Communication Matters

How do we produce voice?
The sound of your voice is affected by the size and shape of your larynx, throat and mouth. Abnormalities in the size and shape of these structures or with the airway (trachea) can affect voice quality. Voice problems can be the result of trauma as well.

To produce voice, air is drawn into the lungs, usually through the nose. The lungs expand when they fill with air, and then we gradually release the air through the trachea and mouth. We control the flow of air with muscles of the diaphragm, ribcage and larynx (voice box). As air passes through the trachea, it passes between the vocal folds. Just after we breathe air in, muscles in the larynx close the vocal folds to help keep the air in the lungs. As air pressure builds, the air pushes against the vocal folds, causing them to open. The interaction of muscle tension (closing the vocal folds) and air pressure (opening the vocal folds) causes a vibration of the vocal folds. This vibration creates sound. That sound is shaped by the size and shape of our vocal folds, throat (pharynx) and mouth.

Phonation refers to the production of voice. Each person’s voice is unique to him or her. Our voices are as identifiable as a fingerprint. The first voiced sound we often hear from an infant is a cry. Generally, in infancy, cries can be differentiated and parents learn the meanings of different cries for hunger, pain/discomfort, etc. As infants grow, they begin to coo, exploring the use of their voices and learning what sounds they can make. Eventually, by listening to others and decoding the language around them, they begin to shape their voices by producing various vowels and consonants that initially make up babble and “baby-talk” and later become real words. Find our speech development chart for children ages 0-5 years here.

What are some common voice problems?
There are certain voice problems associated with congenital problems with the airway or central nervous system. Other voice problems are associated with the structures of the mouth, nose and other structures in the throat such as tonsils and adenoids. Still other voice problems are the result of misuse of the voice.

When the airway is compromised or obstructed, a child may not be able to produce voice (phonate). Oftentimes, these problems require surgery. This is also true of problems with the larynx itself. Vocal fold paralysis accounts for 10 percent of all laryngeal problems. One or both vocal folds can be paralyzed. This paralysis is typically the result of damage or lesion to the nerves that stimulate the muscles of the larynx to move and is considered a problem of the central nervous system. Unilateral (one-sided) vocal fold paralysis can sometimes be managed with surgery. There are also devices that can be used to generate sound when the vocal folds cannot.

Children sometimes develop problems with voice without any type of physical or neurological problems. Like adults, children can develop vocal nodules (small bumps on the vocal folds) that make the voice hoarse or breathy. Misusing the voice by talking in an unnatural manner, screaming harshly or making certain noises such as truck and car sounds can lead to changes in voice quality. This in turn can affect how easy or difficult it is to understand what the child says.

Stuttering can become a lifelong part of talking for some people. However, it does not have to interfere with your child's ability to make friends, participate in the classroom, make good grades, form lasting relationships or achieve career goals.

Deciding whether to take your child to speech therapy can be a difficult decision, however, many parents are concerned that taking a child to therapy will increase his or her awareness of the stuttering and thus have a negative effect or are unsure about the best time to start their child in therapy, especially when they get conflicting advice about whether to "wait and see" versus take action. Adding to the confusion, research suggests that as many as 70 percent of all children who start stuttering will outgrow it on their own with no speech therapy. But research also indicates that if a child has been stuttering longer than a year, the likelihood that he or she will outgrow it without any speech therapy is reduced.

Unfortunately, there are no firm guidelines about the best time to start therapy, although most speech-language pathologists will recommend starting therapy within six to 12 months after you have first noticed the stuttering. One thing we do know, though, is that all children can benefit from therapy, although the outcomes are different for different children.

As a result of speech therapy, some children are able to eliminate stuttering completely. Others learn strategies that help them stutter less, while yet other children learn to talk in a way that is easier and less tense, even though some stuttering is still noticeable. Most importantly, all children can learn to become more confident in their speaking skills, no matter how much stuttering they may still have.

Goals of stuttering therapy:

Your Cleveland Hearing & Speech Center (CHSC) audiologist can place an order for your hearing aids. Before you can order a hearing aid, you must have your hearing tested. Once this testing is done, you should talk with your audiologist to decide which hearing aids are best for you, your hearing loss, and your lifestyle. Next, the audiologist will take an impression of your ear. During this process, she will put a putty-like material in your ear for about five to ten minutes. This material will harden to the shape of your ear so the hearing aid company can make your custom hearing aid.

Infant hearing loss affects approximately 2-3 out of 1,000 live births (NIDCD).

As of July 2004, all babies born in the state of Ohio receive a free hearing screening before they go home from the hospital. The Universal Newborn Hearing Screening (UNHS) legislation has been helpful in detecting hearing loss sooner and allowing families to begin helping their babies earlier. Typically, hearing is tested at birth, and, if it’s normal, is not tested again until approaching age 4. This usually takes place on a visit to the pediatrician. Hearing is screened again when the child enters school. Many schools then alternate between vision and hearing screenings during the school-age years.

Impairments in hearing can happen in either frequency (the high or low pitch of a sound) or intensity (the volume of a sound), or both. For example, a person may not be able to hear very high-pitched noises like a whistle, or they may not be able to hear the TV unless the volume is turned up – or both. Hearing loss severity is based on how well a person can hear the frequency or intensities most often associated with speech. Severity can be described as mild, moderate, sever, or profound. Hearing loss can be congenital (occurring from the time of birth) or acquired (developing later in life after a period of normal hearing). Hearing loss can affect one or both ears – and in different degrees of severity in each ear. A loss that affects one ear is called a “unilateral” (one-sided) hearing loss. A loss that affects both ears is called a bilateral (two-sided) hearing loss.

When your hearing aids do not provide enough help in certain environments, or if you don’t wear hearing aids but need help hearing only in certain situations, you may want to consider an assistive or alerting device. Discuss with your audiologist which devices might be helpful to you. At CHSC, we offer a variety of devices and can you determine which is right for you.

The outer ear is what most people consider “the ear.” It consists of a flap of skin/cartilage (called the pinna or auricle) on the outside of the head. It collects sound and directs it into the ear canal. The ear canal is a closed tube with hairs and “wax glands” in the outer portion. Our ear canal is self-cleaning. The wax glands produce wax, or cerumen, and the tiny hairs push the wax out of our ears. As the wax moves out of the ear, it cleans the ear canal and keeps unwanted critters, such as insects, out of the ear. At the end of the ear canal is the eardrum, or tympanic membrane. When air moves it creates vibrations. These sound vibrations are collected by the pinna and directed into the ear canal, to the eardrum, causing it to vibrate just like the head of a drum when you hit it with a drumstick. When an audiologist or physician looks into a healthy, unobstructed ear with an otoscope, s/he can see the outer surface of the eardrum.

Auditory processing is basically how hearing works between the ear and the brain. It consists of a specific set of skills that most of us perform without any difficulty – or awareness. These include: