Speech Disorders
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Apraxia of speech, also
known as verbal apraxia or dyspraxia, is a speech disorder in which a
person has trouble saying what he or she wants to say correctly and
consistently. It is not due to weakness or paralysis of the speech muscles
(the muscles of the face, tongue, and lips). The severity of apraxia of
speech can range from mild to severe.
What Are the Types and Causes of Apraxia?
There are two main types of speech apraxia: acquired apraxia of speech
and developmental apraxia of speech. Acquired apraxia of speech can affect
a person at any age, although it most typically occurs in adults. It is
caused by damage to the parts of the brain that are involved in speaking,
and involves the loss or impairment of existing speech abilities. The
disorder may result from a stroke, head injury, tumor, or other illness
affecting the brain. Acquired apraxia of speech may occur together with
muscle weakness affecting speech production (dysarthria) or language
difficulties caused by damage to the nervous system (aphasia).
Developmental apraxia of speech (DAS) occurs in children and is present
from birth. It appears to affect more boys than girls. This speech
disorder goes by several other names, including developmental verbal
apraxia, developmental verbal dyspraxia, articulatory apraxia, and
childhood apraxia of speech. DAS is different from what is known as a
developmental delay of speech, in which a child follows the "typical" path
of speech development but does so more slowly than normal.
The cause or causes of DAS are not yet known. Some scientists believe
that DAS is a disorder related to a child's overall language development.
Others believe it is a neurological disorder that affects the brain's
ability to send the proper signals to move the muscles involved in speech.
However, brain imaging and other studies have not found evidence of
specific brain lesions or differences in brain structure in children with
DAS. Children with DAS often have family members who have a history of
communication disorders or learning disabilities. This observation and
recent research findings suggest that genetic factors may play a role in
the disorder.
What Are the Symptoms?
People with either form of apraxia of speech may have a number of
different speech characteristics, or symptoms. One of the most notable
symptoms is difficulty putting sounds and syllables together in the
correct order to form words. Longer or more complex words are usually
harder to say than shorter or simpler words. People with apraxia of speech
also tend to make inconsistent mistakes when speaking. For example, they
may say a difficult word correctly but then have trouble repeating it, or
they may be able to say a particular sound one day and have trouble with
the same sound the next day. People with apraxia of speech often appear to
be groping for the right sound or word, and may try saying a word several
times before they say it correctly. Another common characteristic of
apraxia of speech is the incorrect use of "prosody" -- that is, the
varying rhythms, stresses, and inflections of speech that are used to help
express meaning.
Children with developmental apraxia of speech generally can understand
language much better than they are able to use language to express
themselves. Some children with the disorder may also have other problems.
These can include other speech problems, such as dysarthria; language
problems such as poor vocabulary, incorrect grammar, and difficulty in
clearly organizing spoken information; problems with reading, writing,
spelling, or math; coordination or "motor-skill" problems; and chewing and
swallowing difficulties.
The severity of both acquired and developmental apraxia of speech
varies from person to person. Apraxia can be so mild that a person has
trouble with very few speech sounds or only has occasional problems
pronouncing words with many syllables. In the most severe cases, a person
may not be able to communicate effectively with speech, and may need the
help of alternative or additional communication methods.
How Is It Diagnosed?
Professionals known as speech-language
pathologists play a key role in diagnosing and treating apraxia of
speech. There is no single factor or test that can be used to diagnose
apraxia. In addition, speech-language experts do not agree about which
specific symptoms are part of developmental apraxia. The person making the
diagnosis generally looks for the presence of some, or many, of a group of
symptoms, including those described above. Ruling out other contributing
factors, such as muscle weakness or language-comprehension problems, can
also help with the diagnosis.
To diagnose developmental apraxia of speech, parents and professionals
may need to observe a child's speech over a period of time. In formal
testing for both acquired and developmental apraxia, the speech-language
pathologist may ask the person to perform speech tasks such as repeating a
particular word several times or repeating a list of words of increasing
length (for example, love, loving, lovingly). For
acquired apraxia of speech, a speech-language pathologist may also examine
a person's ability to converse, read, write, and perform non-speech
movements. Brain-imaging tests such as magnetic resonance imaging (MRI)
may also be used to help distinguish acquired apraxia of speech from other
communication disorders in people who have experienced brain damage.
