喉内镜检查的临床意义课件

1、喉内窥镜的临床含义Endoscopic Examination of LarynxInterpretation of Major ParametersFundamental FrequencyPeriodicityAmplitude of Horizontal ExcursionGlottal ClosureSymmetry of Bilateral MovementMucosal WaveNon-vibrating PortionSupraglottal ObservationInterpretation of Major ParametersFundamental Frequency 基频

2、Periodicity 周期性Amplitude of H. Excursion 振幅的水平位移Glottal Closure 声门关闭Symmetry of Bilateral Movement 双侧运动对称性Mucosal Wave 粘膜波Non-vibrating PortionSupraglottal ObservationFundamental Frequency基频基频决定基频的三大因素声带振动部分的长度 vibrating part声带组织的硬度 tissure声带质量的大小 massThe Shorter the Vibrating Part, the Greater the

3、Fundamental FreqWhen the vibrating part of the vocal folds is shorter,F0 increases,Pitch increases. (Laryngeal Web) 声带振动部分越短，基频越大声带的振动部分越短基频 F0 增加音调增高 例如：喉蹼患者 Laryngeal Web 小孩的基频高于成人喉蹼：薄而透明的先天性蹼喉蹼 喉蹼：前端外伤后蹼The Stiffer the VF Tissue, the Greater the Fundamental FreqPhysiological Base: An increase of

4、cricothyroid muscle activity stiffens the vocal fold tissue. When Stiffness increases,F0 increasesPitch increases (Sulcus vocalis)声带组织的硬度增加，基频增加当环甲肌的运动增加时，造成声带组织紧张基频 F0 增加音调增高 例如：声带沟 Sulcus vocalis声带沟慢性喉炎：厚皮性The Greater the Mass of VF, theSmaller the Fundamental FreqWhen the mass of the vocal folds

5、increases,F0 decreases,Pitch decrease. (Vocal polyp) (Reinkes edema)声带质量增加，基频减小当声带质量增加时基频 F0 减小音调降低例如：声带息肉 Vocal polyps 声带小结 Vocal nodules 雷氏水肿Reinkes edema 半透明息肉双叶血管性息肉软性小结双侧硬性小结雷氏水肿 III期声带出血（血肿）声带出血（血肿）慢性喉炎： 肥厚性 Periodicity周期性PeriodicityPeriodicity is based on the regularity of successive apparent

6、 cycles of vocal fold vibration.Periodic vibration is considered to be uniform in amplitude and time.Aperiodic vibration can vary in either or both.Periodicity Ratings 周期性等级Regular (periodic) 规则Image in the beat off state is static.Irregular (aperiodic) 不规则Successive cycles of vibration appear irreg

7、ular and no observable movement of the vocal folds is noted in the beat off state.Inconsistent 不协调 The vibratory pattern is sometimes regular and sometimes irregular.Irregular (aperiodic)Asymmetry 不对称Interference with homogeneity 同型干预Flaccidity 弛缓Unsteady tonus 不稳定Inconsistent force 受力不均 AsymmetryMa

8、rked asymmetry in the mechanical properties of the vocal folds can be caused by unilateral recurrent laryngeal nerve paralysis, unilateral polyps, or unilateral carcinoma.不对称 Marked asymmetry in the mechanical properties of the vocal folds can be caused by unilateral recurrent laryngeal nerve paraly

9、sis, unilateral polyps, or unilateral carcinoma.由单侧喉返神经麻痹，单侧息肉或单侧癌变引起。麻痹：内收性左声带麻痹癌：疣性Interference with Homogeneity Marked interference with the homogeneity of the vocal fold(s) can be caused by a small cyst, or small carcinoma.同型干预Marked interference with the homogeneity of the vocal fold(s) can be

10、caused by a small cyst, or small carcinoma.由较小囊肿或癌变引起。血管性囊肿慢性喉炎：卡他性慢性喉炎：疱疹性 慢性喉炎：吸烟引起 慢性喉炎：霉菌 慢性喉炎：霉菌 FlaccidityAbnormally flaccid or pliable tissue can be caused by severe recurrent laryngeal nerve paralysis, or an edematous lesion.弛缓Abnormally flaccid or pliable tissue can be caused by severe recu

11、rrent laryngeal nerve paralysis, or an edematous lesion.由严重的喉返神经麻痹或水肿性病变引起。Unsteady TonusIncapability of maintaining a steady tonus of the laryngeal muscles can be caused by spastic dysphonia, or other neuromuscular diseases不稳定音调Incapability of maintaining a steady tonus of the laryngeal muscles can

12、 be caused by spastic dysphonia, or other neuromuscular diseases.由痉挛性发声障碍或其它神经性肌肉疾病引起。Inconsistent ForceIncapability of exhaling air from the lungs with a consistent force can be caused by neuromuscular diseases or pulmonary diseases.受力不均Incapability of exhaling air from the lungs with a consistent

13、force can be caused by neuromuscular diseases or pulmonary diseases.由单侧喉返神经麻痹，单侧息肉或单侧癌肿变引起。Amplitude of Horizontal Excursion振幅的水平位移Amplitude of Horizontal ExcursionAmplitude is defined as the extent of horizontal excursion of the vocal folds during vibration. Each vocal fold is rated independently.A

14、mplitude RatingsZerono horizontal excursionSmallsmaller than normalNormalwithin the normal rangeGreatgreater than normalAmplitude Ratings 振幅等级Zero 零no horizontal excursionSmall 小smaller than normalNormal 正常within the normal rangeGreat 大greater than normalAmplitude RatingsThe amplitude of the two voc

15、al folds should be compared and the findings should be described as:Right Left Assessment of AmplitudeThe center line is no horizontal excursion.The first mark (1/3 from center line) is rated as normal.The second mark (2/3 from center line) is rated as great.振幅的水平位移正常波: 指波动传播声带的1/3宽度。The Shorter Vib

16、rating Portion, the Smaller the AmplitudeLaryngeal Web Male Female Child振动部分越短，振幅越小例如：喉蹼患者 (Laryngeal Web) 小孩的振幅高于成人The Stiffer the Vocal FoldTissue, the Smaller the AmplitudeCarcinoma, papilloma, scar, sulcus vocalis, firm nodule, or firm polyp Falsetto voice声带越是紧张，振幅越小例如：癌，乳头状瘤，硬型小结， 硬型息肉，疤痕，声带沟双侧

17、硬性小结The Greater the Mass of Vocal Fold, the Smaller the AmplitudeCarcinoma, papilloma, Reinkes edema, or firm polyp 乳头状瘤声带质量越大，振幅越小例如： 癌，乳头状瘤，息肉，雷氏水肿息肉The Existence of an Obstacle Decreases AmplitudeCarcinoma, papilloma, polyp, or cyst of the contralateral vocal fold产生振幅减小的赘生物例如： 癌，乳头状瘤，息肉， 对侧声带囊肿，肉

18、芽肿The Greater the SubglottalPressure, the Greater the AmplitudeLoud phonation 声门下压越大，振幅越大例如： 响亮发声Too Tight Glottal Closure Results in a Small AmplitudeSpastic dysphonia, or hyperkinetic phonation声门关闭太紧，使振幅变小例如： 痉挛性发声障碍， 运动亢进性发声Glottal Closure声门关闭Glottal ClosureGlottal closure is determined by the ex

19、tent of vocal fold approximation during the maximum closing of the vibratory cycle.Glottal Closure RatingsComplete 完全The glottis is completely closed.Incomplete 不全 The glottis is never closed.Inconsistent 不协调 The glottis is completely or incompletely closed sometimes.Completely ClosedWhen completely

20、 closed, the closed phase should be described as:very long 很长 Long 长fairly long 相当长 Short 短very short 很短 Incompletely ClosedWhen incompletely closed, the shape of the glottis at the maximum closing should be described as seven glottal closure patterns.Incompletely ClosedSpindle-shaped gap along the

21、entire lengthSpindle-shaped gap at middleHourglass-shaped gapGap by unilateral oval massGap with irregular shapeGap at posterior glottisGap along entire lengthComplete closureSpindle-shaped gap along the entire lengthSpindle-shaped gapat middleHourglass-shaped gapGap by unilateral oval massGap at po

22、sterior glottisGap with irregular shapeGap along entire lengthIncompletely ClosedAn incomplete closure during vocal fold vibration can result from:Impaired adduction of vocal fold(s)Nonlinear edgeObstacle between the vocal foldsStiff edgeDominant cricothyroid activityImpaired AdductionRecurrent lary

23、ngeal nerve paralysis, ankylosis the cricoarytenoid joint(s) or luxation of the cricoarytenoid joint(s)内收损伤 Recurrent laryngeal nerve paralysis, ankylosis the cricoarytenoid joint(s) or luxation of the cricoarytenoid joint(s).由喉返神经麻痹，环杓关节强硬或脱位引起。次环杓关节强硬 Nonlinear EdgeA nodule, polyp, cyst, papilloma

