1. Frances Ascott Clinical Lead Speech and Language Therapist
Vocal Health
24/04/2017
Frances Ascott
Clinical Lead Speech and Language Therapist

2. Contact information
Frances Ascott
ENT Dept
Manchester Royal Infirmary
(voic )

3. Course Outline Basic structure of vocal mechanism
Day to day protection-recognising a problem
Common problems and advice
Seeking further help
Dealing with stresses
Anat- today but don’t give up
Function-how we make sound and different sounds Falsetto, twang, belt some learning through experience
Observation of function- opportunity to be scoped see anatomy see it function. All or as many want in 4 groups 30mins each

4. Learning Objectives To understand the factors which affect voice
To know how to keep the voice healthy
To know what to do when something goes wrong.

5. Opportunity for Questions
As we go along
At the end of sessions
Make an appointment/arrangement
At end of course

6. Oral and Pharyngeal cavity
24/04/2017
Oral and Pharyngeal cavity
The oral cavity (volume 100cc) is a primary location for the articulatory shaping of the voice signal. Not fixed shape or size. The articulators -- the lips, tongue, teeth, and jaws -- are responsible for shaping the voiced signal into the different types of phonemes such as consonants and vowels. The oral cavity is bounded by the lips anteriorly, the cheeks laterally, the hard and soft palates superiorly, the tongue inferiorly, and the faucial pillars and pharyngeal wall posteriorly
Label tonsils, epiglottis, adenoids, larynx, vocal cords, etc Pharyngeal Cavity volume 80cc
The pharyngeal cavity runs from the base of the cranium to the top of the oesophagus at an approximate level of the sixth cervical vertebrae. The pharynx is formed primarily by three muscles arranged in a circular pattern that attach to structures anteriorly. The pharyngeal muscles, also known as the constrictors, include the superior, middle and inferior pharyngeal constrictor muscles. The pharyngeal space allows communication between the nasal, oral, and laryngeal cavities. It forms a connecting corridor located posteriorly to the nose, mouth, and larynx. The pharynx is subdivided into three functional levels that correspond to the structures found anteriorly. The nasopharynx is located posterior to the nasal cavity, the oropharynx is located posterior to the oral cavity, and the laryngopharynx /Hypo pharynx is located posterior to the larynx. Supraglottic Vocal Tract may also be used as a term to include

7. Oral cavity Contains the articulators Lined with moist mucosa
Salivary glands secrete to maintain moisture
Air enters through here for singing

8. 24/04/2017
Nasal cavity

9. Nasal Cavity Nasal sounds m, n ng
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Nasal Cavity
Nasal sounds m, n ng
Nasality controlled by the velopharyngeal port
Too much air escape = hypernasal
Inadequate nasality “bunged up” = hyponasal
Cranial bones superiorly, nasal turbinates laterally, the hard and soft palates inferiorly and the pharyngeal wall posteriorly.
Lined with wet mucosal membrane
Air warmed and moistened as passes over large surface area. Smell receptors linked to brain. Sinuses and cavities in skull are linked to nose

10. The Larynx Part of the vocal tract Top of the trachea
Primarily designed for airway protection so is hard wired t.o close up. 3 sphincters
Raising and lowering

11. Laryngeal Framework Cartilages Bone 1 x epiglottis 1 x thyroid
1 x cricoid
2 x arytenoid
2 x corniculate
2 x cuneiform
Bone
hyoid
The larynx is a musculocartilaginous structure located in the anterior neck which is suspended by muscle and ligaments to the hyoid bone superiorly and attached to the trachea inferiorly. There are 9 laryngeal cartilages
Corniculate - set on apex of arytenoid cartilages
Cuneiform - embedded in aryepiglottic folds

12. Laryngeal framework

13. Soft Tissue Structures
24/04/2017
Epiglottis
Ventricular bands
Vocal cords
White, shine,
Play video clip, show open, closed, breathing, phonation
Trachea

14. Extrinsic muscles Titze 1994

15. Laryngeal Elevators Elevators Digastric Stylohyoid Mylohyoid
Geniohyoid
Hyoglossus
Genioglossus muscles
Listed so that you have heard of them
How named attached to hyoid / tongue
Point to note that there are more of them than the depressors
Palpate mylohyoid +/- swallow

16. Laryngeal depressors Sternohyoid Omohyoid
The laryngeal depressors are the sternohyoid and omohyoid muscles. They pull down the larynx rather than push it down (infra hyoid muscles)
Much lowering of the larynx is by a relaxation of the suprahoid muscles

17. Looking after your voice

18. General Voice Care Principles
Levels of care different for each person
Male voice generally stronger
Take responsibility for your voice
Take extra care when more at risk
Risk factors change with age/fitness
Age 45 and develop problems

19. Warning signs 1
These are symptoms that you may experience, which will alert you to the need to take extra care, or that you are not using your voice correctly. Each symptom listed may occur for a number of reasons, however we have made some specific suggestions of responses to try first.

20. Warning signs 2
Frequent throat clearing - Don’t do it sip water instead
Pain/soreness in the throat - yawn to release tension, don’t push
Hoarseness/Croakiness/Creak - don’t run out of breath
Tickly cough - don’t be too loud & push 

21. Warning signs 3 Voice loss - watch breath support and neck tension
Voice tired at the end of the day- watch breath support etc
Lump in throat - reflux, yawn to relieve tension
Loss of power/ability to shout - practise humming and breath support apply to being loud situations
Dryness – sip water frequently

22. Times to take care
When you return to work/singing after a holiday or illness
When you are experiencing some of the warning signs
Sore throats with/without an infection
When you are tired
When you are stressed

23. Avoidance of strain
Avoid unnecessary talking over noise and incorrect shouting. If you need to shout try to do so with a smile. It should feel comfortable. Do not compete with background noise particularly when tired
Avoid repeated throat clearing. Try swallowing or sipping water. Be aware of catarrh. Inhaling steam may help, catarrh may be linked to dairy products
Sing instead of shout
Voice projection even when close
Frequent throat clearing causes catarrh
How to recognise strain
Tickle, dryness,voice crack up, fatigue,change quality,pressed sound

24. Areas affecting safe voice production
Tension and relaxation
Posture
Breathing
Resonance
Volume
Muscular energy
Intonation, pitch, pace and pause
Use salutations

25. Environment
Reduce the effects of hot dry environment by opening windows, layer dressing so keeping cool and comfortable.
Avoid environmental fumes such as smoke and chemical smells where possible.
A lot of individual differences here
NB take note when at risk
Smoking
SHOW smoking clip

26. Posture and Breathing
Maintain good posture with no unwanted tension. Check: easy head / neck / back alignment
Use good breathing from the lower part of the lungs.
Chan R. W. Does the voice improve with vocal hygiene education? A study of some instrumental voice measures in a group of kindergarten teachers J Voice 8 (3): , 1994
Those with problems improved
Alexander technique