VOICE Flashcards
(199 cards)
1
Q
voice
A
sound produced by the larynx & modified by the vocal tract
2
Q
phonation
A
expiration of air through vibrating vocal folds
3
Q
what is a voice disorder
A
abnormal voice quality resulting from anatomic, physiologic, or psychogenic causes
voice that draws attention to itself/doesn’t align w/ one’s gender identity/age
4
Q
dysphonia
A
abnormal voice or voice problem
sometimes colloquially described as hoarseness
5
Q
aphonia
A
no voice
6
Q
voice disorders incidence
A
~30% of people will experience at some point in their lives
7
Q
voice disorders prevalence
A
8% of adults currently report voice difficulties
only about 10% of them will seek treatment
8
Q
voice disorders prevalence in children
A
1.4-6%
9
Q
risk factors for voice disorders
A
longer NICU stays
females (adults)
males (kids)
aging
alc & smoking
reflux
dehydration
phonotrauma
prolonged intubation
high vocal demands
illness (upper respiratory infection)
surgery (to head or neck)
trauma to head or neck
neurological conditions
10
Q
populations at risk
A
teachers
singers
atorneys
telemarketers
service & industry workers
manufacturing workers
11
Q
voice disorders consequences
A
missed days at work / school
lower productivity at work / participation in school
anxiety & depression
12
Q
functions of the larynx
A
airway protection
allows us to breathe
swallowing assistance
phonation
thoracic function
13
Q
swallowing assistance
A
laryngeal movement upward & forward propels food back into esophagus
pulls upper esophagus open
14
Q
respiratory valve
A
oxygen in, carbon dioxide out
15
Q
airway protection
A
adduction of vocal folds & ventricular folds
& closure of epiglottis against arytenoids & aryepiglottic folds
during swallong
coughing, throat clearing
16
Q
abdominal (thoracic) fixation
A
adduction of vocal folds effectively fixes air in abdomen
gives firm foundation to push/pull
17
Q
communicative functions of the larynx
A
carry linguistic info & affective info about the speaker
18
Q
suprasegmental phonation
A
prosody:
stress, intonation, rhythm
19
Q
Is the hyoid bone part of the larynx
A
considered part of laryngeal framework but not technically part of larynx
20
Q
what is the hyoid bone important for
A
suspension point for larynx
important site for the muscular attachments of the larynx via the suprahyoid & infrahyoid muscles
21
Q
cricothyroid joints
A
will stretch or relax the vocal folds when acted upon by intrinsic laryngeal muscles
22
Q
cricoarytenoid joints
A
rock of arytenoids (vocal processes move down & inward or up & outward)
sliding of arytenoids (anterio-posterior movement)
23
Q
thyroid connection points
A
cricoid
vocal folds
24
Q
thyroid relationship to vocal folds
A
attaches to front of vocal folds
25
thyroid landmarks
laryngeal prominence
superior & inferior cornu
lamina
angle
26
cricoid connection points
thyroid
1st tracheal ring
arytenoids
27
cricoid relationship to vocal folds
below
28
cricoid landmarks
facets
arch
lamina
29
epiglottis connection points
thyroid
base of tongue
30
epiglottis relationship to vocal folds
above
31
epiglottis landmarks
body
lingual surface
petiolus
32
arytenoids connections points
cricoid
33
arytenoids relationship to vocal folds
vocal process attaches to vocal folds & opens/closes them
34
arytenoids lanmarks
vocal process
muscular process
apex
35
corniculate / cuneiform connection points
arytenoid
36
corniculate / cuneiform relationship to vocal folds
above
37
corniculate / cuneiform landmarks
on top of arytenoids
38
laryngomalacia
cartilages too soft
flapping into airway
39
glottis
space between vocal folds
40
cricothyroid joints
stretch & relax vocal folds
41
cricoarytenoid joints
rocking & sliding of arytenoids
42
rocking of arytenoids
vocal processes rotate medially & laterally
43
sliding of arytenoids
anterior-posterior movement of carilage
44
ventricular folds
false vocal folds
extend from laryngeal cavity's side walls into airway
45
ventricular folds attachments
thyroid anteriorly
arytenoids posteriorly
46
ventricular folds in relation to vocal folds
superior (?)
