voice disorders COPY Flashcards by Sylvia Bettencourt

what are the extrinsic laryngeal muscles of larynx

supra hyoid
infahyoid
(pg. 344)

How well did you know this?

Not at all

Perfectly

what are the supra hyoid muscles

mylohyoid
geniohyoid
digastrics
hyoglossus
styloglossus
genioglossus
(pg. 344)

How well did you know this?

Not at all

Perfectly

what are the infra hyoid muscles?

thyrohyoid
omohyoid
sternothyroid
sternohyoid
(pg. 344)

How well did you know this?

Not at all

Perfectly

what are the abductor muscle(s) of the larynx

posterior cricoarytenoid

pg. 344

How well did you know this?

Not at all

Perfectly

what are the adductor muscles of the larynx

lateral cricoarytenoids
interarytenoids (oblique and transverse)
(pg. 344)

How well did you know this?

Not at all

Perfectly

what are the tensor muscles of the larynx

cricoarytenoids (pars recta and pars oblique)
thyroarytenoids
- medial/internal (thyrovocalis)
- lateral/external (thyromuscularis)

How well did you know this?

Not at all

Perfectly

what are the layers of the vocal folds?

cover (squamous epithelium, superficial or lamina propria)
transition (form the vocal ligament)
body ( thyroarytenoid muscle)
(pg. 344)

How well did you know this?

Not at all

Perfectly

what are the 3 branches of the vagus (X) nerve?

pharyngeal
superior laryngeal
recurrent laryngeal nerve
(pg. 344)

How well did you know this?

Not at all

Perfectly

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

-innervates soft palate via pharyngal plexus

a. pharyngeal nerve (pg.345)

How well did you know this?

Not at all

Perfectly

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

interanal branch: sensory to glottal area and above
external branch: motor to cricothyroid muscle

b. superior laryngeal nerve (pg.345)

How well did you know this?

Not at all

Perfectly

a. pharyngeal nerve
b. superior laryngeal nerve
c. recurrent laryngeal nerve

sensory to glottal area and infra glottal area
motor to all intrinsic laryngeal muscles except cricothyroid
right and left branches differ in length
left branch is longer because it wraps around the aorta before coursing upward
right branch wraps around subclavian artery before entering larynx
enters larynx though the thyroid gland

c. recurrent laryngeal nerve (pg.345)

How well did you know this?

Not at all

Perfectly

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

-an active process resulting primarily from acton of diaphragm and external intercostal muscles

a. inhalation (pg.345)

How well did you know this?

Not at all

Perfectly

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

passive during quiet breathing
is active during breathing for speech

b. exhalation (pg.345)

How well did you know this?

Not at all

Perfectly

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. checking action

-amount of air available for use when lungs are inflated maximally

c. vital capacity (pg.345)

How well did you know this?

Not at all

Perfectly

a. inhalation
b. exhalation
c. vital capacity
d. relaxation pressure
e. resting expiratory level
f. checking action

the volume level in lungs at the end of exhalation in tidal breathing, when no respiratory muscles are active
volume level where the forces of contraction of the lungs are balanced by the forces of expansion of the chest wall

e. resting expiratory level (pg.345)

How well did you know this?

Not at all

Perfectly

the average subglottic pressure during speech is ______ in conversational voice

4-6 cm H20 (pg.345)

How well did you know this?

Not at all

Perfectly

relaxation pressure and subglottic pressure are equal at about ____% vital capacity

55 (pg.345)

How well did you know this?

Not at all

Perfectly

true/false: vocal folds open for inhalation and to produce voiceless sounds due to action of the PCAs

true (pg.345 )

How well did you know this?

Not at all

Perfectly

true/false: during voicing/vibration, vocal folds open due to the buildup of air below the vocal folds sufficient to overcome the resistance of the folds and push the tissue upward and apart

true (pg.345)

How well did you know this?

Not at all

Perfectly

vocal folds adduct due to the action of the ___ and ____

lateral cricoarytneoids and the interarytenoids (pg.346)

How well did you know this?

