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CD 661 Voice > Neurologic Voice Disorders > Flashcards

Neurologic Voice Disorders Flashcards

1
Q

What are the three categories of phonatory dysfunction?

A
  • adduction/abduction problems*
  • stability problems*
  • coordination problems*
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2
Q

The following are part of adduction/abduction problems except for:

A.) Vocal Fold Paralysis

B.) SLN Paralysis

C.) Huntington’s Corea

D.) Parkinson’s

E.) All except D

A

Vocal Fold Paralysis, Vocal Fold Paresis, SLN Paralysis, Pseudobulbar Palsy, Adductor Spasmodic Dysphonia, Huntington’s Corea

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3
Q

What are the five categories of Neurological Voice Disorders?

A

Category I : Constant voice disorders

Category II : arrhythmically fluctuating

Category III : rhythmically fluctuating

Category IV : Paroxysmal

Category V : Loss of volitonal phonation

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4
Q

True or False: Paralysis in the adducted position causes strained/strangled, monotone, low pitched, low volume voice (hypernasality), and respiratory compromise

A

True

*Vocal Fold Bilateral Paralysis

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5
Q

True or False: Paralysis in the abducted position causes aphonia and lack of airway protection for swallowing

A

True

*Vocal Fold Bilateral Paralysis

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6
Q

Some of the causes for Bilateral VF Paralysis:

A

cerebral damage, damage to brainstem in area of CN X

*44% latrogenic

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7
Q

Management of Bilateral VF Paralysis

Abductor Paralysis (PCA is paralyzed) and VFs in medial or paramedian position

A

airway is acceptable, wait and see if nerves spontaneously recover

cordectomy, arytenoidectomy or VF lateralization

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8
Q

Management of Bilateral VF Paralysis:

Adductor paralysis (TA, LCA & IA are paralyzed) and VFs in abducted position

A
  • tracheostomy*
  • AC medial rotation*
  • *Dx: Endoscopy*
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9
Q

Unilateral Vagus Nerve X accounts for 90% of ______ and cause flaccidity, decreased tone and dysphagia

A

Unilateral Vocal Fold Paralysis

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10
Q

True or False: Common cause is disease or trauma to RLN (Recurrent Laryngeal Nerve) with injury to the left during surgery in Unilateral Vocal Fold Paralysis

A

True

* Dx: videostroboscopy, EMG, MRI, CN Exam X and XI

*Other causes: unilatearl brainstem strokes, unilateral trauma to RLN, and viral infection

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11
Q

Perceptual:

hoarse, breathy, weak, strained

A

Unilateral Vocal Fold Paralysis

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12
Q

True or False: There is no compensatory muscle tension present in Unilateral Vocal Fold Paralysis

A

False - there is compensatory muscle tension

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13
Q

What’s this?

A

Unilateral Vocal Fold Paralysis

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14
Q

Most common causes for SLN Paralysis are:

A.) latrogenic

B.) viral infections

C.) thyroid surgery

D.) only a and b

E.) All of the above except for D

A

E - all of the above except for D

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15
Q

Videostroboscopic:

look for rotation of posterior glottis to affected side, look for difference in vertical level of VFs

A

SLN Paralysis

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16
Q

Perceptual:

decreased habitual pitch, breathiness, decreased pitch and intensity ranges

A

SLN Paralysis

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17
Q

Some of the causes for Vocal Fold Paresis are:

A.) Neuropathy

B.) Goiter/Thyroiditis

C.) Idiopathic

D.) Lyme’s Disease

E.) All of the above

A

E - all of the above

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18
Q

Distinguishing feature from Laryngeal Muscle Tension and Vocal Fold Paresis:

A

Videostroboscopy:

rapid repeated ‘ee’

repeated ‘ee-hee, pa, ta, ka’

whistling

19
Q

Perceptual:

decreased intensity range and max intensity breathiness, hoarseness, unstable, inconsistent phonation, vocal fatigue

A

Vocal Fold Paresis

*Paresis: muscle weakness

20
Q

Aging, muscle atrophy (hypotonicity), stiffer, thinner mucosa in males, edematous in females, ossification of cartilages,

A

Presbyphonia/Presbylarynges

21
Q

Videostroboscopic:

vocal processes prominence, atrophy and VF thinning, VF bowing, glottic gap, decreasd amplitude of vibration, edema, yellowish coloration

A

Presbylaryngis/Presbyphonia

22
Q

Perceptual:

breathy, hoarse, low pitch, tremor

A

Presbyphonia

23
Q

What’s this?

