Neurosensory disorders generally fall into three major categories: hearing disorders, swallowing and voice disorders and/or taste and smell disorders. In addition, our neurosensory center also treats trigeminal neuralgia and facial pain.
Click to expand a topic and learn more about the types of neurosensory disorders:
Idiopathic Subglottic Stenosis
Idiopathic means unknown cause. Subglottic refers to the part of the airway that is immediately below the vocal cords. Stenosis refers to circumferential narrowing, usually due to scar tissue. Idiopathic subglottic stenosis has become one of the most common indications for tracheal resections and reconstruction. This condition, which is uncommon, affects women more than men. Symptoms include noisy breathing (stridor), recurring croup, hoarseness and/or inability to breathe without a tracheostomy tube.
Tracheal stenosis is a condition where the windpipe (trachea) narrows or becomes constricted (stenosis). There are several different types of tracheal stenosis. Congenital stenosis is present from birth. Acquired stenosis is developed later in life. Tracheal stenosis can be cause by treatments, such as endotracheal intubation, tracheostomy radiotherapy, surgery, external injury, cancer and autoimmune conditions like polychodritis, sarcoidosis or Wegener’s granulomatosis.
Some patients with a tracheal stenosis do not exhibit any symptoms. Others may have one or more of the following symptoms:
- shortness of breath
- difficult or labored breathing (dyspnoea),
- breathing noise that is louder and harsher than a wheeze in someone with a windpipe or voice box obstruction
- bluish color in the skin or mucous membranes such as in the mouth or nose
- frequent lung inflammation
Learn more about available treatment options for adult airway disorders.
Hearing loss is a common condition that affects patients of all ages, from infancy to adulthood. Hearing loss can result from bacterial and viral infections, environmental and work-related noise exposure, genetics, medication toxicity or trauma. Hearing loss is divided into two categories: conductive and sensorineural.
Conductive Hearing Loss
The eardrum (tympanic membrane) and the ear bones (ossicles) work together to conduct and amplify sound to the inner ear. When these components fail to function properly, hearing loss occurs. Ear infections are a frequent cause of conductive hearing loss. While acute ear infections can cause temporary hearing loss, chronic ear disease may result in permanent damage. Cholesteatoma is a common cause of conductive hearing loss. Rare but serious complications of untreated chronic ear disease include deafness, vertigo, facial nerve paralysis, meningitis and spinal fluid leakage.
Sensorineural Hearing Loss
Sensorineural hearing loss arises from damage to either the cochlea (in the inner ear) or the auditory nerve. There are a wide variety of causes, including genetic or familial hearing loss, noise-induced hearing loss, Meniere’s disease, ototoxicity from certain medications and infections (such as meningitis), head trauma and certain brain tumors.
Tinnitus, a ringing, chirping or buzzing sensation in the ears, is a common symptom of ear damage. Once biological causes have been ruled out, strategies to alleviate the discomfort and nuisance associated with these sounds can include masking devices, hearing aids and tinnitus biofeedback. These treatments are available through the UC Division of Audiology.
Learn more about available treatment options for hearing and balance disorders.
Acid reflux causes stomach acid to back up into the esophagus and sometimes into the larynx and pharynx. This can cause inflammation of the lining. Heartburn is common when the esophageal lining is inflamed. Other symptoms, such as a sore throat, dry cough or frequent throat clearing are common when the laryngeal mucosa is inflamed.
Trauma that affects the brain can cause neurological problems that impair swallowing, while trauma to the neck can cause swallowing problems by changing the structure of the pharynx, larynx or esophagus.
Esophageal and Pharyngeal Stenosis
This refers to narrowing of the pharynx or esophagus. This can be caused by many conditions, including prolonged inflammation, trauma and radiation to the neck.
The most common symptom of Zenker’s diverticulum is difficulty swallowing food. Food may come back up out of the mouth several minutes to even hours after eating. Patients also suffer from choking, feeling mucus collecting in the throat, hoarseness or bad breath. The symptoms can be quite embarrassing and debilitating.
