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Praxis > Voice > Flashcards

Voice Flashcards

1
Q

In the cover-body theory of phonation, what is thecover

A

Epithelium

Superficial, intermediate, and deep layers of lamina propria

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2
Q

which nerve innervates the posterior belly of the digastric

A

VII

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3
Q

What does the internal branch of the SLN innervate

A

sensory info

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4
Q

what arteries supply the larynx

A

superior laryngeal
cricothyroid
inferior laryngeal

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5
Q

which are the 5 intrinsic laryngeal muscles

A
  1. thyroarytenoid
  2. cricothyroid
  3. posterior cricoarytenoid
  4. lateral cricoarytenoid
  5. interarytenoid (transerves and oblique)
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6
Q

which muscles depress the larynx

A
  1. thyrohyoid
  2. omohyoid
  3. sternothyroid
  4. sternohyoid
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7
Q

which muscles elevate the larynx

A
  1. digastric
  2. geniohyoid
  3. mylohyoid
  4. stylohyoid
  5. genioglossus
  6. hyoglossus
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8
Q

what is the mean fundamental frequency of a child

A

age 7 to 8; 281 TO 297 HZ

age 10 to 11: 238-270 HZ

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9
Q

what are the max phonation times for children

A
  1. age 3-4: 7.5 to 8.95 sec

2. age 5-12: 14.97 to 17.74 sec

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10
Q

what is the fundamental frequency of men

A

100-150 Hz or approx 125

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11
Q

what is the fundamental frequency of women

A

180 to 250 or approx 225

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12
Q

what is the max phonation time for adults

A

20.9 to 24.6 seconds

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13
Q

what happens to men’s and women’s fundamental frequency as they age

A

women lower to 201 and men raise to 132-146

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14
Q

what are age related changes in the larynx

A
  1. hardening of cartilages
  2. degeneration and atrophy of muscles
  3. degeneration of mucosa
  4. decreased flexibility of cricoarytenoid joint
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15
Q

what is presbyphonia

A

age related voice disorder characterized by perceptual changes in quality, range, loudness, and pitch

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16
Q

what is assessed in voice

A
  1. pitch
  2. loudness
  3. quality
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17
Q

what is fundamental frequency

A

vibration of the vocal fold

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18
Q

what determines the pitch of the vocal fold

A
  1. mass
  2. tension
  3. elasticity
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19
Q

what is jitter

A

irregular vibration of the vocal fold

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20
Q

what is shimmer

A

cycle to cycle variation in amplitude

more than 1 dB variation makes someone dysphonic

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21
Q

what is hoarseness

A

combination of breathy and harsh from irregular vocal fold vibration
sound low pitched breathy and husky

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22
Q

what is harshness

A

rough, unpleasant, gravelly
associated with excessive muscular tension.
folds too tightly adducted and air released too abrupt

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23
Q

what is a strain-strangle quality

A

phonation is effortful
patient sounds as if squeezing the voice at the gottis
initiating and sustaining voice difficult

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24
Q

what is breathiness

A

breathy voice from folds being slightly open
often quiet with little variation in loudness
restricted vocal range

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25
Q

what is glottal fry

A

when folds vibrate very slowly with no clear, regular pattern of vibration
results in bursts of extremely low pitch
sounds crackly

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26
Q

what is vocal fry

A
  1. vibratory cycle near the bottom of normal pitch range
  2. produced at end of long phrase when air flow and pressure are low
  3. may help modify stridency
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27
Q

what is diplophonia

A
  1. occurs when folds vibrate at different frequencies to to different degrees of mass or tension
  2. can occur with a unilateral polyp
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28
Q

what is stridency

A

shrill, unpleasant voice, somewhat high pitched and tinny

2. caused by hypertonicity or tension of pharyngeal constrictors and elevated larynx

