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SPH511 > Voice (dysphonia) > Flashcards

Voice (dysphonia) Flashcards

1
Q

What are the 2 critical questions we always consider when working with clients in voice?

A

a. Describe the specifics of the client’s vocal fold function during phonation: what is the nature of the client’s vocal function?
b. How easily can the client control their voice? With lots of emphasis on ease, in relation to vocal control.

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2
Q

Layered tissue structure of the vocal folds. Why this is importandt for phonation.

A

Voice clarity.

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3
Q

3 factors we’re concerned with in voice?

A
  • Vocal pitch/tone
  • loudness
  • Voice quality
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4
Q

Does the epiglottis close actively or passively during swallowing?

A

Closes passively as the larynx rises during swallowing.

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5
Q

What closes during swallowing?

A
  • true vocal folds
  • false vocl folds
  • epiglottis (closes passively as the larynx rises).
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6
Q

Normal vocal behaviour:

A
  • voice and respiration in emotional expression (laughter, crying, anger, fear).
  • Our voice is varied without pain or vocal damage, for expressing full range of desired meaning.
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7
Q

What should be a goal for clients with voice problems?

A

To have effortless control of voice, for the purpose of communication in everyday life.

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8
Q

What should the speaking voice be like in normal situations?

A
  • Effortlessly and smoothly produced (automatically).
  • Well controlled, coordinated and controllable.
  • Strong.
  • Clear, appropriately resonant and pleasant to hear.
  • Appropriate for the situation, culture and person’s life context.
  • Not inapproprately rough or hoarse.
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9
Q

What should the speaking voice be like in normal situations?

A
  • Effortlessly and smoothly produced (automatically).
  • Well controlled, coordinated and controllable.
  • Strong.
  • Clear, appropriately resonant and pleasant to hear.
  • Appropriate for the situation, culture and person’s life context.
  • Not inapproprately rough or hoarse.
  • approapriate speaking pitch and pitch variation (intonation).
  • approprate loudness for background noise and situation.
  • +/- able to imitate/produce different kinds of voices voluntarily.
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10
Q

Is voice a body structure?

A

No. It’s a body function - a behaviour (we do, rather than have, a voice).

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11
Q

Why do we normally have poor awareness of our own vocal behaviour, generally?

A

Because we use our voices automatically, employing different voices unconsciously, in different situations (so we don’t have to think about it).

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12
Q

What is proprioception?

A

The ability to sense the position, location, orientation and movement of the body and its parts.

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13
Q

Why do we have to work fairly indirectly with voice clients?

A

People have poor proprioceptive awareness of the internal throat and laryngeal structures directly.

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14
Q

Aesthetic or social judgements about the voice can lead to a client presenting with a “voice disorder”…

A

Be aware of society’s judgements about different voices: for example, pitch and gender, loudness behaviour, voice quality, vocal tone.

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15
Q

There are abductor, adductor, tensor and relaxer muscles in the larynx. True or false?

A

True.

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16
Q

What do the abductor muscles in the larynx do?

A

separate the arytenoids and the vocal folds for respiratory activities.

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17
Q

What do the adductor muscles in the larynx do?

A

approximate the arytenoids and the vocal folds for phonation and for protective purposes.

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18
Q

What do the glottal tensor muscles in the larynx do?

A

Elongate and tighten the vocal folds (opposed by the relaxer muscles, which shorten them).

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19
Q

How many non-paired intrinsic laryngeal muscles are there?

A

NONE! Intrinsic laryngeal muscles always act in pairs (one on each side of the larynx).

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20
Q

What are the two main forces of the vocal folds?

A
  • Medial compression (how much force you adduct the cords with).
  • Longitudinal tension (the degree of stretching force).
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21
Q

What is medial compression (in voice)?

A

How much force you adduct the vocal cords with.

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22
Q

What is longitudinal tension (in voice)?

A

The degree of stretching force on the vocal folds.

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23
Q

Which two muscles are the muscles of the actual vocal folds themselves?

A

Thyro-arytenoid muscle and Vocalis muscle.

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24
Q

What do the Thyro-arytenoid and vocalis muscles do?

A

They are the muscles of the actual vocal folds, and act as adductors, tensors and relaxers (mainly tensor-relaxers).

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25
Q

How many abductor muscles in the larynx?

A

ONE - the posterior cricoarytenoid.

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26
Q

Which muscles abducts the vocal folds?

A

Posterior cricoarytenoid.

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27
Q

What does the Lateral crico-arytenoid muscle do?

A

It is an adductor (and relaxer). Important for regulating medial compression.

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28
Q

A muscle important in regulating medial compression?

A

Lateral crico-arytenoid muscle.

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29
Q

What are the arytenoid muscles also know as?

A

Interarytenoids

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30
Q

What is the criss-cross muscle which approximates the arytenoid cartilages and helps regulate medial compression called?

A

The Oblique arytenoid muscles.

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31
Q

Name some muscles involved in regulating medial compression:

A
  • Lateral crico-arytenoid muscle.

* Oblique and transverse arytenoid muscles.

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32
Q

Two muscles involved in approximating the arytenoid cartilages (therefore helping regulate medial compression):

A
  • Oblique arytenoid muscles (the criss-cross ones).

* Transverse arytenoid muscles (the non-criss-cross ones).

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33
Q

What effect does raising tension and reducing mass on the vocal folds have?

A

Increasing pitch.

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34
Q

Which muscles acts to elongate the vocal folds?

A

Cricothyroid muscle.

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35
Q

Which muscle brings the cricoid and thyroid cartilages closer together? What effect does this have?

A
  • Crycothyroid muscle.

* stretches (elongates) vocal folds and reduces their mass per unit length, which increases vocal pitch.

36
Q

Which nerve ducks under the aortic arch before heading to the larynx?

A

*recurrent laryngeal nerve.

red current heads under the main blood flow

37
Q

The recurrent laryngeal nerve is a branch of which CN?

A 
CN X (Vagus)
[Vegas is a bloody place. Lots of people shot under the aortic arch].
38
Q

Which cranial nerve has a different distribution on the LHS?

A

CN X (Vagus) - due to recurrent laryngeal nerve.

39
Q

Which nerve supplies most of the intrinsic laryngeal muscles?

A

Recurrent laryngeal nerve.

40
Q

Why does heart/lung surgery carry risks for the larynx?

A

Recurrent laryngeal nerve passes under the aortic arch before coursing back up to supply most of the intrinsic laryngeal muscles.

41
Q

Are there a pair of recurrent laryngeal nerves, or just one?

A

A pair - right and left. But they follow different paths. The LHS recurrent laryngeal nerve courses down, hooks under the aortic arch, then course back up to supply all intrinsic muscles of the larynx EXCEPT the cricothyroid.

42
Q

Why does the recurrent laryngeal nerve on the RHS have a much shorter path than the LHS of the pair?

A

Because the RHS recurrent laryngeal nerve passes under the subclavian artery then goes to innervate intrinsic laryngeal musches (not cricothyroid), but the LHS goes much further down to pass under the aortic arch before coming up to the larynx.

43
Q

Why is the recurrent laryngeal nerve called ‘recurrent’?

A

recurrent = ‘back + run’ –> runs back in the opposite direction of the path taken by the rest of the vagus nerve, which heads down to the thorax. The recurrent laryngeal nerve turns and runs back up to larynx.

44
Q

Which nerve supplying the larynx lacks bilateral symmetry?

A

Recurrent laryngeal nerve. LHS ducks under the aortic arch before heading up to larynx. RHS under subclavian artery. To LHS longer than R.

45
Q

Is the superior laryngeal nerve likely to be damaged in heart/lung surgery?

A

No. It comes off the vagus nerve near the top of thyroid cartilage and heads straight in.

46
Q

5 structural layers divided into 3 functional parts of what?

A

Vocal folds.

47
Q

Name the 3 functional parts of the vocal folds:

A
  • Cover
  • Transition
  • Body
48
Q

Which layer of the vocal folds consists of stratified squamous epithelium?

A

Outer layer. Loose fitting - free to ripple as vocal fold vibration occurs.

49
Q

What is the mucosal wave?

A

The rippling effect of the outer stratified squamous epithelium layer of the vocal folds. -> V. important for good voicing.

50
Q

What layer of the vocal folds is next, under the stratified squamous epithelium?

A

Superficial lamina propria (Reinke’s space).

51
Q

What is Reinke’s space?

A

superficial lamina propria (2nd top layer of the 5 layers of the vocal folds).

52
Q

What is the middle layer of the 5 layers of the vocal folds?

A

*Intermediate lamina propria.

53
Q

What is the 4th layer from surface of the 5 layers of the vocal cords?

A

*Deep layer of lamina propria.

54
Q

What is the deepest (5th) layer of the 5 layers of the vocal folds?

A

*Vocalis muscle.

55
Q

Why is the outer epithelial layer of the vocal folds loosely coupled to the inner layers?

A

To enable an efficient mucosal wave, that creates a clear vocal tone during phonation.

56
Q

How does vocal fold scarring reduce vocal clarity?

A

It can ‘tether’ the outer epithelium to the inner layers of the vocal folds, disrupting the mucosal wave.

57
Q

What is the epithelial outer layer of the vocal folds also called?

A

The cover.

58
Q

What are the inner layers of the vocal folds (4 layers below the epithelial cover).

A

The body.

59
Q

What is the mucosal wave?

A

The rippling effect of the movement of the outer cover of the vocal folds during phonation (can only be seen in slow motion - ie videostroboscopy of the larynx)

60
Q

Can vibration of the vocal folds be seen with the naked eye?

A

No. Too fast to see. CAN be seen in slow motion.

61
Q

Do you need to have closed vocal folds for the voice to work?

A

Yes

62
Q

What causes the vibration (rapid opening and closing) of the vocal folds?

A

The positive airflow –> Bernoulli effect (cause the vocal folds to blow apart momentarily)

63
Q

What part of voice relates to the length-mass relationship of the vocal folds?

A

Pitch

64
Q

Does airflow change the voice pitch.

A

No, vocal fold stretching or relaxing changes pitch as this changes the mass per unit length of the vocal folds.

65
Q

Longer, thinner, tighter vocal folds vibrate more quickly. True or false?

A

True.

66
Q

What is needed to produce voice?

A
  • Power source (lungs) - airflow drives vocal fold vibration (myoelastic aerodynamic theory of vocal fold vibration).
  • Vibrating source (vocal folds provide the “buzz”).
  • Filter (resonance chamber) - vocal tract above the larynx modifies sound produced.
67
Q

What is the myoelastic aerodynamic theory of vocal fold vibration (**beware: according to Wikipaedia!)

A

The myoelastic theory states that when the vocal cords are brought together and breath pressure is applied to them, the cords remain closed until the pressure beneath them, the subglottic pressure, is sufficient to push them apart, allowing air to escape and reducing the pressure enough for the muscle tension recoil to pull the folds back together again. The pressure builds up once again until the cords are pushed apart, and the whole cycle keeps repeating itself. The rate at which the cords open and close, the number of cycles per second, determines the pitch of the phonation.

68
Q

What are the 3 dimensions that make up the sound of the voice?

A
  • Voice intensity (perceptual correlate: loudness)
  • Voice frequency (perceptual correlate: pitch)
  • Voice quality (resonance plus… lots of stuff…)
  • *THEN… connected speech interacts with these dimensions and affects voice sound…)
69
Q

Fo

A

Fundamental frequency

70
Q

What is the fundamental frequency re: voice?

A

The intrinsic pitch (Fo).

71
Q

MPT

A

Maximum phonation time (important objective measure in a voice assessment BUT subject to variation, trainable, and test can be cheated). It is a maximal performance based on combined respiratory and phonatory control).

72
Q

Main key for louder voice?

A

Increase subglottic pressure.

73
Q

Factors involved in making the voice louder:

A
  • Respiratory factors
  • Glottic factors
  • Supraglottic factors
74
Q

How can we increase subglottic pressure to make the voice louder?

A

*Increased laryngeal resistance (increase adductory force of vocal folds) This gives a greater proportion of each vibratory cycle with the vocal folds spent closed.
Spectoral characteristics in the vocal tone (???)
*Modifications in the vocal tract
*Alison says don’t just jump to diaphragmatic breathing to increase loudness - lots of ways to do it. You need a strong rationale and evidence.

75
Q

What do the suprahyoid muscles do?

A

Elevate the larynx.

76
Q

Name the suprahyoid muscles:

A
  • Digastric (anterior and posterior bellies)
  • Geniohyoid
  • Stylohyoid
  • Mylohyoid
77
Q

What do the anterior and posterior bellies of the digastric muscle do?

A

Bring the hyoid bone up and forward.

78
Q

What does the genoihyoid muscle do?

A

Draws tongue and hyoid bone forward.

79
Q

What does the stylohyoid muscle do?

A

Elevates and retracts the hyoid.

80
Q

What does the Mylohyoid muscle do?

A

Elevates the hyoid (anteriorly) OR depresses mandible.

81
Q

Which muscles depress the larynx?

A
  • Sternohyoid
  • Sternothyroid
  • Omohyoid (from the scapula).
82
Q

What does the sternohyoid muscle do?

A

*Pulls the hyoid down.

83
Q

What does the sternothyroid muscle do?

A

*Pulls the thyroid down.

84
Q

What does the Omohyoid muscle do?

A

Depresses and retracts the hyoid (attaches to scapula).

85
Q

What are the four infrahyoid muscles?

A
  • Sternohyoid.
  • Sternothyroid
  • Omohyoid.
  • Thyrohyoid.
86
Q

What does the thyrohyoid muscle do?

A
  • EITHER depresses hyoid bone OR (if the hyoid bone is in a fixed position), elevates the thyroid cartilage.
  • Brings the thyroid cartilage and hyoid bone closer together.
87
Q

What is the antagonist of the lateral cricoarytenoid muscle? (Whisper)

A

Posterior cricoarytenoid muscle

SPH511 (10 decks)

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