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A&P of Speech and Hearing > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Framework of the larynx

A
  • Musculocartilaginous structure
  • Comprised of three unpaired and three paired cartilages
  • Sits atop the trachea
  • Average length is 44mm for males, and 36mm for females
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2
Q

Hyoid bone

A
  • Provides the union between the tongue and the laryngeal structure
  • Only free-floating bone in the body
  • Articulates loosely with the superior cornu of the thyroid cartilage
  • Corpus or body: attachment for muscles
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3
Q

Thyroid cartilage

A
  • Largest unpaired cartilage
  • Enables larynx to rock forward/backward and elevate/depress
  • Vocal folds attach to the thyroid just behind the thyroid notch
  • Inferior cornu articulates with the cricoid cartilage
  • Superior cornu articulates with the hyoid
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4
Q

Cricoid cartilage

A
  • Unpaired ring shape that sits on the trachea
  • Posterior lamina: connects to arytenoid cartilage
  • Lateral surface: connects with thyroid inferior horns
  • Would fit loosely on your little finger
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5
Q

Arytenoid cartilages

A
  • Paired cartilage
  • Sit on posterior portion of cricoid cartilage
  • Posterior attachment for the vocal folds
  • Vocal processes project anteriorly toward the thyroid notch
  • Muscular process projects laterally
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6
Q

Corniculate cartilages

A
  • Paired cartilage
  • Sits on the superior surface of each arytenoid cartilage
  • Prominent landmarks in the aryepiglottic folds
  • Another attachment for muscles
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7
Q

Cuneiform cartilages

A
  • Paired cartilages embedded within the aryepiglottic folds
  • Situated above and anterior to the corniculate cartilages
  • Provide support for the membranous laryngeal covering
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8
Q

Epiglottis

A
  • Unpaired cartilage
  • Arises from the inner surface of the thyroid
  • Attached by the thyroepiglottic ligament
  • Laterally joined with the arytenoid cartilages via the aryepiglottic folds
  • Projects upward beyond the larynx and above the hyoid bone
  • Attached to the root of the tongue by ligaments
  • Attached to the hyoid bone via the hyoepiglottic ligament
  • Surface is covered with a mucous membrane lining
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9
Q

What is the larynx’s most important nonspeech role?

A

Protection by prohibiting the entry of foreign objects into the lungs

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10
Q

Cough

A
  • Sensation to irritant or foreign object
  • Vagus nerve
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11
Q

Throat clearing

A
  • Not as violent as a full cough
  • Builds pressure in the subglottal region and clamps the vocal folds shut to restrain the pressure
  • Places the vocal folds under a great deal of strain
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12
Q

Abdominal fixation

A
  • Capturing air within the thorax to provide the muscles with a structure to push/pull
  • Similar to a cough
  • Take in a large breath, tight adduction of the vocal folds
  • Thorax becomes a rigid frame
  • Some air may escape through the adducted vocal folds and you may “grunt” when lifting something heavy
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13
Q

Breathing

A
  • Normal breathing requires the vocal folds to be abducted (open)
  • During forced exhalation (like when exercising) the need for air causes you to increase the abduction of the vocal folds
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14
Q

The only functionally mobile points of the larynx:

A

The cricothyroid and cricoarytenoid joints

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15
Q

Cricothyroid joint

A
  • Connects cricoid cartilage and inferior cornu of thyroid cartilage
  • Gliding joint
  • Thyroid rocks down in front
  • Thyroid glides forward/backward
  • Change in vocal pitch
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16
Q

Cricoarytenoid joint

A
  • Connects cricoid and arytenoid cartilages
    Gliding joint
  • Vocal processes rock towards each other (vocal folds approximate)
  • Arytenoids glide, which changes vocal fold length
  • Arytenoids rotate, which permits abduction
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17
Q

What is the aditus?

A

The entry to the larynx

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18
Q

What is the vestibule of the larynx?

A

The space between the aditus and the ventricular folds (false vocal folds)

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19
Q

What is the laryngeal ventricle?

A

The middle space of the larynx, which lies between the false and true vocal folds

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20
Q

What are the extrinsic ligaments of the larynx?

A

Thyrohyoid membrane, lateral thyrohyoid ligament, median thyrohyoid ligament, hyoepiglottic ligament, and cricotracheal ligament

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21
Q

Thyrohyoid membrane

A

Lies between the greater cornu of the hyoid and thyroid laminae

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22
Q

Lateral thyrohyoid ligament

A

Extends from the superior cornu of the thyroid to the posterior tip of the greater cornu of the hyoid

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23
Q

Median thyrohyoid ligament

A

Extends from the corpus hyoid to the thyroid notch

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24
Q

Hyoepiglottic ligament/thyroepiglottic ligament

A

Attach the epiglottis to the hyoid and inner thyroid cartilage, just below the notch

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25
Q

Cricotracheal ligament

A

Attaches the trachea to the larynx

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26
Q

What are the intrinsic ligaments of the larynx, and what do they do?

A

Quadrangular membranes and aryepiglottic muscles… they connect the cartilages of the larynx and form the support structure for the cavity of the larynx and vocal folds

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27
Q

Quadrangular membranes

A
  • Form false vocal folds
  • Originates at the inner thyroid angle and sides of the epiglottis and form an upper cone that narrows and terminates at the arytenoid and corniculate cartilages
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28
Q

Aryepiglottic muscles

A
  • Extend from the side of the epiglottis to the arytenoid
  • Form the upper margin of the quadrangular membrane
  • Form the aryepiglottic folds
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29
Q

Pyriform sinus

A

The space between the aryepiglottic fold and the thyroid cartilage

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30
Q

Vocal fold structure

A

Epithelium, superficial lamina propria, intermediate lamina propria, deep lamina propria, and thyroarytenoid muscle

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31
Q

Most superficial layer of the vocal folds

A

Epithelium
- Glistening white appearance
- Protective layer

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32
Q

Second vocal fold layer

A

Superficial lamina propria (SLP)
- Elastin fibers
- Stretched
- Cushions

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33
Q

Third vocal fold layer

A

Intermediate lamina propria (ILP)
- Elastin fibers running in an A-P direction
- Provide elasticity and strength

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34
Q

Fourth layer of vocal folds

A

Deep lamina propria (DLP)
- Contains collagen fibers that prohibit extension

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35
Q

Vocal ligament is made up of:

A

ILP and DLP (providing stiffness and support)

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36
Q

Fifth layer of vocal folds

A

Thyroarytenoid muscle (thyrovocalis)

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37
Q

Mucosal lining

A

A combination of the epithelial lining and first layer of the vocal folds

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38
Q

Intrinsic laryngeal muscle general characteristics

A
  • Origin and insertion on the laryngeal cartilages
  • Fine adjustments to the vocal mechanism
  • Opening, closing, tensing, lengthening, and relaxing the vocal folds
  • Opening and closing is achieved by the coordinated effort of many of the intrinsic muscles of the larynx
  • Changing pitch is reflected by a change in mass or tension
39
Q

What are the intrinsic laryngeal muscles?

A

Lateral cricoarytenoid muscle, transverse cricoarytenoid muscle, oblique arytenoid muscles, posterior cricoarytenoid muscle, and cricothyroid muscle

40
Q

Lateral cricoarytenoid muscle

A
  • Originates at the arch of the cricoid cartilage
  • Attaches to the cricoid and the muscular process of the arytenoid cartilage
  • Rocks the arytenoid inward and downward, adducts and lengthens the vocal folds
  • Innervated by the vagus nerve
41
Q

Transverse arytenoid muscle

A
  • Runs between the two arytenoid cartilages on the posterior surface
  • Pulls the two arytenoids closer together, approximates the vocal folds, and increases medial compression which is increased force of adduction
  • Vital element in vocal intensity change
  • Innervated by the recurrent laryngeal nerve of the vagus nerve
42
Q

Oblique arytenoid muscles

A
  • Paired muscles
  • Originate at the posterior base of the muscular process and course obliquely up to the apex of the opposite arytenoid (forming an X)
  • Pull the apex medially, promote adduction, enforce medial compression
  • Rock the arytenoid and vocal folds down and in
  • Aid in pulling the epiglottis to cover the opening to the larynx
  • Innervated by the recurrent laryngeal nerve of the vagus nerve
43
Q

Posterior cricoarytenoid muscle

A
  • Originates from the posterior cricoid lamina
  • Projects up to insert into the posterior aspect of the muscular process of the arytenoid cartilage
  • Pulls muscular process anteriorly and rocks the arytenoid cartilage
  • Sole abducter of the vocal folds
  • Innervated by the recurrent laryngeal nerve of the vagus nerve
44
Q

Which muscle is the sole abducter of the vocal folds?

A

The posterior cricoarytenoid muscle

45
Q

Cricothyroid muscle

A
  • Pars recta: originates on the anterior surface of cricoid cartilage and courses up to the lower surface of the thyroid lamina
    • Rocks the thyroid cartilage downward, brings the thyroid and cricoid closer together in front, makes the posterior cricoid more distant from the thyroid
    • Vocal folds are stretched
  • Pars oblique: arises from the lateral cricoid cartilage to the point of juncture between the thyroid laminae and inferior horns
    • Thyroid slides forward, tenses the vocal folds
  • Both tense the vocal folds
  • Together they are the major contributors for pitch change
  • Innervated by the superior laryngeal nerve of the vagus nerve
46
Q

Laryngeal and hyoid elevators

A

Digastrics, stylohyoid, mylohyoid, geniohyoid, hyoglossus, genioglossus, and thyropharyngeus

47
Q

Laryngeal and hyoid depressors

A

Sternohyoid, omohyoid, sternothyroid, and thyrohyoid

48
Q

Digastrics

A
  • Anterior belly originates on the inner surface of the mandible
    Inserts into the hyoid
    • Draws the hyoid up and forward or depresses the mandible
    • Innervated by the trigeminal nerve
  • Posterior bellyo riginates on the mastoid process of the temporal bone
    • Inserts into the juncture of the hyoid corpus and greater cornu
    • Draws hyoid up and back
    • Innervated by the facial nerve
49
Q

Stylohyoid

A
  • Originates on the styloid process
  • Inserts into the corpus of the hyoid
  • Elevates and retracts the hyoid
  • Innervated by the facial nerve
50
Q

Mylohyoid

A
  • Originates on the underside of the mandible
  • Inserts into the corpus hyoid
  • Forms the floor of the oral cavity
  • Elevates and projects the hyoid or depresses the mandible
  • Innervated by the trigeminal nerve
51
Q

Geniohyoid

A
  • Originates at the inner mandibular surface
  • Inserts into the hyoid bone at the corpus
  • Elevates and draws forward the hyoid or depresses the mandible
  • Innervated by the hypoglossal nerve
52
Q

Hyoglossus

A
  • Originates from the superior surface of the greater cornu
  • Inserts into the side of the tongue
  • Tongue depressor or hyoid elevator
  • Innervated by the hypoglossal nerve
53
Q

Genioglossus

A
  • Originates on the inner mandibular surface
  • Inserts into the tongue tip, dorsum, and anterior surface of the hyoid corpus
  • Tongue depressor and hyoid elevator
  • Innervated by the hypoglossal nerve
54
Q

Thryopharyngeus

A
  • Part of the inferior pharyngeal constrictor
  • Originates from the thyroid lamina
  • Inserts into the posterior pharyngeal raphe
  • Elevates the larynx and constricts the pharynx
  • Innervated by the recurrent laryngeal nerve of the vagus nerve
55
Q

Sternohyoid

A
  • Originates at the sternum
  • Inserts into the inferior margin of the hyoid
  • Depresses the hyoid and fixes the hyoid and larynx
56
Q

Omohyoid

A
  • Deep to the sternocleidomastoid
  • Superior belly terminates on the side of the hyoid corpus
  • Inferior belly has its origin on the upper border of the scapula
  • Depresses the hyoid bone and larynx
57
Q

Sternothyroid

A
  • Originates from the sternum and first costal cartilage
  • Inserts into the oblique line of the thyroid cartilage
  • Depresses the thyroid cartilage
  • Innervated by the hypoglossal nerve
58
Q

Thyrohyoid

A
  • Originates from the thyroid cartilage
  • Inserts into the inferior margin of the greater cornu of the hyoid bone
  • Depresses the hyoid or raises the larynx
  • Innervated by the hypoglossal nerve
59
Q

Glottis

A

The space between the vocal folds

60
Q

Subglottal region

A

The area below the vocal folds

61
Q

What is phonation?

A

Voicing; the product of vocal fold vibration

62
Q

What is respiration?

A

The energy source that permits phonation to occur

63
Q

Thyroarytenoid

A
  • Thyrovocalis
    • Medial muscle of the vocal folds
    • Originates from the inner surface of the thyroid cartilage
    • Inserts into the vocal process of the arytenoid
    • Glottal tensor: tenses the vocal folds
  • Thyromuscularis
    • Originates on the inner surface of the thyroid cartilage near the notch
    • Inserts into the muscular process of the arytenoid
    • Laryngeal relaxer
    • Relaxes the vocal folds
64
Q

Properties of the vocal folds

A
  • Elasticity: they are able to return to their original state
  • Stiffness: strength of the forces that restore it to the original state
  • Inertia: a body in motion tends to stay in motion
65
Q

Basic physics concepts of the vocal folds

A
  • Cycle: moving from one point in a pattern to the same point again
  • Period: the time it takes to pass through one cycle
  • Periodic: repeats itself in a predictable fashion
  • Frequency: how often a cycle of vibration repeats itself
  • Hertz: cycles per second (100 Hz is 100 cycles per second)
66
Q

Fundamental frequency

A
  • Frequency of vibration of sustained phonation of conversational speech
  • Males 80-150 cycles per second (Hz)
  • Females 190-235 cycles per second (Hz)
67
Q

The changeable elements of pitch

A

Tension, length, and mass

  • Cricothyroid and lateral cricoarytenoid: lengthen the vocal folds
  • Thyrovocalis: tenses the vocal folds
68
Q

Intensity

A
  • “Loudness”
  • Power or pressure in opening and closing the vocal folds
  • Medial compression: transverse and oblique arytenoids
  • Increase subglottal pressure to increase vocal intensity
69
Q

Changing intensity

A

Requires increased medial compression of the vocal folds
- Vocal folds are tightly compressed
- Takes more force to blow them open, which means more air
- They close more rapidly
- They stay closed because they are tightly compressed

70
Q

Attack

A

The process of bringing vocal folds together to begin phonation, requires muscular action

71
Q

Simultaneous vocal attack

A

Coordinates adduction and onset of respiration so that they occur simultaneously

72
Q

Breathy vocal attack

A

Starts significant airflow before adducting the vocal folds

73
Q

Glottal attack

A

Adduction of the vocal folds occurs prior to the airflow, much like a cough

74
Q

Hard glottal attack

A

An attack is misused - too much force - which causes damage to the vocal folds

75
Q

Termination

A
  • When phonation stops, the vocal folds abduct
  • We pull the vocal folds out of the airstream far enough to reduce the turbulence (using muscular action) and the vocal folds stop vibrating
  • It occurs many times during running speech
76
Q

Adduction

A
  • Is constant in all types of phonation and attack
  • The arytenoid cartilages move in three dimensions: rotating, rocking, and gliding
  • Primary movement for adduction in inward rocking
  • Combined forces of the cricothyroid and lateral cricoarytenoid cause the entire glottis to lengthen
77
Q

Sustained phonation

A
  • Vocal attack and termination requires muscular action
  • Sustained phonation requires maintenance of a laryngeal posture through sustained contraction of musculature
  • Vocal folds are held in place - it is not the product of repeated adduction and abduction - muscle spindles embedded within the thyrovocalis and thyromuscularis serve the function in holding sustained posture
78
Q

Mode of vibration

A

The pattern of activity that the vocal folds undergo during a cycle of vibration

79
Q

Modal register

A
  • Pattern of phonation used in daily conversation
  • Most efficient pattern of vibration
  • Puts the least amount of strain on the vocal folds
  • Related to your habitual pitch
80
Q

Glottal fry/pulse register

A
  • Crackly, popcorn quality of voice
  • Low in pitch, sounds rough
  • Low subglottal pressure
  • Lateral portion of the vocal folds in tensed - strong medial compression with short, thick, vocal folds
  • Syncopated mode of vibration - a secondary beat for every cycle - the vocal folds don’t just vibrate slower, but differently
81
Q

Falsetto

A
  • Vocal folds lengthen and become thin and reed-like
  • Vibrate along the tensed, bowed margins
  • Make contact only briefly and the degree of movement is reduced
  • Thin, high-pitched voice
82
Q

Breathy phonation

A
  • Vocal folds are inadequately approximated
  • Vibrating margins permit excessive airflow between them
  • Inefficient and causes air wastage
  • May signal the presence of vocal nodules, polyps, or laryngeal cancer
83
Q

Whispering

A
  • No vibration of the vocal folds
  • Vocal folds are partially adducted and tensed to develop turbulence in the airstream
  • The turbulence is the noise you use to make speech
  • Arytenoid cartilages are rotated slightly in, but are separated posteriorly
  • No voicing, however, is strenuous and can cause vocal fatigue
84
Q

Intensity

A
  • Relative power or pressure of an acoustic signal, measured in dB
  • Amount of pressure exerted by the sound wave
85
Q

Ventricular phonation

A
  • False or ventricular vocal folds are technically unable to vibrate for voice
  • In some instances, clients may use ventricular phonation as an adaptive response to severe vocal fold dysfunction
  • Forces the lateral superior walls close together
  • Phonation is deep, raspy
86
Q

Pitch

A
  • Psychological correlate of frequency
  • As frequency increases, pitch increases (cycles/second)
  • Frequency of vibration changes when mass and elastic elements change
87
Q

Optimal pitch

A
  • Vocal fold vibration that is more appropriate for an individual
  • Most efficient for a pair of vocal folds
  • Can be estimated from a throat clearing or a “huhummm”
  • Varies from gender to age
  • Females average 212 Hz, males 132 Hz
88
Q

Habitual pitch

A
  • Frequency of vibration of vocal folds that is habitually used during speech
  • Ideally this would be the same as optimal pitch
  • The choice to use an abnormally higher or lower fundamental frequency is often not a conscious decision
  • When forcing vocal folds to extremes of their range of ability, it takes greater effort and physical fatigue
89
Q

Bernoulli effect

A
  • Explains how we maintain phonation
  • Needs a constant volume flow of air
  • Vocal folds become a source of turbulence in the vocal tract
  • Effects of constricting a tube during air flow
  • As the air flows through the constriction, the rate (velocity) of flow increases, but the pressure decreases
  • Vibration of the vocal folds is the product of airflow interacting with the tissue in the absence of repetivity muscular constriction
90
Q

Myoelastic aerodynamic theory

A
  • Myo: muscles adduct the vocal folds
  • Subglottal pressure builds beneath the vocal folds (positive pressure) which blows them apart
  • Subglottal pressure then becomes negative
  • The elasticity of the vocal folds allows them to return to a closed position
  • The steady stream of air with the bernoulli effect continues the vibratory cycle without specific muscular action
91
Q

What are the three voice disorders listed?

A

Vocal nodules, laryngitis, and spasmodic dysphonia

92
Q

Vocal nodules

A
  • Aggregates of tissue on the vocal fold
  • Caused by vocal abuse
  • Can lead to permanent change in the vocal fold tissue
  • Redness, swelling
  • Hoarse, breathy voice
  • Voice treatment focuses on hygiene of the vocal folds and healthy ways to use the voice
93
Q

Laryngitis

A
  • Inflammation of the larynx, including the vocal folds
  • Redness, swelling
  • Hoarseness and loss of voice (aphonia)
  • Can be painful
  • Treatment includes increasing hydration, vocal rest and not overusing your voice
94
Q

Spasmodic dysphonia

A
  • Laryngospasms of the adductor or abductor muscles
  • Effortful, jerky tone
  • Almost sounds like stuttering
  • Usually no spasms with coughing or singing - reflexive skills
  • Cause is most likely a central motor processing disorder of the basal ganglia
  • Treatment can focus on eliminating abusive behaviors or Botox injections into the vocal folds

A&P of Speech and Hearing (5 decks)

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