Laryngeal Trauma

Trauma to the larynx is a relatively rare clinical entity. Estimates in the literature indicate that acute laryngeal trauma accounts for 1 in 15,000 to 1 in 42,000 emergency room visits. A large number of such traumatic injuries are the result of accidental blunt trauma to the neck; causes include motor vehicle collisions, falls, athletic injuries, and the like. Another portion of these injuries are the result of violence, such as shooting or stabbing, which may result in penetrating injuries not only of the larynx but also of other critical structures in the neck. Blunt laryngeal trauma is most commonly reported in persons less than 30 years old.

In cases of blunt trauma to the larynx, the primary presenting symptoms are hoarseness, pain, dyspnea (shortness of breath), dysphagia, and swelling of the tissues of the neck (cervical emphysema). Injuries may involve fractures of laryngeal cartilages, partial or complete dislocations, lacerations of soft tissues, or combined types of injury. Because laryngeal trauma, no matter how minor, holds real potential to affect breathing, medical intervention is first directed at determining airway patency and, when necessary, maintaining an adequate airway through emergency airway management (Schaefer, 1992). When airway compromise is observed, emergency tracheotomy is common. Laryn-geal trauma is truly an emergency medical condition. When injuries are severe, additional surgical treatment may be warranted. Thus, whereas vocal disturbances are possible, the airway is of primary concern; changes to the voice are of secondary importance.

Injuries to the intrinsic structures of the oral cavity are also rare, although when they do occur, changes in speech, deglutition, and swallowing may exist. Although the clinical literature is meager in relation to injuries of the lip, alveolus, floor of the mouth, tongue, hard palate, and velum, such injuries or their medical treatment may have a significant impact on speech. Trauma to the mandible also can directly impact verbal communication. Unfortunately, the literature in this area is sparse, and information on speech outcomes following injuries of this type is frequently anecdotal. However, in addressing any type of traumatic injury to the peripheral structures of the speech mechanism, assessment methods typically employed with the dysarthrias may be most appropriate (e.g., Dworkin, 1991). In this regard, the point-place system may provide essential information on the extent and degree of impairment of speech subsystems (Netsell and Daniel, 1979).

Speech Considerations. Speech management initially focuses on identifying which subsystems are impaired, the severity of impairment, and the consequent reduction in speech intelligibility and communicative proficiency. A comprehensive evaluation that involves aerodynamic, acoustic, and auditory-perceptual components is essential. Information from each of these areas is valuable in identifying the problem, developing management strategies, and monitoring patient progress. Because of variability in the extent of traumatic injuries, the literature on the dysarthrias often provides a useful framework for establishing clinical goals and evaluating treatment effectiveness.

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