Skip to main content
Book cover

Dysphagia pp 257–274Cite as

Voice and Dysphagia

  • Chapter
  • First Online:

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

The anatomical interaction between the upper respiratory and digestive tracts conditions the smooth running of their functions: breathing, swallowing, and voice articulation. The phylogenetic evolution of our species has rendered possible the optimum integration of these functions, creating the conditions for an extremely refined timing. This functional optimization has facilitated the phono-articulatory function with the possibility of highly skilled aesthetic results, as in artistic voice production.

This anatomical integrity is essential for a proper and optimal functioning. Anatomical alteration may change a function, just as a functional alteration may facilitate, in the presence of comorbidity, anatomical changes. In singing, for example, the physiological adjustments required to produce a more resonant voice can alter, over time, the physiology of structures involved in swallowing. The lowering of the laryngotracheal axis, which facilitates the mechanisms of articulation and vocal projection, may affect the timing of swallowing. The pressures usually required in singing can modify the functioning of the valves between the chest and abdominal cavities.

The chapter reviews the main changes in the physiology and physiopathology of the upper respiratory and digestive tracts and the impact that artistic vocal performances have on swallowing. Similar considerations are made for other voice users. The chapter concludes with a review of the literature on the topic.

This is a preview of subscription content, log in via an institution.

References

  • Altman KW, Atkinson C, Lazarus C (2005) Current and emerging concepts in muscle tension dysphonia: a 30-month review. J Voice 19(2):261–267

    Article  PubMed  Google Scholar 

  • Angsuwarangsee T, Morrison M (2002) Extrinsic laryngeal muscular tension in patients with voice disorders. J Voice 16(3):333–343

    Article  PubMed  Google Scholar 

  • Ardzakus FK, Wyke B (1979) Innervation of the subglottic mucosa of the larynx and its significance. Folia Phoniatr (Basel) 31:271–283

    Article  Google Scholar 

  • Arensburg B, Tillier AM, Vandermeersch B, Duday H, Schepartz LA, Rak Y (1989) A middle palaeolithic human hyoid bone. Nature 338:758–760

    Article  CAS  PubMed  Google Scholar 

  • Aronson AE (1980) Clinical voice disorders: an interdisciplinary approach. Thieme Medical Publishers, New York

    Google Scholar 

  • Baitha S, Raizada RM, Kennedy Singh AK, Puttewar MP, Chaturvedi VN. Clinical profile of hoarseness of voice. Indian J Otolaryngol Head Neck Surg January–March 2002;54(I).

    Google Scholar 

  • Baken RJ (1997) Airflow and volume. In: Baken RJ (ed) Clinical measurement of speech and voice. Singual Publishing, San Diego

    Google Scholar 

  • Behlau M, Zambon F, Madazio G (2014 Jun) Managing dysphonia in occupational voice users. Curr Opin Otolaryngol Head Neck Surg 22(3):188–194

    Article  PubMed  Google Scholar 

  • Belafsky PC, Postma GN, Koufman JA (2001) The validity and reliability of the reflux finding score (RFS). Laryngoscope 111(8):1313–1317

    Article  CAS  PubMed  Google Scholar 

  • Belafsky PC, Postma GN, Koufman KA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16:274–277

    Article  PubMed  Google Scholar 

  • Bergamini G, Casolino D, Schindler O (2002) Inquadramento delle disfonie. In: Casolino D (ed) Le disfonie: fisiopatologia, clinica ed aspetti medico-legali. Pacini Editore Medicina, Pisa

    Google Scholar 

  • Blitzer A, Brin MF, Ramig LO (1992) Neurologic disorders of the larynx, 2nd edn. Thieme Medical Publishers, New York

    Google Scholar 

  • Bouchayer M, Cornut G, Witzing E, Loire R, Roch JB, Bastian R (1985) Epidermoid cysts, sulci and mucosal bridges of the true vocal cord. Laryngoscope 95:1087–1094

    Article  CAS  PubMed  Google Scholar 

  • Brodnitz FS (Feb 1971) Hormones and the human voice. Bull N Y Acad Med 47(2):183–191

    PubMed  PubMed Central  CAS  Google Scholar 

  • Cammarota G, Elia F, Cianci R, Galli J, Paolillo N, Montalto M, Gasbarrini G (2003) Worsening of gastroesophageal reflux symptoms in professional singers during performances. J Clin Gastroenterol 36(5):403–404

