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by: Janell Barker

ALL OF SPAA 161 Spaa 161

Janell Barker
GPA 3.8

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This is ALL of my notes from the whole semester. Hope this is beneficial to you! Sorry if there are some misspellings, she goes so fast and doesn't spell out words sometimes! I got an A in the clas...
Anatomy and Physiology of Speech
Speech Anatomy
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This 12 page Bundle was uploaded by Janell Barker on Friday January 22, 2016. The Bundle belongs to Spaa 161 at Ball State University taught by Condon in Summer 2015. Since its upload, it has received 108 views. For similar materials see Anatomy and Physiology of Speech in Linguistics and Speech Pathology at Ball State University.

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Date Created: 01/22/16
vUrvl app  Yellow elastic – stretchable, allows for recoil. Things can move. Found in trachea, lungs, Visible body $30 bronchi, penne of ear, nose, etc.  Cartilage – shock absorber – allows for gliding of -> student -> libraryies, database -> health -> bones across each other. Ex. Ribs attach to anatomy TV sternum – bone to bone – there is cartilage - Clinical specialities between them. There is cartilage in larynx itself  Blood – red, white blood cells, platelets, plasma  Bone – compact or spongey bone. Basis & Cardinal planes and anatomical positioning: foundation of skeleton – which supports muscles  Transverse – top to bottom view and ligaments  Coronal – front to back 3. Muscular  Striated - skeleton  Sagittal – left and right halves  Smooth – organs  Cardiac - combination of striated and smooth; referring uniquely to heart - Superior – above 4. Nervous - Inferior – below  Neurons – transfer information from tissue to - Medial – in the middle. To medialize right arm, you tissue bring it to the middle of the body  Glial cells – transfer nutrients through the blood- - Lateral – further away from midline – go outward brain barrier - Proximal – closer to root or attachment of structure  Dendrites go away from cell, axons go toward - Distal – further away from point of attachment - External – outside of structure. Ex. Larynx – Types of Joints: externally, is attached to tongue and vocal cords. Internally, has things inside the larynx itself 1. Fibrous joint – has very little movement; ex. Skull - Internal – inside of structure 2. Cartilaginous – joints that put two things together – ex. Sternum and ribs Origin – where muscle starts; doesn’t move very much 3. Synovial joints –moveable joint between two bones; there is synovial fluid that provides lubrication within Insertion – greatest area movement; where the muscle goes a synovial joint. Throat – allows you to change to octaves when singing. Ex. Knee. Two types of joints: - Prone – laying down, on belly sliding (surfaces are flat; also called arthrodial) and - Supine – laying down face up spheroid (may also be called the cotyloid or - Flexion – flex/tense muscles at a joint reciprocal; ex. Ball and socket of shoulder. Fit together) - Extension – extend muscles, pull two ends further apart - Hyperextension – dorsi flexion; going beyond neutral. Muscles: Ex. Putting chin up - Plantar – sole of the foot;  Agonist (contraction; prime mover muscles) vs. antagonist (opposes contraction) - Ipsilateral – one side is affected - Contralateral – both sides affected  Fixators stabilize function again  Origin – where muscle starts Tissue = to weave; refer to cell structure and organization  Insertion – where muscle goes to  Synergists – muscles that are stabilizers 4 tissue types (different structures have different functions) –  Isometric – tensing smaller muscles  Muscles contract to 1/3 original length 1. Epithelial cell tissue/ epithelia is the layer of collagen that sits under cell base. Epithelia is the barrier to prevent or permit substances to pass through them or be contained by them  Squamous – building block; squared foundation; 4 properties unique to muscle tissue: single layer of flat cells found within the lining of 1) Contractibility blood vessels, heart, and alveoli, part of the 2) Excitability- nerves supply electrical current lungs 3) Extensibility – stretch  Cuboidal – cube-shaped cell; in glands that 4) Elasticity- recoil, falls back to resting state secrete. Ex. thyroid  Columnar – they look like toilet paper rolls, Diameter of muscles are directly related to its strength stacked up like soldiers; in lining of stomach, 4 functions of muscle tissue: intestines, gall bladder, etc.  