How Is It Treated?
In some cases, people with acquired apraxia of speech recover some or
all of their speech abilities on their own. This is called spontaneous
recovery. Children with developmental apraxia of speech will not outgrow
the problem on their own. Speech-language therapy is often helpful for
these children and for people with acquired apraxia who do not
spontaneously recover all of their speech abilities.
Speech-language pathologists use different approaches to treat apraxia
of speech, and no single approach has been proven to be the most
effective. Therapy is tailored to the individual and is designed to treat
other speech or language problems that may occur together with apraxia.
Each person responds differently to therapy, and some people will make
more progress than others. People with apraxia of speech usually need
frequent and intensive one-on-one therapy. Support and encouragement from
family members and friends are also important.
In severe cases, people with acquired or developmental apraxia of
speech may need to use other ways to express themselves. These might
include formal or informal sign language, a language notebook with
pictures or written words that the person can show to other people, or an
electronic communication device such as a portable computer that writes
and produces speech.
What Research Is Being Done?
Researchers are searching for the causes of developmental apraxia of
speech, including the possible role of abnormalities in the brain or other
parts of the nervous system. They are also looking for genetic factors
that may play a role in DAS. Other research on DAS is aimed at identifying
more specific criteria and new techniques that can be used to diagnose the
disorder and distinguish it from other communication disorders. Research
on acquired apraxia of speech includes studies to pinpoint the specific
areas of the brain that are involved in the disorder. In addition,
researchers are studying the effectiveness of various treatment approaches
for acquired and developmental apraxia of speech.
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Auditory processing is a term used to describe what happens when your
brain recognizes and interprets the sounds around you. Humans hear when
energy that we recognize as sound travels through the ear and is changed
into electrical information that can be interpreted by the brain. The
"disorder" part of auditory processing disorder means that something is
adversely affecting the processing or interpretation of the
information.
Children with APD often do not recognize subtle differences between
sounds in words, even though the sounds themselves are loud and clear. For
example, the request "Tell me how a chair and a couch are alike" may sound
to a child with APD like "Tell me how a couch and a chair are alike." It
can even be understood by the child as "Tell me how a cow and a hair are
alike." These kinds of problems are more likely to occur when a person
with APD is in a noisy environment or when he or she is listening to
complex information.
APD goes by many other names. Sometimes it is referred to as central auditory processing
disorder (CAPD). Other common names are auditory perception
problem, auditory comprehension deficit, central auditory dysfunction,
central deafness, and so-called "word deafness."
What causes auditory processing difficulty?
We are not sure. Human communication relies on taking in complicated
perceptual information from the outside world through the senses, such as
hearing, and interpreting that information in a meaningful way. Human
communication also requires certain mental abilities, such as attention
and memory. Scientists still do not understand exactly how all of these
processes work and interact or how they malfunction in cases of
communication disorders. Even though your child seems to "hear normally,"
he or she may have difficulty using those sounds for speech and
language.
The cause of APD is often unknown. In children, auditory processing
difficulty may be associated with conditions such as dyslexia, attention
deficit disorder, autism, autism spectrum disorder, specific language
impairment, pervasive developmental disorder, or developmental delay.
Sometimes this term has been misapplied to children who have no hearing or
language disorder but have challenges in learning.
What are the symptoms of possible auditory processing difficulty?
Children with auditory processing difficulty typically have normal
hearing and intelligence. However, they have also been observed to
- Have trouble paying attention to and remembering information
presented orally
- Have problems carrying out multistep directions
- Have poor listening skills
- Need more time to process information
- Have low academic performance
- Have behavior problems
- Have language difficulty (e.g., they confuse syllable sequences and
have problems developing vocabulary and understanding language)
- Have difficulty with reading, comprehension, spelling, and
vocabulary
How is suspected auditory processing difficulty diagnosed in
children?
