Anatomy

Front 1

What is the biological function of the larynx?
What is one important overlaid function of the larynx?

Back 1

Biological function of the larynx is for airway protection during swallowing. Speech is an overlaid function over the life-sustainging functions of breathing and swallowing.

Front 2

What is the larynx?
Where is it located?
Why is it important to know where the larynx is located?

Back 2

The larynx is an unpaired, midline, musculocartilaginous structure.
It is located in the anterior of the neck between the trachea inferiorly and the hyoid bone superiorly. It is anterior to cervical vertebrae 3-6.
It is important to know the larynx's location in the case of a patient who has had cervical fusion which will narrow the pharynx (may restrict introversion and retroversion of the epiglottis).

Front 3

What are the three subsystems of voice?

Back 3

1. Respiration (Power): the lungs
2. Phonation (Source): the larynx, or voice box
*makes the vibration in the neck)
3. Resonance (Filter): the cavities of the inside of your throat, mouth and nose, including the tongue, lips, and teeth

Front 4

What comprises the larynx?

Back 4

1. Three paired cartilages
2. Three unpaired cartilages
3. ligaments
4. membranes
5 mucous membrane lining

Front 5

Why is the hyoid bone important to the larynx?
What does the hyoid bone articulate with?

Back 5

It unites the tongue and larynx
The superior horn of the thyroid cartilage

Front 6

Name the parts of the hyoid bone.
-greater horns/cornua
-lesser horn/cornu
What is the juncture of the greater horn with the body characterized by?

Back 6

The juncture of the greater horn with the body is characterized by a superiorly directed cone shaped prominence called a lesser horn or cornu

Front 7

Name and label the cartilages of the larynx.

Back 7

Front 8

Describe the thyroid cartilage.

Back 8

It is the largest of the laryngeal cartilages and is composed of two somewhat quadrilateral plates called the thyroid lamina. They are fused at the midline anteriorly and form the most anterior and lateral walls of the larynx. When you feel the front of your neck, it is the thyroid lamina.

Front 9

What does the incomplete fusion of the lamina in the thyroid cartilage result in?

Back 9

A notch called the Adam's apple.

Front 10

Where do the vocal folds attach?

Back 10

Just behind the notch (Adam's apple) in the thyroid lamina of the thyroid cartilage.

Front 11

What do the inferior horns of the thyroid cartilage articulate with?

Back 11

cricoid

Front 12

What do the superior horns of the thyroid cartilage articulate with?

Back 12

Hyoid bone

Front 13

Describe the cricoid cartilage.

Back 13

It is ring-shaped and forms the lower body of the larynx.

Front 14

Where is the cricoid cartilage located?

Back 14

Immediately above the trachea and into the space between the inferior horns of the thyroid (articulates wit the thyroid.

Front 15

What does the cricoid cartilage consist of?

Back 15

Anterior arch and posterior quadrate lamina

Front 16

Where is the cricoid cartilage the highest?

Back 16

In the back

Front 17

The cricoid cartilage supports the ____________ on the convex superior surface of the posterior quadrate lamina.

Back 17

Arytenoids

Front 18

What do the inferior horns of the thyroid cartilage articlate with?

Back 18

The facets ont he lateral margin of the cricoid cartilage

Front 19

Why is the articlation between the cricoid cartilage and the arytenoid and thyroid cartilages important?

Back 19

Because they form important joints that allow for the vocal folds to abduct and adduct, stretch and shorten.

Front 20

Describe the arytenoids.

Back 20

They are pyramidal (concave base, apex, three surfaces), they articulate with the superior surface of the cricoid, their muscular process is posteolateral, and their vocal process is anterior with posterior attachment of the vocal folds.

Front 21

What are the corniculates?

Back 21

The apex of the arytenoid cartilages which are horn-like shaped and have little known function (vestigial structures)

Front 22

What are the cuneiforms?

Back 22

They are superior and anterior to the corniculate cartilages and are embedded in the aryepiglottic folds. They have no known speech function. Supposed function is the support the membrane. They are small and wedge-shaped.

