Greene and Mathieson's the Voice and its Disorders

Lesley Mathieson

• Publisher: Wiley
• Year: 2013
• ISBN:
  9781118713358
• Edition: 6
• Topic: Medicina
• Subtopic: Audiologia e logopedia

This edition has been extensively rewritten in order to reflect the changes in clinical practice and learning methods which have taken place since the 5th edition was published. The seventeen chapters are divided into three sections: normal voice, descriptions of the various types of voice disorders, and the methods of treating abnormal voice.

A profile summary of each voice disorder is provided for easy reference and comparison, and tables are used throughout the text. New laryngeal images and electroglottographic interpretations have also been included.

The current emphasis on evidence-based practice is addressed in the review and descriptions of intervention strategies used in voice therapy.

Part I

Normal Voice

Chapter 1

Communicative functions of the voice: an overview

The human voice fulfils a number of roles in the process of oral communication, as well as contributing to the way in which individuals relate to each other. It is essential for clinicians who treat patients with voice disorders to have some understanding of the range of the communicative functions of the voice in order to comprehend the effects of vocal impairment on the individual. The multiple roles of the voice described in this chapter demonstrate the importance of its subtle, as well as its more obvious, aspects. When any aspect of vocal function is impaired, the speaker’s communicative effectiveness is reduced.

It is generally recognised that the human voice makes a major contribution to the audibility of verbal communication. Most people have lost their voices at some time and remember the difficulty of trying to make themselves heard, even in quiet settings. It is also generally accepted that voices tend to be identifiable as belonging to particular individuals and can be recognised, like faces, although this is not entirely true. The functions of the voice are much more extensive than this, however, and it is through the voice that considerable information about the speaker is conveyed to the listener. The speaker is frequently unaware that the voice is potentially so revealing and that what is heard and perceived also depends on the listener’s experience and sensitivity. A speech-language pathologist or linguist, for example, will be aware of nuances that may evade the non-professional. Throughout life, emotions are reflected in the voice and aspects of the personality are revealed. Infant vocalisation progresses to babbling as a preliminary to speech, and the intonation patterns of the home language are absorbed and form musical patterns which gradually incorporate words and phrases. As the social and emotional boundaries of a child’s life expand, the voice absorbs characteristics of the socio-economic groups encountered, and the peculiarities of regional dialect and social class. In adulthood, the voice eventually provides an amalgam of personal information.

Inferences from vocal behaviour

Even when it might be regarded as neutral, a voice constantly transmits information about the speaker. Even more is revealed as it changes in different social contexts and reflects responses and attitudes to situations encountered. Vocal behaviour is one aspect of the total image – a composite of dress, grooming, posture, gesture and facial expression – presented by an individual. Individuals rarely think about how to use their voices, unless the situation particularly demands care, although they frequently consider what to say. Yet everything has to be said in a certain way, in a certain tone of voice, at a certain pitch and at a certain loudness (Tannen, 1995). It is perhaps surprising, therefore, that ‘the voice’ has not generally been considered an element of the individual that can be ‘groomed’ or manipulated for everyday communication. Articulation, language structure and content, accent and dialect are all the subjects of formal instruction, but development of vocal skills has largely remained the territory of voice and singing teachers who teach actors, singers and public speakers. Although this tuition addresses many aspects of vocal function, it is related to the speaker’s or singer’s ability to perform the adopted role effectively. It has been known for many years by sociolinguists, however, that listeners draw inferences from the voice regarding sex, age, intelligence, regional and socioeconomic origins, education and occupation (Ryan, Giles and Sebastian, 1982). Recently, politicians, businesses and others have become aware of the importance of the inferences that listeners draw from the various aspects of the speaker’s voice and this is influencing training patterns for an increasing number of people. As yet, it is probably unusual for individuals to consider trying to alter their voices aesthetically for everyday life, in the way that they would go to a gym for a more beautiful body. Attempts to achieve a more desirable accent is routine in some cultures, but it is unusual for most people to attempt to make their communication skills more effective by changing subtle aspects of vocal behaviour.

