Anatomy: Larynx

Front 1

What are the four main functions of the larynx?

Back 1

1. maintain airway
2. expel foreign objects
3. subglottic air pressure for straining and pushing
4. voice production

Front 2

Define Amplitude Perturbation

Back 2

Shimmer; loudness will subtly change from cycle to cycle; noisy voice; intensity/amplitude varies, reported in dB (below .4 dB is normal)

Front 3

Define Aperiodic Components of glottal Spectrum.

Back 3

noise, non-patterned energies; see more in a situation with abnormalities.

Front 4

Define Bernoulli Effect.

Back 4

As velocity of a fluid increases, pressure must decrease, so long as total energy remains constant. Pressure is perpendicular to the direction of fluid flow. So if volume of fluid flow is constant, velocity will increase at an area of constriction with a corresponding decrease in pressure at the constriction. Applies to VF, as air is passed through at a high speed the negative pressure will cause the vf to come back together.

Front 5

Define dysphonia

Back 5

any voice impairment; defective phonation.

Front 6

Define Frequency perturbation.

Back 6

jitter; frequency variance from cycle to cycle; voice becomes rough; reported in Hz or % (below .6% is normal)

Front 7

Glottal (source) spectrum:

Back 7

the distribution of energy production at the vf level, increase to vocal tract and is selectively amplified by movement of the articulators. Some cavities amplify the E and some dampen it.

Front 8

Harmonic Frequencies

Back 8

with regard to the E spectrum; it represents each line of energy on the spectrum (they are in even numbers)

Front 9

Harmonic spacing-significant to voice quality.

Back 9

in normal speech the spacing is almost equal between lines; in distorted speech the spacing is off and this leads to increased perturbation.

Front 10

Input pressure to the vocal tract.

Back 10

comes from the respiratory tract

Front 11

Intonation contour:

Back 11

the pattern of rising and falling pitch in speech that helps distinguish b/w questions, statements, and other types of speech.

Front 12

Medial Compression

Back 12

bring vf together at midline as they're adducted. Increase vf mass/unit area will decrease the fundamental freq.; decrease in vf length will also decrease the fundamental frequency.

Front 13

Mucosal Wave

Back 13

Vibration wave; travels along the laryngeal mucosa from inferior to superior surface; travels across the upper surface but dissipates before reaches thyroid cartilage; opens inferior to superior and posterior to anterior.

Front 14

Close phase of vibratory cycle

Back 14

no vibration of vf; it is critical in determining the rate (freq) of vibration b/c it determines how long the vf are approximated until the next vibration. Little to no rima glottis (opening) Compliance of vf determines length of closed phase.

Front 15

Closing phase of vibratory cycle.

Back 15

rima glottis (RG) getting smaller, vf are vibrating; vf brought back to midline by elastic recoil force but not completely returned, rf is narrowed, airflow creates a negative subg. pressure and sucks vf together via Bernoulli effect; shape of RG constantly changing.

Front 16

Opening phase of the vibratory cycle:

Back 16

RG getting larger, vf are vibrating, begins when vf are blown apart, amt of RG opening depends on natural properties of vf; shape of rg constantly changing.

Front 17

Phonation threshold pressure:

Back 17

amount of pressure required to cause a vibration cycle

Front 18

Phonatory attack phase:

Back 18

involves the further bringing together of vf and as air flow reaches the narrow space b/w them it passes through with high velocity and pressure, this creates a negative P around the nedial surface of folds. Bernoulli effect occurs here.

Front 19

Phonatory range

Back 19

all of the frequencies (lowest to highest) that the human vocal tract can produce. 3 ranges- loft, modal, and pulse.

Front 20

Pitch sigma:

Back 20

variability during speech is measured as the standard deviation of the frequencies.

