1、organic voice disorders 3topics-Congenital abnormalities-Cysts-Endocrine changes Congenital abnormalities先天性異常1、laryngomalacia 喉軟骨軟化病Cause/etiology The failure of cartilage to stiffen with development Population with high riskNeonate1、laryngomalacia 喉軟骨軟化病LocationEpiglottis Be too pliabe and collape

2、s into the airwayTypical symptomsStridor （喘鳴）Evident at birth or within the first few hours or days of lifeNo hoasenessDyspnea（呼吸困難）In severe condition1、laryngomalacia 喉軟骨軟化病ExaminationsTransnasal fiberoptic laryngoscopyDirect laryngoscopeBig and pliable or curly epiglottisNo stridor after moving ep

3、iglottis 1、laryngomalacia 喉軟骨軟化病TreatmentsMild to moderate outgrow laryngomalacia by 18 monthsSevereSupraglottoplasty（聲門上成形術）tracheostomy（氣管切開術）2、subglottal stenosis 聲門下狹窄DefinitionA lumen 4.0 mm in diameter or less at the level of the cricoid cartilage Cause/etiology Congenital embryological develo

4、pmentCricoid cartilageThe conus elasticus （彈性圓錐）Acquired endotracheal intubationScarringHypertrophy2、subglottal stenosis 聲門下狹窄Population with high riskNeonateTypical symptoms - In severe conditionDyspnea（呼吸困難）StridorExercise intolerance2、subglottal stenosis 聲門下狹窄Treatments (stenosis grading)Grade 1

5、to 2 careful observationGrade 3 to 4Endoscopic or surgical interventionVoice therapy to followed3、tracheoesophageal 氣管食管瘺DefinitionTEF are opennnings that occur between the esophagus and trachea Cause/etiology Vascular compromise to developing esophagus3、tracheoesophageal 氣管食管瘺Typical symptomsGastri

6、c distentionDirect tracheal aspirationReduced diaphragmatic excusionTreatments (stenosis grading)surgical interventionVoice and therapy to followedcysts囊腫cystsCause/etiology Abnormal blockage of the ductal system of laryngeal mucous glands CongenitalAcquiredLocationVocal folds inner margin, superior

7、 or inferior surfaceVentricular folds - anywhereUnilateralcystsTypical symptomsLow vocal quality - hoarsenessBreathnessLower pitch Increased aperiodicityExaminationsFiberoptic laryngoscopyStroboscopyBiopsycystscystsTreatments surgerySuperficial incision along the superior edge of the VFsNo disruptin

8、g the glottal marginVoicetherapyPostsurgicallyEliminate any voice compensationsEndocrine changes 內分泌的改變1、pituitary 腦垂體 HypofunctionLaryngeal growth retardHigh pitchLack of secondary sexual characteristicsEndocrine therapycausesymptomsTreatment 1、pituitary 腦垂體 HyperfunctionPrecocious pubertyAcromegal

9、y(肢端肥大)surgerycausesymptomsTreatment 2、adrenal glands 腎上腺 HypofunctionPrepubescent voice in maleLack of secondary sexual characteristicsEndocrine therapycausesymptomsTreatment 2、adrenal glands 腎上腺 HyperfunctionVirilization男性化Deepening of the voice嗓音低沉SurgerycausesymptomsTreatment 3、thyroid gland 甲狀腺

10、 Hypothyroidism甲狀腺功能低下Low pitchHoarsenessThyroid hormone therapycausesymptomsTreatment 3、thyroid gland 甲狀腺 Hyperthyroidism甲狀腺功能亢進Jumpinessand irritabilityBreathy voiceMedicine SurgerycausesymptomsTreatment 4、premenstrual vocal syndrom 經前期發聲綜合征Typical symptoms before 4-5 days before menstruation in 33% of womenVocal fatigueReduced pitch rangeHypophoniaLoss of certain harmonics4、premenstrual vocal syndrom 經前期發聲綜合征Videostroboscopic examinationCongestion 充血MicrovariesVF thickeningReduced vibratory amplitudeTreatmentOral contraceptive pills5、climacteric 更年期Typi