47
thyroarytenoid function
shortens, thickens, adducts (CLOSES), & tenses vocal fold body
relaxes vocal fold cover
48
thyroarytenoid location
inside vocal fold
main mass of vocal folds
aka vocal fold body
49
posterior cricoarytenoid location
back of cricoid to muscular process of arytenoid
50
PCA function
abducts (OPENS) vocal folds
51
lateral cricocarytenoid location
cricoid upper rim to muscular process of arytenoid
52
LCA function
rocks arytenoids forward & medially to adduct (CLOSE) membranous vocal folds
53
cricothyroid function
tenses, thins, & lengthens vocal folds by rotation or sliding
54
transverse interarytnoids location
back surface of 1 arytenoid to back of another
55
transverse interarytenoids function
pulls arytenoids towards one another
adducts cartilaginous vocal folds (back portion)
56
oblique interarytenoids location
above transverse interaytenoid
arytenoids muscular process --> apex of another
some muscle fibers extend around side of epiglottis to form aryepiglottic muscle
57
oblique IA function
tips arytenoids toward each other to adduct (CLOSE) cartilaginous vocal folds
58
oblique IA / aryepiglottic muscle function
pulls epiglottis back & down to cover laryngeal opening
59
recurrent laryngeal nerve
motor to all intrinsic muscles except to CT
sensory to subglottic region
60
superior laryngeal nerve external branch
motor to CT
61
superior laryngeal nerve internal branch
sensory to supraglottic region
62
upward movement of larynx
epiglottic inversion & propels food to esophagus vs trachea
higher vocal pitch (tense vf & make them thinner)
63
downward movement of larynx
lower vocal pitch (relax vf & make them thicker)
64
forward movement of larynx
opens esophagus for food to enter
65
supra hyoid muscles function
elevate larynx
66
infrahyoid muscles function
depress larynx
67
phonation
vocal fold vibration
68
what muscles are NOT involved in phonation
aBductory (OPEN) muscles
69
myoelastic aerodynamic theory - myo
muscles adduct vfs
establish levels of tension & elasticity
70
myoelastic aerodynamic theory - elasticity
allows vfs to come apart & return in each cycle
71
myoelastic aerodynamic theory - aeirdynamic
subglottic pressure form the lungs drives vibration
72
myoelastic aerodynamic theory - physical
forces set the vocal folds into motion in each cycle
73
vibratory cycle
vfs adduct via adductory muscles
subglottic pressure builds & pushes vfs apart, bottom up
elasticity of vfs & Bernoulli effect brings vfs back together
74
Bernoulli effect
air flow through small passage, increases velocity
increased velocity = decreased pressure
pressure drop sucks vfs back together
75
vf layers
epithelium
lamina propria - superficial, intermediate, deep
muscle - thyroarytenoid
76
what happens as you move deeper through the tissues
they become stiffer / less elastic
77
which layers are most important for vf vibration
top 2
epithelium & superficial lamina propria
aka cover
78
do the body & cover of the vf vibrate the same
no
79
vocal ligament
intermediate & deep lamina propria
needs to be able to stretch w/out breaking
restricts separation of arytenoids & thyroid
80
fundamental frequency
rate at which vfs vibrate
measured in cycles / second
Hz
81
male vf
125 Hz fund freq
longer & thicker
more mass --> less vf vibration / sec
82
female vf
250 Hz fund freq
shorter & thinner
less mass --> more vf vibration / sec
83
how do we change fund freq (pitch)
the greater the stiffness of vfs --> the faster they vibrate --> the higher the fund freq of the voice
84
what muscle facilitates higher pitch
cricothyroid
increases vf length & stiffness of body & cover
decreases thickness
85
what muscle facilitates lower pitch
thyroarytenoid
increases stiffness of muscular portion of vf
while slackening non-muscular vf cover
increases thickness
86
secondary way to increase fund freq
elevation of larynx
using suprahyoid muscles
increases vf stiffness by pulling downward on vfs
or:
increase subglottic pressure
87
how to decrease fund freq
decrease vf stiffness
- contract TA
- relax CT
- lower larynx (infrahyoid muscles)
decrease subglottic pressure
88
intensity
measure of sound's physical magnitude
dB
loudness
89
how do we increase intensity
tight vf closure --> builds subglottic pressure
big breath
