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Voice Disorders > Voice Disorders Study Notes 2 > Flashcards

Voice Disorders Study Notes 2 Flashcards

2
Q

5 layers of vocal folds

A

1 Epithelium 2 Superficial layer of the Lamina Propria 3 Intermediate layer of the lamina Propira 4 Deep layer of the lamina Propria 5 Vocalis muscle

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3
Q

Epithelium

A

Outer most layer the free edge of the vocal fold Mucosal cell Stratified Squamous Cell Thinnest layer and very compliant Layer of mucus lubrication that helps it oscillate

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4
Q

Basement Membrane Zone BMZ

A

a well defined microcellular transition region between the epithelium and the superficial lamina propria It is made up of collagen anchoring fibers that allow tissue in the VF mucosa to shift and glide Transition and Attachment

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5
Q

Superficial Layer of the Lamina Propria

A

Also has elastin and collagen fibers Fairly loose and flexible and is described as gelatin like Has a lot of movement during phonation If a pathology like a cyst or tumor grows down in this layer the fold will not vibrate well and it will effect vocal quality

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6
Q

Reinkes Space

A

Located in the superficial layer of the lamina propria part of the superficial layer an area that is susceptible to edema

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7
Q

Intermediate layer of the Lamina Propria

A

Mostly elastin fibers denser more mass still vibrates but not as much as the outer two layers

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8
Q

Deep Layer of the Lamina Propria

A

Mostly collagen and more dense less vibratory

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9
Q

Vocalis Muscle

A

Part of the thyroid arytenoid muscle The more internal edge of the muscle Represents the main body of the vocal folds Creates tone stability and mass Only part that can contract and have msucle control

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10
Q

Afferent sensory

A

1 Sensory messages from sensory receptors in the laryngeal mucosa and respiratory passages send afferent messages to the CNS via the internal branch of the Superior Laryngeal Nerve branch of the Vagus Nerve X and terminate in the medulla at the necleus tractus solitaries NTS

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11
Q

Efferent motor

A

1 Motor commands for voice production originate in the pre central gyrus of the cortex 2 Both pyramidal and extrapyramidal motor pathways are involved in laryngeal control 3 The nucleus ambiguous contains central origins of the laryngeal motoneurons for all intrinsic laryngeal muscles motoneurons for esophageal and respiratory control are also located here The nucleus ambiguous is located in the reticular formation

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12
Q

2 branches of the Vagus Nerve

A

Superior Laryngeal Nerve SLN and Recurrent Laryngeal Nerve RLN

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13
Q

Superior Laryngeal Nerve

A

1 Internal branch 2 External branch

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14
Q

Internal branch

A

provides sensory information to the larynx

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15
Q

External branch

A

Motor innervations to the Cricothyroid muscle Only muscle of the voice that innervates Causes mono pitch

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16
Q

Recurrent Laryngeal Nerve

A

1 courses down near the heart then back up more so on the left than on the right Therefore they are more susceptible to injury 2 Supplies all sensory information below the vocal folds trachea cough 3 Supplies all motor innervations to the posterior cricoarytenoid lateral cricoarytenoid thyroarytenoid and oblique transverse interarytenoids all intrinsic except the cricothyroid m

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17
Q

IX glossalpharyngeal

A

Sends motor info down to pharynx and helps innervate the soft palate RESONANCE

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18
Q

XI Spinal accessory Nerve

A

Innervates some of the neck muscles which can effect hyper function of the larynx Levator Veli Palatini and the uvula RESONANCE LARYNGEAL POSITIONING

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19
Q

XII Hypoglossal

A

Innervates tongue and the strap muscles of the neck POSITIONING MUSCLES IN NEXT can effect tension

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20
Q

Laryneal reflexes

A

Will shut down maybe due to irritation maybe a form of spasm New name irritable larynx syndrome You inhale something you should not it closes off But if it happens in a non protective way it is a problem 1 Laryngeal adductor response 2 Laryngospasm

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21
Q

Laryngeal Adductor Response

A

tight sphincteric closure to protect the airway to closing off the trachea and lungs via sensory receptors in the mucosal tissue joints and muscles

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22
Q

Laryngospasm

A

extreme glottis closure in response to stimulants that irritate the VF mucosa

23
Q

Developmental Babies

A

Larynx is very high in the neck around C3 or C4 vertebrate As the babies grow it descends

24
Q

Developmental Childhood

A

Vocal folds lengthen and same process in boys and girls until 10 years of age Gradual and consistent growth until puberty Very slow amount of change in voice before puberty

25
Q

Developmental Puberty

A

By puberty the larynx has descended down to the C6 C7 level and facial structure has changed a lot Increased vocal tract which changes resonance Testosterone levels significantly increase in males causing anterior growth in the thyroid prominence aka adams apple pharynx in males often widens a lot

26
Q

Developmental Adulthood

A

5 layers are formed The average length of the female vocal folds is 11 to 15 millimeters and 17 to 21 millimeters for males

27
Q

Developmental Old Age Geriatric folds

A

Presbylaryngeous fold become thinner often become bowed deterioration in vocal quality pitch and loudness Ranges reduced and endurance probably due to the lamina propria becoming looser and thinner Folds also get more fibrous and stiffer do not vibrate as well

28
Q

Myoelastic Aerodynamic Theory

A

Pre phonation phase and Phonation phase

29
Q

Pre phonation Phase

A

1 Exhalation begins 2 Vocal folds begin to adduct approximate each other secondary to the reaction of the adductor muscles

30
Q

Phonation Phase

A

1 Subglottic pressure below the folds begins to build 2 Subglottic pressure continues to build up until it overcomes the resistance pressure of the folds and blows them apart 3 Subglottic pressure decreases 4 The flow rate through the folds is going to increase becomes the air is going to burst through velocity of airflow through the folds is going to increase 5 Pressure and flow are inversely proportional Bernouli 6 When the air flow increases then the pressure between the folds is going to drop suddenly creates a momentary negative pressure between the folds which sucks them back together 7 In addition the natural elasticity of the folds also helps them come back together elastic portion 8 As soon as that happens one cycle has been completed 9 As soon as they come back together the process starts again for 125 to 150 for men and 225 to 250 for woman a second

31
Q

Hirano Body cover Theory

A

Hirano re groups the 5 layers epithelium 3 layers of lamina propria muscle tissue vocalis into 3 distinct vibratory divisions based on their unique vibratory properties really focuses on vibration and mucosal wave labeled based on vibratory factors

32
Q

Hirano 3 layers

A

1 Cover is the epithelium and superficial layer of the LP 2 Transition is the intermediate and deep layers of LP 3 Body is the vocalis muscle

33
Q

Mucosal wave

A

The flexible and compliant layers of the LP and epithelium oscillate over the mass and stability of the vocalis muscle and deeper layers of the LP to create an undulating or oscillating motion a ripple affect or complex waveform that moves across the vocal folds Horizontal vertical and longitudinal movements are present

34
Q

Titzes Self Oscillating Theory

A

Focuses more on air flow and the respiratory part 1 Describes the vocal folds as a flow induced self oscillating system sustained across time by aerodynamic forces of pressure and flow 2 Respiration sets the folds in motion oscillating then the interchange between pressure and flow keeps them vibrating A Subglottic region just below the folds B Intraglottal space between the folds C Supraglottic air column just above the folds

35
Q

Pitch control is determined by

A

1 Length and tension of the vocal folds Subglottic pressure changes more air is being pushed through so more air increase the velocity more cycles can occur 2 Your vocal folds can only do so much there is a limit if you are at the loud end of your loud range you would not be able to do as much with pitch 3 Amplitude change can effect your pitch if you are really loud or really soft you might not be able to reach your highest pitch range

36
Q

Pitch control to increase pitch

A

Cricothyroid muscles is going to contract rocking the thyroid forward stretching VF They are longer thinner with increased tension equals faster vibrations and increased pitch Some of the adductors can activate and help increase pitch

37
Q

Pitch control to decrease lower pitch

A

Cricothryoid relaxes and the thyroid arytenoid contracts to shorten the folds They become shorter fatter and less tense so the pitch will decrease

38
Q

Pitch control changes in subglottic pressure

A

As pressure increase the airflow will increase that that will cause more cycles with high pitch Changes in amplitude High end of pitch limited in amplitude High end of amplitude limited in Amplitude

39
Q

Pitch in vibratory amplitude

A

Amplitude change can effect your pitch if you are really loud or really soft you might not be able to reach your highest pitch range

40
Q

Intensity Control Loudness

A

Determined by amplitude Increase subglottic pressure take a bigger breath So when we let that air go its going to blow the folds further apart increased amplitude The closed phase of the cycle is longer longer they stay together the more pressure Resonators also contribute to loudness

41
Q

Vocal Quality Control

A

1 Affected by Integrity 2 Deviation of cycle to cycle variations

42
Q

Vocal Quality Integrity

A

Regular Symmetrical Phase shape ie bowed glottis or other miss shaped glottis upon adduction Tissue deformity can effect phase shape also scaring bump etc Degree of glottal constriction ie too tight Characteristics of the supraglottic vocal tract resonators

43
Q

Deviations or cycle to cycle variations

A

If we hear something we do not want to hear in a voice we call that noise Signal to noise ratio You want the cycles to be consistent and symmetrical It will give the voice the best quality If you have cycle to cycle variations then that makes the voice sound bad

44
Q

Types of Deviations

A

1 Shimmer 2 Jitter

45
Q

Shimmer

A

cycle to cycle variations in the loudness

46
Q

Jitter

A

Cycle to cycle variations in pitch

47
Q

Periodicity

A

refers to the cycle to cycle variation

48
Q

Registers Characteristic vibratory patterns

A

1 Falsetto 2 Modal 3 Glottal fry 4 Laryngeal whistle 5 Vibrato

49
Q

Falsetto loft

A

Highest voice in your range cricothyroid strongly contracted Thin high pitched voice The folds are super tight Done with a lot of airflow and subglottic pressure But because you are holding it so tight it does not increase in amplitude

50
Q

Modal chest

A

Frequency range we usually use for normal speaking and singing Complete glottic closure average amplitude and healthy mucosal wave Mid range

51
Q

Glottal fry pulse

A

Lowest end of fundamental frequency Really low subglottic pressure long closed phase and relaxed folds

52
Q

Laryngeal whistle

A

very high pitched female voice with a lot of air escaping Whistle sounding voice

53
Q

Vibrato

A

Singers Produced because of very small rapid pitch changes while they are phonating Can be adjusted to do tremolo or trill

Voice Disorders (2 decks)

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