Voice Flashcards
Nasalization
communication between the vocal tract and the nasal passageway
Hypernasality
presence of nasal resonance during the production of nonnasal voiced sounds, particularly vowels, and diphthongs.
To assess hypernasality, a completely nonnasal phrase loaded with voiced sounds
is required
Hyponasality
occurs when there is insufficient nasal resonance on nasal sounds due to a blockage in the nasopharynx or nasal cavity
Denasality
e lack of nasal resonance on sounds that should be nasalized and, as such, can occur only on /m/, /n/, and /ŋ/. For evaluation of denasality, a phrase loaded with nasal sounds is ideal
Hoarseness
combination of breathy
and harsh qualities. It’s caused by
irregular vocal fold vibration,
making the voice sound breathy,
low-pitched, and husky
Pitch
perception of fundamental frequency
Roughness
perception of irregularity of voice
Breathiness
perception in air escaping voice
Strain
perception of excessive vocal effort
Indirect Laryngoscopy
- examine the larynx and vocal folds
indirectly, aiding in identifying voice disorders and laryngeal issues. - observes:
-Vocal Fold Mobility
-Structural Anomalies
- Mucosal Wave Action
-Symmetry and Closure
Direct Laryngoscopy
- invasive procedure that allows for a close examination of the larynx
using a laryngoscope, which is inserted through the mouth and into the pharynx under general anesthesia. - Primarily used for detailed inspection, biopsy, and surgical interventions within the larynx.
- Observes:
Structural Assessment
Biopsy Capability
Surgical Interventions
Flexible or Rigid Endoscopy with Videostroboscopy
- advanced diagnostic procedure combining endoscopy with
stroboscopic lighting to visualize the vocal folds’ vibratory patterns in slow motion - observes:
Vibratory Patterns
Vocal Fold Amplitude
Glottal Closure
Mucosal Wave
Lesions or Neoplasms
Jitter
tiny, usually unintended changes in
how fast your vocal folds vibrate when you talk or sing
Shimmer
fluctuation in your voice’s volume: small, often
unintentional changes in how loud your vocal folds make sounds as you talk or
sing
Harshness
excessive muscular tension and effort. It occurs when vocal folds are adducted too tightly, producing a rough, unpleasant, and “gravelly” sound.
Cul De Sac Resonance
resonance disorder that occurs when sound becomes trapped in a cavity, such as the throat, nose, or mouth, and is unable to exit. This is usually due to an obstruction in the vocal tract
FUNDAMENTAL FREQUENCY
Males: 100-150 Hz
Average 125 Hz
Females: 180-250 Hz
Average 200
MAXIMUM PHONATION TIME
Max time a tone can be sustained on a single breath
Males: 20 seconds
Females: 15 seconds
Children: 10 seconds
S:Z RATIO
Should be 1.0
How long a patient
can hold out /s/ v.s. /z/
Above 1.4 is indicative of pathology
Vocal Nodules
- Small nodes that develop on the superficial layer of the lamina propria
- Cause: vocal abuse or misuse
- TX: Behavioral voice therapy
Vocal Polyps
- Masses that grow and bulge from surrounding tissue in the middle 1/3rd of the superficial lamina propria.
- Cause: Traumatic use of the vocal folds
- TX: Vocal rest and change in vocal habits
Cysts
- Unilateral, benign and filled with mucus like fluid cyst on the
membranous portion of the vocal folds - Cause: Vocal misuse or abuse
- TX: Surgical intervention is usually most effective
Granulomas
- Localized, inflammatory, vascular lesion on the vocal process of the arytenoid cartilages
- Cause: Vocal strain, intubation, injury to the larynx & Laryngopharyngeal Reflux (LPR)
- TX: Surgery, voice therapy or both
Contact Ulcers
- Sores or crater-like area of ulcerated, granulated tissue that
develops (usually bilaterally) along the posterior third of the
glottal margin - Cause: Constant low pitch phonation, GERD, intubation
- Medical treatment (to fix
GERD) & voice therapy
Vocal Fold Thickening
- Vocal folds thicken along the anterior two-thirds of the glottal
margin - Cause: Vocal misuse or abuse
- Tx: Change in vocal habits
Traumatic Laryngitis
- Vocal folds become swollen causing the voice to be hoarse and
low pitched with pitch breaks - Cause: Vocal misuse or abuse
- Tx: Vocal rest and change in vocal habits
Hemangioma
- Similar to granulomas but are soft, pliable and filled with blood
- Cause: Acquired: posterior glottal area creating hoarse vocal quality
Congenial: subglottic region creating stridor - Tx: Surgical intervention followed up by voice therapy
Reinke’s Edema
- Fluid builds up in the superficial lamina propria causing swelling
- Cause: Continuous vocal abuse, exposure to cigarette smoke &
Laryngopharyngeal Reflux (LPR) - Tx: Reduction or elimination of
exposure to toxins and
irritants
Varices
- Distended and prominent veins usually at the mid portion of the
superficial lamina propria - Cause: Phonotrauma
- Tx: Vocal rest & vocal hygine
education
Vocal Fold Hemorrhage
- Blood vessels burst within the vocal folds. Depending on the
severity of the bleeding, the voice can sound hoarse and can
range from mildly dysphonic to aphonic. - Cause: Phonotrauma
- Tx: After hemorrhage is healed, remaining vocal issues can be treated through vocal fold augmentation
Hyperkeratosis
1.Rough, pinkish lesion that can appear in the oral cavity, larynx or
pharynx. May involve the epithelial cover as well as the
superficial layer of lamina propria
2. Cause: Tissue irritation, smoking, GERD or vocal abuse
3. Tx: Eliminating irritants, ablative
surgery and/or voice therapy
Leukoplakia
- Benign growths of thick whitish patches on the surface of the
membrane of the mucosa - Cause: Tissue irritation by smoking, alcohol or vocal abuse
- Tx: Combination of eliminating irritants, surgery and voice therapy
Laryngomalacia
- Soft ‘floppy’ laryngeal cartilage. Most common cause of stridor in
infants - Cause: The epiglottis is very soft a pliable due to abnormal development so
when the child breathes, the epiglottis resists the airstream - Tx: Usually resolves
spontaneously. More severe
cases may require surgery
Subglottal stenosis
- Narrowing of the subglottic space
- Cause:
Congenital: arrested development
of the conus elasticus or interruption of the cricoid cartilage during embryological development
Acquired: endotracheal intubation - Tx: Surgery and vocal
intervention
Papiloma
- Wart-like growths that are pink, white, or both and may be found
anywhere in the airway. Can cause hoarseness, breathiness and
low pitch - Cause: Human Papilloma Virus (HPV)
- Tx: Multiple surgeries followed by voice therapy
Laryngeal Web
- A membrane that grows across the anterior portion of the glottis.
Will cause difficulty breathing and inspiratory stridor - Cause: Congenital: present at birth
Acquired: due to trauma to the inner edges of the vocal folds - TX: Congenital: immediate
surgery followed by
tracheotomy
Acquired: surgery to remove
the web followed by voice
therapy
Sulcus Vocalis
- Thinning and bowing of the superficial lamina propria of the vocal folds. Can be unilateral or bilateral
- Cause: Unknown
- Tx: Surgical augmentation using
fats or fascia
Ankylosis
- Stiffening of the joints. The movement of the arytenoid is
restricted because of a bone-joint disease - Cause: Arthritis or cancer
- Tx: Treat the cause first
Structural Voice Disorder
- physical changes of vocal mechanism
- ie cysts, growths, laryngeal trauma, ulcers, lesions, edema, laryngitis, glottal stenosis
Neurogenic Voice Disorder
- innervation to structures is impaired/damaged
ie Spasmodic Dysphonia, PD, MG, ALS, vocal tremor
Functional Vocal Misuse
- normal structure, improper use/misuse
ie muscle tension dysphonia, vocal fatigue, diplophonia
Psychogenic Voice Disorder
- normal structure, psychological cause
ie conversion dysphonia, conversion aphonia, puberphonia
Aryepiglottic Folds
acts as a sphincter for the laryngeal inlet, preventing food or liquid from entering the lower respiratory tract
Cover Body theory of Phonation
cover-body theory of phonation states that the epithelium and the superficial, inter-
mediate, and deep layers of the lamina propria vibrate as a”cover” on a relatively stationary “body” This bodyis composed ofthe remainder of the TA muscle.
PVFM (Paradoxical Vocal Fold Motion)
also known as vocal cord dysfunction or laryngospasms, is a voice disorder that causes breathing difficulties when the vocal cords close instead of opening during inhalation.
