Voice Midterm_LMenchini Flashcards
(130 cards)
1
Q
definition: organic voice disorders
A
result from a physical condition and not secondary to vocal misuse/abuse
2
Q
systems of voice production?
A
- articulatory system - resonance
- laryngeal system - vf vibration
- respiratory system - outgoing airflow for egressive sounds and relatively constant Psg
3
Q
location: laryngeal system
A
suspended from hyoid bone
b/t artic and resp. systems
sits on top of the trachea
4
Q
primary function: laryngeal system
A
control airflow into and out of lungs
prevent food and fluid from entering airway
5
Q
secondary function: laryngeal system
A
voice production
6
Q
voice tells us about…
A
- laryngeal pathology
functional, organic, or neurogenic - whole person
emotions
7
Q
describe: aspiration penetration and choking
A
aspiration- entered lungs
penetration- at level of vf
choking- entered larynx
8
Q
GERD:
symptoms?
structural changes?
A
(organic - LPR)
symp: primary = hoarsness
others = heartburn, sore throat, chest pain, bad breath with sour taste, freq. clearing and throat coughing
structural changes= posterior glottal redness–> contact ulcers–> granulomas
9
Q
granuloma
causes?
how formed?
effect on voice?
A
(organic disorder - ext. of contact ulcers)
causes: primarily by intubation, others are vocal abuse, laryngeal injury, and GERD
how: damaged vocal process mucosa–> ulcer–> granuloma
effect: breathy and hoarse, need to clear throat
10
Q
definition: contact ulcers
A
chronic inflammatory disease of the larynx
functional - MTD
11
Q
definition: granuloma
A
granular tissue in a rounded sac that is an extension of contact ulcers
12
Q
contact ulcers: effect on voice
A
hoarse
pain in laryngeal area
vocal fatigue
freq. throat clearing
(functional - MTD)
13
Q
acquired laryngeal web
cause:
symptoms:
A
caused by bilateral trauma to medial edges of vf
symptom: high pitch, hoarsness, SOB
(organic)
14
Q
Reinke’s edema:
definition-
location-
cause-
effects-
A
def - accumulation of fluid (edema) in Reinke’s space
loc-bilaterally @ anterior 2/3 of vf
cause - long term cig. smoking
effects - more frequent in women, low pitch and hoarseness, possible SOB
(organic)
15
Q
symptoms of laryngeal cancer:
A
primary: persistent hoarseness
others: lump in neck, broadening of larynx, pain in laryngeal area swallowing difficulty, pain on swallowing
16
Q
elevator and depressor: (describe)
A
- thyrohyoid m. - elevates thyroid up and depresses hyoid down
- cricopharyngeus m. - sphincter on top of esophagus that goes from cricoid to pharyngeal walls. It allows for swallowing and is the source of esophageal speech
(extrinsic laryngeal m.’s)
17
Q
describe: arytenoids
position -
function -
A
(paired laryngeal cartilages)
posteriorly on top of cricoid
muscle process, vocal process, apex
18
Q
definition: functional (conversion) aphonia
A
complete absence of voice without laryngeal pathology
19
Q
pharyngeal nerve: damage symptoms
A
efferent: hypernasality (velum isn’t contracting and cannot elevate) and nasal regurgitation: again velum isn’t elevating so food is escaping through nasal cavity
afferent: swallowing difficulty: loss of sensation of when bolus triggers reflex to swallow so may not know when to
20
Q
describe: pharyngeal nerve
A
(branch of vagus X)
efferent: delivers motor commands to all velopharyngeal m. except the veli tensor palatine
afferent: sensations of upper pharynx and base of tongue sent to CNS
21
Q
laryngeal cancer:
TNM system
A
for classification and treatment:
T- site of primary tumor
N- involvement of lymph nodes (if spread)
M- metastasis (Secondary locations)
22
Q
puberphonia:
aka?
what?
voice?
