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ggarriott
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What physiological change happens in regard to general pulmonary functioning with advanced age?
Less vital capacity (40 yrs old+)
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What physiological change happens in regard to Speaking Fundamental Frequency (SFF) with advanced age?
- Raises in men
- Lowers in women
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What physiological change happens in regard to Maximum Phonational Frequency Range (MPFR) with advanced age?
Reduced in men and women
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What physiological changes are less stable in men and women of advanced age?
- Speaking Fundamental Frequency (SFF)
- Amplitude
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Maximum intensity of ___________ is reduced in men and women of advanced age.
Vowel production
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What physiological change increases in men and women with advanced age?
Perturbation (jitter, shimmer, spectral noise)
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___________ of vowels is common in older speakers.
Centralization
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Lengthening of the vocal tract in older speakers contributes to changes is _________ frequencies.
Formant
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In old age, how does fundamental frequency change in men? In women?
- Raises in men
- Lowers in women
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What's the most common cause of hoarseness in the elderly?
Benign vocal fold lesions such as polyps
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In the elderly, what effect does physical fitness have on the voice?
Positive effect--may improve laryngeal physiology & better respiratory efficiency
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What's the relationship between the age at which hearing loss occurs and its effect on the voice?
Earlier onset of symptoms=more severe speech and language impairment
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How are pitch & pitch variability affected by hearing loss?
- Excessive pitch variability and loudness
- Elevated fundamental frequency
- downward formant shifts
- Slower rate of speech--prolonging vowels
- Variations in prosody
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What effect does excessive vertical movement of the larynx have on pitch?
Inappropriately high pitch level
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What type of tongue posturing problem is observe in deaf children?
Posterior carriage of the tongue causing marked variations in nasal resonance
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Nonorganic disorder that is tricky to treat of the upper airway with both true and false vocal folds exhibiting wrong positioning during function of closure on inspiration, expiration, or a combination of both.
Paradoxical Vocal Fold Movement (PVFM)
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What disorder is becoming more increasingly recognized when symptoms of respiratory distress don't respond to tx for asthma?
Paradoxical Vocal Fold Movement (PVFM)?
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What effect does tracheostomy have on voice? Why?
- Alters physiology of voice and swallow
- Stoma is below the level of the larynx
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When surgery to treat laryngeal cancer leaves a glottal gap, how does the glottal gap affect voice?
- Breathy vocal quality
- Irregular vocal fold vibration
- Inadequate loudness
- Short phonation times
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How is this glottal gap reduced in voice therapy?
Upward Pitch Shift--slightly increases vocal fold tension and helps gain slightly better approximation which also increases loudness
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What effect does laryngectomy have on speech, respiration, and swallowing? Why?
- Speech--will have to use alternate method of speaking
- Respiration--will "breathe" through a stoma
- Swallowing--will have to be more careful not to aspirate
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What are the sound sources for artificial larynx, esophageal speech, & tracheoesophageal puncture?
- Artificial larynx--Electrolarynx instrument placed against the throat or inserted into the mouth (sounds robotic and monotone)
- Esophageal speech--Pharyngoesophageal (PE) segment tissue vibration
- Tracheoesophageal puncture--Upper Esophageal Sphincter vibration
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Is the reported rate of surgical complications for tracheoesophageal puncture (TEP) high or low?
Very Low
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What problem results if the TEP prosthesis is too long? Too short?
- Too long--make contact with pharyngeal wall interfering with voice production & causing leak-malfunction of the valve
- Too short--may be expelled during forceful coughing
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Which type of resonance problem is most common?
Hypernasality
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What are the characteristics of velopharyngeal disfunction (VPD)?
- Incompetance-impaired motion of mechanism
- Insufficiency--tissue deficiency
- Inadequacy--mixture of both
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How are the phonemes /m/, /n/, and /ng/ produced by the hyponasal speaker?
- Hyponasaly--they will be perceived as the voiced nonnasal phonemes:
- /b/
- /d/
- /g/
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What types of problems cause hyponasality? Hypernasality? Assimilative nasality?
- Hyponasality--adenoids, tonsils, deviated septum, obstructed naris, choanal atresia, swelling, allergies, polyps
- Hypernasality--neurological, congenital (cleft palate/submucous cleft of velum), or surgery
- Assimilative nasality--overexposure to faulty speech models
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What nasal resonance is described as happening when VP port is opened too soon & remains open too long so that vowel or voiced consonant resonance preceding and following nasal consonant resonance is also nasalized?
Assimilative nasality
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Is the velopharyngeal port open or closed during production of nasal phonemes?
Open
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Impaired motion of the VP mechanism is known as what?
Velopharyngeal incompetence
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Mixture of both Velopharyngeal incompetance and insufficiency is known as what?
Velopharyngeal inadequacy
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Tissue deficiency of the Velopharyngeal mechanism is known as what?
Velopharyngeal insufficiency
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What levels of intraoral pressure and nasal airflow rates are associated with production of nasal consonants?
- LOW pressure (intraoral)
- HIGH rate (nasal airflow)
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Are high nasal airflow rates associated with hypernasality or hyponasality?
Hypernasality
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How does loading target sentences with nasal phonemes help the SLP diagnose resonance disorders?
Hyponasality is confirmed when there is an absence of normal nasal resonance on these nasally loaded phrases
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Is nasal emission classified as a voice disorder?
No...it's classified as an articulation disorder but can be an important diagnostic sign of velopharyngeal adequacy
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Does the oral examination allow the SLP to determine the adequacy of velopharyngeal function?
No, because VP function cannot be seen simply by viewing through the oral cavity.
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Can tongue size and function cause nasality problems?
Yes
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What is measured by pressure transducers?
Relative air pressures and airflows emitted simultaneously from the nasal and oral cavities during speech
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What is measured by pneumotachometers?
Relative air pressures and airflows emitted simultaneously from the nasal and oral cavities during speech
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What is measured by manometers?
Pressure of the emmitted airstream (does not measure resonance since it's a perceptual event)
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What is measured by nasometers?
Amount of nasalance (oral-to-nasal acoustic energy) in a voice signal
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Perception of how oral or nasal voice sounds is known as _________.
Nasalance
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Is voice therapy effective with patients who have velopharyngeal insufficiency?
No
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What is it called when there is alterations in nasal resonance often accompanied by excessive pharyngeal resonance?
Cul-de-sac nasality
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What causes cul-de-sac nasality?
Excessive Posterior Tongue Posturing
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How common is laryngeal cancer?
- 1 to 2% of ALL cancers
- 20% of Head/Neck cancers
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Do head and neck cancers have a high cure rate?
Yes
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What are the 2 methods of teaching esophageal speech? Which one is easier to teach?
- Injection--easiest to teach
- Inhalation
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In TE puncture, what is the indwelling prosthesis?
Inserted and removed by the physician or SLP
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What are the advantages of tracheoesophageal speech over esophageal speech?
- Easy/Less to learn
- More air to speak on; can speak longer utterances
- Voice quality is more natural
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Why does the patient with a PE puncture occlude his stoma with his finger as he speaks?
- Divert tracheal air directly into the esophagus
- To speak
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What is is being tested when we see how well patient can produce an errored sound when repeated presented with correct sound through both auditory & visual stimuli?
Stimulability
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What does stimulability distinguish between?
- True problems VP inadequacy
- Functional VP inadequacy
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