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Voice and Resonance Disorders > Chapter 2: Anatomy and Physiology > Flashcards

Chapter 2: Anatomy and Physiology Flashcards

1
Q

Where is the adult larynx located?

A

Opposite the 3rd, 4th, 5th, and 6th vertebrae (descends with age)

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2
Q

Where is the child larynx located

A

opposite ~4th vertebrae

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3
Q

What are the 4 parts of the laryngeal valve

A

cartilage, muscles, connective tissues, mucosa

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4
Q

What are the 3 main functions of the laryngeal valve?

A

1) airway preservation for ventilation 2) airway protection 3) phonation

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5
Q

What are the 3 levels of the vocal folds?

A

1) aryepiglottic folds 2) ventricular folds/vestibular folds 3) true vocal folds

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6
Q

Phonation relies on the power of what?

A

pulmonary respiratory power

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7
Q

What are the 4 aspects of what provides pulmonary respiratory power?

A

1) abdominal and thoracic musculature 2) lungs 3) diaphragm 4) pleural wall

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8
Q

What are the 5 muscles of inspiration?

A

1) diaphragm 2) external intercostals 3) sternocleidomastoids 4) scalenes 5) pectoralis (major and minor)

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9
Q

The diaphragm is _____-shape and does what upon inspiration?

A

dome; flattens

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10
Q

What do the external intercostals do when they contract?

A

Pull upward on the ribs they attatch to

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11
Q

What are the 5 muscles of expiration?

A

1) internal intercostals 2) rectus abdominis 3) transverse abdominus 4) internal obliques 5) external obliques

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12
Q

The muscles of expiration work in combination with what 3 things?

A

1) passive forces of torque 2) tissue elasticity 3) gravity

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13
Q

During speech, the expiratory muscles assist passive forces in order to do what things?

A

1) compress the abdominal viscera 2) force diaphragm upward and depress lower ribs 3) decrease thoracic cavity size (in order to sustain pulmonary pressure)

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14
Q

What are the 2 structural supports for the larynx?

A

1) hyoid bone

2) laryngeal cartilages

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15
Q

What are the 4 laryngeal cartilages?

A

1) epiglottis
2) thyroid
3) cricoid
4) arytenoids (corniculates and cuneiforms)

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16
Q

Where are the attachments for extrinsic laryngeal muscles?

A

One outside the larynx, one within the larynx

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17
Q

The extrinsic laryngeal muscles do what 3 things?

A

1) influence laryngeal height/position in neck
2) alter shape/filtering characteristics of supraglottic tract
3) modify vocal pitch, loudness, and quality

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18
Q

What are the 2 categories of laryngeal muscles?

A

1) suprahyoids

2) infrahyoids

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19
Q

What do the suprahyoids do?

A

raise the larynx

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20
Q

What are the 4-5 suprahyoids?

A

1) stylohyoid
2) mylohyoid
3) digastrics (anterior and posterior bellies)
4) geniohyoid

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21
Q

What do the infrahyoids do?

A

lower the hyoid and larynx

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22
Q

What are the 4 infrahyoids?

A

1) thyrohyoid
2) sternothyroid
3) sternohyoid
4) omohyoid

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23
Q

What do the intrinsic laryngeal muscles do?

A

affect the position, length, and tension of the vocal folds

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24
Q

What 3 things do the intrinsic laryngeal muscles do to change VF position, length, and tension?

A

1) change position of cartilage framework housing VFs
2) alter length, tension, and shape of the VF edge
3) change shape of glottal opening between VFs

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25
Q

What are the 5-6 intrinsic laryngeal muscles?

A

1) cricothyroid (CT)
2) thyroarytenoid (TA)
3) lateral cricoarytenoid (LCA)
4) interarytenoids (transverse and oblique)
5) posterior cricoarytenoid (PCA)

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26
Q

Which intrinsic laryngeal muscle is a tensor?

A

cricothyroid

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27
Q

What intrinsic laryngeal muscles are adductors?

A

1) thyroarytenoid
2) lateral cricoarytenoid
3) interarytenoids

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28
Q

What intrinsic laryngeal muscles are abductors?

A

posterior cricoarytenoid

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29
Q

Membranous portions of the VFs do what?

A

Oscillate (vibrate) to create sound

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30
Q

The integrity of the vibratory pattern for phonation requires what?

A

pliable, elastic structure

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31
Q

The adult VFs contain how many layers that vary in what 2 things?

A

5 discrete histological layers

composition and mechanical properties (giving different flexibility and stability)

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32
Q

What are the 5 layers of the vocal folds from superficial to deep?

A

1) epithelium
2) lamina propria (LP)
a) superficial (SLLP)
b) intermediate (ILLP)
c) deep (DLLP)
3) vocalis muscle (aka TA)

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33
Q

What increases when you progress from superficial to deep layers of the VF?

A

density and stiffness of tissue

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34
Q

The stiffness gradient of the VF layers is critical for what?

A

sustained vocal fold oscillation

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35
Q

Which VF layer is the outermost layer?

A

epithelium

36
Q

Which VF layer can be described as mucosal, thin, and pliable?

A

epithelium

37
Q

The epithelium is a thin layer of slippery mucous lubrication that is needed for what?

A

best VF oscillation

38
Q

What covers the epithelium?

A

mucociliary blanket

39
Q

What are the 2 layers of the mucociliary blanket?

A

1) mucinous

2) serous

40
Q

What are 4 potential environmental influences that the epithelium can be exposed to?

A

1) humidity
2) dehydration
3) pollution
4) reflux

41
Q

What is the basement membrane zone?

A

a transition zone between epithelium and lamina propria

42
Q

What are the 3 layers of the lamina propria?

A

1) superficial layer
2) intermediate layer
3) deep layer

43
Q

What are the 2 types of fibrous proteins (connective tissue) in the lamina propria?

A

1) elastin

2) collagen

44
Q

What does elastin do?

A

allows tissue to deform/stretch

45
Q

What does collagen do?

A

less stretchy than elastin, but tolerates stress and provides tensile strength

46
Q

The lamina propria vibrates in a __________ manner in response to ________________ forces

A

passive

aerodynamic forces

47
Q

The superficial layer is also called what?

A

Reinke’s space

48
Q

Which layer of the LP is loose and flexible; soft, slippery, gelatin-like substance; and vibrates significantly during phonation?

A

superficial layer

49
Q

Which layer of the LP has mostly elastic fibers and some collagen and also vibrates during phonation?

A

intermediate layer

50
Q

Which layer of the LP is mostly collagen fibers and is interspersed with muscle fibers to join LP to underlying vocalis muscle?

A

deep layer

51
Q

What are the intermediate and deep layers of the LP combined sometimes called?

A

vocal ligament

52
Q

What does the vocalis muscle form?

A

body of the vocal fold

53
Q

What 3 things does the vocalis muscle provide to the VF?

A

1) tone
2) stability
3) mass

54
Q

Does the vocalis muscle oscillate during VF vibration?

A

Yes, but not as much as cover and transition layers of VF

55
Q

What are the 3 divisions of the VFs?

A

1) cover = epithelium and SLLP
2) transition = ILLP and DLLP
3) body = vocalis muscle

56
Q

What is one way to divide the VFs so there are 2 divisions of the VFs?

A

1) cover = epithelium, SLLP, ILLP (flexible)

2) body = DLLP and vocalis muscle (dense/stiff)

57
Q

The predominant blood supply to the VFs are to what areas?

A

ILLP, DLLP, and vocalis muscle

58
Q

Limited blood supply to the SLLP and epithelium gives us what?

A

a degree of protection from injury

59
Q

What are the 3 parts of neurologic supply to the VFs?

A

1) CNS (sensory receptors and motor commands)
2) peripheral innervation
3) laryngeal reflexes

60
Q

What CN is involved in the peripheral innervation of the VFs?

A

X - Vagus

61
Q

What are the 2 parts of CNX involved in VF inneravation?

A

1) superior laryngeal nerve (SLN)

2) recurrent laryngeal nerve (RLN)

62
Q

What are the two parts of the superior laryngeal nerve and what do they control?

A

1) internal - sensory for larynx above the VFs

2) external - motor principally the CT msucle

63
Q

What is unique about the way the recurrent laryngeal nerve courses?

A

The left and right RLN paths are different

64
Q

What does the recurrent laryngeal nerve provide motor innervation to?

A

all intrinsic laryngeal muscles except for the CT

65
Q

What does the recurrent laryngeal nerve provide sensory innervation to?

A

below the vocal folds

66
Q

What are the three theories of vibration?

A

1) Van den Berg’s Aerodynamic-Myoelastic Theory
2) Hirano’s Body-Cover Theory
3) Titze’s Self-Oscillation Theory

67
Q

What does Van den Berg’s Aerodynamic-Myoelastic Theory say?

A

VF oscillation is a function of covarying pressure and flow as well as mechanical properties of tissue deformation and collision

68
Q

What does Hirano’s Body-Cover Theory say?

A

Important role of the loose, passive (non-muscular) superficial layers (cover) to VF vibration as compared to the dense/stiff layers (body)

69
Q

What does Titze’s Self-Oscillation Theory say?

A

The VFs are a flow-induced self-oscillating system, that are sustained across time by forces of pressure and flow; the convergent and divergent shaping of VFs in a back and forth motion creates an alternating exchange of airflow and pressure peaks

70
Q

The VFs do NOT open and close during phonation due to what?

A

separate muscle contraction for each open/close movement

71
Q

What is required for the VFs to open and close?

A

As long as VFs are in approximated position and have sufficient buildup of pressure below them

72
Q

What is the fundamental frequency (Fo)?

A

rate of VF vibrations (cycles per second or Hertz)

73
Q

The Fo is the acoustic-perceptual correlate of what?

A

pitch

74
Q

What are 4 factors that influence Fo?

A

1) vocal fold length
2) longitudinal tension
3) vibratory amplitude
4) subglottal pressure

75
Q

What is intensity?

A

Sound pressure level of acoustic output

76
Q

What is intensity the perceptual correlate of?

A

loudness

77
Q

What are the 4 factors that influence intensity?

A

1) subglottal pressure
2) vocal fold vibratory phase closure
3) transglottal flow
4) supraglottic vocal tract tuning

78
Q

What are the 3 phonation modes?

A

1) falsetto/loft
2) modal/chest
3) glottal fry/pulse

79
Q

What is the most important consideration in the pediatric population?

A

preservation of airway, the larynx/airway is most important system of the entire infant

80
Q

In the pediatric larynx, what 2 structures are not as prominent as in an adult and which one of those is obscured by the overlapping hyoid bone

A

thyroid (obscured)

and cricoid

81
Q

What 2 structures of the larynx are large relative to other structures?

A

1) aryepiglottic folds

2) arytenoid cartilages

82
Q

What is the estimated percent of infants with an omega shaped epiglottis?

A

50%

83
Q

What is the length of VF in newborns?

A

1.25-3.0mm

84
Q

When does difference in VF length with gender begin to occur?

A

around 10

85
Q

What is the adult male and female VF lenghts?

A 
Male = 17-21mm
Female = 11-15mm

Voice and Resonance Disorders (14 decks)

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