Speech Disorders Quiz 3

Are voice disorders more common in males or females?

Males

What happens to the larynx after birth?

Lowers as we age

Where exactly does the larynx move to after birth?

Begins at C3, moves to C6 at 5 years old, C7 at 15-20

What happens to the vocal folds as we age?

VFs change from 3 mm at birth

To puberty: boys 10mm and thickening, girls less change and thickening

Adulthood: Men: 17-20mm, Females 12.5-17mm

Why is pitch different from guys to girl?

More mass in VF in men

What are the cartilages involved with voice disorders?

Cricoid, thyroid, arytenoid (including vocal process), corniculates, cuneform, epiglottis

What do the intrinsic laryngeal muscles do? Give an example.

Adduct (close) the VFs, and abduct (open) the VFs

Adductor: lateral cricoarytenoids (paired)

Abductor: posterior cricoarytenoids (paired)

Glottal tensor & glottal relaxer

Glottal tensor: cricothyroid & thyrovocalis

Glottal relaxer: thyromuscularis

What does the cricothyriod muscle do?

Tenses the muscle by pulling thyroid cartilage to raise pitch

What does the thyrovocalis do?

Known as the true VFs, relates to pitch raising

What does the thyromuscularis do?

Outside muscle which relaxes thyrovocalis

What is the origin and insertion of the VFs?

origin: laryngeal prominence

insertion: vocal process of the aryteniods

What are the extrinsic mucles?

digastric (raises the larynx)

omohyoid (lowers the larynx)

What is the differences between the intrinsic and extrinsic muscles?

Extrinsic muscles is on the outside of the larynx, intrinsic is at the larynx (inside). Extrinsic muscles do most of the moving, whereas intrinsic muscles don't do much moving

What is the biology function of the VFs and larynx?

swallowing (protecting airway)

What is the overlaid function?

Speech function

What is the Bernoulli Effect?

The process of air pressure causing the VFs to push apart, then lets air through to push the VFs back shut

What does phonation involve?

Both the PNS and CNS

What does the motor strip include?

Primary motor cortex and Broca's Area

What does the sensory strip include?

Primary sensory strip, auditory cortex, and Wernicke's Area

What other CNS systems are included in speech?

Basal ganglia, and Cerebrum

What is the neural pathway included?

Pyramidal system: corticobulbar tract

CN X Vagus

What is CN X Vagus?

superior laryngeal nerve (crocithyroid muscle only), recurrent laryngeal nerve

What happens with unilateral damage to CN X Vagus?

Flaccid/weak VF (horse/breathy tone)

What happens with bilateral damage to CN X Vagus?

Paralyzed VFs

What does an indirect laryngoscopy look like?

Mirror- rounded mirror (used in dentist), makes it difficult to see entire larynx

Fiber-optic endoscopy- threaded scope through nasal cavity to larynx (preferred method)

What does a direct laryngoscopy look like?

scope places directly into throat to allow for direct inspection of structures (done by a physician to screen for cancer)

What is a stroboscopy?

Strobe light used to see VF move more slowly (used with rigid stroboscope)

What are other tests used to inspect the larynx?

CT scan and ultra-sound

Who is involved in the medical personal team alongside the SLP?

otolaryngologist, neurologist, psychiatrist/psychologist, radiologist, plastic surgeon, medical pathologist

What are associated medical aspects?

drug treatment: SLPs are familiar with drugs that may affect the voice (know what medications client's are taking)

What is phonosurgery?

Surgery aimed to improve and reconstruct the voice

What are the five parameters/terms of voice?

1. pitch

2. loudness

3. quality

4. non-phonatory behaviors

5. aphonia

What is pitch?

psychological correlate of frequency

What is true vocal fold vibration?

fundamental frequency: average frequency spoken which is heard

What is optimal pitch?

the most efficient and comfortable pitch

What is habitual pitch?

the average pitch a person speaks at daily

How do you measure pitch?

Measuring pitch range and optimal pitch

What is monopitch?

the lack of inflectional variation AKA inappropriate pitch (too low, too high, vocal breaks, etc...)

What is loudness?

psychological correlate of amplitude

Why does loudness vary?

varies with degree of subglottic pressure and duration changes in VF adduction

What are considered "normal" intenisities?

about 60dB

about 50% of the time the VFs are closed

What are "higher" intensities?

