= بهترین  کرج پزشک، اطفال= بهترین  کرج پزشک، جراح مغز و اعصاب= بهترین  کرج پزشک، جراح کلیه و مجاری ادرار= بهترین  کرج پزشک، دندانپزشک= بهترین  کرج پزشک، کلیه و مجاری ادرار= بهترین  کرج پزشک، آلرژی= بهترین  کرج پزشک، ارتودنسی= بهترین  کرج پزشک، بیهوشی= بهترین  کرج پزشک، پوست و مو و آمیزشی

   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ Ґ ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی   Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   () ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    Ґی ј ی یȘ   ی ی- јی Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    Ԑ ی ј ی یȘ   ی ی- јی   Ԑ   ی ј ی یȘ   ی ی- јی      ǁ  ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی     Ԑ ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی        ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی        ی ј ی یȘ   ی ی- јی    Ԑ     ی ј ی یȘ   ی ی- јی    Ԑ      ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی     Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  () ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی   Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  	 ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ѐ   ی ј ی یȘ   ی ی- јی    Ԑ       ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی    Ԑ     ی ј ی یȘ   ی ی- јی  Ґ ی ј ی یȘ   ی ی- јی  Ԑ Ґ ی ј ی یȘ   ی ی- јی  Ԑ   Ґ ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی   Ԑ     ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   _     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   ( )  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ӑ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  ѐ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   ( )  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ӂ

بهترین  کرج پزشک، جراح پلاستیک= بهترین  کرج پزشک، جراح دهان و فک و صورت= بهترین  کرج پزشک، جراح عمومی= بهترین  کرج پزشک، جراح قلب و عروق= بهترین  کرج پزشک، جراح لثه= بهترین  کرج پزشک، چشم پزشک= بهترین  کرج پزشک، خون شناسی= بهترین  کرج پزشک، داخلی= بهترین  کرج پزشک، روانپزشک= بهترین  کرج پزشک،

  آمار بازدید کنندگان                       

 

 

کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج رادیولوژی= بهترین  کرج روانشناسی= بهترین  کرج ساختمان پزشکان= بهترین  کرج سرنگ، تولید= بهترین  کرج سمعک و

 

روماتولوژی= بهترین  کرج پزشک، زنان و زایمان= بهترین  کرج پزشک، طب فیزیکی و توانبخشی= بهترین  کرج پزشک، عفونی= بهترین  کرج پزشک، عمومی= بهترین  کرج پزشک، قلب و عروق= بهترین  کرج پزشک، گوارش= بهترین  کرج پزشک، گوش و حلق و بینی= بهترین  کرج پزشک داخلی، ریه= بهترین  کرج پزشک داخلی، غدد= بهترین  کرج پزشکی باروری و ناباروری= بهترین  کرج پزشکی هسته ای= بهترین  کرج ترمیم مو= بهترین  کرج تغذیه بالینی و رژیم درمانی= بهترین  کرج دارو، پخش= بهترین  کرج دارو، تولید= بهترین  کرج داروخانه= بهترین  کرج داروی گیاهی، پخش= بهترین  کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج وبلاگ سایت گفتار توان گستر =بهترین  کرج دارو، پخش= بهترین  کرج دارو، تولید= بهترین  کرج داروخانه= بهترین  کرج داروی گیاهی، پخش= بهترین  کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج  

 گفتار در مانی  کاردرمانی  فیزیو تراپی   شنوایی شناسی بینایی سنجی   ارتوپدی فنی   

  مجلات علمی    دانشگاه ها و دانشکده ها  کلینیکهای تخصصی   مراکز توانبخشی                        

مراکز تشخیصی و  درمانی        تجهیزات پزشکی          مراکز آموزشی خصوصی

اطلاعات  پزشکان تهران                             اطلاعات پزشکان مشهد                     اطلاعات  پزشکان کرج  

اطلاعات مراکز توانبخشی و درمانی  استان مازندران

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رادیولوژی= بهترین  کرج روانشناسی= بهترین  کرج ساختمان پزشکان= بهترین  کرج سرنگ، تولید= بهترین  کرج سمعک و شنوایی سنجی= بهترین  کرج سنجش تراکم استخوان= بهترین  کرج سونوگرافی= بهترین  کرج سی تی اسکن= بهترین  کرج طب سوزنی= بهترین  کرج عطاری= بهترین  کرج عینک، واردات و صادرات= بهترین  کرج عینک سازی= بهترین  کرج

 

 صفحه اصلی 

  درباره ما 

  تماس با ما

     نظر سنجی

 تماس با شما

   نحوه تبلیغات در سایت

  مشاوره 

  لینکهای ما

  تولیدات ما

     عضویت

  
 

 


        

 

 

  ی = ј ی یȘ   ی ی- јی یј ی یȘ   ی ی- јی  = === = =     =  ј ی یȘ   ی ی- јی  = " " ј ی یȘ   ی ی- јی یј ی یȘ   ی ی- јی  ј ی یȘ   ی ی- јی ј ی یȘ   ی ی- јی = = =ی = =  ј ی یȘ   ی ی- јی  ی ی= ی= ی   =ʐ ی =  = یی  ی=јј ی یȘ   ی ی- јی  ј یј ی یȘ   ی ی- јی  ј ј ی یȘ   ی ی- јی

 

 


 

 

 

لکنت شکن دیجیتال ورژن دوј ی یȘ   ی ی- јی بهترین  کرج پزشک، جراح کلیه و مجاری ادرار= بهترین  کرج پزشک، دندانپزشک= بهترین  کرج پزشک، کلیه و مجاری ادرار= بهترین  کرج پزشک، آلرژی= بهترین  کرج پزشک، ارتودنسی= بهترین  کرج پزشک، بیهوشی= بهترین  کرج پزشک، پوست و مو و آمیزشی

لکنت شکن همراه ...ویژه رفع (stuttering) و حرکات ثانویه صورت و فکها و زبان و ایجاد هماهنگی در تنفس و گفتار

 

       بدون نیاز به تنظیم متوالی ...پرتابل..  مطمئن.. قابل شارژ  ...D.S.A

 

لطفا  در صورت تمایل برای کسب اطلاعات بیشتر این لینک را کلیک کنید

 

توضیحات تکمیلی

 

 


 

 

گفتار توان گستر ѐی ј ی ی 

 

 

                     ی ی  ј ی یȘ   ی ی- јی     ј ی یȘ   ی ی- јی    ی ی  ј ی یȘ   ی ی- јی  ǐییی Ϙ یј ی یȘ   ی ی- јی ی ј ی   ј ی یȘ   ی ی- јی  ی ی ییј ی یȘ   ی ی- јی   ی ی Ϙ    ʐی ی ی Ș ییی  یی=  ی یȘ ј ی یȘ   ی ی- јی  ی ј ј ی یȘ   ی ی- јی  یی - ǘی=   ی =ϐیی Ϙ ی= ύ ی ʘی  =Ϙ ύ   = ی = ی یј ی یȘ   ی ی- јی  ی ی ј ی یȘ   ی ی- јی  ی ی     = ی ј ی یȘ   ی ی- јی ی      = ی یј ی یȘ   ی ی- јی  ی ی ј ی یȘ   ی ی- јی  ی ی     = ی ј ی یȘ   ی ی- јی ی  Ϙ    یј ی یȘ   ی ی- јی  ی  SIј ی یȘ   ی ی- јی ی یی ј ی یȘ   ی ی- јی  یј ی یȘ   ی ی- јی ǎ  ی ی ییی =  ʐی ی یȘ = ی یی ј ی یȘ   ی ی- јی Ϙ ی

 


 ی ʐی ی ی Ș ییی - یی ی یȘ  ی ј یی - ǘی

ی یϐیی Ϙ ی ύ ی ʘی

 

Ϙ ύ  - ی - ی ی   ی ی (autism spectrum disorder)  ی ی

 

 

ی SI  - ی یی  - ی -  ǎ ( P.N.F) ی ی ییی - ʐی ییȘ یȘ

 

  ی یی Ϙ ی ی ј ی ی .


  با تعیین وقت قبلی     =      آدرس مطب    =    کلیک کنید

 

 

                      


 

مطالب مرتبط

آخرین اخبار

علمی

پزشکی

ادبی

فرهنگی

سیاسی

اجتماعی

اقتصادی

ورزشی

فلسفی

مدیریت

خانواده

کامپیوتر

الکترونیک

مذهبی

روانشناسی

شیمی

طنز

سرگرمی

 

 

 

 

 

 

 

 

 

 

 

  •  

 

 

 
 

 

 What Is Voice? What Is Speech? What Is Language?

 On this page:

 Voice

 Speech

 Language

 Additional Resources

 The functions, skills, and abilities of voice, speech, and language are related   Some dictionaries and textbooks use the terms almost interchangeably   But for scientists and medical professionals, it is important to distinguish among them 

 Voice

 Voice (or vocalization) is the sound produced by humans and other vertebrates using the lungs and the vocal folds in the larynx, or voice box   Voice is not always produced as speech, however   Infants babble and coo; animals bark, moo, whinny, growl, and meow; and adult humans laugh, sing, and cry   Voice is generated by airflow from the lungs as the vocal folds are brought close together   When air is pushed past the vocal folds with sufficient pressure, the vocal folds vibrate   If the vocal folds in the larynx did not vibrate normally, speech could only be produced as a whisper   Your voice is as unique as your fingerprint   It helps define your personality, mood, and health 

 Approximately 7  5 million people in the United States have trouble using their voices   Disorders of the voice involve problems with pitch, loudness, and quality   Pitch is the highness or lowness of a sound based on the frequency of the sound waves   Loudness is the perceived volume (or amplitude) of the sound, while quality refers to the character or distinctive attributes of a sound   Many people who have normal speaking skills have great difficulty communicating when their vocal apparatus fails   This can occur if the nerves controlling the larynx are impaired because of an accident, a surgical procedure, a viral infection, or cancer 

 Speech

 Humans express thoughts, feelings, and ideas orally to one another through a series of complex movements that alter and mold the basic tone created by voice into specific, decodable sounds   Speech is produced by precisely coordinated muscle actions in the head, neck, chest, and abdomen   Speech development is a gradual process that requires years of practice   During this process, a child learns how to regulate these muscles to produce understandable speech   

 However, by the first grade, roughly 5 percent of children have noticeable speech disorders; the majority of these speech disorders have no known cause   One category of speech disorder is fluency disorder, or stuttering, which is characterized by a disruption in the flow of speech   It includes repetitions of speech sounds, hesitations before and during speaking, and the prolonged emphasis of speech sounds   More than 15 million individuals in the world stutter, most of whom began stuttering at a very early age   The majority of speech sound disorders in the preschool years occur in children who are developing normally in all other areas   Speech disorders also may occur in children who have developmental disabilities 

 Language

 Language is the expression of human communication through which knowledge, belief, and behavior can be experienced, explained, and shared   This sharing is based on systematic, conventionally used signs, sounds, gestures, or marks that convey understood meanings within a group or community   Recent research identifies "windows of opportunity" for acquiring language--written, spoken, or signed--that exist within the first few years of life   

 Between 6 and 8 million individuals in the United States have some form of language impairment   Disorders of language affect children and adults differently   For children who do not use language normally from birth, or who acquire an impairment during childhood, language may not be fully developed or acquired   Many children who are deaf in the United States use a natural sign language known as American Sign Language (ASL)   ASL shares an underlying organization with spoken language and has its own syntax and grammar   Many adults acquire disorders of language because of stroke, head injury, dementia, or brain tumors   Language disorders also are found in adults who have failed to develop normal language skills because of mental retardation, autism, hearing impairment, or other congenital or acquired disorders of brain development 

 Additional Resources

 MEDLINE/PubMed

 MEDLINE (Medical Literature, Analysis, and Retrieval System Online) is the U  S   National Library of Medicine's (NLM's) premier bibliographic database that contains over 12 million references to journal articles in life sciences with a concentration on biomedicine   It can be searched via PubMed or the NLM Gateway at http://www  nlm  nih  gov

 How to perform a MEDLINE/PubMed search   MEDLINE can be searched using NLM's vocabulary-based browser known as MeSH, short for Medical Subject Headings, or by author name, title word, text word, journal name, phrase, or any combination of these   The result of a search is a list of citations (including authors, title, source, and often an abstract) to journal articles   PubMed also searches MEDLINE "in-process" citations that are added daily, as well as some citations that arrive electronically directly from publishers  

 Facts About Oral Cancer

 Definition

 A malignant growth that affects any part of the oral cavity, including the lips, upper or lower jaw, tongue, gums, cheeks, and throat 

 Causes

 Cigarette, cigar, or pipe smoking; smokeless tobacco; or excessive use of alcohol   There has been a recent increase in the use of smokeless tobacco in any form, such as plug, leaf, and snuff   However, the most popular with adolescent and young adult males is the practice of "dipping snuff  " This tobacco product, in the form of a moist powder, is placed between the cheek and gum   Nicotine and other carcinogens are then absorbed directly through the skin 

 Incidence

 Oral cancer is the sixth most common cancer in the world (1)   The literature indicates that at least 30,000 new cases of oral and oralpharyngeal cancers are diagnosed each year (2, 3)   Incidence rates are greater than 2:1 male-to-female for oral cavity cancers, and are greatest in men over age 40 (2, 4

 Warning Signs

 A red or white patch or a lump anywhere in the mouth that lasts for more than a month, or a sore that bleeds easily or doesn't heal   Difficulty in chewing, swallowing or moving the tongue and jaw are later symptoms 

 Early Detection

 Dentists and primary care physicians are often the first to detect these signs during regular checkups   Speech-language pathologists also make note of unusual or abnormal growths during oral examinations and provide referrals to appropriate medical professionals 

 Treatment

 The rate of curability of cancers of the lip and oral cavity varies depending on the stage and specific site   Most patients present with early cancers of the lip, which are highly curable by surgery or by radiation therapy with cure rates of 90% to 100% (5

 Effects on Speech and Swallowing

 Coordinated movement of all structures in the mouth and throat is essential for the production of intelligible speech   These same abilities are also necessary for a person to swallow normally 

 The effects of a cancer on speech and swallowing depend on the location and size of the growth   For example, a sore or lump on the lips may restrict movement   This could result in unclear production of speech sounds made with the lips (labial sounds) such as /p/, /b/, and /m/   Restricted movement of the lips might also reduce people' s ability to hold food in their mouth when eating   A lesion on the tongue may affect the intelligibility of some lingual sounds, such as /l/ and /r/, and limit the ability to move food around the mouth or push food back toward the throat during swallowing   A growth on the roof of the mouth (soft palate) or in the throat may change the nasal quality of the voice 

 Postsurgical outcomes on speech and swallowing abilities also depend on the location and size of the cancerous growth   However, other important factors include the amount of tissue removed in surgery, the availability and frequency of speech/swallowing treatment, and the motivation of the patient 

 In some cases, reconstructive plastic surgery or the use of prosthetic devices can restore oral functioning to near normal levels 

 Role of the Speech-Language Pathologist

 Evaluation and treatment by a speech-language pathologist is essential to restore speech intelligibility and swallowing skills   Speech-language pathologists are integral parts of the hospital-based cancer team and perform both pre- and postsurgical assessments in addition to treatment 

 Standard articulation tests are used to assess intelligibility of speech, along with analysis of tape-recorded conversational speech samples   To assess nasal air escape, the speech-language pathologist uses critical listening skills to analyze and describe resonance patterns   Sometimes X-rays and special instrumentation are used to evaluate nasality problems   If a swallowing problem exists, an X-ray called a "modified barium swallow" is generally recommended   Sometimes, the swallowing process is viewed through a small fiberoptic tube inserted in the nose and passed down to the back of the throat 

 The speech-language pathologist can teach modifications in oral movements

 Treatment often includes helping clients adapt to the differences in the size, shape, and feel of their mouth   The speech-language pathologist will also teach a client how to make specific modifications in oral movement to produce the most intelligible speech sounds   Oral exercises help the client develop better control over weakened muscles in the throat or palate and to correct nasality problems   Treatment for swallowing problems varies from simple changes in food consistency to exercises for weak oral muscles to learning totally new ways to swallow   In many cases, improvement is evident within several months 

 Speech for Patients With Tracheostomies or Ventilators

 You have to breathe to live   But what happens when a progressive disease like muscular dystrophy or amyotrophic lateral sclerosis (Lou Gherig's disease) moves from attacking arms and legs to attacking breathing (respiratory) muscles? Or what happens when a car accident survivor is left with a head injury and swelling that slows down the response of the brain's respiratory center? And what about children born with lung disease or deformities of the chest wall and spine that interfere with breathing? These patients will have to breathe   How do they do it?

 Tracheostomy

 A surgical opening is made in the windpipe (trachea) by cutting the neck below the Adam's apple, below the vocal cords   A tube is placed in the opening, and air is inhaled and exhaled through the tube rather than through the mouth and nose   For some, a tracheostomy is a short-term measure   For others, it is long-lasting or permanent 

 Such life support does have a price   As a result of tracheostomy and the new route of air travel, structures of the upper airway that warm and moisten air, filter air-borne debris, and facilitate coughing, sneezing, smelling, tasting, and swallowing play a reduced or non-existent role   The extra debris, without the normal means of clearing it, can cause a buildup of fluids and secretions in the lungs that need to be cleared by suctioning through the tracheostomy tube   Reduced smell, taste, and swallowing can reduce appetite and food intake to the point, in the most severe cases, of threatening life once again   Food and secretions can be misdirected (aspirated) into the lungs and potentially cause pneumonia and even asphyxiation 

 Lack of Speech

 If these were not enough potential problems, air flow as a result of the tracheostomy by-passes the vocal cords that allow for the production of sound and speech   Air takes the path of least resistance, with most of it going out the tracheostomy tube   Some air may leak up to the vocal cords, but it may not be forceful enough to drive the vocal cords into vibration, or it may only allow enough force for very short utterances 

 Caretakers and family members become frustrated because they do not know the needs and wants of the patient   The patient feels isolated and alone at a time when his or her life is undergoing dramatic change 

 Young children are deprived of the vocal explorations and social interactions that are critical to the development of language skills   The situation is made worse because caretakers tend to talk less to children who cannot communicate   These children are then robbed of the rich models they need to hear so they can figure out what language is all about   What can be done?

 Speech With Tracheostomy

 There are a number of options for speaking with a tracheostomy   Tracheostomy tubes can consist of plain tubes or can come with inflatable cuffs that, when pumped up, provide a greater seal against the neck than plain tubes   This increased seal can provide greater air supply to the lungs, but may not allow enough air leakage to power the vocal cords 

 Patients with a cuffless tube or patients who may only need the cuff inflated at certain times, for example during eating or sleeping, may get enough air leakage for speech, or they may be able to produce speech by blocking or occluding the tube with their fingers or hand   Then the patient will breathe through the mouth and nose and vibrate the vocal cords as they did before surgery 

 These methods do not work for all patients for a variety of reasons   Covering the tube may cause an increased resistance to breathing that is intolerable to some patients   Contaminants from the hand or fingers may introduce infection into the body, a particularly critical situation for patients with aspiration problems   Some patients may not get enough air for speech without blocking the tube, but may not have the awareness, muscle movement, or muscle tone to make a good occlusion 

 Talking Valves

 As an alternative, a variety of valves are available that can be attached to the tracheostomy tube   These valves allow air to enter via the tube, but leave by way of the mouth and nose   Use of certain valves is also reported to have secondary benefits of reducing secretions, increasing the sense of smell, reducing aspiration, facilitating tube removal in patients for whom tracheostomy is not permanent, and perhaps even increasing oxygenation of blood in the arteries   Because all valves do not produce the same quality of speech or the same secondary benefits, a valve for a specific patient should be selected based on the scientific and clinical results 

 Ventilator Users

 For some patients, a tracheostomy tube alone may not be enough   The tube may need to be connected to a breathing machine (ventilator) that provides a mixture of gases for life support   Patients on ventilators can speak as long as the tracheostomy tube allows flow through the larynx and vocal cords   However, the speech patterns of ventilator users present particular problems 

 Because of the design of the ventilator, speech occurs during the expiratory cycle of the ventilator   Then there is a long silence until the next cycle of the ventilator   During this silence, the patient may lose his or her turn to talk as conversation partners fill the silence with their own speech   Listeners may also find it hard to follow the patient's communication message because the normal rhythm of conversational give-and-take is disrupted 

 Spoken phrases may have sudden bursts of loudness, reduced loudness at the end of phrases, and changes in voice quality because pressure in the trachea from the ventilator gases is not as stable as this pressure is in typical speech production   Recent research has indicated that the speech of patients on ventilators may be improved by making simple adjustments to ventilator settings, particularly if no other problems exist besides breathing insufficiency   There is also at least one speaking valve available that can be used with a ventilator 

 Speech-Language Pathologist and the Rehabilitation Team

 The multiple and interrelated decisions that need to be made for patients with tracheostomies or ventilators cannot be made by one professional   Physicians, nurses, respiratory therapists, dietitians, speech-language pathologists, and others must all work together to choose the options that best meet the patient's total health needs   The speech-language pathologist assesses the patient's cognitive and language abilities to determine communication potential, evaluates oral-motor and swallowing functions, and assesses the patient's ability to produce voice in different situations that may include using a speaking valve   Whatever mode of communication is recommended for the patient in the context of his or her other needs, the speech-language pathologist plays a central role in ensuring that patients and caretakers know how maximum communication can be achieved   Speech-language pathologists also treat problems of swallowing when indicated 

 Tracheostomy and ventilator use is life sustaining   Speech for patients with tracheostomies or ventilators is life enriching 

 Find a speech-language pathologist near you who is certified by the American Speech-Language-Hearing Association   

 The Basics: Disorders of Vocal Abuse and Misuse

 Have you "lost" your voice?

 When you abuse or misuse your voice, you can damage your vocal folds, causing temporary or permanent voice changes such as

 Laryngitis

 Vocal nodules

 Vocal polyps

 Contact ulcers

 Who is at risk?

 Anyone who uses his or her voice excessively may develop a vocal abuse or misuse disorder   These problems are fairly common among

 Lawyers

 Teachers

 Clergy

 Cheerleaders

 Singers

 Actors

 Children

 Diagnosis

 If you've had vocal change or hoarseness for more than 2 weeks, see a doctor, preferably an otolaryngologist 

 Treatment

 Most disorders of vocal abuse and misuse can be cured   The best treatment is to eliminate the vocal behavior that caused the problem

 Spasmodic Dysphonia

 We have all experienced problems with our voices, times when the voice is hoarse or when sound will not come out at all! Colds, allergies, bronchitis, exposure to irritants such as ammonia, or cheering for your favorite sports team can result in a loss of voice   But, people with spasmodic dysphonia, a chronic voice disorder, face the persistent question: "What's wrong with your voice?"

 With spasmodic dysphonia, movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice   Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur 

 At first, symptoms may be mild and occur only occasionally   Later on, they may worsen and become more frequent before they stabilize   Even then, symptoms may be worse when a person is tired or stressed   Or, they may be greatly reduced or even disappear, for example, during singing or laughing 

 Spasmodic dysphonia is a disorder characterized by involuntary movements of one or more muscles of the larynx or voice box   The first signs of spasmodic dysphonia are most often found in individuals between 30 and 50 years old   More women appear to be affected by spasmodic dysphonia than men (1)   The effortful voice spasms of spasmodic dysphonia fluctuate in severity and may remit for hours or even days at a time (2

 Causes

 When not used for talking, the vocal cords of people with spasmodic dysphonia are normal in appearance and function   However, when the vocal cords are brought together for talking, their movement is uncontrolled 

 Symptoms come from more than one source   Some people appear to have nervous system changes that produce an organic tremor of the vocal chords   Others may have dystonia, another kind of neurologic disorder that creates abnormal muscle tone   In rare cases, people can have spasmodic dysphonia symptoms because of acute or chronic life stress   Diagnosis

 There is no simple test for spasmodic dysphonia   Rather, diagnosis is based on the presence of the typical signs and symptoms described above and the absence of other conditions that can produce similar problems   The best evaluation involves as interdisciplinary approach and includes a speech-language pathologist to evaluate voice production and voice quality, an otolaryngologist (ear, nose, and throat specialist) to examine the vocal cords and their movement, and a neurologist who looks for signs of neurological problems 

 Find a speech-language pathologist near you 

 Treatment

 At present, there is no cure for spasmodic dysphonia   However, several treatment options do exist for voice improvement 

 Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords is frequently recommended   Botox weakens the laryngeal muscles and results in a smoother, less effortful voice because of less forceful closing of the vocal cords   Temporary breathiness or difficulty swallowing sometimes occurs for a short time after injection   Treatment by a speech-language pathologist may also be recommended following injections to optimize voice production 

 Speech language pathology services alone are most helpful when symptoms are mild   Clients learn techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications   Surgical cutting of the recurrent laryngeal nerve to paralyze one vocal cord initially met with good results by reducing the force of vocal cord closure   Surgery was frequently followed by speech-language pathology treatment   Long-term follow-up has shown return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients with a disturbing number who were worse than before 

 Psychological or psychiatric counseling is most useful when acceptance of the disorder and learning coping techniques are the desired goals   Career or vocational counseling may also be advised for persons who fear that the disorder threatens their occupation   Participation in local self-help support groups can also promote adjustment to the problem and provide contact with excellent sources of information

 Vocal Fold Nodules and Polyps

 What are vocal fold nodules and polyps

 Vocal fold nodules are benign growths on both vocal folds that are caused by vocal abuse   Over time, repeated misuse of the vocal folds results in soft, swollen spots on each vocal fold that develop into harder, callus-like growths   The nodules will become larger and more stiff the longer the vocal abuse continues 

 Polyps , on the other hand, can take a number of forms and are sometimes caused by vocal abuse   Polyps appear on either one or both of the vocal folds and appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion   Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema   

 What will my voice sound like if I have nodules or polyps?

 Nodules and polyps cause similar symptoms and include:

 Hoarseness

 Breathiness

 A "rough" voice

 A "scratchy" voice

 Harshness

 Shooting pain from ear to ear

 A "lump in the throat" sensation

 Neck pain

 Decreased pitch range

 Voice and body fatigue

 What causes nodules and polyps?

 Nodules are most frequently caused by vocal abuse or misuse   Polyps may be caused by prolonged vocal abuse, but may also occur after a single, traumatic event to the vocal folds, such as yelling at a concert   Long-term cigarette smoking, hypothyroidism, and gastroesophageal reflux may also cause polyp formation   Vocal abuse takes many forms and includes:

 Allergies

 Smoking

 "Type A" personality (person who is often tense or anxious)

 Singing

 Coaching

 Cheerleading

 Talking loudly

 Drinking caffeine and alcohol (dries out the throat and vocal folds)

 It has been noted that, for unknown reasons, vocal nodules occur more frequently in women between the ages of 20 and 50   

 How are nodules and polyps diagnosed

 If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician   A thorough voice evaluation should include a physician's examination, preferably by an otolaryngologist, who specializes in voice, a voice evaluation by a speech-language pathologist, and possibly a neurological examination   The voice team will assess vocal quality, pitch, loudness, ability to sustain voicing, and other characteristics of the voice   An instrumental examination may take place, which involves inserting an endoscope into the mouth or nose to look at the vocal folds and larynx in general   A stroboscope (flashing light) may be used to watch the vocal folds as they move   

 What can be done to get rid of nodules and polyps?

 Nodules and polyps may be treated medically, surgically, and/or behaviorally   Surgical intervention involves removing the nodule or polyp from the vocal fold   This approach only occurs when the nodules or polyps are very large or have existed for a long time and is rare for children   Contributing medical problems may be treated to reduce their impact on the vocal folds   This includes treatment for gastroesophageal reflux, allergies and thyroid problems   Medical intervention to stop smoking or to control stress is sometimes warranted 

 A majority of people receive behavioral intervention, or voice therapy, from a speech-language pathologist   Voice therapy involves teaching good vocal hygiene, eliminating vocal abuses, and direct voice treatment to alter pitch, loudness, or breath support for good voicing   Stress reduction techniques and relaxation exercises are often taught, as well 

 Vocal Fold Paralysis

 What causes vocal fold paralysis

 Vocal fold paralysis is caused by head and neck injuries, tumors, disease, surgery, or stroke   Nerve damage to the vagus nerve, which has branches that run from the brainstem to the larynx and regulates the movement of the vocal folds, is the specific cause of vocal fold paralysis   

 What are the symptoms of vocal fold paralysis?

 The severity of voice and swallowing problems depends on where the nerve damage occurs   Typical symptoms include:

 Hoarseness

 Breathy voice

 Inability to speak loudly

 Limited pitch and loudness variations

 Voicing that lasts only for a very short time (around one second)

 Choking or coughing while eating

 Possible pneumonia due to food and liquid being aspirated into the lungs (the vocal folds cannot close adequately to protect the airway while swallowing)

 Are there different types of paralysis?

 Yes   Bilateral vocal fold paralysis involves both vocal folds, which become stuck halfway between open and closed (the paramedian position) and do not move either way   This condition often requires a tracheotomy (an opening made in the neck to provide an airway) to protect the airway when the person eats 

 

 Unilateral vocal fold paralysis is more common than bilateral involvement   Only one side is paralyzed in the paramedian position or has a very limited range of motion   The paralyzed vocal fold does not move to vibrate with the other fold, but vibrates abnormally or does not vibrate at all   The individual will run out of air easily and be unable to speak clearly and with sufficient loudness to be understood 

 How is vocal fold paralysis diagnosed?

 The vocal folds can be examined by using an endoscope that is inserted through the nose or mouth   A light on the endoscope allows the examiner to view the folds and movement patterns during phonation (producing sound) and at rest   Swallowing problems can also be evaluated by endoscopy or fluoroscopy, a radiology procedure that allows the examiner to view the movement of food and liquid mixed with barium from the mouth to the esophagus   Typically a complete voice evaluation is conducted by a speech-language pathologist and otolaryngologist (ear, nose, and throat doctor)   

 How is vocal fold paralysis treated?

 Bilateral paralysis is often medically treated and may require a tracheotomy to allow the person to eat safely   Surgery may be considered to bring one or both vocal folds closer to midline 

 

 Unilateral paralysis can be treated medically and/or behaviorally   Medical treatment includes muscle-nerve transplant, medialization thyroplasty (moving the paralyzed vocal fold toward midline), or injection of a substance to increase the size of the paralyzed vocal fold 

 

 Behavioral treatment includes voice therapy by a speech-language pathologist and may be the only treatment required for the individual   The individual will work with the SLP on pitch alteration, increasing breath support and loudness, and finding the correct position for optimal voicing (such as turning the head to one side or manipulating the thyroid cartilage)   Research has shown that voice therapy is an effective intervention in the interim period between diagnosis of the paralysis and final resolution of the problem 

 

 

 Laryngeal Papillomatosis

 On this page:

 Description

 Treatment

 Research

 Additional Resources

 Description

 Laryngeal papillomatosis is a disease consisting of tumors that grow inside the larynx (voice box), vocal cords, or the air passages leading from the nose into the lungs (respiratory tract)   It is a rare disease caused by the human papilloma virus (HPV)   Although scientists are uncertain how people are infected with HPV, they have identified more than 60 types of HPVs   Tumors caused by HPVs, called papillomas, are often associated with two specific types of the virus (HPV 6 and HPV 11)   They may vary in size and grow very quickly   Eventually, these tumors may block the airway passage and cause difficulty breathing 

 Laryngeal papillomatosis affects infants and small children as well as adults   Between 60 and 80 percent of cases occur in children, usually before the age of three   Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may experience difficulty swallowing   Adults with laryngeal papillomatosis may experience hoarseness, chronic coughing, or breathing problems 

 There are several tests to diagnose laryngeal papillomatosis   Two routine tests are indirect and direct laryngoscopy   An indirect laryngoscopy is done in an office by a speech-language pathologist or by a doctor   To examine the larynx for tumors, the doctor places a small mirror in the back of the throat and angles the mirror down towards the larynx   A direct laryngoscopy is performed in the operating room under general anesthesia 

 This procedure is usually used with children or adults during lengthy examinations to minimize discomfort   It involves looking directly at the larynx   Direct laryngoscopy allows the doctor to view the vocal folds and other parts of the larynx under high magnification and samples of unusual tissue lesions that may be in the larynx or other parts of the throat 

 Treatment

 Many forms of treatment have been used to remove laryngeal papillomas such as surgery, chemotherapy, or antibiotic therapy   Currently, traditional surgical removal of the tumors and another technique, carbon dioxide laser surgery, are both used   Carbon dioxide laser surgery uses intense laser light as the surgical tool 

 Once they have been removed, these tumors have a tendency to return unpredictably   It is not uncommon for patients to require repeat surgery   With some patients, surgery may be required every few weeks in order to keep the breathing passage open, while others may require surgery only once a year   In the most extreme cases where tumor growth is aggressive, a tracheotomy may be performed   A tracheotomy is a surgical procedure where an incision is made in the front of the patient's neck and a breathing tube (trach tube) is inserted through a hole, called a stoma, into the trachea (windpipe)   Rather than breathing through the nose and mouth, the patient will now breathe through the trach tube   Although the trach tube keeps the breathing passage open, doctors try to remove it as soon as it is feasible   However, there may be some patients who may be required to keep a trach tube indefinitely in order to keep the breathing passage open   In addition, because the trach tube re-routes all or some of the exhaled air away from the vocal cords, the patient may find it difficult to speak   With the help of a voice specialist or speech-language pathologist the patient learns how to reuse the voice   

 Research

 Scientists have developed a new technique using photodynamic therapy (PDT)   With PDT, a physician injects a special dye that is sensitive to bright light into the blood stream   This dye collects in tumors but not healthy tissue, and when the dye is activated by a bright light of a specific wavelength, the tumors that absorbed the dye are destroyed   In addition to eliminating the tumors using PDT, scientists found that tumor regrowth decreased, even for patients with the most severe form of the disease 

 PDT was first developed to kill certain tumors in humans   Although treatment was promising, results were inconsistent and the technique was soon abandoned   However, recent research shows that treating patients with laryngeal papillomatosis using PDT appears to control tumor growth   The development of newer forms of the dye has contributed to the resurgence of this promising form of treatment may prevent patients from having multiple surgical procedures 

 

 


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