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86 Cards in this Set
- Front
- Back
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Hyoid Bone
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3 parts
Greater Cornua Lesser Cornua Corpus (body) Larynx suspended from the hyoid bone. |
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Cuniform Cartilages
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paired
Hyaline cartilaginous tissue Embedded within aryepiglottic folds |
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Aditus Larynges
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Opening from the pharynx into the larynx
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Ventricle of Morgagni
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space between the true and false vocal folds.
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Arytenoids
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Paired
Hyaline cartilagenous tissue Tetrahedrons Cartilaginous glottis |
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Pyriform Sinuses
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Spaces at the bottom of the valleculae where pooling can occur
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Valleculae
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groove between the base of the tongue and epiglottis that diverts saliva.
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Vocal Process
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anterior projection at the base o the arytenoid cartilages
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Quadrangular membrane
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layer of submucosa that contains the cuniform cartilages
Connect epiglottis with the arytenoid and thyroid |
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Cricoid
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unpaired
Hyaline cartilaginous tissue Most inferior cartilage Signet ring Top of Trachea |
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Epitheilial tissue
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First layer of the vocal folds
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Trachea
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Windpipe
C-shaped cartilage |
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Glottal chink
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space between the arytenoids during adduction
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Lateral Cricoarytenoid
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Innervated by the recurrent laryngeal nerve
Adducts membranous portion of the vocal folds Antagonist to the posterior cricoarytenoid |
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Posterior Cricoarytenoid
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innervated by recurrent laryngeal nerve
Abductor |
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Full adduction
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LCA and Interarytenoids (Transverse and Oblique)
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Cricothyroid
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Superior laryngeal nerve
Vocal fold lengthener Pars Recta Pars Oblique Thyroid tilts forward arytenoids rock backward |
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Thyroarytenoids
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Vocalis
Muscularis Most of the mass of the vocal folds |
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Thyrovocalis
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Tensor
Shortens the vocal folds |
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Thyromuscularis
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Vocal fold relaxer
Lengthens the vocal folds antagonistic to cricothyroid - thyroid back, arytenoids forward |
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Interarytenoids
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adducts vocal folds
along with LCA run in between cartilagenous portion of the VFs Transverse Oblique Cartilagenous portion |
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Transverse
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Adductor
Runs horizontally adductor |
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Oblique
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run diagonally
adductor |
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Triticial
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Connects greater cornua of the hyoid bone to with superior cornua of the thyroid cartilage.
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Adduction
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Vocal folds together
VFs must be adducted to produce sound |
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Vocal folds
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Vibrate in a cycle from closed to open to closed
Must be adducted for vibe cycle |
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Abduction
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vocal folds apart
during rest , yawning, production of unvoiced consonants breathing |
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Vocal Fold Attacks
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When VFs move from abduct to adduct phase
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Simultaneous attack
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Vocal folds adduct and air goes through at the same time
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Hard glottal attack
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abusive behavior
Vocal folds come together before air escapes |
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Breathy attack
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Air escapes after vocal folds approximate
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Open / close
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terms used to describe the action of the vocal folds vibrating during adduction.
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Pitch
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2 Factors
Mass Tension More tension - higher pitch Greater mass - lower pitch Children - 320 Women- 220 Males-120 |
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Perceptual Characteristics
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pitch
loudness quality |
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Accoustic characteristics
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Frequency
Intensity Complexity |
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Frequency
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Perceived as pitch
Accoustically fundamental frequency rate of vocal fold vibration Hz (cycles per second) |
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False vocal folds
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greater mass - lower pitch
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Habitual pitch
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pitch that is usually used may or may not be the optimal pitch
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Loudness
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intensity of the sound signal
effected by individual's ability to control the closed phase of the vibaratory cycle Longer closed phase - louder signal |
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Quality
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Complexity
Harsh , breathy, hoarse Overall pleasantness of voice Must vibrate with periodocity (repeat the vibe pattern over time) and in phase (both vocal folds in same point ofvibe cycle) |
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Vibratory pattern
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vocal folds vibrate in a cycle
From closed to open to closed VFs adducted in order to produce sound |
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Control of loudness
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depends on the individual's ability to close vocal folds and control the closed phase of the vibratory cycle.
