Voice Disorders 2
Terms
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- Longitudinal tension
- Tension in vocal folds responsible for pitch changes. Thyroarytenoid and cricothyroid.
- Myoelastic aerodynamic theory of phonation
- Myoelastic-certain amount of elasticity in all structures in larynx. Aerodynamic-lungs and airflow must be normal for phonation.
- Onset of phonation
- first cycles are abnormal Two phases prephonatory phase, attack phase
- prephonatory phase
- mover from rest toward midline(adduction)-no phonation. Duration is variable only ms.
- Attack phase
- begin vibration-the relation between adduction and air release from lungs. First cycles of vibration
- Three vocal attacks
- simultaneous attack, breathy attack, and hard glottal attack
- breath attack
- air release before adduction/ learned/physical.
- hard glottal attack
- vocal folds slammed hard before air stream is released-tension require a lot of air to get through vocal folds.
- Bernoulli effect
- begins in attack phase and continued thorugh vibration-moves vocal folds mediall and subglottic pressure blows vocal folds apart.
- Fundamental freq.
- rate at which vocal folds open and close per second. Dependent on age, gender, context, and health.
- Normal range
- two/three octaves-octave doubling frequency.
- High subglottic pressure
- assoc. w/ high pitches
- Male fund freq.
- 111-133
- female fund freq
- 188-252
- Larynx of females
- almost adult size before puberty
- Larynx of males
- Grows 2-3 x's as much before puberty than females. More thyroid growth. Growth cause voice to change
- waivering voice
- due to less fine motor control
- Aging respiratory
- lower respiratory support and less control over airflow all complicated by hearing loss
- Aging voice changes
- hoarsness, breathy due to physical and structural changes-epitheal and lamina propria become less elastic.
- Congenital laryngeal malformation
- present at birth-result in airway obstructiton-noticeable by strider (noisy inhale/exhale) weak cray/aphonia, hoarse, swallwoing dysphasia.
- Congenital laryngeal malformation types
- Vocal fold hemangioma, laryngeal papilloma, laryngomalacia, laryngeal wel, subglottic stenosis, laryngocele, laryngeal cyst, laryngoesophageal cleft.
- syndrome
- a group of symtoms and signs which when appearing simultaneous form a definite pattern of a specific condition disease abnormality w/one underlying cause.
- Vocal fold hemangioma
- tend to grown and then get smaller-obstruct airway.
- Laryngeal Papilloma
- Viral, cauliflower, rapidly growing, may invade larynx, trachea, and bronchi. May grow rapidly until puberty.
- Laryngomalacia
- floppy larynx Epiglottis, cunieform, and corniculates not keep airway open especially on inhale. May resolve may need trach.
- Laryngeal web
- vocal folds did not separate from one another-range from microweb->complete obstruction.
- Subglottic stenosis
- narrowing of area around cricoid 2-3mm below vf 2xs as common in females Limit respiratory support-weak cry 60-80% need trach or dilation
- Subglottic stenosis treatment
- Feeding, swallowing, language development
- laryngocele
- fluid/air filled sacs. internal/external cause some airway obstruction interfere w/ vf vibration.
- laryngocele treatment
- help achieve best voice possible
- laryngoesophageal cleft
- rare-no compatible w/ life usually aborted/stillborn. part of another syndrome.
- Laryngoesophageal treatment
- Surgery swallowing, feeding, and alt. comm. there will be cognitive and physical impairment because one midline problem indicates others.
- Jitter
- associated w/ Down syndrome cycle to cycle variation in time
- Shimmer
- associted w/ Down syndrome-cycle to cycle variation in amplitude.
- Down syndrome voice charaters
- breathy hoarse lower pitch, decreases phonation time, decrease intonation, shimmer and jitter.
- Down syndrome
- Trisomy 21 1 in 500-600 births. large tongue, hypotonia, excessive mucous lining in larynx up to pharynx affect thickness of vf cover.
- Neurofibromatosis
- spontaneous mutation, benign tumors anywhere there's nerve, abnormal skin pigment, 1 in 2500 births found in cns small->large tumors
- Treatment neurofibromatosis
- surgically remover but can come back
- Neurofibromatosis voice characters
- breatyness, hoarsness, monotone, CNX affected->short phonation/duration. May result in swallowing probs and shortness of breath.
- Cri du chat (cry of the cat)
- 5p chromosome deficiency, kitten mew at birth, distinct facial features, mod->severe cog., diff. in fine motor. Help functionally communicate
- Cri du Chat voice character
- abnormal larynx develop, strained voice quality, inhale stridor, cry on inhale,
- Cleft palate
- not syndrome, not assoc. w/ cog. defecits. palatal shelves didn not fuse during 9-10 weeks.
- Cleft palate voice characters
- may result velopharyngeal disfunction, hypernasal (resonance) excessive larynx tense. hoarseness, breathyness, laryngeal tension, vocal strain, treat as vocal abuse.
- Microganthia
- small jaw, characteristic of cri du chat
- hypotonia
- low muscle tone cri du chat and DS
- hypertelorion
- eyes far apart cri du chat
- strabisms
- crossed eyes cri du chat
- microcephaly
- small head
- hypernasality
- not a voice disorder, resonance disorder
- FTT
- failure to thrive-not growing despite adequate nutrition. cri du chat
- Laryngeal cyst
- Do not have opening Develop in lamina propria, limit pitch range, limit respiratory support for intensity, breathyness, sugery causes damage to vf.
- Cri du chat physical
- micrognathia, hypotonia, microcephaly, hypertelorion, strabisms, FTT, laryngomalacia, may have cleft soft/hard palate ?austistic.