The voice and laryngeal dysfunction in stroke: A report from the Neurolaryngology Subcommittee of the American Academy of Otolaryngology-Head and Neck Surgery

Abstract

Objective

Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It affects as many as 5% of the population over 65 years old, and this number is growing annually due to the aging population. A significant portion of stroke patients that initially survive are faced with the risk of aspiration, as well as quality-of-life issues relating to impaired communication. The goal of this paper is to define the scope of practice in otolaryngology for these patients, and to review pertinent background literature.

Study Design

Consensus report and retrospective literature review.

Results

Otolaryngology involvement in these patients is critical to their rehabilitation, which often requires an interdisciplinary team of specialists. This committee presentation explores epidemiological data regarding the impact of stroke and its complications on hospitalizations. A pertinent review of neuroanatomy as it relates to laryngeal function is also discussed. State-of-the-art diagnostic and therapeutic procedures are presented.

Conclusion

There is a well-defined set of diagnostic and therapeutic options for laryngeal dysfunction in the stroke patient.

Significance

Otolaryngologists play a critical role in the interdisciplinary rehabilitation team.

Get full access to this article

View all access options for this article.

References

Feigin

Lawes

CMM

Bennett

Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the later 20th century. Lancet Neurol 2003; 2:43–53

American Heart Association Heart Disease and Stroke Statistics—2005 Update. Dallas, Texas: American Heart Association, 2005. Available at http://www.americanheart.org/statistics/index.html

Fang

Alderman

MH.

Trend of stroke hospitalization, United States, 1988-1997. Stroke 2001; 32:2221–6

Gordon

Hewer

Wade

DT.

Dysphagia in acute stroke. Br Med J (Clin Res Ed) 1987; 295:411–4

Wolfe

Taub

Woodrow

Patterns of acute stroke care in three districts of southern England. J Epidemiol Community Health 1993; 47:144–8

Odderson

Keaton

McKenna

BS.

Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil 1995; 76:1130–3

Mann

Hankey

Cameron

Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30:744–8

Smithard

O'Neill

Parks

Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996; 27:1200–4

Hertegard

Focus report on dysphagia in Stockholm. Sweden: Stockholm County Council; 2005

10.

Svensson

Symptoms of dysphagia, a survey of an adult general population. Master thesis at University of Gothenburg, Sweden. Department of Logopedics and Phonatrics, 2003

11.

Altman

Simpson

Amin

Cough and paradoxical vocal fold motion. Otolaryngol Head Neck Surg 2002; 127:501–11

12.

Jurgens

Neural pathways underlying vocal control. Neurosci Biobehav Rev 2002; 26:235–58

13.

Price

CJ.

The anatomy of language: contributions from functional neuroimaging. J Anat 2000; 197:335–59

14.

Alcock

Wade

Anslow

Pitch and timing abilities in adult left-hemisphere-dysphasic and right-hemisphere-damaged subjects. Brain Lang 2000; 75:47–65

15.

Marien

Engelborghs

Fabbro

The lateralized linguistic cerebellum: a review and a new hypothesis. Brain Lang 2001;580–600

16.

Urban

Wicht

Vukurevic

Dysarthria in acute ischemic stroke: lesion topography, clinicoradiologic correlation, and etiology. Neurology 2001; 56:1021–7

17.

Aronson

AE.

Clinical Voice Disorders. New York: Thieme; 1995

18.

Rigueiro-Veloso

Pego-Reigosa

Branas-Fernandez

[Wallenberg syndrome: a review of 25 cases].

Revista de Neurologia 1997; 25(146):1561–4

19.

Hendricks

van Limbeek

Geurts

Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil 2002; 83:1629–37

20.

Hartmann

von Cramon

Acoustic measurement of voice quality in central dysphonia. J Commun Disord 1984; 17:425–40

21.

Hanson

DG.

Neuromuscular disorders of the larynx. Otolaryngol Clin North Am 1991; 24:1035–51

22.

Aronson

AE.

Clinical voice disorders. 3rd ed. New York: Thieme; 1990

23.

Darley

Aronson

Brown

JR.

Differential diagnostic patterns of dysarthria. J Speech Lang Hear Res 1969; 12:246–69

24.

Walker

FO.

Voice fatigue in myasthenia gravis: the sinking pitch sign. Neurology 1997; 48:1135–6

25.

Neal

Clarke

LR.

Neuromuscular disorders. Otolaryngol Clin North Am 1987; 20:195–201

26.

Adams

SG.

Hypokinetic dysarthria in Parkinson's disease. In: McNeil

, editor. Clinical management of sensorimotor speech disorders. New York: Thieme; 1997. p. 261–85

27.

Robert

Pougt

Giovanni

Quantitative voice analysis in the assessment of bulbar involvement in amyotrophic lateral sclerosis. Acta Otolaryngol (Stockh) 1999; 119:724–31

28.

Fulton

Allen

ER.

Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 2005; 17:123–32

29.

Haring

HP.

Cognitive impairment after stroke. Curr Opin Neurol 2002; 15:79–84

30.

Farrell

Poststroke depression in elderly patients. Dimens Crit Care Nurs 2004; 23:264–9

31.

McLean

DE.

Medical complication experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil 2004; 85:466–9

32.

Bassetti

CL.

