situation remains the professional responsibility of the practitioner. Because standards of practice and usage change, it is the responsibility of the practitioner to keep abreast of revised recommendations, dosages and procedures.

Library of Congress Cataloging-in-Publication Data

Names: Zraick, Richard I., 1962- author. | Von Berg, Shelley L., author. | Boone, Daniel R. Voice and voice therapy. Title: The voice and voice therapy / Richard I. Zraick, Shelley L. Von Berg. Description: Eleventh edition. | San Diego, CA: Plural Publishing, Inc., [2026] | Preceded by The voice and voice therapy / Daniel R. Boone, Stephen C. McFarlane, Shelley L. Von Berg, Richard I. Zraick. Tenth edition. [2020]. | Includes bibliographical references and index. Identifiers: LCCN 2024024557 (print) | LCCN 2024024558 (ebook) | ISBN 9781635507621 (hardcover) | ISBN 1635507626 (hardcover) | ISBN 9781635504903 (ebook) Subjects: MESH: Voice Disorders — diagnosis | Voice Disorders — etiology | Voice Disorders — therapy | Speech, Alaryngeal Classification: LCC RF510 (print) | LCC RF510 (ebook) | NLM WV 500 | DDC

616.85/56 — dc23/eng/20240625 LC record available at https://lccn.loc.gov/2024024557 LC ebook record available at https://lccn.loc.gov/2024024558

Preface ix Prologue xiii Acknowledgments xv About the Authors xvii About the Contributors xix List of Videos xxiii

Chapter 1.

The Biological Function of the Larynx 3 The Emotional Function of the Larynx 4 The Linguistic Function of the Voice 5 Prevalence of Voice Disorders in the General Population 6 Prevalence of Voice Disorders in Specific Populations 8 Management and Therapy for Voice Disorders 14 Summary 18

Chapter 2.

Normal Aspects of Voice 22 Normal Processes of Voice Production 22 The Respiratory System 23 Structures of Respiration 23 Control of Breathing 31 The Respiratory Cycle (Inhalation and Exhalation) 31 Respiratory Volumes and Capacities 36 The Effects of Aging on the Respiratory System 37 Breathing for Life Versus Breathing for Speech 38 The Phonatory System 39 Anatomy of Phonation 39 Voice Production 59 Resonance 66 Structures of Resonance 69 Mechanism of Resonance 70 Summary 72

An Introduction to Voice Disorders and Their Management 1

Normal Voice: Anatomy and Physiology Throughout the Lifespan 21

vi The Voice and Voice Therapy

Chapter 3. Functional Voice Disorders 75

Excessive Muscle Tension Disorders 76 Benign Pathologies Resulting From Excessive Muscle Tension Disorders 81 Voice Characteristics With Excessive Muscle Tension Disorders 87 Psychogenic Voice Disorders 90 Summary 96

Chapter 4.

Congenital Abnormalities 100 Acid Reflux Disease 102 Vocal Fold Granulomas 103 Vocal Fold Cysts 105 The Endocrine System and Voice 106 Laryngeal Hemangioma 108 Leukoplakia and Hyperkeratosis 109 Laryngitis 110 Recurrent Respiratory Papillomatosis 111 Summary 115

Chapter 5.

A Working View of the Nervous System 120 The Central Nervous System, the Cortex, and Its Projections 120 Neurotransmitters 123 The Brainstem and the Cerebellum 124 The Peripheral Nervous System 125 Conditions Leading to Neurogenic Dysphonia 128 Vocal Fold Paralysis 130 Spasmodic Dysphonia 135 Essential Voice Tremor 141 Differences Between Spasmodic Dysphonia, Essential Voice Tremor, and Muscle 143

Parkinson’s Disease 143 Cerebrovascular Accident 146 Traumatic Brain Injury 147 Summary 147

Organic Voice Disorders 99

Neurogenic Voice Disorders 119

Tension Dysphonia

Chapter 6.

