CMDS 4540 Chapters 1,2 and 3

Historical perspective- Hippocrates

"father of medicine" Responsible for separating medicine from magic, made observations about the voice. He was the first person to write that observations of the voice quality, whether clear or hoarse, is one means by which a physical diagnosis may be reached. He failed to identify the source of the voice.

Laryngeal Development

-4th/5th week of fetal development the laryngotracheal sulcus appears and there are definite arytenoids of the larynx -3rd month of fetal development the thyroid lamina fuse and the laryngeal ventricle appear between the true and false Vfs -12th week of fetal development the Vfs are complete -2nd trimester diaphragmatic and laryngeal movements can be identified

Ventricular Vocal Folds

-AKA false vocal folds -sit superior and lateral to the true Vfs -composed of seromucous glands -play major role in preventing invasion of pathogenic agents

Interarytenoid (IA)

-Adduct the arytenoids, closes posterior glottis, adduct membraneous Vf, shorten, thicken, and slacken Vfs

Conditions that create high laryngeal airway resistance that restricts airflow...

-Adductor -muscle tension dysphonia -other dynamic laryngeal dysfunction conditions -Dyspnea

What are some of the symptoms of COPD

-Dyspnea (sensation of breathlessness) -Reduced vocal loudness -Hoarseness

Pulse Modal Falsetto

-F0 range at the low end of the freq. scale (glottal fry) -F0 range most commonly used as a speaker (right in the middle and where you want to be speaking) -F0 range at the upper end of the Vf vibrating capacity (really high)

Title's Self-Oscillation Theory (Phonation)

-Myoelastic theory is incomplete -2 factors: vocal tract inertance and non-uniform tissue movement -Inertance is the sluggishness or inertia of movement of the air column in the vocal tract; this sluggishness causes a momentary delay in the start of air flow, and results in a positive pressure subglottally which forces the Vfs back open -pulses of air

Alter abduction/adduction

-Posterior cricoarytenoid (PCA) -Lateral cricoarytenoid (LCA) -Interarytenoid (IA)

How might chronic illnesses contribute to voice disorders?

-Sinusitis or other resp. disorders may cause habitual coughing or throat clearing which leads to lesions -necessary medications can dry the Vfs or cause side effects that alter the voice -GI disorders GERD cause hoarseness, fatigue, chronic cough, globes sensation, choking in the middle of the night, stomach acid is irritating the laryngeal mechanism. -endocrine disorders: hormonal changes are usually drying -cardiac: d/t injury of RLN -arthritis: could have arthritic in cricoarytenoid joint, could be so severe that the joint becomes fixed and it looks as though a person has Vf paralysis.

Disorders resulting in inability to generate high enough muscular forces to support voice and speech:

-Spinal cord injury -Neuromuscular degenerative diseases -Chronic obstructive pulmonary disease (COPD)

Phonation

-The Vfs come together harder, maybe they are yelling or using a hard glottal attack as a habit. Also if someone is using a whispering -h sounds before everything they say. Glottal fry can also cause fatigue

Myoelastic-Aerodynamic Theory (Phonation)

-Vf vibration is achieved via flow-induced oscillation -both airflow and muscular properties account for convergent/divergent motion of Vfs -when Vfs are closed subglottal pressure builds up, sub glottal pressure builds enough to blow Vfs apart, elasticity causes the Vfs to close, sub glottal pressure builds back up and the process is repeated.

Mechanisms of changing Loudness

-Vfs close faster and stay closed longer as loudness increases -subglottal pressure, Vfs vibratory phase closure and supraglottic vocal tract tuning influence vocal intensity

Males vs Females laryngeal anatomy

-adult males Vfs: 17-21 mm -adult females Vfs: 11-15mm

Subglottal pressure contributes a variety of parameters related to voice production such as:

-airflow -glottal area -fundamental frequency (pitch) -sound pressure level It is fuel for the voice and speech

Membraneous Vfs vs Cartilaginous Vfs

-anterior 2/3 of the vocal folds (comprised of 5 layers) -the posterior 1/3 of the vocal folds

Vocal Registers

-appears as a tilted football -little intensity at low and high end with best dynamic loudness for tones in the middle range -vocal range profile

The arytenoids are connected to the epiglottis by a muscle called the

-aryepiglottic muscle/fold and the thyroid cartilage anteriorly by the vocal ligament

Omohyoid

-at the front of the neck and consist of two bellies separated by an intermediate tendon -when the omohyoid muscle contracts, its action depresses the hyoid bone and the larynx

