气管食管裂隙状瘘发音重建术的声学分析

目的　客观评价气管食管裂隙状瘘发音重建术后的发音效果 ,并以此指导临床工作。方法　对喉全切除术后Ⅰ期与Ⅱ期气管食管裂隙状瘘发音患者、食管发音患者、安装Blom Singer发音钮患者以及健康人分别进行语音测试 ,分析 7项客观声学参数 ,比较发音效果。结果　经统计学t检验 ,气管食管裂隙状瘘语音最长发音时间短于健康人 ,明显长于食管音 ,但和Blom Singer发音钮语音差异无显著性 ;其声音的强度和健康人及Blom Singer发音钮差异无显著性 ,明显高于食管音 ;其基频明显低于健康人 ;其频率微扰和振幅微扰明显高于健康人 ,而明显低于食管发音 ,与Blom Singer发音钮语音差异无显著性 ;其共振峰频率和能量仅在F1共振峰能量上明显高于食管音 ,其余各频率上差异均无显著性。虽然喉全切除Ⅰ期气管食管裂隙状瘘发音重建术中制作帽状气室 ,而Ⅱ期发音重建术中不制作帽状气室 ,但两者语音声学分析各参数间差异均无显著性。结论　气管食管瘘语音比食管音接近健康人语音 ,能满足日常生活需要。气管食管裂隙状瘘发音重建术中不制作帽状气室不影响术后的发音。     

不同发声方式下正常儿童嗓音的声学分析

目的　研究正常儿童三种发声方式下嗓音声学参数的特点。方法　对 2 4 0例正常儿童的自然舒适音、真声最高音、真声最低音进行声学分析。结果　正常儿童的微扰值、规范化声门噪声能量值均为真声最低音 >舒适音 >真声最高音 ;基频标准差值为真声最高音 >真声最低音 >舒适音 ;谐噪比、信噪比与性别、年龄及发声方式无关。结论　正常儿童三种发声方式下的嗓音质量是不同的 ,嗓音声学测试结果的判断应结合受试者的发声方式。     

气管食管裂隙状瘘发音重建术的声学分析

目的 客观评价气管食管裂隙状瘘发音重建术后的发音效果，并以此指导临床工作。方法 对喉全切除术后I期与Ⅱ期气管食管裂隙状瘘发音患者、食管发音患者、安装Blom—Singer发音钮患者以及健康人分别进行语音测试，分析7项客观声学参数，比较发音效果。结果 经统计学t检验，气管食管裂隙状瘘语音最长发音时间短于健康人，明显长于食管音，但和Blom—Singer发音钮语音差异无显著性；其声音的强度和健康人及Blom—Singer发音钮差异无显著性，明显高于食管音；其基频明显低于健康人；其频率微扰和振幅微扰明显高于健康人，而明显低于食管发音，与Blom—Singer发音钮语音差异无显著性；其共振峰频率和能量仅在F1共振峰能量上明显高于食管音，其余各频率上差异均无显著性。虽然喉全切除I期气管食管裂隙状瘘发音重建术中制作帽状气室，而Ⅱ期发音重建术中不制作帽状气室，但两者语音声学分析各参数间差异均无显著性。结论气管食管瘘语音比食管音接近健康人语音，能满足日常生活需要。气管食管裂隙状瘘发音重建术中不制作帽状气室不影响术后的发音。     

特发性嗓音震颤的嗓音变化与声学特征分析

目的：探讨特发性嗓音震颤（EVT）的嗓音变化及声学特征。方法：对18例EVT的患者的临床表现及嗓音进行了观察及声学分析。结果：18例EVT的患者中。女性占72％（13／18例）,平均发病年龄为57岁,89％（16／18）无神经系统异常。临床表现为嗓音颤抖、发声困难,甚至频繁出现语音中断。喉体出现不自主的规律性颤动,双声带、室带及杓状软骨呈规律性开闭样颤抖,同时均伴有构音器官（软腭、舌及咽侧壁）的颤动。嗓音震颤的频率为4～6Hz。嗓音的声学分析特征为振幅微扰明显升高,软发声指数、无声度、嗓音中断度及嗓音震颤等参数出现特异性改变。结论：EVT的嗓音变化是一种频率较低的规律性震颤,严重者表现为发声困难、频繁出现语音中断。     

