1
Q
Three functions of the larynx
A
- primary biological function: protection of the airway.
- pressuring valving
- phonation
2
Q
three important landmarks on the hyoid bone
A
- corpus or body
- lesser cornu
- greater cornu or horns
3
Q
The larynx is comprised of nine cartilages
A
Thyroid cartilage cricoid cartilage arytenoid cartilages (2) cuneiform cartilages corniculate cartilages (2) epiglottis.
4
Q
Motor signals from the cerebral cortex descend via _________________ to the brainstem.
A
upper motor neurons
5
Q
Where do the upper motor neurons synapse on the LMN?
A
brainstem
6
Q
CN X provides motor or sensory info?
A
both
7
Q
Where is CN X located?
A
nucleus ambiguus in the medulla
8
Q
2 branches of CN X that serve the larynx
A
- superior laryngeal nerve (SLN)
- recurrent laryngeal nerve (RLN).
9
Q
The SLN consists of 2 branches:
A
internal branch
external branch.
10
Q
The VF is made up of 3 layers.
A
mucosoa or cover
vocal ligament or transition
thyroarytenoid muscle or body
11
Q
mucosoa or cover
A
epithelium
superficial lamina propria
12
Q
vocal ligament or transition
A
intermediate lamina propria
deep lamina propria
13
Q
thyroarytenoid muscle or body
A
vocalis and muscularis
14
Q
When does the lamina prorpria develop into a 3 layer structure?
A
11-15 years old
15
Q
2 aerodynamic forces that are determinants of VF vibration
A
- Positive Subglottal pressure that builds below VF
2. Negative pressure due to Bernoulli effect
16
Q
Steps of vibration
A
- Subglottal air pressure (Ps) builds beneath VFs
- Ps overcomes closed VFs and folds are blown open
- VFs open at the bottom first, then opening proceeds t top
- As top opens, bottom begins to close, creating a vertical phase difference (Mucosal wave )
17
Q
What will stiffness do to the mucosal wave?
A
make it decreased or absent
18
Q
Healthy VFs will exhibit a healthy mucosal wave that travels _____ to _____ of the way from the lateral portion of the VFs.
A
1/3 to 2/3
19
Q
Myoelastic Aerodynamic Theory of Phonation
A
- Laryngeal muscle activity can effect VF elasticity (elasti recoil)
- After the VFs have been blown open, the VFs recoil to the midline due to their mass and elasticity.
20
Q
Types of glottal pressure
A
- Subglottal pressure=below vf
- Transglottic pressure=pressure between vf
- Supraglottic pressure=above folds
21
Q
Bernoulli Effect- when a gas/liquid flows from a larger passage into a constricted or narrower passage, the velocity of the gas/liquid molecules must _________while the outward pressure of the molecules on the walls of the narrow passage _________.
A
increase
decreases
22
Q
Phonation threshold pressure (PTP)
A
minimum amount of pressure to just get the VFs oscillating (vibrating).
23
Q
What affects Phonation threshold pressure (PTP)?
A
stiffness and viscosity.
24
Q
Tension and stiffness will cause PTP to be ____________.
A
greater
25
Air flow
quantity of a gas or fluid which passes a point in unit time.
26
Pressure
ratio of force to the area over which that force is distributed
27
Periodic
sound wave repeats itself exactly for each cycle of vibration.
28
Non-periodic
sound wave is not the same cycle to cycle.
29
Complex tone
s a tone with more than one frequency and consists of the fundamental frequency and its harmonics.
30
Sine wave or pure tone......
consists of only one frequency.
31
Fundamental frequency
lowest frequency in the tone.
32
VF vibration is actually ‘_____________ This means that there is some, although very slight, variation or ‘irregularity’ in the vibratory characteristics of VF vibration.
quasi-periodic.’
33
Octave
doubling of frequency,
i.e. 200 Hz – 400 Hz is one octave, 200 Hz – 800 Hz is 2 octaves, etc.
34
Frequency of VF vibration is dependent upon
VF length and tension
35
three vocal registers
modal or chest
Falsetto
glottal fry
36
Falsetto register
produces our highest frequencies.
37
glottal fry register
‘air stingy’ and does not project well.
38
modal or chest register
The register we speak in
39
Maximum Flow Declination Rate (MFDR)
aerodynamic measurement that can be taken during a voice evaluation which tell us how quickly the VFs are closing by showing us how rapidly the transglottal airflow goes to zero.
40
Quality
- -Determined by the periodicity of VF vibration and degree of glottal closure.
- -descriptors such as breathy, rough, and hoarse etc.
41
Resonance
- Result of vocal tract filtering on the spectrum of the glottal source
- timbre of the voice which can be bright, dark, throaty, nasal, and twangy etc.
42
5 parameteres used to describe Voice production
```
quality
pitch
oudness
resonance
register
```
43
Laryngeal and VT Anatomy in Children:
Infant Vocal Tract length.
