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Swallowing and Voice > Functional disorders and disorders of neurological origin > Flashcards

Functional disorders and disorders of neurological origin Flashcards

1
Q

What is a neurological voice disorder?

A

Caused by interruption of nervous innervation supplied to the larynx, leading to abnormal control, coordination, or strength of laryngeal muscles

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2
Q

What is a functional voice disorder?

A

Arising from non-organic and non-neurologic causes

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3
Q

3 categories of phonatory dysfunction affected by neurological disorders

A
  1. Adduction/abduction
  2. Stability
  3. Coordination
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4
Q

Parkinson’s disease: hypo-adduction - perceptual, visual, management

A

Perceptual
- Monopitch, breathy, rough, reduced loudness, shorter bursts due to respiration affected, difficulty initiating phonation
Visual
- VF may appear normal or bowed (-> breathiness)
- Laryngeal tremor
- Abnormal phase closure and symmetry
Management
- LSVT LOUD: phonation and loudness

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5
Q

Myashthenia gravis: hypo-adduction - perceptual, visual, management

A
  • Autoimmune neuromuscular disease
  • 2x more women than men
  • Fatigability, fluctuation of function
    Perceptual:
  • Breathy, weak
  • Muscle weakness on prolonged sounds
  • Other: Stridor, reduced loudness, monotone, hypernasality, tremor
    Visual
  • Fluctuating impairment of VF mobility: reduced phase closure and vibratory amplitude
    Management
  • Pharmacological treatments to improve muscle contraction
  • Surgery, removal of thymus gland
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6
Q

Unilateral vocal fold paralysis: hypo-adduction

A
  • Complete immobility of one VF, can’t move toward midline
    Perceptual
  • Aphonia through to normal voicing
  • Breathy, rough, strained (trying to compensate)
    Visual
  • Affected VF weak or bowed
  • Passive vibration due to flow of exhaled air
    Management
  • Wait and see 6-9 months
  • Behavioural voice therapy
  • Surgery, medialisation of VF + reinnervation to RLN)
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7
Q

Bilateral vocal fold paralysis

A
  • Phonation may be preserved by airway obstruction an issue
  • Often caused by surgical trauma, malignancies, intubation
    Perceptual
  • Normal voicing through to severe breathiness/aphonia
  • Inspiratory stridor if in adducted position
    Visual
  • VF floppy/bowed
  • Artytenoid cartilage on both sides does not abduct/adduct
    Management
  • Wait and see 6-9 months if no airways obstruction
  • Tracheotomy if airway obstructed
  • Surgery, lateralisation of VF to widen glottis
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8
Q

Supranuclear palsy: hypo-adduction

A
  • Rare prog neuro
  • Damage to brain cells that control body movement/coordination
  • Perceptual: strain, reduced loudness, breathy
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9
Q

Shy-Drager/Multiple Systems Atrophy: hypo-adduction

A
  • Rare degenerative neuromuscular disorder
  • Affects body’s involuntary functions, including motor control
  • Can have VF paresis
  • Perceptual: weak, reduced loudness, stridor
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10
Q

Laryngeal dystonia/spasmodic dystonia (phonatory instability): hyper-adduction

A
  • Neuro disorder affecting intrinsic laryngeal muscle control
  • Affects laryngeal adductory and abductory muscles during voice
  • More women than men 3:2
    Two varieties
    1. Abductor laryngeal dystonia 15%
  • Uncontrolled opening of VFs
  • Breathy, weakness
    2. Adductor laryngeal dystonia 85%
  • Irregular closing of VFs
  • Strain
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11
Q

Abductor laryngeal dystonia

A

Uncontrolled opening of VFs
Perceptual
- Weak and breathy
- Voice stoppages
- Delayed onset of voicing
Visual
- VF in open position when should be closed
Management
- Botox injection into laryngeal muscles

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12
Q

Adductor laryngeal dystonia

A

Irregular closing of VFs
Perceptual
- Strain
- Voice stoppages
- Delayed onset of voicing
Visual
- VF in closed position when should be open
Management
- Botox injection into laryngeal muscles

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13
Q

Huntington’s disease: hyper-adduction

A
  • Chorea
  • Perceptual: involuntary noises, monopitch, strain
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14
Q

Pseudobulbar palsy: hyper-adduction

A
  • Progressive lesions that occur bilaterally in corticobulbar tract, usually from stroke
  • Perceptual: hoarse
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15
Q