Quantitative evaluation of the voice range profile in patients with voice disorder

In 1953, Calvet first displayed the fundamental frequency (pitch) and sound pressure level (intensity) of a voice on a two-dimensional plane and created a voice range profile. This profile has been used to evaluate clinically various vocal disorders, although such evaluations to date have been subjective without quantitative assessment. In the present study, a quantitative system was developed to evaluate the voice range profile utilizing a personal computer. The area of the voice range profile was defined as the voice volume. This volume was analyzed in 137 males and 175 females who were treated for various dysphonias at Kyushu University between 1984 and 1990. Ten normal subjects served as controls. The voice volume in cases with voice disorders significantly decreased irrespective of the disease and sex. Furthermore, cases having better improvement after treatment showed a tendency for the voice volume to increase. These findings illustrated the voice volume as a useful clinical test for evaluating voice control in cases with vocal disorders.     

病态嗓音基频和音域的变化

目的：研究４种发音方式下基频（Ｆｏ）和真假声音域的关系。方法：用电子计算机分别测试真声最低音、舒适音、真声最高音、假声最高音的Ｆｏ值。结果：病态嗓音的真声最低音Ｆｏ值升高,假声最高音Ｆｏ值下降;真假声音域缩窄,假声音域变化更明显。结论：病态嗓音的假声最高音基频下降,假声音域变窄。     

Voice prosthesis in patients after total laryngectomy

The aim of the study is to present the role of voice prostheses in the voice rehabilitation in patients who underwent total laryngectomy. 7 patients with laryngeal cancer were included in the study. All patients are males aged 41-72 years (mean age 58) treated in the Department of Otolaryngology Medical Academy of Bialystok from November 2001 to March 2002. The voice prostheses were placed during the total laryngectomy in 5 patients. In 2 patients the voice prosthesis was placed in the period of 1.5 to 2 years after laryngectomy. The voice prostheses type Provox 2 were used in all cases. In 2 cases the prosthesis was in size of 8 mm, in 5 cases--10 mm. The control group included 7 patients after total laryngectomy without placing the voice prostheses. These patients developed oesophageal speech. All patients underwent phoniatric measurements during 12 to 30 days after the surgical procedure. The data indicate that patients who developed oesophageal speech, their voice in the range of subjective measurements is understandable but it is necessary to emphasize that the voice is harsh, low without fluency of the speech result from the intervals essential to accumulate the air in the oesophagus. The patients with voice prostheses have dull voice but more fluent and louder. The clarity of the voice of the patients with voice prostheses is significantly higher. According to the objective measurements all parameters are better in the oesophageal speech.     

Analysis of factors influencing voice quality and therapeutic approaches in vocal polyp patients

The task of the present study was to investigate the relationship between parameters and factors predictive of voice quality and to suggest treatment guidelines for patients suffering from vocal polyps. In total, 158 patients diagnosed with vocal polyps and who received voice therapy were enrolled. Clinicomorphological factors such as size, location, color, and type of the polyp were evaluated. Perceptive and acoustic voice evaluation was conducted and the relationship of these voice parameters with clinicomorphological factors was analyzed. Additionally, factors favorable for voice therapy were investigated. GRBAS scale grade was closely related to acoustic parameters, such as jitter and shimmer. Univariate analysis showed the size of the polyp, the color of the vocal fold, a history of voice abuse, associated muscle tension dysphonia (MTD), and opposing reactive scar affected voice quality. In multivariate analysis, only the size of the polyp was associated with voice quality. The patients in whom the voice quality improved with voice therapy initially had smaller polyps and whitish-colored vocal folds. Results of the present study indicate that although the most influential factor on voice quality in vocal polyp patients was the size, several other factors should be considered in evaluating and treating vocal polyps. The size of the polyp and the color of the vocal fold are indicative of success or failure in voice therapy.     