You, a teacher, or a day care provider may be the first person to
notice symptoms of auditory processing difficulty in your child. So
talking to your child's teacher about school or preschool performance is a
good idea. Many health professionals can also diagnose APD in your child.
There may need to be ongoing observation with the professionals
involved.
Much of what will be done by these professionals will be to rule out
other problems. A pediatrician or a family doctor can help rule out
possible diseases that can cause some of these same symptoms. He or she
will also measure growth and development. If there is a disease or
disorder related to hearing, you may be referred to an otolaryngologist--a
physician who specializes in diseases and disorders of the head and
neck.
To determine whether your child has a hearing function problem, an
audiologic evaluation is necessary. An audiologist will give
tests that can determine the softest sounds and words a person can hear
and other tests to see how well people can recognize sounds in words and
sentences. For example, for one task, the audiologist might have your
child listen to different numbers or words in the right and the left ear
at the same time. Another common audiologic task involves giving the child
two sentences, one louder than the other, at the same time. The
audiologist is trying to identify the processing problem.
A speech-language
pathologist can find out how well a person understands and uses
language. A mental health professional can give you information about
cognitive and behavioral challenges that may contribute to problems in
some cases, or he or she may have suggestions that will be helpful.
Because the audiologist can help with the functional problems of hearing
and processing, and the speech-language pathologist is focused on
language, they may work as a team with your child. All of these
professionals seek to provide the best outcome for each child.
What current research is being conducted?
In recent years, scientists have developed new ways to study the human
brain through imaging. Imaging is a powerful tool that allows the
monitoring of brain activity without any surgery. Imaging studies are
already giving scientists new insights into auditory processing. Some of
these studies are directed at understanding auditory processing disorders.
One of the values of imaging is that it provides an objective, measurable
view of a process. Many of the symptoms described as related to APD are
described differently by different people.
Imaging will help identify the source of these symptoms. Other
scientists are studying the central auditory nervous system. Cognitive
neuroscientists are helping to describe how the processes that mediate
sound recognition and comprehension work in both normal and disordered
systems.
Research into the rehabilitation of child language disorders continues.
It is important to know that much research is still needed to understand
auditory processing problems, related disorders, and the best
interventions for each child or adult. All the strategies undertaken will
need to be suited to the needs of the individual child, and their
effectiveness will need to be continuously evaluated. The standard for
determining if a treatment is effective is that a patient can reasonably
expect to benefit from it.
What treatments are available for auditory processing difficulty?
Much research is still needed to understand APD problems, related
disorders, and the best intervention for each child or adult. Several
strategies are available to help children with auditory processing
difficulties. Some of these are commercially available, but have not been
fully studied. Any strategy selected should be used under the guidance of
a team of professionals, and the effectiveness of the strategy needs to be
evaluated. Researchers are currently studying a variety of approaches to
treatment. Several strategies you may hear about include:
- Auditory trainers are electronic devices that allow a person to
focus attention on a speaker and reduce the interference of background noise.
They are often used in classrooms, where the teacher wears a microphone
to transmit sound and the child wears a headset to receive the sound. Children
who wear hearing aids can use them in addition to the auditory trainer.
- Environmental modifications such as classroom acoustics, placement,
and seating may help. An audiologist may suggest ways to improve the listening
environment, and he or she will be able to monitor any changes in hearing
status.
- Exercises to improve language-building skills can increase the
ability to learn new words and increase a child's language base.
- Auditory memory enhancement, a procedure that reduces detailed
information to a more basic representation, may help. Also, informal auditory
training techniques can be used by teachers and therapists to address specific
difficulties.
- Auditory integration training may be promoted by practitioners
as a way to retrain the auditory system and decrease hearing distortion.
However, current research has not proven the benefits of this treatment.
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What Is Autism?
The brain disorder autism begins in early
childhood and persists throughout adulthood affecting three crucial areas
of development: verbal and nonverbal communication, social interaction,
and creative or imaginative play.
