1
Q
Framework of the larynx (bone(s) and cartilage(s)) (7):
A
- Hyoid bone (only bone in the larynx, a “floating” bone)
- Epiglottis
- Thyroid cartilage
- Corniculate cartilages
- Arytenoid cartilages
- Cuneiform cartilages
- Cricoid cartilage
2
Q
Hyoid bone
A
- only floating bone in body besides patella (knee cap)
- Osseous
- U-shaped (opens posteriorly)
- Supports tongue and serves as attachment point for 9 muscles
- Three elements of the hyoid bone
- Corpus/body of hyoid is shield-like structure that forms the front of the bone
- Corpus is the point of attachment for 6 muscles
3
Q
Epiglottis
A
– leaf-like cartilage that acts as a protective structure when it inverts to cover the laryngeal opening during swallowing
4
Q
Thyroid cartilage
A
– largest of the laryngeal cartilages
5
Q
Arytenoid cartilages
A
- ride on the high-backed upper surface of the cricoid cartilage, forming the posterior point of attachment for the vocal folds
- 2 processes attach (Vocal and Muscular)
- Provide attachments for the Thyromuscularis and Thyrovocalis
6
Q
Corniculate cartilages
A
– sit at the apex of the arytenoid cartilages, horn-like shaped
7
Q
Cuneiform Cartilages
A
– paired wedge-shaped rods embedded within the aryepiglottic folds
8
Q
Cricoid cartilage
A
– complete ring sitting on top of the trachea, on lateral view it gives the appearance of a signet ring (back arches up relative to the front)
9
Q
2 Processes attached to the arytenoid cartilages:
A
- Vocal process
2. Muscular process
10
Q
Function and location of the Vocal process:
A
– projects anteriorly toward the thyroid notch, the vocal folds attach here
11
Q
Function and location of the Muscular process:
A
– point of attachment for muscles that adduct and abduct the vocal folds
12
Q
Laryngeal membranes (3):
A
- Intrinsic ligaments
- Quadrangular membranes (paired)
- Conus elasticus connects the thyroid, cricoid and arytenoids cartilages
13
Q
Intrinsic ligaments (location:
A
connect the cartilages of the larynx and form the support structure for the cavity of the larynx as well as the vocal folds
14
Q
Quadrangular membranes (paired) (location):
A
are the upper portion of the elastic membrane lining the larynx
15
Q
Conus elasticus (location):
A
connects the thyroid, cricoid and arytenoids cartilages
16
Q
Arytenoid Folds (location):
A
- Folds of mucous membrane which enclose ligamentous and muscular fibers, extend from the sides of the epiglottis to the apexes of the arytenoid cartilages
- Form the entrance to the larynx
- Connect the arytenoids and the epiglottis
17
Q
Vocal folds:
A
- composed of five layers of tissue
- Thin sheet of squamous epithelium (gives VFs glistening white appearance)–>healthy VFs = white
- Deep to this layer is the lamina propria which is comprised of three different tissues
- The fifth layer of the VFs is the Thyrovocalis muscle.
18
Q
5 layers of the true vocal folds:
A
- Epithelium
- Lamina propria
- ->Superficial layer
- ->Intermediate layer
- ->Deep layer
- Thyroarytenoid m.
19
Q
Ventricular Folds:
A
- a.k.a. false (vocal) folds or vestibular folds
- thick folds of mucous membrane
- above true vocal folds
- not used in normal phonation
20
Q
False vocal fold engage when…
A
…there is hyperactivity or if they lost their true vocal fold due to disease
21
Q
Innervation to Larynx (Motor + Sensory):
A
- Motor: Vagus (CN X) – RLN & SLN
- Sensory:
–>Glossopharyngeal (CN IX)
–>Internal laryngeal (X) above the false vocal folds
RLN (X) below the false vocal folds
22
Q
What’s the first question to ask if a client has a paralyzed vocal fold?
A
Ask if they have had any heart surgery
The Recurrent laryngeal nerve could have been nip b/c it wraps around the heart.
