Voice/ Disorders Flashcards
1
Q
The opening between the vocal folds is called the ____
A
glottis
2
Q
Layered structure of the vocal folds composed of:
A
Epithelium
Thyroarytenoid (TA) muscle
Layers of lamina propria
3
Q
Cover-body theory of phonation
A
The epithelium and the superficial, intermediate and deep layers of the lamina propria vibrate as a “cover” on a relatively stationary “body”.
4
Q
During phonation, ______ occurs. This is the movement of the mucous membrane of the vocal folds
A
Muscolal wave action
5
Q
What lies laterally and above the “true” vocal folds?
A
Ventricular (vestibular) or false vocal folds
6
Q
They do not usually vibrate during normal phonation and are only using during activities such as lifting or coughing.
A
Ventricular (vestibular) or false vocal folds
7
Q
T or F? The ventricular folds protect the true vocal folds and also protect the airway during swallowing
A
True
8
Q
The ____ is the space between the true and false vocal folds
A
Ventricle
9
Q
What is the U-shaped bone that sits above the thyroid cartilage?
A
Hyoid bone
10
Q
T or F? Many extrinsic laryngeal muscles are attached to the hyoid bone, thus supporting the laryngeal framework
A
True
11
Q
The second largest unpaired cartilage that completely surrounds the trachea. It is linked with the arytenoid cartilages and the thyroid cartilages
A
Cricoid cartilage
12
Q
- What’s the mean fundamental frequency for men, women, and kids?
- What’s Jitter? What measurement is considered WNL?
- What’s shimmer? What measurement is considered WNL?
A
- Men: 100-150
Women: 180-250
Children: 230-290 - Irregularities or cycle-to-cycle variations in vocal fold vibrations that are often heard in dysphonic patients - more than 1% = laryngeal pathology
3.
Cycle-to-cycle variations in vocal fold amplitude. more than ~ 1 dB can sound dysphonic
13
Q
Describe Glottal/vocal fry. How could it be useful as treatment?
A
When vocal folds vibrate very slowly with no clear, regular pattern of vibration. Voice sounds “crackly”
- May help modify vocal quality problems such as stridency or slightly increasing subglottal air pressure
14
Q
Diplophonia
A
Double voice
- Usually caused by VFs vibrating at different frequencies
15
Q
Stridency
A
Pt with strident voice sounds shrill, unpleasant, somewhat high pitched and “tinny”
- Physiologically, stridency is often caused by hypertonicity or tension of the pharyngeal constrictors and elevation of the larynx.
- Tense patients may sound strident
16
Q
Explain the difference between direct and indirect laryngoscopy. What could it be used for?
A
Indirect laryngoscopy:
Instrumental evaluation in which specialist uses a bright light source and small, round mirror to lift the velum and press gently against patients posterior pharyngeal wall area
Direct laryngoscopy:
Instrumental evaluation in which patient is under general anesthesia. The instrument is introduced through mouth into the pharynx and positioned above vocal folds.
Good for obtaining a biopsy due to suspicion of laryngeal cancer
17
Q
Which instrument cannot allow the pt to phonate?
A. Flexible endoscopy
B. Electromyography
C. Direct laryngoscopy
D. Videokymography
A
C. Direct laryngoscopy
- It it performed by a surgeon and the patient is under general anesthesia.
- This is valuable to obtain a direct microscopic view of the larynx or when a biopsy is required
18
Q
What is videostroboscopy useful for?
A
Differentiating between functional and organic voice problems
19
Q
Instrumental evaluation that allows patient to speak or sing during procedure, and the specialist can obtain an excellent, prolonged view of the velopharyngeal and vocal mechanisms.
Can also view false VF to observe if maladaptive compensatory movements of false VF present during phonation.
A
Flexible or rigid endoscopy/videoendoscopy
20
Q
Describe what Sound spectrography is.
A
Instrumental evaluation that is useful for evaluating clients with voice disorders as it gives a graphic representation of the stability/instability of the harmonic structure
21
Q
Spectrogram
A
p.287
22
Q
Describe what Electroglottography is.
A
Instrumental Ax tool that places electrodes on the neck to observe vocal fold closure pattern.
