声带注射治疗声带麻痹及检测喉发音的研究

对30例不同病因所致单侧声带麻痹患者,采用经环甲间隙穿刺声带注射硅胶的方法进行治疗.治疗前后对患者的最长发音时间(MPT)、喉平均呼气流率(MFR)、基频值(F_0)、声强级(SPL)、频率微扰商(PPQ)、振幅微扰商(APQ)、噪声能量级(NNE),频闪喉镜下声带振动发音过程中的对称性(SYM)、规则性(REG)、振幅(AMP)、闭合状态(GLO)、粘膜波动(MUC)、等质性(NON)和嗓音心理听觉评价参数:音哑总分度(G)、粗糙型(R)、气息型(B)、无力型(A)、紧张型(S)进行检测,并对测试结果进行统计学分析.实验结果表明,上述各项参数值在治疗后较治疗前有明显改善,其中MPT、GLO值的增高,MFR、PPQ、APQ、NNE值下降表现最明显:心理听觉评价参数GRBAS值治疗后较治疗前也有明显好转.对各参数进行统计学分析得出:声带麻痹嗓音中噪音成分主要同声带振动的规则性、振幅和粘膜波呈正相关(P<0.05或 P<0.01).声带麻痹嗓音的主观心理听觉评价是以气息型和无力型为主.它主要与喉平均呼气流率,声带振动的规则性、闭合度、振幅、声带粘膜波及对称性呈正相关.从而证明,经环甲间隙声带注射硅胶治疗单侧声带麻痹是一种简单、实用、安全的治疗方法.若一次不成功还可以重复治疗.     

声带癌治疗前后嗓音学检测及动态喉镜检查的对比分析

本文应用嗓音的主观１客观评价方法对３０例声带癌患者应用激光或放射治疗前后嗓音分析与动态喉镜检查结果相比，经统计学相关分析得出如下结论：（１）由于激光或放疗对声带造成的损伤影响声愈合，使喉发音进气体从声门漏出而产生气息型嗓音；（２）声带癌患者治疗前与治疗后嗓音声学参数对比分析未见有统计学显著性差异；（３）嗓音声学分析参数与Ｇ．Ｂ．Ｓ型心理听觉参数呈正相关；（４）嗓音声学参数与动态喉镜检查结果进行相关     

声带癌治疗前后嗓音声学检测及动态喉镜检查的对比分析

本文应用嗓音的主观、客观评价方法对３０例声带癌患者应用激光或放射治疗前后嗓音分析与动态喉镜检查结果相对比，经统计学相关分析得出如下结论：①由于激光或放疗对声带造成的损伤影响声带闭合，使喉发音时气体从声门漏出而产生气息型嗓音；②声带癌患者治疗前与治疗后嗓音声学参数对比分析未见有统计学显著性差异；③嗓音声学分析参数与０．Ｂ．Ｓ型心理听觉参数呈正相关；④嗓音声学参数与动态喉镜检查结果进行相关分析发现ＡＰＱ与ＧＬＯ，ＮＮＥａ与ＡＭＰ，ＮＯＮ呈显著性正相关（Ｐ＜０．０５）。     

嗓音声学检测分析

目的重点介绍嗓音声学检测分析方法的分类及其临床意义.方法嗓音声学检测分析主要分为主观心理听觉评估和客观声学检测分析两种.主观心理听觉评估方法应用最多的是GRBAS评估标准,包括：音哑总分度G（overall grade degree）,粗糙型R（rough）,气息型B（breath）,无力型A（asthenic）,紧张型S（strained）;客观检测分析方法主要包括：嗓音声学分析,声带形态及运动检测,喉空气动力学检测,喉肌电图分析.结果嗓音声学检测分析方法可检查喉病治疗效果及喉功能恢复改善情况.对用喉者的发音状况进行监测,对喉病作辅助诊断.结论嗓音声学检测分析是喉发音功能评估主要方法之一,采用多参数综合检测分析将会更全面地反应喉的生理功能状况.     

