Voice Flashcards
1
Q
In the cover-body theory of phonation, what is thecover
A
Epithelium
Superficial, intermediate, and deep layers of lamina propria
2
Q
which nerve innervates the posterior belly of the digastric
A
VII
3
Q
What does the internal branch of the SLN innervate
A
sensory info
4
Q
what arteries supply the larynx
A
superior laryngeal
cricothyroid
inferior laryngeal
5
Q
which are the 5 intrinsic laryngeal muscles
A
- thyroarytenoid
- cricothyroid
- posterior cricoarytenoid
- lateral cricoarytenoid
- interarytenoid (transerves and oblique)
6
Q
which muscles depress the larynx
A
- thyrohyoid
- omohyoid
- sternothyroid
- sternohyoid
7
Q
which muscles elevate the larynx
A
- digastric
- geniohyoid
- mylohyoid
- stylohyoid
- genioglossus
- hyoglossus
8
Q
what is the mean fundamental frequency of a child
A
age 7 to 8; 281 TO 297 HZ
age 10 to 11: 238-270 HZ
9
Q
what are the max phonation times for children
A
- age 3-4: 7.5 to 8.95 sec
2. age 5-12: 14.97 to 17.74 sec
10
Q
what is the fundamental frequency of men
A
100-150 Hz or approx 125
11
Q
what is the fundamental frequency of women
A
180 to 250 or approx 225
12
Q
what is the max phonation time for adults
A
20.9 to 24.6 seconds
13
Q
what happens to men’s and women’s fundamental frequency as they age
A
women lower to 201 and men raise to 132-146
14
Q
what are age related changes in the larynx
A
- hardening of cartilages
- degeneration and atrophy of muscles
- degeneration of mucosa
- decreased flexibility of cricoarytenoid joint
15
Q
what is presbyphonia
A
age related voice disorder characterized by perceptual changes in quality, range, loudness, and pitch
16
Q
what is assessed in voice
A
- pitch
- loudness
- quality
17
Q
what is fundamental frequency
A
vibration of the vocal fold
18
Q
what determines the pitch of the vocal fold
A
- mass
- tension
- elasticity
19
Q
what is jitter
A
irregular vibration of the vocal fold
20
Q
what is shimmer
A
cycle to cycle variation in amplitude
more than 1 dB variation makes someone dysphonic
21
Q
what is hoarseness
A
combination of breathy and harsh from irregular vocal fold vibration
sound low pitched breathy and husky
22
Q
what is harshness
A
rough, unpleasant, gravelly
associated with excessive muscular tension.
folds too tightly adducted and air released too abrupt
23
Q
what is a strain-strangle quality
A
phonation is effortful
patient sounds as if squeezing the voice at the gottis
initiating and sustaining voice difficult
24
Q
what is breathiness
A
breathy voice from folds being slightly open
often quiet with little variation in loudness
restricted vocal range
25
what is glottal fry
when folds vibrate very slowly with no clear, regular pattern of vibration
results in bursts of extremely low pitch
sounds crackly
26
what is vocal fry
1. vibratory cycle near the bottom of normal pitch range
2. produced at end of long phrase when air flow and pressure are low
3. may help modify stridency
27
what is diplophonia
1. occurs when folds vibrate at different frequencies to to different degrees of mass or tension
2. can occur with a unilateral polyp
28
what is stridency
shrill, unpleasant voice, somewhat high pitched and tinny
| 2. caused by hypertonicity or tension of pharyngeal constrictors and elevated larynx
29
what is needed in a voice case history
1. patient perception of problem, onset, duration, causes, and variability
2 any associated symptoms
3. health, environmental and family history
4. previous therapy, medical interventions
5. daily usage
6. medical history
7. obtain perceptions of what constitutes a typical voice in culturally and linguistically diverse
30
what is necessary to have before you start voice treatment
medical evaluation by laryngologist
31
what is an indirect laryngoscopy
use a bright light and small mirror to lift the velum and press against the posterior pharyngeal wall to view larynx during phonation
32
what is direct laryngoscopy
performed by surgeon under general anesthesia
2. laryngoscope introduced through mouth to vocal folds
3. patient cannot phonate so it is a visual only
33
what is a rigid endoscopy with videostroboscopy
1. introduced orally
34
