Kinds of Voice Disorders

1. Kinds of Voice Disorders

2. Importance of Voice • 6 out of 100 people have voice dis • Communication 7%; what to say 93%; how you say it

3. SLPs with a specialty in voice Voice specialist Voice pathologist Voice therapist Voice teacher Singing teacher Voice coach, drama coach Your titles

4. Clients looking for better image making Politicians CEOs Entrepreneurs Who can you help?

6. Real problems

7. 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 Pts w hyperfunctional（功能亢进） voice usage (mostly kids) Pts w emotional problem (females) Who can you help? (Continued)

8. Real Voice Patients (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 Who can you help? (Continued)

9. Real Voice Patients (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） Who can you help? (Continued)

10. HOW TO DIAGNOSE (f, O VS N)?

11. 1、Voice History, Examination and Testing

12. Case History • Variety of types 不同类型 • Observations 观察 • Waiting room 候诊室 • Office/clinic room 诊室 • During evaluation 评估过程

13. Case History Continued • 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

14. Case History Continued • Patients voice use 病人用嗓情况 • Health 健康 • Vocational 职业 • Recreational 爱好 • Psychological 心理

15. Examination of the Voice • Indirect Laryngoscopy 间接喉镜 • Flexible fiberoptic laryngoscopy 纤维喉镜 • Stroboscopy 动态喉镜

16. 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

17. Physiological Studies 生理学检查 • Electroglottography 电声门图 • Subglottal Air Pressure 声门下压 • Electromyography 肌电图

18. 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

19. 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

20. Noninstrumental Objective Measurements非设备客观检查 • Maximum phonation time 最长声时 • s/z ratio s/z比

21. 2、Differential Diagnosis of Voice Problems

22. 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

23. 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

24. 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

25. 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 Major signs of voice problems

26. 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

27. 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

28. 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. Let’s experience!

29. Voice Disorders TreatmentThyroplasty (Before & After Surgery)

30. Voice Disorders TreatmentThyroplasty (Before & After Surgery)

31. 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 • PAS

32. Vocal Function Tests continued • Electroglottography 电声门图 • Electromyography 肌电图 • Dr Speech • CSL

33. Stroboscopic Observations 动态镜观察 • 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

34. Laryngoscopic Signs 喉镜检查 • 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

35. That’s all for today! Thanks for your attention! Hope you have a nice lunch!