CMD Final Review PDF

CMD FINAL REVIEW LECTURE 7 LECTURE 8 LECTURE 9 LECTURE 10 LECTURE 11 LECTURE 12 LECTURE 13 **** LECTURE 14 LECTURE 7 Physiology of Respiration Respiration determined by the body's ability to successfully control muscular action and effort Nature of inspirat...

CMD FINAL REVIEW LECTURE 7 LECTURE 8 LECTURE 9 LECTURE 10 LECTURE 11 LECTURE 12 LECTURE 13 **** LECTURE 14 LECTURE 7 Physiology of Respiration Respiration determined by the body's ability to successfully control muscular action and effort Nature of inspiration-expiration Inspiration: Can be quiet or forced depending on the activity Always an active process Always involved muscle contraction Expiration: Elimination of the waste products of respiration Passive process during quiet breathing Relaxation of the muscles that were contracted for inhalation, thorax and lungs return to starting size Active process during forced exhalation Involved contraction of thoracic and abdominal muscles to “push a little more air out” Respiratory System Pressures Atmospheric pressure (P ATM) served as the reference 4 respiratory system pressures 1. Intraoral (mouth): Pm 2. Subglottal (below vocal folds): Ps  a. Vocal folds open; Pm=Ps 3. Alveolar (present within the individual alveolus): Pal a. Vocal folds open; Pm= Ps= Pal 4. Pleural/ Intrapleural (in the space between visceral and parietal pleura): Ppl Respiratory System Pressures and Respiration Lungs are never totally deflated When vocal folds are open, such as during respiration: ○ Passageway from lungs all the way to lips is totally open When vocal folds are closed, such as during phonation: ○ Upper and lower respiratory tracts are closed off to one another ○ Ps builds under closed (adducted) vocal folds ○ = large pressure differential between Ps and Pm Thorax size increases for inspiration: Pal drops ○ Lungs follow expansion of thorax due to pleural linkage ○ Pleurae provide a low friction surface for movement ○ O2 and CO2 diffuse across the alveolus capillary boundary Inspiration airflow equalizes Pal and Patm on a momentary basis Thorax size decreases for expiration: Pal increases ○ Lungs return to starting size as well Respiration Vital for life; goal= oxygenation of blood and elimination of carbon dioxide Basic 4 stages of gas exchange: 1. Ventilation: actual movement of air in the pathway 2. Distribution: of air to alveoli, which at the same time are oxygen-poor  3. Perfusion: delivery of blood via the right pulmonary artery to the capillaries that supply the alveoli 4. Diffusion: actual gas exchange across the alveolar capillary membrane Respiration One cycle of respiration= 1 inspiration and 1 expiration Average # of cycles of respiration/ minute for adults between 12 and 18 Quiet breathing pattern= tidal respiration ○ Involves about 500 ml of air with each cycle ○ We process 6000-8000 ml of air every minute (“minute volume”) ○ Oxygen requirements increase by a factor of 20 during strenuous breathing (adult male) Life Breathing vs. Speech Breathing Life Breathing (tidal breathing) Air taken in at the nose Inhale 40% Exhale 60% 500cc (ml) volume of air (10%VC) Passive muscle activity for exhalation Speech Breathing Air intake at the mouth Inhale 10% Exhale 90% Volume of air varies depending on utterance (20-25% VC) Active muscle activity for exhalation Lung Volumes and Capacities Vital Capacity (VC) Total amount of air available for life and speech (max inhalation to max exhalation) Total volume of air that can be inspired after a maximal expiration TV + IRV + ERV 4,000-5,000 cc typical VC in adults Total Lung Capacity (TLC) Total amount of air lungs are capable to holding VC (which= TV + IRV + ERV)+ RV 6,000 cc typical VC in adult males; 5,000 cc typical VC in adult females Tidal Volume/ Tidal Breathing Volume of air exchange during a respiratory cycle Depends upon task demands- varies with exertion, body size, age Quiet tidal volume: for adult males= 600 cc, adult females= 450 cc, average of 525 cc for adults Residual Volume Volume of air remaining in lungs after maximum exhalation Always some volume of air left that cannot be eliminated Increases with age RV range (adults): 1,000 to 1,500 cc Expiratory Reserve Volume Quantity of air that can be exhaled after passive, tidal expiration Also called resting lung volume (RVL), volume present in the resting lungs after passive exhalation ERV range (adults): 1,000 to 2,000 cc Inspiratory Reserve Volume volume/ quantity of air that can be inhaled after natural inhalation IVR range (adults)- 1,500 to 2,500 cc LECTURE 8 Phonation  The source of voicing for speech Occurs in the larynx Exhaled air becomes sound wave, source of voicing for speech Voice is created at larynx NOT speech ○ Relies primarily on movement of the vocal folds and airstream from the lungs Respiration provides the energy source for phonation Bernoulli Effect and Air Flow for Speech Vocal folds provide turbulence in the vocal tract as air passes from the lungs to the oral cavity ○ Air has to detour around the vocal folds Bernoulli effect: given a constant flow of air: ○ There will be decreased air pressure and increased velocity in the flow of the air at a point of constriction ○ Air forced through a narrow tube, same total volume of air has to squeeze through a smaller space ○ Each unit mass of air becomes longer and narrower, covering a long stretch of the tube’s walls Exhale air, moves through abducted folds, air pressure between folds drops to create vacuum space, folds are pulled towards each other to begging adduction