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PHONATIO
N
Process
by which
vocal folds produce
certain sounds
through periodic vibration .
OSCILLATION
Repeated back & forth movement

VOCAL CORD OSCILLATION
Flow induced oscillation
Steady flow of air
Pass by a wall / surface

Surface vibrates
VOCAL FOLDS
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข
โ€ข

Housed with protective cartilage of larynx
Vocal folds very small {18mm - women ; 23mm -men}
Part of fold responsible for sound production is further
smaller
During phonation โ€“ only anterior part of fold is free to
vibrate
Appearance : Pearly white bands
looks like โ€œ V โ€ on rest
During phonation they close together at Posterior part
Bottom of this V points to front of neck and Adams
apple
Space b/w vocal folds GLOTTIS which opens for
respiration & closes for phonation
above the folds pink-coloured ventricular folds , also k/a
false vocal folds
A curved structure k/a epiglottis
arise from the closed point of the vocal folds
cover airway during swallowing and direct food into the
esophagus toward the stomach
VOCAL FOLD STRUCTURE
Vocal folds โ€“ body & cover
Cover - lined by Stratified Squamous Epith
Aka Mucosa of the vocal folds
Below vocal folds โ€“ lined by Ciliated Columnar Epith.
Body : Has thyroaretynoid muscle
(Origin : Thyroid cartilage & Insetion : Arytenoid
cartilage)
A transitional layer b/w muscle & epithelial cover
LAMINIA PROPRIA
Has 3 layers
Superficial
Outer most layer

Intermediate
Middle layer

Superficial Layer
Joins epith. Via basement memb
Thinnest layer
Lowest viscosity
Intermediate Layer
More wider
More viscous
Vocal ligament passess through this layer

Deep
Inner layer
Deep Layer
Densest & most viscous
Transition from vocal fold cover to body is completed
Lamina propria compared :
To a 3-layered gelatin dessert in which
Superficial layer - incompletely set
Intermediate layer - normal gelatin
deep layer more - resembles a gummi
This pattern helps the cover to slide gently in position
relative to body
oscillation facilitated In healthy vocal folds
.
using high-speed or stroboscopic cameras ,surface of fold appears to
ripple in a wave like motion k/a MUCOSAL WAVE
Voice disorders impair phonation:
By impeding mucosal wave formation ( Eg: the hoarseness or loss of
voice) from
๏‚ž

laryngitis (laryngeal inflammation) โ€“ d/t vocal fold swelling - makes the
cover adhere tightly to body. The folds lose their suppleness and
become too rigid to oscillate
THEORIES OF VOCAL
OSCILLATION

FOLD

Muscular activities alone are not able to open and
close the glottis rapidly enough for sound
๏‚ž Production
๏‚ž

To sing

vocal folds must open and close at a much
faster rate up to 1400 times / sec
No muscles can do this
MYOELASTIC AERO DYNAMIC
THEORY
Vocal cord oscillation

Muscular + Aerodynamic process

Aerodynamic Process
Demonstrated by Daniel Bernoulli (18 century)
Fluid Dynamic
If Vol. of fluid / Gas

Pass confined area

inversely propotional to

Constant energy

Expressed as pressure & flow
Eg : Water passing through a pipe
VOCAL FOLD OSCILLN. & ROLE OF BERNOULLI EFFECT
Laryngeal mus.
Close vocal folds Air pr. ses` beneath

Air flows thru glottis
opens glottis from bottom to top
with velocity & press.
until air escapes
Glottis closes d/t

air flow pr.

Process repeats
The time of Open : close ratio of vocal folds
Measuring the images by
High speed or Stroboscopic motion picture
Also measured by a painless , non invasive
Electroglottograph (EGG)
{ Elecrodes

placed on either side of neck - radio freq waves
passed via larynx - Glottic opening & closing induce changes
in electrical resistance - measured & plotted by EGG }
RATE OF GLOTTIC OPENING & CLOSING
OPEN : CLOSED RATIO
NORMAL PHONATION

