Voice Disorders #1

At birth the larynx is ______ the dimension of the adult larynx.

At birth the larynx is _____ and ______.

At birth the larynx does not possess a _____ ____ structure and shows no ______ differentiation.

At birth the neonate's larynx is ______ in the neck than in adults.

In baby's the epiglottis is in contact with the velum allowing ____?

There is a _______ relationship between the descent of the larynx and the decrease in average voice pitch.

As the pharyngeal tube elongates, it resonates ______ fundamental frequencies.

The descent of the larynx is ______ unique to humans.

Evolutionary cause of the descent of the larynx: 1.______ 2. ______

Ossification of the hyoid bone begins by age ____?

By the _____ or ______ decade, all the laryngeal cartilage, except the elastic epiglottis, cuniforms, and corniculates, have ______ in males.

The female larynx _____ _____ ossifies.

The infant has a proportionally larger _____ than the adult.

Absolutes glottal dimensions _____ with age.

4 distinctive types of infant cries?

Acoustic characteristics from infants with neuorological damage, SIDS, prematurity, and various medical conditions _____ from _____.

Universal fact about the larynx: the vocal folds respond _______, depending on _________.

A cry that is strained, tense, harsh, and forced owing to massive, tight, effortful closure of the entire laryngeal tract.

A cry that is more sonorous, lax, and devoid of strain or tension.

_____ cries are longer in duration than ______ cries.

Research suggest that crying is _______meant to communicate meaning.

Infant cries serve to maintain to and elicit ____ from caregivers.

Infant cries and other vocalizations are _______ from associated ______ expressions and _______ movements.

Two types of vocalizations?

positive vocalizations?

Negative vocalizations?

The fundamental frequency if the voice drops towards the _____ of a sustained utterance or breath group.

When there is a voice drop at the end of an utterance it is because of the decline of _______ as exhalation progresses and there is _____ respiratory support.

Infants respond to ______ first before they are able to comprehend language.

Three intonational stages in the development of language?

Fundamental frequency in males drops ____% from the infant cry ____HZ to childhood voice ____ HZ and another ___% from childhood voice to adulthood ____HZ.

The decrease in fundamental frequency in females is _____ dramatic but also reaches adult maturity during puberty.

Until puberty, the larynx is ______ in the male and female.

At puberty, the males laryngeal growth _______ the female laryngeal growth.

The greater enlargement of the ______ in most males resuls in a more prominent _____ in vital capacity than seen in females.

During puberty the larynx continues to ______ in the neck, and the neck itself _____.

Onset of puberty occurs _____ in warmer climates and with children who are _____ weight.

In temperature climates, onset of puberty in females ranges from __ to __ and in males __ to __.

Near the _____ puberty is accelerated 1 to 2 years and near the ____ it is delayed 1 year.

Onset of puberty may be delayedin females by _______ or _______.

The average time from onset to completion of adolescent voice change is _____ to _____, ____ at most.

Acoustic signs of puberty occur ___ to ____ months before onset.

3 time periods of pubertal voice change:

In females the voice change is complete by age ___ and in males age ____

Males and females complete the change at approximately _______.

During puberty, the most marked drop in fundamental frequency occurs in ____ and is thought to be related to the laryngeal growth changes resulting from _______.

The male voice drops by approximately ______

pervasive sudden voice breaks from high to low pitch, or the reverse, or excessively husky or hoarse voice associated with adolescent voice change.

_____ _____ can span an entire octave, transcending vocal registers from high-pitched falsetto to bass.

There is a high prevalence of transient dysphonia during ______ voice change.

The majority of male adolescents have ______ voice change.

adolescent voice change does not constitute a _____ ______.

The most notable voice changes occurs between ______ and ______.

After pubertal changes the voice remains ______ until the 6th decade when _______ voice may lower in some females and around the _____ when the male fundamental frequency may rise slightly.

Structural changes of the respiratory system and the vocal folds occur with age including:

________ in the mass of the vocal folds may be the cause for ________ of the fundamental frequency and roughness and hoarseness of voice in elderly women.

________ speakers have a tendency to misuse their voices.

Perceptual studies indicate that listeners can identify ____________ by the sound of their voice.

9 cartilages:

Protects the airway by acting as a moveable leaf-shaped cover.

Prevents food or liquid from entering the trachea during swallowing.

The rocking and sliding action that are responsible for moving the true vocal folds, which are attached posteriorly to the arytenoids vocal processes.

Forms a protective shield in the front and sides of the larynx.

Forms the most anterior portion of the larynx and the thyroid eminence (Adam's apple)

Forms the base of the larynx

The thyroarytenoid muscle that, with the vocalis muscle, forms the vocal folds.

Contraction of the __________ pulls the arytenoids muscles foward causing anteriorposterior closure of the glottis.