Autism is the most common of a group of conditions called pervasive developmental
disorders (PDDs). PDDs involve delays in many areas of childhood
development. The first signs of autism are usually noticed by the age of
three. Many individuals who are autistic also develop epilepsy, a brain
disorder that causes convulsive seizures, as they approach adulthood.
Other characteristics may include repetitive and ritualistic behaviors,
hand flapping, spinning or running in circles, excessive fears,
self-injury such as head banging or biting, aggression, insensitivity to
pain, temper tantrums, and sleeping and eating disturbances. Autistic
individuals live a normal life span, but most require lifelong care and
supervision.
Leo Kanner first identified autism in 1943 when he described 11
self-absorbed children who had "autistic disturbances of affect contact."
At first, autism was thought to be an attachment disorder resulting from
poor parenting. This has been proved to be a myth. While the cause remains
a mystery, most specialists now view autism as a brain disorder that makes
it difficult for the person to process and respond to the world. Autism
has been observed in several members of the same families. Therefore, many
scientists believe that, at least in some individuals, autism may be
genetic. Scientists have identified some genes as playing a possible role
in the development of autism.
Who Is Affected by Autism?
Autism is one of the most common developmental disabilities.
Individuals are of all races and ethnic and socioeconomic backgrounds.
Current estimates suggest that approximately 400,000 individuals in the
United States have autism. Autism is three to four times more likely to
affect boys than girls. Autism occurs in individuals of all levels of
intelligence. Approximately 75 percent are of low intelligence while 10
percent may demonstrate high intelligence in specific areas such as
math.
How Do Speech and Language Normally Develop?
The most intensive period of speech and language development is during
the first three years of life, a period when the brain is developing and
maturing. These skills appear to develop best in a world that is rich with
sounds, sights, and consistent exposure to the speech and language of
others. At the root of this development is the desire to communicate or
interact with the world.
The beginning signs of communication occur in the first few days of
life when an infant learns that a cry will bring food, comfort, and
companionship. Newborns also begin to recognize important sounds such as
the sound of their mother's voice. They begin to sort out the speech
sounds (phonemes) or building blocks that compose the words of their
language. Research has shown that by 6 months of age, most children
recognize the basic sounds of their native language.
As the speech mechanism (jaw, lips, tongue, and throat) and voice
mature, an infant is able to make controlled sound. This begins in the
first few months of life with "cooing," a quiet, pleasant, repetitive
vocalization. Usually by 6 months of age an infant babbles or produces
repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon
turns into a type of nonsense speech called jargon that often has the tone
and cadence of human speech but does not contain real words. By the end of
their first year, most children have mastered the ability to say a few
simple words. Children are most likely unaware of the meaning of their
first words, but soon learn the power of those words as others respond to
them.
By 18 months of age most children can say 8 to 10 words and, by age 2,
are putting words together in crude sentences such as "more milk." During
this period children rapidly learn that words symbolize or represent
objects, actions, and thoughts. At this age they also engage in
representational or pretend play. At ages three, four, and five a child's
vocabulary rapidly increases, and he or she begins to master the rules of
language. These rules include the rules of phonology (speech sounds),
morphology (word formation), syntax (sentence formation), semantics (word
and sentence meaning), prosody (intonation and rhythm of speech), and
pragmatics (effective use of language).
What Causes Speech and Language Problems in Autism?
Although the cause of speech and language problems in autism is
unknown, many experts believe that the difficulties are caused by a
variety of conditions that occur either before, during, or after birth
affecting brain development. This interferes with an individual's ability
to interpret and interact with the world. Some scientists tie the
communication problems to a "theory of mind" or impaired ability to think
about thoughts or imagine another individual's state of mind. Along with
this is an impaired ability to symbolize, both when trying to communicate
and in play.
What Are the Communication Problems of Autism?
The communication problems of autism vary, depending upon the
intellectual and social development of the individual. Some may be unable
to speak, whereas others may have rich vocabularies and are able to talk
about topics of interest in great depth. Despite this variation, the
majority of autistic individuals have little or no problem with
pronunciation. Most have difficulty effectively using language. Many also
have problems with word and sentence meaning, intonation, and rhythm.
