tag:blogger.com,1999:blog-55543123598096091112024-03-11T23:36:44.266-07:00張學逸教授的聲音保健教室張學逸,長期從事聲音醫療,現主持振興醫院嗓音特別門診、兼陽明大學教授、台灣音聲(嗓音)醫學會創會理事長,曾任台北榮總耳鼻喉部喉科主任、部主任、台灣耳鼻喉科醫學會理事長。本部落格並非以吸引大眾閱讀為目的,而是依臨床經驗與學術觀點,在非商業性的原則下,為聲音有問題的人,提供簡要並隨時更新的資訊。Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.comBlogger24125tag:blogger.com,1999:blog-5554312359809609111.post-21795952773222536892016-12-08T02:40:00.000-08:002017-02-09T02:14:06.451-08:00聲帶自體脂肪注射治療說明<div class="MsoNormalCxSpFirst">
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">1. </span><span style="font-family: 標楷體;">本特殊技術在局部麻醉下施行,事前不要熬夜或吃太飽,注射後禁食二小時,禁聲</span><span style="font-family: 標楷體; text-indent: -18pt;">二天,不要用力咳嗽。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">2. </span><span style="font-family: 標楷體;">注射後會有暫時性的發聲困難和聲音沙啞,此現象會逐漸減輕<span lang="EN-US">(</span>通常在二至四週內<span lang="EN-US">)</span>,</span><span style="font-family: 標楷體; text-indent: -18pt;">請交代親友不要擔心。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">3. </span><span style="font-family: 標楷體;">自體脂肪是最自然的活性填充物,具有幹細胞促進組織再生的長期療效。注射後可</span><span style="font-family: 標楷體; text-indent: -18pt;">搭配發聲之語言訓練。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">4. </span><span style="font-family: 標楷體;">每次注射量不能太多,是否需再次注射,取決於個人的聲帶狀況、脂肪存活再生能</span><span style="font-family: 標楷體; text-indent: -18pt;">力和生活工作需要。</span></span></div>
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<span lang="EN-US" style="font-family: "新細明體" , "serif"; font-size: 14.0pt;"> 引用請註明出處 </span><span style="font-family: "新細明體" , "serif"; font-size: 14.0pt;">嗓音特別門診
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com2tag:blogger.com,1999:blog-5554312359809609111.post-24516752132431710462016-05-02T06:31:00.000-07:002017-02-09T02:17:16.829-08:00聲帶微量類固醇注射治療說明<div class="MsoListParagraph" style="line-height: 22.0pt; margin-left: 0cm; mso-line-height-rule: exactly; mso-para-margin-left: 0gd;">
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">1. </span><span style="font-family: 標楷體;">本特殊技術是將很微量的類固醇<span lang="EN-US">(</span>小於一粒藥丸的劑量<span lang="EN-US">) </span>精確的注入患部,</span><span style="font-family: 標楷體;">可以避免類固醇的副作用。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">2. </span><span style="font-family: 標楷體;">本特殊技術在局部麻醉下施行,事前不要熬夜或吃太飽,注射後禁食二小時,</span><span style="font-family: 標楷體;">禁聲一天,不要用力咳嗽。</span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="font-family: 標楷體;">3. </span><span style="font-family: 標楷體;">注射後暫時性的聲音沙啞會逐漸消失,同時在一到三個月內發揮消腫和軟化</span><span style="font-family: 標楷體;">的效果,也可以多次注射。</span></span></div>
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<span style="font-family: "新細明體" , "serif"; font-size: 14.0pt;"> 嗓音特別門診 敬啟<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com2tag:blogger.com,1999:blog-5554312359809609111.post-4500375942297910952015-01-15T19:08:00.000-08:002015-04-03T02:53:43.722-07:00新版衛教單: 聲音保健(二): 咽喉胃酸逆流 的 預防保健 <div class="MsoNormal">
<span style="background-color: white; color: #141823; font-family: 新細明體, serif; font-size: 14pt;">一般人對於</span><span lang="EN-US" style="color: #141823; font-family: 新細明體, serif; font-size: 14pt;"> [</span><span style="background-color: white; color: #141823; font-family: 新細明體, serif; font-size: 14pt;">咽喉胃酸逆流</span><span lang="EN-US" style="color: #141823; font-family: 新細明體, serif; font-size: 14pt;">] </span><span style="background-color: white; color: #141823; font-family: 新細明體, serif; font-size: 14pt;">應該比較陌生,它的症狀和治療與熟知的</span><span lang="EN-US" style="color: #141823; font-family: 新細明體, serif; font-size: 14pt;"> [</span><span style="background-color: white; color: #141823; font-family: 新細明體, serif; font-size: 14pt;">胃食道逆流</span><span lang="EN-US" style="color: #141823; font-family: 新細明體, serif; font-size: 14pt;">] </span><span style="background-color: white; color: #141823; font-family: 新細明體, serif; font-size: 14pt;">有相當大的差異。</span></div>
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<span style="background: white;">[</span><span style="background: white; font-size: 14pt;">咽喉胃酸逆流<span lang="EN-US">] </span>通常沒有溢胃酸的感覺,因為發生的主要問題在於逆流的胃酸在咽喉</span><wbr style="background-color: white; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>造成聲帶發炎和周圍組織的傷害,而會有喉嚨不適卡卡的、有異物感<wbr style="background-color: white; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>或有痰想要清喉嚨、咳嗽或喉嚨敏感、聲音沙啞、發聲吃力等症狀。<wbr style="background-color: white; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>另外有些人也會有鼻涕倒流、喉嚨痛、口臭或牙齦靡爛等現象。胃鏡<wbr style="background-color: white; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>檢查不一定能看出有胃食道逆流,但咽喉內視鏡檢查可以看見聲帶及<wbr style="background-color: white; font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>喉部組織發炎腫脹等現象。</span><span lang="EN-US" style="color: #141823; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Helvetica;"><br />
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</span><span style="background: white; color: #141823; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Helvetica;">發生原因</span><span lang="EN-US" style="color: #141823; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Helvetica;"><br />
</span><span style="background: white; color: #141823; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Helvetica;">一般人多多少少會有胃酸逆流的情況,但可經由吞嚥及正常的消化道<wbr style="font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>蠕動,將逆流而上的胃酸排空。然而,有<span lang="EN-US"> [</span>咽喉胃酸逆流<span lang="EN-US">] </span>問題的患者,常會因吞嚥道的肌肉緊張或消化道蠕動機能不好、胃酸<wbr style="font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>分泌過多、腹壓太大,食物或藥物等原因造成逆流的胃酸殘留在咽喉<wbr style="font-family: Helvetica, Arial, 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 15px; line-height: 20px;"></wbr>而導致傷害。此外不正常的生活作息或飲食習<span class="textexposedshow">慣、情緒壓力或失眠,都會讓<span lang="EN-US"> [</span>咽喉胃酸逆流<span lang="EN-US">] </span>更嚴重。<span lang="EN-US"><br />
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</span><span class="textexposedshow">預防保健方法</span><span lang="EN-US"><br />
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</span><span class="textexposedshow">盡量避免刺激交感神經興奮的、增加胃酸分泌的、酸性及產氣性的食<wbr></wbr>物<span lang="EN-US">: </span>如<span lang="EN-US">: </span>咖啡、可樂、茶、酒、酸辣或高油脂飲食、巧克力或其他甜食<span lang="EN-US">; </span>薄荷、蕃茄醬等添加物<span lang="EN-US">; </span>檸檬、鳳梨等酸性水果<span lang="EN-US">; </span>汽水、洋蔥、韭菜等產氣食物。</span><span lang="EN-US"><br />
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</span><span class="textexposedshow">調整生活作息<span lang="EN-US">: </span>常喝水<span lang="EN-US">(</span>少量多次<span lang="EN-US">)</span>、戒菸、吃飯八分飽、不亂吃藥<span lang="EN-US">(</span>尤其止痛藥<span lang="EN-US">)<wbr></wbr></span>、不吃宵夜、晚上睡前或躺下前二至三小時禁食、規律的飲食、睡覺<wbr></wbr>時頭及上半身微墊高、避免熬夜或失眠、維持輕鬆的情緒、穿寬鬆的<wbr></wbr>褲子、維持適當的體重等,皆能減輕<span lang="EN-US">[</span>咽喉胃酸逆流<span lang="EN-US">]</span>的症狀。</span><span lang="EN-US"><br />
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</span><span class="textexposedshow">若症狀無法藉由上述預防胃酸逆流的生活習慣及飲食習慣而緩解<span lang="EN-US">,</span>則<wbr></wbr>需要搭配中和胃酸、減少胃酸分泌、放鬆咽喉肌肉及促進腸胃道蠕動<wbr></wbr>的藥物,按照醫師的指示長期使用及追蹤檢查。</span><span lang="EN-US"><br />
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</span><span class="textexposedshow">摘錄自<span lang="EN-US">blog & facebook: </span>張學逸教授的聲音保健教室</span><span lang="EN-US"><br />
<span class="textexposedshow"><a href="http://sychang3750.blogspot.tw/" style="cursor: pointer;" target="_blank"><span style="color: #3b5998;">http:/</span><span style="color: #3b5998;">/</span><wbr></wbr><span style="color: #3b5998;"></span><span style="display: inline-block;">sychang3750.blogspot.tw/</span></a></span><span class="apple-converted-space"> </span><span class="textexposedshow">;</span><span class="apple-converted-space"> </span><span class="textexposedshow"><a href="https://www.facebook.com/voice.health.class" style="cursor: pointer;"><span style="color: #3b5998;">https://www.facebook.com</span><span style="color: #3b5998;">/</span><wbr></wbr><span style="color: #3b5998;"></span><span style="display: inline-block;">voice.health.class</span></a></span><br />
</span><span class="textexposedshow">引用請註明出處。</span></span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-34747811613714810922014-06-02T07:16:00.001-07:002014-06-02T07:16:38.656-07:00聲帶黏膜下的病灶: 囊腫或纖維腫<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">囊腫或纖維腫引起的聲音沙啞,時常不容易被看出來,因為聲帶表面看起來好好的,或只有局部些微隆起,也時常和慢性聲帶炎、結節、息肉或聲帶溝並存,診斷難度相當較高,需要使用頻閃光源內視鏡檢查,而且如何消除這種聲帶深處的病灶,同時避免傷口結疤,更極具挑戰性。
