Speech Disorders quiz 6

Owens Ch 3 (Resp & LArynheal) + ALL Ch 9

our primary means of expression and is an essential feature of speech + emotional outlet + delivers a message/adds meaning

Voice

the quality of the voice that is produced form sund vibrations in the pahryngeal, oral, and nasal cavities

Resonance

failure of the VP mechanism to separate the oral and nasal cavities during speech and/or swallowing

Velopharyngeal Dysfunction/Insufficiency (VPD/VPI)

Vocal Pitch

directly tied to F0 (fundamental frequency) associated w/ rate of vocal fold vibration

measured in Hz

Hz

# of vocal fold vibration sper sec

F0 for men

125Hz

F0 for women

250Hz

F0 for children

up to 500Hz

Frequency of the voice…

constantly varies during speech

Monotone pitch

big indicator of Parkinsons

result of not varying habitual speaking frequency

What is necessary to change pitch?

modifications in length + tension of vocal folds

varying pitch has…

linguistic significance

Formants

many of them

SLPs care about: F1 - F3 (F4)

Vocal Loudness

perceptual correlate of intensity

measured in decibles (dB)

conversation speech happens at ___

60 dB

dB is measured on a…

logarithmic scale

alveolar pressure

pressure below vocal folds

major determinant of vocal intensity

Voice Quality

unique traits of an individual’s voice quality are derived from the anatomy of the larynx, shape of the vocal tract and its resonant chractersitics + suprsegmental aspects of speech

Lifespan issues

laryngeal cartilages + joints begin to ossify or calcify around the third (men) + fourth (women) decades

Presbyphonia: voice disorder characterized by perceptual changes in pitch. pitch range, loudness, + voice quality in older individuals

menopause +hormone related factors causing swelling/edema may be responsible for the change in women (lowered F0)

for men, age-related chnages to laryngeal muscle due to atrophy may be responsible for increased F0 in older men

Resonance

largely determined by VP structure + function

structures include

• velum

• lateral pharyngeal walls

• posterior pharyngeal wall

VP port remained open most of the time to allow nasal breathing and for nasal consonants

hyper + hyponasality

Resonancy lifespan issues

closure patterns may vay among individuals and can chnage over time

young children with adenoidectomy may have to chnage thei rown closure patterns

VP function duirng speech production remians intact and unchanged from young adulthood through advanced age

F1

tells us tongue height

F2

tongue forward or backness

frequency

tells us pitch

deviations can be in…

voice quality, pitch, or loudness

what % of adults in US have a voice disorder?

3-9%

High Risk Individuals for Voice + Resonance Disorders

Occupational Voice Users

• Teachers

• Singers

• Construction Workers

• Smokers

• Actors

• Public Speakers/News Anchors

• Cheerleaders

• Pastors

T/F: Women are more affected than men by Voice/Resonance Disorders

True

Kids that are ost affected by voice/resonance disorders

3-10 year olds ~6%

boys more affceted

specific vocal behaviors such as loud talking, coughing, or throat clearing may…

predispose some individuals to voice disorders

Voice disorders in kids are related to…

misuse/abuse

are temporary

adult voice disorders are…

varies

initial benchmarks in differential diagnosis

perceptual signs

case history

When one or more perceptual aspects of voice like pitch loudness or voice quality are outside range of normal for an individual’s age sex cultural background or geographic location

Voice disorder

Organic Voice Disorder

Physical changes to larynx can result from aging or structural abnormalities

Neurological disorders interfere with normal vocal fold vibration as the result of damage to central PNS

Structural Abnormalities in voice disorder

Vocal nodules (growths caused by frequent hard vocal collisions, usually bilateral, anterior 1/3 + posterior 2/4 of vocal folds, soft + pliable but can become hard and fibrous, most common for women btwn 20-50yr old, can also occur in children prone to excessive loud talking + screaming, hoarseness and breathiness, sore throat + inability to use upper 1/3 of pitch range, new = treated w/ vocal rest, voice therapy and education recommended, last resort is surgery bc they come back)

Glottis

Specs between vocal folds

Laryngel Webs

connective tissue growing btwn vocal folds

makes opening + closing vocal folds more difficult

• blocks some sound/breathing (stridor)

• must be surgically removed

Laryngeal Cancer

has been linked w/ cigarette smoking and excessive use of alcohol

hoarseness in the absence of colds or allergies is an early sign

removal of larynx is often necessary

trachea is repositioned to form a stoma for breathing (CPR will not work)

esophageal speech: esophagus is the vibratory source for speech (burping ABCs)

Electrolarynx: prosthetic device that has a vibrating diaphragm placed on the lateral aspect of teh neck

tracheoesophogeal puncture (TEP) or tracheoesophogeal shunt: air is directed from the trachea to the esophogus so teh speaker can use the cricopharyngeas m. for voice production

Laryngectomy

removal of larynx

• also no vocal folds, hyoid bone, or epiglottis

Neurologic Voice Disorders

Damage to CN X (Vagus)

• unilateral + bilateral vocal fold paralysis

• recurrent laryngeal nerve supplies most of laryngeal m. for voice

• unilateral vocal fold paralysis: hoarse/breathy, reduced loudness, monoloudness, pitch breaks, diplophonia

  • can do head turns to test for unilateral paralysis

• Bilateral vocal fold paralysis: voice is breathy, weak, or absent

• risk of aspiration increases when vocal folds are abducted

• surgical intervention may be needed

• vocal treatment following surgery aims to increase vocal fold closure + loudness

Parkinson Disease (hypokinetic dysarthria)

Degeneration of dopaminergic neurons in the substantia nigra, interfering with function of the basal ganglia

characteristics

• muscle rigidity, reduced ROM, tremor at rest, hypokinesia, mask-like face

• reduced loudness, monopitch, monoloudness, hoarseness, harshness, breathiness

treated medically or possibly w/ deep brain stimulation

intensive voice treatment aimed at increasing vocal fold adduction is successful in improving vocal loudness and intelligibility

Amyotrophic Lateral Sclerosis (ALS)

motor neuron disease

degeneration of both upper + lower motor neurons causing both flaccid + spastic weakness

breathiness, harshness, and/or strained/strangled vocal quality, reduced loudness, monoloudness, inspiratory stridor, abnormally high/low pitch

compensatory strats are beneficial as ALS is degenerative

AAC eventually needed

NEVER DO VOICE THERAPY, SUPER UNETHICAL —> DO VOICE BANKING

Functional Voice Disorders