腭裂术后语音障碍的学龄儿童及成人患者语音训练方法研究北大核心CSCD

目的探讨适用于学龄及成人腭裂术后语音障碍患者的个性化语音训练方法,提高语音训练效果。方法将86例(7~26岁)学龄及成人腭裂术后语音障碍患者随机分为常规组和优化组,每组各43例,常规组接受传统模式的语音训练,优化组针对患者辅音错误类型采用个性化的语音矫正及训练方案,在训练前和训练3个月后进行语音清晰度(phonetic intelligibility,PI)测试,比较两组结果,评价训练效果。结果训练前两组PI值差异无统计学意义,训练3个月后常规组PI由训练前的33.19%±3.99%提高到73.93%±5.77%,优化组PI由训练前35.00%±4.66%提高到85.67%±5.73%,训练后两组患者PI均较训练前显著提高,差异均有统计学意义(P<0.05),且优化组患者PI提高值明显高于常规组,差异有统计学意义(t=-7.757,P<0.001)。结论对学龄及成人腭裂术后语音障碍的患者实施有针对性的、个性化的语音训练方法效果确切。     

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.     

814例舌系带过短儿童异常语音的探讨及矫治效果分析

目的探讨舌系带过短儿童的异常语音特点及矫治方法。方法采用启音博士Dr．Speech软件及四川大学华西口腔医院唇腭裂外科语音清晰表对814例确诊为舌系带过短患儿进行语音测评,对有发音障碍的575例按2～4岁、4～6岁、6岁以上分为3组,随机在3组中抽出100例单纯语训,100例单纯手术,375例手术一个月后仍有263例在语音错误,对263例进行语训,然后进行矫治和分组对比。结果舌系带过短导致言语障碍的发生率为70．6％;从发音的位置整理声母错误情况,由高至低依次为舌尖后音、舌根音、舌尖音、舌尖前音、舌面音．唇齿音．双唇音;舌系带过短患儿有语音障碍单纯语训的有效率为67．0％;单纯手术后语音自行康复率为32.0％;手术配合语训的有效率为98．5％。结论准确的干预可以帮助舌系带过短患儿更好地发展语言,手术配合语训是治疗舌系带过短患儿语音异常的最佳治疗方法。     

顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的分析

目的：探讨顶舌法联合刮舌法对舌系带过短患儿术后舌尖音训练效果的影响。方法采用随机对照研究设计,将50例舌系带过短术后仅有舌尖音发音障碍的患儿（4～8岁）随机分为实验组25例,对照组25例。实验组在常规语音训练的基础上配合顶舌刮舌法训练,对照组采用常规语音训练,分别测试两组患儿在语音治疗前和治疗3个疗程后的语音清晰度,比较两组结果。结果实验组及对照组患儿治疗前的语音清晰度分别约为37．91％、37．69％,治疗后分别为87．69％、72．99％,两组患儿治疗前语音清晰度差异无统计学意义（t＝0．726,P ＞0．05）,治疗后两组患儿语音清晰度均较治疗前明显提高,差异有统计学意义（P ＜0．001）,且实验组患儿语音清晰度显著高于对照组。结论顶舌法联合刮舌法可以促进舌系带过短患儿术后仅有舌尖音发音障碍患儿语音清晰度的提高。     

粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎患者的临床效果评估

目的 探究粉尘螨滴剂舌下含服免疫治疗对不同年龄段变应性鼻炎(AR)患者的临床效果。 方法 将2016年3月~8月收治的240例AR患者根据年龄分为6组,学龄前组为3~6岁,学龄期组为7~12岁,青春期组为13~20岁,青年期组为21~40岁,中年期组为41~60岁,老年期组为60岁以上,每组40例。均采用舌下含服粉尘螨滴剂变应原特异性免疫治疗+药物治疗,其中粉尘螨滴剂的脱敏治疗分为递增及维持剂量2个阶段。脱敏治疗同时根据患者情况联合控制症状药物治疗。6个月后比较各组症状评分、药物评分、体征评分及视觉模拟量表(VAS)评分,并统计各组有效率及不良事件发生率。 结果 治疗6个月后各组症状评分、药物评分、体征评分及VAS评分均有显著改善,学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期症状评分分别为(3.20±0.79)、(3.58±0.81)、(3.92±0.70)、(4.25±0.72)、(4.59±0.75)、(4.96±0.80)分,药物评分分别为(0.84±0.32)、(0.98±0.30)、(1.14±0.41)、(1.33±0.44)、(1.52±0.40)、(1.72±0.48)分,体征评分分别为(0.18±0.02)、(0.21±0.05)、(0.24±0.06)、(0.27±0.07)、(0.31±0.06)、(0.35±0.07)分,VAS评分分别为(1.82±0.39)、(2.08±0.51)、(2.31±0.50)、(2.54±0.53)、(2.78±0.52)、(3.00±0.46)分,年龄越低的组,各项评分改善效果越显著,差异均有统计学意义(F分别为28.111、28.111、48.241、32.607,P均<0.001);学龄前组、学龄期组、青春期组、青年期组、中年期组、老年期组治疗有效率分别为95.00%、95.00%、90.00%、87.50%、87.50%、82.50%,各组比较差异无统计学意义(χ2=20.293,P=0.161);青年期组、中年期组及老年期组不良事件发生率(30.00%、25.00%、25.00%)低于学龄前组、学龄期组及青春期组(7.50%、5.00%、7.50%),差异均有统计学意义(χ2分别为6.646、4.501、4.501,8.658、6.275、6.275,6.646、4.501、4.501,P分别为0.010、0.034、0.034,0.003、0.012、0.012,0.010、0.034、0.034)。 结论 AR患者应用粉尘螨滴剂舌下含服免疫治疗效果均较好,且随患者年龄增长,效价相对降低,安全性相对升高。     

