5. Speech

Question 1

Requirements for Speech Production:
— ____
— Phonation
— ____/ Resonance

Answer 1

respiration

articulation

Question 2

Sound Production:
— Two things required:
— ____/ Energy Source — ____ element

— For speech, power source is air from the ____ and the vibrating element is the vibrating ____

Answer 2

power
vibrating
lungs
vocal folds

Question 3

Respiration:
— The upper respiratory tract — \_\_\_\_
— \_\_\_\_
— \_\_\_\_
— \_\_\_\_

— The lower respiratory tract — ____
— ____
— ____

Answer 3

nasal cavity
oral cavity
pharynx
larynx

trachea
bronchi
lungs

Question 4

Phonation:
— Occurs in the ____ or “Voice Box” —

The Larynx is composed of:
— Cartilages (6)
— Single cartilages: ____, Thyroid, ____
— Paired cartilages: ____, Corniculate, and ____

Answer 4

larynx
epiglottis
cricoid
arytenoid
cuneiform

Question 5

Anatomy of the Larynx: Cartilages

• The thyroid cartilage is the ____ of the single cartilages. It’s a shield-shape, and it comes to a prominence or a notch in the front, and that’s what we recognize as an Adam’s Apple.
• Then there’s the cricoid cartilage, which supports the ____ on the bottom there,it’s sort of shaped like a ring and then lower underneath.
• Then there’s the epiglottis, which is like a leaf in shape, and the attachment allows it to invert over the airway as we swallow. So it ____ the airway, protects the vocal folds as we swallow, and ____ the food and liquid into the esophagus.
• The paired cartilage includes the Arytenoid Cartilages and they’re little pyramid shapes and ____ attach into them. So they allow the vocal folds to open and close. And then there’s Cuneiform and Corniculate Cartilages. They’re very small. They really don’t have any clear- cut function there.

Answer 5

largest
vocal cords
protects
directs
vocal cords

Question 6

Anatomy of the Larynx: Muscles
— Muscles and Ligaments
— Support and connect ____ of the larynx with adjacent structures
— Form the ____

Answer 6

cartilages

vocal folds

Question 7

Anatomy of Larynx: Muscles

Intrinsic
Both of their attachments are within the ____

Extrinsic
Attach to a site within the larynx and to a site ____ of the larynx (such as the hyoid bone, jaw, etc.)

Answer 7

larynx

outside

Question 8

Anatomy of the Larynx: Intrinsic Muscles

— ____, lateral cricoarytenoid, ____, cricothyroid, and ____ (true vocal fold) muscles
— All of the intrinsic muscles are ____- with the exception of the ____.
— All of the intrinsic laryngeal muscles work together to ____ (close) the vocal fold with the exception of the posterior cricoarytenoid, which is the only muscle that ____ (opens) the vocal folds.

Answer 8

interarytenoid
posterior cricoarytenoid
thyroarytenoid

paired
transverse interarytenoid
adduct
abducts

Question 9

Intrinsic muscles of the larynx

Points out the transverse arytenoid muscle between the two arytenoid cartilages

The PCAs (posterior crico-arytenoid muscles) are back here. they ____ the vocal folds

So these are all the intrinsic muscles, all within the vocal folds themselves

Answer 9

open

Question 10

• I don’t need to go over all of these, but this just shows the actions of the muscles and how they work in terms of moving the vocal folds either into closed position, open position, or for this cricothyroid, it ____ the vocal folds and makes them tense and makes the pitch go up.

Answer 10

elongates

Question 11

Anatomy of Larynx: Extrinsic
muscles

Suprahyoid group (above the hyoid bone)
— ____, mylohyoid, ____, and ____ muscles.
— work together to ____ the larynx

Infrahyoid group (below the hyoid bone)
— ____, sternohyoid, ____, and ____ muscles
— work together to ____ the hyoid bone and larynx

Answer 11

stylohyoid
geniohyoid
digastric
raise

sternthyroid
thyrohyoid
omohyoid

lower

Question 12

Anatomy of the Larynx: Nerves
— Recurrent Laryngeal Nerve
— Branch of the ____
— Travels up the side of the ____ to the larynx
— Innervates all the intrinsic muscles except for the ____
— Provides sensation to the larynx-____ vocal folds
— ____- innervated by this nerve
— Not ____- the left nerve looping under the right subclavian artery and the traveling upwards

Answer 12

vagus
trachea
cricothyroid
below
PCA
symmetric

Question 13

RLN Paralysis
— Unilateral/ Bilateral
— ____- tumors of the skull base, neck, and chest
— ____- iatrogenic, complication during intubation, blunt neck or chest trauma
— ____
— Results in ____, dysphagia, ____

Answer 13

neoplastic
trauma
idiopathic

dysphonia
dyspnea

Question 14

Anatomy of the Larynx: Nerves

SLN: External branch
Lies immediately posterior to the ____
— Innervates cricothyroid muscle- which ____ the vocal folds to increase pitch
— Branches to ____ plexus and superior portion
of the inferior pharyngeal constricto

SLN: Internal branch
Descends to the thyrohyoid
membrane with the ____ artery
— Sensory branches to ____, base of tongue, aryepiglottic fold
— Essentially all laryngeal sensation ____ the vocal folds

Answer 14

superior thyroid artery
tenses
pharyngeal

superior laryngeal
epiglottis
above

Question 15

SLN paralysis

— Known to cause ____, decreased ____, decreased ____, and ____ fatigue
— Patients with SLN paralysis may have normal ____ voice but an abnormal ____ voice

Answer 15

hoarseness
vocal projection
pitch range
vocal

speaking
singing

Question 16

Anatomy of the Larynx:Vocal Folds
— Housed within the ____
— Attached anteriorly to the ____ cartilage and posteriorly to the ____ cartilages.
— Vocal folds are stretched by the forward rotation of the ____ cartilage and posterior rotation of the ____ cartilage.
— Loosen by ____ muscles

Answer 16

larynx
thyroid
arytenoid
thyroid
arytenoid
thyroarytenoid

Question 17

Vocal folds:
— Closed when we swallow to ____ our airway
— Open when we are ____ in order to allow air in/out of lungs
— In order to produce sound, ____ muscles (the “vocal cord closers”) are activated, providing resistance to exhaled air from the lungs. Air then bursts through the closed vocal folds. As the air rushes through the vocal folds, the pressure between the folds ____, sucking them back together.

Answer 17

protect
breathing
adductor
drops

Question 18

Phonation:
— When air is forced through the closed vocal folds, the vocal fold ____ and phonation occurs
— The pitch of the sound produced in the larynx is dependent upon the ____ of the vocal folds
— ____ and tension of the vocal folds results in the faster vibration= high frequency pitch/ pitch
— ____ and relaxation of the vocal folds results in slower vibration= lower frequency range
— Fundamental Frequency for male= ____ Hz
— Fundamental Frequency for females= ____ Hz

Answer 18

vibrate
tension
elongation
shortening
130
220

Question 19

Phonation:
— The loudness of sounds produced in the larynx is dependent upon the ____ of air flowing through the glottis (space between vocal folds)
— The air speed is greatest when the pressure build up ____ the vocal folds (subglottic pressure) is high.

Answer 19

speed

below

Question 20

Articulation:
— \_\_\_\_
—Teeth
— \_\_\_\_
— Alveolar Ridge (gums behind upper teeth)
— \_\_\_\_
— Soft Palate
— The variable action of the tongue on all the structures listed above result in our ability to produce different speech sounds

Answer 20

lips
tongue
hard palate

Question 21

Articulation: lips
— Muscles:
— ____- principal muscle acting upon the lips. Its an oval shaped ring of muscle fibers located within the lips and completely encircles the mouth
— ____- muscle in the cheek
— Nerves: ____- innervates all muscles of facial expression

Answer 21

orbicularis oris
buccinator
facial nerve (VII)

Question 22

Articulation: lips
— Speech sounds can be articulated with ____ movement of the lips
— Lips are involved with ____ sounds (p,b)
— Lip closure builds intraoral air pressure, and released in a ____ manner (both lips involved)

Answer 22

minimal
labial
plosive

Question 23

Lips:
— Short Upper Lip: dysmorphology and/ or cleft palate —
____ causes lip to shorten
— Can cause difficulty with bilabial ____ at rest
— Can affect bilabial competence during speech production of ____ speech sounds (p, b, m)

Answer 23

scarring
competence
bilabial

Question 24

Articulation: Teeth
— Major function is chewing
— Directly involved in speech production
— Consonants- the tongue makes contact with the ____ during production of many sounds
— Nerves: ____ nerve (VII) carries sensory fibers to the teeth

Answer 24

teeth

trigeminal

Question 25

Articulation: teeth
— Normal dentition and occlusion is important for aesthetics, chewing, and speech
— Most consonants are produced in the ____ part of the oral cavity (near teeth)
— Abnormalities of the anterior dental arch can interfere with the movement of the tongue tip and lips
— ____ maxillary arch can cause oral cavity crowding and distorted speech and resonance

Answer 25

anterior

narrow

Question 26

Articulation: Tongue
— Primary biological function is taste, mastication, and deglutition.
— Most important and most active articulator for speech — Has 4 intrinsic and 4 extrinsic muscles:
— Intrinsic muscles are ____ the substance of the tongue and do not insert on bone
— Extrinsic muscles originate ____ the tongue and insert within in
— Muscles do not act in ____, intrinsic muscles alter the ____ of the tongue and extrinsic alter its ____.

