Anatomy, Physiology, and Assessments Flashcards

Question

What are the 4 "airway dilator" muscles?

Answer 1

1. Genioglossus/Geniohyoid 2. Anterior digastric 3. Dilator naris 4. Posterior cricoarytenoid "Dilate a GAP"

Answer 2

p4 paired muscles, 1 unpaired muscle Abductor (only 1): 1. Posterior Cricoarytenoid (x2 paired) - Innervation: RLN - Function: only vocal fold abductor Adductor (4) 1. Cricothyroid (x2) - Innervation: External branch of SLN - Function: Adducts, Lengths and tautens vocal folds to increase pitch 2. Lateral Cricoarytenoid (x2) - Innervation: RLN - Function: Adducts vocal folds 3. Interarytenoid (x1 unpaired) - Sometimes referred to as transverse and oblique arytenoids - Innervation: RLN (bilateral innervation as it's an unpaired muscle) - Function: Adducts vocal folds 4. Thyroarytenoid (x2) - aka. vocalis - Innervation: RLN - Function: Adducts, Shortens and relaxes vocal folds to lower pitch WITHIN THE CONUS ELASTICUS: 1. Thyroaytenoid (vocalis) 2. Interarytenoid 3. Lateral cricoarytenoid 4. Posterior cricoarytenoid WITHIN THE QUADRANGULAR MEMBRANE: 1. Thyroepiglottic (widen laryngeal inlet) 2. Aryepiglottic (close laryngeal inlet) 3. Thyroarytenoid 4. Cricothyroid ## Footnote Kevan Page 5 Laryngology anatomy

Answer 3

1. Innervation to the cricothyroid 2. Sensory mucosal innervation superior to the true vocal folds

Answer 4

RLN - Cricothyroid joint Internal branch of SLN - Pierces the thyrohyoid membrane along within the superior laryngeal artery

Answer 5

Three paired cartilages: 1. Arytenoid 2. Corniculate (sits like a "crown" on the arytenoids) 3. Cuneiform (floats in AE folds to add structural support) Three unpaired cartilages: 1. Thyroid cartilage 2. Cricoid cartilage 3. Epiglottis Variable presence: 1. Triticeal cartilage: small cartilage located within the lateral aspect of the thyrohyoid membrane, that may be bilateral, unilateral or absent. It is considered a lateral anatomical variant

Answer 6

Superior Laryngeal Nerve: 1. External Branch: Motor to cricothyroid muscle 2. Internal Branch: Sensation to supraglottis and glottis. Pierces through thyrohyoid membrane Recurrent Laryngeal nerve: a. Motor to all other intrinsic muscles of the larynx except the cricothyroid muscle b. Sensation to the subglottis and glottis c. Goes through the cricothyroid joint. Nerve of Galen: - Anastomosis between SLN and RLN at glottis

Answer 7

Branches from CNX at lower aspect of the nodose ganglion (sensory) ~36mm from jugular foramen/nucleus ambiguous (motor), divides ICA and IJV with CNXII Internal branch: - Sensory, enters larynx with superior laryngeal artery off of superior thyroid artery through thyrohyoid membrane, supplies false fold, epiglottis, pyriform sinus, Glottis and partly subglottis External branch: - Motor, supplies cricothyroid - Runs on the posterior surface of the sternohyoid

Answer 8

Right non-recurrent laryngeal nerve Aberrant right subclavian (retroesophageal) Absent innominate

Answer 9

Right: 0.5% (1/200) associated with aberrant subclavian artery (artenia lusoria) Left: 0.004% (1/250000) associated with situs inversus and dextrocardia

Answer 10

5 layer scheme: 1. Squamous epithelium 2. Superficial lamina propria 3. Intermediate lamina propria 4. Deep lamina propria 5. Vocalis (thyroarytenoid) Vocal ligament = ILP + DLP 3 layer scheme: 1. Mucosa = epithelium -- separated by Reinke's space = SLP 2. Vocal ligament = ILP + DLP 3. Muscle = Vocalis 2 layer scheme (cover + body): 1. Cover = Epithelium + SLP + ILP 2. Body = DLP + Vocalis ## Footnote Kevan Page 6

Answer 11

Cover = Epithelium + SLP Transition zone = ILP + DLP Body = Vocalis The contrasting masses and physical properties of the cover and body causes them to move at different rates which create vibration and sound at the level of the vocal folds. Vocal adjustments are regulated by changing the mechanical and vibratory properties of both.

