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Voice Disorders > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What 3 facets of voice are assessed?

A

Quality, Pitch, and Loudness

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2
Q

Aphonia

A

loss of ability to speak through disease of or damage to the larynx or mouth

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3
Q

Roughness

A

Related more towards the irregularity in the voice, glottal fry, low tone.

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4
Q

Strain

A

*usually related to the effort, sounding pressed

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5
Q

Diplophonia

A

Perceiving two pitches in the same voice as a result of the false vocal folds vibrating as well

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6
Q

Opposite of Fry

A

Falsetto

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7
Q

Asthenia

A

Tiredness in the voice that results due to abnormal weakness

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8
Q

Pitch instability vs. Tremor

A

Pitch instability is usually over a longer sentence or phrase. Tremor is regular change that is consistent and smaller; often seen in sustained phonation activities.

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9
Q

Spasmodic Dysphonia

A

neurological disorder resulting a strained/strangled voice. Also known as laryngeal dystonia. The muscles that generate a person’s voice go into periods of spasm.

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10
Q

Dysphonia

A

difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

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11
Q

Vallecula

A

Space between tongue and epiglottis

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12
Q

Presbylaryngis

A

Age-related vocal cord changes may include loss of volume and bowing (inward curvature) of the vocal cord inner edges, a condition termed presbylaryngis or presbyphonia.

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13
Q

3 Domains of Voice Qualities

A

Pitch, Loudness, quality (Roughness, strain, etc.)

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14
Q

Acoustic Correlate of pitch

A

frequency (Hz)

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15
Q

Acoustic Correlate of Loudness

A

Amplitude/Energy/Intensity (dBs)

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16
Q

Ways to get a voice sample

A

prolonged phonation, reading sample, and spontaneous conversation sample.

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17
Q

Acoustic Measure of Quality

A

Noise related measures that make the rough, strained, or other noises.

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18
Q

What does a high frequency signal look like?

A

More waves closer together. They have a smaller bandwidth.

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19
Q

What is Perturbation Analysis?

A

Analysis of the variability of one cycle ( of a sound wave) to the rest of the cycles in the sample.

[Cycle to cycle changes.]

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20
Q

What is Jitter? (Perturbation Measure)

A

Cycle to Cycle changes with respect to frequency (Pitch.) (Think Perturbation.)

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21
Q

What is Shimmer? (Perturbation Measure)

A

Cycle to cycle changes with respect to intensity (loudness.) (Think Perturbation.)

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22
Q

What is a cause of jitter and/or shimmer?

A

An erratic mucosal wave in the vocal folds. There isn’t coordination. Each wave is different than the other wave.

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23
Q

Perceptual Measures of sound are: Pitch, loudness, and quality.
What are the corresponding acoustical measures?

A

Pitch –> Frequency (Hz)
Loudness –> amplitude, intensity, energy (dBs)
Quality —> Noise

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24
Q

What is the functional frequency value for women?

A

220 - 260 hz

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25
Q

What is the functional frequency value for men?

A

80 - 140 hz

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26
Q

What is NHR? Define.

A

Noise to Harmonic Ratio. (A Noise Related Measure.)

Signal = Noise (bad) + harmonics (good.)
NHR divides the good aspects of a voice by the good aspects of a voice.
A good NHR should be close to 0! Hopefully under 1. (Sometimes the computer measures HNR. In this case, a number higher than 1 is better.)

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27
Q

Jitter and Shimmer give us information regarding the [blank] of a voice.

A

Quality

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28
Q

What is VTI? Define.

A

Vocal Turbulence Index.

Similar to NHR but,
Looks at Noise signal in higher frequencies.
Giving us information about the deviance in voice quality.

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29
Q

What are the noise (Quality) related measures?

A

NHR and VTI

Noise to harmonics ration and voice turbulence index.

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30
Q

What are the frequency (Pitch) related measures?

A
  • Fundamental Frequency: the lowest frequency that the VF vibrate with.
  • SD of fundamental Frequency
  • Frequency range - min to max
  • Jitter: cycle to cycle changes in frequency.
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31
Q

What are the intensity (Loudness) related measures?

A
  • Absolute amplitude (mean amplitude.)
  • SD of Amplitude
  • Intensity range - min to max
  • Shimmer: cycle to cycle changes in intensity.
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32
Q

Where is information regarding pitch derived?

A

from frequency related measures

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33
Q

Where is information regarding loudness derived?

A

from intensity related measures

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34
Q

Where is information regarding quality derived?

A

from noise related measures + perturbation measures of jitter and shimmer.

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35
Q

What is the disadvantage of perceptual analysis? (Think CAPE-V)

A

its subjective, reliability is low. Can use acoustic analysis to provide consistent numbers. But, perceptual analysis is still the gold standard in voice treatment.

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36
Q

Define Mean Fundamental Frequency.

A

Average number of VF vibrations per second.

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37
Q

What aspects of voice are revealed in Spectography?

A

frequency, intensity, and duration

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38
Q

What are CSL (MDVP and Real Time Pitch) PRATT, Visipitch, and Sonapitch examples of?

A

Software for acoustic analysis.

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39
Q

What is EGG? Define.

A

Electroglottography.
Because human tissue is a good conductor of electricity, electrodes are placed around the neck while a low voltage current is running. Resistance will be less when the VF are adducted. This gives us information regarding VF contact.

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40
Q

What are the 4 phases of a vocal cycle?

A

Opening phase
Open phase
Closing phase
Closed Phase

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41
Q

What does high resistance/low conductivity mean in EGG?

A

There isn’t enough glottal closure

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42
Q

What are the four measures seen on EGG?

A

Open Quotient
Closed Quotient
Speed Quotient
Speed Index

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43
Q

What is the open quotient refer to on an EGG?

A

The Open Phase/Time
You want a number between 0-1
Complete adduction = 0
Complete abduction = 1

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44
Q

What is the closed quotient/contact quotient refer to on an EGG?

A

The Closed Phase/Time
You want a number between 0-1
Complete adduction = 1
Complete abduction = 0

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45
Q

What is the speed quotient refer to on an EGG?

A

opening time/closing time

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46
Q

What 6 things should you do when a patient first comes to you with voice issues?

A

Conduct Case History
Conduct a Perceptual Assessment (Like CAPE-V)
Conduct an Acoustic Analysis
Conduct an Aerodynamic Evaluation
Assess Quality of Life w/ respect to voice health
Conduct Visual Perceptual Assessment

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47
Q

What does an Aerodynamic evaluation look at?

A

Airflow

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48
Q

What is differential diagnosis?

A

Differentiating among disorders by eliminating possibilities.

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49
Q

What is a subjective (perceptual) aerodynamic eval?

A
  • Maximum Phonation Duration (MPD)
  • Number of words per breath (healthy average = 7)
  • s/z ratio: the duration the patient takes to produce the ‘s’ versus the ‘z’. There should be a similar duration, but ‘z’ should last longer because air moves out at a slower rate. Normative values: 0.8 - 1

looking at “where” someone is breathing from (clavicular, belly, etc.)

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50
Q

What is included in an objective aerodynamic eval?

A
  • Assess vital capacity (gives info re: respiratory abilities)
  • Mean Airflow Rate(MAFR): Air/Max Phon Duration (Air and VFs are used for phonation)
  • Phonotory Quotient (PQ): Vital Capaticy/Max phon duration. (Air is max and the MPD is phonation.)
  • Variation in Sound Pressure Level (VSPL)
  • Voicing Efficiency
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51
Q

How can you use objective measures of aerodynamic evaluation to determine whether an issue is at the respiratory level or the laryngeal level?

A

By comparing the MAFR and PQ, one can make a differential diagnosis.

This is because the MAFR reports numbers regarding respiration for phonation.
But the PQ compares regular respiration and compares it to length of phonation.

If PQ has a number within normal limits while MAFR is deviant, then the issue is at the laryngeal valving level.

