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Diagnostic Voice Evaluation(影像學) - Coggle Diagram
Diagnostic Voice Evaluation(影像學)
Introduction
Importance
Understanding voice disorders
Evaluating phonation physiology
Enhancing communication function
Causes and Symptoms
Causes of Voice Disorders
Organic causes
Functional causes
Vocal Symptoms
Hoarseness
Weakness
Impact
On communication ability
On physiological processes (respiration, phonation, resonance)
Patient Assessment
Patient Interview
Medical history review
Lifestyle and vocal habits assessment
Self-Evaluation
Patient's perception of voice quality
Impact on daily activities
Perceptual Evaluation
Acoustic Measures
Fundamental frequency measurement
Procedure: Patient sustains vowel sounds into a microphone for software analysis.
Harmonic-to-noise ratio assessment
Procedure: Analyzing sustained phonation for noise-to-signal ratio.
Aerodynamic Measures
Mean airflow rate
Procedure: Measuring airflow during sustained phonation using a pneumotachograph.
Intraoral pressure during speech tasks
Procedure: Use of pressure sensors placed in the oral cavity during repeated consonants.
Instrumental Measurements
Laryngeal Imaging (喉鏡成像)
Stroboscopy (電視頻閃觀測儀)
Vocal fold vibration visualization (聲帶振動可視化)
Procedure: Strobe light flashes triggered by fundamental frequency while observing vocal folds through a rigid or flexible scope.
Kymography (描波器)
Glottic cycle imaging (聲門週期影像)
Procedure: Continuous scanning of vocal fold vibration line using specialized imaging.
High-Speed Photography (高速攝影)
Real-time vocal fold movement visualization (實時聲帶運動)
Procedure: Capturing high-speed images of vocal fold motion to analyze dynamic events.
用途
一般用在實驗室比較多
優勢
Endoscopy (內窺鏡)
Rigid Scope (硬式鏡)
Disadvantages
插入口腔時要把舌頭拉出來，可能會讓患者感到不適。受限於患者的姿勢，舌頭和喉部肌肉會更緊張，無法捕捉自然語音中的連續動作，影響判讀結果
Procedure: 透過口腔插入(有分70/90度)，適合觀察持續發音（如母音 /i/）。
Advantages
提供高解析度影像，能清楚觀察聲門及聲帶結構。
90度：在70度導致作嘔反應時改用90度，放在口腔後方，看聲帶較不清楚
麻醉
5%-10%的個案需要麻藥 避免嘔吐反射
Flexible Scope (軟式鏡/纖維內視鏡)
Advantages:可以觀察連續語音的動作，例如談話的時候觀察喉部收縮動作，移動方便，可看到軟顎或會厭軟骨的運動。適用於生物回饋治療
Disadvantages: 光線亮度較低，照到面積較小，影像質量可能不如硬式鏡清晰。
因為從鼻腔插入，部份發聲動作和吞嚥動作
Procedure: 透過鼻腔插入，適合在更自然的語言和發聲情境中觀察。
麻醉
絕大部分需要麻醉
看清楚嗓音異常的直接原因,尤其是構造上的問題
Videostroboscopy (聲門攝影檢查)
Examination Protocol
Sustained vowel /i/ at varying pitches and loudness levels
Observations: Habitual pitch, high and low pitch, loudness variations
Procedure: Patient produces sustained /i/ while adjustments in pitch and loudness are made.
Laryngeal diadochokinesis tasks (喉部快速交替運動任務)
Patterns: /i i i i/ and /hi hi hi hi/
Functions: Rapid vocal fold movements, closure timing
Procedure: Patient rapidly alternates sounds to evaluate glottal function.
Visual Perceptual Judgments
Steady Light (穩定光源)
Glottic closure pattern (聲門閉合模式)
Types: Complete, incomplete (hourglass, posterior, anterior, spindle-shaped)
Procedure: Observe glottis during sustained phonation.
Supraglottic hyperfunction
Features: Medial compression of ventricular folds
Patterns: Anterior-posterior squeeze of epiglottis
Procedure: Assess for hyperfunction during normal phonation.
Mucus on vocal folds
Indications: Mucosal irritation or lesions
Procedure: Visual inspection for mucus presence.
Structural appearance of the larynx
Features: Asymmetry, abnormalities
Procedure: Full laryngeal structure analysis.
Strobe Light (閃光燈)
Vibratory glottic closure pattern
Categories: Complete, incomplete
Procedure: Evaluate vibratory cycles under stroboscopic illumination.
Phase closure
Ratio of open vs. closed phases
Procedure: Analyze phase ratios during vibratory patterns.
Mucosal wave evaluation (黏膜波評估)
Flexibility: Amplitude, stiffness, absence of wave
Procedure: Observe mucosal wave movement during phonation.
Amplitude of vibration