Midterm Flashcards
(353 cards)
1
Q
Larynx
A
Gateway to the respiratory tract
2
Q
Larynx length and Circumference (Male and Female)
A
Circumference = 120 mm or 5 inches
Length Males = 44 mm or 1.7 inches
Length Females = 36 mm or 1.5 inches
3
Q
Biological Functions of Larynx:
A
- Prevent liquid and foods from entering the airway (aspiration)
- Life- sustaining breathing
- Fixing the thorax in place during demanding highly elevated abdominal pressure (ex: childbirth, heavy lifting)
4
Q
Emotional Function of the Larynx:
A
- Emotionality and vocal function are intertwined and require a total person approach during therapy
- Emotions can be heard in the sound of the voice as well as prosodic rhythm patterns of vocalization
- emotions can affect respiration and the vertical positioning of the larynx
5
Q
Linguistic Function of the Larynx:
A
- How we say it
- Suprasegmental phonation – prosodic vocal patterns existing beyond individual word or segment
- Suprasegmental voicing – the jargon leading up to the word, diminishes after 18 months but we continue to use suprasegmental vocalization in all aspects of speech
6
Q
Positioning of the Larynx
A
- Sits at the front, bottom of the throat (pharynx) and the top of the trachea
- During swallowing: the larynx moves up, the tongue comes back and the epiglottis closes, covering the glottis
- Located deep within the strap muscles of the neck
- Located at the C3-C6 cervical vertebras for adults – higher in children
7
Q
Regions of the Larynx:
A
- Supra-glottic – above the level of the true vocal folds
- Glottic – at the level of the true vocal folds
- Subglottic – below the level of the true vocal folds
8
Q
Laryngeal Framework Overview:
A
- Gives the larynx form
- The extrinsic muscles and the intrinsic muscles are connected which help facilitate laryngeal movement
- Superiorly, ligaments and membranes connect larynx to the hyoid, inferiorly to the cricoid cartilage. anterior to the epiglottis, loosely positioned in the midline of the neck, can move up and down and side to side.
9
Q
Cartilages within the Larynx (3 unpaired)
A
- Cricoid Cartilage
- Thyroid Cartilage
- Epiglottis
10
Q
Cricoid Cartilage
A
- Immediately above the trachea and attaches by the means of the cricotracheal membrane
- Points of attachment for thyroid cartilage on the lateral surfaces
- Arytenoid cartilages on its posterior/superior surface
- Forms the solid base of the larynx
- Has the appearance of a signet ring
11
Q
Two Parts of the Cricoid Cartilage
A
- Anterior Arch
- Posterior Laminae
12
Q
Thyroid Cartilage
A
- Largest cartilage of the larynx
- Articulates with cricoid cartilage inferior to the thyroid cartilage
- Site of the Cricothyroid joint is important for pitch change
13
Q
Hyoid Bone
A
- A supportive structure at the root or base of the tongue
- Serves as a point of attachment for some of the extrinsic larynx muscles (inferiorly)
- Attaches to the muscles of the tongue superiorly
- NOT directly attached to any other bone in the skeleton
14
Q
Vocal Folds
A
- Serves as a valve between the speech tract and respiratory tract – valve generates voice (phonation)
Positioning: within a fixed laryngeal framework
15
Q
What moves the Vocal Folds?
A
Muscles within the larynx: intrinsic laryngeal muscles that facilitate abduction and adduction, the intrinsic muscles cause changes in elastic properties of the VFs which affects rate of vibration, as well as the outgoing airstream affects VF vibration
16
Q
The Junction of the Thyroid Cartilage is (V shaped prominence anteriorly)….
A
The Thyroid Angle (Notch)
17
Q
The Area Below the Thyroid Angle (Notch) is called…
A
The Thyroid (Laryngeal) Prominence (Adam’s apple)
18
Q
Epiglottis
A
- Unpaired cartilage
- Leaf like structure
- Posterior to the hyoid Bone and root/base of the tongue
19
Q
Shape of the Upper and Lower Aspect of the Epiglottis
A
- Upper aspect of the epiglottis is broad and round
- Lower aspect is narrow and stalk-like
20
Q
What ligament connects the epiglottis to the internal surface of the thyroid?
A
inferiorly by the thyroepiglottic ligament (almost at the level of the TVF)
21
Q
What ligament connects the epiglottis in the superior fastening the epiglottis to the hyoid bone?
A
hyoepiglottic ligament
22
Q
What is the Epiglottis’s primary function?
A
Airway protector during swallowing (folds down and covers the laryngeal vestibule)
23
Q
How does the epiglottis invert to cover the airway?
A
Through muscular contraction of muscle fibers within the aryepiglottic folds
24
Q
During Swallowing as the Larynx Elevates the Hyoid Bone moves…..
A
Anteriorly and the epiglottis folds down
25
Paired Cartilages of the Larynx: Arytenoid Cartilages
- Hyaline Cartilage
- Sits on the superior/lateral surface of the posterior aspect of the cricoid cartilage
- Resembles a 3 sided pyramid
26
What is included in the "3 sided pyramid" of the Arytenoid Cartilages?
Base, apex, and 3 surfaces
27
Paired Cartilages of the Larynx: Arytenoid Cartilages have two Important Processes... What are they?
- Muscular process
- Vocal process
28
Muscular Process of the Arytenoid Cartilages
- Projects laterally and serves as attachment of the muscles which abduct and adduct the VF's
29
Vocal Process of the Arytenoid Cartilages
- Directed anteriorly and serves as the attachment for the vocal ligament (gives the vocal folds the flat/smooth margin) which is the medial most aspect of the VF's
- Forms the posterior attachments of the VF
30
How do the Arytenoid Cartilages Move?
