VOICE, LARYNX & SWALLOWING
Neurological Problems
Neurological problems are concerns related to the brain, spine or nerves.
Vocalisation and swallowing are complex processes that are under the control of your nervous system. Neurological problems can affect your ability to speak and swallow normally.
What type of neurological problems can affect speech or swallowing?
Many neurological disorders can cause speech and/or swallowing difficulties.
Neurological conditions may be developmental, like cerebral palsy, or they may be acquired later in life.
Neurological conditions that affect speaking and swallowing, usually cause symptoms that affect other parts of the body.
These include:
- Stroke
- Parkinson’s Disease
- Amyotrophic Lateral Sclerosis (ALS)
- Traumatic Brain Injury
- Multiple Sclerosis
Patients with these conditions are primarily cared for neurologists, but are occasionally referred to an ENT specialist for help with voice and swallowing problems.
Some neurological conditions specifically affect the larynx and lead to voice problems, these are best managed by a voice specialist, like A/Prof McGuinness. Neurological conditions that primarily affect the voice include spasmodic dysphonia and vocal tremor.
What is spasmodic dysphonia?
Spasmodic dysphonia is a voice disorder caused by involuntary spasms in the muscles that control the vocal cords. Spasmodic dysphonia is a chronic condition, which typically starts between the ages of 30 and 50. It is more common in women. In a lot of ways it is like “stuttering” but confined only to the voice box.
There are two types of spasmodic dysphonia:
- Adductor spasmodic dysphonia - This type of dysphonia causes the vocal cords to close too tightly, making speech sound forced and strained.
- Abductor spasmodic dysphonia - This type of dysphonia is less common. When a spasm occurs, the vocal cords are forced open, making it difficult to speak. Abductor dysphonia causes speech to sound breathy and weak.
Very rarely, a person may experience symptoms of both types of dysphonia.
Patients with spasmodic dysphonia may find that stress triggers spasms. Interestingly spasms do not usually happen when singing or laughing.
What causes spasmodic dysphonia?
Spasmodic dysphonia may be caused by a problem in the basal ganglia, a region of the brain that coordinates muscle movement. The exact cause for spasmodic dysphonia remains unknown, although it may be hereditary in some cases.
How is spasmodic dysphonia treated?
Symptoms of spasmodic dysphonia vary from mild to incapacitating. Although treatment cannot cure this condition, it can relieve the symptoms.
Speech therapy is an important component of treatment for patients with spasmodic dysphonia. It is used both to diagnose and treat the condition
Many patients are helped by Botulinum toxin (Botox) injections into the affected muscles of the larynx. This causes the muscles to relax and helps to prevent spasms. This treatment can usually be provided as an office procedure. It often needs to be repeated on a 3-6 monthly basis.
What is vocal tremor?
Vocal tremor is a neurological voice disorder that commonly affects people over the age of 50. A vocal tremor causes a shaky voice, with interruptions in sound production and changes in volume or pitch.
How is vocal tremor treated?
Speech therapy can improve voice clarity and stamina for patients suffering from vocal tremor. Botulinum toxin injections may occasionally be used. In some cases, medications can help to control the tremor.
Neurological voice problems can be very distressing. If you are suffering from one of these conditions, A/Prof McGuinness can provide an expert opinion and offer you the latest, evidence-based care.