Voice disorders are medical conditions involving abnormal pitch, loudness or quality of the sound produced by the larynx and thereby affecting speech production. These include:

1. Puberphonia

2. Chorditis

3. Vocal fold nodules

4. Vocal fold cysts

5. Vocal cord paresis

6. Reinke's edema

7. Spasmodic dysphonia

8. Bogart–Bacall syndrome

9. Laryngeal papillomatosis

10. Aphasia

11. Parkinson's Disease

12. Speech disorder

13. Vocology

1. Puberphonia

Introduction

Typically, adolescent males undergo voice changes to a much lower pitch due to a sudden increase in the length and thickness of the vocal folds. Often this size change is noticed as the sudden enlargement of the larynx (aka "Adam's Apple" when viewed as a protrusion at the anterior of the neck). This is uncommon in females because their vocal folds do not show a sudden increase in size.

Definition

Puberphonia is the functional, habitual use of high-pitched voice post puberty after the vocal folds have reached typical adult size. The muscles directly alongside the larynx become too tight, which causes the patient to constantly speak in falsetto. The condition does not go away on its own, and requires physical therapy to correct. This condition is seen in males more often than in women. Puberphonia is also more noticeable in men than women because men are expected to speak much lower than women, and less noticeable in women because women typically speak much higher than men.

Epidemiology

The incidence of puberphonia in India is estimated to be about 1 in 900,000 population

Causes

· Emotional stress

· Delayed development of secondary sexual characteristics

· Psychogenic

· Skipped fusion of thyroid laminae

Treatment

Voice therapy

This condition is best treated by voice therapy (vocal exercises) by speech-language pathologists (SLPs) /speech therapists having experiences in treating voice disordersbecause puberphonia is not a very common problem. The duration of treatment can usually be one to two weeks.^[3]

It includes:-

· Cough

· Speech range masking

· Glottal attack before a vowel

· Relaxation techniques to relax the laryngeal musculature

· Visi pitch

· Lowering of larynx to appropriate position

· Humming while sliding down the scale

· Half swallow Boom technique

Larynx manipulation

Surgery

Type III phonosurgery can be done, which includes surgical shortening and relaxation of the vocal cords.

2. Chorditis

Chorditis is the inflammation of vocal cords (vocal folds) usually as a result of voice abuse but sometimes because of cancer.

Types:-

· Chorditis fibrinosa

· Chorditis nodosa

· Chorditis tuberosa

3. Vocal fold nodule

Vocal fold nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the vocal nodules via laryngeal endoscopy remains the primary diagnostic method. Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the mass of the vocal folds and changing the configuration of the vocal fold closure pattern. Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse. In children, they are more common in males; in adulthood, they are more common in females.

symptoms

Ø Perceptual signs and symptoms

One of the major perceptual signs of vocal fold nodules is a change in the quality of the voice. The voice may be perceived as hoarse, due to aperiodic vibrations of the vocal folds, and may also be perceived as breathy, due to an incomplete closure of the vocal folds upon phonation.

Ø Acoustic signs

Major acoustic signs of vocal fold nodules involve changes in the frequency and the intensity of the voice. The fundamental frequency, an acoustic measure of voice pitch, may be normal.

Ø Aerodynamic signs

If the nodules affect the closure of the vocal folds, airflow levels during speech may be increased in comparison to the speaker’s habitual levels. However, airflow levels may still fall within the upper limits of the normal range.

Epidemiology

Research on the epidemiology of vocal fold nodules in children has suggested that nodules are more common in boys (2:1), in particular boys who are active and scream more frequently.

signs

Nodules cause similar symptoms:

hoarseness
breathiness
a "rough" voice
a "scratchy" voice
harshness
shooting pain from ear to ear
a "lump in the throat" sensation
neck pain
decreased pitch range
voice and body fatigue

causes

Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by long-term vocal abuse but may also occur after a single, traumatic event to the vocal cords, such as yelling at a concert. Long-term cigarette smoking, hypothyroidism, and GERD may also cause polyp formation. Vocal abuse takes many forms and includes:

allergies
smoking
tense muscles
singing
coaching
cheerleading
talking loudly
drinking caffeine and alcohol (dries out the throat and vocal cords)

It has been noted that, for unknown reasons, vocal nodules occur more frequently in women between the ages of 20 and 50.