Those who can speak often say things that have no content or
information. For example, an autistic individual may repeatedly count from
one to five. Others use echolalia, a repetition of something previously
heard. One form, immediate echolalia, may occur when the individual
repeats the question, "Do you want something to drink?" instead of
replying with a "yes" or "no." In another form called delayed echolalia,
an individual may say, "Do you want something to drink?" whenever he or
she is asking for a drink.
Others may use stock phrases such as, "My name is Tom," to start a
conversation, even when speaking with friends or family. Still others may
repeat learned scripts such as those heard during television commercials.
Some individuals with higher intelligence may be able to speak in depth
about topics they are interested in such as dinosaurs or railroads but are
unable to engage in an interactive conversation on those topics.
Most autistic individuals do not make eye contact and have poor
attention duration. They are often unable to use gestures either as a
primary means of communication, as in sign language, or to assist verbal
communication, such as pointing to an object they want. Some autistic
individuals speak in a high-pitched voice or use robot-like speech. They
are often unresponsive to the speech of others and may not respond to
their own names. As a result, some are mistakenly thought to have a
hearing problem. The correct use of pronouns is also a problem for
autistic individuals. For example, if asked, "Are you wearing a red shirt
today?" the individual may respond with, "You are wearing a red shirt
today," instead of "Yes, I am wearing a red shirt today."
For many, speech and language develop, to some degree, but not to a
normal ability level. This development is usually uneven. For example,
vocabulary development in areas of interest may be accelerated. Many have
good memories for information just heard or seen. Some may be able to read
words well before the age of five but may not be able to demonstrate
understanding of what is read. Others have musical talents or advanced
ability to count and perform mathematical calculations. Approximately 10
percent show "savant" skills or detailed abilities in specific areas such
as calendar calculation, musical ability, or math.
How Are the Speech and Language Problems of Autism Treated?
If autism or some other developmental disability is suspected, the
child's physician will usually refer the child to a variety of
specialists, including a speech-language pathologist, who performs a
comprehensive evaluation of his or her ability to communicate and designs
and administers treatment.
No one treatment method has been found to successfully improve
communication in all individuals who have autism. The best treatment
begins early, during the preschool years, is individually tailored,
targets both behavior and communication, and involves parents or primary
caregivers. The goal of therapy should be to improve useful communication.
For some, verbal communication is a realistic goal. For others, the goal
may be gestured communication. Still others may have the goal of
communicating by means of a symbol system such as picture boards.
Treatment should include periodic in-depth evaluations provided by an
individual with special training in the evaluation and treatment of speech
and language disorders, such as a speech-language
pathologist. Occupational and physical therapists may also work with
the individual to reduce unwanted behaviors that may interfere with the
development of communication skills.
Some individuals respond well to highly structured behavior
modification programs; others respond better to in-home therapy that uses
real situations as the basis for training. Other approaches such as music
therapy and sensory integration therapy, which strives to improve the
child's ability to respond to information from the senses, appear to have
helped some autistic children, although research on the efficacy of these
approaches is largely lacking.
Medications may improve an individual's attention span or reduce
unwanted behaviors such as hand-flapping, but long-term use of these kinds
of medications is often difficult or undesirable because of their side
effects. No medications have been found to specifically help communication
in autistic individuals. Mineral and vitamin supplements, special diets,
and psychotherapy have also been used, but research has not documented
their effectiveness.
What Research Is Being Conducted to Improve the Communication of
Individuals with Autism?
In addition to ongoing research on other aspects of autism across the
National Institutes of Health (NIH), researchers at the National Institute
on Deafness and Other Communication Disorders (NIDCD) are also
investigating the communication difficulties or differences of people who
have autism. At the heart of the research effort is a five-year
collaborative NIH effort between the NIDCD and the National Institute of
Child Health and Human Development (NICHD) which was launched in May 1997.
The effort involves more than 65 scientists at 24 universities from around
the world, including the United States, Canada, Britain, France, and
Germany, who are examining how autism develops. In addition, scientists
are also exploring the speech and language features in autism, evaluating
current treatment practices, and designing new treatments. Additional
studies include investigations of brain development and functioning in
autism and the use and effects of certain drugs on communication
behavior.
