Voice Disorder Notes Part 1

Question 1

A voice disorder exists when

Answer 1

1 A person quality pitch and loudness differ from those of similar age gender cultural background and geographic location The voice is not representative of the speaker 2 When the perceptual properties of voice are so deviant that they draw attention to the speaker 3 When the structure and or function of the laryngeal mechanism no longer meet the voice requirements of the speaker our voices should be able to handle what we ask of it in a day The voice should be able to meet those demands without physical effort or tension in the larynx

Question 3

Three goals in the assessment and management of voice disorders

Answer 3

1 Evaluation of laryngeal function using auditory and visual perceptual tasks looking and listening acoustic analysis and aerodynamic measures done instrumentally 2 Identification and modification or elimination of functional causes that lead to the development of the voice disorder causing or maintaining the voice disorder get rid of it or minimize 3 Develop a plan that will remediate the voice disorder and return the voice to improved function given the nature of the larynx if its too damage it may not be able to return to normal

Question 4

In order to meet these goals the SLP must

Answer 4

1 understand the anatomy and physiology of voice production 2 be familiar with common vocal fold pathologies 3 understand etiologic factors 4 know appropriate diagnostic techniques and 5 develop a tool box of clinical management strategies

Question 5

Early foundations of voice rehab evolved in several general voice management orientations

Answer 5

1 Hygienic voice therapy Vocal Hygiene concentrate on trying to identify behavioral causes of the voice disorder and then trying to modify or eliminate them 2 Symptomatic voice therapy Modify the deviant vocal symptoms So you listen to the voice and try and decide what is deviant about it Too high Too much of a glottal stop Too loud 3 Psychogenic voice therapy Addressing the emotions and psycho social status of the patient and anything related to that that leads to or maintains a voice disorder 4 Physiologic voice therapy Techniques that rely on direct modification of respiration phonation or resonation to improve the balance of laryngeal muscle effort the correct the focus of their tone Systemic approach Work on getting the muscles and they systems back in balance 5 Eclectic approach A mixture of all of the above What we do in real life

Question 6

Larynx

Answer 6

a cartilaginous tube connects pulmonary power supply the laryngeal valve where sound is produced and the supraglottic above the vocal folds Normal voice production relies on all three working together You have to look at all three in assessment respiration phonation and resonation

Question 7

Three Levels of Folds

Answer 7

1 Areyepiglottic folds 2 Ventricular folds 3 True Vocal folds

Question 8

Areyepiglottic folds

Answer 8

1 Connect the epiglottis to the arytenoids and form the upper rim of the larynx structure 2 When the epiglottis retroverts comes down these help to seal off the vestibule for airway protection

Question 9

Ventricular folds

Answer 9

False vocal folds 1 just superior to the true folds above the ventricles 2 They compress tightly during coughing sneezing and physical activities requiring a build up of subglottic pressure thoracic fixation Should not compress when a healthy voice is being used 3 They assist with airway protection during swallowing 4 They may close during hyperfunctional phonation The more they compress the more hyperfunctional the patient is To hard and they will have ventricular phonation and if it accompanies true fold phonation they will have diplophonia

Question 10

True Vocal folds

Answer 10

1 Open for breathing closed for airway protection and vibrate to produce sound 2 Close tightly for vegetative acts such as cough throat clear swallow or activities requiring thoracic fixation Should not be closing tightly during phonation for speech

Question 11

5 Restoring Forces

Answer 11

1 Torque of the ribs 2 Gravity 3 Relaxation of the muscles of the chest 4 Natural elasticity of the lung tissue 5 Visceral abdominal organs pressure on the diaphragm

Question 12

Inspiration Muscles

Answer 12

1 Diaphragm 2 Costal Elevators 3 External intercostals 4 Scalene Muscles 5 Sternocleidomastoid 6 Pectoralis Major and Minor

Question 13

Expiration Muscles

Answer 13

1 Internal and External Obliques 2 Rectus Abdominus 3 Posterior Abdominal 4 Transverse Abdominus 5 Transverse Thorascis 6 Internal intercostals

Question 14

Resonation

Answer 14

Sound waves are generated by the vocal folds and travel through the vestibule pharynx oral and nasal cavities and across artic structures such as the velum tongue palate teeth etc

Question 15

Laryngeal Structures

Answer 15

1 Hyoid bone 2 Epiglottis 3 Thyroid cartilage 4 Cricoid cartilage 5 Arytenoids cartilage 6 Cuneiform cartilages 7 Corniculate cartilages

Question 16

Laryngeal Joints

Answer 16

1 Cricoarytenoid joint 2 Cricothyroid joint

Question 17

Laryngeal Muscles

Answer 17

1 Extrinsic Muscles 2 Intrinsic Muscles

Question 18

Suprahyoid muscles

Answer 18

Generally pull the larynx up elevators 1 stylohyoid 2 digastic M 3 Geniohyoid M. 4 Mylohyoid M

Question 19

Infrahyoid muscles

Answer 19

Generally pull the larynx down depressors 1 Omohyoid 2 Sternohoid 3 Sternothyroid 4 Thyrohyoid

Question 20

Extrinsic Muscles

Answer 20

Suprahyoid and Infrahyoid

Question 21

Intrinsic Muscles

Answer 21

1 Cricothyroid 2 Thyroarytenoid 3 Lateral Cricoarytenoid 4 Interarytenoids 5 Posterior Cricoarytenoid

Question 22

Hyoid bone

Answer 22

Only bone that is not connect to another bone

Question 23

Epiglottis

Answer 23

Large leaf shaped structure It retroverts to help close airway It attaches to the thyroid by a ligament thyroepiglottic ligament

Question 24

Thyroid Cartilage

Answer 24

Two flat plates are called the thyroid lamina Cut out area is called the thryoid notch and the area that bulges out is called the thyroid prominence Superior and inferior corneu of the thyroid

Question 25

Cricoid Cartilage

Answer 25

sits at the top of the trachea A modified tracheal ring Looks like a class ring The flat part is called the cricoid lamina

Question 26

Arytenoid Cartilages

Answer 26

Look like pyramids they sit on top of the cricoid lamina They are in the posterior They have two processes Vocal process Inner where the vocal folds attach and the muscular process outer where the muscles attach

Question 27

Cuneiform cartilages

Answer 27

holds fold open likes the edge of the ear it helps give shape to the aryepiglottic fold AKA Cuneiform tubercle

Question 28

Corniculate cartilages

Answer 28

they do not do anything except sit on top of the arytenoids

Question 29

Cricoarytenoid Joint

Answer 29

Cricoid and Arytenoid The joint is so the arytenoids can move around on top They make a rocking like elevator door and rotating movement on top Job abduct and adduct the vocal folds

Question 30

Cricothyroid joint

Answer 30

Cricoid and Thyroid Back and forth motion stretches the folds which cause the pitch to go up Job pitch adjustment

Question 31

Cricothyroid Muscle

Answer 31

Attach to the Cricoid Cartilage and the thyroid cartilage When it contracts it is going to pull the thyroid cartilage forward The action that it creates is stretching and tensing the vocal folds Adductor Only one innervated by superior laryngeal nerve and not a recurrent laryngeal nerve

Question 32

Thyroarytenoid Muscle

Answer 32

Attaches to Thyroid and Arytenoid VOCAL FOLDS Two components the vocalis inner edge and the thryromuscularus gets heavier and thicker as it goes

Question 33

Lateral Cricoarytenoid

Answer 33

goes opposite direction of the posterior Cricoarytneoid Adductor Pulls the arytenoids back around and closes them

Question 34

Interarytenoids

Answer 34

Oblique Arytenoids and Transverse Arytenoids Because they go form one arytenoid to the other Oblique means criss cross in anatomy Adductor Squeezes them together Transverse goes across

Question 35

Posterior Cricoarytenoid

Answer 35

Posterior contracts and rotates teh arytenoids out so they ABduct and open