Answer 12

Previous theory "Neurochronaxic Hypothesis" where vocal fold movement was caused by thyrhmic impulses in the nerves of the larynx. However, this was not reasonable given the frequency of vibration that was needed. Myoelastic Aerodynamic Theory: 1. Inhalation = air enters lungs 2. Glottic closure = Voluntary adduction of the cords by the intrinsic laryngeal musculature 3. Expiratory force = Diaphragm contracts for expiration 4. Increased subglottic pressure builds below the glottis with expiration 5. Pressure opens the glottis from inferior and moves superiorly 6. Vocal folds spring back to midline (which involves 2 components) i/ Aerodynamic component: Due to negative pressure from Bernouilli's principle, as air rushes through a narrowed glottis, the vocal folds pull together ii/ Myoelastic component: Elastic recoil occurs from the vocal folds 7. Cycle repeats, and this forms the mucosal wave ## Footnote Kevan Page 6

Answer 13

- Vocal fold vibration occurs in lateral & vertical planes - Sequence: lower margin separates, elliptical volume of air formed in subglottal vault, glottal puff is released as upper margin separates, lower margin returns to midline, then upper margin does also - This occurs anterior then posterior - Phase delay (vertical phase difference) - the time delay between closure of upper and lower vocal fold margins - should normally be 1/3-1/2 of the vibratory cycle

Answer 14

According to myoelastic aerodynamic theory of phonation: 1. Bernouilli effect 2. Elastic recoil

Answer 15

1. Phonation 2. Airway protection 3. Respiration (breathing) 4. Valsalva (generating intrathoracic pressure)

Answer 16

1. Respiration/Generator = Lungs produce airflow 2. Phonation = generation of sound by vocal fold vibration 3. Articulation = shaping of the voice into words 4. Resonance = induction of vibration of the rest of the vocal tract (chest, pharynx, head) to modulate laryngeal output with selective amplification of certain component frequencies 5. Prosody = Intonation

Answer 17

1. Adequate breath support /expiratory force 2. Regular approximation of the vocal folds 3. Favourable vibratory properties 4. Favourable vocal fold shape 5. Control of length and tension of the vocal folds

Answer 18

A. Posterior commissure closure & glottal gap - Interarytenoid & lateral cricoarytenoid muscles both close and oppose the vocal folds B. Symmetric thyroarytenoid stiffness - Increase pitch and resistance - Cricothyroid antagonizes the thyroarytenoid while also thinning and lengthening the vocal fold - This increases tension and pitch while decreasing the area of contact C. Equal vertical height position of the vocal folds

Answer 19

Formants are specific harmonic frequencies that are amplified by resonance through the vocal tract. In phonetics, formants are the prominent frequency bands that are used to determine the phonetic quality of a vowel (typically the first 2 formants are enough to identify a vowel). Each vowel sound production usually has 4-5 formants: 1. First 2 are responsible for vowel recognition 2. 3-5 color the sound and provide timbre 3. Voice professionals can bring formants 3-5 closer together to form a "ring", termed the singer's formant

Answer 20

Dysphonia = Altered vocal quality, pitch, loudness, or vocal effort that impairs communication as assessed by a clinician and/or affects quality of life Hoarseness is a symptom of altered voice quality reported by patients

Answer 21

1. OPQRST - onset, provoking and resolution factors, quality, severity, timing/duration 2. Dysphagia, odynophagia, globus 3. Dyspnea, stridor 4. Dysphonia (GRBAS - grade, roughness, breathiness, aesthenia, straining) 5. Constitutional symptoms 6. History of voice abuse 7. History of professional voice use - for singers, their level of training, amplification, practice schedule, style, amount of time practice/performing, changes in vocal range, environmental changes, air travel (dry air) 8. Voice use demands (occupation, social voice use, kids/pets/large friend groups) 9. Smoking and alcohol consumption, caffeine water intake in day 10. Symptoms of GERD 11. Psychosomatic stressors 12. Recent surgery or intubation 13. Past laryngeal procedures 14. Autoimmune conditions 15. Medications

Answer 22

1. Voice handicap index (VHI) 2. Voice related QOL (V-RQOL) 3. Voice symptom scale (VSS) 1. Reflux symptom index (RSI) 2. Speech Handicap index (used in patients with H/N cancer) 3. Cough severity index 4. Dyspnea index

