声带良性病变的电声门图波形特征和参数分析

目的 :探讨电声门图 (EGG)在声带良性病变中测试的敏感性、特异性及其临床应用价值。方法 :对36 5例显微喉镜手术前后的声带息肉、声带囊肿和声带白斑患者进行EGG测试 ,分析其波形和参数。结果 :声带息肉、囊肿和白斑患者术前EGG波形多数异常 ,尤以波形呈单一固定的切迹或渐开相陡直为主 ,术后波形多数转为正常 ,每组患者手术前后EGG波形间差异均有极显著性 ,而不同病变之间EGG波形无差异。声带息肉和囊肿间EGG参数值无差异 ,而白斑患者接触率 (CQ)值相对较低 ,接触幂 (CI)相对较高。显微喉镜术后 ,息肉和囊肿患者EGG参数基频微扰 (jitter)、振幅微扰 (shimmer)、谐噪比 (HNR)、CQ和接触微扰 (CQP)改善 ,而白斑患者仅HNR提高。结论 :EGG波形在声带良性病变的检测中具有一定的灵敏度 ,而无特异性 ,其参数值受局部病灶和声带内在炎症的影响。     

喉部疾病263例患者的电声门图分析

目的 :探讨电声门图 (EGG)的波形变化对喉部疾病的诊断价值。方法 :采用Dr .speech 3.0软件对12 0例声带息肉、4 2例声带小结、2 1例单侧声带麻痹、4 2例声门型喉癌及 38例Reink’s水肿等 5种喉部疾病患者进行EGG测试 ,对其波形变化进行分析。结果 :不同病变的EGG显示出不同的特殊波形 ,表现出较高的敏感性和特异性。结论 :EGG波形的变化对喉部疾病的诊断提供了客观的量化指标     

嗓音声学分析及声门图在喉科疾病的应用初探

目的了解噪音声学分析及声门图在喉科疾病中的应用。方法应用Dr．speech软件对99例声带息肉、22例喉癌、23例声带白斑患者作了嗓音声学分析、电声门图和声谱图分析。结果声带息肉组中shimmer值异常者占75％;各组病变的EGG波形均有不同程度的改变,但声门型喉癌的波形明显趋于无规律性;声带息肉组以一、二型声谱图为主,而声门型喉癌以三、四型声谱图为主。结论这三种测试方法各有特点,互为补充,综合运用可为喉功能的量化检查奠定基础及提供客观指标。     

声带小结者嗓音分析和电声门图参数变化的比较

目的比较分析声带小结者嗓音参数和电声门图（EGG）参数的变化，评价这些参数在该病的诊断和疗效观察中的意义。方法采用Dr．SpeechScienceforWindows软件对42例未经手术的声带小给患者作嗓音分析和EGG检测，对其主要声学参数变化进行比较，并对声带小结的EGG波形作了观察。结果在声带小结的诊断中，两种方法中的声学参数基音频率微扰（jitter）和基音振幅微扰（shimmer）均是有价值的，二者可以相互替代。EGG的标准声门噪声能量（NNE）特异性高，嗓音分析中的NNE则敏感性高。结论EGG中声门波的特征结合嗓音分析及EGG的jitter和shimmer值对声带小结的诊断和疗效观察有较大的意义。     

声带振动功能的无创检测

检测60例正常人和20例单侧声带麻痹患者的EGG参数CQ、CI和声学参数NNE,并进行统计分析。结果显示：正常人声门闭合较完全,声门接触相中,逐渐关闭的过程快于逐渐张开的过程（CI为负数）。麻痹患者声门闭合程度下降（NNE增大）,声门闭合过程中渐触相时程延长（CI增大）。麻痹组与正常组间CQ值无显著性差异。提示EGG和NNE的无创测试可用来分析声带振动功能;单侧声带麻痹后声带振动模式出现病理性改变。     

单侧声带麻痹的电声门图测试

为探讨单侧声带麻痹患者的声带振动规律,文中对46例患者作了电声门图(electroglottograph,EGG)测试,将参数接触率(contact quotient,CQ)、接触率微扰(contact quotient perturbation,CQP).接触幂(contact index,CI)和接触幂微扰(contact index perturbation,CIP)与声带固定的位置相结合进行统计学分析,结果为多数单侧声带麻痹患者EGG参数异常,包括CQ减少,Cl、CQP及CIP增大.其中,声带固定在正中位组EGG各参数正常率高于旁正中位组,CQ异常率旁正中位组高于正中位组,中间位组EGG各参数均异常,声带固定的位置不同,CI及CQP、CIP无显著性差异.因EGG能描记每一振动周期特点,对研究缺乏规律性的声带振动,有一定的应用前景.     

