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喉部解剖與聲帶發聲

喉部解剖與聲帶發聲. 高雄榮總耳鼻喉部 喉科主任 紀昭全. 音聲醫學 phoniatrics or vocology. 聲音 (sound): 20~20000Hz 音聲 (voice) 語言 (language): 符號 , tone 言語 (speech):voice, articulation, rhythm and voice signal. 呼吸系統的構造. 氣道 肺與胸廓. 改變胸腔體積的肌肉. 吸氣肌肉 : 橫膈肌 外肋間肌 呼氣肌肉 : 內肋間肌 前腹壁肌肉羣. 舌骨. 甲狀軟骨. 環狀軟骨.

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喉部解剖與聲帶發聲

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  1. 喉部解剖與聲帶發聲 高雄榮總耳鼻喉部 喉科主任 紀昭全

  2. 音聲醫學phoniatrics or vocology • 聲音 (sound): 20~20000Hz • 音聲 (voice) • 語言 (language): 符號, tone • 言語 (speech):voice, articulation, rhythm and voice signal

  3. 呼吸系統的構造 • 氣道 • 肺與胸廓

  4. 改變胸腔體積的肌肉 • 吸氣肌肉: 橫膈肌 外肋間肌 • 呼氣肌肉: 內肋間肌 前腹壁肌肉羣

  5. 舌骨 甲狀軟骨 環狀軟骨

  6. 喉內在肌肉 • 共五種喉內肌, 有四成對共九條 • 環甲肌, 甲杓肌, 側環杓肌, 後環杓肌, 杓間肌 • 都是由迷走神經支配 (CN.X) • 上喉神經支配環甲肌 • 返喉神經支配其他的喉內肌

  7. 中英對照與縮寫 • 環甲肌: crico-thyroid m. --- CT • 甲杓肌: thyro-arytenoid m. ---TA • 側環杓肌: lateral crico-arytenoid m. -LCA • 後環杓肌: post. crico-arytenoid m. -PCA • 杓間肌: inter-arytenoid m. --IA • 上喉神經: superior laryngeal n. --SLN • 返喉神經: recurrent laryngeal n. --RLN

  8. LCA PCA

  9. Reinke`s space • 疏鬆柔軟的彈性及膠原纖維組織和細胞 間液所組成 • 內含 類似液體的不定形物質: glucosaminoglycan, hyaluronic acid • 聲帶振動扮演最重要的角色

  10. Cover-body theory • Hirano : 包膜-軀體理論 • 包膜: 包括黏膜, Reinke’s space和聲帶韌 帶 • 軀體就是聲帶肌 • 硬度比例 黏膜和Reinke`s space:聲帶韌帶:聲帶肌 = 1 : 7 : 10

  11. Two-mass theory • 1972 Ishizaka提出雙實體理論解釋複雜的聲帶立體波動 • 聲帶的下唇至上唇間, 互相獨立進行近乎簡諧運動的振動 • 黏膜波動的過程分為closed and open phase

  12. 雙實體理論示意圖 1972 Ishizaka

  13. convergent divergent

  14. 聲門下壓力 • 一般言語時聲門下壓力約0.5至1kPa, 除了大聲吼叫外, 很少超過2kPa • 歌唱時常需用到3至4kPa的聲門下壓力, 有些特殊歌唱甚至需達6至7kPa才可唱出表達內容

  15. Examination • 軟性纖維內視鏡 fiberscopy • 頻閃鏡檢錄影法 videostroboscopy • 間接式反射性喉鏡

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