功能性发声障碍的语言训练

目的探讨功能性发声障碍的临床特点及康复治疗。方法对功能性发声障碍儿童48例及功能性发声障碍成人20例进行语言评价及语言训练,比较并分析儿童及成人功能性发声障碍患者的特点及疗效。结果发声检查,儿童与成人的发音主要错误方式为歪曲、置换,主要的错误声为舌尖前声、舌尖后声、舌根声、舌面声和舌尖声;儿童与成人平均错误声差异无显著性(P>0.05)。训练时引出每个目标声正确发声平均需时儿童较成人长(P<0.001),而每个目标声较熟练应用所需时间儿童较成人短(P<0.001);经训练后,48例儿童患者中有40例完成纠正,8例部分纠正,治愈率为83.3%;20例成人患者全部纠正,成人患者治愈率为100.0%;总治愈率为88.2%。结论儿童与成人功能性发声障碍的临床特点差别不大,均以歪曲、置换的错误方式为主;语言训练效果好,但开始训练的时机应该适当,并非越早训练效果越好。     

应用发音钮发音重建出现发音障碍的原因分析

喉癌病人施行喉全切除术后,恢复发音功能的方法很多。临床证明其各有所长,但亦有不足。我们以医用硅橡胶研制的发音钮,又叫发音管(图1),1900年2月至1994年5月,临床应用于75例本病患者发音重建,其中12例不能发音。为提高发音钮的临床应用效果,现对应用发音钮后出现发音障碍的原因进行分析,报告如下。     

发声、发音和发音障碍

书刊中常有将“发音”一词和“发声”一词通用、混用的情况。“发音”(articulation)和“发声”(phonation)有不同含义。“phonation”在《英汉耳鼻咽喉科学词汇》中和《语音学和音系学词典》中译为‘发声’。“发声”指“在气流帮助下 ,利用喉产生可听声的声源 ,这个声源的声能量 ,可受声道的调制。”“某些时候特别作为voicing的同义词”(《语音学和音系学词典》)。发声是在呼出气流的同时 ,声门区与之作相关活动的行为。声门区不同类型的动作 ,使“发声”可分为不同的类型 ,如清音发声 (nilphonation)、气音 (breath)、耳语、挤喉音、正…     

痉挛性发音障碍的研究进展

本对近年来痉挛性发音障碍的研究进行综述。回顾了本病的基本概念，发生机制的研究进展，收集了有关诊断方面的信息，并着重介绍了本病的治疗现状，尤其是对肉毒杆菌素的治疗情况进行详述。     

嗓音训练改善职业用声者发音的疗效研究

目的 应用嗓音训练方法改善职业用声者发音并验证其有效性.方法 选择31例有嗓音症状但无声带器质性病变的职业用声者作为研究对象接受为期4周的嗓音训练.训练的内容包括嗓音卫生教育、改善呼吸支持及增强共鸣等.应用嗓音障碍指数量表、最长发声时间测量及嗓音声学分析进行训练前后的评估.结果 受试者接受嗓音训练后嗓音障碍指数值((-x)±s,以下同)由(33.7±19.2)分降至(18.8±18.4)分,差异具有统计学意义(t=6.14,P＜0.05).受试者接受嗓音训练后最长发声时间由(15.5±5.8)s延长至(18.6±6.0)s,差异具有统计学意义(t=-3.43,P＜0.05).受试者接受嗓音训练后基频微扰有显著性下降,由0.42%[0.36%;0.62%](中位数[25分位数;75分位数])降至0.35%[0.29%;0.47%],Z=-2.51,P＜0.05;而噪谐比、振幅微扰变化无统计学意义.结论 嗓音训练能够减轻职业用声者嗓音障碍症状,降低嗓音障碍程度并增加发音过程呼吸支持的效率,改善嗓音质量.

Abstract：

Objective To explore the effectiveness of voice training on professional voice users with voice disorders. Methods Thirty one professional voice users suffering from voice symptoms without organic disorder were treated with a four-week voice training program, including vocal hygiene education, respiratory training and resonant therapy. Voice handicap index, maximum phonation time, noise to harmonic ratio,jitter and shimmer were compared before and after the training. Results The voice handicap index ((-x) ± s)decreased from 33.7 ± 19. 2 to 18. 8 ± 18.4 after the training and the difference was significant (t =6. 14,P ＜ 0. 05 ). Maximum phonation time ( (-x) ± s) increased significantly from ( 15. 5 ± 5. 8 ) s to ( 18.6 ± 6.0) s (t = - 3.43, P ＜ 0. 05 ). jitter ( M [P25; P75] ) decreased significantly after the training from 0. 42%[0.36%; 0.62%] to0.35% [0.29%; 0.47%] (Z= -2.51, P＜0.05), while there was no significant change in shimmer and noise to harmonic ratio. Conclusion Voice training can effectively reduce the vocal symptoms in professional voice users, decrease the handicap degree and increase the respiratory support during phonation, thus improve the voice quality.     

