ANATOMY AND PHYSIOLOGY larynx

ANATOMY AND PHYSIOLOGY larynx

By:

Tutut SRIWILUDJENG T.

Dr. Wahidin Sudiro Husodo Mojokerto

INTRODUCTION:

Why do we have to have a good sound? (Sound. sound in nature, Voice. The human voice). Humans need to speak with a good ability to communicate! It can communicate without a sound like the internet, writing, etc.. But with voice / speech can be said to express feelings (love), teaching (for students), High-pitched sounds - low, etc. wholeheartedly.

Man as God's creation last (After God created the animals) are able to speak good compared with the animals.

The sound of children crying "ibuuu" as it falls, the other with cheerful voice "ibuuu" due to meet after the long break by the tsunami. Sometimes a mother says: "if you hear your voice your body hurt you?"

Humans can sound kind of - kind: mastermind, capable of imitating other sounds with the voice Krishna Petruk.

To meet needs good sound good anatomy and physiology. Because if raucous, less than perfect communication

1. How can we speak of good?

How anatomy and physiology of the larynx that normal?

Anatomy and physiology of the larynx should be good.

Larynx as a sound source (= organ sound) by the pharynx, mouth, teeth, lip-nose as a resonator is converted into a greeting word - the word.

High tone (pitch) depending on the length - the cord elasticity and vocalist.

Loud sound depends tensions chordae vocalist and blowing air from the lungs.

The hormone testosterone affects the growth of cord vocalist. In adult male vocalist elongated chordae 1-2 times, while women only adds a few mm so the sound is an octave above her male flare. In the men's C tone at 125 Hz and 250 Hz in females.

Anatomy: Korda vocalist intact thin and flat.

Physiological chordae vocalist should be moved to the medial

Korda vocalist is the term for Surabaya / Sulawesi. If the term jakarta / Sumatra: the vocal cords. The term Java middle Plika vocalist.

Figure 1: frontal section of the larynx. Quoted from Subotta

Korda vocalist is actually not a "ribbon" because it is the fold: see Figure 1 looks like a white ribbon as partially enclosed by pilka ventrikularis. Korda this vocalist sharp edges.(Can ditumpul - bold: low tone voice)

Organ larynx:

a. Organ / device should be single (empties into the upper lung - lung). Imagine if there were two larynx. One for the melody one for bass?

b. Must be narrow: In order to ensure well-formed voice: to lose if it can narrow crowded if there is a closed airway abnormalities such as tumors, inflammation of the small child and abductor paralysis.

2. How good sound is formed.

2.1. Air enters the lungs - pulmonary order to be exhaled out through the larynx.

2.2. After the air is exhaled, chordae vocalist:

- Moves to the medial, neural drive necessary

- Docked at the medial, need staraf activator

- Vibrate: the mucosal wave: the blast of air from the lungs.

Mucosal wave vibration is 0.5 - 1 mm / sec.

2.3 Korda vocalist can be diluted and stretched: the high notes or in bold and loose for low tones.

Later in the pathology seen in inflammation, thickened chordae vocalist: a low tone on the tumor: a husky because they could not Necessary - diluted.

There are 2 theories for the vibration of the chordae vocalists this:

a. Myeolastic aerodynamic theory that says that early cord vocalists - initially closed, opened by a blast of air from the lungs Korda vocalist will open - close again change - change, there was a stretch and air compression sound waves eventually occur.

b. Neurochronacxi theory which says that the voice in shape by cords vocalist who vibrate, vibrated by N Recurens.

Neurochronacxi theory has been abandoned.

3. How does this vocalist cords vibrate.

When viewed from the frontal section, chordae inferior vocalist seemed to open the first (because it pushed the air from the lungs) and then followed by the superior. When closing also followed the first part of the inferior superior vocalist chordae So close it does not open immediately the superior and inferior conjunction (Figure 2).

Opening and closing movement is carried out by the mucosal so-called mucosal wave that is why a bump of 1 mm as in the nodule will result in harsh because the mucosal wave movement disrupted. Small bumps cause the air "leaking" so that his voice hoarse and unable to voice a long sound (Wktu Fonasi Maximum: WFM is limited).Despite the "rough" Time Fonasi Maximum can be used to measure progress there after being given speech therapy (speech therapy).

Figure 2: frontal section of the mucosal wave: opening the formerly closed the inferior part is also part of the inferior first, so it is not the same. Quoted from Damste.

With stroboscopy to learn how this vocalist cord vibration. Stroboscopy principle: Vibration cords vibrate periodically vocalist. If this vocalist cord irradiated with the same phase with the vibrations, chordae lead singer will appear as "silent" for a late impression of our eyes see it (after-images).

In stroboscopy appears that the opening of the anterior chordae to the posterior, then close together and open up again and so on. So open it rather than all at once all chordae pernmukaan vocalist, but from the anterior part first. (Figure 3)

Other important anatomical: subglotik is jaringna tie loosened, the child of this network so much easier udim (Figure 4). So that small children can laryngitis akuta tightness, whereas in adults are not crowded. Kebengkakan ins can be eliminated by injection kortikoesteroid high dose (0.3 mg / kg), if necessary, can be repeated 3 times, a distance of 3 minutes. Hence since 1977 in Dr. Acute laryngitis Soetomo child tracheotomies almost never done anymore. Tracheotomies done if udimnya not be removed by kortikoesteroid, usually because of laryngitis primary diphtheria or foreign objects.

