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72 Cards in this Set

  • Front
  • Back
Describe these terms as they relate to speech:
-cog: ideas that form lang.
-res: the acoustic signal sent by air molecules
-artic: shape the acoustic sig.
-phon: generation of sounds from the VFs
-resp: movement of air from the lungs
What is a voice disorder vs a voice difference?
disorder = dysphonia, abnormal voice

diff = WNL
What are some factors that contribute to the acoustic "blueprint" of a voice?
•Fundamental frequency
What parameters help define normal range for an individual's voice?
–Profession or occupation
What are some possible etiologies for voice disorders?
•Congenital (born with problem)
•Inflammation (viral)
•Neoplastic (cancer + tumors)
•Trauma (injury)
•Neurologic (CNS or PNS problems)
•Endocrine related (hormones)
•Anatomic-structural (cleft palate)
•Arthritis (of laryngeal joints)
•Psycho-social -emotional -stress -related
What is the underlying mech. of hoarseness in voice?
-roughness, raspy
-too much noise in voice
What is the underlying mech. of breathiness in voice?
-too much air in voice
What is the underlying mech. of too low/too high pitch in voice?
-too low: increased mass on VFs

-too high: decreased mass of VFs, increased tension
What is the underlying mech. of tremor in voice?
-alternating contractions of VFs
Define these vocal parameters:
•Noise or roughness
•Pitch = fundamental frequency (Hz: cps)
•Loudness = intensity (dB)
•Noise or roughness = pertubation(%)
–Freq. or Amp.
•Flexibility = max/min pitch, loudness, semitones, etc.
What is the cause and tx for laryngeal web?
-congenital web of tissue attached at the level of the VFs
-risk of asphyxiation
-surgical removal necessary
What is the cause and tx for VF cysts?
-congenital small fluid-filled projections on VFs or larynx
-surgical removal necessary
What is the cause and tx for papilloma?
-congenital, more common in children than adults
-cauliflower-looking, viral in origin
-subside with age or require surgical removal
What is the cause and tx for laryngomalacia?
congenital laryngeal stridor
What affect does inflammation have on voice?
-may be chronic or acute
-increases mass of VFs
-causes low pitch and hoarseness
What are some endocrine related issues which may affect voice?
•Hypothyroidism or Hyperthyroidism
•Hyperpituitarismor Hypopituitarism
•Menopause (deeper, lower pitch voice)
•Virilization(too much testosterone)
•Systemic effects of hormones
What are some examples of phono-trauma?
-vocal overuse, resulting in nodules (in some cases)
-injury (surgery, whip-lash)
What are some examples of neurological vocal problems?
-dysphonia due to a MSD (dysarthria, AOS)
-VF paralysis
What are some structural/anatomical problems of voice?
-VF insufficiency
-cleft palate
What are some factors affecting voice as a person ages?
•Growth: changes in vocal fold length
–cricothyroid and thyroarytenoid muscles
•Changing structure of vocal fold tissues
•Ossification of the cartilage in the larynx
What is the size of the VFs at birth (both genders)?
What is the growth rate/final size of VFs in the first 20 years of life (males/females)?
For males:
–growth rate is ~ 0.7 mm per year
For females:
–growth rate is ~ 0.4 mm per year
Final length:
–16 mm for men
–10 mm for women.
Are children quieter than adults?
Explain this phenomena
-children have higher pitch and greater lung pressure, which makes for voices as loud (or louder) than adults
What change does puberty bring to the voice in boys?
-fast growth of larynx
-increased mass of VFs
-->lower pitch
What factors contribute to vocal changes during adolescence?
–facial development (related to voice resonance)
–a descent of the larynx (lengthens the vocal tract)
–increased circumference of chest wall and lung (providing greater breathing capacity)
What factors contribute to voice changes after middle age?
–ossification (hardening) of laryngeal cartilages
–atrophy: wasting away of cells
