neurogenic voice disorders Flashcards
(59 cards)
1
Q
what does the recurrent laryngeal nerve (RLN) innervate?
A
all intrinsic laryngeal muscles EXCEPT cricothyroid
2
Q
what does the external superior laryngeal nerve (SLN) innervate? internal?
A
- external: motor to cricothyroid
- internal: sensory to larynx
3
Q
what is the most common neurogenic voice disorder?
A
vocal fold paralysis
4
Q
what is the most frequent cause of VF paralysis?
A
peripheral involvement of RLN
5
Q
etiologies of VF paralysis? (5)
A
- surgical trauma
- cardiovascular disease
- neurological disease
- mechanical trauma
- idiopathic onset (often follows virus)
6
Q
peripheral nerve damage causes paralysis that is ____ in nature. what does this lead to (2)?
A
- flaccid
- flaccid paralysis leads to loss of intrinsic muscle tone + atrophy of muscle tissue
6
Q
LOW PERIPHERAL PARALYSES: what does isolated supralaryngeal nerve paralysis lead to? what about isolated recurrent nerve paralysis?
A
- Isolated SLN paralysis: isolated cricothyroid paralysis; laryngeal asymmetry.
- isolated RLN paralysis: paralyzed VF rests in paramedian position.
7
Q
what is high peripheral paralysis? (2)
A
- combined RLN and SLN paralysis
- VF rests in abducted position
8
Q
positions of paralyzed VFs? (5)
A
- medial (fully adducted)
- paramedian
- intermediate
- abducted
- wide abducted
9
Q
what is bilateral abductor paralysis? (3)
A
- VFs paralyzed in ADDUCTED position
- may severely compromise respiration
- vocal function and airway protection usually good
10
Q
what is the most severe form of VF paralysis?
A
bilateral abductor paralysis
11
Q
bilateral abductor paralysis tx?
A
- tracheotomy if necessary
- phonosurgery (suturing or complete removal of one arytenoid)
- post-op voice and swallowing tx
12
Q
cons of phonosurgery for bilateral abductor paralysis? (2)
A
- +risk of aspiration
- -vocal function
13
Q
what is bilateral adductor paralysis? (4)
A
- VFs stuck in ABDUCTED position
- good respiration
- poor phonation or complete aphonia
- high risk of aspiration
14
Q
bilateral adductor paralysis tx? (2)
A
- gastronomy feeding tube
- AAC (i.e., electrolarynx, speech amp system)
15
Q
bilateral adductor paralysis: what happens 6-9 months post onset? what voice quality does this lead to?
A
- fibrosis and contraction of glottis
- breathy/hoarse
16
Q
bilateral adductor paralysis: sometimes an arytenoid may collapse. what happens as a result?
A
- some phonation may occur
17
Q
what is unilateral abductor paralysis? (4)
A
- paralyzed fold remains in median (or paramedian) position
- usually good resp, phonation, and aspiration protection bc other fold is functional
- dynamic range decreased
- airway diameter reduced; may = stridor during physical activity
18
Q
unilateral abductor paralysis tx? (1)
A
voice tx to increase dynamic range
19
Q
what is unilateral adductor paralysis (2)? symptoms (3)?
A
- paralyzed fold is frozen in intermediate, abducted, or wide abducted position
- severity depends on position and vertical height of abducted fold
- symptoms: breathy or diplophonic voice, vocal intensity/range decreased, physical fatigue
20
Q
what is the most common type of VF paralysis?
A
unilateral adductor paralysis
21
Q
unilateral adductor paralysis tx? (2)
A
- voice tx
- phonosurgery to push to midline
22
Q
causes of superior nerve paralysis (3)? how do you diagnose it (3)?
A
- causes = thyroid surgery, thyroid disease, idiopathic
- dx via visual and stroboscopic exam + EMG confirmation bc voice is not very impacted
23
Q
if a pt has superior nerve paralysis, what symptom might let them know that somethings wrong?