23
Q
Laryngeal electromyography
A
LEMG is an invasive procedure that directly measures laryngeal function to study pattern of electrical activity of the VF and view muscle activity patterns.
- Inserting electrodes in pt’s laryngeal muscles.
LEMG is useful when attempting to determine VF pathology. Also useful in verifying excessive muscle activity prior to injection of Botox for spasmodic dysphonias
p.289
24
Q
Videokymography
A
- High speed medical imaging method used to visualize human vocalf fold vibration dynamics
- Uses a traditional rigid endoscope and modified video camera and shown on a monitor.
- Allows visual of left-right vocal fold asymmetries, propagation of mucosal waves, and movement of the upper and lower margins of the vocal folds
25
What does aerodynamic measurements evaluate?
- Dysphonia, monitor voice changes and treatment progress, differentiate between laryngeal and respiratory problems.
- Helps with determining lung volumes because breath support for optimal voice may be lacking
26
Tidal volume
Vital capacity
Total lung capacity
Tidal volume: Amount of air inhaled and exhaled during normal breathing cycle
Vital capacity: Volume of air that the patient can exhale after a maximal inhalation
Total lung capacity: Total volume of air in the lungs
27
CAPE-V
Research and clinical tool created to encourage people to use a standardized approach to evaluating/documenting auditory-perceptual judgments of voice quality.
Not to be used as stand alone assessment of individual's voice
P 291
28
Is it more common to hear hyper or hyponasality in HOH patients?
Hypernasality
29
What could cause hypernasality?
- Can be functional or organic factors but there are no physical factors of hypernasality
- The patient has just made a habit of "talking through their nose"
30
What could cause hyponasality?
- Colds and allergies (temporary)
- Obstructions in the nasal cavity (nasal polyps of papilloma)
- Enlarged adenoids or tonsils (common in children)
- Deviated septum
Hyponasal patients may be mouth breathers
31
1. Describe what hypofunctional disorders are.
2. What are examples of hypofunctional disorders?
3. What are possible treatments for hypofunctional disorders?
1. Voice disorders that are caused by insufficient muscle action of the vocal mechanism. Vocal folds do not come together fully, causing excessive airflow and creating vocal quality that is breathy, hoarse, reduced in loudness, and possibly aphonic.
2. VF paresis and paralysis are hypofunctional disorders
3. Vocal function exercises that emphasize adductory power, use of the nasometer to receive visual feedback through a computer display, nasal-glide stimulation, etc.
32
1. Describe what a hyperfunctional voice disorder is.
2. Provide examples.
3. What are treatment options?
1. Voice disorders caused by excessive muscle action of the vocal mechanism, There is not enough airflow, creating a voice that is tense, strained, rough and hoarse.
2. Most VF lesions (nodules, cysts, polyps) cause hyperfunctional voice disorders.
3. Vocal function exercises (VFE) that emphasize on coordinating the breath with the voice to produce smooth vocal quality, use of the nasometer to receive visual feedback through a computer display, etc.
33
What voice disorder could cause a reactive lesion on the other vocal fold if left untreated?
Cysts
34
Assimilative nasality
- When the sound from a nasal consonant carries over to adjacent vowels
Ex. banana, the two last a's sound hypernasal because of the nasal sound /n/
35
Cul-de-sac resonance
Occurs when sound waves enter vocal tract but are blocked from exiting. The trapped sound is the absorbed by the soft tissues in the vocal tract, creating speech that sounds muffled or hollow
Three types:
- Oral: partially blocked from exiting oral cavity during speech production
- Nasal: Sound is partially obstructed from exiting nasal cavity during production of speech
- Pharyngeal: Sound is blocked from exiting oropharynx during speech production
Regardless the type, always caused by structural anomaly
36
Velopharyngeal insufficiency (VPI)
- Cause of hypernasality
- Velopharyngeal mechanisms is inadequate to achieve closure
37
3 causes of Velopharyngeal insufficiency (VPI)
- Decreased muscle mass of th velum to achieve closure
- Adenoidectomy or tonsillectomy. Requires surgery to fix
- Paresis (weakness) or paralysis of the velum
38
1. Describe what Blom-Singer tracheoesophageal puncture (TEP) procedure is.
2. Advantages and disadvantages
1. The tracheoesophageal wall, which separates the trachea and the esophagus, is punctured. This puncture can be created during the total laryngectomy operation or 6 weeks, once tissue has healed
2.