create space in mouth --> allow sound to travel into space
90
amplitude
distance vfs separate during phonation
91
what does it mean when vfs separate very far
more abrupt vf movement to midline
faster airflow decline`
92
what does higher intensity look like on a glottogram
higher peak = vfs came apart further --> come back together harder
longer closed phase --> to build subglottic pressure
93
monoloudness
lack of normal variation in intensity
94
loudness variations
extreme variations in intensity
95
vocal quality
sound of the voice beyond pitch & loudness
influenced by source & filter
vocal folds
breathy, strain, rougness
96
resonance
happens above the vocal folds
pharynx, oral, & nasal cavity
huge aspect of quality
97
voice registers
similar voice quality produced across range of pitches via specific pattern of vf vibration
pulse = low pitch
modal = medium, conversational register
loft/falsetto = high pitch
98
T/F - the larynx sits lower in the neck in adults than children
true
99
T/F - the layer structure of the vfs is fully formed at birth
false
100
where is the cricoid in infant larynx
C3-C4
101
where are adults cricoid
C7
102
thyroid & hyoid placement at birth
on top of each other w/ little space between them
gradual separation
103
implications of softer laryngeal cartilage in infants
less susceptible to blunt force trauma
more susceptible to airway invasion
harden w/ age
104
when do babies develop layered structure of vfs
4 years
affects what they can do w/ their voices --> ex: tone stability
105
how do the laryngeal cartilages age
cartilages become stiff & turn to bone
epiglottis & arytenoids become hard
joints become eroded & sometimes deformed -- can affect movement
106
how do vfs age
changes in layer structure
muscle atrophy
decreased elasticity
107
does laryngeal aging happen earlier in males or females
males by about a decade
108
older men have higher or lower fund freq than younger men
higher
muscle atrophy, LP thinning, loss of mass ==> faster vf vibration
109
older women have higher or lower fund freq than younger women
lower
edema ==> slower vf vibration
110
signs
observable &/or measurable features of voice problem
111
symptoms
patient experience of voice problem
112
types of voice disorders
(organic)
structural
neuro-motor / neurological
functional
113
types of treatment for voice disorders
indirect voice therapy / vocal hygiene (habit / lifestyle changes)
direct voice therapy
phonosurgery
hearing testing / intervention
medications
counseling
114
etiological factors
phonotrauma
poor vocal hygiene
nerve famage
age related
neurological disease
muscular imbalances
115
hypofunction
too loose
vocal fold muscles don't close vfs enough during voicing
breathiness, hoarseness, aphonia
116
hyperfunction
too tight
vfs &/or ventricular fold muscles are overly tense
compress or stretch vfs too tightly during voicing
too loud, too high, too strained
117
presbyphonia
normal voice changes related to aging (65+)
reduced respiratory efficiency
loss of elasticity in cover
less muscle in TA
ossification of cartilage
118
presbyphonia auditory perception
thin & muffled
decreased loudness
breathy
instable pitch
lack of vocal endurance
119
presbyphonia treatment
voice therapy
phonosurgery
120
what is the most at risk pop for nodes
pre pubescent children & adult women
higher voice = higher fund freq = vfs hitting each other more often
121
can nodes be unilateral
no
always bilateral
122
nodes signs / symptoms
frequent voice loss
vocal fatigue
voice changes w/ use
vocal effort
rough, hoarse
breathy
strain
123
nodes managment / treatment
behavioral voice therapy + vocal hygiene
phonosurgery not necessary & has risks
124
vf scar
permanent tissue changes in cellular structure of the lamina propria
prevents regular wave like motion of cover
125
vf scar cause
intubation
surgery
trauma
voice use
radiation therapy
126
vf scar signs / symptoms
mild to severe reductions in vocal quality
increased vocal fatigue & effort
voice breaks
127
vf scar management / treatment
phonosurgery & voice therapy can help but won't fix
128
reinke's edema / polypoid degeneration
buildup of fluid in the superficial layer
129
reinke's edema cause
cig smoke
sometimes hormonal --> post menopausal
130
reinke's edema signs / symptoms
