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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
What might Bilateral Adductor Paralysis require?
Tube feedings
26
How might Bilateral Adductor Paralysis affect vocal quality? | 3
Very dysphonic (secondary muscle tension) Breathy Weak
27
What is Unilateral Abductor Paralysis?
One VF remains paralyzed fold at midline
28
How does Unilateral Abductor Paralysis affect the airway? | 2
Usually no difficulty with airway May demonstrate stridor upon inhalation
29
How does Unilateral Abductor Paralysis affect voice quality? | 2
Mildly dysphonic Can have difficulty elevating loudness levels
30
What is Unilateral Adductor Paralysis?
Affected fold fails to adduct to midline Vocal fold usually in a paramedian position
31
How does Unilateral Adductor Paralysis affect voice quality?
Varies depending on position of cord and size of glottal gap during phonation
32
What is the most common type of vocal fold paralysis?
Unilateral Adductor Paralysis
33
Which is more frequent: Superior Laryngeal Nerve Paralysis or Recurrent Laryngeal Nerve Paralysis?
Superior Laryngeal Nerve Paralysis
34
How might Superior Laryngeal Nerve Paralysis affect the VFs? | 2
Oblique positioning (overlap) of the VFs Cricothyroid unable to significantly stretch the VFs
35
How does Superior Laryngeal Nerve Paralysis affect voice quality? (2)
Loss of pitch range Vocal fatigue
36
Do those with Superior Laryngeal Nerve Paralysis sometimes develop hyperactive compensatory behaviors?
Yes
37
What is Neuropathy?
Disorder of the nerves
38
What is Myopathy?
Disorder of the muscles
39
What is Myoneural Junction Disease?
Disorder where the nerve and muscle intersect
40
What is the difficulty in VF Adduction Paralysis? What is the cause?
Difficulty adducting the VF Could be a disfunction of the nerve, the muscle, or the myonerual junction
41
What is the difficulty in VF Abduction Paralysis?
Difficulty abducting the VF
42
What is the biggest concern in VF Adduction Paralysis?
Aspiration
43
What is the biggest concern in VF Abduction Paralysis?
Adequate respiration
44
What is the biggest concern in Superior Laryngeal Nerve Paralysis?
Silent aspiration
45
What is Spasmodic Dysphonia?
Involuntary adductor or abductor spasms occurring during phonation
46
What causes Spasmodic Dysphonia? What does the term describe?
Uncertain etiology Describes a family of symptoms
47
What is the neurologic origin of Spasmodic Dysphonia? What does it come from?
Focal dystonia A disruption in the extrapyramidal supply from the central nervous system
48
What are the symptoms of Spasmodic Dysphonia? | 3
Strained voice Strangled voice Effortful voice production
49
Does Spasmodic Dysphonia affect men or women more frequently?
Women
50
What is the typical onset age of Spasmodic Dysphonia?
Between the ages of 40-60
51
What is more affected in Spasmodic Dysphonia: consonants or vowels?
Vowels
52
Is singing usually affected by Spasmodic Dysphonia?
No
53
Which is more common: Adductor Spasmodic Dysphonia or Abductor Spasmodic Dysphonia?
Adductor Spasmodic Dysphonia
54
What is the vocal quality of Adductor Spasmodic Dysphonia? | 4
Pressed Strained Strangled Effortful
55
What happens during phonation in both Adductor and Abductor Spasmodic Dysphonia?
Involuntary spasms
56
Is vocal fold structure normal in Adductor Spasmodic Dysphonia?
Yes
57
Can intermittent periods of normal phonation occur in Adductor Spasmodic Dysphonia?
Yes
58
How is vocal quality in Abductor Spasmodic Dysphonia? | 2
Intermittently breathy with phonation breaks Short periods of aphonia
59
Is vocal fold structure normal in Abductor Spasmodic Dysphonia?
Yes
60
Can intermittent periods of normal phonation occur in Abductor Spasmodic Dysphonia?
Yes
61
How do we assess Spasmodic Dysphonia? | 5
Undisrupted singing Laughing Coughing Throat clearing Humming
62
What is more affected in Spasmodic Dysphonia: vowels or consonants? How does this affect assessment?
Vowels We typically assess using sentences with predominantly vowel sounds (e.g. We eat eggs every Easter)
63
Does stress and increased speaking demands exacerbate symptoms of Spasmodic Dysphonia?
Yes
64
How can we best treat Spasmodic Dysphonia?
BOTOX injections
65
What is an Organic Voice Tremor? | 2
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
At what age Organic Voice Tremors typically begin? | 2
Gradual onset Typically between ages 40-60
67
Are Organic Voice Tremors more frequent in males or females?
Males
68
Might Organic Voice Tremors be hereditary?
Yes
69
What are the symptoms of Organic Voice Tremors? | 3
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
How do we treat Organic Voice Tremors?
Limited success with BOTOX
71
Neurological Voice Disorders that are related to diseases of Nervous System affect ______________.
Multiple neuromuscular systems
72
What are some examples of Neurological Voice Disorders related to Nervous System diseases? (7)
Myasthenia Gravis Gullain-Barre’s Parkinson’s Disease Huntington’s Disease ALS MS — Mutliple Sclerosis TBI — Traumatic Brain Injury
73
What is Myasthenia Gravis? What kind of disease is it?
Autoimmune neuromuscular disorder (Production of antibodies that block acetylcholine receptors) Myoneural Junction Disease
74
What are the symptoms of Myasthenia Gravis? | 3
(Name means "muscle fatigue") Weakness/atrophy of muscles, Asthenia and fatigue in voice. Usually improves after a period of rest.
75
How do VFs in Myasthenia Gravis look in visual exam? | 2
Sluggish and atrophied Mucosal wave abnormalities
76
How might voice sound in Myasthenia Gravis? | 3
Breathy Hoarse Weak
77
What is Parkinson's Disease?
Depletion of dopamine in the substantia niagra region of the basal ganglia.
78
What are symptoms of Parkinson's Disease? | 7
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
Parkinson's Disease often has diminished vocal fold movement due to ______.
Rigidity
80
What can we see from a visual examination of VFs in Parkinson's Disease? (5)
Prolonged opening phase Tremor Mucosal wave aperiodicity Asymmetry of VF Sometimes strained phonation
81
What is Huntington’s Chorea? | 2
Hyperkinesia characterized by... - Jerky - Purposeless and abrupt motor movements.
82
What can be acoustically perceived in Huntington’s Chorea? | 4
Harshness Monopitch Strain Voice arrests due to sudden adductory/abductory patterns.
83
What acoustic measuresments are seen in Huntington’s Chorea? | 4
Reduced frequency Reduced intensity Increased jitter Increased shimmer
84
What is Cerebellar Ataxia?
Incoordination muscles for accurate vocal fold closure.
85
What is often seen in Cerebellar Ataxia?
Hypotonia (reduced range of movements and musclular contraction)
86
What is perceived in Cerebellar Dysphonia? | 4
Harshness Monopitch Reduced pitch Strain
87
How does Cerebellar Ataxia affect speed of adduction and abduction?
It is reduced
88
What are symptoms of Multiple Sclerosis? | 3
Incoordination Spasticity Muscle weakness
89
How does Multiple Sclerosis affect speech? | 7
Impaired control of loudness Harshness Hoarseness Hypernasality Impaired pitch control Reduced rate of speech Scanning speech
90
What are general symptoms of Gilles de la Tourette Syndrome? | 3
Twitching Grimacing ‘Tics’
91
How does Tourette Syndrome affect voice? | 1+2
Vocal tics - Unusual noises - Explosive outbursts

ECU Voice Disorders (23 decks)

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