Laryngology neurologic disorders

Question 1

Intermittent strangled or strained voice breaks
during speech, particularly during words starting
with vowels, is suggestive of which diagnosis?

Answer 1

Adductor spasmodic dysphonia

Question 2

Describe the difference between adductor spas-
modic dysphonia (ADSD) and muscle-tension dys-
phonia (MTD) during auditory – perceptual

evaluation?

Answer 2

ASD is task dependent, whereas MTD is not. Patients with
both disorders may have a strangled or strained voice
quality, but in MTD this will be constant across all vocal
tasks. In ADSD, symptoms will be worse during sentences
rich in voiced consonants and during connected speech and
will improve during sustained vowels and sentences with
predominantly voiceless consonants.

Question 3

Which laryngeal muscles are selectively injected
during botulinum toxin treatment of adductor
spasmodic dysphonia?

Answer 3

Thyroarytenoid muscles

Question 4

What are the most common adverse effects of

botulinum toxin injection for ADSD?

Answer 4

Breathy voice and aspiration of fluids, which are usually self-limiting

Question 5

True or False. Breathy voice and aspiration of
liquids after botulinum toxin injection for adductor
spasmodic dysphonia are likely to last up to 2
weeks and then resolve spontaneously.

Answer 5

True

Question 6

Describe the voice and speech characteristics

associated with abductor spasmodic dysphonia.

Answer 6

Intermittent breathy voice breaks during speech, particularly following voiceless consonants

Question 7

Which laryngeal muscles are selectively injected
during botulinum toxin treatment of abductor
spasmodic dysphonia?

Answer 7

Posterior cricoarytenoid muscles

Question 8

Describe paradoxical vocal-cord motion.

Answer 8

Inappropriate adduction of the true vocal folds during inspiration

Question 9

What spirometry finding is associated with paradoxical vocal-fold motion?

Answer 9

Flat inspiratory portion of the flow-volume loop

Question 10

How can you test for suspected exercise-induced

paradoxical vocal-fold motion in the office?

Answer 10

Provocation testing. Ask the patient to exercise until he or
she becomes symptomatic, and then immediately perform
flexible fiberoptic laryngoscopy. The diagnosis will be
confirmed with observation of adduction of the vocal folds
during inspiration.

Question 11

What is the treatment of choice for paradoxical

vocal-fold motion?

Answer 11

● Voice therapy
● Relaxation and breathing exercises, such as laryngeal
control therapy

Question 12

What percentage of patients with essential tremor will develop vocal tremor?

Answer 12

10 to 20%

Question 13

What muscles are selectively injected with botu-

linum toxin in the treatment of vocal tremor?

Answer 13

The strap muscles and/or intrinsic laryngeal muscles may be
injected, based on which muscles appear most tremulous
on examination.

Question 14

What diagnosis must be considered in a patient
with Parkinson disease and vocal-fold motion
abnormalities?

Answer 14

Shy-Drager syndrome, a form of multiple-system atrophy, is
a Parkinson-plus syndrome that may lead to life-threatening
sleep apnea. Tracheotomy may be required.

Question 15

What are the voice and speech characteristics

observed in amyotrophic lateral sclerosis?

Answer 15

Monotonous hoarse voice with hypernasal and dysarthric

speech

Question 16

Describe the distinctive vocal features of spastic

dysarthria.

Answer 16

Harsh quality, low fundamental frequency, strained/
strangled sound, and pitch breaks resulting from injury of
the pyramidal and extrapyramidal tracts

Question 17

Injury to what structure(s) results in flaccid

dysarthria?

Answer 17

Damage to any of the cranial nerves involved in speech (V,

VII, X, XII) results in flaccid dysarthria.

Question 18

Describe the speech pattern associated with ataxic

dysarthria.

Answer 18

Ataxic dysarthria is associated with disorders of the
cerebellum and is characterized by a harsh, breathy voice
with a strained tremulous quality and fluctuating pitch and
volume. Tremulous laryngeal muscle contractions are noted
during speech but not at rest.

Question 19

Describe the characteristic features of dysarthria

associated with Parkinson disease.

Answer 19

Hypokinetic dysarthria: Low volume, reduced pitch varia-
tion, rushed speech, and reduction of articulation-associ-
ated movements

Question 20

Describe the key features of muscle tension

dysphonia.

Answer 20

Posterior glottic chink, high larynx, suprahyoid muscle

tension, breathiness, and glottal fry

Question 21

True or False. Muscle tension dysphonia is often the result of an unconscious attempt to compensate for glottic insufficiency.

Answer 21

True. Therefore, treatment focuses initially on voice therapy.

Question 22

What physical examination findings are associated

with excessive laryngeal muscle tension?

Answer 22

Pain on palpation of the larynx and extrinsic laryngeal
muscles, small thyrohyoid space, high hyoid bone and
larynx, difficulty rotating the larynx

Question 23

Describe the voice characteristics associated with

dysphonia plica ventricularis.

Answer 23

Ventricular dysphonia, or dysphonia plica ventricularis, refers
to phonation resulting from false vocal-fold vibration as
opposed to true vocal-fold vibration. The resulting voice is
characteristically low pitched and hoarse, with intermittent
voice breaks and diplophonia.