Professional Documents
Culture Documents
Dr R Anbuchezhian
PHONATION
PROPERTIES OF SOUND
SOUND
INTENSITY
FREQUENCY
TIMBRE
RESONANCE
Respiratory bellows
Vibratory mechanism
Resonating chambers
THEORIES OF PHONATION
I.
NEUROMUSCULAR THEORY
II.
AERODYNAMIC THEORY
III.
COVER/BODY THEORY
AERODYNAMIC THEORY
Myo elastic theory/ Tonic theory
Van den Berg in 1958
Classic and still the most accepted theory
Postulates that effective force setting the VC in
vibration is the infraglottic air column.
Opening and closing of the VC are passive result
of raised pressure of air stream passing through,
while the tonically contracted VC muscles
maintains the apposition.
COVER/BODY THEORY
Phonation
VC Adduction
Pulmonic air exaled between adducted
vocal cords generating vocal fold
oscillations.
PHONATION THRESHOLD
PRESSURE
Air pressure required to begin
voicing( 2.5 mm H2O AT 75 db
APPROX)
VIBRATORY CYCLE
ADDUCTION
RECOIL
AERODYNAMIC
SEPARATION
BERNOULLIS EFFECT.
DECREASED PRESSURE
STAGES OF V C VIBRATION
Periods of V C Contact / lack
1.Closing
2. Closed
3. Opening
4. Open
REGISTERS
Perceptually distinct regions of vocal quality over certain ranges of pitch and loudness.
Highest frequency
Larynx raised
Pharynx shortened
Vocal fold extremely tense and thinned
Position adducted (almost)
Vibration minimal
F0 - 275 - 1100 hz
MODAL REGISTER
Quality
Frequency
Amplitude
QUALITY
FREQUENCY
AMPLITUDE
QUALITY
Quality depends on vibratory characteristics
of the laryngeal structures. Regularity of
waves
Breathy voice - Incomplete add with air leak
Hoarseness - irregular mucosal waveform
vibration
Whisper - insufficient VC adduction for vibration,
but sufficient to cause audible turbulent air
Strained voice - Strong adduction with inc
subglottal air pressure
Noise Aperiodic sound
CHARACTERISTICS OF GLOTTIC
SOUND
QUALITY
FREQUENCY
AMPLITUDE
FREQUENCY
Def : No of vibratory cycles per second
Frequency is proportional to length,
elasticity and tension
Jitters/pitch perturbation - short
term variance in the frequency of
vocal cord
CHARACTERISTICS OF GLOTTIC
SOUND
QUALITY
FREQUENCY
AMPLITUDE
AMPLITUDE
Def : Size of the oscillation of the vocal
fold.
Shimmers/amplitude perturbation
- short term variance in the intensity
of the vocal signal
PITCH CONTROL
CONTRACTION OF
THRYOARYTENOID
DECREASES PITCH
CONTRACTION OF
CRICOTHYROID
INCREASES PITCH
TENSION
VOCAL RESONANCE
LEADS TO PROLONGATION
- AMPLIFICATION
- FILTERING OF SOUND
VOCAL RESONANCE
Oral resonance
Degree of jaw mvmt, mouth opening,
tongue raising,
Pharyngeal constriction
Nasal resonance
Velopharyngeal spincter
ARTICULATION
Synchronised movements of the organs of articulation
(eg. Palate , tongue, lips, etc) to change glottal sound
into a recognisable speech.
DESCRIBED BY SOURCE FILTER MODEL
vowels)
Source
larynx
Filters
VOWELS
These are sounds where there is no
Obsrtuction to flow of air as it passes from
larynx to lips
Eg : A, E, I, O, U
CONSONANTS
These are sounds where there is more
definitive obstruction to air
Eg : P, B, M, W, F, T, S, Z, R,
Different consonants are produced by :
- place of articulation
- Manner of articulation
- State of larynx
CONSONANTS
BILABIAL
LABIODENTAL
DENTAL
BASED ON PLACE
OF ARTICULATION
ALVEOLAR
PALATAL
VELAR
GLOTTAL
BILABIAL
UPPER
AND
LOWER LIP
- P, B,
M,W
LABIODENTA
L
-TOP TEETH
AND
LOWER LIP
-- F, V
DENTAL
- TONGUE TIP
WITH
TOP TEETH
OCCLUSION
- th
ALVEOLAR
-TONGUE TIP
TOUCHING
RIDGE
BEHIND TEETH
-- T, D, N, S, Z,
R, ch, dj
PALATAL
-MIDDLE
TONGUE
WITH
HARD PALATE
- Y
VELAR
-POSTR
TONGUE
AND
SOFT PALATE
- K, G, ng
Plosives
: p, b, t, d,
k, g
Fricatives
: F, V, S, Z,
th
Affricatives
: ch, dj
NASAL
: M, N, ng
Approximant
: w, y, l, r,
Voice
Acoustic output from the vocal tract that
are characterised by their dependence
on the vocal fold vibratory inputs
Pathological phonation
Imbalance in normal ratio of periodic
sound and noice components of acoustic
signal resulting in poor voice quality
HOARSENESS
Hoarseness is described as
having difficulty producing
sound when trying to speak, or
a change in the pitch or quality
of the voice. The voice may
sound excessively breathy or
husky.
