嗄声

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(声の)しわがれた;(人・動物が)しわがれ声の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/04 23:22:00」(JST)

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Dysphonia is the medical term for disorders of the voice: an impairment in the ability to produce voice sounds using the vocal organs (it is distinct from dysarthria which means disorders of speech, that is, an impairment in the ability to produce spoken words). Thus, dysphonia is a phonation disorder. The dysphonic voice can be hoarse or excessively breathy, harsh, or rough, but some kind of phonation is still possible (contrasted with the more severe aphonia where phonation is impossible).

Dysphonia has either organic or functional causes due to impairment of any one of the vocal organs. However, typically it is caused by some kind of interruption of the ability of the vocal folds to vibrate normally during exhalation. Thus, it is most often observed in the production of vowel sounds. For example, during typical normal phonation, the vocal folds come together to vibrate in a simple open/closed cycle modulating the airflow from the lungs. Weakness (paresis) of one side of the larynx can prevent simple cyclic vibration and lead to irregular movement in one or both sides of the glottis. This irregular motion is heard as roughness. This is quite common in vocal fold paresis.^[1]

Common types of dysphonia

Organic dysphonia
- Laryngitis (Acute: viral / bacterial) - (Chronic: smoking / GERD / LPR (Laryngopharyngeal Reflux) ).
- Neoplasm (Premalignant: dysplasia) - (Malignant: Squamous cell carcinoma).
- Trauma (Iatrogenic: surgery / intubation) - (Accidental: blunt / penetrating / thermal).
- Endocrine (Hypothyroidism / hypogonadism).
- Haematological (Amyloidosis).
- Iatrogenic (inhaled corticosteroids)

Functional dysphonia
- Psychogenic
- Vocal misuse
- Idiopathic

Associated conditions (incomplete list)

Voice disorders
- Laryngitis
- Chorditis
- Vocal cord nodules
- Vocal fold cyst
- Reinke's Edema (Mostly caused by smoking)
- Laryngeal papillomatosis
Gastroesophageal reflux disease: When there is a clinical suspicion for GERD as the cause of the dysphonia, an Esophageal pH Monitoring is required to confirm the diagnosis and establish the relationship between GERD and dysphonia.

Laryngeal cancer
Myasthenia gravis
Hypothyroidism
Hyperthyroidism
Sinusitis
Lung cancer
Juvenile dermatomyositis
Parkinson's disease
Botulinum toxin

Clinical measurement

Dysphonia is measured using a variety of examination tools that allow the clinician to see the pattern of vibration of the vocal folds, principally laryngeal videostroboscopy. Acoustic examination is also common, obtained by recording the sounds made during sustained phonation or whilst speaking. Another tool is electroglottography.

Subjective measurement of the severity of dysphonia is carried out by trained clinical staff. The GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale or the Oates Perceptual Profile are widely used for this purpose. Objective measurement of the severity of dysphonia typically requires signal processing algorithms applied to acoustic or electroglottographic recordings. These include algorithms such as jitter, shimmer and noise-to-harmonics ratios, but these have been shown to have some critical limitations, particularly for severe dysphonia. Recent advances in signal processing theory have led to more robust algorithms.^[2]

References

^ Little, M.A. et al. (2009). Objective dysphonia quantification in vocal fold paralysis: comparing nonlinear with classical measures. Journal of Voice (in press).
^ Little, M.A. et al. (2007). Exploiting nonlinear recurrence and fractal scaling properties for voice disorder detection. Biomed Eng Online, 6:23.

External links

Vocal Dysphonia and Vocal Disorder Online Support Network
VoiceInfo.org
Pediatric ENT
WrongDiagnosis
Objective measurement of dysphonia for clinical purposes.
Marshall
NetDoctor
Singing Voice
National Center for Voice and Speech's official website
The Department of Speech Pathology and Audiology at the University of Iowa's official website
The Voice Academy's official website

UpToDate Contents

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English Journal

Intubation of the morbidly obese patient: GlideScope(®) vs. Fastrach™.

Ydemann M, Rovsing L, Lindekaer AL, Olsen KS.SourceDepartment of Anaesthesiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2012 Jul;56(6):755-61. doi: 10.1111/j.1399-6576.2012.02693.x. Epub 2012 Apr 23.
BACKGROUND: Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc
PMID 22524487

Hypothyroidism in the elderly: Diagnostic pitfalls illustrated by a case report.

Maselli M, Inelmen EM, Giantin V, Manzato E.SourceDepartment of Medicine and Surgical Sciences, Geriatrics Division, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
Archives of gerontology and geriatrics.Arch Gerontol Geriatr.2012 Jul;55(1):82-4. Epub 2011 Jun 2.
A diagnosis of hypothyroidism in the elderly can easily be overlooked if we rely exclusively on its clinical presentation because this may be highly non-specific, since the signs and symptoms of the disease are common to other diseases typical of old age, and even to the normal aging process. Imagin
PMID 21640396

Japanese Journal

縦隔血腫が原因と考えられた反回神経麻痺例

牧野寛之,岡木牧人,中山明仁
耳鼻咽喉科臨床 104(10), 721-725, 2011-10-01
… Subject: A 69-year-old woman referred for sudden hoarseness and breathing difficulty had suffered a heavy coughing attack one night before symptoms appeared. …
NAID 10029659236

小児に発生した声門下顆粒細胞腫例

大村学,辻川敬裕,渡邉大樹,四ノ宮隆,柴田敏章,馬場均,高原哲夫,久育男
耳鼻咽喉科臨床 104(10), 715-719, 2011-10-01
… A 10-year-old boy seen for hoarseness was found in flexible fiberscopic examination to have a submucosal mass below the left vocal cord. …
NAID 10029659210