24、 or carcinoma边缘不齐A nodule, polyp, cyst, papilloma or carcinoma由声带小节，息肉，囊肿，乳头状瘤或癌引起。乳头状瘤：激光手术的九个步骤癌：原位癌有霉菌感染癌：疣性 癌：T1N0癌：角化过度,T2N0 癌：声带切除术 ,类型I癌：声带切除术,类型I癌：T1N0, 类型II癌：T2N0, ,类型III喉气囊肿：功能性后室带疝会厌谷囊肿：巨型会厌囊肿会厌谷囊肿：喉外型囊肿Obstacle between Vocal FoldsA foreign body, or a granuloma声带间障碍A foreign body, or a gr

25、anuloma由异物，喉蹼或肉芽肿引起。肉芽肿扁平溃疡性肉芽肿双侧巨型肉芽肿喉狭窄：喉肉芽与粘连血管病理月经期后静脉曲张和水肿血管病理微静脉曲张, 血管瘤Stiff EdgeIf the edge is stiff, no mucosal wave occurs or the Bernolli effect does not work efficiently. (Scar, sulcus vocalis)边缘僵硬 If the edge is stiff, no mucosal wave occurs or the Bernolli effect does not work efficient

26、ly. (Scar, sulcus vocalis)粘膜波消失，由疤痕或声带沟引起。Dominant Cricothyroid ActivityFalsetto voice环甲关节活动过度 Falsetto voice由假声或声门关闭不全引起。Symmetry of Bilateral Movement双侧运动对称性Symmetry of Bilateral MovementSymmetry is based on the degree to which the two vocal folds provide mirror images of one another during vibrat

27、ing.Symmetry RatingsSymmetryAsymmetryAny difference in mechanical properties (such as the position, shape, mass, tension, elasticity) cause asymmetry vibratory movement.An unilateral lesion provides an example of these differences.Symmetry振幅和相位对称Asymmetry in Amplitude 振幅不对称Asymmetry in Phase相位不对称Asy

28、mmetry in Amplitude and Phase振幅和相位不对称Mucosal Wave粘膜波Mucosal WaveThe occurrence of mucosal waves travelling the vertical length of the vocal folds is an important feature of vibration.Mucosal Wave RatingsAbsentNo travelling wave is present.SmallThe travelling wave is present, but less marked.NormalTh

29、ere is a clearly observable travelling wave.GreatThe travelling wave is extraordinarily marked.粘膜波等级Absent 消失No travelling wave is present.Small 小The travelling wave is present, but less marked.Normal 正常There is a clearly observable travelling wave.Great 大The travelling wave is extraordinarily marke

30、d.Mucosal Wave RatingsThe relative displacement of the mucosal wave should be compared between the two vocal folds and the findings should be described as:Right Left Mucosal WaveNormal RangeThe normal range means the range of the size and the extent of the travelling wave for the habitual pitch and

31、habitual loudness in normal subjects.Mucosal WaveNormal RangeOne can clearly observe the upper and lower lips at and after the maximum opening, and also one can see the upper and lower lips travelling laterally on the upper surface of the vocal folds.The extent this wave travels varies, but it norma

32、lly traverse at least half the entire width of the visible part of the vocal fold during normal pitch and loudness.粘膜波：正常在声门开放最大时，观察声带上下缘的粘膜波的波动。在声带的上层表面，观察声带上下缘的移行波。正常发声时，至少有可见的1/2声带宽度能观察到粘膜波的传播。粘膜越紧张，粘膜波越不明显The Stiffer the Mucosa, the Less Marked the Mucosal WaveFalsetto voiceScarsCarcinomasPapill

33、omaCystsfibrotic Nodules 纤维性变的小结firm Polyps 硬型息肉epithelial hyperplasia 上皮层增生案例In cases of recurrent laryngeal nerve paralysis, mucosa is stiffened because the vocalis muscle that opposes the cricothyroid activity is inactive.喉返神经麻痹麻痹：右声带麻痹麻痹：特氟隆注射后右声带麻痹案例In case of edematous lesions, the mucosa is a

34、bnormally pliable, resulting in an increase in mucosa wave. 水肿性病变雷氏水肿 I期雷氏水肿 II期雷氏水肿 III期雷氏水肿 III期Partially Stiff MucosaWhen the mucosa is partially stiff, the wave stops travelling at the stiff portion. Sulcus vocalis, localized scar, small cyst, small carcinoma, or small epithelial hyperplasia粘膜部分僵硬Sulcus vocalislocalized scar 局部疤痕small cyst 较小的囊肿small carcinoma较小的癌small epithelial hyperplasia小区上皮增生声带沟血管性囊肿癌：T1N0The Greater the Subglottal Pressure, the More Marked the Mucosal WaveLoudness phonation声门下压越大，粘膜波越明显响亮发声Tight or Loose Glottal ClosureToo tiger or loose glottal cl