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

156           THE LARYNX, BRONCHI AND OESOPHAGUS

use falsetto voices on occasion. This is a trick whereby the voice is produced
by vibrating the anterior part of the vocal cords thus causing a tremendous
'shortening' effect combined with an increased cordal tension. The same is true
of yodelling. This is the extreme situation, but it occurs in miniature when a
natural baritone tries to sing tenor parts, and a natural contralto sings
soprano. It happens, too, with anyone who pitches the voice far too high.
Maximum vibration occurs in the anterior larynx and at the posterior part of

Fig. 73. Bowing of vocal cords        Fig. 74. Triangular gap from           Fig. 75. Singer's nodules,

due to thyro-arytenoid muscle        weakness    of    interarytenoid
weakness.                                      muscle.

this maximally vibrating portion, fibrosis and traumatic scarring occurs on
both cords.

Thus, typical nodules are bilateral, small, and greyish-white and are
situated at the junction of the anterior third and posterior two-thirds of the
glottis (Fig. 75). This point is half way along the membranous vocal cord
because the vocal process forms the posterior third of the cord. The patient
becomes hoarse, and the nodules require to be removed at direct laryngoscopy
using microsurgical techniques. If they are very small speech therapy can
sometimes improve the situation. In all cases, after surgery, the advice of a
speech therapist should be obtained to correct the causative factor in voice
production.

DYSPHONIA PLICAE VENTRICULARIS

As the term implies, this is phonation with the false cords instead of the true
cords. It can occur in extreme vocal cord strain, after operations on the vocal
cords^or for no apparent reason. The voice has a peculiar sound, almost like a
duet, and is therefore called diplophonia. In some instances the patient's
breathing pattern may be improved by the speech therapists with a consequent
improvement in the voice. Generally, however, the results of speech therapy in
this condition are not good.

FUNCTIONAL VOICE PROBLEMS

Aphonia is dealt with in the chapter on vocal cord paralysis (p. 189).

Phonic spasm is a condition met with in adults who use their voice profes-
sionally. The cords act quite normally during respiration, but when the
patient attempts to speak they become firmly pressed together after a few