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Edema
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swelling caused by fluid in tissues
Adds mass Pitch decreased |
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Pitch
Cricothyroid |
lengthens and raises pitch
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Pitch
Edema |
adds mass lowers pitch
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Salpingopharyngeus
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contrictor muscle in the lateral wall of the pharynx
Raises pharynx inward Assists with VP closure |
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Palatoglossus
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depresses vellum to open the VP port
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VP port
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passage between the oral and nasal cavities
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VP mechanism
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structures (velum and pharynx) that block off VP port
Port open for nasals Closed for orals |
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Perturbation
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a disturbance
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Shimmer
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cycle to cycle variation in intensity
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Jitter
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cycle to cycle variation in pitch and frequency
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Laryngeal malacia
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floppy larynx
Newborns , preemies, cry is different usually heals itself |
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Contact ulcers
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•excessive collision of arytenoid cartilages usually due to hard glottal attack
•excessive throat clearing •intubation bilateral or unilateral hoarseness, breathiness, lowered pitch, decreased pitch range |
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Endocrine changes
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Anything having to do with changes in estrogen or progesterone
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Hemangioma
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soft pliable fluid filled sack
Caused by vocal hyperfunction, hyperacidity , intubation breathing difficulty and hoarseness Surgically removed by laser |
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Vocal nodules
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•benign lesion
•bilateral, whitish protuberance on the glottal margin of each fold (like a callous) •due to continous hyperfunction Anterior 1/3 of glottal margin Treatment 4-8 weeks |
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Dysarthria
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problems with respiration, prosody, pitch, loudness
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Functional dysphonia
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harsh / hoarse/ breathy voice
does not result from organic or structural pathology due to laryngeal and supralaryngeal shut down or psychological issues |
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Functional aphonia
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no voice at all
whisper voice VFs do not adequately vibrate |
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Intubation granuloma
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- Damage to vocal folds due to intubation too long or when removing it
- Like contact ulcers - Lesions/bruises in the vocal folds that cause an inflammation or a firm granulated sac filled with capillaries that can bleed - 3 causes of granuloma: intubation (or extubation), glottal trauma from abuse or misuse, and laryngeal reflux disease - Granulomas are vascular lesions that are most often the result of laryngopharyngeal reflux (acid reflux into the larynx), laryngeal intubation during surgery, or voice misuse. Because granulomas often occur on the vocal process of the arytenoid cartilage and not on the actual vocal fold, vocal quality may not be affected; however, vocal symptoms may include hoarseness, breathiness, reduced pitch range, and vocal fatigue. - Treatment: In cases where the granuloma is felt to be related to laryngopharyngeal reflux, anti-reflux medications are usually prescribed. Surgical removal may be necessary. Voice therapy is often recommended. |
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vocal polyp
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•lesion is soft, fluid filled, and occurs in the inner margin of one vocal fold
•due to hyperfunction after ONE event •sessile or pedunculated •severe dysphonia •vocal therapy is the first approach |
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Papilloma
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•wartlike growths, viral in origin
•usually found in children under 5 •can be a threat to the airway, if so, surgery is needed |
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Diplophonia
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•double voice, 2 distinct voice sources
•etiology- polyps, vocal fold paralysis, laryngeal web •treatment- voice therapy or surgery |
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Ventricular dysphonia
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•the false folds adduct together over the true vocal folds, may also display diplophonia
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Nasality
Rhinolalia |
Clausa - open - hyponasality
Aperta - open - hypernasality |
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Adductor paralysis
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Vocal folds cannot adduct
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Bilateral vocal fold paralysis
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•Life threatening
