喉部分切除术后发音功能的微机检测分析

应用ＨＧＦ－Ｉ型喉发音微机分析系统对２８例不同术式喉部分切除术后患者的发音功能进行了观察和分析，结果显示各患者间的发音部位及发音功能差异有显著性，发音功能与发音部位密切相关，“新声带”形成的患者和水平关喉切除术的患者发音功能接近正常人；声门上结构参与发音者和发音管发音者发音功能明显受损，声波曲线周期不明显，频谱曲线噪音水平高，共振峰出现蜂族现象。此微机系统包括频谱分析、自相关、互相关分析和声图，可     

喉疾病微机检测分析系统临床应用的初探

为探讨ＨＧＦ－Ｉ型分析系统在临床喉部疾病鉴别诊断中的价值，了解喉癌治疗中不同术式对术后发音功能的影响，采用该系统对正常对照者和较为常见的６种喉疾病患者、以及行水平和垂直半喉切除术患者进行频谱分析、相关分析和声图检查。与正常对照组相比，各喉疾病组的多项分析参数、曲线以及声图的差异有显著性，而各组间各项参数差异的显著程度均不相同；部分喉疾病组的频谱或相关曲线，以及声图具有较为特征性表现。喉部手术后，不同发音方式的发音功能变化情况明显不同。认为喉疾病微机检测、分析技术在喉科的科研及临床等方面具有一定的实际意义和应用价值。     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月～１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁～７８岁。全喉切除术后Ⅰ期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显。部分患者能唱歌，随访观察：在发音钮有效使用时间（１～２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装、更换方便，使用时间长，术后不用鼻饲等优点，为无喉者发音提供了又一有效途径。     

喉部分切除术后不同声源振动模式转换与代偿研究

目的研究喉部分切除术后喉的振动源变化及声带振动模式的代偿、转归,以探讨嗓音功能保留情况. 方法研究93例喉部分切除术患者(28例水平喉部分切除、35例垂直喉部分切除、30例3/4喉部分切除)及50例健康对照者不同嗓音声学、气流动力学及频闪喉镜下喉功能特点. 结果水平喉部分切除术后声带对称、表层肥厚,粘膜波活跃,嗓音声学参数与正常差异有显著性(P<0.05).垂直喉部分切除患者为非声门源振动发音,新振动体为健侧室带与对侧修复肌瓣或修复肌瓣与喉前庭粘膜(杓区、会厌根粘膜)振动发音,健侧声带未参与,嗓音声学参数与正常差异有极显著性(P<0.01).3/4喉部分切除后为部分非声门源振动发音,代偿振动模式为修复肌瓣与健侧声带振动发音和修复肌瓣与健侧杓区肥厚粘膜形成振动体颤动发音2种,嗓音声学参数与正常差异有显著性(P<0.01).3/4喉部分切除与垂直喉部分切除比较后者嗓音声学参数略差,但无统计学意义. 结论在喉部分切除术中,水平喉部分切除术后嗓音功能最佳,而垂直喉部分切除术后最差;修复体形态、功能特性直接影响术后效果.手术修复过程应充分利用机体的代偿功能,使术后声音质量有所提高.     

环状软骨上喉部分切除术嗓音的演化

目的：研究环状软骨上喉部分切除术后的嗓音声学特征。方法应用计算机言语实验室言语系统对５是否 状软骨上喉部分切除术的患者术后１８个月中嗓音及言语的演化过程进行前性研究。结果：环状软骨上部分切除术后患者发音参烽不稳定，而言语参数一直保持稳定。结论：在喉癌环状软骨上喉部分切除术中只保留一侧的杓状软骨，发音功能仍能保留。     

食管充气试验在二期发音重建中的作用

目的 尽快恢复无喉者语言功能，减少手术创伤，提高预测二期发音重建手术成功的准确性，客观评价食管充气试验的实际临床意义。方法 对全喉切除术后无喉者行食管充气试验及二期发音重建，特别就食管充气试验阴性患者进行研究分析。结果 ４５例食管充气试验阴性患者行二期发音重建，而不行咽缩肌切断术的发音成功率９４％（３６／３８），阳性患者成功率１００％（７／７）；无论充气试验阴性或阳性患者术后发音效果均好于预测试验     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月￣１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁￣７８岁，全喉切除术后１期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显，部分患者能唱歌，随防观察：在发音钮有效使用时间（１￣２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装，     

