Voice 2b) - Neurogenic voice disorders

unilateral TVF paralysis

damage to vagus → unilateral, ipsilateral TVF paralysis → flaccid dysphonia

the level of movement across visual examination changes as

the recurrent laryngeal nerve regenerates

TVF paralysis is a symptom of

• surgical trauma

• tumours/neoplasms

• idiopathic factors

• trauma

• CNS dysfucntion

• radiation

• inflammation

• cardiovascular

location of paralysis depends on

site of lesion

unilateral TVF paralysis visual ax

• paralyzed fold may look to be above or below the other side

• pooling of saliva lateral to paralyzed cord and ipsilateral pyriform

• passive vibration and unequal vibratory patterns between folds

• no movement of affected arytenoid

first step of unilateral TVF paralysis management

wait and see, allow for spontaneous recovery of nerve, 9-12 moths

behavioural voice tx for UTFV paralysis

• strengthening vocal muscles and improving speaking technique

• starting treatment 2-6 weeks following injury significantly improves perceptual and acoustic measures by six months

treatments after wait and see for UTVF paralysis

• surgical interventions:

• injection of teflon, fat, or other soft tissue fibres

• medialization thyroplasty

• reinnervation

bilateral TVF paralysis

paralysis of both TVFs

often in paramedian position

what may be a major issue in BTVF paralysis

aspiration

what does BTVF paralysis result from?

lesions high in the trunk of the vagus or nuclei in the medulla

surgical trauma

malignancies

endotracheal intubation

neurologic disease

idiopathic causes

BTVF paralysis perceptual ax

aphonic → normal

stridor

BTVF paralysis visual ax

no abductory or adductory movement

BTVF paralysis behavioural management:

inspiratory pressure threshold training, electrical stimulation

BTVF paralysis management if airway not threatened

wait and see 6-9 months

BTVF paralysis management if airway compromised

• surgery

• tracheostomy

• unilateral removal of one arytenoid with cauterization of muscular attachments

what muscle does the superior laryngeal nerve innervate?

the cricothyroid

what are the two functions of the muscle that innervates the SLN?

lengthening and tensing the vocal folds (increasing pitch)

causes of SLN paralysis

primarily viral infections causing neuritis

traumatic, neoplastic, or infectious conditions

SLN paralysis perceptual ax

• breathy voice

• decreased pitch range

• difficulty producing high pitches

SLN paralysis visual ax

variable presentation

during phonation:

• ipsilateral bowing

• height asymmetry of vocal processes

• ipsilateral hyperadduction of the FVF

at rest:

• larynx may be rotated toward affected side

SLN paralysis management

• first wait and see

• reinnervation

• surgical: fusion of the thyroid and cricoid cartilages, thryoplasy

spasmodic dysphonia (think selma blair)

focal laryngeal dystonia affecting adductor and/or abductor muscles during phonation

two types of spasmodic dysphonia

Abductor SD (AbSD)

Adductor SD (AdSD) (most common)

Mixed = quite rare

evidence now supports what as the cause for spasmodic dysphonia (not psychological)

supranuclear, cortical lesions

psycho-emotional correlates are secondary to the SD

spasmodic dysphonia occurs with

other dystonias

management for AdSD

• RLN sectioning

• Botox → if it doesn’t change quality, it changes patient’s perceived level of effort and voice interruption

• voice tx relatively ineffective but may be paired with pharma therapy to assist in improving voice quality

behavioural voice tx for AdSD

• easy breath cycle

• yawn sigh

• reducing muscle tension

• 
  

true or false: essential tremor is the most common movement disorder

true

essential tremor commonly affects what

the hands and limbs

can also affect tongue, velar, laryngeal and pharyngeal structures

essential tremor is more common in who?

older adults

what is the cause of essential voice tremor

varies, but is centrelly driven

symptoms of essential voice tremor worsen with what?

prolonged phonation of vowels in isolation

EVT perceptual ax

• audible, rhythmic cycles occur every 4-6 Hz on sustained phonation

• pitch and voice breaks

• can be confused with AdSD

EVT visual ax

• bilateral tremor of TVFs

• movement at rest, increases during phonation

EVT management

• pharmacological controls

• beta-blockers, porpranolol, metoprolol preferred

• bilateral botox

• DBS