Larynx Musculo-cartilaginous structure ○ Made up for cartilages, ligaments, membranes Sits atop the first tracheal ring  Average length in adult males: 5 cm Positioned higher than the throat ○ In infants, primates, and early humans Positioned anterior/ adjacent to C4-C6 in adults (anterior to esophagus) Comprised of cartilages and membranes Paired cartilages: arytenoid, corniculate, and cuneiform cartilages Unpaired cartilages: thyroid and cricoid Cartilages articulate with each other and form joint, giving the larynx flexibility and strength Function of the Larynx Protection of airway (trachea and lungs) Locks air into lungs for certain activities Phonation Swallowing Laryngeal System- Cartilages Thyroid cartilage (unpaired): Inferior to hyoid  Largest cartilage in the larynx 2 fused lamina in front= thyroid laminae ○ Joined midline at the thyroid angle ○ Superior-most point on the angle= thyroid notch Posterior aspect is open with 2 sets of cornu ○ Inferior cornu project down to articulate with the cricoid cartilage and form a joint ○ Superior cornu project up to articulate with the hyoid LECTURE 9 Laryngeal System- Extrinsic Ligaments Extrinsic ligaments provide attachment between the hyoid or trachea and the cartilage of the larynx Thyroid membrane (connects hyoid bone & thyroid cartilage): stretches across the space between the greater cornu of hyoid and lateral thyroid Lateral thyrohyoid ligament (connects hyoid bone & thyroid cartilage found towards the side): posterior to thyrohyoid membrane Median thyroid ligament (connects hyoid bone & thyroid cartilage found towards middle of larynx): runs from the corpus hyoid to the upper border of the anterior thyroid Hyoepiglottic ligament (connects hyoid bone & epiglottis) and thyroepiglottic ligament (connects thyroid cartilage and epiglottis): attaches epiglottis to the corpus hyoid and inner thyroid cartilage Lateral and medial glossoepiglottic (connects tongue & epiglottis) ligament: attach epiglottis to the tongue ○ One is on the side on is in the center ○ Overlay of mucous membrane on these ligaments creates valleculae between the tongue and epiglottis Cricotracheal (connects cricoid cartilage to trachea) membrane: connects trachea to larynx Larynx- creates phonotation and voice Laryngeal Systems- Intrinsic Ligaments Connects the cartilages of the larynx; forms structural support for the larynx and vocal folds  Quadrangular membranes: connective tissues, run from arytenoids to epiglottis and thyroid cartilages ○ Form false vocal folds Aryepiglottic muscles: course from side of epiglottis to arytenoid apex, form upper margin of QM and aryepiglottic folds Pyriform sinus: space between the aryepiglottic fold and thyroid cartilage Laryngeal System- Joints Cricoarytenoid and cricothyroid: synovial joints (free movement) Cricoarytenoid Found between base of arytenoid (concave) and the superior surface of the cricoid (convex) Rocking action brings 2 vocal processes towards each other allowing them to approximate ○ Important for adduction and abduction of vocal folds ○ They also can change vocal fold length Cricothyroid Found between inferior cornu of the thyroid and lateral aspect of the cricoid cartilages Thyroid cartilage rocks down in front, and glides forward and back in relation to the cricoid cartilage Lengthen and shorten the vocal folds for pitch and regulation of the voice Vocal folds attach to vocal processes, part of arytenoids Sit on the back upper edge of cricoids to form a joint. Arytenoid moves on the cricoid so vocal folds can move because they are attached. Laryngeal Systems- Vocal Folds Vocal Fold (True) 5 Layers: Epithelium (1) outermost layer Lamina Propia (3) made up of fibrous tissue, collagen and elastic fibers Thyrovocalis muscle (1) ○ Vocal folds have to be abducted during respiration. Vocal folds are adducted during speech Vocal ligaments: first 2 layers of lamina propria Anterior/ posterior fibers of elastin Anterior/ posterior fibers of collagen “Cover” of the folds: first 3 layers of the vocal folds (don’t need) Epithelium Lamina propria: random elastin fibers Lamina propria: anterior/ posterior elastin fibers “Body” of the folds: innermost 2 layers of the vocal folds Lamina propria: collagen fibers Thyrovocalis muscle Glottis Space between the vocal folds, size changed on moment to moment bias depending on if vocal folds are adducted or abducted Lateral margins= vocal folds and arytenoid cartilages ○ margin= membranous and cartilaginous ○ Anterior ⅗ of the vocal margin= soft tissue of vocal folds (membranous) ○ Posterior ⅖ of the vocal margin= cartilage of the arytenoids 20 mm long in adults from anterior to posterior commissure (length) At rest posterior glottis is 8 mm wide (quiet breathing) Less than 3 mm wide during adduction. Twice as wide when running vs breathing quietly ○ Slightly open during quiet breathing, open widely during forced inhalation, closed during phonotation Hyoid Bone Small “U” shaped, unpaired bone Loosely articulates with the superior cornu of the thyroid cartilage Only bone in the body that does NOT attach to another bone (“unarticulated”) 3 major elements ○ 1. Corpus is prominent, shield-like, and can be palpated with the finger ○ 2. Front of the corpus is convex, inner surface is concave  Corpus is the site of attachment for 6 muscles ○ 3. Greater cornu projects posteriorly from lateral surface of the corpus At junction of cornu and corpus is lesser cornu 3 additional muscles are attached at greater and lesser cornu Laryngeal System- Anatomy False folds (also called ventricular/ vestibular folds) Made up of mucous membrane and fibrous vestibular ligament No function for phonation, are protective of true folds ○ During breathing false folds sit in an open abducted position ○ Abducted position unless eating or drinking to protect larynx Slightly superior/ parallel to true vocal folds Separated from the true vocal folds by laryngeal ventricle Space between the false vocal folds= rima vestibuli Open during normal phonation, closed during swallowing and effort activities Aryepiglottic Folds Run from sides of epiglottis to apex of each arytenoid cartilage Are stiffened by the cuneiform cartilages, which lie within the posterior margin, seen as whitish prominences Epiglottis: medial to hyoid, shaped like a leaf Single piece of cartilage Folds over top of larynx when you eat or drink (protection)  Hypothesized to be protective during swallowing in humans, covers the larynx during eating and drinking so that food and liquid goes down esophagus only LECTURE 10 Laryngeal Muscles Two types of muscles: extrinsic muscles and intrinsic muscles Extrinsic: one attachment in larynx or hyoid, one attachment outside ○ Elevated or depressed Intrinsic: both attachments within larynx or hyoid ○ Vocal folds adductors or abductors, glottal tensors or relaxes ○ All innervated by Cranial 10 (X) Vagus Laryngeal Elevators (17:25, on video) Digastrucus: paired contraction of anterior and posterior bellies elevate the hyoid  Posterior and anterior bellies converge at the hyoid, can contract separately or simultaneously Anterior: origin: mastoid process, insert: into hyoid Posterior: origin:mastoid process insert: into hyoid corpus/ greater cornu Innervation: anterior CN 5 (v) trigeminal (jaw) posterior: cranial nerve VII: facial Stylohyoid: elevates and retracts hyoid Origin: on prominent styloid process of temporal bone (bone in front of the ear) Inserts: Courses down medially into corpus of hyoid Innervation: motor branch of cranial nerve VII (facial) Mylohyoid: elevates the hyoid, depresses mandible, elevated the floor of the mouth during deglutition (chewing) insert: on underside of the mandible courses to corpus of hyoid origin: mandible ○ Depresses mandible, pulls hyoid up and mandible down Fibers of the mylohyoid form the floor of the oral cavity Innervation: mandible branch of cranial nerve V: trigeminal Milo and genio mean mandible Geniohyoid: elevates and draws hyoid forward Superior to mylohyoid Origin: inner mandible surface Insert: corpus hyoid Innervation: cranial nerve XII (12): hypoglossal Hyoglossus: lingual depressor/ hyoid elevator When contracts hyoid up and tongue down, moving towards each other Origin: lateral surface of greater cornu of hyoid Insert: course upward to the tongue Innervation: motor branch of cranial nerve XII: hypoglossal Genioglossus: hyoid elevator/ lingual depressor Origin: inner surface of mandible  Insert: tongue and courses up back and down to anterior surface of hyoid corpus Innervation: cranial nerve XII: hypoglossal Thyropharyngeus: pharyngeal constrictor, helps elevate the larynx, propels food down pharynx Not needed Origin: posterior pharynx Insert: thyroid lamina and inferior cornu of the thyroid Innervation: cranial nerve X: vagus, and recurrent laryngeal off the vargi Laryngeal Depressors Sternohyoid: contraction depresses the hyoid Origin: on sternum at the clavicle Insert: courses up to insert into inferior margin of hyoid corpus Innervation: C1-C3 spinal nerves (not needed) Omohyoid: 2 bellies; depresses the hyoid and larynx  Superior belly: continues from inferior, which originates on upper border of Origin: scapula “dogleg” angle to superior belly insert: hyoid Bellies are joined by an intermediate tendon Innervation: C1-C3 spinal nerves Sternothyroid: depresses the thyroid cartilage, helps depress the larynx during swallowing Origin: manubrium sternum and first costal cartilage Insert: courses up to oblique line of thyroid cartilage Innervation: fibers from spinal nerve C1 that course into hypoglossal nerves Laryngeal Muscles- Intrinsic (both attachments in larynx) Adductor Muscles (3): close vocal folds All 3 contact at the same time All innervated by cranial nerve X: vagus Muscle contraction is the only way vocal folds adduct 1. Lateral Cricoarytenoid (LCA): paired Arises at superior-lateral border of the cricoid, inserts into muscular process of the arytenoid  Contraction pulls the muscular processes anterior and medial, pulls vocal processes towards each other, vocal folds are in turn brought together 2. Transverse Interarytenoid (TIA): paired Muscles fibers run from posterior surface of 1 arytenoid to the posterior surface of the other arytenoid Contraction pulls the arytenoids closer together, and thus the vocal folds Provides additional support for medial compression of the folds Vocal folds abducted 3. Oblique Interarytenoid (IA): paired Immediately superficial to the TIA, similar function Originates at posterior base of the muscular processes, course obliquely up the apex of opposite arytenoid Contraction makes arytenoids glide medially towards each other, closing posterior portion of the glottis Works with aryepiglottic muscles to pull the epiglottis to cover larynx Abductor Muscle (1): opens vocal folds You can abduct vocal folds without PCA Posterior Cricoarytenoid (PCA) Paired Originates on posterior part of cricoid cartilage, inserts into the muscular process of each arytenoid Pulls arytenoids apart to help with adduction Innervation: cranial nerve X vagus Contraction pulls the muscular processes back, opening vocal folds During strenuous activity, this muscle will abduct the folds in order to allow more air in and out of lungs Laryngeal Muscles- Intrinsic Glottal Tensors: add tension to the vocal folds making them vibrate faster Cricothyroid: muscle primarily responsible for pitch change. When this contracts vocal folds vibrate faster making voice pitch go up Composed of 2 heads: pars recta and pars oblique Thyrovocalis (vocalis): muscle of the vocal folds (part of thyroarytenoid) Part of the thyroarytenoid muscle (along with thyromuscularis) Origin: inner surface of the thyroid cartilage, near thyroid notch Insertion: courses back to lateral surface of the arytenoid vocal process Contraction draws the thyroid and cricoid cartilages farther apart in front, tenses vocal folds Glottal tensor Glottal Relaxers Thyromuscularis (muscularis): paired (part of thyroarytenoid) Relaxes vocal folds and lowers pitch of voice Part of the thyroarytenoid muscle (along with thyrovocalis) lateral to thyrovocalis Originates on the inner surface of the thyroid cartilage, near the thyroid notch, inserts into the muscular process of the arytenoid cartilage Is the muscle different from the vocalis? Anatomically, unsure Functionally: yes. Muscularis has the same effect upon contraction as the LCA, adduction and lengthening vocal folds LECTURE 11 Physiology of Phonation Nonspeech laryngeal activity Coughing: response to presence of a foreign body or irritant in the respiratory passageway. Something in larynx on way to trachea that shouldn't be ○ Deep inhalation through widely abducted vocal folds, then tensing and tight adduction of the vocal folds along with laryngeal elevation Throat clearing: slightly less irritating than coughing, builds subglottal pressure, adducts folds to restrain it. ○ Can still cause long term damage to the tissue of the respiratory system Vocal Folds Quiet Respiration: vocal folds are 8 mm apart, abducted Phonation: vocal folds are completely adducted Forced Respiration: vocal folds are widely abducted and 16 mm apart Whispering: vocal folds are adducted anteriorly, posterior part of folds are open enough for voice to come out breathy Laryngeal Function for Speech Pre Phonatory Stage: vocal folds are abducted enough to prohibit vibration of vocal folds by air turbulence in the airway Vocal folds adducted 8 mm, about to talk, 3 adductor muscles close folds to prepare speech Need folds to move into adducted position in order to initiate phonation Muscular action is required to achieve this. Adductor muscles Attack Stage: vibratory stage (adduction- abduction cycle) Many of these cycles are seen in continuous speech Process of vocal folds coming together for the beginning of phonation 3 types of attack: ○ Simultaneous vocal attack ○ Breathy vocal attack ○ Glottal attack Attack Types Simultaneous Vocal Attack Respiration begins and vocal folds are already adducting Adduction and onset of respiration occur simultaneously Vocal folds reach critical adduction positions at the same time as the flow of air is adequate to support phonation. Vocal folds close and you start exaltation for speech Breathy Vocal Attack You inhale, folds adduct, start exhaling before folds are completely closed ○ Exhale before adduction. Simultaneou is happening at the same time Common during continuous speech, air is continuously flowing, words that start with “h” (not abnormal) Glottal Attack Opposite of breathy Adduction leads exhalation Adduction of the vocal folds before airflow, similar to a cough Used when a word that begins with a stressed vowel “up” /^p/ All 3 types are normal because they are used at different points  Termination of phonation requires abduction of vocal folds When you stop talking vocal folds abduct, back to quiet breathing Removal of the folds from the airstream using muscular action to stop vibration Vocal Fold Vibration: Stages & Mechanisms Attack Stage: vibratory stage (adduction- abduction cycle) Vocal folds adduction when 3 adductor muscles contract. If something is preventing them from working you cannot adduct vocal folds or produce speech Aerodynamic forces operate: Bernoulli Effect ○ With constant volume, air flows through a constriction at increased velocity, with a corresponding drop in pressure at that site Air moves through glottis this is a narrow constriction) at increased velocity Increased velocity leads to pressure drop at the point of constriction, which leads to negative air pressure at the glottis, creating a “vacuum space” Suction forces serve to adduct folds Subglottal pressure blows vocal folds apart. When you exhale air from lungs vocal folds are closed, air comes up and pressure builds up subglottal pressure to blow folds apart causing abduction Vocal folds then start to close again due to elastic recoil forces ○ Vocal folds form a constriction as they start to close creating negative pressure, Bernoulli effect takes over ○ Adduction begins and the cycle beings over again ○ Vocal folds don't need complete closure for phonation, but cannot be breather than 3 mm apart One opening and closing of the vocal folds= 1 complete cycle of vocal fold vibration ○ There are hundred of cycles produced per second, exact number is dependent on age and gender of talker Vibratory Cycle Characteristics Vibratpry Rate: amount of cycles per second can be measured. This is called fundamental frequency, or pitch of the voice. Number of times vocal folds open and close in one second of time (depends