what is flexible endoscopy
inserted through nasal passage
passes over velum
3. patient can speak
4. can also view false vocal folds to see if there are maladaptive compensatory movement
35
how does videostroboscopy work
1. pulsing light is flashed at same fundamental frequency of folds
2. microphone placed on neck along thyroid cartilage
3. image yields info about periodicty of fold vibrations, amplitude, glottal closure, adequacy of mucosal wave, and possible presence of lesions
36
how are acoustic measures evaluated
1. sound spectography
2. electroglottography
3. laryngeal electromyography
4. video mymography
37
what is sound spectography
graphic representation of sound wave's intensity and frequency over time
38
what is the value of wide band spectograms
wide band spectograms give better time resolution
39
what is the value of narrow band spectograms
narrow band have better frequency resolution
harmonics are easily seen
useful for evaluating voice disorders because it creates a graphic representation of the harmonic structure
40
what is electroglottography
surface electrodes placed on both sides of thyroid cartilage
| 2. high frequency electric current passed between electrodes during phonation
41
what is electromyography
needle inserted into peripheral laryngeal muscles
2. look for reduced or increased speed of muscle activation, extraneous bursts of muscle activity
3. useful to determine pathology caused by neurologial or neuromuscular disease
4. used prior to Botox injection
42
what is videokymography
high speed medical imaging of vocal fold vibration
2. allows visualization of left-right vocal fold asymmetries, propagation of mucosal waves, and movement of upper and lower margins of folds
43
what is tidal volume
the amount of air inhaled and exhaled during normal breathing cycle
44
what is vital capacity
volume of air that patient can exhale after max inhalation
45
what is total lung capacity
total volume of air in lungs
46
what does a Visi pitch measure
dynamic range
intensity
frequency variability
pitch and loudness
47
what do you look for to assess respiration perceptually
1. clavicular breathing: shoulders elevate during inhalation
2. diphragmatic breathing: uses lower thoracic cavity and abdomine
3. thoracic breathing: uses rib cage
3. thoracic breathing
48
how is phonation assessed
1. max phonation time
| 2. s/z ratio
49
what is an s/z ratio
1 indicates the efficiency of glottal closure
| 2. a ratio of 1.4 is indicative of laryngeal pathology
50
what do QOL assessments evaluate
1. physical aspects of the voice disorder
2. functional impacts on daily activities
3. social impact or how patient feels about it
51
where is hypernasality mostly perceived
high vowels because held longer than consonants, and the high tongue position reduces space for oral resonance and increases pressure through the velum
52
which consonants are affected by hypernasality
fricatives, affricates, and plosives
53
what is velopharyngeal insufficiency
mechanism is inadequate to achieve closure
54
what are the major causes of VIP
1. decreased muscle mass of velum
2. adenoidectomy or tonsillectomy
3. paresis of velum which reduces mobiity
55
which are frequent substitutes for hyponasality
b for m
d for n
and g for ng
56
what is assimilative nasality
when a sound from a nasal consonant carries over to adjacent vowels
example: the ae in banana sounds hypernasal because it is next to /n/
57
what is the cause of assimilative nasality
velar opening begins too soon and lasts too long
58
what is cul de sac resonance
when sound enters the vocal tract but is blocked from exiting
trapped sound is absorbed by soft tissue
speech sounds muffled
always caused by structural issue
59
what are the different types of cul de sac resonance
1. oral: sound blocked from exiting oral cavity due to tongue blocking
2. nasal: sound obstructed from exiting nasal cavity. Mostly occurs with anterior blockgte such as deviated septum or narrowing of nares
3. pharyngeal: sound blocked from exiting oropharynx due to hypertrophied tonsils, adenoids etc
60
what is a nasometer
an instrument that allows the patient to receive visual feedback.