CO2激光喉显微外科技术治疗喉良恶性病变

目的回顾分析应用CO2激光喉显微外科技术治疗喉部良恶性病变的效果。方法自1999年1月1日至2003年6月30日，应用CO2激光喉显微外科技术治疗喉部良恶性病变313例，其中采用切割或汽化方法切除声带息肉236例，声带小结30例；采用声带黏膜剥脱术切除声带白斑、声带角化症、声带不典型增生27例；应用声带黏膜剥脱术或声带切除术切除声门型喉癌(T1aN0M0％)20例。结果所有患者均一次切除病变，术中出血少或不出血，术野清楚。术后无一例出现呼吸困难、出血等严重并发症。声带息肉和声带小结患者的有效率达100％；声带白斑、角化症、不典型增生患者的有效率为92．6％；声门型喉癌患者半年复发率10％。结论应用CO2激光进行喉显微外科手术术中出血少、术野清楚，有效率高，拓展了手术的适应证和范围，值得推广应用。     

噪音声学分析及声门图在喉科疾病的应用初探

目的 了解噪音声学分析及声门图在喉科疾病中的应用。方法 应用Ｄｒ．ｓｐｅｅｃｈ软件对９９例声带息肉,２２例喉癌,２３例声带白斑患者作了噪音声学分析、电声门图和声谱分析。结果 声带息肉组中ｓｈｉｍｍｅｒ值异常者中７５％;各组病变的ＥＧＧ波形均有有不同程度的改变,但声门型喉癌的波形明显趋于无规律性;声声息肉组以一、二型声谱图米,而声门型喉以三、四型声谱图为主,结论这三种测试方法各有特点,互为补充,综合     

CO2激光切除声带良、恶性肿瘤术后客观嗓音声学分析比较

目的比较CO2激光切除声带良恶性肿瘤术后客观嗓音声学分析。方法选取我院2015~2019年收治的34例声带良恶性肿瘤患者,其中恶性病变21例,良性病变13例,均行支撑喉镜下CO2激光切除术,两组患者分别于术前、术后1周、术后1月、术后3月行频闪喉镜及客观嗓音学分析,记录jitter、shimmer数值。另取15例正常健康人群,记录客观嗓音分析数值作为对照。结果良恶性病变患者各有1例复发,其余恢复良好。良性病变患者术后1周、术后1月jitter、shimmer值较术前下降,但仍高于正常健康人群,差异有统计学意义,术后3月行频闪喉镜检查声带运动及jitter、shimmer值均基本达到正常健康水平,差异无统计学意义。恶性病变患者术后1周jitter、shimmer值略高于术前,术后1周、1月、3月仍明显高于良性病变者,差异有统计学意义。结论CO2激光切除声带良恶性肿瘤均取得良好疗效,总体术后嗓音恢复良性病变优于恶性病变,良性病变jitter、shimmer术后3月基本恢复正常;恶性病变jitter、shimmer术后1周高于术前,术后3月较术前好转,但仍不能达到健康人群水平。     

支撑喉镜联合内镜声带良性病变切除术66例疗效分析

目的探讨支持喉镜联合内镜声带良性病变切除术的疗效及优缺点。方法对66例声带良性病变(声带息肉49例,声带小结14例,声带囊肿3例)患者采用支撑喉镜联合硬管喉内镜行病变摘除术,术后随访1年,观察手术效果。结果所有病例均一次性治愈,发声良好,随访1年无复发病例。结论支撑喉镜联合内镜声带良性病变切除术术野清晰,手术效果好。     

Usefulness of electroglottogram (EGG) and photoglottogram (PGG) for the analysis or vocal fold vibration--a high speed digital imaging study

Simultaneous recordings of EGG, PGG and high-speed digital imaging (HSDI) of vocal fold vibration were made in 3 normal male subjects and the results were compared to evaluate the usefulness of EGG and PGG for the analysis of the vibratory pattern. Each subject was required to produce sounds of 3 different pitches at 3 different intensity levels in the recording sessions and the 27 sets of data samples were collected. For each data set, the glottal area waveform (GAW), glottal width waveform (GWW), EGG, differentiated EGG, PGG, differentiated PGG, and voice waveform were displayed in a graphic form on the same time axis and their patterns were compared. Based on the analysis of GAW and GWW, it was found that there were variations in the pattern of closing and opening of the vocal fold margin corresponding to the differences in the type of phonation. The EGG waveform appeared to correspond well to that of the movement of the vocal fold margin in the closing phase, while the correspondency was less apparent in the opening phase. It is considered that the EGG waveform is dependent on the mode of contact between the two vocal folds and that a careful observation of the EGG is useful and practical for predicting the pattern of vocal fold vibration. On the other hand, it was difficult to determine the onset of the closing and opening phases only from PGG waveform and there was a timing difference between the PGG and GAW. Although PGG seemed to be useful for judging the presence or absence of the opening phase and for the pitch measurement, it is considered to be unsuitable for a precise cycle-by-cycle analysis of the pattern of vocal fold vibration.     