A

Presbylaryngis

24
Q

CNS lesion, possibly basal ganglia and supplementary motor areas

A

Spasmodic Dysphonia

25
Q

How many types of Spasmodic Dysphonia are there?

A

Three

26
Q

This type of Spasmodic Dysphonia is where the LCA, IA, and TA spasm periodically causing undesired hyperadduction, resulting in harsh, strained and strangled sound

A

Adductor

27
Q

The type of Spasmodic Dysphonia were the PCA spasms and abducts the Vocal Folds causing a breathy, weak voice, decreased loudness is a problem

A

Abductor

28
Q

The combination of both types of Spasmodic Dysphonia

A

Mixed SD

29
Q

True or False: Does not affect women as much, age of onset is between 30-50 years, reported occuring after URI (Upper Respiratory Infection)

A

False - affects women more

30
Q

True or False: The main difference betwen Abductor and Adductor Spasmodic Dysphonia is that Adductor sounds more strained, while Abductor patients have trouble transitioning from voiceless stops to vowels

A

True

31
Q

CNS lesion in the extrapyramidal system

A

Essential Tremor

32
Q

True or False: The tremor frequency characterized in Essential Tremor is about 10 - 15 Hz

A

False - 3 - 7 Hz

33
Q

The following characteristics about Essentail Tremor are true except for:

A.) Called Organic or Familial Tremor

B.) Isolated to the voice, but can also be associated to the head, jaws, hands, etc.

C.) Quiet at rest but present during volitional movement

D.) Sometimes present in sustained phonation

E.) All of the above except for D

A

E - Always present in sustained phonation

34
Q

What are the two steps involved differentially diagnosing SD, MTD, and Tremor?

A

Step One - perform laryngeal palpation

Step Two - perform laryngeal massage and teach supraglottic relaxation exercises

*MTD = voice will improve

*Tremor = tension/strain will decrease and tremor present

*SD = little change

35
Q

Bilateral lesions in corticobulbar tract at level of internal capsule, midbrain or pons

A

Pseudobulbar Palsy

36
Q

True or False - laryngeal muscle weakness and hyperactivity co-exist causing both hyperadduction and incomplete closure in Pseudobulbar Palsy

A

True

*Treatment: Easy onset phonation, flow phonation, aspirated onsets, frontal tone focus, adequate breath support

37
Q

Perceptual:

breathiness, strain/struggle, harshness, monopitch, monoloudness

A

Pseudobulbar Palsy

38
Q

Progressive disease of unknown cause in which affects upper and lower motor neurons (causing the muscles waste away, twitch, weaken, and spasm)

A

ALS - amyotropic lateral sclerosis

*articulation problems, dysphagia

39
Q

Perceptual:

hoarseness, harshness, strain/struggle, hypernasal, breathy

A

ALS

40
Q

The hyperkinesias (lesion to basal ganglia or other parts of extrapyramidal system) are:

*HINT: too much movement

A

Choreas: quick, jerky, purposeless movement
-irregular pitch/loudness, irregular respiration

Athetosis: hyperkinetic dystonia - slow, writhing movements
-variable loudness, pitch, vocal quality

Huntington’s Chorea: autosomal dominant,
-strained, strangled, harsh, monopitch, variable loudness, jerky irregular bursts of loud voice

41
Q

The hypokinesias (too little movement) are:

A

Parkinson’s Disease: lack of dopamine in substantia nigra
-breathy, weak, decreased loudness, monopitch, monoloudness, hoarse/harsh

42
Q

Videostroboscopic:

vocal fold bowing or incomplete, compensatory supraglottic squeezing, A-P compression, FVF approximation

A

Parkinson’s Disease

43
Q

Demyelinating progressive disease that attacks myelin sheath

A

Multiple Sclerosis

*Voice: impaired loudness control, harshness, hypernasality, decreased respiratory control, slow speech rate, impaired articulation

44
Q

Autoimmune disease, progressive failure to sustain maintain or repeated contraction of striated muscles due to blockage of acetylcholine at Neuromuscular Junction (muscle flaccidity)

A

Myasthenia Gravis

*onset 30 (women), 60 (men)
*Voice: breathy, hypernasality, weak voice, decreased loudness, intermittent aphonia

*Incomplete adduction/abduction of VF with movement deterioration with task repetition

CD 661 Voice (13 decks)

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