If they are BOTH deviant, the issue is at the respiratory level.

52
Q

What is Variation in Sound Pressure Level (VSPL)?

A

The ability to be able to change loudness.

The patient is instructed to produce the syllable string /pa:pa:pa:/ at usual, half usual, and twice usual loudness levels, three times without phonation break at each loudness level.
Gives you info regarding control of subglottal pressure.

53
Q

What is Voicing Efficiency?

A

Measure of air=pressure to voicing.

The patient is instructed to repeat the voiced vowel /a/ and the voiceless stop plosive /p/ nine times in vowel or consonant format (apapapapapapapa/), placing equal stress on each syllable. Gives information about airway resistance.
This gives us an idea of the pressure at the larynx because air seeks to maintain the same amount of pressure.

54
Q

What are VHI, VR-QOL, and VAPP examples of?

A

Quality of life measures for voice patients.

55
Q

What is a visual perceptual analysis?

A

When you physically look at the vocal folds and assess their health. (Laryngoscopy, nasalendoscopy,

56
Q

What is stroboscopy?

A

A microphone is placed on the patient’s neck which records the sound and measures the frequency. The strobe light instrument is synchronized with this value and emits flashes of light at a lower frequency (1-2 Hz.)

57
Q

What is electromyography?

A

Electro: electricity
Myo: Muscle
Graphy: picturing
Place an electrode on a muscle (surface or intra) and have the person use that muscle. Gives an index of muscle functioning.

58
Q

What is the difference between a rigid and flexible laryngoscopy?

A

Rigid laryngoscopy uses a better camera that is passed through the oral cavity to view the VFs.
Flexible laryngoscopy uses a fiber optic tube wiht a camera to pass through the nasal cavity to view the VFs.

59
Q

What 6 things do you look for in a Stroboscopy?

A 
Symmetry
Structure (upper lip/lower lip)
Periodicity/homogeneity
Glottal closure patterns - width, area, horizontal excursion.
Muscle Tension
Movements of the VF - Arytenoids
60
Q

List the three unpaired cartilages in the larynx.

A

Thyroid, cricoid, and epiglottis

61
Q

List the three paired cartilages in the larynx.

A

Arytenoids, cuniform, and corniculate

62
Q

What is the thyroid notch?

A

The superior notch where the two laminae join creating the thyroid.

63
Q

What are the superior and inferior cornua?

A

The superior cornua is located at superiorly on the thyroid and articulates with the greater horns of the hyoid bone.
The inferior cornua is located inferiorly on the thyroid, creating a synovial joint with the cricoid (the cricothyroid joint.)

64
Q

What is the Epiglottis?

A

An oblong, feather-shaped fibroelastic cartilage that is attached to the inner surface of the thyroid laminae just above the anterior commissure.
It prevents aspiration.

65
Q

What is the “signet-ring” shaped cartilage?

A

Cricoid Cartilage

66
Q

Which is the only laryngeal cartilage to completely encircle the airway?

A

Cricoid Cartilage

67
Q

Where do the arytenoids articulate?

A

with the posterior lamina of the cricoid cartilage at the cricoarytenoid joint.

68
Q

What are the two processes (points) on the arytenoid cartilages?

A

The muscle process, which attaches to the posterior cricoarytenoid muscles behind, and to the lateral cricoarytenoid muscles in front.

The Vocal Process, which is attached to the vocal ligaments or vocal folds.

69
Q

What are the corniculate cartilages?

A

The corniculate cartilages (cartilages of Santorini) are two small conical nodules consisting of elastic cartilage, which articulate with the summits of the arytenoid cartilages and serve to prolong them posteriorly and medially.

70
Q

What is the function of the cuniform cartilages?

A

Function of the cuneiform cartilages is to support the vocal folds and lateral aspects of the epiglottis. They also provide a degree of solidity to the folds in which they are embedded

71
Q

What is the purpose of the intrinsic muscles of the larynx and list them.

A

They move the arytenoid cartilages and adjust the tension applied to the vocal folds.