- Towards and away from midline
- Slide medially and laterally
- Rock anteriorly
31
Paired Cartilages of the Larynx: Corniculate Cartilages
- Support mechanism for keeping homeostasis
- Sit on the apex/tip of each of the arytenoid cartilages
- Elastic cartilage
- Function may be supportive in nature (not known)
32
Paired Cartilages of the Larynx: Cuneiform Cartilages
- Housed within the aryepiglottic folds
- Elastic cartilage
- Function is unknown but may provide support
- Lies superior and lateral to the corniculate cartilage
- Vestigule structures
33
Extrinsic Laryngeal Muscles
Move the larynx as a whole
34
Extrinsic Laryngeal Muscles (8 total)
- Divided into 2 groups
- Suprahyoid (Elevators of the larynx)
- Infrahyoid (Depressors of the larynx)
- Raising and lowering of the larynx
- Most predominant during the pharyngeal stage of swallowing
- Protects airway from aspiration of food and liquids
- Have a slight role in the production of higher and lower pitch
35
Suprahyoid Muscles
- Elevate the larynx
- Digastric
- Stylohyoid
- Hyoglossus
- Mylohyoid
- Geniohyoid
36
Infrahyoid Muscles
- Omohyoid
- Sternohyoid
- Sternothyroid
37
Intrinsic Laryngeal Musculature
- Muscle group which have both their origin and insertion within the laryngeal vestibule
- 6 intrinsic muscles of the larynx
- All but one is paired
38
Intrinsic Laryngeal Musculature: Posterior Cricoarytenoid Muscle (PCA)
- Only abductor muscle of the larynx
- Opens airway by moving the VF's laterally and away from midline
- Innervated by the recurrent laryngeal nerve (RLN)
- Largest of the intrinsic muscle of the larynx
39
Intrinsic Laryngeal Musculature: Lateral Cricoarytenoid Muscle (LCA)
- Adductor muscle of the larynx
- Closes the airway by moving the VF's medially, toward the midline
- Attaches to upper border of cricoid cartilage
- Inserts on the muscular process of the arytenoids
- Antagonist to the PCA
- Innervated by the recurrent laryngeal nerve (RLN
40
Intrinsic Laryngeal Musculature: Interarytenoid Muscles (2) - Transverse Arytenoid (TA)
- Only unpaired muscle of the larynx
- Origin in one arytenoid cartilage and lateral margin of the opposite arytenoid
- Approximates the bodies of the arytenoids cartilages
- Adducts the VF's
- Compresses the VF's
- Innervated by the RLN
41
Intrinsic Laryngeal Musculature: Interarytenoid Muscles (2) - Oblique Arytenoid Muscles
- originated in the muscular process of one of the arytenoids and inserts into the apex or tip of the opposite muscular process
- the fibers continue superiorly to the lateral border of the epiglottis, they leave the apex of the epiglottis and become known ad the Aryepiglottic folds
- Abduct the tip of the arytenoid cartilages
- Innervated by the RLN
42
Intrinsic Laryngeal Musculature: Thyroarytenoid Muscle
- Makes up the bulk of the VF's
- responsible for shortening VF's during pitch lowering and assisting with adduction
- divided into 2 sections
- Vocalis muscle - the most medial and approximates the vocal ligament along the medial margin of the glottis
- Thyromuscularis - external thyroartenoid muscle - forms more lateral aspect of the VF's
43
Intrinsic Laryngeal Musculature: Cricothyroid Muscles
- originates in the lateral cricoid arch and inserts into the lower horn of the thyroid cartilage
- increases the distance between the cricoid cartilage and the thyroid cartilage
- elongate (stretches) the VF's
- Contributes to pitch elevation
- Only laryngeal intrinsic muscle of the larynx to be innervated by the superior laryngeal nerve (SLN)
44
How does the Thyroid Rock Anteriorly and Posteriorly?
- Thyroid rocks based on tension from cricothyroid muscles
- Rocking anteriorly elongates the VF's which raises pitch
- Rocking posteriorly shortens the VF's and lowers pitch
45
Larynx is more complex and more _______ than the way the larynx functions as a airway protector in other ________.
Suble, Mammals
46
__% to __% of normal population may have a voice disorder.
3% to 9%
47
NIDCD indicated in 2007 reported _____ million children had "trouble using their voice"
7.5
48
Organic Disorders
Combination of structural changes of the VF cartilages with interruption of neurological innervations of the laryngeal mechanism Ex: After stroke, cerebral palsy
49
Organic Voice Disorders include structural devotions of the VF's and .....
- Lungs
- Muscles of repiration
- Larynx
- Pharynx
- Oral Cavity
50
Once a structural problem is stabilized, what is the goal of therapy for the SLP?
Develop best voice possible using therapeutic methods
51
Functional Disorders
- Psychogenic Voice Disorders
- Muscle Tension Dysphonia
52
Muscle Tension Dysphonia
- Most prevalent voice disorder in children and adults
- Vocal hypertension = too much effort in phonation
- Overuse of respiratory, phonation, pharyngeal, tongue functions
- Begins gradually, after a while they may experience pain
- Discomfort in the throat area
- Fatigue
- Effort increase with voice use
53
Organic Voice Disorder - Neurogenic Voice Disorders
- Muscle control and innervation of the muscles of respiration, phonation, resonance, articulation
- Impaired at birth or acquired
- Disease of the peripheral or CNS occurs at any age
- Motor speech disorder after stroke
54
Functional Voice Disorders - Psychogenic Voice Disorders
- Severe emotional trauma
- Conflict in some kind of physical alteration
- The reaction may manifest as complete loss of voice
- Voice therapy usually doesn't work without counseling to address problem
55
Voice Disorders - 7 causal classficiations
- Laryngeal problems- structural
- Inflammatory conditions
- Trauma or injury
- Systemic Conditions
- Non-laryngeal aerodigestive disorders
- Psychiatric / psychological disorders
- Neurological Disorders
56
Vagus Nerve
- The longest CN
- Innervates soft palate to transverse colon
- Nuclei lies within the medulla
- CNS injury will likely impact larynx
- Unilateral VF paralysis likely a LMN deficit
57
Vagus Nerve
Innervates most striated muscle of the pharynx (except Stylopharyngeus)
58
Vagus Nerve (motor - efferent)
Innervates all striated muscles of the larynx
59
Components of the Vagus Nerve (sensory - afferent)
- Sensation of the larynx
- Sensation of the trachea (some of it)
- Sensation of the skin behind the ear
- Sensation in the external auditory meatus
- Sensation in a portion of the Tympanic Membrane
- Special sensory... taste at root of tongue.. (epiglottic region)
60
Course of the Vagus (neck)
- Exits the skull through the jugular foramen (bilaterally)
- Housed within a carotid sheath
- Travels through the neck along with the carotid artery and internal jugular vein
- Once exited from skull... there are 2 sensory ganglion (superior and inferior) that are present
61
Vagus: Sensory Ganglion
Allows communication from the vagus to other cranial nerves (IX, VII, XI, XII)
62
Vagus: From the Ganglion breaks into 2 branches arise and pass into the neck
- Pharyngeal branch
- Superor Laryngeal nerve
63
Vagus: Pharyngeal Branches
- Motor innervation
- Serve the pharyngeal plexus
- Supplies motor innervation to all of the muscles of the pharynx
- all pharyngeal constrictors
- some longitudinal pharyngeal muscles (shortening the pharynx mostly during swallowing but sometimes during voice)
- Most of the soft palate except tensor deli palatine (V)
64
Vagus: Superior Laryngeal Nerve (motor and sensory)
- Branch is considered mixed
- Inferior sensory ganglion
- Internal and external superior laryngeal nerve
- Bifurcation occurs at the level of the thyroid cartilage
65
Vagus: Superior Laryngeal Nerve - Internal Branch
- Pierces the Thyrohyoid membrane
- Provides sensory innervation to
- the mucus membranes of the base of tongue
- Epiglottis
- Pharynx
- Larynx (entire thing)
- True VF's
66
Vagus: Superior Laryngeal Nerve - External Branch
- Vital to tensing and relaxing the VF's
- Continues inferiorly to pierce the inferior pharyngeal constrictor muscle and the cricothyroid muscle
- Provides motor innervation to the cricothyroid
67
Left Side of the Body - Course of the Vagus Nerve (RLN)
- Emerges from Vagus nerve at the arch of the aorta and loops around the aortic arch and ascends back up into the neck within the traceoesiohageal groove
- Contact the thyroid gland before entering larynx
68
Right Side of the Body - Course of the Vagus Nerve (RLN)
- Emerges from the vagus at the level of the subclavian artery
- Passes around this artery before it courses upward and ascends within the traceoscophageal groove
- Coming into contact with the thyroid gland
69
Vagus Nerve: Course of Both Right and Left RLN
- Nerves enter the larynx
- Provide motor innervation to all intrinsic muscles of the larynx except the cricothyroid (innervated by the external branch of the SLN)
- Provides sensory innervation to the TVF's, subglottic region and trachea
- RLN is activated when we cough
70
The Pitch Mechanism: Cricothyroid Muscle
- Most important role in pitch change ability
71
The Thyroarytenoid plays a role in which aspect of voice?
