Voice and Craniofacial Disorders By: Grace Castillo & Christine - - PowerPoint PPT Presentation

Voice and Craniofacial Disorders

By: Grace Castillo & Christine Truong

What is a Voice Disorder?

• A voice disorder is differences in quality, loudness, and pitch compared to

“normal”. ○ “Normal” being different than people with similar:

• Age, gender, geographic location, cultural background

○ Perceptual features (what we hear vs. what we expect to hear) deviate from norms such that they draw attention of those listening

Terms to Know

• Pitch: The perceptual correlate of frequency that is largely based on the frequency with which

the vocal folds vibrate

• Volume: The perceptual correlate of intensity which is determined by the intensity of the

sound signal

• Intensity: Sound pressure
• Jitter (Frequency Perturbation): Variations in vocal frequency that are often heard in dysphonic

patients

• Shimmer (Amplitude Perturbation): Cycle-to-cycle variation of vocal intensity
• Hoarseness: A combination of breathiness and harshness which results from irregular vocal

fold vibrations

• Harshness: Rough, unpleasant, and “gravelly” sounding that is associated with excessive

muscular tension and effort

• Strain: Phonation is effortful and the patient sounds as if he/she is squeezing the voice at the

glottal level

Terms to Know

• Glottal fry (Vocal Fry): Heard when the vocal folds vibrate very slowly with the resulting sound
• ccurring in slow but discrete bursts and extremely low pitch
• Glottal stop /Ɂ/: A stop consonant produced in place of other glottal consonants
• Diplophonia: “Double voice”; occurs when a listener can simultaneously perceive two distinct

pitches during phonation

• Stridency: Voice sounds shrill, unpleasant, somewhat high pitched and tiny
• Breathiness: Results from the vocal folds being slightly open or not firmly approximated

during phonation

• Hypernasality: Excessive nasality; sounds like the patient is speaking through their nose
• Hyponasality: Patients speak with decreased or insufficient intraoral breath pressure,

affecting the production of fricatives, affricates, and plosives

Risk Factors of a Voice Disorder

• Vocal abuse

○ Phonotrauma ■ Repetitive throat clearing ■ Coughing ■ Talking over background noise

• Medically related

○ Direct and indirect surgeries ○ Medical/health conditions ○ Medications

• Personality Related

○ Environmental stress ○ Identity conflict ■ Gender dysphoria ○ Psychological and psychiatric problems

Associated Cranial Nerves and Their Function

• CN X (Vagus)

○ The primary CN involved in laryngeal innervation

• Functions:

○ Motor: controls most muscles of the larynx, pharynx, and palate for phonation, swallowing, and resonance; controls the gag reflex with CN IX ○ Sensory: sensation from posterior tongue and larynx; regulates oxygen intake and lung Inflation

CN X Branches

• SLN

○ Internal branch provides all of the sensory information to the larynx ○ External branch supplies motor innervation solely to the cricothyroid muscle

• RLN

○ Supplies all motor innervation to the interarytenoid, posterior cricoarytenoid, thyroarytenoid, and lateral cricoarytenoid muscles ○ Supplies all sensory information below the vocal folds

Associated Cranial Nerves and Their Function

• CN VII (Facial)

○ Innervates the posterior belly of the digastric muscle of the vocal folds

Respiratory System

• Respiratory system

○ One of the suppliers for the power of the voice

• Ventilation

○ Air movement (transfers air in/out of the lungs)

• Respiration

○ Gas movement across membranes ○ Exchanging: ■ Atmospheric gas with that of blood gases ■ Blood gases with that or organ-producing gases ■ Take oxygen in and release carbon dioxide

Clavicular Breathing

• Most shallow type of breathing
• Breathing into the top third of the lungs

and no deeper

• How it works:

○ Raising the clavicle & shoulders during Inhalation ○ Keep the rest of the torso motionless

Clavicular Breathing Example

Diaphragmatic-Abdominal Breathing

• Helps strengthen your diaphragm
• One of the biggest benefits is reducing stress
• How it works:

○ The diaphragm is a dome-shaped respiratory muscle found near the bottom of your ribcage. When you inhale and exhale air, the diaphragm & other respiratory muscles around your lungs contract. ○ During inhalation, your diaphragm contracts so that your lungs can expand into the extra space and let in as much air as is necessary. ○ Muscles in between your ribs, known as intercostal muscles, raise your rib cage in order to help your diaphragm let enough air into your lungs.

