不同舌重建术后患者语音功能的评价

目的:评价不同舌重建术式对舌癌患者术后语音功能恢复的影响。方法:32例舌癌患者据重建术式分组:带蒂胸大肌肌皮瓣修复组5人,除1例外舌切除缘范围均过中线;前臂游离皮瓣修复组和邻近组织瓣修复组分别为16人和11人,除1例外舌切除缘范围均不过中线。采用汉语语音清晰度测试和短句测试方法,对患者手术前后语音清晰度变化情况进行分析,并对前臂游离皮瓣修复组和邻近组织瓣修复组的评价结果进行团体t检验。结果:带蒂胸大肌肌皮瓣修复组、前臂游离皮瓣修复组和邻近组织瓣修复组术后的语音清晰度平均下降值分别为26.60、7.84和4.18分,短句测试得分下降值分别为1.60、0.50和0.27分;t检验结果显示,前臂皮瓣和邻近组织瓣修复组的语音清晰度和短句测试得分下降值间无显著性差异(P>0.05)。结论:舌癌手术切除后运用前臂游离皮瓣或邻近组织瓣进行舌重建均能较好地恢复患者术后的语音功能,且两者间没有显著差异;对于舌缺损范围较大尤其是超过半侧舌的患者,采用带蒂胸大肌皮瓣也能够在一定程度上改善患者术后的语音功能。     

舌癌患者术后元音共振峰频谱分析

目的分析舌癌患者术后元音共振峰的变化,了解患者的语音功能状况。方法20名舌体切除范围不超过半舌的舌癌患者为研究对象,对其手术前、后的6个汉语单元音共振峰(F1、F2、F3)进行分析比较。结果手术后患者元音/e/F1、/i/F1、/u/F1、/o/F2、/u/F2上升,/櫣/F2、/i/F3、/櫣/F3下降。结论舌癌术后,患者的语音功能发生明显变化,使用VS-99语音工作站可对患者手术前后语音功能变化特征进行定量分析,为临床语音功能训练提供参考。     

腭裂语音元音共振峰特点的分析

目的　了解腭裂术后患者语音矫治后元音发音的改变,明确语音矫治对腭裂患者语音改善的重要性。方法　应用VS-99语音工作站对10例健康儿童、未进行语音训练的33例腭裂术后患者及16例语音矫治后患者的4个单元音[a]、[e]、[i]、[u]发音进行语音分析。结果　①元音[a]前3个共振峰频率(F1,F2,F3)平均值,3组间无显著件差异(P>0.05)。②元音[e]的F1,F2,F3平均值,语音矫治前组与对照组,矫治前组与矫治后组比较,均有显著性差异(P<0.05);而矫治后组与对照组间无显著性差异(P>0.05)。③元音[i]的F1,F2,F3平均值,矫治前组与矫治后组比较有显著性差异(P<0.05),矫治后组与对照组比较F2、F3有显著性差异(P<0·05)。④元音[u] 的F1,F2,F3平均值,矫治前组与矫治后组比较有显著性差异(P<0.05),其他各组间无显著性差异(P>0.05)。结论　腭裂修复术可使患者达到解剖结构上的正常或接近正常,但未达到完善的腭咽闭合,因而需要语音矫治与训练;语音矫治后患者语音有明显改善;通过语音频谱的分析,可为语音矫治提供依据。     

舌再造术后语音功能的检测

舌缺损严重影响语音功能，本实验中开发了语音分析ＬＰＣＦＦＴ计算机软件，对患者术后的发音情况给予客观评价，技术指标为：元音ＬＰＣ共振峰测定，辅音ＦＦＴ谱线观察，手术前后元音及辅音离散度分析等。结果发现舌部手术以后，在［ａ］、［ｉ］、［ｕ］３个元音中以［ｉ］音的变化较明显，元音［ｉ］的语音指标能较好地反映舌部的功能状态。我们还进行耳听语音测定，并与频谱检查结果之间进行相关分析，结果元音［ｉ］的离散度与耳测评分之间相关性好。     