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29
Q

what is needed in a voice case history

A
  1. patient perception of problem, onset, duration, causes, and variability
    2 any associated symptoms
  2. health, environmental and family history
  3. previous therapy, medical interventions
  4. daily usage
  5. medical history
  6. obtain perceptions of what constitutes a typical voice in culturally and linguistically diverse
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30
Q

what is necessary to have before you start voice treatment

A

medical evaluation by laryngologist

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31
Q

what is an indirect laryngoscopy

A

use a bright light and small mirror to lift the velum and press against the posterior pharyngeal wall to view larynx during phonation

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32
Q

what is direct laryngoscopy

A

performed by surgeon under general anesthesia

  1. laryngoscope introduced through mouth to vocal folds
  2. patient cannot phonate so it is a visual only
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33
Q

what is a rigid endoscopy with videostroboscopy

A
  1. introduced orally
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34
Q

what is flexible endoscopy

A

inserted through nasal passage
passes over velum
3. patient can speak
4. can also view false vocal folds to see if there are maladaptive compensatory movement

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35
Q

how does videostroboscopy work

A
  1. pulsing light is flashed at same fundamental frequency of folds
  2. microphone placed on neck along thyroid cartilage
  3. image yields info about periodicty of fold vibrations, amplitude, glottal closure, adequacy of mucosal wave, and possible presence of lesions
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36
Q

how are acoustic measures evaluated

A
  1. sound spectography
  2. electroglottography
  3. laryngeal electromyography
  4. video mymography
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37
Q

what is sound spectography

A

graphic representation of sound wave’s intensity and frequency over time

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38
Q

what is the value of wide band spectograms

A

wide band spectograms give better time resolution

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39
Q

what is the value of narrow band spectograms

A

narrow band have better frequency resolution
harmonics are easily seen
useful for evaluating voice disorders because it creates a graphic representation of the harmonic structure

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40
Q

what is electroglottography

A

surface electrodes placed on both sides of thyroid cartilage

2. high frequency electric current passed between electrodes during phonation

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41
Q

what is electromyography

A

needle inserted into peripheral laryngeal muscles

  1. look for reduced or increased speed of muscle activation, extraneous bursts of muscle activity
  2. useful to determine pathology caused by neurologial or neuromuscular disease
  3. used prior to Botox injection
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42
Q

what is videokymography

A

high speed medical imaging of vocal fold vibration
2. allows visualization of left-right vocal fold asymmetries, propagation of mucosal waves, and movement of upper and lower margins of folds

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43
Q

what is tidal volume

A

the amount of air inhaled and exhaled during normal breathing cycle

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44
Q

what is vital capacity

A

volume of air that patient can exhale after max inhalation

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45
Q

what is total lung capacity

A

total volume of air in lungs

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46
Q

what does a Visi pitch measure

A

dynamic range
intensity
frequency variability
pitch and loudness

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47
Q

what do you look for to assess respiration perceptually

A
  1. clavicular breathing: shoulders elevate during inhalation
  2. diphragmatic breathing: uses lower thoracic cavity and abdomine
  3. thoracic breathing: uses rib cage
  4. thoracic breathing
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48
Q

how is phonation assessed

A
  1. max phonation time

2. s/z ratio

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49
Q

what is an s/z ratio

A

1 indicates the efficiency of glottal closure

2. a ratio of 1.4 is indicative of laryngeal pathology

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50
Q

what do QOL assessments evaluate

A
  1. physical aspects of the voice disorder
  2. functional impacts on daily activities
  3. social impact or how patient feels about it
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51
Q

where is hypernasality mostly perceived

A

high vowels because held longer than consonants, and the high tongue position reduces space for oral resonance and increases pressure through the velum