Diaphragmatic-Abdominal Breathing Example

Thoracic Breathing

• How it works:

○ Start by inhaling (this expands the thorax) ○ This causes the intercostal muscles to elevate the ribs (as compared to abdominal breathing using the diaphragm)

Thoracic Breathing Example

How Vocal Folds Vibrate

Myoelastic-Aerodynamic Theory

Myo = Muscle Elastic = Stretchy Aerodynamic = Airflow & pressure

• Starting point: VFs are in the closed position
• Build up of air pressure from lungs increases → causes VFs to abduct
• Air flows through the glottis
• Natural tissue elasticity takes over to bring VFs to adducted position
• This is one vibration cycle
• This theory assumes air pressure below and airflow between the VFs

interact with VF tissues to set them in motion for a time

• Problem: VF vibration will dampen over time

Hirano’s Body-Cover Theory

• Takes into account role of the layers and how

they contribute to VF movement

• VFs can move in 3 ways:

○ Horizontally: closed at midline to opening out (clap hands) ○ Vertically: down to up (zipper) ○ Longitudinally: front to back

• Speed and extent of VF movement increases or decreases based on these

types of movements

• This theory focuses on VF movement

Titze’s Self-Oscillation Theories

• One-mass or uniform block model

○ Air from lungs moves in one direction ○ Air pressure builds up below the VFs, pulls them apart, and then the VFs are pulled back together ○ As the VFs move closer together, airflow between them is reduced (less space for air to pass) ○ Air above closing VFs continues to move up at the same speed (inertia) ○ Speed of air pressure is maintained except for just above the VFs

Titze’s Self-Oscillation Theories cont.

• Three mass model

○ Added 2 other masses: VF cover & thyroarytenoid ○ Masses move independently yet are linked ○ At different points in the vibration cycle ■ Bottom portion of the VFs are farther apart than the upper portion and vice versa ○ There is greater air pressure when bottom parts are further apart ■ Uneven air pressure maintains VF vibration

• This model is better than the first one

Vocal Tract

• Sound/voice (starts out as acoustic energy) is generated by a subglottic air

pressure

• It is powered by the respiratory system
• Source: laryngeal complex - VF vibration
• Filtered by: size and shape of vocal tract

resonating cavities

• 3 subsystems

○ Oral cavity ○ Nasal cavity

○

Pharynx

Vocal Fold Microstructure

• 5 Layers

○ (1) Epithelium ○ Lamina Propria ■ (2) Superficial layer (Reinke’s Space) ■ (3) Intermediate layer + (4) Deep layer = Vocal Ligament ○ (5) Vocalis Muscle [Thyroarytenoid muscle]

Key Voice Characteristics

• Pitch

○ Fundamental frequency (FF) - rate of vibrations of the VFs ○ Measured in Hz ○ Phonatory modes or registers ■ Falsetto ■ Modal ■ Glottal fry ○ Factors affecting FF ■ VF length ■ VF tension ■ Subglottic pressure ■ Amplitude of vibration

Key Voice Characteristics

• Quality

○ Perceptual judgments of quality are often subjective, though standard measures make this somewhat more objective ○ Factors that influence phonatory quality: ■ Integrity of vibration: regular, symmetry, phase shape/closure and slope of glottal flow waveform ■ Integrity of the respiratory system ■ Supraglottic vocal tract

