患者自我评估与嗓音声学分析的比较

目的分析嗓音疾病患者自我评估的可靠性及其与嗓音声学检测的相关性。方法对35例嗓音疾病患者进行自我评估和嗓音声学检测。采用嗓音障碍指数(voice handicap index，VHI)和嗓音相关生活质量(voicerelated quality of life，V—RQOL)评估法。嗓音声学检测主要测试基频微扰、振幅微扰及标准化噪声能量三个参数，将自我评估结果与嗓音声学检测结果进行相关分析。结果VHI的功能、生理和情感三个范畴之间与V—RQOL的生理一功能、社会一情感两个范畴间有相关性；声学检测三个参数间相关性良好；而嗓音自我评估与声学参数间无相关性。结论嗓音疾病患者自我评估方法是获得患者全面信息的重要方法．客观检查不能预测主观评估的结果．     

嗓音障碍主观听感知评估现状

嗓音关系着人们的生活质量和幸福指数，如何对嗓音障碍患者的嗓音进行恰如其分的评价，判断其病变程度和评价治疗效果至关重要。目前国内的嗓音主观听感知评估才刚起步，尚缺乏规范化的评估方法以及标准化培训系统，导致对嗓音疾病准确的评估无法实现，限制了嗓音疾病诊疗工作的广泛开展。本文就嗓音障碍主观听感知评估的现状予以综述，并对未来的发展方向进行展望。     

早期声门癌经口激光显微手术患者获较高语音基频

目的评估早期声门癌患者治疗后嗓音特征和生活质量的长期疗效。研究设计回顾性分析台湾一家医学中心的患者资料。方法42例声门癌患者接受放疗（radiation therapy，RT）或经口激光显微手术（transoral laser microsurgery，TLM）治疗12个月后评估其嗓音和生活质量。结果24例患者接受RT，18例患者接受TLM。两组患者无听力学和空气动力学差异，对于男性患者仅有发音基频的差异。在癌症治疗——头颈调查的功能性评估中，TLM治疗组比RT治疗组能更好地交流，但无嗓音质量和强度的差异。同样，这两组在嗓音障碍指数10（VHI-10）评估中也没有显著性差异。结论接受TLM治疗的男性患者比接受RT治疗组的男性患者。具有较高的发音基频。对于早期声门癌患者，无论是接受TLM治疗，还是接受RT治疗，嗓音相关的生活质量是相似的：但是接受TLM治疗患者具有更好的交流能力。     

非线性动力学分析方法在嗓音医学中的应用进展

言语交流是人类社会生存的基本功能,生活质量与嗓音功能密切相关。伴随着日趋频繁的社会交往活动,嗓音疾病的患病率也逐年增加,因此,在治疗嗓音疾病时重视嗓音功能的保护有重要意义。目前,临床上对嗓音功能的评估主要包括：声带振动特征评价、发声质量的主客观评估、喉神经肌肉电生理评估、气流动力学评估等方面［1］。其中,因其客观性、方便性及实用性,声带振动特征评价和发声质量的客观评估在临床上应用广泛。正常声带发声时呈双侧对称的周期性振动,而病变声带可因声带的位置、形状、质量、张力、弹力及粘弹性等发生改变,导致声带产生不规则的振动,从而产生很强的非周期性嗓音声学信号。声带的位置、形状、质量、张力、弹力及粘滞性等因素均会对组织产生非线性影响,病变声带振动的过程不可能只按照某一因素的变化产生线性的变化,而是受多因素的影响产生非线性现象。本文对非线性动力学方法在嗓音医学中的应用进展及相关参数进行综述。     

早期喉癌等离子消融术后的嗓音评价

目的　评价经支撑喉镜等离子消融术治疗的早期声门型喉癌术后嗓音的康复情况。方法　2014年1月~2016年9月在我院就诊的42例早期声门型喉癌患者,经支 撑喉镜内镜辅助下行喉部肿瘤等离子消融切除术,手术前及术后3、6、9及12个月应用嗓音障碍指数VHI-10、RBH听感知评估及Praat嗓音分析对患者嗓音进行主客观评估。结果　所有患者随访12个月以上,嗓音评估显示术后3个月嗓音质量明显下降,6个月后逐渐好转,9~12个月后,除气息声和基频以外其他嗓音评估参数均较术前提高（P 均<0.05）。其中T1a级患者术后嗓音客观参数均较T1b及T2级恢复更好（P 均<0.05）。结论　经支撑喉镜等离子消融切除术治疗早期喉癌术后嗓音功能恢复较好。     