Loudness
72
You need a lot of subglottic ______ to increase loudness?
Tension
73
Which layer of the VF's does cancer usually develop?
Squamous epithelium
74
What are the 3 pillars of voice?
- Vocal hygiene
- Respiration
- Quality
75
What are the 5 layers of the VF's? (SBSIDV)
- Squamous epithelium (skin) or cover
- Basement membrane
- Superficial layer of the lamina propria (reinke's space)
- Intermediate layer of the lamina propria (vocal ligament)
- Deep layer of the lamina propria (vocal ligament)
- Vocalis muscle (Muscle layer)
76
Epithelium is the ____ ____ layer of the VF
- Outer most
- Encapsulates the other layers
- .05 - .10 mm think
- Composed of squamous cells (flat cells)
77
Epithelial Cells
- Secures the epithelium to the lamina propria
- Quality issues if the fibers pull away from the lamina propria
78
What happens to the basement membrane zone when there is phono trauma (nodules)?
- The basement membrane zone gets disrupted and the anchoring fibers are pulled away from the lamina propria
79
3 Layers of the Lamina Propria
Superficial Lamina Propria
Intermediate Lamina Propria
Deep Lamina Propria
80
Securing a cell to a non cellular protein strand is achieved by _______ ________.
Anchoring fibers
81
What are the 3 layers of the Lamina Propria mostly made of?
- Mostly of non-cellular matrix (ECM)
- Made up of few cells (fibroblasts)
82
Characteristics of the Superficial layer of the Lamina Propria
- 0.5 - 1.0 mm thickness in the middle of the fold... thinner at the ends
- Soft and pliable
- loosely organized protein stands surrounded by interstitial fluids that lubricate and absorb mechanical stress
- Fibers are short which gives it the ability to move
- Not aligned in a specific direction
83
Smoking can cause _____ of the Lamina Propria?
Thickening
84
Characteristics of the Intermediate and Deep Layers of the Lamina Propria
- 1-2 mm thick
- AKA the vocal ligament
- Fibers are highly aligned in the Anterior-Posterior direction
85
Characteristics of the Intermediate Layer of the Lamina Propria
- Intermediate layer has a high concentration of protein fibers called elastin.. which stretches linearly
- Distinctly different from superficial layer because of the linearity of the fibers
86
Characteristics of the Deep Layer of the Lamina Propria
- More collagen fibers
- Has different type of protein
- Collagen fibers are not linearly elastic
- Runs parallel to the free margin of the VF's
- Serve to withstand high tensile stress during phonation
- with age the density of the elastic fibers tends to decrease causing thinning and degeneration of its contour (bowing can cause breathiness and hoarseness)
87
The Epithelium is also called...
Mucosa
88
What is the muscle layer of the VF's made up of?
- the Thyroarytenoid muscle
89
Thyroarytenoid Muscle
- attaches to the thyroid cartilage ventrally (toward the front)
- attaches to the arytenoids dorsally (toward the back)
- striated
- stranded with fibers
- constitutes 2/3 of the volume of the VF's
- Subdivided
- vocal portion (medial portion)
- musculraris (lateral portion)
90
Thyroarytenoid Muscle: Vocalis Portion
- Relatively high proportion of slow switch, fatigue resistant fibers which allows us to continue to talk
- Uses oxygen metabolism (aerobic)
91
Thyroarytenoid Muscle: Muscularis Portion
- Higher proportion of fast twitch fibers, not fatigue resistant
- Uses anaerobic, uses glycolyic metabolism
92
The CNS and PNS coordinate all ______ operations?
Laryngeal Operations
93
A cut RLN causes unilateral VF ______ ?
Paralysis
94
Unilateral UMN lesions produce ________ ?
Hypertonity
95
LMN lesions result in _____ and ______
Flaccidity and muscle atrophy
96
Nerves with Direct Impact on Speech
CN V, VII and VIII
97
Nerves with Some Role in Phonation and Voice Resonance
CN IX, X, XI, XII
98
Surgeries low in the neck are prone to damage of what nerve?
- Left Recurrent Laryngeal Nerve
99
The RLN is vital to _____________ functions of the true VF's?
Abduction and Adduction
100
The RLN innervates 4 of the 5 ________ muscles of the larynx?
Intrinsic
101
Paralysis of the Thyroarytenoid due to cutting of the RLN will lead to?
- VF atrophy
- Weakness in VF approximation
- VF bowing (mild)
- Dysphonia
- Pitch variation and compromised
102
What is the primary symptom of posterior Cricoarytenoid paralysis?
- Inability to open the glottis on the involved side
- Unilateral abductor paralysis
103
Cranial Nerve XI - Accessory Nerve
- Innervates strap muscles of the neck
- Lesions of the XI can cause resonance issues and respiratory issues
104
Cranial Nerve XII - Hypoglossal Nerve
- Motor nerve innervation of the extrinsic and intrinsic muscles of the tongue
- some strap muscles
- Innervates the omohyoid, sternothyroid, styloglossus, hypoglossus, genioglossus, geniohyoid, sternohyoidf and all instrinsic muscles of the tongue
- Helps position the larynx (depression and elevation of laryngeal body)
- Essential for all intrinsic muscles of tongue
- Voice problems = resonance and quality
105
CN IX - Glossopharyngeal Nerve
- Taste on posterior 1/3 of tongue
- Sensation to fauces
- Sensation to tonsils
- Sensations to pharynx
- Sensation to soft palate
- Motor innervation to the superior pharyngeal constrictor in the pharynx and stylopharyngeas muscle
106
CN X - Vagus Nerve
- Two branches innervates the larynx
- Superior Laryngeal Nerve
- Recurrent Laryngeal Nerve
- Sensory innervation of the pharynx and larynx
- Motor innervation of velum, base of tongue, superior, middle and inferior pharyngeal constrictors, larynx (all intrinsic muscles except cricothyroid), and autonomic ganglia of the thorax
107
Clinical Instrumentation Cannot Replace the ____, ____, _____ of a well trained clinician.
replace the mind, eyes, ears
108
Instrumental give us more quanititve data rather than ______ ?
Subjective data
109
How to get a good voice recording?
- Keep sound isolation and consider ambient room noise
- choose a good microphone
- Use a good sound decibel meter
- use a computer that can run the voice software
- use reliable software
- Choose a good video recorder and playback on good monitor
110
What is important in an acoustic analysis?
- Discriminate the normal from the dysphonic voice
- correlate positively with the clinicians auditory perceptual judgments of the voice
- sufficiently stable to assess change across time
111
An acoustic analysis should include the analysis of?
- Frequency
- Intensity
- Quality of voice
112
Perceptual aspect of Frequency?
Pitch
113
Perceptual aspect of Intensity?
Loudness
114
Perceptual aspect of Time Variation and Spectral Content
Timbre
115
Types of Acoustic Analysis
- Sound spectrography
- Frequency-related paramters
- Intesity-related parameters
- Vocal perturbation-related parameters
- Vocal noise-related parameters
116
Sound Spectrograph
- A visual representation of the frequency and intensity of the sound wave as a function of time
- Broken into Formant
117
Spectrogram
- reflects harmonic structure of the glottal sound source and resonant characteristics of the vocal tract
- frequency is represented on the vertical axis
- time is represented on the horizontal axis
- intensity is represented by the darkness of the trace on the screen
- usually measures up to 8 harmonics
118
The ___ of the larynx gives us each our own voice.