  • Transverse Arytenoid
  • Lateral Cricoarytenoids
  • Posterior Cricoarytenoids
  • Vocalis and Thyroarytenoids
  • Cricothyroids
72
Q

What does the transverse arytenoid do? Innervation?

A

Connects the two arytenoids and ADDUCTS vocal folds

Innervated by the recurrent laryngeal nerve (RLN)

73
Q

What do the lateral cricoarytenoids do? Innervation?

A

Connects the cricoid cartilage and the artenoid cartilages to ADDUCT the vocal folds.
Innervated by the recurrent laryngeal nerve (RLN)

74
Q

What do the posterior cricoarytenoids do? Innervation?

A

Connects the cricoid cartilage and the arytenoid cartilages to ABDUCT the vocal folds.
Innervated by the recurrent laryngeal nerve (RLN)

75
Q

What do the Vocalis and Thyroarytenoids do? Innervation?

A 
They lengthen (TA) and relax (VO) the vocal folds to affect the pitch. 
Innervated by the recurrent laryngeal nerve (RLN)
76
Q

What do the cricothyroids do? Innervation?

A

They lengthen the vocal folds the increase pitch.

They are the only INTRINSIC laryngeal muscle innervated by the external branch of the superior laryngeal nerve.
CT = Innervated by External Branch of SLN

77
Q

What muscle is responsible for ABDUCTION?

A

The posterior cricoarytenoids.

78
Q

What is the differences between Anatomy and Physiology?

A

Anatomy is the study of structures.

Physiology is the study of how structures FUNCTION to produce an action.

79
Q

What are the basic elements of the respiratory system?

A

lungs, ribcage, and diaphragm

80
Q

How many lobes are in each lung? Why is the number different?

A

There are three lobes in the right lung and two in the left to allow space for the heart.

81
Q

How many cartilaginous rings makes up the trachea?

A

16

82
Q

Air travels down through the trachea to what structures next?

A

from the trachea to the right and left main bronchi, from the main bronchi, there are branches of bronchioles which have alveoli where the gas exchange occurs, allowing air to enter the blood.

83
Q

How many pairs of ribs are there?

A

12

84
Q

What’s special about rib pairs 11 and 12?

A

They are floating ribs because they do not attach anteriorly to anything (like the sternum) like the rest of the ribs.

85
Q

What is the major muscle of inspiration?

A

Diaphragm

86
Q

What are the other two sets of muscles for respiration?

A

External and internal Intercostal muscles

87
Q

Which muscle set pulls the ribs down during forced expiration?

A

Internal Intercostals

88
Q

Which muscle set pulls the ribcage up and outward during inspiration?

A

External intercostals

89
Q

What is the serous membrane called that lines the lungs/internal thoracic walls?

A

pleura

90
Q

What are two kinds of pleura that line the lungs/thoracic walls?

A

Visceral Pleura and the Parietal Pleura

91
Q

Which pleura lines most closely to the lungs?

A

Visceral Pleura

92
Q

Which pleura lines most closely to the thoracic wall?

A

Parietal Pleura

93
Q

What are the four pulmonary volumes?

A

Tidal volume (TV)
Inspiratory reserve volume (IRV)
Expiratory Reserve Volume (ERV)
Residual Volume (RV)

94
Q

What is tidal volume?

A

Volume of air inspired or expired during a normal inspiration or expiration

95
Q

What is inspiratory reserve volume?

A

Amount of air inspired forcefully after inspiration of normal tidal volume

96
Q

What is expiratory reserve volume?

A

Amount of air expired forcefully after expiration of normal tidal volume

97
Q

What is the residual volume?

A

Volume of air remaining in respiratory passages and lungs after the most forceful expiration

98
Q

What are the 4 pulmonary capacities?

A

Inspiratory Capacity
Functional residual Capacity
Vital Capacity
Total Lung Capacity

99
Q

What is Inspiratory Capacity?

A

Tidal volume + inspiratory reserve volume

TV + IRV

100
Q

What is Functional Residual Capacity?

