PRAXIS Phonotrauma

When the larynx is protecting the vocal folds, behaviors that can be observed include ventricular fold medialization, approximation of the arytenoid cartilages with the epiglottis (arytenoid-epiglottis approximation), and squeezing of the false supraglottal structures to obscure visualization of the laryngeal inlet and true vocal folds.

When behaviors appear to require excessive effort or contribute to a dysphonic voice, it is reasonable to consider them as comprising "misuse." It is important to be cautious in characterizing any isolated behavior as hyperfunctional or abusive, but if they negatively affect vocal production and perception, they can be considered as potential misuse.

The hard glottal attack, also known as glottal coup, is a manner of initiating vowels characterized by rapid and complete adduction of the vocal folds before phonation begins. It involves forcefully closing the vocal folds, requiring increased subglottal pressure to overcome the resistance and start phonation. It produces an abrupt, explosive, and hard-edged onset of phonation.

The hard glottal attack produces a characteristic sound of an abrupt, explosive, and hard-edged onset of phonation. It can be observed fiberoptically, especially when individuals are asked to produce isolated vowel sounds. There are two variations of the hard glottal attack: one with simultaneous medial compression of the vocal folds and the other with prephonatory laryngeal constriction where the ventricular folds, arytenoids, and epiglottis approach each other, obscuring the view of the true vocal folds. As phonation begins, the vocal folds suddenly spring open.

Yes, the hard glottal attack can occasionally be observed in individuals with normal voices who are not experiencing voice problems. It may also be a reaction to the examination procedure and associated tensions. The presence of the hard glottal attack alone does not necessarily indicate misuse but should be interpreted in the context of other behaviors and the degree to which it is present.

The hard glottal attack, when present to a significant degree, can be one of several behaviors indicating increased tension and strain. It should be considered along with other evidence of vocal misuse and the circumstances under which it is observed.

There are differing opinions among singers, singing coaches, and voice scientists regarding the benefits of maintaining a low laryngeal position. Some believe that raising the larynx with increased pitch is improper singing technique and detrimental to the voice, while others argue that varying laryngeal position may be useful and not abusive.

Raising the larynx in singing results in a shortening of the vocal tract, a stiffening of vocal fold tissues, and an increased tendency for tight vocal fold closure. These changes affect the formant frequencies, fundamental frequency, and vocal fold vibration pattern. However, the effects of laryngeal position may differ between singing and speaking due to the specific demands of each activity.

Vocal tension is characterized by increased tension in both intrinsic and extrinsic laryngeal muscles. A high laryngeal position may be associated with excessive tension in both muscle groups. The muscles involved in raising the larynx can also influence vocal fold vibration, resulting in increased stiffening of the vocal fold margin.

Individuals with a high laryngeal position and vocal tension may report sensations of pain or soreness in the neck area beside the larynx. These sensations may radiate upward or downward. They may also experience worsening of their voices with increased use and feel that speaking requires excessive effort, particularly by the end of the workday.

Anteroposterior laryngeal squeezing refers to the observation of the epiglottis and the arytenoids approaching each other during phonation, resulting in a narrowed or squeezed laryngeal space. This squeezing behavior is often seen in voice-disordered patients during endoscopic laryngeal examinations.

In patients with anteroposterior laryngeal squeezing, the squeezing behavior affects vowel production, even in the production of vowels like /ee/ and /oo/. The squeezing behavior obscures visualization of the true vocal folds along their full length, making it difficult to see the vocal fold vibration pattern and vocal fold closure during phonation.

Individuals who habitually exhibit anteroposterior laryngeal squeezing tend to maintain a closed laryngeal posture even when raising pitch. This can lead to difficulties in raising pitch and a reduced phonational range. It is considered an indication of disturbed phonatory physiology likely caused by excessive strain and tension.