Fripty Study Bundle SLP Set 12 - Student Developed - Fripty Approved

What is the cover body theory of phonation?

The cover that vibrates is the epithelium, superficial layer of the lamina propria and the intermediate layer of the lamina propria. The body is relatively stationary and consists of the remainder of the intermediate layer, the deep layer and the TA muscle.

How does a voice change from infancy through adolescence?

Your mean fundamental frequency decreases, because as you get older, your pitch becomes lower. May start at 280-300 Hz when you're 8 and then change to about 115 Hz when you're 18.

Maximum phonation time (ability to sustain ah) increases. For children, it's about 7-9 seconds. For adolescents, it's about 15-18 seconds.

What is the typical fundamental frequency for women? men? typical maximum phonation time?

225 Hz-women

125 Hz-men

20-25 seconds

What happens to your vocal anatomy as you get older?

hardening of cartilages

degeneration and atrophy of muscles, glands, joints

What is presbyphonia?

Age related voice disorder characterized by perceptual changes in quality, range, loudness and pitch

What is fundamental frequency generally considered?

Any individuals typical pitch.

What determines pitch?

mass, tension and elasticity of vocal folds.

Thinner vocal folds, more tense result in higher pitch

Thicker vocal folds, more relaxed result in lower pitch

What is jitter?

Aka frequency perturbation. Variations in vocal frequency. A jitter of less than 1% is normal.

What is the perceptual correlate of volume?

intensity or loudness

What is shimmer?

Amplitude perturbation. Cycle-to-cycle variation of vocal intensity. A shimmer of less than 1 dB is seminormal

Describe hoarseness

A combination of breathiness and harshness which results from irregular vocal fold vibrations.

Describe harshness

rough, unpleasant, gravelly sounding. excessive muscular tension and effort.

Describe strain-strangle

phonation is effortful and the patient sounds as if they're being squeezed. talking fatigues patients.

Describe breathiness

vf are slightly open.

Describe glottal fry

When vf vibrate very slowly. sounds crackly. extremely low pitch.

Describe diplophonia

double voice. when a speaker uses two pitches.

Describe stridency

they sound shrill, unpleasant, term-17 high pitched and tinny. caused by tension.

What information do you gather in a case history when evaluation voice disorders?

-Obtain information about onset, duration, causes and variability of voice disorder

-Obtain information regarding slurring of speech

-Identify any contributing factors

-Gather information regarding previous therapy/intervention

-Obtain description of daily vocal use

-Obtain information about what constitutes a typically sounding voice for CLD clients

What is an indirect laryngoscopy?

Aka mirror laryngoscopy. A mirror with a slender handle. Lifts velum and presses against pharyngeal wall to view laryngeal structures during phonation and at rest

What is a direct laryngoscopy?

Done while under anesthesia. Laryngoscope goes through mouth and ends above VFs. The surgeon can directly see the structures but no phonation can be done at this time. Good for determining laryngeal cancer.

What is a flexible fiber-optic laryngoscopy?

Insert tube containing lens and light through a clients nasal passage and ending above larynx. Client can talk and sing. We can see rapid vocal fold movement.

What is a endoscopy?

Rigid endoscopy is introduced orally. Flexible endoscopy is introduced nasally. There is light at the tip and the specialist can view the structures.

What is acoustic analysis?

You look at the sound spectography, which is a graphic representation of a sound wave's intensity and frequency. It reflects the resonant characteristics of the vocal tract

What tools can clinicians use to gather baseline and post therapy data for voice patients?

-Digital SonoGraph

Computer Speech -Laboratory

What is a videostroboscopy?

It's helpful in differentiating between functional and organic voice problems. It's what's used to make the vocal folds appear to be moving in slow motion.

What is an electroglottography?

An EGG yields indirect measures of vocal fold closure patterns. They put electrodes on both sides of the thyroid cartilage and pass high frequency electric current. A glottal wave form is the result and they evaluate that. It's an iffy tool.

What is a videokymography?

High speed medical imaging method used to visualize human vocal fold vibration dynamics.

What are aerodynamic measures?

The airflow, air volume and average air pressure measurements of the respiratory, laryngeal and supralayrngeal airways. Used for dysphonia, voice changes, treatment progress and differentiation.

What is tidal volume?

amount of air inhaled and exhaled during a normal breathing cycle.

What is vital capacity?

the volume of air that the patient can exhale after a maximal inhalation.

What is total lung capacity?

total volume of air in lungs.

What are some instruments that can be used to measure aerodynamics? ---spirometers, manometric devices and plethysmographs

What instruments can be used to measure pitch?

The Visi-Pitch

Gives you information on dynamic range, intensity, frequency, pitch, loudness

What measure can be used to perceptually assess voice?

The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Clinician uses nominal rating scale to evaluate vocal parameters.

What is maximum phonation time?

the ability to sustain an "aah"

What is a s/z ratio?

Used to see if there is laryngeal pathology present. patient says /s/ then /z/. you divide the longest /s/ by the longest /z/. A ratio of more than 1.4 may indicate laryngeal pathology

Why does hypernasality occur?

the velopharyngeal mechanism does not close the opening to the nasal passage during the production of non nasal sounds

How does a hypernasal client sound?

too much air escaping through their nose on non nasal sounds

they speak with decreased intraoral breath pressure

What are causes of hypernasality?

Functionally, the patient could develop a habit of just talking that way. Also, many individuals who are deaf are hypernasal due to their inability to self monitor.

Organically, cleft palate, sub mucous cleft and velopharyngeal inadequacy are causes

What are some causes of velopharyngeal inadequacy?

-Decreased muscle mass of the velum

-Adenoidectomy or tonsillectomy

-Paresis of the velum

What are some frequently substituted sounds in hyponasal individuals?

b for m

d for n

g for ng

What are some causes of hyponasality?

Temporary, cold or allergies

Also, any obstruction in the nasal cavity, such as polyps. Enlarged adenoids, tonsils, deviated septums

What is assimilative nasality?

When the sound from a nasal consonant carries over to the adjacent vowel. The velar opening begins too soon and lasts too long.

What is cul-de-sac resonance?

Backward retraction of the tongue. The person's voice sounds muffled and hollow

What is the nasometer?

A tool to help hyper nasality. It gives the patients visual feedback.

What are treatment strategies to help hypernasality?

Visual aids to help show inappropriate nasal airflow, like a mirror

Ear training (helping them learn to monitor)

Increasing mouth opening

Increasing loudness

Improving articulation

Changing the rate

Decreasing pitch

What are treatment strategies to help hyponasality?

Nanometer

Focusing on facial mask area. (nose bridge). have patient feel vibration

Nasal-glide stimulation

Visual aids (tissue)

What are some quick facts regarding laryngeal cancer?

Larynx is a common site for cancer

55,000 Americans develop cancer in the head and neck

Found more in men

Contributed by alcohol, tobacco, toxins, reflux, smoke and HPV

Early signs are hoarseness, difficulty swallowing, sore throat that doesnt go away, ear pain, lump in neck

How do doctors classify laryngeal cancer?

T: primary site of tumor (supraglottic, glottic, subglottic)

N: involvement of lymph nodes

M: metastasis (if it spread)

How can laryngeal cancer be medically treated? Describe

Surgery: laryngectomy, where larynx is removed (either total laryngectomy or hemilaryngectomy)

Chemo: for more severe cancer

Radiation: usually try before surgery

What is a laryngectomee?

Person who has had their total larynx removed.

What is a stoma?

An opening in the lower part of the neck that connects to the trachea. It's where the patient breathes through after a laryngectomy.

How can laryngectomees produce speech?

External devices

Esophageal speech

Surgical modifications

What is an electrolarynx?

A mechanical, handheld device that generates sound. They press it against their neck. The sound is transferred to the mouth and they can articulate in an exaggerated manner.

What is esophageal speech?

Speaking on burps

Injection method: patient traps air which is then pushed back into the esophagus and then expelled which causes the soft tissue of esophagus to vibrate

Inhalation method: they inhale quickly which does the same thing as above

What is the Blom-Singer tracheoesophageal puncture?

A surgical method to help with speech.

The tracheoesophageal wall is punctured and a shunt is placed in. It prevents passage of liquids into trachea. If you place a finger on the stoma, it forces the exhaled air to go through the tube anteriorly which causes esophagus to vibrate