Upper Airways and Larynx Flashcards
Major functions of the larynx
Phonation
1) Phonation = production of primary vocal tone at vocal folds–> vocal quality modified by resonation through upper airway and sinonasal tract and articulated into speech
Major functions of the larynx
Respiration and swallowing
Airway patency and protection
–> normal swallowing = laryngeal elevation, posterior deflection of epiglottis, closure of true and false vocal folds to prevent aspiration
Major functions of the larynx
Valsalva
Incr pressure against tightly closed glottis –> cough, straining, throat clearing
5 Layers covering vocal folds
1) epithelium
2) superficial lamina propria
3) intermediate lamina propria
4) deep lamina propria
5) vocalis muscle (medial thyroarytenoid)
Movement of mucus through epithelium
1) moved by cilia from trachea to post glottis
2) pushed over nonciliated margin to ciliated ant commissure
Why are some diseases more prone to occur in post glottis (TB/Fungal?)
HPV tends to occur in glottis and supraglottis rarely unless you introduce epithelium
because HPV is epithelial disease
respiratory epithelium into squamous epithelium allows flow to become laminar
—> depends on whether vocal folds are together or separated
Source of voice production
Vibratory production from where?
Resonance from where?
Pulmonary/infraglottic- diaphragm, intercostal musculature
laryngeal- extrinsic and intrinsic
supraglottic and oral phase
Vib
Anterior-posterior/infraglottic components
1) tracheobronchial tree, lungs thorax
2) Abdomen- support and expiratory
3) diaphrgam - inspiratory and singing
4) passive force = lungs and rib cage
5) accessory breathing = intercostals
Purpose of abdominal support system- infraglottic
1) maintain efficient constant power source
2) inspiratory-expiratory
how can msk hurt vocal production
1) small change in posture/stance significant
2) body tension in any muscle can make larynx compensate
role of autonomic nervous system in vocal
1) ANS = muscus production and voice stability
2) fine muscular control at risk with symp stim
Extrinsic muscles involved in vocal
outside of the trachea
Strap muscles- ansa cervicalis, C1-C3
hold larynx in neck for consistent sound
changes in tension, position, tilt of extrinsic muscle changes resting length of ___
intrinsic muscles
which muscles are key to vocal consistency
extrinsic muscles
extrinsic muscles
infrahyoid
1) thyrohyoid
2) sternohyoid
3) sternothyroid
4) omohyoid
Suprahyoid muscles
1) digastric
2) mylohyoid
3) geniohyoid
4) stylohyoid
Most important vocal cartilages
functions of each
1) thyroid = open in posterior position
2) cricoid = only complete ring in airway = anatomic limit to size of airway = larger in back than in front
3) paired arytenoids = sit on cricoarytenoid joint
connected by soft tissue to change angles/distances/shape/tension via thyrohyoid membrane and cricothyroid ligament
function of intrinsic muscles
where is it located a
what is bulk of vocal fold
most important muscle in larynx is =
control actual motion of larynx
in between thyroid and cricoid and arytenoids
bulk of vocal fold = thyroarytenoid muscle
posterior cricoarytenoid muscle = contracts and pulls vocal folds together
vocal fold central innerv
what is role of nervous system
Cerebral cortex
1) speech area of temporal cortex
2) voice area of precentral gyrus
3) corticobulbar tract
4) nucleus ambiguus
5) cranial nerve X and spinal cord
6) coord laryngeal muscles, sensation, and musculature
innervation of vagus nerve
innervation of superior laryngeal nerve
- internal
- external
innerv of recurrent laryngeal nerve
1) vagus nerve = meducalla to jugular foramen
2) internal = sensation to supraglottic = incr sensitivity in people with sensitive cough
external = motor to cricothyroid muscle = stretches vocal fold to incr pitch
3) all intrinsics except cricothyroid=
more recurrent on left than right
starts in brain and ends in thyroid
incr sensitivity = incr likelihood of lung or thyroid cancer
development of
C3-C4
C6
C7
when?
C3-C4 = birth
C6= 5 y/o
C7 = 15-20 y/p
Descent of larynx leads to ____
with aging, more ___
lower vocal pitch
more descent
function of vibrator
1) air from bottom
2) opens folds apart
3) pressure incr, and pulls vocal folds together
Components of supraglottic - resonance
function?
supraglottic larynx, lips, teeth, tongue, palate, pharynx, nasal cavity, sinuses
!!!!All shape sound quality (resonance)
what happens if you have edema from URI, scarring, or muscle tension
decr resonance
how can we change frequencies of resonance?
changing shape of vocal tract
(jaw, tongue, lips, nasopharynx)
Shorter vocal tract lengths means ___
higher fundamental frequencies
children and female higher
Definitions of hoarseness
Hoarseness = abnormal voice changes, breathy, raspy, strained, weak
vocal tremor,strained, altered pitch
Definition of dysphonia
usually a __ source
§general alteration of voice quality. (tremulous, muscle tendon…)
Usually a laryngeal source
Definition of dysarthria
usually a ___ source
defect in rhythm, enunciation, articulation.
