SHS 303 Final Notes

Thyroid; isthmus

The _ gland consists of two lobes placed on either side of the lower larynx and connected by a strip of thyroid tissue called the _

Thyroxin

The Thyroid gland produces the hormone _

Thyroxin

_ affects growth in children; two much/too little can cause disfunction

Goiters

Large abnormal growth on the thyroid gland

Iodine

Goiters grow because a person does not have enough _ in their system

Wanderer

Vagus means what?

Cranial Nerve X (10)

Vagus nerve is also known as what?

Brainstem

Vagus nerves descends from the _ into the lower body

Pacemaker for the heart

As the vagus nerve wanders to the downward side of the body, it also acts as a …

Vagus nerve (cranial nerve X)

Supplies nerve supply for the lungs, esophagus, stomach, abdominal viscera (large and small intestine)

Graves disease

Noticeable when people put on weight, have thinning hair, dry/scaly skin, and most prominently if their eyes start to bulge from their head

ENT (ear, nose, and throat doctors) and otorhinolaryngologists

Physicians who work with VF pathologies are called what? (hint - 2 names)

ENTs

Hearing loss, PE tubes in babies, otitis media, evaluate/determine if someone has a cleft of the lip or palate, determine if there’s a nasal occlusion

Indirect Laryngoscopy

Takes gauze, pulls a patient’s tongue out and gets a laryngeal mirror; least invasive; will ask patient to make a high pitch “E” sound to help elevate the Larynx

Peroral endoscopy and nasoendoscopy

Two types of endoscopy procedures (direct laryngoscopy)

By

Per means what?

Mouth

Oral means what?

Peroral endoscopy

Takes the same endoscope and places it into the oral cavity; hangs over the base of the tongue and the ENT can get further down into the larynx and esophagus

Nasoendoscopy

Take a flexible and rubber tube that has a light source on one end and a camera on the other. They will spray lidocaine to help numb and then insert it into one nostril and will lay down on the velum? to see the larynx

Prephonation phase and Attack phase

Two phases of the onset of phonation

Prephonation phase

Vocal folds at rest are in this phase; VFs are abducted or very loosely adducted (like coughing or clearing your throat)

Attack phase

Close vocal folds at midline; subglottal air pressure blows VFs upward and outward

• Simultaneous attack

• Breathy attack

• Glottal attack

What are the three different ways to initiate phonation?

Moore, 1938

Who suggested the three ways to initiate phonation?

Simultaneous attack

Recommended by most SLPs; easiest on the voice. Subglottal air pressure moves up through the trachea and meets adducted VFs at midline

Breathy attack

The breath stream is released due to a larger opening at the level of the glottis

Glottal attack

Medial compression of the VFs is hard and when they release it creates a rapid voice onset time (VOT); hard on the VFs

• Vocal nodules

• Contact ulcers (can also occur at areas where VFs come together)

What are laryngeal pathologies?

Vocal nodules

Similar to calluses that build up on the VFs due to vocal abuse or misuse (most common)

• common in people who clear their throats frequently, concert singers

• when these meet at the midline, the VFs can’t actually meet (affects mass of VFs). Subglottal air comes from the lungs and escapes around the opening creating a breathy voice

Puts them on vocal rest immediately (no talking, coughing, etc.)

What does an SLP do when finding out a person has vocal nodules?

