_（声带损伤）课件

-Factors related to pitch,loudness and voice quality -common kinds of voice disorders -Etiology -Diagnosis of Voice Problems -Differential Diagnosis of Voice Problems -Functional voice disorders -Hygiene（卫生保健） Primary biomechanical determinants of the rate of VF vibration: Length Mass Tension Other changes during pich changing: Subglottal pressure Medial compression of the VF Glottal airflow rates Primary intrinsic laryngeal muscle involved in pitch change: Cricothyroid muscle thyrovocalis Primary biomechanical determinants of intensity: Subglottal pressure Medial compression of the VF Duration, speed and degree of VF closure Result from changes at 2 levels of the speech production system: glottal source Resonant characteristics of the vocal tract Types of abnormal voice quality: Breathy Rough Strained Harsh（粗糙声） Hoarse（嘶哑声） Breathy Incomplete glottal closure-turbulent airflow Intensity diminished Rough Aperiodic VF vibration-irregular mucosal wave Intensity maybe increased Strained Considerable medial compression of the true (perhaps false)VFs Aperiodic VF vibration-irregular mucosal wave Intensity maybe increased Harsh（粗糙声） Strained + rough Hoarse（嘶哑声） Strained + rough + breathy Professional Voice Users 1) clergymen 2) teachers (females esp English), physical ed teacher 3) coaches in a prof sports team (esp football) 4) Singers 5) SLPs Pts w hyperfunctional（功能亢进） voice usage (mostly kids) Pts w emotional problem (females) Organic VF lesions Cancer （癌症） Papilloma （乳头状瘤） webbing（喉蹼） Reflux（返流） Physical trauma on the neck 1) a youngster who had a motorcycle accident 2) a pt who had a fall by her neck 3) a lady who got strangled by her neck by a robber - arytenoid cartilage was dislocated Neurogenic pts CVA（Cerebrovascular Accident） 脑血管意外 TBI（Traumatic Brain Injury） 外伤性脑损伤 Parkinsons dis 帕金森氏病 Vocal Ford Paralysis 声带麻痹 Interferes with efficiency and effectiveness Increased tension or strain Hard glottal attacks （声门激烈撞击) High laryngeal position （喉位置高） anteroposterior laryngeal squeezing （前后部喉的挤压） Inappropriate pitch （不合适的音调） Puberphonia = mutational falsetto （男声女调） Persistent glottal fry （压低音调） Lack of pitch variability （音调单一） Excessive talking Ventricular phonation （室带发声） Functions are harsher and tend to cause trauma Excessive, prolonged loudness Strained and excessive use when folds are edematous 水肿 Excessive coughing and throat clearing Screaming and yelling Exercising and vocalizing Sinusitis （鼻窦炎） Xerosis = drying of mucosa （干涸症） Gastroesophageal reflux (GER) （胃液返流） CNS stimulants and depressants （中枢神经兴奋剂和抑制 剂） coordination （协调） Anesthetics （麻醉剂） proprioception （本体感受） Bronchodilators and constrictors （支气管扩张剂与收缩剂） tremors （震颤） decongestants （减少充血药） increases thickening of secretions Drying agents （干燥剂） reduce secretions Hormone （激素） therapy increase muscle mass Aspirin （阿司匹林） risk of hemorrhage（出血） Beta Blockers -（受体阻滞剂） reduces inhibitions, increase tension Tobacco （烟草） increase edema and drying Variety of forms Observations made in waiting room and office Protocol of evaluation Information to gain description of problem onset and progression of problem variability and consistency of problem symptoms and sensations voice use changes in their voice and affects on life goals Examination of the voice Lab testing（实验室检查） Physiological studies（生理学检查） Critical listening（听感） Diagnosis testing probes（诊断性测试） Noninstrumental objective measurement（非设备客 观检查） Indirect Laryngoscopy 间接喉镜 Flexible fiberoptic laryngoscopy 纤维喉镜 Stroboscopy 动态喉镜 Acoustic Studies 声学检查 Fundamental frequencies 基频 Phonational range 发声范围 Vocal intensity 声音强度 Perturbation 微扰 Spectrogram 频谱图 Electroglottography 电声门图 Subglottal Air Pressure 声门下压 Electromyography 肌电图 Pitch 音调 Loudness 响度 Voice quality 音质 Unusual vocal characteristics 异常声音的特征 Tasks Sustained vowels 连续元音 Syllables and sentences 音节及句子 Frequency range and intensity range 基频及强度的范围 Rainbow Passage 短文 Sample of conversational speech 简单的交流语言 Reflexive