《嗓音障碍》特殊儿童教育课件Voice3

1、Phonotrauma （声带损伤）topics-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） Factors related to pitch, loudness and voice quality1、pitchPrimary biome

2、chanical determinants of the rate of VF vibration:LengthMassTensionOther changes during pich changing:Subglottal pressureMedial compression of the VFGlottal airflow rates pitchPrimary intrinsic laryngeal muscle involved in pitch change:Cricothyroid musclethyrovocalis 2、loudnessPrimary biomechanical

3、determinants of intensity:Subglottal pressureMedial compression of the VFDuration, speed and degree of VF closure 3、voice qualityResult from changes at 2 levels of the speech production system:glottal sourceResonant characteristics of the vocal tract voice qualityTypes of abnormal voice quality:Brea

4、thyRoughStrainedHarsh（粗糙声）Hoarse（嘶哑声） voice qualityBreathyIncomplete glottal closure-turbulent airflowIntensity diminishedRoughAperiodic VF vibration-irregular mucosal waveIntensity maybe increased voice qualityStrainedConsiderable medial compression of the true (perhaps false)VFsAperiodic VF vibrat

5、ion-irregular mucosal waveIntensity maybe increased voice qualityHarsh（粗糙声）Strained + roughHoarse（嘶哑声）Strained + rough + breathy Common kinds of voice disordersFunctional Problems 功能性问题Professional Voice Users1) clergymen2) teachers (females esp English), physical ed teacher 3) coaches in a prof spo

6、rts team (esp football) 4) Singers5) SLPs Pts w hyperfunctional（功能亢进） voice usage (mostly kids)Pts w emotional problem (females)Organic Problems 器质性问题Organic VF lesionsCancer （癌症）Papilloma （乳头状瘤）webbing（喉蹼）Reflux（返流）Physical trauma on the neck1) a youngster who had a motorcycle accident2) a pt who h

7、ad a fall by her neck3) a lady who got strangled by her neck by a robber- arytenoid cartilage was dislocatedNeurogenic Problems 神经性问题Neurogenic ptsCVA（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Etiology（常见病因）1、Misuse 误用Interferes wit

8、h efficiency and effectivenessIncreased tension or strainHard 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）Misuse continuedInappropriate 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

9、（音调单一）Excessive talkingVentricular phonation （室带发声）2、Abuse 滥用 Functions are harsher and tend to cause traumaExcessive, prolonged loudnessStrained and excessive use when folds are edematous 水肿Excessive coughing and throat clearingScreaming and yellingExercising and vocalizing3、Conditions Affecting Vo

10、cal foldsSinusitis （鼻窦炎）Xerosis = drying of mucosa （干涸症）Gastroesophageal reflux (GER) （胃液返流）4、Effects of Medications/DrugsCNS 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）

11、 increases thickening of secretionsEffects of Medications/Drugs contdDrying agents （干燥剂）reduce secretionsHormone （激素） therapy increase muscle massAspirin （阿司匹林） risk of hemorrhage（出血）Beta Blockers -（受体阻滞剂） reduces inhibitions, increase tensionTobacco （烟草） increase edema and dryingdiagnosis1、Case His

12、toryVariety of formsObservations made in waiting room and officeProtocol of evaluationCase History contdInformation to gaindescription of problemonset and progression of problemvariability and consistency of problemsymptoms and sensationsvoice use changes in their voice and affects on lifegoals2、Dia

13、gnostic proceduresExamination of the voiceLab 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） Examination of the VoiceIndirect Laryngoscopy 间接喉镜Flexible fiberoptic laryngoscopy 纤维喉镜Stroboscopy 动态喉镜Lab Testi

14、ng 实验室检查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Physiological Studies 生理学检查Electroglottography 电声门图Subglottal Air Pressure 声门下压Electromyography 肌电图Critical Listening 听感Pitch 音调Loudness 响度Voice quality 音质Unusual vocal char

15、acteristics 异常声音的特征TasksSustained 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Diagnostic Testing Probes 诊断性测试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Al

16、tering 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Noninstrumental Objective Measurements非设备客观检查Maximum phonation time 最长声时s/z ratio s/z比Diagnostic proceduresSimple methods objectify the symptoms 1) MPT2) S/Z ratio3) Pitch range4) Intensity (loudn

17、ess) range Differential Diagnosis of Voice ProblemsProceduresInterviewExamination of medical recordsRating of auditory perceptual characteristicsMeasurement of acoustic, aerodynamic, vibratory, and muscle action eventsExamination of the laryngeal structures and their functionEvaluation of other bodi