Front 23

What is the epiglottis?
Where does the epiglottis attach?
What is it's function?

Back 23

It is a leaf-like structure located behind the hyoid at the root of the tongue.
A stalk is attached to the inside of the thyroid cartilage by the thyroepiglottic ligament.
There is no known speech function; function for swallowing is to cover to protect the airway. It relays sensory information via the internal laryngeal nerve branch of the Vagus (X) nerve.

Front 24

Back 24

Front 25

What are the two laryngeal joints that have functional movement and what do they do?

Back 25

1. Cricothyroid joint is the main mechanism of voice pitch control
2. Cricoarytenoid joint is a mechanism of opening and closing the glottis

Front 26

Where is the cricrothyroid joint located?

Back 26

At the juncture of the inferior horns of the thyroid cartilage and the cricoid cartilage

Front 27

How does the thyroid have to move in order for the vocal folds to be pulled taut (becoming long, thin, and tight)?

Back 27

Thyroid tilts down and forward towards the cricoid

Front 28

Where is the cricoarytenoid joint?

Back 28

Located at the muscular process of the arytenoids and the superior articulate facets of the cricoid

Front 29

The _______ arytenoid articulates with the ________ cricoid.

Back 29

Concave; convex

Front 30

What kind of movement does the cricroarytenoid joint make?

Back 30

rocking (rotation) and gliding

Front 31

When the arytenoids move, what else moves?

Back 31

The vocal folds that are attached to them

Front 32

What is the glottis?
What is the supraglottis (supraglottal)?
What is the subglottis (subglottal)?

Back 32

the changing space between the vocal folds
the cavity above the glottis; ventricle of larynx and ventricular folds
the cavity below the glottis; from the vocal folds to the inferior portion of the cricoid

Front 33

Where is the origin and insertion of the intrinsic muscles of the larynx? What do they do?

Back 33

On laryngeal cartilages; they make fine adjustments of vocal mechanism for sound production (vibrations come from here)

Front 34

Where are the extrinsic muscles of the larynx originating and inserting? What do these muscles do?

Back 34

1 laryngeal attachment and 1 non-laryngeal attachment
They raise and lower the larynx, support the larynx and coordinate with tongue in articulation and swallowing.

Front 35

What are the three intinsic muscles of the larynx which cause adduction of the vocal folds?

Back 35

1. Lateral cricoarytenoid muscles (main adductor)
2. Transverse arytenoid muscle
3. Oblique arytenoid muscle

Front 36

Where does the lateral cricoarytenoid originate and insert? What is it's innervation and function?

Back 36

Origin: superior-lateral surface of the cricoid cartilage
Course: up and back
Insertion: X, recurrent laryngeal nerve
Function: adducts vocal folds, increases medial compression

Front 37

What is the origin, course, insertion, innervation, and function of the transverse artytenoid?

Back 37

Origin: lateral margin of posterior arytenoid
Course: laterally
Insertion: lateral margin of posterior surface of opposite arytenoid
Innervation: X, recurrent laryngeal nerve
Function: adducts vocal folds, important for medial compression

Front 38

What is the origin, course, insertion, innervation, and function of the oblique arytenoid?

Back 38

Origin: posterior base of muscular process
Course: obliquely up
Insertion: apex of opposite arytenoid
Innervation: X, recurrent laryngeal nerve
Function: pull the apex of arytenoid cartilages medially for adduction

Front 39

What is the intrinsic, abductor muscle of the vocal folds in the larynx?

Back 39

Posterior cricoarytenoid

Front 40

What is the origin, course, insertion, innervation, and function of the posterior cricoarytenoid?

Back 40

Origin: posterior lamina of cricoid
Course: up and out
Insertion: posterior aspect of muscular process of arytenoid
Innervation: X, recurrent laryngeal nerve
Function: Abducts vocal folds

Front 41

What are the intrinsic tensor muscles of the vocal folds in the larynx?

