speech and voice disorders very important

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1. SPASMODIC DYSPHONIA

2. voice disorder arising from a focal dystonia involving certain laryngeal muscles but reflecting central motor processing issues/abnormalities. Background of normal speech overlain by vocal spasms not under voluntary control Types :- Adductor Abductor Mixed DEFINITION:-

3. The adductor muscles of larynx go into spasm causing vocal cords to go into adduction aetiology :- uncertain , but one should exclude neurological conditions such as Parkinsonism, myoclonus, pseudobulbar palsy, multiple sclerosis, cerebellar disorders, tardive dyskinesia clinical features :- Voice becomes strangulated /creaky / scracthy , and phonation is interrupted in between leading to voice breaks. Adductor dysphonia :-

4. Management :- Treatment consists of botulinum toxin injections in the thyroarytenoid muscle on one or both sides to relieve spasm Voice therapy alone without injection does not help much. Section of recurrent laryngeal to paralyze the cord/cords has been used in the past but it interferes with glottic closure leading to breathy and weak voice and swallowing discomfort

5. ABDUCTOR DYSPHONIA :- It is due to spasms of posterior cricoarytenoid muscle (the only abductor) and thus keeping the glottis open. aetiology :- Like adductor spasm dysphonia, cause of abductor spasmodic dysphonia is not known Clinical features :- Patient gets a breathy voice or breathy breaks in voice.

6. Management :- injection of botulinum toxin in posterior cricoarytenoid muscles. Disadvantages of injection treatment are that it may compromise vocal cord movements with respiration leading to airway obstruction. Patients who do not respond to toxin injection can be treated by thyroplasty type I or fat injection Speech therapy should be combined with injection treatment

7. Mixed dysphonia :- It is more complex, both the adductor and abductor function may be affected.

8. Rhinolalia :- Rhinolalia is an altered speech due to abnormal airflow through the nose during phonation Types :- Rhinolalia clausa ( Hyponasal speech) Rhinolalia aperta ( Hypernasal speech)

9. HYPONASALITY (RHINOLALIA CLAUSA) :- It is lack of nasal resonance for words which are resonated in the nasal cavity, e.g. m, n, ng. It is due to blockage of the nose or nasopharynx Causes :- common cold , nasal allergy ,nasal polypi , nasal growth , adenoids, nasopharyngeal mass , habitual Treatment :- After treating the cause, the patient is sent for voice therapy.

10. 2 . HYPERNASALITY (RHINOLALIA APERTA) :- It is seen when certain words which have little nasal resonance are resonated through nose. Due to abnormal communication between the oral and nasal cavities. Causes :- Velopharyngeal insufficiency, Congenitally short soft palate , Submucous palate, Large nasopharynx , Cleft of soft palate, Paralysis of soft palate, Postadenoidectomy ,Oronasal fistula ,Familial speech pattern Habitual speech pattern Treatment: Treatment of the cause is important. Voice therapy helps in functional causes.

11. Aphasia :- Aphasia means partial or complete loss of speech after the completion of language acquisition. Predisposing factors are : Arterial hypertension Disorders of fat metabolism Diabetes mellitus Generalized atherosclerosis Management :- treatment of the cause and speech therapy.

12. STUTTERNIG :- Definition :- Stuttering is a neurologic, movement disorder in which abnormal, involuntary and inappropriate use of the speech muscles results in dysfluency

13. Clinical Features :- Child is of 18 months to 8 years with a peak between 2 to 3 years and 5 to 7 years It begins over weeks and months starting with repetitions of words Frustration, while trying to communicate Eye blinking, while talking Head jerks and feeling of embarrassment, while trying to speak

14. Diagnosis :- Disturbances in the normal fluency is inappropriate for that age, which is characterized by one or more of the following: Prolongations of sound Broken words Words substitution Repetition of words

15. Management :- Assessment of child and his parents is quite important Psychotherapy: It is indicated, when stutterers are anxious, depressed and have a poor self image and show an emotional disorder Hypnosis also helps temporarily Psychopharmacological treatment with haloperidol, which causes relaxation

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