Contact ulcers

By slamming the VFs together or acid reflux falling onto the VFs

Sit at 45 degree angle; sleep in a recliner

What to do when acid reflux gets on VFs

Edema

Swelling due to coughing, throat clearing, and everything else that goes with allergies

Polyps

Blisters on the VFs

• not sure what causes them but they also add weight to the VFs and slow down VF vibration

Papilloma

?? Growths that grow in the vocal tract

• tend to caise a hoarse breathy voice and restrict the airway

Granuloma

A sand-filled sac

Hemangioma

A grain-filled sac

• usually caused by some type of trauma

Laryngeal cancer

Most severe

• unusual in that it really depends where it occurs as to whether it will spread quickly

• Vocal nodules

• Contact ulcers

• Edema

• Polyps

• Papilloma

• Granuloma

• Hemangioma

• Laryngeal cancer

List the different VF pathologies

• Age

• Health

• Gender

• Emotional status

You can tell a lot about the speaker by listening to the person’s voice. Give examples

Optimal pitch

VFs vibrate most easily

Habitual pitch

May or may not correlate with optimal pitch. Ideally, they match each other

Fairbanks (1959)

During normal conversational speech, pitch levels may vary over a range of almost two octaves. Who found this?

Fundamental frequency

The average rate of VF vibration

• Can be influenced by culture as well

• Men - 130 Hz

• Women - 210 Hz

List fundamental frequency for men and women

Locating the note that’s ¼ of the way up their total singing range (including falsetto voice)

How can you determine a person’s optimal pitch?

Locate the note that is 1/3 up

How to locate optimal pitch if they don’t utilize falsetto voice?

Falsetto voice

Musically trained people can’t hear the transition to the what?

Relative pitch rather than perfect

More people have what pitch?

Intonational patterns

Rise-fall in pitch

Visi-pitch

Speak in a microphone, sing as low and as high as you can. Now used to determine optimal pitch

Cricothyroid and Thyroarytenoid

What are the two tensor muscles of the larynx?

Tissue elasticity

__ accounts to some extent for our ability to lower pitch below optimal pitch

Thyroarytenoid

The _ muscle assists in accompaning lowering pitch by drawing the thyroid and arytenoid cartilages together

3 cm of H2O

Subglottal pressure of … is sufficient to sustain phonation

8 to 12

As subglottal pressure is doubled, vocal intensity increases anywhere from _ to _ dB

6

As your distance from a sound source doubles, there is a corresponding _ dB decrease in intensity of the sound

Psg - Po

TPD = what?

Transglottal pressure differential

What does TPD stand for?

For articulation

Why is TPD important?

Decreases

As supraglottal pressure increases, subglottal pressure does what?

The VFs won’t vibrate

What happens when supraglottal pressure equals subglottal air pressure?

1. Loft

2. Modal

3. Pulse

Vibrato and Trill (other voice registers)

Most voice instructors recognize three registers. Name them

Falsetto voice - high voice

What is the voice register Loft?

Normal voice range

What is the voice register Modal?

Glottal fry - low voice

What is the voice register Pulse?

Vibrato

Opera singers have a lot of what in their voices?

Tremelo

Term for when you try to voice a vibrato

Trill

Rapid alternation between two consecutive tones; can also be produced by people who practice

1. Maximum frequency (pitch) range

2. Mean rate of VF vibration (habitual pitch)

3. Air cost (maximum phonation time)

4. Minimum-maximum intensity at various pitches

5. Periodicity of VF vibration (jitter)

6. Noise

7. Resonance

8. Sound pressure level (SPL) meter

What are the parameters of voice production?

15-20 seconds

Average person should be able to maintain phonation for how many seconds?

Periodicity of VF vibration

Relates to jitter - there is a jitter when trying to sustain a note for a long period of time

Shimmer

Relates to the loudness produced

Sound spectograph (visi-pitch)

What is the sound equipment used to measure jitter vs. shimmer

Sound spectogram (graphic recording)

Sound spectograph produces a __

Noise

Quality of voice as a consequence of a periodicity or a random distribution of acoustical energy in the voice spectrum

Resonance

Determining the _ of a person’s voice can determine the quality of their voice

Sound pressure level (SPL) meter

Often utilized to determine acoustic measurements of a specific…

50

If someone produces _ decibels it is within normal limits

20; 70

Minimum SPL of _ decibels, max SPL of _ decibels

50

There should be approximately a _ decibel difference of your quietest and loudest voice