    Article  PubMed  Google Scholar 

  • Cammarota G, Masala G, Cianci R, Palli D, Capaccio P, Schindler A, Cuoco L, Galli J, Ierardi E, Cannizzaro O, Caselli M, Dore MP, Bendinelli B, Gasbarrini G (2007) Reflux symptoms in professional opera choristers. Gastroenterology 132(3):890–898

    Article  PubMed  Google Scholar 

  • Castell DO (1999) The esophagus, 3rd edn. Lippincott, Philadelphia

    Google Scholar 

  • Cesari U, Galli J, Ricciardiello F, Cavaliere M, Galli V (2004) Dysphonia and laryngopharyngeal reflux. Acta Otorhinolaryngol Ital 24(1):13–19

    PubMed  CAS  Google Scholar 

  • Cook IJ, Kahrilas PJ (1999) AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 116:455–478

    Article  CAS  PubMed  Google Scholar 

  • Côrtes Gama AC, Camargo Z, Rocha Santos MA, Carlos RL (2015 Mar) Discriminant capacity of acoustic, perceptual, and vocal self: the effects of vocal demands. J Voice 29(2):260.e45–260.e50

    Article  Google Scholar 

  • Coyle SM, Weinrich BD, Stemple JC (2001) Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population. J Voice 15:424–440

    Article  CAS  PubMed  Google Scholar 

  • D’haeseleer E, Behlau M, Bruneel L, Meerschman I, Luyten A, Lambrecht S, Cassol M, Corthals P, Kryshtopava M, Wuyts FL, Claeys S, Van Lierde K (2016) Factors involved in vocal fatigue: a pilot study. Folia Phoniatr Logop 68(3):112–118

    Article  PubMed  Google Scholar 

  • Dejonckère PH (1987) Physiologie phonatoire du larynx: le concept oscilloimpédantiel. Rev Laryng 108:365–368

    PubMed  Google Scholar 

  • Dent J, Wylie J, Dodds J et al (1983) Interdigestive phasic contractions of the human lower esophageal sphincter. Gastroenterology 84:453–460

    PubMed  CAS  Google Scholar 

  • Diez Gross R, Mahlmann J, Grayhack JP (2003) Physiologic effects of open and closed thacheostomy tubes on the pharyngeal swallow. Ann Otol Laryngol 112:143–152

    Article  Google Scholar 

  • Duchin LE (1990) The evolution of articulate speech: comparative anatomy of the oral cavity in Pan and Homo. J Hum Evol 19:687–697

    Article  Google Scholar 

  • Elias ME, Sataloff RT, Rosen DC, Heuer RJ, Spiegel JR (1997) Normal strobovideolaryngoscopy: variability in healthy singers. J Voice 11(1):104–107

    Article  CAS  PubMed  Google Scholar 

  • Emerenziani S, Zhang X, Blondeau K et al (2005) Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux. Am J Gastroenterol 100:1251–1256

    Article  PubMed  Google Scholar 

  • Fant G (1983) The voice source: theory and acoustic modeling. In: Titze RI, Scherer R (eds) Vocal fold fisiology: biomechanics, acoustics and phonatory control. Center for Performing Arts, Denver

    Google Scholar 

  • Fouad YM, Khoury R, Hatlebakk JG, Katz PO, Castell DO (1998) Ineffective esophageal motility [IEM] is more prevalent in reflux patients with respiratory symptoms. Gastroenterology, Vol. 114, A123.

    Google Scholar 

  • Fussi F (2003) I parametri acustici nell’estetica e nella fisiologia del canto. In: Fusi F (ed) La voce del cantante, vol II. Omega, Turin

    Google Scholar 

  • Gerhardt DC, Shuck TJ, Bordeaux RA, Winship DH (1978) Human upper esophageal sphincter: response to volume, osmotic and acid stimuli. Gastroenterology 75:268–274

    PubMed  CAS  Google Scholar 

  • Hamdan AL, Sharara AI, Younes A, Fuleihan N (2001) Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux. Acta Otolaryngol 121(7):868–872

    Article  CAS  PubMed  Google Scholar 

  • Heman-Ackah YD, Dean CM, Sataloff RT (2002) Strobovideolaryngoscopic findings in singing teachers. J Voice 16(1):81–86

    Article  PubMed  Google Scholar 

  • Hirano M (1977) Structure and vibratory pattern of the vocald folds. In: Sawashima N, Cooper FS (eds) Dynamic aspects of speech production. University of Tokio Press, Tokio

