Dental Lect

Role of ENT specialist
in Speech & voice defects
Balakrishnan D
Professor of ENT & Audiology,

Dean Medical Research
Hon Secretary, Association of Paed. Otolaryngologists of India
Temples of Learning
MMC SMC
Speech
The single faculty which distinguishes the

human from lower animals is the ability to
communicate
Speech
The single faculty which distinguishes the

human from lower animals is the ability to
communicate
The main tool of communication is Speech.

There are two components to speech
1. You decide what to speak

2. And, then you say that
The first is triggered by inputs

from the ear, eyes and past
experiences.
There are two components to speech
1. You decide what to speak

2. And, then you say that
The first is triggered by inputs

from the ear, eyes and past
experiences.
Sensory and motor cortex
Blue is a quiet colour - receives information - Sensory

Red means action - Motor area
A little imp sits on your head
The representation of
various parts of body in
the motor and sensory
areas of the cortex
This imp is called the homunculus…

Now, this is also a form of speech
Don’t you understand

what she says?
Res ipsa loquieter. The act speaks for itself.

No sound comes out. Still, the idea is conveyed.
Voice production
Modulation of voice (Articulation)
Obstructed airway > Facial dysmorphism
Investigations - Rx - Prevention
Any defect in any of these places can
lead to faulty voice
Bellows, column producer, Articulators

Voice Production
Bellows
Modulation
Normal vocal cords
During respiration, it is wide open.

During speech it is closed.
Larynx
Adult Child
What are the symptoms …
Breathing difficulty
Hoarseness
Loss of voice
snoring
Muffling of voice
Causes of faulty voice production 1
Congenital web of larynx - hoarseness, severe

cases cause stridor and / or dyspnoea
Laryngomalacia
Papillomas produce a husky cry
Simple acute laryngitis - a spectrum of hoarseness,
weak cry to even total loss of voice
Cysts of larynx - hoarse cry
More follow…
Haemangioma of glottis or subglottis - hoarse cry

Congenital subglottic stenosis
vascular anomalies
Unilateral and bilateral abductor paralyses may

occasionally produce dyspnoea, not to be
confused with laryngomalacia
More follow…
Inflammation (infection, over use, abuse)

Vocal nodule
Gramnuloma
Cancer
Pictures follow…
Laryngomalacia
Mechanism
1
1
Normal
MOVIE
Laryngomalacia
Laryngomalacia cont…
Early vocalisation difficult

Feeding difficulties because of stridor. Child does
not gain weight
Frequent episodes of LRI. In practice, the child
always has ‘cold’
Gets worse until 8-9 mo., then gradually gets better
Most children completely relieved by age 2 yrs.
Unilateral vocal cord paralysis
Hoarse cry initially. Eventually,

The other cord compensates
fully, resulting in normal voice.
But, tires easily and becomes
Weak.
No respiratory distress.
No aspiration
Bilateral vocal cord paralysis
Both cords are in midline
Voice is clear, but weak.

Presence of dyspnoea depends on
onset.
If sudden e.g. trauma or
thyroidectomy, the dyspnoea may
require a tracheostomy.
If gradual e.g. upper oesophageal
cancer, glottic chink allows quiet
respiration.
Subglottic Stenosis
Laryngeal groove
Laryngeal grooving
The sharp groove prevents the cords from closing

Vocal cord cyst
Papilloma larynx
Papilloma may occur in any place. Removal by laser

or conventional forceps avoids a tracheostomy.
Repeated removal is necessary in both means.
Laryngeal Webs
Thick Web
Thin
web>> >>
All the webs produce weak voice. Dyspnoea occurs

early or late, depending on the size - Rx by excision.
Laryngeal cleft
Normal larynx Cleft larynx
>
Frequent regurgitation, aspiration, cough… Urgent

protection of the airway by tracheostomy or by repair of
defect is required.
Stridor - Haemangioma
These enlarge by the

3rd mo. And cause
stridor. Look for
haemagiomas in other
Haemangioma Haemangioma sites
Glottic Subglottic
Subglottic Hemangioma
Treatment:
Laser excision
Steroid injection
Stridor - Carcinoma Larynx
Most common cause in elderly males
Carcinoma Larynx
Extensive & advanced

Congenital Subglottic stenosis
Treatment : Dilate the area by
1. Cricoid cartilage split

