Lecture 13 Child and Adult Voice

Question 1

What makes an infant vocal tract different from an adult?

Answer 1

shorter VT

Velum & epiglottis are in closer proximity

VFs (one big body, no ligament nor distinguishing layers)

Arytenoids are large

Laryngeal position is high (C2-C4)

Hyoid and Thyroid Cartilage are contiguous

Question 2

When does the VT lengthen?

Answer 2

4-6 months

Question 3

Velum and epiglottis reach their adult distance by?

Answer 3

4-6 months

Question 4

When do the arytenoids reach their adult size?

Answer 4

4-6 months

Question 5

By what age does the larynx descend to C6-C7?

Answer 5

15 years

Question 6

When does the lamina propria develps into three distinguished layers ?

Answer 6

puberty - complete by 16-17

Question 7

When does the vocal ligament first appear?

Answer 7

appears at age 4, but continues to develop

Question 8

What is the main disadvantage of having a thick VF cover and increased vascularity for a child?

Answer 8

Makes the VF cover more susceptible to inflammatory and post-traumatic edema

Question 9

By not having a differentiated layer (LP), what does this do to a child’s voice?

Answer 9

affects child’s ability to make fine adjustments for register control and create mucosal wave

Question 10

Young children have more of this type of muscle fibers

Answer 10

type II (more fast acting, but fast fatiguing)

Question 11

Adolescents or around the age of puberty, Laryngeal muscles are made up of this type of muscle fiber

Answer 11

type I : slow contracting, fatigue resistant

Question 12

The thyroarytenoid muscle continues to develop until around:

Answer 12

age 3

Question 13

The Superior Laryngeal and Recurrent Laryngeal Nerve fibers increase in number, myelination and axonal & dendritic endings until

Answer 13

age 3

Question 14

True or False:

Children have a high fundamental frequency at infancy, but slowly lowers as child gets older

Answer 14

True

Question 15

True or False:

Subglottic pressure (Ps) is is lower for children than for adults

Answer 15

False

*higher

Question 16

True or False:

Children have lower mean airflow rates

Answer 16

True

Question 17

True or False:

Max phonation times are lower until puberty

Answer 17

True

Question 18

How would you describe a child’s lung volume and use of breathing?

Answer 18

A child has less lung volume, rib use is greater than abdominal when compared to adults

Question 19

Fill in the Acoustic Norms for children:

Jitter - norm=_____ s.d=______

RAP - norm=_____ s.d.=______

Shimmer - norm=_____ s.d.=______

NHR - norm=_____ s.d.=______

Answer 19

Jitter : n - 1.4 /s.d. - 0.07

RAP : n - 0.75 / s.d. - 0.04

Shimmer : n - 3.35 / s.d. - 0.12

NHR : n - 0.11 / s.d. - 0.002

Question 20

Match the max phonation time to their appropriate age groups:

1. ) 6-10 seconds A.) 10-12 yrs
2. ) 14-17 seconds B.) 6-10 yrs
3. ) 15-22 seconds C.) 3-5 yrs

Answer 20

6-10 seconds : 3-5 yrs

14-17 seconds: 6-10yrs

15-22 seconds: 10-12 yrs

Question 21

What is laryngomalacia?

Answer 21

laryngeal cartilages are soft / may collapse into airway upon inhalation / usually resolves with maturation

*common cause of infant stridor

*Signs: collapse of laryngeal cartilages / enlarged or floppy AC / excessive AC mucosa

Question 22

Congenital Disorder that may be related to autosomal dominant pattern of inheritance

Answer 22

Laryngeal Cleft

Question 23

Having a laryngeal cleft on this portion of the cricoid cartilage will cause the airway to narrow

Answer 23

posterior

Question 24

What are the symptoms and problems associated with laryngeal cleft?

Answer 24

Inspiratory and expiratory stridor

Dyspnea

Aspiration

Feeding difficulties

Question 25

Congenital Disorder which narrows the tissue *below* the level of the glottis

Answer 25

Subglottic Stenosis

Question 26

What are the symptoms of subglottic stenosis?

Answer 26

Inspiratory and expiratory stridor Dyspnea Low pitch cough Nostril flaring excessive chest wall movement

Question 27

What are some congenital anomalies that are seen amongst children?

Answer 27

Laryngeal Paralysis - birth trauma or CNS damage (Arnold Chiari Malformation) Laryngeal Web - chormosomal abnormality Congenital Cyst - rare VF Papilloma

Question 28

This is the most common **acquired** voice disorder in children

Answer 28

Nodules \*accounts for 50% of pediatric voice disorders

Question 29

What are some examples of an acquired disorder that you can see with children?

Answer 29

VF nodules VF paralysis Laryngopharyngeal reflux

Question 30

What is the method of treatment for children who have nodules?

Answer 30

\*conservative approach is always best (no surgery) \*have the family and teacher involved \*identify and modify casual behaviors \*Resonant Voice Therapy and Flow Phonations \*Breathing & Muscle Relaxation Exercises

Question 31

True or False: Adults who have nodules as children seem to have a higher incidence of voice problems

Answer 31

True

Question 32

What are some of the VF characteristics of an adult over 65 years old?

Answer 32

\*laryngeal cartilages calcify \*lamin propria thickens \*less elastin and collagen, more fibrotic tissue \*atrophy of sub mucous gland \*atrophy muscles \*decreased neural firing rates for TA and CT

Question 33

What are some perceptual changes for the geriatric voice?

Answer 33

\*habitual pitch higher in males / lower in females \*hoarseness \*breathiness \*decreased frequency & intensity ranges

Question 34

What are the acoustical characteristics of a geriatric voice?

Answer 34

Greater F₀ variability increased jitter decreased intensity variability slower speaking rate

Question 35

What are the aerodynamic qualities of a geriatric voice?

Answer 35

smaller lung capacity decreased lung pressure greater peak airflow and greater air leakage greater open quotient decreased MFDR (maximum declination rate)

Question 36

What are the laryngoscopic findings of a geriatric voice?

Answer 36

bowing, incomplete closure, posterior gap vocal process prominence atrophy & thinning of VFs edema decr. mucosal wave & amplitude of vibration incr. VF stiffness increased aperiodicity

Question 37

What are the most disorders for the geriatric population?

Answer 37

Laryngeal Cancer (men) VF paralysis Edema Nodules/Polyps (women)