Speech and hearing science exam 2

Alveolar duct

openings of the respiratory bronchioles loading into an alveolus

Alveolar sac

2 or more alveoli sharing a common opening

Alveolus

tiny air sac at the end of a bronchiole in the lungs that provides surface area for gas exchange to occur

Arborize

to become branched like the bronchial tree, specifically like the branches of the lungs

Bronchial tree

part of the respiratory system that includes the trachea, bronchi, and bronchioles.

Bronchioles

smallest subdivision of the bronchial tree

Capillary bed

interwoven network of capillaries between arterioles and venules

Diaphragm

Muscles that make up the floor of the thoracic cavity and is instrumental in respiration

Expiration

breathing out (exhalation)

Inspiration

breathing in (inhalation)

Main stem bronchi

primary bronchi entering the lungs

Primary function

trachea splitting into two branches

Respiration

Inhalation and exhalation of air.

Secondary bronchi

subdivisions of the secondar bronchi, supplying the segment of the lungs

Tertiary bronchi

subdivision of the secondar bronchi, supplying the segment of the lungs

The bronchial tree consists of what?

trachea, bronchi, and bronchioles

Where does the trachea begin?

below the vocal folds

Describe (width length, ) the trachea. How many divisions are there in the bronchial tree?

LENGTH: 10CM (3.9'') - 16cm

WIDTH: (6.3'') 2.0 cm (0.8'') - 2.5cm (1'')

There's also 20-28 divisions

What happens with each division of the bronchial tree?

Changes with each division

Every division is a little less than half the diameter of the previous branch.

Know that the advantage for this is that it increases the total surface area

What do the initial three branches of the bronchi enter and how many are there?

Main stem bronchi (2)

Secondary bronchi (5)

Tertiary bronchi (18)

How many alveoli are in the lungs?

480 million

How are gases exchanged in the lungs?

The walls of the alveoli and the walls of the capillaries are very thin; O2 and CO2 are diffused through the walls

What is the primary muscle of inspiration?

diaphragm

What is the diaphragm's role in respiration?

the diaphragm moves during inspiration and during expiration.

In general, how do the accessory muscles of inspiration in the neck chest, and abdomen assist in inhalation?

Expands the rib cage.

- scalene muscles (ribs 1 & 2)

-sternocleidomastoid (rib cage)

- serratus anterior

- serratus posterior superior

Describe a cycle of respiration.

The diaphragm contracts and simultaneously the exsternal intercostal muscles lift and expand the ribs, increasing the volume in the lungs; this decreases the pressure in the lungs causing air to rush in. When the muscles relax, the lungs return to the normal size, decreasing the volume in the lungs. This increases presure in the lungs, that cause the air to rush out.

Expiratory reserve volume (p. 69 & 71)

all extra air you can breath out; is the amount of air a person can exhale forcefully after a normal exhalation. volume of air that can be exhaled below tidal volume

Functional residual capacity (p. 69 & 72)

amount of air left in lungs after normal breath. volume of air remaining in the lungs and airways at the end-expiratory level

Inspiratory capacity (p. 69 & 72)

sum of the tidal and inspiratory reserve volume. maximum volume of air that can be inspired from end expiratory level

Inspiratory reserve volume (p. 69 & 70-71)

after breathing in you can bring more air in; is the amount of air a person can inhale forcefully after normal tidal volume inspiration. the volume of air that can be inhaled above tidal volume

Residual volume (p. 69 & 71)

air that you can't breath out anymore. volume of air remaining in the lungs after a maximum expiration and that cannot be voluntarily expelled

Resting expiratory level (p. 69)

state of equilibrium in the respiratory system

Spirometer (p. 68)

instrument that measures lung volumes

Tidal volume (p. 69 & 70)

volume of air inhaled and exhaled during a cycle of respiration

Total (lung) capacity (p. 73)

total air in lungs; total amount of air the lungs can hold

Vital capacity (p. 69 & 72)

breath in as much as you can and blows out as much as you can; volume of air that can be exhaled after a maximum inhalation

Volumes (p. 69)

independent measures of air flow

Why are volume classifications useful?

they allow both laboratory and clinical measurements to be made in various populations of individuals

Why do average breathing rates of men and women differ? (p. 67-68)

Men typically have larger lungs than women, so women need to breath more often because they have a smaller space for air

Air intake depends on what? (p. 75)

O2 and CO2 levels in the blood

What is speech breathing? (p.75)

breathing to generate power for speech

What is life breathing? (p. 75)

an unconscious, automatic process; the rate and extent of breathing are determined by the needs of one's body at a particular moment in time

Describe 5 major ways that life breathing is different from speech breathing.

-Both inhalation and exhalation in life breathing typically occur through the nose

-Inhaling and exhaling for speech occurs through the oral cavity.

-In life breathing, the proportion of the respiratory cycle taken for inhalation is nearly the same as for exhalation

-In speech breathing Inhalation time shortens to about 10 percent of the total cycle, whereas exhalation time extends to about 90 percent of the cycle.

-Inhalation for life breathing begins at REL (38 to 40 percent of VC) and goes up by 10 to 12 percent, to around 50 percent of VC. The individual then exhales back down to REL.

-The volume inhaled for speech is variable, depending on the length and loudness of the upcoming utterance.

???

-When breathing for life, the abdominal wall is displaced slightly outward relative to the rib cage.

-For speech breathing, the abdomen is displaced further inward relative to the rib cage, causing the abdominal contents to push the diaphragm upward

Why are respiration measures (volumes and capacities) important for SLPs to know? (p. 68)

they allow both laboratory and clinical measurements to be made in various populations of individuals

What is the benefit of nasal inhalation?

- warms

- moisturizes

- filters air

Airflow

a measure of a volume of air moving in a certain direction at a particular location per unit of time

Pneumotachometer

»measures oral and nasal airflow during speech

Pulmonary function testing

»an assessment of the amount and the efficiency of airflow during breathing

What does pulmonary function testing measure?

the amount and the efficiency of airflow during breathing

What factors are used in determining normative data?

age, gender, body height and size, and race

How is severity of a pulmonary disorder determined?

based on the percentage that airflow as compared to the predicted value

What is a disadvantage of spirometry? What's the solution?

that it cannot be used during speech; Respiratory kinematic analysis

How does respiratory kinematic analysis measure airflow?

estimates lung volumes through rib cage and abdominal movement during speech

What are three categories of respiratory problems?

- obstructive

-restrictive

-central

What is an obstructive airway problem?

block or narrow the airway

What are some examples of obstructive airway problems?

Asthma, bronchitis, emphysema, COPD

What are symptoms of obstructive respiratory problems?

coughing, wheezing, shortness of breath

Why do obstructive airway problems effect speech?

block or narrow the airway

What is a restrictive airway problem?

more difficulties with exhalation

What are some examples of restrictive airway problems?

lung disease (e.g., fibrosis, connective tissue diseases, neuromuscular disease, etc.)

What are symptoms of restrictive respiratory problems?

problems expanding lungs, chest pain, dry cough, wheezing, shortness of breath after exercising

Why do restrictive airway problems effect speech?

More difficulties with inhalation because of reduced ability to expand the thorax and rib cage

What is a central airway problem?

caused by neurological dysfunction in the respiratory brain centers in the brain stem

What may cause central airway problems?

a stroke that causes inadequate ventilation, side effect of some drugs that depress the nervous system

What are the four principles of management for respiratory airway problems?

1. Measure the patient's respiratory function in speech and non-speech tasks

2. Tailor treatment to patient's specific respiratory difficulty

3. Sequence clinical activities in order of pressure variables, volume variables, and chest-wall shape variables

4. Practice respiratory exercises in speech contexts

What are some disorders that are commonly associated with respiratory problems?

- Parkinson's

- Cerebral Palsy

- Stuttering

- Paradoxical Vocal Fold Motion

What are some voice characteristics of Parkinson's disease?

weak, breathy, monotonous; speak in short phrases, breathing forcefully, sustaining voiceless sounds

What is the only voice treatment for Parkinson's disease that has evidence-based practice support?

Lee Silverman Voice Treatment

What is our strategy to treat a patient with cerebral palsy?

Strengthen muscles of chest wall to create louder voice

What can stuttering be considered a respiratory problem?

There are disruptions in the flow of speech

Problematic control of subglottal pressure

Delayed onset of phonation

Excessive subglottal pressure

Expiration prior to phonation

Cessation of speech during phonation

What do you need to teach a client with stuttering with regard to respiration?

Need to regulate breathing

Use shorter phrases

Relaxation of muscles

Begin with less force

What is paradoxical vocal fold motion?

Vocal fold dysfunction; Vocal folds close when they should remain open

3. What are the primary and secondary functions of the larynx?

primary function- protect the airway

secondary function- provide voice, abdominal fixation

Action

how the structure moves

Function

the effect it has

Infrahyoid muscles

sternohyoid, omohyoid, sternothyroid, thyrohyoid

Insertion

structure that moves

Intrinsic muscles

has both attachments on laryngeal structures.