A
less range or diplophonia when raising pitch to falsetto
24
which register would bilateral SLN paralysis leave a pt with?
modal
25
what does cricothyroid paralysis lead to?
decreased lengthening of VFs
26
how does unilateral SLN paralysis lead to vertical gap?
asymmetrical approx of cricoid + thyroid cartilages = oblique position of VFs
27
what effects does unilateral SLN paralysis have on voice? (4)
- despite incomplete closure, usually good convo speech
- decreased pitch and intensity range
- vocal fatigue
- inability to sing
28
SLN paralysis tx? (1)
voice tx only; education and voice convo
29
what is mysasthenia gravis? (3)
- autoimmune lower motor neuron impairment = rapid muscle fatigue
- can be isolated to vocal fatigue (myasthenia laryngis) or velar fatigue with hypernasality
- with rest, symptoms improve
30
myasthenia gravis tx? (4)
- anticholinesterase meds (+neuromuscular transmission)
- immunosuppressive drugs (-abnormal antibodies)
- voice tx
- voice amp in severe cases
31
what is spasmodic dysphonia? (2)
- strained and effortful voice production
- recent lit says it's a focal dystonia
32
what is a focal dystonia? (3)
1. involuntary
2. task-specific
3. action-induced
33
briefly define:
a) blepharospasm
b) spasmodic torticollis
c) oromandibular dystonia
d) meige's syndrome
e) writer's cramp
a) eyelid twitch
b) unilateral neck/shoulder contraction
c) jaw shut or open
d) blepharospasm + oromandibular dystonia
e) finger spasm during fine motor activities
34
spasmodic dystonia is associated with lesions in the _______.
extrapyramidal system close to the basal ganglia
35
characteristics of spasmodic dysphonia? (4)
1. effortful voice production
2. non-speech may be unaffected
3. non-propositional speech (emotional, singing) may be possible
4. persists regardless of emotional status
36
T or F: secondary behaviours can occur with spasmodic dysphonia
true
37
how do some pts with spasmodic dysphonia ease their symptoms? (2)
- elevating pitch
- whispering
38
is spasmodic dysphonia more prevalent in males or females? adults or children?
- females
- middle age adults
39
what is onset of spasmodic dysphonia associated with? (2)
- traumatic events
- upper resp infections
40
when do symptoms of spasmodic dysphonia peak?
during first year
41
what are the 3 types of spasmodic dysphonia?
1. adductor type (involuntary adductions)
2. abductor type (involuntary abductions, often after voiceless consonants)
3. mixed type
42
which type of spasmodic dysphonia is more frequent?
adductor type
43
T or F: adductor type spasmodic dysphonia is associated with vocal hypofunction and decreased muscle tone
false -- vocal hyperfunction and increased muscle tone
44
T or F: spasmodic dysphonia can be quickly diagnosed
false -- requires careful examination of the individual’s speech and voice symptoms across time
45
T or F: medical and behavioural therapy have NOT been proven to be consistently effective for spasmodic dysphonia
true
46
how is botulinium toxin used to treat spasmodic dysphonia?
in extremely diluted form, botox can be used to deactivate specific muscles for weeks or months
47
botox eligibility criteria? (2)
- symptoms are persistent or progressive
- behavioural tx and speech therapy have failed to produce successful results
48
where do you inject botox for adductor vs abductor type spasmodic dysphonia? how successful is this?
- adductor type: vocalis muscle (usually successful)
- abductor type: PCA or vocalis mucsle (results can be less predictable)
49
current vs historical botox injection techniques?
- current: percutaneous thru CT space with EMG/endoscopy
- historically: intraoral with laryngeal mirror
50
voice tx for spasmodic dysphonia? (2)
- confidential voice
- relaxation techniques to reduce effort and 2nd behaviours
51
what is essential (idiopathic) vocal tremor? (2)
- CNS disorder characterized by rhythmic tremors (4-7Hz)
- tremor can effect head, arms, tongue, larynx in isol or combo
52
when is most common vocal tremor onset? more common in males or females? dispositions?
- onset 50-60 yo
- females
- inherited disposition
53
T or F: vocal tremor may be associated with other neurological signs but is independent of other neurological disorders such as Parkinson’s or ataxia
true
54
when is vocal tremor most noticeable?
on prolonged vowels
55
why is vocal tremor sometimes confusable for spasmodic dysphonia?
severe tremor can lead to voice breaks and complete aphonia, which may sound like spasmodic dysphonia in connected speech
56
how to differentiate essential tremor and spasmodic dysphonia?
- phonation of sustained vowel
- SD = normal phonation but intermittent spasms
- ET = rhythmic modulation
57
T or F: spasmodic dysphonia and tremor cannot co-occur
false
58
tx of essential tremor?
- currently no treatment that is equally effective for all patients
- some report relief from botox, meds, and DBS