A
aka: falsetto, mutational falsetto, incomplete mutation of voice
voice disorder when used as primary voice by males/females w/o endocrine/structural disorders
breathy, unnatural, too high for speaker
(psychogenic vd - functional)
23
Q
congenital laryngeal web
cause?
symptoms?
A
cause: incomplete maturation of larynx (at birth)
symptoms: weak high pitched cry, stridor, SOB
24
Q
GERD affects ____ b/c of gravity
A
cartilaginous portion of vf
25
definition: laryngeal cancer
malignant condition affecting the supraglottal, glottal, and/or subglottal areas
26
contact ulcers
what?
cause?
location?
(functional - MTD)
what? chronic inflammatory disease of the larynx
cause? 3 main causes: 1. slamming together of the arytenoids (FD), intubation (OD), GERD (OD)
location? ulcerations along posterior 1/3 of vf
27
describe the functional disorder of contact ulcers:
hard glottal attacks as habitual way of contacting vf
28
vocal nodules
| on voice:
breathy and hoarse, sensation of something on vf, need to clear throat
(functional MTD)
29
damage symptoms:
| superior laryngeal n.
(branch of Vagus X)
afferent: loss of sensation in upper larynx - may not know if something is caught in larynx
efferent: monopitch - cricothyroid m. no longer contracting
30
how to treat vocal nodules:
initially, with voice behavioral therapy (when soft)
| later it is through surgery but always work on behavior therapy prior to the surgery
31
glottal vs subglottal
glottal = level of vf / subglottal= beneath the glottis. cricoid, trachea
32
perceptual signs of voice problems: loudness
monoloudness, reduced loudness range, loudness variation
33
laryngeal changes w/ age:
F0?
vf length?
F0 females: higher
F0 males: lower
Length females: shorter
Length males: longer
34
F0, jitter, shimmer, MPT:
children
female/male adults
female/male elderly
children: 240-290Hz, up to 1%, 13-21sec
f. adult: 200-250Hz, up to 1%, 16-35sec
m. adult: 100-150Hz, up to 1%, 16-35sec
f. elderly: lower, up to 1%, 10-20sec
m. elderly: slightly higher, up to 1%, 10-20sec
35
ex: organic voice disorders
```
laryngeal cancer
GERD
granulomas
Reinke's edema
Laryngeal web
```
36
definition: laryngeal web
thin membrane forms across glottis in anterior-posterior direction
37
what is intubation?
insertion of a tube posterior portion of vf for feeding or breathing purposes. Primary cause for granulomas
38
cricopharyngeus m.
source of vibration in esophageal speech
| extrinsic laryngeal m. elevator&depressor
39
describe myo-elastic aerodynamic theory of phonation
1. adductor m. (posterior cricoarytenoid m.) adducts the vf and vibration begins
2. Psg builds up beneath closed vf, and once it reaches 3-6cmH2O the vf burst open
3. Due to elasticity and Bernoulli effect (as air travels from area of high vol. to low vol., speed will increase and cause decrease in pressure - vf stick shut)
4. Abductor m. (lateral cricoarytenoid m. and transverse/oblique interarytenoid m.) abduct aryt. and vibration ends
40
paramedian
1 vf is paralyzed in between abducted and median positions
41
laryngeal cancer:
accounts for?
causes?
threats?
voice?
: 6% of malignancies diagnosed annually in the US
: smoking, alcohol, GERD, environmental influences (asbestos), combo of these
: serious threat to airway adequacy
: depends on position of tumor (TNM)
42
what is considered misuse/abuse?
