KINDS OF VOICE DISORDERS
IMPORTANCE OF VOICE
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6 out of 100 people
have voice dis
voice
visual
content
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Communication
7%; what to say
93%; how you say it
YOUR TITLES
SLPs with a specialty in voice
Voice specialist
 Voice pathologist
 Voice therapist
 Voice teacher
 Singing teacher
 Voice coach, drama coach
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WHO CAN YOU HELP?
Clients looking for better image making
Politicians
 CEOs
 Entrepreneurs
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REAL PROBLEMS
WHO CAN YOU HELP? (CONTINUED)
Real Voice Patients (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
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Pts w hyperfunctional（功能亢进） voice usage (mostly kids)
Pts w emotional problem (females)
WHO CAN YOU HELP? (CONTINUED)
Real Voice Patients (Organic Problems 器质性问题)
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Organic VF lesions
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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
WHO CAN YOU HELP? (CONTINUED)
Real Voice Patients (Neurogenic Problems 神经性问题)
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Neurogenic pts
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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）
HOW TO DIAGNOSE (F, O VS N)?
1、VOICE HISTORY, EXAMINATION AND
TESTING
CASE HISTORY
Variety of types 不同类型
 Observations 观察
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 Waiting
room 候诊室
 Office/clinic room 诊室
 During evaluation 评估过程
CASE HISTORY CONTINUED
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Information to gain
 Description
of problem 描述问题
 Onset and progression 起病及发展过程
 Variability and consistency 可变性和稳定性
 Symptoms and sensations 症状及患者感觉
CASE HISTORY CONTINUED
Patients voice use 病人用嗓情况
 Health 健康
 Vocational 职业
 Recreational 爱好
 Psychological 心理
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EXAMINATION OF THE VOICE
Indirect Laryngoscopy 间接喉镜
 Flexible fiberoptic laryngoscopy 纤维喉镜
 Stroboscopy 动态喉镜
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LAB TESTING 实验室检查
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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
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CRITICAL LISTENING 听感
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Pitch 音调
Loudness 响度
Voice quality 音质
Unusual vocal characteristics 异常声音的特征
Tasks
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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
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声带发声
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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
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2、DIFFERENTIAL DIAGNOSIS OF VOICE
PROBLEMS
PROCEDURES
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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
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PRIMARY SYMPTOMS OF VOICE PROBLEMS
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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
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Pitch
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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
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Loudness
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Monoloudness 响度单一
Loudness variation 响度变化
大
Reduced loudness range响度
变化范围减小
Quality
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Other behaviors
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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
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Consistent 持续失声
Episodic 偶发失声
ACOUSTIC ASSESSMENT 声学评估
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Frequency
 Fundamental
frequency 基频
 Phonational range 基频变化范围
 Frequency perturbations – Jitter 基频微扰
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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
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Respiratory and Laryngeal Control
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Maximum phonation time (MPT)
S/Z ratio
Noise related measures
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Signal to noise ratio 信噪比
Spectral analysis 频谱分析
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Dr Speech
 CSL
 MDVP
 Praat
LET’S EXPERIENCE!
1) Dr. Speech measurements (next 2 slides)
very useful both in assessment and in Rx
2) CSL info is in the DVD clip
3) Praat
Please download the program! It’s free!
Experience it yourself!
It’s more of a research tool than clinical tool.
VOICE DISORDERS TREATMENT
THYROPLASTY (BEFORE & AFTER SURGERY)
VOICE DISORDERS TREATMENT
THYROPLASTY (BEFORE & AFTER SURGERY)
AERODYNAMIC MEASUREMENTS
空气动力学测试
Airflow 空气流量
 Subglottal pressure 声门下压
 Respiratory movements 呼吸运动
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PAS
VOCAL FUNCTION TESTS CONTINUED
Electroglottography 电声门图
 Electromyography 肌电图
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Dr Speech
 CSL
STROBOSCOPIC OBSERVATIONS 动态镜观察
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Degree of glottal closure 声门关闭程度
Phase closure 关闭相
Vertical level 室带水平
Amplitude of vibration 振幅
Mucosal wave 粘膜波
Vibratory behavior 振动
Phase symmetry 两边声带时否同步运动
Periodicity 周期性
LARYNGOSCOPIC SIGNS 喉镜检查
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Vocal fold approximation 声带靠近程度
Vocal fold movement 声带运动
Tissue changes 组织变化
Pyriform changes 梨状窝改变
Anteroposterior laryngeal dimensions 喉的前后大小
Ventricular folds 室带
Anatomical malformations and congenital anomalies 喉的
畸形和先天性异常
Vocal fold lengthening 声带的长度
Vertical laryngeal position 喉室的位置
Involuntary laryngeal activity 喉的不随意运动
THAT’S ALL FOR TODAY!
Thanks for your attention!
Hope you have a nice
lunch!