What is the only intrinsic muscle of the larynx that abducts the vocal folds?
posterior cricoarytenoids
- the only muscle involved in abduction
When inhaling, the vocal folds are
abducted
What are the three voice subsystems?
- air pressure system, vibratory system, resonating system
what organs are involved in the air pressure system?
diaphragm, chest muscles, ribs, abdominal muscles, lungs
What is the role of the air pressure system in sound production?
- provides or regulates air pressure to cause vocal folds to vibrate
What voice organs are involved in the vibratory system?
larynx, vocal folds
What is the role of the vibratory system in sound production?
vocal folds vibrate, changing air pressure to sound waves producing "voiced sound", frequently described as a "buzzy sound", varies pitch of sound
What are the voice organs of the resonating system?
vocal tract: throat, oral cavity, nasal cavities
What is the role of the resonating system in sound production?
changes the "buzzy sound" into a person's recognizable voice
What are the adductor muscles of the larynx?
- thyroarytenoid (vocalis)
- lateral cricoarytenoid
- interarytenoid
- cricothyroid
thyroarytenoid (vocalis)
- CN X RLN
- both adducting the cords and decreasing the tension of the vocal ligament to modulate pitch
lateral cricoarytenoid
- CN X RLN
- adducts the cords and internally rotates the arytenoid
interarytenoid
- CN X RLN
- works with the lateral cricoarytenoid by maintaining the closure of the glottis after the cords have adducted
cricothyroid
- CN X SLN external
- displaces the thyroid cartilage downward and tenses the vocal cords
posterior cricoarytenoid muscle
- CN X RLN
- abduct and externally rotate the arytenoid in antagonism to the lateral cricoarytenoid muscle
What is the larynx role in respiration?
- open glottis
- vocal folds abduct during breathing
What is the larynx role in cough reflex?
- adduct, then abduct glottis
- larynx closes the glottis to build up pressure, then opens it for the forceful expelling of air during cough
What is the larynx role in swallowing?
- adduct glottis
- muscles of the larynx coordinate to bring both vocal folds to the midline to prevent aspiration
what is the larynx role in voice?
- adduct glottis and adjust vocal fold tension
- muscles of the larynx brings both vocal folds to the midline to allow vocal fold vibration during speaking and singing
- muscles of the larynx adjusts vocal fold tension to vary pitch (how high or low the voice is) and changes in volume (such as loud voice production)
dysphonia
voice disorder
aphonia
no voice/absence of voicing
presbyphonia
age related voice changes
puberphonia
puberty related voice changes
diplophonia
double voicing
phonotrauma
excessive voice use that causes trauma to the vocal folds
odynophonia
pain with voicing
what is an organic voice disorder?
physiological voice disorders that result from alterations in respiratory, laryngeal, or vocal tract mechanisms
What are the two types of organic voice disorders?
- structural
- neurogenic
what are structural voice disorders?
organic voice disorders that result from physical changes in the vocal mechanism, such as
- alterations in vocal fold tissues (e.g., edema, vocal nodules) and/or
- structural changes in the larynx due to aging
what are neurogenic voice disorders?
organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism, such as vocal tremor, spasmodic dysphonia, vocal fold paralysis
what are functional voice disorders?
voice disorders that result from inefficient use of the vocal mechanism when the physical structure is normal, such as vocal fatigue, muscle tension dysphonia or aphonia, diplophonia, or ventricular phonation
Vocal nodules
- organic voice disorder
- causes: phonotrauma (excessive voice use)
- tx: voice therapy, surgery should be considered last
- most commonly seen in professional voice users
- hoarseness, breathy voice, vocal fatigue, loss of upper range
vocal fold polyp
- causes: phonotrauma (overworking voice for extended period of time)
- Tx: voice therapy, surgery
- breathiness, hoarseness, diplophonia
vocal fold cyst
- causes: phonotrauma, congenital
- Tx: surgery
- hoarseness, vocal fatigue
vocal fold hemorrhage
- causes: phonotrauma, iatrogenic
- Tx: voice rest
vocal fold carcinoma
- causes: irritants, smoking, alcohol
- Tx: surgery, radiation therapy, chemotherapy
- hoarseness, sore throat, cough, swallowing difficulty
vocal fold edema (reineke's edema)
- causes: smoking, irritation
- Tx: voice therapy, surgery
- low, breathy, raspy voice, shortness of breath
vocal fold atrophy
- causes: aging
- Tx: voice therapy or vocal fold medialization via injections
- breathy voice, more effort, fatigue, low powered voice
vocal fold scarring
- causes: physical trauma, iatrogenic, inflammatory response to infection
- Tx: prevention, voice therapy
vocal tremor
- neurogenic voice disorder
- no structural abnormalities
- movement abnormalities - wavering movement in voice
laryngeal dystonia
- abductor or adductor (more adductor)
- adductor: voice breaks
- tx: botox
- abductor: breathy intermittent changes
vocal fold paralysis
- tx: vocal fold medialization via injection or thryoplasty
- causes: surgery, viral infection
-
muscle tension dysphonia
- hyper function of muscles of the larynx
- hoarseness, effortful voicing, vocal fatigue, difficulty projecting voice
- supraglottic compression
- causes: post URI, presence of other voice disorders, traumatic life events, etc.
- tx: voice therapy
what medications can be used for voice?
- PPI/HR blockers: acid reducing medications to manage GERD or acid reflux
- allergy medication: manage irritants to the larynx
- Parkinson's medication: manage Parkinson's symptoms
what surgical options can be used for voice?
- thyroplasty: vocal fold paralysis, implant behind non functioning vocal fold for better voicing
- injections: vf atrophy, vf paralysis, glottic gap to bring the vocal folds closer by bulking them up so that they can get better closure
- botox: spasmodic dysphonia
- steroids: laryngeal edema or inflammation
- fat/filler
- removal of lesion
what is part of voice therapy?
- vocal hygiene, reduce phono traumatic behaviors, proper voice use
- vocal exercises that optimize the voice and improve efficiency
- resonant voice therapy: forward resonance & feeling sounds in the front of the face rather than back in the throat
- semi-occluded vocal tract: lip trill, cup bubbles
- abdominal breathing
what are examples vocal/laryngeal hygiene treatments?
- reduce irritants: smoking, allergies, acid reflux, throat clearing, excess caffeine & alcohol
- stay hydrated: system hydration, drink plenty of water, surface hydration (inhale steam)
- healthy lifestyle choices: sleep, eat healthy foods
- voice use: avoid loud voice use, voice naps