Pros: Most natural-sounding voice quality for laryngectomees. Prevents passage of fluid and food into the trachea
Cons: Pts need to be able to manipulate to remove, clean and re-insert
39
Difference between supraglottic, glottic and subglottic tumors
Supraglottic: Above VF
Glottic: On VF
Subglottic: Under VF
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40
Total laryngectomy vs hemilaryngectomy
Total laryngectomy
- Entire laeynx is removed
Hemilaryngectomy
- Only the diseases part of the larynx is removed
41
stoma
301
42
3 ways laryngetcomees produce sound:
(Pros and cons)
- Electrolarynx (artificial larynx)
Pros: Can be done immediately following surgery and can be kept as a backup if Pt wants to try another form of voice
Cons: Robotic voice
- Esophageal speech
Pros: Inexpensive, hands-free method that don't rely on protheses
Cons: Difficult to learn
- Surgical modification and implanted devices, primarily the Blom-Singer tracheoesophageal puncture (TEP)
Pros: most natural sounding
Cons: Pt must have dexterity to remove and clean device (ex. would be hard for pts with arthritis)
43
What's an electrolarynx? How does it work ? How is it beneficial?
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44
Esophageal speech
The esophagus is also a source of sound. Pts can be taught esophageal speech in which they speak on burps or belches.
Usually done with laryngectome pts but it can be hard to learn
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45
What voice disorder is described as inefficient muscle action of the vocal fold mechanisms? Provide examples.
Hypofunctional disorders
- VF paralysis/paresis
46
What are some general issues in rehabilitation of the laryngectomee
- Pt and family will need pre and post op counselling
- Experienced, rehabilitated laryngectomees may be helpful in providing information
47
What are the two kinds of polyps?
Sessile: Broad base on the vocal fold and are blister-like
Pedunculated: Attached to the VF by a stalk
48
1. Describe what cysts are.
2. What's the Tx options?
1. Appears on membranous portion of vocal fold
- unilateral, benign and filled with mucus-like fluid
- Can create opposite lesion on other vocal fold if left untreated
2. Surgical removal is recommended (no voice therapy)
49
1. Name the voice disorder:
- Localized, inflammatory vascular lesion that is usually comprised of granular tissue in a firm, rounded sac.
- Usually develop on vocal processes of arytenoid cartilages
- Can be unilateral or bilateral
Cause: vocal strain, intubation during surgery, LPR. Often associated with contact ulcers.
2. What are the treatment options?
Granuloma
Tx: surgery, voice therapy or both. If granuloma is associated with LPR, change of lifestyle is needed.
50
Name the voice disorder:
Sores or crater-like areas of ulcerated, granulated tissue that develop (usually bilaterally) along the posterior third of the glottal margin.
Often seen in hard-driving patients who speak forcefully and talk excessively, GERD, Intubation for surgery
Patients may complain of vocal fatigue and pain in laryngeal area. Often clear their throats.
Tx?
Contact ulcers
- Surgery is NOT recommended, medical treatment such as GERD meds may be needed though. Voice therapy techniques are geared toward taking extra effort out of phonation.
51
What voice disorder is a precursor to nodules or polyps and are caused by vocally abusive behaviours such as throat clearing, screaming, etc.
Vocal Fold thickening
52
Traumatic laryngitis
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53
Name the voice disorder:
- Similar to granulomas, but soft, pliable, and filled with blood. Usually caused by intubation or hyperacidity due to GERD. Can also be congenital.
Tx?
Hemangioma
- Surgery, with voice therapy follow-up
54
What voice disorder is not recommended for surgery as it could make it worse?
Contact ulcers
55
Name the voice disorder:
Distended and prominent veins that are a result of phonotrauma, such as shouting and over use during singing.
Tx?
Varices
- Voice rest, and possibly surgery
56
What's the Tx for Vocal Fold Hemorrhage? What increases the risks for Vf Hemorrhage?