Usually a neurological or muscular source
Definition of stridor
Definition of stertor
§Stridor = large airway noise from obstruction Stertor = snoring sound from nose, nasopharynx
Definition of wheezing
pulmonary from smaller airways
causes of inspiratory stridor
expiratory stridor
biphasic stridor
§Inspiratory – supraglottic, extrathoracic = fixed obstructive mass above thoracic cavity; vocal cord dysfunction = when breathe in, close glottis
§Expiratory – tracheal, large bronchi intrathoracic = lower lesion
§Biphasic – laryngeal, immediate subglottis = narrowest point in airway so if stridor never goes away; air flow is turbulent = concerning for significant obstruction
type of stridor assoc with?
supraglottic, extrathoracic
tracheal, large bronchi intrathoracic
laryngeal, immediate subglottis
§
inspiratory
expiratory
biphasic
radiologic sign of inspiratory stridor
thumb sign
most common causes of hoarseness
1) acute viral laryngitis
3) chronic reflux
when should you see ENT for hoarseness
> 2-3 weeks
assoc with 1) pain, (ear radiation normal), 2) hemoptysis, 3) neck lump 4) complete loss of voice 5) difficulty swallowing with weight loss
work up for immobile vocal folds
1) nerve path, CT scan of skull base through aortic arch with contrast
2) laryngeal EMG
define laryngopharyngeal reflux
LPR = escape of stomach acid from stomach into esophagus through LES
–> reach larynx, oral cavity, lungs
how to treat paralyzed vocal fold
1) thyroplasty
2) injection, medialization
concerns with laryngopharyngeal reflux?
1) hoarseness
2) chronic cough
3) foreign body sensation (globus)
4 ) tracheal stenosis
5) chronic ear disease or sinusitis
Symptoms of laryngopharyngeal reflux
1) bad breath or bitter taste in a.m.
2) a.m. hoarseness or after meals
3) sensation of a lump in the throat (globus)
4) sensation of post-nasal drip but no nasal issues
5) heartburn not always present
if patient presents with
§bad breath or bitter taste in a.m.
§a.m. hoarseness or after meals
§sensation of a lump in the throat (globus)
§sensation of post-nasal drip but no nasal issues
§heartburn not always present
laryngopharyngeal reflux
laryngeal manifestations of GERD
1) voice complaints
2) > 70% asymptomatic singers have signs on examination
3) > 40 y/o
Primary treatment of laryngeal cancer
paradigm change?
primary = chemorads
laryngectomy saved for salvage only
___ if hoarsneess lasts 2-3 weeks
Reflux
Character of Hoarseness
Hoarseness is a ____ not a diagnosis
a very breathy voice could indicate ___
a weak monotonous quality indicates ___
define voice quality (characters)
1) symptom
2) paralyzed vocal fold
3) neurologic = Parkinson’s
4) hoarse, rough, weak, abnormally low/high pitched
if a patient has breathy dysphonia with abnormally high pitched quality ____
if patient has mild-mod hoarseness to complete aphonia _____
if patient has weak “old person quality” with or without tremor ____
if patient has severe hoarseness that fluctuates with voice usage ____
if patient has hoarse and low-pitched for gender ____
if patient has moderate to severe hoarseness for weeks ____
1) vocal cord paralysis
2) larynx cancer
3) presbyphonia (vocal fold atrophy)
4) vocal fold polyp/nodule
5) benign smoker’s polyp
6) acute laryngitis
Speech disorders
1) rare neuro disorder that causes changes in intensity, timing of segments, rhythm, cadence
2) difficulty producing specific sounds (what are subtypes)
3) impaired function of larynx or vocal resonance
4) weak or paralyzed speech muscles
5) caused by stroke or neuro; incosistent production of speech osunds and rearranging of sounds
1) dysprosody
2) speech sound disorders - articulation and phonemic
3) voice disorders
4) dysarthria
5) apraxia
speech disorders= describe
1) dysprosody
2) speech sound disorders - articulation and phonemic
3) voice disorders
4) dysarthria
5) apraxia
1) rare neuro disorder that causes changes in intensity, timing of segments, rhythm, cadence
2) difficulty producing specific sounds (what are subtypes)
3) impaired function of larynx or vocal resonance
4) weak or paralyzed speech muscles
5) caused by stroke or neuro; incosistent production of speech osunds and rearranging of sounds
Mechanism of voice production
1) in and out breathing laminar flow
2) at glottis becomes rhythmic
3) becomes pitches and freq
what drug do you use if person’s voice quivers or spasms on stage?
use beta blockers
nDescribe croup
airflow gets skinny for long time (inflammed airway below glottis)
Vocal nodules due to …
calluses = talking too muc
treated by speech or if become fibrotic then go surgery
Causes of inspiratory stridor
1) laryngomalacia = soft cartilage of upper larynx collapses inward during inhalation —> obstruction
2) epiglottitis = swollen infectious epiglottis
3) epiglottic cancer = biphasic fixed mass
Causes of biphasic stridor
1) patient intubated for long period of time –> tube in airway
and develop granulation tissue around so can’t open
2) croup = airflow gets skinny for long time
Describe:
1) vocal fold cysts
1) created by surgery with layer of squamous epithelium enters or from trauma
2) after screaming so much; treat with speech
3)