Back 41

1. Cricothyroid muscles (pars recta and pars oblique)
2. Thyrovocalis muscles (it is the inner portion of the thyroarytenoid muscle, the outer portion is the thyromuscularis)

Front 42

What is the origin, course, insertion, innervation, and function of the cricothyroid (pars recta)?

Back 42

Origin: anterior surface of the cricoid cartilage beneath the arch
course: up and out
insertion: lower surface of the thyroid lamina
innervation: X, superior laryngeal nerve (only one!)
Function: depress thyroid relative to cricoid, tense vocal folds, change pitch

Front 43

What is the origin, course, insertion, innervation, and function of the cricothyroid (pars oblique)?

Back 43

Origin: cricoid cartilage lateral to the pars recta
Course: obliquely up
Insertion: thyroid cartilage between lamina and inferior horns
Innervation: X, superior laryngeal nerve
Function: depress thyroid relative to cricoid, tense vocal folds, change pitch

Front 44

What is the difference between the thyroarytenoid muscles?

Back 44

The thyrovocalis is a tensor and the thyromuscularis is a relaxer.

Front 45

What is the origin, course, insertion, innervation, and function of the thyrovocalis muscles?

Back 45

Origin: thyroid cartilage just below the notch
Course: back
Insertion: vocal process of the arytenoid cartilage
Innervation: X, recurrent laryngeal nerve
Function: tense vocal folds

Front 46

What is the origin, course, insertion, innervation, and function of the thyromuscularis muscles?

Back 46

Origin: thyroid notch, lateral to the thyrovocalis muscle
Course: back
Insertion: muscular process and base of arytenoid cartilages
Innervation: X, recurrent laryngeal
Function: relaxes vocal folds when medial fibers contract due to the arytenoids being pulled towards the thyroid cartilage

Front 47

What are the two groups of extrinsic muscles in the larynx?

Back 47

1. Hyoid and laryngeal elevators
2. Hyoid and laryngeal depressors

Front 48

What is the origin, course, insertion, innervation, and function of the digastric anterior muscle?

Back 48

Origin: inner surface of the mandible
Course: medial and down
Instertion: hyoid bone
Innervation: CN V
Function: draws hyoid up and forward; elevate with help from posterior

Front 49

What is the origin, course, insertion, innervation, and function of the digastric posterior muscle?

Back 49

Origin: mastoid process of temporal bone
Course: medial and down
Insertion: hyoid bone
Innervation: CN VII
Function: draw hyoid up and back; elevate with help from anterior

Front 50

What is the origin, course, insertion, innervation, and function of the stylohyoid muscle?

Back 50

Origin: styloid process of the temporal bone
Course: medially down
Insertion: corpus of hyoid bone
Innervation: CN VII
Function: elevates and retracts hyoid

Front 51

What is the origin, course, insertion, innervation, and function of the mylohyoid muscle?

Back 51

Origin: mylohyoid line on the inner surface of the mandible
Course; fan-like to median fibrous raphe and hyoid
Insertion: corpus of hyoid bone
Innervation: CN V
Function: elevates hyoid or depresses mandible

Front 52

Back 52

Front 53

What is the origin, course, insertion, innervation, and function of the geniohyoid muscle?

Back 53

Origin: mental spines on the inner surface of the mandible
Course: back and down
Insertion: corpus of the hyoid bone
Innervation: CN XII
Function: elevate hyoid and depress mandible

Front 54

Back 54

Front 55

What is the origin, course, insertion, innervation, and function of the genioglossus muscle?

Back 55

Origin: inner surface of the mandible
Course: up and back
Insertion: tongue and corpus of hyoid
Innervation: CN XII
Function: elevates hyoid; depress, retracts, and protrudes tongue

Front 56

What is the origin, course, insertion, innervation, and function of the hyoglossus muscle?

Back 56

Origin: side of the tongue
Course: down
Insertion: greater cornu of hyoid
Innervation: CN XII
Function: hyoid elevator, tongue depressor

Front 57

What is the origin, course, insertion, innervation, and function of the sternothyroid muscle?