Answer 23

1. GRBAS: Grade, Roughness, Breathiness, Asthenia, Strain 2. CAPE-V: Consensus Auditory Perceptual Evaluation of Voice

Answer 24

Grade (overall) Roughness Breathiness Asthenia (weakness) Strain Each is graded from a score of 0-3 for a total score of 15

Answer 25

CAPE-V = Consensus Auditory Perceptual Evaluation for Vocal assessment - Rating tool based on 6 core parameters: overall severity, roughness, breathiness, strain, pitch, loudness. This is marked on a 10cm line - Scored based on 2 sustained vowels, 6 standard sentences, and at least 20 seconds of natural running speech 6 Standard Sentences "All WHEMP" 1. "The blue spot is on the key again" -- contains all the english vowel sounds 2. "We were away a year ago" -- All voiced (W) (Adductor SD) 3. "How hard did he hit him?" -- Soft onsets (H) (Abductor SD) 4. "We eat eggs every easter" -- Hard glottal onsets (E) (Adductor SD) 5. "My mamma makes lemon muffins" -- Nasal sounds (M) 6. "Peter will keep at the peak" -- Voiceless plosives (P) (Abductor SD) ## Footnote Kevan Page 8

Answer 26

FAV People are on SNL Total of 44 phonemes in the English language, grouped in 7 different types. 1. Fricatives (aka. Sibilants) - Sounds produced by frication (air turbulence) - Eg. "S" "Sh" 2. Affricates - Stop sound + fricative - Eg. Ch = t+sh 3. Vowels - Speech sound without any stricture in the vocal tract (a, e, i, o, u, sometimes y) 4. Semivowels - Phonetically similar to a vowel but forms the boundary of a syllable rather than the nucleus - Eg. W in "west", Y in "Yes" 5. Stops (aka. Plosives) - Sounds that stop and then release oral airflow - Eg. "P", "B" 6. Liquids - Voiced continuant sounds made when the tongue partially closes the mouth, producing vowel like sounds - Eg. "L", "R" 7. Nasals - Sounds produced by occluding mouth and directing airflow through the nose - Eg. "M" "N" "Ng" are the only nasal consonants

Answer 27

Phonetically balanced standardized text. Used to facilitate objective voice analysis.

Answer 28

Hypernasal, Hyponasal, Cul-de-sac, Mixed Hypernasal = Too much sound energy in nasal cavity during phonation Hyponasal = Too little sound energy in nasal cavity during phonation Cul-de-sac = Sound resonates in a cavity but is "trapped" and cannot exit due to obstruction Mixed = Combination of the above

Answer 29

A. Auditory Perceptual Assessment 1. GRBAS 2. CAPE-V 3. Resonance (hypernasal, hyponasal, cul-de-sac) 4. Prosody (speech rate, intonation, stress patterns) B. VIsual Perceptual Assessment 1. General Appearance 2. Posture, MSK tension 3. Neurologic signs (e.g. tremor, wasting, slowness, dyscoordination, focal dystonias, etc.) 4. Syndromic Features C. Tactile Perceptual Assessment 1. Palpation of laryngeal neck muscles 2. Mobility of larynx and cartilages

Answer 30

Components: 1. Intraoral air pressure (aka. Subglottic air pressure) 2. Phonation threshold pressure 3. Airflow 4. Laryngeal airway resistance 5. Maximal phonation time 6. Velopharyngeal function Intraoral pressure: - Measured during a stop (aka. plosives), usually "p" - Estimate for subglottal air pressure, which requires a direct tracheal puncture to actually measure - Abnormal values may indicate lack of driving pressure, VPI, increased vocal fold mass or stiffness - Normal = ~7cm H2O Phonation Threshold Pressure (PTP): - Defined as the minimum subglottal pressure necessary to initiate vocal fold vibration - May correspond to symptoms of increased vocal effort - Can change with dehydration, vocal fatigue, voice warm-ups - Normal ~3cm H2O, 8cmH2O for high pitches (range 6-8) Airflow: - Airflow through glottis and subglottic pressure measured, which determines the glottic resistance (Ohm's law) - Vocal efficiency = acoustic power/subglottic power (pressure) - Airflow voice measures include MPT and phonation threshold pressure; measurements can be obtained with a phonatory aerodynamic system (PAS) sold by pentax. - Measured in volume (mL or L) per unit of time - Increased with poor glottal closure (e.g. VFI or paresis) and can be decreased with vocal fold hyperfunction - Normal = ~100ml/sec Laryngeal Airway Resistance: - Defined as ratio of translaryngeal air pressure to airflow - High pressure + low airflow = high resistance - Higher laryngeal resistance can indicate increased vocal intensity, longer closed phase, or higher force of glottal closure - Normal ~27-51cm H2O/L/s (lower for men, higher for women) Maximal Phonation Time: - Normal values: Women = 15-25s, Men = 25-35s - MPT of ≤ 7 seconds indicates poor glottic efficiency Velopharyngeal Function: - Nasometry can measure nasalance (ratio of nasal sound energy to total sound energy) - Hypernasal = Nasalance > 25-33% for non-nasal passages - Hyponasal = Nasalance < 50% for nasal passages