18、ly functions and systems as deemed appropriateExperimental therapy, or treatment probingSymptoms vs SignsA symptom（症状） is a complaint or perceptual characteristics of the voiceA sign （体征）is a characteristic of the voice that can be observed or testedPrimary symptoms of voice problemsHoarseness 粗糙声Vo

19、cal 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Major signs of voice problemsPitchMonopitch 音调单一Inappropriate pitch 怪声怪调Pitch breaks 音调变化过大Reduced pitch

20、range 音调范围减小LoudnessMonoloudness 响度单一Loudness variation 响度变化大Reduced loudness range响度变化范围减小QualityHoarse 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 behaviorsStridor 尖锐声Excessive throat clearing 清嗓过度Aphonia失声Consistent 持续失声

21、Episodic 偶发失声Acoustic Assessment 声学评估FrequencyFundamental frequency 基频Phonational range 基频变化范围Frequency perturbations Jitter 基频微扰IntensityMean intensity level 平均强度Dynamic range 强度变化范围Amplitude perturbation Shimmer 振幅微扰Acoustic Assessment ContinuedRespiratory and Laryngeal ControlMaximum phonation ti

22、me (MPT)S/Z ratioNoise related measuresSignal to noise ratio 信噪比Spectral analysis 频谱分析Dr SpeechCSLMDVPPraatFunctional voice disorders1、Nodules声带小结Cause/etiology Abuse of larynx Misuse of the voiceLocationAnterior - 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Bil

23、ateral 双侧性Pathological changesVascularized or edematous 充血或水肿Fibrous 纤维化1、Nodules声带小结Typical symptomsExcessive throat clearingGlottic foreign body sensationSeems have excessive mucus or sth on the VFsVocal fatigue Voice seem to deteriorate with contimuous voicingLow vocal qualityBreathnessLower pitc

24、h Increased aperiodicityVocal nodule1、Nodules声带小结Treatments Vocal NodulesLarger or long-establishedA trial of period of voice therapy SurgeryA brief period of complete voice rest Voice therapySmall or recently acquiredVoice therapy2、Polyps 声带息肉Cause/etiology vocal hyperfunctionOnce a small polyp beg

25、ins, any continued phonotrauma will irritate the areaSmoking LocationAnterior - 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2、Polyps 声带息肉Types Pedunculated(narrow-necked) 有蒂型息肉Sessile(broad-based) 无蒂型基地较宽的息肉 mostlyTypical symptomsLow vocal qualityBreathnessLo

26、wer pitch Increased aperiodicity 2、Polyps 声带息肉2、Polyps 声带息肉Treatments Polyps(esp. sessile)Voice therapy SurgeryA brief period of complete voice rest Voice therapy3、Edema or Reinkes edema 水肿或任克氏水肿Cause/etiology SmokingChronic vocal hyperfunctionLaryngopharyngeal refluxVocal Ford paralysisLocation Sup

27、erficial layer 发生在浅层Bilateral or unilateral 双侧或单侧Pathological changesGelatinous material develops in Reinks space 在任氏间隙聚集了胶状物质3、Edema or Reinkes edema 水肿或任克氏水肿Typical symptomsExcessive throat clearingVocal fatigue Voice seem to deteriorate with contimuous voicingLow vocal qualityhoarsenessLower pitc

28、h Reinke Edema (III)3、Edema or Reinkes edema 水肿或任克氏水肿Treatments Reinkes edema Extensive A trial of period of voice therapy Medcine and SurgeryA brief period of complete voice rest Voice therapyMild to moderatVoice therapy4、Traumatic Laryngitis 外伤性喉炎Cause/etiology excessive and strained vocalizationY

29、elling, screamingLocation Surface of true (perhaps false) VFsBilateral 双侧性Pathological changesInflammation 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4、Traumatic Laryngitis 外伤性喉炎Typical symptomsThe acute stage VFs increase in size and massLow vocal qualit

30、yhoarsenessLower pitch The chronic stage become a more permanent polypoid thickening, such as polyps, nodulesVocal painLow vocal qualityhoarsenessLower pitch Acute Laryngitis after Surgery4、Traumatic Laryngitis 外伤性喉炎Treatments Traumatic laryngitisAcute Eliminate the abuse Good night sleepChronicElim

31、inate the abuseComplete voice rest5、ventricular dysphonia室带发声Cause/etiology Disease of the true VFs(paralysis, polyps, cancer)LocationVentricular foldsmore often is produced by the true VFs vibrating in an abnormal fashion due to the false fords riding the true ones5、ventricular dysphonia室带发声Typical symptomsLower pitch Little pitch variability HoarseBreathyDiagnosisCoronal X-ray of the sites of vibrationNasoendoscopyEndoscopic stroboscopy 5、ventricular dysphonia室带发声Treat