Phonation Quiz 1/ With REL and lung capacities/volumes

lung/pulmonic (alveolar pressure)

_________: pressure within the lungs and specifically in alveoli

subglottal pressure

_________: pressure below the level of vocal folds (trachea)—same as lung pressure.

atmospheric pressure

_________: pressure arising from the force of gravity on air molecules of the atmosphere- we consider this 0

Resting Expiratory Level

_________: is the level of equilibrium on the rest point for our respiratory system.

diaphragm contracting for inspiration

During this moment, the __________ and external intercostals contract and increase thoracic volume (and maybe accessory muscles of inspiration). This expands the lungs as they go with the enlarged thoracic cage. Then, the alveolar, subglottal, and intraoral pressures become negative re-atmospheric, and air flows into the lungs.

beginning of expiration

During this process the diaphragm and external intercostals, etc, begin to relax, recoil of lungs and rib cage begins to reduce thoracic volume. The subglottal, alveolar and intraoral pressure become positive relative to atmospheric pressure and air flows out of the lungs.

end of exhalation

This process goes back to REL, the alveolar, subglottal, and intraoral pressures are at atmospheric, and no airflow is in the lungs.

spirometer

_________: This is used often in clinics for pulmonary function tests, it measures the volume of air that is displaced.

volumes

_________: a discrete volume of air, may change depending on the activity you are completing during a respiratory cycle, and typically measured in cubic centimeters or ccs.

capacities

_________: the sum of two or more volumes and is functionally defined

tidal volume

_________: volume of air inhaled and exhaled during any single expiratory cycle. These changes based on your respiratory needs

• Resting ___= passive breathing (sleeping/sitting)

• Will be higher when talking/walking/etc.

• On average ____ is at rest=525 cc

• ______ during heavy work: as high as 2300 cc!

Inspiratory Resting Volume (IRV)

_________: the quantity of air which can be inhaled in a tidal volume cycle.

• (what is left after you inhale your tidal volume)

Residual Volume (RV)

_________: the quantity of air that remains in the lungs and airways even after a maximum exhalation. This air is unable to be removed from the lungs.

Expiratory Reserve Volume (ERV)

_________: the amount of air that can be forcibly exhaled following an initial exhalation. Essentially the air that could still be functionally exhaled after REL (doesn’t include RV).

Functional Residual Capacity (FRC)

_________: the volume of air remaining in the lungs following exhalation to the resting expiratory level. It is not very functional for speech (because of RV) but still participates in gas exchange.

Inspiratory Capacity (IC)

_________: the maximum volume of air that can be inhaled from REL. The tidal volume + inspiratory reserve volume. This essentially achieves REL and inhalation maximum

Vital Capacity

_________: the quantity of air that can be exhaled after as deep an inhalation as possible (or vice versa).

• Most frequently cited capacity

• ___=TV+IRV+ERV

• Changes with age and health of respiratory structures

Total Lung Capacity (TLC)

_________: quantity of air the lungs are capable of holding at the height of a maximum inhalation.

• Includes the air you cannot exhale

• ___= Residual+Tidal+IRV+ERV

• Also depends on age, size of human and ability of inspiratory muscles to do their job!

TV, IRV, ERV, RV

What are the lung volumes?

FRC, IC, VC, TLC

What are the lung capacities?

in centimeters of water.

How is respiratory pressures measured?

low loudness-level speech

_________: this is quiet speech that is just above a whisper.

• minimum pressure required to drive vocal folds: 3 or so cm H2O subglottal pressure

mid-loudness level speech

_________: conversational level speech

• usually 8-10 subglottal pressure

higher loudness level speech

_________: shouting and singing

• needs 20-60 cm H2O of subglottal pressure

passive/quiet breathing

This is a nearly 50/50 process
Inspiratory phase:
◦ Uses diaphragm and external
intercostals
◦ 500 ccs (half a liter) for adult males
◦ Expiratory phase:
◦ Passive (non-muscular) forces used
◦ Ends at REL

speech breathing

Inspiratory phase:
◦ Steeper inhalation slope
◦ The proportion of the inhale compared to the rest
of the breathing cycle is small
◦ Refills at grammatical boundaries
◦ Larger volume of air, esp. for loud speech
◦ Expiratory phase:
◦ Longer phase due to the resistance from the vocal
folds preventing you from running out of air quickly
(quite stopping and starting the airstream
back up)
◦ USUALLY ends at RELh

Relaxation pressure

_____: is that pressure generated as a result of relaxing muscular contraction (passive forces)

• non-muscular: forces that are present across the spectrum of lung volumes.

