-factors related to pitch,loudness and voice quality -common kinds of voice disorders -etiology...
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-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)
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
Primary intrinsic laryngeal muscle involved in pitch change: Cricothyroid muscle thyrovocalis
Primary biomechanical determinants of intensity: Subglottal pressure Medial compression of the VF Duration, speed and degree of VF
closure
Result from changes at 2 levels of the speech production system: glottal source Resonant characteristics of the vocal
tract
Types of abnormal voice quality: Breathy Rough Strained Harsh (粗糙声)
Hoarse (嘶哑声)
Breathy Incomplete glottal closure-turbulent airflow Intensity diminished
Rough Aperiodic VF vibration-irregular mucosal wave Intensity maybe increased
Strained Considerable medial compression of
the true (perhaps false)VFs Aperiodic VF vibration-irregular
mucosal wave Intensity maybe increased
Harsh (粗糙声)
Strained + rough
Hoarse (嘶哑声)
Strained + rough + breathy
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 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 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
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)
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)
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
Sinusitis (鼻窦炎)
Xerosis = drying of mucosa (干涸症)
Gastroesophageal reflux (GER) (胃液返流)
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
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
Variety of forms Observations made in waiting
room and office Protocol of evaluation
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
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)
Indirect Laryngoscopy 间接喉镜 Flexible fiberoptic laryngoscopy 纤
维喉镜 Stroboscopy 动态喉镜
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
Electroglottography 电声门图 Subglottal Air Pressure 声门下压 Electromyography 肌电图
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
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
Maximum phonation time 最长声时 s/z ratio s/z 比
Simple methods objectify the symptoms 1) MPT 2) S/Z ratio 3) Pitch range 4) Intensity (loudness) range
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
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
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
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
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
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
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 or edematous 充血或水肿 Fibrous 纤维化
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
Treatments
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
Types 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
Treatments
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
Typical symptoms Excessive throat clearing Vocal fatigue
Voice seem to deteriorate with contimuous voicing
Low vocal quality hoarseness Lower pitch
Treatments
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
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 Low vocal quality
hoarseness Lower pitch
Treatments
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
Typical symptoms Lower pitch Little pitch variability Hoarse Breathy
Diagnosis Coronal X-ray of the sites of vibration Nasoendoscopy Endoscopic stroboscopy
Treatments
Cause/etiology Irregular VF vibration(such as VF
paralysis, scaring, laryngitis… )
Typical symptoms Double voice
Diagnosis Auditory perceptual analyses Acoutice analyses
Treatments
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
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
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