- Phonosurgery of varices can prevent hemorrhaging. Total voice rest is recommended for acute VF hemhorrage, then VF augmentation (fat or collagen injection)
- Blood thinners can increase risk for VF hemhorrage.
57
Name the voice disorder:
- Rough, pinkish lesion that appear in oral cavity, larynx, or pharynx. Often benign but may be precursor to malignancy
- Caused by tissue irritation and may arise due to smoking, GERD, and vocal abuse.
Tx?
Hyperkeratosis
- Eliminating the tissue irritants, possible ablative surgery, and voice therapy
58
Which voice disorder should be referred to an oncologist?
- Leukoplakia, considered as precancerous and must be monitored to ensure that it does not develop into squamous cell cancer
- Hyperkeratosis, as may be precursor of cancer
59
Name the voice disorder:
Benign growths of thick, whitish patches on the surface membrane of the mucosa. occur due to tissue irritation, especially caused by smoking, alcohol or vocal abuse.
What's Tx?
Leukoplakia
- Combination of surgery, voice therapy, and eliminating exposure to irritants.
60
Name the voice disorder:
Soft, floppy laryngeal cartilages, epiglottis particularly affected. Most common cause of stridor in infant.
What's the Tx?
Laryngomalacia
- Usually resolves itself by 2-3 years old. If not, surgery.
61
Name the disorder:
- Narrowing of the subglottic space
- Aquired or congenital
Congenital:
- Result of arrested development of the conus elasticus or interruption of the cricoid cartilage during embryological development
Aquired:
- Result of endotracheal intubation that occurs as part of surgery or lifesaving procedures
- VF paralysis may be present
Subglottal stenosis
- Tx: surgical or endoscopic intervention, followed by voice intervention
62
What's the treatment for Papilloma?
Cup forceps surgery, interferon medication, and CO2 laser surgery (most common)
Voice therapy can be helpful after surgical treatment - relaxation exercises, teaching patient to use amplification devices, help patient decrease supraglottic hyperfunction.
63
Name the voice disorder:
Membrane that grows across the anterior portion of the glottis
Two types: Congenital and aquired (due to trauma - prolonged intubation, surgery, severe laryngeal infection, accidental injury)
Would usually cause difficulty breathing and stridor.
Tx?
Laryngeal web
- Congenital: Immediate surgery followed by tracheostomy
- Aquired: surgery to laryngeal keel between vocal folds to prevent web from growing back. Pt does vocal rest for 6-8 weeks, then keel is removed.
64
Laryngeal Trauma
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65
Sulcus Vocalis
Thinning and narrowing of superficial lamina propria
Cause: unknown
Symptoms: hoarse, experience fatigue and increased effort for phonation needed
Tx: surgical augmentation using fat/fascia, augmentation using collagen
315
66
1. Describe what GERD and laryngopharyngeal reflux (LPR) are.
2. Presence of these can suggest what voice disorder?
GERD
- Gastric contents spontaneously empty into esophagus when person has not vomited or belched
- Contact ulcers or hyperkeratosis
LPR
- Gastric contents spill into the upper pharynx and upper airway, causing irritation in the mucosa of these areas.
- Reinke's edema or granuloma
67
Ankylosis
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68
1. Describe what Paradoxical Vocal Fold motion disorder is.
2. What is it caused by?
3. What's the treatment?
1. Inappropriate closure or adduction of the true vocal folds during inhalation, exhalation, or both.
2. Attributed to both psychological and physiological disorders
3. Tx: Depends on the cause. Combination of psychological, medical and behavioral Tx.
Some benefit from respiratory training or endoscopic approaches to understand their symptoms, rythmic breathing method
69
What does Paradoxical Vocal Fold motion disorder (PVFM) sound like?
A. hoarse, breathy
B. Stridor and dysphonia
C. Dysphonic only
B. Stridor and dysphonia. Sometimes, only stridor is present. Pts with PVFM sometimes sound asthmatic.
70
Paralysis (unilateral and bilateral)
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71
1. Describe what Spasmodic dysphonia is. (adductor vs abductor)
2. What are the Tx options for both?
ABDUCTOR:
- Created by intermittent, involuntary, fleeting vocal fold abduction when patient tries to phonate. Loudness is reduced, and the patient is occasionally aphonic, with breathy or whispered speech.