Amyotropic lateral sclerosis: phonatory stability

A
  • Attacks neurons for controlling voluntary muscle contraction
  • Spasticity and weakness
    Perceptual
  • Weak, rough, strained, some hypernasaltiy
    Visual
  • Incomplete VF closure
    Management
  • No effective treatment
  • AAC
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16
Q

Essential tremor: phonatory stability

A
  • Rhythmic tremors that can involve larynx (+ head, arms, neck, tongue, palate, face)
  • Laryngeal tremor most noticeable during vowel prolongation
  • Can also affect connected speech: voice breaks, complete voice stoppage
17
Q

Cerebellar ataxia: mixed disorder

A
  • Disorder of cerebellum
  • Muscle coordination and movement impacted
  • Perceptual: hoarse
18
Q

Multiple sclerosis: mixed disorder

A
  • White and grey matter of CNS affected
  • Perceptual: weakness, difficulty increasing loudness
19
Q

Examples of functional voice disorders (5)

A
  1. Puberphonia
  2. Ventricular phonation
  3. Muscle tension dysphonia
  4. Conversion aphonia
  5. Paradoxical vocal fold dysfunction
20
Q

Puberphonia: functional disorder

A
  • Pitch hasn’t lowered in puberty
  • Proposed to have either a psychological or physical basis
    Perceptual
  • Pitch higher than typical
  • Breathy
  • Reduced loudness
    Visual
  • Commonly normal adult male larynx
  • Incomplete glottal closure
  • Increased VF stiffness
  • Laryngeal hyperfunction, maintaining high pitch
    Management
  • In absence of physiological cause, management is behavioural, eg. voice therapy to reduce pitch
21
Q

Ventricular phonation: functional disorder

A
  • Use of false/ventricular VFs instead of/with true VFs
  • Often associated with severe muscle tension or VF dysfunction as compensation
    Perceptual
  • Voice sounds low pitch with reduced range
  • Rough
  • Strain
    Visual
  • Atypicall adduction and vibration of VFs
    Management
  • Need to demonstrate efficacy of phonation with true VFs, if so then voice therapy appropriate, needs to relax ventricular folds and allow true VF to vibrate
  • Surgery
22
Q

Muscle tension dysphonia

A
  • Excessive tension of laryngeal muscles
  • 3 subgroups of aetiologies: psychological, vocal misuse, compensation for underlying disease
    Perceptual
  • Strain, high pitch, breathy, weak
    Visual
  • Excessive contraction of laryngeal muscles
  • Possible incomplete closure
    Management
  • Focus on normal muscle use
  • Indirect therapy: vocal hygiene, education
  • Direct therapy: voice therapy
  • Medical treatment for contributing factors, eg. reflux
  • Surgery for secondary organic lesions
23
Q

Conversion aphonia

A
  • Manifestation of stress/depression/anxiety
  • Psychogenic, unconscious stimulation of illness
  • Emerges very quickly, can be associated with trauma or severe stress
  • No evidence of cause or of patients faking it
    Perceptual
  • Aphonia
  • High pitch and very strained
  • Neck pain, laryngeal muscle tightness
    Visual
  • Normal non-phonatory movements
  • VF movement irregular and insufficient vibratory cycle
    Management
  • Complete physical examination
  • Psychiatric treatment may be necessary (+ voice therapy?)
  • CBT, hypnosis, antidepressants
24
Q

PVFM

A
  • Episodic/involuntary adduction of VFs, can occur on expiration
  • Multifactorial causes
  • Difficulty breathing/dyspnea, cough, stridor, tightness
  • Rapid onset, resolution
    Perceptual
  • Stridor, audible airway obstruction
  • Strain, muscle tightness
  • Chronic cough
  • Roughness, strain, breathy, weak, diplophonia
    Visual
  • Intermittent nature so won’t always show, ideally need to see it mid-flare up
    Management 3 phases
    1. Differential diagnosis of cause
    2. Psychoeducation
    3. Maintenance
25
Q

Transgender voice

A
  • Change voice pitch
  • Perceptual: voice too high/too low, resonance, intonation, rate, loudness
  • Visual: WNL for gender assigned at birth
  • Management: Behavioural, surgical, HRT

Swallowing and Voice (11 decks)

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