Sternohyoid

-attaches the hyoid and sternum -when it contracts it depresses the hyoid bone and larynx

Phonotrauma

-behaviors that contribute to laryngeal injury and is any damage that is done to your Vfs. They might be purposeful or the person could be unknowingly committing to these actions -can also be called hyper adduction and hyperfunction -can be caused from yelling, talking for long periods of tim, talking in a pitch that isn't natural to you, coughing/ clearing throat habitually

Sternothyroid

-beneath the sternohyoid and originates from the manubrium of the sternum and inserts into the oblique line of the thyroid cartilage -when it contracts it depresses the larynx

Elastic cartilages

-collagenous fibers and a matrix of the elastic cartilage also contains a network of branched yellow elastic fibers -does NOT ossify -forms with the epiglottis

Deep Layer of the Lamina Propia

-composed mainly of collagen fibers which run parallel to the vibrating edge of the vocal fold

Intermediate Layer of the Lamina Propia

-composed of elastin and collagen fibers -course of fibers allows this layer to stretch only in an anteroposterior direction

Thyrohyoid

-continuation of the sternothyroid -originates from the oblique line on the thyroid lamina and inserts into the greater cornu of the hyoid bone -when it contracts it moves the hyoid bone closer to the larynx

Posterior cricoarytenoid (PCA)

-courses up and forward to insert in the muscular process of the arytenoids -rotates the muscular process of the arytenoid cartilage postero-medially and vocal processes laterally -ABDUCTS Vfs

Lateral cricoarytenoid (LCA)

-courses upward and backward to insert into the muscular process of arytenoid cartilage -muscular process rotate anteriolaterally and the vocal process medially -ADDUCTS Vfs

Alter pitch

-cricothyroid (CT) -Thyroarytenoid (TA)

What categories or surgically-related voice disorders can occur?

-direct surgery (laryngectomy, glossectomy), those that can directly alter the larynx -indirect surgery (cardiac or thyroid surgery), those that can indirectly alter the voice

Suprahyoid muscles

-elevate the hyoid bone and larynx primarily with their function serving jaw movement. Include: Digastric, Mylohyoid, Stylohyoid and Geniohyoid

What are anatomical parts involved in laryngeal valving for protection against aspiration?

-epiglottis, ventricular folds, true vocal folds

Aryepiglottic folds

-extend bilaterally between arytenoid cart. and the lateral margin of the epiglottis -serve as a lateral anatomical border of the laryngeal space -withstands collapse during inspiration

Hyaline cartilage

-flexible and elastic -made of collagen (basic building block of cartilage) and other proteins -forms the thyroid, cricoid and arytenoid cartilages -ossifies with age

The intrinsic laryngeal muscles

-found within the larynx -include a total of 5, all of which are paired -these muscles work together to regulate tension in the vocal ligament and the size and shape of the glottal space

How does larynx control frequency and intensity?

-freq:by altering the stiffness of the Vfs using CT and TA -intensity: by increasing sub glottal pressure

Mechanisms of changing Pitch

-frequency relates to mass and stiffness of Vf tissue -lengthening the Vfs increase stiffness -fundamental frequency can also be increase by increased sub glottal pressure

Innervation (sensory)

-from mucosa to brainstem -receptors send info to the brainstem via afferent fibers in the internal branch

Innervation (motor)

-from the brainstem to the muscles -anything below the Vf is going to the brain and through the recurrent laryngeal nerve

Digastric

-has 2 muscular bellies (ant. and post.) which are joined by an intermediate tendon -pulls the hyoid forward and upward and the posterior belly pulls the hyoid back and upward.

Mylohyoid

-helps form the muscular floor of the mouth -contracts and elevates the floor and tongue and depresses the jaw as long as the hyoid is stabilized.

Epiglottic downward movement to closure is the biomechanics effect of:

-hyolaryngeal movement -downward blogs movement -tongue base retraction

How do infant Vfs differ from geriatric Vfs

-infant Vfs 1.25-3mm and have more membraneous portion of Vfs, no vocal ligament, structures are very soft -geriatric Vfs are bowed, thinned and decreased flexibility

2 types of laryngeal muscles

-intrinsic and extrinsic

Thyroid carilage

-largest unpaired cartilage in the laryngeal framework -"adam's apple" (superior thyroid notch) -angle is wider in females (110-120 degrees) -angle is more acute in males (90 degrees) *more prominent in men