Front 21

Prephonatory adductory settings or adjustments:

Back 21

various events that proceed the vf beginning to vibrate; length, tension, mass changes (prescribed by brain); gross positioning of vf

Front 22

subglottic pressure

Back 22

pressure built up beneath approximated vf; drives vibration of vf

Front 23

Neurochronaxic theory:

Back 23

each vibratory cycle is initiated by a nerve impulse to vocalis muscle via recurrent/vagus nerve; freq. depends on the rate of impulses delivered; DISPROVEN

Front 24

Aerodynamic-myoelastic theory of voice production.

Back 24

air forces cause the vf to vibrate; SEE HANDOUT

Front 25

Transglottic pressure

Back 25

pressure differential across the glottis; influenced by the oral airway opening.

Front 26

vertical phase difference

Back 26

vf open inferior to superior

Front 27

breathy vocal attack

Back 27

aspirate attack; vf separate from each other as air stream comes up from lungs; eggressive air flow passes through before vf come together. Pathological

Front 28

Coup de glotte vocal attack

Back 28

vf come together with medial compression; requires a significant amount of subglottal force to get them back apart. Increase in subglottic pressure "pop" we hear when use this. Pathological.

Front 29

simultaneous vocal attack

Back 29

normal, mode of initiation-air released just as vf meet at midline

Front 30

quasiperiodic nature of vf vibration

Back 30

vibrations in four directions, up and down and side to side

Front 31

Loft Register

Back 31

falsetto; vf maximally elongated but don't come totally together; tone is produced w/vibration of mucosal surface of vf; range depends on the individual modal register. Btw 150-750 Hz for men and 220-1700 Hz for women.

Front 32

Modal Register

Back 32

most speaking and singing here. Utilize the full range of manipulation of length, mass/unit area on vocal fold, moderately high air flow. Between 75-500 Hz males, and 130-750 Hz women.

Front 33

Pulse register (vocal fry)

Back 33

creaky voice; little frequency modulation, have loading on vf by vestibular folds (dampen vibration); depend on muscle activity. VF shorter, thicker, little air flow. Greatest Subglottal Pressure and resistance. Between 1-70 Hz for men and women.

Front 34

How does the larynx build up intra-thoracic and intra-abdominal pressures?

Back 34

1. by bringing vf together (valsalverate)
2. increased pressure creates firm platform against which muscles act.

Front 35

What is phonation?

Back 35

speech function of the larynx

Front 36

What is the oral cavity relationship with the larynx?

Back 36

1. relationship to base of tongue
2. tongue movement can influence larynx

Front 37

What is the pharyngeal relationships with the larynx?

Back 37

1. location in adults is C3-C6; location in children is C2-C4
2. sits on top of trachea in the hypopharynx
3. attached to epiglottis via glossoepiglottic folds
4. relationship with entrance to esophagus.

Front 38

What are the major cartilages associated with the larynx?

Back 38

1. Thyroid
2. Cricoid
3. Arytenoid

Front 39

What are the main features of the thyroid cartilage?

Back 39

a. "Adam's apple"
b. 2 laminae (plates) fused at midline, terminating into
c. 2 superior cornue (horns)
d. 2 inferior cornu (horns)
e. thyroid notch (@ anterior midline where laminae don't attach)
f. 2 tubercles (elevations) on each side
g. oblique line (for tendon attachment) between 2 tubercles

Front 40

Where are the three points of attachment for thyroid cartilages?

Back 40

1. Oblique line (inferior pharyngeal constrictor, Sternothyroid muscle, thyrohyoid muscle)
2. Inferior horns (part of cricothyroid joint)
3. Superior horn (connected with hyoid bone)

Front 41

What are the features of the cricoid cartilage?

Back 41

a. "Signet ring" shape
b. anterior arch, widens and terminates into
c. posterior lamina
d. 2 articular facets

Front 42

What are the points of attachment for the cricoid cartilage?

Back 42

1. 2 articular facets (cricothyroid joint and cricoarytenoid joint)
2. ridge on lamina (posterior cricoarytenoid muscle)

Front 43

What are the features of the arytenoid cartilages?

