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ECU Voice Disorders > 12 - Neurogenic Voice Disorders > Flashcards

12 - Neurogenic Voice Disorders Flashcards

1
Q

What are Neurogenic Voice Disorders?

A

Ones that are caused by disruption to the neural supply to the larynx

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2
Q

What is Dysarthria?

A

Neuro-motor speech disorders that affect the five subsystems of speech

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3
Q

What are the five subsystems of speech affected by Dysarthria?

A

Respiration

Phonation

Resonance

Articulation

Prosody

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4
Q

Are there multiple types of Dysarthria?

A

Yes

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5
Q

Ascending pathways are ______.

A

Sensory

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6
Q

Descending pathways are ______.

A

Motor

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7
Q

Motor pathways are classified as ______ and ______.

A

Pyramidal

Extra-pyramidal.

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8
Q

What are the two parts of the Vagus Nerve that affect voice?

A

Superior laryngeal nerve

Recurrent laryngeal

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9
Q

What are the two parts to the Superior Laryngeal Nerve?

A

Internal branch

External branch

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10
Q

What does the INTERNAL Branch of the Superior Laryngeal Nerve do?

A

Provides all sensory information to the larynx

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11
Q

What does the EXTERNAL Branch of the Superior Laryngeal Nerve do?

A

Provides motor innervation to cricothyroid

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12
Q

What are does the Recurrent Laryngeal Nerve do?

A

Supplies all sensory information below the vocal folds

Motor innervation to all other intrinsic laryngeal muscles (except the cricothyroid)

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13
Q

What are three examples of Neurogenic Voice Disorders?

A

Vocal fold paralysis

Spasmodic dysphonia

Organic Voice Tremor (Essential Tremor)

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14
Q

What is Vocal Fold Paralysis?

A

The inability to move the VFs

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15
Q

What may be the cause of Vocal Fold Paralysis?

A

Peripheral damage to the recurrent laryngeal nerve or the superior laryngeal nerve

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16
Q

Is Vocal Fold Paralysis bilateral or unilateral?

A

Can be either

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17
Q

What are five things may cause nerve damage that might cause Vocal Fold Paralysis?

A

Surgery

Neurological disease

Head/neck trauma

Viral infections

Tumors

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18
Q

Does Vocal Fold Paralysis effect adductor or abductor muscles?

A

Either

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19
Q

What are four symptoms of Vocal Fold Paralysis?

A

Breathiness

Low intensity

Low pitch

Intermittent diplophonia

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20
Q

What is Bilateral Abductor Paralysis?

A

VFs are paralyzed in the closed position

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21
Q

What is the danger in Bilateral Abductor Paralysis?

How might this need to be treated?

A

Patient cannot abduct sufficiently for respiration

Requires surgical establishment of airway

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22
Q

What are two surgical ways of treating Bilateral Abductor Paralysis?

A

Remove arytenoid or suture it in an open position

Tracheostomy

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23
Q

What is Bilateral Adductor Paralysis?

A

Both VFs are in a paramedian position

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24
Q

What is an important issue in Bilateral Adductor Paralysis?

A

Airway protection

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25
Q

What might Bilateral Adductor Paralysis require?

A

Tube feedings

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26
Q

How might Bilateral Adductor Paralysis affect vocal quality?

3

A

Very dysphonic (secondary muscle tension)

Breathy

Weak

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27
Q

What is Unilateral Abductor Paralysis?

A

One VF remains paralyzed fold at midline

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28
Q

How does Unilateral Abductor Paralysis affect the airway?

2

A

Usually no difficulty with airway

May demonstrate stridor upon inhalation

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29
Q

How does Unilateral Abductor Paralysis affect voice quality?

2

A

Mildly dysphonic

Can have difficulty elevating loudness levels

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30
Q

What is Unilateral Adductor Paralysis?

A

Affected fold fails to adduct to midline

Vocal fold usually in a paramedian position

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31
Q

How does Unilateral Adductor Paralysis affect voice quality?

A

Varies depending on position of cord and size of glottal gap during phonation

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32
Q

What is the most common type of vocal fold paralysis?

