Transcript Lecture 7 - Fredonia.edu

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 H20
• Normal (women)- 5 cm H20
• Normal (men)- 6 cm H20
– 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: .162 -.247
l/sec, Bilateral: .256-.359 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
Nasal
Cavity
Oral
Cavity
Vocal
Folds
Trachea
Oral
Cavity
Cavities
Nasopharynx
Oral Cavity
Oropharynx
Laryngopharynx
Cavities
• Major subdivisions of the vocal
tract that participate in articulation:
– Pharyngeal Cavity (throat)
– Nasal Cavity (nose)
– Oral Cavity (mouth)
Oral Cavity
Rugae
Hard Palate
Median
Raphe
Velum
Uvula
Anterior Faucial
Pillar
Palatine
Tonsils
Posterior Faucial
Pillar
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
Functions:
Superior
Constrictor
Middle
Constrictor
Inferior
Constrictor
1. NonspeechSwallowing-Mash food
-Major function to
shoot food into
esophagus
2. SpeechNarrowing 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