Dysphagia, or difficulty swallowing, is often noted in stroke survivors. The patient may cough or choke while attempting to swallow saliva, liquids or food. A phenomenon called silent aspiration also may occur. This is when saliva, food and liquids enter into the lungs without any coughing or choking. In these patients, there are no outward signs or symptoms of a swallowing problem, but the condition can potentially cause bronchitis or pneumonia. A speech-language pathologist often evaluates a patient’s ability to swallow safely, without food or liquid going into his or her airway/lungs.
Many patients with Parkinson’s disease have dysphagia (difficulty swallowing) due to a loss of control of the mouth and throat muscles. This might make it difficult for the patient to chew and manage solid foods. A delay in the swallowing process in either the throat or pharynx (the digestive tube between the esophagus and mouth) might also make it difficult to swallow without coughing or choking.
Dysphagia increases the risk of aspiration (inhaling fluid or stomach contents) and pneumonia in patients with Parkinson’s disease. At times, making dietary changes and following special swallowing techniques are sufficient to improve the safety of swallowing. At other times, alternative means of providing fluids and nutrition are necessary.
Amyotrophic Lateral Sclerosis (ALS) (also known as Lou Gehrig’s Disease)
ALS is a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal column. These nerve cells control voluntary muscles, which in turn allow movement. Over a period of months or years, ALS causes muscle weakness and an inability to control muscle movement. This can cause swallowing problems such as dysphagia.
Learn more about available treatment options for swallowing disorders.
It is rare for patients to truly lose their sense of taste. More often a loss of taste — described as the inability to detect flavors of food — is mistaken for a loss of smell. However, true taste loss can occur after trauma, after certain infections and as a secondary effect of some medical or surgical therapies. Many people suffer a persistent salty, bitter, metallic or other unpleasant taste that is not necessarily associated with a taste loss. Sometimes this can be associated with a burning mouth or tongue.
The sense of smell, often taken for granted, is more integral to day-to-day living than most people realize. Without the sense of smell, foods will still taste salty, sour, sweet or bitter. But chocolate will seem no different than vanilla and a grapefruit no different than an orange. The loss of smell can also raise safety concerns if patients are unable to smell a gas leak, something burning or spoiled foods. The sense of smell can be lost for a variety of reasons. After an appropriate history and examination, the reason for the loss can usually be identified. This leads to a prognosis and treatment.
Learn more about available treatment options for taste and smell disorders.
Trigeminal neuralgia is a condition in which inflammation of the trigeminal nerve causes excruciating, sudden or sporadic pain in the face. Episodes can vary in length, lasting only a few seconds or up to two minutes. These episodes of pain can come in waves and can persist for an hour or more. The stabbing, knife-like pain has been likened to an electric shock on one side of the face.
The condition, which affects one in every 25,000 people, is caused by injury or damage to the trigeminal nerve. The trigeminal nerve is a sensory and motor nerve that originates in the brain and spreads to the cheeks, jaw and the area of the forehead and eyes. The trigeminal nerve delivers feeling to the face and allows facial movements to occur. Trigeminal neuralgia generally affects adults and is not uncommon in patients who suffer from multiple sclerosis. Most medical scientists believe it is caused by an abnormal vein or artery that compresses the trigeminal nerve.
Trigeminal neuralgia is also known as tic douloureux, because the pain can cause uncontrollable facial twitching.
Learn more about available treatment options for trigeminal neuralgia.
Many patients suffering from a Voice Disorder experience the following symptoms: shortness of breath, chronic hoarseness or raspiness, frequent urge to cough or throat clearing, loss of vocal range, heartburn, vocal fatigue, loss of control or projection, acidic taste in the mouth and/or voice cuts out for no reason.
Hoarseness refers to any abnormal voice (also known as dysphonia). Not all hoarse voices sound alike. Characteristics that can be seen in some hoarse voices include breathiness (as in the classic Marilyn Monroe voice), roughness, decreased loudness, inability to project the voice, strain or the complete lack of a voice (aphonia).
Laryngitis refers to inflammation of the vocal cords and the area around them. Laryngitis can produce a rough voice, decreased loudness, and even aphonia (see above). The inflammation can have many different causes, including allergies, environmental irritants, a cold, the flu, bronchitis, sinusitis, and other respiratory infection.
