Chapter 11 Flashcards
Definition of voice
the complex, dynamic product of vocal fold vibration that allows us to vocalize and verbalize
Definition of vocalize
to make sounds
Definition of verbalization
to produce language through speech
Definition of adduction state
when the the vocal folds must be closed, or adducted, at midline
Definition of abduction
when not producing voice, the vocal folds rest in an open, or abducted, position so that one can breathe
what has to happen for phonation to occur?
air is exhaled from the respiratory system upward against the adducted vocal folds, which are then blown apart and vibrate
Definition of resonation
actual air vibration within the pharyngeal column, which impacts the quality of the voice
Definition of articulation
when the voice is manipulated within the oral cavity
Definition of frequency
the rate of vocal fold vibration, expressed in cycles per second, or hertz
Frequency is an _____, _____ measurement of vibratory rate
objective, physical
Pitch is the ____ equivalent to frequency
perceptual
Definition of Fundamental frequency
the arithmetic mean of the rates of vibration for the vocal folds
if an individual’s vocal folds vibrate 250 times in a second, what is the fundamental frequency?
FO is 250 Hz
a person’s fundamental frequency relates to what three characteristics of the vocal folds?
length
mass
tension
effect of length of vocal folds
Longer vocal folds contribute to a lower FO
effect of mass of vocal folds
Thicker vocal fold mass contributes to a lower FO
Definition of tension of vocal folds
Greater tension contributes to a higher FO
true or false: the greatest amount of change occurs between birth and puberty
true
when does fundamental frequency decreases most significantly for males?
puberty
when does fundamental frequency decreases most significantly for females?
midlife
Definition of Intensity
the physical measurement of sound pressure reported in decibels (dB), which corresponds to the perception of loudness
What two features of vocal production does loudness relate to?
the amount of airflow from the lungs
the amount of resistance of the airflow by the vocal folds
true or false: an increase in airflow from the lungs is the only way to result in increased loudness
false: increased resistance – achieved through compression of the vocal folds at the midline also increases in loudness
Definition of phonatory quality
how well the two vocal folds work during the vibratory cycle
When do individuals exhibit a voice disorder?
When their pitch, loudness, or phonatory quality differs significantly from that of persons of a similar age, gender, cultural background, and racial and/or ethnic group
must be serious enough to draw attention and to detract in some way from performance in school, home, community, and/or work
Definition of dysphonia
the umbrella term used to refer to a voice that is disordered in some way
Definition of aphonia
the total loss or lack of voice
Definition of hypofunction
vocal folds that are under functioning and have inadequate tension
true or false: with hypofunction the vocal folds do not come together adequately or evenly, allowing air to escape through the vocal folds and resulting in a breathiness or hoarseness.
true
is any voice produced with complete hypo function?
no
true or false: hypofunction affects both vocal folds
false: hypofunction affects only one vocal fold and the other works normally
Definition of hyperfunction
vocal folds that are overly tense and compress together too tightly
true or false: hyper functioning voice may sound too loud, too high, and/or too strained
true
what may accompany the hyperfunctioning voice?
Excessive tension in the neck or jaw
true or false: in some cases, hyperfunctioning vocal cords completely impede the production of voice, resulting in spasticity, in which the voice stops and starts intermittently
true
Definition of diplophonia
means “double pitch” and describes a vocal quality in which the vocal folds produce two different pitches simultaneously
what are the two primary causes of diplophonia?
the two vocal folds have different mass characteristics and therefore vibrate at different rates
it can also occur if one vocal fold is paralyzed or hyperfunctioning
Definition of laryngectomy
a procedure in which a person’s larynx is surgically removed
two primary reasons for a laryngectomy
laryngeal cancer and laryngeal trauma
Definition of alaryngeal communication
speech is produced outside the larynx, an alternative way to produce speech
what is intensity equivalent to?
voice quality
Phonatory quality is influenced by how well the two vocal folds work during the vibratory cycle and ____.
the resonation of the voice as it travels up from the vocal folds through the pharynx and into the oral and nasal cavities
true or false: prevalence and incidence of voice disorders in both children and adults is relatively low compared to other disorders of communication
false: relatively high
true or false: prevalence and incidence of voice disorders in adult women are higher than men
true - 7% for females and 5% for males
when do voice disorders peak for adults?
between 40-60 years old
what is the prevalence rate of voice disorders for adults?
29%
what is the incident rate of voice disorders for adults?
6%
five common causes of voice disorders
vocal nodules
vocal fold paralysis
edema/swelling
polyps
carcinoma
what percentage of voice disorders have a functional etiology?
10%
what combination of two factors pose the greatest risk for a voice disorder?
constant voice use (or overuse)
noisy environment
true or false: one-fourth of children exhibit significant vocal problems
true
what percent of children who exhibit significant vocal problems reflect ongoing rather than transient problems?
40%
true or false: a small number of cases reflects a congenital problem with the vocal apparatus and a larger number of children, the problem is acquired.
true
what is the most common cause of voice dysfunction in children?
vocal nodules
what three reasons do voice disorder cases go undiagnosed and untreated?
treatment access
knowledge
social perceptions
true or false: ASHA requires that patients receive a medical evaluation from a physician prior to beginning voice therapy with a SLP
TRUE
Definition of vocal abuse
chronic or intermittent overuse or misuse of the vocal apparatus
what is the most common cause of voice disorders in both children and adults?
vocal abuse
Definition of vocal nodules
small, bilateral protuberances or calloused growths on the inner edges of the vocal folds
what is the most common symptom of vocal nodules?
hoarseness
Definition of Acute nodules
bruising on the vocal folds, which over time will thicken and harden as they become a chronic condition and advance to becoming fibrous protuberances
Definition of Contact ulcers
inflamed lesions that develop on the arytenoid’s cartilages in the posterior region of the larynx
how do contact ulcers develop?
repeated forceful contact of the vocal folds and progress from tissue irritation to necrosis, or death of the tissue
Definition of granuloma
a generated mass of healing tissue at the site of the ulcer
contact users and granulomas affect both men and women in what ratio?
roughly 4:1
Definition of neurogenic Disorders
a result from illness, damage, or disease to the neurological system associated with voice production
true or false: damage to either the CNS or the PNS can cause dysfunction of the vocal mechanism
true
where do neurogenic disorders get their name?
etiology stems from neurological malfunctioning
three causes of vagus Nerve Lesions
surgical damage (particularly thyroid surgery)
trauma
viral infections
what is the most serious outcome of vagus nerve damage?
unilateral vocal fold paralysis
Definition of abduction paralysis
when the vocal fold is paralyzed in an adducted position (cannot open)
true or false: with adduction paralysis, the voice usually is not affected because the other fold can press against it to phonate
false: ABduction paralysis
true or false: with adduction paralysis, breathing is affected
true
Definition of adduction paralysis
when the vocal fold is paralyzed in an abducted position (cannot close)
true or false: with abduction paralysis, vocal production is compromised because the two folds do not meet at the midline
false: ADDuction paralysis
true or false: with adduction paralysis, voice quality is affected
true
Definition of tracheostomy
an artificial airway is placed below the larynx so the individual can breathe
when is a tracheostomy needed?
when complete paralysis of the vocal folds occurs, leaving them completely opened or completely blocking the airway
Definition of spasmodic dysphonia
a disorder affecting motor control of the larynx
what is the hallmark of spasmodic dysphonia?
vocal spasms that result in intermittent voice
six characteristics of spasmodic dysphonia
An occasionally normal voice
Intermittent breaks in voicing
normal-sounding whisper
Improved voice at high pitches
Worsening voice with stress
Periods of significant dysphonia
Definition of adductor spasmodic dysphonia
a hyperfunctioning voice that seems strangled, strained, and squeezing
Definition of abductor spasmodic dysphonia
hypo functioning voice that is breathy and open
what percentage of spasmodic dysphonia are adductor?
50%
Definition of Amyotrophic Lateral Sclerosis
a progressive, degenerative, neuromuscular disease resulting from a muscular weakness, fatigue, and atrophy
true or false: the cause of ALS is unknown
true
what does a vocal disorder with ALS show?
soft, breathy
low in pitch and loudness with limited variability
hyper nasal
true or false: cognitive abilities of people with ALS remain intact
true
true or false: ALS patients are unable to produce voice or speech early on in the disease progression
false: later on in the disease progression
what can provide a person with ALS an alternative way to communicate with others?
augmentative communication
Definition of Parkinson’s disease
a progressive, degenerative neurological disease, one that is caused by dopamine depletion
what three voice disorder symptoms does Parkinson’s disease exhibit?
weak voice because of a weakened respiratory system
reduced loudness and a breathy
hoarseness and monotonic
what two characteristics result from or are linked to psychogenic disorders of voice?
emotional and psychological characteristics
true or false: a voice disorder can be a result of stress, anxiety or depression
true
Definition of conversion disorder
a psychological disturbance in which an individual exhibits symptom of a physical disease or disorder
what is a possible symptom of conversion disorder?
dysphonia or aphonia
Definition of vocal tic disorder
sudden, rapid, recurrent vocalizations
Definition of Tourette’s disorder
when vocal tics occur simultaneously with other motor tics affecting the head, torso, and extremities
true or false: the vocal tics seen in both vocal tic disorder and Tourette’s syndrome are not linked to any known physical cause
true
what is mutational falsetto (pubertonia)?
a male child or adolescent who exhibits an inappropriately high-pitched voice
what is Juvenile voice disorder?
when women maintain a juvenile voice into adulthood
what three characteristics accompany the childlike pitch?
low intensity
nasally
breathiness
Definition of Alaryngeal Communication
voice production without a larynx; most often results from a tracheostomy or a laryngectomy
Definition of tracheostomy
a surgical procedure in which a trach tube, is inserted through the neck below the vocal folds to direct air into the lungs
true or false: for children being on a trach for an extended period of time won’t undermine their ability to develop speech, language, and communication abilities
false - it will undermine them
Definition of Passy-Muir tracheostomy speaking valve
a valving system that sends air downward into the pulmonary system during inhalation but directs exhaled air over the vocal folds to produce speech
what is the most common reason for alaryngeal communication in adults?
the removal of the larynx due to trauma or cancer
what do you call a person whose larynx has been removed?
laryngectomee
four risk factors of laryngeal cancer
male
african american
tobacco use
alcohol use
what is the most consistent early symptom of laryngeal cancer?
hoarseness
As a general rule, what is the longest anyone should ever allow hoarseness to continue without medical evaluation?
two weeks, max
what are the first two goals in cancer treatment?