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">聲帶囊腫分為滯積性囊腫<span lang="EN-US">(retention cyst)</span>及皮樣囊腫<span lang="EN-US">(dermoid cyst)</span>兩種,東 方人大多屬於前者。因為聲帶有很多分泌潤滑黏液的小腺體,聲帶發炎腫脹可能導致黏液腺出口阻塞,形成滯積性囊腫。滯積性囊腫的囊壁很薄,只有一到三層細胞,皮樣囊腫的囊壁比較厚實,它是由異位性皮樣組織細胞造成,至於纖維腫則是一種沒有囊壁的纖維化組織,可能與聲帶慢性發炎有關。這類病灶存在於聲帶黏膜下方,其外側時常緊貼著聲帶韌帶,甚至部分陷入其中,如果將發聲時決定音質好壞的聲帶黏膜波動,比喻為規律性的水波,這種病灶就如同水面下的礁石,它會嚴重影響黏膜波動。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">在治療上,黏膜下摘除病灶雖然最為理想,但是需要相當困難的迷你顯微黏膜瓣<span lang="EN-US">(mini-microflap)</span>技術,保留正常黏膜覆蓋傷口,避免聲帶韌帶的暴露,以減少術後結疤,不過在合併有聲帶黏膜病變時就不可能做到,而且對於最常見的滯積性囊腫,因為囊壁很薄,現實上難以避免囊壁在摘除的過程中破裂,它可能導致囊腫復發或傷口過度結疤,成為難治的聲音沙啞,這是這種治療的特殊風險,不過多年來筆者採用自行研發的聲帶局部注射或囊腫開放手術技術,則可以避免這些問題。
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-80708189074043915042014-03-09T06:32:00.004-07:002014-03-09T06:32:58.400-07:00嗓音的印記:聲帶溝或疤痕 <div class="MsoNormal">
<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt;">每一個人都有不同的聲音特質,但是在一群人當中,常常會發現有些人聲音比較沙啞、不宏亮,聲音聽起來有些刺耳或有雜音或氣音,音域比較窄,發聲比較吃力,容易疲勞,這種現象通常長期穩定的存在。使用喉頻閃內視鏡檢查,可以在一側或兩側聲帶表面,看到長短、大小和深度不一的縱向凹陷,凹陷底部粘膜和聲帶韌帶有些沾黏,導致發聲時聲帶粘膜波動減少和聲門閉合不全,此外,也時常合併有聲帶萎縮的現象,並伴隨代償性的肌肉緊張性音聲障礙<span lang="EN-US">(muscle tension dysphonia)</span>或聲帶息肉,須要仔細評估。</span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">聲帶溝或疤痕的嚴重度個別差異很大,輕微者症狀不明顯,研究報告顯示,至少五分之一的人有聲帶溝,其成因通常被認為是先天性,所以通常在青春期聲帶發育後才有症狀,此外,用聲不當導致的聲帶傷害、胃酸或外物刺激、慢性發炎、聲帶手術、聲帶老化、退化性疾病或、皮樣囊腫,都可能加重纖維化、疤痕、聲帶溝或萎縮。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">治療的困難度和複雜性都很高,首要先避免可能的因素,對時常使用聲音者安排語言治療,有些患者使用局部微量類固醇注射,可能讓疤痕組織軟化而改善聲音,若需要進一步治療可考慮使用特殊的聲帶黏膜下重建技術,這種治療主要是讓發聲比較不吃力,但音質不佳的問題,比較嚴重者才可能獲得明顯的改善,因為音質對聲帶淺層構造的變化非常敏感,任何手術傷口都可能影響音質。手術的方法需要用特殊的顯微技術,先將沾黏在一起的粘膜和聲帶韌帶分離,分離出來的空間再置入自體脂肪、筋膜或其他生物物質,以重建</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">聲帶粘膜下的軟組織,改善</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">發聲時的聲帶粘膜波動和聲門閉合,此外,若合併有聲帶萎縮,自體脂肪注射或甲狀軟骨成型術也能改善聲門閉合不全,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">至於使用幹細胞及支架或加入各種生長因子的聲帶粘膜下軟組織<span lang="EN-US">ECM</span>之再生治療,則尚在實驗階段。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。 <span lang="EN-US"><o:p></o:p></span></span></div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-83532867713905886702014-01-26T01:52:00.001-08:002015-04-03T03:14:50.760-07:00聲音的老化(二): 診斷與治療<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">老人的聲音問題時常被以為是老化的現象,而忽略了其他病變,所以需要先排除非老化引起的聲音問題,如咽喉發炎、發聲傷害、咽喉胃酸逆流、感染、神經病變、腫瘤、機能性或心因性音聲障礙等。在診斷上,除了前文所述的症狀之外,使用喉頻閃內視鏡檢查,可以看到發聲時聲門閉鎖不全<span lang="EN-US">(</span>但機能代償導致的肌肉緊張性音聲障礙<span lang="EN-US">muscle tension dysphonia</span></span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">可能減輕這種現象<span lang="EN-US">)</span>、聲帶凹陷、聲帶突<span lang="EN-US">(vocal process)</span>突出、粘膜腫脹或萎縮、聲帶震幅較大或震動不規則,以及兩側黏膜波動減少或不對稱,不過,若兩側聲帶運動不對稱,則須注意其他問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">在治療上,要先了解個人對聲音要求的高低,以及飲食生活習慣、情緒睡眠、神經系統、呼吸功能和呼吸道狀態,並評估個人對治療的承受度與治療效果等,目前有以下幾種治療方法:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">一、發聲訓練:這是第一線療法,患者必須先了解聲音老化的原理,維持良好的飲食、發聲習慣與精神狀態,再施以強化呼吸和發聲運動的訓練,加快說話的速度,增加神經肌肉的協調性,同時改善病患對聲音的感覺,並練習發出具有共鳴、適當音調、穩定又有強度的聲音。發聲訓練需要多次進行,但對嚴重聲音老化者比較沒有幫助。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">二、聲帶注射:就是將物質注入萎縮的聲帶肌肉,以增加聲帶的豐滿度,可以改善聲門閉鎖不全引起的氣音,以及發聲吃力、緊張、彈性不佳、疲勞或哽嗆等現象,同時增加聲音的強度。注射的物質有很多種,目前最自然和安全的方法是自體脂肪注射,</span><span style="font-family: 新細明體, serif; font-size: 14pt;">它可能附帶促進組織再生的幹細胞和生長因子,</span><span style="font-family: 新細明體, serif; font-size: 14pt;">不過須盡量避免脂肪被過度吸收,注射後有些人需做發生訓練,也可多次注射。若使用玻尿酸,通常只有暫時性的效果。傳統上聲帶注射是在全身麻醉下經喉內視鏡施行,筆者使用的經聲門下腔注射法,可在門診局部麻醉下為之,雖然更為直接、精確,但技術的要求比較高。因為目前的治療方法還無法讓表皮組織年輕化,所以在聲音的音質上比較難以改變。</span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">三、甲狀軟骨成形術:對聲帶注射有效,但注射物質容易被吸收,或不適合聲帶注射的患者可以使用這種手術方法,它是在甲狀軟骨做一小窗口,再由此放入不會被吸收的穩定物質,其作用和聲帶注射類似,需要相當的技術和經驗,在局部麻醉下,依病患的聲音做調整,有些人可以做兩側成形術或進行再度調整,以達到較佳的效果。不過,因為放入的物質沒有組織活性,也無法改變聲帶肌肉及表皮的老化,只能改善聲門閉鎖不全導致的問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">四、利用幹細胞或生長因子等組織工程技術,改變聲帶黏膜下組織或肌肉的成份與結構,以及運用電刺激強化肌肉神經功能,改善聲帶老化的問題,則尚處研發階段。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-74257383005656861292014-01-08T05:15:00.000-08:002014-01-26T00:41:51.282-08:00嗓音的老化(一): 症狀與原因 <div class="MsoNormal">
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> <span lang="EN-US"> </span>聽到稍有年紀的病患哽咽地說:「我以前卡拉<span lang="EN-US">OK</span>唱得很好,現在卻只敢在旁幫朋友點歌,人生唯一的樂趣都沒有了」,原來他的問題也源自於老化。聲音老化是人體老化的一種現象,但須排除非老化引起的聲音問題,如咽喉發炎、咽喉胃酸逆流、發聲傷害、機能性音聲障礙、神經病變、腫瘤等病變。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">大家都知道,老化會讓皮膚、肌肉或神經組織強度降低,但是聲音的問題卻常被忽視,聲音老化的現象包括聲音變弱或薄、出現氣音、音質變粗、音調改變、音域縮小、聲音投射度不佳、發聲吃力、聲音不穩定或必須重複發音,也時常衍生代償性的</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">肌肉緊張性音聲障礙<span lang="EN-US">(muscle tension dysphonia)</span></span><span style="font-family: 新細明體, serif; font-size: 14pt;">,或在較長的用聲後出現疲乏、變聲,甚至容易哽嗆</span><span style="font-family: "新細明體","serif"; font-size: 14pt;">,</span><span style="font-family: "新細明體","serif"; font-size: 14pt;">有些人會因而感到焦慮、沮喪或逃避社交,影響生活品質,不過並非所有老人的聲音變化都是病態,而是要看個人的感受和需要,甚至也有人喜歡以老化的聲音來博取尊重。</span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">聲音老化通常具有多重因素,涵蓋下列各種相關器官的變化:<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">一、做為發聲動力來源的呼吸,不論因為老化或其他肺部疾病,甚至駝背或其他<span lang="EN-US"> </span>姿勢變化都會影響呼吸功能、降低肺活量和組織彈性,造成發聲時聲門下壓力不足、音量變小,而且呼吸和喉部發聲的協調也變差。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">二、對神經肌肉系統的影響:中樞神經老化、原發性顫抖、巴金氏症等神經退化</span><span style="font-family: 新細明體, serif; font-size: 14pt;">性疾病或中風,都可能喪失神經對發聲機能的精密控制。此外,喉部的末梢
神經可見神經軸變細或消失、營養神經的細胞減少,聲帶的神經肌肉交點呈現類似去神經化</span><span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt;">(denervation)</span><span style="font-family: 新細明體, serif; font-size: 14pt;">現象,肌肉纖維和血管變性或減少,而且被膠原和脂肪取代,導致肌肉變弱、變薄、萎縮、聲帶凹陷、聲門閉鎖不全、發聲容易疲勞,甚至容易哽嗆。</span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">三、聲帶表皮及其下多層構造發生的變化:聲帶黏膜變硬、女性變厚、男性變薄,</span><span style="font-family: 新細明體, serif; font-size: 14pt;">黏膜下疏鬆組織的膠原纖維變多、排列混亂,彈性纖維減少、不規則,纖維母細胞產生的玻尿酸等細胞外間質變少,這種間質是維持聲帶表面彈性和柔軟的重要物質,這些變化和皮膚或肺泡的老化現象類似,會導致發聲時黏膜波動不良、音調改變、音質變差,也更加重肌肉萎縮引起的聲門閉鎖不全與氣音的問題。</span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">四、老人的喉頭在頸部位置較低,喉軟骨鈣化、僵硬,軟骨關節和肌腱的活動性</span><span style="font-family: 新細明體, serif; font-size: 14pt;">和彈性降低,發聲腔道變長,口腔變大,這些現象會影響聲帶運動的順暢,並改變咽喉口腔的彈性和聲音共鳴。此外,老化引起的黏液分泌減少或濃稠,也會減損它在聲帶震動發聲時的潤滑功能。</span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-2643348189676055542013-12-22T06:30:00.002-08:002013-12-22T06:32:55.509-08:00聲帶麻痺 <div class="MsoNormal" style="line-height: 150%;">
<span lang="RU" style="font-family: 新細明體, serif; line-height: 150%;"> </span><span lang="RU" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">當聲音沙啞伴隨漏氣聲、音量提不高、講幾個字就必須換氣或用假聲來發音、講話吃力、容易嗆到或痰不易咳出,就是聲帶麻痺造成聲門閉鎖不全的症狀。</span><br />
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<span lang="RU" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">在喉頭聲門的兩側是聲帶,兩側聲帶的前端靠在一起附著於甲狀軟骨上,後端則各自連接到兩側杓狀軟骨,杓狀軟骨和其下方的環狀軟骨之間有一個可以讓杓狀軟骨轉動的關節。呼吸時因為聲帶外轉肌肉收縮,帶動杓狀軟骨和聲帶的外轉而張開聲門,發聲時因為聲帶內轉肌肉收縮,帶動杓狀軟骨和聲帶的內轉而閉鎖聲門,此時呼氣經兩側聲帶間隙沖出,引起聲帶震動而發聲,這是基本的解剖生理。<span lang="RU"><o:p></o:p></span></span></div>
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<span lang="RU" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">單側聲帶麻痺就是支配聲帶肌肉的神經</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">或肌肉本身</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">發生病變,讓肌肉喪失收縮運動的能力,造成聲帶無法內外轉動及肌肉萎縮,導致聲門閉鎖不全。大部分患者的聲門閉鎖不全主要由聲帶肌肉萎縮引起,少數患者發聲時</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">兩側聲帶後方的</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">軟骨突<span lang="RU">(vocal process)</span>有明顯的間隙,閉鎖不全更為嚴重,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">有些部份麻痺患者則須用頻閃光源內視鏡或肌電圖才能看出</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">。這些問題的各異性都很大</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">它關係到症狀的嚴重度和治療的方法。<span lang="RU"><o:p></o:p></span></span></div>
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<span lang="RU" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">對聲帶麻痺患者,除了要看聲門附近有無病灶之外,也要檢查支配肌肉的神經經路 <span lang="RU">(</span>顱底、頸部及上胸腔<span lang="RU">)</span>, 有無外傷、腫瘤或其他病變,如果查不出原因,則可能是神經本身的炎症造成。因為神經有再生的能力,所以通常在麻痺後三到六個月,即神經再生完成後還有聲音的問題才需要治療,不過急需用聲者可先做暫時性的處置,另外復健運動也可能有些幫助</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">,最近的研究報告也顯示,早期改善聲門閉鎖不全有聲帶按摩的效果,能促進神經再生。<span lang="RU"><o:p></o:p></span></span></div>