61
what is nasalance
ratio of oral to nasal production
62
how is hypernasality treated
1. visual aids: tissue or missor under nose
2. ear training: video or audio recording
3. increase patient mouth opening so oral resonance is enhanced
4. increase patient loudness through respiration training
5. improve articulation: exaggerating consonants can contribute to a perception of less hypernasality
6. change speaking rate
7. decrease pitch which can create greater oral resonance
63
how is hyponasality treated
1. directing sound into the area above the maxillary sinuses. have patient feel the vibrations as they exaggerate the nasal sounds
2. nasal glide stimulation: clinician selects words with glides and nasals ( lemon, lawnmower). this combination helps direct the resonance into nasal cavity and gives auditory and kinesthetic feedback
3. visual aids
64
what are the early signs of laryngeal cancer
1. hoarseness
2. difficulty swallowing
3. sore throat that doesnt go away
4. ear pain
5. pitch change due to added mass
6. lump in the throat
65
what are the categories that are assessed to classify the stage of cancer
1. T: primary site of the cancer
2. N: involvement of lymph nodes
3. M: metastasis
66
what are the treatment options for cancer
1. surgery
2. chemotherapy
3. radiation
67
what is a hemilaryngetomy
when only the diseased portion of the larynx is removed
68
when is radiation therapy used
1. may be used before surgery to attempt to eliminate the cancer
2. may be used alone or combined with surgery
69
what are the side effects of radiation
1. skin burn
2. cavities
3. edema
4. swallowing problems
5. diminshed taste
6. sore throat
7. fatigue
8. thrush
9. xerostomia
10. thick secretions
70
what is involved in presurgery support of laryngectomy
education on anatomy and physiology and how that will change with laryngectomy
knowledge of problems that may occur post surgery
71
what is the injection method of esophageal speech
1. positive pressure method: patient impounds air in mouth as in saying /t/, /k/, or /p/
2. impounded air is pushed back into the esophagus then expelled
3. air is belched into speech
72
what is the inhalation method of esophageal speech
1. negative pressure; patient is taught to inhale quickly while keeping the esophagus open
2. the inhaled air sets the tissues into vibration
73
what causes hyperfunctional voice disorders
when there is not enough airflow, creating a tense, strained, rough, or hoarse voice
typically from nodules, cysts, or polyps
74
what are causes of hypofunctional voice disorders
caused by inefficient muscle action
vocal folds dont come together causing excess airflow
vocal quality is breathy, hoarse, soft, and possibly aphonic
can be due to paresis
75
what are nodules
1. small nodes that develop on superficial layer of lamina propria
2. typically bilateral opposite each other at the junction of anterior and middle two thirds of fold
3. increase mass and stiffness of folds
4. due to phonotrauma
76
how are nodules treated
voice therapy
| surgery
77
what are polyps
masses that originate in middle one third of superficial lamina propria
2. may be filled with fluid
78
what are sessile polyps
have a broad base and are blister like
79
what are pedunculated polyps
attached to the vocal fold by a stalk
80
what causes polyps
1. phonotrauma causes submucosal bleeding which causes tumor to form
2. can occur after just one instance of vocal abuse
3. occurs more often in adults
4. voice sounds breathy and hoarse. May have diplophonia
81
what are cysts
fluid filled sac on one fold
can create a reactive lesion on opposite fold
result of phonotrauma
82
how are cysts treated
surgery followed by education on vocal hygiene
83
what is a granuloma
vascular lesion composed of granlar tissue in a firm round sac
2. frequently form on the vocal process of the arytenoid cartilage
3. can be unilateral or bilateral
84
what causes granulomas
1. vocal strain
2. intubation during surgery
3. injury to larynx
4. laryngopharyngeal reflux LPR
5. associated with contact ulcers
85
what are the symptoms of granulomas
1. sound breathy and hoarse
| 2. feel need to frequently clear throat which only makes the irritation worse
86
how are granulomas treated
surgery, voice therapy or both
| lifestyle change if associated with LPR
87
what are contact ulcers
ares of ulcerated tissue that develops usually bilaterally on the posterior third of glottal margin
88
what causes contact ulers
1. slamming together the arytenoid cartilages during low pitched phonation accompanied by hard glottal attack
2. frequently seen in hard driving patients who speak forcefully
3. GERD
4. intubation for surgery
89