33% in the closed state with higher intensities

How do you measure loudness?

sound level meter: depends how far it is from the patient

normal conversational speech is about 60dB

What is mono-loudness?

lacking in normal loudness

variations in loudness

What are possible causes to mono-loudness?

neurological damage, habits, psychiatric problems

What causes for hoarse and rough voice quality?

various etiologies leading to edema (VFs that don't vibrate at the same rate)

Can these voice quality altering pathologies temporary or permanent?

Certain pathologies are temporary, but some can be permanent like vocal nodules

How is breathiness caused?

too much air through the glottis caused by lesions which results from a neurological issue

What is a vocal tremor?

variations caused in pitch/loudness

What causes a vocal tremor?

Neurological damage of CNS

What is a strained or strangled vocal quality?

difficulty initiating/maintaining voice

What causes a strained or strangled quality?

neurological or psychological damage

How does one measure vocal qualtiy?

this is a real skill, since no objective ways to measure exact vocal quality

What are non-phonatory behaviors?

noise not being generated from the VFs

What is stridor-noisy breathing?

Caused by a blockage

What is transient aphonia?

temporary loss of voice (flu)

What is consistent aphonia?

permanent loss of voice

What caused consistent aphonia?

VF paralysis, CNS damage, or psychological problems

What is episodic aphonia?

loss of voice that comes and goes

What causes episodic aphonia?

CNS damage or other psychological problems

Why is it challenging to decide who really needs therapy?

some disorders are subtle and hard to detect

What are objective measurements of voice disorders?

Measurements of picth

What are subjective measurements of voice disorders?

Measurements of voice quality

Do you refer a patient with transient issues?

NO!

When do most people refer to a physician?

when a difference in quality of noticed, strained or strangled tone, difficulty breathing

Wen do you NOT refer to a physician?

high pitched. slight nasal. softer or louder (temporary)

What is a bottom line when deciding whether to refer or not?

When in doubt, refer!!

Who is first to notice voice problems?

Teachers

When is a screening necessary?

only when persistent problems need intervention

What is a simple way to perform a screening?

counting 1-10

what is a full evaluation?

detailed case study

What is a necessary data to obtain during a full evaluation?

background of disorder (onset, history, related illnesses, etc.) and general background information (stress, work, relations, etc.)

What is a medical review in terms of a full evaluation?

prescribed and not prescribed medications and possible exacerbating influences like drugs, caffeine, smoking, drinking

What is a worrisome with hold long the voice disorder persists?

2 weeks

What is a jitter measurement?

measured in milliseconds which is cycle variations

What is a shimmer measurement?

measured in millivolts which is cycles variations in amplitude, fundamental frequency, or pitch range

What is known as instrumentation for voice disorders?

VisiPitch or a computerized speech lab, electroglottalgraph, audio recorder, sound level meter

What is a computerized speech lab?

tools placed on VFs to measure VF movement

What is an audio recorder?

device that records voice to review and refer back to

What is a sound level meter?

teaches different levels of speech

What is considered conversation speech taught by the sound level meter?

60 dB

What is considered maximum VF level taught by the sound level meter?

100-110 dB

What is a minimum VF level taught by the sound level meter?

40 dB

What tools do SLPs use to do a physical inspection of the VFs?

endoscope

Who can diagnosis, SLPs or physicians?

physicians

When can V-P port result?

issues with hypernasality

What is most common instrument to assist with hypernasality?

nasometer

Do most patients with voice disorders have sufficient breath support?

yes

What conditions cause for insufficient breath support?

Parkinson's Disease (weaker muscles)

What is maximum phonation duration?

how long you can phonate for

What is basal pitch?

most comfortable pitch

What is ceiling pitch?

most uncomfortable pitch

What is a hypofunctional quality?

too little pressure with VFs

What does hypofunctional quality sound like?

breathiness, whisper, aphonia

What is a hyperfunctional quality?

too much pressure in the VFs

What does hyperfunctional quality sound like?

pressed (excess tension), spastic, glottal attacks (hard)

What are the three types of voice disorders (dysphonia)?

1. functional (misuse/abuse)

2. neurological (damage to CNS)

3. organic (other medical issues (ex. cancer))

What is an example of misuse or abuse in terms of functional voice disorders?

eccessive screaming/coughing/talking

Where are vocal nodules found?

anterior 2/3 of VFs and are bilateral

What do vocal nodules look like?

soft + pilable (red) at first but can become white, hard, and fibrous