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HowtheLarynx(VoiceBox)Works

CharlesR.Larson,PhD Ifyouloveopera,orifyouadmirethevoicesofpopsingerssuchasCelineDionorBarbraStreisand,you mayhavewonderedhowitisthesemarveloussingersareabletocreatesuchbeautifulmusicwiththis instrumentwecallthehumanvoice.Youmayalsoknowofsomeonewhohasabadvoiceorhashadto havetheirvoicebox,orlarynx,removedbecauseofillnessorinjury. Thelarynxisacriticalorganofhumanspeechandsinging,anditservesimportantbiologicalfunctionsas well.Let'shavealookatthelarynxtounderstanditsfunctions,whatitlookslikeandhowitworks. Itisthoughtthatthesamefactorsthatfavoredtheevolutionofairbreathinganimalsonearthledtothe evolutionofthelarynx.Lungsarecomprisedofverydelicatetissuesthatmustbemaintainedwithin strictbiologicallimits,thatis,temperature,humidityandfreedomfromforeignparticles.Thus,along withthefirstairbreathinganimals,thereappearedaprimitivesortoflarynx,whoseoneandonly functionwasprotectionofthelung.Thisfunctionremainsthemostimportantofthosethelarynxhas assumedinsubsequentevolutionarydevelopments.Now,ofcoursewerecognizethatthelarynxis criticalforhumanspeechandsinging.Butwealsoshouldrealizethatthelarynxisimportantfor swallowing,coughing,vomitingandeliminatingcontentsoftheabdomen. Ifyouhaveeverfeltyour'Adam's Apple',thenyouknowwherethe larynxis.TheAdam'sAppleisa protuberanceonthefrontofthe larynx.Thisprotuberanceispartofone ofthemainskeletalpartsofthelarynx, thethyroidcartilage.Thelarynxis comprisedofseveralothercartilages aswellasasinglebone,thehyoid. Altogether,thecartilagesandbone Figure provideasomewhatflexibleandrigid 1:Thisfigureillustratesthelocationofthelarynxwithinthe frameworkforsupportofsoftertissues neck.A:Hyoidbone,B:Thyroidcartilage,C:Cricoidcartilage,D: andmuscles. Trachea.Clickontheimageforalargerview. Thelarynxisattachedbelowtothetrachea,orwindpipe,whichgoes downtothelungsinthechestandcarriestheairwebreathe. Immediatelybehindthelarynxisthepharynx.Thepharynxisatube likestructurethatextendsfromtheupperborderoftheesophagus, whichisatthelevelofthebottomofthelarynx,allthewayupandin backoftheoralandnasalcavities.Theupperborderofthelarynx opensupintothepharynx.Thus,theairwebreathtravelsthrough theupperpartofthepharynxandthenintothelarynx.One unfortunateconsequenceofhumanevolutionisthefactthatthefood weeatandtheairwebreathesharepartofthepharynx,andifa persontriestospeakwhileswallowingfood,thefoodcanenterthe larynxandcausethepersontochoke.Thischokingactuallyservesan importantfunction,keepingfoodoutoforremovingitfromthe larynxandtracheaforprotectionofthelungs.Anotherkeyprotective Figure2:Thisfiguredepictsa

sectionthroughthecenterofthe featureofthelarynxisaratherfloppycartilageknownasthe headandneckalongthemidline. epiglottis.Theepiglottisfoldsdownovertheentryintothelarynx Inthetop,onecanseetheinside duringswallowingtohelpkeepfoodoutofthelarynx. ofthenasalcavity(A),oral cavity(C),tongue(D),palate(B), jaw(J)andlips(I).Posteriortothe nasalandoralcavitiesliesthe pharynx(E).Intheneck,the insideofthelarynx(K)isshown anteriortothepharynxand esophagus(H).Notetheposition oftheepiglottis(F)extendinginto thepharynxoverthetopofthe entryintothelarynxfromthe pharynx(G).Clickontheimage foralargerview. Nowlet'sexaminewhat'sinsidethelarynxandlearnaboutthestructures thatareinvolvedinchoking,holdingone'sbreathorthecreationofthe soundsofsingingorspeech,whichwecallvocalizationorphonation.The insideofthebottomofthelarynxisroundandshapedlikeacylinder.As airascendsthroughthelarynx,itencounterstwofoldsoftissuethat extendoutfromtheleftandrightsidesofthelarynx.Theseareknownas thevocalfolds.Thevocalfoldsarealsocalledthe'truevocalfolds' becauseimmediatelyabovetheventricle,thereisasecondsetoffolds calledthe'falsevocalfolds',orventricularfolds. Thesearecalled'false'becausetheearlydoctorsuponlookingdowninto apatient'sthroatwiththeaidofabentmirror,oftenmistookthe'false' foldsforthe'true'folds.However,thefunctionofthefalsevocalfoldsis thoughtnottobenearlysocriticalforairwayprotectionorvocalization asarethetruevocalfolds. Figure3:Thisfigureillustrates howdoctorsvisualizethe larynx.Asmallmirror attachedtoabentrodisused tolookdownintothelarynx fromtheopenmouth.Click ontheimageforalarger view. Thetruevocalfoldsareattachedtotheinsideofthethyroid cartilageatabouttheleveloftheAdam'sApple.Posteriorly,the vocalfoldsareattachedtoasetofcartilagesknownasthe arytenoidcartilages.Thereareseveralsetsofmusclesthatattachto thearytenoidcartilages,andbytheircontraction,canmovethe arytenoidsandalongwiththemtheposteriorpartofthevocalfolds. Figure4:Thisfigureillustratestwo Becauseoftheseanatomicalrelationships,thespaceinthemiddle viewsofthevocalfoldsobserved ofthelarynxbetweenthevocalfoldstheglottisistriangularin fromthelaryngealmirror(Figure shape,withthenarrowpartofthe'V'pointingtowardsthefront.