术后发音矫治对嗓音显微手术治疗声带息肉发音功能的影响

嗓音显微手术是在手术显微镜下,应用先进的显微技术,在力求治愈疾病的同时最大限度的保护发音功能的一种喉内手术,切除病变与改善发音功能是嗓音显微手术的两个主要目的川。回顾性分析2006年7月-2006年12月随访3个月以上的80例经嗓音显微手术治疗的声带息肉患者,其中40例辅助术后嗓音矫治,所有患者均进行动态喉镜及嗓音声学分析以评价治疗效果。     

嗓音训练改善职业用声者发音的疗效研究

Objective To explore the effectiveness of voice training on professional voice users with voice disorders. Methods Thirty one professional voice users suffering from voice symptoms without organic disorder were treated with a four-week voice training program, including vocal hygiene education, respiratory training and resonant therapy. Voice handicap index, maximum phonation time, noise to harmonic ratio,jitter and shimmer were compared before and after the training. Results The voice handicap index ((-x) ± s)decreased from 33.7 ± 19. 2 to 18. 8 ± 18.4 after the training and the difference was significant (t =6. 14,P ＜ 0. 05 ). Maximum phonation time ( (-x) ± s) increased significantly from ( 15. 5 ± 5. 8 ) s to ( 18.6 ± 6.0) s (t = - 3.43, P ＜ 0. 05 ). jitter ( M [P25; P75] ) decreased significantly after the training from 0. 42%[0.36%; 0.62%] to0.35% [0.29%; 0.47%] (Z= -2.51, P＜0.05), while there was no significant change in shimmer and noise to harmonic ratio. Conclusion Voice training can effectively reduce the vocal symptoms in professional voice users, decrease the handicap degree and increase the respiratory support during phonation, thus improve the voice quality.     

喉发音钮术后痉挛性发音障碍

喉发音钮术后痉挛性发音障碍丁浩，刘清明，韩在文，赵立民喉全切除术后用发音赝复物重建发音具有发育清晰、易懂、应用范围广、安装成功率高及使用方便等优点，但亦可见并发症或痉挛性发音障碍。我科于１９９０年用自行研制新型硅橡胶发音钮用于全喉切除患者，发现８例痉...     

舌系带过短儿童发音障碍及矫治效果分析

目的 探讨舌系带过短对儿童发音的影响及有效的矫治方法.方法采用多媒体Dr.Speech软件对163例确诊为舌系带过短的患儿行语音评估,对有发音错误的136例行舌系带松解术,术后复查语音情况,已恢复者不再语训,对没有改善的85例进行语训并对其发音清晰度进行观察分析.结果舌系带过短引起发音错误有136例,占83.43%（136/163）,手术配合发音训练后发音改善有效率达97.64%.结论舌系带过短导致舌前部运动障碍,影响儿童的语音发育.舌系带松解术有利于语音清晰度的改善,配合有效的语音训练疗效更好.     

内收型痉挛性发音障碍的语音特征

目的 探讨内收型痉挛性发音障碍的语音特征.方法 采用嗓音和语音的声信号和三维语图分析及主观评价的方法对1O例内收型痉挛性发音障碍患者(女7例,男3例)的语音特征与10例健康志愿者(男5例,女5例)进行对比.结果 内收型痉挛性发音障碍主要表现为音质、音韵及语音的流畅性改变,在朗读文章时出现紧张性发音困难,语音颤抖,频率及响度瞬间起伏,嗓音挤卡、中断,语音延长,失去正常韵律.10例患者中表现为轻度障碍者(异常音节数<25%)1例,中度障碍(异常音节数占25%～49%)6例,重度(异常音节数占50%～74%)1例,极重度(异常音节数≥75%)2例.10例患者朗读时间中位数为49 S,声信号中间断出现无音区,无音比率中位数为42%;而健康对照组朗读时间中位数为30 S,无声音中断.在三维语图中不同的患者在各自症状音节中可以看到嗓音起始时间延长,元音共振峰不规则、断裂甚至消失,症状音节的辅音缺失,或塞擦音的擦音成分延长等.结论 内收型痉挛性发音障碍语音特征为音质、音韵及语音的流畅性改变,在症状音节的三维语图中可以看到相应的元音或辅音音素的特征性改变.     