    Google Scholar 

  • Houghton P (1993) Neandertal supralaryngeal vocal tract. Am J Phys Anthropol 90(2):139–146

    Article  CAS  PubMed  Google Scholar 

  • Jaeger MJ, Matthys H (1968) The pattern of flow in the upper human airways. Respir Physiol 6:113–127

    Article  CAS  PubMed  Google Scholar 

  • Jones K, Sigmon J, Hock L, Nelson E, Sullivan M, Ogren F (2002) Prevalence and risk factors for voice problems among telemarketers. Arch Otolaryngol Head Neck Surg 128:571–577

    Article  PubMed  Google Scholar 

  • Jurgens U (1974) On the elicitability of vocalisztion from the cortical lerynx area. Brain Res 81:564–566

    Article  CAS  PubMed  Google Scholar 

  • Karkos PD, Yates PD, Carding PN, Wilson JA (2007) Is laryngopharyngeal reflux related to functional dysphonia? Ann Otol Rhinol Laryngol 116(1):24–29

    Article  PubMed  Google Scholar 

  • Kirchner JA (1993) The vertrebate larynx: adaptation and aberrations. Laryngoscope 103:1197–1201

    Article  CAS  PubMed  Google Scholar 

  • Kouffman JA, Amin MR, Panetti M (2000) Prevalence of reflux in 113 consecutive patients with laringea and voice disorders. Otolaryngol Head Neck Surg 123:385–388

    Article  Google Scholar 

  • Koufman JA (1991) The otolaryngologic manifestation of gastroesophageal disease (GERD) a clinical investigation of 225 patients using ambulatory 24-pH monitoring and an experimental investigation of the role of acid and pepsin in the development pf laringea injury. Laryngoscope 101(Suppl 53):1–78

    Article  CAS  PubMed  Google Scholar 

  • Koufman JA, Wiener GJ, Wu WC, Castell DO (1988) Reflux laryngitis and its sequelae: the diagnostic role of ambulatory 24-hour pH monitoring. J Voice 2(1):78–89

    Article  Google Scholar 

  • Koufman JA, Aviv JA, Casiano RR, Shaw GY (2002) Laryngopharyngeal reflux: position statement of the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology–Head and Neck Surgery. Otolaryngol Head Neck Surg 127:32–35

    Article  PubMed  Google Scholar 

  • Laitman JT, Reindenberg JS (1993) Specializations of the human upper respiratory and upper digestive system as seen through comparative and developmental anatomy. Dysphagia 8:318–325

    Article  CAS  PubMed  Google Scholar 

  • Larson CR, Yajima Y, Ko P (1994) Modification in activity of medullary respiratory-related neurons for vocalisation and swallowing. J Neurophysiol 71:2294–2304

    Article  CAS  PubMed  Google Scholar 

  • Lieberman P (1979) Hominid evolution, supralaryngeal vocal tract physiology, and the fossil evidence for reconstructions. Brain Lang 7(1):101–126

    Article  CAS  PubMed  Google Scholar 

  • Long J, Williford HN, Olson MS, Wolfe V (1998) Voice problems and risk factors among aerobics instructors. J Voice 12:197–207

    Article  CAS  PubMed  Google Scholar 

  • Lotze M, Seggevies G, Erb M, Grodd W, Birbaumer N (2000) The representation of articulation in prymary sensori motor cortex. Neuroreport 11:2985–2989

    Article  CAS  PubMed  Google Scholar 

  • Lundy DS, Casiano RR, Sullivan PA, Roy S, Xue JW, Evans J (1999) Incidence of abnormal laryngeal findings in asymptomatic singing students. Otolaryngol Head Neck Surg 121(1):69–77

    Article  CAS  PubMed  Google Scholar 

  • Maddock DJ, Gilbert RJ (1993) Quantitative relationship between liquid bolus flow and laringea closure during deglutition. Am J Physiol 265:G704–G711

    Article  CAS  PubMed  Google Scholar 

  • Marchese M, Spada C, Costamagna G (2008) Stress-related esophagopharyngeal reflux during warm-up exercises in a singer. Gastroenterology 134(7):2192–2193. author reply 2193–2194. Epub 2008 May 16

    Article  PubMed  Google Scholar 

  • Milutinovic Z (1966) Classification of voice pathology. Folia Phoniatr Logoped 48:301–308