频谱分析技术在腭裂语音研究中的应用

目的用语音共振峰的原理建立腭裂语音研究的客观方法。方法对正常儿童、腭裂术前儿童、腭裂术后儿童分别进行单元音[a]、[o]、[e]、[ī]、[u]、[ü]的录音及语音频谱分析,计算各组儿童的第一、二、三共振峰数值,对腭裂术后儿童的腭咽闭合不全率及语音清晰度进行测量,并评价其与共振峰的对应关系。结果正常儿童的第一、二、三共振峰数值是比较恒定的,腭裂术前儿童的共振峰数值明显下降,腭裂术后儿童的共振峰数值随腭咽闭合程度和语音清晰度的改善而显著提高。腭咽闭合完全者发[i]时,F3值明显大于腭咽闭合不全者。结论语音共振峰可以客观地反映腭咽闭合状况,单元音[i]可以作为此种检测的标准音素。     

舌癌患者术后语音功能的影响因素分析

目的：评价舌癌患者手术前、后的语音功能,探讨患者术后语音功能的影响因素。方法：收集2001年10月—2004年6月在上海交通大学医学院附属第九人民医院口腔颌面外科I病区接受手术的舌癌患者27例,所有患者的舌切除范围均在半舌内。根据重建术式分为前臂游离皮瓣修复组（16例）、邻近舌组织瓣修复组（11例）;根据肿瘤大小和分期分为T1组（9例）、T2组（13例）及T3组（5例）;根据肿瘤切除后缺损的部位分为舌前部切除组（5例）、舌中部切除组（6例）、舌后部切除组（12例）和半舌切除组（4例）;根据术后舌活动度分为I度受限（14例）、Ⅱ度受限（7例）和Ⅲ度受限（6例）。采用100个具有代表性的汉字组成的汉语语音清晰度测试字表作为检测手段,对每例患者手术前、后语音清晰度变化情况进行采样,利用SPSS11.5软件包对所获资料进行方差分析,评价原发灶大小、手术切除部位、修复术式、邻近结构保存以及术后舌活动度等因素对患者术后语音清晰度的影响。结果：前臂游离皮瓣组和邻近舌组织瓣修复组间,术后语音清晰度比较无显著性差异（P〉0.05）;对原发灶大小不同的舌癌患者术后语音清晰度的比较表明,T1和T3组间有显著性差异（P〈0.05）;舌前份切除者的语音清晰度显著低于后份切除者（P〈0.05）,保存舌尖和口底组术后的语音清晰度明显高于未保存组（P〈0.05）,保存舌根组和未保存组间的语音清晰度改变无显著差异（P〉0.05）;不同程度伸舌受限者,术后语音清晰度下降有显著差异（P〈0.01）。结论：对半舌范围内行舌切除的舌癌患者,手术切除部位和邻近结构以及舌活动度的保存与否是影响术后语音功能的敏感因素,原发灶大小在一定程度上决定术后语音清晰度的高低,而选择何种修复手段并不是其主要影响因素。     

以声学分析法对腭裂术后语音不良机理的初步分析

从声学角度出发应用计算机语音分析技术测试反映腭裂术后患者声道形态特征的元音共振峰。结果表明，腭裂术后语音不良组（Ａ组）除〔ａ〕外，其余５个单元音的第三共振峰频率（Ｆ３）均显著低于腭裂术后语音清晰度组（Ｂ组）（Ｐ＜０．０５）；声学元音图直观显示了（Ａ组）的声学感知空间较（Ｂ组）小。提示腭裂术后语音不良的原因可能系腭裂术后存在不同程度的腭咽闭合不全及腭裂患者长期形成的舌位后移，下颌开度不准和口唇肌运动不协调等代偿性不良发音习惯未得到完全矫正。文中指出，腭裂术后清晰可懂的语音是建立在腭咽闭合完全的基础上，逐渐矫正长期形成的代偿性不良发音习惯的结果。     