Ciliated – microscopic hair can trigger 1) Produces movement something; cylindrical cells, in lining of nose, 2) Helps open & close body passages. Sphincter ears, larynx, trachea, and bronchi; these move 3) Maintain posture and stabilize joints more rapidly in one direction, and more slowly 4) Generate heat when returning to position 2. Connective – supports & protects Speech systems  Areolar – elastic, loose tissue – between muscles and organs Respiration – “air/gas exchange”; 3 foundation  Adipose – fat cells on organs, muscles, etc structures:  White fibrous – closely packed ligaments binding  Bony thorax – spinal column, pelvis, ribs, bones pectoral girdle, sternum  Visceral thorax -  Muscles of respiration (concentrating, sometimes do this when you’re Phonation – action of larynx in the throat Articulatory – mouth, face, tongue running) Resonance – sound leaves  Book pg. 92  Hypernasality – too much nasal activity  All these muscles provide trunk control, or core control. It affects speech  Hypo = sounds like a cold  Traps sound in the nose – cul-de-sac? Crura – attached to the spine. Anchors the diaphragm low Boyle’s Law – as the volume of a container increases, the air pressure within increases. Muscles of forced expiration:  Pressure: force distributed over area  Negative pressure: will cause air to equalize  Active expiration requires muscles to indirectly  Positive pressure: molecules are closer together “squeeze” the air out Opens 1:00 Monday (in class review) the 14 – sept 17 Anterior pulls ribs down. midnight  Internal intercostal – attaches ribs Pneumothorax/collapsed lung  Transversus thoracis – by sternum, attaches ribs Posterior  Subcostal – innermost intercostals - Muscles of Respiration:  Serratus posterior inferior – comes from spine, wraps around to front Inspiration:  Innermost intercostal -  Latissimus dorsi – big muscle on back; originates 1. Diaphragm- biggest muscle for inspiration  Separates abdominal from thoracic cavities from vertebra, lets you move upper extremety, stabilize chest, expiration  Muscle fibers radiate from the central tendon to the vertebrae Abdominal muscles:  Phrenic nerve – electrical impulse; makes the diaphragm work  Transversus abdominus – big muscle on side  Internal oblique – up higher on side  Rectus abdominus – vertical muscle if you have a six pack abs 2. Thorax  Quadratus lumborum – runs vertically, what you use Antherior: if youre leaning over to the side  External intercostals - exhalation Muscles of thorax:  Interchondral portion internal (internal intercostal) Posterior:  internal intercostal – maintain rib space, support and protect rib cage  Levatores costarum (brevis and longis)  transversus thoracis – muscle tissue directly over  Serratus posterior superior cartilage Interchondral portion of the internal intercostals  innermost intercostals –  external – go across back ribs 3. Neck muscles *Read page in book about wind getting knocked out of you  Sternocleidomastoid – big muscles that turn your head  Scalenes – anterior, medial, posterior, a lot smaller Terfaction – chemical that is given to babies to develop lungs before they’re born. Ex. If a mother is going to go into labor early 4. Muscles of thorax, back, and upper limb  Pectoralis major – main chest muscle - lung development should be completed by week 32  Pectoralis minor – more on the side of gestation process  Serratus anterior – starts in back and wraps around ribs pleurae  Subclavius – clavicle area, wraps around back too  Levator scapulae – more on back of neck that is often - multiple membranes that encase lungs and line thorax; intra-pleural fluid between membranes massaged  Rhomboideus major – starts at spine creates an air tight seal (negative pressure) between  Rhomboideus minor- smaller, starts at spine and lungs and thoracic cavity. It prevents collapse of lungs; allow lungs to follow motion of thoracic cavity wraps around to ribs as it expends  Trapezius – big muscle that goes from bottom of skull - measuring respiration – spirometer (the thing you to end of rib cage on back blow into and the blue part rises), manometer (measures digitally or with a dial; would have to be trained to use it) and ventilation (being on respirator/ventilator. It does the breathing for you;  About 20 breaths per minute is normal for an adult. For a baby, it’s a lot faster, they don’t considered life support. Lots of tubes, etc; 3 ways to have as much capacity ventilate – nose mouth, or hole in neck)  Quiet breathing (not thinking about it, passive lung volumes: breathing, like sleeping) vs. active breathing - tidal volume – amount of air exchanged during one cycle of respiration - inspiratory reserve volume – extra breath you can take in - expiratory reserve volume – extra breath you can breathe out - residual volume – - Dead air – air left in lungs after exhaling Lung capacities: - Vital capacity - - Functional residual capacity – Pressure points - Oral pressure - Subglottic pressure – below level of vocal folds - Pulmonic or alveolar pressure – - Intrapleural pressure – sac around the lungs have pressure REVIEW FOR TEST 1: - Look at anatomy tv - All vocab in pp 1 - Look at youtube videos about positioning & procedures - Joints have different functions - 4 functions of muscle tissue - 4 systems – respiration, phonation, resonance, ?? - Table in book that shows muscles for inspiration and expiration - Boyle’s law – pressure issue - Ribs – makeup of rib cage, how it attaches to spine – 12 pairs of ribs. 10% of population has 13 - Muscles can shorten to 1/3 of length (contracting) - Bony thorax, visceral, etc. - Broncheals go straight (right lung); left lung is curved. - Mediastinum – space where heart lies - COPD is not reversible – asthma may be reversible - Ciliated fibers are in the lungs so we can bring things up (cough) - Origin & insertion of muscles – origin is the place where the muscle least moves. Insertion is place that moves a lot.  Thyroarytenoid (relaxer) VOCAL FOLD. Artyntenoid does most movement because in these words, insertion comes section. Thyro is origin (little movement)  Throvocalis is the medial edge of the vocal fold  Thyromucularis is the other edge of the vocal fold  Auxiliary – thyroepiglotticus, superior thyroarytenoid, thyroarytenoid, aryepiglotticus Vocal fold vibration:  Muscle contraction  Elasticity of tissues  Air pressure (the Bernoulli effect) Intrinsic larynx: Anatomy and Physiology of Phonation  Extrinsic – has one attachment to a laryngeal Foundation structures: cartilage and the other attachment on a non  Hyoid bone laryngeal structure  Thyroid cartilage  Cricoid cartilage Vocal folds, 3 basic layers  Cover Pharynx = back part of the F  Transition - Vibration of vocal folds produces tone  Vocal ligament, goes from loose to stiffer - Resonance is when the sound waves leave vocal  Body folds and it bounces around  cookie layer, thyroarytenoid  area of least vocal activity The intrinsic laryngeal structures vocal register is affected by:  Arytenoids – bumps on the top that look like bones above vocal folds; in posterior - compliance – stretch; low to high; flexible  Corniculates - length – can you stretch the length for high and low  Cuneiform cartilages – wristburg; embedded notes within arytenoids, gives it the extra bump - elasticity – will it spring back?  Anterior commissure – certain position - Mass – it should be constant SapMuc – symmetry (right fold do same as left), amplitude (of mucosal wave), periodicity (you should be able to find  Sphincter muscle – resting position is closed. pattern/routine, mucosal wave, (amplitude of the horizontal When contracts, it opens then goes back to its excursion), closure resting position no correlation with vocal complaint with vocal sound  Cricoartytenoid – sits on top of arytenoid (someone complaining, we wont see anything. Not cartilage complaining, we see a lot of problems)  Intrinsic – has both attachments (origin and Reinke’s – laryngitis – this area is loose, pliable, most voicing activity – area to get damaged the insertion) on a laryngeal cartilage most. Ex. Nodes  Adductors (put together)- lateral - Squamous cell carcinoma (throat cancer) cricoarytenoid, transverse or interarytenoid Extrinsic muscles arytenoid, oblique arytenoid  Abductors (pull apart)- posterior  Help with phonation and pitch but not a lot, cricoarytenoid  Tensors – throvocalis cricothyroid  Anything that moves the larynx up and down in your  Cricothyroid – stretches for hitting high throat  Affects swallowing notes  Parsrezta – part of cricothyroid muscle, most  Larynx elevates, comes slightly forward and goes medial part back down during swallowing  Transverse arytenoid- responsible for Elevators: posterior glottis chink (normal)  False vocal folds (ventricular folds) do not move when you talk  Stylohyoid (elevates and retracts the hyoid bone), mylohyoid (elevate hyoid bone also and also brings Layers of vocal folds: forward; this is called hyrolaryngeal elevation and hylolaryngael excursion;)elevates floor of the mouth during swallowing), geniohyoid (under base of tongue, depress/pull down mandible slightly;), genioglossus (largest muscle of the tongue, attaches from tongue to hyoid bone), hyoglossus (more in back part of tongue, helps with oral motor skills, click Review: tongue for ex.), inferior pharyngeal constrictor - Trachea is horseshoe shaped (muscle of swallowing; posterior wall), digastricus - Disk of the neck – cervical disk 4 is where swallowing (anterior and posterior, elevates hyoid bone) happens - If you have deposits on the spine, it will pertrude Depressors – - Tracheotomy – parts are in, but manipulated; reason is to maintain a patent airway (some level of  Sternothyroid – big one, depresses and lowers respiratory compromise) mandible  Sternohyoid – depresses hyoid bone - Laryngectomy – everything is removed; no voice  Omohyoid – important in the pharyngeal phase of Medical diagnosis – swallowing, pulls hyoid bone down  Throhyoid - - Chronic obstructive pulmonary disease (COPD) - Trauma (airbags in car for ex.) - Tracheal stenosis (narrowing of trachea; see a lot in Glossus = tongue babies; lose muscular control) Laryngeal Nerves: - Sleep apnea - Neuromuscular diseases  X Vagus – main innovator of the larynx, current - Tracheomalacia (sinks on itself) branch of vagus nerve is very long; has a hole that Effects on speech: stimulates digestions tract, innervates afferent fibers and control heartbeat - Pharyngeal  Need to get air through the VF to initiate phonation - Superior – interior superior (inferior pharyngeal  Ventilator vs no vent  Coordinate breathing and talking constrictors; ex. Pharynx) & external superior branch (controls motor function to cricothyroid and to  Weakness & endurance inferior constrictors);  Sense of smell is worse - Recurrent – wraps around the heart; does not Parts of trach tube: contract cricothyroid but controls everything else; sensation below vocal folds  V Trigeminal – controls jaw movement  If someone is on a ventilator, the cuff is inflated (bulb - looking thing)  Occlude – maintain pressure and redirect air for  VII Facial – starts at cheekbones, makes it possible to smile putting in a trach -  XII Hypoglossal – tongue movements Laryngectomee:  VIII - ears  Total removal of the larynx largely due to cancer  May have partial laryngectomee  Supra glottis lar- above glottis Maxiumum phonation time – how long can you hold out a vowel Radical Neck Dissection - May include removal of: lymph nodes, Modal pitch – average pitch sternocleidomastoid, omohyoid, internal jugular vein, Glottal fry – grudge sound. You have nucosal wave, but only spinal accessory nerve, and/or submaxillary salivary about 70 hertz gland - Additionally: external carotid artery, strap neck About 18 seconds for holding a note is the norm muscles, vagus nerve, hypoglassal nerve, lingual branch of the trigeminal s/z ratio – measure of respiratory/phonatory sufficiency – hold out s, then hold out z sound, and when you divide s/z, the Passy muir valve – shown in class number should be 1 Subglottic air pressure- pressure that builds up underneath pitch range – should accompany any assessment – should the level of the vocal folds have 2 octaves Outer hub is universal, inside is not habitual pitch – pitch you speak most of the time; same as modal pitch - A laryngectomy cannot aspirate optimal pitch – controversial; for your body, age, gender, etc. Communication options – there is a perfect pitch that you should speak all the time  Writing perturbation (RAP/Jitter) – relative averave perturbation –  Esophageal or alaryngeal speech (belching) vocal fold pathology is pattern isn’t right; consistency of tone;  Electro larynx how periodic the sound wave is; PITCH/FREQUENCY  Trachea esophageal puncture (TEP) shimmer – refers to volume and how consistent it is; Voice prosthesis (prosthetic voice) – small tube. Channels air LOUDNESS to esophagus Vocal cord disfunction – narrowing of airway when a female, usually, is very active. Can be paradoxical vocal cord movement. Vocal cords come together when you’re trying to breathe and block the airway Nodes: vocal cord nodules – like a callus. Heavy, thickened area on the folds, typically on the medial edge Cysts: don’t know what causes then, but we see them a lot. They move. They can come back again if removed. Much bigger than calluses Polyp – similar to a cyst. A bump. Looks more like a bubble. You can cough them up. You get them from rock concerts and straining Functional dysphonia – can have adductor or abductor spasms – too much strain. Swelling around voicebox. Can be fixed with massaging, etc - There have been 2 recorded laryngeal transplants What structures are discussed & labeled in the F-shaped box? Epiglottis, vocal folds, trachea, nasal cavity, oral cavity, pharynx(back of those cavities), posterior pharyngeal wall, nasopharynx, oralpharynx, glottis, tongue base, pitch at level of vocal folds, resonating factors give it the uniqueness (accent), know body parts: upper thyroarytenoid is main muscle for vocal folds. Front v when vocal folds come together is anterior