A&P
Describe cranial nerve innervation of the intrinsic laryngeal muscles.
CN X-RLN: PCA, interarytenoids, LCA, thyroarytenoid
CN X-SLNib: sensation
CN X-SLNeb: cricothyroid
Describe source filter theory.
where components of voice production originates
power = lungs/respiration
source = larynx/phonation
filter = vocal tract (supraglottic space thru pharyngeal + oral cavities thru lips/nasal cavity)/resonance
What are the components of a voice assessment?
What are the 6 sub-systems of voice?
respiration
phonation
resonance
pitch
loudness
rate
Describe the differences between voice treatment for ages 1-4 vs 4+.
Ages 1-4
-Education of parents regarding good vocal hygiene/use
-Behavioral management of communication environments by parents/caregivers
- Awareness of parent/child level of emotions while speaking
- Encouraging quiet time
- Education of siblings for supporting a healthy communication environment
Ages 4+
- 6-8 sessions, 50 min each
- Weekly -> Progressively more spaced out
- 1. Basic exercises -> 2. Convos
- Home practice compliance
- Collaboration with all SLPs involved w/ care
Describe vocal fold microstructure.
- Superior Lamina Propria: loose, fibrous
- Intermediate Lamina Propria: elastic
- Deep Lamina Propria: Collagenous fibers
- Body: stiff skeletal muscle (thyroarytenoid)
Describe the flaws of the "Neurochronaxic Theory" and why the "Myoelastic-Aerodynamic Theory of Phonation" is a better explanation of voice production.
1. Neurochronaxic Theory: VF vibration = rate of neural impluses
2. Myoelastic-Aerodynamic Theory of Phonation (YES)
What are important characteristics of a patient interview/case history?
reason for referral
history of problem
medical history
social history
OME
associated symptoms/sensations
1. Hoarse = breathy and rough = hypo+hyperadduction
2. Breathy = airy/escape of air = hypoadduction
3. Rough: coarse/irregular vibration = hyperadduction
For transgender voice tx: do clients wanting masculization tx or feminization tx typically need more assistance for voice modifications? Describe one common tx approach used for this population
Feminization = baseline pitch too low/ transitioning from male to female
MORE assistance = feminization because hormone medications for masculinization will naturally lower pitch
SOVTs
Pitch modification tx
visual feedback system (visipitch)
What is vital capacity? What is the purpose of knowing a client's vital capacity? Which lung volumes are involved?
1. Total volume of air that can be exhaled after maximal inhalation
2. Amount of air available for speech
3. Inspiratory Reserve Volume + Tidal Volume + Expiratory Reserve Volume (NO Residual Volume)
Describe Titze Phonation Theory Expansion.
Expansion of Myoelastic Aerodynamic theory
- TVF vibration continues due to 1. air in lungs 2. pressure and flow interchanges between sub+supraglottic regions of larynx
TOP-DOWN loading effect: decreased supraglottic pressure= increased collision impact = BAD/hyperadduction
Differentiate between endoscopy and stroboscopy.
Endo = full laryngeal appearance
Strobo= TVF vibratory patterns
What are the 4 etiologies of voice disorders?
1. Vocal misuse
2. medically related issues (surgery/medicinal)
3. Secondary to primary disorder
4. personality related
What are the 5 different orientations of voice tx? Describe each one.
1. Hygienic:Elimination/modification of causes
2. Symptomatic: Behavioral modification of symptom (aka subsystems of voice + tension)
3. Psychogenic: Attention to psychodynamics of problem
4. Physiological: Direct physiologic exercise/direct tx and attention to mucosal covering of TVF and voice producing mechanisms of respiration, phonation, and resonance)
5. Eclectic: ALL ABOVE COMBINED
List the suprahyoid and infrahyoid muscles. What is the purpose supra vs infrahyoid muscles?
Suprahyoid muscles: elevate larynx/hyoid
Infrahyoid muscles: depress larynx
Describe the Bernoulli Effect.
- Increase speed of air molecules = Decrease in pressure
- Inverse relationship between speed of air molecules and pressure in laryngeal space (suction of pressure)
Define fundamental frequency and intensity.
1. F0 = vibration rate of TVf
2. perceptual loudness
Describe the characteristics of ...
1. nodes
2. polyps
3. cysts
1. N: bilateral, midmembranous edema of VF cover = fatigue, breathy, hoarse, rough
2. P: unilateral, midmembranous fluid-filled lesion w/ own blood supply = hoarse, rough, breathy, globus sensation, strain, fatigue
3. C: unilateral, midmembranous, mucus filled lesion = globus sensation, mild-severe hoarseness
Describe and list the pros and cons for the following types of voice available to HNC clients.
1. Artificial Larynx
2. Tracheoesophageal Speech
3. Esophageal Speech
1. AL = Hand-held device that creates vibration on FOM to create sound
- Pros: easy to learn, more easy to discriminate sounds in noisy environments, intelligibility similar to ES
- Cons: Robotic, mobility of 1 hand, pitch/intensity issues, cost/mechanical issues
2. TES: Vibration of tissues in lower pharynx is the new sound source due to TE Puncture: fistula created between trachea and esophagus + Prosthesis Device
- Pros: more natural speech, natural pitch/intensity/rate, hands free, easy to learn, longer stretches of speech
- Cons: secondary to fistula creation during surgery, daily prosthesis management, leakages, cost
3. ES:PE segment is sound generator for sound through inhaling air into esophagus
- Pros: hands free, most natural, no mechanical device or prosthesis
- Cons: hard to learn, short rushes of speech, low intensity/pitch
Describe the function of all the intrinsic laryngeal muscles.
Posterior Cricoarytenoid: ABDUCT
Lateral Cricoarytenoid = ADDUCT
Thyroarytenoid: ADDUCT/RELAX = lower pitch
Interarytenoids (Transverse+Obliques): ADDUCT
Cricothyroid: TENSOR = raise pitch
Name the 3 priorities of the laryngeal complex from most imperative during tx to least important.
1. MOST: airway protection
2. swallowing
3. voice
Describe the effects of (BELOW) as related to hypo vs hyperfunction of the TVF.
1. vocal quality
2. airflow rate
3. subglottic pressure
4. Possible pathologies associated
Hypofunction
1. breathy
2. increased
3. decreased
4. paresis, paralysis, atrophy, bowing, sulcus
Hyperfunction
1. rough
2. decreased
3. increased
4. nodes, cyst, polyps, edema, granduloma
What are the 8 categories of vocal pathologies? Provide one example of each.
1. Structural: nodes, cyst, polyp, edema, RRP, glottal webbing, presbyphonia
2. Inflammatory: arthritis, laryngitis
3. Trauma/injury: chemical exposure, assault, sports injury
4. Systemic: endocrine or immunologic disorder
5. Aerodigestive: respiratory disease, GERD
6. Psychiatric/Psychological: conversion aphonia, malingering
7. Neurological: ALS, PD, HD, MS, MG, CVA, Essential voice tremor, Spasmodic dysphonia
8. Functional: phonotrauma, MTD, PVFM
Name a symptomatic voice tx for
1. Respiration:
2. Phonation:
3. Resonance:
4. Pitch:
5. Loudness:
6. Rate:
7. Tension:
1. Respiration: phrase markers, abdominal breathing/box breathing
2. Phonation: breathy=wall push, glottal fry=slight increase in pitch, rough = start w/ h for easy onset of airflow
3. Resonance: negative practice, denasality tx, non-speech phonation, nasalized phrase production
4. Pitch: depends on etiology lol oops
5. Loudness: check hearing status, biofeedback
6. Rate: exaggerate vowels, reading
7. Tension: progressive relaxation, chewing, yawn-sigh