声带息肉患者的嗓音声学分析与VHI的相关性研究

目的 探讨嗓音声学分析与嗓音障碍指数(voice handicap index,VHI)用于嗓音质量评估的临床意义及其相关性,并进一步验证VHl的实用性.方法 对35名声带息肉患者(患者组)及35名嗓音正常人(对照组)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括振幅扰动商(amptitude perturbation quotient,APQ)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(NHR),VHI调查包括功能(F)、生理(P)、情感(E)三个范畴,记录三方面得分及总分(TVH)分值.结果患者组的APQ、jitter、shimmer、NHR均高于正常组,差异有统计学意义(P<0.05);患者组VHI的TVH平均值为43.32±4.66分,而正常组的平均值为12.51±1.88分,两组间差异有统计学意义(P<0.05).声带息肉患者嗓音声学分析参数与VHI之间无显著相关性.结论 临床上不能以嗓音声学分析为标准来判断或推测声带息肉患者症状轻重;VHI可主观反映患者嗓音障碍程度.     

嗓音疾病患者手术前后的自我评估、声学分析、喉镜检查及其相关性研究

目的:研究嗓音疾病患者手术前后的自我评估、声学分析、喉镜检查及其相关性.方法:对50例嗓音疾病患者手术前后分别进行自我评估、声学分析和喉镜检查3项内容.自我评估采用嗓音障碍指数(VHI)量表中文版,包括功能(F)、生理(P)、情感(E)3个方面,其总和记为T.声学分析通过嗓音分析软件Dr. Speech对患者的声音样本进行分析,选取基频微扰(J)、振幅微扰(S)、标准化噪声能量(NNE)3个参数.喉镜检查为客观的形态学检查,主要观察声带的闭合情况.结果:VHI量表中除E外,F、P、TVH(TVH=F+P)之间的相关性良好,声学分析J、S、NNE 3个参数之间相关性良好,VHI量表中除E外,F、P、TVH与声学分析参数J、S、NNE之间有良好的相关性,闭合程度与VHI量表中除E外的F、P、TVH以及声学分析参数J、S、NNE之间有良好的相关性,以上均应用Pearson相关检验.结论:VHI量表中文版以患者的主观感受为中心,对嗓音疾病的生活影响进行自我评估,受东西方文化差异、年龄、教育程度等影响,存在一定的局限性.声学分析则从客观方面详细地分析了患者的嗓音质量,评估手术疗效.喉镜检查从形态学方面提供了极好的佐证.三者结合的一致性能对嗓音疾病起到综合评估作用.     

嗓音障碍指数对嗓音外科手术效果评估的价值

目的运用改良中文嗓音障碍指数量表,结合客观检查手段,评估嗓音障碍指数对嗓音疾病患者临床疗效分析的价值。方法 50例嗓音疾病患者手术前后分别进行自我评估、声学分析和喉镜检查。自我评估采用嗓音障碍指数(voice handicap index,VHI)量表中文版,包括功能(F)、生理(P)、情感(E)三方面评分,其总和记为T,其中,P+F=TvH;通过Dr.Speech嗓音分析软件对患者的嗓音样本进行声学分析,观察基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(normalized noise energy,NNE)三个指标。纤维喉镜检查主要观察声带闭合情况,记为C。结果 VHI量表中剔除了情感(E)方面后的嗓音自我评估分数,F、P、TvH之间的相关性良好,F、P、TvH与jit-ter、shimmer、NNE之间有良好的相关性,声带闭合程度(C)与VHI量表中的F、P、TvH以及jitter、shimmer、NNE之间有良好的相关性。结论改良的中文VHI量表,可有效地评估嗓音疾病严重程度及临床疗效,有较高的临床应用价值。     

嗓音障碍指数主观评估与发音障碍严重程度指数客观检测的相关性分析

目的 探讨声带息肉患者嗓音障碍指数（voice handicap index,VHI）量表自我评估和发音障碍严重程度指数（dysphonia severity index,DSI）客观评估的相关性。 方法 取104例声带息肉患者,用VHI中文版量表进行自评及DIVAS2.5声学分析软件分析DSI,按性别、侧别、形状、大小分组比较,分析VHI和DSI的相关性。结果 声带息肉的大小、形状对VHI各指标差异均无统计学意义,但较大或广基底形息肉基频微扰较重;女性患者功能、生理和VHI总体评价高于男性,但DSI却低于男性;双侧息肉比单侧在生理方面影响较重,同时DSI也较重;VHI量表各指标与嗓音声学分析各参数之间无明显相关性。结论 目前临床上评估嗓音障碍程度的两种主客观方法都不理想,应进一步研究更好的评价方法。     

咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。     

应用嗓音主客观参数评估不同大小 声带息肉显微手术的临床疗效

摘要：目的探讨不同大小声带息肉显微手术疗效的多参数评估方法。方法根据声带平行的息肉最大直径与同侧声带膜部的比例，将30例女性单发声带息肉患者分为两组，小息肉组（17例）和大息肉组（13例），分别进行喉显微手术，术后所有患者均休声2周；同期选取15例正常人群为对照组，术后分别进行总嘶哑度G、嗓音障碍指数量表(voice handicap index scale, VHI)、嗓音声学参数等指标的检测。分析上述指标间的差异性和相关性，同时分析手术疗效的主客观评估的一致性。结果①术前组总嘶哑度G和VHI评分（功能、生理、情感及总体评价）均高于术后组和对照组(P＜0.05)；②不同大小声带息肉术前组、术后组和对照组间基频微扰（jitter）、振幅微扰（shimmer）呈递增趋势,噪音障碍严重指数（dysphonia severity index, DSI）呈递减趋势(P＜0.05)；最长发声时间（maximum phonation time, MPT）术前组较术后组和对照组下降，且大息肉术前组较小息肉术前组降低(P＜0.05)；③功能、生理、总体评价之间呈正相关，情感与总体评价呈正相关；jitter与shimmer呈正相关(P＜0.05)；④总嘶哑度G的主观评级和DSI的客观分级总体一致性达82.67%，正常嗓音组一致性最高，达91.43%，中度嗓音障碍一致性最低，达71.43%。结论嗓音声学主客观检测参数可作为声带息肉病情严重程度和手术疗效的重要参考依据。     

教师声带息肉患者的嗓音声学分析与嗓音障碍指数相关性研究

目的探讨教师声带息肉患者的嗓音声学分析与嗓音障碍指数的相关性。方法对70例教师声带息肉患者(教师息肉组,男30例,女40例)和70例嗓音正常者(对照组,男28例,女42例)进行嗓音声学分析和嗓音障碍指数(voice handicap index,VHI)评估。嗓音声学分析指标包括基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)和谐噪比(HNR),比较两组结果,并分析教师组嗓音声学分析指标与VHI分值的相关性。结果①男性和女性教师息肉组F0、HNR较对照组降低,jitter、shimmer和VHI分值较对照组升高,差异均有统计学意义(均为P<0.05);②教师息肉组男性患者的F0、jitter、shimmer和HNR与VHI值无相关性(P>0.05);女性患者除F0与VHI值无相关性外,jitter和shimmer与VHI值呈正相关(r=0.681和0.405,P<0.05),HNR与VHI值呈负相关(r=-0.468,P<0.05)。结论声带息肉对教师的嗓音和生活质量有重要影响,且不同性别患者的影响程度不同;嗓音声学分析可衡量声带息肉患者嗓音异常程度,VHI可作为职业用嗓者发声困难时嗓音评估的重要补充。     

声带息肉患者的嗓音障碍客观指数测定

目的研究嗓音障碍客观指数(dysphonia severity index,DSI)测试在声带息肉患者嗓音分析中的临床应用.方法对31例声带息肉患者和12例正常受试者分别进行主观自我评估和客观嗓音声学检测.主观自我评估采用嗓音障碍指数(voice handicap index,VHI)量表进行评估,客观声学检测采用德国XION公司生产的嗓音分析软件DiVAS进行测试.结果声带息肉患者组DSI均低于正常对照组,差别有统计学意义(P<0.05);VHI高于正常对照组,结果具有统计学差异(P<0.05).声带息肉患者的DSI与VHI之间没有显著相关性.结论嗓音障碍客观指数(DSI)能够客观评估声带息肉患者的嗓音障碍程度.     

小学教师嗓音质量评估的研究

目的探讨嗓音声学分析与嗓音障碍指数（voicehandicapindex,VHI）用于小学教师嗓音质量评估的临床意义。方法30例嗓音正常教师（G1组）与同一学校年龄、性别、教龄相匹配的30例嗓音障碍教师（G2组）均行间接喉镜检查、嗓音声学分析、V…量表自我评估,两组结果进行比较分析。结果嗓音障碍组（G2）中慢性喉炎占77％（23／30）、声带息肉占1O％（3／30）。声带小结占13％（4／30）。嗓音障碍组（G2）的Jitter．Shimmer、噪谐比（NHR）均高于嗓音正常组（G1）,差异有统计学意义（p〈o．05）。嗓音障碍组（G2）与嗓音正常组（G1）的功能（functional,F）、生理（physical,P）．情感（emotional,E）三方面得分及VHI总分（totalscoresoftheVHl,Tvh）分值两组间差异有统计学意义（P〈0．05）。嗓音障碍组（G2）VHI量表中除E外,F、P、Tvh与Jitter、Shimmer、NHR之间有良好的相关性。结论临床上可以用嗓音声学分析中各项指标判断教师嗓音障碍的严重程度,VHI可主观反映教师嗓音疾病的严重程度,二者在嗓音质量评估中具有一定的临床应用价值。     

甲状舌管囊肿术后嗓音分析

目的探讨甲状舌管囊肿(TDC)患者手术前后的嗓音变化特点。方法选取2018年1月—2019年12月行TDC切除术的患者49例为研究对象，其中男24例，女25例，年龄为22~65岁，平均年龄为(41.55±11.78) 岁。对患者术前，术后1周及术后6个月分别行嗓音障碍指数（VHI）和GRBAS的主观评估、嗓音声学分析的客观检测以及频闪喉镜检查，比较手术前后的评估结果。结果①VHI的评估：女性患者的情感（E）评分在术后1周较术前显著性差异（P<0.05），术后6个月与术前差异不明显，而其功能（F）和生理（P）评分较术前无明显差异；男性患者手术前后的VHI各评分均无显著性差异；②GRBAS的评估：女性患者的气息度（B）和无力度（A）评分在术后1周较术前差异显著（P<0.05），术后6个月同术前差异不大，而其总分（G），粗糙度（R）和紧张度（S）评分无显著性差异；男性患者手术前后的GRBAS各评分均无显著性差异；③嗓音声学分析：男性及女性患者的基频（F0）和最长发声时间（MPT）在术后1周均较术前差异显著（P<0.05），术后6个月同术前差异不明显；而其基频微扰（jitter）和振幅微扰（shimmer）无显著性差异。结论TDC患者手术后会出现嗓音评估指标的一过性改变，及早行嗓音评估、发音训练或心理干预，有利于患者的嗓音康复。     

Correlation between voice handicap index and voice laboratory measurements in dysphonic patients

Factors underlying voice disorders can be categorized into three distinct domains: emotional, physical, and functional. The Voice Handicap Index (VHI) subjectively evaluates voice disorders in terms of these three factors. On the other hand, Voice Laboratory Measurements (VLM) use objective criteria to evaluate the severity of voice disorders. Use of these two different tests (VHI and VLM) on dysphonic patients has, however, tended to yield results that vary widely in their conclusions. This report reviewed 135 testing sessions on dysphonia patients. Seventy-nine of the tests were VHI, and 56 were VLM. All VHI and VLM parameters were entered into a statistical program and analyzed using a Pearson correlation. The results show that each VHI parameter provides a significant level of reliability (P < 0.01) when compared with other VHI parameters. Four VLM parameters also demonstrated significant reliability (P < 0.01) in comparison with other VLM parameters. However, when comparing across testing methods, VHI and VLM parameter reliability is shown to be poor (P > 0.05). With such a large discrepancy between the results of VHI and VLM testing, no objective parameter can yet be regarded as a definitive prognostic factor in a subjective evaluation of dysphonic patients. Received: 31 July 2001 / Accepted: 13 September 2001     

Development and validation of the voice handicap index-10

OBJECTIVES/HYPOTHESIS: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI). STUDY DESIGN: Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI. METHODS: Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index-10 (VHI-10). Statistical analysis comparing the validity of the VHI-10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders. RESULTS: Statistical analysis of the VHI and VHI-10 scores from the study group showed no statistically significant differences between the VHI and the VHI-10. Irrespective of diagnosis, the correlation between the VHI and the VHI-10 was greater than .90 (P = .01). The ratios of the VHI-10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI-10 may be a more robust instrument than the VHI. CONCLUSION: The VHI-10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI-10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.     

Voice in early glottic cancer compared to benign voice pathology

The purpose of this study is to compare (Dutch) Voice Handicap Index (VHIvumc) scores from a selected group of patients with voice problems after treatment for early glottic cancer with patients with benign voice disorders and subjects from the normal population. The study included a group of 35 patients with voice problems after treatment for early glottic cancer and a group of 197 patients with benign voice disorders. Furthermore, VHI scores were collected from 123 subjects randomly chosen from the normal population. VHI reliability was high with high internal consistency and test–retest stability. VHI scores of glottic cancer patients were similar to those of patients with voice problems due to benign lesions. Both groups of patients were clearly deviant from the normal population. Within the normal population, 16% appeared to have not-normal voices. Based on ROC curves a cut-off score of 15 points was defined to identify patients with voice problems in daily life. A clinical relevant difference score of 10 points was defined to be used for individual patients and of 15 points to be used in study designs with groups. Patients with voice problems after treatment for early glottic cancer encounter the same amount of problems in daily life as the other voice-impaired patients. The VHI proved to be an adequate tool for baseline and effectiveness measurement of voice.     

