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


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Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University. The “Plan”. RELAX!!! Be comfortable Ask questions Get answers Go home with new information Take with you material that you can use. Common Terms. Voice Disorder Hyperfunction Hypofunction

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

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Peter R. LaPine, Ph.D.

Department of Audiology

and

Speech Sciences

Michigan State University


The “Plan”

  • RELAX!!!

  • Be comfortable

  • Ask questions

  • Get answers

  • Go home with new information

  • Take with you material that you can use


Common Terms

  • Voice Disorder

  • Hyperfunction

  • Hypofunction

  • Aphonia

  • Dysphonia

  • Laryngeal Pathology

  • Vocal Pathology :{ )


Speech Dynamics

  • Speech on exhalation from lungs

  • Activates the vocal folds

  • Voiced sound (phonation) passes through the pharynx and oral cavity

  • Articulators modulate


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


  • TVF = true vocal fold

  • FVF = false vocal fold

  • Trachea = “windpipe”


Coronal Section of the Larynx

  • TVF and FVF

  • TVF shape and histology


Valve Functions of the Larynx

  • Abduct: Posterior cricoarytenoid m.

  • Adduct: Lateral Cricoarytenoid m. (and the Transverse and Oblique Arytenoid muscles.

  • “Open” at rest


Vocal Fold Activity

  • Closed-Open-Closed

  • Medial Compression

  • Vocal “cord”, ligament and fold

  • Frequency, Amplitude and Waveform

  • Perturbation values: jitter and shimmer


  • 1 cycle of vocal fold vibration

  • “closed-open-closed”

  • Aerodynamic process

  • Myoelastic process

  • Frequency perceived as “pitch”


Vocal Fold Movement

  • Closed-Open-Closed

  • Stroboscopic view

  • Medial compression

  • Male Frequency Range: 118-150 Hz

  • Female Frequency Range: 180-240 Hz


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


Recurrent Laryngeal Nerve

  • Asymmetrical branch of CX

  • “Feeds” the intrinsic laryngeal muscles

    • PCA

    • LCA

    • OA/TA

    • TA


Nerve Damage

  • CX: The Vagus

  • Recurrent Laryngeal Nerve

  • Image of unilateral cord paralysis

  • Dec’d pitch

  • Respiration for speech is inefficient


Medications

  • Coordination and proprioception (stimulants, sedatives,nervousness, tremors, pain masking)

  • Airflow (bronchodilators, constrictors, nervousness, tremor)

  • Fluid balance (decongestants,---”rebound effect”--edema, sedating, decreased energy


Medications, cont.

  • URT secretions--(antihistamines, dryness, sedation)

  • Hormonal (androgens, increasing vocal mass)

  • Gastrointestinal Reflux Disorder: GERD---OTC medications, diet.


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


Benign Lesions

  • Vocal Nodules

  • Vocal Polyps:SessilePeducunlated

  • Contact Ulcers

  • Granuloma

  • Papilloma


Added Mass

  • Top view: vocal nodules (bilateral)

  • Bottom view: vocal polyp (sessile)


Swelling

  • Reinke’s Edema

  • Increased mass, decreased pitch (frequency)

  • Atypical perturbation values


Plicae Ventricularis

  • False vocal fold vibration

  • Decreased pitch and decreased frequency (< 90 Hz)

  • Limited Pitch e.g., “Monopitch”


“Bowed Vocal Cords”

  • Chronic Laryngitis

  • Presbylaryngis

  • Fatigue/Overuse

  • Symptoms:

    • decreased intensity

    • decreased respiratory control

    • decreased pitch range


Granuloma

  • Associated with physical irritation; abrasion of the mucous cover of the vocal fold

  • Adds mass: decreases pitch (frequency), increases perturbation values


Intracordal cyst

  • Note left side of body (slide right!)

  • Added mass

  • Incomplete medial compression of true vocal fold

  • Result: increased mass and air escape


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