1. excessive talking/shouting
2. cheering
3. hard glottal attacks
4. inappropriate pitch level
5. prolonged loudness
6. excessive throat clearing/coughing
7. the "screamer"
8. talking in noisy environment
43
individuals w/ functional aphonia speak with ____
clear whisper
44
conversion reaction
psychological issue manifests itself physically in some way
ex: stressed-->sick-->lose voice
(apart of functional (conversion) aphonia.
functional -PVD)
45
aryepiglottic folds
folds that go from the sides of the epiglottis to the arytenoids. Cuneiform cartilage found inside of them
46
diplophonia
producing 2 F0's at the same time due to second source of vibration. Symptom seen in vocal polyps because of the sessile or pedunculated polyp vibrating
47
definition: puberphonia (aka)
voice disorder when used as primary voice by males/females without endocrine/structural disorders (falsetto, mutational falsetto, incomplete mutation of voice)
48
pitch
perceptual correlate of frequency(Hz). It is subjective
49
functional aphonia aka..
```
conversion aphonia
(functional - PVD)
```
50
descrive: superior laryngeal nerve
(branch of Vagus X)
afferent: internal branch and upper larynx sensation
efferent: external branch and cricothyroid m. motor commands
51
progression of functional voice disorders:
misuse/abuse (MTD) --> structural change (PVD) --> voice disorder --> social, personal, emotional or occupational problems
52
definition: GERD
gastroesophageal refulx disease: overflow of gastric juices from stomach into esophagus when person has not vomited for belched
53
definition: functional voice disorders
normal mechanism used in faulty manner
54
perceptual signs of voice problems: pitch
monopitch
inappropriate pitch
pitch breaks
reduced pitch range
55
examples: Functional Voice Disorders
```
vocal nodules (MTD)
vocal polyps (MTD)
contact ulcers (MTD)
puberphonia (PVD)
functional (conversion) aphonia (PVD)
```
56
3 Groups of Voice Disorders
functional, organic, and neurogenic
57
hyoid:
- shape
- purpose
- attachments-
- horseshoe shaped
- provides support for tongue root
- inferior attach 4 tongue muscles, superior attach 4 extrinsic laryngeal m.
58
how does the afferent component of the Pharyngeal Nerve relate to swallowing?
because included is the upper pharynx, and base of tongue. In that area is the trigger for when we sense the bolus and swallow. Thus lifting the larynx, flipping the epiglottis, and elevating the velum
59
dysphonia VS. aphonia
dysphonia= reduced voiced but not a complete loss of voice (breathy)
aphonia= complete absence of voice
60
vocal nodules:
what?
cause?
location?
appearance?
most common benign growths on the vf
caused by continuous misuse/abuse of voice
bilaterally, @ the anterior-middle third junction
initially soft, later hard
61
definition: organic voice disorders
result from a physical condition and not secondary to vocal misuse/abuse
62
```
vocal polyps:
what?
cause?
location?
appearance?
```
(FD-MTD)
masses along the vocal folds
single traumatic event--> hemorrhage-->polyp
unilateral @ anterior-middle third junction
softer than nodules often filled with fluid
63
what are the two types of vocal polyps?
what are polyps affect on voice?
(FD-MTD)
1. sessile- broad base
2. pedunculated- stem as base
breathy and hoarse
possible diplophonia
64
who has higher risk of developing contact ulcers and granuloma?
those with GERD/LPR
65
vocal nodules vs. vocal polyps
VN: bilateral @ anterior-middle third junction, caused by continuous vocal misuse/abuse, most common benign growths, initially soft but later hard
VP: unilateral @ anterior-middle third junction, single traumatic event-hemorrhage-polyp, masses on the vf, softer than nodules & fluid filled
66
modal register (aka)
chest register- speaking in one's comfortable and habitual F0
67
median
position where arytenoids and vf are at the midline (adducted)
68
2 types of functional voice disorders are?
muscle tension dysphonia- misuse/abuse of the voice that leads to structural changes and reduced voice
psychogenic voice disorder- psychological reasons for not using our mechanisms adequately
69
fundamental frequency (F0)
frequency of vf vibration (Hz)
70
incidence of voice disorders:
- children
- adults
- professional voice users
- elderly
- 6-9%
- 3-9%
- 30%
- 47%
71
perceptual signs of voice problems: in quality
hoarseness, breathiness, harshness, strain-strangle, tremor
72
how does the artic. system provide resonance?
