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77 Cards in this Set
- Front
- Back
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Major Cartilaginous Structures that make up the larynx |
Thyroid Cartilage, Cricoid Cartilage, and Arytnoid Cartilage
They serve to protect the vocal folds and serve as anchor points for the origin and insertion of the muscles responsible for producing sound. |
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The layers of the Vocal folds |
Epithelial, Lamina Propia, Thyroartenoid
Vocal Folds attach to the back of the thyroid cartilage |
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Epithelial Layer |
Outermost (like the skin of your mouth) |
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Lamina Propia |
Second Layer (jello like layer, rubber-band layer, and a cotton-string layer) |
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Thyroarytenoid |
Bulk of the vocal fold's muscle |
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Pitch |
Related to the number of vocal fold vibrations produced within a given period of time (frequency)
*Males-125 cycles Hz, Females- 225-250 Hz, Children- 400 Hz* |
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Loudness |
Related to the amount of subglottal air pressure that is built up and the compression and tension of the vocal folds (intensity) |
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Resonance |
How sounds produced by the vocal folds vibrate in the Pharyngeal, Oral, and Nasal Cavaties
Hypernasal-too much resonance in the nose Denasal (hyponasal) not enough resonance (like a cold) |
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Vocal Quality |
Perceptual judgement based on resonance and laryngeal tension
*Too much laryngeal tension produces a rough or breathy sound* |
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Voice Disorder Statistics |
3-6% of school-age children exhibit voice disorders 3-9% of the entire population has a voice disorder
Teachers exhibit almost double the number of voice problems compared to non-teachers.
Women exhibit greater numbers of voice problems compared to men |
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Voice Disorder |
The abnormal production and/or absences of vocal quality, pitch, loudness, resonance, and/or duration that is innopropriate for an individuals age and/or sex |
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Phonotrauma |
A voice disorder that is related to the relationship between vocal behaviors, changes in laryngeal tissue, and the resulting voice problems |
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Hard Glottal Attack |
Hard starts to a speech |
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Puberphonia |
Males who have a higher pitch after puberty and use their vocal mechanism incorrectly |
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Persistent Glottal Fry |
Innopropriate use of the vocal mechanism
*corn popping sound* |
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Excessive Talking |
Changes voice production |
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Vocal Abuse |
Manner in which the individual uses his or her vocal mechanism
*Excessive and prolonged loudness, increase subglottal air pressure, screaming excessively |
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Traumatic Laryngitis |
Results from screaming, yelling, and loud. Vocal folds appear red and swollen. Vocal folds will return to normal after a period of rest. |
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Vocal Nodules |
Benign (noncancerous) growths of the vocal folds resulting from vocal abuse. Swelling Occurs a third of the way from the front vocal fold attachment. Starts off as soft and pliable but can become hard & fibrous. Can be unilateral or bilateral. |
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Vocal Polyps |
Benign (noncancerous) laryngeal growth about one third of the way up on the vocal fold. Occur from a single event, such as yelling at a sporting event. Unilateral and remains soft and pliable. An individual may sound hoarse and breathy. |
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Vocal Fold Paralysis |
*Type of Neurological Disorder*
Bilaterial Adductor: Inability to close the vocal folds. Cannot produce sound and can lead to aspiration or sucking or inhaling a fluid or food into their lungs
Bilateral Abductor: Inability to open the vocal folds. Respiration is the primary concern and often leads to tracheotomy
Unilateral: Most common type of paralysis often associated with trauma or disease. |
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Spastic Dysphonia |
*Type of Neurological Disorder*
Excessive laryngeal adduction. Patient exhibits a lot of struggle and strain when attempting to talk and occasional stoppages of the voice are noted. |
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Granulomas |
*Organic Disease*
Inflammation that is breathy and hoarse in quality
Vocal Process Granuloma (Contact Ulcer): Associated with gastroesophogeal reflux disease (GERD). Low pitch, vocal fatigue, and frequent throat clearing. |
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Papilloma |
*Organic Disease*
Wart like growth caused by a virus that can result in the obstruction of the airway. Typically removed by surgery although they tend to reoccur. Scar tissue can develop resulting in voice changes |
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Carcinoma (cancer) |
*Organic Disease*
Associated with smoking, environmental irritants, and metabolic disturbances
*sign of cancer is persistent hoarseness for more than 2 weeks* |
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Interviews for Voice Disorders |
Individuals will be asked to describe the problem, how it has developed, and if there are any other associated symptoms. SLP will obtain medical history, job history, family constellation, and academic history. |
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Viewing the Larynx for Voice Disorders |
Direct Laryngoscopy: Invasive procedure to view the larynx while the patient is asleep
Indirect Laryngoscopy: Fiber optic laryngoscope is a flexible bundle of glass fibers that has a camera on one end which is inserted into the patients nasal passage and moved back down to the throat.