- Tx: Botox injections, speech therapy involving relaxation techniques and continuous voicing, and pharmacological interventions.
ADDUCTOR:
- The most common type, is characterized by overpressure due to prolonged overadduction or tight closure of the vocal folds.
- Voice may sound choked and strangled.
- Tx. CO2 laser surgery, RLN resection, botox injections, AAC devices, voice therapy.
72
Adductor or Abductor spasmodic dysphonia?
- Created by intermittent, involuntary, fleeting vocal fold opening when patient tries to phonate. Loudness is reduced, and the patient is occasionally aphonic, with breathy or whispered speech.
- Tx: Botox injections, speech therapy involving relaxation techniques and continuous voicing, and pharmacological interventions.
Abductor
73
Adductor or Abductor spasmodic dysphonia?
- The most common type, is characterized by overpressure due to prolonged overadduction or tight closure of the vocal folds.
- Voice may sound choked and strangled.
- Tx. CO2 laser surgery, RLN resection, botox injections, AAC devices, voice therapy.
Adductor
74
1. Describe what Multiple Sclerosis is.
2. How does it affect speech?
3. What are Tx options?
1. Progressive disease relating to myelin sheaths on the axons of neuron cells.
2. impaired prosody, pitch and loudness control (harshness, breathiness, hypernasality; articulation breakdown; and nasal air escape)
3. There is no cure for this disease, but pharmacological treatments and cordnisone steroids (prednisone) may be used to treat symptoms.
75
1. Describe what Myasthenia gravis is.
2. How does it affect speech?
3. Tx. options?
1. Autoimmune disease that produces fatigue and muscle weakness. Decreased amount of acetylcholine at the myoneuronal junction, so muscles have difficulty contracting.
2. Hypernasal, breathy, hoarse, monotonous, and soft in volume. Dysphagia and distorted articulation may be present
3. Corticosteroids, which improves strength and endurance of bulbar muscle.
Thymectomy: removal of the thymus gland
76
Voice symptoms of patients with ALS and Tx
- Breathy, low pitched, monotonous.
- Poor respiratory control
- Because ALS is progressive, clinicians focus Tx efforts on AAC forms of communication that an be used even in later stages of the disease
77
Voice symptoms of patients with ALS and Tx
- Breathy, low pitched, monotonous.
- T: L-dopa to increase dopamine. LSVT as voice treatment
78
Name the voice disorder:
- Occurs when the voice is abnormal in the presence of normal laryngeal structures.
Laryngoscopical examination reveals normal vocal structures but during attempted phonation, the VF may remain fully or partially abducted.
Tx?
Psychogenic voice disorder
Tx: Counselling or behavior therapy
79
1. Describe what Hysterical (conversion) aphonia is.
2. What is it caused by?
3. Treatment options?
1. No evidence of structural pathology, and no known physiological or neurological basis for patient's voice loss. Loss can be sudden or gradual.
2. Patients often experience voice loss after an emotionally traumatic event (ex. violent crime).
3. Impacts all aspects of individual's life, especially occupationally and socially, but prognosis is good.
80
1. Describe what Muscle tension dysphonia
2. What's the cause?
3. Treatment options?
1. Significant over activity of the head and neck muscles during phonation. In some cases, the intrinsic laryngeal muscles are also coordinated. High-pitched voice and strained because of increased tension
2. May be caused by high levels of stress and depression, but could also be caused by vocal abuse and GERD
3. Voice therapy often used to treat MTD, circumlaryngeal massage (pressure is applied to hyoid bone, thyrohoid space, and posterior aspect of thyroid cartilage)
81
Mutational falsetto (puberphonia)
- What it is
- Etiology
- Tx techniques
- When young man speaks with high pitch, although larynx has grown normally and puberty is completed.
- Can occur due to psychosocial factors (embarrassed of voice getting deeper), endocrine disorders, neurologic diseases or physical causes (hearing impairment)
- Tx should be initiated in teens/early 20s as some atrophy of the muscles may occur is persists untreated.
- Tx technique: Digital manipulation of the thyroid cartilage.
