1. Phonotrauma （声带损伤）

2. 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）

3. Factors related to pitch, loudness and voice quality

4. 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

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

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

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

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

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

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

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

12. Common kinds of voice disorders

13. 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)

14. 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

15. 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

16. Etiology（常见病因）

17. 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）

18. Misuse continued Inappropriate pitch （不合适的音调） Excessive talking
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）

19. 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

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

21. 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 （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

22. Effects of Medications/Drugs cont’d
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

23. diagnosis

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

25. 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

26. 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）

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

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. 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
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

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. 1、Nodules声带小结 Cause/etiology Location Pathological changes
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

43. 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

44. Vocal nodule

45. 1、Nodules声带小结 Vocal Nodules Treatments Larger or long-established
A trial of period of voice therapy
Surgery
A brief period of complete voice rest
Voice therapy
Small or recently acquired

46. 2、Polyps 声带息肉 Cause/etiology Location vocal hyperfunction Smoking
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

47. 2、Polyps 声带息肉 Types Typical symptoms 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

48. 2、Polyps 声带息肉

49. A brief period of complete voice rest
2、Polyps 声带息肉
Treatments
Polyps(esp. sessile)
Voice therapy
Surgery
A brief period of complete voice rest

50. 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 changes
Gelatinous material develops in Reink’s space 在任氏间隙聚集了胶状物质

51. 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

52. Reinke Edema (III)

53. 3、Edema or Reinke’s edema 水肿或任克氏水肿
Treatments
Reinke’s edema
Extensive
A trial of period of voice therapy
Medcine and Surgery
A brief period of complete voice rest
Voice therapy
Mild to moderat

54. 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

55. 4、Traumatic Laryngitis 外伤性喉炎
Typical symptoms
The 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

56. Acute Laryngitis after Surgery

57. 4、Traumatic Laryngitis 外伤性喉炎
Treatments
Traumatic laryngitis
Acute
Eliminate the abuse
Good night sleep
Chronic
Complete voice rest

58. 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

59. 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

60. 5、ventricular dysphonia室带发声
Treatments 1
Cure the disease of the true VFs 2
Voice therapy (such as inhalation phonation)

61. 6、diplophonia 复音 Cause/etiology Typical symptoms
Irregular VF vibration(such as VF paralysis, scaring, laryngitis… )
Typical symptoms
Double voice

62. 6、diplophonia 复音 Diagnosis Auditory perceptual analyses
Acoutice analyses

63. 6、diplophonia 复音 Treatments 1
Voice therapy (reducing laryngeal hypertension) 2
surgury

64. hygiene （卫生保健）

65. 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

66. Do These! Hydration Tongue-tip-up breathing (no mouth breathing)
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

67. Its all for today!