4.Vocal-fold cyst

Vocal fold cysts are benign masses of the membranous vocal folds. These cysts are enclosed, sac-like structures that are typically of a yellow or white colour. They usually form unilaterally on the midpoint of the medial edge of the vocal folds.

There are two types of vocal fold cysts that differ in terms of location:

1. Sub-epithelial vocal fold cysts which are located in the superficial lamina propria of the vocal folds.

2. Ligament vocal fold cysts which are located within the deeper layers of the lamina propria or on the vocal ligament

Causes

There are several causes of vocal fold cysts:

1. They can be congenital.

2. They can result from the blockage of a mucous gland's excretory duct. In this case, they are sometimes referred to as retention cysts.

3. They can be the result of phonotrauma. Phonotrauma refers to behaviours that can lead to vocal fold injuries, such as vocal overuse (i.e. too much speaking), vocal misuse (i.e. speaking in an unnaturally high or low pitch), or vocal abuse (i.e. yelling or whispering for prolonged periods)

Signs and Symptoms

Both sub-epithelial vocal fold cysts and ligament vocal fold cysts involve similar symptoms.^] The presence and the severity of symptoms may be influenced by the location and size of the cyst. Common symptoms include:

· Hoarse voice

· Inability to produce high pitch notes

· Fatigue when speaking

· Limited pitch range

· Pain near the larynx

· Variations in pitch when speaking

Prevention

A key aspect of preventing vocal fold cysts is good vocal hygiene. Good vocal hygiene promotes the healthy use of the vocal apparatus and the avoidance of phonotrauma. Good vocal hygiene practices involve the avoidance of:

· Shouting

· Whispering loudly or for long periods of time

· Large quantities of talking over loud background noise

· Talking while yawning

· Continual clearing of the throat

· Speaking in an unnatural voice (i.e. too high or low)

· Talking with a cold or laryngitis

· Smoking tobacco or marijuana

· The consumption of alcohol and coffee

· The use of antihistamines, aspirin, steroids, tricyclic antidepressants, or any substance that alters perception (i.e. sleeping pills)

· Foul air

Vocal fold paresis

Recurrent laryngeal nerve paralysis (also called vocal fold paralysis or paresis) is the medical term describing an injury to one or both recurrent laryngeal nerves (RLNs), which control all muscles of the larynx except for the cricothyroid muscle. The RLN is important for vocalization, breathing and swallowing. The primary larynx-related functions of the mainly efferent nerve fiber RLN, include the transmission of nerve signals to the muscles responsible for regulation of the vocal folds' position and tension to enable vocalization, as well as the transmission of sensory nerve signals from the mucous membrane of the larynx to the brain.

Symptoms

Symptoms of vocal fold paresis from RLN damage include:

Symptoms of vocal fold paresis from SLN damage include:

· Rough voice quality

· Breathy voice quality

· Vocal fold bowing

· Decreased vocal fold mobility

· Glottal insufficiency

· Hyperfunction

· Vocal fatigue

· Reduced vocal stamina

· Changes in voice pitch or pitch range

· Difficulty varying pitch at a quick rate

· Difficulty projecting voice or speaking loudly or in noisy environments

· Throat pain

· Bouts of choking

· Diplophonia

· Swallowing difficultie

· Chronic coughing

· Globus sensation

· Hypersensitivity or abnormal sensation

· Vocal fold spasms

· Pain from vocal use

· Loss of voice in high pitch ranges^[

Causes

There are a wide variety of possible causes of vocal fold (VF) paresis, including congenital (i.e. present at birth) causes, infectious causes, malignancies and tumors, traumatic causes, endocrinologic diseases, and systemic neurologic diseases.