Not at all

Perfectly

true/false: vocal fold vibration occurs when the vocal folds are positioned in the adducted position and airflow from the lungs causes repeated opening and closing

true (pg.346)

How well did you know this?

Not at all

Perfectly

a. normal voice
b. breathy voice
c. whisper

regular bursts of air through the glottal opening
full opening and closing of vocal folds with vibration

a. normal voice (pg.346)

How well did you know this?

Not at all

Perfectly

a. normal voice
b. breathy voice
c. whisper

noise puls air burst
vocal folds partly open and partly closed; closed portion vibrates

b. breathy voice (pg. 346)

How well did you know this?

Not at all

Perfectly

a. normal voice
b. breathy voice
c. whisper

noisy frication airflow
narrow vocal fold opening, no vibration

c. whisper (pg.346)

How well did you know this?

Not at all

Perfectly

a. voiceless b. strained (creaky) c. glottal fry d. glottal stop - noiseless airflow - vocal folds open, no vibration

a. voiceless (pg. 346)

a. voiceless b. strained (creaky) c. glottal fry d. glottal stop - irregular bursts of air through vibrating vocal folds - full vocal folds opening and closing with increased medial compression

b. strained (creaky) (pg. 346)

a. voiceless b. strained (creaky) c. glottal fry d. glottal stop - low frequency irregular air bursts - only a small portion of vocal fold margin opens and closes

c. glottal fry (pg.346)

a. voiceless b. strained (creaky) c. glottal fry d. glottal stop - no vibration at all; stoppage of airflow - folds fully shut with no vibration

d. glottal stop (pg.346)

____ is a series of ranges of consecutively phonated frequencies that can be produced with nearly identical voice quality and that ordinary do not overlap

a. pulse register b. modal register c. loft register - lowest portion of one's phonation range - vocal folds are relaxed and vibrate with minimal subglottic pressure - frequency range is about 30-80Hz - closed phase is greatest protion of the glottal cycle - sometimes heard as glottal fry

a. pulse register (pg.346)

a. pulse register b. modal register c. loft register - the largest portion of one's frequency range, comprise about 1.5 octave - voice quality has the greatest timber and flexibility

b. modal register (pg.346)

a. pulse register b. modal register c. loft register - also known as falsetto, the highest portion of one's range - vocalfolds are stretched and tense, vibrating at their medial edges - airflow rate is increased

c. loft (pg. 346)

- the average cycle-to-cycle change in frequency from one cycle to the next - also known as pitch perturbation

jitter (pg.347)

-average cycle-to-cycle change in amplitude from one cycle to the next

shimmer or perturbation (pg.347)

a. harmonics-to-noise ratio b. long-term average spectrum c. soft phonation index d. voice turbulence index -quantifies the amount of additive noise in the voice signal

a. harmonics-to-noise ratio (pg.347)

a. airflow rate b. subglottic pressure c. glottal resistance d. maximum phonation time - pressure measured below the vocal folds usually during vibration - related to degree of medial compression of the closed vocal folds - associated with the intensity of voice produced

b. subglottic pressure (pg.347)

a. airflow rate b. subglottic pressure c. glottal resistance d. maximum phonation time - is the maximum time a subject can produce a vowel following a deep inhalation - may reflect phonation type in addition to characteristics of breath support for speech - typically improves with practice and/or training

d. maximum phonation time (pg.347)

quality of voice is that perceived by listeners as distinguished from pitch and loudness and sometimes called _______

timbre (pg.347)

stroboscopic and related visual measures a. symmetry b. amplitude c. periodicity d. closed pattern -refers to whether the left and right vocal folds move symmetrically during vibration

a.symmetry (pg.347)

stroboscopic and related visual measures a. symmetry b. amplitude c. periodicity d. closed pattern -the extent of horizontal excursion of the vocal folds during vibration

b. amplitude (pg.347)

stroboscopic and related visual measures a. symmetry b. amplitude c. periodicity d. closed pattern -the regularity of successive cycles of vibration

c. peridoicity (pg.347)

stroboscopic and related visual measures a. symmetry b. amplitude c. periodicity d. closed pattern -the portion of the vocal folds and any space between them during the most closed phase of vibration

