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72 Cards in this Set
- Front
- Back
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Describe these terms as they relate to speech:
•Cognition •Resonation •Articulation •Phonation •Respiration |
-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 |
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What is a voice disorder vs a voice difference?
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disorder = dysphonia, abnormal voice
diff = WNL |
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What are some factors that contribute to the acoustic "blueprint" of a voice?
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•Formants
•Fundamental frequency •Intensity •Noise •Subharmonics |
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What parameters help define normal range for an individual's voice?
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–Community
–Society –Culture –Age –Gender –Profession or occupation |
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What are some possible etiologies for voice disorders?
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•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 |
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What is the underlying mech. of hoarseness in voice?
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-roughness, raspy
-too much noise in voice |
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What is the underlying mech. of breathiness in voice?
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-too much air in voice
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What is the underlying mech. of too low/too high pitch in voice?
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-too low: increased mass on VFs
-too high: decreased mass of VFs, increased tension |
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What is the underlying mech. of tremor in voice?
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-alternating contractions of VFs
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Define these vocal parameters:
•Pitch •Loudness •Noise or roughness •Flexibility |
•Pitch = fundamental frequency (Hz: cps)
•Loudness = intensity (dB) •Noise or roughness = pertubation(%) –Freq. or Amp. •Flexibility = max/min pitch, loudness, semitones, etc. |
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What is the cause and tx for laryngeal web?
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-congenital web of tissue attached at the level of the VFs
-risk of asphyxiation -surgical removal necessary |
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What is the cause and tx for VF cysts?
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-congenital small fluid-filled projections on VFs or larynx
-surgical removal necessary |
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What is the cause and tx for papilloma?
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-congenital, more common in children than adults
-cauliflower-looking, viral in origin -subside with age or require surgical removal |
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What is the cause and tx for laryngomalacia?
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congenital laryngeal stridor
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What affect does inflammation have on voice?
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-may be chronic or acute
-increases mass of VFs -causes low pitch and hoarseness |
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What are some endocrine related issues which may affect voice?
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•Hypothyroidism or Hyperthyroidism
•Hyperpituitarismor Hypopituitarism •Menopause (deeper, lower pitch voice) •Virilization(too much testosterone) •Systemic effects of hormones |
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What are some examples of phono-trauma?
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-vocal overuse, resulting in nodules (in some cases)
-injury (surgery, whip-lash) |
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What are some examples of neurological vocal problems?
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-dysphonia due to a MSD (dysarthria, AOS)
-VF paralysis |
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What are some structural/anatomical problems of voice?
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-VF insufficiency
-cleft palate -laryngectomy |
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What are some factors affecting voice as a person ages?
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•Growth: changes in vocal fold length
•Development: –cricothyroid and thyroarytenoid muscles •Changing structure of vocal fold tissues •Ossification of the cartilage in the larynx |
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What is the size of the VFs at birth (both genders)?
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2mm
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What is the growth rate/final size of VFs in the first 20 years of life (males/females)?
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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. |
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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
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What change does puberty bring to the voice in boys?
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-fast growth of larynx
-increased mass of VFs -->lower pitch |
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What factors contribute to vocal changes during adolescence?
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–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) |
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What factors contribute to voice changes after middle age?
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–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 |
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compare Asian/AA/Wt subjects in terms of pitch for vowels
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high-low: asian, wt, AA
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Which demo. groups had more noise (shimmer) in Dr. A's study?
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-men > women
-Asians > other groups |
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compare demo groups in terms of speaking rate (wpm)
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AA and MAE faster than chinese
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How did the Greeks compare to the other demo groups in the study?
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-louder, lower pitch
-rougher voices -faster speakers |
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Which structures act as resonators in the vocal tract?
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•Larynx
•Pharynx •Oral Cavity •Nasal Cavity •Nasopharynx |
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Name the laryngeal cartilages
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Three paired
–Arytenoids (2) –Corniculates(2) –Cuneiforms (2) •Three unpaired –Thyroid (1) –Cricoid(1) –Epiglottis (1) •One related cartilage –Hyoid (1) |
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Name the intrinsic laryngeal muscles and their purposes
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-Thyroarytenoid (the VFs!): relaxesV VFs
-cricoarytenoid: adduct VFs -crigothyroid: tenses VFs |
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What is a pseudobulbar condition (such as Spastic Dysphonia)?
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•from bilateral UMN damage
•produces spasticity •a “Spastic Dysphonia” marked by: –VF over-adduction or hyper-adduction –due to loss of inhibition of UMNs. |
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Describe the respiratory system at rest
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•Pleural pressure is slightly less than atmospheric
–usually -1mm Hg •Alveolar pressure (inside lungs) –equal to atmospheric pressure •Respiratory muscles are at rest |
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Describe the respiratory system during inhalation
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•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 |
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Describe the respiratory system during exhalation
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•Inhalatory muscles relax
•Elastic recoil of lungs •Thoracic cage collapses •Alveolar pressure > atmospheric pressure •Air is forced out of lungs •Larynx moves upward |
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Compare respiration at rest vs in use for speech
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**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 |
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What does the dorsal respiratory group (from the medulla) control?