Electroglottography and vocal fold physiology

The electroglottogram (EGG) is known to be related to vocal fold motion. A major hypothesis undergoing examination in several research centers is that the EGG is related to the area of contact of the vocal folds. This hypothesis is difficult to substantiate with direct measurements using human subjects. However, other supporting evidence can be offered. For this study we made measurements from synchronized ultra high-speed laryngeal films and from EGG waveforms collected from subjects with normal larynges and patients with vocal disorders. We compare certain features of the EGG waveform to (a) the instant of the opening of the glottis, (b) the instant of the closing of the glottis, and (c) the instant of the maximum opening of the glottis. In addition, we compare both the open quotient and the relative average perturbation measured from the glottal area to that estimated from the EGG. All of these comparisons indicate that vocal fold vibratory characteristics are reflected by features of the EGG waveform. This makes the EGG useful for speech analysis and synthesis as well as for modeling laryngeal behavior. The limitations of the EGG are discussed.     

声带息肉及小结的电声门图分析

目的探讨电声门图（ＥＧＧ）在临床上应用的可能性。方法用ＥＧＧ对声带息肉和声带小结患者进行测试和分析,并对手术的患者做了术前术后的对比。结果声带息肉和小结患者的ＥＧＧ波形的下降支出现“平台”和“副峰”样的特征性轨迹,且这种改变与息肉和小结的大小、形状、硬度和位置有关。结论ＥＧＧ可能反映声带的病理性变化,并可做为声带小结和息肉的诊断及治疗效果评价的一个客观方法。     

Glottal area waveform analysis of benign vocal fold lesions before and after surgery

Glottal area waveform (GAW) is the plot of relative glottal area versus time through 1 representative glottal cycle. It is derived from the quantitative analysis of the videostroboscopic image. A GAW analysis was performed on 24 patients before and after microlaryngeal phonosurgery. Patients with vocal fold polyps, polypoid degeneration, cysts, sulcus vocalis, and Reinke's edema were included. From each GAW, 5 parameters were determined and compared: maximum normalized glottal area, maximum opening rate, maximum closing rate, percent open time at 50% glottal opening, and glottal gap size. Statistically significant differences in postoperative states included an increased maximum glottal area, an increased maximum opening rate, and an increased maximum closing rate. Glottal opening and closing rate are objective measures of vocal fold pliability that have clinical relevance. The GAW may be used to quantitate vocal fold vibratory capability.     

动态喉镜图像定量分析技术的应用

目的探索图像定量分析技术在声带振动研究中的应用。方法应用计算机软件、分析６０例正常人和２０例单侧声带麻痹患者的动态喉镜图像。结果正常组声带振动均呈规律性,多数声门闭合完全;麻痹组声带振动均不规律,多数声门闭合不全,发声相声门最小面积（Ａｍｉｎ）麻痹组明显大于正常组,而最大面积（Ａｍａｘ）两组间无显著性差异。结论动态喉镜计算机图像分析技术可用于声带振动功能的定量分析。     

Laryngeal configuration associated with glottography

This report describes a method for testing and confirming the relationship of glottography to the vibratory movements of the vocal folds. According to this method, vocal fold movement is monitored by photoglottography (PGG) and electroglottography (EGG) as photographs are taken using a 80-microsecond flash provided by a laryngostroboscope. The flash is recorded as an impulse on the PGG waveform, indicating the location on the glottographic signals of the corresponding single frame photograph. We then present a test case, in which various vocal fold configurations are documented, demonstrating that the timing of glottal events can be correlated to glottographic signals by this method.     

Effects of thyroplasty type I on vocal fold vibration

OBJECTIVE: To ascertain effects of medialization thyroplasty on vocal fold vibration in glottic incompetence dysphonia. STUDY DESIGN: Quantitative videostroboscopic glottic measurements and vocal function study were perioperatively undertaken in 20 patients undergoing Isshiki's thyroplasty type I. METHODS: In digitized images, the glottal area, glottal width, posterior glottal width, and amplitude over an entire glottal cycle were measured and normalized by membranous vocal fold length. The ratio of closed phase to total phase of vibratory cycle was calculated from the data of the glottal area and the glottal width at the middle point of the membranous vocal fold. Well-accepted acoustic, aerodynamic, and perceptual measures analyzed vocal function. RESULTS: Glottal area and glottal width were reduced after surgery. While preoperative closure of glottal area was incomplete in all 20 patients, incomplete closure was obtained in 16 patients after surgery. In these 16 patients, closure of glottal width at the middle point of the membranous vocal fold was complete, whereas a posterior glottal gap remained in 14 patients. Closed phase over one cycle of glottal width waveform and amplitude of vocal fold vibration were increased after surgery. Glottal area, glottal width, posterior glottal width, and closed phase over one cycle of glottal width waveform correlated with vocal function measures. CONCLUSIONS: Thyroplasty type I reduces a glottal gap and increases closed phase over one cycle and amplitude of vocal fold vibration, although a posterior glottal gap remains. With the improved glottic vibration, thyroplasty type I provides more efficient phonation in patients with glottic incompetence dysphonia.