食管充气试验在二期发音重建中的作用

目的尽快恢复无喉者语言功能，减少手术创伤，提高预测二期发音重建手术成功的准确性，客观评价食管充气试验的实际临床意义。方法对全喉切除术后无喉者行食管充气试验及二期发音重建，特别就食管充气试验阴性患者进行研究分析。结果４５例食管充气试验阴性患者行二期发音重建，而不行咽缩肌切断术的发音成功率９４％（３６／３８），阳性患者成功率１００％（７／７）；无论充气试验阴性或阳性患者术后发音效果均好于预测试验时。结论食管充气试验对预测术后发音具有一定参考意义，可作为ＢｌｏｍＳｉｎｇｅｒ法二期发音重建术前常规检查，但测试时因受诸多因素影响，不能作为判定术后发音效果的唯一依据。     

喉全切除术和喉激光部分切除术后不规则声音的评估

激光喉部分切除术是一类器官保留性手术 ,术后具有较好的发音功能。喉全切除术后食管发音以及发音管植入后的气管食管音 ,尤其是后者使患者恢复了一定的语言交流功能 ,因此也具有较好的可接受性。在关于发音质量的自我评估中 ,这两者之间没有显著的差异。但作为聆听者则认为喉全切除术后语言质量较差。本文采取横向研究的方法 ,对 11例激光喉部分切除术后以及 18例喉全切除术后患者的声音质量进行了分析 ,并对计算机辅助声音分析程序的实用价值进行了评估。术后电话测试分析作为一种客观的言语可懂度检查方法 ,显示激光喉部分切除术后患者的…     

鸭嘴型硅胶发音管全喉切除术后发音重建

１９８６～１９９３年采用食管镜下气管食管间造瘘植入鸭嘴型硅胶发音管的方法为全喉切除术后患者行发音重建４３例，其中二期完成４０例，一期完成３例。１９８６～１９８９年间１２例中７例（５８．３％）获得满意声音。１９９０年以后对部分患者行环咽肌切断术、环状软骨切除术，并以食管吹气发音试验进行术前训练，完成３１例（其中３例全喉切除术同期完成发音重建），２９例（９３．３％）获满意声音。未见严重并发症。     

喉良性增生性病变的嗓音学特点及治疗转归

目的 :探讨喉良性增生性病变对发声功能的影响及CO2 激光显微外科术后的转归特点。方法 :对2 92例喉良性增生性病变患者 (声带息肉、任克水肿、声带小结、囊肿、慢性肥厚性喉炎 )的流行病学、嗓音声学、形态及CO2 激光显微外科术后转归进行分析。结果 :声带小结患者均为青年女性 ,2 3.0 8%与职业有关 ;任克水肿为中老年患者。声带息肉及小结病变局限 ,手术仅涉及声带局部 ,术后改善明显 ,术后 1个月达正常状态 ;任克水肿患者术后 1个月改善明显 ,术后 3个月恢复最佳稳定 ;声带囊肿患者术后 1个月声音达最佳状态 ,但由于病变切除术后局部存在缺损 ,一定程度上影响预后 ;慢性肥厚性喉炎患者术后改善不满意。术后声门上代偿纠正均不明显。结论 :喉良性增生性病变主要累及声带被覆层 ,嗓音声障碍的程度及疗效与受累范围有关 ,激光显微外科手术可以保留良好结构及功能。除外科治疗外 ,还应及时矫正不良发声习惯等因素 ,以期获得最佳疗效。     

T3 Supraglottic Cancer: Treatment Results and Prognostic Factors

Objective—A retrospective study was performed in order to analyze the treatment results and prognostic factors in patients with T3 supraglottic carcinoma and to differentiate between the treatment results obtained for T3 transglottic carcinoma and T3 pure supraglottic carcinoma. Material and Methods—Thirty-two patients who underwent surgery with or without postoperative radiation therapy between 1990 and 2000 were studied. Neck dissection was performed in 27 patients and 24 received postoperative radiation therapy. Results—The 3-year overall survival rate was 81.7%. The 3-year overall survival rates for T3 pure supraglottic carcinoma and T3 transglottic carcinoma were 91.7% and 73.2%, respectively (p<0.05). Univariate analysis revealed a prognostic significance for vocal cord fixation. T3 transglottic carcinoma was significantly correlated with vocal cord fixation. Conclusions—We suggest that surgery, either alone or in combination with postoperative radiation therapy, provides acceptable cancer control and survival rates for patients with T3 supraglottic carcinoma. Vocal cord fixation detected during preoperative fiberoptic laryngoscopy is a significant prognostic factor. T3 transglottic cancer needs more aggressive management.     

