Lecture 13 Child and Adult Voice Flashcards
What makes an infant vocal tract different from an adult?
shorter VT
Velum & epiglottis are in closer proximity
VFs (one big body, no ligament nor distinguishing layers)
Arytenoids are large
Laryngeal position is high (C2-C4)
Hyoid and Thyroid Cartilage are contiguous
When does the VT lengthen?
4-6 months
Velum and epiglottis reach their adult distance by?
4-6 months
When do the arytenoids reach their adult size?
4-6 months
By what age does the larynx descend to C6-C7?
15 years
When does the lamina propria develps into three distinguished layers ?
puberty - complete by 16-17
When does the vocal ligament first appear?
appears at age 4, but continues to develop
What is the main disadvantage of having a thick VF cover and increased vascularity for a child?
Makes the VF cover more susceptible to inflammatory and post-traumatic edema
By not having a differentiated layer (LP), what does this do to a child’s voice?
affects child’s ability to make fine adjustments for register control and create mucosal wave
Young children have more of this type of muscle fibers
type II (more fast acting, but fast fatiguing)
Adolescents or around the age of puberty, Laryngeal muscles are made up of this type of muscle fiber
type I : slow contracting, fatigue resistant
The thyroarytenoid muscle continues to develop until around:
age 3
The Superior Laryngeal and Recurrent Laryngeal Nerve fibers increase in number, myelination and axonal & dendritic endings until
age 3
True or False:
Children have a high fundamental frequency at infancy, but slowly lowers as child gets older
True
True or False:
Subglottic pressure (Ps) is is lower for children than for adults
False
*higher
True or False:
Children have lower mean airflow rates
True
True or False:
Max phonation times are lower until puberty
True
How would you describe a child’s lung volume and use of breathing?
A child has less lung volume, rib use is greater than abdominal when compared to adults
Fill in the Acoustic Norms for children:
Jitter - norm=_____ s.d=______
RAP - norm=_____ s.d.=______
Shimmer - norm=_____ s.d.=______
NHR - norm=_____ s.d.=______
Jitter : n - 1.4 /s.d. - 0.07
RAP : n - 0.75 / s.d. - 0.04
Shimmer : n - 3.35 / s.d. - 0.12
NHR : n - 0.11 / s.d. - 0.002
Match the max phonation time to their appropriate age groups:
- ) 6-10 seconds A.) 10-12 yrs
- ) 14-17 seconds B.) 6-10 yrs
- ) 15-22 seconds C.) 3-5 yrs
6-10 seconds : 3-5 yrs
14-17 seconds: 6-10yrs
15-22 seconds: 10-12 yrs
What is laryngomalacia?
laryngeal cartilages are soft / may collapse into airway upon inhalation / usually resolves with maturation
*common cause of infant stridor
*Signs: collapse of laryngeal cartilages / enlarged or floppy AC / excessive AC mucosa
Congenital Disorder that may be related to autosomal dominant pattern of inheritance
Laryngeal Cleft
Having a laryngeal cleft on this portion of the cricoid cartilage will cause the airway to narrow
posterior
What are the symptoms and problems associated with laryngeal cleft?
Inspiratory and expiratory stridor
Dyspnea
Aspiration
Feeding difficulties
Congenital Disorder which narrows the tissue below the level of the glottis
Subglottic Stenosis
What are the symptoms of subglottic stenosis?
Inspiratory and expiratory stridor
Dyspnea
Low pitch cough
Nostril flaring
excessive chest wall movement
What are some congenital anomalies that are seen amongst children?
Laryngeal Paralysis - birth trauma or CNS damage (Arnold Chiari Malformation)
Laryngeal Web - chormosomal abnormality
Congenital Cyst - rare
VF Papilloma
This is the most common acquired voice disorder in children
Nodules
*accounts for 50% of pediatric voice disorders
What are some examples of an acquired disorder that you can see with children?
VF nodules
VF paralysis
Laryngopharyngeal reflux
What is the method of treatment for children who have nodules?
*conservative approach is always best (no surgery)
*have the family and teacher involved
*identify and modify casual behaviors
*Resonant Voice Therapy and Flow Phonations
*Breathing & Muscle Relaxation Exercises
True or False:
Adults who have nodules as children seem to have a higher incidence of voice problems
True
What are some of the VF characteristics of an adult over 65 years old?
*laryngeal cartilages calcify
*lamin propria thickens
*less elastin and collagen, more fibrotic tissue
*atrophy of sub mucous gland
*atrophy muscles
*decreased neural firing rates for TA and CT
What are some perceptual changes for the geriatric voice?
*habitual pitch higher in males / lower in females
*hoarseness
*breathiness
*decreased frequency & intensity ranges
What are the acoustical characteristics of a geriatric voice?
Greater F0 variability
increased jitter
decreased intensity variability
slower speaking rate
What are the aerodynamic qualities of a geriatric voice?
smaller lung capacity
decreased lung pressure
greater peak airflow and greater air leakage
greater open quotient
decreased MFDR (maximum declination rate)
What are the laryngoscopic findings of a geriatric voice?
bowing, incomplete closure, posterior gap
vocal process prominence
atrophy & thinning of VFs
edema
decr. mucosal wave & amplitude of vibration
incr. VF stiffness
increased aperiodicity
What are the most disorders for the geriatric population?
Laryngeal Cancer (men)
VF paralysis
Edema
Nodules/Polyps (women)
