CSDS 115 - UNIT 6 - Vocal Fold Paralysis + Related Disorders

Unilateral True Vocal Fold Paralysis

• Results from:

  • Surgical trauma

  • Tumors/neoplasm

  • Trauma

  • CNS dysfunction

  • Radiation

  • Inflammatory

  • Cardiovascular and unknown idiopathic factors

• May result in:

  • Aphonia to normal voicing

• 90% vocal fold paralysis is unilateral

• Majority - adductor type

• Paralysis v. paresis

• Recurrent laryngeal nerve (Vagus CN X) - "wandering" nerve damage - flaccid dysphonia

• Management:

  • Goal - improve voice + prevent aspiration

  • Surgical - with recurrent laryngeal damage, it’s a "wait and see" approach from 6-9 months

    • Medialization

    • Arytenoid adduction

    • Vocal fold augmentation

    • Reinnervation surgical approaches

    • Gene therapy

  • Behavioral voice therapy

    • Vocal function exercises

    • Resonant voice therapy

    • Lee Silverman Voice Treatment (LSVT)

Bilateral Abductor True Vocal Fold Paralysis

• Characteristics:

  • Life threatening condition when bilateral paramedian vocal fold paralysis

  • Results from

    • Surgical trauma

    • Malignancies

    • Endotracheal tube intubation

    • Neurological diseases

    • Idiopathic causes

  • Variable voice symptoms

 

• Management:

  • Laryngoscopic eval - show no movement of wither vocal fold during respiration and phonation, further confirmed with laryngeal EMG

  • "wait and see" approach for 6-9 months

  • Pacing strategies may include electrical stimulation of vocal folds, botox injections to obtain adequate glottal opening.

Superior Laryngeal Nerve Paralysis

• Characteristics:

  • Superior laryngeal nerve innervated the cricothyroid muscles bilaterally

  • Visual assessment - difficult to diagnose (vocal folds appear normal or "rotated" at rest to weakened side.

  • Vocal fold bowing and shortening, ipsilateral hyperadduction of the false vocal fold

  • Symptoms:

    • Disruption of adduction and elongation for increased pitch

    • Weak breathy voice

    • Hoarseness

 

• Management:

  • "wait and see" approach

  • Surgical management may include - fusion of thyroid and cricoid cartilages

Spasmodic Dysphonia

• Characteristics:

  • Focal laryngeal dystonia with unknown origin

  • Adductor spasmodic dysphonia (85% of cases) - intermittent strained strangled quality

  • Abductor spasmodic dysphonia - intermittent breathiness

  • Perceived stoppages of voice are heard with vowel prolongation and connected speech

  • More severe during connected speech

 

• Management:

  • Botox injections; voice therapy may play some role in improvement

Essential Voice Tremor

• Characteristics:

  • Most common movement disorder - varying etiology

  • May be inherited - worsens with age

  • More frequently - tremor affects the hands

  • Audible rhythmic cycles of tremor can be heard during vowel prolongation

  • Cyclic tremor

  • Possible pitch or voice breaks

 

• Management:

  • With medication (beta-blockers, propranolol, metoprolol)

list the types of vocal fold paralysis and related disorders

• unilateral true vocal fold paralysis

• bilateral abductor true vocal fold paralysis

• superior laryngeal nerve paralysis

• spasmodic dysphonia

• essential voice tremor