d. closed pattern (pg.347) can be described as complete, incomplete, irregular, hour -glass-shaped, with an anterior to posterior chink

stroboscopic and related visual measures a. mucosal wave b. vocal fold edge - corresponds to the movement of the superior surface, or cover, of the vocal fold laterally during vibration - travels about half the width of the vocal fold at typical pitch and loudness

a. mucosal wave (pg.348)

stroboscopic and related visual measures a. mucosal wave b. vocal fold edge -can be described as smooth and even, irregular with an excrescence, etc

b. vocal fold edge (pg.348)

larynx forms from branchial arches ____,____, and _____ and all structures are present at ___ months gestation

4,5,6 and 3 (pg.348)

the vocal ligament is present by age ____ and develops to about age ____

2, 16 (pg.348)

what is ADMET?

aerodynamic myoelastic theory of phonation (pg.348)

what are the 5 mechanisms involved in one cycle of glottal vibration that results in vocal fold vibration in ADMET

1. the adductor muscles (LCA and IA) close the vocal folds while the tenors (CT and TA) stiffen the vocal folds to the desired fundamental frequency 2. as person begins to exhale, sub glottal pressure builds beneath the vocal folds. pressure builds until it is great enough to overcome the resistance of the vocal fold and push the folds open 3. a glottal pulse is released creating an acoustic shock wave traveling through the vocal folds 4. once the folds have been blown open forces of the elastic recoil and the bernoulli effect help to bring the folds back to there original position 5. the opening and closing of the vocal folds during phonation is the result of the aerodynamic and muscular foyers indicated above (pg. 348-349)

what does the cover-body theory of vocal fold vibration state?

- the vocal fold cover moves independently of the body - the TA muscle (body) participates very little in vibratory movement - movement of the vocal ligament falls in between the significant movement of the cover and the minimal movement of the body - this theory suggests that anything that interferes with the movement of the cover will affect the resulting voice quality (pg. 349)

what are common disorders associated with phono trauma?

1. vocal nodule 2. polyps 3. polypoid degeneration (reinke's edema) (pg. 349)

Abuse-Based Disorders of Phonation: a. vocal nodule b. polyps c. polypoid degeneration d. contact ulcers e. vocal fold thickening f. traumatic laryngitis - small nodes that develop on vocal folds and protrude - at first reddish and pinkish - as they develop, turn whitish and grayish - typically appear anterior ⅔ of folds or at junction of folds - more pronounced at first but diffuse over time - increase mass of folds causing slower vibration - usually bilateral

a. vocal nodule (pg.349)

Abuse-Based Disorders of Phonation a. vocal nodule b. polyps c. polypoid degeneration d. contact ulcers e. vocal fold thickening f. traumatic laryngitis - soft masses that grow and bulge - may be filled with fluid or have vascular tissue - tend to be unilateral - Sessile polyps are at base of vocal fold - pedunculated are attached to folds by stalk - can grow over time or happen instantly - more frequently seen in adults than children

b. polyps (pg.350)

Abuse-Based Disorders of Phonation a. vocal nodule b. polyps c. polypoid degeneration d. contact ulcers e. vocal fold thickening f. traumatic laryngitis - crater like sores of unlacerated, granulated tissue that develop - usually bilateral - usually along posterior third of glottal

d. contact ulcers

Abuse-Based Disorders of Phonation a. vocal nodule b. polyps c. polypoid degeneration d. contact ulcers e. vocal fold thickening f. traumatic laryngitis - slow and gradual thickening of anterior 2/3s of folds - precursor to nodules or polyps

e.vocal fold thickening

Abuse-Based Disorders of Phonation: a. vocal nodule b. polyps c. polypoid degeneration d. contact ulcers e. vocal fold thickening f. traumatic laryngitis -irritation to folds that causes swelling.

