86 Chapter 4
was the tendency to produce a “chink” sound during an injection. He was able to eliminate this
distracting noise after I brought it to his attention. During the final session, I was treated to his
great sense of humor. I was explaining the finer points of coordinating breathing with speaking
when he interrupted me, saying, “I’ll get a hamburger for lunch.” I looked at him quizzically,
and he laughingly said, “Sorry about the interruption, but I had a true belch and I didn’t want
to waste it.”
I never saw Alvin again. Several months later, I telephoned him to check on his pro gress. He
said his speech was very good and things were going well. His speech was so good, in fact, that
it was difficult to know he had had a laryngectomy; he simply sounded as though he had a cold.
Alvin the Great had truly mastered esophageal speech.
Voice and resonance disorders involve prob lems with the source of voiced speech sounds,
such as occurs with vocal nodules, polyps, and contact ulcers. The most severe sound source–
communication disorder is laryngectomy, and patients must learn alternative methods of creating
a voice. The sound source may also be impaired when the larynx is damaged or impaired by burns,
diseases, traumas, or psychological factors. The voice also involves the resonance occurring in the
cavities in the head and neck; orofacial anomalies can cause nasal emission and hypernasality.
Most voice disorders are successfully treated with medical and therapeutic management.
- Compare the workings of a brass or reed musical instrument to the sound source–resonating
system of the human voice. - Describe Bernoulli’s princi ple and explain how it is partially responsible for closing the vocal
cords during phonation. - Describe the muscular forces involved in the myoelastic- aerodynamic princi ple of vocal fold
vibration. - What are the functions of extrinsic and intrinsic laryngeal muscles?
- List four voice qualities and discuss the psychological and personality attributes a listener may
perceive when hearing them. - Describe cleft lip and palate and discuss the likely causes.
- Discuss the levels of neurological damage and the dif fer ent types of laryngeal paralysis.
- What are three methods of alaryngeal speech? Describe them.
- List vocally abusive be hav iors and ways of eliminating or reducing them.
- Discuss the origins and manifestations of psychogenic voice disorders and ways of obtaining
normal speech. - List the members of a cleft palate medical team and describe their responsibilities.
- Describe how you would teach a patient esophageal speech.
Boone, D., McFarlane, S., Von Berg, S., & Zraick, R. (2013). The voice and voice therapy (9th ed.). Boston, MA: Pearson.
This classic textbook provides a comprehensive overview of the voice and the treatment of voice disorders.
Culbertson, W., Christensen, S., & Tanner, D. (2013). Anatomy and physiology study guide for speech and hearing (2nd ed.).
San Diego, CA: Plural.
This unique workbook has an active study guide on the anatomy and physiology of the speech and hearing mecha-
nisms, including vocal functioning.