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Voice Flashcards

1
Q

Sulchus Vocalis

A

Etiology: Unknown, either congenital or acquired
Location: Both Uni and bi
Physical Characteristics: Spindle opening.
Voice: breathy, reduced loudness, hoarse
Treatments: voice therapy (pitch shift down) or surgery

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2
Q

Contact Ulcer

A

Etiology: 1. Intubation 2. GERD 3. Vocal abuse
Location: Posterior 1/3 on cartilaginous portion, typically unilateral
Physical Characteristics:
Voice: n/a
Treatments: Therapy not usually surgery

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3
Q

Vocal abuse

A

Hard glottal attacks
Excessive coughing
Throat clearing
Habitually loud voice

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4
Q

Contact granulomas

A

Occur with contact ulcers or alone
Etiology: GERD, intubation, vocal abuse.
Location: posterior 1/3 on cartilaginous portion
Physical characteristics: depression in VF, sometimes opposite contact ulcers
Treatments: therapy, not surgery

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5
Q

Cancer

A

Etiology: Most commonly long term smoking in addition to alcohol abuse.
Location: Varies, supraglottically, glottically, or subglottically
Physical characteristics: Bulky lesion, ranges depending on stage: TNM
T= size of the lesion 1-4
N= local spread of the disease into the neck, 1-3
M=metastasis, distant spread either 0 or 1 (most commonly into lung)
Treatments: Chemoradiation, surgery
Vocal characteristics:

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6
Q

Leukoplakia

A

aka Hyperkeratosis (pinkish)
Etiology: Smoking or other irritants
Location: larynx, oral cavity, pharynx etc.
Physical characteristics: white patchy flat “cottage cheese”
Treatments: Eliminate irritant and scrape off lesions
Vocal characteristics:

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7
Q

Endocrine changes

A

Etiology: Endocrine dysfunction, hyperfunction of pituitary gland or adrenal glands, hypothyroidism, menstrual changes, menopause.
Location: Vocal folds, glands
Physical characteristics: Increased mass of vocal folds
Treatments: Endocrine therapy
Vocal characteristics: Higher or lower than normal pitch

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8
Q

Hemangioma

A

Similar to granulomas, but soft.
Etiology: vocal hyperfunction, hyperacidity and intubation.
Location: Posterior aspect of vocal folds (difference from polyp which is anterior)
Physical characteristics: Soft blood-filled lesion
Treatments: Surgery with vocal hygeine
Vocal characteristics:

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9
Q

Infectious Laryngitis

A

Etiology: Infection
Location: Larynx
Physical characteristics: Edema, irritation, fever, URI, headache.
Treatments: Rest, increased fluid intake, antibiotics.
Vocal characteristics: Dysphonia or aphonia

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10
Q

Laryngectomy

A

Partial or complete resection of the larynx.
Stoma
Manages T3 or T4 tumors

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11
Q

Papilloma

A 
Etiology: HPV
Location: Anywhere
Physical characteristics: wart like growths
Treatments: Surgery
Vocal characteristics:
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12
Q

Pubertal changes

A

Before 9 years male and female voices have the same frequency of 265 Hz.
Females have 4 note drop.
Males have an 8 note drop

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13
Q

Web

A

Etiology: Congenital- glottal membrane fails to separate during embryonic development. Acquired- bilatera trauma to medial edges of vocal folds
Location: most common anteriorly due to proximity.
Physical characteristics: Lesion formed between 2 vocal folds, respiration difficulty.
Treatments: Surgery with keel and voice therapy after surgery.
Vocal characteristics: dysphonia, high pitched, rough sounding

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14
Q

What does the vagus nerve innervate?

A 
Striated muscles of the soft palate
Most striated muscles of the pharynx
All striated muscles of the larynx
Smooth muscles of pharynx
Smooth muscles of larynx
Sensory:
taste at root of tongue
epiglottis
Larynx
trachea
esophagus
skin behind ear
external acoustic meatus
tympanic membrane
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15
Q

Where does the Vagus nerve exit the skull?

A

Jugular foramen

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16
Q

What houses the vagus nerve as it travels through the neck?

A

Carotid sheath

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17
Q

What is the inferior sensory ganglion?

A

It allows communication with CNs VII, IX, X, XII and XII

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18
Q

What does the pharyngeal branch innervate?

A

Motor

Pharyngeal plexus, pharyngeal muscles, soft palate (except tensor vili palatini V)

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19
Q

What does the superior laryngeal nerve enervate?

A

Motor and sensory

  • Internal Branch: Sensory to mucous membranes of the base of the tongue, epiglottis, pharynx and larynx and some glands
  • External Branch: Cricothyroid muscle
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20
Q

What does the recurrent laryngeal nerve enervate?

A

Motor to all intrinsic muscles of the larynx (except cricothyroid [SLN])
Sensory to true vocal folds, subglottic region and trachea
Movement of vocal folds

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21
Q

How can the SLN be damaged?

A

Strangulation, thyroid surgery

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22
Q

How can the RLN be damaged?

A

Thyroid surgery

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23
Q

Abduction

A

Movement of the vocal folds laterally, away from the midline of the laryngeal airway.

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24
Q

Adduction

A

Movement of the vocal folds medially, toward the midline of the laryngeal airway.

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25
Amplitude perturbation
Shimmer | Irregularity of vocal fold vibration manifested by cycle to cycle variation in amplitude.
26
Shimmer
Amplitude perturbation.
27
Aphonia
Absence of a definable laryngeal tone. Breathy Whispered
28
Dysphonia
Abnormal voice, as judged by the listener, involving either pitch, loudness, quality, flexibility or a combination.
29
Fundamental frequency
F0 | The rate at which a waveform is repeated per unit time
30
Frequency perturbation
Jitter | Refers to the irregularity of vocal fold vibration manifested by cycle to cycle variation in fundamental frequency
31
Functional voice disorder
No identifiable organic etiology for the dysphonia | Voice disorder that is the result of abnormal function.
32
Glottis
The space between and bordered by the vocal folds
33
Habitual pitch
Speaking pitch | The most frequently occurring or modal pitch level used by the speaker.
34
Loudness
The perceptual correlate to intensity
35
Maximum phonation time
Vowel sustaining period possible following deep inspiration and vocalizing at a comfortable pitch and loudness. Established norms are then applied to assess adequacy of performance
36
Modal Register
May be divided into chest, middle and head Encompasses the rance of notes employed in speech This is the register used in speech.
37
Mute
Inability to phonate or articulate.
38
Organic voice disorder
Visible pathology Caused by a structural, anatomic or physiologic disease. Either a disease of the larynx itself or of a remote systemic illness which impairs laryngeal structure or function. Nodules, lesions
39
Perceptual aspects of voice
Characteristics of voice perceived by the listener. Subjective in nature Clinically, paired with the history serving as an initial guidepost in the process of differential diagnosis
40
Phonation
Physical act of sound production by means of vocal fold interaction with the exhaled airstream Puffs of air are released within an audible frequency range which resonate in the supraglottic cavities.
41
Phonation breaks
Sudden and temporary loss of voice which may occur at a syllable, word, phrase, or sentence level Etiology: hyperfunction, lesion, reduced subglottic air, mucus on vocal folds, edema
42
Phonation range
Dynamic range Difference between lowest sustained tone in the modal register and the highest in falsetto. Measured in Hz, and converted to whole notes or semitones for recording and norms comparison.
43
Pitch
The perceptual correlate of F0
44
Pitch break
Rapid shift of frequency, unexplained and uncontrolled in an upward or downward direction. Readily perceived. May occur as a result of laryngeal pathology or an accompaniment to conditions that involve some loss of neural control of phonation.
45
Symptom
``` A voice complaint. What patient reports about a problem and its characteristics 8 primary symptoms or voice problems Hoarseness Vocal fatigue Breathiness Reduced phonational range Aphonia Pitch Breaks/High pitch Strain/Struggling voice Tremor ```
46
Videolaryngoscopy
Method of evaluating and documenting the physiologic and pathologic conditions of the pharynx and larynx using a laryngoscope and specialized video equipment
47
Voice
Audible sound produced by phonation
48
Vocal folds
Shelves of thyroarytenoid muscle covered with mucous membrane and fibroelastic tissue which project into the laryngeal airway
49
Vocal fry
Creak, chest register Low pitched rough voice May be present in everyday speech Frequent in vocal strain and abuse
50
Vocal hyperfunction
Classification of a voice disorder according to the position of the vocal folds in an over adducted posture during phonation
51
Vocal hypofunction
Classification of a voice disorder according to the position of the vocal folds in an under adducted posture during phonation
52
Vocal parameters