A

Unilateral Adductor Paralysis

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33
Q

Which is more frequent: Superior Laryngeal Nerve Paralysis or Recurrent Laryngeal Nerve Paralysis?

A

Superior Laryngeal Nerve Paralysis

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34
Q

How might Superior Laryngeal Nerve Paralysis affect the VFs?

2

A

Oblique positioning (overlap) of the VFs

Cricothyroid unable to significantly stretch the VFs

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35
Q

How does Superior Laryngeal Nerve Paralysis affect voice quality?

(2)

A

Loss of pitch range

Vocal fatigue

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36
Q

Do those with Superior Laryngeal Nerve Paralysis sometimes develop hyperactive compensatory behaviors?

A

Yes

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37
Q

What is Neuropathy?

A

Disorder of the nerves

38
Q

What is Myopathy?

A

Disorder of the muscles

39
Q

What is Myoneural Junction Disease?

A

Disorder where the nerve and muscle intersect

40
Q

What is the difficulty in VF Adduction Paralysis?

What is the cause?

A

Difficulty adducting the VF

Could be a disfunction of the nerve, the muscle, or the myonerual junction

41
Q

What is the difficulty in VF Abduction Paralysis?

A

Difficulty abducting the VF

42
Q

What is the biggest concern in VF Adduction Paralysis?

A

Aspiration

43
Q

What is the biggest concern in VF Abduction Paralysis?

A

Adequate respiration

44
Q

What is the biggest concern in Superior Laryngeal Nerve Paralysis?

A

Silent aspiration

45
Q

What is Spasmodic Dysphonia?

A

Involuntary adductor or abductor spasms occurring during phonation

46
Q

What causes Spasmodic Dysphonia?

What does the term describe?

A

Uncertain etiology

Describes a family of symptoms

47
Q

What is the neurologic origin of Spasmodic Dysphonia?

What does it come from?

A

Focal dystonia

A disruption in the extrapyramidal supply from the central nervous system

48
Q

What are the symptoms of Spasmodic Dysphonia?

3

A

Strained voice

Strangled voice

Effortful voice production

49
Q

Does Spasmodic Dysphonia affect men or women more frequently?

A

Women

50
Q

What is the typical onset age of Spasmodic Dysphonia?

A

Between the ages of 40-60

51
Q

What is more affected in Spasmodic Dysphonia: consonants or vowels?

A

Vowels

52
Q

Is singing usually affected by Spasmodic Dysphonia?

A

No

53
Q

Which is more common: Adductor Spasmodic Dysphonia or Abductor Spasmodic Dysphonia?

A

Adductor Spasmodic Dysphonia

54
Q

What is the vocal quality of Adductor Spasmodic Dysphonia?

4

A

Pressed

Strained

Strangled

Effortful

55
Q

What happens during phonation in both Adductor and Abductor Spasmodic Dysphonia?

A

Involuntary spasms

56
Q

Is vocal fold structure normal in Adductor Spasmodic Dysphonia?

A

Yes

57
Q

Can intermittent periods of normal phonation occur in Adductor Spasmodic Dysphonia?

A

Yes

58
Q

How is vocal quality in Abductor Spasmodic Dysphonia?

2

A

Intermittently breathy with phonation breaks

Short periods of aphonia

59
Q

Is vocal fold structure normal in Abductor Spasmodic Dysphonia?

A

Yes

60
Q

Can intermittent periods of normal phonation occur in Abductor Spasmodic Dysphonia?

A

Yes

61
Q

How do we assess Spasmodic Dysphonia?

5

A

Undisrupted singing

Laughing

Coughing

Throat clearing

Humming

62
Q

What is more affected in Spasmodic Dysphonia: vowels or consonants?

How does this affect assessment?

A

Vowels

We typically assess using sentences with predominantly vowel sounds (e.g. We eat eggs every Easter)

63
Q

Does stress and increased speaking demands exacerbate symptoms of Spasmodic Dysphonia?

A

Yes

64
Q

How can we best treat Spasmodic Dysphonia?

A

BOTOX injections

65
Q

What is an Organic Voice Tremor?

2

A

Essential tremor

Must be caused by a central nervous system disorder localized to the larynx
(General = involuntary, regular tremors in the limbs, head, larynx, or other oral structures)

66
Q

At what age Organic Voice Tremors typically begin?