A cross-disciplinary approach and the study of various attitudes in social settings is recognised as necessary in any comprehensive evaluation of communicative behaviour (Edwards, 1982). This is the core construct of sociolinguistics that provides an integrative approach to social psychology. The aspects of voice from which inferences are drawn are known as paralinguistic features; they run parallel to the linguistic message and are important for placing it in context. This introduction to vocal function will be directed broadly into these two areas – paralinguistic and linguistic – although in practice the two aspects are not always clearly defined, and they frequently overlap and fuse.

Voice permanence

The distinctive vocal characteristics by which each person is identifiable are dependent to some extent on anatomical features, but they are also determined by habitual settings of the vocal tract.

ANATOMICAL FEATURES

The configuration of the vocal tract of each individual is unique. It imparts the particular vocal quality that distinguishes one individual from another and that contributes to identification of the speaker. These anatomical features of the vocal tract result in the permanent voice quality over which there is little control and which cannot be completely suppressed or disguised.

VOCAL SETTINGS

Superimposed on the permanent anatomical voice features are many possible ‘voice settings’. These are the muscular adjustments of the vocal tract, which are learned unconsciously in the family and, later on, in the school, social, professional or occupational group. They affect the timbre of the voice as well as determining the characteristic levels of volume and pitch. As they are habitual, there is no awareness of them in the majority of speakers, although they can be controlled by the individual. It is this aspect of the voice that impersonators manipulate when imitating the voice of a well-known personality. The settings can be assumed and imitated and are peculiar to different groups within regional and local populations. An interesting illustration of this is the evidence that suggests that many American males have learned to use a lower part of the pitch range than British males (Giles and Powesland, 1975) (see ‘Contact ulcers’, page 172).

The sociolinguistic implications of an individual’s speech patterns are acknowledged in the literature, but these usually relate to articulatory patterns rather than to the voice itself. For example, the class-conscious British detect the background of a speaker very readily (Scherer and Giles, 1979). It is agreed that ‘received pronunciation’ (RP) is the most prestigious standard accent in Britain (Kramarac, 1982), with high status and competence connotations, placing speakers in a socially superior position to those with apparently less advantageous antecedents. Conversely, some speakers consciously reject RP because they do not want to be perceived as members of an élitist and privileged group. The English are reputed to be the most class-conscious race in Europe, whereas Americans acknowledge regional differences of accent but are less likely to perceive them as important markers of social class. In Italy, a Tuscan accent is quite different from that of the north or south. It is appreciated for its beauty but does not place these Italians on a higher social plane, although it has great cultural status.

Studies of the voice and social grouping are less common, however, and appear to be less frequently considered. A study in Edinburgh (Scherer and Giles, 1979) produced results showing a correlation between social status and voice settings. Higher social status was associated with more ‘creaky’ phonation, whereas lower social status revealed voices with more whispering and harshness. It is suggested by some writers that future academic success can be predicted by voice pitch and range. Scherer and Giles (1979) cite a study by Freuder, Brown and Lambert in which teachers evaluating young school children judged slow speech at a low pitch to be indicative of school failure. This study was confirmed by Edwards (1982). It was found that the academically successful pupils of low socio-economic status did actually use higher pitch, less volume and more appropriate intonation than their unsuccessful peers. The judgement of an individual’s abilities and intelligence from the voice is obviously highly dubious. Some teachers and many other members of society unconsciously hold stereotyped and often negative views of certain ethnic and social groups.

PARALINGUISTIC FEATURES

In contrast to the long-term nature of the anatomy and voice settings that combine to make voice permanence, there are paralinguistic features of the voice that change with emotion. These result from changes in tension in the vocal folds and the vocal tract which, in turn, affect vocal features. Shades of feeling are reflected in the voice and are inextricably linked with the verbal message and may override it. These features are recognised as timbre, tone of voice or vocal quality. Crystal (1980) refers to them as voice qualifiers. Such changing vocal settings are difficult to measure, but it is universally recognised that voices change ‘colour’ with changing emotion. This is reflected in the way a remark is delivered rather than how it is worded: It wasn’t what she said but the way that she said it that made me mad. I know perfectly well what he meant although he didn‘t say it in so many words. An impartial judge may be totally bewildered by the feelings of bitterness and aggression that arise between the protagonists and by the way in which innocent words can be misinterpreted. Inevitably, changes in articulation are associated with vocal variation; increases in tension in the vocal tract, for example, may manifest themselves in the tongue and lips as well as in the muscles of the larynx.

