Chapter 2: Anatomy and Physiology

Question 1

Where is the adult larynx located?

Answer 1

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

Question 2

Where is the child larynx located

Answer 2

opposite ~4th vertebrae

Question 3

What are the 4 parts of the laryngeal valve

Answer 3

cartilage, muscles, connective tissues, mucosa

Question 4

What are the 3 main functions of the laryngeal valve?

Answer 4

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

Question 5

What are the 3 levels of the vocal folds?

Answer 5

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

Question 6

Phonation relies on the power of what?

Answer 6

pulmonary respiratory power

Question 7

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

Answer 7

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

Question 8

What are the 5 muscles of inspiration?

Answer 8

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

Question 9

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

Answer 9

dome; flattens

Question 10

What do the external intercostals do when they contract?

Answer 10

Pull upward on the ribs they attatch to

Question 11

What are the 5 muscles of expiration?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

What are the 2 structural supports for the larynx?

Answer 14

1) hyoid bone

2) laryngeal cartilages

Question 15

What are the 4 laryngeal cartilages?

Answer 15

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

Question 16

Where are the attachments for extrinsic laryngeal muscles?

Answer 16

One outside the larynx, one within the larynx

Question 17

The extrinsic laryngeal muscles do what 3 things?

Answer 17

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

Question 18

What are the 2 categories of laryngeal muscles?

Answer 18

1) suprahyoids

2) infrahyoids

Question 19

What do the suprahyoids do?

Answer 19

raise the larynx

Question 20

What are the 4-5 suprahyoids?

Answer 20

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

Question 21

What do the infrahyoids do?

Answer 21

lower the hyoid and larynx

Question 22

What are the 4 infrahyoids?

Answer 22

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

Question 23

What do the intrinsic laryngeal muscles do?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

What are the 5-6 intrinsic laryngeal muscles?

Answer 25

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

Question 26

Which intrinsic laryngeal muscle is a tensor?

Answer 26

cricothyroid

Question 27

What intrinsic laryngeal muscles are adductors?

Answer 27

1) thyroarytenoid 2) lateral cricoarytenoid 3) interarytenoids

Question 28

What intrinsic laryngeal muscles are abductors?

Answer 28

posterior cricoarytenoid

Question 29

Membranous portions of the VFs do what?

Answer 29

Oscillate (vibrate) to create sound

Question 30

The integrity of the vibratory pattern for phonation requires what?

Answer 30

pliable, elastic structure

Question 31

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

Answer 31

5 discrete histological layers | composition and mechanical properties (giving different flexibility and stability)

Question 32

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

Answer 32

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

Question 33

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

Answer 33

density and stiffness of tissue

Question 34

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

Answer 34

sustained vocal fold oscillation

Question 35

Which VF layer is the outermost layer?

Answer 35

epithelium

Question 36

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

Answer 36

epithelium

Question 37

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

Answer 37

best VF oscillation

Question 38

What covers the epithelium?

Answer 38

mucociliary blanket

Question 39

What are the 2 layers of the mucociliary blanket?

Answer 39

1) mucinous | 2) serous

Question 40

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

Answer 40

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

Question 41

What is the basement membrane zone?

Answer 41

a transition zone between epithelium and lamina propria

Question 42

What are the 3 layers of the lamina propria?

Answer 42

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

Question 43

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

Answer 43

1) elastin | 2) collagen

Question 44

What does elastin do?

Answer 44

allows tissue to deform/stretch

Question 45

What does collagen do?

Answer 45

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

Question 46

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

Answer 46

passive | aerodynamic forces

Question 47

The superficial layer is also called what?

Answer 47

Reinke's space

Question 48

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

Answer 48

superficial layer

Question 49

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

Answer 49

intermediate layer

Question 50

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

Answer 50

deep layer

Question 51

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

Answer 51

vocal ligament

Question 52

What does the vocalis muscle form?

Answer 52

body of the vocal fold

Question 53

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

Answer 53

1) tone 2) stability 3) mass

Question 54

Does the vocalis muscle oscillate during VF vibration?

Answer 54

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

Question 55

What are the 3 divisions of the VFs?

Answer 55

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

Question 56

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

Answer 56

1) cover = epithelium, SLLP, ILLP (flexible) | 2) body = DLLP and vocalis muscle (dense/stiff)

Question 57

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

Answer 57

ILLP, DLLP, and vocalis muscle

Question 58

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

Answer 58

a degree of protection from injury

Question 59

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

Answer 59

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

Question 60

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

Answer 60

X - Vagus

Question 61

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

Answer 61

1) superior laryngeal nerve (SLN) | 2) recurrent laryngeal nerve (RLN)

Question 62

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

Answer 62

1) internal - sensory for larynx above the VFs | 2) external - motor principally the CT msucle

Question 63

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

Answer 63

The left and right RLN paths are different

Question 64

What does the recurrent laryngeal nerve provide motor innervation to?

Answer 64

all intrinsic laryngeal muscles except for the CT

Question 65

What does the recurrent laryngeal nerve provide sensory innervation to?

Answer 65

below the vocal folds

Question 66

What are the three theories of vibration?

Answer 66

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

Question 67

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

Answer 67

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

Question 68

What does Hirano's Body-Cover Theory say?

Answer 68

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

Question 69

What does Titze's Self-Oscillation Theory say?

Answer 69

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

Question 70

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

Answer 70

separate muscle contraction for each open/close movement

Question 71

What is required for the VFs to open and close?

Answer 71

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

Question 72

What is the fundamental frequency (Fo)?

Answer 72

rate of VF vibrations (cycles per second or Hertz)

Question 73

The Fo is the acoustic-perceptual correlate of what?

Answer 73

pitch

Question 74

What are 4 factors that influence Fo?

Answer 74

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

Question 75

What is intensity?

Answer 75

Sound pressure level of acoustic output

Question 76

What is intensity the perceptual correlate of?

Answer 76

loudness

Question 77

What are the 4 factors that influence intensity?

Answer 77

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

Question 78

What are the 3 phonation modes?

Answer 78

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

Question 79

What is the most important consideration in the pediatric population?

Answer 79

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

Question 80

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

Answer 80

thyroid (obscured) | and cricoid

Question 81

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

Answer 81

1) aryepiglottic folds | 2) arytenoid cartilages

Question 82

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

Answer 82

50%

Question 83

What is the length of VF in newborns?

Answer 83

1.25-3.0mm

Question 84

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

Answer 84

around 10

Question 85

What is the adult male and female VF lenghts?

Answer 85

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