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（Ｅｌｅｃｔｒｏｇｌｏｔｔｏｇｒａｐｈｙ，ＥＧＧ）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（ＲＥＧ）、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，其中ＳＹＭ、ＲＥＧ、ＧＬＯ与电声门图切迹相关，ＲＥＧ及ＭＵＣ与陡直变化相关；带蒂小息肉使振动参数接触商（ＣＱ）及基频（Ｆ０）降低，电声门图以切迹为主；带蒂大息肉（均单侧）除使ＣＱ升高外，余变化与上述相同；单或双侧广基息肉使ＣＱ及Ｆ０升高，电声门图分别以接触开放相陡直和波峰平坦为主。结论通过喉动态镜及电声门图综合检测可更深刻地认识声带振动模式及其影响因素，发现声带息肉这一声带振动体被覆层病变所致的声带振动模式改变的规律性，为临床提供理论参考。     

声带振动模式及其变异的语音及电声门图分析

为更直观有效地了解正常男女性声带疾病患者在发声和声带振动的频率、幅度及声门开放、闭合过程的速度变化，我们采用嗓音测试仪观察正常男、女性声带振动的模式和声带疾病组的变异情况。将语言信号和电声门图信号的各个参数进行比较（ｔ检验）分析得出，健康男、女性波形规则均匀，女性频率快、幅度小，男性较女性的声门开放、闭合速度为快；疾病组中波形变化较大，频率或幅度都有不同的变化；嘶哑程度也不同地影响了声带运动中的开放和闭合过程。     

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。     

声带小结患者发音矫治前后电声门图参数变化

目的 比较分析声带小结患者发音矫治前后电声门图参数变化，评价发音矫治对声带小结的疗效。方法 对48例声带小结（软性小结）患者发音矫治（3～6个月）前后分别进行电声门图检测，并对其主要参数进行比较分析。结果 发音矫治后平均基频、接触率较矫治前有显菩性升高（P〈0．05），基频微扰、振幅微扰、噪声能量较矫治前有显著性下降（P〈0．05）。结论 发音骄治前后电声门圈参数变化结果提示，发音矫治对声带小结具有一定的治疗效果。     

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），声门闭合过程中断触相时程延长（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发迹     

声带小结及声带局部肥厚患儿嗓音声学及电声门图分析

目的 研究声带小结、声带局部肥厚患儿及正常儿童嗓音声学及电声门图参数之间的差异,为临床诊治提供依据.方法对342例正常儿童及76例声带局部肥厚患儿、52例声带小结患儿进行嗓音声学测试及电声门图分析,对三组参数进行方差分析并作两两比较.结果声带小结与声带局部肥厚患儿的嗓音声学分析的标准化噪声能量（NNE）与基频方差（SDFo）无显著差异,频率微扰（jitter）、振幅微扰（shimmer）在两组间差异有显著统计学意义;声带小结与声带局部肥厚患儿的电声门图频率微扰（jitter）、振幅微扰（shimmer）差异无统计学意义,NNE和SDFo在两组间差异有统计学意义.结论 jitter、shimmer、NNE、SDFo四项参数在区分正常嗓音和病理性嗓音时非常重要而且非常敏感;在病理性嗓音中以上四项参数各有异同;嗓音声学参数较电声门图参数更有意义.     

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。     

电声门图测试在声带振动体病变中的应用价值

声带振动的组织学基础为包含被膜层和本体层的双重振动体结构 ,常用检测方法有动态喉镜和电声门图(ｅｌｅｃｔｒｏｇｌｏｔｔｏｇｒａｐｈ ,ＥＧＧ) ,动态喉镜图像具有直观性 ,但对非周期性振动难以量化。我们应用ＥＧＧ技术对双重振动体的代表性病变 (声门型喉癌和声带息肉 )进行测试 ,并与健康人比较 ,探讨声带振动模式的变化规律。一、材料与方法声门型喉鳞状细胞癌患者 136例 ,Ｔ1期 33例 (Ｔ1ａ10例 ,Ｔ1ｂ2 3例 ) ,Ｔ2期 5 5例 ,Ｔ3期 18例 ,Ｔ4期 30例 ;除Ｔ1期有 2例女性患者外 ,其余均为男性 ;年龄 4 3～ 81岁 ,平均 5 9 1岁。男性…     