Laryngopharyngeal Acid Reflux (LPR)
LPR is caused by stomach acid coming up from the esophagus and irritating the larynx and pharynx. This condition is different from gastroesophageal reflux disease (GERD). In GERD, the acid causes inflammation of the esophageal lining, and the main symptom is heartburn. In LPR, the acid produces inflammation of the lining of the larynx and pharynx. Common symptoms in LPR include a dry cough, frequent throat clearing and a feeling that something is stuck in the throat. This condition is usually treated with lifestyle and dietary modifications and with medication.
Recurrent Respiratory Papillomatosis (RRP)
(RRP) is a disease in which tumors grow inside the larynx, vocal cords and trachea. It affects both children and adults and is caused by the Human Papilloma Virus (HPV). Depending on the location and extent of the disease, RRP will present with hoarseness and/or shortness of breath.
Spasmodic Dysphonia (SD)
SD is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two, or they may experience significant difficulty in communication. Although stress does not cause this disease, it can make the voice worse. In the early stages of the disease, many patients find that singing is easier than talking. There are two types of SD. In adductor SD, the vocal cords squeeze together too much. This makes it difficult for a person to “get words out” and causing a strained voice. In abductor spasmodic dysphonia, the voice becomes very breathy when a patient attempts to pronounce certain consonants such as “k.”
When vocal cord paralysis occurs on one side only, the paralyzed cord will shift away from midline. One treatment (see vocal cord paralysis section) is to “push” the cord back to midline by injecting a substance in the vocal cord itself. In the past, Teflon has been used for this purpose. It has the advantage of being a relatively permanent material. However, one major disadvantage is that an inflammatory reaction can occur around the Teflon, forming a mass of very firm tissue known as a Teflon granuloma. This granuloma can prevent the vocal fold from vibrating, thus impairing voice; it can also be large enough to cause airway obstruction and breathing difficulties.
Vocal Cord Cancer
Most of the cancers in this area originate from squamous cells that normally located in the mucosal lining of the cord. The earliest symptom is usually hoarseness. We recommend you be evaluated by an otolaryngologist, if you have hoarseness lasting greater than 3 weeks. Risk factors for this cancer include smoking and alcohol use. There also may be an association with Human Papilloma Virus (HPV). Surgery or radiation are very successful in curing this disease for early, less severe vocal cord cancers. More advanced cases usually require both surgery and radiation and sometimes chemotherapy.
Vocal Cord Granuloma
A granuloma is a type of laryngeal lesion that represents the body’s response to chronic irritation or trauma. This is usually seen after prolonged intubation and is made worse by stomach acid.
Vocal Cord Nodule
Vocal cord nodules are masses of tissue that grow on both vocal folds (vocal cords). They are similar to calluses and are usually the result of talking loudly or in a noisy environment. These are usually treated with voice therapy.
Vocal Cord Paralysis
Vocal cord paralysis is a voice disorder that occurs when one (unilateral) or both (bilateral) of the vocal cords do not move. Normally, our vocal cords move apart when we breathe and together when we talk. In unilateral paralysis, the paralyzed cord is usually in a position such that the normal cord cannot meet it during speech. This produces a gap between the cords and can cause symptoms such as a breathy voice, decreased loudness and vocal fatigue. Treatment includes temporarily or permanently moving the paralyzed vocal cord to midline. Reinnervation, when another nerve is attached to the paralyzed nerve, can also give good results under certain conditions. In bilateral paralysis, both vocal cords are at the midline position and they cannot move apart during breathing. This usually produces airway obstruction, and the voice is much less affected. There are a variety of surgical procedures designed to treat bilateral vocal cord paralysis.
Vocal Cord Polyp
Vocal cord polyps represent benign lesions that may have a variety of appearances. Polyps may be single or multiple, involve one cord or both and may be big or small. Polyps cause a hoarse voice and are usually treated with a combination of voice therapy and surgery.
Professional and Occupational Voice Users
Professional and occupational voice users are defined as individuals who use their voices daily as an essential part of their job. Such occupations range from professional performers (singers, actors, actresses and broadcast personalities) to public speakers and care providers (teachers, clergy, salespeople, courtroom attorneys, telemarketers, physicians, nurses and receptionists). UC Gardner Neuroscience Institute has a dedicated team of professionals available to assist these professionals to help them achieve their highest vocal quality potential.
Learn more about available treatment options for voice disorders.