Vocal fold immobility with normal LEMG: A range of possibilities

ObjectiveThe objective of this paper is to study the etiology of vocal fold immobility with non-pathological LEMG.MethodsA retrospective study was performed on patients who presented with vocal fold immobility and underwent LEMG from 2009 to 2017. Those patients with normal LEMG findings were selected. The different causes of vocal fold impairment were studied.ResultsOf the 120 patients included in this study, 15 had a normal LEMG recording. The different etiologies of vocal fold immobility were idiopathic, central nervous system damage, iatrogenic, and external compression.ConclusionsVocal fold immobility and vocal fold paralysis are not equal terms. Vocal fold immobility with normal LEMG has a heterogeneous group of causes. It is not correct to assume that the major cause of immobility in patients with normal LEMG is always cricoarytenoid joint fixation.     

喉环上切除术后的嗓音研究

目的：探讨喉癌功能性外科手术喉环上切除术（SCPL）后，新喉的嗓音学特征及喉发声共振体的振动特性。方法：应用Dr．Speech（DSS）技术及频谱分析法，对21例患者行SCPL4种不同术式，即A：环状软骨-舌骨-会厌固定术（SCPL-CHEP），B：环状软骨-舌骨固定术（SCPL-CHP），C：气管-环状软骨-舌骨-会厌固定术（SC-PL-TCHEP），D：气管-环状软骨-舌骨固定术（SCPL-TCHP），并对术后嗓音学参数进行分析比较。结果：4种不同术式术后新声门区的振动模式大致相同，表现为黏膜波动增强，新声门区的振动模式随患者术后时间的推移而逐渐增强，且渐趋于稳定；患者术前、术后的基频、基频微扰、振幅微扰、标准化噪声能量及谐噪比等声学参数对比正常值，差异均有统计学意义。结论：SCPL中切除双侧声带和室带，保留两侧或一侧环杓单元即可重建新喉的发声功能，同时能保留喉的吞咽、呼吸功能和维持声门下压的生理功能；新喉的嗓音声学特征非常明确。     

Vocal function after transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancer

Abstract

Conclusion: The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling.

Objectives: Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists.

Methods: Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified.

Results: Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0018) and neck dissection (p?=?.0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p?=?.0021) was associated with post-operative voice impairment.     

Quantification of static and dynamic supraglottic activity.

For estimating supraglottic compression in disordered voice production, categorical rating scales of true vocal fold coverage by supraglottic structures are the current standard. Quantification of change in the position of supraglottic structures compared to no supraglottic activity would be a better method for distinguishing between and within voice-disordered groups. This study developed a method for quantifying static supraglottic activity and extent of false vocal fold (FVF) motion during dynamic supraglottic activity. Twelve control participants and 12 individuals with voice disorders (6 with complaints of vocal fatigue and 6 with vocal fold nodules) were enrolled in the study. These individuals participated in a transnasal fiberoptic laryngeal examination in which various speech tasks were recorded. Single-frame images were selected to represent the positions of minimum and maximum supraglottic compression for each speech task. Two individuals rated these single-frame images using a categorical rating scale. Two other individuals measured the anterior-to-posterior (A-P) distance, vocal fold length, and vocal fold area. A-P and FVF compression were derived from these three measures. Reliability was demonstrated between judges for the ratings and between and within judges for the measures. Significant differences in normalized static supraglottic compression measures corresponded to the rating scale categories. Significant differences in normalized dynamic supraglottic compression measures corresponded to the differences in category ratings between minimum and maximum compression. Using the normalized measures, the voice-disordered groups demonstrated significantly greater static A-P compression (t test, p < .03) than did the control participants. These results suggest that static supraglottic activity may be diagnostic of voice disorder. Normalized dynamic FVF compression ratios were not significantly different between groups. This supports a previous hypothesis that dynamic supraglottic activity serves as an articulatory function at the level of the larynx and is part of the linguistic/phonemic system, rather than evidence of disordered laryngeal function.     

