Neurologic Voice Disorders Flashcards
What are the three categories of phonatory dysfunction?
- adduction/abduction problems*
- stability problems*
- coordination problems*
The following are part of adduction/abduction problems except for:
A.) Vocal Fold Paralysis
B.) SLN Paralysis
C.) Huntington’s Corea
D.) Parkinson’s
E.) All except D
Vocal Fold Paralysis, Vocal Fold Paresis, SLN Paralysis, Pseudobulbar Palsy, Adductor Spasmodic Dysphonia, Huntington’s Corea
What are the five categories of Neurological Voice Disorders?
Category I : Constant voice disorders
Category II : arrhythmically fluctuating
Category III : rhythmically fluctuating
Category IV : Paroxysmal
Category V : Loss of volitonal phonation
True or False: Paralysis in the adducted position causes strained/strangled, monotone, low pitched, low volume voice (hypernasality), and respiratory compromise
True
*Vocal Fold Bilateral Paralysis
True or False: Paralysis in the abducted position causes aphonia and lack of airway protection for swallowing
True
*Vocal Fold Bilateral Paralysis
Some of the causes for Bilateral VF Paralysis:
cerebral damage, damage to brainstem in area of CN X
*44% latrogenic
Management of Bilateral VF Paralysis
Abductor Paralysis (PCA is paralyzed) and VFs in medial or paramedian position
airway is acceptable, wait and see if nerves spontaneously recover
cordectomy, arytenoidectomy or VF lateralization
Management of Bilateral VF Paralysis:
Adductor paralysis (TA, LCA & IA are paralyzed) and VFs in abducted position
- tracheostomy*
- AC medial rotation*
- *Dx: Endoscopy*
Unilateral Vagus Nerve X accounts for 90% of ______ and cause flaccidity, decreased tone and dysphagia
Unilateral Vocal Fold Paralysis
True or False: Common cause is disease or trauma to RLN (Recurrent Laryngeal Nerve) with injury to the left during surgery in Unilateral Vocal Fold Paralysis
True
* Dx: videostroboscopy, EMG, MRI, CN Exam X and XI
*Other causes: unilatearl brainstem strokes, unilateral trauma to RLN, and viral infection
Perceptual:
hoarse, breathy, weak, strained
Unilateral Vocal Fold Paralysis
True or False: There is no compensatory muscle tension present in Unilateral Vocal Fold Paralysis
False - there is compensatory muscle tension
What’s this?
Unilateral Vocal Fold Paralysis
Most common causes for SLN Paralysis are:
A.) latrogenic
B.) viral infections
C.) thyroid surgery
D.) only a and b
E.) All of the above except for D
E - all of the above except for D
Videostroboscopic:
look for rotation of posterior glottis to affected side, look for difference in vertical level of VFs
SLN Paralysis
Perceptual:
decreased habitual pitch, breathiness, decreased pitch and intensity ranges
SLN Paralysis
Some of the causes for Vocal Fold Paresis are:
A.) Neuropathy
B.) Goiter/Thyroiditis
C.) Idiopathic
D.) Lyme’s Disease
E.) All of the above
E - all of the above
Distinguishing feature from Laryngeal Muscle Tension and Vocal Fold Paresis:
Videostroboscopy:
rapid repeated ‘ee’
repeated ‘ee-hee, pa, ta, ka’
whistling
Perceptual:
decreased intensity range and max intensity breathiness, hoarseness, unstable, inconsistent phonation, vocal fatigue
Vocal Fold Paresis
*Paresis: muscle weakness
Aging, muscle atrophy (hypotonicity), stiffer, thinner mucosa in males, edematous in females, ossification of cartilages,
Presbyphonia/Presbylarynges
Videostroboscopic:
vocal processes prominence, atrophy and VF thinning, VF bowing, glottic gap, decreasd amplitude of vibration, edema, yellowish coloration
Presbylaryngis/Presbyphonia
Perceptual:
breathy, hoarse, low pitch, tremor
Presbyphonia
What’s this?