The patient will be required to: Raise and lower pitch, produce a loud and soft voice, sustain phonation, and produce conversational speech |
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Treating Phonotrauma |
Teach the individual how the system works, increase awareness of innopropriate vocal behaviors, and encourage patients to make changes |
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Alaryngeal Communication |
Communicating without a larynx. Three options for those who had a laryngectomy: Artificial Larynx, Esophogeal Speech, and Tracheaoesophogeal Puncture |
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Artificial Larynx |
Provides a source of vibration when placed on the patients neck or in the mouth. Monotone quality. |
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Esophogeal Speech |
Uses the esophogus as the sound source for the voice |
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Tracheaoesophogeal Puncture |
Direct air from the trachea tot he esophogus so that the sound is produced |
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Deglutition |
Swallowing |
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Swallowing Serves two purposes |
-Airway production -Movement of foods and liquids from the oral cavity to the stomach |
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Dysphagia |
Difficulty Moving food from the mouth to the stomach |
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Epiglottis |
Cartilaginous structure found within the pharyngeal cavity that covers the opening of the larynx |
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Pharyngeal Recess |
Pockets in the pharyngeal cavity that prevents food and liquid from entering the larynx
*Valleculae and Pyriform Sinuses* |
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Cricopharyngeous Muscle |
Located between the base of the pharynx and top of the esophogus. Prevents air or refluxed stomach contents from entering the pharynx |
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Oral Prepatory Phase (1st phase of swallowing) |
Prepares solids and liquids for swallowing. Soft palate lowers and the tongue gathers all the materials. Respiration continues through the nasal cavity |
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Bolus |
Solids and liquids formed into a ball |
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Oral Phase (second phase of swallowing) |
Bolus is moved to the back of the mouth. Timing of the oral phase is 1-1.5 seconds. Lips are closed during this phase and respiration continues |
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Pharyngeal Phase (third phase of swallowing) |
Bolus moves from the back of the oral cavity though the pharynx to the opening of the esophogus. Timing of the pharyngeal stage is about 1 second |
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Esophogeal Phase (fourth phase of swallowing) |
Movement of the bolus from the esophogeal opening to the stomach takes 8-20 seconds. Upper esophogeal sphincter joins the pharynx and esophogus. Peristalsis occurs. |
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Peristalsis |
Muscular contraction that pushes the bolus through the esophogus |
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Diagnosis of Dysphagia |
When there is:
residue- remaining food or liquid present in the mouth or throat
laryngeal penetration- bolus enters the laryngeal area above the vocal folds
aspiration pneumonia- food or liquid enters the bronchi of the lungs resulting in an infection of the lungs |
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Dysphagia in oral prepatory phase |
Food may fall from the mouth
Difficulty forming the bolus
Liquids or solids may prematurely enter the pharynx |
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Dysphagia in the oral phase |
Delay in moving the bolus
Bolus may break apart
Liquids or solids may enter the pharyngeal cavity |
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Dysphagia in the pharyngeal phase |
Bolus may arrive in the pharynx before the swallow has been initiated
Velopharyngeal closure may be delayed causing nasal backflow |
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Dysphagia in the esophogeal phase |
Esophogeal backflow from food or liquid that has entered the esophogus |
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Stroke |
Right Hemisphere Stroke: Causes lengthened time for food to move through the pharynx
Left Hemisphere Stroke: Exhibit a delay or absent pharyngeal response and aspiration during and after a swallow |
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Traumatic Brain Injury |
Exhibit a delay or absent pharyngeal response and aspiration during and after a swallow |
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Amyotriphic Lateral Sclerosis (ALS) |
Exhibit difficulty with chewing, swallowing, and coughing |
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Parkinson's Disease |
Exhibit difficulty with the oral phase and delays in the pharyngeal phase resulting in aspiration |
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Head and Neck Cancer |
Movement of food toward stomach might be obstructed |
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Screening Swallowing |
Determines if there is a presence of a problem |
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Clinical Assessment of Swallowing |
-Obtaining and reviewing case history info -Obtaining family info -Assessing the patient's oral structures and ability to eat and drink |
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Videofluroscopic Swallow Study (VFSS) |