Basement membrane zone

-located between the epithelium and the superficial lamina propia -secures epithelium to superficial lamina propia -vulnerable to injury from vibration and shearing forces -allows the mucosa to shift and glide

Cricoid Cartilage

-made of hyaline tissue -connected to thyroid cart. via inferior horn and superiorly by the cricothyroid membrane -also attaches to the 1st tracheal ring by the cricotracheal ligament/membrane

Superficial Layer of the Lamina Propia

-main vibrating portion the Vfs -composed mostly of elastin fibers, making it loose and pliable -the epithelium and superficial layer are commonly referred to as the "cover"

Thyroarytenoid (TA) muscle

-most medial portion of the thyroarytenoid muscle (vocalis), makes up the bulk of the vocal fold structure -the only active portion of the Vfs that can contract and relax -all other layers are passive and vibrate with the power of respiration

2 groups of intrinsic laryngeal muscles

-muscles that cause rotation of the cricothyroid joint, adjusting the length of the vfs -muscles that cause rotation and translation of the arytenoids, adjusting position of the vfs

cricothyroid (CT)

-origin in the anterolateral arch of the cricoid cartilage -fibers course vertically upward to insert into the lower margin of the thyroid lamina -when stimulated, it rocks the cricoid back, stretching, elongating, thinning and slighting adducting the vfs

Stylohyoid

-originates from the styloid process of the temporal bone and inserts into the body of the hyoid -when contracted, the stylohyoid muscle pulls the hyoid upward and back during swallowing fixes the hyoid bone for infrahyoid action.

Corniculate cartilages

-paired -appear mounted on top of arytenoid cartilages -serve no role in voice production

Cuneiform cartilages

-paired -small, rod shaped elastic cartilages embedded in the aryepiglottic muscle/fold -supports lateral portions of the epiglottis and ifs

Arytenoid cartilage

-paired, pyramid shape and consists of hyaline and elastic tissue -2 processes: vocal and muscular process -serve as the posterior attachment for the false vocal folds

Infrahyoid muscles

-primarily depress the hyoid and larynx with its other functions serving jaw movement. -include: sternohyoid sternothyroid omohyoid thyrohyoid

Ossification

-process where cartilage is replaced by bone In the larynx, the thyroid cart. ossifies more frequently than the cricoid but each starts to ossify by the third decade of their life.

Phonation

-produce sound, Vfs vibrate 100 times per seconds -100-250 Herts for adults -Hertz:number of vibrations in one second -1 hz=one cycle per second -adult male:100 hz -adult female: 250 hz -young child: 300 hz

Hirano's Body Cover Theory (Phonation)

-recognize distinct role of passive cover for Vf vibration -the vibrating cover is more flexible and pliable with greater tissue displacement while the deeper body provides stiffer -3 phases (horizontal, longitudinal and vertical) can see the horizontal and longitudinal portions

Extrinsic laryngeal muscles

-responsible for larger laryngeal movements, like elevation and depression of the larynx (gross motor)

Intrinsic laryngeal muscles

-responsible for the movement of the laryngeal cartilages and fine control of the laryngeal structures. They serve to alter the larynx for changes in pitch and medial/lateral positions (fine motor)

Respiration

-shallow breathing, there is a lot of movement in their chest. They can weaken their voice, there is extra tension that builds up because all the pressure. Leads to weaker/softer voice and muscle tension

Thyroarytenoid (TA)

-shortens the vfs when it contracts -membraneous VFs are slightly adducted -referred to as the deepest layer of the vocal fold structure -2 sections 1)vocalis- medial section, tenses the vocal fold when it contracts 2)more lateral section, relaxes the vocal fold when it contracts

Hyoid bone

-site for muscular attachment of the larynx via the supra hyoid and infra hyoid muscles -no attachment to other bones -attached to the tongue via a ligament called the glossoepiglottic ligament

Epiglottis

-superior part of the larynx -posterior to the hyoid bone and base of the tongue -broad at the top and narrow at the base -composed of elastic cartilage

Arytenoid movement allows for

-the adduction and abduction (these movements occur because of the cricoarytenoid joint)

Sensation from the Larynx

-the laryngeal mucosa contains some of the most dense sensory receipts in the human body -we need our larynx to be sensitive because we need to protection for our Vfs

Epithelium

-thin covering of the Vfs, protecting them from intrinsic and extrinsic environment -composed of stratified squamous cells which are flat/plate-like in shape

Vocal misuse

-things that the patient doesn't know is bad for them

Genohyoid

-when contracted it elevates the hyoid bone, raises the floor of the mouth for swallowing and depresses the mandible when the hyoid is stabilized

Vocal abuse

-yelling at a sporting event

What 3 actions occur during laryngeal valving?

