What is functional dysphonia?

Definition >>

Functional dysphonia is the abnormal use of voice despite normal anatomy and function of the vocal folds and the larynx which produce the voice and the pharynx and mouth which produce resonances. This condition can be related to the abuse or misuse of voice or habituation of compensatory techniques developed from the condition of the larynx.

Classification>>

Functional Dysphonia is often classified into 5 types.
- Conversion aphonia
- Habituated hoarseness
- Inappropriate falsetto
- Vocal misuse/abuse syndrome
- Postoperative dysphonia
- Relapsing aphonia

* Conversion aphonia

It is a dysphonia caused by conversion which is a psychiatric disorder. It is caused by the loss of voluntary control ability due to environmental stress of impairment in social areas. The symptoms include loss or impairment of speech, and dramatic improvements of voice can be brought through psychological treatment.

* Habituated hoarsenessIt is a voice disorder or impairment which appears continuously after an acute laryngitis or a vocal fold surgery while the vocal fold system is normal and has no complications. Although it is sometimes related to laryngopharyngeal reflux, it is more often caused by the social desire to be compensated.

The voice may sound raspy, strained, breathy, or there may be changes in volume or pitch. Treatments include voice therapies using masking sounds, asymptomatic attack, or yawning. About 63% of the cases can be treated by voice therapy.

* Inappropriate falsettoFalsetto voice is when a person makes a very high-pitched voice even in usual conversations. This voice is made from thin vocal lips or excessive contact of the arytenoids cartilages.

About 86% can be treated with voice therapy.

* Vocal misuse/abuse syndromeVocal abuse is any behavior or occurrence that strains or injures the vocal folds. Vocal misuse is improper voice usage such as speaking too loudly or at an abnormally high or low pitch. Frequent vocal abuse and misuse can damage the vocal folds and cause temporary or permanent changes in vocal function, voice quality, and possible loss of voice.

In order to maintain good vocal hygiene, avoid speaking in loud places and rest the voice completely through a counseling program.

* Postoperative dysphoniaIt is a severe voice disorder after vocal fold surgery while there is no abnormality in the vocal folds. Patients with postoperative dysphonia feel a pain when speaking and are easily exhausted. The voice sounds rough and low-pitched.

Patients should be instructed not to abuse or misuse the voice and prevent frequent coughing or gastroesophageal reflux.

* Relapsing aphoniaRelapsing aphonia is a voice disorder which involves severe symptoms of dysphonia or continuous silence. It is often related to undesired happenings or events and is caused by environmental stress or social relations. It has no following symptoms, and the symptoms may get better or worse depending on the mental or psychological state of the patient.

Unlike conversion dysphonia, relapsing aphonia is chronic and relapsing, and does not react to voice therapy. Treatment should involve a psychologist if necessary.

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* Contact KMH to make an appointment for functional dysphonia treatment.

 

Tel: +82-2-519-8013/8021

Email: hello@hucaregroup.com

What is vocal fold paralysis?

The vocal folds of the larynx which is a major source of sound in speech, is controlled by the vagus nerve, the 10th of the 12 cranial nerves. By the recurrent laryngeal nerve and the superior laryngeal nerve inside the vagus nerve, the muscles inside the larynx and the vocal folds move together naturally to cause sounds and breathing, and to prevent food from going down through the trachea.

The vocal folds are brought together by the action of laryngeal nerves, so that air pressure builds up beneath the larynx, generating sound through the rhythmic opening and closing of the vocal folds. However, when the nerves are paralyzed, the vocal folds do not open or close properly and remain open, leaving the airway passage and the lungs unprotected. It causes hoarseness and coughing because the food goes down and gets stuck in the trachea.

Vocal Fold Paralysis View (1)

Vocal Fold Paralysis View (2)

This condition is called vocal fold paralysis. When only one side is paralyzed, it is called unilateral vocal fold paralysis, and when both sides are paralyzed, it is called bilateral vocal fold paralysis.

However, it is very important to know that laryngeal nerve paralysis is not the only cause for abnormal movement of the vocal fold. There may be other reasons such as:

- A tumor inside the larynx
- Arytenoids dislocation from trauma
- Damage to the joints
- Congenital malformation
- Inflammation
- Infection of the larynx
- Scarred vocal fold

Therefore, it is important to find out the exact reason why this has occurred.

For this differential diagnosis, examinations such as computer filming, laryngoscope, and laryngeal stroboscopy are performed. The most important thing is to have Laryngeal Electromyography (LEMG) and find out the accurate reason. Yeson Voice Center has the High-tech Laryngeal Electromyography Equipment and laryngeal imaging equipment which have not been introduced even in university hospitals.

