Phonotrauma （ 声带损伤）

1. Phonotrauma （声带损伤）

2. -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） topics

3. Factors related to pitch, loudness and voice quality

4. 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 1、pitch

5. Primary intrinsic laryngeal muscle involved in pitch change: • Cricothyroid muscle • thyrovocalis pitch

6. Primary biomechanical determinants of intensity: • Subglottal pressure • Medial compression of the VF • Duration, speed and degree of VF closure 2、loudness

7. Result from changes at 2 levels of the speech production system: • glottal source • Resonant characteristics of the vocal tract 3、voice quality

8. Types of abnormal voice quality: • Breathy • Rough • Strained • Harsh（粗糙声） • Hoarse（嘶哑声） voice quality

9. Breathy • Incomplete glottal closure-turbulent airflow • Intensity diminished • Rough • Aperiodic VF vibration-irregular mucosal wave • Intensity maybe increased voice quality

10. Strained • Considerable medial compression of the true (perhaps false)VFs • Aperiodic VF vibration-irregular mucosal wave • Intensity maybe increased voice quality

11. Harsh（粗糙声） • Strained + rough • Hoarse（嘶哑声） • Strained + rough + breathy voice quality

12. Common kinds of voice disorders

13. 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) Functional Problems 功能性问题

14. 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 Organic Problems 器质性问题

15. Neurogenic pts • CVA（Cerebrovascular Accident）脑血管意外 • TBI（Traumatic Brain Injury）外伤性脑损伤 • Parkinson’s dis 帕金森氏病 • Vocal Ford Paralysis 声带麻痹 Neurogenic Problems 神经性问题

16. Etiology（常见病因）

17. 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） 1、Misuse 误用

18. 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） Misuse continued

19. 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 2、Abuse 滥用

20. Sinusitis （鼻窦炎） Xerosis = drying of mucosa （干涸症） Gastroesophageal reflux (GER) （胃液返流） 3、Conditions Affecting Vocal folds

21. 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 4、Effects of Medications/Drugs

22. 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 β-（受体阻滞剂） • reduces inhibitions, increase tension • Tobacco（烟草） • increase edema and drying Effects of Medications/Drugs cont’d

23. diagnosis

24. Variety of forms Observations made in waiting room and office Protocol of evaluation 1、Case History

25. 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 Case History cont’d

26. 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） 2、Diagnostic procedures

27. Examination of the Voice • Indirect Laryngoscopy 间接喉镜 • Flexible fiberoptic laryngoscopy 纤维喉镜 • Stroboscopy 动态喉镜

28. Lab Testing 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

29. Physiological Studies 生理学检查 • Electroglottography 电声门图 • Subglottal Air Pressure 声门下压 • Electromyography 肌电图

30. Critical Listening 听感 • 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

31. 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 • 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

32. Noninstrumental Objective Measurements非设备客观检查 • Maximum phonation time 最长声时 • s/z ratio s/z比

33. Simple methods objectify the symptoms • 1) MPT • 2) S/Z ratio • 3) Pitch range • 4) Intensity (loudness) range Diagnostic procedures

34. Differential Diagnosis of Voice Problems

35. Procedures • 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

36. Symptoms vs Signs • 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

37. Primary symptoms of voice problems • 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

38. 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 Major signs of voice problems

39. Acoustic Assessment 声学评估 • 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

40. Acoustic Assessment Continued • 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

41. Functional voice disorders

42. 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 1、Nodules声带小结

43. 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 1、Nodules声带小结

44. Vocal nodule

45. Treatments 1、Nodules声带小结

46. 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 2、Polyps 声带息肉

47. 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 2、Polyps 声带息肉

48. 2、Polyps 声带息肉

49. Treatments 2、Polyps 声带息肉

50. 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 Reink’s space 在任氏间隙聚集了胶状物质 3、Edema or Reinke’s edema 水肿或任克氏水肿