f. traumatic laryngitis

Physically and Neurologically Based Disorders of Phonation: - Localized, inflammatory vascular lesion usually composed of granular tissue in a firm rounded sac - often ass. w/contact ulcers a. Hyperkeratosis b. Granuloma c. Leukoplakia d. Hemangioma e. Laryngomalacia

b. Granuloma

Physically and Neurologically Based Disorders of Phonation: -similar to granulomas but soft, pliable and filled with blood a. Granuloma b. Leukoplakia c. Hyperkeratosis d. Hemangioma e. Laryngomalacia

d. Hemangioma

Physically and Neurologically Based Disorders of Phonation: - benign growths of thick, whitish patches - considered precancerous can develop into squamous cell carcinoma a. Leukoplakia b. Granuloma c. Hyperkeratosis d. Hemangioma e. Laryngomalacia

a. Leukoplakia

Physically and Neurologically Based Disorders of Phonation: - rough , pinkish lesion - often benign but precursors to malignancy a. Leukoplakia b. Granuloma c. Hyperkeratosis d. Hemangioma e. Laryngomalacia

c. Hyperkeratosis

Physically and Neurologically Based Disorders of Phonation: - aka congenital laryngeal stridor - soft, floppy cartilages - when child breathes, epiglottis resists airstream causing stridor a. Leukoplakia b. Granuloma c. Hyperkeratosis d. Hemangioma e. Laryngomalacia

e. Laryngomalacia

Physically and Neurologically Based Disorders of Phonation: -narrowing of subglottic space a. Subglottal Stenosis b. Papilloma c. Laryngeal Trauma d. Laryngeal Web

a. Subglottal Stenosis

Physically and Neurologically Based Disorders of Phonation: -many kinds of injury a. Subglottal Stenosis b. Papilloma c. Laryngeal Trauma d. Laryngeal Web

c. Laryngeal Trauma

Physically and Neurologically Based Disorders of Phonation: -membrane that grows across anterior portion of epiglottis a. Subglottal Stenosis b. Papilloma c. Laryngeal Trauma d. Laryngeal Web

d. Laryngeal Web

Physically and Neurologically Based Disorders of Phonation: - occur primarily in children - wart like growths - pink, white or both a. Subglottal Stenosis b. Papilloma c. Laryngeal Trauma d. Laryngeal Web

b. Papilloma

Physically and Neurologically Based Disorders of Phonation: - focal laryngeal dystonia - average onset is between 40-50 - reated by intermittent, involuntary, fleeting vocal fold abduction during phonation. a. Paradoxical Vocal Fold Motion Disorder (PVFMD) b. GERD c. Paralysis and Ankylosis d. Abductor Spasmodic Dysphonia

d. Abductor Spasmodic Dysphonia

Physically and Neurologically Based Disorders of Phonation: - gastric contents empty into esophagus w/o belching or vommiting - can cause contact ulcers or other vocal fold changes a. Paradoxical Vocal Fold Motion Disorder (PVFMD) b. GERD c. Paralysis and Ankylosis d. Abductor Spasmodic Dysphonia

b. GERD

Physically and Neurologically Based Disorders of Phonation: - paralysis - in unilateral paralysis, fold can be static toward midline or far from midline, causing aphonia - bilaterial-when both fold paralyzed open, leads to aphonia. If paralyzed in adducted position, pt struggles for breath - ankylosis-stiffening of joints of arytenoids a. Paradoxical Vocal Fold Motion Disorder (PVFMD) b. GERD c. Paralysis and Ankylosis d. Abductor Spasmodic Dysphonia

c. Paralysis and Ankylosis

Physically and Neurologically Based Disorders of Phonation: - -aka laryngeal dyskinesia and episodic paroxysmal laryngospasm - inappropriate closure/adduction of the true vocal folds during inhalation, exhalation, or both. a. Paradoxical Vocal Fold Motion Disorder (PVFMD) b. GERD c. Paralysis and Ankylosis d. Abductor Spasmodic Dysphonia

a. Paradoxical Vocal Fold Motion Disorder (PVFMD)

what are the 3 types of spasmodic dysphonia?

