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Dysphagia and Voice Disorders > Organic and neurogenic voice disorders and CNs for voice > Flashcards

Organic and neurogenic voice disorders and CNs for voice Flashcards

1
Q

What CNs are involved in voice and resonance?

A

CN IX, CN X, CN XI, CN XII

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2
Q

What CNs are involved in speech?

A

CN V, CN VII, CN VIIi, CN IX, CN X, CN XI, CN XII

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3
Q

Vocal fold paralysis is caused by damage to which CN?

A

CN X

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4
Q

CN XI innervates which muscles?

A

trapezius and sternocleidomastoid muscles

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5
Q

The recurrent laryngeal branch of CN X innervates which of the following muscles?

A

intrinsic laryngeal muscles (PCA, LCA, TA, thyroarytenoid) and inferior pharyngeal constrictor

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6
Q

The external branch of the superior laryngeal nerve of CN X innervates which of the following muscles

A

cricothyroid muscle

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7
Q

What is an organic voice disorder? What are examples of organic voice disorders?

A

A voice disorder that’s due to a specific and observation lesion on the larynx or mechanisms involved in voice production. Examples are polyps, trauma, or congenital diseases

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8
Q

Describe the motor pathway.

A

Motor pathway begins with the UMNs, whose cell bodies are in the primary motor cortex. The UMN axon extends from the motor cortex to the brainstem where it synapses with the lower motor neuron. The LMN axon then carries the signal and innervates the muscle fibers.

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9
Q

Describe the role of the primary sensory neuron in the sensory pathway.

A

Dendrites of the primary sensory neuron innervate the end receptor cells (e.g., skin and tongue) and its axons extend to the sensory neuron located in a specific region of the brainstem.

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10
Q

Describe the role of the secondary sensory neuron in the sensory pathway.

A

The cell bodies of secondary sensory neurons are in the brainstem nucleus associated with the nerve. Its axons extend to the thalamus (i.e., sensory relay station).

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11
Q

Describe the role of the tertiary sensory neuron in the sensory pathway.

A

The cell bodies of tertiary sensory neurons are in the thalamus. Its axon extends to the primary sensory cortex.

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12
Q

What parts of the CNS are involved in voice production?

A

cerebral cortex, cerebellum, basal ganglia, frontal lobe, dorsal laryngeal motor cortex, left temporal lobe

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13
Q

Regarding voice, what role does the dorsal laryngeal motor cortex play?

A

Pitch control and pitch change

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14
Q

What roles do the frontal lobe and left temporal lobe play in voice production?

A

motor innervation of voice production

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15
Q

What role do cerebral cortex, cerebellum, and basal ganglia play in voice production.

A

Control voice

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16
Q

Where in the brain does voice begin? What happens afterwards?

A

primary motor cortex; nerve impulses are sent from PMC to the brainstem nuclei via the corticobulbar tract. Concurrently, a person hears and processes ongoing voice production via Heschl’s gyrus in the temporal lobes.

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17
Q

What is the special sensory function of CN IX?

A

processes taste from posterior 1/3 of the tongue

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18
Q

What is the general sensory function of CN IX?

A

pain, touch, and proprioception from posterior 1/3 of the tongue, general sensation from the hard and soft palate, faucial pillars, tonsils, and upper pharynx

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19
Q

What does someone with UVFP sound like? What other voice disorder can result if UVFP is not treated?

A

monoloudness, reduced loudness, breathy, reduced phonation, reduced duration, pitch breaks; MTD

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20
Q

UVFP can result in what physiological symptoms

A

Glottal incompetence and VFs not fully abducted and adducted.

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21
Q

What are the four etiologies of UVFP?

A

Neoplastic, traumatic, medical disease, or idiopathic

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22
Q

What are common neurological conditions affecting voice and thereby leading to neurogenic dysphonia?

A

Acquired brain injury (CVA/Stroke or TBI), laryngeal dystonia, Parkinson’s disease, Essential Tremor, VFP (unilateral and bilateral)

23
Q

A person with a neurogenic voice disorder would be seen by a team consisting of

A

neurologist, SLP, ENT, and surgeon

24
Q

Management of UVFP includes

A

Spontaneous recovery (e.g., CN X is not paralyzed anymore); if not then surgery (i.e., vocal fold medialization and vocal fold re-innervation) followed by voice therapy where the focus is on adequate breath support for speech and phonation with not much effort; botox type A injection

25
Q

When a person with UVFP receives Botox Type A injections, what symptoms may they experience temporarily?

A

high flow rate, low pressure, and breathy voice

26
Q

What two surgical procedures can be done for vocal fold medialization?

A

Injection laryngoplasty and thyroplasty

27
Q

What is the general sensory function of CN X?

A

processes pain, temperature, and touch from the outside of the eardrum, back of the ear, external auditory meatus, and parts of the larynx and pharynx

28
Q

What is the visceral sensory function of CN X?