Comparative study of vocal function after near-total laryngectomy.

OBJECTIVES: To assess vocal function after near-total laryngectomy (NTL) and to compare that with after vertical hemilaryngectomy (VHL), both of which use the laryngeal mucosa as the vibratory tissue. STUDY DESIGN: We retrospectively evaluated 29 patients, 11 of whom underwent NTL and 18 of whom underwent VHL. However, 2 patients failed to speak and 1 patient's voice sample was lost following NTL, so we analyzed the voices of 8 patients who underwent NTL and 18 patients who underwent VHL. METHODS: Vocal function was examined by acoustic and aerodynamic analysis. Acoustic analysis involved the evaluation of pitch, intensity, pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy. In aerodynamic analysis, we studied the mean airflow rate, vocal efficiency index (alternating current/direct current [AC/DC]), and maximum phonation time. RESULTS: Vocal function except pitch after either NTL or VHL had much variability, but the results following each procedure did not differ significantly. CONCLUSIONS: There are no significant differences between vocal function following NTL and VHL. Fiberscopic examination of the mucosa of the arytenoid was observed to vibrate in patients who underwent NTL, so that the phonatory mechanism after NTL resembled that after VHL.     

Vocal Function Following Radiation for Non‐Laryngeal Versus Laryngeal Tumors of the Head and Neck

Objective The larynx may receive high doses of radiation even in the absence of disease. Preliminary investigation has provided evidence that significant voice alterations exist in patients who received radiotherapy (RT) for non‐laryngeal tumors of the head and neck. This study evaluates subjective and objective parameters of vocal function in this patient population compared with a control group of patients irradiated for early glottic tumors. Study Design Retrospective cohort study. Methods Vocal function in patients irradiated for non‐laryngeal and early glottic tumors was assessed in a comprehensive manner and compared. Microanalytical and macroanalytical acoustic analyses, aerodynamic measurements, and videostroboscopy were performed on vowel production data. The Voice Handicap Index was administered for self‐assessment of voice quality. All subjects were male, smokers, and greater than 12 months post‐RT. Results Seventeen patients with non‐laryngeal tumors and 13 patients with early glottic tumors were evaluated. Microanalytical acoustic parameters were worse for 75% (6 of 8) of the acoustic measures of vowel production in the non‐laryngeal group. These include jitter, relative amplitude perturbation, amplitude perturbation quotient, normalized noise energy, pitch amplitude, and spectral flatness ratio. Macroanalytical acoustic analyses revealed no difference in fundamental frequency but numerically smaller phonational frequency range in the non‐laryngeal group. All aerodynamic measures, including mean phonation time, mean airflow, and vocal fold diadochokinetic rate, were decreased in the non‐laryngeal group. Videostroboscopy demonstrated increased supraglottic activity in the non‐laryngeal group. Voice handicap was significantly greater in the non‐laryngeal group. Conclusions When compared with patients receiving RT for early glottic tumors, there is objective and subjective evidence of vocal dysfunction in patients treated with wide‐field RT for non‐laryngeal tumors.     

Prognostic value of vocal cord fixation with respect to treatment in cancers of the supraglottis and pyriform sinus

Vocal cord fixation in supraglottic and pyriform sinus cancers has, in the past, precluded management by radiotherapy alone. Ninety-eight patients were reviewed to determine the prognostic effect of vocal cord fixation. The predictive value of cord mobility status after 50 Gy was evaluated with respect to treatment modality. For patients treated with radiotherapy alone, cord mobility status was predictive of recurrence, yielding 3 year recurrence rates of 33.3% (mobile) versus 80% (fixed) [p = 0.04]. Mobile cords after 50 Gy had similar recurrence rates (33.3% vs. 40.0%, p = 0.60) whether treated by radiotherapy or radiotherapy/surgery. Radiotherapy alone may be used in cases when fixed cords become mobile after 50 Gy without compromising cure rates or laryngeal function. Combined modality provides the best results when cords remain fixed.