功能性发声障碍109例分析

伦敦Middlesex医院语言治疗科对在1977～1981年间对已完成一疗程治疗的109例功能性发声障碍的患者进行了分析。本病通常认为与精神因素有关,既往常用病名有:精神性发声障碍,癔病性发声障碍,心身性发声障碍,非器质性嗓音疾患等。本文所以称其为功能性发声障碍,为了表明主要是由功能失调而非结构病变所致。     

发声功能障碍

发声困难分为器质性和功能性两大类。在诊断器质性病变方面由于检查手段的进步,已可发现一些以前未发现的病变,如声带沟、声带纹(vergetures)、血管性声带炎以及微型喉蹼;但即使有明显的器质性病变,仍应想到可能有功能性因素并存。引起发声功能障碍的原因有:家庭或工作中的困     

计算机声学测试在发声障碍鉴别诊断中的应用

目的 观察器质性与功能性发声障碍噪音学参数及声谱图表征,探讨计算机声学检测系统在发声障碍鉴别诊断中的应用价值。方法 采用计算机噪音声学测试系统（Ｄｒ．Ｓｐｅｅｃｈ Ｓｃｉｅｎｃｅ ｆｏｒ Ｗｉｎｄｏｗｓ）对７０例正常成人、６０例器质性声带疾病及５０例功能性发声障碍噪音元音信号“ａ”进行测试,观察分析其声学参数（ｊｉｔｔｅｒ,ｓｈｉｍｍｅｒ,ＮＮＥ）及声谱图特征。结果 ６０例器质性声带疾病嘶哑噪音表     

嗓音声学检测中的常用指标及意义

嗓音的声学检测是喉功能检查的客观手段,发声是喉的重要功能之一,喉疾病往往出现发声障碍,故嗓音的声学检查一直为喉科医生、言语病理学家所重视.检查的目的是:①动态观察病变的转归情况;②估计病变的程度;③判定发声障碍的程度与范围;④预后估计;⑤疗效的客观分析;⑥对部分病例的诊断也起重要作用[1].     

“调节异常”而不是“功能性”发声障碍——欧洲嗓音医师协会的建议书

<正>临床上通常将嗓音疾病分为器质性发声障碍和非器质性发声障碍，器质性发声障碍是指声道中有结构改变的疾病，包括息肉、神经源性疾病（如帕金森病）、由激素改变引起的疾病（如肢端肥大症）等。非器质性发声障碍无声道结构改变，与心理社会因素或行为因素有关，通常被称为“功能性发声障碍”。然而，这个术语在日常临床使用中有些混乱，含糊其辞，被批判为不精确，因为它的病因学意义并不代表疾病的起因。     

手法按摩治愈功能性发声障碍二例

功能性发声障碍[1]是常见嗓音疾病,患者虽然嗓音异常,但喉结构正常,咳嗽声正常,多见于女性.常见的有癔病样发声障碍,室带代偿性发声、变声期后假声等类型.常用的治疗方法为嗓音矫治、针灸、颈部按摩等.北京友谊医院嗓音门诊遇到2例特殊类型功能性发声障碍患者,使用放松疗法和颈部手法按摩治愈,现报告如下.     

肌张力性发声障碍可能是潜在的声门关闭不全的表现

高动力性喉表现(室带在前后向的收缩或内外向的压缩)被归为非器质性或功能性发音紊乱,亦名肌张力性发音不良(MTD),是正常喉发声不当或发声过度的后果。随纤维喉镜、电视喉动态镜、喉肌电图、电声门     

功能性发声障碍患者嗓音及心理状态评估分析

目的 通过对功能性发声障碍患者进行嗓音和心理状态评估,探讨其在功能性发声障碍诊疗中的临床意义.方法 选取72例功能性发声障碍患者(实验组)和无嗓音障碍的正常人(对照组)40例.其中功能性发声障碍组中功能增强型发声障碍50例,功能减弱型发声障碍22例.所有患者均进行计算机嗓音评估、GRBAS评估、嗓音障碍指数量表(VHI...     

功能性发声障碍的喉镜检查及计算机声学分析

目的 观察功能性发声障碍的临床特征、嗓音声学参数和声谱图特征，探讨喉镜检查及计算机声学分析在功能性发声障碍诊断中的应用价值。方法 采用喉镜和计算机声学测试系统对71例功能性发声障碍患者和50例正常人进行喉镜检查及噪音元音／a：／进行测试，分析各项声学参数特点并行统计学分析。结果 高功能性发声障碍患者基频较正常升高；低功能性发声障碍患者基频较正常降低；基频微扰、振幅微扰、NNF较正常增高，最大发声时间缩短。均有统计学意义。90.14%(64/71)功能性发声障碍患者的噪音信号中可发现正常声学特征。声谱图特征为谐波及共振峰不规则、断裂甚至消失，噪声成分增加等。结论 应用计算机声学分析对功能性发声障碍患者的声学特征进行客观分析，有 地功能性发声障碍的诊断／     

功能性发声障碍的喉镜观察及声学、空气动力学研究

目的　观察功能性发声障碍患者的喉镜图像、嗓音声学特征及空气动力学变化,探讨其在功能性发声障碍诊断、分类中的价值。方法　对78例功能性发声障碍患者和5 0例正常成人进行喉镜检查,并对嗓音元音信号/a :/进行声学和空气动力学测试,观察喉部图像特征,分析声学和空气动力学参数特点并行统计学分析。结果　根据颈部及喉镜检查结果将功能性发声障碍分为高功能性发声障碍及低功能性发声障碍两组。高功能性发声障碍患者基频升高,平均气流率降低。低功能性发声障碍患者基频降低,平均气流率增加。所有功能性发声障碍患者频率微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(NNE)较正常增高,最大发声时间(MPT)均缩短。91.0 3%的功能性发声障碍患者嗓音信号中出现正常声学特征。声谱图均表现为谐波及共振峰不规则、断裂甚至消失,噪声成分增加等。结论　采用喉镜、声学和空气动力学检测方法有助于功能性发声障碍的分类、诊断及鉴别诊断     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.