Phonatory Final Exam

What is the role of the recurrent laryngeal nerve in voicing?

Supplies the motor control or function to all of the intrinsic laryngeal muscles except for the cricothyroid muscle

abducts (PCA) , adducts, increases and reduces tension of the vocal folds (TA)

What is the role of the superior laryngeal nerve in voicing?

internal - sensory and autonomic (thyrohyoid and supplies sensory fibers to laryngeal mucosa, laryngeal cavity, and superior surface of the VF.

external - motor and supplies the cricothyroid muscle.

laryngeal sensation is important for the reflexive functions of swallow and cough

What is the role of the intrinsic muscles of the larynx?

internal branch provides sensory (autonomic) input to the thyrohyoid, laryngeal mucosa, laryngeal cavity, and superior surface of VF

external branch provides motor input to cricothyroid

What are the layers of the vocal folds?

From top to bottom

1. Epithelium

2. SUPERIOR lamina propria

3. INTERMEDIATE lamina propria

4. DEEP lamina propria

5. thyrovocalis (vocalis muscle) AKA ‘the body’

What is the body cover theory?

a theory for how the VF vibrate.

Suggests that the COVER (epithelium and lamina propria) is passive with no neurological input

and that the BODY (thyrovocalis) is active with contractive properties

What are the main points of the Bernoulli effect?

the airstream will maintain a constant velocity until a point of glottal constriction - at which point the vocal folds with ‘blow’ apart.

at the point of glottic constriction, the velocity increases as the air passes through which ‘sucks’ the VF back together - due to the negative pressure created

Hirano’s body-cover theory is the _____ component while the Bernoulli effect is the _____ of this theory.

Myoelastic; aerodynamic

How does the Bernoulli effect impact vibration/oscillation of the vocal folds?

the repositioning of the vocal folds creates a Bernoulli effect whereby a negatie pressure between the VF is created causing an inward pull on the vocal folds - closing them.

the cycle repeats itself (vf open due to positive pressure and close due to negative pressure)

with increased resistance (such as mass or tension) greater pressure is necessary to both open and close the VF

What are the factors that affect frequency/pitch?

vocal fold length (affects tension and stiffness)

cricothyroid muscle affects VF length (CONTRACTION INCREASES PITCH)

thyroarytenoid makes VF more rigid (creating a faster rate of VF vibration)

What are the factors that impact amplitude/loudness?

increasing subglottal pressure (lung pressure increases peak glow rate and results in a greater vibratory amplitude of VF).

increased mouth opening and F0

alterations in phase lag between lower and upper margins of VF

What is and how does vocal tract resonance work?

It is how the shape and size of the vocal tract impacts how sound is changed after leaving the VF.

Areas that can influence resonance; larynx, phraynx, oral and nasal cavities, mouth opening, articulators (tongue, lips, cheeks etc).

What are the key components of vocal hygiene?

Smoking (cigarettes, vapes, marijuana), chewing tobacco, coughing and throat clearing, alcohol intake, caffeine intake, sleep deprivation, vocal load and vocal fatigue, loud talking, poor nutrition, obsesity, dehydration, allergies.

all of the above can contribute to or exacerbate an existing vocal challenge that a client has.

How is voice treatment different from voice surgery?

Voice treatment is a combination of exercises to, in some cases, strengthen the vocal cords, reduce tension, increase respiration-phonation coordination etc. and does not inherently change the structure of the vocal cords.

Voice surgery, on the other hand, are procedures that clients undergo to change the structure of their vocal cords. This can sometime be shortening or lengthening the cords, adjusting the tension of laryngeal structures, botox injections to increase mass etc.

What are the types of voice disorders?

Functional - disorders with an unknown cause that do not cause structural damage

Organic - disorders with an unknown cause that cause structural or neurological damage

Neurologic - caused or affecting the central or peripheral nervous sustem

What are some functional disorders?

muscle tension dysphonia, vocal fatigue, psychogenic voice loss, puberphonia, hyperfunction, gender affirming voice

What are some organic disorders?

nodules, polyps, cysts, edema, vocal cord paralysis, papilloma, webs, leukoplakia, cancer, sulcus vocalis, presbylaryngis

Can functional disorders lead to organic lesions over time?

yes

What are some neurologic disorders?

dysarthria (flaccid, spastic, ataxic, hypokinetic, hyperkenetic), unilateral true vocal fold paralysis, bilateral abductor true vocal fold paralysis, superior laryngeal nerve paralysis, essential tremor, hypophonia (associated with Parkinson’s), MS, ALS, MSA

What are the components of an evaluation?

Voice history

Patient interview

Case history of the voice problem

Effect of the voice problem

History of the voice problem

Duration of the voice problem

Variability/Consistency of the voice problem

Associated symptoms and sensations

Voice use (vocation, social

Health

Psychological impact (stress)

F0

Phonation range

Vocal Intensity

Perturbation (roughness)

Spectrogram

Air Volumes

Respiratory Movements

Observations and Descriptions (Noninstrumental objective measures (maximum phonation time, s/z ratio)

Recording

Questionnaires (VHI)

What are the main characteristics of hyperfunction?

What are the main characteristics of hypofunction?

Breathy voice caused by atrophy of the vocal folds

Strain and roughness if the patient is trying to copensate for the reduced closure by straining

Incomplete closure of the vocal folds

How do the components of evaluation affect therapy?

What is the difference between direct and indirect therapy?

What are the indications for use of hyperfunction as a therapy technique?

What are the indications for use of hypofunction as a therapy technique?

What therapy techniques work best for hypofunction AND hyperfunction?

What is the difference between pre and post laryngectomy anatomy?

Trachea is dissociated from the upper airway

Permanent stoma is created in the neck for breathing

What are the types of laryngectomy?

Total Laryngectomy - done with large lesions

Endoscopic excision - carcinoma in situ on the cover of the VF

Cordectomy/Partial Cordectomy - all or part of the VF is surgically removed

Partial laryngecomy - vertical, horizontal, subtotal, near total

What are the alaryngeal communication options post laryngectomy?

Electrolarynx (a device that produces sound electronically and transmits the vibrations to the upper airway, move articulators to create speech sounds)

Esophageal speech (inject air into esophagus and directs is back out vibrating the tissue in the neopharynx - like burping)

Tracheoesophageal Speech (TEP) (small hole between trachea and esophagus to allow for a high-quality ‘voice’)

How do you determine TEP candidacy?

1. patient must be motivated

2. patient myst have adequate understanding of post surgical anatomy including TE puncture

3. patient must have pbasic understanding of function of the prosthesis

4. patient must demonstrate adequate manual dexterity to manage prosthesis

5. patient must have adequate visual acuity to manage stoma and prostehsis

6. patient must exhibit ability to care for prosthesis

7. patient should not have significatn hypopharyngeal stenosis

8. patient should demonstrate positive results following esophageal air insufflation test

9. patient must have adequate pulmonary support for prosthesis use

10. patient should have stoma of adequate depth and diameter for prosthesis to avoid airway occulsion

11. patient should be mentally stable

12. patient must be able to come to clinic in a timely fashion for prosthesis changes or be able and willing to complete changes on their own with patient changeable prosthesis

What are the considerations of a TEP?

What is some important terminology to know for counselling?

What is the SLP role in gender affirming care?

What is metatherapy?

What is the SLP role in trach care?

What is the SLP role in spasmodic dysphonia?