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What is Landau-Kleffner syndrome?
Landau-Kleffner syndrome
(LKS) is a childhood disorder. A major feature of LKS is the gradual
or sudden loss of the ability to understand and use spoken language. All
children with LKS have abnormal electrical brain waves that can be
documented by an electroencephalogram (EEG), a recording of the electric
activity of the brain. Approximately 80 percent of the children with LKS
have one or more epileptic seizures that usually occur at night.
Behavioral disorders such as hyperactivity, aggressiveness and depression
can also accompany this disorder. LKS may also be called infantile
acquired aphasia, acquired epileptic
aphasia or aphasia with convulsive disorder. This syndrome was first
described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who
identified six children with the disorder.
What are the signs of Landau-Kleffner syndrome?
LKS occurs most frequently in normally developing children who are
between 3 and 7 years of age. For no apparent reason, these children begin
having trouble understanding what is said to them. Doctors often refer to
this problem as auditory agnosiaor "word deafness." The auditory agnosia
may occur slowly or very quickly. Parents often think that the child is
developing a hearing problem or has become suddenly deaf. Hearing tests,
however, show normal hearing. Children may also appear to be autistic or
developmentally delayed.
The inability to understand language eventually affects the child's
spoken language which may progress to a complete loss of the ability to
speak (mutism). Children who have learned to read and write before the
onset of auditory agnosia can often continue communicating through written
language. Some children develop a type of gestural communication or
sign-like language. The communication problems may lead to behavioral or
psychological problems. Intelligence usually appears to be unaffected.
The loss of language may be preceded by an epileptic seizure that
usually occurs at night. At some time, 80 percent of children with LKS
have one or more seizures. The seizures usually stop by the time the child
becomes a teenager. All LKS children have abnormal electrical brain
activity on both the right and left sides of their brains.
How common is Landau-Kleffner syndrome?
More than 160 cases have been reported from 1957 through 1990.
What causes Landau-Kleffner syndrome?
The cause of LKS is unknown. Some experts think there is more than one
cause for this disorder. All of the children with LKS appear to be
perfectly normal until their first seizure or the start of language
problems. There have been no reports of children who have a family history
of LKS. Therefore, LKS is not likely to be an inherited disorder.
What is the outcome of Landau-Kleffner syndrome?
There have not been many long-term follow-up studies of children with
LKS. This lack of evidence, along with the wide range of differences among
affected children, makes it impossible to predict the outcome of this
disorder. Complete language recovery has been reported; however, language
problems usually continue into adulthood. The continued language problems
can range from difficulty following simple commands to no verbal
communication. If recovery takes place, it can occur within days or years.
So far, no relationship has been found between the extent of the language
impairment, the presence or absence of seizures and the amount of language
recovery. Generally, the earlier the disorder begins, the poorer the
language recovery.
Most children outgrow the seizures, and electrical brain activity on
the EEG usually returns to normal by age 15.
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What Is Vocal Cord Paralysis?
Vocal cord paralysis is a
voice disorder that occurs when one or both of the vocal cords (or vocal
folds) do not open or close properly. Vocal cord paralysis is a common
disorder, and symptoms can range from mild to life threatening.
The vocal cords are two elastic bands of muscle tissue located in the
larynx (voice box)
directly above the trachea (windpipe). The vocal cords produce voice when
air held in the lungs is released and passed through the closed vocal
cords, causing them to vibrate. When a person is not speaking, the vocal
cords remain apart to allow the person to breathe.
Someone who has vocal cord paralysis often has difficulty swallowing
and coughing because food or liquids slip into the trachea and lungs. This
happens because the paralyzed cord or cords remain open, leaving the
airway passage and the lungs unprotected.
What Causes Vocal Cord Paralysis?
