dr. Rohmania Setiarini

Fisiologi menelan dan keluarnya suara

Fase menelanFase oralFase faringealFase esofagal

Fase oral• Sadar• Bolus• Kontraksi m.levator veli palatini

→palatum mole &passavant’s ridge terangkat→bolus terdorong ke posterior →penutupan nasofaring

• Kontraksi m.palatoglosus→ismus fausium tertutup→kontraksi m.palatofaring→bolus tdk balik ke rongga mulut

Oral phase

Movement of the mandible (masseter, temporalis, lateral and medial pterygoid muscles)Formation of food into bolusFood held anterolaterally against the hard palate

Oral phase

Manipulation of food bolus in central portion of tongueSequential anterior to posterior tongue elevationTriggering pharyngeal reflex as bolus enters pharyngeal phaseVoluntary phase controlled by the cerebral cortex (corticobulbar tract)

Fase faringeal• Reflek• Faring→esofagus• Faring&laring bergerak ke atas• Aditus laring tertutup oleh epiglotis• Sfingter laring tertutup• Penghentian aliran udara ke laring• Valekula&sinus piriformis

lurus→bolus ke esofagus

Pharyngeal phase

Reflex < 1sStimulation of swallowing receptor areas –tonsillar pillars brain stem Closure of the nasal part of the pharynxSoft palate elevation – levator veli palatiniPulling forward of the posterior pharyngeal wall – superior constrictor muscle

Contraction of the palatopharyngeal muscle

Pharyngeal phase (cont’d)Larynx pulled upward by contraction of stylopharyngeus, salpingopharyngeus, tyrohyoid and palatopharyngeus musclesElevation of the larynx beneath the posteriorly bulging tongue displaces the epiglottis backwards – closure of the larynx

Pharyngeal phase (cont’d)

Bolus moves downward over the epiglottis and reach lower part of the pharynx

Relaxation of UOS

Deglutition (Swallowing)

Fase esofagal• Esofagus→lambung• Relaksasi m.krikofaring→introitus

esofagus terbuka• Peristaltik esofagus• Sfingter esofagus terbuka→bolus

lwt→sfingter tertutup• Saat istirahat, Sfingter esofagus

bag bwah sll tertutup→regurgitasi tdk tjd

Oesophageal phase

Final phaseInvoluntaryPeristaltic wave from UOS to LOS to stomach continuation of waves from pharynx, controlled by skeletal nerve impulses from IX and X nerve

Oesophageal phase (cont’d)

inititated by myenteric nervous system and vagal afferent fibres medulla vagal efferentRelaxation of LOS

Lower Esophageal Sphincter

19

Laryngeal Anatomy – Superior view

Dorsal/Posterior

Ventral/Anterior

True vocal fold

False (ventricular) fold

esophagusarytenoid

aryepiglottic fold

epiglottis

glottis Pyriform sinus

20

Why does phonation occur?Aerodynamic-myoelastic theory of phonationGlottal vibration is the result of an interaction

between aerodynamic forces and vocal fold muscular forces

Three things are necessary and sufficient for phonation

1. Adduction2. Longitudinal tension (the vocal fold must

have an appropriate amount of tension along its length)

3. Aerodynamic forces (pushing and pulling by air flow and pressure)

Phonation: Vibrating Mechanism

The vocal cords adduct during phonation (creating of sound)The cords vibrate against each other hundreds of times per second; the number of times they vibrate is known as frequency and this is measured in Hertz (Hz)

3 major aspects of voice influenced by vocal fold movement

Pitch - frequency of vibration• the rate of vocal fold vibration is called the FUNDAMENTAL FREQUENCY

•an increase in pitch involves an increase in frequency (hi pitch; hi frequency)

• the frequency of vocal fold vibration depends on the mass and length of the vocal folds and the tension

3 major aspects (con’t)Loudness - intensity of sound• involves the amount of energy generated by the vocal fold movements

• intensity increases with increased air pressure from the lungs and increased amplitude of the vocal fold vibration

Quality - the sound quality of the voice• this is affected by the pattern of movement of the vocal folds

Resonance: The characteristic quality of the voice

The speech mechanism is a resonator -- it is like an air-filled tube (closed on one end and open at the other end)

the fundamental frequency generated at the vocal folds is resonated in the vocal tract that is now also vibrating -- the vibration of the vocal tract is the HARMONIC FREQUENCY

every body has its own natural frequency

Resonance (con’t)

Pharynx is the primary resonatorthe 3 parts of the pharynx (nasopharynx, oropharynx, laryngopharynx)the nasopharynx and oropharynx are the 2 resonating systemsthese 2 systems provide resonance to sounds that pass through the oral and nasal cavities

Physical parts of the vocal system

Creating sound requires numerous muscles, bones and organs of the bodyThree main anatomical aspects:•Actuators: Lungs/diaphragm/intercostal muscles; these organs deal with breathing/“air management”

•Vibrator: Voice box (larynx); this deals with the creation of pitch in the form of a sound wave

•Resonators: Throat (pharynx), mouth/lips/teeth, nose; these deal with the modification of sound into tones

27

Laryngeal Anatomy – Superior view

Dorsal/Posterior

Ventral/Anterior

True vocal fold

False (ventricular) fold

esophagusarytenoid

aryepiglottic fold

epiglottis

glottis Pyriform sinus