Answer 31

- Transglottal airflow rate = 100cc/sec - Glottal resistance = 30-50 cm H2O - Subglottal pressure = 6-8 cm H2O

Answer 32

Elements: 1. Fundamental Frequency 2. Intensity 3. Range 4. Perturbation Measures 5. Spectral/Cepstral Assessment Fundamental Frequency: - Men 100-125Hz, Women 190-225Hz (approx 100Hz more) - Voice is a complex group of waves. Any frequencies above the Fundamental Frequency (F0) are multiples of F0 called harmonics. - Maximum frequency range = 2.5-3 octaves Intensity: - Measured in dB SPL (Sound Pressure Level) - Average = 70dB SPL (60-110) - Acoustic correlate to loudness - Implications of abnormal values: Parkinson's, VF motion impairments, Difficulty speaking quietly in scarring of VF lesions. Range: - Minimum and maximum frequencies an individual can produce - Normal 80-1100Hz Perturbation Measures: - Measures of variability in the sound wave / noise - Jitter = Cycle to cycle variation in frequency. Normal ≤0.4% - Shimmer = Cycle to cycle variation in amplitude. Normal ≤0.5dB - Harmonic-to-Noise Ratio = 10xlog10(harmonic%/noise%) - quantifies the degree of hoarseness, normal > 7dB. Increasing jitter and shimmer results in increased hoarseness - Perturbation analysis cannot be done if they are markedly dysphonic and cannot set a fundamental frequency Spectral/Cepstral Assessment: - Spectrum = Displays frequency vs. amplitude - Spectral tilt = indicates whether low or high frequencies dominate the spectrum - Increased spectral tilt (ie. less high frequency information) is associated with a breathy voice - Cepstrum = Spectrum of a spectrum - Cepstral Peak Prominence (CPP) = Measure of signal periodicity that corresponds to regularity of harmonic peaks - Higher CPP = better voice quality and vice versa ## Footnote Kevan Page 10

Answer 33

Maximum phonation time divided by patient's vital capacity

Answer 34

1. Vocal fry 2. Modal 3. Falsetto 4. Whistle

Answer 35

- Men ~125Hz (increases with age) - Women ~225Hz (decreases with age) - Children ~250-300Hz - Vocal range = 80-1100Hz

Answer 36

1. Glottography 2. Video stroboscopy 3. Air flow measures 4. Acoustic measures

Answer 37

Method to measure / monitor vibrations of the vocal folds Glottography types: 1. Photoglottography (PGG): Measures degree of light passage through vocal folds (change in light transillumination) 2. Electroglottography (EGG): Measures degree of electrical conduction across vocal cords during closure (change in electrical conduction) Measurements: 1. Speed Quotient = Ratio of time vocal folds are opening to time vocal folds are closing 2. Shift Quotient = Ratio of (time to peak VF opening) to (Duration of VF opening) 3. Open Quotient = Proportion of time VFs are opwn during cycle (normal is 2/3) 4. Closed Quotient = Proportion of time VFs are closed during cycle (normal is 1/3) Electroglottography (EGG) = Transcutaneous measurement of the contact time of the vocal folds. Measured using 'conductance' of the electric signal from the vocal folds to the electrodes. - Conductance INCREASES when Vocal folds contacts = positive EGG slope tracing - Conductance DECREASES when Vocal folds separate = negative EGG slope tracing Results show the opening and closing rates of the vocal folds. The results are relative (not absolute) and do not measure glottal area or closure. The waveform shape just describes the pattern of VF vibration. Purpose of the results is to allow isolated measurement of vocal fold fundamental frequency and vibration without the influence of surrounding resonant structures or shaping (ie. formants). ## Footnote Kevan page 11