Key Voice Characteristics

• Loudness

○ Vocal intensity - SPL of acoustic signal we hear ○ Measured in dB ○ Factors affecting intensity: ■ Subglottic air pressure ■ Transglottic air flow ■ VF vibration phase closure ■ Supraglottic vocal tract resonating cavities

Vocal Pathologies

• 8 Categories

○ Structural ○ Inflammatory ○ Trauma/injury ○ Systemic ○ Nonlaryngeal Aerodigestive ○ Psychiatric/Psychological ○ Neurologic ○ Other Disorders ■ Separate Category: Gender Dysphonia & Gender Reassignment

Structural Pathologies: Benign VF Lesions

Etiology Characteristics Treatment Vocal Nodules

• Phonotrauma
• Vocal misuse
• Vocal abuse
• Rough, breathy, tense,

difficulty breathing

• Voice therapy to ensure

proper voice use

• Surgery

Vocal Polyps

• Dysphonia
• Surgery
• Vocal rehab therapy

Vocal Cysts

• Dysphonia/aphonia

Does not respond to therapy!!!

• Surgery

Reactive VF Lesions

• Caused from a contralateral

VF cyst; it’s a reaction to a unilateral VF lesion

• Hoarseness
• Voice therapy
• Conservative management

Vocal Pathologies: Structural

Etiology Characteristics Treatment Reinke’s Edema

• Chronic VF abuse
• Smoking
• Hoarse, rough, low pitch
• Surgery

VF Scarring

• Chronic voice misuse and

abuse

• Presence of a lesion
• Post-op
• Rough
• Affected pitch and loudness
• Compensation for

permanent damage Sulcus Vocalis

• Unknown
• Dysphonia
• Voice therapy

Granuloma

• Inflammation that arises

from irritated vocal tissue

• Occurs after surgery
• Hoarse, breathy, pitch

changes

• Medication
• Voice therapy

Vocal Pathologies: Structural

Etiology Characteristics Treatment Fibrous Mass

• Accumulation of fibrous

material within the lamina propria

• f the vocal fold
• Hoarseness
• Surgery

Pseudocyst

• Phonotrauma
• Hoarseness
• Surgery
• Behavioral management

Contact Ulcer

• Mechanical tissue irritation (from

tube)

• Other irritants (chemical irritants,

reflux)

• Chronic misuse
• Pitch may be reduced
• Possible some pain
• Medication
• Surgery
• Voice therapy

Subglottic and Glottic Stenosis and Acquired Anterior Web

• Post-intubation scarring or

trauma (GSW)

• Labored breathing, shorter

breaths, stridor (high pitched sound during breathing)

• Surgery

Vocal Pathologies: Structural

Etiology Characteristics Treatment VF Hemorrhage, Hematoma, Varix, Extasia

• Acute phonotrauma or injury
• Use of anti inflammatory

medicines

• Dystonia, sudden hoarseness

and roughness

• Pitch and loudness can be

affected

• Medical or surgical to stop

bleeding (steroids)

• Voice therapy
• Total voice rest for 7-10

days (no coughing, no talking, no throat clearing) Epithelial hyperplasia aka keratosis

• Chemical irritants
• White plaque on VF
• Surgery

Leukoplakia

• Vocal abuse
• Stiffness
• Phonosurgery
• Voice therapy

Erythroplasia

• Combo to hyperfunctional

voice use and chemical irritants

• Redness on VF

Vocal Pathologies: Structural

Etiology Characteristics Treatment Recurrent Respiratory Papilloma

• HPV
• Severe dysphonia
• Compromised breathing
• Surgery
• Tracheostomy

Epithelial dysplasia

• Irritation from smoking and

alcohol

• Mild to severe dysphonia
• Hoarseness
• Difficulty breathing
• Radiation
• Surgical excision
• Chemo
• Combo of the above

Laryngectomy

• Surgery
• Inability to phonate due to the

lack of a larynx

• Electrolarynx
• Esophageal speech
• Tracheoesophageal puncture

Puberphonia (Falsetto, Juvenile)

