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Piper DoeringSpring, 2013Compare and contrast vocal fold paralysis in the pediatric and adult populations Vocal fold paralysis (VFP) is the complete absence of movement in the affected vocal fold, either unilaterally or bilaterally (Sapienza & Hoffman Ruddy, 2009). VFP occurs in both the pediatric and adult populations; however, there are similarities and differences between these two populations considering etiology, signs/symptoms, spontaneous recovery, and treatment. These populations and categories are compared and contrasted below.For both populations, etiology is often medical. Pediatric VFP due to medical intervention includes surgery of the thorax, trachea, and espohagus (King & Blumin, 2009). Surgical trauma carries a similar risk for adults, reported for 40.2% of adult VFP cases (Sapienza et al., 2009). In general, neurologic disruption due to surgical intervention creates a risk of VFP. Other causes for pediatric VFP include trauma, intubation, and cardiovascular anomalies (King et al., 2009). Etiologies for the adult population are similar, with addition of tumors (Sapienza et al., 2009). This is logical considering a tumor may result from certain lifestyles over time. These etiologies do not account for all cases of VFP. Many cases are still idiopathic (Sapienza et al., 2009).Signs and symptoms change with the type and severity of VFP. Pediatric VFP is often present within the first two years of life; stridor is the most common sign for bilateral VFP, while dysphonia and feeding difficulties are common in unilateral VFP (King et al., 2009). These signs hold true for adults. Additional consideration is given to the adult population in terms of voicing. Phonation varies from perceptually normal, when vocal folds are fixed in an adducted position, to completely aphonic, when vocal folds are fixed in an abducted position (Sapienza et al., 2009). As expected, vocal quality would change in terms of increased breathiness, hoarseness, and strain as a result of the abnormal closure patterns and increased effort.Recovery outcomes vary, with spontaneous recovery occurring more often in pediatric than adult clients (King et al., 2009). While spontaneous recovery is fairly predictable in younger clients, recovery time is not. Recovery time ranges anywhere from one month to five years (King et al., 2009). Adults with VFP are typically given six to nine months to spontaneously recover before intervention; this “wait and see” approach allows time for functional recovery and neurological regeneration (Sapienza et al., 2009).The number one concern for treatment is airway management, followed by swallowing and voice (King et al., 2009). All populations with unilateral VFP may make some improvement with voice therapy. Intervention may include pushing techniques, vocal function exercises, resonant voice, and Lee Silverman Voice Therapy (Sapienza et al., 2009). For pediatrics, voice therapy must be modified in terms of technique explanation and presentation. This holds true for medical procedures as well. For unilateral VFP, vocal fold augmentation and thyroplasty medialization are used to bring the vocal folds together (Sapienza et al., 2009). For bilateral VFP in the abducted position, medialization procedures are used in addition to surgical procedures to restore the airway; when in the adducted position, surgical procedures are conducted to increase glottal opening for breathing (Sapienza et al., 2009). Pediatric medialization and surgical procedures have not been studied extensively and long-term effects are unknown (King et al., 2009). More research is necessary.As a whole, all populations are similar in terms of etiologies, signs/symptoms, spontaneous recovery, and treatment. However, differences must be noted for the most effective and efficient treatment. The pediatric population will require extra research to ensure evidence-based practice. Compare and contrast abductor and adductor spasmodic dysphonia Dystonia is characterized by jerking movements of the body resulting from abnormal muscle tone (Sapienza et al., 2009). Specific to the vocal folds is abductor and adductor spasmodic dysphonia. Both are similar in that they affect the laryngeal muscle movement during phonation; however, there are notable differences in consideration to symptoms and treatment.Abductor spasmodic dysphonia (ABSD) is characterized by uncontrollable abductions of the vocal folds (Sapienza et al., 2009). In essence, the vocal folds open sporadically, allowing air to escape. This inconsistent closure pattern results in a symptom of ABSD: an excessively breathy voice quality (Sapienza et al., 2009). In contrast, adductor spasmodic dysphonia (ADSD) is characterized by a noticeable strained and strangled voice quality, resulting from abnormal adduction patterns (Sapienza et al., 2009). The vocal folds come together frequently at an irregular rate. As expected, irregular closing leads to irregular phonation, a symptom of ADSD. Although they sound perceptually different, ABSD and ADSD also have similar symptoms. Voice stops occur during sustained vowels and conversational speech (Sapienza et al., 2009). Other common characteristics include delayed onset during initiation of sound, decreased intelligibility, and impaired communication effectiveness (Sapienza et al., 2009). There are treatments to manage these symptoms. In general, treatments aim to gain control over laryngeal muscle spasms. One option is the injection of the botulinum toxin into the spastic laryngeal muscles (Sapienza et al., 2009). Guided into location by electronic signals, the injected laryngeal muscles are temporarily denervated by “blocking the release of acetylcholine at the neuromuscular junction” (Sapienza et al., 2009, p. 287). Denervation decreases the likelihood of muscle spasms, resulting in a smoother voice production. However, since this treatment is temporary, more injections are necessary once spasmodic symptoms return.While both ABSD and ADSD clients will benefit from botulinum toxin injections, ADSD clients are more likely to benefit from voice therapy. Existing behavioral treatment techniques that focus on a breathy voice, noncommunicative vocalizations, singing, humming, and pitch alterations are also used for clients with ADSD (Sapienza et al., 2009). These techniques allow clients to gain a greater control over their voice.Both ABSD and ADSD are neurological voice disorders that result in abnormal movement of the laryngeal muscles. With this general definition, ABSD and ADSD are very similar. However, each disorder has unique symptoms that set them apart from one another; differences which need to be considered during treatment.ReferencesKing, E.F. & Blumin, J.H. (2009). Vocal cord paralysis in children. Current Opinion in Otolaryngology & Head and Neck Surgery, 17, 483-487.Sapienza, C.M. & Hoffman Ruddy, B. (2009). Voice disorders. San Diego, CA: Plural Publishing, Inc. – Chapter 6: Neurologically based voice disorders (pp. 267-313). ................
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