Answer 26

within
outside
isolation
shape
position

Question 27

Tongue: muscles

Intrinsic
— Intrinsic muscles are within the substance of the organ and do not insert on bone
—____, Inferior longitudinal, ____, Vertical
— Alter the ____ of the tongue

Extrinsic
— Originate outside the tongue and insert within it
— ____, Hyoglossus, ____, Palatoglossus
— Alter ____ of the tongue

Answer 27

superior longitudinal
transverse
shape

genioglossus
styloglossus
position

Question 28

Intrinsic Muscles of the Tongue

— Superior Longitudinal Muscle- ____ the tongue and thereby turns tip of tongue ____
— Inferior Longitudinal Muscle- ____ the tongue or pulls the tongue tip ____
— Transverse Muscle- contraction of this muscle causes the tongue to ____ and to become ____
— Vertical Muscle- ____ the tongue

Answer 28

shortens
upward

shortens
downard
narrow
flattens

Question 29

Extrinsic Muscles of the Tongue:
— Genioglossus-strongest, ____ muscle of the tongue
—
Posterior fibers- draws the whole of the tongue ____ to ____ the tip from the mouth or to press the tip against the teeth and alveolar ridges
— Anterior fibers- responsible for ____ of the tongue, while contraction of the entire muscle draws the tongue ____, thus making the dorsum like a trough
— Styloglossus Muscle- draws the tongue ____ and backward and thus may be considered to a true ____ of the genioglossus muscle.

Answer 29

anteriorly
protrude

retraction
downward
upward
anatgonist

Question 30

Extrinsic muscles of the tongue:
— Palatoglossus-upon contraction, it may either ____ the soft palate or ____ the back of the tongue to the groove the dorsum.
— Hyoglossus-____ and ____ the tongue

Answer 30

lower
raise
retracts
depresses

Question 31

Articulation: Tongue
— Stops airf low and releases it in ____ manner (t,k,d,g) — Constricts air passage, creating ____ noises (s,z)
— Stop airf low and release with ____ noise (ch, j)

Answer 31

plosive
fricative
fricative

Question 32

Tongue: nerves
— Motor innervation for all of the muscles of the tongue comes from the ____ nerve -with the exception of the palatoglossus, which is supplied by the ____ nerve.
— General sensation of the anterior two thirds of the tongue is supplied by the ____ nerve - specifically the ____ branch
— The posterior third of the tongue (taste and sensation is innervated by the ____ nerve (

Answer 32

hypoglossal
vagus

trigeminal

glossopharyngeal

Question 33

Tongue: nerve injury
— Injury to the hypoglossal nerve (cranial nerve XII) results in deviation of the tongue ____ the paralyzed side during protrusion. The tongue also ____ over time on the paralyzed side.
— May cause speech and swallowing difficulty

Answer 33

toward

atrophies

Question 34

Anomalies of the Tongue
— Macroglossia- ____ Syndrome
— Lingual ____, open mouth posture —
Interferes with all tongue tip sounds

— Microglossia
— ____ to cause speech problems
— Pseudomacroglossia- associated with a very small jaw, such as ____ and Treacher Collins syndromes
— Black, Hairy Tongue-papillae become elongated- can be associated with chronic intraoral ____ or prolonged ____ therapy.

Answer 34

downs
protrusion
rare
pierre robin
bleeding
antibiotic

Question 35

Articulation: The palate
— Commonly called the roof of the mouth
— Consists of three parts: the ____, the hard
plate, and the____
— Hard palate in front is a fixed bony plate and soft palate is a muscular valve
— Alveolar arch consists of the bony, tooth-bearing process of the maxillae and its mucous membrane covering

Answer 35

alveolar ridge

soft palate

Question 36

Articulation: the palate
— Soft palate retracts and ____ during speech to separate the oral cavity from the nasal cavity in order to produce the oral speech consonants.
— When this separation is incomplete, air escapes through the ____, causing speech to be perceived as nasal

Answer 36

elevates

nose

Question 37

Muscles of the soft palate
— Tensor Veli Palatini and Levator Veli Palatini muscles form a “____,” lifting the soft palate ____ and backwards, ____ off the entrance to the nasal cavity.
— Palatoglossus and Palatopharyngeus muscles ____ off the opening to the oropharnx

Answer 37

sling
up
closing
close

Question 38

The Palate: nerves
— All muscles are innervated by the pharyngeal plexus via the ____ nerve , with the exception of the tensor veli palatini (innervated by the ____ nerve, ).

