SLP 585 Voice Disorders and Laryngeal Anatomy Study Guide

Flashcards testing laryngeal anatomy, physiology of phonation, vocal fold layers, dynamic ranges, and voice disorder etiologies from the SLP 585 study guide.

What are the three subsystems responsible for voice production?

Respiration, Phonation, and Resonance

How is a voice disorder defined?

A voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual's age, gender, cultural background, or geographic location, or is present when an individual expresses concerns.

What is the Myoelastic Aerodynamic Theory of phonation?

It explains voice production as a cycle where vocal folds adduct, subglottal pressure builds from exhaled air, pushes the folds open, and air rushes through causing a pressure drop due to the Bernoulli effect; elasticity then brings the folds back together to repeat the self-sustained oscillation cycle.

What are the six laryngeal cartilages mentioned in the study guide?

Thyroid, Cricoid, Epiglottis, Arytenoid, Cuneiform, and Corniculate cartilages.

What are the shape and location of the thyroid cartilage?

It is shield-shaped and located at the front and sides of the larynx.

What are the shape and location of the cricoid cartilage?

It is signet-ring shaped and located below the thyroid cartilage.

What are the shape and location of the epiglottis?

It is leaf-shaped and located behind the tongue and above the larynx.

What are the shape and location of the arytenoid cartilages?

They are pyramid-shaped structures located on the back/top of the cricoid cartilage where the vocal folds attach.

What are the shape and location of the cuneiform cartilages?

They are small wedge-shaped cartilages located within the aryepiglottic folds and above the corniculates, providing structural stability to the voice box.

What are the shape and location of the corniculate cartilages?

They are small horn-shaped cartilages sitting on the apex of the arytenoid cartilages.

Which nerve innervates the cricothyroid muscle versus the other intrinsic laryngeal muscles?

The cricothyroid muscle is innervated by the Superior Laryngeal Nerve (SLN), while all other intrinsic laryngeal muscles are innervated by the Recurrent Laryngeal Nerve (RLN).

What are the main functions of the cricothyroid muscle?

It increases the length and tension of the vocal folds to increase pitch.

According to the laryngeal muscle action table shown, which intrinsic muscle is solely responsible for vocal fold abduction?

Posterior cricoarytenoid

Which intrinsic laryngeal muscles perform vocal fold adduction?

Lateral cricoarytenoid, Oblique arytenoid, Transverse arytenoid, and Thyrovocalis.

What are the three main components of the Cover-Body Theory of the vocal folds?

1. Cover: Epithelium and superficial layer of the lamina propria. 2. Transition: Intermediate and deep layers of the lamina propria (vocal ligament). 3. Body: Deeper, stiffer thyroarytenoid/vocalis muscle.

What anatomical structures of the larynx are identified in this endoscopic view diagram?

True vocal folds, false vocal folds, tracheal rings, cuneiform, laryngeal vestibule (aryepiglottic fold), and epiglottis.

What is phonatory threshold pressure?

The minimum amount of subglottic pressure needed to start phonation.

How do the Cricothyroid (CT) and Thyroarytenoid (TA) muscles control pitch?

Higher pitch occurs when the CT contracts, making folds longer and tighter for faster vibration. Lower pitch occurs when the TA contracts, making folds shorter and thicker for slower vibration.

What are the typical pitch frequency ranges for adult feminine and masculine voices?

Feminine voice: 180-240 Hz; Masculine voice: 150-180 Hz.

What are the normative dynamic range decibel values for a whisper, normal conversation, a shout, and the hearing loss threshold?

Whisper: 40 dB; Normal conversation: 60 dB; Shout: 100 dB; Risk of hearing loss: 120 dB.

What is phonotrauma and what are four common examples?

Phonotrauma (phonatory abuse/misuse) is using the voice in ways that place excessive force, strain, or stress on the vocal folds. Examples include excessive talking, frequent throat clearing, forceful coughing, and using an inappropriate pitch.

What is the prevalence of voice disorders in children and in adults?

Children: 1/4% to 6%; Adults: 8%.

What are the characteristics, vocal fold motion, and treatment for Paradoxical Vocal Fold Movement (PVFM)?

Vocal folds adduct during inhalation, causing inhalatory stridor and airway distress. Cause is unknown but common in adolescents and extreme athletes. Treatment involves education, trigger identification, isometric exercises, and recovery breathing techniques.

What are the etiology, appearance, and primary treatment approach for vocal nodules?

Caused by excessive mechanical stresses. Features bilateral swellings at midline along the membranous portion of the vocal folds in the superficial layer of the lamina propria with hourglass closure. Primary treatment is voice therapy.

What is the cause, vocal fold appearance, and primary treatment for laryngeal papilloma?

Caused by a human virus. Appears as neoplastic raspberry-like white tissue on the vocal folds or subglottic/supraglottic regions. Treatment is surgery (or tracheostomy if the airway is compromised).

