36 Change in voice and swallowing INTRODUCTION Dysphagia A difficulty or inability to swallow is called dysphagia and it presents as: gagging, retching, choking, extending or flexing the neck during swallowing, repeated attempts to swallow, coughing when eating or drinking, nasal discharge, and pseudo-ptyalism. Swallowing (deglutition) is initiated by sensory information from the oral cavity (CN V), pharynx (CN IX) and epiglottis (CN X). Food, voluntarily pushed to the pharynx by the masticatory muscles (CN V), the palatine muscles (CN V), and caudal tongue movement (CN XII), stimulates the reflex which is coordinated by the swallowing centre within the medulla oblongata. Cessation of respiration and closure of the glottis (CN X) is synchronized with contraction of the pharyngeal muscles (CNN IX, X) to avoid aspiration. Folding of the epiglottis over the glottis is achieved by contraction of the geniohyoideus (CN XII) and mylohyoideus (CN V) muscles, pulling the larynx forward. An inability to swallow saliva causes drooling (pseudo-ptyalism). Oral dysphagia is the inability to prehend food and form a bolus. Voice production Laryngeal paralysis can present with the following signs: an altered volume, pitch or character of voice (dysphonia), lack of voice (aphonia), inspiratory dyspnoea, sonorous respiration, high-pitched wheezing sound (stridor), gagging or coughing when eating or exercise intolerance with or without collapse. Voice is generated by air passing through the larynx. Alteration of this process changes voice quality. An inability to create and expel a thoracic reservoir of air results in hypophonia (quiet voice) or aphonia. Weakness or paralysis of the respiratory muscles from UMN lesions (e.g. C1–5 spinal cord disease or tetanus), or LMN origin (e.g. myasthenia gravis or polyradiculoneuritis) is generally accompanied by non-ambulatory tetraparesis or tetraplegia. Airflow through the larynx is impeded by paralysis of the dorsal cricoarytenoid muscle. This muscle, innervated by a branch of the vagus nerve (CN X), functions as chief abductor of the paired vocal folds and arytenoid cartilages which together create the glottis, the cranial opening of the larynx. Narrowing of the airflow creates stridor, dysphonia, and most importantly, inspiratory dyspnoea. Obstruction of the upper airway by nasopharyngeal polyps or a long soft palate creates a turbulent airflow and loud, stertorous respiration (e.g. snoring or snorting) but rarely results in dyspnoea. Presentation is prompted by dyspnoea, whereas specific questioning of the owner is usually required to discover changes in the pet’s vocalization. Inability to close the glottis risks aspiration of pharyngeal contents (saliva, food and water). The chief laryngeal adductor is the thyroarytenoid muscle, also innervated by the vagus. Coughing and gagging while eating and drinking is a reflex protective of the airways. Sensation to laryngeal mucosa is supplied by the internal branch of the cranial laryngeal nerve, a division of CN X. Unilateral laryngeal paralysis would be noticed in athletic, working animals during exercise, but as most pets are relatively sedentary it takes bilateral paralysis to produce clinical signs. Concomitant signs of aspiration pneumonia may be present: fever, tachypnoea, cough or anorexia. Severely dyspnoeic animals choose to breathe rather than eat as to do both simultaneously would be impossible. Increased muscle tone in myotonia congenita produces stridorous breathing and a high-pitched bark along with the generalized appendicular muscle stiffness. Dyspnoea and cyanosis have been reported during the increased muscular effort of whelping, or a sudden change of posture. Laryngospasm is a complication of tetanus. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Metabolic encephalopathy: hepatic encephalopathy Meningioma Behaviour change – an introduction LMN paresis and paralysis: Brachial plexus avulsion Stay updated, free articles. Join our Telegram channel Join Tags: Saunders Solutions in Veterinary Practice Small Animal Neurology Sep 3, 2016 | Posted by admin in SMALL ANIMAL | Comments Off on Change in voice and swallowing Full access? Get Clinical Tree
