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Speech, language, and voice disorders.

Disorders of speech, language, and voice are still somewhat underappreciated within the otolaryngology community. Although not as prevalent as hearing disorders, speech-language and voice problems are more common than many of us may appreciate. Information available through the federal government (www.nidcd. and the American Speech-Language-Hearing Association (ASHA) ( sld.htm) provides data with which otolaryngologists should be familiar, some of which is reviewed in this editorial.

Speech and language disorders affect articulation, fluency, comprehension, and language expression and reception. Structural defects may cause speech disorders. Rarely, an extremely short lingual frenulum, for example, may prevent enunciation of some consonants. More major defects have obvious adverse effects on speech. Cleft palate is one example, and it occurs in approximately 1 of every 700 births, making it the fourth most common birth defect. Speech disorders differ from voice disorders, which affect phonation, although speech-language and voice disorders may occur concurrently.

Etiologies such as head trauma commonly cause disorders of speech-language and voice. As the National Institute on Deafness and Other Communication Disorders (NIDCD) has noted, head injuries are particularly common among males between 15 and 24 years of age, young children, and people more than 75 years of age. Motor vehicle accidents, falls, and violent crimes are among the most common causes. However, there are many other etiologies that give rise to impairments of speech, language, voice, or a combination of these functions.

Because our society is still relatively tolerant of speech, language, and voice disorders, they may be overlooked or ignored; however, we see them often. In young children, the prevalence of speech sound disorders is 8 to 9%; approximately 5% of children have noticeable speech disorders identified by the time they enter first grade, most of which are idiopathic. (1)

Language impairment may involve the form of language (syntax, phonology, morphology), language content (semantics), or language function. Language impairment is present in 6 to 8 million people in the United States, about 1 million of whom have aphasia. (1) Aphasia is associated most commonly with stroke and results in defects in language, expression, or comprehension. About 3 million Americans stutter; stuttering is most common from the ages of 2 to 6 years and is three times more prevalent in boys than girls. (1) It resolves in most cases but can persist throughout life, affecting fewer than 1% of adults. (1)

Voice disorders affect vocal quality, pitch, volume, resonance, endurance, effort, and other characteristics. They usually are associated with laryngeal function or dysfunction. The NIDCD estimates that approximately 7.5 million people in the United States have voice disorders. (1) However, many laryngologists believe that this figure underestimates the prevalence of voice disorders because of societal acceptance of phonation that is tolerated as "normal" but that laryngologists and speech-language pathologists would consider pathologic. In some cases, pathologic voices are even admired or revered as has been the case with many sports announcers, blues singers, and world-class performers, such as Louis Armstrong and perhaps Lauren Bacall, Debra Winger, and others.

A great many causes of dysphonia exist, including voice abuse or misuse, congenital malformations of the vocal folds such as sulcus vocalis, laryngopharyngeal reflux, hypothyroidism or other endocrine dysfunction, vocal fold paresis or paralysis, papillomatosis, laryngeal cancer, and many others. Like disorders of speech and language, dysphonia may be a symptom of serious underlying pathology that can have long-term, adverse health effects not only on the voice, but also systemically.

In the past few decades, awareness of voice disorders among otolaryngologists has improved, and awareness of speech and language disorders might have improved somewhat. However, these problems are still not highlighted in many residency programs, and diagnosis and treatment in many centers remain relegated to speech-language pathologists, neurologists, and other non-otolaryngologists.

Speech, language, and voice disorders are common, and they are important impairments for our patients. Otolaryngologists should not only be familiar with scientific and clinical advances in the diagnosis and treatment of these disorders, but we also should be the leaders among medical professionals who recognize, diagnose, and treat them. Information on these subjects should be included and stressed within our training programs, and we should be involved in the establishment and leadership of the interdisciplinary teams required for optimal management of impairments of speech, language, and phonation.


(1.) Statistics about Voice, Speech, and Language. National Institute on Deafness and Other Communication Disorders. National Institutes of Health. aspx. Last accessed October 6, 2011.

Robert T. Sataloff, MD, DMA, FACS Editor-in-Chief EAR, NOSE & THROAT JOURNAL
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Title Annotation:EDITORIAL
Author:Sataloff, Robert T.
Publication:Ear, Nose and Throat Journal
Article Type:Editorial
Geographic Code:1USA
Date:Nov 1, 2011
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