上气道多平面扩容术对重度阻塞性睡眠呼吸暂停低通气综合征患者嗓音的影响

目的：探讨上气道多平面扩容术对重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者嗓音的影响。方法：对26例重度OSAHS患者于上气道多平面扩容术前后,分别应用针对嗓音相关的主观调查问卷和嗓音频谱分析软件进行客观统计学分析。结果：主观调查问卷结果显示,26例患者上气道多平面扩容术后4例（15．4％）出现短时间的轻度腭咽闭合功能不全所致的鼻腔反流现象,均于术后1周内消失;3例（11．5%）术后发声有轻度鼻音增高,尤以术后1周内较明显而后逐渐消失;2例（7．7％）扁桃体Ⅲ度肥大者诉发声清晰度较前提高,原有轻微含糖音消失;总体评价是嗓音障碍指数量表、嗓音相关生活质量量表评分手术前后均无明显变化（P〉0．05）。嗓音客观参数基频F0和F1、F2、F3及F4共振峰频率手术前后均无统计学差异。结论：上气道多平面扩容术能够解除重度OSAHS患者上气道的阻塞性因素,同时进行鼻腔和咽腔的塑形,在一定程度上改变了声道共鸣腔,但对重度OSAHS患者嗓音的主观心理听觉评估无明显变化,嗓音客观参数基频F0和F1、F2、F3及F4四个共振峰频率均无明显的变化。     

Multidimensional assessment of functional outcomes of medialization thyroplasty

Medialization thyroplasty (MT) is the most widely used laryngeal framework phonosurgical procedure for managing glottic incompetence secondary to unilateral vocal fold paralysis (UVFP). The aim of the study was to evaluate the functional outcomes of MT in 32 UVFP patients, comparing multidimensional perceptual and instrumental measures of voice before and after surgery, and to evaluate how close to normal that postoperative voice measure became. Video laryngostroboscopy (VLS), auditory perceptive evaluation of voice, the patients self-evaluation of hoarseness on the Visual Analogue Scale (VAS) and calculation of the Voice Handicap Index (VHI), analysis of objective acoustic voice parameters, quantitative assessment of phonetograms and measurement of maximum phonation time were conducted. Vocal function was evaluated before the surgery and for the period from 1 month to 3 years (Mo 1.0 month; Me 2.0 months) after MT. VLS confirmed remarkable medialization of the paralyzed vocal fold. As a consequence, hoarseness and breathiness were found to be significantly decreased after MT. Pitch and intensity range and phonetogram area were significantly increased. A significant decrease of jitter, shimmer and normalized noise energy reflected improvement of the stability of acoustic signal and a more efficient pattern of phonation. Thus, the perceptual and acoustic voice parameters studied showed statistically significant differences (P<0.001) between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. A high degree of patient satisfaction with the MT was confirmed by a significant decrease of VHI and hoarseness on VAS. Thus, results of the present investigation confirm the functionality and effectiveness of MT in patient voice rehabilitation with UVFP. However, the means of acoustic voice parameters measured in the study did not reach normal limits, probably because of the remaining underlying condition of UVFP.This study was presented at the 4th Congress of the European Laryngological Society, Brussels, 5–7 September 2002.     

Voice handicap evaluation after supracricoid partial laryngectomy

The importance of patient self-impressions has been emphasized in determining the success of cancer treatment. The supracricoid partial laryngectomy (SCPL) is recognized as a suitable procedure for the treatment of T1b and T2 glottic carcinoma. The aim of this surgical procedure is the preservation of a physiologic phonation with optimal oncologic control. METHOD: Measurements included Voice handicap Index (VHI), Voice Related Quality of'Life (VRQL), subjective (GRBAS) and objective analysis. Objectives: evaluate voice problems after SCPL, provide correlations between patients' daily activities, VHI, and subjective evaluation of the dysphonia. PATIENTS: 53 patients were assessed more than 1 year after SCPL. 26 patients, less than 60 years of age and professionally active were included. The mean age was 48 years (43 to 59 years). Eleven patients had professional activities in the communications industry requiring a compulsory daily use of their voices. RESULTS: 57.6% of the active patients underwent a cessation or an adaptation of their professional activities. The mean VHI was 52.22. It was respectively 36.3, 50.03 and 52.42 according to the grade 1, 2, 3 of dysphonia. Correlations between VHI and the time laps since intervention (p: 0.047). discontinuation of professional activities (p: 0.037), and grade of dysphonia (p: 0.049) were found. CONCLUSION: VHI allows an evaluation of the voice problems after SCPL. A significant impact on voice is reported after SCPL and may influence the patient's life, with potential disturbance of their professional activities. Potential post surgical voice impact must be considered when the therapeutic options are discussed.