Voice Disorders
Voice Disorders
SPTH 204
HEAD AND NECK ANATOMY
VOICE DISORDERS
Fall 2018-2019
NEUROGENIC VOICE
DISORDERS
INNERVATION: VOCAL FOLDS
Main Cranial Nerve: Vagus (X)
•
-Divides into left & right branches, then
further divides into 3 branches,
1) Pharyngeal
2) Superior laryngeal
3) Recurrent laryngeal
Vagus Nerve Branches
Superior Pharyngeal
Constrictor Muscle
Nucleus
Middle Pharyngeal
Ambiguus
Constrictor Muscle
Jugular Foramen
Pharyngeal Branch
Inferior
Superior Pharyngeal
Laryngeal Constrictor
Vagus Nerve Nerve Muscle
(x)
Recurrent
Laryngeal
Nerve
PHARYNGEAL BRANCH
A) Unilateral lesions:
• unilateral v.f. paralysis
• breathiness and aphonia
• tremorous vowel prolongation's
• reduced loudness
• reduced endurance
• lowered pitch
• diplophonia
• hypernasal resonance
• swallowing problems
SYMPTOMS
B) Bilateral lesions:
• bilat. v.f. paralysis
• open glottis
• marked hypernasality
• Requires tracheotomy
LOWER MOTOR NEURON DISEASE: BILATERAL
MUSCLE WEAKNESS
• Corticosteroids
• anticholinesterase drugs to improve the action of the
neurotransmitter chemical acetylcholine
• removal of thymus gland
• adrenocorticotrophic hormone therapy
• palatal lift prosthesis to compensate for velar inadequacy
• voice therapy to increase hyperadduction if medical
treatment does not work
UPPER MOTOR NEURON DISORDERS: SUPRA
OR PSEUDOBULBAR PALSY
• Primary Voice Symptom:
– Hoarseness or harshness
– Stroboscopy-
• Reduced vocal fold amplitude
• Diminished mucosal wave
• Excessive glottal closure
• Asymmetry, aperiodicity
PARKINSON’S
• Primary Voice Symptom:
– Monopitch
• Acoustic Signs:
– Fundamental frequency within the normal range
• Greater variation of fundamental frequency in sustained vowels
• Higher jitter values
• Lower SNR
PARKINSON’S
• Measurable Physiological Signs:
– Higher activity in the interarytenoid & posterior cricoarytenoid muscles
– Greater activity in lip muscles