Voice exam revised

Muscles of Inhalation

Diaphragm, external intercostal muscles, and accessory chest and shoulder muscles.

Muscles of Exhalation

Abdominal muscles and internal intercostal muscles.

Process of Inhalation

Muscles contract, chest cavity increases, lungs expand via pleural linkage, lung volume increases and pressure decreases (Boyle's law), causing air to flow inward.

Process of Exhalation

Passive or active; ribcage decreases in size, lung volume decreases, pressure increases, and air flows outward.

RTD (Resting Tidal Volume)

Amount of air exchanged during rest breathing.

REL (Resting Expiratory Level)

Point at which respiratory system is completely balanced at 38% vital capacity without using muscle contraction.

VC (Vital Capacity)

Maximum amount of air we can inhale versus the maximum amount we can exhale.

TV (Tidal Volume)

Amount of air exchanged for any given activity (varies depending on task).

IRV (Inspiratory Reserve Volume)

Air we would inhale but choose not to for the specific task.

ERV (Expiratory Reserve Volume)

Air we exhale but choose not to for the task.

RV (Residual Volume)

Air that we cannot use.

TLC (Total Lung Capacity)

All of the air in the respiratory system (IRV + TV + ERV + RV).

IC (Inspiratory Capacity)

Capacity of air we could exhale above resting expiratory level up to maximum inhalation.

FRC (Functional Residual Capacity)

All air left in lungs from resting expiratory level down to completely empty lungs.

Lateral Cricoarytenoid (LCA)

Intrinsic laryngeal muscle that adducts the membranous glottis.

Interarytenoid Cartilage (IA)

Intrinsic laryngeal muscle that adducts the cartilaginous portion of the vocal folds.

Posterior Cricoarytenoid (PCA)

Intrinsic laryngeal muscle that abducts the vocal folds.

Cricothyroid Muscle

Intrinsic laryngeal muscle that lengthens the vocal folds, increasing fundamental frequency.

Vocalis Muscle / Medial Thyroarytenoid

Intrinsic laryngeal muscle that shortens and tenses the vocal folds (body of VF tissue).

Suprahyoid Muscles

Extrinsic laryngeal muscles that raise the larynx.

Infrahyoid Muscles

Extrinsic laryngeal muscles that lower the larynx.

Vagus Nerve (CN 10)

Innervates the larynx via the recurrent laryngeal branch (motor) and superior laryngeal branch (motor and sensory).

Vocal Fold Layers

Epithelium, superficial layer of lamina propria, intermediate layer, deep layer, and vocalis muscle.

Vocal Registers: Modal

Normal speaking register; VF together 50% of the time and separated 50% of the time.

Vocal Registers: Vocal Fry

Lowest speaking register; VF 90% together and 10% separated with low or absent fundamental frequency.

Vocal Registers: Falsetto

High fundamental frequency requiring greater pressure; VF 100% separated and 0% together.

CAPE-V

Consensus Audio-Perceptual Evaluation of Voice (subjective evaluation).

GRBAS

Subjective audio-perceptual evaluation assessing Grade, Roughness, Breathiness, Asthenia, and Strain.

Role of the SLP in Voice Disorders

Diagnoses and treats dysphonia (the change in the sound of the voice).

Role of the ENT in Voice Disorders

Diagnoses the pathology and determines if treatment should be medical.

Primary Muscle Tension Dysphonia

Voice problem in the absence of an organic or neurologic voice problem that changes the sound of the voice.

Secondary Muscle Tension Dysphonia

Too much muscle activity co-occurring with an organic or neurologic problem.

Nodules

Always bilateral and at the mid-membranous location; leads to reduced amplitude, disrupted mucosal wave, and rough voice.

Polyps

Fluid-filled region usually at the mid-membranous location on one fold, impacting symmetry and reducing amplitude.

Cysts

Fluid-filled or semisolid sacks usually on one VF at a time, reducing amplitude, mucosal wave, and symmetry.

Flow Phonation

Voice therapy approach focusing on air flow release, stretch and flow, and articulatory precision.

Circumlaryngeal Massage

Therapy technique targeting the hyoid bone, thyrohyoid space, thyroid cartilage, and cricothyroid space.

Resonant Voice Therapy

Therapy where vocal folds barely touch, patient feels a buzz, tickle, or tingle in the front of the face.

acoustic measures that require frequency

fundamental frequency, standard deviation of fundamental frequency, Jitter and shimmer, noise to harmonic ratio

acoustic measures that no NOT require fundamental frequency

cepstral peak prominence, low to high spectral ratio, cepstral spectral index of dysphonia

measures of respiratory phonatory effciency/loudness

related to loudness on CAPE-V, s/z ratio, maximum phonation time

cepstral peak prominence

related to breathiness and roughness

low to high specctral ratio

related to breathiness

cepstral spectral index of dysphonia

related to overall severity of CAPE-V

The overall severity on your audio perceptual is high, which acoustic measure would help support that

cepstral spectral index of dysphonia

instrumental measures

airflow measures, pressure measures

airflow measures

average airflow, DC airflow

average airflow

lower with hyperfunction, higher with glottal incompetence

DC airflow

lower with hyperfunction, lower with airlfow leak

the average airflow is low, what would you expect the DC airflow to be?

lower

pressure measures

subglottal pressure, laryngeal resistance

flexible scope

for speech

rigid scope

better color

strobe light

movement of VF

constant light

structures