嗓音障碍的评估(Ⅰ)

随着社会的进步、生活水平的提高和社会交往的频繁，人们对如何保留和提高发声功能越来越重视。虽然嗓音疾病的诊断与治疗已经取得了相当的进步，但是还缺乏有效评价发声功能和嗓音障碍程度的方法，原因在于嗓音是一种复杂的多维现象，它既是一种在呼气流作用下的声带振动和产生声音的声学现象，又是一种主观心理听觉现象。因此，建立统一规范的嗓音障碍评估方法，     

嗓音医学的范畴和疾病分类

随着生活水平的提高,大众对于嗓音的要求也随之提升,进而为嗓音医学的相关从业人员提出了更高的要求.但是目前在嗓音医学的范畴以及嗓音疾病、嗓音障碍分类等问题方面,仍存在一定程度的混乱,也为临床工作带来了困难.针对目前这种情况,对嗓音医学的范畴进行了界定,并在以往嗓音障碍分类基础上,根据对嗓音疾病的理解,提出了嗓音疾病的分类...     

声带任克水肿临证验案分析

随着社会的发展,过度用嗓及不良生活习惯等导致的嗓音疾病的发生率日益增长,且人们对生活质量的要求提高迫使嗓音疾病的就诊率较前明显增加。嗓音疾病中声带任克水肿的发生率也在日益提高,其常规的治疗方式一般选用外科手术干预。随着手术技术的创新,其手术方式由最初的上皮剥脱术、发展至激光技术、显微微瓣吸引、缝合技术~([1])。由于喉显微手术的开展并不普及,患者出于对嗓音质量的要求,使得患者在选择手术治疗前,愿意尝试中医药保守治疗。陈小宁教授长期临床观察,综合分析患者全身伴随症状,辨证施治,运用健脾化痰的方法,治疗声带任克水肿,取得较好的临床效果。     

嗓音障碍主观听感知评估研究现状

嗓音异常是患者就诊于嗓音门诊的主要原因,通过听觉判断嗓音质量是临床上最占老、最普遍用于诊断嗓音疾病和判断治疗效果的方法.嗓音的主观听感知分析也被国际上用来作为检验嗓音客观检测有效性的参考方法.在目前缺少病理性嗓音发生机制模式或理论指导的情况下,嗓音的客观参数如声学参数、空气动力学参数和生理学参数的可靠性和有效性,只能以嗓音的主观听感知评估结果作为参考来检验.因此,嗓音主观听感知评估方法的研究就成为嗓音分析的重点和中心问题.     

显微缝合技术治疗声带任克水肿患者的嗓音评估

目的：采用嗓音主客观评估方法对手术中应用显微缝合技术治疗声带任克水肿的患者进行嗓音评估。方法：选择经手术治疗的20例声带任克水肿患者，均采用全身麻醉支撑喉镜显微镜下外侧微瓣技术切除病变，保留声带表面部分的正常黏膜，应用显微缝合技术将黏膜对位间断缝合。对所有患者分别进行术前和术后2周、3个月、6个月的嗓音评估，嗓音评估的结果与20例（男性）正常嗓音对照，评估采用显微缝合技术的声带愈合时间和嗓音恢复程度。结果：术后2周时双声带充血，声带振动幅度及黏膜波轻度减低，患者嗓音质量与术前相比明显改善（P〈0．05）；术后3个月时声带形态基本恢复正常，声带振动幅度及黏膜波正常，患者嗓音质量与术前相比明显改善（P〈0．05），与正常对照组比较差异无统计学意义（P〉0．05）；术后6个月时，嗓音质量保持稳定，与术后3个月比较无明显差异（尸〉O．05）。结论：采用显微缝合技术治疗声带任克水肿，术后恢复时间短，术后3个月时嗓音质量基本恢复正常。     

Voice disorders in childhood

Voice disorders in the pediatric population are relatively common. The education of families, teachers and clinical staff on etiology and treatment of pediatric voice disorders have led to greater attention being paid to hoarseness in childhood and improving early detection of pediatric voice disorders. Pediatric voice problems can have a number of causes. Most commonly, childhood dysphonia is caused by vocal fold nodules due vocal ab- and misuse. Other reasons might be congenital laryngeal dysplasia, vocal fold cysts and laryngeal papilloma. Medical examination is necessary in order to initiate appropriate treatment. In the case of vocal fold cysts and laryngeal papilloma, phonosurgery is indicated. Vocal fold nodules should be treated by voice therapy in order to change vocal behaviour. If voice therapy fails, phonosurgical intervention is recommended, since vocal fold nodules can persist into adulthood with a negative impact on voice quality.     

