Voice Midterm Exam

High Risk Populations for Voice Disorders

School-aged children, older adults, teachers, singers, teleconference tech users, GERD

Power

breath support (diaphragm/lungs)

Source

Larynx (adduction of the true vocal folds)

Filter

Vocal tract (pharynx, oral cavity, nasal cavity)

Functional Disorder

Insufficient/improper use of phonation, Normal structure, problem with function (psychogenic, phono trauma)

Organic Disorder

Pathological changes in the larynx/ vocal folds (lesions, cancer, nodes, polyps, papillomas)

Muscles of inspiration

diaphragm and external intercostals

Muscles of expiration

internal intercostals and abdominal muscles

Breathing for life

exhale and inhale are equal, use 10% of vital capacity, involuntary

Breathing for speech

exhale > inhale, use 25% of vital capacity, voluntary

autonomic (involuntary) nervous system

brainstem, regular involuntary breathing

central (voluntary) nervous system

higher cortical structures, used to coordinate voice, speech, language

Normal phonation

Move arytenoids to open/close (abduction/adduction)

Vagus nerve (CN X)

swallowing, phonation, and airway shape, motor control

Superior/Recurrent Laryngeal

vagus nerve branches into these, main innovators for the larynx

cricothyroid joints

lengthening/shortening the vocal folds to regulate pitch

cricoarytenoid joints

involved in adduction/abduction of vocal folds

3 systems for voice production

respiration (airflow), phonation (vibration), resonance (shape/amplifies sound)

gas exchange in lungs

inspiration: expand lungs, more volume, low pressure system. expiration: less volume, high pressure, air wants to escape

neurological voice disorder

pathologic changes in the CNS/PNS (tremor, spasmodic dysphonia, vocal fold paraysis)

bony thorax

provides breath support, posture, nerve supply, muscle tension

diaphragm nerves

innervated bilaterally by phrenic nerves (C3-C5)

respiratory exchange

takes place in the brochioles

voice straining

This happens when pressure is too high

breathiness

voice pressure is too low

normal phonation involves

airflow, vocal fold structure/function, nervous system control, supraglottic structure/function

primary function of larynx

airway protection

secondary function of larynx

speaking, singing, etc

posterior cricoarytenoid

only muscle of abduction

extrinsic muscles of larynx

move larynx up/down for speech and swallowing (elevators/depressors)

recurrent laryngeal nerve

PRIMARY/Main nerve innervation of the larynx

prevent folds from coming together smooth/vibrating properly

How does a lesion impact vocal quality

instrumentation

how to tell the different diagnosis from organic/functional

direct treatment

actually changing something about the person's voice, respiration, phonation, articulation, and resonance

Indirect treatment

changes factors affecting the voice, fix the environment around the voice, but not voice itself (i.e. education)

Conversational training therapy

patient led conversations, unstructured, to change respiration, phonation, resonance, articulation

Respiratory muscle strength training

increase maximum expiratory pressure, strengthen inspiratory/expiatory muscles through resistance using device

MPT

28 sec for males, 22 for females, 14 for older adults

S/Z phonation times

20-25 seconds for both

Organic case study

continues to get worse, past phonotrauma

Functional case study

Recent phonotrauma, sudden onset, not long period of time, not worsened

auditory perceptual evaluations

CAPE-V, GRBAS

voice hanicap index

quality of life self-evaluation

Semi-occulated vocal tract exercises

reduce collision impact between folds, partial occlusion of lips (straw, lips, trill, kazoo)

instrumental evaluation

imaging, strobing, acoustic analysis

Muscle Tension

Excessive tension of the intrinsic and/or extrinsic laryngeal muscles causing inefficient voice production

Lesions

polyps, cysts, nodules

Reinkes Edema

Fluid filled swelling of the top tissue, caused by smoking

Body cover theory

layers of the vocal folds go from more flexible to rigid. Produce smooth voice that can change pitch/quality.

Laryngomalacia

collapse of the supraglottic structures during inhalation

CAPE-V, GRBAS

formal voice assessments

Observation of natural conversation of voice quality

Informal voice assessment

Extrinsic muscles

move larynx as a unit, elevators, depressors Innervations: cranial nerve 5, 7, 12

Intrinsic muscles

fine control of vocal folds