• This pressure varies with % vital capacity

positive pressure

______: exhalation due to passive forces

negative pressure

______: the pressure with which your body wants to back to REL.

Net Inspiratory Force

_____: when the subglottal pressure used for speech is created by contraction of inspiratory muscles (external intercostals) to control air pressure.

Phonation

_______: voicing source of speech

Articulation

_____: mostly tongue/jaw/lip position, and resonance= velar position, Phonation only deals with vocal fold movement.

larynx

The main purpose for ________ is to protect us from aspirating our food, NOT speech

air pressure from the lungs

What pushes the vocal folds apart to cause vibration?

elastic

The vocal folds are _______- at a certain point they recoil back to the midline.

3 factors of phonation

________________:

1. appropriate subglottal pressure (high enough)

2. degree of constriction of vocal folds (close enough)

3. elasticity and tension of vocal folds (not damaged/swollen)

hyoid bone

______: supports the root of the tongue as well as providing support for the larynx.

• “hangs” the larynx

• free-floating: not attached to any other bone

thyroid cartilage

_____: anterior and lateral walls of larynx

cricoid cartilage

_____: broad part (lamina) posteriorly; narrow part anteriorly

• sits above the top-most tracheal ring

• forms the base of the larynx

arytenoid cartilages

_____: paired, located on the superior posterior lateral surface cricoid cartilage.

epiglottis

_____: attached to the interior (aka posterior) of thyroid cartilage just below the thyroid notch.

• ligaments connect to the root of the tongue on the anterior surface

• NO connections on the posterior side= easy to tell what it is

• Epiglottis protects the larynx from food

cricothyroid joint

_____: thyroid cartilage to pivot.

• rocks thyroid cartilage forward: increases tension in the vocal folds (increases the distance between arytenoids and anterior thyroid)

• used for pitch adjustment

cricoarytenoid joint

_____: the primary movement is to rock in and out for adduction/ abduction.

• anterior/posterior gliding to tense vocal folds.

• Third possible movement is rotation.

thyrohyoid membrane

_____: connects from the superior aspect of the thyroid cartilage to the hyoid bone

lateral thyrohyoid ligaments

_____: run from the superior cornu of the thyroid to the posterior tip of the greater cornu of the hyoid.

median thryohyoid ligaments

_____: connects from the corpus of the hyoid to the upper border of the anterior thyroid

hyo-epiglottic ligaments

________: connects the hyoid bone to the anterior aspect of the epiglottis

thryoepiglottic ligaments

_______: (and intrinsic laryngeal ligament) connects the epiglottis to the deep surface of the thyroid cartilage, below the notch.

median glossoepiglottic ligament

________: connects the anterior medial surface of the epiglottic to the base of the tongue medially.

lateral glossoepiglottic ligaments

________: each connects the anterior lateral surface of the epiglottic to the base of the tongue.

cricotracheal ligament

________: connects the cricoid cartilage to the trachea.

cricothyroid ligament (conus elasticus)

_________: originates from the superior surface of the cricoid cartilage, extends superiorly to terminate with a free upper margin, attached anteriorly to the inferior portion of the thyroid cartilage, attached posteriorly to the tip of the vocal processes of the arytenoid cartilage.