2

A

Gradual onset

Typically between ages 40-60

67
Q

Are Organic Voice Tremors more frequent in males or females?

A

Males

68
Q

Might Organic Voice Tremors be hereditary?

A

Yes

69
Q

What are the symptoms of Organic Voice Tremors?

3

A

Regular modulating tremor of frequency and intensity (when producing pitches ranging from 4Hz to 7Hz seen during vowel prolongation)

“Shaky” or “wobbly” voice

Periodic voice breaks with severe forms

70
Q

How do we treat Organic Voice Tremors?

A

Limited success with BOTOX

71
Q

Neurological Voice Disorders that are related to diseases of Nervous System affect ______________.

A

Multiple neuromuscular systems

72
Q

What are some examples of Neurological Voice Disorders related to Nervous System diseases?

(7)

A

Myasthenia Gravis

Gullain-Barre’s

Parkinson’s Disease

Huntington’s Disease

ALS

MS — Mutliple Sclerosis

TBI — Traumatic Brain Injury

73
Q

What is Myasthenia Gravis?

What kind of disease is it?

A

Autoimmune neuromuscular disorder (Production of antibodies that block acetylcholine receptors)

Myoneural Junction Disease

74
Q

What are the symptoms of Myasthenia Gravis?

3

A

(Name means “muscle fatigue”)

Weakness/atrophy of muscles,

Asthenia and fatigue in voice.

Usually improves after a period of rest.

75
Q

How do VFs in Myasthenia Gravis look in visual exam?

2

A

Sluggish and atrophied

Mucosal wave abnormalities

76
Q

How might voice sound in Myasthenia Gravis?

3

A

Breathy

Hoarse

Weak

77
Q

What is Parkinson’s Disease?

A

Depletion of dopamine in the substantia niagra region of the basal ganglia.

78
Q

What are symptoms of Parkinson’s Disease?

7

A

Rigidity (due to hypokinesia)

Resting tremor (pill rolling)

Bradykinesia (slowness of movement)

Mono and reduced pitch

Mono and reduced loudness

Festinating speech (fast bursts of sounds occasionally)

Hoarseness occasionally

79
Q

Parkinson’s Disease often has diminished vocal fold movement due to ______.

A

Rigidity

80
Q

What can we see from a visual examination of VFs in Parkinson’s Disease?

(5)

A

Prolonged opening phase

Tremor

Mucosal wave aperiodicity

Asymmetry of VF

Sometimes strained phonation

81
Q

What is Huntington’s Chorea?

2

A

Hyperkinesia characterized by…

  • Jerky
  • Purposeless and abrupt motor movements.
82
Q

What can be acoustically perceived in Huntington’s Chorea?

4

A

Harshness

Monopitch

Strain

Voice arrests due to sudden adductory/abductory patterns.

83
Q

What acoustic measuresments are seen in Huntington’s Chorea?

4

A

Reduced frequency

Reduced intensity

Increased jitter

Increased shimmer

84
Q

What is Cerebellar Ataxia?

A

Incoordination muscles for accurate vocal fold closure.

85
Q

What is often seen in Cerebellar Ataxia?

A

Hypotonia (reduced range of movements and musclular contraction)

86
Q

What is perceived in Cerebellar Dysphonia?

4

A

Harshness

Monopitch

Reduced pitch

Strain

87
Q

How does Cerebellar Ataxia affect speed of adduction and abduction?

A

It is reduced

88
Q

What are symptoms of Multiple Sclerosis?

3

A

Incoordination

Spasticity

Muscle weakness

89
Q

How does Multiple Sclerosis affect speech?

7

A

Impaired control of loudness

Harshness

Hoarseness

Hypernasality

Impaired pitch control

Reduced rate of speech

Scanning speech

90
Q

What are general symptoms of Gilles de la Tourette Syndrome?

3

A

Twitching

Grimacing

‘Tics’

91
Q

How does Tourette Syndrome affect voice?

1+2

A

Vocal tics

  • Unusual noises
  • Explosive outbursts

ECU Voice Disorders (23 decks)

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