Answer 38

MRS FAAC VP F-CAMPS 1. Mucosal wave (moves in a vertical and horizontal direction - cover over body - starting inferior to superior) 2. Regularity/Periodicity - Degree to which the time it takes to complete one phonatory cycle is similar to the time it takes to complete the next cycle - Best assessed in the locked phase. Regular = image appears static. Irregular = image quivers - Causes of irregularity: VF paresis, lesion, flaccidity, unsteady tonus (SD, neuromuscular disease), inconsistent force (e.g. functional pulmonary disease) - Aperiodicity also increases with age 3. Symmetry: extent to which VF mirrors each other during vibration 4. Fundamental Frequency 5. Amplitude: horizontal excursion from midline during vibration, which is a measure of pliability/stiffness - Normal = one-third to half of the width of the vocal fold - Amplitude = 1/frequency 6. Adynamic Segments 7. Glottic Closure patterns: indicates the degree and pattern of VF contact at the most closed instant of the vibratory cycle (using the most comfortable pitch and loudness) 8. Vertical Closure level - Normal = VF meet at the same vertical plane - Off-plane closure = neuromuscular differences between folds (paralysis, paresis), laryngeal trauma, or surgery 9. Phase Closure: Open phase vs. Closed phase dominant

Answer 39

Phase closure = The amount of time the true vocal folds spend open vs closed during phonation. Normal phase closure - Open = 2/3 of vibratory cycle - Closed = 1/3 of vibratory cycle More time is spent closed at higher frequencies. If more time is spent in open phase = open phase dominant If more time is spent in closed phase = closed phase dominant

Answer 40

1. Sustained "ee" at normal pitch, normal loudness 2. Quiet "ee" 3. Loud "ee" 4. Pitch glide from mid-range to high (CT muscle) 5. Sustaining the high note (CT muscle) 6. PItch glide from mid-range to low 7. Sustaining the low note 8. Phonation on inhalation 9. "Ee" at NPNL with locked phase 10. Physical manipulation of the larynx or trial therapy (unloading) also possible - Monitor the patient's voice so that all of the necessary information is recorded - Most vibratory parameters are rated from "ee" at normal pitch, normal loudness

Answer 41

1. Complete 2. Posterior gap (can be normal in some women, seen in MTD) 3. Anterior gap (can be normal in some men and older women, seen in MTD) 4. Spindle (presbylarynx) 5. Hourglass (bilateral lesions; e.g. vocal fold nodules; unilateral lesion with contralateral reactive lesion; glottic lesions) 6. Asymmetric/irregular 7. Incomplete (gap extends along entire length of VF, usually due to impairment, scar, MTD/aphonia) ## Footnote Kevan Page 20 Vancouver Pg 172

Answer 42

Uses blue light (415nm, green 540nm), which has a shorter wavelength and better absorbed by hemoglobin, to assess for mucosal and vascular irregularities (high Hgb structures become more apparent and well visualized) Clinical implications: 1. Highlights submucosal vascular patterns under leukoplakia, improving identification of suspicious areas that may need biopsy 2. Aids with RRP diagnosis

Answer 43

AKA Tensilon test AKA Acetylcholinesterase inhibitor test Assess for vocal fatigue recovery after administration of an Achase inhibitor (prevents ACh breakdown) Patients with Myasthenia Gravis and vocal manifestations will show transient vocal improvement

Answer 44

1. Thyroarytenoid/vocalis = adduction 2. Posterior cricoarytenoid = abduction 3. Cricothyroid = SLN activity

Answer 45

1. Assess RLN recovery post vocal fold paralysis - Decision for early thyroplasty in unilateral VFP - Decision for lateralizing/destructive procedures in bilateral VFP 2. Differentiate between vagal (RLN+SLN) injury vs. isolated RLN injury 3. Distinguish paralysis vs. fixation 4. Guide/landmark botox injections 5. Intraoperative monitoring 6. Distinguish synkinesis 7. Diagnose neurologic disorders (e.g. decreased laryngeal recruitment over time with myasthenia gravis)

