Dysphonia Consequences Of Acid Reflux
Dr. Michael Rolnick, a speech-language pathologist at Beaumont Health System, provides an overview of the dysphagia associated with acid reflux and the dysphonia associated with laryngopharyngeal reflux.
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Dr. Rolnick has no financial relationships to disclose.
my name is Michael Ruhlman and I’m the Beaumont system director of speech and language pathology I’m also a voice specialist so I work with patients sent to us with voice disorders or dysphonia from physicians called otolaryngologists who have examined the patient’s vocal folds but there are a variety of communication disorders that can cause difficulty for human beings impairments in speech voice language cognition and fluency can affect an individual’s ability to communicate with others in their environment voice disorders or dysphonia z’ can be problematic at all stages of an individual’s life experienced voice problems can affect the quality of our communication can affect volume and make it difficult for an individual to be heard it can affect our social and occupational endeavors and become very frustrating on a daily basis now the vocal cords or vocal folds are the major structures in the production of voice certainly one needs adequate lung capacity or breath support to set the vocal folds into vibration and one also needs appropriate neural pathways to control the laryngeal mechanism also needed are intact and flexible resonance chambers in order to enhance the vocal tone that is produced finally an exquisite level of complex coordination is required to produce a pleasant sounding voice but healthy intact vocal folds are critical in order to produce voice quality that is acceptable to the listener and effective in all walks of life any medical condition that interferes with the complex movement of the vocal folds will have the potential to impact voice production if excessive sinus drainage for instance interferes with vocal fold movement then the voice can become problematic in this case control of that drainage would be most important if acid reflux reaches the vocal folds and interferes with the mucosal wave action that actually determines the quality of the voice then a dysphonia a voice problem can result it is this problem acid reflux that will be discussed with regards to the latest literature as well as common clinical findings in general it is lingo pharyngeal reflux we’ll call it LPR that can affect the vocal folds while gastro esophageal reflux can often affect swallowing approximately 1% of the general population has a form of dysphonia although because of the aging demographic future prevalence studies may find a higher incidence vocal fold bowing due to a problem called press peel oranges with or without reflux seems to be increasing an appropriate laryngeal examination can identify the Ringo pharyngeal reflux in any other condition that may be affecting voice quality referral to a speech language pathologist who specializes in treatment of voice disorders for specific voice rehabilitation is often the case LPR can impact the true vocal folds the arytenoid cartilages the esophageal inlet the epiglottis and the piriform sinus the effects of this reflux invasion if you will of the structures that surround the glottal space can and often do impact voice quality and even swallowing vocal folds swelling a retinoid cartilage edema pachyderm eeeh vocal cord ulcers granulomas glottal stenosis swallowing difficulty ulcerations of the oral pharyngeal airway as well as chronic cough and Globus sensation are all possibilities when reflux is present now invoke Allah Beus or vocal misuse or vocal overuse are combined with these reflux problems then the potential for many types of vocal quality disorders are multiplied vocal cord nodules polyps granulomas and contact ulcers can often diminish pitch levels cause vocal harshness or vocal hoarseness affect vocal stamina result in excessive breath enos to the voice and can affect vocal projection these are all types of presenting symptoms of a classic dysphonia speech and language pathologists use a variety of methods to assess dysphonia including sophisticated acoustic analysis procedures in a modern voice analysis laboratory we make many measurements such as vocal fold perturbation and jitter and shimmer readings we look at harmonic to noise ratios and fundamental pitch levels and we can even assess voice tremor these are just a few of the metrics that can be used to assess the severity and the type of a voice problem these metrics can also help track progress as a consequence of effective medical treatment or surgical intervention or typical therapeutic treatment by a speech pathologist acoustic analysis also helps patients better understand their problem as they can monitor their dis finite condition when reflux does contribute to the development of a dysphonia the use of quality of life measurements utilizing a voice handy have index can identify the actual impact of that voice problem on everyday life the reduced ability to communicate effectively as a consequence of that dysphonia can be a major concern that often impacts social and occupational activities for an individual other voice problems that may not be related to the ring gopher angel reflux include benign vocal cord nodules polyps cysts vocal cord paralysis or even dislocation of the vocal folds during post surgery or vigorous intubation vocal corporations are bowing possibly related to the aging voice and puber fonio or adolescent voice change that continues beyond puberty and vocal cord spasms or spasmodic dysphonia or paradoxical local coordinates function are also problems there can even be dysphonia that can be part of a dysarthria that can result from numerous types of neurologic conditions whether or not laryngeal reflux is the major or minor cause of a particular dysphonia is open to question and requires careful patient evaluation there are those professionals who feel it takes two to tango and this refers to both patient vocal abuse as well as reflux that affects the larynx resulting in a dysphonia in this case laryngeal reflux can actually be considered as like a setup for patients who use their voice forcefully or professionally as the reflux induced irritation is exacerbated by the heavy voice use other professionals feel that LPR is somewhat over diagnosed in many cases certainly reflux should be medically treated and controlled with medication when it is identified with a presenting dysphonia in conjunction with appropriate voice therapy perhaps talk and talk after reviewing more than 2500 articles in the English and German literature said it best when they concluded quote it can be assumed that reflux ate reaching the larynx can damages due to the fact that symptoms possibly related to LPR can however be linked to other causes a careful consideration of the patient’s medical history is of the utmost important followed by mandatory laryngoscopy..