Normal Phonatory Mechanisms and Laryngeal Muscles
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Questions and Answers

What are the two types of functional voice disorders?

Muscle tension dysphonia and psychogenic disorders

What are the 3 dimensions of sound?

  • Tone, Volume, Timbre
  • Frequency, Amplitude, Harmonic Constitution
  • Pitch, Loudness, Quality (correct)

    • What are the 4 factors that determine frequency?

  • Amplitude of the sound wave, Frequency of the sound wave, Intensity of the sound wave, Timbre of the sound wave
  • Length of the vocal cords, Tension of the vocal cords, Subglottal pressure, Elasticity of the vocal cords
  • Size of the sound source, Material or composition of the source, Shape of the source, Manner in which the sound source is set into motion (correct)

    • Aperiodic sounds are produced with harmonics or overtones which are pleasant and less dissonant to the listener.

    <p>False</p> Signup and view all the answers

    Frequency is measured in Hertz or cycles per second.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a valid theory of phonation?

    <p>Acoustic Theory</p> Signup and view all the answers

    What is the optimal pitch known as?

    <p>Best Pitch</p> Signup and view all the answers

    What is NOT a feature assessed by CAPE-V?

    <p>Resonance</p> Signup and view all the answers

    The Voice Handicap Index (VHI) is a measure of patient's perception of their voice disorder.

    <p>True</p> Signup and view all the answers

    Jitter is a measure of short term variability in amplitude.

    <p>False</p> Signup and view all the answers

    Which of the following is a characteristic of a voice disorder associated with muscle tension dysphonia?

    <p>Vocal nodules</p> Signup and view all the answers

    What are the two types of contact ulcers?

    <p>Organic and functional</p> Signup and view all the answers

    The larynx is a valve that temporarily closes to prevent passage but can open to allow passage.

    <p>True</p> Signup and view all the answers

    What are 4 factors that contribute to voice changes in older adults?

    <p>Muscular atrophy, thinning and dehydration of the mucosa, loss of elasticity of ligaments, and calcifications of cartilages.</p> Signup and view all the answers

    What is the name of the theory that explains how vocal folds vibrate?

    <p>Myoelastic Aerodynamic Theory</p> Signup and view all the answers

    Aperiodic sounds are characterized by a continuous regular pattern of vibrations.

    <p>False</p> Signup and view all the answers

    The transverse arytenoid is an abductor muscle.

    <p>False</p> Signup and view all the answers

    The ______ muscle is the only abductor muscle of the larynx.

    <p>Posterior Cricoarytenoid</p> Signup and view all the answers

    The cricothyroid muscle is responsible for lowering pitch.

    <p>False</p> Signup and view all the answers

    What is the normal S/Z ratio?

    <p>1:1</p> Signup and view all the answers

    What is the main function of the larynx?

    <p>To protect the airway</p> Signup and view all the answers

    Whisper phonation is good for the vocal mechanism.

    <p>False</p> Signup and view all the answers

    What is the difference between habitual pitch and best pitch?

    <p>Habitual pitch is the frequency at which a person speaks most frequently, while best pitch is the frequency that is slightly louder and clearer in quality and where the thyroarytenoids and other intrinsic muscles can produce adduction with minimal muscular effort.</p> Signup and view all the answers

    What is the name of the space between the true and false vocal folds?

    <p>Laryngeal ventricle</p> Signup and view all the answers

    Sarcopenia is a disorder of aging.

    <p>False</p> Signup and view all the answers

    What is the name of the condition that causes a complete lack of phonation?

    <p>Aphonia</p> Signup and view all the answers

    A person with a sulcus vocalis has a normal vocal fold structure.

    <p>False</p> Signup and view all the answers

    What is the difference between a vocal nodule and a vocal polyp?

    <p>Vocal nodules are bilateral and caused by chronic misuse, while vocal polyps are unilateral and can be caused by a single traumatic event.</p> Signup and view all the answers

    Match the following voice disorders with their descriptions:

    <p>Muscle Tension Dysphonia = Voice disorder related to misusing the vocal mechanism Psychogenic Voice Disorders = Voice disorders resulting from emotional trauma. Primary Muscle Tension Dysphonia = Patients may have discomfort with phonation; subtle dysphonia, hoarseness Secondary Muscle Tension Dysphonia = Progressive muscle tension dysphonia; develop secondary tissue changes related to hyper-function Conversion Aphonia = Complete lack of phonation, often caused by psychological distress Mutational Falsetto = Inappropriate use of high pitch for males beyond puberty Paradoxical Vocal Fold Movement = Atypical vocal fold movement during breathing Organic Voice Disorders = Voice disorders due to a physiological abnormality in structure or function Sulcus Vocalis = Congenital or acquired indentation on the vocal folds Contact Ulcers = Lesions on the vocal folds, often caused by acid reflux and hyperfunction Reinke's Edema = Vocal fold thickening due to chronic vocal misuse and behaviors Cancer = Tumor in the vocal folds, larynx, or surrounding tissues Leukoplakia = Benign lesions that may be precancerous Endocrine Changes = Hormonal imbalances affecting the vocal folds Hypothyroidism = Insufficient thyroxin production by the thyroid gland Granuloma = Tissue that forms over contact ulcers Hemangioma = Blood-filled sac on the vocal folds, similar to granulomas Hyperkeratosis = Reactive lesions caused by irritation, such as smoke exposure Infectious Laryngitis = Viral infection causing vocal fold swelling Laryngectomy = Complete removal of the larynx</p> Signup and view all the answers

    Study Notes

    Normal Phonatory Mechanisms

    • Normal phonation: vocal folds (VF) approximate along the entire anterior-posterior dimension, termed phonatory expiration.
    • Slight posterior glottal chink: more common in females, a subtle posterior opening in the folds, a normal variation, not a pathology. (subtle breathiness).
    • Non-phonatory expiration: VF abducted but not at extreme positions, no voice production, just exhaling.
    • Forced inspiration: VF widely abducted, deep inhalation.
    • Whisper phonation: anterior 2/3 of VF approximate, posterior chink. Acoustic perception of turbulence (whisper sound), not good for vocal mechanism, aperiodic, significant posterior glottal opening.

    Intrinsic Laryngeal Muscles

    • Six intrinsic muscles: responsible for altering vocal fold position and status.
    • Posterior cricoarytenoid (2): only abductor (opens glottis), rocks arytenoids dorsally, innervated by recurrent laryngeal nerve.
    • Lateral cricoarytenoids (2): adductors, pull muscular and vocal processes medially for vocal fold approximation. Medial compression for phonation posture, innervated by inferior laryngeal nerve (vagus nerve).
    • Cricothyroid (2): adductors, stretch and tense VF, increasing pitch (innervated by superior laryngeal nerve).
    • Transverse arytenoid (1): adductor, approximates arytenoid cartilages, helps with adduction, innervated by recurrent laryngeal nerve.
    • Oblique arytenoids (2): adductors, pulls arytenoids medially, innervated by recurrent laryngeal nerve.
    • Thyroarytenoids (2): bulk of VF muscles, lower pitch, antagonistic to cricothyroid. Lateral portion = thyromuscularis, medial portion = vocalis, differential tensing for phonatory control

    Acoustic Properties of Sound

    • Three perceptual characteristics: pitch, loudness/intensity, quality/timbre.
    • Pitch (frequency): number of vibrations per second (Hz); related to size, material, shape, and motion of sound source.
    • Octave: interval with frequency ratio of 2:1.
    • Intensity (loudness): energy, measured in decibels (dB); louder sounds have more energy.
    • Quality/timbre (harmonic constitution/waveform): combination of sounds, fundamental frequency (F0) and harmonics.
    • Periodic sounds: regular, repeated vibrations, pleasant, mostly vowels.
    • Aperiodic sounds: irregular, not repeated, harsh, mostly consonants.

    Voice Production Theories

    • Puff theory: simplistic, inadequate, air puffs initiating vibration, doesn't address tension, adduction/abduction.
    • Neurochronaxix theory: inaccurate, each vibratory cycle initiated by nerve impulse; doesn't account for subglottal pressure or anatomical differences.
    • Myoelastic aerodynamic theory: considers air pressure, muscle involvement, and elastic properties of vocal folds, correct model for phonation.

    Factors Affecting Pitch, Loudness and Voice Quality

    • VF length/thickness & tension affect pitch. Longer/thinner/tenser folds vibrate faster (higher pitch), short/thicker/laxer vibrate slower (lower pitch).
    • Higher pitches require increased subglottal pressure and VF tension. Lower pitches require relaxation of cricothyroids + contraction of thyroarytenoids.
    • Laryngeal function relates to protection and voice production (secondary).

    Vocal Aging

    • Older adults (69+): experience muscular atrophy, mucosal thinning/dehydration, ligament loss of elasticity, cartilage calcification, vocal fold bowing, and edema.
    • Sarcopenia: natural muscle loss with aging.
    • Presbyphonia: natural vocal changes associated with aging. Male F0 tends to rise, female F0 falls.

    Vocal Quality Assessment

    • CAPE-V: clinical research tool for standardized auditory-perceptual voice assessment. Assesses severity, roughness, breathiness, strain, pitch, loudness.
    • Voice Handicap Index (VHI): self-report instrument measuring functional, physical, and emotional impact of voice disorders on daily life.
    • Jitter: short-term variability in frequency.
    • Shimmer: short-term variability in amplitude.

    Classification of Voice Disorders

    • Functional Voice Disorders: result from abnormal use/misuse. Includes muscle tension dysphonia (MTD), psychogenic disorders (emotional/psychological origin), paradoxical vocal fold movement (PVFM).
    • Organic Voice Disorders: result from physiological abnormality of structure/function in vocal mechanism (l.e. cancer, infections, endocrine disorders).
    • Vocal nodule/polyps, Reinke's edema, traumatic laryngitis, contact ulcers/granulomas, vocal fold thickening, falsetto, phonation breaks, pitch breaks, diplophonia, aphonia, dysphonia, functional dysphonia, conversion aphonia, mutational falsetto, hypernasality, hyponasality, cul-de-sac resonance

    Assessment Tools

    • S/Z ratio: screening measure of expiratory control and phonatory control (Normal = 1:1 or less)

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    Description

    Explore the normal phonatory mechanics and the role of intrinsic laryngeal muscles in voice production. Understand concepts like phonatory expiration, whisper phonation, and the function of key muscles such as the posterior cricoarytenoid. This quiz covers essential aspects of vocal fold behavior and muscle action crucial for effective phonation.

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