Famous Japanese vocal trainers visited Yeson Voice Center

Famous Japanese vocal trainers, Hisanori Ando and Jumi Asakura, have visited Yeson Voice Center last May. They have toured around the facility and undergone voice examination to experience advanced voice examination system of Artceum.

Artceum offers 4 different programs specialized in analysis, enhancement, rehabilitation and management of voice. Artceum is also able to analyze voice ranges and patterns to identify the cause of tone deaf, the possibility of voice disorders and unstable voice.

 

 

Russian medical staffs have visited Yeson Voice Center for a Fam-Tour



A group of visitors including NOVOMED hospital staffs and the CEO of VERNAL Medical Tour Agency  from Vladivostok in Russia has visited YESON Voice Center for familization tour.

 

They were impressed with advaned equipment of the medical center and Articeum and YESON's friendly staffs.

 

This fam-tour is organized to commemorate the opening of U-Healthcare Center, founded by Korea Trourism Organization and Ministry of Culture, Sports and Tourism in Vladivoistok.

 

U-Healthcare Center in Vladivostok is equipped with Remote Medical Consultation System with high-quality video telelcommunication device to deliver numeric and image data in realtime.

A number of medical facilities including Yeson Voice Center will provide the realtime remote medical consultation to Russian patients through this system which will takes a pivotal role for medical tourism in Korea.

 

Vocal Fold Shortening at Yeson Voice Center

Voice Feminization Surgery of Transgender at Yeson voice Center
(Post-Operative voice is recorded 5 months after the surgery.)

What is male-to-female voice phonoplasty?

New Methods of Laryngoplasty in Voice Feminization
- Vocal fold shortening and advancement of anterior commissure (APSAAC)

Features
- Both side of the vocal folds are deepithelialized to the desired length.
Surgical tips
- Mark the vocal folds to the desired length, then deepithelialize.
- Deepithelialize completely to the anterior commisure and subglottic portion.
- Suture the vocalis muscle to the maximum amount including the subglottic portion.

Male to Female Voice Phonoplasty is a procedure that changes the voice of a male into a female voice in order to help establish the sexual identity.
Females usually differ greatly from males in the fundamental frequency and resonance. The fundamental frequency of male voices typically ranges from 100-150 Hz while ranging from 170-220 Hz in females. Men produce low voices because they have bigger chambers of the throat and mouth.
Thus, by altering the larynx, pharynx, and the chambers which produce the sound, a male sounding voice can be changed to a female-sounding voice.

There are 5 major methods used for Male to Female Voice Phonoplasty.
1. Cricothyrodiopexy: Cricothyroidiopexy was the most frequently performed surgery from 1983 and 1990. It pulls the cricoid and thyroid cartilages forward to a fixed position. It is safe because it does not have to operate the vocal folds. However, it is not being used a lot in US for it needs to incise the neck and does not bring long-term satisfaction.
2. Laser assisted thyro-arytenoid muscle resection: Proposed by the French otolaryngologist Dr. Jean Avitol in 1995, the laser assisted thyroarytenoid muscle resection uses a laryngoscope to expose the vocal folds, and reduce the size of the thyroarytenoid, and raise the voice frequency by increasing the tension of the operated area. The advantages are that it is done through endoscope and does not leave a scar in the neck. However, it has limitations in raising the pitch of a very high-pitched voice.
3. Laser assisted voice adjustment (LAVA): Dr. Lisa Orloff of the University of California introduced this surgical method of vaporizing only the mucous membrane of the vocal folds that cause the biggest waves using a laser under endoscope. Thus, it strengthens the mucosal wave the vaporized membranes produce a scar while recovering, and increases the tension of the vocal folds. The advantages are that it is done through endoscope and does not leave a scar in the neck. Its disadvantages are that it requires a long period for recovery and there are limitations in the increase of voice frequency.
4. Anterior Web Creation: It is a method that raises the voice frequency by shortening the front vibrating part of the vocal folds. Dr. Gross has reported in 1999 that the fundamental frequency of a female had increased up to 201 Hz, and there was an average increase of 81Hz. It can be done under endoscope without incising the neck, and it has brought very satisfactory results in long-term observations. However, it is not available for every patient.
5. Thyroid cartilage and vocal fold reduction: Proposed in 2000, this method incises the anterior part of the thyroid cartilage and reduces the vocal folds. It is available for males with severely thick voices and big thyroid cartilages, and it is very effective in getting high-pitches. However, if the vocal folds are excessively incised, it is difficult for the voice to recover.

