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ecu voice Flashcards

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1
Q

what is the function of the larynx

A
  1. respiration
  2. protect airways when swallowing
  3. sub-glottal pressure
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2
Q

what are the average lengths of vocal folds for males and females

A

males: 16-17 mm

females 10-11 mm

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3
Q

what is the mean fundamental frequency in males and females

A

males: 125. range 100-140
females: 225. range 180-250

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4
Q

what are characteristics of the aging voice

A
  1. ossification of cartilages
  2. reduced flexibility
  3. atrophy, dystrophy, and edema
  4. synchrony and symmetry of folds affect vocal quality
  5. vocal fold boing
  6. decreased blood supply
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5
Q

what is the visceral pleura

A

out surface of each lung

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6
Q

what is the parietal pleura

A

lines the internal thoracic walls, mediastinum, and superior surface of the diaphragm

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7
Q

what is the tidal volume

A

volume of air inspired or expired during normal inspiration

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8
Q

what is inspiratory reserve volume

A

amount of air inspired forcefully after inspiration of normal tidal volume

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9
Q

what is expiratory reserve volume

A

amount of air expired forcefully after normal tidal

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10
Q

what is residual volume

A

volume of air that always remains in the respiratory passages after forceful inhalation or exhalation

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11
Q

what is vital capacity

A

what you can inhale and exhale deeply

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12
Q

what are the 3 paired cartilages

A

arytenoid
cuneiform
corniculate

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13
Q

what are the 3 unpaired cartilages

A

thyroid
cricoid
epiglottis

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14
Q

what are the laryngeal elevators

A

digastric
mylohyoid
stylohoid
geneohyoid

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15
Q

what are the laryngeal depressors

A

thyrohyoid
omohyoid
sternohyoid

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16
Q

which are the adductors

A

lateral cricoarytenoid

transverse and oblique arytenoid

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17
Q

which is the abductor

A

posterior cricoarytenoid

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18
Q

what does the cricothyroid do

A

lengthens and tenses the folds

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19
Q

what makes up the body of the folds

A

thyroarytenoid and vocalis

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20
Q

which is the only muscle not innervated by the recurrent laryngeal nerve

A

cricothyroid: innervation from external superior laryngeal

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21
Q

what is the cricothyroid joint

A

tilts the inferior thyroid cornu to increase the disance between the anterior commisure and the vocal process
uses the vertical and oblique cricothyroid muscles

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22
Q

what are 3 regions of the interior larynx

A

supraglotal
glotal
subglottal

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23
Q

what makes up the cover

A

epithelium and superficial lamina propria (Reinke’s)

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24
Q

what makes up the transition

A

intermediate and deep lamina propria

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25
Q

what makes up the body

A

vocalis

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26
Q

what is the cover body theory

A

cells in cover not tightly packed allowing for horizontal and vertical movement
cells in body tightly packed and dont move
transition layer balances movement of 2 layers
wave happens because of difference in properties betwee the 2 layers

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27
Q

what nerve innervate the epiglottis

A

pharyngeal nerve

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28
Q

what 3 properties of the folds affects pitch

A

mass
length
tension

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29
Q

how is loudness changed

A

subglottal pressure
adduction of folds
duration, degree, and speed of VF closure

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30
Q

what causes a breathy voice

A

incomplete glottal closure

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31
Q

what causes a hoarse voice

A

aperiodicity, mucosal wave abnormalities

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32
Q

what causes a strained voiced

A

supraglottal muscle tension

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33
Q

what is included in a voice eval by the SLP

A
  1. case history and interview
  2. oral mech
  3. hearing screening
  4. attitude survey (psychological)
  5. perceptual assessment
  6. stroboscopy
  7. acoustic analysis
  8. QOL assessment
  9. aerodynamic assessment
    10 EGG, EMG
  10. resonance assessment
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34
Q

what is included in the case history

A
  1. what is the problem
  2. how has it affected the voice
  3. onset and duration
  4. variability vs consistency
  5. associated symptoms
  6. medical history including intubation, trauma, medications
  7. list of physicians currently treating
  8. allergies
  9. throat claring and coughing habits
  10. eating habits
  11. history of asthma, stridor etc
  12. psychological issues
  13. voice use history
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35
Q

what is included in a subjective assessment

A
  1. sustained vowel
  2. continuous and spontaneous speech
  3. reading sample
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36
Q

what voice qualities are assessed

A
  1. loudness
  2. pitch
  3. quality
37
Q

how is loudness assessed

A

loudness variability in continuous sample

contrastive stress also used

38
Q

how is pitch assessed

A
  1. habitual pitch
  2. pitch variability
  3. pitch range
  4. tremor
39
Q

how is quality assessed

A
  1. identify voice quality

2. define severity. mild, moderate, severe

40
Q

what subjective and objective parameters are assessed

A

respiration
phonation
resonance

41
Q

how is respiration subjectively assessed

A
  1. look at type of breathing (clavicular, diaphragmatic, thoracic)
  2. read a passage in one breath and count # of words (6-7)
  3. max phonation duration ( 25-30 male, 15-20 female)
42
Q

what acoustic measures are assessed

A

frequency
intensity
noise
perturbation

43
Q

what are amplitude related measures

A

mean amplitude
intensity range
standard deviation of amplitude
shimmer

44
Q

what are frequency related measures

A

mean fundamental frequency
range
standard deviation of Fo
Jitter

45
Q

what are objective noise related measures

A

noise to harmonic ratio

voice turbulence index

46
Q

what is the noise to harmonic ratio

A

noise divided by harmonics ratio. closer to zero the better the voice

47
Q

what is EGG

A

electroglottography
measures electrical resistance between 2 electrodes
less resistance when the VF are in contact
measures open, opening, closed, closing phases and period

48
Q

what is the open quotient

A

open phase divided by time

complete adduction = 0, abduction = 1

49
Q

what is the closed quotient

A

closed phase divided by time

50
Q

what is the only subjective aerodynamic assessment

A

s/z ratio

51
Q

what are objective aerodynamic assessments

A
  1. vital capacity

2. mean airflow rate ( amount of air/ max phonation duration)

52
Q

what is the phonatory quotient

A

vital capacity/max phonation duration

53
Q

how is variation in sound pressure level measured

A

patient produces string /pa pa pa? at usual, half usual, and twice usual loudness levels

54
Q

how is voicing efficiency measured

A

patient repeats /a/ and /p/ (apapapap) with equal stress. Gives info about airway resistance

55
Q

how does a stroboscopy work

A

microphone on neck records sound and measure the frequency

strobe light synchronized with this value and emits flashes of light at lower frequency 1-2 Hz

56
Q

what do you look for with a stroboscopy

A 
symmetry
structure
periodicity
glottal closure patterns
muscle tension
movement of the VF and arytenoids
57
Q

what are organic disorders

A

structural issues with anatomy

58
Q

what are functional disorders

A

anatomy intact, function disturbed

59
Q

what are nodules

A 
masses on folds
always bilaterial
anterior 2/3, posterior 1/3 junction
repeated phonotrauma
symptoms: hoarseness, reduced pitch, reduced loudness
managed by voice rest and hygiene
60
Q

what are polyps

A 
unilateral mass due to phootrauma
have blood supply
sessile: on fold
pedunculated: hangs by stalk
symptoms: hoarseess, reduced pitch and loudness
treated by surgery
61
Q

what is reinke’s edema

A

edema in Reinke’s space

mostly induced by smoking and phonotrauma

62
Q

what is a laryngeal cyst

A

mucous mass under mucosa within the superficial lamina propria

63
Q

what is a granuloma

A

growths due to intubation usually in vocal process

64
Q

what are contact ulcers

A

lesions in posterior VF due to reflux

65
Q

what is a larygeal web

A

webbing of glottis due to irritation
primary symptom respiratory difficulty
voice is harsh and high pitched
can be congenital or due to trauma

66
Q

what is sulcus vocalis

A

groove in VF of unknown cause

67
Q

what is varix

A

superficial prominent vein that is enlarged and dilated

68
Q

what is ectasia

A

fused lesioning of blood vessel on superficial lamina propria

69
Q

what is puberphonia/mutational falsetto

A

unusual high pitch that persists beyond puberty

symptoms: hoarseness, breathiness, pitch breaks, inadequat resoance, shallow breathing

70
Q

what are the laryngoscopic findings with phonotrauma

A
  1. lateral medial compression
  2. anterior posterior compression
  3. strain of supraglottal structures
  4. hyper adduction
  5. elevated laryngeal position
71
Q

what does the superior laryngeal nerve innervate

A

internal: all sensory info to larynx
external: motor innervation to cricothyroid

72
Q

what does the recurrent laryngeal nerve innervate

A

all sensory info below the folds

motor innervation to all intrinsic laryngeal muscles except the cricothyroid

73
Q

what are the characteristics of vocal fold paralysis

A
  1. unilateral or bilateral

2. possible causes are surgery; neurological disease; head and neck trauma; viral infections; tumors

74
Q

what are characteristics of bilateral adductor paralysis

A
  1. both folds in paramedian position
  2. airway protection an important issue, may need tube feeding
  3. dysponic due to secondary muscle tension
  4. breathy and weak voice
75
Q

what are the characteristics of bilateral abductor paralysis

A

folds paralyzed in closed position
critical condition for respiration
sometime remove arytenoid or suture it in an open position

76
Q

what are the characteristics of unliateral abductor paralysis

A
  1. paralyzed fold remains at midline
  2. voice quality mildly dysphonic with possible elevated loudness
  3. may demonstrate stridor
77
Q

what are the characteristics of unilateral adductor paralysis

A
  1. affected fold fails to adduct to midline

2. voice quality varies depending on position and size of glottal gap during phonation

78
Q

what are characteristics of superior laryngeal nerve paralysis

A
  1. Internal: lose sensation of the bolus

2. external: cricothyroid unable to stretch vocal folds resulting in loss of pitch range and vocal fatigue

79
Q

what are characteristics of spasmodis dysphonia

A
  1. involuntary adductor or abductor spasms during phonation

2. symptoms: strained, strangled, and effortful voice production

80
Q

how do you assess spasmodic dysphonia

A
  1. undisrupted: singing, laughing, throat clearing, humming
  2. vowels more affected. Assess by a sentence with predominantly vowel sounds ( We eat eggs every Easter)
  3. treatment: Botox
81
Q

what is organic voice tremor

A
  1. essential tremor to larynx
  2. gradual onset: typically 40-60 years
  3. more frequent in males
  4. may be hereditary
  5. modulating tremor pf pitch and intensity during vowel prolongation
  6. shaky or wobbly voice
  7. limited success with Botox treatment
82
Q

what are characteristics of myethenia gravis

A
  1. autoimmune neuromuscular disorder. Antibodies block AcH receptors
  2. weakness after 5-6 minutes
  3. rest improves
83
Q

what are characeristics of Parkinsonism

A 
monopitch
reduced pitch
monoloudness
reduced loudness
festinating speech
tremor
diminished vocal fold movement due to rigidity
84
Q

what are characteristics of Huntington’s

A
  1. harsh, monopitch, strain, voice arrests due to sudden adduction/abduction
  2. increased jitter, shimmer
85
Q

what are characteristics of cerebellar ataxia

A
  1. hypotonia: reduced range of movement
  2. harsh, monopitch, reduced pitch, strin
  3. reduced speed of adduction and abduction
86
Q

what are characteristics of MS

A
  1. incoordination, spasticity, muscle weakness

2. impaired control of loudness, harshness, hoarseness, hypernasality, impaired pitch, reduced rate, scanning speech

87
Q

what are common congenital pediatric voice disorders

A
  1. VF paralysis
  2. laryngeal stenosis
  3. laryngomalacia: flaccid epiglottis obstructing airway. Omega shaped epiglottis
  4. laryngocele: air filled dilation of the laryngeal vestibule
  5. webbing
88
Q

what are the direct therapy approaches for voice

A
  1. vocal function exercises
  2. flow phonation
  3. Lessac-Madsen REsonant Voice Therapy
  4. LSVT
  5. Inspiratory and expiratory muscle strength training

Praxis (20 decks)

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