BREATHY PHONATION

{ Vocal Cords are not fully closed on Stroboscopy & EGG }
THE ONE MASS MODEL THEORY
Myoelastic-Aerodynamic theory was improved by adding the
contribution of the vocal tract & its impact on airflow
In the physical world
objects experience inertia
which is
resistance to starting & stopping movement
vocal folds and the air moving through the vocal tract also
are subject to this natural law
In A-M theory
glottis initially closed by muscles in larynx
Subglottal air pr.
Till it overcomes muscular & tissue resistance & opens glottis
Air pr. through glottis (Bernoulli)
& elasticity / Inertia of vocal folds
Brings glottis back together
flow of air
Becoz of inertia, air above glottis cont. its 4ward motion through
the glottis
Combined forces of
elastic recoil of the folds + pressure drop through the
glottis + low pressure region above the glottis
completes cycle ,closing the glottis
Asymmetry of air pr. below & above glottis
allows
Vocal fold oscillation
to continue for as many times per second
depending on the pitch that is spoken or sung
THREE MASS MODEL
Vocal folds consider as 3 interconnected masses
First & largest mass - body of the vocal fold ( thyroarytenoid muscle)
Two smaller masses - upper and lower portions of the cover (lamina propria
and epithelium)
Glottis opens and closes asymmetrically with vertical phase difference from
bottom to top.
Air pressure also is asymmetrical
When glottis is
convergent
(Bottoms of 2 folds r farther apart)

Divergent
(tops of 2 folds r farther apart)

Increasing
decreasing
Asymmetry of air pressure + impact of pr. changes above glottis caused by
Inertia
๏‚ž
sufficient to sustain vocal fold oscillation
NEUROCHRONAXIC THEORY
Raoul Husson (1901-67)

French scientist &voice enthusiast

believed that nerve impulses from brain

sole cause of vocal fold vibration &
that airflow only is needed to carry the sound
outside the body
DEGREE OF PHONATION
VOICELESSNESS - NO VIBRATION
๏‚ž

BREATHY VOICE

VOCAL CORDS VIBRATE

WHILE THEY ARE

FURTHER

APART
MODAL VOICE
Max. Vibration
o

STIFF VOICE
Glottal opening is narrower
o
๏‚ž

Faucalized voice (hollow or yawny

voice)

Laryngeal cavity is
expanded
WHISPER
Greater adduction
than in breathy voice
๏‚ž

HARSH VOICE
Ventricular or pressed voice

`
PHONATION DISORDERS
โ€ข

MYAESTHENIA GRAVIS
auto-immune disease affect the nerve-muscle interface
causing general muscle weakness.

HOARSENESS
VOICE FATIGUE
DIFFICULTY IN CONTROLLING PITCH OF VOICE
T/T:
Anti cholinesterase โ€“
restore muscle strength &

tendency towards fatigue
โ€ข

PARKINSONS DISEASE
Degenerative disorder of the CNS
Motor symptoms of Parkinson's disease result from death of
dopamine-generating cells a region of the midbrain

low volume voice with a "monotoneโ€œ
(expressionless) quality

T/t :
Levadopa and dopamine agonists
โ€ข

VOCAL HYPER FUNCTION

Itโ€™s the functional abuse of the vocal mechanism.
e.g : excessively loud speech.
-

Can cause nodule
MCC :

T/T :
Speech Therapy
VOCAL FOLD PARALYSIS
Inability of 1 or both vocal folds (vocal cords) to move
d/t damage to nerves going to vocal cords
d/t damage to the brain itself
How does it affect voice?
Abductor: phonation in inspiration and exhalation
Adductor: no phonation
T/t :
Voice therapy:
To make the working vocal cord "compensate" for the vocal
cord paralysis..

Surgical:
Almost IMMEDIATE improvement of all symptoms seen,
especially vocal quality and strength.
VOCAL CORD POLYP
Non cancerous growths on the vocal cords that affect
voice.
Sometimes caused by vocal abuse
T/t :
Small polyps can be treated with
Voice therapy, but typically they are
surgically removed
VOCAL FOLD CANCER
T/t depends on the site and
extent of involvement
+
consideration of other
health issues the person
may have
โ€ข Treatment options
o Surgery
o Laser surgery
o Radiation therapy
o Chemotherapy
o Combination therapy
Eg of a very early cancer of the vocal folds.If these lesions
are detected early, they can be treated with either radiation
or surgery, with a cure rate approaching 96%.
PHONATION - DR NITIN ANIYAN THOMAS (NATS)