As you can see above, various methods can be used as transsexual phonoplasty. However, you need to first check the larynx, the vocal folds, the vocal membrane wave and the movement of the vocal folds through laryngeal stroboscopy. After a general voice check-up, it is important to predict the best voice condition and select the appropriate surgical method.
It is very dangerous to perform just one surgery without checking your voice condition. A previous check-up must be done to predict the maximum voice condition you will be able to produce and perform the most adequate method.
The voice quality is determined by the larynx, the condition of the vocal folds, the chambers of the throat and mouth, and the lips. The vocal folds, larynx, and the chambers of the throat play the most important role in creating the voice quality and timbre.
Transsexual women have the structures and the chamber of a man, and if their fundamental frequency has been altered through vocal fold surgery, the voice becomes neuter as it passes through the chamber. However, the timbre (the resonance) can be modified through vocal treatments and voice rehabilitation by altering as the features of the chamber are self-changeable. When performed with the change in fundamental frequency, it is possible to produce a low female voice.
The voice feminization therapy must be provided by skilled professionals at a place where vocal treatments are available. You cannot expect good results at a place with no experiment in voice surgery and no availability of medical treatments. Therefore, voice feminization therapy must be provided by an experienced voice specialist under an accurate diagnosis.

Written by Yeson Voice Center

2011 YESON Fam Tour from Singapore & China

On April 12nd, 2011, Korea medical facility tour participants from Singapore, Vietnam, and China visited Yeson Voice Center that was initiated by KHIDI. The participants were consisted of medical doctors and associates, agencies, and CCTV press directors. They showed huge interests about the special medical techniques that Yeson has developed. Most of them are planning to contact with Yeson for continuous business network regarding medical tourism.

Treat Your voice with Laryngoplasty and Phonoplasty at YESON VOICE CENTER

Many undergo cosmetic surgery to overcome inferiority complex in their appearance. Although it is not as common as facial complex, some do have inferiority complex in their voice. You can also improve your inherent voice to more just as you do with your face or body. Dr. Hyung-Tae Kim, a director of Yeson Voice Center, has provided information about ‘Laryngoplasty and Phonoplasty’.

▲ Longer vocal fold even makes women to have low & deep voice. You can obtain clear
high voice by receiving ‘Vocal Fold Shortening and Advancement of Anterior Commissure
(VFS AAS)’.   /   Jiho Shin, a reporter of Health Chosun spphoto@chosun.com

◆ For Vocal Fold Paralysis: Laryngoplasty
Sulcus Vocalis, a groove or infolding of mucosa along the surface of the vocal fold, which causes extremely harsh and reedy voice can be cured with Transcutaneous EMG-guided Injection Laryngoplasty(TEIL). It injects an organic prosthesis into the vocal fold without using anesthesia and making any incisions on skin. In order for the inserted prosthesis to take a proper position in the vocal fold, you should not speak for 2 days after the surgery and avoid making loud sound for additional 3 weeks.
▶Tip: You may experience temporary irritation or burning sensation in your throat 2~3 hours after the surgery.  The surgery costs around 1.8 million KRW.

◆ For women with low & deep voice: Vocal Fold Shortening + Advancement of Anterior Commissure
Those with low & deep voice can gain typical high-pitch voice for women using ‘Vocal Fold Shortening’ and ‘Advancement of Anterior Commissure’ procedures in combination. Women have shorter vocal fold of 1.5~1.8cm compared to men’s of 2.0~2.3cm, and voice frequency is higher at 200~250Hz than men’s 100Hz. However, some have men’s voice regardless their gender because of inherently longer vocal fold or thick vocal fold due to excessive secretion of testosterone. ‘Vocal Fold Shortening’ is a procedure that reduces the length and modifies the shape of vocal fold. ‘Advancement of Anterior Commissure’ is a procedure that ties the upper part of vocal fold to reduce the size. The average voice frequency of 150 patients who have undergone these procedures is increased from 137.3Hz to 211.5Hz.
On the other hand, men with thin & high pitch voice can be treated by injecting botox to the vocal fold to paralyze the muscle that plays high note. Vocal training has to be accompanied as well for better outcome.
▶Tip: It takes 3 months to recover. Voice feminization costs around 3.7million KRW, and Botox treatment around 250,000KRW

▲ A patient is measuring her voice frequency.
Jiho Shin, a reporter of Health Chosun spphoto@chosun.com

◆ Spasmodic Dysphonia: Botox Treatment
Those with breaking voice can be treated with ‘Multiple Laryngeal Muscle Injections with Botox’. Spasmodic Dysphonia occurs due to abnormal larynx nerve signal that controls the movement of vocal fold. Patients with this disorder lose control of their laryngeal muscle, which makes it hard to talk and break off sound. ‘Multiple Laryngeal Muscle Injections with Botox’ help patients to gain control of laryngeal muscle. 92% out of 1700 patients who received this treatment showed improvement. It is recommended to receive the botox injection treatment from experienced otolaryngologists since they need to distinguish laryngeal muscles and vocal muscles through EMG test. Although one botox injection is effective only for 4~6 weeks, the effect can last for 5~6 months if increased the dose.
▶Tip: Your voice may become hoarse for a month if you increase the botox dosage. Although cost varies from hospitals, it costs approx. 250,000KRW.