Furlow反向双Z腭成形术的临床特征及语音评价

对42例行反向双Z腭成形术的复诊患者和10例正常儿童进行主观语音清晰度评定并借助计算机语音信号分析系统测试其反映声道形态特征的各单元音头三个共振峰频率,结果表明,83.3％复诊患者的语音清晰度为89.16％,其各单元音共振峰模式与正常对照组类似(P>0.05);讨论了Furlow反向双Z腭成形术的临床特征及存在问题,从声学角度论证了Furlow反向双Z腭成形术是目前理想的更符合解剖形态与生理功能协调性修复概念的新术式。     

应用计算机语音分析技术对腭裂语音元音音素的初步分析

应用计算机语音信号分析技术对１２例腭裂患儿和１１例正常儿童所发普通话汉语元音的特点进行了对比研究。文中讨论了元音共振峰模式改变的意义，并依据两组元音的声学参数绘制了声学元音图。结果表明：舌位及舌面高点向后移动是腭裂患儿普遍存在的发音动作。代偿性舌位后移是产生腭裂语音的重要原因。声学元音图表明：腭裂元音的发音舌位基本相同，因而元音的区别特征减弱，清晰度下降。文章还讨论了腭裂术前和术后腭咽闭合不全与分支声管和共鸣腔共鸣的关系问题，指出腭裂术后一定程度的腭咽闭合不全的存在不是影响语音效果的主要因素，腭裂术后语音训练应加强低元音鼻化的纠正。     

用USSA语音频谱分析系统对不同磨光面外形全口义齿患者的语音分析

目的：研究不同磨光面外形的全口义齿对语音的影响。方法：我们选择20名无牙颌患,分别制作具备与不具备适宜磨光面外形的两副义齿,隔日更换使用。于初戴、1个月、3个月后利用USSA语音频谱分析系统测试发音情况。结果：二第2共振峰频率差别有显意义,宽带和窄带语图显示前优于后。结论：全口义齿应恢复其原有的解剖形态。     

Volume and location of the defect as predictors of speech outcome after glossectomy: correlation with a classification

The evaluation of speech outcomes after resection and reconstruction of the oral tongue remains largely unsystematic. A cross-sectional study was performed to analyse the speech outcomes of patients who underwent curative treatment with appropriate reconstruction. Sixty-nine patients were assessed for speech intelligibility and phonetics using a validated speech intelligibility assessment tool in the local language. Volume defects were classified as class I (less than one third), II (one third to half), III (half to two-thirds), or IV (two-thirds to total glossectomy). Defect location was defined as lateral, tip, or sulcus. The χ² test and Kruskal–Wallis test were used to test volume and location as predictors. Twenty-six patients had class I defects, 29 had class II defects, seven had class III defects, and seven had class IV defects. Twenty-two patients (31.9%) received adjuvant radiotherapy. Mean vowel, consonant, word, and paragraph intelligibility were 99.27%, 86.86%, 85.52%, and 88.72%, respectively. The incremental volume of the glossectomy defect was significantly correlated with speech intelligibility scores and phonatory alterations. In classes II and III, tip resection significantly affected interdental sounds. All patients in class III had affected alveolar and alveo-palatal sounds. The results positively corroborated the volume and location of the glossectomy defect to a classification system.     

Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic,computer-based speech analysis