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PHONATION - DR NITIN ANIYAN THOMAS (NATS)

  • 2. Process by which vocal folds produce certain sounds through periodic vibration .
  • 3.
  • 4. OSCILLATION Repeated back & forth movement VOCAL CORD OSCILLATION Flow induced oscillation Steady flow of air Pass by a wall / surface Surface vibrates
  • 5.
  • 6. VOCAL FOLDS โ€ข โ€ข โ€ข โ€ข โ€ข โ€ข โ€ข โ€ข โ€ข โ€ข Housed with protective cartilage of larynx Vocal folds very small {18mm - women ; 23mm -men} Part of fold responsible for sound production is further smaller During phonation โ€“ only anterior part of fold is free to vibrate Appearance : Pearly white bands looks like โ€œ V โ€ on rest During phonation they close together at Posterior part Bottom of this V points to front of neck and Adams apple Space b/w vocal folds GLOTTIS which opens for respiration & closes for phonation above the folds pink-coloured ventricular folds , also k/a false vocal folds
  • 7. A curved structure k/a epiglottis arise from the closed point of the vocal folds cover airway during swallowing and direct food into the esophagus toward the stomach
  • 8.
  • 9.
  • 10.
  • 11. VOCAL FOLD STRUCTURE Vocal folds โ€“ body & cover Cover - lined by Stratified Squamous Epith Aka Mucosa of the vocal folds Below vocal folds โ€“ lined by Ciliated Columnar Epith. Body : Has thyroaretynoid muscle (Origin : Thyroid cartilage & Insetion : Arytenoid cartilage) A transitional layer b/w muscle & epithelial cover LAMINIA PROPRIA Has 3 layers
  • 12. Superficial Outer most layer Intermediate Middle layer Superficial Layer Joins epith. Via basement memb Thinnest layer Lowest viscosity Intermediate Layer More wider More viscous Vocal ligament passess through this layer Deep Inner layer
  • 13. Deep Layer Densest & most viscous Transition from vocal fold cover to body is completed Lamina propria compared : To a 3-layered gelatin dessert in which Superficial layer - incompletely set Intermediate layer - normal gelatin deep layer more - resembles a gummi
  • 14. This pattern helps the cover to slide gently in position relative to body oscillation facilitated In healthy vocal folds . using high-speed or stroboscopic cameras ,surface of fold appears to ripple in a wave like motion k/a MUCOSAL WAVE Voice disorders impair phonation: By impeding mucosal wave formation ( Eg: the hoarseness or loss of voice) from ๏‚ž laryngitis (laryngeal inflammation) โ€“ d/t vocal fold swelling - makes the cover adhere tightly to body. The folds lose their suppleness and become too rigid to oscillate
  • 15. THEORIES OF VOCAL OSCILLATION FOLD Muscular activities alone are not able to open and close the glottis rapidly enough for sound ๏‚ž Production ๏‚ž To sing vocal folds must open and close at a much faster rate up to 1400 times / sec No muscles can do this
  • 16. MYOELASTIC AERO DYNAMIC THEORY Vocal cord oscillation Muscular + Aerodynamic process Aerodynamic Process Demonstrated by Daniel Bernoulli (18 century) Fluid Dynamic If Vol. of fluid / Gas Pass confined area inversely propotional to Constant energy Expressed as pressure & flow
  • 17. Eg : Water passing through a pipe VOCAL FOLD OSCILLN. & ROLE OF BERNOULLI EFFECT Laryngeal mus. Close vocal folds Air pr. ses` beneath Air flows thru glottis opens glottis from bottom to top with velocity & press. until air escapes Glottis closes d/t air flow pr. Process repeats
  • 18.
  • 19. The time of Open : close ratio of vocal folds Measuring the images by High speed or Stroboscopic motion picture Also measured by a painless , non invasive Electroglottograph (EGG) { Elecrodes placed on either side of neck - radio freq waves passed via larynx - Glottic opening & closing induce changes in electrical resistance - measured & plotted by EGG } RATE OF GLOTTIC OPENING & CLOSING OPEN : CLOSED RATIO
  • 20. NORMAL PHONATION BREATHY PHONATION { Vocal Cords are not fully closed on Stroboscopy & EGG }
  • 21.
  • 22.
