Laryngeal Paralysis Flashcards
Medulla Oblongata contains nerves innervating….
Palate, tongue, pharynx, larynx
Peripheral pathways to the laryngeal muscles
Bilateral or unilateral
Muscle Tone related to LMN
Flaccid or atrophy
Vagal Nerve Damage at its Origin may be Caused by…
Trauma to brainstem b/c of an accident
Surgery in the medulla oblongata
Tumor pressing on lower brainstem
Causes of Recurrent Laryngeal Nerve Damage
Neck tumors, aortic aneurysm, external injuries, enlarged thyroid gland, thyroid operation, anterior approach to cervical spinal cord surgery
Things in the periphery
Larynx can look tilted and rotated from damage on last bullet point
Left side is longer and loops under aorta
Right side loops under subclavian artery (Can be affected by tumors in the chest)
Paralysis Types
Unilateral vagus nerve lesion Bilateral vagus nerve lesion Unilateral recurrent nerve lesion Bilateral recurrent nerve lesion Unilateral superior laryngeal nerve lesion Bilateral superior laryngeal nerve lesion Unilateral abductor paralysis Bilateral abductor paralysis
Vagus, recurrent, superior, and abductor types
Unilateral Vagus Nerve Lesion (nucleus)
Above origin of pharyngeal, superior laryngeal, & recurrent laryngeal nerves
VF fixed in abducted position
Soft palate paralyzed
Vocal quality exhibits hoarseness, breathiness, poor pitch control, & hypernasality
Bilateral Vagus Nerve Lesion
Both cords fixed in the abducted position on phonation
Soft palate paralyzed bilaterally
Vocal quality aphonic & hypernasal
Unilateral Recurrent Paralysis
Most common paralysis
Adductors & abductors paralyzed
Cord lies in the paramedian position
Vocal quality dysphonic with severe breathiness (will have to train)
Compensation: did they get the closure & did they get good voice?
Progress with a pt with paralysis: voice would get less breathy
Bilateral Recurrent Paralysis
Both adductors & abductors paralyzed
Both cords lie in paramedian position
Vocal quality aphonic
Difference between breathiness (breathy override over voice) in the voice and aphonia (no voice at all)
Poor prognosis (no surgery will help either)
Thyroarytenoid Muscle Paralysis Tx
Try to change pitch some how by lengthening VFs (adduct)—strengthening can help–/i/, /i/, /i/ (diadochokinetic)
Rationale: strengthen VFs and close VFs with a higher pitch
Procedure: hard glottal attack & staccato /i/ productions
If it’s just SLN (pitch), adductors are intact
Unilateral Abductor Paralysis
Unilateral posterior cricoarytenoid paralyzed
Affected cord lies in a central position
Arytenoid tilted forward
Phonation rarely affected
Half of the airway occluded
Ends up being a breathing problem and not a phonation problem
Lateralize that cord—reduced phonation (either want to talk or breathe)
Bilateral Abductor Paralysis
Bilateral posterior cricoarytenoid paralyzed Both cords lie in a central position Airway totally obstructed Pronounced laryngeal stridor Voice unaffected
Damage to the Superior Laryngeal Nerve
Trauma, surgery, tumors, stretching, compression, lacerations
Tracheal Compression Sx’s
Throat clearing, sensations of pain & pressure, difficulty in swallowing, lowered speaking pitch, inability to produce high pitch in singing
Unilateral Superior Laryngeal Nerve Paralysis
Rare
Cricothyroid affected
Slacked cord produces a hoarse rough vocal quality
Front tension (anterior cricothyroid)–bowing