Quantitative evaluation of the voice range profile in patients with voice disorder

In 1953, Calvet first displayed the fundamental frequency (pitch) and sound pressure level (intensity) of a voice on a two-dimensional plane and created a voice range profile. This profile has been used to evaluate clinically various vocal disorders, although such evaluations to date have been subjective without quantitative assessment. In the present study, a quantitative system was developed to evaluate the voice range profile utilizing a personal computer. The area of the voice range profile was defined as the voice volume. This volume was analyzed in 137 males and 175 females who were treated for various dysphonias at Kyushu University between 1984 and 1990. Ten normal subjects served as controls. The voice volume in cases with voice disorders significantly decreased irrespective of the disease and sex. Furthermore, cases having better improvement after treatment showed a tendency for the voice volume to increase. These findings illustrated the voice volume as a useful clinical test for evaluating voice control in cases with vocal disorders.     

Voice disorders in the general population: prevalence, risk factors, and occupational impact

OBJECTIVES: Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare. The purpose of this investigation was to 1) determine the prevalence of voice disorders, 2) identify variables associated with increased risk of voice disorders, and 3) establish the functional impact of voice disorders on the general population. STUDY DESIGN: Cross-sectional telephone survey. METHODS: A random sample (n = 1,326) of adults in Iowa and Utah was interviewed using a questionnaire that addressed three areas related to voice disorders: prevalence, potential risk factors, and occupational consequences/effects. RESULTS: The lifetime prevalence of a voice disorder was 29.9%, with 6.6% of participants reporting a current voice disorder. Stepwise logistic regression identified specific factors that uniquely contributed to increased odds of reporting a chronic voice disorder including sex (women), age (40-59 years), voice use patterns and demands, esophageal reflux, chemical exposures, and frequent cold/sinus infections. However, tobacco or alcohol use did not independently increase the odds of reporting of a chronic voice disorder. Voice disorders adversely impacted job performance and attendance, with 4.3% of participants indicating that their voice had limited or rendered them unable to do certain tasks in their current job. Furthermore, 7.2% of employed respondents reported that they were absent from work 1 or more days in the past year because of their voice, and 2% reported more than 4 days of voice-related absence. CONCLUSIONS: The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders, factors that contribute to voice disorder vulnerability, and the functional impact of voice problems on the general population.     

The dysphonic voice heard by me,you and it: differential associations with personality and psychological distress

The dysphonic voice heard by me, you and it: differential associations with personality and psychological distress Voice production is subject to and indicative of psychological status. The precise relationships of voice disorders and psychological variables remain unclear. We compared the correlations of self‐reported and more objective measures of voice quality in dysphonic patients with personality, coping, affect and somatization. Two hundred and four subjects participating in a randomized, controlled trial of speech therapy underwent self‐report, observer rating and computer acoustic analysis of voice quality. These three indices of voice quality were compared with regard to their correlations with individual differences in neuroticism, alexithymia, negative emotion coping, anxiety, depression, neurotic symptoms, medically unexplained symptoms and quality of life. Significant correlations were observed between self‐reported voice problems and all of the personality/coping and clinical psychological distress measures. People who reported more voice problems had: higher neuroticism and alexithymia; a tendency to use emotion‐oriented coping; more psychological distress; poorer quality of life; and more past medically unexplained symptoms. Expert voice rating correlated weakly with neurotic disturbance, quality of life and previous medically unexplained symptoms. Objective voice assessment (amplitude perturbation) showed no significant associations with any psychological measure. The strongest associations of psychological variables and voice measures are with self‐report measures. This suggests that it is in part the patients' perception of their own voice quality which accounts for the association of voice production and psychological factors in subjects presenting to voice clinics.     