1)Epiglottis inverts to contact the arytenoid cartilage 2)Ventricular fold medialize to protect the airway 3)Vfs medialized to protect the airway

What are the 5 layers of the Vfs

1)Epithelium 2)Superficial Layer of the Lamina Propia 3)Intermediate Layer of the Lamina Propia 4)Deep Layer of the Lamina Propia 5)Thyroarytenoid muscle

What are the 6 vocal components that, when altered, may contribute to development of a voice disorder?

1)Respiration 2)Phonation 3)Loudness 4)Resonance 5)Pitch 6)Rate

Biological Functions of the Larynx

1)breathing 2)during swallowing the vfs adduct highly to avoid penetration of food entering the glottal space and subsequent aspiration

2 types of extrinsic laryngeal muscles

1)suprahyoid muscles- elevate the larynx with the vocal tract 2)Infrahyoid muscles-laryngeal depression

What happens with differential diagnosis?

1. Statement of the problem (client description and review of medical records) 2.Client reported symptoms 3. Clinical signs (observed perceptually or measured (acoustic/aerodynamic/endoscopic)) 4. Response to trial therapy- this is used to figure out what would be good for the patient when they actually start therapy

Historical perspective- Claudius Galenus

131 AD Distinguished 6 pairs of intralaryngeal muscle and divided them into adductor and abductor muscles Identified the thyroid, cricoid, and arytenoid cartilages Described the activity of the recurrent laryngeal nerves He findings were stood and were accepted for 1500 years

Historical perspective- Manuel Garcia

1854 He was a Parisian singing teacher that developed the laryngeal mirror

Newborn Vf length

2.5-3.0 mm with continual linear growth as a function of age

Historical perspective- Aristotle

3rd century BC Was the first to refer to the larynx as a the organ for vocalization He established that phonation and respiration took place through the larynx and windpipe

Atmospheric pressure=

760 mmHG Expiration= 763 mmHg (+3) Inspiration= 757 mmHg (-3)

Circular breathing

A technique of inhaling through the nose while blowing air through the lips from the cheeks, used to maintain constant exhalation especially by players of certain wind instruments. *** guy playing that weird instrument

Diaphragmatic breathing

Abdominal breathing, belly breathing or deep breathing is breathing that is done by contracting the diaphragm, a muscle located horizontally between the thoracic cavity and abdominal cavity. Air enters the lungs and the belly expands during this type of breathing.

Passive and active forces combined

Active expiratory pressure can be added to the passive elastic expiratory driving the force via: -Internal intercostal muscles -Abdominal muscles: rectus abdominis external abdominal oblique internal abdominal oblique transversus abdominis

Respiratory Forces: Alveolar pressure changes by 2 forces

Active force- developed by the contraction of the respiratory muscles Passive force- due to the elastic property of the respiratory system

Adduction vs Abductions

Add- when no air can flow through the glottis Ab- when the glottis widens

Anatomy and Physiology

Anatomy is the biological study of the shape and structure of organisms and their parts. Physiology is there biological study of the functions of a living organism.

Understanding the voice and voice disorders requires knowledge of:

Anatomy/physiology, physiologic systems, perceptual characteristics, acoustics/aerodynamics/laryngeal imaging, neurology

What is the role of laryngeal function?

Biological, linguistic and emotional

Etiology

Cause of the problem

Sign

Characteristics that can be observed or tested More objective than symptom description

Conversational speech vs loud speech

Convo- inhale to about 60% of lung volume Loud- inhale to about 80% of lung volume

Arytenoid cartilages sit on top of the..

Cricoid cartilage

What are the primary muscles of inspiration?

Diaphragm- dome shaped at rest, flattens during contraction External intercostals- found between the ribs, slant downward and outward, their diagonal position allows them to do more work upon their contraction, when they contract they lift the ribs up and outward

Historical perspective- 17th and 19th centuries

Discoveries re: anatomy and physiology continued

What is meant by personality-related etiologies?

Disorders that may result from psychological disorientation. Those that are caused by environmental stress, conversion behaviors, or identity conflict (persons voice doesn't match who they are, transgender). Aphonia, muscle tension

Lungs

Elastic tissue that inflates and deflates, and as a result moves air There are 3 lobes on the right lung and 2 lobes on the left lung The right lung is larger than the left lung to make room for the heart.