• Changes don’t occur in the

voice (For males: voice is high. For females: voice is low)

• Stridor
• Behavioral voice therapy

Vocal Pathologies: Structural

Etiology Characteristics Treatment Congenital Webs

• Extra tissue in the VFs
• Normal to severe

dysphonia

• Surgery

Laryngomalacia

• Congenital abnormality
• Stridor

Presbylaryngis/ Presbyphonia

• Aging
• Thin or muffled voice

quality

• Decreased loudness
• Pitch instability
• Lack of vocal endurance

and flexibility

• Voice rehabilitative

therapy

• Vocal function exercises

Vocal Pathologies: Inflammatory

Etiology Characteristics Treatment Cricoarytenoid & Cricothyroid Arthritis Laryngitis

• Rheumatoid Arthritis
• Breathy
• Aphonia
• Stridor
• Dysphonia
• Anti-inflammatory and

corticosteroid medications Reflux (GERD & LPR)

• Gastric fluid leak into the

pharynx and larynx

• Dysphonia
• OTC/prescription medication
• Surgery

Irritable Larynx Syndrome (ILS)

• Exposure to chemicals
• Weak vocal quality
• Dysphonia
• Vocal fatigue
• Medication
• Trach established respiration

Vocal Pathologies: Trauma/Injury

Etiology Characteristics Treatment Thermal and Chemical Exposure

• Exposure to toxic

chemicals or heat

• Dysphagia
• Hoarseness
• Loss of voice
• Medication
• Voice therapy

Intubation/Extubation Injury

• Intubation/Extubation
• Hoarseness
• Compensation

strategies Arytenoid Dislocation

• Blunt force or

penetrating wound injury

• Dysphonia
• Breathiness
• Weakness/Strain
• Voice therapy

Vocal Pathologies: Systemic

Etiology Characteristics Treatment Hypothyroidism

• Reduced thyroid hormones
• Lowered pitch and range
• Medication
• Surgery

Hyperthyroidism

• Excessive thyroid hormones
• Vocal instability
• Breathy
• Reduced loudness

Sexual Hormone Imbalances

• Excessive/diminished hormone

levels

• Low pitch
• Rough voice
• Dysarthric voice
• Estrogen

Allergies

• Allergic reactions to environment
• Dysphonia
• Medication

Rheumatoid Arthritis (Also Inflammatory)

• Autoimmune disorder
• Dysphonia
• Vocal fatigue
• Loss of vocal flexibility & range
• Roughness

Vocal Pathologies: Nonlaryngeal Aerodigestive

Etiology Characteristics Treatment Asthma

• Respiratory disease
• Stridor
• Heavy breathing
• Inhaled steroids

COPD

• Pulmonary Condition
• Breathlessness
• Inhaled steroids

Reflux (GERD)

• Gastric fluid leak into the

pharynx and larynx

• Dysphonia
• OTC/prescription medication
• Surgery

Croup

• Viral infection
• Inspiratory stridor
• Rough, strained, low pitch
• Antifungal medication

Candida

• Fungal infection
• Rough and strained vocal

quality

Vocal Pathologies: Psychiatric/Psychological

Etiology Characteristics Treatment Functional Dysphonia/Aphonia

• Psychological

imbalance; there is no visual structural or neurological pathology

• Partial or complete

loss of voice

• Voice therapy

Malingering

• Intentional

pretending/inventing

• n an illness of some

gain

• Depends on the

malingerer

• Refer to psych…

Vocal Pathologies: Neurologic

Etiology Characteristics Treatment PNS: VF Paresis/Paralysis

• Neurologic pathology in

the PNS commonly caused as a side effect of surgeries

• Difficulty breathing,

breathiness, fatigue, effortful phonation, aphonia

• Injections

Movement disorder: Spasmodic Dysphonia

• Exact cause is unknown,

but research has shown that damage of the basal ganglia causes this

• Muscle spasms
• Involuntary/abnormal

adduction and abduction of the VFs during phonation, laughing, crying, coughing, etc.