Back 57

Origin: oblique line of thyroid cartilage
Course: down and in
Insertion: manubrium of sternum
Innervation: CN XII and SN C1,2,3
Function: depress thyroid cartilage

Front 58

Back 58

Front 59

What is the origin, course, insertion, innervation, and function of the thyrohyoid muscle?

Back 59

Origin: oblique line of thyroid cartilage
Course: up
Insertion: greater horn of hyoid bone
Innervation: SN C1, XII
Function: depresses hyoid bone or elevates thyroid

Front 60

What is the origin, course, insertion, innervation, and function of the sternohyoid muscle?

Back 60

Origin: manubrium of sternum and clavicle
Course: up
Insertion: inferior margin of hyoid corpus
Innervation: SN C1, 2, 3
Function: depress hyoid bone

Front 61

What is the origin, course, insertion, innervation, and function of the omohyoid muscles (superior/inferior)?

Back 61

Origin: corpus hyoid and scapula
Course: down and laterally
Insertion: intermediate tendon to hyoid
Innervation: SN C1,2,3
Function: depress hyoid bone

Front 62

Back 62

Front 63

What can the layers of the vocal folds be divided into?

Back 63

1. mucosa (epithelium)
2. vocal ligament (lamina propria)
3. underlying muscle (thyrovocalis muscles)

Front 64

What are the three parts of the lamina propria?

Back 64

1. superficial layer of the lamina propria (SLLP)
2. Intermediate layer of the lamina propria (ILLP)
3. deep layer of the lamina propria (DLLP)

Front 65

What are the functions of the vocal fold layers?

Back 65

Cover=the epithelium and the SLLP
Transition (aka ligament) =the ILLP and the DLLP
Body=the thyrovocalis muscle

Front 66

What closure prevents air escape and aids in activities demanding highly elevated abdominal pressures, such as heavy lifting (abominal fixation)?

Back 66

closure of the laryngeal valve

Front 67

What is coughing a reaction to?

Back 67

stimulation of the vagus nerve

Front 68

What is the process of coughing?

Back 68

deep inhalation, forceful adduction, laryngeal elevation, significant subglottal pressure builds, and the vocal folds are forced open

Front 69

What does coughing irritate?

Back 69

the leading edge of the vocal folds

Front 70

What is similar to coughing in that you use forceful adduction and the vocal folds are forced open by high subglottal pressure?
It is also common in persons with functional voice disorders.

Back 70

throat clearing

Front 71

What stabilizes the thorax by containing air and requires tight vocal fold clossure, held in resistance to increasing subglottal pressure?

Back 71

abdominal fixation

Front 72

What is the neurochronaxic theory?

Back 72

Theory of phonation
Each new vibratory cycle is initiated by a nerve impulse transmitted from the brain to the vocalis muscle by way of the recurrent branches of the vagus nerve
refuted in 1960 in favor of the earlier myoelastic aerodynamic theory of phonation

Front 73

What is the myoelastic-aerodynamic theory of phonation?

Back 73

Theory of vocal fold function that accounts for phonation through the lawful interplay of tissue mass, elasticity and aerodynamic principles (Bernoulli Effect)

Front 74

What is the Bernoulli Effect?

Back 74

1. If volume airflow is constant, velocity of flow will increase at an area of constriction, but with a corresponding decrease of pressure at the constriction.
2. Faster, greater airflow reduces pressure perpindicular to flow
3. The vocal folds are initially pushed apart as a result of airflow
4. The Bernoulli effect causes the vocal folds to be pulled back together

Front 75

What is the body/cover theory?

Back 75

Not only do the vocal folds vibrate, but the cover of the vocal folds has movement as well

Front 76

What are the phases of phonation?

Back 76

Prephonation: the period during which the vocal folds move from an abducted to an adducted or partially adducted position
Attack phase: begins vocal fold adduction and extends through the initial vibratory cycles

Front 77

What are the types of attacks in the attack phase of phonation?