what causes vocal fold thickening
1. prolonged vocal abusive behaviors such as throat clearing, screaming
2. folds thicken slowly and gradually
3. often a precursor to nodules or polyps
4. eliminated by vocal hygiene
90
what are symptoms of traumatic laryngitis
1. vocal abuse irritate the folds which swell
2. voice is hoarse and may be low pitched with pitch breaks
3. therapy is vocal rest and changing vocal abuse
91
what are hemangiomas
1. similar to granulomas but are soft and filled with blood
2. caused by intubation or GERD
3. can be congenital
92
where are acquired hemangiomas located
posterior glottal area and creates a hoarse voice
93
where are congenital hemangiomas locatedd
subglottic region. They create difficuty breathing and stridor
94
what is Reinkes edema
build up of fluid in the superficial lamina propria of both folds
result of continuous abuse, smoking and LPR
95
what is the symptom of Reinkes edema
low pitched gravelly voice
| more noticable in women
96
what are varices
distended and prominent veins in the mid portion of superficial lamina propria
result of phonotrauma
3. individuals may have loss of upper range
97
how are vocal fold hemorrhages treated
phonosurgery of varices can prevent hemorrhage
total voice rest during acute phase
after healing, any remaining issues that are a result of scar tissue can be treated with vocal fold augmentation
98
what is hyperkeratosis
1. rough, pink lesion that appears in the oral cavity, larynx, or pharynx
2. may affect the epithelial cover or superficial layer
3. may be precursor to malingnancy
4. may be due to smoking, GERD, or vocal abuse
5. symptoms include reduced loudness, and low pitch
99
what is leukoplakia
thick white patches on mucosa
2. due to tissue irritation caused by smoking, alcohol, or phonotrauma
3. may appear on anterior third of vocal folds and under tongue
4. considered precancerous
5. patients sound rough, hoarse, lowpitched, breathy, soft volume and diplophonia
6. treatment is surgery, therapy, eliminating exposure to irritants
100
what is laryngomalacia
congenital condition of the laryngeal cartilages, especially the epiglottis
2. most common cause of stridor in infants
3. abnormal development of epiglottis which becomes very soft and pliable
4. during breathing, the epiglottis resists the airstream
5. usually resolves on its own
101
what is subglottal stenosis
1. narrowing of subglottic space
2. can be acquired or congenital
3. congenital cause is interruption of the cricoid development
4. acquired is a result of intubatin from scarring
5. symptoms may include stridor or vocal fold paralysis
102
what is a papilloma
wart like growths due to HPV
2. true folds most likely site
3. results in hoarseness, breathiness, low pitch
4. airway obstruction possible
5. treatment includes surgery, interferon (meds) and lasar surgery
6. voice therapy helpful after surgery. Treatment icludes relaxation excercises, amplification devices, and decreasing supraglottic hyperfunction
103
what is laryngeal web
1. membrane that grows acrossthe anterior flottis
2. can be congenital or acquired
3. results in difficulty breathing and stridor
4. treatent for infants involves surgery followed by tracheostomy
5. treatment for adults involves surgery
6. following surgery a laryngeal keel is places between folds to prevent the web from growing back while patient undergoes 6-8 weeks of voice rest
104
what is laryngeal trauma
1. may include burns, motor vehicle accidents, sports related, attempted strangulation, and gunshot wounds
2. symptoms include hoarse voice and stridor
3. surgery is done to reconstruct the vocal mechanism
4. for smokers or those with GERD, life style changes
5. most undergo voice therapy after surgery
105
1. what is sulcus vocalis
1. thinning and bowing of superficial lamina propria
2. can be unilateral or bilateral
3. the effect on the voice depends on the depth of the sulcus
4. can be managed with surgical augmentation using fat or fascia or collagen
106
what is laryngopharyngeal reflux or LPR
when the gastric contents spill into the upper pharynx ad irritate the mucosa
2. may cause contact ulcers
107
how is gERD evaluated
manometry critical before surgery
108
what is the treatment for GERD
antacids
propping up head at night
not exercising directly after eating
change in dietary habits
109
what is ankylosis
stiffening of the joints
2. movement of arytenoids restricted
3. may be due to arthritis
4. vocal folds may not fully close
110
what does paroxysmal mean
symptoms occur in periodic attacks
111
what is the current belief about the cause of spasmdic dysphonia
abnormal functioning of the basal ganglia
112