• Botox

Vocal Pathologies: Other Disorders

Etiology Characteristics Treatment Vocal Abuse/Misuse

• Prolonged and effortful voice

behaviors that have a negative impact

• Reduced breath support
• Excess tension in larynx
• Glottal fry
• Can cause voice trauma
• Benign vocal fold lesions
• Voice therapy

Muscle Tension Dysphonia

• No associated or neurological

cause *our voice book says functional dysphonia is a cause*

• Pain, stiff
• Complaint about tension
• Lump in throat
• Reduced pitch and loudness
• A maladaptive way to

compensate either for a laryngeal pathology, paralysis,

• r just have surgery

Ventricular Phonation (Plica Ventricularis)

• The supraglottic is vibrating

when it shouldn’t be

• Reduced loudness
• Tiring to sustain phonation
• Voice therapy

Vocal Pathologies: Other Disorders

Etiology Characteristics Treatment Vocal Fatigue

• Muscle fatigue, straining of the

pharyngeal muscles, increased thickness of the first two layers, reduced internal hydration, reduced respiratory pressure

• Complaint of lump in throat
• Dry mouth
• Voice therapy

Paradoxal VF Motion or VF Dysfunction

• Unknown, but it causes VFs to

abnormally move and move together unexpectedly

• Stridor
• Difficulty breathing
• Respiratory retraining
• Reflux medication

Irritable Larynx Syndrome

• Exposure to chemicals
• Weak vocal quality
• Dysphonia
• Vocal fatigue
• Medication
• Trach established respiration

Vocal Pathologies: Separate Category

Etiology Characteristics Treatment Gender Reassignment

• Transgender transition
• Changes in pitch,

resonance, intonation, rate, and/or volume

• Voice therapy such as

pitch modification Gender Dysphonia

• Maladaptive behaviors
• r voice misuse

associated with the identification of a different gender

• Voice therapy

Vocal Pathologies: Pictures

Glottic Stenosis VF Polyp Reinke’s Edema VF Hemorrhage; Vascular Lesion Recurrent Respiratory Papilloma Pseudocyst

Vocal Pathologies: Pictures

VF Nodules Fungal Infection VF Cyst Granuloma

Alaryngeal Speech

• Communication without a larynx
• Examples:

○ Esophageal speech ■ Patients literally speak on burps or belches ■ Produced by the pharyngo-esophageus which is the vibratory source ○ Artificial larynx (electrolarynx) ■ A mechanical, handheld device that generates sound ○ Tracheoesophageal speech (TEP)

■

A prosthetic device that is inserted into a tracheoesophageal wall puncture

Assessment

• Purpose

○ Determine etiology ○ Describe the problem ○ Evaluate how the disorder affects vocal components ○ Generate the treatment plan

Assessment Components

• Information gathering and

referral source

• History (past and current)

○ Nature of voice disorder ○ Onset, course, and duration ○ Risk factors ○ Medical issues and medications ○ Social history ○ Voice use ○ Hydration

• Physical Examination

○ CN exam (include a detailed

• ral-peripheral exam)

○ Auditory-perceptual eval (clinical voice eval) ■ Respiration and posture, phonation/quality, loudness, pitch ○ Use various voice measures and severity rating scales (e.g. CAPE-V, Mayo Severity Rating Scale, GRBAS)

Assessment Components

• Instrumental Voice Evaluation

○ Acoustic measures - pitch, loudness, etc. (e.g. Visipitch) ○ Laryngeal imaging (endoscopy and videostroboscopy use various tasks and measures)