Screening for Voice Disorders 152 Medical Evaluation of the Person With a Voice Disorder 154 Review of Auditory and Visual Status 158 Case History 160 Behavioral Observation 162 Auditory-Perceptual Ratings 163 The Oral-Peripheral Mechanism Examination 170 Visualization of the Larynx and Related Structures 171

Evaluation of the Voice 151

Contents vii

The Clinical Voice Laboratory 174 Acoustic Analysis of the Voice 175 Analysis of Voice Dosage 195 Case Studies 197 Summary 207

Chapter 7.

Patient Compliance and Emerging Technologies in Voice Intervention 212 Voice Facilitating Approaches 214 Summary 275

Chapter 8.

Voice Therapy for Specific Populations 278 Voice Therapy for Respiratory-Based Voice Problems 297 Summary 304

Chapter 9.

Types of Head and Neck Cancer 310 Risk Factors and Demographic Facts in Head and Neck Cancer 311 Modes of Cancer Treatment 313 Laryngeal Cancer Case Examples 314 Voice Facilitating Approaches 317 Vocal Hygiene 318 Laryngectomy 318 Tumor Staging 321 Surgical Advances and Organ Preservation Protocols 324 Preoperative Counseling 324 Postlaryngectomy Communication Options 325 The Artificial Larynx 326 Esophageal Speech 327 Tracheoesophageal Puncture 331 Overview of the Pharyngoesophageal Segment 336 Summary 336

Voice Facilitating Approaches 211

Therapy for Specific Patient Populations 277

Management and Therapy Following Laryngeal Cancer 309

Chapter 10.

Disorders of Nasal Resonance 342 Comprehensive Assessment of Nasal Resonance Disorders 343 Laboratory Instrumentation 349 Treatment of Nasal Resonance Disorders 354 Therapy for Oral-Pharyngeal Resonance Problems 364 Summary 368

References 371 Index 443 Laryngeal Image Gallery

Resonance Disorders 341

PREFACE

Updates in This Edition

rom the first publication of The Voice and Voice Therapy in 1971, the authors have attempted to maintain the book’s relevance to students and voice clinicians alike. Each

that supports the behavioral approaches to voice assessment and intervention that are core to the text. In this 11th edition, videos demonstrating voice assessment and voice facilitation approaches appear liberally throughout the chapters. These videos show the authors performing each voice facilitation approach with real clients, demonstrating in real time how each technique improves or normalizes voice. Clinically relevant sidebars guide the reader through a series of thoughtprovoking exercises, illustrating the principles of voice anatomy and mechanics. The 11th edition also features hundreds of self-check quizzes that map onto the chapters’ learning outcomes. Each quiz is followed by feedback for all correct and incorrect answers. These pedagogical enhancements, along with the end-of-chapter Praxis questions, support the book’s use in the classroom and clinic. The culmination of these elements ensures that students and their instructors, or clinicians and their colleagues, have the most current resources they need for voice and voice-related disorders in a single package. Some chapter-by-chapter highlights include the following:

edition has incorporated the most current scientific evidence from a variety of disciplines

●

Chapter 1, “An Introduction to Voice Disorders and Their Management,” features new

data on the incidence and prevalence of voice disorders in the general population and in specific populations, such as children, teachers, and those who use teleconferencing. There are expanded discussions of the classification of voice disorders, approaches to assessment and stimulability probes, and managing the person with dysphonia.

●

Chapter 2, “Normal Voice: Anatomy and Physiology Throughout the Lifespan,”

has been expanded considerably. It features a more comprehensive description of the anatomy and physiology of normal voice production. The detailed, colored anatomical illustrations and accompanying captions make it easy for the reader to “put it all together.” This chapter can stand alone, thus eliminating the need for students, instructors, or clinicians to refer to outside source material.

●

Chapter 3, “Functional Voice Disorders,” presents practical approaches to identifying

and managing behaviorally based voice disorders across the age spectrum. The chapter includes expanded discussions of excessive laryngeal muscle tension and the benign laryngeal pathology that may develop as a result, as well as voice disorders with a psycho-emotional basis or overlay. Special attention is given to the emotional and/or behavioral issues that might result in children with functional voice disorders. Several perceptual measures of voice administered to adults with dysphonia are also explored.

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CONTENTS

PREFACE