on mass, length, and tension of vocal folds) ○ Fundamental frequency: number of times vocal folds open and close ○ Pitch: how you perceive high and low pitches ○ Relationship: fundamental frequency is the measurement of adduction/abduction cycles per second, more cycles per second higher the pitch of voice sounds ○ Someone's vocal folds might vibrate slower than others based on length, mass, and tension of someone's vocal folds ○ Yes you can change the tension of vocal folds by contracting cricothyroid (glottal tensor) When tense and thin they vibrate faster and pitch goes up Open quotient of the glottal wave: the ratio of the time the glottis is open during the cycle to the total amount of time in the entire cycle ○ How long glottis is open in cycle compared to overall time of cycle ○ Glottal wave: voice (sound wave that comes out of larynx specifically glottis) Speed Quotient of the Glottal Wave: the ratio of the time of abduction in the cycle to the time of adduction ○ Not always 50:50 Conditions for Phonation Subglottal pressure must exceed supraglottal pressure (vocal folds are adducted) ○ Subglottal pressure must continue to exceed supraglottal pressure for continued phonation (pushed vocal folds apart) need subglottal pressure to be higher than supraglottal ○ Difference between the 2= transglottal difference in pressure (don't need) Phonation threshold pressure (Pth)= the minimum amount of subglottal pressure needed to set the vocal folds into vibration  Needed phonation threshold pressure (pressure that will blow vocal folds apart) of 3-6 cm H2O (measure of air pressure) to continue phonation at conversational level (about 60dB SPL) Theory of Phonation Myoelastic Aerodynamic Theory Voice production= a combination of MYO (muscle force) ELASTIC (tissue elasticity) AERODYNAMIC (air pressures and flows) ○ Myo: adductors and abductor muscles Main way vocal folds adduct is contraction of 3 adductor muscles ○ Main way vocal folds abduct: blown apart by build up of subglottal pressure ) aerodynamic + bernoulli principle folds start to adduct again then 3 adductor muscles finish adduction ○ Elasticity: elasticity of vocal folds Aerodynamic forces determine vibratory cycles (through neural forces initiate and drive phonation. Your brain is in charge of this whole process telling everything what to do and when) After vocal folds are forced apart due to increased subglottal pressure, a puff of air travels into the vocal tract, setting the air in the tract into vibration Sound wave travels through the vocal tract and is modified on its way out by the articulators, creating different phonemes Phase Difference During Vibration Layered structure of the vocal folds= complex vibratory patterns 1. Vertical Slight time lag between opening and closing of the inferior and superior portions of the vocal folds. Bottom of folds close first and then moves up (zipper like) Called the vertical phase difference (continual wave) Inferior edges close while superior edges still open When superior margins close, inferior edges are already starting to open to start the next cycle 1. Longitudinal  Slight time lag between opening and closing of the anterior and posterior portions of the vocal folds = longitudinal phase difference Open and close front to back Vocal folds open from posterior direction to anterior direction Vocal folds close from anterior direction to posterior direction Mucosal Wave Umbrella term for describing how vocal folds move Timing differences in the opening/ closing of the vocal folds give the vocal fold vibration a wave like motion ○ Glottal wave: complex periodic wave (all vowels) ○ This is very evident in the loose outer covering of the vocal folds, the epithelium and superficial lamina propria Vocal fold vibration generates a complex periodic wave ○ Consists of fundamental frequency (Fo) and harmonics ○ Fo determines the pitch of the voice Voice Fundamental Frequency Rate of vocal folds vibration is determined by their mass, length, and tension ○ Greater mass, less tension and stiffness= slower rate of vibration, lower Fo (voice fundamental frequency) ○ Fo is more affected by tension of the vocal fold cover than length of the folds ○ Primary muscles involved: cricothyroid, thyroarytenoid, posterior cricoarytenoid ○ Fo is changed often during the course of speech ○ Average Fo range for (fundamental frequency): Adult male talkers= 80-150 Hz Adult female talkers= 180-250 Hz Child talkers= 250-300 Hz Voice Intensity (loudness)  Controlled through regulation of subglottal pressure (taking a bigger and deeper breath so folds adduct with more force) Loudness: perception Intensity: measurable Primarily through increased/ decreased medial compression Increased in medial compression= vocal folds more tightly compressed for a long time ○ Get more Ps, stronger force blowing folds apart and stronger excitation of the air molecules of the vocal tract ○ Folds then come together more forcefully as well ○ Forceful adduction of the vocal folds is a result of simultaneous contraction of the lateral cricoarytenoid and arytenoid muscles Sustained Phonation and Vocal Register Sustained phonation requires maintenance of adduction/ abduction (laryngeal posture) through tonic contraction of the musculature Need to hold the folds in place in the airstream Thus, vibration of the folds is not the result of vocal fold adduction and abduction 1. Modal Register: pattern of phonation used in regular conversation (normal register) Vocal folds open from inferior to superior, close from inferior to superior (ventricle) Vocal folds open from posterior to anterior, close at end of the cycle first medially, then anterior, then posterior portions Mucosal wave is created, gives voice fundamental frequency and harmonics 2. Glottal Fry: “pulse register” or “strohbass” crackly voice quality (“crackly”) Requires low subglottal pressure (2 cm H2O) tension of the vocalis is required, vibrating margin of the folds is flaccid and thick Vocal folds spend 90% of the vibratory cycle in approximation, and therefore actually vibrate differently than in modal register Get strong medial compression of thick vocal folds paired with low subglottal pressure = popcorn/ crackly voice quality Creates irritated. Adducted for longer than they should be  1. Falsetto= vocal folds are lengthened and thinned by cricothyroid Vocal folds vibrate along a tensed, bowed, margin, making contact only briefly with a reduced degree of movement compared to other registers The result is an extremely high pitched “thin” voice quality Very high pitched voice Pressed phonation: greatly increased medial compression-voice sounds stronger, louder than normal along with a strident or harsh quality (vocal hyperfunction can = vocal abuse) Breathy phonation: vocal folds are inadequately adducted, air escapes between them during phonation LECTURE 12 Articulatory System  Largest mobile articulator is the tongue (most important), followed by the mandible, lips, velum/ soft palate, cheeks, pharynx (and also hyoid and larynx) Immobile articulators= alveolar ridge, hard palate, teeth Most important articulators: tongue, mandible, teeth, hard palate, velum Cavities of the Vocal Tract Oral: bound by: lips (front), cheeks (sides), palate (roof), tongue (moveable floor), pharynx (back) ○ Velum is a muscular extension of the hard palate, uvula marks the end of the velum ○ anterior/ posterior faucial pillars: tissue on either side of the velum, posterior margin of the oral cavity Buccal (cheeks): lateral to the oral cavity, space between posterior teeth and cheeks (lateral margin) space between teeth and cheek ○ Posterior margin= 3rd molar, anterior= lips Pharyngeal Cavity: 3 parts  ○ Oropharynx: bounded by velum (superior) and hyoid (inferior) ○ Laryngopharynx= superior boundary: hyoid, inferior boundary: esophagus, anterior boundary: epiglottis ○ Nasopharynx: space above the soft palate, also contains pharyngeal tonsils- adenoids Nasal Cavity: produced by maxillae (top jaw), palatine bones (bones of hard palate), nasal bones ○ Divided by nasal septum, lined with mucous membrane and cilia, floor= hard palate ○ Anterior body: nares, posterior: nasal choanae Valves of the Vocal Tract Labia (lips): open and close Lingual (tongue): contracts articulators in various locations. Stops flow of air “t” sound Velopharyngeal: velum touches posterior pharyngeal wall Laryngeal (vocal folds): open or closed position Structures and Muscles of the Face Lips Made of muscles, mucous membrane, glandular tissues, and fat covered in epithelium, highly vascularized Change position of the lips to change shape of the oral cavity ○ Change facial expression and keep food and liquid inside the mouth  Landmarks: cupids bow, columella, philtrum Inner surface of upper lip connects to midline of alveolar region via the superior labial frenulum Lower lip connected to midline of mandible by inferior labial frenulum Main muscle of the lips: orbicularis oris ○ Single muscle encircling the mouth or 2 sets of paired muscles, 2 upper: orbicularis oris superior and 2 lower: orbicularis oris inferior ○ Most of the other facial muscles insert into orbicularis oris, allowing for a large degree of lip movement and facial expression alteration ○ Innervation: mandibular marginal and lower buccal branches of CN VII: facial Muscles of the Face Risorius (“laughing”) Originates from posterior region of the face, superficial to the buccinator, inserts into corners of the mouth Retracts the lips at the corners Innervation: buccal branch of CN VII: facial Buccinator: used for mastication Dominate muscle of the cheeks; deep to risorius Originates from the mandible and maxilla, courses forward, inserts into upper and lower orbicularis oris Innervation: buccal branch of CN VII: facial 3 muscles primarily responsible for upper lip elevation, all insert into mid-lateral region of the upper lip, all innervated by the buccal branches of CN VII 1. Levator Labii Superioris Alaeque Nasi: courses almost vertically from the lateral margins of the nose  2. Levator Labii Superioris: arises from infraorbital margin of the maxilla, courses down into upper lip 3. Zygomatic Minor: arises from facial surface of zygomatic bone Levator Anguli Oris Arises from the canine fossa of the maxilla, inserts into upper and lower lips Draws the mouth corners up and medial-ward Innervation: superior buccal branches of CN VII Zygomatic Major Origin: lateral to zygomatic minor on zygomatic bone, inserts into corner of orbicularis oris Elevates and retracts the angle of the mouth (smiling) Innervation: buccal branches of CN VII Teeth Adults have 32 (16 maxilla/ 16 mandible) children have 20 (10 maxilla/ 10 mandible)- equal numbers on upper/ lower arches 4 Types: incisors, cuspids/ canines/ eye teeth, bicuspids/ premolars, molars Immobile, other articulators move against them to create connections (/s/) Occlusion: relationship between upper and lower teeth and dental arches ○ Class I: normal (neutro-) ○ Class II: mandible behind maxilla- overbite (disto-) ○ Class III: mandible past