Voice Disorders

Question 1

Describe how voice and speech are controlled and the different organs involved?

Answer 1

The lungs force air through the vocal folds.

The vocal folds vibrate creating a sound.

This sound is resonated in the vocal cords.

The sound is then articulated into speech by our oropharynx.

The steps are all coordinated by the brain.

Question 2

Define the following terms dysphasia, dysarthria, dysphonia?

Answer 2

Dysphasia: Impairment of speech and verbal comprehension due to a brain insult.

Dysarthria: Impairment in articulation due to lack of muscle control or coordination

Dysphonia: Impairment in sound production.

Question 3

Why is it important to take a multidisciplinary approach when treating those with voice disorders?

Answer 3

As it allows there to be a joint assessment by both the ENT surgeons and the speech and language specialists.

Allows there to be a joint assessment and management plan as patients will often need speech therapy as well as a medical/surgical approach.

Question 4

What are the key features you need to consider when trying to distinguish between the benign and malignant causes of hoarseness?

Answer 4

Persistent hoarseness lasting >6 weeks

Hoarseness lasting more than 3 weeks requires an urgent chest xray

Progressive hoarseness
Significant smoking history
FH
Presence of leukoplakia

Question 5

What are the symptoms and causes of recurrent laryngeal nn palsy?

Answer 5

Symtoms:
Weak, hoarse, breathy voice
Swallowing disability
SOB
Tires on prolonged talking

It causes there to be a unilateral vocal cord paralysis.

Causes of RLN palsy are:
Trauma (usually surgical, thyroidectomy)
Malignancy (compressing the RLN) 
Idiopathic
Neurogenic

Question 6

What is muscle tension dysphonia, how does it present and how is it treated?

Answer 6

Muscle tension dysphonia is a common voice disorder seen in secondary care in which there is an imbalance of pull due to excessive tension being exerted by the laryngeal muscles.

It presents with variable hoarseness from normal to no voice. and on examination there may be patterns of suprlaryngeal constriction.

It is treated with speech therapy and addressing any underlying cause.

Question 7

List the potential causes of hoarse voice?

Answer 7

Muscle tension dysphonia
Recurrent laryngeal nn palsy
Laryngitis
Vocal fold:, polyp, nodule or cyst.
Reinke's oedema (oedema within the vocal cords)
Laryngeal polyposis