Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University

1. Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University

3. The “Plan” • RELAX!!! • Be comfortable • Ask questions • Get answers • Go home with new information • Take with you material that you can use

5. Common Terms • Voice Disorder • Hyperfunction • Hypofunction • Aphonia • Dysphonia • Laryngeal Pathology • Vocal Pathology :{ )

6. Speech Dynamics • Speech on exhalation from lungs • Activates the vocal folds • Voiced sound (phonation) passes through the pharynx and oral cavity • Articulators modulate

7. Prosection of the Larynx • 9 cartilages; 1 bone • 5 intrinsic laryngeal muscles to regulate mass, length and tension of the vocal fold • It is a VALVE; it’s binary

8. TVF = true vocal fold • FVF = false vocal fold • Trachea = “windpipe”

9. Coronal Section of the Larynx • TVF and FVF • TVF shape and histology

10. Valve Functions of the Larynx • Abduct: Posterior cricoarytenoid m. • Adduct: Lateral Cricoarytenoid m. (and the Transverse and Oblique Arytenoid muscles. • “Open” at rest

11. Vocal Fold Activity • Closed-Open-Closed • Medial Compression • Vocal “cord”, ligament and fold • Frequency, Amplitude and Waveform • Perturbation values: jitter and shimmer

12. 1 cycle of vocal fold vibration • “closed-open-closed” • Aerodynamic process • Myoelastic process • Frequency perceived as “pitch”

13. Vocal Fold Movement • Closed-Open-Closed • Stroboscopic view • Medial compression • Male Frequency Range: 118-150 Hz • Female Frequency Range: 180-240 Hz

14. Speech is a MOTOR act • Nerves activate and fire • Muscles are “moved” by the nerve impulse • Cranial nerves that control speech: Trigeminal, Facial, Hypoglossal, Vagus, and Accessory

15. Recurrent Laryngeal Nerve • Asymmetrical branch of CX • “Feeds” the intrinsic laryngeal muscles • PCA • LCA • OA/TA • TA

17. Nerve Damage • CX: The Vagus • Recurrent Laryngeal Nerve • Image of unilateral cord paralysis • Dec’d pitch • Respiration for speech is inefficient

18. Medications • Coordination and proprioception (stimulants, sedatives,nervousness, tremors, pain masking) • Airflow (bronchodilators, constrictors, nervousness, tremor) • Fluid balance (decongestants,---”rebound effect”--edema, sedating, decreased energy

19. Medications, cont. • URT secretions--(antihistamines, dryness, sedation) • Hormonal (androgens, increasing vocal mass) • Gastrointestinal Reflux Disorder: GERD---OTC medications, diet.

20. Laryngeal Pathology • An ANATOMICAL CHANGE in the size, structure or shape of the larynx • A pathology is a deviation in the normal structure caused by disease or other systemic variation

21. Benign Lesions • Vocal Nodules • Vocal Polyps: Sessile Peducunlated • Contact Ulcers • Granuloma • Papilloma

22. Added Mass • Top view: vocal nodules (bilateral) • Bottom view: vocal polyp (sessile)

23. Swelling • Reinke’s Edema • Increased mass, decreased pitch (frequency) • Atypical perturbation values

24. Plicae Ventricularis • False vocal fold vibration • Decreased pitch and decreased frequency (< 90 Hz) • Limited Pitch e.g., “Monopitch”

25. “Bowed Vocal Cords” • Chronic Laryngitis • Presbylaryngis • Fatigue/Overuse • Symptoms: • decreased intensity • decreased respiratory control • decreased pitch range

26. Granuloma • Associated with physical irritation; abrasion of the mucous cover of the vocal fold • Adds mass: decreases pitch (frequency), increases perturbation values

27. Intracordal cyst • Note left side of body (slide right!) • Added mass • Incomplete medial compression of true vocal fold • Result: increased mass and air escape