–dystrophy: malfunctioning of cells
–edema: swelling due to excessive accumulation of fluids in tissue
–Presbylaryngeus=the aging larynx
compare Asian/AA/Wt subjects in terms of pitch for vowels
high-low: asian, wt, AA
Which demo. groups had more noise (shimmer) in Dr. A's study?
-men > women
-Asians > other groups
compare demo groups in terms of speaking rate (wpm)
AA and MAE faster than chinese
How did the Greeks compare to the other demo groups in the study?
-louder, lower pitch
-rougher voices
-faster speakers
Which structures act as resonators in the vocal tract?
•Oral Cavity
•Nasal Cavity
Name the laryngeal cartilages
Three paired
–Arytenoids (2)
–Cuneiforms (2)
•Three unpaired
–Thyroid (1)
–Epiglottis (1)
•One related cartilage
–Hyoid (1)
Name the intrinsic laryngeal muscles and their purposes
-Thyroarytenoid (the VFs!): relaxesV VFs
-cricoarytenoid: adduct VFs
-crigothyroid: tenses VFs
What is a pseudobulbar condition (such as Spastic Dysphonia)?
•from bilateral UMN damage
•produces spasticity
•a “Spastic Dysphonia” marked by:
–VF over-adduction or hyper-adduction
–due to loss of inhibition of UMNs.
Describe the respiratory system at rest
•Pleural pressure is slightly less than atmospheric
–usually -1mm Hg
•Alveolar pressure (inside lungs)
–equal to atmospheric pressure
•Respiratory muscles are at rest
Describe the respiratory system during inhalation
•Muscles of inhalation contract
•Diaphragm moves in vertical direction
•Thoracic diameter increases/enlarges
•Pleural pressure is negative to atmospheric
•Lungs expand
•Alveolar pressure decreases:
= subatmospheric
•Air flows into lungs
•Larynx moves downward
Describe the respiratory system during exhalation
•Inhalatory muscles relax
•Elastic recoil of lungs
•Thoracic cage collapses
•Alveolar pressure > atmospheric pressure
•Air is forced out of lungs
•Larynx moves upward
Compare respiration at rest vs in use for speech
**Rate at rest
•16-18 cycles per minute
•Each I/E component lasts 2-3 seconds each
**Rate for speech
•8 cycles per minute on average
•Inhalatory component lasts 2-3 seconds each
•Exhalatory component lasts 30-40 seconds each
What does the dorsal respiratory group (from the medulla) control?
•innervate inhalation only
•primary function:
–control basic rhythm of respiration
What does the ventral respiratory group (from the medulla) control?
•location: nucleus ambiguus
•stimulates: exhalation or inhalation
•inactive during quiet respiration
•increase respiratory drive during increased ventilatory needs
What does the apneustic center (from the medulla) control?
•located: lower pons
•prevents: inspiratory pump from switching off
•backup mechanism to drive inspiration
What does the pneumotaxic center (from the medulla) control?
•located: upper pons
•inhibits: inhalation
•regulates: inspiratory volume
What doe the peripheral chemoreceptors do?
•located in carotid body
–base of neck by aortic body/heart
–sensitive to O2 and CO2 concentrations
–increase/decrease excitation to medulla
–innervates respiratory center
Describe the chemical control for respiration
-inc. CO2 excites respiration
-inc. respiration eliminates Co2 from blood
-low O2 levels sensed by periph. chemoreceptors
What do the pulmonary stretch receptors do?
-send info to Vagus nerve and dorsal resp. neuons
-when lungs over stretched, switch off
-inflation reflex activated when tidal volume < 1.5 liters
What are the components of a DDX voice eval?
•Medical exam: minimum ENT evaluation
•Patient diagnostic interview
•Acoustic perceptual voice evaluation:
–subjective + objective measures
•Instrumental evaluation:
–acoustic, aerodynamic, etc.
•Functional evaluation of VFs movement
–endoscopy, digital-video-strobo-endoscopy
Describe Koufman's levels of voice usage
Level I: Elite performer
–singer or actor
Level II: Professional voice user
–lecturer, clergy, broadcaster
Level III: Nonvocal professional
–teacher, lawyer
Level IV: Nonvocal nonprofessional
–clerks, laborers