Back 43

a. pyramidal shape
b. 3 processes (apex, muscular process-->lateral, and vocal process-->medial)
c. 2 fovea (depressions)-->fovea oblonga b/w muscular and vocal processes-->fovea triangularis (more medial)

Front 44

What are the attachments for the arytenoid cartilage?

Back 44

1. muscular process (anterior lateral cricoarytenoid muscle, posterior cricoarytenoid muscle, interarytenoid muscle, -->underneath-->articulation joint for thryocricoid ligament; fovea oblonga (thyroarytenoid muscle); fovea triangularis (vestibular fold-->ventricular/false vocal fold)

Front 45

What are the features of the epiglottis?

Back 45

1. Epiglottis proper: leaf-like structure, narrows into the:
2. Petiole: "little leg" stalk that attaches to the thyroid cartilage
3. Tubercle: an upraising, the dense part of the epiglottis

Front 46

What is the point of attachment for the epiglottis?

Back 46

petiole attaches to the thyroid cartilage

Front 47

Describe the Hyoid bone.

Back 47

1. Not part of the larynx
2. site of attachment for many extrinsic laryngeal muscles
3. Not articulated with any other bone.
4. Position influences position of larynx.

Front 48

What are the features of the hyoid bone?

Back 48

U shaped body; wedge-shaped body; greater horns/cornua(2); lesser horns/cornua(2) at conjunction of greater horns and body.

Front 49

What are the attachments of the hyoid bone?

Back 49

thyrohyoid membrane connects thyroid cartilage.

Front 50

All of the cartilage is composed of what? (Except for the epiglottis)

Back 50

hyaline cartilage

Front 51

What cartilage is the epiglottis composed of?

Back 51

elastic cartilage

Front 52

What are the functions of the laryngeal joints?

Back 52

1. maintain approximation of articular joint surfaces
2. proscribe range of movement
3. protect against damage
4. restorative functions
5. enclose area of joint space
6. consolidate synovial fluid over articular surfaces.

Front 53

What are characteristics of the articular facets with the cricothyroid joint?

Back 53

1. irregularity of articular surfaces
2. articular facets not oriented in sagittal plane
3. rotary movement

Front 54

What is the primary motion of the cricothyroid joint?

Back 54

CTM causes Cricoid cartilage to rotate upwards, posterior lamina lowers, vocal folds lengthen, space between CC/TC is lessened.

Front 55

Describe the sliding movement of the cricothyroid joint.

Back 55

Vocal folds lengthen; mass/unit area is decreased (of vf); rate of vibration and elasticity increase.

Front 56

What is the functional significance of the cricothyroid joint?

Back 56

vocal fold elongation; fundamental frequency modulation (can alter); phrase and accent components of fundamental frequency contour.

Front 57

Describe the articular facets of the cricoarytenoid joint.

Back 57

very symmetrical

Front 58

What is the movement of the cricoarytenoid joint?

Back 58

Rocking (NOT a rotation; causes vocal process of AC to be tipped inward/outward; closely associated with movement of vocal folds and rima glottis

Front 59

What is the functional significance of the cricoarytenoid joint?

Back 59

Regulates size and shape of rima glottis; influences glottal resistance to air flow; positions vocal folds for breathing, glottal attack, and glottal articulations.

Front 60

Describe the shape of the laryngeal cavity.

Back 60

laryngeal cavity is enclosed by the laryngeal skeleton; wide superiorly, narrows at vf, widens again; configuration of shape often altered by muscle/cartilage movements.

Front 61

Describe the supraglottal region of the LC.

Back 61

superior border (aryepiglottic folds); anterior border (epiglottis); inferior border (vestibular folds & ventricle Morgani)--> attach from deep thyroid cartilage to fovea triangularis; walls are fibroelastic tissue (nonmuscular restorative force created when stretched)

Front 62

Describe the glottal region of the LC.