-Shorter VT: lengthens by 4-6 months
44
Laryngeal and VT Anatomy in Children:
INfant Velum & epiglottis
in close proximity til 4-6 mos
45
Laryngeal and VT Anatomy in Children:
vocal ligament
undifferentiated LP, thick cover, w/ more vascularity
46
Laryngeal and VT Anatomy in Children:
-Arytenoids
disproportionately large until 4-6 months
47
Laryngeal and VT Anatomy in Children:
-Laryngeal position
high @ C2- C4; descends to C5 by 2 yrs; C6-C7 by age 15
48
Pediatric Voice
• Differences in pediatric laryngeal anatomy and physiology from adult laryngeal anatomy and physiology result in differences in pediatric acoustic, aerodynamic and perceptual parameters!
49
Intensity can be controlled in several ways.
- adequate respiratory drive and adequate subglottal pressure.
- adequate VFs adduction.
- shaping the vocal tract
50
How does adequate respiratory drive and adequate subglottal pressure control intensity?
must take in enough air AND have adequate laryngeal valving so pressure can build beneath the VFs.
51
How does adequate VFs adduction control intenstity?
.
-VFs remain closed longer and close more rapidly to produce a loud voice.
52
How does shaping the vocal tract control intensity.
enhances the mid and upper frequency harmonics.
53
Types of Laryngeal Exams
- Mirror
- Transnasal Flexible endoscopy
- Oral endoscopy (rigid scope)
- Videostroboscopy (flexible or rigid scope)
- High speech videoendoscopy (flexible or rigid -scope)
- Videokymography
54
Mirror
Utilizes a mirror and light source
Useful only for a GROSS assessment of laryngeal structures
Cannot be used to evaluate vibratory characteristics for accurate diagnosis
55
Transnasal Flexible Endoscopy
- Flexible fiber optic cable arries light source to the scope tip and carries image to camera and computer monitor
- Pros
- --Pt can speak normal and sing
- --Excellent view of supraglottic structures and velar function
- --Less likely to elicit a gag
- Cons
- --Image color and distortion, poor magnification and less bright
56
Oral Rigid Scope
Pros
- ---Good light and color, excellent magnification
- Cons
- ---Can only produce sustained vowels
- ----Increased gag reflex likelihood
57
Videostroboscopy
| Primary Purposes:
- Identifies physiological correlates of perceived resonance and voice quality documents status of speech anatomy and physiology
- Assists education and clinical discussion
- Confirms diagnosis
58
Videostroboscopy Secondary purposes
- Confirms diagnosis
- Improves motivation and counseling
- Provides biofeedback
59
Dynamic strain is the result of __________intensity phonation and may cause a/an ________ in frequency
High ; increase
60
In the One Mass Model (Vocal Tract Inertance) of vocal fold vibration, sustained phonation is driven by
alternating positive and negative transglottal (intra) and supraglottal pressures
61
The Bernoulli Principle states that
an increase in air particle velocity results in a decrease in pressure
62
Regarding nonlinear tissue movement, when the vocal folds are opening the airflow is _________and the net tissue velocity is _________________:
convergent ; outward
63
List three supraglottic indicators of intrinsic laryngeal muscle tension
medial lateral squeezing
anterior posterior squeezing
supraglottic squeezing
false vocal fold medialization
64
Electroglottography
is an indirect measurement of VF contact area
65
Jitter is a
cycle to cycle variation in the frequency, i.e. period, of vocal fold vibration
66
Shimmer is
a cycle to cycle variation in the amplitude of vocal fold vibration
67
A patient who presents with a higher than normal s/z ratio (greater than 1.40), may have___________, while a patient who presents with a lower than normal s/z ratio (less than .80) may have ___________________.:
incomplete glottic closure; vocal fold hyperadduction
68
Bilateral lesions to CN X above the origin of the pharyngeal, SLN and RLN branches results in:
abductor paralysis
69
Ways toincrease water intake
```
use a humidifier
use a facial steamer
take longer showers
avoid excessive caffeine
increase water intake
Humidifier
Steaming
```
70
Info for case histoy
Onset of problems, duration, vocal hygiene, changes
71
Vocal intensity is controlled at the level of the larynx by
increasing vocal fold adduction and speed of closure
| increasing the amount of the time the vocal folds are closed
72
Puberphonia is characterized by
high pitch phonation,
falsetto voice
breathy vocal quality
73
T/F
Restoring a patient’s voice to its pre-morbid status is the primary goal of voice therapy
False
74
T/F
Most geriatric voice problems are not due to aging (presbylaryngis) but due to disease
True
75
T/F
For the transgender male (female to male transition) client, addressing habitual pitch may not be necessary because the use of male hormones typically has the side effect of lowering the voice and decreasing habitual pitch
True
76
What order fortherapy tasks?
relaxation
breathing
voice exercises
77
The Confidential Voice therapy technique
is often used post-surgically
is especially helpful in cases of VF swelling
eliminates hard glottal attacks
78
When treating a transgender female (male to female transition) client the clinician should target a habitual pitch in the___________________
gender neutral pitch range
79
. The most common voice disorder for geriatric women i
vocal fold nodules and polyps
80
Children show levels of subglottal pressure that are??
50% - 100% greater than for adults