Presbylaryngis
CNS lesion, possibly basal ganglia and supplementary motor areas
Spasmodic Dysphonia
How many types of Spasmodic Dysphonia are there?
Three
This type of Spasmodic Dysphonia is where the LCA, IA, and TA spasm periodically causing undesired hyperadduction, resulting in harsh, strained and strangled sound
Adductor
The type of Spasmodic Dysphonia were the PCA spasms and abducts the Vocal Folds causing a breathy, weak voice, decreased loudness is a problem
Abductor
The combination of both types of Spasmodic Dysphonia
Mixed SD
True or False: Does not affect women as much, age of onset is between 30-50 years, reported occuring after URI (Upper Respiratory Infection)
False - affects women more
True or False: The main difference betwen Abductor and Adductor Spasmodic Dysphonia is that Adductor sounds more strained, while Abductor patients have trouble transitioning from voiceless stops to vowels
True
CNS lesion in the extrapyramidal system
Essential Tremor
True or False: The tremor frequency characterized in Essential Tremor is about 10 - 15 Hz
False - 3 - 7 Hz
The following characteristics about Essentail Tremor are true except for:
A.) Called Organic or Familial Tremor
B.) Isolated to the voice, but can also be associated to the head, jaws, hands, etc.
C.) Quiet at rest but present during volitional movement
D.) Sometimes present in sustained phonation
E.) All of the above except for D
E - Always present in sustained phonation
What are the two steps involved differentially diagnosing SD, MTD, and Tremor?
Step One - perform laryngeal palpation
Step Two - perform laryngeal massage and teach supraglottic relaxation exercises
*MTD = voice will improve
*Tremor = tension/strain will decrease and tremor present
*SD = little change
Bilateral lesions in corticobulbar tract at level of internal capsule, midbrain or pons
Pseudobulbar Palsy
True or False - laryngeal muscle weakness and hyperactivity co-exist causing both hyperadduction and incomplete closure in Pseudobulbar Palsy
True
*Treatment: Easy onset phonation, flow phonation, aspirated onsets, frontal tone focus, adequate breath support
Perceptual:
breathiness, strain/struggle, harshness, monopitch, monoloudness
Pseudobulbar Palsy
Progressive disease of unknown cause in which affects upper and lower motor neurons (causing the muscles waste away, twitch, weaken, and spasm)
ALS - amyotropic lateral sclerosis
*articulation problems, dysphagia
Perceptual:
hoarseness, harshness, strain/struggle, hypernasal, breathy
ALS
The hyperkinesias (lesion to basal ganglia or other parts of extrapyramidal system) are:
*HINT: too much movement
Choreas: quick, jerky, purposeless movement
-irregular pitch/loudness, irregular respiration
Athetosis: hyperkinetic dystonia - slow, writhing movements
-variable loudness, pitch, vocal quality
Huntington’s Chorea: autosomal dominant,
-strained, strangled, harsh, monopitch, variable loudness, jerky irregular bursts of loud voice
The hypokinesias (too little movement) are:
Parkinson’s Disease: lack of dopamine in substantia nigra
-breathy, weak, decreased loudness, monopitch, monoloudness, hoarse/harsh
Videostroboscopic:
vocal fold bowing or incomplete, compensatory supraglottic squeezing, A-P compression, FVF approximation
Parkinson’s Disease
Demyelinating progressive disease that attacks myelin sheath
Multiple Sclerosis
*Voice: impaired loudness control, harshness, hypernasality, decreased respiratory control, slow speech rate, impaired articulation
Autoimmune disease, progressive failure to sustain maintain or repeated contraction of striated muscles due to blockage of acetylcholine at Neuromuscular Junction (muscle flaccidity)
Myasthenia Gravis
*onset 30 (women), 60 (men)
*Voice: breathy, hypernasality, weak voice, decreased loudness, intermittent aphonia
*Incomplete adduction/abduction of VF with movement deterioration with task repetition