Size
119
Bands on the Spectrogram
- Lowest energy band represents the fundamental frequency
- Energy in the higher frequencies in the bands above
- Darker gray bands represent greater energy
120
Spectrogram: Two types of filtering
- Narrow band filtering (good frequency resolution not poor time resolution)
- Wide band filtering (good time resolution but poor frequency resolution)
121
Spectrogram: Narrow band
- displays individual harmonics
- well suited to inspecting the vocal acoustic signal in persons with dysphonia
- inspecting changes in the harmonic structure of the voice - clinican can observe stability of the patient's vocal fold vibration
122
Spectrogram: Wide band
Displays a number of harmonics at once
123
Fundamental Frequency (FO)
- The rate of the vibration of the VF's
- Expressed in Hz (# of cycles of vocal fold vibrations per second)
124
Habitual Pitch
- Depends on age, gender and race
- What we use everyday
- norms vary
125
Average FO (hz) for Woman
225 Hz
126
Average FO (hz) for Men
135 Hz
127
Frequency (pitch) Measurements
- Fundamental Frequency (of habitual pitch during reading, counting 1-15 and spontaneous conversation)
- Optimal pitch
- Pitch variability
- Pitch range
128
Speaking Tasks Used to Elicit SFF
- Automatic speech
- Elicited speech
- Spontaneous speech
- Reading aloud
129
Pitch Matching - Typical Adult Male and Female and Children
Male - C3 (131 Hz)
Female - A3 (220 Hz)
Child's Voice - C4 and D4 (262 to 294 Hz)
130
An octave is made up of __ whole notes.
8
131
__ semitones in an octave.
12
132
Each octave represents a doubling of frequency of __ _______.
VF Vibration
133
Voice: Decreased fundamental frequency may present as.....
Monotone
134
Increased frequency variability is perceived as...
Child-like (sing song)
135
Frequency variability is perceived as acceptable changes in _____.
Prosody
136
Pitch can go up with...
- Pain
- Fear
- Aggression
- Woman tend to increase pitch in these situations more than men
137
Average Fundamental Frequency is....
The Speaking Fundamental Frequency (SFF)
138
Maximum Phonation Frequency Range (MPFR)
- From the lowest tone sustainable in the modal register to the highest in the falsetto register
- Reported in semitones
- MPFR of 2 1/2 to 3 octaves is expected
139
Habitual Intensity
- Vocal Intensity corresponds with acoustic power of the speaker
- Coorelates with auditory perception of loudness
140
What is the average loudness used by speaker for their vocalizations?
Normal is 65-80 dB SPL
Average is 70 dB SPL
141
How can you measure Habitual Intensity?
dB meter
142
How do we perceive connected speech?
In chunks
143
Prosody helps make important chunks of speech more prominent than others.. what are the 3 components of prosody?
intonation, during and intensity
144
When working with dysarthria patients on prosody, what should you work on them to extend to improve intelligibly?
Vowels
145
Dynamic Range
- Physiologic range of intensities
- Softest non whisper to loudest shout
- Speakers rarely speak at the end of their dynamic range
- In therapy, focus patient around their habitual loudness
146
Vocal Perturbation Measures
- Indirect measure of vocal fold behavior
- Cycle to cycle variability in the vocal signal results from aperiodic vibration of the VF's
- Aimed at identifying the short- term, cycle to cycle non volitional variability
- Sustained vowels or steady state portions of vowels extracted from connected speech are used to determine vocal perturbation
147
Perturbation: Jitter
Roughness
148
Perturbation: Shimmer
Breathiness
149
Causes of Shimmer and Jitter
- Small structural asymmetries of the VF's
- "material" on the VF's (mucus)
- Biochemical events such as raising/lowering of larynx in the neck
- Small variations in tracheal pressures
- "bodily" events - system noise
150
Measuring Shimmer and Jitter
Shimmer is typically reported as % or dB, norms are not well established.
Jitter is typically reported as % or msec, normal being 0.2-1%
151
Jitter = Short-term variability in....
Fundamental Frequency (F0), less than 1% is normal
152
Shimmer = Short-term variability in.....
Amplitude, less than o.5 dB is normal
153
Children have higher or lower jitter and shimmer than adults?
Higher
154
Jitter and Shimmer should be interpreted using both ______ and _____?
Auditory-Perceptual Data and Clinical Impressions
155
The human voice is not a pure tone; true or false?
True
156
The human voice is made up of harmonics, what are the 2 components?
Periodic and Aperiodic
157
Vocal Vibration is Naturally Aperiodic; true or false?
True
158
In a Dysphonic Voice, the harmonic component is less...?
Dominant
159
Electroglottographic Analysis (EGG) is a....
Noninvasive technique for obtaining an estimate of vocal fold contact patterns during phonation
160
Where are the electrodes for EGG placed? and what does it do?
- Placed on either side of the thyroid cartilage
- A weak high frequency electrical current is passed between the electrodes
- results in an LX waveform
161
During EGG, when the glottis is open resistance ______?
Increases
162
During EGG, when the glottis is closed resistance ______?
Decreases
163
Aerodynamic Measures: Reflect patients ability to ______?
Use the larynx to regular the flow of air for phonation
164
What are the 3 patterns of breathing?
- Clavicular
- Thoracic
- Diaphragmatic-abdominal breathing
165
Aerodynamic Measures: Laryngeal resistance is _____?
- Peak intraorall pressure divided by peak flow rate
- Reflects the overall resistance of the glottis
166
Aerodynamic Measures: Phonation Threshold Pressure is ______?
- The minimal pressure to set VF's into oscillation
167
Describe characteristics of Clavicular Breathing (often used by COPD patients)
- inefficient
- unsat for voice production: weak and shallow breathing does not provide adequate respiratory support for speech and voice
- easy to ID
- patients elevate shoulders on inspiration
- uses the neck accessory muscles as primary muscles of inspiration
- overuse of these muscles may cause larynx tension
- upper chest breathing
- elevation of clavicles
168
Describe characteristics of Thoracic Breathing (normal breathing for most people)
- expansion of the thorax and contraction of the abdomen during inspiration
- reserves during expiration
- sometimes this habit needs to be changed to get more sub-glottic breathing for voice control
169
Describe characteristics of Diaphragmatic-Abdominal Breathing (must use for singing and body often switches to this at night)
- Preferred method of respiration
- patients with heavy vocal demands
- abdominal and lower thoracic expansion on inspiration
- gradual decrease in abdominal and lower thoracic prominence on expiration
170
Respiratory Volumes
- Tidal Volume
- Inspiratory reserve
- Expiratory reserve volume
- Residual volume
171
Tidal Volume average in ml
500 ml
172
Inspiratory Reserve Volume
The maximum volume of air that can be inspired beyond the end of a tidal inspiration
173
Expiratory reserve volume
The maximum volume of air that can be expired beyond the end of a tidal expiration
174
Residual volume
The volume of air that remains in the lungs after a maximum expiration
- not where people speak
175
Tidal Volume
The amount of air inspired and expired during a single respiratory cycle
176
Label the Respiratory Volumes
177
Is air pressure necessary for speech?
Yes
178
Where is it important to have pressure?
- inside the lungs
- below the VF's
- inside the oral cavity
179
The entire vocal tract is what kind of system?
Pressurized
180
Subglottic pressure is important because it does what?
