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Voice and Speech

Speech is a complex process that starts with muscle movement,which involves phonation (voice); respiration (breathing process); and articulation (throat, palate, tongue, lips, and teeth).

These muscle movements are initiated, coordinated, and controlled by the brain, and monitored through hearing and touch.

Voice production, or phonation, is generating and modulating sound as part of the speech process.

Voice is created in the vocal cords (or vocal folds) of the larynx.

The larynx, often referred to as the voice box, is a two-inch long tube-shaped organ located in the neck at the top of the trachea (windpipe). The cartilage in front of the larynx is sometimes called the "Adam's apple."

The vocal cords (or vocal folds) are two bands of muscle that form a "V" shape inside the larynx.

The area of the larynx where the vocal cords are located is called the glottis. The area above the cords is called the supraglottis, and the area below the cords is called the subglottis. The epiglottis is a flap at the top of the trachea that closes over the larynx to protect it from food that is swallowed into the esophagus.

Breath enters the body through the nose or mouth, and then travels to the larynx, trachea, and into the lungs. It exits along the same path. Normally, no sound is made by the vocal cords during breathing or exhaling.

When a person talks, the vocal cords tighten, move closer together, and air from the lungs is forced between them. This makes them vibrate and produces sound.

Source: National Institute on Deafness and Other Communication Disorders

What is stuttering?

Stuttering, sometimes referred to as stammering or diffluent speech, is a speech disorder. As a person who stutters tries to speak, he/she may exhibit these characteristics:

  • frequent repetitions (prolongations) of speech sounds, syllables, or words
  • rapid blinking of the eyes
  • tremors in the lips or jaw
  • other struggling behaviors

Stuttering affects more than 3 million people in the United States. Although it most frequently occurs in children between the ages of 2 and 6, it can affect all age groups. It occurs three times more often in males than females.

What causes stuttering?

The exact mechanical causes of stuttering are not completely understood, but it is thought to be a hereditary condition.

What are the different types of stuttering?

There are several types of stuttering, including:

  • developmental
    This is the most common type of stuttering, which occurs in children. As their speech and language processes are developing, they may not be able to meet verbal demands.
  • neurogenic
    Neurogenic stuttering is also a common disorder that occurs from signal problems between the brain and nerves and muscles.
  • psychogenic
    Psychogenic stuttering is believed to originate in the area of the brain that directs thought and reasoning. This type of stuttering may occur in people with mental illness or who have experienced mental stress or anguish. However, although stuttering may cause emotional problems, it is not believed to the result of emotional problems.

How is stuttering diagnosed?

In addition to a complete medical history and physical examination, diagnosis of stuttering may also include:

  • detailed history of the development of the disorder
  • evaluation of speech and language abilities by a speech-language pathologist

Treatment for stuttering:

Specific treatment for stuttering will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent of the disorder

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disorder

  • your opinion or preference

The goal of treatment is to focus on relearning how to speak, or to unlearn incorrect ways of speaking. Although there is no cure for stuttering, early intervention may keep stuttering from becoming a life-long problem. Speech and language evaluation is suggested for children who exhibit stuttering or struggle behaviors associated with speech for more than six months.

Medications and electronic devices to treat stuttering are sometimes used.

Parents of children who stutter may be encouraged to:
  • provide an atmosphere in the home that is relaxed and allows ample opportunity for the child to speak.
  • listen attentively to the child.
  • wait for the child to say the words without saying them for him/her.
  • speak slowly and in a relaxed manner, which may encourage the child to speak the same way.
  • talk openly about the stuttering if the child brings up the subject.
  • avoid criticizing, punishing, or asking the child to repeat words correctly.
  • avoid asking the child to speak for others.

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Online Resources of Otolaryngology

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