CO_2激光与喉显微手术治疗声带息肉的疗效对比

目的 比较ＣＯ２激光与喉显微手术治疗声带息肉的治疗效果。方法 ６０例声带息肉患者分为激光组和喉显微手术组，每组各３０例。患者手术后行间接喉镜声带检查、嗓音声学分析、主观听觉评价分析。结果激光组术后声带形态的恢复时间要长于喉显微手术组；激光组术后声学参数中的ＰＰＱ值大于而Ｈ／Ｎ值小于显微手术组；激光组术后的嗓音主观听觉评价以粗糙型和紧张型为主，而喉显微手术组仅以粗糙型为主。结论 对声带息肉的治疗喉显微手术方法优于激光手术，喉显微手术较激光手术对组织损伤小，术后愈合时间短，术后嗓音恢复快，同时也减轻了患者的经济负担。     

声带显微微瓣手术后发声功能恢复和嗓音训练时间的初步探讨

目的探讨声带显微微瓣手术后发声功能恢复的规律和嗓音训练最佳时机。方法 48例声带息肉患者行喉显微微瓣声带息肉切除术,于术前、术后3、4、5天行频闪喉镜检查及嗓音声学分析。分析比较声带粘膜波及振动、嗓音基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)等特征。结果术后3天患者嗓音声学分析中的基频微扰、振幅微扰、噪谐比与术前相比差异无统计学意义,术后4、5天患者的嗓音基频微扰、振幅微扰及噪谐比均较术前明显下降,差异有统计学意义(P<0.05),术后3、4及5天与术前相比,患者的声带黏膜波增强,声带无振动部位减少(均为P<0.001)。结论显微微瓣声带息肉切除术后4天患者嗓音功能好转,声带粘膜波及振动已恢复,可开始嗓音训练。     

正常与病态下嗓音的客观指标的评价

对158例正常人和136例各种喉疾病患者连续元音[i]发声时的平均气流率、声强、频率、频率微扰商和发声效率同步进行了测定.并对各测定指标间的相互关系进行了探讨.频率微扰商是表示连续元音发声时声带振动相邻周期间的微细变动量;发声效率反映平均气流率与声能的有效转换率.在低、中和高强度发声时.随发声强度的提高,平均气流率.频率和发声效率随之提高而频率微扰商则变小.中等声强发声时.平均气流率与声强,声强与频率均呈正相关;而平均气流率与发声效率.声强(男性)和频率(女性)与频率微扰商均呈负相关.多数喉疾病患者显示出较正常人高的平均气流率和频率微扰商,发声效率则降低.当声强和频率作为参考指标时,平均气流率,频率微扰商和发声效率可作为评价喉发声功能的客观、定量指标.     

嗓音频率微扰的检测及临床意义

报告对60例20－40岁正常人嗓音和45例患者的病态嗓音进行了频率微扰检测。结果：正常人嗓音频率微扰Jitter值，男性均值为0．036ms，女性为0．027ms；JR值，男性均值为94％，女性为98％。Jitter值和JR值性别间无显著性差异。正常嗓音频率微扰的特点是：周期间频率相同者较多，不同者甚少，频率微扰值较小。病态嗓音的Jitter值和JR值，慢性喉炎与正常嗓音无显著性差异，声带癌、喉癌术后明显高于正常嗓音（P＜0．01）。提示频率微扰可作为喉病声学常规检测中的一项定量客观指标。     

喉部分切除术的发声客观声学评价

目的:探讨计算机辅助声学分析在诊断喉癌及评价喉癌术后发声客观声学上的应用价值.方法:以18～65岁经检查无喉疾病50例为正常组.以40例喉癌患者为喉癌组,手术方式有声带切除术,垂直喉部分切除术,次全喉切除术和近全喉切除发音管成形术,分别于术前及术后1～2个月测试.以各种原因引起的喉返神经麻痹20例为对照组,各组均用声图谱分析仪检测.结果:发i音时喉癌组术前、术后声学参数,如频率均值,平均微扰、频率微扰商、振幅微扰商、谐噪比、音调微扰系数与正常组差异有显著性(P＜0.05),喉返神经麻痹组除频率均值与正常组差异有显著性(P＜0.05)外,余无明显差异.发a音时,除喉癌组术前音调微扰系数外,余者差异均有显著性(P＜0.05).结论:喉癌患者发音参数的频率均值、平均微扰、频率微扰商、振幅微扰商、谐噪比及音调微扰系数与正常组差异有显著性(P＜0.05).发声参数是评价喉癌患者发声客观声学的敏感指标.     

喉癌与声带息肉患者嗓音的计算机定量评估

目的比较喉癌及声带息肉患者主要嗓音参数在不同检测方法中的变化,探讨喉癌与声带息肉对发声功能的影响。方法采用Dr．SpeechScienceforWindows（4．0）软件对正常成人、喉癌患者、声带息肉患者作嗓音声学分析和电声门图检测,并比较其主要参数的变化,分析各自嗓音质量评估的特点。结果①在喉癌和声带息肉患者中,两种嗓音检测方法的嗓音参数,基频微扰、振幅微扰、声门噪声能量均是有价值的,两者的基频微扰、振幅微扰、声门噪声能量可以互相替代,两种方法各参数间比较无统计学差异;②正常成人、喉癌患者、声带息肉患者平均基频之间无统计学意义,基频微扰、振幅微扰、声门噪声能量数值由低到高排列依次为正常成人组、声带息肉组、喉癌组,两两比较均有显著性差异（P〈O.05）;③嗓音质量由好到差排列为正常成人组、声带息肉组、喉癌组。结论计算机声学分析的各项参数可作为嗓音定量评价的客观指标,判断嗓音损害程度。     

