Neuron

cell that transmits an electrical-chemical signal

Motor neuron

sends signal to muscle to contract

Sensory neuron

returns sensory information to the brain

nerve tracts

       Connect brain structures to each other and to the peripheral nervous system

Pharyngeal nerve

palatopharyngeal region

sensory information

-Not at rest

-Worst at maintenance of posture

-Reduced during movement

-Associated with aging

-Might be extrapyramidal

-Focal dystonia affecting laryngeal muscle control during speech

-spasming of muscles of adduction or abduction during speech

-more common

-Strain/struggle

-intermittent voice stoppages

-creaking, glottal fry, loudness and pitch variations and pitch breaks

-Loudness decreases

-Pitch increases

-Whispering

-Laughing

-Singing

1. Psychogenic

2. Neurological

3. Both

1. Medical: recurrent nerve resection, Botox in TA or medication

2. Speech Therapy: with Botox

-Intermittent breathiness

-Sudden drops in pitch

-Vowel prolongations

Keratosis- Leukoplakia 

Pachydermia

-Nodules

-Polyps

-Cyst, Edema, Granuloma

-Scar

-Carcinoma

-Papilloma

-Lesion on mucosa of vocal process of arytenoid

-Tight Adduction of Vocal Process

-Intubation

-GERD

-Contact

-Choking on a foreign object

-Violent Vomiting

-Patient feels pain

-Usually no change in voice

-Antireflux Medicatin

-Therapy to reduce adduction

-Therapy to reduce abuse

-Surgery

-Lesion on epithelium

-2 Types:                        

1. Leukoplakia

2. Papillary

-White plaque

-smoking or air borne pollutants

-Change in Voice: hoarsness

-Quit smoking/ eliminate pollutant exposure

-Surgery

-Most commonly caused by GERD

-Or smoking and alcohol

-No symptoms (reflux/heartburn)

-Lesion the proliferates the epithelium

-Virus; often congenital

-Shortness of breath-airway obstruction

-Significant Change in vocal quality: roughness, breathiness, decreased pitch and pitch range

-Surgery

-possible Laryngectomy

-Smoking

-Environmental irritants

-Chemicals

-Metabolic Distrubances

-Alcohol

-Surgery

-Radiation

-Chemotherapy

-Effect VF vibration

-Effect Voice Quality

-Band of tissue joining the two vocal folds at the anterior commissure

-Congenital or from intubation

-May or may not affect VF vibration/voice quality

-May obstruct airway

-Structural Changes in the VFs caused by:

1. Aging                                   

2. Loss of innervation to TA

-Hoarseness

-Reduced Loudness

-Increased pertubation

-Reduced Closure

-Bowed-looking cord

Presbylarynges/Atrophy/Bowing

Treatment

-Reduce false vocal fold hyperfunction

-Increase true vocal fold adduction and loudness

-Lee Silverman

-Well organized Spheres

-In Superficial layer of lamina propria

-Fluid, mucus filled sack

-May be caused by blockage of grandular duct

-Will never go away but may reduce

-Possibly surgery

-Therapy to reduce abuse and misuse

-Located or diffuse inflammatory lesion in Reinke's space (superficial layer)

-Unilateral

1. Pedunculated

2. Sessile

3. Hemoprrhagic

-Roughness

-Breathiness

Hoarseness

-Throat Clearing

-Voice therapy

-Elimination of abuse/misuse

-Bilateral

-Early stages= edematous/vascular

-Later stages= fibrous/firm

-Hoarseness/breathiness

-Hour glass closure

-Reduced pitch range

-Throat clearing

-Therapy to reduce misuse/abuse

-surgery if fibrotic

-No effect on voice

-May have pain

-Treat GERD of post-nasal drip

-Similar to granuloma therapy

-SLP can only note lack of movement or immobility

-No Voice

-Aspiration

-Voice and Swallowing Okay

-Severe Breathing Problems

Means of Differential Diagnosis

for Paralysis

1. EMG

2. Manual manipultation of cricoarytenoid joint

3. Pain? (can't feel pain w/ paralyis)

T: Tumor Size

N: Spread to regional lymph nodes

M: Distant Metastasis or distant spread

1. Hyoid

2. Epiglottis

3. All laryngeal structures

4. Upper few rings of trachea

1. New opening created above the notch of sternum (Stoma)

2. Trachea tilted forward and attached to stoma

3. May have myotomy

 -2 Separate Pathways

-Loss of vibrator for speech

-Nasal passage not connected to lungs

-swallowing mechanism may be affected

-Stoma necessary for survival

-Inability to build thoracic pressure

-increased mucus

-Breathing mechanism requires maintenance

-Artifical Larynx

-Use of P-E Segment vibration

-Esophageal Speech

Sound source produced by secondary device (electric or pneumatic)

-2 types: esophageal speech or tracheo-esophageal puncture

-requires critical P-E segment tension

-invented by Singer & Blom

-Fistula created between trachea and esophagus

-Prosthesis inserted: silicon tube with one way valve from trachea to esophagus

1. Exhale from lung

2. Cover Stoma (no longer required)

3. Sir forced through prothesis into esophagus

4.Vibrate P-E segment

1. three overuses: too loud, too much, too often

 2. environmental factors: dryness of air, airborne irritants, stress level, communication demands

 3. hygiene: water, caffeine, alcohol, smoking, other dry agents

4. biological: cough/thoat clearing, intrathoracic pressure

  - learned problem may not be generalized to all vocal behaviors

  - relaxation may elicit better production

c. Use of feedback

1. Sigh

  2. Hum

  3. Meow

  4. Glottal fry

  5. Laugh

  6. Gargle

  7. Throat clear

  8. cough

  9. Inhalation phonation