commissure thyroid is biggest muscle, then hyoid bone, cricoid cartilage, petiole of the epiglottis valleculae – space between base of tongue and epiglottis, major landmark in swalling false folds = ventricular. It is the cricothyroid muscle upper esophageal sphincter posterior cricoaryntenoid is the only abductor sapmuc** Bernoulli effect – Cranial nerves = X, 5 trigeminal, 7 facial Vagus nerve (10) – A stoma is reversible; heals quickly A stoma on a laryngectomy, a stoma is not reversible. The airway is not connected to the lungs anymore Review laryngectomy  Writing vs electro larynx vs prosthesis Aloryngeal and esophageal speech is the same False folds = ventricular folds, external thyroarytenoid Structures:  Paletine bone – hard palate, there is tissue over bone. There is no bone under the soft palate. - F shaped tract  Incisive foraman – little dot between top two teeth. If - Articulators it isn’t close, there is a cleft - Bones of face and cranial skeleton - Teeth  Intermaxilarry sutre – line in the middle of hard - Muscles of the face palate  Rugae – bumpy tissue on hard palate - Muscles of the tongue  Transverse paletine sutre - Where hard palate and Point of union between two structures soft palate meet (also called fovai paletine junction or paletine abnorosis) Source filter theory – principle that sound leaves vocal folds and when it bounces around through the upper systems, it’s Nasal conchae – in nose and ears. Articulates with maxillae, the filtering. (sound filtering systems) paletine, and ethmoid bones Within the f shaped tract, we are adding in mandible (jaw), Vomer – center nose, divides nose into interior and posterior. tongue, velum, lips, cheeks, larynx, and hyoid bone Divides nasal cavity into right and left. Has snowplow shape (moveable articulators) Nasal septum is made of vomer, perpendicular plate, and 3 immoble articulators – alveolar ridge, hard palate, teeth ethmoid bone - Soft palate produces nasal sounds, n, m, -ing Zygomatic – forms cheek bone, helps to form outer rim of eye orbit Bones of the Cranial skeleton: Lacrimal bone – deep within skull, gives sideways view of  Ethmoid – bone that makes up the nose (core of the nose. Small portion of lateral and nasal wall and inner of the apple, meaning the core of your head) crista galli is eye the part that will ram up into the brain  Sphenoid – shaped like a wing; gives you articulatory Greater and lesser cornu on hyoid bone. Horn on hyoid is movements regarding temples and is main structure lesser, the knobs on both ends of the bone is greater cornu. for face. Foraman – holes so that nerves can pass through - Lesser wing is a space. Hole on both sides where cranial nerve 5 (trigeminal) goes through called TEETH- foraman rotundum - Baby teeth = milk teeth - Middle is called “crest” - Around 6 months - Branch that hangs down is medial, other branch is - 20 baby teeth, 32 permanent teeth lateral - Pterygoid- points of attachment. Have muscle over - Bite refers to how the back teeth fit together like a puzzle and what the front looks like them  Frontal – big forehead part of cranium; orbital process Class 2 division 2 – Malocclusion – top and bottom teeth line is the eye socket. Nasal process is the nose. up perfectly (they should overlap a little) Zygomatic arch is the process on the side by the temple Class 3 malocclusion – back few teeth don’t align  Parietal – bone on top of head- possible that if someone were in an accident, they will remove part Class 4 – cross bite – position is stacked, moves right to left of parietal bone to allow for swelling and then it goes back to its original size  Occipital – part of skull in the very back, covers Anterior and posterior arches/pillars – tonsils are between occipital lobe is is primary spot for vision, strokes them happen here often 2 types of strokes – clot and bleed Tonsils – gland; function is to filter to keep you from getting  Temporal- part of skull where temples are and ear sick; overtime, tonsils shrink canal goes through Sutra lines – squamosal sutre – front where parietal and temporal and a little of frontal connects. parietoiestoid – Tongue where parietal and temporal connect. Occipitalmastoid – temporal and occipital Vinegar Morphology – study of abnormal shape and structure Facial exam – nasal bridge – space where nose comes  Mandible – lower jaw, only one part.  