NEUROGEnic voice disorders 2

TOpics Flaccid Dysarthria（无力型） Hypokinetic Dysarthria（运动功能减退型） Vocal Fold Paralysis Cricothyroid Muscle Paralysis Bilateral Vocal Fold Paralysis Unilateral Vocal Fold Paralysis Hypokinetic Dysarthria（运动功能减退型） Parkinson’s Disease

Flaccid Dysarthria

Flaccid Dysarthria Cause/etiology Bilateral or unilateral damage to specific cranial nerves At their nuclei in the brain stem Somewhere along their extracranial route to the speech sub system muscles that they innervate

Flaccid Dysarthria Symptoms (damage to peripheral nervous system) Flaccid paralysis Reduced force of muscle contraction（肌肉收缩力量减小） Reduced range of motion（运动范围减小）

Vocal fold paralysis

Vocla fold paralysis A kind of Flaccid Dysarthria patient Cause/etiology Damage to the cranial nerve Ⅹ The type and extent of dysphonia depends on The lesion site Bilateral or unilateral Partial or complete

1、cricothyroid Muscle Paralysis Cause/etiology Mostly viral infection of SLN Bilateral or unilateral Function of cricothyroid Tensing of the VF Elevation of picth VF adduction

1、cricothyroid Muscle Paralysis Sign A slight rotation of the invovled VF A slight bowing of the invovled VF Typical voice symptoms Inability to elevate or lower pitch Some breathiness – bowing

1、cricothyroid Muscle Paralysis Treatment Medicine Corticosteriods and antivirtal agents Surgery Selective reinnervation of the cricothyroid muscle Thyroplasty

2、bilateral VF Paralysis Cause/etiology Lesions in the trunk of the vagus nerve Lesions at the nuclei of origin in the medulla Neonatal stridor 新生儿喉喘鸣（common reason in children）

2、bilateral VF Paralysis Types and symptoms Adductory - neither VF can move to midline Making phonation impossible At risk for aspiration（误吸） Abductory - the VFs remain at the midline Serious respiratory problems tracheostomy

2、bilateral VF Paralysis Treatment – for continued bilateral VF paralysis Tracheostomy – greater airway competence Surgical reinnervation of VFs Unilateral removal of one arytenoid - more anterior glottal closure Electrical stimulation to the posterior cricoarytenoid muscle Laser surgery - decrease open glottal space for bilateral adductor fold paralysis

3、uilateral VF Paralysis (uvfp) Cause/etiology Damage to one side of RLN Disease Trauma - surgical trauma (most common reason) Location Left UVFP is more common The routes of the left and the right RLN are different

3、uilateral VF Paralysis (uvfp) Mechanism Damage to one side of RLN Poor Larygeal adductor muscles (麻痹不能调节自身的张力等因素) Paralyzed fold in paramedian position Neither fully abducted nor adducted (声门不能完全闭合或开放)

3、uilateral VF Paralysis (uvfp) Neither fully abducted nor adducted Breathy Short phonation time Poor Larygeal adductor muscles Pitch breaks Diplophonia Hoarsness Excessive supraglottal constriction Symptoms

3、uilateral VF Paralysis (uvfp) Treatments Traumatic UVFP can have spontaneous recovery with the first 9-12 months postonset Behavioral voice therapy Permanent corrective procedures

3、uilateral VF Paralysis (uvfp) Behavioral voice therapy Half-swallow boom Head positioning Tuck-chin Digital manipulation Focus Tongue protursion /i/ Yawn-sigh Pitch shift up Inhalation phonation

3、uilateral VF Paralysis (uvfp) Permanent corrective procedures Paralyzed VF injection Teflon Fat - reabsorbed Facial tissue Thyroplasty Rectangular window Micrometric screw （微动螺丝） Reinnervating the paralyzed VF Phrenic nerve (膈神经) Section of SLN and hypoglossus nerve

uVFP before & after Surgery (Teflon Injection)

Hypokinetic Dysarthria

Hypokinetic Dysarthria Cause/etiology Problem with the effect of neurotransmitter dopamine on the activities of the basal ganglia Depletion（损耗过多） Functional reduction（功能减退） Symptoms Rigidity, slow movement - bradykinesia Limited range of motion Resting tremor

Parkinson’s Disease

Parkinson’s Disease (PD) 98% hypokinetic dysarthrias are of the Parkinson’s type Symptoms Reduced loudness Breathy voice Monotony of picth Intermittent rapid rushes of speech Soft production of consonants

Parkinson’s Disease (PD) Treatments Task Quick conversational pattern Mechanism Rapid and accelerated movement of the articulators Results Speech is unintelligible

Parkinson’s Disease (PD) Treatments Speak with intent Louder slower Better voice quality Better articulation

Parkinson’s Disease (PD) Treatments LSVT (Lee Silverman Voice Treatment) Increase VF adduction Respiratory effort PLVT (Pitch limiting Voice Treatment) Increase respiratory support Phonation at a low pitch DAF (delayed auditory feedback) Instrumental procedure

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