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: Hz Female Frequency Range: 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: Sessile Peducunlated 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