Vocal cord paralysis may be caused by head trauma, a neurologic insult
such as a stroke, a neck injury, lung or thyroid cancer, a tumor pressing
on a nerve, or a viral infection. In older people, vocal cord paralysis is
a common problem affecting voice production. People with certain
neurologic conditions, such as multiple sclerosis or Parkinson's disease,
or people who have had a stroke may experience vocal cord paralysis. In
many cases, however, the cause is unknown.
What Are the Symptoms?
People who have vocal cord paralysis experience abnormal voice changes,
changes in voice quality, and discomfort from vocal straining. For
example, if only one vocal cord is damaged, the voice is usually hoarse or
breathy. Changes in voice quality, such as loss of volume or pitch, may
also be noticeable. Damage to both vocal cords, although rare, usually
causes people to have difficulty breathing because the air passage to the
trachea is blocked.
How Is Vocal Cord Paralysis Diagnosed?
Vocal cord paralysis is usually diagnosed by an otolaryngologist-a doctor
who specializes in ear, nose, and throat disorders. Noting the symptoms
the patient has experienced, the otolaryngologist will ask how and when
the voice problems started in order to help determine their cause. Next,
the otolaryngologist listens carefully to the patient's voice to identify
breathiness or harshness. Then, using an endoscope--a tube with a light at
the end--the otolaryngologist looks directly into the throat at the vocal
cords. A speech-language
pathologist may also use an acoustic spectrograph, an instrument that
measures voice frequency and clarity, to study the patient's voice and
document its strengths and weaknesses.
How Is Vocal Cord Paralysis Treated?
There are several methods for treating vocal cord paralysis, among them
surgery and voice therapy. In some cases, the voice returns without
treatment during the first year after damage. For that reason, doctors
often delay corrective surgery for at least a year to be sure the voice
does not recover spontaneously. During this time, the suggested treatment
is usually voice therapy, which may involve exercises to strengthen the
vocal cords or improve breath control during speech. Sometimes, a
speech-language pathologist must teach patients to talk in different ways.
For instance, the therapist might suggest that the patient speak more
slowly or consciously open the mouth wider when speaking.
Surgery involves adding bulk to the paralyzed vocal cord or changing
its position. To add bulk, an otolaryngologist injects a substance,
commonly Teflon, into the paralyzed cord. Other substances currently used
are collagen, a structural protein; silicone, a synthetic material; and
body fat. The added bulk reduces the space between the vocal cords so the
nonparalyzed cord can make closer contact with the paralyzed cord and thus
improve the voice.
Sometimes an operation that permanently shifts a paralyzed cord closer
to the center of the airway may improve the voice. Again, this operation
allows the nonparalyzed cord to make better contact with the paralyzed
cord. Adding bulk to the vocal cord or shifting its position can improve
both voice and swallowing. After these operations, patients may also
undergo voice therapy, which often helps to fine-tune the voice.
Treating people who have two paralyzed vocal cords may involve
performing a surgical procedure called a tracheotomy to help breathing. In
a tracheotomy, an incision is made in the front of the patient's neck and
a breathing tube (tracheotomy tube) is inserted through a hole, called a
stoma, into the trachea. Rather than breathing through the nose and mouth,
the patient now breathes through the tube. Following surgery, the patient
may need therapy with a speech-language pathologist to learn how to care
for the breathing tube properly and how to reuse the voice.
What Research Is Being Done on Vocal Cord Paralysis?
The National Institute on Deafness and Other Communication Disorders
(NIDCD) supports research studies that may help provide new clinical
measurements to diagnose vocal cord paralysis. For instance, computer
software is being developed that can describe important aspects of the
health of a person's larynx by analyzing the sounds it produces. By
measuring instabilities in the motion of the vocal cords, the software may
allow scientists and treatment clinics to relate these measurements to the
study of the misuse of the voice and help diagnose disorders such as
muscle paralysis and tissue loss.
Currently, the treatment for patients with damage to both vocal cords
involves a tracheotomy, which may, however, cause voice production
problems and decrease protection of the lungs in an effort to improve the
airway. Recent studies show that another feasible approach to laryngeal
rehabilitation may be using an electrical stimulation device to activate
the reflexes of the paralyzed muscles that open the airway during
breathing.
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