  • 23. THE ONE MASS MODEL THEORY Myoelastic-Aerodynamic theory was improved by adding the contribution of the vocal tract & its impact on airflow In the physical world objects experience inertia which is resistance to starting & stopping movement vocal folds and the air moving through the vocal tract also are subject to this natural law In A-M theory glottis initially closed by muscles in larynx
  • 24. Subglottal air pr. Till it overcomes muscular & tissue resistance & opens glottis Air pr. through glottis (Bernoulli) & elasticity / Inertia of vocal folds Brings glottis back together flow of air Becoz of inertia, air above glottis cont. its 4ward motion through the glottis
  • 25. Combined forces of elastic recoil of the folds + pressure drop through the glottis + low pressure region above the glottis completes cycle ,closing the glottis Asymmetry of air pr. below & above glottis allows Vocal fold oscillation to continue for as many times per second depending on the pitch that is spoken or sung
  • 26. THREE MASS MODEL Vocal folds consider as 3 interconnected masses First & largest mass - body of the vocal fold ( thyroarytenoid muscle) Two smaller masses - upper and lower portions of the cover (lamina propria and epithelium) Glottis opens and closes asymmetrically with vertical phase difference from bottom to top. Air pressure also is asymmetrical When glottis is convergent (Bottoms of 2 folds r farther apart) Divergent (tops of 2 folds r farther apart) Increasing decreasing Asymmetry of air pressure + impact of pr. changes above glottis caused by Inertia ๏‚ž sufficient to sustain vocal fold oscillation
  • 27. NEUROCHRONAXIC THEORY Raoul Husson (1901-67) French scientist &voice enthusiast believed that nerve impulses from brain sole cause of vocal fold vibration & that airflow only is needed to carry the sound outside the body
  • 29. ๏‚ž BREATHY VOICE VOCAL CORDS VIBRATE WHILE THEY ARE FURTHER APART
  • 30. MODAL VOICE Max. Vibration o STIFF VOICE Glottal opening is narrower o
  • 31. ๏‚ž Faucalized voice (hollow or yawny voice) Laryngeal cavity is expanded
  • 32. WHISPER Greater adduction than in breathy voice ๏‚ž HARSH VOICE Ventricular or pressed voice `
  • 33. PHONATION DISORDERS โ€ข MYAESTHENIA GRAVIS auto-immune disease affect the nerve-muscle interface causing general muscle weakness. HOARSENESS VOICE FATIGUE DIFFICULTY IN CONTROLLING PITCH OF VOICE T/T: Anti cholinesterase โ€“ restore muscle strength & tendency towards fatigue
  • 34. โ€ข PARKINSONS DISEASE Degenerative disorder of the CNS Motor symptoms of Parkinson's disease result from death of dopamine-generating cells a region of the midbrain low volume voice with a "monotoneโ€œ (expressionless) quality T/t : Levadopa and dopamine agonists
  • 35. โ€ข VOCAL HYPER FUNCTION Itโ€™s the functional abuse of the vocal mechanism. e.g : excessively loud speech. - Can cause nodule
  • 37. VOCAL FOLD PARALYSIS Inability of 1 or both vocal folds (vocal cords) to move d/t damage to nerves going to vocal cords d/t damage to the brain itself How does it affect voice? Abductor: phonation in inspiration and exhalation Adductor: no phonation
  • 38. T/t : Voice therapy: To make the working vocal cord "compensate" for the vocal cord paralysis.. Surgical: Almost IMMEDIATE improvement of all symptoms seen, especially vocal quality and strength.
  • 39. VOCAL CORD POLYP Non cancerous growths on the vocal cords that affect voice. Sometimes caused by vocal abuse T/t : Small polyps can be treated with Voice therapy, but typically they are surgically removed
  • 40. VOCAL FOLD CANCER T/t depends on the site and extent of involvement + consideration of other health issues the person may have โ€ข Treatment options o Surgery o Laser surgery o Radiation therapy o Chemotherapy o Combination therapy
  • 41. Eg of a very early cancer of the vocal folds.If these lesions are detected early, they can be treated with either radiation or surgery, with a cure rate approaching 96%.

Editor's Notes

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