low pitch & roughness
misgendered on phone
vocal fatigue w/ use
swelling
131
reinke's edema treatment
quit smoking
vocal hygiene
phonosurgery / voice therapy
132
laryngitis
inflammatory condition of vf cover
133
laryngitis cause
reaction to a viral &/or bacterial infection
voice overuse
134
laryngitis signs / symptoms
aphonia
rough, breathy
135
laryngitis treatment
rest
hydration
antibiotics
136
laryngeal papillomatosis
caused by exposure to HPV
wart growths on vfs
137
laryngeal papillomatosis signs / symptoms
reduced vocal quality
vocal effort
vocal fatigue
breathing difficulties
138
laryngeal papillomatosis managment
requires multiple, frequent surgeries --> can lead to vf scar
voice therapy
139
laryngeal cancer
normal tissues divides & grows uncontrollably
may spread to adjacent structures
140
laryngeal cancer cause
smoking & heavy drinking
HPV
141
laryngeal cancer signs / symptoms
hoarseness
change in pitch --> typically lower
vocal strain
sore throat
persistent cough
noisy breathing
swallowing problems
142
laryngeal cancer management
combined modality (surgery, radiation, chemo)
continued surveillance
SLP
143
muscle tension dysphonia
increased muscle activity in head & neck
can be secondary to other voice disorders or neck/shoulder pain
common in adult women
144
MTD symptoms
high vocal demand
increased vocal effort / strain
voice quality changes
stress
throat pain
145
MTD causes
compensation for pathology
stress
146
visual features of MTD
hyper or hypofunction --> prevents normal vibration or any vibration
ventricular compression or phonation
147
MTD management
voice therapy
counseling / psychotherapy
148
puberphonia / mutational falsetto
when male voice does not lower at puberty despite otherwise normal maturation
149
puberphonia signs & symptoms
high pitch
weak
breathy
vfs remain stretched
150
puberphonia managment
voice therapy
151
unilateral true vf paralysis
complete immobility of 1 vf due to nerve damage or joint fixation
contralateral (opposite) damage
152
vf paralysis cause
surgical trauma
idiopathic --> viral infection
neurologic disease
cancer
accidental trauma
153
vf paralysis signs / symptoms
diplophonia --> 2 pitches at one time
highly adducted position --> normal voice or dysapnea
highly abducted --> breathy, weak, dysphagia (swallowing issues)
154
vf paralysis management
sometimes "wait & see"
voice therapy
surgery
155
what do gender affirming communication services address
resonance
intonation
rate
nonverbals
vocal intensity
156
pediatric voice disorders
nodes very common
157
inducible laryngeal obstruction
vf adduction occurs on inspiration
158
ILO signs & symptoms
noisy inhalation
feel obstruction in throat during inhalation
159
ILO treatment
respiratory retraining w/ SLP
160
what can ILO masquerade as
asthma
161
what is the gold standard of care in the voice clinic
multidisciplinary approach
SLP, ENT, nurse, medical assistant, other specialists
162
SLPs do
asses vocal function
diagnose functional voice disorders
provide behavioral treatment
163
SLPs do NOT
make medical diagnoses
provide medical treatment / management (ENT)
164
eval componenets
history
auditory eval
laryngeal imaging
acoustics
aerodynamics -- subglottic pressure, airflow
stimulability
165
case history goals
determine
- chronological history of problem
- etiological factors
- patient motivation
discuss
- medical & social hisotry
166
laryngopharyngeal reflux
acidic & nonacidic contents backflow into pharynx & larynx
167
laryngopharyngeal reflux symptoms
coughing
voice changes
sore throat
excessive phlegm
dysphonia
168
what is it important to LOOK for when working w a patient
breathing patterns
bodily tension
posture
formally - laryngeal imagine
169
what is it important to LISTEN for when working w a patient
pitch
loudness
quality --> consistent or inconsistent
formally - auditory perceptual eval
170
auditory perceptual assessment goals
describe the degree of deviation in voice quality/tone focus, pitch, & loudness
171
severity ratings
normal
mild
moderate
severe
172
auditory perceptual measures of voice quality
formalized eval tools to increase reliability
CAPE-V & GRBAS
173
laryngeal imaging goals
describe apparent structure & function of vfs
174
can vf movement be assessed w/ a mirror exam? why or why not?