82
What's important to factor with behavioural voice therapy?
- Always ensuring a medical evaluation before starting voice therapy
- If voice disorder is product of poor vocal hygiene
- Helping clients to receive environmental modifications (ex. microphone) if vocal trauma is cause
- Ensuring clients understand the anatomy of the larynx and why they developed voice disorder (if caused by trauma)
83
1. Describe the Tx method "Lessac-Madsen resonant voice therapy" (LMRVT)
2. Who can benefit from this Tx method?
1. Principle is to eliminate vocal fold injury by configuring the larynx and surrounding structures to reduce the level of respiratory effort and impact stress on vocal folds.
- LMRVT emphasizes a forward focus and easy phonation, and sensory processing is a key component; client is encouraged to feel the vibrations resonating in front of the face and mouth
2. Hyperfunctional voice disorders.
84
1. Describe the Tx method "Chest resonance"
2. Who can benefit from this Tx method?
1. Similar to LMRVT, but feelings of vibration are forward focus and are placed in the chest.
2. Can be used for clients who have maladaptive high laryngeal positioning and for clients with Reinke's Edema who are not candidates for surgery.
85
1. Describe the Tx method "Yawn-sigh".
2. Who can benefit from this Tx method?
1. Client instructs patient to drop tongue when they sigh; this helps drop larynx and retract false VF, reducing tension in the larynx.
2. Used for hyperfunctional disorders because goal is to increase airflow.
86
1. Describe the Tx method "Vocal function exercises (VFE)".
2. Who can benefit from this Tx method?
1. Described as "physical therapy for the vocal folds" and can be used by anyone to maintain proper vocal health. It helps increase flexibility of vocal folds through structured practice
2. Can be used for hyper or hypo functional disorders.
Hypofunctional: Emphasizing adductory power
Hyperfunctional: Focus more on coordinating breath with voice to produce smooth voice quality
87
Describe the Tx method "Stretch and flow"
- Hierarchical voice therapy technique with a focus on airflow management.
- Used for hyperfunctional voice disorders
- Emphasizes the coordination between the tension and effort of phonation.
88
Describe the Tx method "Twang".
Who can benefit from this?
1. Similar to country singing style.
- Created by the narrowing of the aryepiglottic sphincter, which forms a resonating cavity that matches that of the ear canal.
2. Used for hypofunctional disorder but can also be used for hyperfunctional (ex. nodules)
89
Integrated implicit-explicit approach to voice training
- Consists of 5 steps, combining auditory-perceptual cues with knowledge of anatomy and physiology
90
Describe the Tx method "Singhale". Who can benefit from it?
1. Exercise in which voice is produced on an inhalation rather than exhalation. Made to reduce ventricular phonation
Serves to naturally humidify the vocal folds
91
Describe what the hard glottal attack method.
- Facilitate vocal fold closure in hypofunctional voice disorders
- Some say technique is maladaptive because hard glottal onsets used repeatedly may cause lesions (ex. vocal nodules)
92
1. Describe what Coughing and throat clearing is and how it can be effective in voice therapy.
2. Who can use this as Tx option?
1. Can be used as a way to get vocal fold closure through natural biological function
2. Used with: hypofunctional voice disorders, puberphonia, and muscle tension dysphonia
- Cough is facilitated first into a vowel then to a lip trill. Then client is then introduced to lip trill on a pitch, which will facilitate voice.
93
Describe what the Rythmic breathing method is.
2. Who can benefit from this?
- Can be used with clients with paradoxical vocal fold motion disorder because it coordinates breathing with the opening of vocal folds
94
Describe the Lombard effect. Who can benefit from this Tx method?
- Tx technique for individuals (especially men) who wish to lower vocal pitch
- Pt's voice becomes louder with background noise
95
What's the primary concern for transgender clients?
Achieving appropriate pitch.
96
T or F? Fundamental frequency is used to measure the success of voice therapy in male-to-female transgender clients
True
97
Are pitch changes before and during menstruation a concern for transgender clients?
No, they do not cause a major problem. However, these changes may be troublesome to professional singers as lower levels of estrogen and progesterone before menses can cause VF thickening - which causes hoarseness and lowered pitch.
