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
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
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
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
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
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
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
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
9
Q
What is the larynx’s most important nonspeech role?
A
Protection by prohibiting the entry of foreign objects into the lungs
10
Q
Cough
A
- Sensation to irritant or foreign object
- Vagus nerve
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
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
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
14
Q
The only functionally mobile points of the larynx:
A
The cricothyroid and cricoarytenoid joints
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
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
17
Q
What is the aditus?
A
The entry to the larynx
18
Q
What is the vestibule of the larynx?
A
The space between the aditus and the ventricular folds (false vocal folds)
19
Q
What is the laryngeal ventricle?
A
The middle space of the larynx, which lies between the false and true vocal folds
20
Q
What are the extrinsic ligaments of the larynx?
A
Thyrohyoid membrane, lateral thyrohyoid ligament, median thyrohyoid ligament, hyoepiglottic ligament, and cricotracheal ligament
21
Q
Thyrohyoid membrane
A
Lies between the greater cornu of the hyoid and thyroid laminae
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
23
Q
Median thyrohyoid ligament
A
Extends from the corpus hyoid to the thyroid notch
24
Q
Hyoepiglottic ligament/thyroepiglottic ligament
A
Attach the epiglottis to the hyoid and inner thyroid cartilage, just below the notch
25
Cricotracheal ligament
Attaches the trachea to the larynx
26
What are the intrinsic ligaments of the larynx, and what do they do?
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
27
Quadrangular membranes
- 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
28
Aryepiglottic muscles
- Extend from the side of the epiglottis to the arytenoid
- Form the upper margin of the quadrangular membrane
- Form the aryepiglottic folds
29
Pyriform sinus
The space between the aryepiglottic fold and the thyroid cartilage
30
Vocal fold structure
Epithelium, superficial lamina propria, intermediate lamina propria, deep lamina propria, and thyroarytenoid muscle
31
Most superficial layer of the vocal folds
Epithelium
- Glistening white appearance
- Protective layer
32
Second vocal fold layer
Superficial lamina propria (SLP)
- Elastin fibers
- Stretched
- Cushions
33
Third vocal fold layer
Intermediate lamina propria (ILP)
- Elastin fibers running in an A-P direction
- Provide elasticity and strength
34
Fourth layer of vocal folds
Deep lamina propria (DLP)
- Contains collagen fibers that prohibit extension
35
Vocal ligament is made up of:
ILP and DLP (providing stiffness and support)
36
Fifth layer of vocal folds
Thyroarytenoid muscle (thyrovocalis)
37
Mucosal lining
A combination of the epithelial lining and first layer of the vocal folds
38
Intrinsic laryngeal muscle general characteristics
- 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
What are the intrinsic laryngeal muscles?
Lateral cricoarytenoid muscle, transverse cricoarytenoid muscle, oblique arytenoid muscles, posterior cricoarytenoid muscle, and cricothyroid muscle
40
Lateral cricoarytenoid muscle
- 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
Transverse arytenoid muscle
- 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
Oblique arytenoid muscles
- 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
Posterior cricoarytenoid muscle
- 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
Which muscle is the sole abducter of the vocal folds?
The posterior cricoarytenoid muscle
45
Cricothyroid muscle
- 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
Laryngeal and hyoid elevators
Digastrics, stylohyoid, mylohyoid, geniohyoid, hyoglossus, genioglossus, and thyropharyngeus
47
Laryngeal and hyoid depressors
Sternohyoid, omohyoid, sternothyroid, and thyrohyoid
48
Digastrics
- 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
Stylohyoid
- Originates on the styloid process
- Inserts into the corpus of the hyoid
- Elevates and retracts the hyoid
- Innervated by the facial nerve
50
Mylohyoid
- 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
Geniohyoid
- 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
Hyoglossus
- 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
Genioglossus
- 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
Thryopharyngeus
- 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
Sternohyoid
- Originates at the sternum
- Inserts into the inferior margin of the hyoid
- Depresses the hyoid and fixes the hyoid and larynx
56
Omohyoid
- 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
Sternothyroid
- 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
Thyrohyoid
- 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
Glottis
The space between the vocal folds
60
Subglottal region
The area below the vocal folds
61
What is phonation?
Voicing; the product of vocal fold vibration
62
What is respiration?
The energy source that permits phonation to occur
63
Thyroarytenoid
- 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
Properties of the vocal folds
- 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
Basic physics concepts of the vocal folds
- 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
Fundamental frequency
- Frequency of vibration of sustained phonation of conversational speech
- Males 80-150 cycles per second (Hz)
- Females 190-235 cycles per second (Hz)
67
The changeable elements of pitch
Tension, length, and mass
- Cricothyroid and lateral cricoarytenoid: lengthen the vocal folds
- Thyrovocalis: tenses the vocal folds
68
Intensity
- "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
Changing intensity
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
Attack
The process of bringing vocal folds together to begin phonation, requires muscular action
71
Simultaneous vocal attack
Coordinates adduction and onset of respiration so that they occur simultaneously
72
Breathy vocal attack
Starts significant airflow before adducting the vocal folds
73
Glottal attack
Adduction of the vocal folds occurs prior to the airflow, much like a cough
74
Hard glottal attack
An attack is misused - too much force - which causes damage to the vocal folds
75
Termination
- 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
Adduction
- 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
Sustained phonation
- 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
Mode of vibration
The pattern of activity that the vocal folds undergo during a cycle of vibration
79
Modal register
- 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
Glottal fry/pulse register
- 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
Falsetto
- 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
Breathy phonation
- 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
Whispering
- 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
Intensity
- Relative power or pressure of an acoustic signal, measured in dB
- Amount of pressure exerted by the sound wave
85
Ventricular phonation
- 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
Pitch
- Psychological correlate of frequency
- As frequency increases, pitch increases (cycles/second)
- Frequency of vibration changes when mass and elastic elements change
87
Optimal pitch
- 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
Habitual pitch
- 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
Bernoulli effect
- 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
Myoelastic aerodynamic theory
- 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
What are the three voice disorders listed?
Vocal nodules, laryngitis, and spasmodic dysphonia
92
Vocal nodules
- 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
Laryngitis
- 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
Spasmodic dysphonia
- 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