The function is to fine tune the voice.

Extrinsic muscles

origin: outside the larynx

insertion: inside the larynx

Suprahyoid (geniohyoid, stylohyoid, mylohyoid, digastric, thyrohyoid, omohyoid, sternohyoid )

Lamina propria

middle layer of mucosa

Origin

structure that remains stable

Mucosal wave

The medial-lateral excursion of the vocal fold cover during vibration

Subglottal space

space below the glottis

Ventricle

the large space that serves as an opening or entrance to the larynx

Ventricular folds

-Also known as false vocal folds; along the lower edges of the quadrangular

What is unique about the quadrangular membrane?

What is the dividing point between supraglottal and subglottal spaces?

vocal folds

What is the function of Intrinsic muscles?

Has both attachments on laryngeal structures. The function of the intrinsic laryngeal muscles is to fine-tune the voice.

What is the function of extrinsic muscles?

The function is to position the larynx.

What is the function of the suprahyoid muscle?

raise the larynx

What is the function of Infrahyoid muscles?

lower the larynx

Posterior cricoarytenoid m.-

origin: posterior cricoid c.

insertion: muscular processes of arytenoid m.

action: rotates arytenoid c. laterally

Interarytenoid m. -

origin: apex to base of each arytenoid c.

insertion: apex to base of other arytenoid c.

action: pulls arytenoids together

Lateral cricoarytenoid m. -

origin: lateral superior border of cricoid cartilage

insertion: vocal processes of the arytenoid c.

action: rotates arytenoid c. medially

Cricothyroid m. -

origin: the superior anterior-lateral surface of the anterior arch of the cricoid cartilage; has two bellies, both of which run obliquely to the inferior surface of the thyroid

insertion: the inferior surface of the thyroid c.

Pars recta: is the medial belly

Pars oblique: is the lateral belly and runs at a sharper angle function: tensor

action: tilts thyroid c. forward

Thyroarytenoid m. -

makes up the bulk of the vocal folds. Has two bellies laid side by side.

The medial bellies are the thyrovocalis m. or medial thyroarytenoid m.

The lateral bellies are the thyromuscularis m. or lateral thyroarytenoid m.

Thyrovocalis m.-

origin: internal wall of thyroid c.

insertion: vocal processes of the arytenoid cartilages

action: pulls thyroid c. back to the original position

function: tensor

Thyromuscularis m. -

origin: internal wall of thyroid c.

Insertion: anterior muscular processes of the arytenoid cartilages

Action: pulls thyroid c. back to the original position

Function: relaxer

Neurochronaxic Theory

In 1950 Raoul Husson introduced the neurochronaxic theory in an attempt to refute Helmholtz's Myoelastic Theory.

Husson suggested that opening & closing of the vocal folds were due to muscular effort.

Frequency of the vocal fold vibration is determined by the chronaxy of there current laryngeal nerve, and not by breath pressure or muscular tension.

Measure of the shortest duration of an electrical stimulus needed to stimulate a neuron in muscle tissue.

Every single vibration of vocal folds due to impulses from recurrent laryngeal nerves.

Acoustic center in the brain regulated the speed of vocal fold vibration

Myoelastic-aerodynamic theory

Developed in the 1950's enhanced Helmholtz's Myoelastic Theory by adding the Bernoulli's law.

Describes voice production as a combination of:

Muscle force (myo)

Tissue elasticity (elastic)

Air pressures & flows (aero)

Changes (dynamic)

VFs adduct due to muscular action

Air pressure from lungs builds up &blows vocal folds apart releasing a puff of air

Vocal folds return to midline due to muscular tension, elasticity, and the Bernoulli effect

The decrease in air pressure draws vocal folds back medially

Entire process repeats

One-mass model

Each vocal fold is considered a single mass that vibrates in a uniform manner

This idea expanded the basic myoelastic- aerodynamictheory

This model included additional air pressure in the vocal tract during vibration, namely supraglottal pressure.

As negative pressure closes the glottis, air continues to travel through the vocal tract because of inertia.

The distance between the traveling body of air and the glottis increases, resulting in negative pressure directly above the glottis

The distance between the traveling body of air and the glottis increases, resulting in negative pressure directly above the glottis.

As negative pressure closes the glottis, air continues to travel through the vocal tract because of inertia.

Conversely, when then the positive pressure directly below the vocal folds opens the glottis, this positive pressure meets the positive pressure of the supraglottal air and further raises the positive pressure of the air