If Left paralysis = nerve near heart
If Right or left paralysis = nerve near the thyroid
23
Q
Three Voice Subsystems:
A
- Respiration (Air pressure system)
- Phonation (Vibratory system)
- Resonation (Resonating system)
24
Q
The Respiration system is the:
A
power source for voice
25
The Phonation system is the:
sound source
26
The Resonation system is the:
filter
27
The voice organs for the respiration system are (5):
1. Lungs
2. Diaphragm
3. Chest muscles
4. Ribs
5. Abdominal muscles
28
The voice organ for the phonation system is:
The Larynx (Vocal folds)
29
The voice organ for the resonation system:
Vocal tract:
- -> throat (pharynx)
- -> oral cavity
- -> nasal passages
30
Respiration Systems Role in Sound Production:
Provides and regulates air pressure to cause vocal folds to vibrate
31
Phonation Systems Role in Sound Production:
1. Vocal folds vibrate, changing air pressure to sound waves producing "voiced sound," frequently described as a "buzzing sound"
2. Varies pitch of sound
32
Resonation Systems Role in Sound Production:
Changes the "buzzing sound" into a person's recognizable voice
33
4 Functions of the Larynx:
1. RESPIRATION = breathing for life (open glottis)
2. PROTECTION with cough reflex: Close, then open glottis with help of respiratory system
3. PROTECTION during swallowing: Close glottis with help of respiratory system
4. PHONATION with voice: Close/open
glottis and adjust vocal fold tension
34
If there is a problem at the level of the larynx, it can cause:
breathing problems
35
Which Cranial Nerve Innvervates the Coughing Reflex?
The Vagus innervates
36
What is Silent Aspiration?
When the vagus nerve isn’t working to cause the reflexive cough, material gets all the way into the lungs
37
What happens to respiratory system during inspiration?
1. Active muscle contraction occurs:
- -> Lungs inflate
- -> Rib cage moves in a series of movements
- -> Diaphragm pulls down (contracts)
2. Space in the thoracic cavity increases and pressure decreases creating a negative pressure. At this point, atmospheric pressure is greater so this positive pressure moves toward the negative pressure and follows the path of least resistance
38
The thoracic cavity increases in 3 planes during inspiration:
1. Vertical dimension is increased by the contraction of the dome-shaped diaphragm
2. Transverse (side to side) dimension is increased by raising of the curved ribs
3. Anterior-posterior dimension is increased by simultaneous forward and upward movement of the sternum
39
In order for inspiration to occur the lungs must be
expanded
40
Inspiration is a passive or active process stimulated by
Active Process stimulated by muscle contraction
41
The first step to increasing the lung volume involves contraction of:
Principal inspiratory muscles
- ->diaphragm
- ->external intercostal muscles
42
Diaphragmatic breathing
- deep abdominal breathing
| - good
43
Clavicular breathing
- shallow breathing from excessive use of accessory muscles
44
During quiet breathing you mostly use:
your diaphragm
45
During forced respiration you use:
- the diaphragm
| - accessory muscles are also involved in increasing the size of the thoracic cavity
46
Contraction of the sternocleidomastoid elevates the...
sternum
47
Contraction of the scalenes elevates the...
superior ribs
48
Muscles of Inspiration:
- Diaphragm
- Striated skeletal muscle
- Muscle fibers of the diaphragm
49
Diaphragm
- primary muscle of inspiration
- serves as a separation between the thorax and abdomen
- one of the most important muscles besides the heart
shaped like an inverted bowl, with its attachments along the lower margin of the rib cage, sternum, and vertebral column
- force of contraction directs it downward toward the abdominal viscera
50
Striated skeletal muscle:
- moves skeletal structure
- Attaches to the inferior border of the
rib cage, xiphoid process, and to the
posterior aspect of the vertebral column
- The middle portion is made up of a large,
leafy aponeurosis call the CENTRAL
TENDON (aponeurosis is a sheetlike tendon
is a connective tissue which functions to attach
muscle to bone)
51
Muscle fibers of the diaphragm:
radiate out from the
central tendon, forming the STERNAL (sternum),
COSTAL (rib), and VERTEBRAL (spinal) attachments
52
Function/Motion of the Diaphragm:
- Muscle contracts (flattens)
| - Muscle fibers shorten
53
Innervation of the Diaphragm:
- Innervated by the phrenic nerve
- Diaphragm can be placed under voluntary control (holding your breath)
- Diaphragm is primarily under involuntary control (breathing for life sustaining purposes - no choice but to breathe)
- phrenic nerve = "hiccup nerve"
- -->Anything that changes the pattern of the diaphragm will stop hiccups if they are occuring
54
Accessory Muscles of Inspiration:
1. Anterior
2. Posterior
3. Muscles of the neck
4. Muscles of the thorax, back, & upper limb
55
Anterior Accessory Muscles of Inspiration:
1. External intercostal (important for normal breathing inhalation/inspiration)
2. Internal intercostal (interchondral portion)
56
Posterior Accessory Muscles of Inspiration:
1. Levatores costarum (brevis and longis)
| 2. Serratus posterior superior
57
Muscles of the neck (accessory muscles of inspiration) (3):
1. SCM (Sternoclydomastoid)
2. Scalenes
3. Trapezius
58
Muscles of the thorax, back, & upper limb (accessory muscles of inspiration) (7):
1. Pectoralis major
2. Pectoralis minor
3. Serratus anterior
4. Subclavius
5. Levator scapulae
6. Rhomboideus major
7. Rhomboideus minor
59
Muscles of Expiration (2):
```
Thoracic muscles (anterior and posterior)
Abdominal muscles
```
60
Thoracic Muscles of Expiration:
1. Internal intercostal (interosseous portion)
2. Transversus thoracis
3. Subcostal
4. Serratus posterior inferior
5. Innermost intercostal
6. Latissimus dorsi
61
Abdominal Muscles of Expiration:
1. Transversus abdominis
2. Internal oblique abdominis
3. External oblique abdominis
4. Rectus abdominis
5. Quadratus lumborum
62
Expiration is a passive/active process for normal breathing?