vocal ligament

______: connects the vocal process of the arytenoids to the angle of the thyroid

median cricothyroid ligaments

________: connects the inferior surface of the thyroid cartilage and the superior surface of the cricoid cartilage.

aryepiglottic fold

________: connects from the superior lateral points of the epiglottis to the apexes of the arytenoids.

vestibular ligaments

________: connects from the angle of the thyroid cartilage (inferior to the epiglottis attachment) to the anterolateral surface of the arytenoid cartilage (superior to the vocal process) to form the inferior margin of the false folds.

laryngeal vestibule

________: the entrance to the larynx from above; from the epiglottis and the superior boundary of the aryepiglottic folds to the ventricular folds.

pyriform sinuses

________: the space between the aryepiglottic folds and the thyroid cartilage

laryngeal ventricle

________: aka laryngeal ventricle or ventricle of morgani) the lateral space between the lower margin of the false vocal folds and upper margin of the true vocal folds.

glottis

________: space or air between the vocal folds

supraglottis

________: space or airway above the vocal folds

subglottic

________: space or air below the vocal folds

valleculae

________: collect spit as we sleep so we do not need to constantly swallow.

laryngeal vestibule

________: Space that is enclosed by the aryepiglottic folds
From epiglottis to arytenoids, all the way down to the bottom of the vestibular folds
Aditus, laryngeal inlet, or aryepiglottic sphincter are also commonly used names for the
opening to the vestibule

pyriform sinuses

______: wide variation in size depth, and food that can get trapped here in dysphagia clients.

mucosa

_______: the epithelium, basement membrane, superficial lamina propria, intermediate lamina propria, and deep lamina propria.

muscle

_______: thyroarytenoid muscle (both vocalis and lateral TA).

superficial squamous epithelium

_______: Maintains shape of the vocal folds
 Protects vocal folds
 Helps keep the vocal folds hydrated (barrier to dehydration)

basement membrane

_______: Holds epithelium to the superficial layer of lamina
propecia
Made up of collagen: fibrous and strong

superficial lamina propria

_______: Consists of extracellular matrix (nonliving
structural tissue, found in connective
tissues)
Mostly loose fibrous and elastic components in a matrix
Many immune system organelles can be found in the LP for wound healing
Cushions vocal folds
Consistency of Jell-O and is occasionally
referred to as the ‘gel’ portion

intermediate lamina propria

_______: Consistency of a "bundle of soft rubber bands"
It is composed of mostly elastic fibers

deep lamina propria

_______: Composed of mostly collagenous fibers (texture like cotton string)
Contributes to the durability of the layer
Occasionally referred to as the ‘fiber’ portion

arytenoids

________: Two processes: muscular an vocal. Serve as attachment
points for several muscles. In the image to the right, the vocal folds are shown
only by the vocal ligaments.

true vocal folds

_______: Origin: the posterior surface of the thyroid lamina near the
angle and below the notch (anterior commissure)
◦ Insertion: Vocalis to the vocal processes and muscular to
the muscular processes of the arytenoid cartilage

vocalis

_______: (medial portion – also called thyrovocalis)
Passively: consistency of "stiff rubber bands"
Active: contractile properties control stiffness and therefore pitch, also pliability of mucosal cover
Usually vibrates during phonation

lateral TA

_______: (lateral portion- also called thyromuscularis)
Lateral-most portion of vocal folds
Connects the inner thyroid lamina to the muscular process of the arytenoid

membranous portion

_______: Portion including free margin of vocal folds (touching ligament)
• 15 mm in males – the size of a dime!
• 12 mm in females – slightly larger than
pea sized
• 2-3 mm in peds (birth to 2) – width of a
crayon tip!!
• 2/3 of glottis
• Likely location for pathologies like nodes

cartilaginous portion

_________: Portion made of cartilage of arytenoids
• 1/3 of glottis

false vocal folds

________: Aka ventricular or vestibular folds
• Compose the free lower margin of the quadrangular membrane
• Extend from the angle of the thyroid cartilage to the anterolateral surface of the arytenoid cartilage, directly superior to true VFs
• Function: to protect the true vocal folds and add another layer of protection from aspirating food
• Do not usually adduct closely enough to phonate, though they can in some styles of music (rock, gospel, etc)