Voice Disorders – 10 Previous Year AIIMS PG Question for Practice

DYSPHONIA PLICA VENTRICULARIS

  • Ventricular dysphonia
  • Voice is produced by ventricular folds (false cords)
  • Voice is rough, low pitched and unpleasant.
  • Ventricular voice may be secondary to impaired function of the true cord such as paralysis, fixation, surgical excision, or tumours.
  • Ventricular bands in these situations try to compensate or assume phonatory function of true cords.
  • Functional type of ventricular dysphonia occurs in normal larynx . Here cause is psychogenic.
  • Diagnosis is made on indirect laryngoscopy; the false cords are seen to
  • approximate partially or completely and obscure the view of true cords on phonation.
  • Ventricular dysphonia secondary to laryngeal disorders is difficult to treat but the functional type can be helped through voice therapy and psychological counselling.

FUNCTIONAL APHONIA or HYSTERICAL APHONIA

  • Seen in emotionally labile females in the age group 15 – 30.
  • Does not occur due to vocal cord paralysis.
  • Usually sudden
  • Patient communicates with whisper
  • O/E – vocal cords are seen in abducted position and fail to adduct on phonation
  • Adduction of cords are seen on coughing, which indicates normal adductor function
  • Sound of cough is good
  • Treatment – reassurance and psychotherapy.Speech therapy has no role in it.

PUBERPHONIA or MUTATIONAL FALSETTO VOICE

  • Childhood voice has a higher pitch
  • When the larynx matures at puberty, vocal cords lengthen and voice changes to lower pitch in males
  • Failure of this change is called puberphonia.
  • Voice break may also refer to the deepening of the voice during puberty, known as the voice change.
  • Young man whose voice has not broken is called Puberphonia.
  • Seen in boys who are emotionally immature, feel insecure and show excessive fixation to their mother
  • Physical and sexual development are normal
  • Gutzmann’s pressure test – pressing the thyroid prominence in a backward and downward direction relaxes the overstretched cords and low pitch voice can be produced.
  • Treatment
  • Mostly conservative:Training the body to produce low pitched voice with the help of a speech therapist.
  • Surgery might be needed in few cases:Lengthening of vocal cord i.e.Thyroplasty type III

PHONASTHENIA

  • Weakness of voice due to fatigue of phonatory muscles
  • Thyroarytenoid and interarytenoids are affected
  • Seen in voice abuse or misuse
  • Indirect laryngoscopy shows
    • Elliptical space between the cords in weakness of thyroarytenoid
    • Triangular gap near the posterior commissure in weakness of interarytenoid
    • Key-hole appearance of glottis when both are involved.
  • Voice therapy may help.

HABITUAL DYSPHONIA

  •  When a person always uses a poor voice in normal circumstances, is called habitual dysphonia.
  •  It is not related to stressful events and seems to be a habit.
  • Treatment is Vocal exercise and reassurance.

SPASMODIC DYSPHONIA

Spasmodic dysphonia (or laryngeal dystonia) is a neurological voice disorder characterized by involuntary movements or spasms of one or more muscles of the larynx (vocal folds or voice box) during speech.

Spasmodic dysphonia is not a local laryngeal disorder but a neurolgical disorder and is often associated with other dystonias, e. g. blepharospasm, oromandibular dystonias.

The three types of spasmodic dysphonia :
Adductor spasmodic dysphonia

  • Sudden involuntary muscle movements or spasms cause the vocal cords to slam together and stiffen.These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or are difficult to start because of the muscle spasms.
  • The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort.
  • Stress,often makes the muscle spasms more severe.

Abductor spasmodic dysphonia

  • In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open.
  • The vocal folds cannot vibrate when they are open.
  • The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery.

Mixed spasmodic dysphonia

  • Mixed spasmodic dysphonia involves both muscles that open the vocal folds and those that close them and therefore has features of both adductor and abductor spasmodic dysphonia.

Treatment :

  • Botox injection:The most common treatment for spasmodic dysphonia is the injection of very small amounts of botulinum toxin directly into the affected muscles of the larynx.
    • The toxin weakens muscles by blocking the nerve impulse to the muscle.
  • Surgery:Type 2 Thyroplasty in a case of Adductor Spasmodic Dysphonia.
    • Lateralization thyroplasty is intended to prevent this tight closure of the glottis at the terminal stage of phonation by lateralizing the position of the vocal cord
  • Behavioral therapy :it may work to reduce symptoms in mild cases.
    •  Other people may benefit from psychological counseling to help them accept and live with their voice problem.

 HYPONASALITY or RHINOLALIA CLAUSA   

Due to blockage of the nose or nasopharynx 

  • Common cold
  • Nasal allergy
  • Nasal polypi
  • Nasal growth
  • Adenoids
  • Nasopharyngeal mass
  • Familial speech pattern
  • Habitual

HYPERNASALITY or RHINOLALIA APERTA

Failure of nasopharynx to cut off from oropharynx or abnormal communication between oral and nasal cavities

  • Velopharyngeal insufficiency
  • Congenitally short soft palate
  • Submucous palate
  • Large nasopharynx’
  • Cleft on soft palate
  • Paralysis of soft palate
  • Post-adenoidectomy
  • Oro-nasal fistula
  • Familial/habitual

Exam Question of

  • Rhinolalia clausa is associated with Allergic rhinitis , Adenoids, Nasal polyps.
  • Rhinolalia clausa is associated with Palatal paralysis.
  • In dysphonia plica ventricularis, sound is produced by False vocal cords.
  • Functional Aphonia is seen commonly in females.
  • Functional aphonia is not due to vocal cord paralysis.
  • In a case of functional aphonia,the patient is able to cough.
  • Habitual dysphonia is characterized by poor voice in normal environment  .
  • Treatment of Habitual Dysphonia is Vocal exercise and reassurance.
  • Young man whose voice has not broken is called Puberphonia.
  • Patient with the adductor type of Spasmodic dysphonia have strained and stran­gled voice.
  •  Botulinum toxin is the standard treatment for Spasmodic dysphonia.
  • Spasmodic dysphonia may be associated with other focal dysphonia.
  • Type – III Thyroplasty is the surgical treatment of Puperphonia.

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Question of NBE /NEET / DNB

Voice Disorders

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