ERV

Expiratory reserve volume (1,000 ml) The additional amount of air that can be expired from the lungs by determined effort after normal expiration

Driving forces of the respiratory system

For the lungs to inflate (inspiration), alveolar pressure must be less than atmospheric pressure. For the air to flow out of the lungs (expiration) alveolar pressure must be greater than the atmospheric pressure. Our body is constantly trying to equalize the pressures.

FRC

Functional residual capacity (2,200 ml) Is the volume of air present in the lungs at the end of passive expiration

When the respiratory system is at rest, the lung is partially inflated to approximately 40% of the total lung capacity...

Functional residual capacity (FRC) ***important to remember because the lungs are actually partially inflated at "rest"

Resonance

How we filter our sound, people can be born with it (larynx is higher in the throat). People might come hypo nasal or hyper nasal and now they are trying to accommodate for that.

When did voice therapy become an accepted practice in the profession of SLP?

In the 1930s when people involved in an early voice care team came together with a common goal to rehabilitate the voice.

IC

Inspiratory capacity (3,500 ml) The volume of air that can be inspired after a normal expiration; it is the sum of the TV+IRC

IRV

Inspiratory reserve volume (3,000 ml) The maximal amount of additional air that can be drawn into the lungs by determined effort after normal inspiration

What are perceptual characteristics?

Is listening to someone and all the factors involved in their voice (ruff, strained)

The larynx acts as a sphincter

It closes to protect the lower airways from the foreign material, opens to aid breathing, and serves as the sound source for voice production

respiration

It is a highly controlled and complex process.

Larynx and the framework

It is a multi-structured organ within the vocal tract that serves as a passageway between the upper and lower airway Consist of -bone (hyoid) -cartilages -muscles -membranes, ligaments, and mucosa

Why is airway protection important for the larynx?

It is the most vigorous at the level of the larynx. There is the mechanical closure and the expulsion of foreign substances

What does a spirometry measure?

Measures the air moving in an out of your lungs

The origin of dyspnea can be...

Multifaceted and understanding the cause requires assessment of both lower and upper airway functions.

Thoracic fixation

Occurs when lifting heavy weights or performing activities like bearing a child. It requires a tight vocal fold adduction in order to build high intra-thoracic pressure.

Who is involved in the speech team?

Otolaryngologist (likely to refer to the SLP), Physician, Psychologist/Radiologist/Neurologist/Endocrinologist/etc., and SLPs

What therapy approaches were described by Van Riper?

Patient recognition of the problem Production of new, more appropriate sound Stabilizing the new vocal behavior in different contexts Habituating the new voice behavior in all situations

Nonbiological functions of larynx

Phonation It is the act by which vocal folds produce sound through oscillation that is driven by respiration.

Diaphragm

Primary muscle of inspiration At rest it sits in a dome-shaped position to form the floor of the thoracic cavity It contracts upon inspiration and lowers/flattens, enlarging the chest cavity

Pulmonary function testing

Referral to the pulmonologist recommend to help discern the cause of dyspnea. The test are done with a spirometry

RV

Residual volume (1,200 ml) The volume of air still remaining in the lungs after the most forcible expiration possible

What is the biological function of the larynx?

Respiration, airway protection, reflexive, and under involuntary control

Speech breathing

Shortened inspiration Prolonged expiration Possible use of expiratory muscles for loud or long utterances Loudness depends primarily on power provided by the lungs (also due to the change in amplitude of vf vibration, but mostly lung power)

The cricoarytenoid joint allows the arytenoid joint to...

Slide medically and rock at these joints

T/F The act of inspiration is ALWAYS active

TRUE For inspiration to occur, muscle contraction has to happen

What type of cartilages does the larynx have?

The cartilages protect the ifs and provide a point of attachment for laryngeal musculature. 1) Hyaline 2) Elastic

What is dyspnea?

The conscious awareness of labored breathing or air hunger. It occurs most commonly with heavy exercise but can occur with certain laryngeal conditions

Pleural linkage

The lungs adhere to the thorax via pleural linkage The visceral pleura- a membrane that covers the lungs The parietal pleura- a membrane that covers the thorax

Clavicular breathing

The most shallow type of breathing. It brings oxygen into only the top third of your lungs.

What is the most valuable tool is assessing and treating voice disorders?

The patient interview

We must control lung volume and respiratory muscle activity during expiration to regulate...