V
Workup
HOARSENESS
EVALUATION
OF
A
PATIENT
WITH
HOARSENESS INCLUDES THE FOLLOWING: - HISTORY
- PHYSICAL
EXAMINATION
- ANCILLARY TESTS
HISTORY
History
Infection
- laryngitis
Trauma
- Nerve paralysis
- Laryngeal fractures
- During Intubation
Arytenoids dislocation
Mucosal lacerations
- Granuloma
HISTORY
History
Pulmonary conditions
- COPD
- Asthma
Gastrointestinal
LPR
Autoimmune
- RA
Endocrine
- hypothyroidism (Edematous)
-Danazol in female (Irreversible enlargement of
larynx)
History
HISTORY
Surgical
history
- Skull base
procedures
- Thyroidectomies
- Aortic aneurysm repairs
Social history
- Tobacco
- Alcohol
- Talkativeness
Occupational history
- Voice abuse
Toxic exposures
- Pollutants, pollen grains, ethyl alcohol,
tobacco, allergies
HISTORY
Presbylaryngis
LARYNGEAL EXAMINATION
- INDIRECT LARYNGOSCOPY
- FLEXIBLE LARYNGOSCOPY
- RIGID LARYNGOSCOPY
INDIRECT LARYNGOSCOPY
ADVANTAGES
QUICK
INEXPENSIVE
LITTLE EQUIPMENT
DISADVANTAGES
GAG
ANATOMIC
FEATURES
NONPHYSIOLOGIC
FLEXIBLE LARYNGOSCOPY
ADVANTAGES
WELL TOLERATED
COMPLETE
EXAMINATION
VIDEO
DOCUMENTATION
DISADVANTAGES
MORE TIME
EXPENSIVE
RIGID LARYNGOSCOPY
ADVANTAGES
BEST IMAGES
VIDEO
DOCUMENTATION
DISADVANTAGES
EXPENSIVE
NONPHYSIOLOGIC
GAG
REQ OF GA
VIDEOSTROBOSCOPY
Two Types
- Synchronous motionless
- Asynchronous slow motion
Carried out in the same way as IDL but light
source is flashing Xenon tube. The light source
is linked to Hopkins's rod or Fibrescope
Permits accurate visualization of epithelial
abnormalities which are missed out on IDL due
to fast vibrations
Video recording
Detailed review
Comparison after treatment
VIDEOSTROBOSCOPY
VOCAL FOLD CLOSURE PATTERN
VOCAL FOLD VIBRATORY PATTERN
MUCOSAL WAVE OF EACH VOCAL FOLD
SYMMETRY
VIDEOSTROBOSCOPY
ADVANTAGES: ALLOWS APPARENT SLOW MOTION
ASSESSMENT OF MUCOSAL VIBRATORY DYNAMICS, VIDEO
DOCUMENTATION
DISADVANTAGES: TIME CONSUMING, EXPENSIVE
V
3
PANENDOSCOPY
INDICATIONS
BIOPSY SUSPICIOUS LESION
LARYNGEAL CANCER - TUMOR EXTENT, SECOND
PRIMARY
HOARSE PATIENTS WITHOUT DIAGNOSIS AT END
OF WORKUP
PERSISTENT OR RECURRENT VOCAL SYMPTOMS
(MAY NEED TO REPEAT)
PATIENTS WITH PRIOR
ONSET HOARSENESS
CANCERS
WITH
NEW
OTHER TESTS
LABS: TSH, LFT
PLAIN FILMS: CXR, LAT NECK
CT SCAN :
MRI BA SWALLOW
LARYNGEAL
EMG
MYOPATHY NORMAL FREQUENCY OF
FIRING BUT DECREASED AMPLITUDE (A)
NEUROPATHY DECREASED FREQUENCY
BUT OCCASIONAL NORMAL AMPLITUDES(B)
POLYPHASIC REINNERVATION POTENTIALS
INDICATE SOME LOSS OF FUNCTION BUT
REINNERVATION HAS BEGUN
ACOUSTIC MEASURES
ELECTROLARYNGORAPH
PHONETOGRAM
Visual display of the dynamic range of the voice in
terms of frequency and vocal intensity
SPECTROGRAM
Three dimensional display of time, frequency,
amplitude of a recoded sound signal.
HARMONICS TO NOISE RATIO
Measured in dB
Mean intensity of average waveform/ Mean
intensity of the isolated noise component.
Aerodynamic measures
Air Flow
Air Volume
Air Pressure
THANK
YOU