A

processes sensory information from the larynx, pharynx, abdominal and thoracic viscera, and stretch receptors of the aortic arch and chemoreceptors of the aortic bodies

29
Q

What muscles receive motor innervation from CN X?

A

Superior and middle pharyngeal constrictors, uvula, and all muscles of the velar sling (except tensor veli palatini)

30
Q

What causes bilateral VF paralysis?

A

carcinoma, trauma, base of the skull tumor, damage to medullary nuclei, and lesions high in the path of the Vagus nerve

31
Q

What is adductor paralysis? What can result from it?

A

a type of bilateral vocal fold paralysis (neurogenic voice disorder) where neither VF can move to the midline; aspiration

32
Q

What is abductor bilateral VF paralysis? What can result from it?

A

a type of bilateral vocal fold paralysis (neurogenic voice disorder) where VF remain at the midline; problems with breathing and feeding

33
Q

How would you treat Bilateral VFP? What should you be mindful of when working with children with bilateral VFP?

A

surgery to reinnervate CN X; Botox Type A injections every 3-6 months; with children, be mindful of the reducing Bilateral VFP’s effects on S-L development as well as managing tracheostomy and tracheal valves

34
Q

What is dystonia?

A

a type of hyperkinetic muscle disorder and neurogenic voice disorder of abnormal contractions of a single body part (e.g., eyelids for blepharospasm or spasmodic dysphonia from laryngeal dystonia) or many body parts

35
Q

What is spasmodic dysphonia? What are the three types?

A

a neurogenic voice disorder resulting from laryngeal dystonia (i.e., larynx abnormaly contracting due to UMN damage). Adductor, abductor, and mixed

36
Q

What is adductor spasmodic dysphonia and what are its symptoms?

A

Most common type of spasmodic dysphonia (SD); strained/strangled or on/off voice (all primary symptoms) or hoarseness/harshness and tremor (Secondary symptoms)

37
Q

What is abductor spasmodic dysphonia and what are its symptoms?

A

Less common type of spasmodic dysphonia (SD); breathy voice (primary symptom) and delay of voice onset following voiceless consonants (Secondary symptom)

38
Q

When deciding between diagnosing spasmodic dysphonia (SD) and essential tremor, what will be the key factor?

A

perception of strained/strangled voice quality; essential tremor does not have that quality

39
Q

What can be used to help you diagnose someone with SD?

A

Perceptual judgement scales (e.g., USDRS) and instrumental measures

40
Q

What are management options for SD?

A

voice therapy, botox type-A injection (most popular), surgery to either cut the RLN of CN X or modify the VFs

41
Q

What is essential voice tremor?

A

a type of neurogenic voice disorder due to UMN damage in the cerebellum and accompanied by random and rhythmic movements (i.e., tremors) of other body parts

42
Q

What are symptoms of an essential voice tremor?

A

fluctuation in pitch and loudness, especially when saying a vowel for a long time (i.e., vowel prolongation or sustained phonation, and strained/strangled or harsh voice (Secondary symptoms)

43
Q

What other tools and information would be used to diagnose someone with voice tremor?

A

Flexible endoscopy to examine velar, pharyngeal, and tongue movements as well as a sustained vowel productiont task (e.g., take a deep breath and say ah for as long as you can)

44
Q

What are treatment options for essential voice tremor?

A

voice therapy to reduce voice intensity and modify pitch.

45
Q

Someone with Parkinson’s Disease can show hypokinetic dysarthria and can have voice issues such as _________`

A

intermittent and rushed speech, monotone, reduced loudness, and breathy voice

46
Q

What causes voice issues for someone with PD?

A

issue with laryngeal physiology or VF physiology, such as VFs not closing completely

47
Q

How would one treat PD?

A

LSVT LOUD (Lee Silverman Voice Treatment); SPEAK OUT! and Lowd Crowd

48
Q

What is LSVT LOUD?

A

treatment used for people with PD where they learn how to recalibrate their perception of their voice’s intensity to match what listeners’ hear; effective in ideal situations (E.g., clinical room) but not in real world situations

49
Q

What is SPEAK OUT! and LOUD Crowd!

A

Treatment used with people with PD where they are taught to speak with intention, increased effort, and with a loud and clear voice. They are taught to not focus on how their voice sounds to them.

50
Q

A stroke that leads to UMN damage leads to what symptoms of speech issues?

A

Spasticity; hypernasality; strained voice quality; and slowed articulation

51
Q

A stroke that damages LMNs leads to what symptoms of speech issues?

A

flaccidity; hyponasality; breathiness; reduced loudness; air wastage

52
Q

When managing a patient with laryngeal impairment secondary to stroke, what must you keep in mind?

A

dysphagia/aspiration (most important for SLP); dysphonia; managing secretion; tracheotomy/airway management

53
Q
A

Dysphagia and Voice Disorders (14 decks)

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