by movements of the velum it gives a degree of nasality. elevated = oral cavity/ lowered= nasal cavity
73
what are the systems of voice production? and how do they apply?
articulation=resonance, phonation=voice production (when needed), respiration= outgoing airflow for egressive sounds and constant Psg
74
edema
accumulation of fluid
75
2 types of laryngeal web:
1. congenital 2. acquired
76
LPR (definition)
laryngopharyngeal reflux: flow of gastric juices from esophagus into pharyngolaryngeal area (OD)
77
describe: recurrent nerve
efferent component: sends motor commands to all intrinsic laryngeal m. except the cricothyroid m.
78
supraglottal
above the glottis (FVF, epiglottis, aryepiglottic folds)
79
voice quality: effects
1. effects of resonance: hypernasilty (too much) or hyponasality (too little)
2. effects of vf: breathiness, harshness, hoarseness, strain-strangle, tremor
80
describe nerve for laryngeal innervation
Vagus n. (X)- brings motor commands from CNS to larynx, and sensations from larynx to CNS
has many branches: "wanderer" distributed through neck thorax and abdomen
many branches: SLN, RN, Pharyngeal n.
81
adjustments in loudness/intensity:
increase Psg = louder speech (vf in contact longer and more forceful breath)
decrease Psg= softer speech (vf in contact less and softer breath)
82
shimmer
intensity perturbation. ex: old people voices
83
vestigular
has little or no function at all (FVF, corniculate)
84
infant larynx vs. adult larynx
infant= cricoid at C1-3 level (higher in neck), cartilage more elastic, higher F0 (500Hz cry at birth), shorter vf (3mm)
adult= cricoid at C4-6 level (lower in neck), cartilage more osseous, lower F0, longer vf (15-25mm)
85
jitter
frequency perturbation (waking up in morning)
86
what are the false vocal folds?
aka the ventricular folds. Have no function in phonation. When they start to mimic the TVF that means the TVF aren't working adequately
87
vocal fold physiology = ?
= 2 types of movement
1. adduction + abduction
2. vibration: open and closed
88
dysphonia
reduced voice but not a complete absence of voice (breathy)
89
MPT =
maximum phonation time (sec). Duration of phonation on one breath (children=13-21sec, adults=16-35sec, elderly=10-20 sec)
90
describe: cuneiform
(paired laryngeal cart.) found within the aryepiglottic folds that give support to the aryepiglottic folds
91
loft register (aka)
(falsetto)- speaking in a F0 higher than what is our comfortable F0. Voice too high - more effort
92
cover vs. body?
refers to vf movement (vibration). Cover = most movable (epi+superficial) body= least movable (thyroarytenoid m.)
93
voice is seperate from ____
breathing
94
anatomy of F0: males vs females
```
males= 100-150Hz, 15-20mm
females= 200-250Hz, 20-25mm
```
95
describe: neurogenic
results from neurological damage and or muscle weakness
96
how does respiratory system contribute to: voice production?
by providing outgoing airflow for egressive sounds and keeping a relatively constant Psg (increase in Psg=louder/decrease= softer)
97
depressors:
(extrinsic laryngeal m.)= sternohyoid, omohyoid, sternothyroid
98
damage symptoms: recurrent nerve
1. unilateral damage:
- breathiness: 1 vf paralyzed closer to abducted position
2. Bilateral damage:
- aspiration: both vf paralyzed in abd. position so open for anything to enter
- laryngeal stridor: both vf paralyzed too close to midline. Hear voice in inspiration
- limited pitch range: thyroarytenoid m. not working adequately
99
vocal fold anatomy=
1. function: cover (epi+superficial), transition (intermediate+deep) body (thyroarytenoid)
2. histology: epithelium, superficial intermediate and deep layers of lamina propria, thyroarytenoid m.