Enables the VF's to be set in motion
181
Pressure is measured in what units?
cm in water
182
How many cm of water pressure do you need for conversation speech?
5 to 10 cm
183
What is needed to support the production of speech at a constant vocal intensity?
- Steady lung pressure
- Steady flow through trachea (prior) to voicing
- Gradual drop in lung volume over time
184
What is laryngeal airflow?
- The volume of air passing through the glottis in a fixed period, measured in cubic centimeters (cc) per second
- Normal "ahh" is at 100 cc per second
- breathy is higher than 100 cc per second
- strained or strangled voice quality is less than 100 cc per second
185
How is laryngeal resistance measured?
- Measure derived from peak intraoral pressure and peak airflow during production of the "pi" syllable repeated at a rate of approx. 1.5 syllables per second. Ex: "pi pi pi?
186
What are the mechanics of voiceless sounds?
- Voiceless consonants the laryngeal valve is open, can be resisted by tongue, lips, etc
- Whispering, no voice, but VF's provide resistance, the arytenoid cartilage forms a "glottal chink" (whispering triangle) to permit air to flow through glottis without the VF vibration
187
What should you look for during stroboscopic laryngeal evaluation?
- glottic closure
- supra-glottic activity
- extend of opening
- vertical level approximation
- vocal fold edge
- vocal fold mobility
188
Strobe parameters to measure?
- amplitude of vibration
- mucosal wave
- non-vibrating portions
- phase closure
- phase symmetry
- periodicity/regularity
- overall laryngeal function
(100 point scale can be used)
189
Management of Neurogenic Voice Problems
- SLP may be the first health care professional to see the patient
- May be progressive..
- SLP can establish a baseline, if more difficulties are found, refer to neurologist (like a progressive disease)
- May work on resonance and articulation (at beginning of disease)
190
Management of Psychogenic Voice Problems
- SLP works closely with counselor, psychologist or psychiatrist
- Voice therapy supplemented by psychological therapy
- Therapy may be successful, however needs to be concurrent with psychological improvement
-
191
Puberphonia
- inappropriate use of high-pitched voice beyond pubertal age in males
- It is usually seen in the immediate postpubescent period when the male laryngeal mechanism has undergone significant changes in size and function caused by hormonal changes
- usually only take a couple treatment visits
- usually habit
192
Voice can affect quality of life; true or false?
True
193
The natural voice requires a balance between what?
Breathing, phonation and resonance
194
Speech is produced on what type of breathing?
expiratory air
195
For natural voice we take quick momentary breaths and than we let our voicing/phonation out slow; true or false?
True
196
Speech breathing is different than Tidal (restful) Breathing; true or false?
True
197
Pauses during breaths are natural and not distracting unless ________?
Disordered
198
What is the key to producing a natural voice?
Effort - The natural voice needs to be effortless
199
Natural voice is only produced when the vocal folds are ______ together?
Gently
- too far apart = breathy
- too tight = harsh voice
200
Pitch depends on what characteristics of the VF's?
Thickness
Size
Tension
201
When the VF's are large and relaxed, is pitch high or low?
low
202
When the VF's are thin and tense, is pitch high or low?
high
203
Resonance is produced in our vocal tract above the level of the vocal folds... mainly where?
mainly throat (pharynx), mouth and nose
204
The posterior pharyngeal wall and the lateral pharyngeal wall muscles together allow the contraction of the ______?
Pharynx
205
When contracted the pharynx becomes smaller which helps with ____ pitch?
High
206
When the pharynx relaxes it enlarges and it helps with ____ pitches.
low
207
A lot of resonance occurs in the _____ ______?
Oral cavity
208
The positioning of the tongue is very important; true or false?
True
- the tongue tethered too far back gives a cul-de-sac type resonance
- tongue too far forward = sounds like a baby
209
Good resonance sounds as if it's coming right off the surface of the tongue in the middle of the ______?
Mouth
- forward focus, allowing voice to come forward and resonate as if you were using a megaphone
210
If the velum never opens during ______ than you would have hypo nasality.
phonation
211
What is it called when you have too much nasality?
hyper nasality
212
What is it called when you have too little nasality?
hypo nasality
213
A voice disorder is defined as abnormal changes in _____, ______, and/or vocal ______?
pitch, loudness and vocal quality
214
General symptoms of voice disorders include chronic or intermittent ________, vocal fatigue, laryngeal tightness, loss of loudness or loss of vocal range.
hoarseness
215
There are a variety of causes for voice disorder, among them ______ _____, _______ and trauma.
Vocal abuse, misuse
216
What is vocal abuse/misuse?
- includes potentially damaging behaviors such as smoking, shouting, throat clearing and coughing that is habitual, shouting, screaming and vocal noises.
217
What are some vocal warning signs?
- Change in vocal quality
- A period of voice loss
- Reduced ability to control pitch of your voice
- A loss of voice range, quality, clearness, or resonance
- Soreness or tenderness in the head and neck or neck and throat region
- The need to frequently clear your throat, a dry feeling, a tickle or periodic burning in the throat
- Increased breathiness
- Increased effort needed to produce voice
218
What is phono trauma? (more specific than misuse and abuse)
defined as the behaviors that contribute to laryngeal/vocal fold tissue injury, inflammation, or other forms of damage
219
Phonotrauma can be caused by damage to the VF's and laryngeal cartilage which can include?
- Penetrating neck injuries related to gun shot wound or stabbings
- Larynx fractures caused by car accidents and/or instances of strangulation
- Inhalation and or swallowing of caustic substances
- Sports related neck injuries
- Traumatic insertion of breathing tubes during a medical emergency or surgery (COVID)
- Failed suicide attempts
- Car accidents
220
The core issues surrounding basic vocal health are....
- Adequate hydration/nutrition
- No smoking
- Alcohol intake
- Stress
- Allergies
221
What are 3 basic principles in Voice Care?
- Learning how to keep the vocal tissue moist
- Learning how to keep the vocal fold tissue free from irritants
- Learning how to avoid phono trauma, abuse/misuse
222
What are the 3 pillars of Voice?
- Vocal hygiene
- Breath Support
- Vocal quality
223
What are some contributions to poor vocal health?
- non prescriptive drug use
- coughing and throat clearing
- Cigarette smoking
- second hand smoke
- E-cigs
- Chewing tobacco
- alcohol intake
- dehydration
- allergies
- acute sinusitis
- caffeine intake
- sleep deprivation
- vocal load
- loudness of voice
- poor nutrition
224
Cigarette Smoking does what?
- Directly harmful to the vocal upper and lower airway
- Largest effect is on the lungs, creating URI, acute bronchitis, pneumonia, and chronic lung diseases such as COPD, emphysema
225
The damage from secondary smoke carries about __% of the effect of primary smoking.
40%
Inhaled smoke is unfiltered
226
Consumption of alcohol can negatively affect adequate ______ levels and ______ behaviors.
hydration, vocal
227
More common negative effects of alcohol intake are....
- increased vocal loudness
- excessive pitch inflection
- poor breath support
228
Voice therapy should...
- center around chief complaint
- be individualized
- focus on making voice functional
- restore the best voice possible
229
Most common voice issue?
Vocal hyperfunction
230
When working on loudness improving posture and mouth opening is important; true or false?
True
231
Louder Voice = ?
Clearer Voice
232
VFA's: Once normal or near normal phonation occurs, patient should leave therapy with?
Homework
233
Recording therapy =
increased patient compliance
234
Voice fascinating techniques can be used with?