What are responsible for abducting the vocal folds and therby opening the glottis?

What are responsible for adducting the vocal folds?

Adduction is also aided by the _____________.

What stabilizes the laryngeal neck posture and can raise or lower the larynx.

The extrinsic muscles of the larynx are sometimes referred to as the ____________.

__________ consist of the thyroarytenoid muscle and the mucous membrane that covers the muscle.

The mucosa is subdivided into the _________ and ___________.

The lamina propria is subdivided into 3 layers:

Appears loose and pliant and it is here that edema often develops.

It is made up primarily of elastic fibers.

It is dense with mostly collagenous fibers.

The _________ is comprised of the intermediate and deep layers of the lamina propria.

The cover consist of the _________ and the ____________. AKA: ______

Most lesions invade the cover and affect ____ and ______.

The term used to describe the structural resistance as opposed to compliance.

The layering of the folds results in:

The mucosal wave is like the _________.

The ___________ of the lamina propria contains few fibroblast, but the _____________ is rich in them.

What are responsible for scar formation?

Removal of lesions, such as cysts, that occur in the cover and do not invade the intermediate and deep layers, usually can be treated surgically without the risk of __________

Space between the vocal folds.

What is the point where the glottal space is widest during abduction?

The point of maximum excursion is the site of ___________ when the folds close during adduction.

The pattern of oscillation that is created by a continual opening and closing of the two masses of the vocal fold cover during voicing.

What is one vibratory cycle (phase)

The folds open from the _________ to the ________ and close in similar fashion.

During one phase of the mucosal wave the vocal folds:

The folds open from the ___-____ and close from the _____-____.

The initiation of sound produced as the folds begin to vibrate.

3 types of voice onset:

When air flows through the glottis before the vocal folds are adducted and vibrating?

When air is flowing through the glottis as vibration of the vocal folds and adduction begins?

When air flows through the glottis after the vocal folds are adducted and vibration begins with a jolt.

3 ways the kind of voice onset habitually used by a particular client can be ascertained?

The vocal folds vibrate with minor fluctuations in _________ and _______.

What is the variation in frequency during vibratory cycles?

What is variation in amplitude during the vibratory cycle?

What is the most sophisticated and complex valve in the vocal tract?

The vibratory of air passes through two other valves before the sound waves are shaped by the ____________ and exit the body through the ____ and _________ cavities.

What are just above and paralled with the true folds?

During swallowing and physical effort the ventricular folds _____, but they remain ______ during normal phonation.

When the ventricular folds are adducted and actually vibrate it is called ______.

The ____ are folds of connective tissue with some muscle fibers that form a ______ to pull the epiglottis posteriorly to close the larynx entrance during swallowing.

Skeletal Structures:

The airway:

Postural muscles:

Primary inspiratory muscle:

Accessory muscles of respiration:

What depresses the rib cage?

What elevates the rib cage?

What compresses the abdomen, also stabilizes the thorax during body functions that demand closure of the vocal folds to maintain inflation of the lungs such as lifting, pushing, bearing down and defecation.

What are involved in clavicular breathing and may assist during inspiration?

The aerodigestive tract:

The bronchial tree:

Types of breathing:

Quiet or passive respiration to sustain life invloves __________.

Only the ___ and the ____ move appreciably during quiet inspiration during at-rest breathing.

_______ is accomplished without muscle movement.

The number of breaths per minute is ___ in the infant than in the adult because of lung size differentials.

What is the amount of air inspired and expired during during a typical respiratory cycle. It is determined by the oxygen needs.

What is the maximum volume of air that can be inspired beyond the end of a tidal inspiration.

What is the maximum volume f air that can be expired beyond the end of a tidal expiration.

What is the volume of air that remains in the lungs after a maximum expiration.

What is the total amount of air that can be expired from the lungs and air passages following a maximum inhalation.

__________ tends to decrease with age.

What represents the total volume of air that can be held in the lungs and airways after a maximum inspiration.

What is determined by how many vibratory closing and openings (cycles) the vocal folds make in one second.

__________ results form our perception of fundamental frequency.

A short, thick, lax vocal fold vibrates at a _____ rate, producing a ______ pitch.

A long, thin, tense vocal fold vibrates at a _____ rate, producing a _____ pitch.

The ________, when contracted, stretches and thins the vocal folds and therefor increases fundamental frequency.

The ________, when contracted, shortens the vocal folds and therefor decreases fundamental frequency.

An increase in _______ causes an increase in perceived vocal loudness.

An increase in ______ causes an increase in perceived loudness.

Opening the mouth wider will cause and __ in perceived loudness.

What are subdivisions within the total range of pitches produced by the voice, vocal fold vibratory patterns vary among registers.