100
describe: extrinsic laryngeal muscles
- position
- primary function
- one attachment on the larynx, one outside
| - for support and positioning of the larynx
101
describe: cricoid
individual laryngeal cartilage. most inferior, sits on top of trachea. Wide posteriorly and narrow anteriorly
102
postion of vf:
abducted: aryt. and vf away from midline
paramedian: 1 vf between abd and add pos.
median/adducted: aryt. and vf are at the midline
103
cricopharyngeus m.:
- what is it
- location
- function
- extrinsic laryngeal muscle: elevator and depressor
- sphincter located on top of the esophagus that goes from cricoid to pharyngeal walls
- it allows for swallow, and is the source of vibration in esophageal speech
104
describe: corniculate
(paired laryngeal cart.) forms of the apex of the arytenoids and is vestigular-no function
105
incidence vs. prevalence
```
I= amount of VD over a period of time
P= amount of VD in that exact moment in time
```
106
extrinsic laryngeal muscles: (definition too)
(one attachment on and one outside the larynx)
elevators: digastric, geniohyoid, mylohyoid, stylohyoid, genioglossus, hyologlossus
depressors: sternohyoid, omohyoid, sternothyroid
elevator + depressor, thyrohyoid, cricopharyngeus m.
107
describe thyroid:
largest laryngeal cartilage. Is individual and shield-like closed anteriorly and closed posteriorly
108
adjustments in pitch/F0:
1. thin and tense (longer): higher pitch (vibrates faster)
| 2. thick and relaxed (shorter)= lower pitch (vibrates slower)
109
aspiration vs penetration vs choking
a: has entered lungs
p: at the level of the vf
c: stuck in larynx
110
superior and inferior attachments of: the hyoid bone
superior: extrinsic laryngeal m.
inferior: for tongue m.
111
loudness
perceptual correlate of intensity (dB)
112
the elevators:
(extrinsic laryngeal m.): digastric, geniohyoid, mylohyoid, stylohyoid, genioglossus, hyoglossus
113
pulse register (aka)
(glottal/vocal fry): going below our comfortable pitch range so our vf begin to pulse do to inadequate length
114
determining the ___ is essential for ____
cause -- treatment
115
instrinsic laryngeal muscles: (definition too)
(both attachments on the larynx)
- adductors: lateral cricoarytenoid m., transverse and oblique interarytenoid m.
- abductor: posterior cricoarytenoid m.
- tensors: pars recta and pars oblique cricothyroid m., thyroarytenoid (vocalis) m.
116
quality
distinctive characteristic of voice exclusive of its pitch and loudness
117
voice tells us about:...
1. laryngeal pathology: functional, organic, neurogenic
| 2. whole person: emotions
118
glottis
anterior 2/3 are muscular, posterior 1/3 is cartilaginous
119
Reinke's space
(aka superficial layer of lamina propria) it is the space between the epithelium and intermediate layer of lamina propria
120
what is the larynx built of?
1. cartilages, 2. one bone, 3. muscles (intrinsic and extrinsic), 4. ligaments/membrane
121
epiglottis: describe
- location
- function
- goes from thyroid to arytenoid cartilages (individual)
| - prevents food/liquid from entering larynx
122
why is the posterior 1/3 of the ___, ___?
glottis = caritlaginous because the vocal processes of the apex are made of cartilage
123
the laryngeal cartilages:
epiglottis, thyroid and cricoid (individual)
| arytenoids, corniculate, cuneiform (paired)
124
GERD, stands for?
gastroesophageal reflux disease
125
theory of phonation:
myoelastic-aerodynamic theory of phonation
126
myo-elastic aerodynamic theory of phonation picture?
goes to 1. adducted and closed--> 2. adducted and open-->3. abducted
127
the fluid inside a polyp is?
jelly-like
128
swallowing difficulties may occur due to ___ damage?
laryngeal cancer, recurrent nerve damage, and pharyngeal nerve damage
129
2 typical perceptual signs for: vocal nodules?
breathiness and hoarseness
130
the contraction of the thyrohyoid m....
elevates the thyroid and depresses the hyoid
