voice disorders Flashcards
what are the layers of the vocal folds?
- cover (
- transition (form the vocal ligament)
- body ( thyroarytenoid muscle)
What makes up the cover of the VF?
- epithelium
- superficial layer of lamina propria
- much of intermediate layer of lamina propria
the average subglottic pressure during speech is ______ in conversational voice
- 4-6 cm H20 (pg.345)
relaxation pressure and subglottic pressure are equal at about ____% vital capacity
55 (pg.345)
describe vf during voicing/vibration.
-vocal folds open due to the buildup of air below the -pressure pushes the tissue upward and apart
____ is a series of ranges of consecutively phonated frequencies that can be produced with nearly identical voice quality and that ordinary do not overlap
register (pg.346)
-the average cycle-to-cycle change in frequency from one cycle to the next
jitter (pg.347)
-average cycle-to-cycle change in amplitude from one cycle to the next
shimmer
stroboscopic and related visual measures
-refers to whether the left and right vocal folds move symmetrically during vibration
symmetry (pg.347)
stroboscopic and related visual measures
-the extent of horizontal excursion of the vocal folds during vibration
amplitude (pg.347)
stroboscopic and related visual measures
-the regularity of successive cycles of vibration
peridoicity (pg.347)
- corresponds to the movement of the superior surface, or cover, of the vocal fold laterally during vibration
- travels about half the width of the vocal fold at typical pitch and loudness
mucosal wave (pg.348)
larynx forms from branchial arches ____,____, and _____ and all structures are present at ___ months gestation
4,5,6 and 3 (pg.348)
the vocal ligament is present by age ____ and develops to about age ____
2, 16 (pg.348)
what is ADMET?
aerodynamic myoelastic theory of phonation (pg.348)
essential tremor of the voiceem?
what is thought to result from a lesion in the extrapyramidal system of the central nervous system?
What makes vocal tremor worse?
worsens with fatigue or strong emotion
treatment for voice tremor ?
none
_____ slightly reduce the frequency and amplitude of the tremor ,but the effect is only temporary for essential tremor of the voice
Botox injections
can speech therapy maximize intelligibility for essential tremor ?
yes
what are some strategies to be addressed during speech therapy for essential tremor?
- shortening vowel duration
- shortening phrases length
- elevating pitch
what are the 4 populations who are high risk of voice disorders
- professional voice users
- transgender individuals
- persons with velopharyngeal incompetency
- persons with hearing loss
(pg. 355-356)
focusing on ____ is the most common, specific feature targeted in therapy, but the overall goal is to modify the overall _____ and _____ projected by the transgender patient
fundamental frequency, image and identity (pg. 355)
why are people with velopharyngeal incompetency at risk for voice disorders?
- they will attempt to compensate for the poor closure by excessive closing of the laryngeal valve
- this repeated hyper function may result in formation of traumatic lesions on the vocal folds
(pg. 355)
the international classification of functioning are categorized into what 3 inter-connected areas?
- impairments
- activity limitations
- participation restrictions
(pg. 356)
what are 5 guidelines for good vocal health?
- rare or minimal use of loud, effortful voice
- attention to potential larygo-pharyngeal reflux
- reducing unnecessary coughing and throat-clearing
- adequate hydration
- holistic elements: good nutrition, enough rest, regular physical exercise, good mental health
(pg. 358)
-focuses on optimizing voice quality through a focus on maximizing oral-pharyngeal resonance and the degree of medial compression between the vocal folds
a. resonant voice therapy (pg.358)
-injection into thyroarytenoid or other intrinsic muscles for treatment of spasmodic dysphonia and sometimes essential tremor of the voice
b. botox (pg.358)
-have been shown to be useful in improving vocal range, stability, flexibility and resonance in a variety of normal and disordered populations
c. vocal function exercise (pg.358)
Instrumental Evaluation:
- views velopharyngeal mechanism, including velopharyngeal valving and laryngeal mechanism
- 2 types of _________-flexible(nasally) and rigid (nasally)
- light and camera attached to scope
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
d. Endoscopy
Instrumental Evaluation:
- acoustic measurement of voice
- spectrogram reflects resonant characteristics of vocal tract and harmonic nature of glottal sound source
- sound spectrograph is graphic representation of wave’s intensity and frequency
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
e. Acoustic Analysis
Instrumental Evaluation:
- excellent view of vocal mechanism during phonation
- thin, flexible tubing containing fiber-optic light bundles
- tube inserted through nasal passage, passes over velum and into position above larynx
- Transmits image to eyepiece
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
c.Flexible Fiber-Optic
Laryngoscopy
Instrumental Evaluation:
- direct microscopic view of larynx
- performed by surgeon
- laryngoscope introduced through mouth into pharynx and positioned about vocal folds.
- valuable when biopsy is required
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
b. Direct Laryngoscopy
Instrumental Evaluation:
- Views laryngeal structures during phonation
- Uses bright light source and small round mirror
- Lift velum and press against posterior pharyngeal wall
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
a. Indirect Laryngoscopy
Instrumental Evaluation:
- info about periodicity or regularity of vocal fold vibrations, vocal fold amplitude, glottal closure, presence and adequacy of mucosal wave and possible presence of lesions or neoplasm
- helpful in differentiating between functional and organic problems
- gives picture of cycle to cycle vibration
- strobe light permits optical illusion of slow motion viewing of vocal folds
a. Indirect Laryngoscopy
b. Direct Laryngoscopy
c.Flexible Fiber-Optic
Laryngoscopy
d. Endoscopy
e. Acoustic Analysis
f. Videostroboscopy
Videostroboscopy
Instrumental Evaluation:
- visualizes human vocal fold vibration dynamics
- medical imaging
- uses videocamera
- allows for view of vocal fold asymmetries, problems with mucosal waves, and movement of upper and lower margins of vocal folds.
a. Electroglottography (EGG)
b. Electromyography (EMG)
c. Videokymography
d. Aerodynamic Measurements
e. Pitch Measurements
c. Videokymography
Instrumental Evaluation:
- measures laryngeal function directly to study pattern of electrical activity of vocal folds and view muscle activity patterns
- electrodes inserted into peripheral laryngeal muscles
- can verify excessive muscle activity, help determine vocal fold pathology.
a. Electroglottography (EGG)
b. Electromyography (EMG)
c. Videokymography
d. Aerodynamic Measurements
e. Pitch Measurements
b. Electromyography (EMG)
Instrumental Evaluation:
- airflows, air volumes, average air pressure as produced by respiratory, laryngeal and supralaryngeal airways.
- used to evaluate dysphonia, monitor voice changes, differentiate between laryngeal and respiratory problems
a. Electroglottography (EGG)
b. Electromyography (EMG)
c. Videokymography
d. Aerodynamic Measurements
e. Pitch Measurements
d. Aerodynamic Measurements
Instrumental Evaluation:
- indirect measure of vocal fold closure patterns
- surface electrodes are placed on both side of thyroid cartilage and high-frequency current is passed between while patient phonates
- -can detect breathy and glottal phonation
- currently efficacy is controversial
a. Electroglottography (EGG)
b. Electromyography (EMG)
c. Videokymography
d. Aerodynamic Measurements
e. Pitch Measurements
a. Electroglottography (EGG)
Instrumental Evaluation:
-many instruments can be used
Quantitative measurements of pitch characteristics
a. Electroglottography (EGG)
b. Electromyography (EMG)
c. Videokymography
d. Aerodynamic Measurements
e. Pitch Measurements
e. Pitch Measurements
total volume of air in lungs
Total lung capacity
volume of air that patient can exhale after maximal inhalation
Vital capacity
amount of air inhaled and exhaled during normal breathing cycle
Tidal volume
Perceptual evaluation
pitch loudness resonance respiration phonation
When sound from nasal consonant arries into adjacent vowels
Velar openings begin too soon and last too long
Functionally or organically based
Assimilative Nasality
Types of alaryngeal speech
external devices
esophageal
surgical modifications
Tracheoesophageal puncture (TEP)-
Tracheoesophageal puncture (TEP)-tracheoesophageal wall that separates trachea and esophagus is punctured and a shunt connects the structures.
To speak pt exhales and closes stoma with finger, air enters through opening of tube, passing from trachea and esophagus. Esophagus vibrates and sound is produced.
Mutational falsetto or puberphonia
high pitch in a man after puberty and a man has developed properly
“Functional”
- Occurs when voice is abnormal in the presence of normal laryngeal structures
- During attempt to phonate, folds may remain fully or partially abducted.
- Hysterical or conversion aphonia, no evidence of structural pathology.
Open-mouth approach
- increases volume
- imrpoves oral-nasal resonance balance
Relaxation Exercises
-reduces tension
Chant-talk method
wprds are spoken in connected manner, with soft glottal attack, even stress, prolongation of sounds and absence of stress on words.
Digital manipulation of larynx
lowers pitch
decreases tension
treatment of Mutational falsetto or puberphonia
digital manipulation
Average MPT for adults
20.9-24.6
fundamental frequency
habitual pitch
pitch
frequency of vocal fold vibration
frequency perturbation or jitter
volume
loudness determined by intensity of sound
amplitude perturbation or shimmer
sound
disturbance of particles that move in waves called amplitude
quality
hysical complexity of layngeal tone modifeid by resonating cavitities
Which instrumental evaluation can give you a quantatative analysis of analysis for speech?
Acoustic analysis in the form of a spectrogram.
How much varaition should a patient have of intensity with each vibratory cycle?
very little or none.
How is shimmer measured?
pt sustains “ahhh”
How much variation in shimmer will make a patient sound dysphonic?
1 dB
How is jitter measured?
pt. sustains an “ahhhh”
How is pitch determined?
mass, tension, and length of vocal folds.
People with no vocal pathology are able too sustain a vowel with less that ____% jitter.
1
What kind of patients show a large amount of jitter?
dysphonic, hoarse, tremor.
Is it ok to advise a transgender client to have surgery?
yes
What is the injection method?
- pt impounds air in the mouth
- impounded air is pushed into the esophagus and then expelled, producing vibrations of the soft tissue of the esophagus
- resulting belch is shaped into speech
What is the inhalation method?
- pt is taught to inhale rapidly while keeping the esophagusopen and relaxed
- relaxed air passes through the esphogusand sets its tissues into vibratory motion.
- resulting sound is shaped into speech
What does the Bloom-singer device do?
prevents passage of fluid and food into the trachea and shunts air from the trachea to the esophagus so the patient can speak on that air.
