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Speech Pathology


Introduction

We presently have one speech pathologist.  She is licensed as a speech pathologist by the Commonwealth of Virginia, and holds the Certificate of Clinical Competence (CCC) in Speech Pathology issued by the American Speech, Language, & Hearing Association (ASHA).  She has over 15 years experience in treating disorders of speech, voice, and swallowing.

Services

Disorders of the larynx (voice box) occur at any age and may result in voice, airway, or swallowing difficulties.  Weprovide comprehensive services for these disorders and more, from diagnostic evaluation through treatment, and management.  Diagnostic services are available at the Fairfax office, and therapy services for most diagnoses at the Fairfax and Reston offices.  Speech Pathology services are available by appointment only on Monday, Wednesday, and Thursday.

Possible Vocal Symptoms

If you have experienced a hoarse voice for more than 2 weeks, you should see a physician.  Vocal symptoms may include hoarseness, breathiness, “rough” voice, harshness, huskiness,  decreased pitch range, vocal fatigue, inability to speak loudly, limited pitch or loudness variations, the voice lasting only for a short time, “lump in throat” sensation, or discomfort in the neck or throat.

Diagnostic Services

Flexible Fiberoptic Laryngoscopy

An instrumental examination which may take place involving application of a topical anesthetic and the insertion of an endoscope through the nose to look at the larynx and vocal folds.

Flexible and Rigid Videostroboscopy

An instrumental examination using a rigid endoscope through the mouth or a flexible endoscope through the nose with a special flashing light called a stroboscope, used to watch the vocal folds vibrate in slow motion, allowing for more specific information on how the voice does or does not work

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

The swallowing process is viewed through a small flexible fiberoptic tube inserted in the nose and passed down to the back of the throat.

Nasopharyngoscopy (velopharyngeal study)

Appropriate manipulation of the velopharyngeal port, the area at the back of the nose where it meets the top of the throat and soft palate, is important for normal speech production.  The function of the velopharyngeal port is examined with a flexible endoscope to observe any impact on speech intelligibility and possibly swallowing.

Voice Function Testing

Measurements of voice quality and loudness are made with a computer based system to define the extent of the voice problem and to document progress following treatment or surgery.

Diagnoses Frequently Treated

Vocal fold paralysis

Vocal fold paralysis is when the motion of the vocal folds is impaired. Injury may be caused by a head or neck injury, tumors, surgery, or stroke. There are two types of paralysis.

  • Bilateral vocal fold paralysis involves both vocal folds, which become stuck halfway between the open and closed position (the paramedian position) and do not move either way. This condition may require a tracheotomy (an opening made in the neck to provide an airway) to help with breathing and possibly swallowing.

  • Unilateral vocal fold paralysis is more common. Only one vocal fold is paralyzed in the paramedian position or has a very limited range of motion. The paralyzed vocal fold does not move to vibrate with the other fold.  This may result in a weak and hoarse voice, and sometimes difficulty swallowing liquids. 

Spasmodic Dysphonia

Spasmodic dysphonia (or laryngeal dystonia) is a neurologic voice disorder causing involuntary movements of one or more muscles of the larynx. People may have occasional difficulty saying a word or two or they may experience difficulty interfering with most communication. There are two primary types, adductor spasmodic dysphonia and abductor spasmodic dysphonia.

Adductor Spasmodic Dysphonia

There are sudden involuntary muscle movements or spasms cause the vocal folds to close during speech, making it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. The spasms are often absent while whispering, laughing, singing, speaking at a high pitch, or speaking on inhalation.

Abductor Spasmodic Dysphonia

There are sudden involuntary muscle movements or spasms cause the vocal folds to open during speech. The vocal folds can not vibrate when they are open. As a result, the voice often sounds weak, quiet, and breathy. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing.

Vocal Tremor

Regular trembling or shaking of one or more of the muscles of the larynx, and possibly the throat or soft palate, resulting in an unsteady sounding voice.

Benign Lesions

This includes vocal nodules, cysts, polyps, and contact granulomas.

