Treat a Young (10 Y-Old)

¶ … treat a young (10 y-old) patient with vocal nodules. It is noteworthy that the vocal cords or vocal folds. The causes for vocal nodules amongst children are many. It is common knowledge that children talk excessively, sing, whisper, cry, shout, scream, grunt and make funny noises and sound affects. Sometimes these activities can cause vocal nodules and the signs and symptoms of this ailment are very clear and evident. Dr. Brown reveals at least seven such common signs:

dysphonia, which is a hoarse, breathy or rough voice; or a voice with excessive glottal fry intermittent aphonia, which is a recurring temporary loss of voice, especially first thing in the morning and at the end of the day, or after specific events such as sports day voice breaks, which are fleeting interruptions to the voice, during speech or singing, as though it "cuts out" for a second pitch breaks, which are fleeting, abrupt changes in the pitch of the voice, during speech or singing, usually from a lower note to a higher note excessively loud voice inability to sustain a note when singing effortful or strained voice"

Vocal cords are made up to several layers of tissues and these tissues are extremely sensitive to abuse, misuse and overuse. Experts Boone and Von Berg (2005) assert that the vocal cords are mainly made up of a muscle called thyroarytenoids. They further explain that the vocal cords, also known as vocal folds, come in pairs and are mainly comprised of different and intricate layers of muscle tissue, each with its own cell dynamics and traits. The phenomenon of voicing is produced when the vocal cords vibrate when an individual breathes out and the different layers of the tissue are the basis for all sounds and voices that an individual makes in normal or heightened conversational situations.

The average speech intensity, which these vocal cords can bear, is approximately 65 decibels (Borden, Harris, & Raphael, 2003). However, constant yelling, screaming ort speaking loudly can push it to levels well above 100 decibels (Fucci & Lass, 1999). Boone and Von Berg (2005) note that such intensity cannot be sustained by the vocal cords and they thus become weak and feeble. Children in turn make extra efforts to speak out which in turn strains the vocal cords even more. Boone and Von Berg (2005) point out, "As the dysphonic voice becomes worse, the swelling and inflammation of the vocal folds become more pronounced. Fluids will begin to build-up between the layers of the vocal folds, and without a significant reduction of speaking (vocal rest) as well as a total cessation of all yelling, small growths known as vocal nodules will develop (Boone et al., 2005)."

Treatment for Vocal Nodules

The fundamental purpose of voice treatment is to educate a powerful, healthy, non-abusive voice generation arrangement. The treatment of nodules as well as vocal strain amongst children starts by informing and educating the adolescent along with his or her parents about the characteristics of the ailment, together with its signs as well as symptoms, causes along with elements of risks. It helps the child as well as family to comprehend the natural anatomy along with he physiology of the "voice box" (also known as the larynx), regarding the child's precise laryngeal pathology (which in this case is nodules).

The possibly hurtful impacts of tension as well as strain on the larynx because of forcing the voice will be clarified to the child as well as the family. The child will be taught about three different aspects of voice production: (1) phonation (how sound is generated); (2) respiration (inhaling and exhaling air); as well as, (3) reverberation.

The concept of sufficient breathing designs will also be taught, and the adolescent will be assisted to "feel" the phenomenon of sufficient breath in sitting position, standing as well as lying down positions. They will be shown how to monitor themselves so that the thyroid notch seizes to increase excessively when the child is humming gently (e.g., "hmmm, ummm, hummm..."). In addition, they will learn to feel their necks, by looking in a mirror. This will help them understand the concepts of increasing muscle tension in the larynx.

Moreover, the child will be taught, by mimicking the voice therapist, how to generate tone from diverse parts of the voice tract: for example, production of chest voice, production of head voice, as well as, production of nasal voice. This form of therapy will help the child produce the best voice with the least amount of effort and energy.

Lastly, resonance training is particularly significant, as it assists children with non-healthy voice generation habits to project their vocals so as to acquire augmented loudness, instead of utilizing a loud and tense voice.

Simple vocal exercises, executed regularly during morning as well as evening, can be helpful in several ways to warm up and cool down the vocal cords. It is noteworthy that all muscles in the human body have got to be exercised as well as rested on a regular basis after they are used. This also applies to the vocal cords, which produce sound. Therapists have listed some very practical and easy exercises for children that can help them ease the tension and stress occurring in the vocal cords and concurrently increase the efficiency and functionality of the vocal cords.

At first the 10-year-old child will be asked to loosen the muscles around the vocal cords. This will be done by asking the child to do the following two exercises. In the first exercise the child will be asked to make a figure of 8 (in his mouth), starting from the right hand side, in such a way that his tongue goes across his upper teeth, towards the middle, thereafter crosses to the lower teeth, towards the left hand side of his mouth, after that, up, and across the top. Furthermore, the child will be asked to keep his mouth closed throughout this exercise.

In the second exercise the child will be asked to put the tip of his tongue behind "the bottom set of front teeth." Thereafter he will be asked to, "let your jaw drop and gently push out your tongue." This will be repeated again a few times.

Once the vocal cords are relaxed and loosened, the child will be asked to explore his natural range by producing several noises. This will be done at diverse pitches to explore the natural range of the child. The voices include "(1) Ga-ga, (2) ge-ge, (3) gi-gi, (4) go-go, (5) goo-goo, (5) Bzzzzzz, (7) I g-uh, (8) ding, (9) ping, (10) ing, (11) ting, (12) mmmmm, (13) hah, (14) oooooh, (15) me, (16) mah, (17) mi, (18) may, (19) my, (20) moo, (21) mu. (22) Yah, (23) Yar, (24) Wow and (25) La-la-la.

Whilst producing the first 4 voices the child will be asked to make baby noises up and down randomly with his natural voice. Whilst producing the 5th voice, the child will be asked to make noises like a bee so that he can feel the buzzing resonance in his mouth and sinus.

Similarly, whilst producing sounds numbered between 6 and 11, the child will be asked to discover the natural resonance in his sinus only. He will also be asked to hold on the "i" sound so that the sinus tickles and resonates.

Whilst producing the 12th sound, Jon writes, "Close your lips, but pull your lips back into your mouth over your teeth. Make a humming noise, and allow your lips to relax, so they are just closed. Change the pitch of your voice until your lips start to tickle. Hold this note for a while and then find other notes / frequencies where this happens." In the same way, for practicing the 13th sound, Jon articulates, "Imagine you are digging a hole (you have to do the actions too!): as you dig into the ground, exhale with a "HUH!" sound. Lift the soil, and as you chuck it over your shoulder, make a "HAH!" noise. Repeat until it gets too silly. You can also practise this by pretending to do Kung-Fu moves - punches and kicks and the likes." The child will be asked to do exactly the same so that the successful results can be produced in the least amount of time.