What are vocal polyps and what is their recommended treatment?

Unilateral fluid-filled lesions (pedunculated or sessile) on the superficial layer of the lamina propria caused by phonotrauma. Treatment includes surgery followed by post-surgery voice therapy.

What causes laryngeal granulomas and what are their signs and symptoms?

Caused by persistent phonotrauma, reflux, or endotracheal intubation. Features an irregularly shaped mass with incomplete closure causing pain, ear discomfort, and vocal fatigue.

What is Reinke's Edema and what is its primary cause?

It is a bilateral buildup of fluid along the length of the vocal folds in the superficial layer of the lamina propria (polypoid degeneration) causing low pitch and hoarseness; it is primarily caused by chronic trauma such as smoking.

What visual feature and clinical outcome are associated with Superior Laryngeal Nerve (SLN) vocal fold paralysis?

Visual feature includes a deviated epiglottis at high pitch with reduced pitch range and fatigue; approximately 60% of patients recover spontaneously within 1 year.

What is the difference in clinical presentation between unilateral and bilateral Recurrent Laryngeal Nerve (RLN) paralysis?

Unilateral RLN paralysis presents with an immobile fold causing breathy voice, low pitch, and diplophonia. Bilateral RLN abductor paralysis causes a critical respiratory condition (dyspnea) requiring surgery to re-establish the airway, while bilateral adductor paralysis results in aphonia.

A patient taking warfarin presents with hoarseness and intermittent aphonia following a night of heavy voice use. What vocal fold disorder is most probable?

Vocal fold hemorrhage

Paradoxical Vocal Fold Movement (PVFM)

A condition of unknown etiology where the vocal folds inappropriately adduct during inspiration, causing inspiratory stridor and respiratory distress. Treated with education, trigger identification, isometric relaxation, and recovery breathing techniques.

Vocal Nodules

Inflammatory degeneration of the superficial layer of lamina propria caused by excessive mechanical stress from phonotrauma. Appears as bilateral, symmetrical swellings along the anterior-middle third junction resulting in an hourglass glottal closure pattern. Behavioral voice therapy is the primary first-line treatment.

Laryngeal Papilloma

A rapidly growing, neoplastic, raspberry-like white tissue mass caused by Human Papillomavirus (HPV) infection. Common in young children and leads to severe hoarseness and compromised airway. Treated via surgical excision.

Vocal Fold Polyps

Unilateral, fluid-filled sacs (pedunculated or sessile) in the superficial layer of lamina propria resulting from acute or chronic phonotrauma. Causes severe hoarseness and reduced pitch range. Treated with surgical removal followed by post-operative voice therapy.

Vocal Fold Web

A membrane tissue web extending across the glottis caused by congenital failure of folds to separate during embryogenesis or acquired secondary to laryngeal trauma/surgery. Treated surgically, often using a vertical keel placed between vocal folds for $6\text{--}8$\text{ weeks}.

Vocal Fold Cysts

Unilateral, encapsulated sphere-shaped lesions inside the superficial layer of lamina propria caused by glandular duct blockage or phonotrauma. Creates focal tissue stiffness and incomplete glottal closure. Treated via surgical excision and voice therapy.

Granuloma

Irregularly shaped vascular mass located at the vocal processes of the arytenoids caused by chronic phonotrauma, laryngopharyngeal reflux, or endotracheal intubation trauma. Symptoms include laryngeal pain and referred ear discomfort (otalgia).

Superior Laryngeal Nerve (SLN) Paralysis

Nerve damage caused by viral neuropathy, thyroid disease, or surgery, resulting in epiglottic deviation toward the affected side during high-pitch vocalizations and an inability to elevate pitch. Approximately $60\%$ of cases recover spontaneously within $1$\text{ year}.

Unilateral Recurrent Laryngeal Nerve (RLN) Paralysis

Loss of function in one RLN leading to an immobile vocal fold, breathy voice quality, low pitch, diplophonia, and reduced dynamic range. Managed through observation for spontaneous recovery or ENT surgical procedures (e.g., medialization thyroplasty).

Bilateral Recurrent Laryngeal Nerve (RLN) Paralysis

Involves both vocal folds. Bilateral abductor paralysis fixes folds at midline, creating a critical respiratory emergency (dyspnea) requiring emergency surgery. Bilateral adductor paralysis fixes folds laterally, causing total aphonia and severe aspiration risk.

Reinke's Edema

Bilateral buildup of fluid throughout the superficial layer of lamina propria (Reinke's space) causing polypoid degeneration. Etiology is strongly linked to long-term smoking, severe phonotrauma, or chronic allergies. Results in an abnormally low pitch and raspy voice.

Vocal Fold Hemorrhage

Acute vocal fold tissue damage caused by heavy vocal overuse/exertion combined with anticoagulant medication usage (e.g., Warfarin). Characterized by sudden onset hoarseness and intermittent aphonia.