声带振动体被覆层病变对声带振动模式影响的探讨

目的 探讨声带振动体被覆层病变对声带振动模式的影响。方法 对５０例成人声带息肉患者手术前和术后５￣７天进行了电视录像硬管望远喉动态镜观察和电声门图检测。结果 声带的振动模式随声带息肉的基底、形态、体积及单双侧的不同而变化，同时其振动参数及电声门图出现相应的变化、所有声带息肉均不同程度地影响声带振动规则性、振幅（ＡＭＰ）、声门闭合度（ＧＬＯ）及粘膜波动度（ＭＵＣ）、单侧息肉影响对称性（ＳＹＭ）显著，     

The relationship between the condition of the brain stem compartments of the acoustic analyzer and rheoencephalography in people who participated in the liquidation of the consequences of the Chernobyl' nuclear plant disaster

Pure-tone and speech threshold and suprathreshold audiometry, short-latent acoustic evoked potentials (SLAEP) and rheoencephalography (REG) were applied in examination of 67 patients with neurosensory hypoacusis (NSH) aged 21 to 45 years. These patients worked as wreckers in the zone contaminated with radionuclides 5 years and later after the Chernobyl accident. Relationships between functional condition of the truncal structures of the acoustic analyser and cerebral hemodynamics were studied. Correlation analysis has shown that there is close correlation between SLAEP and REG, especially in the vertebrobasillar area of cerebral circulation. The closest relations existed between the duration of the latent period of SLAEP wave V, interpeak interval I-V and rheographic index in the vertebrobasillar system. Combination of SLAEP and REG potentialities opens wide prospects for revelation of the key pathogenetic links for disorders of the acoustic system of unconventional origin, improves quality of these disorders diagnosis, promotes individual approach to therapy of such patients.     

Cerebral hemodynamics in patients with neurosensory hearing loss before and after magnetotherapy

Magnetotherapy effects on cerebral hemodynamics were studied using rheoencephalography (REG). When the treatment results and changes in cerebral hemodynamics were compared it was evident that normalization or improvement of vascular status in vertebrobasilar and carotid territories registered at REG results in better hearing. This confirms the role of vascular factor in pathogenesis of neurosensory hypoacusis of different etiology and effectiveness of magnetotherapy in such patients.     

Preventive care and treatment of hearing problems in persons exposed to radiation

Neurosensory hypoacusis (NSHA) was treated in 193 patients exposed to radiation consequently to the Chernobyl accident. The article describes changes observed in the examinees on audiograms, ECG, rheoencephalograms (REG) and acoustic evoked potentials. Treatment of patients with radiation-induced NSHA was aimed at normalization of tonicity of the cerebral vessels, venous outflow, pulse blood filling, arterial pressure, bioelectric activity of the brain, cardiac activity with account to hearing defects in different portions of the acoustic system. The treatment has improved parameters of tonal and speech audiometry, cortical acoustic evoked potentials, REG and EEG in 63.4% of the patients. The rest of the patients achieved stabilization of the process, arrest of progressive hearing loss. Also, positive effects were seen on the general condition of the patients, their working ability. The patients experienced relief of the headache, stuffy ears, noise in the ears, etc.     

喉内显微电离子手术治疗声带良性赘生物

目的探讨电离子手术治疗声带良性赘生物的效果。方法在局麻支撑喉镜下利用电离子治疗仪,对55例声带小结和息肉等良性病变进行治疗,并利用频闪喉镜和声学的主客观评价进行手术前后比较。结果所有良性病变均完整切除,频闪喉镜术后观察声带运动的对称性、规则性、振幅,闭合状态、粘膜波动五项指标较术前明显改善（P＜0．05或P＜0．01）。术后心理听觉评价,粗糙型、气息型声嘶者均较术前明显改善（P＜0．05）。最长发声时间均技术前显著延长（P＜0．05）。结论喉内显微电离子手术治疗声带良性病变,效果良好,值得推广使用。     

Changes in the auditory system related to cerebral circulation in the Ukraine population after the Chernobyl disaster.