•ADDuctory paralysis- phonation impossible, aspiration likely. Surgery needed •ABductory paralysis- causes respiratory problems, traceostomy needed |
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Unilateral vocal fold paralysis
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•often has spontaneous recovery
•some phonation possible •facilitative approach- inhalation phonation, half-swallow boom, digital manipulation |
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Spastic dysphonia
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- sounds strained—as if trying to push air out of tightly adducted vocal folds (treatment: botox injections – injected into the thyroarytenoid,
- the tight voice -hyperadduction of the true vocal folds, o the most common type of SD is ADductor spastic dysphonia (ADSD) – tight laryngeal adduction o a second form of SD is ABductor spastic dysphonia (ABSD) involuntary muscle spasms cause the vocal folds to open – VF can’t vibrate when open |
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Leukoplakia
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- pre-cancerous (whitish in color)
- benign, whitish patches/lesions on the surface membrane of the mucosal tissue - needs to be watched closely because it can become malignant but it doesn’t always - symptoms: hoarseness, breathiness, reduced loudness, lower pitch |
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Congenital webbing
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- a laryngeal web growing across the glottis between the two vocal folds
- caused by the glottal membrane failing to separate in embryonic development - requires surgery - keel |
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Myasthenia Gravis
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- neurological
- vocal fatiguing and problems in adequate breath support - the normal voice changes to a breathy, weak, barely audible voice - after a few minutes of voice rest, voice will be restored and return to normal; however, continued usage will result in the weak voice returning. - Treatment is primarily medical - SLPs often discover the disease, but neurologists diagnose it. - Voice therapy should NOT be provided; SLPs should just monitor the motor response over. |
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ALS - Lou Gehrig's disease
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- difficulty with articulating rapid speech
- progressive degenerative disease of unknown etiology involving the motor neurons of the cortex and the gray bodies within the brain stem and the spinal cord - the early complaints to SLPs are usually: difficulty articulating rapid speech, occasional hoarseness, and occasional swallowing problems - major concern is the inability to clear the throat and cough - clinical focus needs to be on swallowing and coughing, rather than speech and voice |
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Cul de Sac
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- a voice that seems to trapped in nose and throat (yodeling or some dialects)
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Nasometer
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used to evaluate nasalance
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Delayed auditory Feedback
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used to improve fluency
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VPI
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VPI
- velopharyngeal insufficiency – not sufficient tissue o there’s no sufficient tissue for VP closure o surgical procedure to help flap obturator – pg. 296 top picture |
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Velopharyngeal incompetence
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- velopharyngeal incompetence – adequate tissues but not able to perform
o there’s enough tissue but the VP doesn’t do what it’s supposed to do |
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Causes of hyponasality
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- nasal polyps
- allergies - hyperatrophied adenoids |
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Triticial cartilage
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- what connects the superior cornua of the thyroid cartilage and the greater cornua of the hyoid bone
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Primary reason for laryngectomy
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Cancer
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Three therapy / speaking options for laryngectomy
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- esophageal speech
o cricopharyngeus muscle is the vibrating source/structure for esophageal speech - electrolarynx - tracheoesophageal puncture (TEP) – pg. 271, 273, 275 |
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Cranial nerve X
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- two branches: SLN and RLN
o Superior laryngeal nerve (SLN) – innervates the cricothyroid o Recurrent laryngeal nerve (RLN) – innervates all other intrinsic nerves Paths: (**boob-looking drawing in notes) • Left RLN – travels below the aortial artery and goes up to the vocal folds o Can sometimes be flipped during heart surgery and can impact the voice. • Right RLN – travels below the subclavial artery and goes up to the vocal folds |
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Layers of VFs
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1. epithelial
2. Reinke’s space (superficial) 3. Intermediate lamina 4. Deep lamina 5. Ligament |
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Vocal Fold Vibration
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- Caused by air pressure building below the vocal folds in the subglotties where subglottal pressure is released where there is least resistance which will blow the VF apart and because of the elasticity of the VF, they are very quickly pulled back together
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