• Patient Reported Outcomes

○ VHI-10 ○ CSI ○ RSI ○ SVHI-10

• Impressions

○ Prognosis

• Recommendations

○ Treatment methods

• Plan of care

○

Long term goals

○

Short term goals

○

Duration and frequency of therapy

Instrumental Evaluations

• 2 main types: indirect & direct
• Indirect laryngoscopy - indirectly visualizing the larynx using

instrumentation and some kind of light source

• Direct laryngoscopy - directly visualizing the larynx

Indirect Laryngoscopy

• Mirror laryngoscopy - grossly visualizing

structures/functions with an unaided eye

• Rigid endoscopy - rigid metal tube passes

through the oral cavity

• Flexible endoscopy - flexible cable passed

through the nasal cavity to visualize the VFs

Direct Laryngoscopy

• Scope placed in the oral cavity for optimally

visualizing the VFs

• Videostroboscopy - using pulsed light source

to visualize VF vibration in what appears to be slow motion

Functional vs. Perceptual Assessments

• Perceptual - clinician makes subjective judgments of the many vocal

parameters which include the following:

○ Pitch ○ Loudness ○ Resonance ○ Respiration ○ Phonation

• Functional - broader term to utilizing more functional and practical

assessments

Voice Therapy

• What is Voice Therapy?

○ A way to help bring voice change to a level that can be achieved and to achieve realistic voice change to meet the maximum extent of needs as much as possible

• 4 General Principles

○ Reduce/remove barriers to change ○ Provide Feedback ○ Be aware of emotional distress ○ Tailor therapy to individual needs

Voice Therapy Principles: Barriers

• Reduce/remove barriers to change
• Teaching a patient how to use his/her voice in a different, healthier way

involves reducing/removing barriers to change

• Helps to increase likelihood of progress or success
• Some patients are better than others at buying their capacity to change

○ Multiple factors affect this: ■ Willingness to change, how they responded to change in the past, whether they have family support, their beliefs/belief system

Voice Therapy Principles: Feedback

• It helps to show patients where their voice is at and what the goal is for

the day and/or duration of therapy

• This can be accomplished through instrumental measures which can be

used to establish a baseline before starting therapy but also for demonstrating progress, change, and desired goals

Voice Therapy Principles: Emotional Distress

• Consider the impact of the voice disorder on the patient

○ Daily life and associated problems, self-concept, etc.

• Though it is important to treat the etiology of the voice problem,

sometimes the cause may be unknown, or the cause may not be able to be changed

○ It may not be within the SLP scope of practice to change it

Voice Therapy Principles: Individual Needs

• Based on the patient’s needs and abilities:

○ Voice needs ○ Gender ○ Age ○ Health needs ○ Awareness of the problem ○ Motivation to change ○ Culture ○ Intelligence/education ○ Occupation ○ Family support

Treatment Approaches

• Approaches

○ Hygienic/vocal hygiene ○ Symptomatic ○ Physiologic ○ Psychologic

• Underlying Principles

○ Hygienic/vocal hygiene ■ Negative behavior leads to the voice problem ■ Reduce /eliminate negative behavior to improve/resolve the voice disorder

• Symptomatic

○ Identify misuse during assessment ○ Reduce /eliminate through various voice techniques

• Physiologic

○ Disruption of normal physiologic balance of vocal mechanism can cause a voice disorder

• Psychologic

○ While the vocal structure is normal, something has changed within the pt that is manifested in his/her voice

Craniofacial Disorders

• Definition

○ Refers to an abnormality of the face and/or head ○ Can be mild or severe ○ A congenital condition ○ Can be an isolated abnormality or associated with a sequence or syndrome

Craniofacial Disorders

• Syndrome

○ Occurrence of 2 or more anomalies in a single individual where all anomalies are caused by a single primary agent ○ Example: Treacher Collins Syndrome or Stickler Syndrome

• Sequence

○ Multiple anomaly disorder where many of the abnormalities are actually secondary disorders ○ Example: Pierre Robin Sequence

Primary & Secondary Palate Clefts

• Primary palate: the

triangular area of the hard palate anterior to the incisive foramen and includes a portion of the alveolar ridge