- adductor SD - abductor SD - mixed SD (pg. 354)

a. adductor SD b. abductor SD c. mixed SD - patients experience irregular, uncontrolled, random closing spasms of the vocal folds during phonation - resulting voice is often referred to as strained-strangled

a. adductor SD (pg.354)

a. adductor SD b. abductor SD c. mixed SD -experiences irregular, random, uncontrolled opening of the vocal folds and the voice is hears as more breathy

b. abductor SD (pg.354)

true/false: SD may be difficult to differential diagnose from muscle tension dysphonia, or patients may experience muscle tension dysphonia which confound the effect of SD

true (pg.354)

what is though to result from a lesion in the extrapyramidal system of the central nervous system?

essential tremor of the voice (pg. 354)

true/false: vocal tremor worsens with fatigue or strong emotion

true (pg.354)

true/false: there is currently no treatment that has been uniformly efficacious for patients with voice tremor

true (pg. 354)

_____ injections slightly reduce the frequency and amplitude of the tremor ,but the effect is only temporary for essential tremor of the voice

Botox (pg.354)

true/false: speech therapy to maximize intelligibility may be helpful for essential tremor

true (pg.354)

what are some strategies to be addressed during speech therapy for essential tremor?

1. shortening vowel duration 2. shortening phrases length 3. elevating pitch (pg. 354)

a. laryngomalacia b. subglottic stenosis c. laryngeal wed - most common congenital laryngeal disorder - cartilages collapse inward causing stridor and respiratory distress - sometimes surgery to protect the airway is performed

a. laryngomalacia (pg.354)

the most common voice problem in children is ________

bilateral vocal nodules (pg.355)

true/false: surgery is often recommended in children with bilateral vocal nodules

false: surgery is rarely recommended in children, although reflux management may be recommended (pg. 355)

what are the 4 populations who are high risk of voice disorders

1. professional voice users 2. transgender individuals 3. persons with velopharyngeal incompetency 4. persons with hearing loss (pg. 355-356)

focusing on ____ is the most common, specific feature targeted in therapy, but the overall goal is to modify the overall _____ and _____ projected by the transgender patient

fundamental frequency, image and identity (pg. 355)

why are people with velopharyngeal incompetency at risk for voice disorders?

- they will attempt to compensate for the poor closure by excessive closing of the laryngeal valve - this repeated hyper function may result in formation of traumatic lesions on the vocal folds (pg. 355)

true/false: the patient should see the speech pathologist before a medical diagnosis

false: only after a medical diagnosis (pg.356)

the international classification of functioning are categorized into what 3 inter-connected areas?

1. impairments 2. activity limitations 3. participation restrictions (pg. 356)

a. impairment b. activity limitations c. participation restrictions -problems in body function or alteration in body structure

a. impairment (pg.356)

a. impairment b. activity limitations c. participation restrictions -difficulty in executing activities

b. activity limitations (pg.356)

a. impairment b. activity limitations c. participation restrictions -problems with involvement in any area of life

c. participation restrictions (pg. 356)

a. GRBAS b. CAPE-V - grade, rough, breathy, asthenic and strained - most common measurement tool used worldwide for estimating voice quality

a. GRBAS (pg. 356)

a. GRBAS b. CAPE-V -clinicians rate voice quality features in 3 contexts (vowels, six specified sentences, conversation) on a 100 mm visual analog scale

b. CAPE-V (pg.357)

a. maximum phonation time b. airflow rate c. estimates of subglottic pressure d. laryngeal airway resistance -the max time an individual can prolong a vowel on one breath of air

a. max phonation time (pg.357)

what are 5 guidelines for good vocal health?

1. rare or minimal use of loud, effortful voice 2. attention to potential larygo-pharyngeal reflux 3. reducing unnecessary coughing and throat-clearing 4. adequate hydration 5. holistic elements: good nutrition, enough rest, regular physical exercise, good mental health (pg. 358)

a. resonant voice therapy b. botox c. vocal function exercise -focuses on optimizing voice quality through a focus on maximizing oral-pharyngeal resonance and the degree of medial compression between the vocal folds

a. resonant voice therapy (pg.358)

a. resonant voice therapy b. botox c. vocal function exercise -injection into thyroarytenoid or other intrinsic muscles for treatment of spasmodic dysphonia and sometimes essential tremor of the voice

b. botox (pg.358)

a. resonant voice therapy b. botox c. vocal function exercise -have been shown to be useful in improving vocal range, stability, flexibility and resonance in a variety of normal and disordered populations

c. vocal function exercise (pg.358)

what are the effects related to surgery?

