Laryngology neurologic disorders Flashcards
Intermittent strangled or strained voice breaks
during speech, particularly during words starting
with vowels, is suggestive of which diagnosis?
Adductor spasmodic dysphonia
Describe the difference between adductor spas-
modic dysphonia (ADSD) and muscle-tension dys-
phonia (MTD) during auditory – perceptual
evaluation?
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.
Which laryngeal muscles are selectively injected
during botulinum toxin treatment of adductor
spasmodic dysphonia?
Thyroarytenoid muscles
What are the most common adverse effects of
botulinum toxin injection for ADSD?
Breathy voice and aspiration of fluids, which are usually self-limiting
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.
True
Describe the voice and speech characteristics
associated with abductor spasmodic dysphonia.
Intermittent breathy voice breaks during speech, particularly following voiceless consonants
Which laryngeal muscles are selectively injected
during botulinum toxin treatment of abductor
spasmodic dysphonia?
Posterior cricoarytenoid muscles
Describe paradoxical vocal-cord motion.
Inappropriate adduction of the true vocal folds during inspiration
What spirometry finding is associated with paradoxical vocal-fold motion?
Flat inspiratory portion of the flow-volume loop
How can you test for suspected exercise-induced
paradoxical vocal-fold motion in the office?
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.
What is the treatment of choice for paradoxical
vocal-fold motion?
● Voice therapy
● Relaxation and breathing exercises, such as laryngeal
control therapy
What percentage of patients with essential tremor will develop vocal tremor?
10 to 20%
What muscles are selectively injected with botu-
linum toxin in the treatment of vocal tremor?
The strap muscles and/or intrinsic laryngeal muscles may be
injected, based on which muscles appear most tremulous
on examination.
What diagnosis must be considered in a patient
with Parkinson disease and vocal-fold motion
abnormalities?
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.
What are the voice and speech characteristics
observed in amyotrophic lateral sclerosis?
Monotonous hoarse voice with hypernasal and dysarthric
speech
Describe the distinctive vocal features of spastic
dysarthria.
Harsh quality, low fundamental frequency, strained/
strangled sound, and pitch breaks resulting from injury of
the pyramidal and extrapyramidal tracts
Injury to what structure(s) results in flaccid
dysarthria?
Damage to any of the cranial nerves involved in speech (V,
VII, X, XII) results in flaccid dysarthria.
Describe the speech pattern associated with ataxic
dysarthria.
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.
Describe the characteristic features of dysarthria
associated with Parkinson disease.
Hypokinetic dysarthria: Low volume, reduced pitch varia-
tion, rushed speech, and reduction of articulation-associ-
ated movements
Describe the key features of muscle tension
dysphonia.
Posterior glottic chink, high larynx, suprahyoid muscle
tension, breathiness, and glottal fry
True or False. Muscle tension dysphonia is often the result of an unconscious attempt to compensate for glottic insufficiency.
True. Therefore, treatment focuses initially on voice therapy.
What physical examination findings are associated
with excessive laryngeal muscle tension?
Pain on palpation of the larynx and extrinsic laryngeal
muscles, small thyrohyoid space, high hyoid bone and
larynx, difficulty rotating the larynx
Describe the voice characteristics associated with
dysphonia plica ventricularis.
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.