2. If required, splint with
cartilage graft (rib)
3. Laser excision
4. Tracheostomy
Subglottic stenosis - acquired
Corrosive stricture
Trach tube
>
>
Tracheal Stoma >>
Voice modulation (Articulation)
Resonators
Voice Box - Larynx
Vocal cords
Airway obstruction
Cleft palate & lip
Tonsillar enlargement
Adenoid enlargement
Adenoid facies
Examination & Investigations
Examination & Investigations
 Indirect laryngoscopy
 Direct Laryngoscopy
 Fibre optic laryngoscopy
 Rigid laryngoscopy
 Xray
 CT scan
 MRI scan
An early attempt at unravelling the
secrets of human anatomy
Successful visualisation of the vocal cords Indirect

laryngo scopy. Manuel Garcia. France 1900
Neck X ray
Lateral view
Soft tissue
exposure
Direct laryngoscopy
For visualisation & biopsy

Direct laryngo scopy (surgery)
Both hands are free

Operating microscope is used
Telescopes can also be used
The rigid endoscope
0 30 70
Looks Straight ahead a little sideways more reach
12/02/20 A revolution in ENT surgery

db 48
Advantages of telescopes
Magnified image
All can see & discuss
Documentation
Comparison of results
Preventable causes of voice defects
Acute Laryngitis (voice abuse)
Early stage only congestion
Late stage oedema

Vocal nodule
mp4
Polyp Right vocal cord
mp4
Polyps prevent the cords from coming
together >> Hoarseness
Early keratosis of vocal cord
Whitish thickening
Hyper keratosis Laryngis
Extensive thickening &

fibrosis of the larynx
So far, we had seen the influence of the
soft tissue lining of the airway.
Airway
Soft tissues
Tongue,
Tonsils, Adenoids
Outer shell
Bony boundaries
Now, let us see the bony boundaries of the airway
This is done by taking a Lateral Cephalo gram
Actual Ceph Digitised image

Measuring the airway distances …
Three measures of the airway
Retro palatal airway
Retro glottal airway
Hypo pharyngeal
airway
Measuring the airway distances
Facial heights
Ratio
Upper facial height

÷ Lower facial
height
Measuring the airway distances
Position of hyoid horizontally
Hyoid triangle
Retrogonion –
Hyoid
Hyoid – C3
C3 – Retrogonion
Speech defects & Delay
Taking a holistic view
We speak what we hear

We speak what we hear

Find out any organic lesion in the vocalising

apparatus. If amenable to surgical correction,
do that. Institute any adjuvant medical
intervention.
Mentor and monitor the process of correction

and rehabilitation.
Always remember that it is a team work.

Find out any organic lesion in the vocalising

apparatus. If amenable to surgical correction,
do that. Institute any adjuvant medical
intervention.
Mentor and monitor the process of correction

and rehabilitation.
Always remember that it is a team work.

Keys to successful treatment is Learning
A road too far …

Temples of Learning
MMC SMC
Thank you for your patient listening
Balakrishnan D

Dental Lect

Uploaded by

Copyright:

Available Formats

Dental Lect

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dental Lect

Uploaded by

Copyright:

Available Formats

Role of ENT specialist

in Speech & voice defects

Professor of ENT & Audiology,

The single faculty which distinguishes the

The single faculty which distinguishes the

The main tool of communication is Speech.

1. You decide what to speak

The first is triggered by inputs

1. You decide what to speak

The first is triggered by inputs

Blue is a quiet colour - receives information - Sensory

This imp is called the homunculus…

Don’t you understand

Res ipsa loquieter. The act speaks for itself.

Bellows, column producer, Articulators

During respiration, it is wide open.

Congenital web of larynx - hoarseness, severe

Haemangioma of glottis or subglottis - hoarse cry

Unilateral and bilateral abductor paralyses may

Inflammation (infection, over use, abuse)

Early vocalisation difficult

Hoarse cry initially. Eventually,

Voice is clear, but weak.

The sharp groove prevents the cords from closing

Papilloma may occur in any place. Removal by laser

All the webs produce weak voice. Dyspnoea occurs

Normal larynx Cleft larynx

Frequent regurgitation, aspiration, cough… Urgent

These enlarge by the

Extensive & advanced

Treatment : Dilate the area by

1. Cricoid cartilage split

Voice Box - Larynx

Successful visualisation of the vocal cords Indirect

For visualisation & biopsy

Both hands are free

Looks Straight ahead a little sideways more reach

12/02/20 A revolution in ENT surgery

Early stage only congestion

Late stage oedema

Extensive thickening &

Actual Ceph Digitised image

Retro palatal airway

Retro glottal airway

Upper facial height

We speak what we hear

We speak what we hear

Find out any organic lesion in the vocalising

Mentor and monitor the process of correction

Always remember that it is a team work.

Find out any organic lesion in the vocalising

Mentor and monitor the process of correction

Always remember that it is a team work.

A road too far …

You might also like