The acoustic signal produced by the vocal folds would be a weak sounding reedy voice without the additional __________.

The larynx is situated at approximately the ____ cervical vertebra, thus creating a resonating chamber to filter and amplify the acoustic signal.

The _______ is constantly interrupted at various sites from the intrusion and movement of various structures.

Some of the interruptions or constrictions in the vocal tract may be severe such as:

Any movement of the _____, _____, or ______ will greatly alter the opening of the oral caivty.

Some movement in the vocal tract have __ effect on the voice and some of them _____ the voice.

What finally comes out of the mouth or nasal cavity becomes a _____ with the ________ fundamental frequency as the vocal source, but _____ modified in its overall sound characteristic.

By filtering the _______ we can tell if the person has a cold, is upset or angry, tired, frightened, or the meaning could even be changed by the change in quality or emphasis while saying the same words.

each persons voice has a unque characteristic, aka:

Resonance does not change ____.

The configuration of the supraglottal vocal tract is ________.

What happens in any one portion of the tract influences both the ______.

By action of the pharyngeal constrictors and other supraflottal muscles the overall dimesnions of the pharynx are______.

The membranes of the pharynx and the degree of relaxation or tautness of the pharyngeal constrictors have ________.

The mouth is essential for ___ as the pharynx.

The ______ is capable of the most variation in size and shape.

The mouths fixed structures:

The mouths moving structures:

The most mobile articulator:

The tongue possesses both ____to move it.

The tongues extrinsic muscles can, on contraction:

The tongues intrinsic muscles control the :

The various combinations of intrinsic and extrinsic muscle contractions can produce an unlimited number of __________ with resulting _______ of the oral cavity.

The lowering and closing of the ____ contributes to the formation of specific vowels.

The _____ and ______ of the velum are also important for the development of normal voice resonance.

The elevation and tensing of the velum, as well as some pharyngeal wall movement, are vital for achieving _________.

a lack of adequate palatal movement, despite adequacy of velar length, can cause serious problems of _________.

THe movement and the positioning of the velum changes the size and shape of three important resonating cavities:

Any alteration of the velum mayhave a profound influence on ________.

________ is only one component contributing to velopharyngeal closure.

Closure patterns that seperate the oral and nasal cavities from one another include:

Voice disorders result from faulty structure or function somewhere in the vocal tract in the processes of ________.

We say a voice disorder exists when one or more aspects of voice such as ________ are outside of the normal range for the age, gender, or geographic background of the speaker.

Dysphonia means:

The ________ is concerned with identifying the etiological and pathological aspects for purposes of treatment.

The ________ uses imagery in an attempt to get the desired acoustical effect from the voice student.

The __________ has the labratory interest of the physiologist or physicist.

The ______ uses the knowledge and vocabulary of all three disciplines to bring about voice imporvement throught treatment of voice.

The ________ assesses the dynamics of voice production and uses whatever is neccessary to get the best voice.

ASHA affirms the practive of visualization of the larynx by both __________.

_______ and ________ is within the scope of practice for SLP's.

_______and ________ rarely contribute to changes in voice, but they may have negative effects on articulation.

extensive oral lesions invlolving the tongue or palatal and velar cancer can seriously affect:

Partial or total removal of the tongue?

Identified causes of oral cancer include:

The majority of oral lesions are treated successfully with _________.

The most severe vocal tract malignancies involve the ______.

Laryngeal cancer comprises approximately ___ of all malignancies diagnosed annually in the U.S.

3 classifications of laryngeal cancers:

Extensive cancer requires perhaps?

What refers to the failure of cartilage to stiffen with development, resulting in an epiglottis that is too pliable and collapses into the airway?

______ accounts for 75% of all congenital anomalies of the larynx and is the most prevalent cause of stridor in the neonate.

In most children with laryngomalacia symptoms are evident _____.

laryngomalacia is managed by an ___, who normally confirms the condition using ___.

Children with laryngomalacia rarely present with _________.

It is common for children to outgrow laryngomalacia by _________.

Approximately ____ of cases require surgical intervention for laryngomalacia.

What is the narrowing of the subglottic space?

Subglottic stenosis can be _____ or ________.

_________ results from an interruption of teh cricoids cartilage or arrested development of the conus elasticus during embryologic development.

_________ may occur following endotracheal intubation either related to lifesaving procedures or surgery.

If the stenosis is severe, air is not exchanged and ___ may be neccessary.

What are openings that occur between the esophagus and trachea?

TEF is associated with ________ to the developing esophagus.

What is an abnormal occlusion of the esophagus?

The standard intervention of TEF is _ followed by __________ by the SLP.

What are small ulcerations that develop on the medial aspect of the vocal processes of the arytenoid cartilages due to irritation?

When granulated tissue forms over these ulcer as a protective mechanism, they are called _______.

