Vocal fold paralysis and related disorders, vocal fold paralysis/paresis

90% vocal fold paralysis is

unilateral due to peripheral damage to vocal folds

Majority of vocal fold paralysis are

adductor type, can't close the glottal space fully

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

May lead to unilateral true vocal fold paralysis

Unilateral True Vocal Fold Paralysis Etiology

May result from surgical trauma, tumors/neoplasms, trauma, CNS dysfunction, radiation, inflammatory, cardiovascular & unknown idiopathic factors

Unilateral True Vocal Fold Paralysis Voice Characteristics

May result in aphonia to normal voicing because the localization of paralysis will determine it,

Unilateral True Vocal Fold Paralysis Treatment

Surgery, Behavior therapy, Medical care

MANAGEMENT OF UNILATERAL VOCAL FOLD PARALYSIS goals

Improve voice and prevent

Aspiration

MANAGEMENT OF UNILATERAL VOCAL FOLD PARALYSIS Surgical

With recurrent laryngeal

nerve damage, it's a "wait & see" approach for 6-9 months; Medialization, Arytenoid adduction, Vocal fold augmentation, Reinnervation surgical approaches, Gene therapy

Medialization

moving vocal fold towards the middle

Arytenoid adduction

done if theres a large glottal gap

Vocal fold augmentation

fatten up paralyzed vocal cord so stronger cord can contact the closer paralyzed cord, temporary affect, requires reapplication

Reinnervation surgical approaches

to the recurrent laryngeal nerve,

Gene therapy

to the recurrent laryngeal nerve, ongoing research into potential side effects

MANAGEMENT OF UNILATERAL VOCAL FOLD PARALYSIS Behavioral Voice Therapy

Vocal function exercises, Resonant Voice Therapy, Lee Silverman Voice Treatment (LSVT)

Bilateral Abductor True Vocal Fold Paralysis Description

Life threatening condition when there is bilateral paramedian vocal fold paralysis, Variable voice symptoms

Bilateral Abductor True Vocal Fold Paralysis Etiology

Most commonly happens from surgical trauma, malignancies, endotracheal tube intubation neurological diseases, & idiopathic causes

Bilateral Abductor True Vocal Fold Paralysis Management

Management is a "wait & 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 Description

the vocal folds can appear normal or "rotated" at rest to weakened side. Vocal fold bowing and shortening, ipsilateral hyperadduction of the false fold

Superior Laryngeal Nerve Paralysis Symptoms

disruption of adduction and elongation for

increased pitch, weak breathy voice, hoarseness

Superior Laryngeal Nerve Paralysis Managment

wait & see" approach, surgically may include the fusion of the thyroid and cricoid cartilages

Spasmodic Dysphonia Description

focal laryngeal (in vocal folds) dystonia during phonation with unknown origin (can be adductor, abductor, or both dysphonias)

Adductor spasmodic dysphonia (85% of cases)

intermittent strained strangled quality

Abductor spasmodic dysphonia

intermittent breathiness

Spasmodic Dysphonia Symptoms

Perceived stoppages of voice are heard with vowel prolongation and connected speech, More severe during connected speech

Spasmodic Dysphonia Management

Botox injection; voice therapy may play some role in improvement

Essential Voice Tremor Description

Most common movement disorder, varying etiology, inherited and worsens with age, tremor affects the hands

Essential Voice Tremor Symptoms

Audible, rhythmic cycles of tremor can be heard during vowel prolongation, Cyclic tremor, Possible pitch or voice breaks

Essential Voice Tremor Management

with medication (beta-blockers, propranolol, and metoprolol)

Vocal fold paralysis

no movement

Vocal fold paresis

weakness of vocal folds, slight movement is preserved