Oral squamous cell carcinoma (OSCC) and its treatment impair speech intelligibility by alteration of the vocal tract. The aim of this study was to identify the factors of oral cancer treatment that influence speech intelligibility by means of an automatic, standardized speech-recognition system. The study group comprised 71 patients (mean age 59.89, range 35–82 years) with OSCC ranging from stage T1 to T4 (TNM staging). Tumours were located on the tongue (n = 23), lower alveolar crest (n = 27), and floor of the mouth (n = 21). Reconstruction was conducted through local tissue plasty or microvascular transplants. Adjuvant radiotherapy was performed in 49 patients. Speech intelligibility was evaluated before, and at 3, 6, and 12 months after tumour resection, and compared to that of a healthy control group (n = 40). Postoperatively, significant influences on speech intelligibility were tumour localization (P = 0.010) and resection volume (P = 0.019). Additionally, adjuvant radiotherapy (P = 0.049) influenced intelligibility at 3 months after surgery. At 6 months after surgery, influences were resection volume (P = 0.028) and adjuvant radiotherapy (P = 0.034). The influence of tumour localization (P = 0.001) and adjuvant radiotherapy (P = 0.022) persisted after 12 months. Tumour localization, resection volume, and radiotherapy are crucial factors for speech intelligibility. Radiotherapy significantly impaired word recognition rate (WR) values with a progression of the impairment for up to 12 months after surgery.     

Digitised evaluation of speech intelligibility using vowels in maxillectomy patients

Among the functional disabilities that patients face following maxillectomy, speech impairment is a major factor influencing quality of life. Proper rehabilitation of speech, which may include prosthodontic and surgical treatments and speech therapy, requires accurate evaluation of speech intelligibility (SI). A simple, less time‐consuming yet accurate evaluation is desirable both for maxillectomy patients and the various clinicians providing maxillofacial treatment. This study sought to determine the utility of digital acoustic analysis of vowels for the prediction of SI in maxillectomy patients, based on a comprehensive understanding of speech production in the vocal tract of maxillectomy patients and its perception. Speech samples were collected from 33 male maxillectomy patients (mean age 57.4 years) in two conditions, without and with a maxillofacial prosthesis, and formant data for the vowels /a/,/e/,/i/,/o/, and /u/ were calculated based on linear predictive coding. The frequency range of formant 2 (F2) was determined by differences between the minimum and maximum frequency. An SI test was also conducted to reveal the relationship between SI score and F2 range. Statistical analyses were applied. F2 range and SI score were significantly different between the two conditions without and with a prosthesis (both P < .0001). F2 range was significantly correlated with SI score in both the conditions (Spearman's r = .843, P < .0001; r = .832, P < .0001, respectively). These findings indicate that calculating the F2 range from 5 vowels has clinical utility for the prediction of SI after maxillectomy.     

上颌可摘局部义齿戴用前后语音效果对比研究

目的：研究戴用上颌复杂可摘局部义齿对汉语单元音共振峰参数的影响。方法：上颌牙列缺损患者可摘局部义齿戴用前后进行6个单元音的检测并对其前3个共振峰（F）参数进行分析。结果：戴牙后āF1、ēF1下降,ōF1、ēF2、ēF3、īF1、ūFl、ūF2、ǖF2升高。结论：可摘局部义齿修复后,患者的语音功能发生较大变化使用Vsgg语音信号处理系统及Matlab分析程序,能客观地反映语音变化情况,为语音功能的临床评价提供依据。     

Long‐term subjective tongue function after partial glossectomy

There have been limited studies of subjective tongue function over long‐term follow‐up in spite of swallowing and articulation disorders are common complications of glossectomy. To assess long‐term subjective swallowing and articulation function after partial glossectomy. A total of 63 patients with the mobile tongue cancer who underwent partial glossectomy without reconstruction were interviewed to score their swallowing and articulation function on a 100‐point scale. The relation of this subjective scoring to the perioperative data was subjected to multivariate analysis. The mean patient age was 53·4 (19–81) years, and the mean follow‐up duration was 78·9 (14–277) months. Mean swallowing and articulation function score was 87·7 ± 6·1 and 88·6 ± 5·4. Age, follow‐up duration, T stage and resection volume were significantly correlated with swallowing function (P = 0·026, 0·029, 0·016, 0·002, respectively); follow‐up duration was correlated with articulation function (P = 0·039). Patients who undergo partial glossectomy without reconstruction generally demonstrate good function on long‐term follow‐up. Subjective dysfunction was correlated with larger resection volume, older age and shorter follow‐up duration.