____are considered a chronic inflammatory disease of the larynx.

_______ are usually bilateral.

The typical symptoms of contact ulcers:

Contact ulcers result from one of three causes or a combination of these:

Contact ulcers are caused by excessive slamming together of the ________ during production of low pitched phonation coupled with excessively _______ and perhaps increased loudness with frequent throat clearing and coughing.

The speaker is usuallyhard driving person who speaks in a loud controlling ____, often with words punctuated by _______.

Patients who develop contact ulcers and granuloma due to faulty vocal functioning alone are in the _____.

In LPR, ______ is forced up the esophagus and exits the upper esophageal sphincter, thus irritating the area between the ______ or the ________.

Patients who have laryngopharyngeal reflux may be treated with:

Patients with LPR can do behavioral changes such as:

______ is when the physician places a tube down the pharynx into the airway, between the open vocal folds, and on into the trachea.

If the tube is larfer than the glottal opening, the patient runs the risk of______.

The tube being too large for the glottal opening is most common in ____ and ___ who have smaller airways and are thus more often traumatized by large tubes.

Complications from intubation may not appear immediately, but rather _________.

No ___ should be inititated until a laryngeal examination is completed.

If ________ are identified along the posterior glottis, medical-surgical treatment promotes healing and preserves the airway.

_______________ sometimes will produce a reactive tissue irritation leading to the formation of granulomas.

THe most common reactive lesion is ____ of the larynx.

________ is used to give greater bulk to the paralyzed fold in unilateral adducttor paralysis, permitting better approximation of the normal fold with the paralyzed fold.

Other surgical traumas such as _____________, have a possible side effect of the development of reactive tissue granuloma.

Surgically induced irritation with resulting granuloma require _________ of the problem.

Any inflammatory disease of the larynx, such as tuberculosis, syphilis, or sarcoidosis, can lead to ________. This may produce voice symptoms.

______- is the overall management of voice problems related to inflammatory disease.

What is the focus of voice therapy for patients with contact ulcers and/or granuloma?

A patient with contact ulcers and/or granulomas must learn to use a voice pitch that can be prodcued with relatively little strain, to speak with __ jaw and mouth relaxation, to speak at _____ levels of volume, and to eliminate all traces of excessively ________.

Are contact ulcers common?

Cysts in the larynx usually are ____, occurring on the vocal folds or on the ventricular folds.

The cysts often appears ____________, in contrast to the _______ structure of a vocal nodule.

Cysts are often caused by an _____ of the ductal system of laryngeal mucous glands, but there are other causes.

Cysts may be _______.

The site of lesion of the cysts determines if the patient experiences _______ or not.

If a SLP identifies any kind of laryngeal lesion they should refer the patient to:

Cysts ________ resolve spontaneously.

Postsurgical voice therapy is confined to:

Endocrine changes often cause excesses in __________, so that an individuals voice is either too high or too low in pitch.

IN ______ of the pituitary gland, laryngeal growth is retarded.

A pubescent child who has hypofunction of the pituitary gland will experience a lack of secondary ___________ and a _____________.

highpofunction of the pituitary gland may be treated by:

_________ is caused by some tumors of the pituitary gland. It results in precocious puberty and acromegaly.

Hypofunctioning of the adrenal glands can also contribute to:

Adrenal glands are also known as:

________ of the adrenal glands can be caused by tumors in the adrenal system, producing adrenal hormone excesses. Resulting in:

_________insufficient secretion of thyroxin by the thyroid gland, can produce increased mass of the vocal folds, which lowers pitch.

The _____ of hypothyroidism is hoarse, gravelly, and of excessive low pitch. Symptoms can be controlled by:

IN _________ vocal symptoms are less severe, and the patients experience jumpiness and irritability, which result in a breathy voice that may lack sufficient loudness.

What is characterized by vocal fatigue, reduced high pitch range, hypophonia, and loss of certain harmonics?

Premenstraul vocal syndrome begins ___ days before menstuation in 33% of women.

What is the time when some women may experience vocal changes, particulary a lowering of fundamental frequency?

Because of the secretion of excessive androgenic hormones after the menopause, the glottal membrane becomes _______, increasing the size-mass of the folds, and producing a lowering of pitch and sometimes vocal roughness.

The primary treatment for a hormonal imbalance is:

What can help the patient develop the best voice possible with the changing mechanism?

What are similar to contact ulcers and granulomas, differing only in type of lesion.

A ___________ usually is a firm granulated sac, a ____________ is a soft, pliable, blood-filled sac.

Like granulomas, hemangiomas often occur on the ________, frequently associated with vocal hyperfunction, hyperacidity, or intubation.

The blood-filled lesion should be removed ______. As soon as glottal healing permits a _______ should be initiated.