    Article  Google Scholar 

  • Mittal RK, Balaban DH (1997) The esophagogastric junction. N Engl J Med 336:924–932

    Article  CAS  PubMed  Google Scholar 

  • Mittal RK, Fisher M, McCallum RW et al (1990) Human lower esophageal sphincter response to increased abdominal pressure. Am J Phys 258:G624–G630

    CAS  Google Scholar 

  • Mozzanica F, Ginocchio D, Barillari R, Barozzi S, Maruzzi P, Ottaviani F, Schindler A (2016 Nov) Prevalence and voice characteristics of laryngeal pathology in an Italian voice therapy-seeking population. J Voice 30(6):774.e13–774.e21

    Article  Google Scholar 

  • Negus VE (1949) The comparative anatomy and physiology of the larynx. Hainemann, London

    Google Scholar 

  • Nishino T, Yonezawa T, Honda Y (1985) Effects of swallowing on the pattern of continuous respiration in human adults. Am Rev Respir Dis 12:1219–1222

    Google Scholar 

  • Oguz H, Tarhan E, Korkmaz M, Yilmaz U, Safak MA, Demirci M, Ozluoglu LN (2007) Acoustic analysis findings in objective laryngopharyngeal reflux patients. J Voice 21(2):203–210

    Article  PubMed  Google Scholar 

  • Ozturk O, Oz F, Karakullukcu B, Oghan F, Guclu E, Ada M (2006) Hoarseness and laryngopharyngeal reflux: a cause and effect relationship or coincidence? Eur Arch Otorhinolaryngol 263(10):935–939. Epub 2006 Jul 1

    Article  PubMed  Google Scholar 

  • Perello J (1962) La théorie muco-ondulatoire de la phonation. Ann Oto Larynx 79:722–725

    Google Scholar 

  • Pregun I, Bakucz T, Banai J, Molnár L, Pavlik G, Altorjay I, Orosz P, Csernay L, Tulassay Z, Herszényi L (2009) Gastroesophageal reflux disease: work-related disease? Dig Dis 27(1):38–44. Epub 2009 May 8

    Article  PubMed  Google Scholar 

  • Pribuisienë R, Uloza V, Saferis V (2005) Multidimensional voice analysis of reflux laryngitis patients. Eur Arch Otorhinolaryngol 262(1):35–40

    Article  PubMed  Google Scholar 

  • Purves D, Litchman JW (1985) Principles of neural development. Sinauer, Sunderland, MA, p 340

    Google Scholar 

  • Remacle M, Lawson G (1994) Troubles fonctionelle du larynx. Encycl Méd Chir Oto-rhino-laryngologie. Elsevier, Paris

    Google Scholar 

  • Rosen AC, Murry T (2000) Nomenclature of voice disorders and vocal pathology. In: Rosen AC, Murry T (eds) The otolaryngologic clinics of North America (voice disorders and phonosurgery II). WB Saunders Co., Philadelphia

    Google Scholar 

  • Rothstein SG (1998) Reflux and vocal disorders in singers with bulimia. J Voice 12(1):89–90

    Article  CAS  PubMed  Google Scholar 

  • Roy N, Merrill RM, Gray SD, Smith EM (2005) Voice disorders in the general population: prevalence, risk factors, and occupational impact. Laryngoscope 115(11):1988–1995

    Article  PubMed  Google Scholar 

  • Sapir S, Keidar A, Mathers-Schmidt B (1993) Vocal attrition in teachers: survey findings. Eur J Dis Comm 28:177–185

    Article  CAS  Google Scholar 

  • Sataloff RT (1992) The human voice. Sci Am 267:108–115

    Article  CAS  PubMed  Google Scholar 

  • Sataloff RT (1993) The human voice. Sci Am 267:108–115

    Article  Google Scholar 

  • Sataloff RT (1997) Professional voice. The science and art of clinical care, 2nd edn. Singular Publishing, San Diego

    Google Scholar 

  • Sataloff RT, Spiegel JR, Hawkshaw MJ (1991) Strobovideolaryngoscopy: results and clinical value. Ann Otol Rhynol Laryngol 100(9):725–727

    Article  CAS  Google Scholar 

  • Sataloff RT, Castell DO, Katz PO, Sataloff DM (2006) Reflux laryngitis and related disorders, 3rd edn. Plural Publishing, San Diego

