Closing the Gap: Unilateral Vocal Fold Paralysis
Closing the Gap: Unilateral Vocal Fold
Paralysis
Sarah L. Schneider, MS, CCC-SLP
Co-Director, UCSF Voice and Swallowing Center Speech Language Pathology Director Assistant Professor Department of Otolaryngology ? Head & Neck Surgery
UCSF Voice and Swallowing Center
University of California, San Francisco Sarah.Schneider@UCSF.edu
None
Disclosure
UCSF Voice and Swallowing Center
Vocal Fold Motion Impairment The SLP Perspective
Evaluation
? Voice ? Swallowing ? Breathing
Therapy Candidacy ? When to refer for voice therapy
Treatment
? Frequency ? Duration ? Therapy
techniques
UCSF Voice and Swallowing Center
Glottic Insufficiency - Nomenclature
Vocal Fold Immobility/Hypomobility - Absent/reduced movement due to unknown cause
Vocal Fold Paralysis/Paresis - Absent/reduced movement due neurogenic etiology
Vocal fold Immobility/Hypomobility related to the mechanical impairment of the cricoarytenoid joint - Includes posterior glottic scarring/stenosis
Vocal fold Immobility/Hypomobility related to laryngeal malignant disease
Rosen et al 2016
UCSF Voice and Swallowing Center
Clinical Factors and Decision Making
History - Medical history - Onset of symptoms
Patient vs Clinician perception severity Complaints Laryngeal Examination Stimulability for behavioral change Readiness for change/motivation Patient and clinical expectations for recovery Candidacy for surgical intervention
UCSF Voice and Swallowing Center
Patient Intake/History
Onset of Complaints ? gradual, sudden
Specific complaints
- Voice - Swallowing - Breathing Vocal demand Medical/Surgical history Medications
Patient reported measures: ? Voice Handicap Index (VHI)-10 ? Voice Related Quality of Life (VRQOL) ? Dyspnea Index (DI) ? Eating Assessment Tool (EAT)-10
Relevant social history
Leder and Ross 2005
UCSF Voice and Swallowing Center
Perceptual Evaluation
CAPE-V - Standard instructions - Standard tasks
Common voice quality: - Breathiness - Asthenia - Diplophonia - May be worse at lower pitches
Assessing Peri-Laryngeal Tension Peri-laryngeal Palpation
Tension and Tenderness Infrahyoid Sternocleidomastoid Suprahyoid Submental Lateral motion of the Larynx
*Assess at rest and during phonation **Pressure to blanch the thumb nail on a firm surface
UCSF Voice and Swallowing Center
Acoustic and Aerodynamic Testing
Acoustic Measures ? - Jitter, shimmer, noise/ harmonic ratio
Time based acoustic measures unreliable with dysphonic voices
- CSID and CPP speech ?statistically significant improvement pre- and post treatment in this population (Gillespie et al 2014)
UCSF Voice and Swallowing Center
Acoustic and Aerodynamic Testing
Aerodynamic Measures - Speech Aerodynamics. (Gillespie et al.)
Can be done with or without equipment Duration of the first 4 sentences of the Rainbow
passage and count number of breathes With equipment - analyze average airflow
UCSF Voice and Swallowing Center
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