patient is given an array of foods and liquids containing barium and an x-ray study is completed |
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Fiber-optic endoscopic evaluation (FEES) |
Uses a fiberscope to directly view the swallowing process |
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Treatment of Swallowing Disorders |
-Swallowing Compensations (different postures or swallowing manueuvers) -Swallowing Excercises -Education training -Non-oral feeding considerations |
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Pediatric Dysphagia |
May result from neurological or anatomical disorders |
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Fluency |
Smooth and effortless forward flow of speech |
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Disfluency |
Anything that interrupts the forward flow of speech |
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Between-word disfluencies |
-phase repetitions: "I want, I want, I want to go" -Revisions: "I like, I want to go" -Interjections: "I um, like um, to go" -Multisyllabic Whole Word Repetitions: "Mommy, mommy, mommy, I want to go" |
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Within-Word Disfluencies |
Speech that is judged as abnormal or stuttering
-Sound/Syllable Repetitions: "I want an a-a-apple" -Sound prolongations: audible-client stretches the sound for an extended period of time inaudible- client begins a word with a silent pause |
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Incidence |
5% of the population who have stuttered at some point in their life |
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Prevalence |
~1% of the population who presently exhibit the problem |
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Ratios |
2 males to 1 female in children and 4:1 males to females in adults who stutter
Stuttering runs in families
The onset of stuttering can occur within one day and some may start producing moderate to severe stuttering. For other children onset might be more gradual |
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Spontaneous or natural recovery |
Children who outgrow the problem w/o recovery
A preschooler who has begun stuttering has a 65-80% chance of natural recovery by 3-5 years following onset
20% of preschool children will continue stuttering and require some form of intervention
More females recover than men
Children who have family with a history of recovery have a 65% chance of natural recovery |
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Organic Theory |
Focus on the biological or physiological explanations for the onset of the problem
Theory of cerebral dominance: One cerebral hemisphere becomes dominant, which controls the other cerebral hemisphere. *people who stutter do not exhibit this cerebral dominance and as a result the brain is not able to control the fluent production of speech |
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Behavioral Theory |
Stuttering is a learned behavior
Stuttering begins in the listeners ear, not the speakers mouth *Patients who are aware of the problem react to their child's speech which in turn causes the child to react
Diagnosiogenic Theory: Johnson claimed it was the parent's diagnosis of their child's problem that ultimately led to their stuttering |
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Linguistic Theory |
Covert-repair hypothesis: Speaker has an internal, subconscious moniter that enables the speech system to make corrections in the formulations of speech sounds to produce words *For a person who stutters, the ability to moniter their errors is delayed and as a result the person stutters because they cannot make the corrections suggested by the internal moniter |
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Biology Plus Environment |
Demands and capacities model: the child is born with a set of abilities related to motoric function, emotional development, cognitive development, and linguistic development *When the demands of the environment exceeds the childs capacities, stuttering results |
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Evaluating Suttering |
Calculating the client's stuttering in different communicative environments
Interviewing the parent of the child/adult who stutters
Assessing additional speech/language skills
Assessing vocal quality
Assessing speech motor coordination |
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Treating Adults with stuttering |
Stuttering modification therapy: Focuses on the reduction of avoidance behaviors, ultimate goals are to accept stuttering, decrease avoidance, confront fears, and learn or stutter in an easier manner. Clients are taught that stuttering will always be a part of their lives
Fluency Shaping Theory: Replaces stuttered speech with fluent speech. Ultimate goal is for the client to maintain fluent speech during a conversation. The client will recieve praise when fluent speech is utilized and punished when he/she stutters |
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Treating Children with stuttering |
Indirect Therapy: Parents are instructed in methods facilitating communication at home
Direct Therapy: Lidcombe Program- Designed to be administered by the parents Traditional Program- Teaching the client to stretch and connect words |
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Cluttering |
Speech and language processing disorder characterized by rapid and dysrhythmic speech that is frequently unintelligable |
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Neurogenic Stuttering |
Gradual or sudden onset of stuttering like disfluencies in adults associated with strokes, TBI, and diseases that affect the brain |
