2. Peter R. LaPine, Ph.D. Department of Audiology and Speech Sciences Michigan State University

4. The “Plan” RELAX!!! Be comfortable Ask questions Get answers Go home with new information Take with you material that you can use

6. Common Terms *Voice Disorder *Hyperfunction *Hypofunction *Aphonia *Dysphonia *Laryngeal Pathology *Vocal Pathology :{ )

7. Speech Dynamics Speech on exhalation from lungs Activates the vocal folds Voiced sound (phonation) passes through the pharynx and oral cavity Articulators modulate

8. 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

9. TVF = true vocal fold FVF = false vocal fold Trachea = “windpipe”

10. Coronal Section of the Larynx TVF and FVF TVF shape and histology

11. Valve Functions of the Larynx Abduct: Posterior cricoarytenoid m. Adduct: Lateral Cricoarytenoid m. (and the Transverse and Oblique Arytenoid muscles. “Open” at rest

12. Vocal Fold Activity Closed-Open-Closed Medial Compression Vocal “cord”, ligament and fold Frequency, Amplitude and Waveform Perturbation values: jitter and shimmer

13. 1 cycle of vocal fold vibration “closed-open-closed” Aerodynamic process Myoelastic process Frequency perceived as “pitch”

14. Vocal Fold Movement Closed-Open-Closed Stroboscopic view Medial compression Male Frequency Range: 118-150 Hz Female Frequency Range: 180-240 Hz

15. 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

16. Recurrent Laryngeal Nerve Asymmetrical branch of CX “Feeds” the intrinsic laryngeal muscles –PCA –LCA –OA/TA –TA

18. Nerve Damage CX: The Vagus Recurrent Laryngeal Nerve Image of unilateral cord paralysis Dec’d pitch Respiration for speech is inefficient

19. Medications Coordination and proprioception (stimulants, sedatives,nervousness, tremors, pain masking) Airflow (bronchodilators, constrictors, nervousness, tremor) Fluid balance (decongestants,---”rebound effect”--edema, sedating, decreased energy

20. Medications, cont. URT secretions--(antihistamines, dryness, sedation) Hormonal (androgens, increasing vocal mass) Gastrointestinal Reflux Disorder: GERD--- OTC medications, diet.

21. 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

22. Benign Lesions Vocal Nodules Vocal Polyps: Sessile Peducunlated Contact Ulcers Granuloma Papilloma

23. Added Mass Top view: vocal nodules (bilateral) Bottom view: vocal polyp (sessile)

24. Swelling Reinke’s Edema Increased mass, decreased pitch (frequency) Atypical perturbation values

25. Plicae Ventricularis False vocal fold vibration Decreased pitch and decreased frequency (< 90 Hz) Limited Pitch e.g., “Monopitch”

26. “Bowed Vocal Cords” Chronic Laryngitis Presbylaryngis Fatigue/Overuse Symptoms: –decreased intensity –decreased respiratory control –decreased pitch range

27. Granuloma Associated with physical irritation; abrasion of the mucous cover of the vocal fold Adds mass: decreases pitch (frequency), increases perturbation values

28. Intracordal cyst Note left side of body (slide right!) Added mass Incomplete medial compression of true vocal fold Result: increased mass and air escape