Voice Disorders Midterm

What are the types of functions of the larynx?

Biological

• airway protection, elevates during swallowing & closes off airway during swallow

Emotional

• sound of one’s voice mirrors their emotional state

Linguistic

• it’s what we say and how we say it

• babbling is more language differentiated after 6 months

• melody of parent language/prosody begins to color the vocalization of baby

What is the primary function of the larynx?

Airway protection

What is required for effective voice therapy?

Total person, not just voice

What is the prevalence of voice disorders in the general population?

7% always, 30% at least once in their life

______ were almost twice as likely as _____ to be diagnosed with dysphonia.

Females, males

Adults over what age are 2.5% more likely to have a voice disorder?

Adults over 70

What are the most common laryngeal conditions leading to voice therapy referral?

Vocal fold nodules, muscle tension dysphonia

What is the prevalence of voice disorders in children?

Difficult to determine to to methodology limitations, most studies say 4-9% or 20-30%

What is the prevalence of voice disorders in the elderly?

20-30% of people 65+

What is the prevalence of voice disorders in heaving occupational voice users/teachers?

• 5-10% for US workforce “heavy occupational voice users”

• 11% for teachers

What are the types of voice disorders?

Functional, Organice, Neurogenic

What are the 2 types of Functional voice disorders?

Muscle Tension Dysphonia, Psychogenic Voice Disorders

What is Muscle Tension Dysphonia (MTD)?

• Overuse of the respiratory, laryngeal, and supralaryngeal systems

• Experiences fatigue and effort increase, pain/discomfort

• No organic abnormalities

What is the most common voice disorder in children and adults?

Muscle Tension Dysphonia (MTD)

What are Psychogenic Voice Disorders and its treatment?

• Reaction to trauma that manifests in the voice and can cause loss of voice

Treatment

• Voice therapy, counseling

What are organic voice disorders and their treatment?

• Structural deviations of the vocal tract or to diseases of specific structures of the vocal tract

Treatment

• medical, dental, surgical

• SLP can improve physiologic function (maximize vocal potential)

What are neurogenic voice disorders?

• from impairment in the control and innervation of the muscles of respiration, phonation, resonance, articulation

• can’t be cured, BUT SLP maximizes function to as near to normal

Successful intervention requires _______.

identification of the cause

SLPs work with _____ to address organic voice disorders.

ENTs

SLPs work with ______ to help patients with psychogenic voice problems.

counselors, psychologists, or psychiatrists

How are neurogenic voice disorders confirmed?

Referral by the SLP to a neurologist

What does an SLP use to assess a patient with a voice disorder?

• Case history

• Observations

• Instrumental/Noninstrumental approaches

What are diagnostic probes?

Voice stimulability by introducing a few voice therapy approaches

What to diagnostic probes indicate?

The general direction of the therapy that should be provided

How is progress measured in voice therapy?

• Pre- and Post- treatment measures

  • respiratory function

  • acoustic comparisons

  • voice quality

  • resonance changes

Is voice therapy individualized or group based?

individualized

Where does phonation occur?

Larynx

What is phonation?

Vibration of the vocal folds

Where is the larynx located in adults vs children?

Adults: 3rd-6th cervical vertebrae

Children: 4th cervical vertebrae (higher)

In what view can you see most structure of the larynx?

Posterior

What are the 3 main functions of the larynx based on anatomy?

1. Airway protection

2. Thoracic fixation

3. Phonation

What is the larynx framework?

• 1 bone

• 6 cartilages

  • 3 paired/3 unpaired

• Has muscles, cartilage, epithelial tissue

• Bound together by ligaments

• Lined with mucous membrane

What is the only bone in the larynx?

Hyoid bone

What are the unpaired cartilages?

Thyroid, Epiglottis, Cricoid

What are the paired cartilages?

Arytenoids, Corniculates, Cuneiforms

What cartilage has the laryngeal prominance?

Thyroid cartilage

The cricoid cartilage has 4 articular facets, what are they for?

• 2 medial most are for arytenoids

• 2 outmost are for thyroid rocking

What is the difference between the lateral and anterior projection of the Arytenoid cartilages?

• Lateral = Muscular process (on anterior side), abducts/adducts

• Anterior = Vocal process (on posterior part of VF)

What are the laryngeal joints?

Cricothyroid and Cricoarytenoid

What are the movements of the cricothyroid joint?

Rocking

• forward = lengthen VF, backward = shorten VF

• adjusts pitch/increase tension on VF

What are the movements of the Cricoarytenoid joint?

Rocking

• Abduct/Adduct = rocks out and in

Gliding

• Forward = shorten, Backward = lengthen

Rotation

• Used to be most likely movement for adduction

How many extrinsic and intrinsic ligaments are in the larynx?

7 extrinsic, 3 intrinsic

What are the extrinsic ligaments/membranes?