Answer 46

Abnormal laryngeal EMG findings develop 2-3 weeks after injury, as it takes time for denervation to occur. If reinnervation occurs, polyphasic reinnervation potentials start 6-12 weeks after injury. Therefore initial EMG at 6-12 weeks after neural injury is most helpful time for prognostication (but must be at least 3 weeks)

Answer 47

Types of activity recorded: 1. On insertion 2. Spontaneous activity at rest 3. Volitional (with speaking GOOD Prognosis: - Polyphasic action potentials BAD Prognosis: - Sharp waves - Fibrillation potentials - Synkinesis (e.g. activation of TA with sniff, which would suggest adduction with nasal inhlaation) Laryngeal EMG is GOOD at predicting BAD recovery, but BAD at predicting GOOD recovery - Presence of fibrillation potentials or sharp waves at 3 weeks out makes it unlikely that there will be recovery - However, the presence of polyphasic action potentials doesn't predict good recovery - Patients may develop synkinesis (e.g. aberrange regrowth of PCA fibers to the thyroarytenoid --> causing antagonistic activity) ## Footnote Kevan Page 11/12

Answer 48

Aberrant reinnervation of the laryngeal musculature. For example, where fibers to the PCA instead innervate the TA, resulting in no movement of the vocal folds due to simultaneous antagonistic action

Answer 49

Changes in: 1. Vocal fold length 2. VF tension 3. VF mass 4. Subglottic air pressure 5. Vibratory speed

Answer 50

1. Cricothyroid muscle contraction 2. Increase in subglottic pressure (minor factor) 3. Can be increased by shortening the vibratory surface, increasing tension of decreasing the mass of the VF

Answer 51

1. Pliability of the vocal fold tissues 2. Subglottic pressure (decreased pressure = decreased amplitude) 3. Force of medial compression (has to increase along with subglottic pressure to increase amplitude) Most important physiologic mechanism affecting vocal amplitude is subglottic pressure! ## Footnote See Alex's Questions from May 12

Answer 52

See Alex's Questions from May 12

Answer 53

Anything that does the following can lower fundamental frequency: 1. Increase vocal fold mass 2. Lengths or relaxes the vocal folds Pathologies: 1. VF polyp 2. Reinke's edema 3. Tumor 4. Aging in women 5. Puberty 6. Nodules 7. Hypothyroidism NPP HART

Answer 54

Anything that shortens or tenses the vocal folds can raise fundamental frequency. Pathologies; 1. Anterior glottic web (shorter cord overall but over the same amount of tension across the vocal cord, therefore gives you a net increase in tension) 2. Muscle tension dysphonia 3. Parkinson's disease 4. Aging in men 5. Tension-producing VF masses (e.g. Sulcus) 6. Puberphonia MS PAPA

Answer 55

The production of 2 simulatneous fundamental frequencies, caused by asymmetric stiffness of the vocal folds (divergent travelling wave velocities) Plica ventricularis = False VF phonation

Answer 56

Advantages of RIGID: 1. Superior optics (higher resolution and contrast) 2. Superior light (brighter, clearer pictures) 3. Superior resolution and magnification 4. Avoids wide angle distortion compared to flexible endoscopy 5. Can perform interventions through scope 6. Simple exam, does not usually require topical anesthetic Disadvantages of RIGID: 1. Active phonation limited to sustained vowels 2. Requires extended neck, protruded tongue (non-anatomical positioning) 3. Size of glottic gap may appear exaggerated 4. Mobility of arytenoids may not be accurately assessed 5. Disorders more evident in connected speech rather than sustained vowels are not well documented (e.g. MTD, SD) *Note: 90 degree endoscope to reduce neck extension may help improve some of these factors* Advantages of FLEXIBLE: 1. Patient tolerance 2. Patient anatomy may preclude endoscopic visualization 3. Allows for superior functional examination (e.g. advanced speech sets, singing) 4. Can also assess nasopharynx and velopharynx 5. Can assess multiple angles 6. Can do esophagoscopy and tracheoscopy as well 7. Glottic gap more accurately assessed -*Preferred if there is a question of movement rather than structure - e.g. SD, VFI* Disadvantages of FLEXIBLE: 1. Can't manipulate airway/perform procedures 2. Wide angle distortion (fish-eye lens) 3. Honey comb effect of fiberoptic fibers (trade-off between adequate focus and light fiber mismatch) 4. Worse optics, light transport, and magnification 5. Feels more uncomfortable and "invasive" to patient than the rigid 6. Risk of nosebleed, adverse reactions to anesthetic, vasovagal reactions - *a lot of optics issues can be resolved with newer "chip-tip/distal chip" scopes*