Passive
63
Expiration is a passive/active process for labored breathing?
Active
* Only engage muscles of inspiration in labored breathing
e. g. Projecting voice, working out, etc.
64
Anterior Thoracic Muscles of Expiration (2):
* Anterior – decrease volume of thoracic cavity
1. Internal intercostal (bony portion)
2. Transversus thoracic
65
Posterior Thoracic Muscles of Expiration:
* Posterior – decrease volume of thoracic cavity
1. Subcostal
2. Serratus posterior inferior
3. Innermost intercostal
4. Latissimus dorsi
66
Function of the Internal Intercostal Muscles (anterior thoracic muscle):
support, protect & space ribs
67
Function of the Transversus Anterior Thoracic Muscles:
depress rib cage
68
Function of the Subcostal Posterior Thoracic Muscle:
depress the thorax
69
Function of the Serratus Posterior Inferior Thoracic Muscles (posterior Thoracic Muscle):
depresses lower ribs
70
Function of the Intermost intercostal (posterior Thoracic muscle):
depresses rib cage
71
Function of the Latissimus dorsi (posterior Thoracic muscle):
stabilizes chest
72
Abdominal Muscles:
- Like a cumberbund that wraps the abdomen neatly in the front, side and back
- Function by compression of the abdominal viscera which aids in respiration and lifting
- Layers of the abdomen provide excellent support for the rib cage during lifting and other gestures
- These gestures fix the thorax by inflating the lungs and closing off the vocal folds
- The abdominal muscles help to compress the viscera while stabilizing the thorax at the same time
- Layers of connective tissue serve as attachments for muscles of the abdomen
73
Vocal folds are adducted tightly or abducted loosely during abdominal compression?
adducted tightly
74
What is the abdominal aponeurosis?
- A large area of space to cover anteriorly so a tendinous structure
- It provides a place of attachment for muscles to attach to the rib cage, vertebral column and pelvic girdle
75
The "Linea Alba" (part of the abdomen):
- “White line”
| - Runs from the xiphoid process to the pubic symphysis, which forms the midline structure for muscular attachment
76
Transversus abdominis (location and function):
- Deepest of anterior abdominal muscles
| - Contraction reduces the abdominal volume
77
Internal Oblique Abdominis (location and function):
- Located between the external oblique abdominis and the transversus abdominis
- Unilateral contraction – rotates the trunk
- Bilateral contraction – creates flexion of the trunk
-Compresses abdomen
78
External Oblique Abdominis (location and function):
- The most superficial of abdominal muscles and the largest of the group
- Bilateral contraction – flexes the vertebral column
- Unilateral contraction – bends the vertebral column laterally and rotates it
79
Rectus Abdominis (location and function):
- Prominent abdominal muscles of the midline region
- “Rectangular” muscles appear in a series of four or five segments connected and separated by tendinous intersections (each segment capable of independent contraction).