    Google Scholar 

  • Schindler O (1980) Afonie e disfonie. In: Schindler O (ed) Breviario della patologia della comunicazione. Omega Edizioni, Torino

    Google Scholar 

  • Schwartz SR, Cohen SM, Daily SH, Rosenfeld RM et al (2009) Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg 141:S1–S31

    Article  PubMed  Google Scholar 

  • Segre R (1976) La comunicazione orale normale e patologica. Edizioni Medico Scientifiche, Torino

    Google Scholar 

  • Sereg-Bahar M, Jansa R, Hocevar-Boltezar I (2005) Voice disorders and gastroesophageal reflux. Logoped Phoniatr Vocol 30(3–4):120–124

    Article  PubMed  Google Scholar 

  • Shafik A, El-Sibai O, Shafik AA et al (2004) Effect of straining on the lower esophageal sphincter: identification of the “strainingesophageal reflex” and its role in gastroesophageal competence mechanism. J Investig Surg 17:191–196

    Article  Google Scholar 

  • Siupsinskiene N, Adamonis K, Toohill RJ (2009) Usefulness of assessment of voice capabilities in female patients with reflux-related dysphonia. Medicina (Kaunas) 45(12):978–987

    Article  Google Scholar 

  • Smith E, Lemke J, Taylor M, Kirchner L, Hoffman H (1998) Frequency of voice problems among teachers and other occupations. J Voice 12:480–488

    Article  CAS  PubMed  Google Scholar 

  • Soulié A, Bardier F (1907) Recherches sur le developpement du larynx chez l’homme. J Anat Physiol 43:137–240

    Google Scholar 

  • Spiegel JR, Sataloff RT, Cohn JR, Hawkshaw M, Epstein J (1988) Respiratory function in singer: medical assessment, diagnosis and treatment. J Voice 2(1):40–50

    Article  Google Scholar 

  • Titze IR (1994a) Principles of voice production. Prentice Hall, Englewood Cliffs, NJ

    Google Scholar 

  • Titze IR (1994b) Control of vocal intensity and efficiency. In: Titze IR (ed) Principles of voice production. Prentice Hall, Englewood Cliffs, NJ

    Google Scholar 

  • Titze I, Lemke J, Montequin D (1997) Populations in the U.S. Workforce who rely on voice as a primary tool of trade: a preliminary report. J Voice 11:254–259

    Article  CAS  PubMed  Google Scholar 

  • Ursino F Le disfonie. In: Schindler O, Genovese E, Rossi M, Ursino F (eds) Foniatria. Masson, Milano

    Google Scholar 

  • Van Den Berg J (1954) Sur lès théories myoélastique et neurochronaxique de la phonation. Rev Laryngol 75:492–512

    Google Scholar 

  • Vashani K, Murugesh M, Hattiangadi G, Gore G, Keer V, Ramesh VS, Sandur V, Bhatia SJ (2010) Effectiveness of voice therapy in reflux-related voice disorders. Dis Esophagus 23(1):27–32. Epub 2009 Jun 22

    Article  CAS  PubMed  Google Scholar 

  • Vilkman E (2000) Voice problems at work: a challenge for occupational safety and health arrangement. Folia Phoniatri Logop 52:20–125

    Google Scholar 

  • Widdicombe J (1986) The neural reflexes in the airways. Eur J Resp Dis Suppl 144:1–33

    CAS  Google Scholar 

  • Wiener GJ, Koufmann JA, Wu WC et al (1989) Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-pH monitoring. Am J Gasroenterol 84:1,503–1,508

    CAS  Google Scholar 

  • Wingate JM, Brown WS, Shrivastav R, Davenport P, Sapienza CM (2007) Treatment outcomes for professional voice users. J Voice 21(4):433–449

    Article  PubMed  Google Scholar 

  • Wolfson VP, Laitman JT (1990) Ultrasound investigation of fetal human upper respiratory anatomy. Anat Rec 227:363–372

    Article  CAS  PubMed  Google Scholar 

  • Wuttge-Hannig A, Hannig C (2009) Diagnostica per immagini. In: Schindler O (ed) La voce. Fisiologia, patologia clinica e terapia. Piccin, Padova

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniele Farneti M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Farneti, D. (2017). Voice and Dysphagia. In: Ekberg, O. (eds) Dysphagia. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_110

Download citation

  • DOI: https://doi.org/10.1007/174_2017_110

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-68571-7

  • Online ISBN: 978-3-319-68572-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics