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Full text of "Diseases Of The Nose Throat And Ear"

VOICE PROBLEMS                                   155

state that most professional singers sing better than amateurs. The difference
is defined as quality. To a large extent good singers are born rather than made.
With practice, the vertical depth over which the cords meet, i.e. the medial
apposing surfaces of the cords, can be increased in size; this involves hyper-
trophy of the vocalis and thyro-arytenoid muscles. The most important factor
in quality is the relationship of the size of the resonating chambers—the lungs,
pharynx and upper respiratory tract—to the fundamental frequency of the
note produced. It is this relationship that cannot be created by practice, and
one has to be born with it.

VOICE STRAIN

This is a very common problem and will, of course, be noticed much earlier
by, and cause most inconvenience to, professional voice users.

As stated in the previous chapter, the optimum pitch of the voice is one-
third of the way up the person's own range. At this pitch, optimum cordal
length and tension can be maintained, as can a proper breathing pattern. If
any of these factors of pitch, length, tension or breathing is altered, then some
strain will be placed on the thyro-arytenoid and interarytenoid muscles. The
degree of voice strain will depend upon the length of time the person has
practised wrong voice usage, and for how many hours each day. The type of
person who is liable to get voice strain is an actor who has to project his voice
abnormally loudly in poor acoustics, a preacher or a teacher who speaks too
loud and at too high a pitch, a pop singer or someone with an elderly deaf
relative who needs constantly to be shouted at. Another very common cause of
voice strain is to overuse the voice during an acute laryngitis. During an
inflammatory process in the larynx some round-cell infiltration occurs in the
thyro-arytenoid muscle, when a myositis may be said to exist. If the voice is
over used in this circumstance it will become easily tired, and permanent
damage can occur to the muscle. A singer or actor therefore must cancel all
performances if they have acute laryngitis.

APPEARANCES. The larynx has a very typical appearance in this condition.
Basically, it is difficult for the glottis to maintain closure, and some part of it
remains open. If the thyro-arytenoid muscle is most affected there will be
closure of the arytenoids and posterior glottis but not of the cords—this
results in an appearance of bowing (Fig. 73). If the interarytenoid muscle is
most affected there will be closure of the cords but not of the posterior glottis,
leaving a triangular gap posteriorly (Fig. 74). If both muscles are affected the *
larynx will have a keyhole appearance.

MANAGEMENT. The voice will be good in the mornings or after prolonged
rest but will become 'breathy' as the muscles become fatigued with use. The
best treatment therefore is voice rest for 1-2 weeks—and this must be total.
The patient is instructed to use a pad and pencil to write down communica-
tions—whispering is not voice rest. After this time advice should be sought
from a speech therapist to correct the causative factor be it faulty breathing or
faulty pitching of the voice.

VOCAL NODULES

These are also called singer's nodes or screamer's nodes and, from this, some
idea may be obtained of the aetiology. It is fashionable now for pop groups to