The pressure below the vfs (subglottal pressure)

Primary sound source during speech.. and Secondary role of the larynx

The primary functions of the larynx are opening for respiration and closing for the protection which can be done mechanically or after the fact and getting rid of extra things in there. The secondary functions of the larynx are the voice and your emotions

Glottis

The space between the vfs Glottal size and shape changes as a function of the vibratory behavior of the vfs

Muscles of inspiration

There are inspiratory muscles and expiratory muscles

Bronchi

There are two main bronchi that branch off the trachea and go to each lung Bronchioles are the smallest branches stemming from the secondary bronchi (they lead to the alveoli where gas exchange occurs allowing oxygen to enter into the blood)

The larynx as an articulator

There is rapid adjustment of laryngeal articulator for sequencing voiced/voiceless phonemes

Inspiratory muscles

They are active Diaphragm External intercostals Accessory muscles Pectoralis Trapezius SCM Scalenes

Expiratory muscles

They are passive but can be passive in shouting, they are primarily a function of elastic recoil Abdominals (e.g. hey) Internal intercostals (pull the ribs down in panting)

What are acoustics/aerodynamic?

Things that we hear and aerodynamic is assessing the air pathways

Thorax, Ribs and Sternum

Thorax- chest cavity surrounding and protecting the lungs, the heart and other respiratory structures 12 pairs of ribs True ribs: 1-7 False ribs: 8-10 Floating ribs: 11-12 (they don't attach to the sternum like ribs 1-10)

Historical perspective and early folk remedies

Throat liniments derived from centipedes. Gargling the juice of crabs Inhaling the ashes of burned swallows Plant remedies:gargles made of cabbage, garlic, nettles, pennyroyal, and sorrel Wearing beads of various sorts or black silk cord around the throat

TV

Tidal Volume (500 ml) The lung volume representing the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied.

TLC

Total lung capacity (5,700 ml) The IC+FRC ; the volume of air contained in the lungs at the end of a maximal inspiration. How much air you can fit into your lungs total.

Ventilation and Respiration

Ventilation- the movement of air in and out of the lungs respiration- the process of exchanging gases (carbon dioxide and oxygen); alternating contracting and relaxing, which will expand and compress the thoracic cavity which inflates and deflates the lungs

VC

Vital capacity (4,500 ml) The greatest volume of air that can be expelled from the lungs after taking the deepest possible breath.

Intermediate Layer +Deep Layer=

Vocal ligament

Symptom

What the client/ patient reports about the problem and characteristics of the problem It is subjective

When is differential diagnosis used?

When comparing one disease to another

Prebylaryngis

aging of the larynx

Cricothyroid joint

allows the thyroid to rotate anteriorly/posteriorly on the cricoid cartilage (rocks it back and forth)

Extrinsic factors are factors to which the patient may...

be exposed e.g. exposure of the Vfs to cigarette smoke

Primary Disorders Etiologies

cleft palate hearing impairments cerebral palsy neurological diorders (ALS, stroke,Parkinsons, alzheimers) trauma

What are physiologic systems?

endocrine, gastrointestinal, respiratory, cardiac, etc

Intrinsic factors are factors the patient has...

has less control over e.g. anatomical responses of the female Vfs during menstruation

Prosody/ emotional expression of larynx

laughing, crying, sighing, soothing, mirror of "inner health"

Loudness

leads to the ifs closing harder together and faster which can lead to damage of the Vfs. People that whisper are keeping their posterior glottis open and puts a lot of strain on the muscles

It is the most basic elements of the lower respiratory system are the:

lungs, ribcage, diaphragm/abdominal unit

What is a pneumothorax?

occurs when the pleural space is disrupted

What is the primary function of the larynx?

respiration

Anatomy and physiology for the voice respiration>phonation>resonance

respiration-the power of the lungs is whats setting your vfs into vibration. phonation- Vfs will vibrate and oscillate from the pressure changes resonance- the vocal tact shapes and filters the sound after it comes through the vfs ****if any of these are disrupter then the quality will be affected

Clavicle

serves for attachment of certain respiratory muscles: trapezius pectorals major sternonocleidomastoid

The term "support" and "pressure"

support- driving force/pressure for voicing pressure- is the more correct than "support" or "breath support"

The biological importance of the larynx should always be considered when evaluating..

the voice and upper airway disorders

Pitch

too high, too low or monotoned

Vocal health

treating your voice the best that you can

Rate

typically people that talk really fast and there is not sufficient breath support and you are straining to get out the last sentence without breath.