Back 77

Simultaneous Attack: adduction of vocal folds and expiration occur together
Breathy attack: expiration precedes adduction
Hard glottal attack: adduction precedes expiration

Front 78

Why do the vocal folds continue to open and close in the absence of repetitive muscular contraction?
What controls the actual vocal fold vibrations?

Back 78

Due to the motion of the tissue and the airflow disturbing the molecules of air causing sound
The aerodynamics of phonation

Front 79

What are the average frequencies of the vocal folds for women, men and children?

Back 79

110 Hz for men
220 Hz for women
>300 for children

Front 80

What is coarticulation?

Back 80

The cycle of prephonation, attack, phonation, and termination

Front 81

Define cycle, period, frequency, and pitch

Back 81

Cycle: from one point on the waveform to the same point
Period: the time it takes to pass through one cycle of vibration
Frequency (Fo): physical measure, cycles per second, Hz
Pitch: psychophysical measure, our perception of frequency

Front 82

What determines the fundamental frequency of the vocal folds?

Back 82

Physical attributes:
1. elasticity-->the property of material that causes it to return to its original shape after being displaces
2. stiffness-->the strength of the forces are held within a given material that restores it to its original shape on being distended
3. inertia-->the property of mass that dictates that a body in motion tends to stay in motion

Front 83

What happens as mass increases?

Back 83

stiffness decreases, inertia increases, and the frequency of vibration decreases

Front 84

What are the modes of sustained phonation?

Back 84

modal register (normal conversational voicing): open from inferior to superior edge and close from inferior to superior edge
glottal fry or pulse register (creaky voice):reduced thyrovocalis tension, creating shorter, thicker vocal folds; lower subglottal air pressure and lower pitch
falsetto register (head voice): highest register; vocal fold stretched thin and tensed which causes pitch to rise; posterior portion of the vocal folds do not vibrate, shortening vibrating length and increasing pitch
breathy: vocal folds are incompletely adducted which allows excessive airflow
pressed: medial compression is increased and forceful adduction; increased harsh vocal quality and loudness
whispered: non-vocal sound production but involved laryngeal gestures

Front 85

What happens to the arytenoids in a whisper?

Back 85

rotate inward, separate posteriorly

Front 86

Why not tell patients to whisper?

Back 86

increased tension required

Front 87

What is habitual pitch?

Back 87

the pitch usually used in speaking (ideally the same as optimal pitch)

Front 88

What is optimal pitch?

Back 88

pitch (frequency) that is most efficient for a given set of vocal folds with a certian mass, length and elasticity
usually 1/4 octave above lowest attainable frequency

Front 89

What is pitch range?
How many octaves does the average person have?
Who will have a wider range than this?

Back 89

The range of Fo for a person
2 octaves
singers

Front 90

What do you have to do to increase pitch?

Back 90

increase the length of the vocal folds (with the cricothyroid) which results in a decrease in mass, which will result in an increase in pitch

Front 91

What does contraction of the cricothyroid do?

Back 91

decreases distance between cricoid and thyroid anteriorly which results in an increase in the distance between the arytenoid and thyroid cartilages
i.e. elongates the vocal folds and makes them thinner and increases pitch

Front 92

What is the role of the thyroarytenoid in pitch?

Back 92

acting alone will decrease the distance between the arytenoid and thyroid and shorten/relax the vocal folds
i.e. decrease pitch

Front 93

What is needed to lengthen and tense the vocal folds?

Back 93

forces of the cricothyroid and posterior cricoarytenoid muscles

Front 94

What is intensity?
What is it's psychophysical measure?

Back 94

magnitude of sound represented as the relationship between two pressures
loudness

Front 95

What increases intensity?

Back 95

an increase in subglottal pressure caused by a larger inspired volume of air and the vocal folds remaining closed longer with increased medial compression

Front 96

What is increased medial compression a result of?

Back 96

increased muscle tension, which stiffens the vocal folds