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Breathiness results when the vocal folds are slightly open during phonation. While pitch and intensity are related to the physical measures of frequency and intensity, the quality of voice is related to the complexity of the sound wave and many other factors, some of which are not easily measured. Nevertheless, qualities of voice other than its pitch and loudness exist. The drugs also thicken the vocal folds and decrease the vocal pitch. Generally speaking, normal laryngeal structures, acceptable vocal behaviors, appropriate use of the airflow, normal oral-nasal cavities, and good health are all needed to produce normal voice. Drugs that contain male hormones are sometimes used in the treatment of cancer. The vocal folds and the neural innervation to the folds are normal, and a laryngeal examination reveals normal vocal folds. The fundamental frequency of some female speakers changes to a lower level around the time of menopause. Poor general health, diseases of the larynx, faulty ways of producing voice, inappropriate use of the airflow, and deviant oral-nasal cavities can contribute to problems of voice quality. It is known that a lowered level of estrogen and progesterone before the menses can cause a thickening of the vocal folds. Pitch disorders due to hormonal changes are more frequent in females than in males. The essential treatment procedure remains the same as that described for the high-pitched male speaker, except that the clinician progressively models and reinforces lower pitched voice. However, an extremely high-pitched female voice is noticeable for that reason, and voice therapy may be needed. Clinician prefer to treat their clients. The clinicians who believe that functional aphonia is psychogenic, because it is due to an unconscious psychological conflict, prefer to treat their clients with counseling or psychotherapy. However, the person may continue to be aphonic even after the laryngeal disease has been effectively treated or total silence is no longer needed, and thus aphonia at this stage is functional. However, the person may continue to be aphonic even after the laryngeal disease has been effectively treated or total silence is no longer needed and thus aphonia at this stage is functional. The air that escapes through the glottis adds noise to the sound produced by the vocal folds. Of course, the vocal folds must move toward each other to phonate, but when they do not fully approximate, the voice sounds breathy. Menopause is associated with an increased secretion of androgen, which causes a thickening of the vocal folds, hence the lowering of the pitch. These qualities are of immense clinical significance because they often are deviant in vocal pathologies and voice disorders. The air leak and the resulting noise are perceived as breathiness. Vocal changes due to some medication may be irreversible. For example, uterine cancer in women often is treated with testosterone. This can lower pitch and induce some hoarseness as well. Menstruation, menopause, and virilization of the female voice have all been associated with pitch changes. However, the individual is without a voice. Such drugs have a virilizing effect on the female. In most cases, pitch changes experienced before and during menstruation are not a major problem. This type of aphonia is sometimes described as hysterical aphonia or psychogenic aphonia.
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