Dysphonia

Introduction Mainly manifested as the delay and abnormality of pronunciation, the development speed of pronunciation is lower than the corresponding age, and the speech is unclear or incorrect. The most likely to be wrong are s, z, c, sh, ch, zh, l, m, n, j, x, etc. Some of the above-mentioned similar sounds are replaced by each other, such as the teacher (lao shi) as Laoxi (lao xi) and the grandmother (nai nai) as mai mai. Omit the beginning or middle of the sound of the word, fixedly send some sounds wrong, pronounced or incoherent, mild dysphonic disorder only shows inaccurate or unclear pronunciation, speech can make people understand; severe dysphonia Because the pronunciation is obviously wrong, the words are difficult to understand, but because the damage only occurs at the language level and there is no syntactic structure error, it always makes people feel that a potential sentence is spoken, which is developmental. Differences in language barriers.

Cause

The cause of the disease remains unclear. There are two hypotheses, one of which may be due to the developmental delay of the nervous system, which causes the dysfunctional part of the vocal organs to move, and the inheritance may have an effect on this developmental delay. Because the disease is often family-oriented; the other is considered to be caused by environmental factors, because children often form abnormal pronunciation when they are in contact with people with unclear pronunciation. Physiological and psychological causes are also the cause of the disease.

an examination

The auditory voice examination was performed first, and the excessive contraction of the laryngeal muscles, sputum, tremor, and the degree of vocal muscles during speech were observed through laryngoscopy. Then, through the acoustic examination, the change of the fundamental frequency of the arpeggio is observed, and the change of the vocal cord waveform is observed by the sound spectrum analysis. The usefulness and resistance of vocal cord friction were measured by airflow dynamics and the electronic glottal waveform was examined.

The laryngoscope was used to observe the vocal cord movements. The laryngeal electromyography was used to correctly identify the abnormally contracted laryngeal muscles and the abnormal laryngeal muscles and vocal cord muscles. In particular, the laryngeal electromyography is used to observe the pathophysiological abnormalities of the laryngeal muscles, and to determine whether there is abnormal laryngeal reflex, and it is useful for predicting the usefulness of brain learning and the possibility of complete cure.

Differential diagnosis

According to the ICD-10 standard diagnostic points are:

A. The severity of dysphonia in children exceeds the normal variation limit of their mental age.

B, non-linguistic intelligence is normal.

C, language expression and feeling skills are within the normal range.

D. Deleted vocal organs or nervous system diseases.

However, it must be identified with the following conditions:

A. Normal children are unclear: Many consonants in children before 3 to 4 years old are still inaccurate, especially some complex consonants are not correct. But after 4 years of age, you can gradually learn. Some normal children still have wrong sounds even at school age. Unlike developmental dysphonia, they can correct their mistakes themselves or correct their pronunciation errors soon after education. Children with developmental dysphonia have repeated mistakes in pronunciation and cannot correct mistakes spontaneously.

B. Organic structural difficulty: structural damage and defects of vocal organs such as laryngeal diseases, cleft palate, cleft lip and congenital tongue ulcer can cause unclear pronunciation and pronunciation errors; neurological diseases cause cerebellum, medulla, extrapyramidal The system and the nerve damage that governs the movement of the vocal organs can cause difficulty in pronunciation due to uncoordinated movement of the vocal organs. After the ENT examination and detailed neurological examination, abnormalities can be distinguished from developmental dysphonia.

C. Language abnormalities caused by hearing impairment: When mild hearing impairment occurs, the pronunciation may be unclear. Because mild neurological deafness mainly damages high-frequency part of the hearing, the pronunciation is unclear and the main reason is high-frequency sound, and the electrical audiometry is abnormal.

D, special language development disorders.

Repeated words or interrupted words when speaking. The articulated organs can have convulsive movements and paralysis of each group of muscles. Speech is produced by the normal movement of the sound band and the tongue, lip, and mouth of the speech caused by the breathing ribs of the diaphragm. When almost all of these occur, the free movement is lost, and the pronunciation is unclear. Breathing suddenly stops when the patient speaks or when he or she wishes to speak. There are also psychological barriers: fear, pessimism, negative, and wilting.

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