The hearing and cerebral circulation was evaluated in 100 liquidators ranging from 23 to 50 years of age 1 year and 6 to 8 years after the disaster. Also, the hearing state data was compared from 80 liquidators of the same age dwelling in clean and radionuclide-contaminated areas for 5 to 8 years. The control group consisted of 20 young healthy individuals having no history of contact with radiation. Subjective audiometry, AEP and REG was used. Testing performed indicate that under radiation, more pronounced changes occur in the central part of the acoustic analyser rather than in its receptor system. More impaired were the persons residing the radionuclide-contaminated areas. The liquidators of the ChFS accident who live in clean areas presented with better state of the cerebral circulation and bioelectric brain activity. But over the time, the REG data 6-8 years after the disaster became considerably worse, as compared to the data obtained 1 year after the disaster. It should be emphasized that individual irradiated during and after the Chernobyl disaster require a constant dynamic observation and their identified changes require periodical management. Withdrawal of the liquidators from the contaminated to the clean areas is one of the preventive measures against the hearing and cerebral circulation disorders.     

Pharmacopuncture in combined treatment of children with neurosensory hypoacusis

Pharmacopuncture treatment (cerebrolysin, cavinton, prozerin) was given to 120 children with neurosensory hypoacusis aged 4-15 years. The treatment consisted of 3 courses 10 days each with 7-10-day interval. The drugs were injected in the dose 0.1 ml in biologically active points according to the original technique. The treatment lowered tonal thresholds more than by 15 dB in 36% children. Speech intelligibility increased, head ache and nose in the ears relieved in 85% cases. Adaptation to the hearing aid was positive. Clinical evidence was confirmed by REG picture indicating normalization of hemodynamics. Pharmacopuncture is a promising method in the treatment of children with neurosensory hypoacusis.     

Speech-evoked brainstem response in normal adolescent and children speakers of Brazilian Portuguese

This study aimed to analyze the coding responses of speech sounds (syllable/da/) in children and adolescent speakers of Brazilian Portuguese with typical development and normal hearing, aged between 8 and 16 years, in order to establish normative data of speech ABR response. This normative data can be used as a reference for speech ABR responses and also to enable the diagnosis in individuals with different pathologies. The analyze for absolute latency of speech sounds, more specifically the syllable/da/, for speech-ABR in children and adolescent speakers of Brazilian Portuguese with typical development were: right ear - wave V (6,43–6,57), wave A (7,35–7,57), wave C (18,19–18,46), wave D (21,99–22,42), wave E (30,73–31,05), wave F (39,19–39,55) and wave O (47,75–48,24) and left ear - wave V (6,44–6,57), wave A (7,36–7,59), wave C (18,26–18,55), wave D (22,22 -22,50), wave E (30,58–30,97), wave F (39,05–39,35) and wave O (47,78–48,13). For the amplitude values (μv), the responses were within the following ranges: right ear - wave V (0,10–0,14), wave A (0,19–0,25), wave C (0,08–0,13), wave D (0,11–0,17), wave E (0,17–0,42), wave F (0,14–0,33) and wave O (0,11–0,31) and left ear - wave V (0,09–0,13), wave A (0,08–0,23), wave C (0,08–0,14), wave D (0,10–0,15), wave E (0,20–0,26), wave F (0,16–0,22) and wave O (0,12–0,20). For the values of complex VA (slope: μv/ms and area μv x ms) the follow values obtained were: right ear – slope (0,32–0,42) and area (0,29–0,38) and left ear – slope (0,30–0,39) and area (0,27–0,35).     

Ultrastructural abnormalities of the cilia in human nasal epithelia

Nasal mucosal cilia were observed with electron microscope in 14 patients with immotile cilia syndrome (ICS), 9 with nasal papilloma (NP), 23 with sinobronchial syndrome (SB), 2 with sinusitis combined with dextrocardia (SC), 1 with Kartagener's syndrome (KS), and 5 normal controls (C). Abnormalities such as complex cilia, cilia with abnormal axonemes and cilia with randomly oriented central microtubules were frequently found in the groups of ICS (8.1%) and NP (10.4%) while less in other groups: SB (4.9%), SC (5.3%), KS (4.7%) and C (3.9%). The percentage of cilia with defective dynein arms (DA) was the highest in the ICS group (94.0%), followed by the groups of SC (53.7%), SB (47.5%), NP (41.2%), C (35.8%) and KS (33.3%). The ICS group was found to be the largest in the number of defective DA per a cilium (4.1), followed by the groups of NP (1.0), SB (0.6), SC (0.7), KS (0.4) and C (0.4). Increased rates of defective DA were also recognized in cilia of tracheal mucosa and flagella of sperm in 7 patients with ICS examined. In conclusion, neither abnormal cilia nor defective DA of cilia are specific findings for ICS. However, when we observe these findings in high percentage in nasal mucosa as well as in other organs, we may define this condition as ICS.