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<span lang="RU" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">在治療上,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">神經再生法</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">是一種理想,但仍無法恢復聲帶運動,能否有意義的防止肌肉萎縮,則尚須觀察。目前的方法是用注射或手術來改變麻痺聲帶的位置,使其靠近聲門中線,讓對側聲帶在發聲時能夠靠攏,以改善聲門閉鎖的功能。針對大多數聲門閉鎖不全主要由聲帶肌肉萎縮引起者,採用自體</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">脂</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">肪或人造物質注射以填充萎縮的肌肉,或在聲帶外側的甲狀軟骨做一小窗口,再由此窗口放入大小、位置可調整的填充物。針對少數發聲時</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">兩側聲帶</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">軟骨突之間有明顯間隙者,則需要加上難度更高的杓狀軟骨內轉手術,才會有比較好的效果。因為聲音對聲帶的變化極為敏感,這種治療的技術性相當高,聲音進步的差異也很大,目前治療的作用不是恢復聲帶運動,而是調整麻痺聲帶的位置,而且有時需要漸進的調整。<span lang="RU"><o:p></o:p></span></span></div>
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<span lang="RU" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">至於兩側聲帶麻痺,因為比較少見,通常會造成呼吸阻塞,而且治療上牽涉到呼吸和聲音難以兼顧的問題,需要比較深澀、複雜的說明,暫不在此贅述。<span lang="RU"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-67631082367711512982013-12-13T01:57:00.001-08:002013-12-27T07:53:35.661-08:00聲音沙啞的非手術性治療<div class="Style-1">
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt;">聲音沙啞是一般人對各種音聲障礙的統稱,這種問題的治療通常優先考慮非手術性的方法,因為聲音對聲帶組織的變化極為敏感,肉眼看不出來的變化,就會引起明顯的聲音問題,而手術及後續的傷口癒合,多少潛藏著組織傷害的危機,所以不得已才使用手術性治療。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt;">聲音沙啞的原因很多,對沒有明顯構造異常的機能性發音障礙,如</span><span style="font-family: 新細明體, serif; font-size: 14pt;">肌肉緊張性音聲障礙<span lang="EN-US">(muscle tension dysphonia)</span>、變聲性假嗓<span lang="EN-US">(mutational falsetto)</span>、轉化性音聲障礙<span lang="EN-US">(conversion
dysphonia)</span>,</span><span style="font-family: 新細明體, serif; font-size: 14pt;">原則上</span><span style="font-family: 新細明體, serif; font-size: 14pt;">採取語言治療。對機能性問題造成的構造變化如聲帶結節<span lang="EN-US"> (vocal nodule)</span>,基本上先減少用聲,以飲食生活衛教減少咽喉胃酸逆流或併用藥物,並給予聲音衛教或做發聲訓練,也可施行特殊的聲帶粘膜微量類固醇注射。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span><span style="font-family: 新細明體, serif; font-size: 14pt;">至於聲帶息肉<span lang="EN-US"> (vocal polyp)</span>、聲帶囊腫<span lang="EN-US">(cordal cyst)</span>或發炎反應<span lang="EN-US"> (inflammatory reaction)</span>引起的急性聲帶炎<span lang="EN-US">(acute cordites)</span>、慢性聲帶炎<span lang="EN-US">(chronic cordites)</span>、息肉樣聲帶<span lang="EN-US">(polypoid vocal cord)</span>、接觸性潰瘍或肉芽腫<span lang="EN-US">(contact
ulcer or granuloma)</span>,則須先減少用聲並消除發炎的原因,以飲食生活衛教減少咽喉胃酸逆流或併用藥物,也可施行特殊的聲帶粘膜微量類固醇注射。此外,更年期及某些荷爾蒙引起的聲音障礙<span lang="EN-US">(hormonal voice disorder)</span>,則可用荷爾蒙補充療法。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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</span><span style="font-family: 新細明體, serif; font-size: 14pt;">由</span><span style="font-family: 新細明體, serif; font-size: 14pt;">聲帶溝或疤痕<span lang="EN-US">(vocal sulcus or
scar)</span>及</span><span style="font-family: 新細明體, serif; font-size: 14pt;">老化或萎縮<span lang="EN-US">(senile change
or atrophy)</span>引起的聲音沙啞,主要因為聲帶表面僵硬及聲門閉鎖不全,聲帶僵硬是目前十分棘手的問題,特殊的聲帶局部微量類固醇注射可能治療某些病灶,聲門閉鎖不全也可用自體脂肪聲帶注射治療。至於聲帶麻痺<span lang="EN-US">(vocal palsy)</span>引起肌肉萎縮造成的聲門閉鎖不全,則可用自體脂肪或其他安全性物質做聲帶注射。此外,痙攣性音聲障礙<span lang="EN-US">(spasmodic dysphonia)</span>的治療,目前仍先使用肉毒桿菌素聲帶注射。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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</span><span style="font-family: 新細明體, serif; font-size: 14pt;">上述</span><span style="font-family: 新細明體, serif; font-size: 14pt;">非手術性療法,如</span><span style="font-family: 新細明體, serif; font-size: 14pt;">減少用聲、飲食生活衛教、聲音衛教、發聲訓練、口服藥物、聲帶微量類固醇注射、聲帶自體脂肪或肉毒桿菌素注射等方法,其特點是安全、副作用很少。聲帶注射通常在全身麻醉下經硬式喉鏡實施,也可以在門診局部麻醉下為之,但技術門檻較高。因為本文屬概念性的醫療知識,有關專業技術細節,以及疾病療效和醫師能力與治療方法的差異問題,則不在此贅述。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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</span><span style="font-family: 新細明體, serif; font-size: 14pt;">歡迎轉寄,引用請註明出處。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-89804154635008368952013-11-27T05:26:00.000-08:002014-01-08T01:38:34.329-08:00聲音保健 (簡要版)<div align="center" class="MsoNormal" style="text-align: center;">
<span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif";"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">1</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、足夠的睡眠和穩定的情緒<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">可以放鬆肌肉,發聲時肌肉運動才有彈性,不易疲勞。可以調和自律神經,讓黏液分泌穩定,以維持聲帶的潤滑和柔軟,而有益於聲帶震動發聲。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">2</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、<span lang="EN-US"> </span>攝取足夠的水分<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">每人每日需攝取約<span lang="EN-US">2000cc</span>的水分,不要等到口渴才喝,而是要少量多次,如此才能維持穩定濕潤的咽喉及聲帶黏膜,以應聲帶震動發聲之需要。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">3</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、避免吸食刺激物<span lang="EN-US">: </span><span lang="EN-US">(</span>詳請參閱<span lang="EN-US">: </span></span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 細明體;">聲音保健</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">(</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 細明體;">二</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">) </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 細明體;">如何預防咽喉胃酸逆流?</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">)</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;">
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">菸酒、酸辣或含咖啡因的食物,會造成聲帶黏膜刺激或自律神經興奮,導致黏液分泌不穩定或黏膜敏感而阻礙發聲,若需吸食則可喝溫開水予以沖淡。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">4</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、聲音的休息要足夠<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">發聲是十分精密、複雜的運動,需要休息才不易疲勞,所以除了充足的睡眠之外,原則上一天至少要有兩、三次,每次二、三十分鐘以上的禁聲休息。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">5</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、在吵雜的環境少用聲音<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">在吵雜的地方不容易聽到自己的聲音,不覺中會用過度緊張的肌肉和過大的音量說話,而引起各種嗓音障礙,若職業上需要,建議用麥克風或耳機。<span lang="EN-US"> <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">6</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、用適當的音量說話<span lang="EN-US">:</span><span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">通常適當的音量是在伸手可及的距離,讓兩三個人可以聽到的程度,發聲時覺得喉頭緊或不舒服,要注意是否音量過大,若長期需要大聲,建議用麥克風。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">7</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、用適當的呼吸和速度說話<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">原則上說八到十個字就要停下來吸氣,讓發聲有足夠的呼氣支持,才能放鬆喉嚨肌肉,也讓說話的速度不致太快,氣不足時繼續發聲,會引起肌肉緊張。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">8</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、做放鬆喉嚨的動作<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> (</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">讓發聲的彈性、音質和共鳴更好、不易疲勞<span lang="EN-US">)</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">發聲前做嘴巴運動或母音練習,發聲時口部動作加大,都可以讓喉嚨放鬆,並降低說話速度,此外說話時的肢體語言,也能減少喉嚨緊張。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">9</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">、感冒的時候少用聲音<span lang="EN-US">:</span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">感冒會引起上呼吸道發炎腫脹,此時聲帶最為脆弱,如果再過度或不當的發聲,容易造成聲帶震動區的組織傷害。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
</div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">
</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-81895353029771517262013-11-17T01:19:00.000-08:002013-12-29T03:01:59.158-08:00胃酸逆流患者的建議飲食 ( induction reflux diet ) <div class="MsoNormal">
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">脫脂牛奶或豆奶<span lang="EN-US"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">米、糙米、麵包<span lang="EN-US">(</span>全麥或黑麥<span lang="EN-US">)</span>、全麥餅乾、全麥早餐穀物、麵包圈<span lang="EN-US">(</span>貝果<span lang="EN-US">)</span>、鬆餅<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">燕麥片<span lang="EN-US">(</span>全粒穀物<span lang="EN-US">)</span>、通心粉或義大利麵<span lang="EN-US">(</span>不加酸醬<span lang="EN-US">)</span>、馬鈴薯、玉米花<span lang="EN-US">(</span>原味、加鹽、無奶油<span lang="EN-US">)<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">蔬菜
<span lang="EN-US">(</span>洋蔥、蕃茄、胡椒以外的蔬菜或根菜<span lang="EN-US">)</span>、菇類<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">龍舌蘭、蘆薈、芹菜、歐芹、蕪菁甘藍、茴香、薑<span lang="EN-US">(</span>根、粉、醃<span lang="EN-US">) <o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">豆類<span lang="EN-US">(</span>黑豆、紅豆、青豆、扁豆<span lang="EN-US">)</span>、豆腐<span lang="EN-US"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">蛋白<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">魚類<span lang="EN-US">(</span>烤、煮、烘、蒸<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">雞肉<span lang="EN-US">(</span>烤、煮、烘、蒸、去皮<span lang="EN-US">) </span>雞胸<span lang="EN-US">(</span>有機、去皮<span lang="EN-US">) <o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">雞湯、牛肉清湯、家常湯<span lang="EN-US">(</span>加麵或蔬菜<span lang="EN-US">) <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">草藥<span lang="EN-US">(</span>胡椒、柑橘、大蒜、芥末 除外<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">橄欖油<span lang="EN-US">(</span>每日最多二湯匙<span lang="EN-US">)</span>、香醋<span lang="EN-US">(</span>每日最多一茶匙拌沙拉<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">糖精<span lang="EN-US">(</span>每日最多二茶匙<span lang="EN-US">)</span>、焦糖<span lang="EN-US">(</span>每週最多四湯匙<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">蜂蜜<span lang="EN-US"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">香蕉、瓜類<span lang="EN-US">(</span>密瓜、甜瓜、西瓜<span lang="EN-US">)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">甘菊茶、咖啡<span lang="EN-US">(</span>每日最多一杯,最好加奶<span lang="EN-US">)<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;">(</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">摘自<span lang="EN-US">JA
Koufman: Annal Oto Rhinol Laryngol 2011. 5)<o:p></o:p></span></span></div>
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<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-1361701632170458372013-11-11T06:15:00.002-08:002013-12-29T03:04:21.753-08:00「聲音沙啞」與「咽喉胃酸逆流」 <div class="MsoNormal">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">大部分「聲音沙啞」的病人有「咽喉胃酸逆流」的問題,這是一種常見的聲帶炎,但病人聽到醫生說是因為胃酸逆流,往往露出難以置信的表情,因為大部份患者沒有噁酸或</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">胸口灼熱的胃酸逆流</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">感,只有</span><span style="background: white; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana; mso-pattern: solid white; mso-shading: white;">咽喉症狀,如聲音沙啞、清喉嚨、咳嗽、咽喉異物感、鼻涕倒流感、喉嚨痛、喉嚨敏感等等,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">而且胃鏡檢查時常看不到明顯的胃食道逆流,尤其咽喉與胃的距離又比食道遠,所以病人難以想像其因果關係,對後續的長期治療半信半疑,因而影響治療效果。
<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">「</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">咽喉胃酸逆流</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">」</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">是近年來才受到重視的問題,它也是一種吞嚥道蠕動機能障礙,對逆流的胃液排空不良,但與腸胃科「胃食道逆流」的致病機轉不大相同。胃酸逆流造成的發炎和組織傷害,其實是胃蛋白脢的作用,胃酸只是用來活化胃蛋白脢。咽喉對胃酸的忍受度比食道低很多,弱酸就能活化咽喉組織中隨胃液逆流而來的胃蛋白脢,造成聲帶發炎和組織傷害,因此</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">「</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">咽喉胃酸逆流</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">」患者的咽喉特別敏感,</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">除了逆流的胃酸<span lang="EN-US">(</span>弱酸<span lang="EN-US">)</span>之外,酸性食物也會直接活化咽喉組織中的胃蛋白脢,所以病人不一定有溢胃酸的感覺,也時常在胃鏡檢查看不出「胃食道逆流」,但在咽喉內視鏡下可以看到一些特殊的現象。<span lang="EN-US"><o:p></o:p></span></span></div>
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</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">「</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">咽喉胃酸逆流</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">」的治療與腸胃科的</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">「胃食道逆流」不大相同</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">,除了之前「嗓音保健<span lang="EN-US">(</span>二<span lang="EN-US">)</span>如何預防</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">咽喉胃酸逆流<span lang="EN-US">?</span></span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">」一文所述的飲食生活習慣和睡眠情緒調整、避免過度刺激胃酸分泌、改善咽喉腸胃蠕動功能,以及長期的藥物治療之外,必須特別注意避免可樂、柑橘、酸辣醬等酸性食物,以及使用</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">酸性添加劑的飲料和罐頭,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">如需食用此類食物,可同時以穀物或低脂牛奶中和之。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-ansi-language: EN;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-ansi-language: EN;">近年來胃酸逆流的病患越來越多,也有年輕化跡象,相關的嗓音問題、上呼吸道炎症、敏感性疾病,以及咽喉或食道癌也逐年增加,所以「咽喉胃酸逆流」的病人應該接受胃鏡檢查,以排除胃食道癌或潰瘍的可能,對胃鏡檢查看不到明顯胃食道逆流的「咽喉胃酸逆流」患者,健保亦應給付降低胃酸的</span><span style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: 新細明體;">氫離子幫浦抑制劑</span><span lang="EN" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-ansi-language: EN;"> (PPI)</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-ansi-language: EN;">,才能符合現代醫療之需要。<span lang="EN"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。 </span><span lang="EN" style="color: #444444; font-family: "新細明體","serif"; font-size: 14.0pt; mso-ansi-language: EN; mso-bidi-font-family: 新細明體;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-16113523926466612942013-10-27T23:00:00.000-07:002013-12-29T03:06:16.889-08:00聲音沙啞的迷思(三): 嗓音美容 <div class="MsoNormal">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">我能不能變成林志玲的聲音<span lang="EN-US">? </span>聽說有「嗓音美容」,這是最近常被問到的問題,但答案當然是否定的,因為這是中文用詞造成的誤解,這種自創的名詞雖然很有吸引力,但嗓音治療和美容的觀念,其實有相當大的出入。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">每個人都有不同的聲音,而且難以改變,使用頻譜分析可以看到類似指紋的特徵,這就是所謂的「聲紋」,它可以用來辨識發聲者。由於嗓音特質難以改變,所以對嗓音有問題的人,治療的目標是要恢復原來健康的聲音或改善發聲機能,不是要變成另一個人的聲音,它和美容不同,這是應該知道的觀念,不過發聲的習慣或講話的口氣、語調,則可以藉訓練加以改善或模仿。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">嗓音難以改變的根本原因在音質,而音質又由非常細緻的聲帶構造和機能來決定,其間的關係非常精密,肉眼看不到的組織變化就會影響音質,難以用美容的觀念加以調控,改變音質的方法目前仍在研究階段,所以有些嗓音異常,如聲帶溝、結疤、萎縮或老化的治療,主要是針對聲門閉鎖不全,減少發聲吃力的問題,至於音質則尚無穩定有效的改善方法,不能過度期待。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">上帝給我們這個難題,似乎在暗示<span lang="EN-US">: </span>美聲難以強求,不如講求公義。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-48833769659981770162013-10-20T03:13:00.000-07:002013-12-29T03:08:00.045-08:00聲音沙啞的迷思(二): 忽視多重因素 <div class="MsoNormal">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">一般人用「聲音沙啞」來表示發聲有問題,而且對各種發聲障礙往往只注意單一的原因,但其實「聲音沙啞」大多是多重因素造成,如果病患缺乏了解和配合,治療效果就會大打折扣,所以專業醫師看診的時候,須要顧慮並解釋複雜的因素,相當費神又費時。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">在各個多重因素當中,最常見的是咽喉胃酸逆流,因為至少有一半聲音沙啞的病人和它有關,但它和腸胃科的胃食道逆流不同,病人大多不會自覺有溢胃酸,咽喉胃酸逆流的因素,除了體質和飲食生活習慣之外,也和睡眠、情緒有關。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">其次,發聲習慣不良或肌肉緊張、粘膜乾燥也是常見的因素,它又與情緒、個性和用聲的多少或水分的補充有關,但也可能是聲門閉鎖不全或聲帶震動不良導致的代償作用。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">此外,聲帶和其他發聲器官的老化,也時常和聲音沙啞的因素混在一起。至於使用某些藥物或荷爾蒙的問題,以及過敏、新陳代謝、神經肌肉或精神心理病變,也可能影響聲音沙啞。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">所以,治療「聲音沙啞」,不能只注意聲帶構造的變化或其他單純的原因,上述多重因素往往共同存在,需要病患的了解和配合,並接受全面的治療,才能達到根本和長期的效果。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-92183074708113496382013-10-19T08:13:00.003-07:002013-12-29T03:09:26.940-08:00聲音沙啞的迷思(一): 名稱的問題 <div class="MsoNormal">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">聲音沙啞是相當常見的問題,但是很多人往往會有一些不切實際的觀念,而無法客觀面對、適當處理。茲將幾種迷思,分別以短文說明。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">「聲音沙啞」的名稱問題,在於「沙啞」的字義是聲音粗糙、難以發聲的意思,一般人用它來表示發聲有問題,但事實上在各種發聲障礙的疾病當中,只有部份疾病以「聲音沙啞」來表現,所以它是一種非科學性的慣用統稱,會讓人忽視其他不以「聲音沙啞」來表現的發聲障礙疾病。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">發聲障礙的表現方式,除了「沙啞」,亦即聲音粗糙<span lang="EN-US">(rough)</span>之外,也常見「氣聲<span lang="EN-US">(breathy)</span>、無力<span lang="EN-US">(asthenia)</span>、</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">痙攣<span lang="EN-US">(spastic)</span>、顫抖<span lang="EN-US">(tremor)</span>、複聲<span lang="EN-US">(diplophonia)</span>、假聲<span lang="EN-US">(falsetto)</span>」或混合性的症狀等等,而且也各有不同的治療方式。所以</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">「聲音沙啞」雖然是一般人慣用的統稱</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">,但不能因為</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">字義,窄化了發聲障礙的觀念。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">此外,中文也常以「嗓音」來表達動物發出的聲音,「嗓」是喉嚨的意思,但實際上「發聲」還包括很重要的呼氣運動和共鳴,所以「嗓音」這個名詞也容易造成不正確的觀念,而影響判斷和治療,這些都是缺乏科學性的慣用語可能導致的問題,需要予以注意和澄清。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-21558989744939461932013-10-06T06:45:00.002-07:002014-01-08T01:51:34.350-08:00性荷爾蒙與更年期對女性聲音的影響<div class="Style-1" style="line-height: 150%;">
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">為何青春期之後,男女聲音就有明顯的不同<span lang="EN-US">? </span>因為聲帶和喉組織具有各種性荷爾蒙感受器,其中男性主要是雄激素<span lang="EN-US">(androgen)</span>感受器,女性則具有雌激素<span lang="EN-US">(estrogen)</span>、黃體素<span lang="EN-US">(progesterone)</span>和雄激素<span lang="EN-US">(androgen)</span>感受器,這些感受器在青春期接受不同種類和數量的荷爾蒙作用,造成不同的聲帶和喉組織之構造變化,所以發出的聲音男女有別。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">在女性的月經週期當中,月經來潮前到月經期間,因為黃體素<span lang="EN-US">(progesterone)</span>和雌激素<span lang="EN-US">(estrogen)</span>分泌量的變化,有些女性會發生聲帶腫脹、微血管擴張和震動性變差的現象,導致發聲疲累、音域變窄和共鳴減少等問題,這就是所謂的「經前嗓音症候」<span lang="EN-US">(premenstrual vocal syndrome)</span>,不過這種變化通常很細微,對職業用聲者比較有影響,所以在這段期間不要勉強用聲。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">女性到更年期以後,因為雌激素<span lang="EN-US">(estrogen)</span>和黃體素<span lang="EN-US">(progesterone)</span>分泌量降低,造成很多更年期的問題,其中「更年期嗓音症候」<span lang="EN-US">(menopausal
vocal syndrome)</span>比較容易被忽視,這種症候是因為更年期後,逐漸發生的各種聲帶組織之失衡和萎縮,這些變化會導致聲音沙啞、粗造、音調降低、音域變窄、聲音強度減少和喉嚨乾燥等問題,雖然這些問題也是一種老化現象,但對聲音質量要求比較高的職業用聲者,必需在診斷上列入考量,需要時建議補充荷爾蒙,以改善聲音症狀或延緩惡化。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">歡迎轉寄,引用請註明出處。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-15159911385056851952013-09-23T03:36:00.001-07:002013-12-29T03:14:02.640-08:00卡拉OK對健康的好處<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "新細明體","serif";"> </span><span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;"> </span><span style="font-family: 新細明體, serif; font-size: 14pt; line-height: 150%;">一般人唱卡拉<span lang="EN-US">OK</span>主要是為了社交和娛樂,但歌唱也是一種運動,對身體健康具有多方面的好處:</span><br />
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體;">一、</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">可以幫助減肥<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">肥胖是現代文明病,對身體健康威脅很大。一個普通體重的成年人,每天的基礎代謝和日常活動所需的熱量約兩千卡路里,所以每天吃進去的食物熱量超過兩千卡,就會逐漸肥胖。因為唱歌是一種運動,會燃燒醣類及中性脂肪<span lang="EN-US">(</span>即三酸甘油脂,是體內脂肪的一種<span lang="EN-US">)</span>,以提供需要的熱量,運動越久,中性脂肪消耗的比重越大,而人體皮下大部分是中性脂肪,所以想減肥又不喜歡運動的人,唱卡拉<span lang="EN-US">OK</span>是一個好方法,但必須持之以恆,也不能同時大吃大喝。有人計算唱一首歌消耗的熱量,依歌曲的不同大約<span lang="EN-US">5</span>到<span lang="EN-US"> 20</span>卡,耗氧量可以和跑一百公尺相當,在划步機上手腳輕鬆運動半小時約消耗<span lang="EN-US">100</span>卡,體重減輕一公斤需消耗<span lang="EN-US">7000</span>卡。<span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體;">二、</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">調和自律神經<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歌曲是一種具有美感和情感的旋律語言,不管聽或唱卡拉<span lang="EN-US">OK</span>,自然會感受或發洩這種情緒,尤其銀幕上適時顯現的歌詞,大幅降低了記憶歌詞的困難,讓唱歌變得很容易、輕鬆,唱歌時傾聽旋律和節拍,同時必須看銀幕上隨時變化的歌詞,以及優美的風景或正妹、型男,不覺中就會忘記煩惱,放鬆情緒的緊張與壓力,所以深受情緒影響的自律神經會受到調和,進而影響其控制的各種組織器官功能。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">三、促進排便功能<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">前面提到唱卡拉<span lang="EN-US">OK</span>能舒緩情緒,調和自律神經,而與排便有關的腸胃蠕<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">動,就是由自律神經控制,因為情緒放鬆,自律神經中的副交感神經才不會被交感神經過度壓抑,副交感神經可以促進胃腸蠕動和排便功能。此外,唱
歌需要運用腹式呼吸法,也就是唱歌發聲的力道,來自於腹部對呼氣的控制,所以腹腔周圍的肌肉會有比較多的收縮運動,造成腸胃擠壓、按摩的效果,可以改善胃腸蠕動,防治便秘。<span lang="EN-US"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體;">四、</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">改善月事失調<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">月經週期和性荷爾蒙的分泌有關,這些荷爾蒙的分泌又受到心境和情緒的影響,唱卡拉<span lang="EN-US">OK</span>時,心情很容易被銀幕上的歌詞和影像,帶入歌曲的情境,大部分歌曲的創作,又都為了抒發男女情感,所以唱卡拉<span lang="EN-US">OK</span>不覺中會進入這樣的想像和意境,進而刺激腦下垂體,調節性荷爾蒙分泌,因而改善忙碌、緊張引起的荷爾蒙分泌不順和月事失調。 <span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。<span lang="EN-US"><o:p></o:p></span></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-79131583900702956522013-09-22T08:17:00.002-07:002013-12-29T03:16:14.155-08:00卡拉OK用聲要領....給非專業歌唱者<div class="MsoNormal" style="line-height: 150%; margin-left: 7.0pt; text-align: justify; text-justify: inter-ideograph;">
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <span lang="RU"> </span></span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">每一個人都有不同的歌唱天賦,如何唱好卡拉</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">OK? </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">答案雖然不盡相同</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">,但本文以作者平凡的歌唱天賦、過去很少開口唱歌、高音唱不上去的狀況,後來根據音聲<span lang="RU">(</span>嗓音<span lang="RU">)</span>醫學和歌唱的知識自我練習,多數的歌不但唱得上去,而且還唱得不錯之經驗,再加上音聲醫學的觀點,介紹卡拉</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;">OK</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">的演唱要領,希望能切合一般人唱歌時面臨的困難和需要,相信只要依循這些原則做聽唱練習,盡量培養音感,正確的活化發聲肌肉之運動與協調,就能充分發揮自己的嗓音特質。<span lang="RU"> </span></span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">一、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">歌唱的呼吸支持要正確</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">良好的呼吸支持是正確發聲和避免肌肉過度緊張的基礎,它不僅是歌唱的唯一動力來源,也是演唱的一個重要技巧,其要領就是多運用腹式呼吸法,也就是歌唱時呼氣和控制發聲動力的感覺是在腹部,不是在喉部,喉部的動作只是被動的配合,如此才能放鬆咽喉和口腔,發揮最佳之肌肉彈性和共鳴效果</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">。因為人體呼吸的原理是來自於兩組呼吸肌肉群的收縮和放鬆,一呼一吸不用學,但歌唱時這兩組呼吸肌肉群的運作就跟平時的呼吸不一樣,兩組呼吸肌肉群必須彼此互相抗衡,也即是吸氣肌肉群去抗衡呼氣肌肉群,因此歌唱時腹部不會很快的往內收縮,它是歌唱中控制聲音變化的一個重要機轉。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">二、運用最佳發聲共鳴位置</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">卡拉<span lang="RU">OK</span>人人會唱,但每次唱完若感覺不自然、不舒服,喉嚨緊緊的,大多因為呼吸支持不正確,或採用喉音歌唱,缺乏共鳴所致,人的最佳音色共鳴位置是採用鼻腔共鳴,它可以使聲音明亮、圓潤、咬字清晰、音準較佳,以及減少喉音和喉肌的緊張。發聲的共鳴除了要有好的呼吸支持之外,對一般人來講比較抽象、難學,建議模擬貓頭鷹
ㄨ(嗚)<b><span lang="RU">------ </span></b>的叫聲練習高音,學山羊ㄇㄟ<b><span lang="RU">------</span></b>的叫聲練習低音,當發出的聲音具有鼻腔共鳴時,以手指觸摸上顎可感覺到振動,若能善加體會和運用,就能發揮優美的音色,也會讓音域擴大,這是很重要的歌唱技巧。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">三、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">學會聽伴奏音樂</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">唱卡拉<span lang="RU">OK</span>時,會習慣性看字幕唱歌,而忽略聽伴奏音樂,但字幕出現的時間時常不大正確,所以必須根據伴奏音樂,才能配合正確的節拍,讓歌聲有優美的音樂襯托。伴奏音樂都有一定的節拍及速度,通常由低音樂器如鼓、低音大提琴等來掌控節拍速度,輔以高音樂器來吹奏弦律曲調,只要經常注意去聽,聽得懂,聽得熟練,久了你就可以配合伴奏音樂來唱歌了。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">四、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">學打拍子並適當的換氣</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">節奏拍子是歌曲的骨幹與根基,經常發現唱卡拉ok時,兩眼直盯著螢幕,等著歌詞出現才唱出聲音,歌聲往往比伴奏音樂慢半拍,或者長短音參差不齊,其實卡拉ok歌曲大致是每小節三拍或四拍的結構,簡單易學,不過要注意歌詞中,半拍或一拍半的字及其位置,這是重要的節奏變化韻味。至於何時換氣較佳<span lang="RU">? </span>原則上歌詞的逗點或句點,皆是最佳的換氣時間。總之,要以「有足夠的呼氣」來發聲為原則,呼氣不足時就必須換氣,如此才能放得開、輕鬆唱。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">五、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">唱出歌詞中有音調變化的字</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">每一首歌的歌詞當中,多少都要藉一些需要變化音調的單字,來表現韻味和美感,這些轉變音調的地方在歌譜上會標示出來,但一般人唱卡拉<span lang="RU">OK</span>並不會看歌譜,也不容易在伴奏中聽出,這種音調的變化雖然短暫、細微,但卻是唱得好不好聽的一個重要關鍵,所以學唱的時候,要仔細傾聽、模仿歌手唱有音調變化的字,唱出的歌才不會平淡無味。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">六、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">唱適合自己音域的歌曲</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">每個人天生聲帶的長短厚薄,以及咽喉口腔和鼻腔的大小粗細,影響一個人音域的寬度、高低和共鳴,訓練雖然可以進步,但有其極限,無法勉強。因此選擇適合自己音域的歌曲就格外重要,例如男生最好選擇男歌手唱的曲子,女生選擇女歌手的曲子,音域較低者選擇低音歌手的曲目,較高者則選擇高音歌星的曲目,如此才不會在歌唱中出現緊繃刺耳的聲音。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">親愛的朋友,唱歌是為了紓解生活中累積的壓力,發洩情緒,而不是再給自己增加壓力和挫折感!相信只要依據本部落格:如何健康的使用聲音?一文,以及前述的歌唱要領,加以體會學習,將可以為你帶來無限的輕鬆和享受。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"> <o:p></o:p></span></div>
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<span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: 新細明體; mso-fareast-language: ZH-TW;">歡迎轉寄,引用請註明出處。</span><span lang="RU" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-language: ZH-TW;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-6619529614542933582013-09-21T08:21:00.001-07:002014-01-08T01:34:17.382-08:00聲音保健(二) 如何預防咽喉胃酸逆流?<div class="MsoNormal" style="line-height: 150%; mso-char-indent-count: 2.0; text-indent: 24.0pt;">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">胃酸逆流到咽喉會發生組織發炎和敏感度增加等反應,這個問題和聲音有密切關聯,在症狀上大多沒有自覺胃酸逆流,而是以聲音沙啞、喉嚨卡卡的感覺、咳嗽清喉嚨和喉嚨敏感最常見,有些人有痰多、痰黏、異物感、鼻涕倒流感、喉嚨痛、胸痛、氣喘、口臭、牙齦糜爛、噁酸或心灼熱等現象,也有很多人沒有自覺症狀,胃鏡檢查也還看不出胃食道逆流。其原因主要是胃食道交接處的括約肌太鬆、胃酸分泌過多、胃食道排空不良、腹壓太大、藥物或食物刺激引起,此外飲食、睡眠習慣不良或情緒壓力都會導致胃酸逆流。用咽喉內視鏡檢查可以看見聲帶及喉部組織發炎腫脹,聲帶上也常見粘稠分泌物。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">在預防上要針對上述原因,少吃咖啡、可樂、茶、酒等含咖啡因或酒精的食物、高油脂或酸辣食物、巧克力或其他甜食、薄荷、番茄製品,以及汽水、洋蔥、韭菜等產氣食物,此外不抽煙、吃飯八分飽、不吃宵夜、不亂吃藥、睡前兩小時禁食(但可喝少量水)、飯後不馬上平躺或激烈運動、飲食有規律、睡覺時頭及上半身墊高、避免熬夜或失眠、維持輕鬆的情緒、不穿很緊的褲子、減去多餘的體重,都能減輕咽喉胃酸逆流,當咽喉有痰或異物感時也不要用力清喉嚨,要以喝水來減少胃酸的刺激。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">在治療上要養成預防胃酸逆流的飲食生活和睡眠習慣,並放鬆情緒,較嚴重者可使用中和胃酸、改善吞嚥消化道蠕動排空、減少胃酸分泌的藥物,甚或做抗逆流手術。咽喉胃酸逆流是最常見的聲音障礙原因,需要注意和排除。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-2997738833417905462013-09-21T08:18:00.001-07:002014-01-07T20:13:58.941-08:00聲音保健(一) 如何健康的使用聲音? <div class="MsoNormal" style="line-height: 150%;">
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">之前介紹過「發聲機轉」和「音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>障礙」,因為文章主題具專業學術性,讀起來可能比較艱澀,現在我們要進入比較輕鬆且和每個人切身相關的保健單元,筆者盡可能用簡單、易懂的方式表達,希望能提供正確的概念和簡要的查詢資料。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發聲講話或唱歌是人類特別發達的能力,雖然使用非常頻繁,而且輕易、自然,但其實牽涉的器官和功能非常廣泛,是人體最精密、複雜的運動,因此也容易發生各種問題。筆者長期從事喉科專業醫療,看到很多人因為缺乏「聲音問題大多可能自癒、可以預防、個人嗓音特質難以改變」等基本觀念,而沒有適當的面對問題,所以本文特別介紹正確使用聲音的十個要點,這些常識對維護嗓音健康很重要。</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">以下先介紹正確使用聲音的十個要點:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">1</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">足夠的睡眠和穩定的情緒:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發聲是非常精密複雜的運動,足夠的睡眠和穩定的情緒可以讓肌肉充分的休息、放鬆,發聲時肌肉才有充分的彈性,不會很快疲勞、僵硬,此外也可以調和自律神經,讓黏液腺分泌充足的黏液,以維持聲帶表面的潤滑和黏膜的柔軟,順利完成聲帶震動發聲,這些都是嗓音健康的基礎,所以當睡眠和情緒不佳時,要少用聲音,並避免大聲吼叫,否則可能導致聲帶發炎、息肉,或長期反覆而造成肌肉緊張性音聲障礙、聲帶結節。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">2</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">攝取足夠的水分:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
<o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發聲需要靠呼氣來推動,這種空氣流動會增加水分消耗,通常每人每日需要攝取約</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">2000cc</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">的水分,不要等到口渴才喝,而是要少量多次,一次灌太多水反而容易引起腹脹等腸胃問題而影響發聲。總之,攝取足夠的水分才能維持身體代謝的平衡和穩定濕潤的咽喉黏膜,以應健康發聲之需要。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">3</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">避免吸食刺激物:</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">刺激性的食物如菸酒、辣椒,以及含咖啡因的飲料,會造成聲帶黏膜的刺激<span lang="EN-US"> </span>或讓自律神經興奮,導致聲帶黏液分泌不穩定或過度敏感而阻礙發聲,若需要<span lang="EN-US"> </span>吸食這些刺激物,則可再喝些溫開水,以減少刺激。至於這些食物可能造成胃<span lang="EN-US"> </span>酸逆流而影響聲音的問題,待下一篇嗓音保健(二)再介紹。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">4</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">聲音的休息要足夠:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發聲是一種非常精密複雜的運動,當然也需要休息才不會疲勞,所以除了充足的睡眠之外,原則上一天至少要有兩、三次,每次二、三十分鐘以上的完全禁聲休息,才不會因肌肉疲勞導致聲音緊張、無力、發聲疼痛、慢性聲帶炎或聲帶結節等問題。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">5</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">在吵雜的環境少用聲音:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">在吵雜的地方說話,必須和環境噪音競聲,而且不容易聽到自己的聲音,不覺中會用過度緊張的肌肉和過大的音量說話,這種難以自我控制的發聲方式,容易引起各種音聲障礙,若職業上需要,建議使用麥克風或耳機。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">6</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">用適當的音量說話:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">通常適當的音量是在伸手可及的距離,讓兩三個人可以聽到的程度,發聲共鳴好的人,聲音的投射效果較佳,發聲時覺得喉頭緊或不舒服,要注意是否音量過大,若長期要用較大的音量,需使用麥克風,否則可能造成聲帶炎、息肉或發聲肌肉緊張等相關問題。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">7</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">用自然的音調說話:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">每個人聲帶和咽喉的構造都有些差異,所以會有不同的基礎音調,這種音調的高低,可以由咳嗽、呵欠的聲音或</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">ma ma</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">等基本發聲動作聽出來,也可以用樂器的音階來找</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">key</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,用這樣的音調發聲最輕鬆自然,如果時常用不適合自己的音調講話,就會增加聲帶的緊張和負擔,而容易疲勞或導致肌肉緊張性音聲障礙。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">8</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">用適當的呼吸和速度說話:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">呼吸的配合是很重要的發聲基礎,雖然說話的速度每個人不同,但原則上說八到十個字就要停下來換氣,讓發聲有充足的呼氣支持,如此才能放鬆喉嚨肌肉,也讓說話的速度不致太快,在氣不足時繼續發聲,容易發生肌肉緊張性音聲障礙或其他相關問題。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">9</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">做放鬆喉嚨的動作:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">喉嚨放鬆可以讓發聲更有彈性,音質和共鳴更好,而且不易疲勞,要達到這個目的,除了前述的要點之外,發聲前做嘴巴張合運動或做母音練習,發聲時口部動作加大,都可以讓喉嚨放鬆,口部動作大也可以降低說話速度,讓咬字有連貫性,此外說話時頸肩的動作或走動等肢體語言,也能減少喉嚨緊張。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">10</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">感冒的時候少用聲音:</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> <o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">通常感冒會引起上呼吸道發炎腫脹,而影響發聲和共鳴,此時聲帶黏膜及其下微血管等組織最為脆弱,如果再過度或不當的發聲,則容易造成聲帶震動區域的組織傷害,導致慢性聲帶炎或聲帶息肉,所以感冒時,不論有沒有引起聲音沙啞,減少用聲、多休息,就是最有效的治療方法。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">
</span><span lang="EN-US" style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-44469523309186018222013-09-21T08:12:00.001-07:002013-12-29T05:40:05.324-08:00音聲(嗓音)障礙(二)<div class="MsoNormal" style="line-height: 166%;">
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">五、</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%;">聲帶溝或疤痕(<span lang="EN-US">vocal sulcus or scar</span>)</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">聲帶溝是最常見的先天性聲帶異常,通常在青春期聲帶發育後才會表現出聲音尖、粗、不宏亮和發聲吃力的現象,嚴重者發聲時漏氣的現象明顯,會影響社交和工作。理學檢查要在充足的光源和放大的內視鏡或頻閃光源喉鏡錄影下仔細觀察,才容易在聲帶上看到這種縱向疤痕狀凹陷,它會影響發聲時的聲帶振動和黏膜波動,這種構造異常的嚴重度,個別差異很大,輕微者的嗓音症狀不明顯,嚴重者聲帶會呈現萎縮狀態,造成聲門閉鎖不全。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">治療上可嚐試自體脂肪注射或使用甲狀軟骨成形術讓聲帶增厚,或施以特殊的黏膜下顯微手術,這些方法能改善聲門閉鎖的功能,對音質的問題,則只有重度患者才可能有比較明顯改善。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">這種患者通常不建議從事必須常用聲音的工作,因為容易造成肌肉緊張性音聲障礙或息肉,但發聲訓練也能減少這些問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">聲帶疤痕是聲帶經過發炎、外傷或手術引起的傷口結疤現象,臨床症狀及治療方法和聲帶溝相似,因為很小的疤痕就會影響音質,這種音聲障礙在治療上還是難題,但以小量多次的類固醇注射疤痕,可能有些軟化效果。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">對這種難治的聲音沙啞,還有很多細節有待進一步研究和突破。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">六、老化或萎縮(<span lang="EN-US">senile change or atrophy</span>)<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">因為發聲相關器官的老化或萎縮,老年人的聲音常有無力、漏氣、沙啞、顫抖的現象,有些人為了克服這些現象,導致肌肉緊張性音聲障礙,此外發聲的音調也會隨著年齡而改變,女性在更年期後逐漸降低,男性中年之後逐漸升高,在聲帶上可見黏膜厚度、硬度及其下<span lang="EN-US">Reinke’s space</span>的鬆緊變化,而且聲帶肌肉的老化萎縮也會造成聲門閉合不全,這些現象也可能發生在比較年輕的人,但原因不明,這種嗓音障礙嚴重者,可用某些聲帶注射或手術增厚的方法來改善。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">七、荷爾蒙性嗓音障礙(<span lang="EN-US">hormonal voice disorder</span>)<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">人類喉頭聲帶上有男性荷爾蒙受體,所以在青春期發育後,男女就有比較大的差異,男性聲帶會因男性荷爾蒙而變粗長、音調降低,而女性若使用男性荷爾蒙藥物,則會造成聲帶和聲音男性化,因為這是不可逆的組織變化,而且聲帶的構造和發聲機轉又極其精密,目前還沒有理想的方法來逆轉</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Georgia;">,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">雖然有報告指稱某</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Georgia;">些甲狀軟骨成型或聲帶手術,對提高音調可能有效果</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">,但這仍然是男性變性者,難以解決的問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">八、變聲性假嗓(<span lang="EN-US">mutational falsetto</span>)<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">在青春期喉頭聲帶受荷爾蒙的作用而發育,聲帶變得粗長,音調降低,如果下意識抗拒這種改變,就會使用弱小的呼氣和拉緊的聲帶,發出像童音的假嗓音,成為習慣後就不易改變,它通常不是喉頭聲帶發育的問題,接受發聲訓練就能矯正。<span lang="EN-US"><br />
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">九、轉化性音聲障礙(<span lang="EN-US">conversion dysphonia</span>)<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">發生的原因是長期或突發性的情緒壓力,引起喉部肌肉功能失調,嗓音的表現具多樣和不持續性,最常見的是喑啞或耳語聲,喉內視鏡檢查可見聲門閉鎖不全或無異狀,在治療上,除了發聲訓練之外,要讓患者瞭解病因,消除心理因素,才會有比較好的效果。<span lang="EN-US"><br />
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">十、神經肌肉性音聲障礙(<span lang="EN-US">neuromuscular voice disorder </span>)<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">1.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">單側聲帶麻痺(<span lang="EN-US">unilateral vocal fold paralsis</span>)<span lang="EN-US">: </span>聲帶很重要的運動,就是發聲時兩側聲帶內轉靠攏,呼吸時兩側外轉張開,這種功能分別由喉內轉肌和外轉肌來帶動,這些肌肉又受到喉神經的協調控制,當一側喉神經受到發炎、手術或腫瘤等因素之侵害,就會造成該側聲帶麻痺而無法轉動,當不動的聲帶距離兩側正常靠攏的聲門中線越遠,漏氣性的聲音沙啞<span lang="EN-US">(</span>氣聲<span lang="EN-US">)</span>就越嚴重,或造成代償性的假嗓音。處置上要先排除腫瘤的因素,然後在神經自行復原的三到六個月期間,觀察嗓音進步的情形,若三到六個月後仍有音聲障礙,採用某些注射或手術的方法讓聲帶增厚或內轉,就能有效改善聲門閉鎖不全</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%;">引起的聲音沙啞。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">此外最近的研究也顯示,早期注射暫時性填充物於麻痺聲帶肌肉,讓兩側聲帶可以靠攏震動,可能會幫助神經再生,減少肌肉萎縮。<span lang="EN-US"> </span></span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">2.
</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">雙側聲帶麻痺(<span lang="EN-US">bilateral vocal fold
paralsis</span>):發生的原因和單側麻痺相似,但比較少見,它會造成兩側聲帶無法轉動,通常發生初期呈現聲音沙啞,但兩側聲帶會逐漸向聲門中線靠攏,此時聲音雖然改善,但無法外轉的聲帶會造成呼吸阻塞。治療上除非做氣管切開,再壓住氣切口發聲,否則音聲和呼吸很難兼顧,所以雙側聲帶麻痺仍是醫學上棘手的問題。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">3.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">中樞性麻痺<span lang="EN-US">(high level or central vocal palsy): </span>由於喉神經源於腦中樞,中樞神經病變也會造成聲帶麻痺,不過兩側喉神經在腦幹中樞有複雜的交叉,這種麻痺會呈現不規則的聲帶颤動和音聲症狀,目前尚無有效治療方法。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%;">4. </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">運動協調障礙(<span lang="EN-US">coordination disorder</span>)<span lang="EN-US">:
</span>比較常見的聲音顫抖(<span lang="EN-US">vocal tremor</span>)或痙攣性音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>障礙(<span lang="EN-US">spasmodic dysphonia</span>),或兩者混再一起,它被認為是發聲時,協調肌肉收縮的腦幹功能異常,造成聲帶緊張度的協調不良,不過這種病患通常無法檢查出中樞神經病變。在治療上,痙攣性音聲障礙須先與肌肉緊張性音聲障礙鑑別,再使用肉毒桿菌聲帶注射、甲狀軟骨成形術、切除部分聲帶內轉肌</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Georgia;">或神經</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">來改善症狀,但聲音顫抖的治療效較差。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">十一、聲帶囊腫或腫瘤(<span lang="EN-US">cordal cyst or tumor</span>)<span lang="EN-US">: <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 166%; mso-bidi-font-family: Verdana;">聲帶上的任何腫塊都會造成聲帶震動異常或聲門閉鎖不全,而導致聲音沙啞,其中常見的聲帶囊腫大多因為黏液腺出口阻塞引起,由於囊壁很薄且位於黏膜下,需要用精細的頻閃光源喉鏡診斷,並使用特殊的顯微手術技術,才會有較佳的治療效果,手術後造成聲帶疤痕的危險性較高,此外,運用特殊的微量類固醇局部注射技術,也可能消除囊腫。至於聲帶腫瘤,如常見的白斑和聲帶癌,早期就會聲音沙啞,用喉內視鏡雷射顯微手術治療效果良好,愈早治療聲音受到的影響愈小。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">歡迎轉寄</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;">,引用請註明出處。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-62814109971508761972013-09-21T08:10:00.001-07:002013-12-29T05:44:27.859-08:00音聲(嗓音)障礙(一)<div class="MsoNormal" style="line-height: 150%;">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>障礙<span lang="EN-US" style="background: white; mso-pattern: solid white; mso-shading: white;">(</span><span style="background: white; mso-pattern: solid white; mso-shading: white;">俗稱聲音沙啞<span lang="EN-US">)</span></span>依發生的原因,可分為機能性及器質性音聲障礙(<span lang="EN-US">functional
& organic voice disorder</span>),機能性音聲障礙是咽喉、呼吸肌肉緊張或協調不良所致,器質性音聲障礙則因聲帶或相關組織的變化引起,有些機能性音聲障礙會產生器質性病變,反之亦同。在治療方面,每個人對聲音好壞的需求不同,效果也有個異性,因此必須在各方面完整的考量,才能做適當的治療,基本上大多數機能性音聲障礙用音聲衛教或發聲復健訓練即可,但有時須配合藥物或手術,至於器質性音聲障礙通常需要手術或藥物治療及音聲衛教,茲簡介常見的音聲障礙如下:<span lang="EN-US"><o:p></o:p></span></span></div>
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</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">一、 肌肉緊張性音聲障礙(<span lang="EN-US">muscle tension
dysphonia</span>)<span lang="EN-US"> <br />
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">又稱過動性音聲障礙。其發生的原因是聲帶本身或發聲相關肌肉過度緊張或協調不良所致。這種病患</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">通常可在頸部摸到較高的喉頭位置,以及較窄的甲狀軟骨與舌骨之間隙,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">喉鏡檢查聲帶外觀正常,也常見</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發聲時後聲門閉鎖不全或<span lang="EN-US">(</span>及<span lang="EN-US">)</span></span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">較為緊縮的喉室,平常不一定有明顯的聲音變化,但長時間說話後,會出現喉嚨乾、緊、痛、發聲疲乏無力等症狀,甚至有刺耳或痙孿性的聲音。這種音聲障礙通常在聲音</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">使用較</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">多</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,而且發聲習慣不好</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">的人才會發生,但也常發生在上呼吸道感染後、咽喉胃酸逆流或使用不適當音調發聲者,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">它</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">與性格、情緒或睡眠也有關係,因此常與有咽喉異物感的「喉球症候群」(<span lang="EN-US">globus syndrome</span>)精神官能症同時存在。</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">此</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">外,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">咽喉的各種病變和</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">聲門閉鎖不全的人,也會因為過度機能代償</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">的惡性循環</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">而導致此症</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,例如上呼吸道感染或咽喉胃酸逆流引起的發炎、更年期後或老化的聲帶,以及其他各種影響聲門功能的組織構造變化,都可能造成這種代償性的音聲障礙</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">。在治療上</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">必須考量多方面因素</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,例如先排除或治療聲門構造和功能的問題,如果需要時常講話,則</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">可先给予健康用聲及預防咽喉胃酸逆流的衛教,同時</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">做發聲復健訓練,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">或進一步施與喉部按摩,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">其方法主要是減低喉部肌肉緊張,矯正發聲時呼吸、共鳴、音調、音量、速度、緊張度等相關習慣,通常每週訓練一次,為期八週,來改善發聲的技巧和效率,以承受較大的用聲量。至於因</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">組織構造病變造成</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">聲門閉鎖不全,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">或咽喉功能不良而</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">導致此症者,則</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">須先</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">針對原因予以改善。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">二、聲帶結節<span lang="EN-US"> (vocal nodule)<o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發生的原因類似肌肉緊張性音聲障礙,但產生結節需要兩個要素,即長期大量使用聲音和發聲習慣不良。組織變化的初期可能是慢性聲帶炎,再逐漸於聲帶前三分之二的中點發生表皮、甚至皮下組織增厚、變硬,而成為結節。常見於老師、經常喝斥小孩的家庭主婦及喜歡大喊大叫的孩子。臨床上出現講話後喉嚨乾、緊、痛,聲音沙啞及發音吃力等症狀。聲帶結節之所以好發於聲帶前三分之二的中點,乃由於此處為聲帶之最大振動點,兩側聲帶粘膜在此處過度碰撞所引起。對發生半年或一年以內的急性結節之治療,只要去除前述任何一個產生的要素,就可能逐漸痊癒,所以通常採用藥物、音聲衛教、減少用聲或發聲訓練。若結節持續半年或一年以上,會形成不可逆的組織變化,甚至使聲帶彈性變差,而難以完全恢復聲音。這種慢性結節外形大小和音聲症狀常有起伏變化,必須在症狀最輕的時候做治療的選擇,此時若結節小,對聲音及聲門閉合的影響不大,且無音聲的起伏或其他咽喉症狀,可不必治療,若有音聲或其他症狀,則依急性結節的方式治療,讓聲音穩定在較佳的狀態並防止惡化,同時消除其他與發聲有關的症狀。若結節較大,對聲音及聲門閉合影響嚴重,除了聲音沙啞,也會有發聲肌肉緊張的問題,則可用喉鏡顯微手術切除,或對有些較鬆軟的結節做局部藥物注射治療,之後再做發聲訓練,防止復發。至於常見的小孩聲帶結節,主要須與喉乳突瘤鑑別,通常乳突瘤的症狀會持續加重,而小兒聲帶結節則好好壞壞,只要盡量節制大聲吼叫,通常接近青春期就會自行痊癒。<span lang="EN-US"><br />
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">三、聲帶息肉<span lang="EN-US"> (vocal polyp)<br />
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">發生的原因是「發聲創傷」<span lang="EN-US">(phonotrauma )</span>,也就是先有聲帶脆弱的隱因,或先天性的聲帶溝等聲門閉鎖不佳的患者,以及吸道感染、胃酸刺激、抽菸、喝酒使聲帶微血管脆弱的狀況,此時如果大聲喊叫,就容易造成微血管破裂,滲出的血液在粘膜下形成血腫,再變成息肉,它會影響聲帶的閉合和振動而造成聲音沙啞、發聲吃力。病理檢查常見粘膜增生及粘膜下水腫,有時和聲帶結節不易分別。不過,息肉的發生率男多於女,結節則是女多於男,聲帶息肉的發生原因和說話習慣比較沒關係,是一時的發聲刺激引起,聲帶結節則與說話習慣有關。此外聲帶息肉不一定發生在聲帶前三分之二的中點,有些會在聲門前聯合或聲帶的上下方,而且大多是單側,大小差異也比較大。在治療上,以喉顯微手術或局部藥物注射為主,不過短期形成的息肉用藥物及禁聲亦可能痊癒,治療後給予音聲衛教即可。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">四、發炎性反應<span lang="EN-US"> (inflammatory
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">1.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">急性聲帶炎(<span lang="EN-US">acute corditis</span>)<span lang="EN-US">: </span>最常見的原因是上呼吸道感染,其次是刺激引起的發炎反應,如煙酒、胃酸或過度用聲等。臨床上肉眼看不出的聲帶發炎腫脹就會有明顯的聲音沙啞,治療上要注意禁聲,讓聲帶充分休息,否則復原的時間會拖長或變成慢性發炎。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">2.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">慢性聲帶炎(<span lang="EN-US">chronic corditis</span>)<span lang="EN-US">: </span>發生的原因除了反覆的急性發炎,以及長期的發聲肌肉緊張和用聲過量之外,咽喉胃酸逆流(<span lang="EN-US">laryngopharyngeal reflux</span>)是常見的重要原因,有關咽喉胃酸逆流的症狀、原因和預防與治療,請看後續音聲衛教之胃酸逆流一節。慢性聲帶炎的症狀是反覆性聲音沙啞,然後逐漸無法完全恢復,理學檢查可見聲帶上有不同程度的充血、紅腫、粗糙、硬化或白斑,治療的原則除了避免胃酸咽喉逆流或其他外物刺激之外,要避免嗓音濫用,或以發聲訓練,減少發聲時因肌肉緊張造成的聲帶刺激,若長時間不治療,聲帶變粗變硬後要改善十分困難。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">3.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">息肉樣聲帶 (<span lang="EN-US">polypoid vocal cord</span>)<span lang="EN-US">: </span>是一種特殊的慢性聲帶炎,好發於長期抽菸的女性,檢查可見聲帶上廣泛的息肉樣腫,患者音調變低、發聲吃