Maxillae – upper jaw (has two parts) – that’s why cleft down/where you rest your glasses palate exists, comprises hard palate, nose, and upper Ala of nose = where people get their nose pierced dental ridge Inner canthus – inner corner of eye PAGE 316 IN BOOK* Nares – both tonstrils  Nasal bone – very small. Columella is space between nostrils. Celia – tiny hairs that collect dust dirt etc Epicantal folds – creasing, like in Koreans  They also warm the air so that really cold air doesn’t go into your lungs Palpebral fisher – elliptical space between eyelids Filtro ridges – two lines on your upper lip Philtrum – the divet Should be able to elevate, depress, protrude, retract, (tongue- tip deviation, lateral relaxation, narrowing, grooving (baby eating from bottle, wraps tongue around it and channels milk down mouth), posterior elevation, lingual depression) MUSCLES: Dysarthia – sound drunk; slurred speech Face: Orbicularis oris – muscle that goes around your lips, shaped Apraxia (idea is in the brain, but cant make it; damage in the brain; INCONSISTENT IS KEY) – this is language apraxia like a donut; purses when you swallow; constricts oral opening Oral apraxia – cant stick out tongue, etc even though he Risorius – what draws or retracts the lips backward. Their wants to; he may lick something off his lip and that’s moving contraction helps you smile his tongue; but when he’s asked, he can’t stick it out Buccinators – underneath risorius. Superficial to it. Moves food Transverse and vertical muscles of the tongue are not back, side to side etc to chew or swallow antagonistic. They run in the same direction horizontally so they’re parallel - Buckle cavity is on the inside of the mouth, inside of buccinator Palatoglusses can be considered tongue, or a velar muscle – Mentalis – lets you pout; labio-lingual depression. Below lower elevates back of tongue and depresses soft palate lip. Contracts and elevates chin & lower lip Platysma – goes from mandible to sternum, innervated by 7 th Velar muscles cranial nerve - Pertrude, elevation, lateralize, and compress 1. Lavator Veli Palatini & Tensor Palatini  One of the main velar muscles – main function is - Zygomatic major & minor – help with mouth elevation of velum movement  Moves soft palate superiorly and inferiorly (precise Intrinsic lingual muscles and coordinated movement for speech  Helps to open Eustachian tube for drainage and for - Superior longitudinal – surface of tongue; contracts aeration to lift up tongue  Velar movement is synergistic – a lot of things must - Inferior longitudinal – root of tongue to apex (tip) work together - Transverse – helps to narrow tongue; runs horizontal  Lavator sling – concept of comprehensive contraction - Vertical – helps to flatten tongue of many muscles coming together in a sequence Extrinsic lingual muscles Genioglossus – biggest part of tongue; it is underneath’ Intrinsic lingual muslces (tongue) slide 19 Styloglossus – goes on side of tongue and goes to the back - Superior longitudinal - Inferior longitudinal Chondroglossus – small one in the back; helps depress tongue - Transverse Palatoglossus – many consider it to be part of soft palate; - Vertical elevates back of tongue and depresses soft palate Pg 374!!  There are 4 muscles that go to the paletine abnorosa Jaw: Mandibular muscles  2 eustachian tube muscles (ears) go there  Palatoglossus gives movement, palatopharynges Masseter – goes from top of cheek bone to jaw gives you the pull from side to side. You have to have both of those working in conjunction for the velum to Temporalis- temples and parietal bone muscle. When you close properly chew, it moves (your temple) Musculus uvulae – on nasal surface of velum; it gives bulk and Medial pterygoid – elevates mandible; stiffness to the soft palate Lateral pterygoid – underneath medial; pertrudes mandible Velopharyngeal insuffiency (VPI) – girl in the orange; doesn’t close when she goes to talk; very nasaly Digastricus – small muscle; huge for swallowing; connects jaw and hyoid; hyoid bone pertrudes and depress mandible Ways to fix: pharyngeal flap (permanent; close velar port, tissue) and sphincter pharyngo plasty (don’t have lateral wall Mylohyoid – hyoid bone to end of chin. (drops when older) contraction; there are air gaps; cinches muscles so theres not moves when you swallow as big as a gap) Geniohyoid – muscle underneath hyoid bone; depresses hyoid Velo-pharygeal incompetence – the soft palate (velum) is too and helps with mandible movement short and it will never touch the posterior pharyngeal wall Platysma Primary (incisive foramen) and secondary palate (line down the middle to soft palate) Complete (involves the nose) or incomplete (nose not involved, just upper lip) cleft of the primary palate Tongue: Complete (hole goes from incisive foraman all the way to soft palate, you can see up into nose, may not be a uvula) and incomplete (split uvula, may not see a hole) of secondary palate If there is a unilateral cleft palate, it is usually on the LEFT side Clefting also happens to the face – facial cleft; Glossolankylosis – tongue tied Dysarthia – imprecise speech production; can be with velopharyngeal incompetence *genioglossus is the largest tongue muscle Layering gives you precision, or articulation in speech function CONSONANT CHART – what sounds are considered  You have to get speech going to see what the problem is Fliltum, filter ridges Review:  Mandible is the largest bone in the face  Wing bone – sphenoid  Small bony pieces –ethmoid  Where does ear canal  External auditory vegas??  