Organic, functional, neurogenic and special populations
235
Voice issues are a combination of....
Behavioral, emotional, physical, structural issues
236
Voice facilitating techniques can be used to facilitate....?
Pitch
Better Loudness
Better Quality
Better Breath Support
Improve Vocal Health
237
Most hyper functional voice clients take about _____ weeks of sessions once a week with home practice.
4-6 weeks
238
When choosing a procedure...
- You hypothesis that it will yield a change in the patient's vocal behavior
- You observe the patient's response to the procedure (data collection)
- Based on the response, you accept or reject your hypothesis
- Use behavioral observations to discover the outcome, do you need to tweak?
239
Structural pathologies = ?
Voice rest (phono-surgical procedures)
240
Complete voice rest does not aid in the process to reprogram the patient to healthier voice use patterns; true or false?
True
241
Evidence suggests that more than __ days of vocal rest can be harmful.
5
242
Vocal hygiene is the first step in?
Voice management and voice prevention programs
243
Physiologic Therapy Approaches include....?
Semi-occluded vocal tract
lip trills
tongue trills
bilabial fricatives
humming
phonation into tubes/straws
244
Some characteristics of Functional Voice Disorders
- No organic or neurological cause
- Mechanism of respiration, phonation and resonance appear capable of normal voicing
- Lack of proper balance for vocal hygiene
245
Two Causes of Functional Voice Disorders
Excessive muscle tension
Psychogenic origin
246
The superficial layer of the lamina propria can be impacted by functional voice disorder; true or false?
True
247
What layer of the lamina propria does Reinke's edema form?
Superficial layer
248
Excessive muscle tension can cause what types of benign VF masses?
Nodules
Polyps
Reinke's edema
249
Functional Voice Disorders: Muscle Tension Dystonia (MTD)
- Categorized as primary or secondary
- Primary MTD occurs in the absence of current organic pathology
- without obvious psychogenic or neurological etiology
- primary MTD represents 40% of dysphonia seen in voice clinics
250
Functional Voice Disorders: Secondary Muscle Tension Dystonia (MTD)
- Seondary MTD
- Occurs in the presence of current or recent organic pathology
- Psychogenic or neurological etiology
- believe to orginate as a compensatory response to the primary etiology
- can be seen in adults or children
251
MTD: Auditory Perceptual Features
- strained or effortful voice quality
- breathiness
- aberrant pitch
- vocal fatigue
252
MTD: Physiology
- Decreased space between the hyoid bone and larynx
- increased extrinsic laryngeal muscle tone
- Presence of one or more patterns of excessive laryngeal or supra laryngeal constriction
253
Supralaryngeal contraction would be seen in endoscopy: What are the 3 types of patterns of constriction?
- AP compression (can't see the VF's, VF movement is limited)
- Medial compression (you can see the length of the VF's sometimes but not always because of the hypertrophic ventricular folds)
- Sphincter-link (combo of both, almost hidden and person almost has no phonation at all
254
Primary MTD usually starts with.....?
- An illness (cold/flu)
- only takes 7 days to learn a bad habit (deviant ways to work through hoarseness)
255
Excessive VF tension results in under approximation of the _____
VF's
256
MTD vs. Adductor Spasmodic Dysphonia
- Depends on the consistency of laryngeal postures
- Patients with MTD maintain hyperadduction during all activities
- MTD symptoms are consistent and always strained
- Spasmodic dysphonia is intermittent
257
MTD vs. Spasmodic Dysphonia
- Adductor spasmodic dyspohnia is relatively rare
- Adductor spasmodic dysphonia is caused by dystonia
- Adductor Spasmodic dysphonia is a hyperkinetic movement disorder
- For adductor spasmodic dysphonia, voice severity is perceived to be worse for connected speech than sustained vowels
258
MTD treatment can include..?
- Relaxation
- Chant talk
- Chewing
- Digital manipulation
- Focus
- Laryngeal massage
- Yawn-sigh
259
MTD responds well to behavioral therapy, Spasmodic Dysphonia does not; True or False?
True
260
Spasmodic Dysphonia Treatment
- poor prognosis
- easier voice with less effort
- easy breath cycle
- yawn-sign
- relaxation techniques
- Auditory feedback
- Masking
261
What is ventricular dysphonia?
- Also known as dysphonia place ventricular or ventricular phonation, false VF phonation
- Phonation using false VF vibration rather than true VF vibration
- Commonly associated with severe MTD
- Occasionally appropriate compensation for profound true VF dysfunction
- 4 types: two headings; compensatory and non compensatory
262
Ventricular Dysphonia: Compensatory = reaction to true VF disease
Paralysis
True VF surgery
263
Ventricular Dysphonia: 3 Non Compensatory types
- VF are capable of normal vibration
- Habitual: caused by excessive vocal use
- Psycho-emotional: physical and psychogenic tension and distress
- Idiopathic: no know origin
264
False folds move physiologically with the arytenoids to assist in glottic airway ______.
Closure
265
False folds (ventricular folds) do not approximate the median line but do not cover the true VF's during normal ________.
Phonation
266
When ventricular folds become a substitute due to severe disease, what are the characteristics of voice?
usually low pitched
little pitch variability
monotonous
difficulty approximating the entire length of the false folds
vocal quality is hoarse
breathy
267
Ventricular Dysphonia: Special form of diplophonia (double voice)
- True and false folds vibrate
- False VF's are sitting atop the true folds
- ventricular fols uaully not the "sole" source of sound
- alter the true VF sound
- true VF are slightly abducted, false folds relative approximation resting of VF's
268
During normal phonation the ventricular folds will abduct and the VF's will _____?
Adduct
269
Vocal fold nodules: over time nodules become ____?
Fibrotic - smaller and harder
270
Vocal Fold Nodules characteristics
- Most common benign lesions of the VF's in children and adults
- Caused by continuous abuse of the larynx
- misuse of the voice
- bilateral
- white protuberances on the glottal margin of the VF
- Located anterior-middle
- Can be different sizes, numbers and location
- More common in boys early on
- More common in females later
271
VF nodules will appear as...
- Glottal hour glass figure
- lack of complete VF adduction
272
Patients with VF nodules....
- feel the need to clear their throat
- perceive excess mucus
- perceive something on VF's
- voice deteriorates throughout the day
273
VF Nodules are more common in boys ____ puberty and more females _____ puberty.
before, after
274
VF Nodules Treatment
- Small and recent nodules are responsible to treatment
- Identify abuse-misuse
- reduce occurrence of abuse and misuse
- focus on easy optimal vocal production
- may have to be treated with surgery if longstanding
- will return if hyper-function is not resolved
275
Nodules result from _____ (continuous and prolonged) and is observed with hyper functional voices.
MTD
276
Polyps are deeper in the ________ lamina propria than nodules.
superficial
277
Polyps are unilateral but a reactive lesion on ________ might form
other side
278
VF polyps are a focal abnormality of the superficial lamina propria and are near same site as VF nodules; true or false?
True
279
Polyps are usually caused by one ____ vocal event for example _____?
Single, screaming (causes hemorrhagic irritation)
280
Pedunculated polys look like a ________?
Mushroom
281
Polys are usually translucent, _______, hyaline, hemorrhage, ______ polyp that adds to VF.
hyaline, mixed
282
VF polyps look like....