- Use of this muscle is essential for sit-ups
- Contraction compresses the abdominal contents
- Flexes the vertebral column
80
Quadratus Lumborum (location and function):
Located in the dorsal section of the abdominal wall
Unilateral contraction - bends body laterally, “hikes” hip
Bilateral contraction – fixes the abdominal wall to support abdominal compression
81
Normal expiration:
A passive process because no muscular contractions are involved – expiration simply involves eliminating waste products of respiration (e.g. CO2)
82
Forced expiration:
Active
Involves muscle contraction
Expiration begins when the inspiratory muscles relax
As external intercostals relax, the ribs move downward
As expiration begins, the diaphragm relaxes
These movements decrease the vertical and anterior-posterior dimensions of the thoracic cavity.
83
3 forces during passive expiration :
During passive expiration, there are natural forces that go into play to restore the muscle back to relaxation state
1. Torque: the twisting of a shaft (or a rib) while not permitting one end to move
2. Elasticity: the chondral portion of the rib cage
3. Gravity: allows the restoration of the rib cage to drop down to its resting state
When standing or sitting erect, gravity acts to pull the ribs down after expanding through the forces of the accessory muscles of inspiration
Gravity works in favor of maximizing overall capacity because it pulls the abdominal visceral down leaving more room for the lungs
84
Active Expiration involves:
Sometimes it is necessary to go beyond passive expiration and move into active expiration
Use of the expiratory muscles
Further reduces the size of the thoracic cavity by pressing the abdomen and forcing more air out of the lungs beyond the passive expiration level
85
Quiet Tidal Breathing:
Respiration for life – During quiet (tidal) breathing an adult will complete between 12-18 cycles of respiration per minute
A cycle of quiet respiration is defined as one inspiration and one expiration. (10seconds = 1 cycle)
86
Types of Respiration (4):
1. Quiet Inspiration
2. Forced Inspiration
3. Passive Expiration
4. Active Expiration
87
Quiet Inspiration -
Utilizes the diaphragm and external intercostal muscles, but not the accessory muscles
88
Forced Inspiration -
Uses the diaphragm, external intercostal muscles and many of the accessory muscles (e.g. for speech)
89
Passive Expiration –
Allows forces to go back to resting position after inspiration
90
Active Expiration –
Use of muscular effort to push beyond the resting position
91
2 Tools for measuring respiration:
1. Spirometer
| 2. Manometer
92
Spirometer –
Measures respiratory flow, volumes, and lung capacities
| --> Forced Vital Capacity and FEV1
93
Manometer –
Measures air pressure
- ->Maximum inspiratory pressure (MIP)
- -> Maximum expiratory pressure (MEP)
94
Forced Vital Capacity (FVC):
Everything that can force out in one breath
| All of the air in out lungs that we can get out
95
Maximum Expiratory Pressure (MEP):
Measured by a Manometer
Maximum expiratory pressure = peek flow
How much can they forcibly blow into the air pressure gage = tells us how strong the expiratory muscles are
96
Maximum Inspiratory Pressure (MIP):
Measured by a Manometer
All the air they can suck in = MIP
Tells us how strong the inspiratory muscles are
97
Respiratory Volumes refer to:
Applies a number to the amount of air in each compartment of the respiratory system (i.e. the alveoli)
Measured in milliliters (ml) or liters (L)
98
Respiratory Capacities refer to:
Are more functional units of measurement that represent combination of volumes
Measured in milliliters (ml) or liters (L)
99
Types of Respiratory Volumes (5):
1. Tidal Volume (TV)
2. Inspiratory Reserve Volume (IRV)
3. Expiratory Reserve Volume (ERV)
4. FEV1 = forced expiratory volume in the 1st second
5. Residual Volume (RV)
100
Tidal Volume (TV) =
volume of air exchanged in one cycle of respiration
101
Inspiratory Reserve Volume (IRV) =
volume of air that can be inhaled after tidal inspiration (e.g. yawn)
102
Expiratory Reserve Volume (ERV) =
volume of air that can be exhaled after tidal expiration
103
FEV1 =
forced expiratory volume in the 1st second
104
Residual Volume (RV) =
the amount remaining in the lungs after maximum exhalation
105
Types of Respiratory Capacities:
1. Vital Capacity (VC) or forced vital capacity (FVC)
| 2. Total Lung Capacity (TLC)
106
Vital Capacity (VC) or forced vital capacity (FVC) =
Volume of air that can be inhaled following maximal exhalation
IRV+ ERV+TV=VC
Vital capacity represents the capacity available for speech
107
Total Lung Capacity (TLC) =
Sum of inspiratory reserve volume, tidal volume, expiratory reserve volume and residual volume
TLC=IRV + ERV + RV
108
How is Vital Capacity different from Total Lung Capacity?