Frowning – mentalis  Maxilla – left & right – 2  Deciduous – baby teeth – 20 baby teeth – milk teeth  32 permanent teeth  SNORING VIDEO – where snoring comes from - faqu..  Girls are more likely to have clefting of the secondary palate bc their hard palate is open longer in development  Muscles of the tongue  Interior cheek – buckle cavity – food gets stuck there  Outside – master??  Turbinates – 3 – inferior, medial, superior, vomer?? When you swallow, the larynx helps to protect itself:arytenoids roll forward into adducted vocal folds, epiglottis comes up over. Dysphagia – disordered or difficult with swallowing Gastro Esophageal Reflux Disease (GERD) The Physiology of Mastication and Deglutition  Backflow of stomach contents into the esophagus  May come higher into the larynx Mastication - chewing  Acid reflux Deglutition  Heartburn  Often occurs at night bc muscles are relaxed Peristalsis  The actual liquid Gustation - tasting Laryngo Pharyngeal reflux – vapor that can cause damage (fume) Olfaction – smelling  Only 12% of people report heartburn symptoms Esophageal reflux  Cracky voices Nasal regurgitation – food coming out of your nose  Occurs during daytime  Vapor causes nose to run Pharyngeal transit time Chyme – when your stomach secretes a combination of ydrochloric acid, enzymez, pepsin to break down food particles even more Reflexes: - Your stomach produces 2 liters of hydrochloric acid a  Rooting – brush side of cheek, they will turn their day head that direction to search for a nipple - You swallow 2,000+ times a day  Sucking – causes suckling activity – piston-like - It takes about 20 min for intestines.etc to empty your movement of tongue while it is sucking. Touch lip stomach  Chewing reflex – 6 months old – correlates with when baby gets first tooth. Mandibular movement  Gag or pharyngeal reflex – touch or taste  Retching/vomiting reflex – smell (sympathy vomit); H2Blocker – hydrochloric blocker – quick relief of heartbrurn – tums etc can be visually or mentally stimulated too  Cough reflex – good; coughing when you have Proton pump inhibitors – last longer but may take up to 6 noxious stimulation into the pharynx, larynx, or months to work – etc. Nexium bronchial passageway Nissen fundoplication – wrap stomach around itself; not reversible; tighten sphincter, cant throw up 4 phases of swallowing: Double PH probe – run wires w sensors into nose and examine  Oral prepatory phase – when you bite or chew Gastric pull-up - Bolus – blob of food in your mouth – should be cohesive; Barrett’s esophagus – very red  Oral phase – bolus has been chewed, tongue tip goes to alveolar ridge; tongue presses anterior to posterior Auricle – outer ear to push food to the back of the throat  Pinna is thing you can grab  Pharyngeal phase – starts at anterior FOCIAL?? Pillars, all the muscles; goes to the level of the upper  Goes to the tempanic membrane esophageal sphincter Middle ear – malleus, incus, stapes  Esophageal phase – UES opens up, bolus passes through, and goes down Inner ear – where semicircle canal and cochlea are Aspiration – bolus has passed through level of vocal folds and now its into the trachea; bolus hitting the carina causes the cough A tuning fork can be placed on your mastoid bone and you will hear a pitch Penetration – bolus reached level of vocal folds but didn’t pass through;  You hear as your better ear hears Swallow test – side view Air conduction hearing – ear infection, fluid etc FEES (fiberoptic endoscopic evalutation of swallowing) Nerve hearing – something in cochlea doesn’t work well  View is top down Tuesday dec 13 8 am – Thursday dec 15 Thursday About 50% of aspiration is silent (never coughs, complains, Auditory nerve (cranial nerve xii 8) goes straight to the brain etc)  NEED TO KNOW LANDMARKS OF OUTER EAR  Sound is displacement of energy Outer ear funnels sound  Speed of sound = 768 miles per hour or 340.2 milliseconds Concha- part where you can stick your finger Helix – outer rim  Sine wave – periodicity – how true the tone is, steadiness Antihelix – kind of an inner ring  To ossilate