Back 62

narrowest portion of LC; composed of vf only;RIMA GLOTTIDIS(variable space b/w VF)-->anterior: membranous glottis 3/5 total length, bounded by VOCAL LIGAMENT and most ACTIVE in vibration; Posterior: cartilaginous glottis 2/5 total length (bounded by VOCAL PROCESSES and MEDIAL ARYTENOIDS)

Front 63

Describe the subglottal region.

Back 63

1. Superior border: inferior border of VF
2. Inferior border: inferior border of cricoid cartilage
3. Walls are conis elasticus: thicker CT (terminates superiorly at vocal ligament-->part of VF)

Front 64

Describe the pseudostratified ciliated columnar lining in the Larynx.

Back 64

Typical respiratory system lining, found on all surfaces EXCEPT: medial surfaces of fVF and true VF. Loosely bound.

Front 65

Describe the stratified squamous epithelium.

Back 65

Medial surfaces of vestibular/vocal folds; Exposed to abrasion, compressive forces, have to be PROTECTED; tightly bound along aryepiglottic folds; vocal folds come together forcefully, vibrations, protect from each other.

Front 66

What are the two primary extrinsic muscles of the larynx?

Back 66

Stenothyroid and thyrohyoid

Front 67

Describe extrinsic muscles.

Back 67

one attachment on larynx, one outside of larynx; affect vertical position of larynx: raise/lower

Front 68

What are the attachments for the sternothyroid muscle?

Back 68

origitnates from sternum; inserts at oblique line of thyroid cartilage; depresses thyroid cartilage.

Front 69

What are the attachments of the thyrohyoid muscle?

Back 69

originates from oblique line of thyroid cartilage; inserts at inferior border of hyoid bone

Front 70

What are the functions of they thyrohyoid muscle?

Back 70

depresses hyoid if thyroid cartilage is FIXED; raises thyroid cartilage if hyoid is FIXED.

Front 71

What are the features/functions of intrinsic musculature?

Back 71

both attachments on larynx; change relative positions of cartilage to each other; change position of VF via action of cricoarytenoid joint (adducting of abducting VF); Change shape/size of rima glottis; change physical properties of VF (shorten and compliant, long and elastic); innervated by vagus nerve (cranial nerve X)

Front 72

What is the function of the intrinsic abductors?

Back 72

separate arytenoids and vocal folds; respiratory activity

Front 73

What are the function of the intrinsic adductors?

Back 73

approximate arytenoids and vocal folds; phonation and protection

Front 74

What are the function of intrinsic tensors?

Back 74

elongate and tighten vocal folds; more elastic, resistant to deformation

Front 75

What are the function of intrinsic relaxers?

Back 75

shorten and relax vocal folds; more compliant, absorb energy

Front 76

What are the five intrinsic laryngeal muscles?

Back 76

1. Cricothyroid (2 bellies)-->pars recta and pars oblique
2. Lateral cricoarytenoid
3. posterior cricoarytenoid
4. interarytenoid (transverse fibers and oblique fibers)
5. Thryoarytenoid (bulk of vf)

Front 77

What are the features/attachments of the cricothyroid muscle?

Back 77

2 muscle bellies-->originate in lateral surface of cricoid cartilage arch, pars recta travels vertically, pars oblique travels obliquely; innervated by SUPERIOR LARYNGEAL NERVE

Front 78

What are the functions of the CT muscle?

Back 78

Vocal fold tensor/adductor (lengthen VF and increases elasticity); raises cricoid cartilage if thryoid cartilage is FIXED

Front 79

What are the features of the LCA?

Back 79

Fan shaped; originates in upper border of arch of cricoid cartilage; inserts into anterior aspect of muscular process of arytenoid cartilage.

Front 80

What are the functions of the LCA?

Back 80

PRINCIPLE ADDUCTOR (brings vf together medially, closes RG); relaxer (when vf are brought together they are more compliant); innervated by RLN

Front 81

What are the features/attachments of PCA?

Back 81

Fan shaped; originates in depression in posterior surface of cricoid lamina; inserts at muscular process of arytenoid cartilage

Front 82

What are the functions of PCA?