- reddish or white
- large or small
- soft and fluid filled
- hemorrhagic poly is blood filled and forms secondary to bleeding
- lies on glottal margin
- Interferes with VF approximation
283
Pedunculated polys must be surgery removed; true or false?
True
284
What type of polyps respond to therapy? and which ones are more resistant to therapy?
- Translucent sessile polys respond to therapy
- Fibrotic, hyaline or hemorrhagic polys are more resistant
285
The voice is ______ with VF polyps
Dysphonic
286
What does VF polyps therapy address?
Strict vocal hygiene, produce a "good voice: with facilitating techniques
287
What is Reinke's Edema?
Chronic diffuse swelling of the superficial lamina propria
- referred to as polypous degeneration of the VF
- a thick gelatinous, fluid-like material develops in the "reinke's space"
- Usually bilateral
- associated with smoking
- chronic hyperfunction
- laryngopharyngeal reflux
- prolonged exposure to inflammatory stimuli, accompanied by abnormal healing
- surgery not a great option because habits that caused it are probably still there
288
Reinke's Edema is responsive to therapy; true or false?
True
- therapy is highly dependent on eliminating the cause of the problem (smoking)
- Surgery is NOT a permanent soliton
- Voice therapy first
289
What is traumatic laryngitis?
- Functional laryngitis
- swelling (edema) of the VF's
- secondary to the result of excessive and strained vocalization
- voice sounds hoarse, breathy, reduced in volume
- VF increase ins size and mass
- accompanying irritation and increased blood accumulation
- follows a traumatic voice event
- vocal rest is best
290
MTD: What is diplophonia?
- Double voice or double pitch
- produced with two distinct voice sources
- each voice produced simultaneously
- VF vibrating at different rate secondary to differences in mss/tension
- secondary to a space occupying lesion on one VF
291
MTD: Phonation Breaks
- Temporary loss of voice
- occurs over a syllable, word, phrase or sentence
- Complete cessation of voice occurs suddenly
- etiology = hyperfunction
- Presence of a lesion that hampers VF vibration
- Mucus on the VF's
- Reduced subglottic air
292
MTD: Pitch break
- Developmental = occurs during puberty
- When the larynx enlarges typically boys experience a 1 octave change in pitch over several years
- pitch breaks warn of over-use or overworked larynx
293
What is an organic voice disorder?
- Related to structural deviations of the vocal tract (lungs, muscles of respiration, larynx, pharynx and oral cavity)
- Diseases of specific structures of the vocal tract
- primary treatment of organic voice disorder is usually surgery, however treatment by the SLp may have several goals; improving the physiologic function of the damaged larynx and SLP will work with the patient to develop the best voice possible
294
The role of the SLP in organic voice disorders?
- Understand which vocal fold pathologies are classified as structural (organic) voice disorders
- understand contributing causes associated with organic vocal fold pathologies
- understand how to describe the visual, stroboscopic and perceptual features associated with organic vocal fold pathologies
- understand how to describe the visual, stroboscopic and perceptual features associated with organic vocal fold pathologies
295
8 Major Groups for classifying pathologies and conditions that affect voice
1. Structural pathologies
2. Inflammatory conditions
3. Trauma or injury
4. Systemic (organic) conditions
5. Aerodigestive conditions affecting voice
6. Psychiatric or psychological disorders affecting voice
7. Neurologic voice disorders
8. Other voice disorders
296
What is laryngeal trauma?
- penetrating or blunt
- GSW, knife wound, fist fights, weight lifting, sports
- hyoid bone or cartilages being crushed or fractured
297
Laryngeal Trauma Perceptual Signs?
- Hoarseness, inspiratory and expiratory stridor
- pain during rest and voicing (odynophagia)
- possible dysphagia
- dyspnea
298
Laryngeal Trauma Visual assessment
- CT scan usually indicated
- Ranges from hematomas to lacerations to laryngotracheal separation
299
Congenital Abnormalities: Laryngomalacia
Inward collapse of the supraglottic structure of the larynx during inspiration
- 75% of congenital anomalies of the larynx
- Most prevalent cause of stridor in the neonate
- Evident at birth or within a few hours or days of life
- confirmed via direct laryngoscopy under general anesthesia
- usually out grown by 18-24 months
5% need surgery
300
Laryngomalacia Primary Symptoms
- Inspiratory stridor
- Suprasternal retraction
- Substernal retraction
- Feeding difficulty
- Choking
- Post feeding vomit
- Cyanosis
- GERD
301
Laryngomalacia: Visual Assessment
- Collapse of laryngeal cartilages may be seen on inspiration, deep inspiration. Structures blow out again during expiration.
- Evidence of enlarged or floppy arytenoid cartilages, short aryepiglottic folds and omega shaped or elongated epiglottis.
302
Subglottic Stenosis
- Narrowing of the space below the glottis and above the first tracheal ring
- Rare
- Most common causes of chronic upper airway obstruction in infants and children
- Congenital or acquired
- Congenital is second most common cause of stridor in babies
- Most common abnormality necessitating tracheotomy in children
- Acquired subglottic stenosis has poor prognosis compared to congenital
303
Subglottic Stenosis: Acquired
- Mechanical trauma from previous intubation or tracheotomy (#1 cause in children and adults)
- Laryngopharyngeal reflux
- Rheumatologic disease
- External trauma
- Respiratory infections
- "Idiopathic”
- Chondroradionecrosis after radiation therapy (may occur up to 20 years later)
- Inhalation injury
- Neoplasm
304
Organic Disorder: Tracheoesophageal Fistrula
- TEF is a hole in the lower esophagus and allows stomach acid to flow into the lungs and cause damage
- Identified early while nursing, coughing and vomiting during feeding
- Always surgery – treated immediately because of aspiration
- treated immediately at birth
305
Organic Disorder: Esophageal Atresia
- Represents a failure of the esophagus to develop as a continuous passage
- EA and TEF can occur separately or together
- Diagnosed in ICU at birth
306
Organic Disorder: Laryngeal Cleft
- Condition of cricoid cartilage, posteriorly resulting in a mucosal fold forming with narrows the airway.
- rare - 1 in 20,000 births
- More common in boys than girls
- may be related to autosomal dominant pattern
307
Organic Disorder: Laryngeal Cleft Perceptual Signs
- Inspiratory and expiratory stridor
- Dyspnea
- Severe aspiration
- Major respiratory distress and feeding difficulties
308
Organic Disorder: Laryngeal Cleft Management
Surgical, dysphagia treatment post surgery and use of medications to reduce GERD/LPR
309
Organic Disorders: Vocal Fold Pathologies
Structural- cause any alteration in the organization of the vocal fold
Laryngitis acute/chronic
Contact Ulcers/Granuloma
Cysts
310
Organic Disorder: Laryngitis
General term uses to describe voice changes due to inflammatory conditions
Viral
Bacterial (HPV)
Traumatic conditions
Autoimmune diseases
reflux laryngitis
Allergic Rhinitis
- needs medication before seeing SLP
311
Organic Disorder: Infectious Laryngitis
- Abuse
- URT infection
- Loss of voice
- Dysphonia
- Laryngitis
312
Organic Disorder: Infectious Laryngitis Treatment
- Usually viral bacterial treated with anti-biotic
- Vocal rest, humidification, hydration, reduced physical activity, and analgesics
313
Organic Disorder: Infectious Laryngitis Visual assessment
Bilateral edema, reduced or absent mucosal wave, slight reduction in vibratory amplitude of the vocal folds
314
Organic Disorder: Hemangioma
- Similar to contact ulcers and granulomas
- Whereas a granuloma is usually a firm granulated sac, a hemangioma is a soft, pliable, blood-filled sac
- rare
- found posterior
315
Organic Disorder: Hemangioma causes
They are frequently associated with vocal hyperfunction, LPRD, or intubation trauma.