Ø Congenital causes

Conditions present at birth that can cause VF paresis include hydrocephalus, Arnold-Chiari malformation, tracheoesophageal fistula, vascular anomalies (e.g., vascular ring), dysmorphic syndromes (e.g. Mobius, Goldenhaar), syndromes affecting brainstem function, and neuromuscular disorders such as Charcot-Marie-Tooth.

Ø Infectious causes

Many viral infections have been reported as a cause for VF paresis, including herpes simplex virus, Epstein-Barr virus, Varicella-Zoster, cytomegalovirus, HIV, West Nile virus, and upper respiratory infection. Bacterial infections have also been reported to cause VF paresis, such as syphilis and Lyme disease.

Ø Traumatic causes

VF paresis can result from trauma to one of more laryngeal nerves during intubation, surgery (e.g. thyroidectomy, spine surgery, carotid endartectomy, vagal nerve stimulator implantation), injection of botulinum neurotoxin, or penetrating neck trauma.

Ø Endocrinologic (thyroid) diseases

Causes of VF paresis also include diseases of the thyroid gland, such as hypothyroidism, goiter, and thyroiditis.

Ø Systemic neurologic diseases

Examples of systemic neurologic diseases that may cause VF paresis include myasthenia gravis, Charcot-Marie-Tooth, multiple sclerosis, and spinocerebellar atrophy. Systemic rheumatological diseases (e.g. sarcoidosis, rheumatoid, scleroderma) have also been reported as causes for VF paresis

5. Spasmodic dysphonia

Spasmodic dysphonia, also known as laryngeal dystonia, is a disorder in which the muscles that generate a persons voice go into periods of spasm. This results in breaks or interruptions in the voice, often every few sentences, which can make a person difficult to understand^] The person's voice may also sound strained or they may be nearly unable to speak. The disorder affects an estimated 2 per 100,000 people.Women are more commonly affected. Onset is typically between the ages of 30 and 50. Severity is variable between people.

Types

The three types of spasmodic dysphonia (SD) are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

Ø Adductor spasmodic dysphonia

In adductor spasmodic dysphonia (ADSD), sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or are difficult to start because of the muscle spasms.

Ø Abductor spasmodic dysphonia

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open.^[4] The vocal folds cannot vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery.

Ø Mixed spasmodic dysphonia

Mixed spasmodic dysphonia involves both muscles that open the vocal folds and those that close them and therefore has features of both adductor and abductor spasmodic dysphonia.

6. Reinke's edema

Reinke's edema is an enlargement of the upper layer of covering of the vocal fold (called Reinke's space, after the man who first described this layer). The most common cause of Reinke's edema is smoking. In fact, the condition is almost never seen in nonsmokers. The typical enlargement is caused by an accumulation of gelatinous fluid. Sometimes, Reinke's edema is mistakenly identified as 'swollen' vocal folds. The old term for these lesions is "polyp", but now we know that Reinke's edema (also called polypoid corditis, just to confuse you) and vocal fold polyps are not the same.

Mechanism

The vocal cords consist of five layers of cells:

· Squamous epithelium

· Superficial lamina propria (Reinke's space)

· Intermediate lamina propria

· Deep lamina propria

· Vocalis muscle

Symptoms

List of common symptoms:

· "sac-like" appearance of the vocal folds

· Hoarseness and deepening of the voice

· Trouble speaking (Dysphonia)^[

· Reduced vocal range with diminished upper limits

· Stretching of the mucosa (Distension)

· Shortness of breath

Causes & prevention

Smoking is the number one cause of Reinke's edema. Other factors include gastroesophageal reflux, hypothyroidism and chronic overuse of the voice. Smoking is the only risk factor that may lead to cancer. Additionally, the combination of several risk factors increase the likelihood of an individual developing Reinke's edema. For example, an individual who smokes and also has gastric reflux would have an increased susceptibility for developing Reinke's edema over time. Reinke's edema is commonly diagnosed in middle-aged females with a history of smoking (aged 50 years or older). Because males have lower pitched voices than females, males are less likely to observe a significant changes in the voice, and are therefore less likely to seek treatment. Females also report more physical discomfort due to Reinke's edema. The risk of Reinke's edema increases with age and also with prolonged exposure to smoking. Additionally, individuals in professions that require constant use of the voice, such as singers, teachers, and radio hosts, may be at an increased risk for developing the disease.

7. Laryngitis

Laryngitis is inflammation of the larynx (voice box).^[1] Symptoms often include a hoarse voice and may include fever, cough, pain in the front of the neck, and trouble swallowing. Typically, these last under two weeks.

Laryngitis is categorised as acute if it lasts less than three weeks and chronic if symptoms last more than three weeks. Acute cases usually occur as part of a viral upper respiratory tract infection. Other infections and trauma such as from coughing are other causes. Chronic cases may occur due to smoking, tuberculosis, allergies, acid reflux, rheumatoid arthritis, or sarcoidosis. The underlying mechanism involves irritation of the vocal cords.

Signs and symptoms

The primary symptom of laryngitis is a hoarse voice.^[7]^:108 Because laryngitis can have various causes, other signs and symptoms may vary.^[8] They can include

· Dry or sore throat

· Coughing (both a causal factor and a symptom of laryngitis)

· Frequent throat clearing

· Increased saliva production

· Dysphagia (difficulty swallowing)

· Sensation of swelling in the area of the larynx (discomfort in the front of the neck)

· Globus pharyngeus (feeling like there is a lump in the throat)

· Cold or flu-like symptoms (which, like a cough, may also be a causal factor for laryngitis)

· Swollen lymph nodes in the throat, chest, or face

· Fever

· General muscle pain (myalgia)

· Shortness of breath, predominantly in children

Causes

Laryngitis can be infectious as well as noninfectious in origin. The resulting inflammation of the vocal folds results in a distortion of the sound produced there.^[1] It normally develops in response to either an infection, trauma to the vocal folds, or allergies.^[3] Chronic laryngitis may also be caused by more severe problems, such as nerve damage, sores, polyps, or hard and thick lumps (nodules) on the vocal cords.

Acute

Ø Viral

Ø Most acute cases of laryngitis are caused by viral infections,^[1] the most common of which tend to be rhinovirus, influenza virus, parainfluenza virus, adenovirus, coronavirus, and RSV. In patients who have a compromised immune system, other viruses such as herpes, HIV and coxsackievirus may also be potential causes.

Ø Bacterial

· This is another major cause of acute laryngitis, and may develop in conjunction with or due to a viral infection. Common bacterial strains are; group A streptococcus, Streptococcus pneumoniae, C. diphtheriae, M. catarrhalis, Haemophilus influenzae, Bordetella pertussis, Bacillus anthracis, and M. tuberculosis. In developing countries, more unusual bacterial causes may occur such as mycobacterial and syphilitic, though these may occur in developed nations as well.

Ø Fungal

· Laryngitis caused by fungal infection is common but not frequently diagnosed according to a review by BMJ and can account for up to 10% of acute laryngitis cases.^[1]Patients with both functioning and impaired immune systems can develop fungal laryngitis, which may develop as a result of recent antibiotic or inhaled corticosteroids use. Certain strains of fungi that may cause laryngitis include; Histoplasma, Blastomyces, Candida (especially in immunocompromised persons), and Cryptococcus and Coccidioides.

Ø Trauma

· Often due to excessive use of the vocal folds such as excessive yelling, screaming, singing. Though this often results in damage to the outer layers of the vocal folds, the subsequent healing may lead to changes in the physiology of the folds.^] Another potential cause of inflammation may be overuse of the vocal cords. Laryngeal trauma, including iatrogenic (caused by endotracheal intubation), can also result in inflammation of the vocal cords.