Back 82

contracts: AC rock outward; ONLY ABDUCTOR; VF are abducted and elevated; maintains opening of VF : involved in breathing; innervated by RLN

Front 83

What are the features/attachments for the interarytenoid muscles?

Back 83

TRANSVERSE: travel horizontally, originate in lateral/posterior surface of one AC, insert in lateral/posterior surface of other AC; OBLIQUE fibers: travel obliquely (form an X), originate in muscular process of one AC, insert in apex of opposite AC

Front 84

What are the functions of the IA muscles?

Back 84

ADDUCTOR; close posterior portion of rima glottis

Front 85

What are the features/attachments of thyroarytenoid muscle?

Back 85

very complicated; compose bulk of vf; originate in midline of thyroid cartilage; attach to fovea oblong of arytenoids-->vocalis fibers (near vocal process: make up body of VF); muscularis fibers (more laterally)

Front 86

What are the functions of TA muscle?

Back 86

adductor, isometric tensor, relaxer; regulator of longitudinal tension-->when unopposed, ta relaxes vf and closes rg by pulling muscular process forward, when opposed vf tension increases.

Front 87

What are the effects of muscle action on rima glottidis?

Back 87

lateral cricoarytenoids CLOSES RG; posterior cricoarytenoid OPENS RG; Interarytenoids CLOSE cartilaginous (posterior) portion of RG; thyroarytenoids (CLOSES RG)

Front 88

Describe the Vocal fold structure (Thyroarytenoid muscle)

Back 88

multi-layered structure:
COVER: most dynamic, most surface activity-->epithelium (stratified squamous) maintains shape of VF; Superficial lamina Propria-->reinke's space (loose elastic CT)
TRANISITION: Forms the vocal ligament->intermediate lamina propria (dense, elastic CT) and deep lamina propria (collagenous with elastic intermingling)\
BODY: vocalis muscle fibers

Front 89

Describe the differences in properties associated with each layer during vibration.

Back 89

mechanical properties of cover and transition are regulated passively; mechanical properties of body are regulated passively and actively

Front 90

Describe the mucosal wave

Back 90

Vibration wave: a wave traveling along the laryngeal mucosa from inferior to superior surface; travels across upper surface but dissipates before reaching thyroid cartilage; moves inferior to superior and posterior to anterior.

Front 91

What are the 3 phases of the mucosal wave?

Back 91

opening
closing
closed

Front 92

Describe the opening phase

Back 92

RG getting larger: VF vibrating; begins when vf are blown apart: amount of RF opening depends on natural properties of vf.

Front 93

Describe the closing phase.

Back 93

RG getting smaller: VF vibrating; VF brought back to midline by elastic recoil force but not completely returned, RG is narrowed, airflow creates a negative subglottal pressure and sucks VF together via bernoulli effect.

Front 94

Describe the closed phase.

Back 94

Little/no RG: VF NOT vibrating; determines amount of time VF will be vibrating: compliance of VF determines length of closed phase.

Front 95

Describe the external superior laryngeal nerve.

Back 95

Motor nerve; innervates Cricothyroid muscle ONLY!

Front 96

Describe the Internal superior laryngeal nerve

Back 96

sensory fiber; innervates mucosa, supraglottic cavity heavily innervates--lots of protective reflexes.

Front 97

Describe the recurrent laryngeal nerve.

Back 97

innervates all OTHER intrinsic laryngeal muscles; right side loops around subclavian artery; left side travels farther and loops around aortic arch; both sides travel upwards into larynx by means of the tracheo-esophageal groove.

Front 98

What is the relationship between respiratory air source and vocal folds?

Back 98

Power source: respiratory air force; filter: VF cause air to vibrate:

Front 99

Describe the Bernoulli Effect and subglottal pressure.

Back 99

During medial compression, VF come to the midline. The decreased RG causes subglottal pressure (negative) to increase and sucks vf together