Sleep and stroke. Semin Neurol 2005; 25:19–32

33.

Dobkin

BH.

Rehabilitation after stroke. N Engl J Med 2005; 352:1677–84

34.

Sulch

Kalra

Integrated care pathways in stroke management. Age Ageing 2000; 29:349–52

35.

Sulch

Evans

Melbourn

Does an integrated care pathway improve processes of care in stroke rehabiliation? A randomized controlled trial. Age Ageing 2002; 31:175–9

36.

Koufman

Walker

FO.

Laryngeal electromyography in clinical practice: indications, techniques and interpretations. Phonoscope 1998; 1:57–70

37.

Munin

Rosen

Zullo

Utility of laryngeal electromyography in predicting recovery after vocal fold paralysis. Arch Phys Med Rehabil 2003; 84:1150–3

38.

Hillel

Robinson

Waugh

Laryngeal electromyography for the diagnosis and management of swallowing disorders. Otolaryngol Head Neck Surg 1997; 116:344–8

39.

Ertekin

Aydogdu

Electromyography of human cricopharyngeal muscle of the upper esophageal sphincter. Muscle Nerve 2002; 26:729–39

40.

Ramsey

Smithard

Kalra

Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke 2003; 34:1252–7

41.

Paciaroni

Mazzotta

Corea

Dysphagia following stroke. Eur Neurol 2004; 51:162–7

42.

Aviv

Kim

Thomson

Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls. Dysphagia 1998; 13:87–92

43.

Ramsey

Smithard

Donaldson

Is the gag reflex useful in the management of swallowing problems in acute stroke?

Dysphagia 2005; 20:105–7

44.

Splaingard

Hutchins

Sulton

Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment. Arch Phys Med Rehabil 1988; 69:637–40

45.

Leder

Espinosa

JF.

Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia 2002; 17:214–8

46.

Smithard

O'Neill

England

The natural history of dysphagia following a stroke. Dysphagia 1997; 12:188–93

47.

Logemann

JA.

Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg 1997; 116:335–8

48.

Aviv

Sacco

Mohr

Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke. Laryngoscope 1997; 107:1254–60

49.

Aviv

Murry

Zschommler

Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations. Ann Otol Rhinol Laryngol 2005; 114:173–6

50.

Higo

Tayama

Watanabe

Videofluoroscopic and manometric evaluation of swallowing function in patients with multiple system atrophy. Ann Otol Rhinol Laryngol 2003; 112:630–6

51.

Aviv

Takoudes

Office-based esophagoscopy: a preliminary report. Otolaryngol Head Neck Surg 2001; 125:170–5

52.

McCulloch

Andrews

Hoffman

Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope 2002; 112:1235–8

53.

Netterville

Stone

Luken

Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phono-surgical procedures. Ann Otol Rhinol Laryngol 1993; 102:413–24

54.

Tucker

HM.

Nerve-muscle pedicle reinnervation of the larynx: avoiding pitfalls and complications. Ann Otol Rhinol Laryngol 1982; 92:440–4

55.

Zeitels

Hochman

Hilman

RE.

Adduction arytenopexy: a new procedure for paralytic dysphonia with implications for implant medialization.

Ann Otol Rhinol Laryngol 1998; 107(Suppl.):173

56.

Chester

Stewart

MG.

Arytenoid adduction combined with medialization thyroplasty: an evidence-based review. Otolaryngol Head Neck Surg 2003; 129:305–10

57.

Freed

Chatburn

Electrical stimulation for swallowing disorders caused by stroke. Respir Care 2001; 46:466–74

58.

Leelamanit

Limsakul

Geater

Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope 2002; 112:2204–10

59.

Park

O'Neill

Martin

DF.

A pilot exploratory study of oral electrical stimulation on swallow function following stroke: an innovative technique. Dysphagia 1997; 12:161–6

60.

Shaker

Easterling

Kern

Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002; 122:1314–21

61.

Blitzer

Brin

MF.

Use of botulinum toxin for diagnosis and management of cricopharyngeal achalasia. Otolaryngol Head Neck Surg 1997; 116:328–30

62.

Takes

Van den Hoogen

FJA

Marres

HAM.

Endoscopic myotomy of the cricopharyngeal muscle with CO₂ laser surgery. Head Neck 2005;703–9

63.

Ellies

Laskawi

Rohrbach-Volland

Botulinum toxin to reduce saliva flow: selected indications for ultrasound-guided toxin application into salivary glands. Laryngoscope 2002; 112:82–6

64.

Flint

Purcell

Cummings

CW.

Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg 1997; 116:349–54

65.

Woodson

Cricopharyngeal myotomy and arytenoid adduction in the management of combined laryngeal and pharyngeal paralysis. Otolaryngol Head Neck Surg 1997; 116:339–43

66.

Mok

Woo

Schaefer-Mojica

Hypopharyngeal pharyngoplasty in the management of pharyngeal paralysis: a new procedure. Ann Otol Rhinol Laryngol 2003; 112:844–52

67.

Leder

Joe

Hill

Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirating patients. Dysphagia 2001; 16:79–82

68.

Tomita

Tanaka

Shinden

Tracheoesophageal diversion versus total laryngectomy for intractable aspiration. J Laryngol Otol 2004; 118:15–8