VC represents the volume of air involved in a maximal respiratory cycle (without RV) whereas total lung capacity includes RV
109
Volumes and Capacities in relation to Voice:
you need to take enough air (volumes & capacities) in to get words out
110
The minimum power source to make the vocal folds move would elevate a column of water...
...between 3cm-5cm H20.
111
How much power source does one need to be barely heard?
A minimal 3-4cm H2O
112
Conversational speech requires how much power?
~7 cm H2O or ~60 dB
113
Louder speech requires how much power?
~12 cm H2O or ~85 dB
114
Air Pressure (definition and measurement):
Air pressure is the force exerted on the walls of a chamber by molecules of air
Pressure is Force exerted on Area
-->P=F/A
115
Pressures of the respiratory system (4):
1. Atmospheric pressure is used in discussion of respiratory system (Patm)
2. Intraoral pressure in the oral cavity (PM)
3. Subglottal pressure below the vocal folds (Ps)
4. Alveolar or lung pressure within the thoracic cavity (Pal)
116
Phonation:
- a.k.a. voicing
- Sound source
- Larynx the is structure for phonation
117
When the vocal folds are abducted they are:
open
118
When the vocal folds are adducted they are:
closed
119
Parts of the larynx involved in breathing and vocalization:
- Arytenoid cartilage (vocal process, muscular process)
| - Vocal Folds
120
Movements that take place between the arytenoid
| and cricoid cartilages:
The vertical axis is where the arytenoid
cartilage rotates
The movements include:
- adduction (ADD)
- abduction (ABD)
- anterior-posterior (AP) sliding
- medial-lateral (ML) sliding
121
What happens when the lateral cricoarytenoids contract?
adducts the arytenoid cartilages
| to close the glottis
122
When the thyroaryteniods contract...
They pull the arytenoid cartilages forward & backward, thereby loosening and tightening the vocal folds
123
When the posterior cricoarytenoids contract...
They rotate the arytenoid cartilages laterally (abduct),
causing the vocal folds to separate from one another,
opening the glottis
124
When the cricothyroid contracts...
It rotates the thyroid cartilage forward
around an axis through the cricothyroid joint.
This action stretches the vocal cord, thereby tensing it (amount of tension depends on pitch desired)
125
What is the Bernoulli Effect?
At a constant volume flow (of air), at a point of constriction, ↓pressure = ↑velocity of flow
This explains vocal fold vibration (NOT a muscular event)
When airflow comes to a point of constriction (the vocal folds), it creates a build up of pressure to build up subglottic air pressure
When getting ready to voice, we close the vocal folds to build pressure, then the pressure goes down, the velocity of the air flow goes up forcing the air above the folds
Then, the Bernoulli effect sucks the fold back together
126
1 cycles of the vocal folds = ___hz
1
127
Description of the Vibratory System of the Vocal Folds:
Measured in hz
Column of air pressure moves upward
towards vfs in "closed" position
Column of air pressure opens bottom
of vibrating layers of vfs; body of vfs
stays in place
Column of air pressure continues to
move upward, now towards the top of
vfs, and opens the top
The low pressure created behind the
fast-moving air column produces a
Bernoulli effect which causes the
bottom to close, followed by the top.
Closure of the vocal folds cuts off the
air column and releases a pulse of air
128
Average fundamental frequency of men:
110hz
129
Average fundamental frequency of women:
180-220hz
130
Average fundamental frequency of children:
300hz
131
Forces/Properties of Phonation (need 4 to create voice):
- Ps (subglottic air pressure)
- Tissue elasticity (vfs) --> aerodynamic-myoelastic theory (due to the epithelial layer of the vocal folds)
- Constriction of airflow --> Bernoulli Effect
- Laryngeal muscles
132
What is Frequency perceived as?
Pitch
133
How is frequency measured (2):
1. MDVP
| 2. Visipitch
134
What is intensity (dB)/amplitude perceived as?
Loudness
135
How is intensity(dB)/amplitude measured (2):
1. Sound Pressure Level (SPL) Meter- measures loudness
2. LSVT Companion software (Lee Silverman Voice Treatment Companion software- measures loudness level through the computer and stores it)
136
Ligament vs. Tendon:
ligament: connects bone to bone (or cartilage)
tendon: connects muscle to bone
137
Muscles vs. Membranes:
Membrane: covers thing (e.g. muscles, bone, etc.)
Muscle: the mass that contracts
138
genio-
chin
139
mylo-
molar
Voice Disorders
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