Answer 38

vagus

trigeminal

Question 39

Articulation: hard palate
— ____ arch is not problem
— Low, f lat arch can cause lingual ____ and
abnormal resonance due to small cavity size
— Position of ____ relative to tongue is most importance
— Palatal fistula- effect on speech depends on ____ and size

Answer 39

high
crowiding
alveolar ridge
location

Question 40

Articulation: soft palate
— ____ for all oral sounds
— Particularly important for “pressure sensitive”
consonants and all vowels
— ____ valve is open for nasal sounds (m, n, ng)
— Hx of cleft, enlarged tonsils, irregular adenoids
— Velopharyngeal Incompetence- ____,
neuromuscular disorders
— Velopharyngeal Insufficiency- ____ defect, not neurological problem

Answer 40

closed
velopharyngeal
dysarthria
anatomical

Question 41

Articulation: Vowels
— Vowel Sounds- there are 5 vowels in the English language (a, e, i, o, u), but there are 12 different vowel sounds.
— The articulation of the different vowels sounds depends on: — 
The point of \_\_\_\_
— The degree of \_\_\_\_
— The degree of \_\_\_\_
— The degree of \_\_\_\_ tension
— Vowels make up \_\_\_\_% of our speech

Answer 41

constirction
constriction
lip rounding
muscle tension

Question 42

Articulation: Consonants
— Consonants in English are classified by: — Place of \_\_\_\_
— Manner of \_\_\_\_
— Degree of \_\_\_\_
— Consonants make up \_\_\_\_% of our speech

Answer 42

articulation
articulation
voicing
62

Question 43

Consonants: place of articulation
— Bilabial: ____ lips come together (p,b,w,m)
— Labio-dental: ____ lip and upper teeth make contact
(f,v)
— Dental: the tongue makes contact with the ____ teeth (th)
— Alveolar: the tip of the tongue makes contact with the ____ (t,d,s,z,n,l)
Palatal: the tongue approaches the ____ (j,r,sh)
— Velar: back of the tongue contacts the ____ (k,g,ng)
— Glottal: an ____ vowel (h)

Answer 43

both
lower
upper
alveolar ridge
palate
velum
unvoiced

Question 44

Consonants: Manner of articulation
— Manner of articulation refers to the degree of constriction as the consonant starts or ends a syllable
— Stops: complete ____ of the lips and subsequent release (p,b)
— Fricatives: ____ closure of the lips to create turbulent noise (f,s,sh)
— Affricates: combination of a stop and an ____ (ch)
— Nasals: resonate through the ____ (m,n)
— Glides and Liquids: produced when the tongue approaches a point of articulation within the mouth but does not come close enough to ____ or constrict the flow of air enough to create turbulence (l,r,w)

Answer 44

closure
incomplete
turbulent noise
nasal cavity
obstruct

Question 45

Voiced vs. Voiceless consonants
— Voiced consonants are produced with the vocal folds ____
— Voiceless consonants are produced with the vocal folds ____
— Example: The sound of /f/ and /v/ are both labiodental fricatives, however, /f/ is ____ and /v/ is ____.

Answer 45

vibrating
open
voiceless
voiced

Question 46

Resonance
— Dependent upon the size and shape of the —
____
____
____
— The resonant frequency of each of our voices will differ depending on the size and shapes of the structures above.
— Nasopharynx adds ____ to nasal sounds (m, n, ng) — Nasal cavity is normally ____

Answer 46

vocal tract
oral cavity
nasal cavity
resonance
closed

Question 47

Speech Errors:
— Obligatory: errors of distortion where ____ (articulation) is normal, but ____ is abnormal
— Treatment is correction of structure

— Compensatory: errors of distortion where ____ (articulation) is changed in response to abnormal function
— Treatment is correction of function (speech therapy) — After correction of structure as needed

Answer 47

function
structure

function

Question 48

Results:
— Speech intelligibility is 80% with obturator in place, ~ 60% without prosthetic to an unfamiliar listener.
— Increased ____ also noted without upper obturator in place.
— Pt happy with improved aesthetics

Answer 48

drooling