maxilla (mesio-) Hard Palate  Bony, lined with epithelium Roof of oral cavity, floor of nasal cavity Anterior ¾ = palatine processes of the maxilla ○ Palatin processes join at midline and articulate at the intermaxillary suture Posterior ¼ = formed by palatine bones of the skull ○ Meeting of palatine processes and palatine bones form the transverse palatine suture Vault: arch, runs anterior/ posterior and laterally Alveolar ridge directly behind teeth ○ Point of contact for many speech sounds Lecture 13 Soft Palate/ Velum Muscle and soft tissue; moveable Palatal aponeurosis attaches to velum to posterior part of hard palate ○ Also to nerves, blood supply, glands covered in mucous membrane At rest hangs down into pharynx ○ Forms passageway between nasal and oral cavities, the velopharyngeal port ○ VP is open- oral and nasal cavities are couples ○ VP is closed- velum is raised and back to touch posterior pharyngeal wall- barrier between oral and nasal cavities; air must exit oral cavity (most sounds in english) ○ If your sound wave comes from larynx and you want to produce oral sound VP should be closed but it's a little open, it will come out nasally ○ 5 muscles total: 2 elevators, 2 depressors, 1 tensor Elevators: 1. Levator Veli Palatini: makes up bulk of velum, raises velum to close VP port, primary elevator of velum Arieses petrous portion of the temporal bone, courses down and forward, inserts into palatal aponeurosis of soft palate Innervation: pharyngeal plexus, arising from CN XI (accessory) and X (vagus) 2. Musculus Uvulae: branches up and arising from the velum, paired muscle within the uvula Aries from the palatine bones and the palatal aponeurosis, inserts into mucous membrane cover of the velum Innervation: pharyngeal plexus Depressors: 1. Palatoglossus: forms the anterior faucial pillar, posterior boundary of oral cavity (also elevates tongue) Originates at the anterolateral aponeurosis, courses down, inserts into sides of posterior tongue Innervated by the pharyngeal plexus 2. Palatopharyngeus: forms the posterior faucial pillar  Fiber arise from anterior hard palate and middle soft palate, courses down to insert into thyroid cartilage Helps to depress velum, narrow pharyngeal cavity and guide food into pharynx Innervated by pharyngeal plexus Tensor: Veli Palatini: contraction opens eustachian tube for pressure equalization Tongue Most important and active articulator Also important for chewing, swallowing, and taste Parts: ○ Apex: tip ○ Front ○ Back ○ Dorsum (broad superior surface) ○ Body (major mass) ○ Root (attaches to the hyoid, extends along pharynx) Oral/ palatine surface= ⅔ of the total tongue surface in oral cavity Pharyngeal surface= ⅓ of total tongue surface in orthopharynx It is a muscular hydrostat: muscular organ with no skeletal support, skeletal support is achieved through muscular contraction Divides into right and left haves by median fibrous septum Divides into right and left sides by the central sulcus Band of tissue joining inferior tongue to mandible: lingual frenulum Muscles of the Tongue Intrinsic: both attachments within tongue; fine adjustments of shape and position; all are innervated by CN XII: hypoglossal 1. Superior Longitudinal: elevates tip of tongue Arises from mucous layer of tongue near the epiglottis, the hyoid, and median fibrous septum, inserts into lateral tongue margins and region of the apex 2. Inferior Longitudinal: pulls tip down, retracts tongue Arises from mucous layer of tongue near the epiglottis, the hyoid, and median fibrous septum, inserts into lateral tongue margins and region of the apex 3. Transverse: pulls edge toward midline, narrows tongue Arises from median fibrous septum, inserts into sides 4. Verical: pulls tongue down, flattens tongue Fibers course from base of tongue, into membranous cover Extrinsic: move the tongue as a unit in preparation for articulation 1. Genioglossus: retracts or draws tongue forward Arises from inner mandibular surface, inserts into the tip and dorsum of the tongue as well as hyoid in medial position in tongue, other muscles are lateral to it Contraction patterns: (don't need) ○ Anterior fibers: tongue retraction ○ Posterior fibers: tongue thrusted forward ○ Both: middle portion of tongue drawn down 2. Hyoglossus: pulls slides down Arises from greater cornu of the hyoid, courses up to insert into sides of tongue between inf. Long. and styloglossus 3. Palatoglossus: elevates back of tongue, depresses the velum Originates at the anterolateral palatal aponeurosis, courses down, inserts into sides of posterior tongue 4. Styloglossus: elevates and retracts tongue Originates at the anterolateral margin of the styloid process of the temporal bone, courses forward to insert inferior sides of the tongue 5. Chondroglossus: depressor of the tongue (don't need)  Often thought of as part of the hyoglossus Arises from lesser cornu of the hyoid, courses up to insert into sides of tongue between inferior longitudinal and styloglossus Pharynx Important for speech, swallowing, and respiration ○ Very important for speech resonance Long hollow tube, made of muscle, connective tissue, mucous lining ○ 4 cm long, 4 cm wide at top, 2.5 cm wide at bottom  Runs behind nasal cavity, oral cavity and larynx *Major muscles: pharyngeal constrictors (inferior, middle, superior) and cricopharyngeus * ○ Muscles are closely allied with the tongue, facial, and laryngeal muscles Pharynx: Muscles Pharyngeal constrictors: reduce diameter of the pharynx, all innervated by CN XI and CN X via the