Answer 57

VC SPASM: V - Vascularity (or risk of hemorrhage) C - Cords edges S - Structure (overall) P - Change in Position (height) A - Arytenoids movement and position S - Supraglottis/subglottis activity M - Mucosa/mucous color and quantity Tasks: 1. Deep breathing 2. Easy breathing (rest) 3. Sniff 4. Cough (easy cough and throat clear) 5. Long "EEE" at a comfortable pitch and volume 6. Short "EEE's" 7. Laryngeal diadochokinesis: consists of rapid repetitions of "ee" or "hee" with glottal stops between each 8. Repetitions of short "ee" followed by a quick sniff through the nose

Answer 58

An instrument for determining the speed of cyclic motion (vibration) that causes the motion to appear slowed or stopped - Assessed the status of the cover (tethering) - Determines open-closed and phase ratios

Answer 59

Strobe light can be emitted in 2 ways: synchronized or unsynchronized 1. Synchronized (locked) - Strobe light is at the same frequency as phonation (light flashes at same rate equal to frequency, giving illusion of immobility) - Ideally the vocal folds will appear to stand completely still as the light will illuminate at the same portion of the cycle - Movement of the vocal folds suggest aperiodicity 2. Desynchronized (running) - When the light flashes slightly faster or slower than the frequency of the VF vibration, creating the illusion of motion - Strobe light is offset by ±1 to 2Hz to the phonatory pitch, so each flash will illuminate a dfiferent phase - Will give the appearance of slow motion - More commonly used clinically

Answer 60

1. Cannot effectively perform stroboscopy with a markedly dysphonic voice without any periodicity - waveform must be relatively periodic to track fundamental frequency and trigger strobe 2. Shows sampling of vocal fold movements, but not every glottic cycle

Answer 61

Talbot's Law: The retina is only able to resolve around 5 images per second (0.2 seconds per exposure). Thus, sequential images produced at an interval of < 0.2seconds per exposure produce the illusion of a continuous appearance. - Theory behind why stroboscopy gives the appearance of continuous motion - Some studies disprove this theory and state this is not actually how stroboscopy works

Answer 62

The involuntary tendency of speakers to increase their vocal effort when speaking in loud noise to enhance the audibility of their own voice

Answer 63

1. Glottography - Photo or Electroglottography 2. Modified Barium Swallow/Video Fluoroscopic Swallowing study (MBS/VFSS) - assess phases of swallowing across different consistencies 3. Flexible Endoscopic Evaluation of Swallowing (FEES) 4. Laryngeal EMG 5. Flexible Nasolaryngoscopy 6. Video Stroboscopy 7. Narrow Band Imaging 8. Edrophonium (Acetylcholinesterase inhibitor test)

Answer 64

Lateral: Upper lobe of thyroid and superior thyroid artery Medial: Midline Superior: Attachment of sternothyroid to thyroid cartilage

Answer 65

1. Do not prescribe PPI/steroid/antibiotics prior to laryngoscopy 2. All patients should be offered SLP referral 3. All dysphonia > 4 weeks require laryngoscopy

Answer 66

1. Recent H/N or chest surgery 2. Increasing WOB or SOB 3. Associated neck masses 4. Recent intubation 5. Smoking/tobacco use 6. Professional voice user

Answer 67

The release of air as the upper margins of the vocal folds separate

Answer 68

1. Abnormally high fundamental frequency 2. Abnormally low fundamental frequency 3. Abnormally loud voice 4. Abnormally soft voice 5. Decreased smoothness 6. Decreased intelligibility 7. Hypernasality 8. Hyponasality 9. Hoarseness 10. Harshness 11. Diplophonia 12. Tremorous 13. Stridulous 14. Breathy 15. Arrest of phonation (vocal breaks) 16. Aphonia

Answer 69

1. Unloading supraglottis in cases of supraglottic squeeze/MTD to better visualize glottis 2. Better visualization of lesions on inferior glottis edge

Anatomy, Physiology, and Assessments Flashcards

(93 cards)