From the Guidelines
When a patient has difficulty speaking, it's essential to monitor their airway patency, breathing status, and vital signs, including oxygen saturation, respiratory rate, heart rate, and blood pressure, as speech difficulties may indicate respiratory compromise, as recommended by recent guidelines 1.
Key Aspects to Monitor
- Airway patency and breathing status
- Vital signs, including oxygen saturation, respiratory rate, heart rate, and blood pressure
- Facial asymmetry, drooling, or weakness in facial muscles, which could suggest stroke or neurological issues
- Level of consciousness and mental status, noting any confusion or disorientation
- Swallowing difficulties by observing for coughing or choking during attempts to swallow
- Specific speech characteristics, such as slurring, word-finding difficulties, or complete inability to speak
Identifying Underlying Causes
- Assess the patient's history and physical examination to identify underlying causes of dysphonia and factors that modify management, as recommended by 1
- Consider recent surgical procedures, endotracheal intubation, presence of concomitant neck mass, respiratory distress, or stridor, as well as history of tobacco abuse or professional voice use, as indicated by 1
Escalation of Care
- Perform diagnostic laryngoscopy or refer to a clinician who can perform it when dysphonia fails to resolve or improve within 4 weeks, or if a serious underlying cause is suspected, as recommended by 1 and 1
- Consider expedited laryngeal evaluation in patients with recent surgical procedures, endotracheal intubation, or other high-risk factors, as indicated by 1 and 1
Treatment and Management
- Advocate for voice therapy for patients with dysphonia from a cause amenable to voice therapy, as recommended by 1 and 1
- Consider botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngal dystonia, as recommended by 1
- Inform patients with dysphonia about control and preventive measures, as recommended by 1 and 1
From the Research
Monitoring Patients with Difficulty Speaking
When a patient has difficulty speaking, it is essential to monitor their airway, breathing, and circulation (ABC) to ensure effective management. The following aspects should be monitored:
- Airway: ensure a clear airway to prevent complications such as airway compromise 2
- Breathing: assess respiratory function to identify potential problems 3
- Circulation: evaluate cardiac and circulatory function to ensure adequate blood flow and oxygenation 3
- Neurological assessment: monitor the patient's level of consciousness and neurological function, as difficulty speaking can be a sign of an underlying neurological condition 2, 4, 5, 6
Additional Considerations
In patients with acute brain injury or cerebral edema, it is crucial to monitor: