Voice Pathology 2/15/00

Category 1 Vocal Pathologies Secondary to Vocal Abuse & Misuse

Nodules Description/Etiology: –Localized benign growths –Reaction of the tissue to constant stress induced by frequent, hard oppositional movement of the vocal folds Early- –Edema on vocal fold edge –Fairly soft & pliable, reddish in appearance –Remainder of fold edematous –Nodule may only be evident on one side Later- –Tissue undergoes hyalinization & fibrous –Nodule becomes firm –Chronic- Hard, white, thick & fibrosed (bilateral)

Nodules Perceptual Signs & Symptoms: –Hoarseness & breathiness –Soreness & pain in the neck lateral to larynx –Sensation of something in the throat –Difficulty in producing pitches in upper third of range

Nodules Acoustic Signs: –Increased frequency & amplitude perturbation (Jitter -2.61%; Shimmer- 1.87%) –Fundamental frequency in normal range –Phonational range decreased –Reduced ability to produce loud SPL –s/z ratio of 1.65 –Spectrum analysis will show noise

Nodules Aerodynamic Signs: –Airflow- Equal or slightly higher than normal 275 ml/sec (.275 l/sec) Normal (Women)- Normal (men)- 125 ml/sec (.125 l/sec) –Subglottal pressure- Slightly higher than normal 7.45 cm H 2 0 Normal (women)- 5 cm H 2 0 Normal (men)- 6 cm H 2 0 –EGG- Decreased closing times & irregular closing pattern

Polyps Description/Etiology: Localized pedunculated (attached by slim stalk) Sessile (closely adhered to mucosa) Hemorrhagic (blood blister) –Diffuse- covers one half or two thirds of the entire length of the vocal fold –Result from a period of vocal abuse, single traumatic incident (e.g. yelling at a basketball game) –Polyps & nodules same etiology only to a different degree) –Polyp is larger, more vascular, edematous, & inflammatory

Polyps Perceptual Signs: –Hoarseness, roughness or breathiness –Sensation of something in their throat Acoustic Signs: –Increased jitter & shimmer –Reduced phonational ranges & dynamic range –Increased spectral noise

Polyps Measurable Physiological Signs: –Increased airflow if polyp interferes with glottal closure- Unilateral: l/sec, Bilateral: l/sec –Subglottal pressure increases to produce phonation in the presence of a leaky glottis –EGG- Decreased closing times

Intracordal Cysts Description/Etiology: –Small spheres on the margins of the vocal folds –May be mistaken for early nodules –Predominately unilateral –may occur along with vocal nodules –Cause blockage of a granular duct in which mucous is retained (retention cyst) Perceptual Signs: –Hoarseness, lowered pitch –“Tired” voice

Intracordal Cysts Acoustic Signs: –not available –Data similar for nodules Measurable Physiologic Signs: –Few data available –Higher flows & peak flows –EGG- Slower closing phase

Supralaryngeal System

Vocal Tract Sounds are formed in three ways: –Exploding the airstream with bursts of pressure –Constricting it to generate turbulence –Resonating it to shape different qualities of tone

Articulators Articulators or vocal tract include: –Tongue –Lips –Jaw –Velopharynx –Pharyngeal cavities

Development of Vocal Tract What does the shape of vocal tract preserve? –Horizontal orientation of the special sense organs (sight, smell, hearing) & feeding apparatus –Straight continuity between the brain stem and the spinal cord Advantages: –Completely close the nasal cavity while maintaining an open oropharyngeal tract Human infants cannot close nasal tract

Vocal Tract Nasal Cavity Soft Palate Oropharynx Laryngopharynx Oral Cavity Vocal Folds Trachea Oral Cavity Nasal Cavity

Oral Cavity Oropharynx Nasopharynx Laryngopharynx Cavities

Major subdivisions of the vocal tract that participate in articulation: –Pharyngeal Cavity (throat) –Nasal Cavity (nose) –Oral Cavity (mouth)

Oral Cavity Hard Palate Uvula Anterior Faucial Pillar Posterior Faucial Pillar Median Raphe Rugae Palatine Tonsils Velum

Pharyngeal Cavity 3 regions: –Oropharynx Portion of pharynx posterior to fauces, bounded above by velum Lower boundary is the hyoid bone –Laryngopharynx Bounded anteriorly by the epiglottis Inferiorly by the esophagus –Nasopharynx Space above soft palate Bounded posteriorly by the protuberance of occipital bone lateral wall contains the orifice of Eustachian tube

Pharyngeal Muscles 3 large, thin muscles wrap around the sides and back wall of the pharynx –Inferior Constrictor –Cricopharyngeus –Middle Constrictor –Stylopharyngeus –Salpingopharyngeus –Superior Constrictor

Pharyngeal Muscles Superior Constrictor Middle Constrictor Inferior Constrictor Functions: 1. Nonspeech- Swallowing- -Mash food -Major function to shoot food into esophagus 2. Speech- Narrowing pharynx, Velopharyngeal closure

Nasal Cavity Produced by paired maxillae, palatine and nasal bones Divided by the nasal septum Made up of vomer bone, perpendicular plate of ethmoid and cartilaginous septum Nasal cavities & turbinates are covered by mucous membrane

Nasal Cavity Air entering nasal cavity is warmed & humidified to protect lungs Fine nasal hairs prevent particulate matter from entering the lower respiratory passageway Epithelia propel pollutants toward nasopharynx where they are swallowed into the esophagus

Nasal Cavity Nares or nostrils mark anterior boundries of the nasl cavities Nasal choanae are posterior portals connecting the nasopharynx & nasal cavities Floor of nasal cavity is the hard palate