means to vibrate – setting something in Tragus –flap motion is ossilating movement Antitragus – bump above reg. ear piercing spot  Dampening – reduction in amplitude during successive ossilations as a result of friction (why Lobule- ear lobe things sound quiet when they may actually be loud (i.e. barrier or distance))  Positive pressure – top of mucosal wave Ear canal 1.5 cm in a full grown adult Right ear, camera spot will be at 5:00  Negative pressure – bottom of wave Left ear, flash will be at 7:00 Frequency is measured in Hertz Eardrum is shaped like a contact lens – it has LAYERS  Acousitic energy (sound and air ) goes to mechanical  Outermost layer is cuticular energy (bones moving), which goes to electrical-  Intermediate or fibrous - strength and flexibility chemical energy (the nerves)  Innermost layer or mucus layer Conductive hearing loss – conduction does not happen, fluid Aerial transformation isn’t there or too much You can see point of attachment (umbo) of malleus Sensorineural – inner ear; nerves aren’t working Celia hair cells keep bugs, dirt etc out of ear; they also help Mixed – little of both; older people get this with secretion of earwax  Middle ear is supposed to be filled with AIR  Eustachian tubes aerate the middle ear Perception of high frequencies – (i.e. ringing in ears) A CONDUCTED hearing loss can be fixed with tubes in ears Inner ear is supposed to be filled with fluid  Balance for the vestibular system is controlled by the semicircular canals which are fluid filled Tinnitus & vertigo  Choclea has fluid inside; it’s the size of a dime  Sound is vibration and vibration is displacement of  Tinnitus = ringing in ears; phantom noise of beeping rare fraction and condensation etc; nerve was stimulated by something in the ears  Cochlea is where auditory nerve is not sound  Cochlea curves around 2 and 5/8 times.  Subjective tinnitus is most common – overstimulating  The very center is called the apex of nerve  It is helicotrema –  Objective – blood vessel & problems  Cause of tinnitus is unknown but may be damage to  Top is vestibular canal  We measure frequency in cycle-to-cycle variations inner hair cells, hair cells leaking could be tumor on  You can wear out ear hair cells so they wont stand up auditory nerve, frequent exposure to loud noise, anymore earwax blocking the system  Cochlea is a thin, flat, bone like a shell and so are the  Vertigo = you are dizzy; bppv benign paroxysmal semicircular canals positional vertigo; sense that you or something near you is moving; nausea or vomiting, unsteadiness; Occilate = move idiopathic – no known cause; can be realted to hit on head; associated w migrains; more common for ages  Aerial transformation – increase in sound energy and 50+; symptoms can come and go signal energy as the sound moves from the middle  Otolith organs – of ear; help ear to monitor ear to cochlea– force/area= pressure movements of the head; organs contain crystals and  In the middle ear, the lever action of the bones perhaps crystals break lose; body cant keep up; (ossicles) in a chainlike movement of bones sensitive to gravity/g-force; crystals can be dislodged  Malleus is the biggest bone of the middle ear and move into semicircular canals  You can get 2 db gain with just the bone movement  Buckling effect – idea that the tympanic membrane is not flat. The shape gives it more shape, power, and mobility. 1. Cycle of movement (condensing air particles) sound  Impedence mismatch – way that we describe the in motion 2. Pinna collects and funnels sound difference between airfilled and fluid-filled cavities 3. The external auditory funnels sounds (i.e. hearing someone under a pool vs. on land) 4. Tympanic membrane vibrates 5. Ariel transformation overcome impedance mismatch 6. Stapes moves in and out of oval window 7. Scallavestibiti is displaced 8. Hair cells stimulated  If middle ear is filled with fluid, it’s a conductive loss 9. Helicatrima 10. Scaletympani is displaced  Tonotopic mapping – (watch auditory transduction 11. Potassium ions flow causing cycles of excitation and video) high frequencies are on outside of spiral, inhibition 12. Auditory nerve relays electrical info inward is low frequencies – there is a definite order to the spiral and how the hair cells are stimulated 13. Electrical info arrives at auditory cortex 14. I hear it  Conductive hearing loss you can make better. Neuro loss is permanent  Enough increased drastic pressure can cause bleeding and/or hearing loss (grenade)  Go over audio PICTURE  Db is vertical, frequency Is horizontal  Whats responsible for balance? Semicircular canals


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