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52
Q

which consonants are affected by hypernasality

A

fricatives, affricates, and plosives

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53
Q

what is velopharyngeal insufficiency

A

mechanism is inadequate to achieve closure

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54
Q

what are the major causes of VIP

A
  1. decreased muscle mass of velum
  2. adenoidectomy or tonsillectomy
  3. paresis of velum which reduces mobiity
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55
Q

which are frequent substitutes for hyponasality

A

b for m
d for n
and g for ng

56
Q

what is assimilative nasality

A

when a sound from a nasal consonant carries over to adjacent vowels
example: the ae in banana sounds hypernasal because it is next to /n/

57
Q

what is the cause of assimilative nasality

A

velar opening begins too soon and lasts too long

58
Q

what is cul de sac resonance

A

when sound enters the vocal tract but is blocked from exiting
trapped sound is absorbed by soft tissue
speech sounds muffled
always caused by structural issue

59
Q

what are the different types of cul de sac resonance

A
  1. oral: sound blocked from exiting oral cavity due to tongue blocking
  2. nasal: sound obstructed from exiting nasal cavity. Mostly occurs with anterior blockgte such as deviated septum or narrowing of nares
  3. pharyngeal: sound blocked from exiting oropharynx due to hypertrophied tonsils, adenoids etc
60
Q

what is a nasometer

A

an instrument that allows the patient to receive visual feedback.

61
Q

what is nasalance

A

ratio of oral to nasal production

62
Q

how is hypernasality treated

A
  1. visual aids: tissue or missor under nose
  2. ear training: video or audio recording
  3. increase patient mouth opening so oral resonance is enhanced
  4. increase patient loudness through respiration training
  5. improve articulation: exaggerating consonants can contribute to a perception of less hypernasality
  6. change speaking rate
  7. decrease pitch which can create greater oral resonance
63
Q

how is hyponasality treated

A
  1. directing sound into the area above the maxillary sinuses. have patient feel the vibrations as they exaggerate the nasal sounds
  2. nasal glide stimulation: clinician selects words with glides and nasals ( lemon, lawnmower). this combination helps direct the resonance into nasal cavity and gives auditory and kinesthetic feedback
  3. visual aids
64
Q

what are the early signs of laryngeal cancer

A
  1. hoarseness
  2. difficulty swallowing
  3. sore throat that doesnt go away
  4. ear pain
  5. pitch change due to added mass
  6. lump in the throat
65
Q

what are the categories that are assessed to classify the stage of cancer

A
  1. T: primary site of the cancer
  2. N: involvement of lymph nodes
  3. M: metastasis
66
Q

what are the treatment options for cancer

A
  1. surgery
  2. chemotherapy
  3. radiation
67
Q

what is a hemilaryngetomy

A

when only the diseased portion of the larynx is removed

68
Q

when is radiation therapy used

A
  1. may be used before surgery to attempt to eliminate the cancer
  2. may be used alone or combined with surgery
69
Q

what are the side effects of radiation

A
  1. skin burn
  2. cavities
  3. edema
  4. swallowing problems
  5. diminshed taste
  6. sore throat
  7. fatigue
  8. thrush
  9. xerostomia
  10. thick secretions
70
Q

what is involved in presurgery support of laryngectomy

A

education on anatomy and physiology and how that will change with laryngectomy
knowledge of problems that may occur post surgery

71
Q

what is the injection method of esophageal speech

A
  1. positive pressure method: patient impounds air in mouth as in saying /t/, /k/, or /p/
  2. impounded air is pushed back into the esophagus then expelled
  3. air is belched into speech
72
Q

what is the inhalation method of esophageal speech

A
  1. negative pressure; patient is taught to inhale quickly while keeping the esophagus open
  2. the inhaled air sets the tissues into vibration
73
Q

what causes hyperfunctional voice disorders

A

when there is not enough airflow, creating a tense, strained, rough, or hoarse voice
typically from nodules, cysts, or polyps

74
Q

what are causes of hypofunctional voice disorders

A

caused by inefficient muscle action
vocal folds dont come together causing excess airflow
vocal quality is breathy, hoarse, soft, and possibly aphonic
can be due to paresis

75
Q

what are nodules

A
  1. small nodes that develop on superficial layer of lamina propria
  2. typically bilateral opposite each other at the junction of anterior and middle two thirds of fold
  3. increase mass and stiffness of folds
  4. due to phonotrauma
76
Q

how are nodules treated

A

voice therapy

surgery

77
Q

what are polyps

A

masses that originate in middle one third of superficial lamina propria
2. may be filled with fluid

78
Q

what are sessile polyps

A

have a broad base and are blister like

79
Q

what are pedunculated polyps

A

attached to the vocal fold by a stalk

80
Q

what causes polyps

A
  1. phonotrauma causes submucosal bleeding which causes tumor to form
  2. can occur after just one instance of vocal abuse
  3. occurs more often in adults
  4. voice sounds breathy and hoarse. May have diplophonia
81
Q

what are cysts

A

fluid filled sac on one fold
can create a reactive lesion on opposite fold
result of phonotrauma

82
Q

how are cysts treated

A

surgery followed by education on vocal hygiene

83
Q

what is a granuloma

A

vascular lesion composed of granlar tissue in a firm round sac

  1. frequently form on the vocal process of the arytenoid cartilage
  2. can be unilateral or bilateral
84
Q

what causes granulomas

A
  1. vocal strain
  2. intubation during surgery
  3. injury to larynx
  4. laryngopharyngeal reflux LPR
  5. associated with contact ulcers
85
Q

what are the symptoms of granulomas

A
  1. sound breathy and hoarse

2. feel need to frequently clear throat which only makes the irritation worse

86
Q

how are granulomas treated

A

surgery, voice therapy or both

lifestyle change if associated with LPR

87
Q

what are contact ulcers

A

ares of ulcerated tissue that develops usually bilaterally on the posterior third of glottal margin

88
Q

what causes contact ulers

A
  1. slamming together the arytenoid cartilages during low pitched phonation accompanied by hard glottal attack
  2. frequently seen in hard driving patients who speak forcefully
  3. GERD
  4. intubation for surgery
89
Q

what causes vocal fold thickening

A
  1. prolonged vocal abusive behaviors such as throat clearing, screaming
  2. folds thicken slowly and gradually
  3. often a precursor to nodules or polyps
  4. eliminated by vocal hygiene
90
Q

what are symptoms of traumatic laryngitis

A
  1. vocal abuse irritate the folds which swell
  2. voice is hoarse and may be low pitched with pitch breaks
  3. therapy is vocal rest and changing vocal abuse
91
Q

what are hemangiomas

A
  1. similar to granulomas but are soft and filled with blood
  2. caused by intubation or GERD
  3. can be congenital
92
Q

where are acquired hemangiomas located

A

posterior glottal area and creates a hoarse voice

93
Q

where are congenital hemangiomas locatedd

A

subglottic region. They create difficuty breathing and stridor

94
Q

what is Reinkes edema

A

build up of fluid in the superficial lamina propria of both folds
result of continuous abuse, smoking and LPR

95
Q

what is the symptom of Reinkes edema

A

low pitched gravelly voice

more noticable in women

96
Q

what are varices

A

distended and prominent veins in the mid portion of superficial lamina propria
result of phonotrauma
3. individuals may have loss of upper range

97
Q

how are vocal fold hemorrhages treated

A

phonosurgery of varices can prevent hemorrhage
total voice rest during acute phase
after healing, any remaining issues that are a result of scar tissue can be treated with vocal fold augmentation

98
Q

what is hyperkeratosis

A
  1. rough, pink lesion that appears in the oral cavity, larynx, or pharynx
  2. may affect the epithelial cover or superficial layer
  3. may be precursor to malingnancy
  4. may be due to smoking, GERD, or vocal abuse
  5. symptoms include reduced loudness, and low pitch
99
Q

what is leukoplakia

A

thick white patches on mucosa

  1. due to tissue irritation caused by smoking, alcohol, or phonotrauma
  2. may appear on anterior third of vocal folds and under tongue
  3. considered precancerous
  4. patients sound rough, hoarse, lowpitched, breathy, soft volume and diplophonia
  5. treatment is surgery, therapy, eliminating exposure to irritants
100
Q

what is laryngomalacia

A

congenital condition of the laryngeal cartilages, especially the epiglottis

  1. most common cause of stridor in infants
  2. abnormal development of epiglottis which becomes very soft and pliable
  3. during breathing, the epiglottis resists the airstream
  4. usually resolves on its own
101
Q

what is subglottal stenosis

A
  1. narrowing of subglottic space
  2. can be acquired or congenital
  3. congenital cause is interruption of the cricoid development
  4. acquired is a result of intubatin from scarring
  5. symptoms may include stridor or vocal fold paralysis
102
Q

what is a papilloma

A

wart like growths due to HPV

  1. true folds most likely site
  2. results in hoarseness, breathiness, low pitch
  3. airway obstruction possible
  4. treatment includes surgery, interferon (meds) and lasar surgery
  5. voice therapy helpful after surgery. Treatment icludes relaxation excercises, amplification devices, and decreasing supraglottic hyperfunction
103
Q

what is laryngeal web

A
  1. membrane that grows acrossthe anterior flottis
  2. can be congenital or acquired
  3. results in difficulty breathing and stridor
  4. treatent for infants involves surgery followed by tracheostomy
  5. treatment for adults involves surgery
  6. following surgery a laryngeal keel is places between folds to prevent the web from growing back while patient undergoes 6-8 weeks of voice rest
104
Q

what is laryngeal trauma

A
  1. may include burns, motor vehicle accidents, sports related, attempted strangulation, and gunshot wounds
  2. symptoms include hoarse voice and stridor
  3. surgery is done to reconstruct the vocal mechanism
  4. for smokers or those with GERD, life style changes
  5. most undergo voice therapy after surgery
105
Q
  1. what is sulcus vocalis
A
  1. thinning and bowing of superficial lamina propria
  2. can be unilateral or bilateral
  3. the effect on the voice depends on the depth of the sulcus
  4. can be managed with surgical augmentation using fat or fascia or collagen
106
Q

what is laryngopharyngeal reflux or LPR

A

when the gastric contents spill into the upper pharynx ad irritate the mucosa
2. may cause contact ulcers

107
Q

how is gERD evaluated

A

manometry critical before surgery

108
Q

what is the treatment for GERD

A

antacids
propping up head at night
not exercising directly after eating
change in dietary habits

109
Q

what is ankylosis

A

stiffening of the joints

  1. movement of arytenoids restricted
  2. may be due to arthritis
  3. vocal folds may not fully close
110
Q

what does paroxysmal mean

A

symptoms occur in periodic attacks

111
Q

what is the current belief about the cause of spasmdic dysphonia

A

abnormal functioning of the basal ganglia

112
Q

what is abductor spasmodic dysphonia and its symptoms

A

intermittent fold abduction when patient tries to phonate

  1. reduced loudness, aphonia, breathy voice
  2. treatment is Botox
113
Q

what is adductor spasmodic dysphonia

A

more common type characterized by overpressure due to prolonged overadduction

  1. voice sounds strangled
  2. treatment includes botox; laser surgery to thin the paralyzed fold creating a groovewhich pulls the fold away from midline; and RLN resection where the RLN is cut to paralyze the fold on that side; AAC; voice therapy
114
Q

what voice therapy is used for spasmodic dysphonia

A

inhalation phonation

  1. increased pitch
  2. relaxation
  3. head turning
  4. counseling
  5. yawn-sigh approach
  6. easy onset of phonation
115
Q

how does MS affect the voice

A

demylination can impair

  1. prosody
  2. pitch
  3. loudness control
  4. harshness
  5. breathiness
  6. hypernasality
  7. articulatory breakdown
  8. nasal emission
116
Q

what treatments are used for MS voice effects

A
  1. symptoms are treated by steroids
117
Q

how does Myasthenia gravis affect the voice

A

due to decreased acetylchoine at the myoneuron junction:

  1. hypernasality
  2. breathy
  3. hoarse
  4. monotone
  5. softness
  6. may also have dysphagia and distorted artic
118
Q

how is myasthenia gravis treated

A
  1. steroids to improve strength and endurance

2. thymectomy or removal of the thymus gland which is abnormal in MG

119
Q

how does ALS affect the voice

A
  1. breathy
  2. low pitch
  3. monotone
  4. poor respiratory control
  5. present with combinatin of dysarthria, dysphonia, and dysphagia
120
Q

how is ALS treated

121
Q

how does Parkinson’s affect the voice

A
  1. breathy, low pitch, soft and monotone
122
Q

what is conversion aphonia

A

aphonia with no known physiologic or neurological basis

onset can be sudden or gradual

123
Q

what is mutational falsetto or puberphonia

A 
when a young man speaks with a high pitch after puberty
can be due to 
1. psychosocial factors
2. neurologic diseases
3. physical causes
124
Q

how is puberphonia treated

A

digital manipulation of the thyroid cartilage (patient taught to gently push inward on anterior thyroid cartilage while sustaining a vowel)

125
Q

how is muscle tension dysphonia treated

A

circumlaryngeal massage

126
Q

how is voice treated through behavior voice therapy

A
  1. determine reason for disorder
  2. is it hyper or hypofunctioal
  3. eliminate poor vocal hygiene
  4. address environmental factors (occupation etc)
  5. always get medical eval before starting therapy
    6 reduce vocally abusive behaviors
  6. educate patients
  7. work with family
  8. have patients monitor their abusive behaviors
  9. consider audio recordings for feedback to develop self monitoring
127
Q

what is the Lessac-Madsen Resonant Voice Therapy

A
  1. used with hyperfunctinal voice disorders
  2. increases airflow and decreases muscle action
  3. forward focus and easy phonation. Patient encouraged to feel the vibrations resonating in the front of the face and mouth, particularly on alveolar ridge
  4. patient learns by imitating the clinician
128
Q

what is chest resonance therapy

A
  1. used for patients with high laryngeal positioning
  2. client instructed to let the voice fall to the chest
  3. client hums to feel the vibration in their chest and shape the hum into words
129
Q

what is the yawn-sigh therapy

A
  1. used for hyperfunctional
  2. goal is to increae airflow
  3. client instructed to drop their tonge as they sign
130
Q

what are vocal function exercises

A
  1. developed by Semple
  2. can be ued for hyper or hypofunctional voice
  3. increaes flexibility of the folds through structured practice
  4. 4 exercises practiced twice daily as softly as possible without tension
131
Q

what is stretch and flow therapy

A

emphasizes the coordination between respiration and phonation
focus on reducing tension and effort

132
Q

what is singhale

A

an exercise where the voice is produced on inhalation

patients instructed to siren up and down to increase flexibility

133
Q

what is hard glottal attack technique

A

pushing or valsava maneuver to facilitate vocal fold closure in hpofunctional voice

134
Q

what is a technique to get vocal fold closure

A

coughing and throat clearning

135
Q

how is the Lombard Effect used

A

treatment for those who wish to lower their vocal pitch

  1. client oral reads while recorded
  2. near 10th word masking noise is used to make voice louder in response
  3. voice becomes lower
136
Q

how are female to male transgender clients treated

A

hormone therapy

137
Q

how are male to female transgender clients treated

A
  1. thyroplasty and longitudinal incisions can raise pitch
  2. build vocal stamina
  3. teach client to use more rising pitch inflections at end of utterance
  4. teach client to place tongue more anterioraly in the mouth to achieve female sounding resonance
    5

Praxis (20 decks)

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