• Secondary palate:

consists of the remaining hard palate and all of the soft palate

Velopharyngeal Function

• Structures active in VP closure:

○ Velum (soft palate) ○ Lateral pharyngeal walls ○ Posterior pharyngeal wall

• Velopharyngeal closure is a sphincteric activity

that takes place in the nasopharynx and involves movements of the soft palate and pharyngeal walls

• Purpose of the VP valve is to direct transmission of sound energy and

airflow in the oral and nasal cavities during speech

• Normal VP functions must have correct learning (articulation), normal

anatomy (structure) and normal physiology (movement)

○ If any of these components are disrupted, there is velopharyngeal dysfunction

Effects of Cleft Lip & Palate on Speech

• Qualitative & quantitative differences in

pre-linguistic and linguistic development

• Vocalize as frequently as do babies

without cleft palate but may have delayed onset of canonical babbling

• Less variety in the canonical forms

produced

• More restricted consonant inventory

during babbling

• Demonstrate fewer total consonant

productions

• Preference for nasal glides and the

glottal fricative /h/ (compared with typical preference for alveolar stop /d/)

• Delayed onset of first words and acquire

words more slowly

• Demonstrate preference for words

beginning with sonorants (nasals, liquids, glides, vowels)

• As children get older:

○ Articulation may be characterized by a restricted phonetic inventory, sound substitutions/omissions, and obligatory vs. compensatory articulation errors

Effects of Cleft Lip & Palate on Feeding

• Feeding problems vary considerably in infants

with clefting. It depends on the type & severity of the cleft.

• In most cases, infants with clefts who are
• therwise typically developing have normal

pharyngeal swallowing function; once the milk reaches the oropharynx, the swallow is initiated with normal airway protection.

• Babies with cleft lip only typically have little

feeding difficulty. Once the nipple is positioned in the baby's mouth, he or she can usually achieve sufficient compression of the nipple against the intact palate.

• Babies with cleft palate (with or without cleft lip)

may have more significant feeding difficulty. They are unable to separate the nasal cavity from the

• ral cavity and therefore cannot create the

negative pressure necessary for sucking. In addition, they may have difficulty compressing the nipple to express milk because the palatal surface is not intact.

• Potential problems associated with feeding

difficulties include

• Fatigue due to excessive energy

expended during feeding

• Poor weight gain due to inadequate

nutritional intake

• Excessive air intake
• Nasal regurgitation

Quiz!

1. What are the 2 cranial nerve branches related to voice?

a. RLN and SLN

2. What are the 3 types of breathing related to voice?

a. Clavicular, Diaphragmatic-Abdominal, and Thoracic

3. Briefly explain the Myoelastic-Aerodynamic Theory

a. Myo=Muscle. Elastic=Stretchy.Aerodynamic=Airflow & pressure. Problem: VF vibration will dampen over time

4. Briefly explain Hirano’s Body-Cover Theory.

a. VFs can move in 3 ways: horizontally, vertically, longitudinally

Quiz!

5. Briefly explain Titze’s Self-Oscillation Theory.

a. One mass: Air pressure builds up below the VFs, pulls them apart, and then the VFs are pulled back together. It moves in 1 direction b. 3 mass: Masses move independently yet are linked

6. What are the 5 layers of the VF?

a. Epithelium, Lamina Propria (Superficial, Intermediate, Deep), Vocalis

7. Briefly explain the etiology, characteristics, and treatment for nodules.

a. Etiology: phonotrauma, vocal misuse, vocal abuse b. Characteristics: rough, breathy, tense, difficulty breathing c. Treatment: voice therapy to ensure proper voice use, surgery

Quiz!

8. What are the 3 voice characteristics?

a. Quality, pitch, loudness

9. What are the 4 treatment approaches?

a. Hygienic, Symptomatic, Physiologic, Psychologic

10. Name the 4 general principles of voice therapy.

a. Reduce/remove barriers to change, provide feedback, be aware of emotional distress, tailor therapy to individual needs