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Case Study 2

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by

Nicole Farkas

on 14 March 2016

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Transcript of Case Study 2

How does vibration occur?

1. Abduction & Adduction
2. The Bernoulli Effect
3. Myoelastic Elements
Case Study 2
Vocal Fold Granuloma
A granuloma is the body's response to an irritant.
Vocal granulomas = posterior of vocal folds, on lining of arytenoid cartilage (site of contact during fold closure)
Injury to cartilage = exposure to air, food and acid reflux
Granuloma form to protect from further irritation
Changes to Phonation
The vocal folds:
located superior to the subglottal region & inferior to the region of the epiglottis
sound is created as the folds vibrate together when air is passed through
The Vocal Folds (cont.)
Composed of 5 layers of tissue:
Squamous epithelium, superficiallamina propia (SLP)
Cross layered with the intermediate lamina propria (ILP)
Deep Lamina Propria (DLP)
Thyroaryenoid muscle

The Vocal Folds
Vocal Fold Granuloma (cont.)
Vocal fold granuloma caused by 3 main reasons:

1. Endotracheal intubation trauma
2. Irritation from vocal abuse; and/or
3. Gastroesophageal reflux.

Mrs Savage granuloma = endotracheal intubation trauma from surgery 4 months ago
Movements of the vocal folds
functioned by the cartilage movements of the larynx
cricothyroid and cricoaryteniod joints
A comparison of a normal vocal fold vs. a vocal fold with a granuloma [Image] (2014) Retrieved from http://www.voicedoctorla.com/wp-content/uploads/2012/04/granuloma.jpg

A granuloma on the left vocal fold [Image] (2014). Retrieved from http://voicefoundation.org/wp-content/uploads/2013/08/granuloma_160.jpg

A woman with a cough [Image] (2014). Retrieved from http://msnbcmedia.msn.com/i/MSNBC/Components/Photo/_new/g-hlt-130114-coughing-stock-12p.jpg

A woman with a sore throat [Image] (2014). Retrieved from http://img2.timeinc.net/health/img/web/2012/10/slides/cure-a-sore-throat-400x400.jpg

Burdett, E., & Mitchell, V. (2011).
Anatomy of the larynx, trachea and bronchi. Anaesthesia & Intensive Care Medicine, 12
(8), 335-339.

Carroll, T., Gartner-Schmidt, J., Statham, M., & Rosen, C. (2009). Vocal process granuloma and glottal insufficiency: An overlooked aetiology.
The Laryngoscope, 120
(1), 114-120. doi:10.1002/lary.20656

Devaney, K., Rinaldo, A., & Ferlito, A. (2005). Vocal process granuloma of the larynx‚ recognition, differential diagnosis and treatment.
Oral Oncology, 41
(7), 666-669. doi:10.1016/j.oraloncology.2004.11.002

Layers of the vocal folds. [Image] (n.d.). Retrieved from http://www.ncvs.org/.../tut.../voiceprod/tutorial/cover.html

Lions Voice Clinic. (2014).
Types of Voice Disorders
. Retrieved from http://voicefoundation.org/health-science/voice-disorders/voice-disorders/vocal-fold-granuloma/symptoms-of-vocal-fold-granuloma




(Layers of the Vocal Folds, n.d.)
(Skeleton of the Larynx, 1999)
Decreased rate in vocal vibration =
Lower Pitch

Vocal cords unable to vibrate normally through Bernoulli Effect=
Hoarse voice

Poor abduction & adduction =V
ocal fatigue, effortful phonation,breathy voice

Weak or non-existent vibration
= 'Breaks' in voice
Expected changes due to Granuloma
Larynx
(Carroll, Gartner-Schmidt, Statham & Rosen, 2009; The Voice Foundation, 2014)
(The Voice Foundation, 2014)
(Osborne Head and Neck Institute, 2014)
(Devaney, Rinaldo & Ferlito, 2005; Carroll, Gartner-Schmidt, Statham & Rosen, 2009; Gupta, 2014)
(MacMillan, 2014)
(NBC News, 2014)
Responsible for voice production, & aids in swallowing and breathing
Lies between pharynx and trachea
Cartilages
Unipaired
Thyroid
Cricoid
Epiglottic
Paired
Arytenoid
Cuneiform
Corniculate
Larynx
Muscles
Extrinsic
Mylohyoid
Geniohyoid
Digastric
Stylohyoid
Sternyhyoid
Sternothyroid
Omohyoid
Thyroid
Intrinsic
Lateral Cricoarytenoid
Interarytenoid
Cricothyroid
Posterior Cricothyroid
Thyroarytenoid
Location of larynx. [Image] (n.d.). Retrieved fom http://greenworldindonesia.org/wp-content/uploads/2014/02/o-atuh-300x150.jpeg

Marchant, W. (2005). Anatomy of the larynx, trachea and bronchi.
Anaesthesia & Intensive Car Medicine, 6
(8) 253-255.

Seikel, J. A., King, D. W. & Drumwright, D. G. (2010). Anatomy & physiology:
For speech, language and hearing.
Clifton Park, NY: Delmar, Cengage Learning.

Simpson, B., & Rosen, C. (2008).
Anatomy and physiology of the larynx. (pp. 3-8)
Berlin, Heidelberg: Springer Berlin Heidelberg.

Skeleton of the larynx [Image] (1999). Retrieved from https://home.comcast.net/~wnor/lesson11.htm

The Voice Foundation. (2014).
Understanding Vocal Fold Granuloma.
Retrieved from http://voicefoundation.org/health-science/voice-disorders/voice-disorders/vocal-fold-granuloma/understanding-vocal-fold-granuloma/

The Voice Foundation. (2014).
Vocal Fold Granuloma.
Retrieved from http://voicefoundation.org/health-science/voice-disorders/voice-disorders/vocal-fold-granuloma/

Vocal granuloma [Image] (2014). Retrieved from http://www.voicedoctorla.com/voice-disorders/vocal-granuloma/

University of California: Department of Otolaryngology. (2014).
Granuloma
. Retrieved from http://www.ent.uci.edu/clinical-specialties/university-voice-and-swallowing-center/granuloma


(Seikel, King & Drumwright, 2010)
(Seikel, King & Drumwright, 2010)
(Lions Voice Clinic, 2014)
References
Stuart Bartlett
Tutorial Group
Monday 1pm
Breanna Kerr S00167536
Chelsea Gatehouse S00167435
Nicole Fakas S00167228
Zoe Lam S00167714
(Larynx, n.d.)
(Marchant, 2005)
(Simpson & Rosen, 2008)
(Burdett & Mitchell, 2011)
Full transcript