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•innervate inhalation only
•primary function: –control basic rhythm of respiration |
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What does the ventral respiratory group (from the medulla) control?
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•location: nucleus ambiguus
•stimulates: exhalation or inhalation •inactive during quiet respiration •increase respiratory drive during increased ventilatory needs |
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What does the apneustic center (from the medulla) control?
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•located: lower pons
•prevents: inspiratory pump from switching off •backup mechanism to drive inspiration |
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What does the pneumotaxic center (from the medulla) control?
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•located: upper pons
•inhibits: inhalation •regulates: inspiratory volume |
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What doe the peripheral chemoreceptors do?
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•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 |
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Describe the chemical control for respiration
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-inc. CO2 excites respiration
-inc. respiration eliminates Co2 from blood -low O2 levels sensed by periph. chemoreceptors |
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What do the pulmonary stretch receptors do?
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-send info to Vagus nerve and dorsal resp. neuons
-when lungs over stretched, switch off -inflation reflex activated when tidal volume < 1.5 liters |
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What are the components of a DDX voice eval?
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•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 |
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Describe Koufman's levels of voice usage
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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 |
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What does the GRBAS measure? What kind of scale?
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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 |
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Describe levels of subglottal air pressure during speech
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•Low pitches: 3 cm H20
•High pitches: 6 cm H20 •Typically below 10 cm H20 for conversational speech |
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What is translaryngeal pressure?
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–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 |
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What is frequency perturbation? What causes it?
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-aka jitter
-aperiodicities, rough voice -abnormal innervation to CT muscles |
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Describe the effect of edema (increased mass) on the VFs
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-lower Fo
-requires more SAP to maintain normal Fo |
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What will increased SAP lead to?
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-increased intensity (loudness)
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Do women speak louder than men? Explain.
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-same loudness (w/in 1-2dB)
-women have higher pitch w/higher SAP |
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What conditions can present with strained-strangled phonation (vocal hyperfunction/hyperaduction)?
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•Spastic Dysarthria (neurologic)
•Spasmodic Dsyphonia (AD -? neurologic) •Muscle Tension Dysphonia (MTD pattern) •Physiological/psychological stress-related |
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What conditions present with brethiness (vocal hypofunction)?
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•VF paralysis: unilateral vs. bilateral
•Mass-lesion of VFs (obstruction) •Psychogenic •Muscle tension dysphonia |
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What conditions present with hoarseness (rough + breathy)?
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•Mass lesion on VFs (VF nodules)
•Edema of VFs •VF paralysis in the setting of other features: (breathiness, diplophonia, etc.) |
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What conditions present with vocal harshness (strain + rough)?
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•Hyerfunctional conditions:
–MTD, spastic dysarthria, vocal strain, etc. |
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What condition results in diplophonia (2 pitches at once)?
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•Unilataral VF paralysis: LMN usually involving RLN of CN X.
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What conditions result in a falsetto (vib. of ant. 1/3 of VFs)?
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•VF paralysis
•Mutational falsetto •Psychogenic •Preferred pitch level |
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What causes glottal fry (vib. at lower end of pitch range)?
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•hyperfunctional phenomenon (increased tension or hyperadduction of VFs)
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What conditions result in VF tremor (rhythmic VF contractions)?
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•Hyperkinetic phenomenon (neurologic)
•Muscle Tension Pattern (functional or other) •Hyperfunctional phenomenon (hyperadduction) |
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Describe the questions of the VHI-30
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30 total questions
-Scores range from 0-120 -120=worst quality of life -Three domains --Functional --Physical --Emotional |
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Describe the questions of the V-RQOL
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-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 --Social-emotional --Physical |
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Describe the scaling of the GRBAS
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-Each component is rated on a *4-point scale
-0 = Normal -1 = Slight -2 = Moderate -3 = Extreme *Evaluate each vocal parameter -Respiration -Phonation -Resonance -Pitch -Loudness -Rate |
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Describe the rating of the CAPE-V
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-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 |
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Compare ADductor and ABductor types of spasmodic dysphonia
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AD: strain/strang., voice stops, tension
AB: intermit. aphonia, breathiness |
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Name a disorder associated with these dysarthrias:
flaccid spastic ataxic hyperkin. hypokin. mixed |
f: myesthenia gravis
sp: dystonia atx: cerebellar disorders hyper: MS, huntingtons hypo: PD mx: ALS |
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What are the components of a voice dx?
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-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 -recommendations |
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What aspects of voice/resp might use/need instrumental measurements?
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-acoustic measures (Fo, intensity, jit/shim, s:n, range)
-aerodyn (pressure, flow, resistance, SAP) -images (stroboscopy |
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What is the normal Fo for
Kids (boys, girls) Adults (M, F)) (Stemple) |
226hz, 238hz
106hz, 193hz |
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What is the normal intensity for
kids women men |
K: 70dB
M: 70dB F: 68 dB |