1. loss of function related to excised tissues, including effects on speech and swallowing (pg. 359)

what are the effects related to chemotherapy?

1. fatigue, nausea, loss of appetite, change in case and potentially hair loss (pg. 359)

a. supra-glottic laryngectomy b. partial laryngectomy c. semi-laryngectomy -any surgery that involves removing part of the voice producing mechanism

b. partial laryngectomy (pg.360)

a. supra-glottic laryngectomy b. partial laryngectomy c. semi-laryngectomy -the structures and tissues above the level of the true vocal folds are surgically removed

a. supra-glottic laryngectomy (pg.360)

a. supra-glottic laryngectomy b. partial laryngectomy c. hemi-laryngectomy -a vertical portion of laryngeal tissue is resected

hemi-laryngectomy (pg.360)

true/false: glossectomy refers to the surgical recoil of tongue tissue

true (pg.361)

Instrumental Evaluation: - views velopharyngeal mechanism, including velopharyngeal valving and laryngeal mechanism - 2 types of _________-flexible(nasally) and rigid (nasally) - light and camera attached to scope a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

d. Endoscopy

Instrumental Evaluation: - acoustic measurement of voice - spectrogram reflects resonant characteristics of vocal tract and harmonic nature of glottal sound source - sound spectrograph is graphic representation of wave’s intensity and frequency a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

e. Acoustic Analysis

Instrumental Evaluation: - excellent view of vocal mechanism during phonation - thin, flexible tubing containing fiber-optic light bundles - tube inserted through nasal passage, passes over velum and into position above larynx - Transmits image to eyepiece a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

c.Flexible Fiber-Optic | Laryngoscopy

Instrumental Evaluation: - direct microscopic view of larynx - performed by surgeon - laryngoscope introduced through mouth into pharynx and positioned about vocal folds. - valuable when biopsy is required a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

b. Direct Laryngoscopy

Instrumental Evaluation: - Views laryngeal structures during phonation - Uses bright light source and small round mirror - Lift velum and press against posterior pharyngeal wall a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

a. Indirect Laryngoscopy

Instrumental Evaluation: - info about periodicity or regularity of vocal fold vibrations, vocal fold amplitude, glottal closure, presence and adequacy of mucosal wave and possible presence of lesions or neoplasm - helpful in differentiating between functional and organic problems - gives picture of cycle to cycle vibration - strobe light permits optical illusion of slow motion viewing of vocal folds a. Indirect Laryngoscopy b. Direct Laryngoscopy c.Flexible Fiber-Optic Laryngoscopy d. Endoscopy e. Acoustic Analysis f. Videostroboscopy

Videostroboscopy

Instrumental Evaluation: - visualizes human vocal fold vibration dynamics - medical imaging - uses videocamera - allows for view of vocal fold asymmetries, problems with mucosal waves, and movement of upper and lower margins of vocal folds. a. Electroglottography (EGG) b. Electromyography (EMG) c. Videokymography d. Aerodynamic Measurements e. Pitch Measurements

c. Videokymography

Instrumental Evaluation: - measures laryngeal function directly to study pattern of electrical activity of vocal folds and view muscle activity patterns - electrodes inserted into peripheral laryngeal muscles - can verify excessive muscle activity, help determine vocal fold pathology. a. Electroglottography (EGG) b. Electromyography (EMG) c. Videokymography d. Aerodynamic Measurements e. Pitch Measurements

b. Electromyography (EMG)

Instrumental Evaluation: - airflows, air volumes, average air pressure as produced by respiratory, laryngeal and supralaryngeal airways. - used to evaluate dysphonia, monitor voice changes, differentiate between laryngeal and respiratory problems a. Electroglottography (EGG) b. Electromyography (EMG) c. Videokymography d. Aerodynamic Measurements e. Pitch Measurements

d. Aerodynamic Measurements

Instrumental Evaluation: - indirect measure of vocal fold closure patterns - surface electrodes are placed on both side of thyroid cartilage and high-frequency current is passed between while patient phonates - -can detect breathy and glottal phonation - currently efficacy is controversial a. Electroglottography (EGG) b. Electromyography (EMG) c. Videokymography d. Aerodynamic Measurements e. Pitch Measurements

a. Electroglottography (EGG)