声带息肉与声带小结患者发声空气动力学研究

目的探讨声带息肉、声带小结患者发声时空气动力学指标的变化。方法采用嗓音功能分析仪（Aerophone II Voice Function Analyzer）对30例声带息肉、28例声带小结患者及30例正常人进行发声空气动力学检测,对平均气流率（mean airflow rate）、口腔压（intraoral pressure）、声门阻力（glottal resistance）、声门效率（glottal efficiency）进行分析、比较。结果声带息肉、声带小结患者的平均气流率、声门阻力、声门效率分别为254．50±36．02ml／s、33．55±4．63cmH2O／（L·S）、2．46±1．49和177．45±25．93ml／s、38．83±8．88cmH20／（L·S）、7．75±3．71,与正常人118．44±29．98ml／s、53．04±8．64cmH2O／（L·S）、9．17±3．87比较,差异有统计学意义（P〈0．01）;声带息肉患者声门下压力为8．97±1．36cmH2O,与正常人6．24±0．99cmH2O比较,差异有统计学意义（P〈0．01）;声带息肉与声带小结患者平均气流率、声门下压力和声门效率比较,差异有显著统计学意义（P〈0．01）。结论声带息肉患者的声门闭合程度、发声时的效率比声带小结患者更差,空气动力学检测可以对声带息肉、声带小结患者的嗓音功能作出量化的、客观的评价。     

成人病理嗓音电声门图曲线的临床特点

目的 :探讨成人病理嗓音电声门图 (EGG)曲线的临床特点。方法 :对 4 5 3例病理嗓音进行EGG检测 ,分析异常EGG曲线的临床意义。结果 :病理嗓音EGG曲线表现 :①EGG周期由接触期 (CP)和开放期 (OP)组成 ,二者比值界于一定范围 ,CP/OP <0 .70或 >2 .95均为异常 ;②CP又分为接触渐闭相 (CCP)和接触渐离相(COP) ;OP又分为渐开开放相 (OOP)和开放渐触相 (OCP) ;③振动周期中各时相形态异常表现 :CCP平缓、CCP切迹、波峰平坦、COP陡直、COP切迹、COP隆起、OOP隆起、OCP隆起 ;④联波、不规则等情况虽然少见 ,但反映了病理嗓音的特殊振动模式 ;⑤总的各时相异常变化中 ,COP >OP >CCP ,各病理嗓音组呈现不同的特点 ;⑥部分病理嗓音表现为联合异常 ,以COP与OOP联合病变为最多 ,单或双侧声带息肉、Reinke水肿及声门型喉癌组均有相当比例的联合病变。结论 :成人病理嗓音EGG曲线的形态变异错综复杂 ,各种变异形式又有一定的内在联系。确立OP的异常形式增加了病理EGG检出率 ,并且与CP异常密不可分 ;不同病理嗓音EGG曲线异常呈现不同倾向性 ,有一定规律可循。确立病理嗓音EGG曲线各时相形态异常变化形式 ,综合分析病理声带的异常振动模式 ,更深入发掘EGG检测的潜力并且完善病理声带振动机制的研究     

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.     

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.     

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。     

Electroglottographic parameterization of the effects of gender, vowel and phonatory registers on vocal fold vibratory patterns: an Indian perspective