The elements of voice Pitch: the perceptual correlate of frequency Loudness: the perceptual correlate of intensity Quality: The perceptual correlate of complexity Flexibility: The perceptual correlate of frequency, intensity and complexity variations
53
Vocal registers
Fry or pulse-low Modal-Chest, middle and head (speaking) Falsetto-high
54
Falsetto
Puberphonia Treatments: Therapy Vocal characteristics: Immature, high voice Physical characteristics: larynx looks normal
55
Functional aphonia
Treatments: Therapy | Vocal characteristics: Whispered, high pitched shrill voice. Usually have normal laugh/cry
56
Functional dysphonia
Treatments: Therapy Vocal characteristics: Physical characteristics: Feeling of fullness or pain in the larynx, tightness in chest or laryngeal area, neck tightness
57
Muscle Tension Dysphonia
Type of functional dysphonia Similar to adductor spasmodic dysphonia, but responds to treatment. Physical characteristics: Partial closure of the ventricular folds from side to side. A-->P compression of larynx Sphincter-like closure of supraglottic larynx Posterior tongue carriage Vocal characteristics: strained/strangled
58
Diplophonia
Double voice/pitch 2 distinct voice sources Caused by the vocal fold vibrating at a different rate due to difference in mass or tension. Treatment: therapy.
59
Thickening
``` Edema may be focal or generalized 2 Types: Swelling due to trauma Chronic irritation or abuse May be precursor to polyp or nodule Treated with vocal hygiene and removal of irritation ```
60
Reinke's Edema
aka polypoid degeneration Diffuse thickening secondary to chronic abuse and or smoking. Voice is low in pitch Reinke's space becomes fluid filled If caused by abuse and misuse can be treated with therapy. If caused by smoking must be remedied surgically
61
Vocal polyps
Often unilateral on the anterior 2/3 of the folds Soft and fluid filled (hemorragic-filled with blood) Result of single instance of abuse and misuse. Sessile polyps are broad based and respond to therapy and vocal hygiene. Pedunculated polyps are on a stalk and must be removed surgically
62
Vocal nodules
``` Most common benign lesion Typically bilateral at the anterior middle-third juncture. Result of long term abuse and misuse Hourglass closure Lower pitch, breathy hoarse voice ```
63
Traumatic laryngitis
aka functional laryngitis Etiology: Excessive and strained vocalizations, may be due to long term exposure to irritant Vocal characteristics: hoarse, breathy, reduced in volume. Treatment: Vocal rest
64
Ventricular Dysphonia
aka Ventricular phonation Vocal characteristics: low pitch, rough and breathy, lacks pitch variability. Ventricular folds are approximated during phonation. Treatment: Therapy
65
Videostroboscopy
``` Contact microphone Endoscope Light source Monitor Keyboard Software Camera Hard drive Printer Lens adapter Camera head External microphone Equipment cart ```
66
Vocal range
Typically 16 notes, 24 for singers
67
Neurogenic voice disorder
Result of central or peripheral nerve damage Majority are peripheral Paralysis or paresis
68
Divisions of respiratory tract
Upper: level above larynx Lower: below larynx
69
Trachea
From larynx at C6 to carina (branching of bronchi) | Cartilaginous rings and muscle, fibroelastic membrane, intratracheal membrane and epithelium
70
Glottal Fry
Start low and go lower Use for pathologies with hyperfunction: ventricular phonation, paradoxical vocal fold dysfunction, muscular tension dysphonia, nodules
71
Laryngeal Massage
Start under mandible and massage down focusing on areas of spasm Use for functional voice disorders (nodules, polyps)
72
Yawn sigh
Minimizes vocal hyperfunction, drops the larynx and moves the tongue forward. Good for functional dysphonia, spasmodic dysphonia, vocal fold thickening, nodules, polyps
73
Nasal Focus
Put finger on nose to bring focus to the nasal area and lips. Start with syllable hums and increase in length with nasal sounds. Use this for polyps, nodules and ventricular phonation
74
Nasal Glide Stimulation
Uses words containing nasals and glides and continuous voicing Use with functional dysphonia, spasmodic dysphonia, vocal fold thickening, nodules, polyps.
75
Pitch shift
Within a normal range start low and move pitch up or vice versa, can be used with nasal focus or visipitch, Use with ventricular phonation sulcus vocalis, presbylarynx
76
Chant-talk
Pitch and loudness are kept constant, words run together with no stress or prosody. Often combo with nasal focus. Use for hyperfunction, phonation and pitch breaks and nodules and polyps.
77
Pitch inflections
Shift the focus of inflection between words (I want it, I want it, I want it). Used to tread mono-pitch and mono-loudness resulting from dysarthria and functional dysphonia.
78
Visual Feedback
Visi-pitch-use with hearing impaired
79
Digital Manipulation
Grab larynx and pull down. | Use with puberphonia

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