• Thyrohyoid membrane

• Lateral thyrohyoid ligament

• Middle thyrohyoid ligament

• Hyoepiglottic ligament

• Thyroepiglottic ligament

• Glossoepiglottic ligament

What are the intrinsic ligaments/membranes?

• Conus elasticus

• Vocal ligament

• Posterior Cricoarytenoid ligament

What are the cavities of the larynx from top to bottom?

Supraglottal, Ventricles, Subglottal

What tissues make up the larynx from outer to inner?

1) Epithelium

• stiff for protection, white

2) Lamina propria

• superficial: cushions VF

• intermediate: elastic fibers w recoil

• deep: thick collagenous fibers

3) Body

• vibrates VF, length/tension

What nerve innervates the larynx and what are the 2 divisions?

Vagus nerve, emerging from medulla

• Divisions

  • recurrent laryngeal nerve

  • superior laryngeal nerve

Which division of the vagus nerve leaves the larynx and comes back?

Recurrent laryngeal nerve

What is the difference in roles between extrinsic and intrinsic muscles?

Extrinsic = provide support and position for the larynx

Intrinsic = control sound production

What are the intrinsic adductor muscles?

• Lateral cricoarytenoid (LCA)

• Transverse arytenoid

• Oblique arytenoid

What are the intrinsic abductor muscles?

Posterior cricoarytenoid (PCA)

What are the intrinsic glottal tensor muscles?

Cricothyroid, Thyrovocalis

What makes up the thyroarytenoids?

Thyrovocalis and thyromuscularis

What is the intrinsic relaxer muscle?

Thyromuscularis

What are the hyoid and laryngeal extrinsic elevators?

• Digastric: anterior & posterior

• Mylohyoid

• Genioyoid

• Stylohyoid

What are the hyoid and laryngeal extrinsic depressors?

• Thyrohyoid

• Sternohyoid

• Omohyoid

• Sternothyroid

How does the structures of the larynx modify airflow?

Voicing, Voiceless, Intonation

What is voicing?

Adducting the VF to create vibrations

What is voiceless?

Abducting VF

What is intonation?

Changing VF vibration rate changes the perceived pitch

Higher vibrations = higher _____.

pitch

What changes the glottal size/configuration?

Abduction and adduction of the VF

When VF length increase, vibration rate _______.

decreases

As age gets older, pitch gets _____.

Lower

Is there a direct relationship between VF mass and rate of vibration?

NO

What does stiffness mean?

Rigidity, strength of elasticity

Stiffness of VF varies by ______ of the fold.

location

How does sound generate plosives?

• pressurization phase → release phase

• glottla configuration changes add→abd

How does sound generate noise (/h/)?

• results from turbulent airflow

• glottal configuration adjustment → turbulent airflow

• air rushes through constriction

How does sound generate voice?

• sustained airflow

• glottal configuration is adduction

What does myoelastic mean?

Tissue goes back to original place (like a rubber band)

What physiology occurs for abduction and adduction to occur?

• myoelastic

• aerodynamics

What parts make up the aerodynamics of the larynx?

• Opening

  • Positive pressure

• Closing

  • Bernoulli effect and elasticity

What is the Bernoulli effect?

• At a point of constriction, there will be a decrease in air pressure perpendicular to the flow and an increase in velocity of the flow

• Constrictions cause faster airflow around obstruction

________ pressure is built up below the folds.

Subglottal

Do VF open and close during phonation?

No, different muscles are used for each open/close movement

What is needed for VF to open and close automatically?

• Folds are appropriately positioned

• Sufficient buildup of pressure below them

What are the 3 phases manipulated by subglottal pressure for VF closure?

• Opening → Closing → Closed

• Open posterior → open anterior → close anterior → close posterior

What is f0?

Pitch, reflects vibratory rate of VF

What is intensity?

Power of respiratory systems, shape of glottis, shape of vocal tract, lip opening

How does one regulate their voice?

• F0 (pitch)

• Intensity (loudness)

• Quality

What is the difference in type of sound between abduction and adduction?

Abduction = aperiodic, Adduction = periodic

Rate is described as _____/______.

cycles/second

Men’s VF’s vibrate from _________Hz.

90-500

Women’s VF’s vibrate from _________Hz.

150-1000

What factors affect VF rate change?

• tension (stiffness)

• mass (thickness)

• length

• changing volume of airflow

What are the different vocal registers?

Glottal Fry

• lowest f0

Modal

• widest range of f0, normal

Falsetto

• highest f0

More subglottal pressure = ______.

louder

What are the objective parameters to vocal quality?

Acoustic parameters

• f0, intensity, jitter, shimmer, spectrum

Open quotient

Speed quotient

What are the subjective parameters to vocal quality?

• hoarse

• rough

• strained

• strangled

• breathy

• male vs female