A

Expiratory reserve volume + the residual volume

ERV + RV

101
Q

What is vital capacity?

A

Inspiratory reserve volume + tidal volume + expiratory reserve volume

IRV + ERV + TV

The total amount of air you can inhale and exhale with force.

102
Q

What is total lung capacity?

A

Inspiratory Reseve Volume + Expiratory reserve volumes + tidal volume + residual volume

IRV + ERV + TV + RV

ALL THE VOLUMES ADDED UP!

103
Q

What are the 3 biological functions of the larynx?

A

Respiration
Protection of airway during swallowing
The creation of sub-glottal pressure

104
Q

What percentage of the adult population have a voice disorder?

A

3%

105
Q

What percentage of school-age children have a voice disorder?

A

7%

106
Q

On average, how long is an adult male’s vocal folds?

A

16-17 mm

107
Q

On average, how long is an adult female’s vocal cords?

A

10-11mm

108
Q

What is the purpose of the extrinsic laryngeal muscles?

A

to elevate or depress the larynx

109
Q

What are the 4 extrinsic muscles that elevate the larynx?

A

Digastric
Mylohyoid
Stylohyoid
Geneohyoid

110
Q

What are the 4 extrinsic muscles that depress the larynx?

A

Thyrohyoid
Omohyoid
Sternohyoid
Sternothyroid

111
Q

What are the 2 laryngeal joints?

A

Cricothyroid and cricoarytenoid joints

112
Q

List the 3 regions of the larynx.

A

Supraglottal, Glottal (Rima glottis), and subglottal

113
Q

What is the space between the false vocal folds and the true vocal folds called?

A

Laryngeal ventricles

114
Q

What is another name for Reinke’s space? Where is it?

A

The lamina propia
It is the middle layer of the vocal folds, located between the outermost mucosa layer and the deep layer consisting of muscle.

115
Q

What is the body of the vocal folds made up of?

A

The vocalis and thyroarytenoid muscles.

116
Q

What is the cover of the vocal folds made up of?

A

The basement membrane zone and the lamina propria (Reinke’s space.)

117
Q

What is the transition space of the vocal folds made up of?

A

The intermediate and deep lamina proprias
AKA
The Vocal Ligament

118
Q

How does the mucosal wave occur?

A

The mucosal wave occurs because as you go deeper in to the VF, the cells become more compact. The outmost layer has loosely packed cells, allowing for more movement. But the TA and Vocalis, which make up the body of the VF, are densely packed and hardly move at all. The subglottal air pressure that builds up and bursts past the VFs affect different layers differently, creating a wavelike affect.

119
Q

What cranial nerve innervates the larynx?

A

The Vagus nerve

and partly the glossopharyngeal nerve.

120
Q

What 3 branches of the Vagus nerve innervate the larynx?

A

Recurrent Laryngeal Nerve (RLN) (AKA Inferior Laryngeal Nerve)
Superior Laryngeal Nerve (SLN)
Pharyngeal Nerve (Epiglottis)

121
Q

What is the Cover-body theory?

A

The cover is lax and the body is tense/closely packed.

There is a difference in the vibratory properties of different layers leading to a vertical phase difference.

Generation of mucosal wave resulting in smoother quality.

122
Q

Which is the primary muscle involved in pitch change? Which muscle compliments this muscle?

A

Cricothyroid (CT), by lengthening the VF

Complimented by the thryoarytenoid (TA) which relaxes the VF by reducing their length.

123
Q

What mechanism is involved with adjusting loudness?

A

the ability to build subglottal pressure and keep the VFs shut.

124
Q

In Hz, what is the range for the falsetto register?

A

300-600 hz

125
Q

In Hz, what is the range for the modal register?

A

140 -300 Hz

126
Q

In Hz, what is the range for the fry register?

A

90-120 Hz

127
Q

Which part of the VFs serves to resist mechanical forces and shearing?

A

The basement membrane (operate as a shock absorber.)

Voice Disorders (13 decks)

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