316
Acid Reflux
- GERD is the passage of gastric juices from the - stomach into the esophagus
- Can lead to esophagitis
-Ulceration of the esophagus
- Dysphagia
- Barrett’s esophagus
317
LPRD
When acid fluids spill into the pharynx
318
Organic Disorder: Contact Ulcers
- Contact ulcers are small ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation
319
Organic Disorder: Ulcer granuloma
- Granulated tissue forms over the ulcers…they are called contact ulcer granulomas
320
Organic Disorder: Ulcer granuloma visual assessment
- Commonly reveals granuloma to be located on the arytenoid complex or on the lateral wall of the posterior glottis.
- Larger granulomas can interfere with posterior glottic closure and sometimes cause phase asymmetry when unilateral.
- Smaller lesions often result in normal vibratory symmetry and no glottic incompetence.
321
Organic Disorder: Contact Ulcer Causes
- Hard glottal attack
- Increased loudness with frequent throat clearing and coughing
- May result from slamming arytenoids together GERD/LPR and intubation
322
Organic Disorder: Contact Ulcer Symptoms and Treatment
- Symptoms are vocal fatigue after prolonged use, pain in the larynx, throat clearing, hoarse voice
- Voice therapy is usually recommended, surgery usually ineffective except in the case of large granulomas.
323
Organic Disorder: Cysts
Benign mucous/fluid filled lesion surrounded by an epithelial membrane and is located near the vocal fold surface.
324
Organic Disorder: Cysts Cause and Symptoms
Blockage of the ductal system of laryngeal mucous glands
Congenital or acquired
- Generally results in mild to severe hoarseness as a consequence of vocal fold asymmtery and irregular vocal fold closure.
- Variation in voice quality in a function of the size and shape of the cyst.
325
Organic Disorder: Cysts Visual Assessment
Typically appear intracordal, occurring underneath the mucosa of the vocal fold located in the superficial layer of the lamina propria.
- Unilateral, appears soft and pliable
326
Organic Disorder: Cysts Management/Treatment
- Vocal hygiene is often the first line of treatment
- Voice therapy but not likely for full resolution
- Phonosurgical removal- cysts are often close to vocal ligament and the risk of creating scar is high
327
Structural/Organic
- Candida
- Papilloma
- Sulcus Vocalis
- Granular Cell Tumor
- Webs
- Presbylaryngis
- Leukoplakia/Hyperkeratosis
- Cancer
328
Organic Disorder: Candida and Candida Symptoms
- Candidiasis is a fungal yeast infection that occurs
- cigarette smoke can contribute
- Vocal quality moderately hoarse, pressed voice breathy
329
Organic Disorder: Candida Visual Assessment
- Often resembles leukoplakia
- Edema and erythema
- Vocal fold edges appear irregular and glottic closure is often incomplete, stiffness, decreased mucosal wave, asymmetric weakness of vocal folds
330
Organic Disorder: Papilloma
- Wart like growths
- Agressive in children and adults
- Common in kids under 6 years
- May obstruct airway
- Stop recurring by puberty (usually)
331
Organic Disorder: Papilloma Treatment
- Surgery
- Interferon therapy
- HPV genome in the tissue makes the surgery palliative rather than curative
332
Organic Disorder: Papilloma Symptoms
Breathiness
Inspiratory stridor
Chronic cough
Aphonia
333
Organic Disorder: Papilloma Visual Assessment and Treatment
Papilloma tends to interfere with vocal fold closure-incomplete glottic closure
Stiffness
Decreased amplitude
Absent mucousal wave
Ventriuclar compression
- Voice therapy should focus on minimizing compensatory strategies that may have developed
334
Organic Disorder: Granular Cell Tumor
- More common in women
- Benign tumors arising from muscle
- Voice quality is rough/hoarse and dysphagia may be present
335
Organic Disorder: Granular Cell Tumor Visual Assessment and Treatment
Located on posterior aspect of larynx, most often confused with laryngeal granuloma
Biopsy confirms
Posterior laryngeal lesion vibration of vocal folds may not be affected
Surgical removal
336
Organic Disorder: Web (congenital)
Lesion forms across the glottis
Between the two VF
Inhibits vibration
May occur anterior or posterior
Stridor maybe heard during inspiration
Respiratory difficulty
Detected at time of birth
Glottal membrane fails to separate at time of embryotic development
Abnormal high pitch cry
337
Organic Disorder: Web (congenita) Treatment
Surgery only treatment
338
Organic Disorder: Web (acquired)
Result from bilateral trauma to the medial edges of VF
Irritation to the mucosal surface
Causes the disturbed tissue to grow together
Forms a bridge between the VFs in the form of a thin membrane
Typically common anteriorly
Due to close approximation to the VF
Cause severe dysphonia
High pitched voice
Respiratory difficulties depending on size of lesion
339
Organic Disorder: Web (acquired) Treatment
- Stent or keel maybe used to separate the VF
- Vocal rest important after the placement of stent/keel to reduce dislodge
- Removed after 6-8 weeks
340
Organic Disorder: Sulcus Vocalis
Congenital or acquired
Unknown etiology
Unilateral or bilateral
Presents as long oval glottal opening during adduction
Line or furrow running the length of the VF in abducted position
341
Organic Disorder: Sulcus Vocalis Symptoms and Treatment
Reduced loudness
Breathy and hoarse vocal quality
Excessive air wastage due to glottal gap (incomplete glottal closure)
Voice therapy or surgery or combination
342
Organic Disorder: Sulcus Vocalis Visual Assesment
Groove or furrow medical surface
Reduction of mucosal wave
Tissue loss spindle shaped glottic gap
343
Organic Disorder: Presbylaryngis
- Superficial connective tissue in the vocal fold begins to deteriorate with age, becoming thinner and less pliable
- Collagen in deeper portions of the vocal folds become dense
344
Organic Disorder: Presbylaryngis Symptoms and Treatment
- Softer, altered pitch with some roughness may be present
- Older men tend to have higher pitch voice
- Older women's voices tend to lower
- Improving glottal closure, voice therapy, medialization procedures, injectables into vocal folds.
345
Organic Disorder: Presbylaryngis Visual assessment
- Reduction in vibratory, amplitude, reduced speed of glottal closure and increased glottal gap.
- Vocal folds appear thin due to muscle atrophy and thinning of superficial tissues
- Bowing of the TVC
346
What is phonation?
The production of vocie
347
What is aphonia?
The absence of a definable laryngeal tone
Lack of voice
348
What is dysphonia?
Abnormal voice as judged by the listener
349
What is voice?
The audible sound produced by phonation
350
Formula for finding Inspiratory Capacity (IC)?
Tidal Volume + Inspiratory Reserve Volume = Inspiratory Capacity
351
Vital Capacity (VC)
- Total amount of air that can be expired from the lungs and air
passages following maximum inspiration
* Includes all lung volumes EXCEPT residual volume (RV)
352
Total Lung Capacity (TLC)
- Total volume of air contained in the lungs and airways after a
maximum inspiration
* Sum of all 4 lung volumes
353
Relative timing of inspiration-expiration is slightly ______ for exhalation
longer