3).ontheleft,thevocalfoldsare Whentheposteriorcricoarytenoidmusclescontract,thearytenoid pulledlaterallybytheposterior cartilagesandvocalfoldsarepulledlaterallytoopentheglottis cricoarytenoidemuscletoopen (abduction).Everytimewetakeabreathofair,weopentheglottis theglottis,suchaswhenaperson inthisway. inhales,ortakesabreathofair.On theright,thevocalfoldsarepulled towardsthemidlineby'adductor' muscles(seetext),toclosethe glottis,aswhenaspersonvocalizes orholdstheirbreath.Clickonthe imageforalargerview. Mostoftheothermusclespullonthearytenoidstoeitherclosetheglottisorstiffenthevocalfolds.The lateralcricoarytenoidandinterarytenoidmusclespullthemuscularprocessesofthearytenoidsandthe vocalfoldstothecenteroftheglottis,thusclosingit(adduction).Asimilarmuscle,thethyroarytenoid, assistsinclosingtheglottisandinadditionmakesthevocalfoldsbecomeverystiff.Whenallthreeof thesemusclescontract,theglottistightlycloses.Thisisaconfigurationimportantforswallowing, holdingone'sbreath,orgeneratinghighabdominalpressuresassociatedwithdefecation,vomitingand childbirth.Thelastofthemusclestobeconsideredhere,thecricothyroid,isonthefrontofthelarynx andcausesarotationalmovementbetweenthethyroidandcricoidcartilages.Becausethearytenoid cartilagesareattachedtothebackofthecricoidcartilage,andthevocalfoldsareattachedtothe thyroidandarytenoidcartilages,thisrotationalmovementcauseslongitudinalstretchingofthevocal folds.Thisstretchingistheprimarymeansbywhichwechangethepitchofourvoice. Themuscularandcartilaginousactionsmentionedabovearesimilartothoseweusewhenwevocalize forspeechorsinging.Inordertovocalize,theedgesofthevocalfoldsthatfacethemidlineoftheglottis arebroughttowardsthemidline,buttheyarenotpressedtogethertightlyastheyarewhenwechoke, swalloworholdourbreath.Instead,theedgesofthefoldsarepositionedsothattheyarelightly touchingeachotherorareclosetoeachother.Theprocessofvocalizationthenresultsfromblowingair upfromthelungspasttheedgesofthevocalfolds.Theflowofairinitiatesarepetitivecycleofvibratory movementsofthevocalfolds.Highairpressurefrombelow(subglottalpressure)blowsthevocalfolds apart,andthenelasticityofthevocalfoldscausesthemtoreturntothemidline.Eachtimethefoldsare blownapart,asmallpuffofairburstsupthroughthespacebetweenthefoldsand'excites'theair withintheupperpartofthelarynxandpharynx.Excitationisthetermusedtorefertothegenerationof soundbytheexplosivequalityoftheburstofair.Thisvibrationalsequenceofeventsrepeatsitselfon averageabout110timespersecondforanadultmaleandabout200timesforanadultfemale.The sequenceoftheseairburststakesonatonalqualitywhenrepeatedathighfrequency,andthatiswhy ourvoicessoundlikeatoneratherthanaseriesofminiexplosions.Whenwesing,orraisethepitchof ourvoicesforotherreasons,wecontractthecricothyroidmusclestostretchthevocalfolds,andthe stifferthefoldsbecome,thehigherthefrequencyatwhichtheyvibrate. Author CharlesR.Larson,PhD Professor,DepartmentsofCommunicationScienceDisordersandNeurobiologyandPhysiology NorthwesternUniversity