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!




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
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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!