Instrumental Evaluation: -many instruments can be used Quantitative measurements of pitch characteristics a. Electroglottography (EGG) b. Electromyography (EMG) c. Videokymography d. Aerodynamic Measurements e. Pitch Measurements

e. Pitch Measurements

total volume of air in lungs

Total lung capacity

volume of air that patient can exhale after maximal inhalation

Vital capacity

amount of air inhaled and exhaled during normal breathing cycle

Tidal volume

Perceptual evaluation

``` pitch loudness resonance respiration phonation ```

When sound from nasal consonant arries into adjacent vowels Velar openings begin too soon and last too long Functionally or organically based

Assimilative Nasality

Types of alaryngeal speech

external devices esophageal surgical modifications

Tracheoesophageal puncture (TEP)-

Tracheoesophageal puncture (TEP)-tracheoesophageal wall that separates trachea and esophagus is punctured and a shunt connects the structures. To speak pt exhales and closes stoma with finger, air enters through opening of tube, passing from trachea and esophagus. Esophagus vibrates and sound is produced.

Mutational falsetto or puberphonia

high pitch in a man after puberty and a man has developed properly

“Functional”

- Occurs when voice is abnormal in the presence of normal laryngeal structures - During attempt to phonate, folds may remain fully or partially abducted. - Hysterical or conversion aphonia, no evidence of structural pathology.

Open-mouth approach

- increases volume | - imrpoves oral-nasal resonance balance

Relaxation Exercises

-reduces tension

Chant-talk method

wprds are spoken in connected manner, with soft glottal attack, even stress, prolongation of sounds and absence of stress on words.

Digital manipulation of larynx

lowers pitch | decreases tension

treatment of Mutational falsetto or puberphonia

digital manipulation

Average MPT for adults

20.9-24.6

fundamental frequency

habitual pitch

pitch

frequency of vocal fold vibration frequency perturbation or jitter

volume

loudness determined by intensity of sound amplitude perturbation or shimmer

sound

disturbance of particles that move in waves called amplitude

quality

hysical complexity of layngeal tone modifeid by resonating cavitities

Which instrumental evaluation can give you a quantatative analysis of analysis for speech?

Acoustic analysis in the form of a spectrogram.

How much varaition should a patient have of intensity with each vibratory cycle?

very little or none.

How is shimmer measured?

pt sustains "ahhh"

How much variation in shimmer will make a patient sound dysphonic?

1 dB

How is jitter measured?

pt. sustains an "ahhhh"

How is pitch determined?

mass, tension, and length of vocal folds.

People with no vocal pathology are able too sustain a vowel with less that ____% jitter.

What kind of patients show a large amount of jitter?

dysphonic, hoarse, tremor.

Is it ok to advise a transgender client to have surgery?

yes

What is the injection method?

1. pt impounds air in the mouth 2. impounded air is pushed into the esophagus and then expelled, producing vibrations of the soft tissue of the esophagus 3. resulting belch is shaped into speech

What is the inhalation method?

1. pt is taught to inhale rapidly while keeping the esophagusopen and relaxed 2. relaxed air passes through the esphogusand sets its tissues into vibratory motion. 3. resulting sound is shaped into speech

What does the Bloom-singer device do?

prevents passage of fluid and food into the trachea and shunts air from the trachea to the esophagus so the patient can speak on that air.

Which muscles of the larynx are primarily responsible for controlling vocalization?

Intrinsic (thyroarytenoids, cricothyroids)

What are the intrinsic muscles of the larynx?

``` thyroarytenoids cricothyroids posterior cricoarytenoids lateral cricoarytenoids transverse arytenoids oblique arytenoids ```

Which muscles of the larynx impact pitch?

infrahyoid

Which muscles of the larynx elvate that larynx?

suprahyoid