Voice Flashcards
muscles of respiration-expiration
- internal obliques
- external obliques
- internal intercostals
- rectus abdominis
- transverse abdominis
muscles of respiration-inspiration
external intercostals
- diaphragm
- sternocleidomastoid
- scalenes
- pectoralis major
- pectoralis minor
suprahyoid muscles of the larynx
- anterior digastric
- posterior digastric
- mylohyoid
- geniohyoid
- stylohyoid
- hyoglossus
infrahyoid muscles of the larynx
- omohyoid
- thyrohyoid
- sternohyoid
- sternothyroid
intrinsic muscles of the larynx
- thyroarytenoid
- cricothyroid
- interarytenoid
- lateral cricoarytenoid
- posterior cricoarytenoid
three layers of the lamina propria
superficial, intermediate, deep
5 layers of the vocal folds
- epithelium
- superficial lamina propria
- intermediate lamina propria
- deep lamina propria
- vocalis muscle
which of the following allows air to pass into the lungs?
trachea
what cartilage part of the phonatory system has a primary duty to block the opening of the larynx when we swallow so we don’t choke?
epiglottis
according to your test, which can assist in a voice evaluation
laryngeal videostroboscopy
normal voicing requires adequate:
respiration, phonation, resonance
changes in the mucosal layer of the vocal fold body can impact which of the following:
a. vocal quality
b. vocal pitch
c. vocal loudness
d. vocal closure
an extrinsic laryngeal muscle?
mylohyoid
an intrinsic laryngeal muscle?
thyroarytenoid
what are the three MAIN layers of the vocal folds
cover, vocal ligament, body
which branch of the vagus nerve innervates the glottal and supra glottal areas?
internal laryngeal nerve and superior laryngeal nerve
which portion of the vagus nerve innervates the glottal and infra glottal areas?
recurrent laryngeal nerve
what is a modal register?
the largest portion of one’s phonational range
what term refers to the aspects of voice perceived by listeners?
vocal quality
which intrinsic laryngeal muscle is the only source of vocal fold abduction?
posterior cricoarytenoid
which intrinsic laryngeal muscles shorten the length of the vocal folds?
thyroarytenoid and lateral cricoarytenoid
which intrinsic laryngeal muscle upon contraction, creates thinner vocal folds?
cricothyroid
which phonation mode is described by high fundamental frequency, strong cricothyroid contraction, and slightly abducted vocal folds?
falsetto
what laryngeal muscle elongates the vocal folds and stiffens the cover when contracted?
cricothyroid
what is the level of the larynx in the neck of an infant relative to the cervical section of the vertebral column?
c3-c4
what is the average fundamental frequency range of an infant?
400-600 Hz
this disorder is when the false vocal folds are pulled together due to extreme hypertension and actually vibrate instead of or with the true vocal folds
ventricular phonation
this voice disorder has variable symptoms, but no real pathology, often accompanied by tension in the neck, shoulders or jaw, producing a strained vocal quality
muscle tension dysphonia
this voice pathology is caused by damage to the recurrent laryngeal nerve, often a result of a stroke or TBI, the voice tends to sound weak and breathy
recurrent laryngeal nerve paralysis (unilateral)
this condition is characterized by fluid-filled sacks/lesions composed of gelatinous material in the lamina propria
vocal fold polyps
this pathology requires surgery, chemo-therapy, radiation, SLP counseling and rehabilitative treatment of the voice
laryngeal carcinoma
this pathology is marked by inhalation “stridor” and fibrous tissue overgrowth that narrows the glottis
stenosis
this potential pathology occurs when gastric fluids seep through the esophageal sphincter to irritate the mucosa of the laryngeal area
laryngopharyngeal reflux
this vocal disorder results with a total loss of voice where the onset of aphonia is linked to an emotionally traumatic event
psychogenic conversation aphonia
this pathology results in a strained-strangles voce quality ONLY when the person is speaking, spasms are noted when the glottis closes for phonation
adductor spasmodic dysphonia
this condition is common in elite athletes, symptoms tend to be worse under conditions of exercise or stress
paradoxical vocal fold motion
this condition results in a thin voice, decreased loudness, increased breathiness, and lack of vocal flexibility in older adults
presbyphonia
this condition results from long-term trauma, presents with classical symptoms of a “smokers voice”
Reinke’s edema
this pathology occurs as bilateral symmetric lesions occurring on the medial edge between the anterior 1/3 and posterior 2/3’s of the vocal folds, results in mild to moderate dysphonia and roughness
vocal fold nodules
are nodules more prevalent in men or women?
women
this pathology is characterized by unilateral sacs on the cephalic surface or medial edge of the vocal folds
vocal fold cysts
this pathology occurs when scarring occurs on the superior lamina propria that produced a bowing or spindle shaped gap
sulcus vocalis
this condition occurs when there is a permanent tissue change in the structures of the lamina propria
vocal fold scarring
this pathology is when there are wart-like growths that develop in the epithelium and invade deeper in the lamina propria and vocals muscle
recurrent respiratory papilloma
this condition occurs when there is a build up of white plaque on the superior surface of the vocal folds
leukoplakia
this condition occurs when there is an excessive keratin buildup on the vocal folds
keratosis
this condition occurs when the vocal folds appear thickened and red
erythroplasia
this pathology is characterized by unilateral or bilateral vascular exophytic and inflammatory lesions related to tissue irritation in the posterior larynx typically on the medial surface of the arytenoid cartilages
granuloma
this pathology is characterized by ulcerated lesions on the same site and often opposite side of granulomas
contact ulcer
this condition is when post-pubescent males talk in falsetto or near the top of their modal frequency range due to resistance to puberty or feminine self-identification
puberphonia - mutational falsetto
this condition is when post-adolescent females have higher than normal pitch, breathy voice, child-like speech distortions, etc. due to resistance of transition to adulthood
juvenile voice
this pathology occurs when there is a tissue bridge between the two vocal folds at the anterior commissure due to failure of vocal fold separation in embryonic development
congenital webs (synechia)
this pathology is characterized by a floppy epiglottis that is drawn into the airway causing stridor
laryngeal malacia
this is a chronic immunological and inflammatory disorder that disrupts the normal structure and function of synovial joints, characterized by inflammation and edema
rheumatoid arthritis
what is the most common group of inflammatory disorders
allergies
this is when a patient purposefully fakes illness or injury for psychological gain
malingering
this is when patients biological sex conflicts with their desired gender
gender dysphoria
this condition occurs when gastric fluids from the stomach leak from the lower esophageal sphincter into the esophagus
gastroesophageal reflux disease (GERD)
what is the most severe neurological voice disorder
recurrent laryngeal nerve paralysis (bilateral)
this pathology is characterized by consistent and unremitting perceptual symptoms of phonatory spasms
spasmodic dysphonia
what is the main treatment for spasmodic dysphonia
botox
which subtype of spasmodic dysphonia is characterized by strained-strangled voice with voice stoppages/spasms
adductor spasmodic dysphonia
which subtype of spasmodic dysphonia is characterized by involuntary breathy bursts/spasm
abductor spasmodic dysphonia
which condition is characterized by rhythmic tremors that may involve the head, neck, arms, tongue, palate, face, and larynx either in isolation or combination
essential voice tremor
this is when pulmonary air oscillates through the false vocal folds
ventricular phonation
during this technique the clinician provides a recorded sample of the patient’s voice for them to judge correct versus incorrect production
auditory feedback
during this technique the clinician educates the patient about how vocal loudness impacts vocal fold vibration and modifies vocal loudness (either elevating or softening), based on the physical condition of the vocal folds
change of loudness
during this technique the clinician uses the target words as stimuli and they run continuously together without changes in stress or prosody, like Legato. It uses elevated pitches, sustained vowels, no syllable stress, and an elimination of hard glottal attacks. It is then modified to progress into conversational speech
chant talk
this technique is used to facilitate greater oral movements to improve oral resonance, reduce extrinsic laryngeal muscle tension, and reduce vocal strain
chewing
in this technique the clinician helps a patient explore the many intrinsic or extrinsic factors that relate to the condition and/or referring the patient for help with psychological issues when those issues go beyond the scope of practice for the voice pathologist
counseling
in this technique the clinicians use physical pressure on the thyroid cartilage to help reduce excessive extrinsic muscle contraction that is minimizing laryngeal movement
digital manipulation
in this technique the clinician helps the patient identify the behaviors that are causing harmful effects on laryngeal anatomy and/or function
elimination of abuses
in this technique the clinicians help the patient make slight alterations in vocal pitch to ensure that the patient is not straining the vocal folds beyond their normal anatomic range
establishing a new pitch
in this technique the clinicians help patients generate a voice source that is optimal with regard to resonance. The direction to the patient is to “move” the voice from the back of the throat to the front of the mouth while feeling vibrations in the nasal cavity
focus
you use this technique when the client has a a hard glottal attack (mostly) or when there is a breathy onset
glottal attack changes
you use this technique when the aim is to reduce glottal fry in the case of hyperfunctional voice disorders
glottal fry
this technique is used when clinicians help the patient identify the most stressful or anxiety provoking events, comparing situations that create a good voice or a worsening voice
hierarchy analysis
this technique is when clinicians use voice production on inspiration rather than expiration to help modify ventricular phonation of those who are unable to resist voice change when using expiration
inhalation phonation
this technique is when the the larynx is gently massaged to reduce extrinsic laryngeal muscle tension and a lower laryngeal position
laryngeal massage
this technique is when clinicians use a source of noise to induce the Lombard effect (Newby, 1972), which is known to elevate vocal loudness when noise is introduced to the patient via headphones
masking
during this technique the clinicians use words predominated by nasals and glides as therapy stimuli for those with hyperfunctional voice production as it relaxes the articulators and optimizes nasal resonance
nasal glide/stimulation
during this technique the clinicians encourage patients to open their mouth to reduce dampening of sound production and increase oral resonance
open mouth approach
open mouth approach
pitch inflections
during this technique clinicians use this technique to help patients reduce stress via relaxation exercises
relaxation
during this technique the clinician teaches the patient how to coordinate the inspiratory and expiratory phases of voice production, optimizing lung volumes for speech
respiration training
during this technique clinicians work to minimize extreme cases of hyperfunction by posturing the tongue in the position for vowel production of /i/.The high tongue position helps to reduce pharyngeal squeezing and is often used in cases of ventricular hyperfunction/phonation. Works tongue to pull its root of the pharynx and open the laryngeal aditus
tongue protrusion
during this technique clinicians use visual techniques to aid patients in identifying correct from incorrect voice production.
visual feedback
clinicians use this technique in cases of hyperfunctional voice disorders by lowering the position of the larynx, widening the pharynx, moving the tongue forward, and reducing extrinsic laryngeal muscle tension
yawn-sigh
this technique is used for clients with extended dysphonia/aphonia, you demonstrate a tone that is varied up and down in pitch and loudness and have the client imitate it
warble
this technique helps reduce tension from the true and false vocal cords and is used for muscle tension dysphonia, you close or occlude the oral cavity to reduce flow at the lips that encourages relaxation
semi-occluded valve treatment
steps of SOVT
- Insert a straw into the oral cavity about ½ inch
- Place your hand in front of the straw so that you can feel air flow during exhalation
- Now practice with vocalization of a vowel (feeling the air)
- Next practice sliding up and down while vocalizing and feeling the air, still using vowels
- Remove the straw and produce “w” words, like “wow”, “when” (feel the buzz without the straw)
when would you use auditory feedback?
when the client shows a window of improvement during the evaluation
when would you use change of loudness?
when the client has too loud or too soft of a voice, when clients are pushing the loudness the level of the larynx resulting in trauma (vocal nodules, hoarse, polyps)
when would you use chant talk?
when the client has a hyperfunctional voice disorder
when would you use chewing?
when the client has a hyperfunctional voice disorder or reduced movement of the articulators
when would you use counseling?
whenever the clients voice disorder is causing psychogenic or personality problems
when would you use digital manipulation?
for transgender voice alterations, post adolescent males whose pitch remains in prepubescent levels, vocal fold paralysis, anyone who has excessive laryngeal vertical movement or is concerned about laryngeal posturing at high or low levels
when would you use elimination of abuses?
for clients that engage in various activites of vocal abuse or misuse, hyperfunctional disorders, vocal nodules, polyps, cysts
when would you use establishing a new pitch?
when you want to reduce the stress of a healing lesion, vocal fatigue, transgender voice
when would you use focus?
when a clients voice sounds like it is coming from deep in their throat or hyperfunctional voice
when would you use glottal attack changes?
when clients that have a hard glottal attack or breathy voices (maybe unilateral paralysis or an aging voice). Hard glottal attacks may be seen in patients with posterior lesions such as granulomas or contact ulcers or hyperfunctional voices.
when would you use the glottal fry technique?
when a client has vocal nodules, polyps, cord thickening, functional dysphonia, and spasmodic dysphonia, ventricular (false fold) phonation
when would you utilize the head positioning technique?
when a client has unilateral vocal fold paralysis or vocal hyperfunction to help relax
when would you use a hierarchy analysis?
it is best for patients with some kind anxiety associated with their voicing problem, hyperfunctional voice, functional dysphonia, VF nodules, polyps, and vocal fold thickening
when would you use inhalation phonation?
when you have clients with functional aphonia, functional dysphonia, perseverates using ventricular phonation, functional dysphonia who have maladaptive voice that resists change
when would you use laryngeal massage?
clients with head/neck cancers, functional dysphonia, muscle tension dysphonia
when would you use masking?
clients with functional aphonia, functional dysphonia
when would you use nasal glide/stimulation?
clients with supraglottal resonance, functional dysphonia, spasmodic dysphonia,vocal fold thickening, nodules, polyps
when would you use the open mouth approach?
good technique for performers, when you want optimal approximation of the vocal folds
when would you use pitch inflections?
when your client has monotone voice that needs more pitch variablity or increase in pitch to help activate the cricothryroid muscle
when would you use relaxation techniques?
clients with diplophonia, dry throat/mouth, harshness, elevated pitch, functional dysphonia short of breath
when do you use tongue protrusion
clients with ventricular phonation or tightness in the voice
when do you use the yawn-sigh?
when you want to minimize tension due to vocal hyper function, functional dysphonia, spasmodic dysphonia, dysphonia related to thickening, vocal fold nodules and polyps
when do you use the warble?
clients with habitual dysphonia, nodules, vocal fold thickening, polyps, hoarse, rough, or breathy voice, aphonia
when do you use SOVT?
clients with muscle tension dysphonia