What does the GRBAS measure? What kind of scale?
Uses a 4pt scale to measure:
•G = grade: degree of hoarseness
•R = rough: degree of irregularity
•B = breathy: extent of air leakage
•A = aesthnic: degree of power in voice
•S = strained: degree of vocal hyperfunction
Describe levels of subglottal air pressure during speech
•Low pitches: 3 cm H20
•High pitches: 6 cm H20
•Typically below 10 cm H20 for conversational speech
What is translaryngeal pressure?
–SAP minus Supraglottal Air Pressure
–Determines difference between:
•sub & supra pressure acting on
•inferior & superior VF surfaces
–Drives air through glottis
–Creation & duration of phonation depends on:
•VF approximation
•Amount of TLP
What is frequency perturbation? What causes it?
-aka jitter
-aperiodicities, rough voice
-abnormal innervation to CT muscles
Describe the effect of edema (increased mass) on the VFs
-lower Fo
-requires more SAP to maintain normal Fo
What will increased SAP lead to?
-increased intensity (loudness)
Do women speak louder than men? Explain.
-same loudness (w/in 1-2dB)
-women have higher pitch w/higher SAP
What conditions can present with strained-strangled phonation (vocal hyperfunction/hyperaduction)?
•Spastic Dysarthria (neurologic)
•Spasmodic Dsyphonia (AD -? neurologic)
•Muscle Tension Dysphonia (MTD pattern)
•Physiological/psychological stress-related
What conditions present with brethiness (vocal hypofunction)?
•VF paralysis: unilateral vs. bilateral
•Mass-lesion of VFs (obstruction)
•Muscle tension dysphonia
What conditions present with hoarseness (rough + breathy)?
•Mass lesion on VFs (VF nodules)
•Edema of VFs
•VF paralysis in the setting of other features: (breathiness, diplophonia, etc.)
What conditions present with vocal harshness (strain + rough)?
•Hyerfunctional conditions:
–MTD, spastic dysarthria, vocal strain, etc.
What condition results in diplophonia (2 pitches at once)?
•Unilataral VF paralysis: LMN usually involving RLN of CN X.
What conditions result in a falsetto (vib. of ant. 1/3 of VFs)?
•VF paralysis
•Mutational falsetto
•Preferred pitch level
What causes glottal fry (vib. at lower end of pitch range)?
•hyperfunctional phenomenon (increased tension or hyperadduction of VFs)
What conditions result in VF tremor (rhythmic VF contractions)?
•Hyperkinetic phenomenon (neurologic)
•Muscle Tension Pattern (functional or other)
•Hyperfunctional phenomenon (hyperadduction)
Describe the questions of the VHI-30
30 total questions
-Scores range from 0-120
-120=worst quality of life
-Three domains
Describe the questions of the V-RQOL
-10 questions
-Raw scores range from 10-50
-Converted using a algorithm from 0-100
-0 = worst quality of life
-Scale allows you to calculate a total score plus the two domain scores
-Two domains
Describe the scaling of the GRBAS
-Each component is rated on a *4-point scale
-0 = Normal
-1 = Slight
-2 = Moderate
-3 = Extreme
*Evaluate each vocal parameter
Describe the rating of the CAPE-V
-Clinician is to describe overall severity, roughness, breathiness, strain, pitch, loudness
-Indicate the degree of perceived deviance from normal using a 100-mm visual analog scale
Compare ADductor and ABductor types of spasmodic dysphonia
AD: strain/strang., voice stops, tension

AB: intermit. aphonia, breathiness
Name a disorder associated with these dysarthrias:
f: myesthenia gravis
sp: dystonia
atx: cerebellar disorders
hyper: MS, huntingtons
hypo: PD
mx: ALS
What are the components of a voice dx?
-reason for referral
-hx of problem
-medical hx
-social hx
-oral periph exam
-voice component eval (resp, phon, res, pitch, loud, rate
-clinical impressions, prognosis
What aspects of voice/resp might use/need instrumental measurements?
-acoustic measures (Fo, intensity, jit/shim, s:n, range)
-aerodyn (pressure, flow, resistance, SAP)
-images (stroboscopy
What is the normal Fo for
Kids (boys, girls)
Adults (M, F))
226hz, 238hz

106hz, 193hz
What is the normal intensity for
K: 70dB

M: 70dB
F: 68 dB