In-depth study on laryngeal biomechanics and vocal fold vibratory patterns reveal that a single vibratory cycle can be divided into two major phases, the closed and open phase, which is subdivided into opening and closing phases. Studies reveal that the relative time course of abduction and adduction, which in turn is dependent on the relative relaxing and tensing of the vocal fold cover and body, to be the determining factor in production of a particular vocal register like the modal (or chest), falsetto, glottal fry registers. Studies further point out Electroglottography to be particularly suitable for the study of vocal vibratory patterns during register changes. However, to date, there has been limited study on quantitative parameterization of EGG wave form in vocal fry register. Moreover, contradictory findings abound in literature regarding effects of gender and vowel types on vocal vibratory patterns, especially during phonation at different registers. The present study endeavors to find out the effects of vowel and gender differences on the vocal fold vibratory patterns in different registers and how these would be reflected in standard EGG parameters of Contact Quotient (CQ) and Contact Index (CI), taking into consideration the Indian sociolinguistic context. Electroglottographic recordings of 10 young adults (5 males and 5 females) were taken while the subjects phonated the three vowels /a/,/i/,/u/ each in two vocal registers, modal and vocal fry. Obtained raw EGG were further normalized using the Derived EGG algorithm and theCQ and CI values were derived. Obtained data were subject to statistical analysis using the 3-way ANOVA with gender, vowel and vocal register as the three variables. Post-hoc Dunnett C multiple comparison analysis were also performed. Results reveal that CQ values are significantly higher in vocal fry than modal phonation for both males and females, indicating a relatively hyperconstricted vocal system during vocal fry. The males have significantly greater CQ values than females both at modal and vocal fry phonations which indicate that the males are predisposed to greater vocal fold constriction. Females demonstrated no significant increase in CI values in vocal fry state; and in some cases actually decrease in the CI values which suggest an inherently distinct vocal fold physiological adjustment from that in males. No vowel effects were found in any conditions. Perturbation values (CQP and CIP) are significantly more in vocal fry register than in modal register, and the increase was more in case of females than males. The findings give strong evidence to certain hypotheses in literature regarding effects of vowel, gender and phonatory register on vocal fold vibratory patterns.     

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。     

声带息肉的电声门图波形特征

对２０１例不同部位和形态的声带息肉的ＥＧＧ波形进行分析，结果显示：带蒂的息肉ＥＧＧ波形主要表现为开启相切迹，广基的息肉主要为开训相陡直；波形为闭扰相切迹的息肉，基底多数位于声带下缘，息肉在声带前后的位置和单，双侧对ＥＧＧ波形无影响。表明ＥＧＧ是一项有潜力的研究带振动理论的手段，对声带息肉的发生部位和形态具有诊断价值。     

Effectiveness of the Computed Analysis of Electroglottographic Signals in Muscle Tension Dysphonia

Objective: To investigate the usefulness of electroglottography (EGG) parameters in the diagnosis and estimation of efficacy of voice therapy for muscle tension dysphonia (MTD). Patients and Methods: Nineteen MTD participants, an equivalent number of dysphonic ('organic') patients with vocal fold lesions and as many normal speakers were enrolled. Acoustic (Ac) and EGG signals during sustained phonation were recorded simultaneously. The period and amplitude perturbation quotient of both signals, the closed quotient (CQ) of EGG signals (mean CQ) and its standard deviation (CQSD) were calculated, and subsequently compared among the three groups. These parameters in the MTD group were compared before and after voice therapy. Results: The perturbation measures of both signals in the MTD group were either as high as or significantly higher than those in the organic group or the control group, respectively. Both the Ac and EGG parameters after therapy significantly decreased. The CQSD, but not mean CQ, also decreased after therapy. Conclusion: EGG parameters related to the regularity of vocal fold vibration, but not to the degree of vocal fold contact (mean CQ), are useful for the diagnosis and estimation of voice therapy outcome in MTD.     

Correlation between glottal area and photoglottographic signal in normal subjects

Photoglottography (PGG) is an established technique for depicting the vibratory patterns of the vocal folds. The present study investigates the correlation between the glottal area and the corresponding PGG signal. Six normal (five male, one female) subjects who did not use their voices professionally were investigated during constantly sustained phonation at spontaneous pitches. Laryngostroboscopy was performed in combination with PGG. The simultaneously recorded laryngostroboscopic images and PGG signals were directly digitized and stored on a computer. The correlation between the glottal area and the corresponding PGG amplitudes across each vibratory cycle of the vocal folds was calculated and they were found to be highly and positively correlated (r = 0.973, p < 0.001). The PGG signal reflects changes in the glottal area during the vibration cycle of the vocal folds. The proposed simultaneous laryngostroboscopic and PGG technique has proved to be useful for facilitating the interpretation of changes in glottal area.