力,甚至造成呼吸阻塞。治療上除了戒菸並避免咽喉胃酸逆流等發炎的因素<span lang="EN-US"> </span>之外,可用特殊的喉內視鏡顯微手術去除息肉樣腫,但保留足夠的聲帶粘膜<span lang="EN-US"> </span>和粘膜下的組織彈性。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">4.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">接觸性潰瘍或肉芽腫(<span lang="EN-US">contact ulcer or granuloma</span>)<span lang="EN-US">: </span>因為發聲時肌肉緊張,造成兩側聲帶靠攏時,聲帶勺狀軟骨過度碰撞,或因為全身麻醉的喉氣管插管,造成勺狀軟骨粘膜損傷,加上咽喉胃酸</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">逆流</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">刺激就會形成肉芽腫。 在治療上,</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">要</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">去除原因</span><span style="color: windowtext; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">如治療咽喉胃酸逆流、做發聲訓練或改善聲門閉鎖不全,以減少發聲時的肌肉緊張,讓肉芽腫</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">慢慢縮小,甚至脫落。若有明顯的嗓音症狀,也可先夾除大部份的肉芽腫。<span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">5.</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Georgia;">其他如結核菌、黴菌、免疫性疾病或其他特殊原因引起的炎症。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%;">,引用請註明出處。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com0tag:blogger.com,1999:blog-5554312359809609111.post-78548813572968669622013-09-21T07:53:00.000-07:002013-12-29T05:54:09.680-08:00發聲的機轉<div class="MsoNormal" style="mso-char-indent-count: 1.5; text-indent: 18.0pt;">
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">說話和唱歌必須透過中樞神經、周邊神經、自律神經、肌肉和黏液腺等功能,對聲帶、構音及呼吸等器官做精密的協調和控制,因此發聲雖然是人類不覺中使用最頻繁的本能,但事實上是一種極其複雜、精密的生理機轉,牽涉的範圍很廣,也容易發生各種問題。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">一、動力來源</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><br />
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">發聲需要利用呼出的空氣,呼氣經由氣管至喉頭,再通過靠攏的兩側聲帶間隙,造成聲帶振動而發聲,所以呼氣就是發聲的動力來源,因為呼氣之前必須吸氣,所以發聲要靠呼吸運動,呼吸運動和全身的機能又有廣泛的牽連,這是非常重要且容易被忽視的觀念。</span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">二、聲帶振動<span lang="EN-US"><!--[if gte vml 1]><v:shapetype
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBFhJwniJgfiCaOGIHzVRLpB9tFYcWSsE_pN9OVdE7nbS9tzev1-AEk3Vm2cRlazIlDawKRDIAXE0ZCa0oNVQSAWqhCgdMnhpWyhlSdDKvqvkfkg96ZQ8gCykwxaZahVS5tf5sg2pLqHoK/s1600/glottis+open+&+closed.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBFhJwniJgfiCaOGIHzVRLpB9tFYcWSsE_pN9OVdE7nbS9tzev1-AEk3Vm2cRlazIlDawKRDIAXE0ZCa0oNVQSAWqhCgdMnhpWyhlSdDKvqvkfkg96ZQ8gCykwxaZahVS5tf5sg2pLqHoK/s400/glottis+open+&+closed.jpg" width="400" /></a></div>
<a href="http://www.blogger.com/blogger.g?blogID=5554312359809609111" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">呼吸時兩側聲帶張開,發聲時兩側聲帶向中間靠攏,呼氣再由其間隙沖出,引起兩側聲帶之振動而發聲。這種振動基本上是呼氣推開兩側閉合的聲帶,再馬上因聲帶的彈性回復閉合的狀態,是一種極快速的反覆動作,我們可以將上下嘴唇當作聲帶,粗略模擬聲帶發聲時的震動,做法是經由輕鬆閉合的嘴唇吐氣,體驗嘴唇被呼氣推開後自然彈回的反覆震動。由聲帶的橫切面來看,其游離緣是一層粘膜,附近有很多分泌黏液的小腺體,在粘膜下方則是鬆軟並富於水分的組織,稱為<span lang="EN-US">Reinke’s space</span>或<span lang="EN-US">superficial lamina propria</span>,此層的下方則是聲帶韌帶,再深處則為聲帶肌肉。發聲時的聲帶振動相當複雜,它包含內外及上下的振動,同時在聲帶表面會有由下向上的水樣波紋,稱之為粘膜波動,這種粘膜波動的狀態,與粘膜和<span lang="EN-US">Reinke’s space</span>的鬆軟度,以及聲帶肌肉的緊張度有關,它是決定音質的要素。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">三、嗓音變化</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><br />
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">除了前述聲帶振動造成不同的音質之外,比較客觀的嗓音變化就是音調和音量。音調的高低與聲帶振動的頻率有關,而聲帶振動的頻率又與聲帶的緊張度、厚度、長短,以及表面的軟硬度有關,當緊張度高、厚度薄、長度短,以及表面僵硬時,發出的音調<span lang="EN-US">(</span>音聲頻率<span lang="EN-US">)</span>較高,反之則變低,除了聲帶構造不同會造成音調不同之外,音調的高低也可由聲帶相關的肌肉來調節,例如環甲肌
(<span lang="EN-US">cricothyroid muscle</span>) 收縮會使聲帶拉緊,甲杓肌(<span lang="EN-US">thyroarytenoid
muscle</span>)收縮會使聲帶放鬆,此外音調的變化還包括其他肌肉器官的協調,以及咽喉、口腔和鼻腔共鳴的效果。至於音量的變化,則與聲帶振動的幅度有關,當振幅大時音量較大,要使聲帶的振幅大,就需要較大的聲門下呼氣壓力、聲門氣流量和共鳴。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">四、共鳴</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">發聲是說話或歌唱的基礎,聲帶震動產生的音源會經過咽喉、口腔、鼻腔和鼻竇的共鳴,此共鳴隨著這些空腔的形狀和彈性而變化,構成一個相當複雜的頻率和響度之音聲組合,此音聲組合又經過舌、腭、齒、唇的動作來改變,此改變稱之為構音,最後再成為我們實際聽到的話語或歌聲,共鳴有擴大和潤飾嗓音的作用,是重要的發聲技巧。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> 五、內視鏡檢查</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt;"><br />
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">在門診使用喉反射鏡、<span lang="EN-US">70</span>度的遠距鏡,以及由鼻腔放入的軟式纖維或電子咽喉鏡,可以觀察發聲時聲帶、咽喉和口腔的構造與運動。其中軟式咽喉鏡,可在接近自然發聲的狀態下觀察,是一種重要的發聲機能檢查。由於發聲時聲帶振動頻率每秒一百至三百次,不可能以肉眼觀察如此快速的振動,但此振動過程卻是音質非常重要的決定因素,因此目前最常使用頻閃光源做內視鏡檢查(<span lang="EN-US">stroboscopy</span>),它是一種快速閃動的光源,閃亮的頻率會隨著發聲基礎頻率而改變,當閃亮頻率和聲帶振動頻率成等差,且閃亮頻率比視覺暫留快,快速的聲帶振動看起來便成為慢速的狀態,如此才能觀測振動的過程,另外為了反覆觀察和慢速分析,也使用錄影重播,仔細評估兩側聲帶振動的對稱性、振幅、閉合性、規則性,以及粘膜波動。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: 新細明體, serif; font-size: 14pt; text-indent: 18pt;">六、嗓音評估</span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">可使用主觀評估表、錄音、聲學及聲譜分析、空氣動力及發聲能力分析,做嗓音紀錄及主客觀的評估和比較。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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<span style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt;"> </span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/03172036142410522293noreply@blogger.com1tag:blogger.com,1999:blog-5554312359809609111.post-71572105247705839282013-08-30T18:38:00.001-07:002013-12-29T05:55:50.021-08:00前言<div class="MsoNormal" style="margin-bottom: 14.0pt;">
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">筆者在長期從事音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>專業醫療及教學研究當中,</span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">時常提醒學生,遇到任何問題或做任何事情,都要進一步</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">思索其原理</span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,雖然有些原因還不是很清楚,但養成這種習慣,就能培養思考和學習的能力,在生活中自然不斷的進步。不過,對不是自己專業的問題,只需要了解</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">簡要的原理</span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">,輕鬆自然的學習和思考,就能用正確的概念做初步處置。因為在此專業精深</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">、</span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">資訊豐富,但良莠不齊的時代,對非專業領域過度自行鑽研,不但浪費時間,反而容易迷失方向,形成偏見。所以本部落格將依實際之臨床</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">經驗與學術原則,以簡要並隨時更新的嗓音保健常識<span lang="EN-US"> (</span></span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">不會用一般人不需要的艱深資料,以及片面、感性或聳動的言論和影音來吸引讀者<span lang="EN-US">)</span>,</span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">在理性、客觀和非商業性的核心價值上,</span><span style="color: #666666; font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">提供簡易、實用的資訊。</span><span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">為何在學術專業上稱人類的發聲為「音聲」? 因為它是一種複雜的人體功能,牽涉的器官不只華語俗稱的「嗓子」<span lang="EN-US">(</span>指喉頭、聲帶<span lang="EN-US">)</span>,所以若稱之為「嗓音」,則容易造成誤解而導致不當的保健觀念,此外若單獨使用「聲音」來表達人類的發聲,包括的範圍又太廣,所以在學術上我國和日本都以「音聲」來表示人類的發聲,也就是華文俗稱的「嗓音」。音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>除了是最常用的溝通、傳達工具之外,音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>和臉部表情也是人類特有的情緒表現方式,未來音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>辨識也將逐漸取代按鍵輸入,所以它是一種非常重要的功能。此外,發聲也是人類最精密和複雜的運動,此運動引起的兩側聲帶碰觸,可能造成人體最長期和頻繁的組織傷害。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">由於聲帶的構造和功能十分精密複雜,對組織的變化極為敏感,所以容易發生各種問題,但是大多可能自癒,也可以預防,此外個人先天的音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>特質,目前仍難以用所謂「整形美容」的方法加以改變,所以對音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>障礙<span lang="EN-US">(</span>俗稱的聲音沙啞<span lang="EN-US">)</span>,是「治療」而非「美容」,我們強調的是健康。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">有關發聲機轉、音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>障礙、音聲<span lang="EN-US">(</span>嗓音<span lang="EN-US">)</span>衛教、說話和唱歌,以及咽喉功能和病痛等知識,會在後續文章一一向大家介紹。<span lang="EN-US"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;"> </span><span style="font-family: "新細明體","serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Verdana;">歡迎轉寄,引用請註明出處。<span lang="EN-US"> <o:p></o:p></span></span></div>
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