In more subtle emotional contexts, feelings such as sadness, disappointment, happiness, love and joy are reflected in the voice. The sincerity and empathy of a speaker are conveyed to the listener, and words not sincerely felt may be recognised as false. The paralinguistic features of voice allow us to communicate feeling without being explicit when it would be difficult or socially inappropriate to make an overt statement. Siegman (1987) suggests that, in this way, we can express feelings without taking full responsibility for them. Although paralinguistic features usually emerge unconsciously, it is also possible for them to be consciously manipulated in order to make them appropriate to the situation or to influence the listener to the speaker’s advantage.

Social group differences

Paralinguistic features of voice are not necessarily interpreted correctly between individuals of different ethnic groups. Scherer and Giles (1979) observed, for instance, that West Indians in normal calm conversation will suddenly alter pitch and increase loudness of the voice for emphasis. This may be interpreted as an angry outburst by those of other groups, and emphatic speech may be incorrectly regarded as angry or aggressive. The potential dangers to relationships between different ethnic and social groups are obvious.

Personality indicators

Inferences can be drawn from the voice about a speaker’s personality, although the same inference is not necessarily made by each listener. For example, relatively high vocal pitch may indicate positive aspects of personality such as competence, dominance and assertiveness to one listener, but another may conclude that the speaker is nervous and deceitful (Street and Hopper, 1982). There seems to be a general assumption that a speaker is dynamic and extrovert if the pitch shows marked variability. A loud voice can also indicate extroversion but, if the voice is inappropriately loud, it may signal insensitivity to the situation and embarrass the listener (Street and Hopper, 1982). Addington (1968) says that nasality is strongly linked to negative attributes such as unattractiveness and neuroticism.

Psychiatrists recognise the voices of anxiety, depression and despair. Moses (1954) emphasised the vocal symptoms exhibited by distressed individuals. Ostwald (1963) noted the importance of listening to different vocal qualities such as a more ‘hollow tone’ and a flatter intonation than the ‘robust’ voice. There is evidence that it is the frequency range of a voice that has the most powerful effect on listener judgements of the speaker’s emotional status (Scherer, 1995). A wide frequency range expresses high arousal, whether negative or positive, whereas a narrow frequency range is perceived as sadness or neutrality. Low vocal pitch in association with slow speech is recognised as indicating depression and breathy, irregular voice accompanying rapid speech may indicate anxiety (Gudykunst, 1986).

The voice, therefore, can indicate who we are and how we are feeling. It is one of the most informative clues about any individual. As a result, changes in the voice as a result of illness or injury make the speaker feel at a disadvantage, because it is realised intuitively that the voice might be conveying erroneous messages about important aspects of the personality. A ‘beautiful’ speaking voice, on the other hand, encourages positive responses from the listener and could be regarded as enhancing the perception of the speaker’s personal attributes. What constitutes the ‘beautiful’ voice is debatable and probably varies from one culture to another.

Voice loudness

Loudness is a parameter of voice that varies from one individual to another and will vary at different times within the same individual, according to the emotional or linguistic content of the communication. There appear to be differences of voice volume between the sexes, with men generally talking more loudly, although women are more likely to compensate for external noise by increasing vocal intensity (Scherer and Giles, 1979). It is suggested that both sexes tend to talk more loudly to members of the opposite sex in general conversation, although the quiet voices of a close relationship maintain intimacy.

The ability to vary vocal volume allows the speaker considerable control over the behaviour of others. Increasing loudness is an effective way of establishing the speaker’s turn in a conversation and will also deter the intervention of other speakers. Margaret Thatcher’s dominant role in the House of Commons demonstrated this publicly, but increased vocal volume has a similar effect in other contexts. The loud voice used for commanding, calling, warning and attracting attention cannot be ignored by the listener very easily, whereas the whisper or very quiet voice signals the appropriate behaviour for the listener. In anger, the amplitude of the voice may be the dominant feature in communicating the heartfelt message.

Non-verbal co...