Disorders Of Speech Dysphonia

Sound is produced by the passage of air over the vocal cords.

Respiratory disease or vocal cord paralysis results in a disturbance of this facility -dysphonia. A complete inability to produce sound is referred to as aphonia. Dysarthria often co-exists.

DIAGNOSTIC APPROACH

If, despite attempts, there is deficient sound production then examine the vocal cords by indirect laryngoscopy.

Normal abduction of vocal cords -■Ahh'

Spastic Dysphonia

Sounds as though speaking while being strangled!

May be a functional disorder, form of 'focal' dystonia, occurs with essential tremor or hypothyroidism.

Mirror held in posterior pharynx

Causative Diseases e.g. Medullary damage:

- infarction

- syringobulbia

Paralysis of both vocal cords

Patient speaks in whispers and inspiratory stridor is present.

e.g. Recurrent laryngeal nerve palsy: - following thyroid surgery

- bronchial neoplasm

- aortic aneurysm

Paralysis of left vocal cord which does not move with 'Ahh' while right abducts. When patient says '£' normal cord will move towards paralysed cord. The voice is weak and 'breathy' and the cough 'bovine'.

OTHER DISORDERS OF SPEECH

Mutism: An absence of any attempt at oral communication. It may be associated with bilateral frontal lobe or third ventricular pathology (see Akinetic mutism). Echolalia: Constant repetition of words or sentences heard in dementing illnesses. Palilalia: Repetition of last word or words of patient's speech. Heard in extrapyramidal disease. Logorrhoea: Prolonged speech monologues; associated with Wernicke's dysphasia.

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