Written by Heejun Han
Reporter of Health Chosun hj@chosun.com

How is the voice made?

(1) The parts that make the voice

The voice is created by the vocal organs, such as the lungs, larynx, pharynx, mouth, and lips. Air pressure from the lungs creates a vibration in the air through the larynx, and passes through the pharynx (back of the throat) to form a timbre, which then passes through the mouth and lips and is made into an understandable sound. Thus, the voice is made through the harmonic procedure of vocal organs moving according to the systematic and sophisticated signal from the cerebrum.

The vocal organs mainly consist of 4 kinds.

1. The Generator: It controls the breath from the lungs. The flow of air created when breathing is the main energy that vibrates the vocal folds. If there is no flow of air through the larynx, then a sound cannot be made in the vocal folds. Therefore, the voice is greatly influenced by the condition of the lungs and how you breathe.

2. The Vibrator: This refers to the larynx, especially the vocal folds that are inside the larynx. The vocal folds are simply involved in producing the vibration. Rich sound or articulation is produced by the ‘resonator’ and the ‘articulator’ located in the upper area of the larynx.

[The structure of the larynx]

3. The Resonator: This refers to the area above the vocal folds, and it comprises the pharynx. The resonator is the space back of the mouth which creates different tones or qualities of voice. For instance, a well trained opera singer controls the resonator and makes resonances at 2500 hertz in order for the voice to be heard clearly without being absorbed in the sounds played by the orchestra. Voice problems related to this resonator do not usually occur. However, when a singer gets a surgical removal of the tonsils, it affects the resonator and can change the voice.

4. The Articulator: The tongue, lips, cheek, teeth, and the soft palate are included here. These organs modify the sounds to create words or speech. Although medical disorders related to the articulator are not common, articulation problems found in singers can be corrected their voice advisors.

Therefore, a problem in just one of the 4 vocal organs can cause voice disorder. The most common voice disorders occur when problems are found in the vibrator, that is, the vocal folds inside the larynx.

(2) Production of voice

The vibrator, or larynx, not only makes the sound, but also works as a protector that prevents the swallowed food from entering the airway, and as a way through which one can breathe.

The two bar-like structures called vocal folds, covered by a mucous membrane, move toward each other to bring a vibration in the membrane and cause fluctuations in the air to make a sound.

View the movement of normal vocal folds

The muscles of the vocal folds are forced apart by the increasing air pressure from the lungs, letting air go through again. Then the muscles of the vocal folds contract again by the Bernoulli effect (high velocity in the flow of a fluid causes a decrease in pressure). This process continues in a periodic cycle that is felt as a vibration, creating sound waves and sounds.

The sound made in the vocal folds passes through the resonator and is modified according to the position and shape of vocal organs, resulting in different tones and qualities of sound. This determines the characteristics of each individual’s voice.

Written by Yeson Voice Center

YESON has renamed its voice examination center as 'ARTCEUM'

Yeson Voice Center published "Yeson ARTCEUM" introduction catalogue recently.
The Voice Examination Center has now re-named as “ARTCEUM”, which includes the meaning of art institute & voice.  It introduces that the ARTCEUM performs professional and scientific examination and analysis of voice pattern, voice profile range, and voice color with using cutting edge equipment. The ARTCEUM will prepare to be a leading voice examination center of Korea’s representative for all patients who are concerned with their voice.

Miss Queen Beauty Thailand 2010 visited Yeson Voice Center

JJ (Varattaya Norkaew), who won the “Miss Queen Beauty Thailand 2010 (Ladyboy beauty contest)”, visited Yeson Voice Center to receive Voice Feminization Surgery. The purpose of her visit was to experience the high quality of Korea medical service as well as to become a complete woman as receiving the voice feminization surgery.
She had decided to have the surgery at Yeson Voice Center because a lot of transgenders do not satisfy with the surgical technique in Thailand. JJ’s operation was performed successfully and she was satisfied with the outcome of her voice. She mentioned that she cannot wait to tell her friends to recommend the Medical Tourism in Korea.