Chronic

Ø Allergies

Ø Findings are unclear as to whether asthma may cause symptoms commonly associated with laryngitis.^] Some researchers have posited that allergic causes of laryngitis are often misdiagnosed as being the result of acid reflux.

Ø Reflux

· One possible explanation of chronic laryngitis is that inflammation is caused by gastro-oesophageal reflux which causes subsequent irritation of the vocal folds.

Ø Autoimmune disorders

Approximately between 30-75% of persons with rheumatoid arthritis report symptoms of laryngitis.

· Symptoms of laryngitis are present in only 0.5-5% of people that have sarcoidosis. According to a meta-analysis by Silva et al. (2007), this disease is often an uncommon cause of laryngeal symptoms and is frequently misdiagnosed as another voice disorder.

8. Bogart–Bacall syndrome

Bogart–Bacall syndrome (BBS) is a voice disorder that is caused by abuse or overuse of the vocal cords.

People who speak or sing outside their normal vocal range can develop BBS; symptoms are chiefly an unnaturally deep or rough voice, or dysphonia, and vocal fatigue. The people most commonly afflicted are those who speak in a low-pitched voice, particularly if they have poor breath and vocal control. The syndrome can affect both men and women.

In 1988 an article was published, describing a discrete type of vocal dysfunction which results in men sounding like Humphrey Bogart and women sounding like Lauren Bacall. BBS is now the medical term for an ongoing hoarseness that often afflicts actors, singers or TV/radio voice workers who routinely speak in a very low pitch.

Treatment usually involves voice therapy by a speech language pathologist.

9. Laryngeal papillomatosis

Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis or glottal papillomatosis or associated with condyloma acuminata, is a rare medical condition (2 per 100,000 adults and 4.5 per 100,000 children),^[1]^:411 caused by a human papillomavirus (HPV) infection of the throat.^[2]^:411 Laryngeal papillomatosis causes assorted tumors or papillomas to develop over a period of time. Without treatment it is potentially fatal as uncontrolled growths could obstruct the airway.

Signs and symptoms

Ø Adults

In adults, the symptoms of laryngeal papillomatosis are hoarseness, or a strained or breathy voice. Size and placement of the tumors dictate the change in the person's voice. Breathing difficulties may occur but more commonly are found in children.^[4]

Ø Children

In babies and small children, the signs and symptoms include a weak cry, trouble swallowing, noisy breathing, and chronic cough. Noisy breathing may be a stridor, which can sound like a whistle or a snore, and is a sign that the laryngeal or tracheal parts of the airway are narrowing

10. Aphasia

Aphasia is an inability to comprehend and formulate language because of damage to specific brain regions. This damage is typically caused by a cerebral vascular accident (stroke), or head trauma, however these are not the only possible causes. To be diagnosed with aphasia, a person's speech or language must be significantly impaired in one (or several) of the four communication modalities following acquired brain injury or have significant decline over a short time period (progressive aphasia). The four communication modalities are auditory comprehension, verbal expression, reading and writing, and functional communication.

Signs and symptoms

People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia. Aphasia symptoms can vary based on the location of damage in the brain. Signs and symptoms may or may not be present in individuals with aphasia and may vary in severity and level of disruption to communication.^[5] Often those with aphasia will try to hide their inability to name objects by using words like thing. So when asked to name a pencil they may say it is a thing used to write.^[6]

· Inability to comprehend language

· Inability to pronounce, not due to muscle paralysis or weakness

· Inability to speak spontaneously

· Inability to form words

· Inability to name objects (anomia)

· Poor enunciation

· Excessive creation and use of personal neologisms

· Inability to repeat a phrase

· Persistent repetition of one syllable, word, or phrase (stereotypies)

· Paraphasia (substituting letters, syllables or words)

· Agrammatism (inability to speak in a grammatically correct fashion)

· Dysprosody (alterations in inflexion, stress, and rhythm)

· Incomplete sentences

· Inability to read

· Inability to write

· Limited verbal output

· Difficulty in naming

· Speech disorder

· Speaking gibberish

· Inability to follow or understand simple requests

v The following table summarizes some major characteristics of different acute aphasias:

Type of aphasia	Repetition	Naming	Auditory comprehension	Fluency
Receptive aphasia	mild–mod	mild–severe	defective	fluent paraphasic
Transcortical sensory aphasia	good	mod–severe	poor	fluent
Conduction aphasia	poor	mild	relatively good	fluent
Anomic aphasia	mild	mod–severe	mild	fluent
Expressive aphasia	mod–severe	mod–severe	mild difficulty	non-fluent, effortful, slow
Transcortical motor aphasia	good	mild–severe	relatively good	non-fluent
Global aphasia	severe	mod-severe	severe-profound	non-fluent
Mixed transcortical aphasia	moderate	poor	poor	non-fluent

Prevention

Following are some precautions that should be taken to avoid aphasia, by decreasing the risk of stroke, the main cause of aphasia:

· Exercising regularly

· Eating a healthy diet

· Keeping alcohol consumption low and avoiding tobacco use

· Controlling blood pressure

11. Parkinson’s Disease

Parkinson's disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson's disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms. The specific group of symptoms that an individual experiences varies from person to person. Primary motor signs of Parkinson’s disease include the following.

· tremor of the hands, arms, legs, jaw and face

· bradykinesia or slowness of movement

· rigidity or stiffness of the limbs and trunk

· postural instability or impaired balance and coordination

Symptoms

The diagnosis of PD depends upon the presence of one or more of the four most common motor symptoms of the disease. In addition, there are other secondary and nonmotor symptoms that affect many people and are increasingly recognized by doctors as important to treating Parkinson’s.

Find out more by reading detailed descriptions of Parkinson's symptoms below:

· Primary Motor Symptoms

· Secondary Motor Symptoms

· Nonmotor Symptoms

Primary Motor Symptoms

Almost 200 years after Parkinson's was first discovered and after many new discoveries about the biology of the disease, a diagnosis still depends on identifying the core features — tremor, slowness and stiffness — described by James Parkinson

Resting Tremor: In the early stages of the disease, about 70 percent of people experience a slight tremor in the hand or foot on one side of the body, or less commonly in the jaw or face. A typical onset is tremor in one finger.

Bradykinesia: Bradykinesia means “slow movement.” A defining feature of Parkinson’s, bradykinesia also describes a general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressivity. Bradykinesia causes difficulty with repetitive movements, such as finger tapping.

Rigidity: Rigidity causes stiffness and inflexibility of the limbs, neck and trunk. Muscles normally stretch when they move, and then relax when they are at rest. In Parkinson’s rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes contributing to a decreased range of motion.

Postural Instability: One of the most important signs of Parkinson’s is postural instability, a tendency to be unstable when standing upright.

Secondary Motor Symptoms

In addition to the cardinal signs of Parkinson’s, there are many other motor symptoms associated with the disease.

· Freezing: Freezing of gait is an important sign of PD that is not explained by rigidity or bradykinesia. People who experience freezing will normally hesitate before stepping forward. They feel as if their feet are glued to the floor.

· Micrographia: This term is the name for a shrinkage in handwriting that progresses the more a person with Parkinson’s writes. This occurs as a result of bradykinesia, which causes difficulty with repetitive actions.

· Mask-like Expression: This expression, found in Parkinson’s, meaning a person’s face may appear less expressive than usual, can occur because of decreased unconscious facial movements.

· Unwanted Accelerations: It is worth noting that some people with Parkinson’s experience movements that are too quick, not too slow.

Additional secondary motor symptoms include those below, but not all people with Parkinson’s will experience all of these.

Stooped posture, a tendency to lean forward
Dystonia
Impaired fine motor dexterity and motor coordination
Impaired gross motor coordination
Poverty of movement (decreased arm swing)
Akathisia
Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
Difficulty swallowing
Sexual dysfunction
Cramping
Drooling and excess saliva resulting from reduced swallowing movements

Nonmotor Symptoms

Most people with Parkinson’s experience nonmotor symptoms, those that do not involve movement, coordination, physical tasks or mobility. While a person’s family and friends may not be able to see them, these “invisible” symptoms can actually be more troublesome for some people than the motor impairments of PD.

