neurogenic voice disorders Flashcards
(41 cards)
What is a neurogenic voice disorder?
They arise from impairments in the nervous system, that affect the muscles for voice production!
Can happen bc of neurological conditions
Leads to changes in voice quality, pitch, loudness and vocal effrot
What is the RLN important for?
All muscles except the cricothyroid
What is VF paralysis?
Most common neurogenic VD
Usually happens because of lesions of the RLN, less commonly seen in SLN
“The location of the lesion along the pathway will determine the type of paralysis and the resultant voice quality.”
What are some causes of VF paralysis?
- Surgical trauma
- Cardiovascular disease
- Neurological disease
- Mechanical trauma
- Idiopathic onset (often following viral infections)
What is peripheral paralysis?
Peripheral nerve damage causes paralysis that is flaccid! The nerve doesnt get CNS instruction
Leads to loss of intrinstic muscle tone and atrophy of muscle tissue
What are the five positions of a paralyzed VF?
Median (fully adducted)
Paramedian
Intermediate
Abducted
Wide abducted
What is low peripheral paralysis?
Isolated SLN paralysis= leads to cricothyroid paralysis, affecting pitch and causing laryngeal asymmetry
Isolated RLN paralysis= paralyzed VF rests in paramedian position, allows for near normal voice production but may cause issues with voice strength and quality
What is high peripheral paralysis?
This is COMBINED SLN and RLN nerve paralysis where VF rests in open position!! Causes significant voice and airway protection issues
What is adductor paralysis?
This is when muscles that bring the VF together are impaired
Leads to a breathy/weak voice because of incomplete closure of VF during phonation
What is abductor paralysis?
When is when muscles that seperate the VF are paralyzed (PCA), can lead to breathing issues ):
What are the four types of VF paralysis?
Unilateral adductor paralysis
Bilateral adductor paralysis
Unilateral abductor paralysis
Bilateral abductor paralysis
What is Unilateral adductor paralysis?
Most common type of VF paralysis
It is frozen in intermediate, abducted or wide abducted position
The position and vertical height of the abducted fold and resulting gap determines the severity of the voice disorder
Tx= voice therapy or phonosurgery
What is the voice quality of unilateral adductor paralysis?
Voice quality is breathy and can be
diplophonic
Vocal intensity and range are decreased
Patients complain of physical fatigue
because of increased vocal effort
What is bilateral adductor paralysis?
Both VF are frozen in abducted position
Good respiration
Poor phonation or complete aphonia
High risk of aspiration; gastronomy tubes needed in patients
Bilateral adductor paralysis tx?
Nasogastric or Percutanous Endoscopic
Gastrostomy (PEG) feeding tube
Augmentative communication devices:
electrolarynx, speech amplification systems
Fibrosis and contraction of the glottis starts 6-9
months post onset and can reduce the glottal
opening considerably
This approximation of the vocal folds facilitates
breathy, hoarse phonation and increases airway
protection but may decrease the air passage
What is unilateral abductor paralysis?
When the paralyzed fold is in median or paramedian position
Usually good respiration, phonation and protecting because of the other fold
Flaccid paralysis of affected fold decreases patients dynamic range
Airway diameter is reduced which may lead to inspiratory stridor in heavy physical activity
Tx= not much, voice therapy to increase dynamic range
What is bilateral abductor paralysis?
Both vocal folds are paralyzed in the
adducted position
The most severe form of vocal fold
paralysis
May severely compromise respiration
Vocal function and airway protection are
usually good
Tx= Tracheotomy, if necessary
Phonosurgery: lateral suturing or complete
removal of one arytenoid opens the airway
– Increases risk of aspiration during swallowing
– Vocal function deteriorates
Post-operative voice and swallowing therapy to restore vocal function and prevent aspiration
What is superior nerve paralysis?
Less often than RLN paralysis
Causes: Thyroid surgery or thyroid disease!!
Hard to diagnose ):
EMG confirmation needed
Can be idiopathic as well
If its isolated, its hard to detect because only the cricothyroid is affected, patients may notice diff in range or pitch as a result
What is unilateral SLN paralysis?
Asymmetrical approximation of the cricoid and thyroid cartilages leads to an oblique position of the VF leading to a vertical gap
Despire the incomplete VF closure, many speakers still have good conversational speech!
Pitch and intensity range are decreased too
Vocal fatigue
Inability to sing ):
What is bilateral SLN paralysis?
Very rare and an EMG confirmation is necessary
Cricothyroid paralysis leads to decreased lengthening of VF
Reduced pitch and intensity range
Now the patient cannot stretch VF with one cricothyroid
Very little variation beyond regular speaking voice
What is treatment for SLN paralysis?
Nothing! LMAO
No medical treatment
Voice therapy= can educate and do voice conservation as appropriate
Help patient get remaining voice
Use activating voice therapy
What is myasthenia gravis?
It is an autoimmune lower motor neuron impairment that causes rapid muscle fatigue
Usually generalized throughout body but can be isolated to vocal fatigue as well
This is when prolonged speech tasks result in fatigue, rest improves symptoms
Voice giving out and coming back w rest
What is the tx for myasthenia gravis?
Anticholinesterase medications (improve neuromuscular transmission)
Immunosuppressive drugs reduce abnormal antibodies
Voice therapy in individuals who continue to show symptoms and in severe cases use voice amplification
What is spasmodic dysphonia?
Etiology = the older literature suspected a neuropsychiatric origin
More recent literature concludes that spasmodic dysphonia is a focal dystonia (movement disorder)
Thought to be psychological
Hard time producing voice, it is unpredictable and you really cannot overcome it!