  • Vocal Nodules are benign growths on both vocal folds that are caused by vocal abuse. Over time, repeated misuse of the vocal folds results in soft, swollen spots on each vocal fold that can develop into harder, callus-like growths. The nodules will become larger and stiffer the longer the vocal misuse continues.
  • Polyps can take a number of forms and are sometimes caused by vocal abuse. Polyps appear on either one or both of the vocal folds and appear as a swelling or bump, a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema.
  • Cysts are a firm mass of organized material within a sac typically within the vocal fold. The size and location will determine its impact on voice function.
  • Contact Granulomas are an ulceration and reactive tissue that forms on the cartilage of the vocal fold at the back of the larynx. This often develops in the setting of reflux exposure, but could develop following endotracheal intubation. These may or may not interfere with voice production, and often result in throat clearing and focal pain or discomfort.

Muscle Tension Dysphonia

Muscle tension dysphonia is a voice disorder characterized by strained, effortful phonation usually causing vocal fatigue with extensive use. This may develop during speaking in which the muscles in the neck are tense and when no other vocal cord lesion or paralysis are seen, or as a compensation in the setting of paralysis, paresis or muscular weakness causing the person to squeeze other parts of the larynx to help produce sound.

The Aging Larynx

Presbylaryngeus is the medical term for the aging voice. The classic appearance of the vocal folds is a slightly bowed space between the vocal folds during vibration resulting in incomplete closure, presumably because of loss of vocal fold bulk and flexibility. Too much air escapes through the vocal folds so that voice may be hoarse and weak. In order for voice quality to be normal, the vocal folds must close completely.

Head and Neck Cancer

This may be a malignant growth that affects any part of the oral cavity, including the lips, upper or lower jaw, tongue, tonsils, cheeks, and throat. The effects of a cancer on speech and swallowing depend on the location and size of the growth, medical treatment, and surgery.

Paradoxical Vocal Fold Dysfunction/Laryngeal Disordered Breathing

Laryngeal disordered breathing occurs with abnormal movement of the vocal folds while breathing. Normally the vocal folds are in an abducted (open) position in the shape of a "V" during breathing, which easily allows for the passage of air into and out of the lungs. The vocal folds adduct (close) during a cough, while swallowing, and when producing voice. During episodes of paradoxical vocal fold motion, the vocal folds partially or fully close during breathing, restricting the passage of air to the lungs, when they should be opening.

Tracheotomy

A surgical opening is made in the windpipe (trachea) by cutting the neck below the vocal cords. A tube is placed in the opening, and air is inhaled and exhaled through the tube rather than through the mouth and nose. For some, a tracheostomy is a short-term measure. For others, it is long-lasting or permanent. There may be an impact on voice and swallowing with the presence of a tracheostomy tube. Treatment strategies are available including speaking valves to address these concerns.

Dysphagia

Difficulty swallowing can be characterized by needing to swallow multiple times to clear food from the mouth or throat, a wet voice after swallowing, coughing or choking during mealtimes, the need to modify foods or liquids to ease consumption, or perhaps discomfort with swallowing. There are multiple reasons for swallowing difficulties, including neurological, mechanical, and behavioral.

Dysarthria

Difficulty forming sounds into words to speak clearly may occur following surgery of the mouth, tongue or neck, or often in neurological conditions because of weakness or even too much muscle activity limiting range of motion. Speech may be slurred, slowed rate, a rapid rate with a mumbling quality, abnormal pitch or loudness fluctuations, or changes in nasality.

Therapy Services

Treatment may consist of medical management, surgery, behavioral therapy (voice, swallowing, or breathing), or a combination of the three.

Vocal Rehabilitation

Therapy efforts for children and adults focus on enhancing quality, vocal power, and endurance, through tasks emphasizing breath support, voicing, and resonance. Voice therapy involves introducing good vocal hygiene, eliminating vocal abuses, and direct voice treatment to alter pitch, loudness, and breath support for optimal voicing and endurance.

  • Swallowing Therapy Therapy efforts for adults are designed to improve the safety, ease, and efficiency of swallowing, while optimizing the enjoyment of mealtimes.
  • Speech Therapy Therapy efforts for adults are pursued to enhance the pronunciation of sounds, overall speech intelligibility, and optimize the communication experience.

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