what is abductor spasmodic dysphonia and its symptoms
intermittent fold abduction when patient tries to phonate
2. reduced loudness, aphonia, breathy voice
3. treatment is Botox
113
what is adductor spasmodic dysphonia
more common type characterized by overpressure due to prolonged overadduction
2. voice sounds strangled
3. treatment includes botox; laser surgery to thin the paralyzed fold creating a groovewhich pulls the fold away from midline; and RLN resection where the RLN is cut to paralyze the fold on that side; AAC; voice therapy
114
what voice therapy is used for spasmodic dysphonia
inhalation phonation
2. increased pitch
3. relaxation
4. head turning
5. counseling
6. yawn-sigh approach
7. easy onset of phonation
115
how does MS affect the voice
demylination can impair
1. prosody
2. pitch
3. loudness control
4. harshness
5. breathiness
6. hypernasality
7. articulatory breakdown
8. nasal emission
116
what treatments are used for MS voice effects
1. symptoms are treated by steroids
117
how does Myasthenia gravis affect the voice
due to decreased acetylchoine at the myoneuron junction:
1. hypernasality
2. breathy
3. hoarse
4. monotone
5. softness
6. may also have dysphagia and distorted artic
118
how is myasthenia gravis treated
1. steroids to improve strength and endurance
| 2. thymectomy or removal of the thymus gland which is abnormal in MG
119
how does ALS affect the voice
1. breathy
2. low pitch
3. monotone
4. poor respiratory control
5. present with combinatin of dysarthria, dysphonia, and dysphagia
120
how is ALS treated
AAC
121
how does Parkinson's affect the voice
1. breathy, low pitch, soft and monotone
122
what is conversion aphonia
aphonia with no known physiologic or neurological basis
| onset can be sudden or gradual
123
what is mutational falsetto or puberphonia
```
when a young man speaks with a high pitch after puberty
can be due to
1. psychosocial factors
2. neurologic diseases
3. physical causes
```
124
how is puberphonia treated
digital manipulation of the thyroid cartilage (patient taught to gently push inward on anterior thyroid cartilage while sustaining a vowel)
125
how is muscle tension dysphonia treated
circumlaryngeal massage
126
how is voice treated through behavior voice therapy
1. determine reason for disorder
2. is it hyper or hypofunctioal
3. eliminate poor vocal hygiene
4. address environmental factors (occupation etc)
5. always get medical eval before starting therapy
6 reduce vocally abusive behaviors
7. educate patients
8. work with family
9. have patients monitor their abusive behaviors
10. consider audio recordings for feedback to develop self monitoring
127
what is the Lessac-Madsen Resonant Voice Therapy
1. used with hyperfunctinal voice disorders
2. increases airflow and decreases muscle action
3. forward focus and easy phonation. Patient encouraged to feel the vibrations resonating in the front of the face and mouth, particularly on alveolar ridge
4. patient learns by imitating the clinician
128
what is chest resonance therapy
1. used for patients with high laryngeal positioning
2. client instructed to let the voice fall to the chest
3. client hums to feel the vibration in their chest and shape the hum into words
129
what is the yawn-sigh therapy
1. used for hyperfunctional
2. goal is to increae airflow
3. client instructed to drop their tonge as they sign
130
what are vocal function exercises
1. developed by Semple
2. can be ued for hyper or hypofunctional voice
3. increaes flexibility of the folds through structured practice
4. 4 exercises practiced twice daily as softly as possible without tension
131
what is stretch and flow therapy
emphasizes the coordination between respiration and phonation
focus on reducing tension and effort
132
what is singhale
an exercise where the voice is produced on inhalation
| patients instructed to siren up and down to increase flexibility
133
what is hard glottal attack technique
pushing or valsava maneuver to facilitate vocal fold closure in hpofunctional voice
134
what is a technique to get vocal fold closure
coughing and throat clearning
135
how is the Lombard Effect used
treatment for those who wish to lower their vocal pitch
2. client oral reads while recorded
3. near 10th word masking noise is used to make voice louder in response
4. voice becomes lower
136
how are female to male transgender clients treated
hormone therapy
137
how are male to female transgender clients treated
1. thyroplasty and longitudinal incisions can raise pitch
2. build vocal stamina
3. teach client to use more rising pitch inflections at end of utterance
4. teach client to place tongue more anterioraly in the mouth to achieve female sounding resonance
5