- rid body of malignancy
2. maintain the body’s functions and structures
conservation approach to laryngeal cancer
the larynx remains, with portions of it removed.
cordectomy approach to laryngeal cancer
one of the vocal folds is surgically removed and laryngectomy portions of the laryngeal cartilages are removed
what three perceptual characteristics can voice disorder impacts?
resonance
loudness and pitch
phonatory quality
Definition of disorders of resonance
problems with control of the velopharyngeal port due to velopharyngeal inadequacy that occurs when there is imperfect closure of the port because of structural or muscular problems
Four common causes of velopharyngeal inadequacy
Cleft palate and cranio-facial anomalies
iatrogenic problems
Allergies
Neuromuscular impairment
four conditions that cause hyponasality
Acute rhinitis
Allergic rhinitis
Papilloma
tonsiuitis
Definition of Glottal fry
a pitch disturbance in which the pitch is low, produced on tight vocal folds
Definition of habitual pitch
the pitch used in normal speaking situations without applying any extra physiological effort
Definition of optimal pitch
the pitch at which one’s voice is the least abusive, least effortful, and most efficient
Definition of basal pitch
the lowest steady pitch a person can produce without pitch breaks or glottal fry
Definition of ceiling pitch
the highest pitch at which a voice can be sustained without pitch breaks
Definition of vocal range
the difference between a basal and a ceiling pitch, normally covering two to three octaves
Definition of Underloudness
a lack of respiratory force due to neurological injury or disease
true or false: both overloudness and underloudness are considered vocal abuse
true
five common disturbances of phonatory quality
Glottal fry
Hard glottal attack
Hoarseness
Breathy phonation
Spasticity
warning Signs of a Voice Disorder
change in the resonance, pitch, loudness, or phonatory quality of an individual’s voice lasts longer than two weeks
four roles for SLP’s in assessment
characterize the general features of the voice
establish whether any of these features differ significantly from normal
identify the cause of any disorder
identify the most beneficial approach to improving the client’s voice
four different tools clinicians use to identify the most successful approach for a voice disorder
Case History and Interview
Oral-Motor Examination
Clinical Observation
Instrumental Observation
true or false: velopharyngeal inadequacy causes either hypernasality or hyponasality
true
with hypernasality, the velopharyngeal port remains ____, allowing _____ resonance in the nasal cavity
open; too much
what does it mean when nasal emissions are present?
air emits from the nose during speech
with hypernasality, _____ pressure in the oral cavity also degrades the production of some oral speech sounds
lowered
With hyponasality, there is ____ nasal resonance
too little
what happens when the nasal cavity is blocked in some way and thus not available to serve as a resonating chamber?
sounds that require nasal resonation become denasalized
three characteristics of sound that is hyponasality
denasalized, stuffy, and congested
true or false: voice disorders can also affect loudness
true
two characteristics of sound affected by loudness
insufficiently or overly loud
one in which loudness does not vary - monotonic
what occurs to produce an overly loud voice?
the air pressure under the vocal folds must build up
why is excessive loudness is sometimes seen in persons who are deaf or hard of hearing?
because they are unable to monitor the loudness of their own voices
why does persistent underloudness can cause vocal strain and fatigue
because the vocal muscles must work harder, given the inadequate force of the air stream
how can symptoms of vocal abuse be treated?
surgery on the vocal folds
is voice therapy that focuses on changing vocal behaviors as successful as surgery?
typically at least as successful as surgical intervention for vocal nodules and contact ulcers
true or false: surgery on vocal folds is enough to keep those symptoms from reappearing
false - treatment focused on better use of voice is essential to keep those symptoms from reappearing, even with surgery
what does treatment for Neurogenic Disorders look like?
combination of medical interventions and voice therapy
what does treatment for Psychogenic Disorders look like?
multidisciplinary treatment program that focuses on primarily on counseling, reducing tension, and eliminating any voice abuses or misuses
true or false: individuals whose larynx has been removed must develop alternative ways to produce voice
true
when the larynx is removed, the airway between the lungs and the mouth is _____.
closed
what happens to the airflow when the larynx is removed?
the airflow is shunted out the front of the neck via a stoma
what used to be the most commonly used alternative for alaryngeal communication?
esophageal speech – which the individual traps air in the esophagus and then uses that air to produce voice
three alternatives for laryngeal communication
an artificial larynx
esophageal speech
tracheoesophageal puncture (TE)
Definition of tracheoesophageal puncture (TE)
a surgical procedure used to create a channel between the trachea and the esophagus, into which a prosthetic device is inserted
how does an individual after a tracheoesophageal puncture speak?
takes a deep breath, covers the stoma, and forces the air into the esophagus, providing an air source for speaking