小学教师嗓音疲劳测试结果分析

目的：分析成都市某区小学教师嗓音疲劳状况及嗓音疾病患病情况。方法采用二阶段随机抽样调查方法抽取成都市某区小学教师389名,填写咽喉部症状调查表并行嗓音疲劳测试（观察嗓音疲劳测试失败率、平均声压级、平均基频）及频闪喉镜检查。结果①本组教师咽喉不适症状以声音嘶哑最常见,其次为咽痛、咽干及发声易疲劳;②本组教师中189例患嗓音疾病,患病率为48．58％（疾病组）,以慢性喉炎最常见,其次为声带息肉;余200例教师无明显嗓音疾病及发声功能障碍（嗓音正常组）;③两组教师嗓音疲劳测试80 dB SPL 音量时失败率均明显高于75 dB SPL 时,且第1、2、10分钟嗓音疾病组的失败率高于嗓音正常组,差异有统计学意义（P ＜0．05）;在第3分钟时,嗓音正常组平均声压级低于嗓音疾病组,第9分钟时,嗓音正常组平均声压级高于嗓音疾病组（均为 P ＜0．05）;在第1、3、4、6、7、10分钟嗓音疾病组平均基频高于嗓音正常组,差异有统计学意义（P ＜0．05）。结论嗓音疲劳在小学教师中普遍存在,且音量要求高时更易发生,其嗓音疾病的患病率也较高,应加强小学教师的嗓音保健,以改善嗓音疲劳症状,有利于降低罹患嗓音疾病的几率。     

Response of the female vocal quality and resonance in professional voice users taking oral contraceptive pills: a multiparameter approach

OBJECTIVE/HYPOTHESIS: The purpose of this study was to analyze the vocal quality and resonance (nasality and nasalance values) during the menstrual cycle in professional voice users using oral contraceptive pills (OCPs). Although professional voice users are more sensitive and aware of their vocal quality, no changes of voice and resonance characteristics were expected because OCPs create a stable hormonal balance throughout the menstrual cycle. STUDY DESIGN: The authors conducted a comparative study of 24 healthy, young professional voice users using OCPs. One assessment was performed between the 10th and 17th day of pill intake, when hormonal levels reached a steady state. The second assessment was performed during the first 3 days of menses, when no pills were taken and hormonal levels were minimized. METHODS: Subjective (perceptual evaluation of voice and nasality) and objective (aerodynamic, voice range, acoustic, Dysphonia Severity Index [DSI], nasometer) assessment techniques were used. RESULTS:: The Mann-Whitney U test showed no significant difference between the perceptual evaluation of the voice and the nasality in the two assessments. The paired Student t test showed no significant difference regarding the maximum phonation time, the vocal performance, the acoustic parameters, and the DSI. CONCLUSIONS: These findings indicate that OCPs do not have an impact on the objective and subjective voice and resonance parameters in young professional voice users. This information is specifically relevant to professional voice users who are more aware of vocal quality changes and ear, nose and throat specialists/voice therapists who treat professional voice users with voice problems/disorders. Further research regarding the impact of increased vocal load during the premenstrual or menstrual phase in professional voice users using OCPs should be considered.     

频域相对信噪比正常,病态嗓音声学的分析

通过对３６例正常人和３０例病态嗓音者的频域相对信噪比进行分析，结果表明，正常女性嗓音的频域相对信噪比呈稳定分布，而病态嗓音的相对信噪比，１７００Ｈｚ频段，与正常人比较，有显著差异，可以认为频域相对信噪比及区分病态嗓音和正常嗓音的有效参数。     

First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy

CONCLUSION: The new Provox NID non-indwelling voice prosthesis investigated in this study provides a good option for laryngectomized patients using non-indwelling voice prostheses and can potentially improve safety and increase patients' satisfaction with their voice and speech. OBJECTIVE: To investigate the feasibility of and patient satisfaction with the Provox NID non-indwelling voice prosthesis. MATERIAL AND METHODS: Pre- and post-study questionnaires were used to evaluate the patients' former voice prosthesis and the Provox NID voice prosthesis. In addition, measurements of pull-out force, maximum phonation time and loudness were made for both voice prostheses. In vitro measurements of airflow characteristics were also made. Following a 6-week trial, all patients provided feedback on the new voice prosthesis and the results were used to further improve the Provox NID. This final version of the new voice prosthesis was subsequently trialled and evaluated by 10 patients 6 months later. RESULTS: Overall results showed that patient satisfaction with the Provox NID non-indwelling voice prosthesis was favourable. The pull-out force for the new prosthesis was significantly higher than that for the formerly used prosthesis and its aerodynamic characteristics were better.     

