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Voice and Fluency > Voice Midterm_LMenchini > Flashcards

Voice Midterm_LMenchini Flashcards

1
Q

definition: organic voice disorders

A

result from a physical condition and not secondary to vocal misuse/abuse

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2
Q

systems of voice production?

A
  1. articulatory system - resonance
  2. laryngeal system - vf vibration
  3. respiratory system - outgoing airflow for egressive sounds and relatively constant Psg
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3
Q

location: laryngeal system

A

suspended from hyoid bone
b/t artic and resp. systems
sits on top of the trachea

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4
Q

primary function: laryngeal system

A

control airflow into and out of lungs

prevent food and fluid from entering airway

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5
Q

secondary function: laryngeal system

A

voice production

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6
Q

voice tells us about…

A
  1. laryngeal pathology
    functional, organic, or neurogenic
  2. whole person
    emotions
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7
Q

describe: aspiration penetration and choking

A

aspiration- entered lungs
penetration- at level of vf
choking- entered larynx

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8
Q

GERD:
symptoms?

structural changes?

A

(organic - LPR)
symp: primary = hoarsness
others = heartburn, sore throat, chest pain, bad breath with sour taste, freq. clearing and throat coughing

structural changes= posterior glottal redness–> contact ulcers–> granulomas

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9
Q

granuloma

causes?

how formed?

effect on voice?

A

(organic disorder - ext. of contact ulcers)

causes: primarily by intubation, others are vocal abuse, laryngeal injury, and GERD
how: damaged vocal process mucosa–> ulcer–> granuloma
effect: breathy and hoarse, need to clear throat

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10
Q

definition: contact ulcers

A

chronic inflammatory disease of the larynx

functional - MTD

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11
Q

definition: granuloma

A

granular tissue in a rounded sac that is an extension of contact ulcers

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12
Q

contact ulcers: effect on voice

A

hoarse
pain in laryngeal area
vocal fatigue
freq. throat clearing

(functional - MTD)

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13
Q

acquired laryngeal web

cause:

symptoms:

A

caused by bilateral trauma to medial edges of vf

symptom: high pitch, hoarsness, SOB

(organic)

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14
Q

Reinke’s edema:

definition-
location-
cause-
effects-

A

def - accumulation of fluid (edema) in Reinke’s space

loc-bilaterally @ anterior 2/3 of vf

cause - long term cig. smoking

effects - more frequent in women, low pitch and hoarseness, possible SOB

(organic)

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15
Q

symptoms of laryngeal cancer:

A

primary: persistent hoarseness
others: lump in neck, broadening of larynx, pain in laryngeal area swallowing difficulty, pain on swallowing

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16
Q

elevator and depressor: (describe)

A
  1. thyrohyoid m. - elevates thyroid up and depresses hyoid down
  2. cricopharyngeus m. - sphincter on top of esophagus that goes from cricoid to pharyngeal walls. It allows for swallowing and is the source of esophageal speech

(extrinsic laryngeal m.’s)

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17
Q

describe: arytenoids

position -

function -

A

(paired laryngeal cartilages)

posteriorly on top of cricoid

muscle process, vocal process, apex

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18
Q

definition: functional (conversion) aphonia

A

complete absence of voice without laryngeal pathology

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19
Q

pharyngeal nerve: damage symptoms

A

efferent: hypernasality (velum isn’t contracting and cannot elevate) and nasal regurgitation: again velum isn’t elevating so food is escaping through nasal cavity
afferent: swallowing difficulty: loss of sensation of when bolus triggers reflex to swallow so may not know when to

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20
Q

describe: pharyngeal nerve

A

(branch of vagus X)

efferent: delivers motor commands to all velopharyngeal m. except the veli tensor palatine
afferent: sensations of upper pharynx and base of tongue sent to CNS

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21
Q

laryngeal cancer:

TNM system

A

for classification and treatment:
T- site of primary tumor
N- involvement of lymph nodes (if spread)
M- metastasis (Secondary locations)

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22
Q

puberphonia:

aka?
what?
voice?

A

aka: falsetto, mutational falsetto, incomplete mutation of voice

voice disorder when used as primary voice by males/females w/o endocrine/structural disorders

breathy, unnatural, too high for speaker

(psychogenic vd - functional)

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23
Q

congenital laryngeal web

cause?
symptoms?

A

cause: incomplete maturation of larynx (at birth)
symptoms: weak high pitched cry, stridor, SOB

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24
Q

GERD affects ____ b/c of gravity

A

cartilaginous portion of vf

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25
Q

definition: laryngeal cancer

A

malignant condition affecting the supraglottal, glottal, and/or subglottal areas

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26
Q

contact ulcers

what?
cause?
location?

A

(functional - MTD)

what? chronic inflammatory disease of the larynx

cause? 3 main causes: 1. slamming together of the arytenoids (FD), intubation (OD), GERD (OD)

location? ulcerations along posterior 1/3 of vf

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27
Q

describe the functional disorder of contact ulcers:

A

hard glottal attacks as habitual way of contacting vf

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28
Q

vocal nodules

on voice:

A

breathy and hoarse, sensation of something on vf, need to clear throat

(functional MTD)

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29
Q

damage symptoms:

superior laryngeal n.

A

(branch of Vagus X)
afferent: loss of sensation in upper larynx - may not know if something is caught in larynx

efferent: monopitch - cricothyroid m. no longer contracting

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30
Q

how to treat vocal nodules:

A

initially, with voice behavioral therapy (when soft)

later it is through surgery but always work on behavior therapy prior to the surgery

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31
Q

glottal vs subglottal

A

glottal = level of vf / subglottal= beneath the glottis. cricoid, trachea

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32
Q

perceptual signs of voice problems: loudness

A

monoloudness, reduced loudness range, loudness variation

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33
Q

laryngeal changes w/ age:

F0?
vf length?

A

F0 females: higher
F0 males: lower

Length females: shorter
Length males: longer

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34
Q

F0, jitter, shimmer, MPT:

children

female/male adults

female/male elderly

A

children: 240-290Hz, up to 1%, 13-21sec

f. adult: 200-250Hz, up to 1%, 16-35sec
m. adult: 100-150Hz, up to 1%, 16-35sec

f. elderly: lower, up to 1%, 10-20sec
m. elderly: slightly higher, up to 1%, 10-20sec

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35
Q

ex: organic voice disorders

A 
laryngeal cancer
GERD
granulomas
Reinke's edema
Laryngeal web
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36
Q

definition: laryngeal web

A

thin membrane forms across glottis in anterior-posterior direction

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37
Q

what is intubation?

A

insertion of a tube posterior portion of vf for feeding or breathing purposes. Primary cause for granulomas

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38
Q

cricopharyngeus m.

A

source of vibration in esophageal speech

extrinsic laryngeal m. elevator&depressor

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39
Q

describe myo-elastic aerodynamic theory of phonation

A
  1. adductor m. (posterior cricoarytenoid m.) adducts the vf and vibration begins
  2. Psg builds up beneath closed vf, and once it reaches 3-6cmH2O the vf burst open
  3. Due to elasticity and Bernoulli effect (as air travels from area of high vol. to low vol., speed will increase and cause decrease in pressure - vf stick shut)
  4. Abductor m. (lateral cricoarytenoid m. and transverse/oblique interarytenoid m.) abduct aryt. and vibration ends
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40
Q

paramedian

A

1 vf is paralyzed in between abducted and median positions

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41
Q

laryngeal cancer:

accounts for?
causes?
threats?
voice?

A

: 6% of malignancies diagnosed annually in the US
: smoking, alcohol, GERD, environmental influences (asbestos), combo of these
: serious threat to airway adequacy
: depends on position of tumor (TNM)

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42
Q

what is considered misuse/abuse?

A
  1. excessive talking/shouting
  2. cheering
  3. hard glottal attacks
  4. inappropriate pitch level
  5. prolonged loudness
  6. excessive throat clearing/coughing
  7. the “screamer”
  8. talking in noisy environment
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43
Q

individuals w/ functional aphonia speak with ____

A

clear whisper

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44
Q

conversion reaction

A

psychological issue manifests itself physically in some way
ex: stressed–>sick–>lose voice

(apart of functional (conversion) aphonia.
functional -PVD)

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45
Q

aryepiglottic folds

A

folds that go from the sides of the epiglottis to the arytenoids. Cuneiform cartilage found inside of them

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46
Q

diplophonia

A

producing 2 F0’s at the same time due to second source of vibration. Symptom seen in vocal polyps because of the sessile or pedunculated polyp vibrating

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47
Q

definition: puberphonia (aka)

A

voice disorder when used as primary voice by males/females without endocrine/structural disorders (falsetto, mutational falsetto, incomplete mutation of voice)

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48
Q

pitch

A

perceptual correlate of frequency(Hz). It is subjective

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49
Q

functional aphonia aka..

A 
conversion aphonia
(functional - PVD)
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50
Q

descrive: superior laryngeal nerve

A

(branch of Vagus X)
afferent: internal branch and upper larynx sensation

efferent: external branch and cricothyroid m. motor commands

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51
Q

progression of functional voice disorders:

A

misuse/abuse (MTD) –> structural change (PVD) –> voice disorder –> social, personal, emotional or occupational problems

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52
Q

definition: GERD

A

gastroesophageal refulx disease: overflow of gastric juices from stomach into esophagus when person has not vomited for belched

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53
Q

definition: functional voice disorders

A

normal mechanism used in faulty manner

54
Q

perceptual signs of voice problems: pitch

A

monopitch
inappropriate pitch
pitch breaks
reduced pitch range

55
Q

examples: Functional Voice Disorders

A 
vocal nodules (MTD)
vocal polyps (MTD)
contact ulcers (MTD)
puberphonia (PVD)
functional (conversion) aphonia (PVD)
56
Q

3 Groups of Voice Disorders

A

functional, organic, and neurogenic

57
Q

hyoid:

  • shape
  • purpose
  • attachments-
A
  • horseshoe shaped
  • provides support for tongue root
  • inferior attach 4 tongue muscles, superior attach 4 extrinsic laryngeal m.
58
Q

how does the afferent component of the Pharyngeal Nerve relate to swallowing?

A

because included is the upper pharynx, and base of tongue. In that area is the trigger for when we sense the bolus and swallow. Thus lifting the larynx, flipping the epiglottis, and elevating the velum

59
Q

dysphonia VS. aphonia

A

dysphonia= reduced voiced but not a complete loss of voice (breathy)

aphonia= complete absence of voice

60
Q

vocal nodules:

what?
cause?
location?
appearance?

A

most common benign growths on the vf

caused by continuous misuse/abuse of voice

bilaterally, @ the anterior-middle third junction

initially soft, later hard

61
Q

definition: organic voice disorders

A

result from a physical condition and not secondary to vocal misuse/abuse

62
Q 
vocal polyps:
what?
cause?
location?
appearance?
A

(FD-MTD)
masses along the vocal folds

single traumatic event–> hemorrhage–>polyp

unilateral @ anterior-middle third junction

softer than nodules often filled with fluid

63
Q

what are the two types of vocal polyps?

what are polyps affect on voice?

A

(FD-MTD)

  1. sessile- broad base
  2. pedunculated- stem as base

breathy and hoarse
possible diplophonia

64
Q

who has higher risk of developing contact ulcers and granuloma?

A

those with GERD/LPR

65
Q

vocal nodules vs. vocal polyps

A

VN: bilateral @ anterior-middle third junction, caused by continuous vocal misuse/abuse, most common benign growths, initially soft but later hard

VP: unilateral @ anterior-middle third junction, single traumatic event-hemorrhage-polyp, masses on the vf, softer than nodules & fluid filled

66
Q

modal register (aka)

A

chest register- speaking in one’s comfortable and habitual F0

67
Q

median

A

position where arytenoids and vf are at the midline (adducted)

68
Q

2 types of functional voice disorders are?

A

muscle tension dysphonia- misuse/abuse of the voice that leads to structural changes and reduced voice

psychogenic voice disorder- psychological reasons for not using our mechanisms adequately

69
Q

fundamental frequency (F0)

A

frequency of vf vibration (Hz)

70
Q

incidence of voice disorders:

  • children
  • adults
  • professional voice users
  • elderly
A
  • 6-9%
  • 3-9%
  • 30%
  • 47%
71
Q

perceptual signs of voice problems: in quality

A

hoarseness, breathiness, harshness, strain-strangle, tremor

72
Q

how does the artic. system provide resonance?

A

by movements of the velum it gives a degree of nasality. elevated = oral cavity/ lowered= nasal cavity

73
Q

what are the systems of voice production? and how do they apply?

A

articulation=resonance, phonation=voice production (when needed), respiration= outgoing airflow for egressive sounds and constant Psg

74
Q

edema

A

accumulation of fluid

75
Q

2 types of laryngeal web:

A
  1. congenital 2. acquired
76
Q

LPR (definition)

A

laryngopharyngeal reflux: flow of gastric juices from esophagus into pharyngolaryngeal area (OD)

77
Q

describe: recurrent nerve

A

efferent component: sends motor commands to all intrinsic laryngeal m. except the cricothyroid m.

78
Q

supraglottal

A

above the glottis (FVF, epiglottis, aryepiglottic folds)

79
Q

voice quality: effects

A
  1. effects of resonance: hypernasilty (too much) or hyponasality (too little)
  2. effects of vf: breathiness, harshness, hoarseness, strain-strangle, tremor
80
Q

describe nerve for laryngeal innervation

A

Vagus n. (X)- brings motor commands from CNS to larynx, and sensations from larynx to CNS
has many branches: “wanderer” distributed through neck thorax and abdomen
many branches: SLN, RN, Pharyngeal n.

81
Q

adjustments in loudness/intensity:

A

increase Psg = louder speech (vf in contact longer and more forceful breath)
decrease Psg= softer speech (vf in contact less and softer breath)

82
Q

shimmer

A

intensity perturbation. ex: old people voices

83
Q

vestigular

A

has little or no function at all (FVF, corniculate)

84
Q

infant larynx vs. adult larynx

A

infant= cricoid at C1-3 level (higher in neck), cartilage more elastic, higher F0 (500Hz cry at birth), shorter vf (3mm)

adult= cricoid at C4-6 level (lower in neck), cartilage more osseous, lower F0, longer vf (15-25mm)

85
Q

jitter

A

frequency perturbation (waking up in morning)

86
Q

what are the false vocal folds?

A

aka the ventricular folds. Have no function in phonation. When they start to mimic the TVF that means the TVF aren’t working adequately

87
Q

vocal fold physiology = ?

A

= 2 types of movement
1. adduction + abduction

  1. vibration: open and closed
88
Q

dysphonia

A

reduced voice but not a complete absence of voice (breathy)

89
Q

MPT =

A

maximum phonation time (sec). Duration of phonation on one breath (children=13-21sec, adults=16-35sec, elderly=10-20 sec)

90
Q

describe: cuneiform

A

(paired laryngeal cart.) found within the aryepiglottic folds that give support to the aryepiglottic folds

91
Q

loft register (aka)

A

(falsetto)- speaking in a F0 higher than what is our comfortable F0. Voice too high - more effort

92
Q

cover vs. body?

A

refers to vf movement (vibration). Cover = most movable (epi+superficial) body= least movable (thyroarytenoid m.)

93
Q

voice is seperate from ____

A

breathing

94
Q

anatomy of F0: males vs females

A 
males= 100-150Hz, 15-20mm
females= 200-250Hz, 20-25mm
95
Q

describe: neurogenic

A

results from neurological damage and or muscle weakness

96
Q

how does respiratory system contribute to: voice production?

A

by providing outgoing airflow for egressive sounds and keeping a relatively constant Psg (increase in Psg=louder/decrease= softer)

97
Q

depressors:

A

(extrinsic laryngeal m.)= sternohyoid, omohyoid, sternothyroid

98
Q

damage symptoms: recurrent nerve

A
  1. unilateral damage:
    - breathiness: 1 vf paralyzed closer to abducted position
  2. Bilateral damage:
    - aspiration: both vf paralyzed in abd. position so open for anything to enter
    - laryngeal stridor: both vf paralyzed too close to midline. Hear voice in inspiration
    - limited pitch range: thyroarytenoid m. not working adequately
99
Q

vocal fold anatomy=

A
  1. function: cover (epi+superficial), transition (intermediate+deep) body (thyroarytenoid)
  2. histology: epithelium, superficial intermediate and deep layers of lamina propria, thyroarytenoid m.
100
Q

describe: extrinsic laryngeal muscles
- position
- primary function

A
  • one attachment on the larynx, one outside

- for support and positioning of the larynx

101
Q

describe: cricoid

A

individual laryngeal cartilage. most inferior, sits on top of trachea. Wide posteriorly and narrow anteriorly

102
Q

postion of vf:

A

abducted: aryt. and vf away from midline
paramedian: 1 vf between abd and add pos.
median/adducted: aryt. and vf are at the midline

103
Q

cricopharyngeus m.:

  • what is it
  • location
  • function
A
  • extrinsic laryngeal muscle: elevator and depressor
  • sphincter located on top of the esophagus that goes from cricoid to pharyngeal walls
  • it allows for swallow, and is the source of vibration in esophageal speech
104
Q

describe: corniculate

A

(paired laryngeal cart.) forms of the apex of the arytenoids and is vestigular-no function

105
Q

incidence vs. prevalence

A 
I= amount of VD over a period of time
P= amount of VD in that exact moment in time
106
Q

extrinsic laryngeal muscles: (definition too)

A

(one attachment on and one outside the larynx)
elevators: digastric, geniohyoid, mylohyoid, stylohyoid, genioglossus, hyologlossus

depressors: sternohyoid, omohyoid, sternothyroid

elevator + depressor, thyrohyoid, cricopharyngeus m.

107
Q

describe thyroid:

A

largest laryngeal cartilage. Is individual and shield-like closed anteriorly and closed posteriorly

108
Q

adjustments in pitch/F0:

A
  1. thin and tense (longer): higher pitch (vibrates faster)

2. thick and relaxed (shorter)= lower pitch (vibrates slower)

109
Q

aspiration vs penetration vs choking

A

a: has entered lungs
p: at the level of the vf
c: stuck in larynx

110
Q

superior and inferior attachments of: the hyoid bone

A

superior: extrinsic laryngeal m.
inferior: for tongue m.

111
Q

loudness

A

perceptual correlate of intensity (dB)

112
Q

the elevators:

A

(extrinsic laryngeal m.): digastric, geniohyoid, mylohyoid, stylohyoid, genioglossus, hyoglossus

113
Q

pulse register (aka)

A

(glottal/vocal fry): going below our comfortable pitch range so our vf begin to pulse do to inadequate length

114
Q

determining the ___ is essential for ____

A

cause – treatment

115
Q

instrinsic laryngeal muscles: (definition too)

A

(both attachments on the larynx)

  • adductors: lateral cricoarytenoid m., transverse and oblique interarytenoid m.
  • abductor: posterior cricoarytenoid m.
  • tensors: pars recta and pars oblique cricothyroid m., thyroarytenoid (vocalis) m.
116
Q

quality

A

distinctive characteristic of voice exclusive of its pitch and loudness

117
Q

voice tells us about:…

A
  1. laryngeal pathology: functional, organic, neurogenic

2. whole person: emotions

118
Q

glottis

A

anterior 2/3 are muscular, posterior 1/3 is cartilaginous

119
Q

Reinke’s space

A

(aka superficial layer of lamina propria) it is the space between the epithelium and intermediate layer of lamina propria

120
Q

what is the larynx built of?

A
  1. cartilages, 2. one bone, 3. muscles (intrinsic and extrinsic), 4. ligaments/membrane
121
Q

epiglottis: describe
- location
- function

A
  • goes from thyroid to arytenoid cartilages (individual)

- prevents food/liquid from entering larynx

122
Q

why is the posterior 1/3 of the ___, ___?

A

glottis = caritlaginous because the vocal processes of the apex are made of cartilage

123
Q

the laryngeal cartilages:

A

epiglottis, thyroid and cricoid (individual)

arytenoids, corniculate, cuneiform (paired)

124
Q

GERD, stands for?

A

gastroesophageal reflux disease

125
Q

theory of phonation:

A

myoelastic-aerodynamic theory of phonation

126
Q

myo-elastic aerodynamic theory of phonation picture?

A

goes to 1. adducted and closed–> 2. adducted and open–>3. abducted

127
Q

the fluid inside a polyp is?

A

jelly-like

128
Q

swallowing difficulties may occur due to ___ damage?

A

laryngeal cancer, recurrent nerve damage, and pharyngeal nerve damage

129
Q

2 typical perceptual signs for: vocal nodules?

A

breathiness and hoarseness

130
Q

the contraction of the thyrohyoid m….

A

elevates the thyroid and depresses the hyoid

Voice and Fluency (3 decks)

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