98
What's mainly helps female-to-male transgender clients with their pitch?
Hormonal therapy - testosterone thickens the vocal folds, thus helping produce a lower pitch.
99
Does estrogen help with the pitch of male-to-female transgender patients?
No. While estrogen helps with the physical changes, it does not affect the vocal folds. Therefore, the patient will still have a masculine-like voice.
100
What do most transgender patients complain about in therms of their voice?
Vocal fatigue
101
T or F? If a male-to-female transgender patient undergoes surgery to achieve a higher pitched voice, they do not need voice therapy.
False. Even with surgery, male-to-female transgender patients are recommended to undergo voice therapy as well.
102
What are some components of male-to-female transgender voice therapy?
- Teaching client to use a greater number of rising pitch inflections at end of utterances
- Teaching client to use greater articulatory precision, a softer voice, and more modals (can, may, will, shall, must)
- Teach patient to place their tongues more anteriorly in their mouths during speech; helps client achieve a more "forward" resonance, which is believed to be characteristic of the female voice
- Feminine body language (gestures and facial expressions)
103
T or f? Sucking, blowing, and oral-motor exercises are effective in improving velopharyngeal closure or abnormal resonance
False.
104
What are voice quality characteristics of VPI?
- Excessively nasal speech quality (hypernasality)
- Leakage of air through the noise while speaking
- Speech sounds weak or muffled
- Abnormal articulation
- Leakage of food or liquid through the nose while eating
105
VP insufficiency or incompetence?
- Structural defects resulting in insufficient tissue to accomplish closure
Velopharyngeal insufficiency
106
VP insufficiency or incompetence?
- Soft palate lets air into the nose because of a muscular or nerve problem, rather than because of the structure of the back of the mouth.
Velopharyngeal incompetence
107
VP insufficiency or incompetence?
- Seen in patient with cleft palate, down syndrome, large tonsils, can develop after surgery to remove the adenoids
VP insufficiency
108
VP insufficiency or incompetence?
- Usually due to a neurological disorder or injury (ex. cerebral palsy or TBI)
VP incompetence
109
Is surgery usually necessary for VPI?
Yes
110
What case history information should you make sure to include for a child with voice issues?
Family history
Other language/behaviour development history
Other developmental milestones
Environmental factors
Medical factors
111
What two conditions need be met for vocal folds to be set in motion?
- Vocal folds sufficiently approximated.
- There is sufficient subglottal pressure.
112
How are vocal tract resonances created?
Vocal tract resonances will be created, corresponding to formant frequencies, which are properties of the filter.
F1 = Mostly determined by tongue height - vertical plane
F2 = Mostly determined by tongue “backness” - horizontal plane
113
Describe the skeletal framework of the larynx.
Hyoid bone: Considered “free-floating” (not attached to any other bone)
Thyroid cartilage: Anterior prominence/ notch = Adam’s apple. Largest component; provides protection to other laryngeal structures
Cricoid cartilage: Ring-like structure located above trachea. The cricoid is the only complete cartilaginous ring of the airway.
Arytenoid cartilages (2): Sit atop the cricoid cartilage
Corniculate cartilages (2): The corniculate and cuneiform cartilages have fibrous attachments to the arytenoids and are located on top of and anterior to the arytenoid cartilage, respectively. The true function of these structures is unknown, but they increase and stiffen the aryepiglottic fold and may therefore aid in prevention of aspiration during swallowing.
Epiglottis: A single cartilage positioned behind hyoid bone and root of the tongue. Lingual surface attaches to hyoid bone; the lower part attaches to the inner part of the thyroid cartilage just below the thyroid notch.
114
What muscles make up the vocal folds and cords?
Folds: exterior part made up of external and internal thyroarytenoid muscles and the vocal ligament
Vocal cord: interior thyroarytenoid and vocal ligament.
115
Where do the vocal folds attach to?
Anterior: inner surface of the thyroid.
Posterior: Arytenoids.
116
Describe the myoelastic aerodynamic theory.
Vocal folds move towards the midline
Subglottal air pressure builds and blows VF apart
Muscle recoil (elasticity) and Bernoulli Effect (increase in velocity decreases pressure between the VF and sucks them back together again) creates vibration
