Hoarse（嘶哑声）

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 QUALITY 1、PITCH  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 PITCH  Primary intrinsic laryngeal muscle involved in pitch change:  Cricothyroid  thyrovocalis muscle 2、LOUDNESS  Primary biomechanical determinants of intensity:  Subglottal pressure  Medial compression of the VF  Duration, speed and degree of VF closure 3、VOICE QUALITY  Result from changes at 2 levels of the speech production system:  glottal source  Resonant characteristics of the vocal tract VOICE QUALITY  Types of abnormal voice quality:  Breathy  Rough  Strained  Harsh（粗糙声）  Hoarse（嘶哑声） VOICE QUALITY  Breathy  Incomplete glottal closure-turbulent airflow  Intensity diminished  Rough  Aperiodic VF vibration-irregular mucosal wave  Intensity maybe increased VOICE QUALITY  Strained  Considerable medial compression of the true (perhaps false)VFs  Aperiodic VF vibration-irregular mucosal wave  Intensity maybe increased VOICE QUALITY  Harsh（粗糙声）  Strained  + rough Hoarse（嘶哑声）  Strained + rough + breathy COMMON KINDS OF VOICE DISORDERS FUNCTIONAL PROBLEMS 功能性问题  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 PROBLEMS 器质性问题  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 PROBLEMS 神经性问题  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 ETIOLOGY（常见病因） 1、MISUSE 误用 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） MISUSE CONTINUED  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）  2、ABUSE 滥用 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  3、CONDITIONS AFFECTING VOCAL FOLDS Sinusitis （鼻窦炎）  Xerosis = drying of mucosa （干涸症）  Gastroesophageal reflux (GER) （胃液返流）  4、EFFECTS OF MEDICATIONS/DRUGS  CNS stimulants and depressants （中枢神经兴奋剂和抑制剂）  coordination  （协调） Anesthetics （麻醉剂）  proprioception  Bronchodilators and constrictors （支气管扩张剂与收缩剂）  tremors  （本体感受）（震颤） decongestants （减少充血药）  increases thickening of secretions EFFECTS OF MEDICATIONS/DRUGS CONT’D  Drying agents （干燥剂）   Hormone （激素） therapy   risk of hemorrhage（出血） Beta Blockers β-（受体阻滞剂）   increase muscle mass Aspirin （阿司匹林）   reduce secretions reduces inhibitions, increase tension Tobacco （烟草）  increase edema and drying DIAGNOSIS 1、CASE HISTORY Variety of forms  Observations made in waiting room and office  Protocol of evaluation  CASE HISTORY CONT’D  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 2、DIAGNOSTIC PROCEDURES 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） EXAMINATION OF THE VOICE Indirect Laryngoscopy 间接喉镜  Flexible fiberoptic laryngoscopy 纤维喉镜  Stroboscopy 动态喉镜  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 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 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 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 NONINSTRUMENTAL OBJECTIVE MEASUREMENTS 非设备客观检查 Maximum phonation time 最长声时  s/z ratio s/z比  DIAGNOSTIC PROCEDURES  Simple methods objectify the symptoms  1) MPT  2) S/Z ratio  3) Pitch range  4) Intensity (loudness) range DIFFERENTIAL DIAGNOSIS OF VOICE PROBLEMS 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 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  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 MAJOR SIGNS OF VOICE PROBLEMS  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   Other behaviors    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 Stridor 尖锐声 Excessive throat clearing 清嗓过度 Aphonia失声   Consistent 持续失声 Episodic 偶发失声 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 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 FUNCTIONAL VOICE DISORDERS 1、NODULES声带小结  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  Fibrous 纤维化 or edematous 充血或水肿 1、NODULES声带小结  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  VOCAL NODULE 1、NODULES声带小结  Treatments Vocal Nodules Small or recently acquired Larger or long-established A trial of period of voice therapy Surgery A brief period of complete voice rest Voice therapy Voice therapy 2、POLYPS 声带息肉  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  Types  Pedunculated(narrow-necked) 有蒂型息肉  Sessile(broad-based) 无蒂型基地较宽的息肉 – mostly  Typical  Low symptoms vocal quality Breathness  Lower pitch  Increased aperiodicity  2、POLYPS 声带息肉 2、POLYPS 声带息肉  Treatments Polyps(esp. sessile) Voice therapy Surgery A brief period of complete voice rest Voice therapy 3、EDEMA OR REINKE’S EDEMA 水肿或任克氏水肿  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  Gelatinous 集了胶状物质 changes material develops in Reink’s space 在任氏间隙聚 3、EDEMA OR REINKE’S EDEMA 水肿或任克氏水肿  Typical symptoms  Excessive throat clearing  Vocal fatigue  Voice seem to deteriorate with contimuous voicing  Low vocal quality hoarseness  Lower pitch  REINKE EDEMA (III) 3、EDEMA OR REINKE’S EDEMA 水肿或任克氏水肿  Treatments Reinke’s edema Mild to moderat Extensive A trial of period of voice therapy Medcine and Surgery A brief period of complete voice rest Voice therapy Voice therapy 4、TRAUMATIC LARYNGITIS 外伤性喉炎  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 4、TRAUMATIC LARYNGITIS 外伤性喉炎  Typical  The  symptoms 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  ACUTE LARYNGITIS AFTER SURGERY 4、TRAUMATIC LARYNGITIS 外伤性喉炎  Treatments Traumatic laryngitis Acute Eliminate the abuse Good night sleep Chronic Eliminate the abuse Complete voice rest 5、VENTRICULAR DYSPHONIA室带发声  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 5、VENTRICULAR DYSPHONIA室带发声  Typical symptoms  Lower pitch  Little pitch variability  Hoarse  Breathy  Diagnosis  Coronal X-ray of the sites of vibration  Nasoendoscopy  Endoscopic stroboscopy 5、VENTRICULAR DYSPHONIA室带发声  Treatments •Cure the disease of the true VFs •Voice therapy (such as inhalation phonation) 6、DIPLOPHONIA 复音  Cause/etiology  Irregular VF vibration(such as VF paralysis, scaring, laryngitis… )  Typical symptoms  Double voice 6、DIPLOPHONIA 复音  Diagnosis  Auditory perceptual analyses  Acoutice analyses 6、DIPLOPHONIA 复音  Treatments •Voice therapy (reducing laryngeal hypertension) •surgury HYGIENE （卫生保健） AVOID!            Smoking Alcohol Caffeine (coffee, coke, mountain dew, chocolate 等等) Dairy products (milk, cheese 等等) Screaming Throat clearing Excessive exercise while talking Talking in a noisy environment (Lombard effect) Gastroesophageal reflux (GERD) Occupational stress Personal stress DO THESE!  Hydration 1. Drink lots of water (until urine is clear) 2. Particularly when traveling on a plane (esp singers) 3. Use lemon wedge 4. Operate humidifier 5. Inhale moisture thru mouth from a hot towel 6. Inhalator (small device producing hot moisture)     Tongue-tip-up breathing (no mouth breathing) Protect neck & head (25% of body heat) Maintain overall health Use voice amplifier ITS ALL FOR TODAY!

Hoarse（嘶哑声）

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