Early Symptoms

Many researchers believe that nonmotor symptoms may precede motor symptoms — and a Parkinson’s diagnosis — by years. The most recognizable early symptoms include:

· Loss of sense of smell, constipation

· REM behavior disorder (a sleep disorder)

· Mood disorders

· Orthostatic hypotension (low blood pressure when standing up).

Other Nonmotor Symptoms

Some of these important and distressing symptoms include:

· Sleep disturbances

· Constipation

· Bladder problems

· Sexual problems

· Excessive saliva

· Weight loss or gain

· Vision and dental problems

· Fatigue and loss of energy

· Depression

· Fear and anxiety

· Skin problems

· Cognitive issues, such as memory difficulties, slowed thinking, confusion and in some cases, dementia

Causes

To date, despite decades of intensive study, the causes of Parkinson’s remain unknown. Many experts think that the disease is caused by a combination of genetic and environmental factors, which may vary from person to person. The chemical or genetic trigger that starts the cell death process in dopamineneurons is the subject of intense scientific study. Many believe that by understanding the sequence of events that leads to the loss of dopamine cells, scientists will be able to develop treatments to stop or reverse the disease

Speech disorders or speech impediments are a type of communication disorder where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute.

Classification

Classifying speech into normal and disordered is more problematic than it first seems. By a strict classification,^{[citation needed]} only 5% to 10% of the population has a completely normal manner of speaking (with respect to all parameters) and healthy voice; all others suffer from one disorder or another.

There are three different levels of classification when determining the magnitude and type of a speech disorders and the proper treatment or therapy:^[2]

1. Sounds the patient can produce

1. Phonemic – can be produced easily; used meaningfully and constructively

2. Phonetic – produced only upon request; not used consistently, meaningfully, or constructively; not used in connected speech

2. Stimulate sounds

1. Easily stimulated

2. Stimulate after demonstration and probing (i.e. with a tongue depressor)

3. Cannot produce the sound

1. Cannot be produced voluntarily

2. No production ever observed

Social effects

Suffering from a speech disorder can have negative social effects, especially among young children. Those with a speech disorder can be targets of bullying because of their disorder. The bullying can result in decreased self-esteem.

Language disorders

Language disorders are usually considered distinct from speech disorders, even though they are often used synonymously.

Speech disorders refer to problems in producing the sounds of speech or with the quality of voice, where language disorders are usually an impairment of either understanding words or being able to use words and do not have to do with speech production

Causes

In most cases the cause is unknown. However, there are various known causes of speech impediments, such as "hearing loss, neurological disorders, brain injury, intellectual disability, drug abuse, physical impairments such as cleft lip and palate, and vocal abuse or misuse.

LIST OF VOICE DISORDERS

Ø Perceptual signs and symptoms

Ø Acoustic signs

Ø Aerodynamic signs

signs

causes

Vocal fold paresis

Ø Congenital causes

Ø Infectious causes

Ø Traumatic causes

Ø Endocrinologic (thyroid) diseases

Ø Systemic neurologic diseases

Ø Adductor spasmodic dysphonia

Ø Abductor spasmodic dysphonia

Ø Mixed spasmodic dysphonia

Acute

Ø Viral

Ø Bacterial

Ø Fungal

Ø Trauma

Chronic

Ø Allergies

Ø Reflux

Ø Autoimmune disorders

Approximately between 30-75% of persons with rheumatoid arthritis report symptoms of laryngitis.

Signs and symptoms

Ø Adults

Ø Children

Symptoms

Primary Motor Symptoms

Secondary Motor Symptoms

Nonmotor Symptoms

Causes

Speech disorders or speech impediments are a type of communication disorder where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute.

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