频域相对信噪比对正常、病态嗓音声学的分析

通过对36例正常人和30例病态嗓音者的频域相对信噪比进行分析，结果表明：正常女性嗓音的频域相对信噪比呈稳定分布，而病态嗓音的相对信噪比＞1700Hz频段，与正常人比较，有显著差异（P＜0．01）。可以认为频域相对信噪比是区分病态嗓音和正常嗓音的有效参数。     

年龄和性别对临床嗓音分析影响的研究

目的：探讨年龄、性别因素在噪音分析中的影响，比较区分与不区分年龄、性别在成年噪音检测中对噪音评价结果的差异。方法：使用美国泰亿格电子（上海）有限公司的Dr.Speech(4.0版）噪音测试软件系统，利用系统默认的正常参考标准（A标准，不分年龄、性别）与我们早期的研究成果（B标准，区别年龄、性别）分别对558例声带疾病患者进行噪音评估，并对评估结果分析比较。结果：两标准对噪音的评估程度不同，其差异具有一致性（P≤0.001),并且与使用两种不同标准有中等程度的相关（0．4≤κ≤0．8）；使用B标准后，总体使噪音评估程度在男性改变为35．52％，女性为63．21％，并且改变率的大小各组并不一致：女性比男性的改变率大，女性中年组变化最大，男性中老年组变化最大；B标准比A标准总的噪音评估检出率提高了20．52％。结论：年龄、性别对临床噪音客观分析有较大的影响，区分年龄、性别进行噪音分析精确、细致；提倡使用B标准作为噪音分析评估的参考值。     

The dysphonic voice heard by me,you and it: differential associations with personality and psychological distress

Voice production is subject to and indicative of psychological status. The precise relationships of voice disorders and psychological variables remain unclear. We compared the correlations of self-reported and more objective measures of voice quality in dysphonic patients with personality, coping, affect and somatization. Two hundred and four subjects participating in a randomized, controlled trial of speech therapy underwent self-report, observer rating and computer acoustic analysis of voice quality. These three indices of voice quality were compared with regard to their correlations with individual differences in neuroticism, alexithymia, negative emotion coping, anxiety, depression, neurotic symptoms, medically unexplained symptoms and quality of life. Significant correlations were observed between self-reported voice problems and all of the personality/coping and clinical psychological distress measures. People who reported more voice problems had: higher neuroticism and alexithymia; a tendency to use emotion-oriented coping; more psychological distress; poorer quality of life; and more past medically unexplained symptoms. Expert voice rating correlated weakly with neurotic disturbance, quality of life and previous medically unexplained symptoms. Objective voice assessment (amplitude perturbation) showed no significant associations with any psychological measure. The strongest associations of psychological variables and voice measures are with self-report measures. This suggests that it is in part the patients' perception of their own voice quality which accounts for the association of voice production and psychological factors in subjects presenting to voice clinics.     

Subjective and objective voice assessment following partial resection of the larynx

There is no generally accepted, standardized approach for evaluation of voice quality and of intelligibility after partial laryngectomy. A voice evaluation which considers some aspects of voice quality is possible by assessing physical and acoustic voice parameters. But this approach does not consider how the patient subjectively assesses his postoperatively altered voice and how the patient believes he is understood by various communication partners. In this study objective and subjective variables of the voice quality of 32 patients with partial laryngectomies were measured. First, selected physical and acoustic variables of voice quality were quantified. Second, subjective criteria of voice quality and of intelligibility were assessed by a questionnaire. A significant correlation between variables of objective and subjective voice quality was found. The maximum vocal intensity, the maximum pitch, and the intensity range correlated significantly with the subjective assessment of intelligibility. No relationship was found between the acoustic variables and the subjectively perceived degree of vocal disability.