36 Change in voice and swallowing INTRODUCTION Dysphagia A difficulty or inability to swallow is called dysphagia and it presents as: gagging, retching, choking, extending or flexing the neck during swallowing, repeated attempts to swallow, coughing when eating or drinking, nasal discharge, and pseudo-ptyalism. Swallowing (deglutition) is initiated by sensory information from the oral cavity (CN V), pharynx (CN IX) and epiglottis (CN X). Food, voluntarily pushed to the pharynx by the masticatory muscles (CN V), the palatine muscles (CN V), and caudal tongue movement (CN XII), stimulates the reflex which is coordinated by the swallowing centre within the medulla oblongata. Cessation of respiration and closure of the glottis (CN X) is synchronized with contraction of the pharyngeal muscles (CNN IX, X) to avoid aspiration. Folding of the epiglottis over the glottis is achieved by contraction of the geniohyoideus (CN XII) and mylohyoideus (CN V) muscles, pulling the larynx forward. An inability to swallow saliva causes drooling (pseudo-ptyalism). Oral dysphagia is the inability to prehend food and form a bolus. Voice production Laryngeal paralysis can present with the following signs: an altered volume, pitch or character of voice (dysphonia), lack of voice (aphonia), inspiratory dyspnoea, sonorous respiration, high-pitched wheezing sound (stridor), gagging or coughing when eating or exercise intolerance with or without collapse. Voice is generated by air passing through the larynx. Alteration of this process changes voice quality. An inability to create and expel a thoracic reservoir of air results in hypophonia (quiet voice) or aphonia. Weakness or paralysis of the respiratory muscles from UMN lesions (e.g. C1–5 spinal cord disease or tetanus), or LMN origin (e.g. myasthenia gravis or polyradiculoneuritis) is generally accompanied by non-ambulatory tetraparesis or tetraplegia. Airflow through the larynx is impeded by paralysis of the dorsal cricoarytenoid muscle. This muscle, innervated by a branch of the vagus nerve (CN X), functions as chief abductor of the paired vocal folds and arytenoid cartilages which together create the glottis, the cranial opening of the larynx. Narrowing of the airflow creates stridor, dysphonia, and most importantly, inspiratory dyspnoea. Obstruction of the upper airway by nasopharyngeal polyps or a long soft palate creates a turbulent airflow and loud, stertorous respiration (e.g. snoring or snorting) but rarely results in dyspnoea. Presentation is prompted by dyspnoea, whereas specific questioning of the owner is usually required to discover changes in the pet’s vocalization. Inability to close the glottis risks aspiration of pharyngeal contents (saliva, food and water). The chief laryngeal adductor is the thyroarytenoid muscle, also innervated by the vagus. Coughing and gagging while eating and drinking is a reflex protective of the airways. Sensation to laryngeal mucosa is supplied by the internal branch of the cranial laryngeal nerve, a division of CN X. Unilateral laryngeal paralysis would be noticed in athletic, working animals during exercise, but as most pets are relatively sedentary it takes bilateral paralysis to produce clinical signs. Concomitant signs of aspiration pneumonia may be present: fever, tachypnoea, cough or anorexia. Severely dyspnoeic animals choose to breathe rather than eat as to do both simultaneously would be impossible. Increased muscle tone in myotonia congenita produces stridorous breathing and a high-pitched bark along with the generalized appendicular muscle stiffness. Dyspnoea and cyanosis have been reported during the increased muscular effort of whelping, or a sudden change of posture. Laryngospasm is a complication of tetanus. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Metabolic encephalopathy: hepatic encephalopathy Meningioma Behaviour change – an introduction LMN paresis and paralysis: Brachial plexus avulsion Stay updated, free articles. Join our Telegram channel Join Tags: Saunders Solutions in Veterinary Practice Small Animal Neurology Sep 3, 2016 | Posted by admin in SMALL ANIMAL | Comments Off on Change in voice and swallowing Full access? Get Clinical Tree