pharyngeal plexus ○ Superior, middle and inferior ○ Inferior makes up the inferior pharynx often referred to as a separate muscles, the cricopharyngeus Salpingopharngeus: elevates the pharyngeal wall ○ Innervated by CN XI and CN X via pharyngeal plexus Stylopharyngeus: elevates and opens the pharynx, deglutition ○ Innervation: muscular branch of CN IX Muscles of Mastication Chewing food into appropriate sizes requires mandibular movement, and strong, coordinated muscles 3 types: mandibular elevators, depressors, protruders Elevators: 1. Masseter: most superficial, massive muscle Arises from the zygomatic arch, courses down, inserts into mandible Raise mandible for purpose of chewing Innervation: CN V- trigeminal 2. Temporalis: deep to the masseter, contracts more rapidly than the masseter, elevates and retracts mandible Arises from the temporal and parietal bones passes through the zygomatic arch and inserts into the mandible Raise mandible for purpose of chewing Innervation: mandibular division of CN V- trigeminal 3. Medial Pterygoid (internal pterygoid): elevates the mandible, works in conjunction with the masseter  Aeries from the medial pterygoid plate of the mandible and courses down and back to insert into the mandibular ramus Innervation: mandibular division of CN V- trigeminal Muscle of Protrusion (moves forward) Lateral (external) Pterygoid: muscle of protrusion Arises from the sphenoid bone, inserts into the lower inner margin of the mandible Contraction protrudes the mandible, helps achieve grinding action with molars Innervation: mandibular branch of CN V Depressors: 1. Digastricus: paired contraction of anterior and posterior bellies elevate the hyoid, when the hyoid bone is fixed by the infrahyoid muscles, contraction of the anterior component depresses the mandible (previous notes) 2. Mylohyoid (lecture 10) 3. Geniohyoid (lecture 10) 4. Platysma: arises from the fascia overlying the pectoralis major and deltoid (shoulder), courses up and inserts into the corner of the mouth and lower margin of the mandible a. Innervated by CN VII LECTURE 14 Speech Perception Perception: understanding what was said or heard Need reception of the sound to occur before perception can occur Auditory system and brain are responsible for reception/ perception of sound Sound Reception Detection of presence of a sound by the auditory system Requires adequate access to sound, enough hearing to be able to detect sounds Anatomy of the Auditory System 2 sections of the ear Peripheral Auditory System ○ Outer, middle, inner ear Central Auditory System ○ CN VIII: vestibulocochlear, pathways to the brainstem, auditory cortex Peripheral Auditory System Location of the ear in the skull ○ Petrous portion of the temporal bone 3 parts ○ Outer ear ○ Middle ear ○ Inner ear Outer Ear Pinna/ auricle cartilaginous Landmarks: ○ Helix ○ Concha ○ Lobule ○ Tragus ○ Antitragus Funcation: helps sound into the ear, protects the canal, sound localization External Auditory Meatus/ canal  ○ Tube open on 1 end (EAM) and closed on the other (tympanic membrane) ○ 7mm diameter, 2.5 cm long in adults ○ Outer ⅓= cartilaginous inner ⅔= bony ○ Is “s” shaped, therefore has 2 turns or bends ○ Lined with cilia, constraints cerumen Tympanic Membrane Provides the boundary between outer and middle ear Healthy TM= translucent, pearly gray 3 cartilage layers ○ Outermost epithelial, middle fibrous, innermost mucous membrane 2 portions ○ Pars tensa (3 layers) ○ Pars flaccida (2 layers) 4 quadrants: provide orientation ○ Anterior-Superior ○ Anterior- Inferior ○ Posterior-Superior ○ Posterior-Inferior Middle Ear Middle ear space Eustachian tube Ossicles Oval window Round window Middle Ear Space Dry, air-filled cavity ○ Air pressure, which is regulated by the eustachian tube, should be = P ATM Lined with mucus membrane Superior-posterior aspect= oval window, below that is the round window (membrane covered)  ○ Between the 2= promontory, a bulge created by a cochlear turn Anterior wall= eustachian tube Beneath the floor of ME= jugular bulb Roof of the ME= tegmen tympani Space on top of ME= aditus to mastoid antrum Eustachian Tube Essentially connects the ears, nose, throat 36 mm long Normally in a collapsed state; can be forced to open, tensor palatini responsible for this action 3 functions ○ Pressure equalization ○ Ventilation of the ME space ○ Drainage Placement in the head: adult vs. child Ossicles Smallest bones in the body Always articulate with each other; collectively called the ossicular chain, held in place by ligaments Maleus (“hammer”): largest, connects to the tympanic membrane ○ Can often be seen through the TM  ○ Parts: handle/ manubrium, head, anterior and lateral processes Incus (“anvil”): articulates with the malleus via the head ○ Parts: long process (7mm), short process, corpus Stapes (“stirrup”): smallest ○ Head articulates with the incus, neck bifurcates and becomes the crura, which coverage on the footplate ○ Staples footplate fits in the oval window Muscles of the Middle Ear 1. Stapedium 6 mm long, embedded in the bone of the posterior wall of the middle ear Inserts into the neck of the stapes, contraction rotates the stapes; contraction rotates the stapes posteriorly Innervation: stapedial branch of CN VII 2. Tensor Tympani 25 mm long, arises from the anterior wall of the middle ear, inserts into the upper manubrium of the malleus Innervation: CN V Protective function? Vital capacity: total amount of air for speech and breathing Forced inhalation: active process 4 stages of gas exchange