A comparative study of voice complaints and risk factors for voice complaints in female student teachers and practicing teachers early in their career

A cross-sectional questionnaire survey was performed to compare female student teachers (454 subjects; 1st to 4th year of training) and practicing teachers (82 female teachers; 1st to 4th year of teaching career) of primary education early in their career, with regard to risk factors perceived to be a negative influence on the voice, and the relative risk of the given risk factors for voice complaints. This enables the observation of whether there is a sudden increase or difference in the perceived risk factors after starting a professional teaching career. Additionally, the existence of a history of voice problems during training was questioned among the teachers. Teachers with voice complaints compared to teachers without voice complaints reported a history of voice complaints during their training (P =0.013). Teachers compared to student teachers reported more voice complaints at the moment and/or during the past year (P =0.002). The following data were obtained from student teachers and teachers reporting voice complaints. Only around a third of the subjects of both groups sought voice care (P =0.286–0.893). Risk factors were estimated in relation to voice complaints. Student teachers reported less frequently than teachers that stress (P =0.014), work pressure (P =0.003) and the composition of the class (P =0.013) have a negative influence on their voice. Student teachers reported less frequently than teachers that the number of people they communicate with (P <0.001) and the deterioration of their general physical condition (P =0.010) have a negative influence on their voice. Student teachers reported more frequently than teachers that environmental irritants (P <0.001) and humidity (P =0.020) of the classroom have a negative influence on their voice. Student teachers more than teachers were of the opinion that the attention paid to the voice during their training was sufficient (P <0.001). To test whether professional status (student teacher versus teacher) is an effect modifier for the risk factors, odds ratios (OR) were compared between the group of teachers and of student teachers (total group with and without voice complaints) to search for interactions between the risk factors and professional status. There is a significant difference in the pattern of risk factors for student teachers and teachers (P =0.010). There is an indication that vocal loading factors and environmental factors are more influential in student teachers and that there is a tendency for psycho-emotional factors to be more influential for teachers early in their career.     

Association between laryngeal findings and vocal qualities in muscle tension dysphonia with supraglottic contraction

Muscle tension dysphonia (MTD) is a voice disorder associated with abnormal laryngeal posture or glottic configuration induced by excessive contraction of the laryngeal muscles, and supraglottic contraction is one of the characteristic findings in MTD. In recent study we investigated the changes in laryngeal findings and voice quality and the association between them in the course of voice therapy for MTD with supraglottic contraction. The effects of voice therapy on the laryngeal and the vocal findings were assessed by two rating methods: the MTD score and the conventional GRBAS scores and both scores were gradually improved. Of the two components of supraglottic contraction, false vocal cord compression was more curable than anterior-posterior compression at the aryepiglottic level. Little correlation was found between the scores at the first examination, but significant associations (p < 0.05) were found between the differences of MTD score and G/R/S scores but not B/A scores before and after the series of voice therapy. These results suggest that supraglottic contraction is a crucial factor worsening voice quality and that MTD score is useful to assess the efficacy of voice therapy for MTD.     

Voice rehabilitation after total laryngectomy using the Newvox voice prosthesis

OBJECTIVES: To evaluate the anatomy, as well as the probability of restoring voice (study of the methods of vocal recovery) with the Newvox voice prosthesis. MATERIAL AND METHODS: This study relates to 225 patients having undergone a total laryngectomy and a Newvox voice prosthesis (one or more prosthesis) between April 1979 and November 2003. All the cases were followed up for 2 years. During evolution the complications were noted. All the valves removed were sent for microbiological analysis, including culture. The Statistical Analysis were carried out on the cohort of patients defined as having benefited from one or more voice prostheses after undergoing total laryngectomy. The lifespan of the implants has been described by the median duration (corresponding to the duration above which 50% of the implants lasted) the first quartile (corresponding to the duration above which 75% of the implants lasted) and the third quartile (corresponding to the duration above which 25% of the implants lasted). RESULTS: No infection by candida albicans was found. Complete removal of the Newvox voice prosthesis for local problems was necessary only in 20 cases (8.9% of the cases). The general lifespan (on 225 patients) of the 1st implant corresponded to a median of 252 days (8.4 months) with a first quartile of 452 days (1.2 year). The statistical analysis of the lifespan of the Newvox voice prosthesis made it possible to study the impact of radiotherapy on the quality of the results. The time to onset of satisfactory phonation was studied: The general median (time above which includes 50% of the patients) was three weeks. After two weeks, 25% of the patients obtain a satisfactory voice. CONCLUSION: On the whole, out of 185 documented cases, a satisfactory voice was obtained in 84% of patients, either by the voice prosthesis or by oesophageal voice. The absence of infection by candida albicans of the Newvox voice prosthesis is one of the factors which probably account for it being so well tolerated and having a significantly longer lifespan compared with other prostheses.     

Early rehabilitation of laryngectomized patients with the electrolarynx?

Seventy-three patients were asked to fill in a questionnaire to determine whether a laryngectomee can be rehabilitated better with the oesophageal voice or with the vibrator voice. This evaluation showed no significant difference between these two methods of voice rehabilitation. Patients rehabilitated with the vibrator learn oesophageal voice in addition without undue difficulties. Therefore, we recommend voice rehabilitation of the laryngectomee by both the above methods.     

喉癌前病变100例分析

对１００例喉癌前病变进行临床及病理学分析。发现喉癌前病变的发病和过度使用嗓音及长期大量吸烟有密切关系。其病理表现为上皮典型增生及轻、中、重度非典型增生（亦称异型）。扫描电镜观察到随喉粘膜上皮细胞异型程度的增加，细胞表面形状、大小、边缘、细胞间连接等有显著不同。１００例中有２０例转为恶性。其中，慢性肥厚性喉炎的恶变率为１１．６％，喉角化症为１９％，喉乳头状瘤为３６％。临床表现及病理均证明为喉息肉的病例也有恶性变者，故临床上应加以警惕。     

Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers]

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.     

Voice disorders in teachers and the general population: effects on work performance, attendance, and future career choices.

To examine the frequency and adverse effects of voice disorders on job performance and attendance in teachers and the general population, 2,401 participants from Iowa and Utah (n1 = 1,243 teachers and n2 = 1,279 nonteachers) were randomly selected and were interviewed by telephone using a voice disorder questionnaire. Teachers were significantly more likely than nonteachers to have experienced multiple voice symptoms and signs including hoarseness, discomfort, and increased effort while using their voice, tiring or experiencing a change in voice quality after short use, difficulty projecting their voice, trouble speaking or singing softly, and a loss of their singing range (all odds ratios [ORs] p <.05). Furthermore, teachers consistently attributed these voice symptoms to their occupation and were significantly more likely to indicate that their voice limited their ability to perform certain tasks at work, and had reduced activities or interactions as a result. Teachers, as compared with nonteachers, had missed more workdays over the preceding year because of voice problems and were more likely to consider changing occupations because of their voice (all comparisons p <.05). These findings strongly suggest that occupationally related voice dysfunction in teachers can have significant adverse effects on job performance, attendance, and future career choices.     

A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy

Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance in the last 10 years. Several reliable voice prostheses have been developed and used successfully. Priorities for further development of the methods and instruments for prosthetic voice rehabilitation have led to the design of a low-resistance, self-retaining voice prosthesis (Provox) and an adapted replacement method. The results obtained in 79 patients are described. In vivo airflow resistance ranged from 1.0 to 3.8 kPa (mean = 1.9 kPa). Speech quality was good in 91% of the patients. The self-retaining properties of the prosthesis appeared to be satisfactory. The average device-life was more than 5 months. Replacement of the prosthesis with a new disposable guide wire was done quickly as an outpatient procedure. Maintenance of the prosthesis by the patient was simple. The new low-resistance, self-retaining Provox voice prosthesis and the modified replacement method appeared to further improve the results of prosthetic voice rehabilitation after total laryngectomy.     

An evaluation of the 'voice test' as a method for assessing hearing in children with particular reference to the situation in developing countries

In developing countries with limited no or access to standard audiometric methods a 'voice test' is a potential non-technological alternative method of assessing hearing. A three level 'voice test' was developed, refined and standardised-accurate response to a whispered voice equating with normal hearing, to a conversational voice with mild hearing loss and to a loud voice to moderate/severe hearing loss. In a hospital based study 177 children were voice tested in sound treated rooms and then tested using standard audiometric procedures to determine precise hearing thresholds. In this situation the voice test had a specificity of 95.9% and a sensitivity of 80%. When the test was evaluated on 201 children aged 3-8 years, first voice tested and then tested with standard audiometry in the classrooms of their pre-primary schools it was found to have a specificity of 97.8% and a sensitivity of 83.3%. With this degree of accuracy in detecting hearing impairment and given the simplicity required to administer the test, it is felt that such a test could be recommended for use by primary health care workers in developing countries where access to standard audiometric methods for assessing hearing are not available.