Figure 3: Photograph mucodal wave motion in the anterior part stroboscopy first opened and then fully open. Closing the same time so it does not open - close together.

Figure 4: In acute laryngitis subglotik a loose network of children will udim and close the airway. Quoted from Gerling.

To move kemedial need many muscles (5 pairs: m thyroarytenoideus lateral, lateral arytenoideus Crico m, m Crico thyrodeus, m and m arytenoideus thyroarytenoideus internus obliqus and tranversus) Compare with the muscle to move laterally (1 pair: m crico arytenoideus posterior). Due to move medially necessary to produce a good sound: a high tone - low, emphasis: red, soft in sorrow: be more complicate. While the muscle to move to the lateral movement when breathing is simple, do not have much muscle.

Ability to move to the medial can fail if there is muscle paralysis (peralisis). Aduktor paralysis can be caused by trauma to the n laryngeus inferor as in post strumektomi, trauma to the neck, the left inferior n laryngeus indeed more "long" because they have to go down and through the aorta, the right just past a. Subclavian (Figure 5). Therefore easy to obstructions such as aneurysm, mediastinis, aortic knob, Scwartze lung. With surgery, the paralyzed cord vocalist is urged to medial to meet with the other side, so the sound is formed again. This displacement with the network - Gore tex. See said the following.

Figure 5: the left inferior Laryngeus meliwati aortic knob. Quoted from Bailey

If there is paralysis (paralysis) abduktor: unable to lateral, so chordae voklais in the midline, may cause shortness of inspiration if bilateral. If unilateral (50%) has not been crowded.

In laryngeal tumors closed until just short of 90%, because people with breathing (inspiration) is slowly - land, adaptation and because tumors grow slowly - land. This is clearly detrimental to patients because of new symptoms of shortness if the tumor was almost certainly made it difficult to close the tracheotomies. Though there are very early symptoms: a lump of 1 mm was hoarse. So persistent hoarseness and progressive needs to be checked in case of early symptoms of laryngeal tumors.

So what if the result of abnormal anatomy and physiology?

Korda vocalist can not afford:

1. moved to the medial as paresis abduktor: husky

2. docked at the median line: if there are lumps nodule: husky

3. thinned - Bold: inflammation: a big voice

4. moved to the lateral at the abductor paresis: if bilateral going shortness: inspiration stridor occur.

So a little anatomy and physiology of the larynx, especially p. cords vocalist, as a basis to be able to understand the disease - a disease that causes hoarseness and treatment.

Literature

1. De Wit G: inleiding in de keel neus oorhelkunde 2de Druk Erven J Bijleved Utrecht 1986: 131-135.

2. PG and Hammelberg E. Gerling Neus Keel en Oorhelkunde Haarlem, de Erven F Bohn 1971: 33-36.

3. Petcu LG, Sasaki CT. laryngeal Anatomy and Physiology. In: Ballenger JJ, ed.Diseases of the Nose, Throat, Ear Head, and Neck 14 ed. Philadelpia: Lea & Febiger, 1991: 494.

4. Subotta Atlas of human anatomy, CD interactif

5. Keel LBW Jongkes oorheelkunde neus en 2de Druk Agon Elsvier Amsterdam Brussels 1972: 35.

6. Kircher JA. Physiology of the larynx. In Paparella MM, Shumrick DA, eds.Otolaryngology Vol 1-3, ed. Philadelpia: WB Saunders. Co., 1991:339.

7. G Portman Diseases of the Ear Nose and Troath the William & Wilkins Co. 1951: 494-96.

8. Zemlin WR Speech and Hearing scince, anatomy and Physiology Englewood Cliffs New Jersey Printice Hall Inc., 1968: 139-40.

9. Rontal E. Rontal M and Rolnick ML. Objective evaluation of vocal pathology using voice sperthography otol Ann Rhinol Laryngol 1975; 84: 662-71.

10. Coates GM Schenk HP and Miller MV Otolaryngology WF priors Co. 1956: 90-30

11. Moore GP Observation on Laryngeal diseases laryngeal behavior and voices. Otol Ann Rhinol Laryngol 1976; 85: 553-64.

12. Damste PH. Disorders of the voice. In: Kerr AG, Groves J, Steel PM, eds. Scott Brown's Otolatyngology. Vol: Laryngology 5th Ed. London: Butterwood 1987:128

13. Soedjak S. Measuring the maximum phonation time to evaluate a hoarse voice.OthoRhinolarynggica Indonesiana. Vol XXVII June 1995: 457-463.

14. Berke GS. Voice disorders and phonosurgery. In: BaileyBJ, Pillsbury HL, eds.Otolaryngology Head and Neck surgery Vol 1. Philadelpia: JB Lippiancott co, 1993:649. Iancott co, 1993:649.

Editing By: Enong