Vocal Fold Histology

Question 1

_____ means ____ structure, ______, and _____ of tissues.

Histology is the ____ and physiology on a _____ ____.

The _____ of the _____ ____ is the _____ for the _____ ____.

Answer 1

Histology means minute structure, composition, and function of tissues.

Histology is the anatomy and physiology on a cellular scale.

The histology of the vocal folds is the reason for the mucosal wave.

Question 2

The ________ of the glottis consists of an ____________ portion, from the anterior ________ and attachment at the ______ cartilage, to the tip of the _____ processes of the arytenoid ________.

The intermembranous ______ of the glottis is roughly the _______ 2/3 of the true vocal folds.

It also consists of the _____________ portion which is roughly the _______ 1/3 of the true vocal folds.

The line between the intermembranous ______ and the inter________ portion is located at the tip of the _____ processes of the _______ cartilages.

Answer 2

The histoanatomy of the glottis consists of an intermembranous portion, from the anterior commisure and attachment at the thyroid cartilage, to the tip of the vocal processes of the arytenoid cartilages.

The intermembranous portion of the glottis is roughly the anterior 2/3 of the true vocal folds.

It also consists of the intercartilagenous portion which is roughly the posterior 1/3 of the true vocal folds.

The line between the intermembranous portion and the intercartilagenous portion is located at the tip of the vocal processes of the arytenoid cartilages.

Question 3

The anterior glottis is ______ where most of the _______ takes place for _______.

The _______ portion of the true vocal folds is the part that is ________ to the thyroid cartilage _______ and that connection is made by the ______ _____ and the anterior _______ tendon.

The posterior/___________ glottis is the part that opens the ______, and is where ____ of the air passes through for ________.

The ________ macula flava connects the posterior/___________ glottis to the vocal ________ of the arytenoid cartilages.

Answer 3

The anterior glottis is primarily where most of the vibration takes place for phonation.

The vibratory portion of the true vocal folds is the part that is connected to the thyroid cartilage anteriorly and that connection is made by the macula flava and the anterior commisure tendon.

The posterior/intermembranous glottis is the part that opens the widest, and is where most of the air passes through for respiration.

The posterior macula flava connects the posterior/intermembranous glottis to the vocal processes of the arytenoid cartilages.

Question 4

The macula flava in _______ is important for the _____ of the true vocal folds, the development of the ______ structure of the vocal folds, and the development of the vocal _______.

In the adult, the ______ of the macula flava is more for the ________ of the cells of the TVF’s. The metabolism of the TVF cells _______ damaged ______.

The macula flava _______ what is called the ________ ______. This is the ______/__________ material in between the cells.

___-related changes in the macula flava change the _____ of the voice and the ability of the TVF’s to ______ themselves.

Answer 4

The macula flava in newborns is important for the growth of the true vocal folds, the development of the layered structure of the vocal folds, and the development of the vocal ligament.

In the adult, the function of the macula flava is more for the metabolism of the cells of the TVF’s. The metabolism of the TVF cells replaces damaged fibers.

The macula flava replaces what is called the extracellular matrices. This is the structure/scaffolding material in between the cells.

Age-related changes in the macula flava change the sound of the voice and the ability of the TVF’s to repair themselves.

Question 5

There are ______ changes between the stiffness of the ____________ glottis and the inter_________ glottis because the vocal ________ of arytenoid cartilages are made up of ______ cartilage.

The ________ of the vocal folds are _______ anteriorly, and then ______ over the ______ processes.

The _____ vocal processes bend and are significant in ________ of the TVF’s.

______ to the TVF’s like ______ or polyps will happen right at the ___ of the vocal processes between the anterior _/_ and posterior _/_.

Answer 5

There are gradual changes between the stiffness of the intercartilagenous glottis and the intermembranous glottis because the vocal processes of arytenoid cartilages are made up of elastic cartilage.

The vibrations of the vocal folds are greatest anteriorly, and then dampens over the vocal processes.

The elastic vocal processes bend and are significant in adduction of the TVF’s.

Injury to the TVF’s like nodules or polyps will happen right at the tip of the vocal processes between the anterior 2/3 and posterior 1/3.

Question 6

The adult vocal fold has _ ______ and it’s these layers that allow the _________ of the ______.

There are 5 tissues that make up the _______ _________ of the adult vocal folds and are divided into _ ______.

The 3 groups are ________ of the _____, the __________, and the ____ of the vocal folds.

Answer 6

The adult vocal fold has 5 layers and it’s these layers that allow the vibration of the tissue.

There are 5 tissues that make up the layered structure of the adult vocal folds and are divided into 3 groups.

The 3 groups are composed of the cover, the transition, and the body of the vocal folds.

Question 7

The _____ or the outer surface of the vocal folds is composed of the ______/__________, the _____ ______, and the _______ ______.

The basal lamina is located ________ the mucosa/________ and acts as a second layer. Also called the “_________ membrane ____.”

The ______ layer in the cover is the _________ layer of the lamina propria.

Then there is a _________ which is the cellular ___________ between the cover and the ____. This is the second group of the adult vocal fold.

The transition is made up of the _________ and ____ layers of the lamina propria.

The body is the ______ group of the adult vocal fold and is composed of the _____-________ muscle.

This layered structure is __________ for the ________ of the TVF’s. The ______ of voice depends on the attributes of the _________.

Answer 7

The cover or the outer surface of the vocal folds is composed of the mucosa/epithelium, the basal lamina, and the lamina propria.

The basal lamina is located underneath the mucosa/epithelium and acts as a second layer. Also called the “basement membrane zone.”

The third layer in the cover is the superficial layer of the lamina propria.

Then there is a transition which is the cellular connection between the cover and the body. This is the second group of the adult vocal fold.

The transition is made up of the intermediate and deep layers of the lamina propria.

The body is the third group of the adult vocal fold and is composed of the thyro-arytenoid muscle.

This layered structure is responsible for the vibration of the TVF’s. The timbre of voice depends on the attributes of the epithelium.

Question 8

The average fundamental frequency of the male voice is _____ Hz. The average fundamental frequency of the female voice is ____Hz.

When the vocal folds create the _______ wave, each cover has to make _______.

The _______ glottis or _______ portion is covered with _______ _________ epithelium.

The ________ glottis is covered with _____________ _______ epithelium. The ______ of this epithelium is known as ________ and _______. Anytime epithelium is _______, that cilia is meant to move _____.

Answer 8

The average fundamental frequency of the male voice is 160Hz. The average fundamental frequency of the female voice is 220Hz.

When the vocal folds create the mucosal wave, each cover has to make contact.

The anterior glottis or vibratory portion is covered with stratified squaemous epithelium.

The posterior glottis is covered with pseudostratified cilliated epithelium. The surface of this epithelium is known as microridges and microvilli. Anytime epithelium is ciliated, that cilia is meant to move mucus.

Question 9

_________ of the vocal folds is absolutely essential to ________ health. They have to be slippery and slimy to _____ past each other. If they are dry, they ___ and ________ the epithelial tissue.

Spit/saliva needs to be really ____, _______, and clear in order to ______ without irritation. Sticky saliva can cause _______ because they are catching and _______ as they vibrate.

In order to maintain good vocal _______, you need to drink a lot of _____.

Answer 9

Lubrication of the vocal folds is absolutely essential to epithelial health. They have to be slippery and slimy to slide past each other. If they are dry, they rub and irritate the epithelial tissue.

Spit/saliva needs to be really thin, slippery, and clear in order to vibrate without irritation. Sticky saliva can cause irritation because they are catching and rubbing as they vibrate.

In order to maintain good vocal hygiene, you need to drink a lot of water.

Question 10

_______ on the vocal folds ________ the _____________ ciliated epithelium and also ruins the ________ epithelium.

Surgery cuts the tissue which is really ____/_______. This makes it highly susceptible to _______. The tissue does not _______ well causing a stiff or ______ spot on the vocal folds.

When vocal folds are ______, instead of a higher pitch you get a _____ voice like Julie Andrews. Poor Mary Poppins.

Answer 10

Surgery on the vocal folds disrupts the pseudostratifiated ciliated epithelium and also ruins the squaemous epithelium.

Surgery cuts the tissue which is really thin/delicate. This makes it highly susceptible to scarring. The tissue does not recover well causing a stiff or rigid spot on the vocal folds.

When vocal folds are scarred, instead of a higher pitch you get a raspy voice like Julie Andrews. Poor Mary Poppins.

Question 11

The layers of the _______ ______ are made up of superficial, _________, and deep ______. These fibers contain a lot of _________ tissues.

The extracellular tissues are _________ within the cells and then thrown out to exist in the ________ spaces. Not a lot of _____ supply in the extracellular tissues.

The __________, deep, and _________ layers of lamina propria are structured by extracellular matrices which are made of ___________ fibers, collagen fibers, _______ fibers, and elastic fibers.

Answer 11

The layers of the lamina propria are made up of superficial, intermediate, and deep fibers. These fibers contain a lot of extracellular tissues.

The extracellular tissues are manufactured within the cells and then thrown out to exist in the interstitial spaces. Not a lot of blood supply in the extracellular tissues.

The intermediate, deep, and superficial layers of lamina propria are structured by extracellular matrices which are made of cartilagenous fibers, collagen fibers, reticular fibers, and elastic fibers.

Question 12

The ______ fibers are much more _________ compared to the elastic and reticular fibers.

As all of the fibers run ________ to the vocal folds, they form the ______ _______. The intermediate and deep layers are the ________, attaching the cover to the ____ with these different fibers.

The __________ layer of the lamina propria are primarily ______ fibers and the deep layer is primarily _______ fibers.

As we age ______ fibers and tissue become ______ and _______ breaks down. This causes changes in the TVF’s.

Answer 12

The collagen fibers are much more organized compared to the elastic and reticular fibers.

As all of the fibers run parallel to the vocal folds, they form the vocal ligament. The intermediate and deep layers are the transition, attaching the cover to the body with these different fibers.

The intermediate layer of the lamina propria are primarily elastic fibers and the deep layer is primarily collagen fibers.

As we age elastic fibers and tissue become stiffer and collagen breaks down. This causes changes in the TVF’s.

Question 13

The ______ ________ arises from the _______ border of the _______ cartilage and courses upward in an “upside down funnel shape.”

When the ______ of the conus elasticus are at the level of the _____, they terminate in _____ borders. It is the edges of the conus elasticus that forms the ______ ________.

The ___________ membrane (QM) arises from the _______ borders of _______ and from the central structure of _______ cartilage. The QM begins superiorly, courses inferiorly, and then it has its free borders in the _____.

Answer 13

The conus elasticus arises from the inferior border of the cricoid cartilage and courses upward in an “upside down funnel shape.”

When the edges of the conus elasticus are at the level of the TVF’s, they terminate in free borders. It is the edges of the conus elasticus that forms the vocal ligament.

The quadrangular membrane (QM) arises from the lateral borders of epiglottis and from the central structure of thyroid cartilage. The QM begins superiorly, courses inferiorly, and then it has its free borders in the FVF’s.

Question 14

There are lots of ________ in the larynx from _____ to ____ ____.

The position of the ______ changes in the neck from ________ to ________. The _____ of the larynx changes, and there are several ______ changes from birth to old age.

At _____, the cricoid cartilage is at about the ______ of __. In an ______, the larynx goes from roughly __ to __ so the larynx sits right under the ______.

The ________ of an infant is actually contacting the velum due to the _______ postion of the larynx. It is also _____ ___ and bulkier.

The ______ _____ is only partly ________ and the cartilages of the larynx are very _____ and pliant. The __________ of the hyoid bone is usually complete by _ ____ of age.

The high position of the larynx in the neck limits the types of sounds an _____ can make and therefore they cannot speak.

Answer 14

There are lots of changes in the larynx from birth to old age.

The position of the larynx changes in the neck from childhood to adulthood. The size of the larynx changes, and there are several tissue changes from birth to old age.

At birth, the cricoid cartilage is at about the level of C4. In an infant, the larynx goes from roughly C4 to C1 so the larynx sits right under the velum.

The epiglottis of an infant is actually contacting the velum due to the elevated postion of the larynx. It is also curled up and bulkier.

The hyoid bone is only partly occified and the cartilages of the larynx are very soft and pliant. The occification of the hyoid bone is usually complete by 2yrs of age.

The high position of the larynx in the neck limits the types of sounds an infant can make and therefore they cannot speak.

Question 15

Humans undergo a substantial ___________ of _____-________ control at about _-_ mths of age as well as patterns of _________ and of breathing.

Due to this change in neuro-muscular control, _________ becomes slightly ______ during this period and is when infants are most ________ to _______ _______ _____ _______ (SIDS).

______ also begins to _______ at 4-6 mths. The lowering of the larynx and change in size of the _______ allows the baby to make more ______. At about age _, cricoid cartilage is about the same level of __.

Answer 15

Humans undergo a substantial reorganization of neuro-muscular control at about 4-6 mths of age as well as patterns of swallowing and of breathing.

Due to this change in neuro-muscular control, breathing becomes slightly unstable during this period and is when infants are most susceptible to Sudden Infant Death Syndrome (SIDS).

Larynx also begins to descend at 4-6 mths. The lowering of the larynx and change in size of the pharynx allows the baby to make more sounds. At about age 7, cricoid cartilage is about the same level of C5.

Question 16

In an ______, the larynx is ________ in relative size than in an adult.

The ________ part of the airway is ________, underneath the TVF’s to the cricoid cartilage. In an adult and older child, the narrowest space is the ______.

From _____-_ ____ of age the larynx will _____ postion and _____. This age is when children sound about the same.

From _ ____-puberty is when some children experience a _______ change in their voices.

_______ is when the _______ change in the larynx occurs, much more so in ___ than in women.

Answer 16

In an infant, the larynx is smaller in relative size than in an adult.

The narrowest part of the airway is subglottal, underneath the TVF’s to the cricoid cartilage. In an adult and older child, the narrowest space is the glottis.

From birth-6yrs of age the larynx will lower postion and grows. This age is when children sound about the same.

From 7 yrs-puberty is when some children experience a gradual change in their voices.

Puberty is when the massive change in the larynx occurs, much more so in men than in women.

Question 17

The _______ propria in an _______ is only 1 layer compared to the _ layers in an adult.

An infant has no _______ ________, the conus _______ has not grown up into the ___. The vocal ligament does not begin to appear until _ years of age which is only _ layers at this point.

The ________ lamina propria with _ layers is not present until ________.

The _______ of a baby’s vocal folds is about _-_mm compared to _-__mm in an ______. A baby’s vocal folds are __/__ between inter__________ and inter_________.

The fundamental frequency of a baby’s voice is about ____-____Hz.

Answer 17

The lamina propria in an infant is only 1 layer compared to the 3 layers in an adult.

An infant has no vocal ligament, the conus elasticus has not grown up into the TVF. The vocal ligament does not begin to appear until 4 years of age which is only 2 layers at this point.

The mature lamina propria with 3 layers is not present until puberty.

The length of a baby’s vocal folds is about 6-8mm compared to 8-12mm in an adult. A baby’s vocal folds are 50/50 between intercartilagenous and intermembranous.

The fundamental frequency of a baby’s voice is about 400-500Hz.

Question 18

The _______ change in the larynx takes place during _______ where it descends ______.

In women, the inferior border of _______ cartilage ends at about __. In ____, it ends at about C7.

The larynx drops quite a bit which ________ the _______.

The voice is the ____ of the ______, it absolutely reflects your ________ state. It is also very susceptible to _______ changes.

Answer 18

The largest change in the larynx takes place during puberty where it descends lower.

In women, the inferior border of cricoid cartilage ends at about C6. In men, it ends at about C7.

The larynx drops quite a bit which lengthens the pharynx.

The voice is the crux of the psyche, it absolutely reflects your emotional state. It is also very susceptible to hormonal changes.

Question 19

The ______ change during _______ comes about through a __________-________ axis. These _________ are produced in the cerebrum.

_________ stress can also produce ________ changes that will reflect on the voice. ______ effects are induced by the ________ system.

The hormone ________ is produced in the _______ and ____________ is produced in the ______ for women. For ____, the androgen ___________ is produced in the testes.

These hormones are ________ in the sex organs, but are ________ by the ___________ and the _______ gland.

Answer 19

The voice change during puberty comes about through a hypothalamic-pituitary axis. These hormones are produced in the cerebrum.

Emotional stress can also produce hormone changes that will reflect on the voice. Large effects are induced by the endocrine system.

The hormone estrogen is produced in the ovaries and progesterone is produced in the uterus for women. For men, the androgen testosterone is produced in the testes.

These hormones are produced in the sex organs, but are regulated by the hypothalamus and the pituitary gland.

Question 20

________ doesn’t have any big effect on _______. They have some effect on _________ bone. Also have an effect on ________ tissue, thickening the ______ of the lamina propria.

Can cause a proliferative effect of an ____________ of mucosa. Estrogens also lessen the __________ effect which scrapes off the _______ cells of the intercartilagenous _______.

Increases _______ permeability, meaning it allows more __________ fluid to pass through ______ _____/________ spaces of the extracellular matrices causing puffines.

________ the speed of _____ -_______ ____________ through the PNS and CNS. Women become __________ during menstruation. Menstruation can also cause a change in ______ of voice.

Answer 20

Estrogen doesn’t have any big effect on muscle. They have some effect on thickening bone. Also have an effect on mucosal tissue, thickening the cover of the lamina propria.

Can cause a proliferative effect of an overproduction of mucosa. Estrogens also lessen the desquamating effect which scrapes off the squamous cells of the intercartilagenous membrane.

Increases capillary permeability, meaning it allows more extracellular fluid to pass through capillary walls/interstitial spaces of the extracellular matrices causing puffines.

Increases the speed of neuro signal transmission through the PNS and CNS. Women become hypersensitive during menstruation. Menstruation can also cause a change in quality of voice.

Question 21

When _______ levels go down after menstrual cycle __________ levels rise.

Because estrogen has an effect on the ______ of _______ transmission, this can potentially show up on results of ______-_______ disease.

The menstruation cycle can affect neuro-muscular control in women with Parkinsons, ALS, and MS.

_________ only has a serious effect if there has been a serious _____ in estrogen. Levels go back to normal when estrogen levels come down.

All women are very different in hormone levels. Progesterone acts as a ______ and decreases _____ _________ in the capillary walls.

Answer 21

When estrogen levels go down after menstrual cycle progesterone levels rise.

Because estrogen has an effect on the speed of stimuli transmission, this can potentially show up on results of neuro-muscular disease.

The menstruation cycle can affect neuro-muscular control in women with Parkinsons, ALS, and MS.

Progesterone only has a serious effect if there has been a serious spike in estrogen. Levels go back to normal when estrogen levels come down.

All women are very different in hormone levels. Progesterone acts as a diaretic and decreases fluid permeability in the capillary walls.

Question 22

___________ is an androgen and is produced in the ______. Has a much greater effect on bone ______/______ and muscle ________/______, seen during puberty (lasts 2-5yrs).

Not too much of an effect on _______ of TVF’s. Thyroid cartilage thickens and ________ TVF’s, thickens ________ muscle. Testosterone is essential for _______ characteristics in men. Puberty usually occurs from __-__yrs.

The effect of testosterone is to _______ fat content and causes change in _________ and ___________ capacity. Men have more _________ and thicker skin.

There is a ______ in the relationship btw the ______ and the thyroid cartilage. In men, the __________ muscle becomes ________ and _________ of this muscle allows falsetto production.

In a child’s _____ from the _______ cricothyroid to the posterior cricoarytenoid the vocal folds are _____. During ______, the vocal folds become more ______ and is more pronounced in men.

Answer 22

Testosterone is an androgen and is produced in the testes. Has a much greater effect on bone density/growth and muscle thickness/growth, seen during puberty (lasts 2-5yrs).

Not too much of an effect on mucosa of TVF. Thyroid cartilage thickens, lengthens TVF and, thickens striated muscle. Testosterone is essential for sexual characteristics in men. Puberty usually occurs from 12-17yrs.

The effect of testosterone is to reduce fat content and causes change in pulmonary and cardiovascular capacity. Men have more hemoglobin and thicker skin.

There is a change in the relationship btw the cricoid and the thyroid cartilage. In men, the cricothyroid muscle becomes broader and contraction of this muscle allows falsetto production.

In a child’s glottis from the anterior cricothyroid to the posterior cricoarytenoid the vocal folds are level. During puberty, the vocal folds become more angled and is more pronounced in men.

Question 23

In adulthood, from early ____ to old age elastin (highly elastic protein) content changes in the ______ and _______.

You get more elastic fibers in the layers of the ______ ______, collagen fibers _________, fewer _______ fibers, but as we age the ________ of our tissues decreases. The vocal folds become _______ through adulthood and into old age.

________ is also being _______. By age 60, the ________ of the larynx can potentially become _____.

This _________ process can also be affecting the ______ of the larynx through _______, which causes the joints to become _______.

Answer 23

In adulthood, from early 20’s to old age elastin (highly elastic protein) content changes in the cover and transition.

You get more elastic fibers in the layers of the lamina propria, collagen fibers deteriorate, fewer reticular fibers, but as we age the elasticity of our tissues decreases. The vocal folds become stiffer through adulthood and into old age.

Cartilage is also being occified. By age 60, the cartilages of the larynx can potentially become bone.

This calcification process can also be affecting the joints of the larynx through ankylosis, which causes the joints to become immobile.

Question 24

In _____, the vocal folds undergo a change in tissue. These changes are _____ ______.

As the VF ages in men, the ________ layer of the lamina propria begins to _________. Testosterone levels start to drop so _______ muscle (TVF) _______/________. The intermediate layer as well as the ________ muscle also begins to ______.

For __________ women, estrogen level drops and become more susceptible to vocal ______, _____ function, and _____ change. Begin to lose bone _______ and are vulnerable to _________.

Answer 24

In aging, the vocal folds undergo a change in tissue. These changes are sex related.

As the VF ages in men, the superficial layer of the lamina propria begins to deteriorate. Testosterone levels start to drop so striated muscle (TVF) shrinks/atrophes. The intermediate layer as well as the thyrovocalis muscle also begins to atrophe.

For menopausal women, estrogen level drops and become more susceptible to vocal fatigue, vocal function, and pitch change. Begin to lose bone density and are vulnerable to osteoporosis.

Question 25

There is an effect on the _______ due to vocal ______. _______ fatigue is due to _______ exercise or use.

Everytime your VF brush together the _______ tissue is being squeezed. This causes epithelial _____ to wear off. We must consider how quickly does tissue and muscle _______.

________ of the tissue has to do with how fast the _______ repairs itself, whether or not there is a _____ response to the site of ______ Fluid rushes to site closing off ________ and providing ________ to heal the injury.

If tissue repair is either not allowed enough ____ to heal or the process is just slow in a certain individial, _______ are the result.

_______ are fluid-filled blisters on the TVF’s. The tissue tries do ______ itself by filling itself with fluid. If ______ of voice continues, nodules turn into _______ that can affect mucosa further.

Answer 25

There is an effect on the mucosa due to vocal fatigue. Muscle fatigue is due to excessive exercise or use.

Everytime your VF brush together the epithelial tissue is being squeezed. This causes epithelial cells to wear off. We must consider how quickly does tissue and muscle recover.

Recovery of the tissue has to do with how fast the mucosa repairs itself, whether or not there is a fluid response to the site of injury. Fluid rushes to site, closing off capillaries and providing nutrients to heal the injury.

If tissue repair is either not allowed enough time to heal or the process is just slow in a certain individial, nodules are the result.

Nodules are fluid-filled blisters on the TVF. The tissue tries do defend itself by filling itself with fluid. If abuse of voice continues, nodules turn into calluces that can affect mucosa further.