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Questions and Answers
What are the two main types of functional voice disorders?
What are the two main types of functional voice disorders?
What is the primary purpose of the larynx?
What is the primary purpose of the larynx?
Protect the airway
The myoelastic aerodynamic theory explains how the vocal folds vibrate during phonation.
The myoelastic aerodynamic theory explains how the vocal folds vibrate during phonation.
True
Which of these is NOT an intrinsic muscle of the larynx?
Which of these is NOT an intrinsic muscle of the larynx?
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Which muscle is responsible for adduction of the vocal folds?
Which muscle is responsible for adduction of the vocal folds?
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What is the difference between pitch and frequency?
What is the difference between pitch and frequency?
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What is the unit of measurement for frequency?
What is the unit of measurement for frequency?
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Which of these is NOT a perceptual characteristic of sound?
Which of these is NOT a perceptual characteristic of sound?
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Aperiodic sounds are characterized by a regular, repeating pattern of vibrations.
Aperiodic sounds are characterized by a regular, repeating pattern of vibrations.
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What is the difference between a periodic tone and a complex tone?
What is the difference between a periodic tone and a complex tone?
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What is the name of the space between the true and false vocal folds?
What is the name of the space between the true and false vocal folds?
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Older adults typically experience a decrease in both vocal fold length and thickness.
Older adults typically experience a decrease in both vocal fold length and thickness.
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What is the term for age-related changes in the voice?
What is the term for age-related changes in the voice?
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Which of these is NOT a characteristic of a breathy voice?
Which of these is NOT a characteristic of a breathy voice?
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Hypernasality indicates an excessive amount of nasal resonance.
Hypernasality indicates an excessive amount of nasal resonance.
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Match the voice quality terms with their descriptions.
Match the voice quality terms with their descriptions.
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What is the purpose of the S/Z ratio test?
What is the purpose of the S/Z ratio test?
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What does CAPE-V assess?
What does CAPE-V assess?
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Which of these is NOT a vocal register?
Which of these is NOT a vocal register?
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Habitual pitch is the same as the optimal pitch for an individual.
Habitual pitch is the same as the optimal pitch for an individual.
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What is the primary focus of the Voice Handicap Index (VHI)?
What is the primary focus of the Voice Handicap Index (VHI)?
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Which of these is a measure of short-term variability in frequency?
Which of these is a measure of short-term variability in frequency?
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Perturbation measures are highly reliable in identifying specific voice disorders.
Perturbation measures are highly reliable in identifying specific voice disorders.
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What is the key characteristic of vocal nodules?
What is the key characteristic of vocal nodules?
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Describe the difference between primary and secondary muscle tension dysphonia (MTD).
Describe the difference between primary and secondary muscle tension dysphonia (MTD).
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Reinke's edema is a type of vocal fold thickening caused by a build-up of fluid beneath the cover of the vocal folds.
Reinke's edema is a type of vocal fold thickening caused by a build-up of fluid beneath the cover of the vocal folds.
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Which of these is a common cause of contact ulcers?
Which of these is a common cause of contact ulcers?
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What is the primary difference between a vocal nodule and a polyp?
What is the primary difference between a vocal nodule and a polyp?
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Falsetto is always a sign of a voice disorder.
Falsetto is always a sign of a voice disorder.
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What causes aphonia?
What causes aphonia?
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Which of these is an organic voice disorder?
Which of these is an organic voice disorder?
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What is the name of the condition involving the false vocal folds vibrating during phonation?
What is the name of the condition involving the false vocal folds vibrating during phonation?
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Leukoplakia is a precancerous lesion that needs to be monitored carefully.
Leukoplakia is a precancerous lesion that needs to be monitored carefully.
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What is the primary characteristic of paradoxical vocal fold movement (PVFM)?
What is the primary characteristic of paradoxical vocal fold movement (PVFM)?
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A laryngectomy involves the complete removal of the larynx.
A laryngectomy involves the complete removal of the larynx.
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Study Notes
Normal Phonation
- Vocal folds (VF) approximate along the entire anterior-posterior dimension during phonation, known as phonatory expiration.
Posterior Glottal Chink
- A subtle posterior opening in the vocal folds is more common in females and is a normal variation, not a pathology. It may manifest as subtle breathiness.
Non-Phonatory Expiration
- Vocal folds are abducted (opened) but not to their extremes during exhalation without voice production.
Forced Inspiration
- Vocal folds are widely abducted during deep inhalation.
Whisper Phonation
- Anterior 2/3 of vocal folds approximate, producing turbulent air flow. Significant posterior glottal chink is present. Not a healthy vocal mechanism.
Intrinsic Laryngeal Muscles
- Six intrinsic muscles control vocal fold position and function: Posterior cricoarytenoid (2), Lateral cricoarytenoids (2), Cricothyroids (2), Transverse arytenoid (1), Oblique arytenoids (2), Thyroarytenoids (2).
Posterior Cricoarytenoids
- Only muscle that abducts (opens) the vocal folds. Rocks arytenoids dorsally. Innervated by the recurrent laryngeal nerve.
Lateral Cricoarytenoids
- Adduct (close) the vocal folds. Innervated by the inferior laryngeal nerve (vagus nerve). Crucial for medial compression.
Cricothyroids
- Stretches and tenses vocal folds, increasing pitch. Innervated by the superior laryngeal nerve.
Transverse Arytenoids
- Adduct vocal folds. A single muscle, not paired, innervated by the recurrent laryngeal nerve.
Oblique Arytenoids
- Adduct vocal folds. Innervated by the recurrent laryngeal nerve.
Thyroarytenoids
- Form bulk of vocal folds. Lower pitch by shortening and thickening the folds. Contains thyromuscularis (lateral) and vocalis (medial) portions.
Dimensions of Sound
- Pitch (frequency), loudness/intensity (amplitude), and quality/timbre (harmonic constitution/waveform) are the three dimensions that describe any simple sound perceptually.
Pitch (Frequency)
- Measured in Hertz (Hz) – cycles per second. Higher frequency = higher pitch; lower frequency = lower pitch. Frequency depends on sound source size, material, shape, and motion.
Octave
- Interval between two notes whose frequency ratio is 2:1.
Intensity/Loudness
- Measured in decibels (dB). Greater energy corresponds to louder sounds.
Quality/Harmonic Constitution/Waveform
- Combination of overtones/harmonics determines the sound quality. A complex tone has a fundamental component (primary frequency) and harmonic components (multiples of the fundamental).
Periodic Sounds
- Harmonics/overtones create a pleasant, less dissonant sound. Produced by continuous, regular patterns of vibration with sufficient mass and elasticity. Vowels predominantly periodic.
Aperiodic Sounds
- No clear harmonic relationships. Characterized by irregular, sudden changes in vibration, potentially resulting from turbulent air flow during consonants.
Myoelastic Aerodynamic Theory
- A comprehensive theory of phonation that considers air pressure, muscle activity, and elasticity of vocal folds (and tissues of the voice mechanism.)
Summary of Vocal Fold Length & Pitch
- Shorter, thicker folds vibrate slower, producing lower pitch. Longer, thinner, more tense folds vibrate faster, producing higher pitch. Higher pitch requires increased sub-glottal pressure and tension.
Laryngeal Function
- Protection of the airway and secondary voice production. Prevents foreign materials from entering the respiratory system, is a valve for air intake, and is a component of forceful exhalation (coughing).
Older Adult Voice Changes
- Muscular atrophy, mucosal thinning/dehydration, loss of ligament elasticity, cartilage calcification, flaccidity, and edema. Sarcopenia (muscle loss) contributes to these changes.
Voice Descriptors: Harsh, Hoarse, Strident, Thin
- Harsh: rough, unmusical voice due to excessive tension.
- Hoarse: breathy and rough
- Strident: tight, hard, pharyngeal tension.
- Thin: tight, hard, oral cavity tension."
Nasality
- Hypernasality: excessive nasality (e.g., cleft palate)
- Hyponasality: reduction in nasality.
Speech Pathology Evaluation
- S/Z ratio: screening tool assessing expiratory control during sustained phonation and phonation-exhalation/control, (comparison of /s/ and /z/ production).
- CAPE-V: standardized clinical evaluation tool for auditory-perceptual voice quality assessment
Vocal Registers
- Glotal, Modal, Midvocal, Falsetto (low to high).
Voice Handicap Index (VHI)
- QoL instrument assessing the functional, physical, and emotional effects of voice disorders.
Perturbation Measures (Jitter & Shimmer)
- Jitter: short-term variability in frequency.
- Shimmer: short-term variability in amplitude.
Functional Voice Disorders
- Result from incorrect use of phonatory system; muscle tension dysphonia (MTD) and psychogenic disorders.
Organic Voice Disorders
- Caused by physiological abnormalities in vocal tract structure or function; e.g., nodules, polyps, cancer, laryngeal nerve injury
Specific Voice Disorders (Examples)
- Vocal Nodules: bilateral, anterior-posterior junctions, misuse;
- Vocal Polyps: unilateral, usually from single events, misuse
- Reinke's Edema: vocal fold thickening due to misuse;
- Contact Ulcers (granulomas): chronic coughing, throat clearing or related to GERD.
- Cancer: tumors in larynx
- Various other factors/diseases which also cause voice disorders
Psychogenic Voice Disorders
- Result from emotional trauma or conflict. Conversion aphonia (complete loss of voice) and other examples.
Specific Psychogenic Voice Disorders
- Aphonia
- Dysphonia
- Functional Dysphonia
- Conversion Aphonia related to inadequate vocal fold adduction.
- Mutational Falsetto (inappropriate high pitch)
- Paradoxical Vocal Fold Movement (PVFM), related to an atypical breathing pattern causing VF adduction during inhalation, prevalent in females.
Additional Notes
- Prevalence of voice disorders may vary based on criteria and diagnosis. Thorough assessment is crucial, often involving collaboration among various healthcare providers.
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Description
Test your knowledge on the mechanics of vocal fold function including normal phonation, variations, and intrinsic laryngeal muscles. This quiz covers various concepts related to phonation and respiration techniques involving the vocal folds. Perfect for students in speech and voice disciplines.