sounds 反射性声音如哭、咳嗽 Altering pitch 改变音调 Sustaining steady, prolonged phonation 持续稳 定的发声 Altering vocal loudness 改变声音的强度 Phonation with effortful glottal closure 努力闭合 声带发声 Placing the voice 找到最好的共鸣腔 Maximum phonation time 最长声时 s/z ratio s/z比 Simple methods objectify the symptoms 1) MPT 2) S/Z ratio 3) Pitch range 4) Intensity (loudness) range Interview Examination of medical records Rating of auditory perceptual characteristics Measurement of acoustic, aerodynamic, vibratory, and muscle action events Examination of the laryngeal structures and their function Evaluation of other bodily functions and systems as deemed appropriate Experimental therapy, or treatment probing A symptom（症状） is a complaint or perceptual characteristics of the voice A sign （体征）is a characteristic of the voice that can be observed or tested Hoarseness 粗糙声 Vocal fatigue 声带疲劳 Breathy voice 气息声 Reduced phonation range 发声范围减小 Aphonia 失声 Pitch breaks or inappropriate high pitch 怪声怪调 Strain/struggle with voice 声音发紧 Tremor 声颤 Pain and other physical sensation 发声痛 Pitch Monopitch 音调单一 Inappropriate pitch 怪声怪 调 Pitch breaks 音调变化过大 Reduced pitch range 音调 范围减小 Loudness Monoloudness 响度单一 Loudness variation 响度变 化大 Reduced loudness range响 度变化范围减小 Quality Hoarse or rough 嘶哑或粗糙声 Breathy 气息声 Tension 声音紧刺 Tremor 声颤 Strain/struggle声音发紧 Sudden interruption of voicing 突 然失声 Diplophonia 复音 Other behaviors Stridor 尖锐声 Excessive throat clearing 清嗓过 度 Aphonia失声 Consistent 持续失声 Episodic 偶发失声 Frequency Fundamental frequency 基频 Phonational range 基频变化范围 Frequency perturbations Jitter 基频微扰 Intensity Mean intensity level 平均强度 Dynamic range 强度变化范围 Amplitude perturbation Shimmer 振幅微扰 Respiratory and Laryngeal Control Maximum phonation time (MPT) S/Z ratio Noise related measures Signal to noise ratio 信噪比 Spectral analysis 频谱分析 Dr Speech CSL MDVP Praat Cause/etiology Abuse of larynx Misuse of the voice Location Anterior - middle third site 前中1/3交接处 Lesions in superficial layer of lamina propria 发生在固有层的 浅层 Bilateral 双侧性 Pathological changes Vascularized or edematous 充血或水肿 Fibrous 纤维化 Typical symptoms Excessive throat clearing Glottic foreign body sensation Seems have excessive mucus or sth on the VFs Vocal fatigue Voice seem to deteriorate with contimuous voicing Low vocal quality Breathness Lower pitch Increased aperiodicity Treatments Cause/etiology vocal hyperfunction Once a small polyp begins, any continued phonotrauma will irritate the area Smoking Location Anterior - middle third site 前中1/3交接处 Superficial layer of lamina propria 发生在固有层的浅层 Unilateral 单侧的 Types Pedunculated(narrow-necked) 有蒂型息肉 Sessile(broad-based) 无蒂型基地较宽的息肉 mostly Typical symptoms Low vocal quality Breathness Lower pitch Increased aperiodicity Treatments Cause/etiology Smoking Chronic vocal hyperfunction Laryngopharyngeal reflux Vocal Ford paralysis Location Superficial layer 发生在浅层 Bilateral or unilateral 双侧或单侧 Pathological changes Gelatinous material develops in Reinks space 在任氏间隙聚 集了胶状物质 Typical symptoms Excessive throat clearing Vocal fatigue Voice seem to deteriorate with contimuous voicing Low vocal quality hoarseness Lower pitch Treatments Cause/etiology excessive and strained vocalization Yelling, screaming Location Surface of true (perhaps false) VFs Bilateral 双侧性 Pathological changes Inflammation 红肿 Increased vascularity 血管增多 Chronic thickening and other changes in tissue 组织慢性- 增厚及有其他改变 Typical symptoms The acute stage VFs increase in size and mass Low vocal quality hoarseness Lower pitch The chronic stage become a more permanent polypoid thickening, such as polyps, nodules Vocal pain Low vocal quality hoarseness Lower pitch Treatments Cause/etiology Disease of the true VFs(paralysis, polyps, cancer) Location Ventricular folds more often is produced by the true VFs vibrating in an abnormal fashion due to the false fords riding the true ones Typical symptoms Lower pitch Little pitch variability Hoarse Breathy Diagnosis Coronal X-ray of the sites of vibration Naso