嗓音训练治疗声带小结的疗效观察

目的观察嗓音训练治疗声带小结的疗效。方法对19例声带小结患者进行为期8周的嗓音训练,训练内容包括嗓音卫生教育、改善呼吸支持及增强共鸣等,训练前后分别应用嗓音障碍指数量表、最长发声时间、嗓音声学分析及频闪喉镜检查进行评估。结果 19例声带小结患者接受嗓音训练后嗓音障碍指数值由56.9±15.7分降至23.8±17.4分,差异有统计学意义(P<0.05);最长发声时间由11.3±5.5s延长至19.1±8.2s,差异有统计学意义(P<0.05);基频微扰由0.57%±0.04%降至0.33%±0.09%,振幅微扰由1.99%±0.36%下降至1.42%±0.19%,噪谐比由0.175±0.065dB下降为0.131±0.047dB,差异均有统计学意义(P均为<0.05)。训练结束后频闪喉镜检查示9例患者声带小结消失,7例小结明显变小,3例变化不明显。结论嗓音训练能够降低嗓音障碍程度并增加发声过程呼吸支持的效率,改善嗓音质量。     

Vocal tremor analysis with the Vocal Demodulator.

Acoustic analysis of vocal tremor has the potential to make significant quantitative and diagnostic contributions to the study of vocal disorders. This paper presents a new device for analysis of vocal tremor. The Vocal Demodulator produces amplitude- and frequency-demodulated outputs and measures the frequency and level (percent) of low-frequency tremor components in sustained phonation. A standard microphone is used to transduce the voice signal for input to the demodulator. The input fundamental frequency (F0) range is 70-1200 Hz, and frequency response of the amplitude and frequency demodulation is 2.5-25 Hz. Five parameters are displayed in real time: F0, amplitude-modulation frequency, amplitude-modulation level, frequency-modulation frequency, and frequency-modulation level. Validation, calibration, and reliability data from synthesized test signals with modulation, as well as phonation from subjects with vocal tremor, subjects producing vibrato, and subjects with normal voice are presented. Research and clinical applications of this device are suggested.     

Vocal emergencies

Acute management of vocal emergencies can be a difficult and stressful element in otolaryngology. A thoughtful history coupled with appropriate diagnostic instrumentation is the cornerstone of evaluating a patient with a vocal emergency. This article explores the differential diagnosis, evaluation, and treatment of vocal emergencies in the performer. Understanding the various causes of acute dysphonia in the performing artist as well as awareness of the additional pressures placed upon performing artists empowers the otolaryngologist to help patients in this interesting and unusual niche of the specialty.     

Vocal cord sulcus

Vocal cord sulcus is a congenital condition consisting of a furrow on the medial edge of the vocal cord. It is most often bilateral but may be unilateral. The symptoms are a hoarse and breathy voice due to incomplete closure of the vocal cords. The present series comprises 15 patients found among 1,400 patients with voice and speech disorders. The condition is often overlooked and regarded as part of a primary functional hyperkinetic voice disorder. By close inspection the furrow can often be seen by indirect laryngoscopy. In many cases, however, microlaryngoscopy under general anaesthesia should be performed, but the furrow is only detected if a search is made for it. The condition is often found in younger patients, probably due to the fact that the sulcus is difficult to detect in older patients who have developed severe organic changes in a effort to overcome the incomplete closure of the glottis.     

Vocal fold cancer

Ninety percent of vocal fold cancers take the form of squamous cell carcinoma. Since the 1980s, incidence in France has been constantly falling in males while increasing in females. The main risk factor is smoking, alcohol being less implicated than in other laryngeal or extralaryngeal locations. Vocal fold squamous cell carcinoma generally develops on healthy mucosa, although primary precancerous lesions such as leukoplakia or papillomatous keratosis are also frequent. The tumor usually originates in the non-lymphophilic mucosal free edge of the vocal fold then invades the various anatomic subunits of the larynx, acquiring lymph-node metastatic potential. Dysphonia is the first presenting symptom, initially caused by defective mucosal vibration and then by impaired mobility and finally fixation of the vocal fold. Extension, risk factor and pretreatment assessments are as in other upper-aerodigestive-tract cancer locations. The possibilities of laryngoscopic exposure and the tumor limits, however, need to be precisely determined if transoral resection is to be considered. For small tumors, surgery or exclusive radiation therapy can be suggested to the patient as part of an individual treatment plan, each having its advantages and drawbacks. Cutting-edge teams report 5-year local control rates of 85-95% in T1-class tumor and 60-90% in T2. Whatever the treatment option, smoking cessation, close surveillance and cardiovascular prevention enable screening of other oncologic locations and limit onset of the other pathologies implicated in most deaths.