no
the vfs move faster than the human eye can see
175
endoscope
used in oral rigid laryngoscopy
an instrument that is passed into the body
176
oral rigid endoscopy advantage
offers stable, high res view of larynx & vfs that is minimally invasive
177
oral rigid endoscopy disadvantages
patient may not tolerate
sample limited to /i/
178
transnasal flexible laryngoscopy
a flexible endoscope is passed through the nasal cavity
179
transnasal flexible laryngoscopy advatages
allows for assessment of vf function during connected speech & song production
provides broader view of vocal tract & supraglottic region
can be used for biofeedback
180
transnasal flexible laryngoscopy disadvantage
sometimes possible darker image w/ older tech
more invasive than rigid
less stable image interrupted by laryngeal movements like swallowing
181
visual exam
both of the oral & flexible laryngoscopic techniques can be coupled w/ videostroboscopic equipment
182
digital laryngostroboscopy
imaging the larynx using a strobe light
allows us to visualize vf vibratioin by detecting fund freq
flashing light at points across vibe cycle by timing lights to fund freq providing the illusion of apparent motion
183
mucosal wave
wave length motion of the vfs while they vibrate
184
amplitude
how far open the vfs go
185
supraglottic activity
constriction of supraglottic structures
186
glottic closure
how well the glottis closes
complete
anterior gap
posterior gap
hourglass
spindle
irregular
incomplete
187
free edge contour
smoothness of the edge of the vocal fold
normal
concave
convex
irregular
rough
188
acoustic measurement goals
provide info about physical sound properties of voice
intensity, fund freq, dynamic range, quality
189
acoustic measures
recorded voice via mic hooked up to computer w/ measurement software
norm values by age & sex
considered objective but only as good as the clinician
190
aerodynamic measurement goals
describe laryngeal airway
hope open or closed airway is during phonation
considered objective
measured w/ a mask
191
types of aerodynamic measures
subglottic pressure
translaryngeal airflow (airflow through vfs)
phonation thresholf pressure (min amount (quietest voice) of subglottic pressure required for vf vibration)
192
what is the first line treatment before more invasive approaches
voice therapy
193
goals of voice therapy
restore the best possible voice
reeducate patient on how to effectively use voice
194
voice therapy research
superior
but hard to study
195
what does successful treatment of voice disorders depend on
correct diagnosis
proper functional assessment
SLP knowledge & skill
patient investment
196
vocal hygiene
water intake
caffeine intake
smoking/alc
chronic throat clearing, coughing, grunting, screaming
allergies
197
abdominable breathing goal
promote relaxed expansion of ribs & abs
efficient inhalation
greater airflow into lungs & less tension
198
semi-occluded vocal tract exercises (SOVTs) goal
less impact & stress on vfs
back pressure in vocal tract from partial closure of mouth
max vocal efficiency w/ minimal vocal effort
199
