Swallowing & Voice Disorders

Swallowing Disorder 

Dysphagia or swallowing disorder is a general term used to describe the inability to move food from the mouth to the stomach.

Dysphagia is classified into:

	Oropharyngeal dysphagia
	Esophageal dysphagia
	Functional dysphagia

Signs and Symptoms may include:

	Difficulty controlling food in the mouth.
	Inability to control food or saliva in the mouth.
	Difficulty initiating a swallow.
	Inability to swallow solid food.
	Coughing, choking, frequent pneumonia, unexplained weight loss, gurgly or wet voice after swallowing, nasal regurgitation.
	Pain on swallowing or odynophagia is a distinctive symptom that can be highly indicative of carcinoma.
	Achalasia (an esophageal motility disorder) is a major exception to usual pattern of dysphagia in that swallowing of fluid tends to cause more difficulty than swallowing solids.

Management may include:

	Swallowing Therapy / Retraining.
	Reassurance / Psychological interventions.
	Surgery.
	Medications.

HOW DOES A SPEECH LANGUAGE PATHOLOGIST HELP?
Patients who exhibit difficulty with swallowing should be referred to a speech language pathologist. The speech language pathologist develops and implements intervention programs for the feeding process which include:

	Determining food and liquid consistencies to be presented to the patient.
	Deciding which compensatory strategies will be used with the patient.
	Administering the standard swallow examination.
	Instructing the family and patient on safe swallowing strategies.

Voice Disorders

a. Puberphonia
The persistence of adolescent voice even after puberty in the absence of organic cause is known as Puberphonia. This condition is commonly seen in males. This is remarkable marked with unusually high-pitched voice.

b. Vocal Cord Paresis
Vocal cord paresis (or paralysis) is weakness of one or both vocal folds.

Symptoms of paresis include:

	Hoarseness
	Vocal fatigue
	Mild to severe reduction in vocal volume
	Pain in the throat when speaking
	Shortness of breath
	Aspiration (food or liquids going down the trachea) with frequent resultant coughing, and in extreme cases may cause death.

c. Spasmodic Dysphonia

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

The three types of spasmodic dysphonia:

	Adductor spasmodic dysphonia
	Abductor spasmodic dysphonia
	Mixed spasmodic dysphonia

d. Vocal Cord Nodules, Polyps & Cysts

A vocal cord nodule is a mass of tissue that grows on the vocal folds (vocal cords). Typically, this mass will appear on the junction of the anterior 1/3 and posterior 2/3 of the vocal fold, where contact is most forceful. Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

Polyps can take a number of forms. They are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.

Nodules and polyps cause similar symptoms:

	Hoarseness		Shooting pain from ear to ear
	Breathiness		A "lump in the throat" sensation
	A "rough" voice		Neck pain
	A "scratchy" voice		Decreased pitch range
	Harshness		Voice and body fatigue

Vocal fold cysts are collections of fluid in sac-like formations on the vocal folds. Cysts can deteriorate the quality of human speech production, causing diplophonia, a condition where the vocal cords produce multiple tones at the same time, or dysphonia, an impaired quality of voice typically involving hoarseness or a breathy sound. Females are more likely than males to develop vocal fold cysts and the menstrual cycle may alter the size of the cyst. The cysts usually appear on one side of the vocal fold but may cause swelling on the opposite side due to irritation.

There are two types of vocal fold cysts:

i. Mucus retention cysts occur when a glandular duct becomes blocked and is unable to secrete. This can occur after an upper respiratory infection combined with vocal overuse.

ii. Epidermoid cysts result from either developmental problem before birth or from an injury to the mucous membrane. A ruptured cyst may result in a scar.

Management may include:

	Voice Therapy		Surgery
	Vocal Training		Medications

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