腭裂患者普通话最小语音对特征初步研究

目的 建立适用于汉语普通话的<腭裂语音清晰度词表>,探讨腭裂患者普通话最小语音对的特征.方法 对30例腭裂语音障碍患者进行<腭裂语音清晰度词表>的测评,通过SPSS16.0软件进行统计分析,计算语音清晰度和最小语音对错误率.通过逐步回归分析,寻找对语音清晰度预测价值最大的特征语音对.结果 30例研究对象的语音清晰度范围在37%至92.4%之间.语音对错误率范围从0.13至0.80.错误率最高的三类语音对(从高到低排列)依次为:发音部位中的舌尖前音和舌尖后音语音对(0.80)、发音部位中的舌尖后音和舌背音语音对(0.68)以及发音方式中的塞擦音的送气音和不送气音语音对(0.66).通过测评不送气塞擦音与送气塞擦音、舌尖前音和舌背音两类特征语音对的错误率,对语音清晰度预测的准确率可以达到71.5%.结论 <腭裂语音清晰度词表>的建立,从最小语音对的角度考察,可以有效地对腭裂患者的语音清晰度进行定性和定量评估.     

“多人言语声”语音训练对人工耳蜗植入儿童声调感知能力干预效果研究

目的探讨“多人言语声”语音训练法对人工耳蜗植入儿童声调感知能力康复训练效果。方法研究对象为16例3~7岁双耳重度、极重度感音神经性听力损失并单侧植入人工耳蜗的儿童,其中干预组8例,平均年龄为5.99±0.63岁,听觉年龄为4.36±0.86岁;对照组8例,平均年龄为5.95±0.49岁,听觉年龄为3.77±1.27岁。使用“多人言语声”语音训练方法对干预组儿童进行声调感知训练,以个训的形式分五次完成对10位发音人共600个语音样本的声调识别训练,语音训练周期为一个月。对照组儿童不进行干预训练。采用自编声调测试材料,分别于干预前、干预后和干预结束3个月后对两组儿童进行声调感知能力测试,比较两组声调识别正确率反正强变换转化为的RAU值。结果干预前干预组和对照组声调感知表现无显著差异(P=0.71);所有受试儿童二声-三声平均分辨正确率的RAU值为47.11,显著低于其他声调配对(P<0.05)。语音训练干预后,干预组声调分辨正确率(101.34±10.14)显著高于对照组(86.02±20.4)(P=0.02);干预结束三个月后两组儿童声调分辨差异呈现边缘性显著(P=0.088)。结论二声和三声相较其他声调配对更难分辨;使用“多人言语声”语音训练方法可以短时间内有效提升人工耳蜗术后儿童声调感知能力。     

言语及发声障碍患者矫治效果分析

目的探讨言语及发声障碍的矫治方法及效果。方法对116例言语或发声障碍病例进行言语及发声矫治,其中口吃31例,声带息肉25例,声带小结18例,功能性失声15例,青春期后假声11例,开放性鼻音16例。结果经3个月治疗后口吃患者治愈率68%,功能性失声治愈率100%,青春期后假声治愈率73%,开放性鼻音及声带息肉、声带小结经手术及术后训练,治愈率100%。结论对言语或发声障碍患者予分类诊断后,再作相应的言语或发声训练治疗,是行之有效的方法。     

学龄期听力正常儿童瞬态诱发耳声发射的特征及测试体会

目的 探讨学龄期听力正常儿童瞬态诱发耳声发射(TEOAE)的特征及测试方法.方法 对20例(男女各10例)听力正常的学龄期儿童行TEOAE检测,分析其特点.结果 ①学龄期儿童的TEOAE总强度为13.11±4.13 dB SPL,其中女性为14.16±4.24 dB SPL,男性为11.76±3.69 dB SPL,女性高于男性2.40 dB,但差异无统计学意义(P=0.091).TEOAE总重复率为86.43%±8.78%,A&B值为13.38±3.93 dB SPL,A-B值为3.55±2.80 dB;②学龄期儿童TEOAE频带信噪比(SNR)在1.5 kHz频带最高,之后随频率增加而降低,在4 kHz频带SNR最低.结论 学龄期儿童TEOAE的测试噪声及频带SNR的分布与成人接近,TEOAE反应强度高于成人,尤其在较高频带区.     

舌系带延长术后构音障碍患者异常舌尖前音的语音特点及康复训练

目的：探讨舌系带延长术后构音障碍患者异常舌尖前音的语音特点和康复训练方法。方法选择107例（3～26岁,平均7．21±4．55岁）舌系带延长术后构音障碍患者为研究对象,分析舌尖前音的构音障碍特点,再从中选择32例（3～24岁,平均7．59±5．10岁）有舌尖前音构音障碍的患者进行3个疗程的语音康复训练,分析康复效果。结果107例患者中／z／、／s／的构音错误形式主要是与／a／、／o／、／e／、／u／或以其为介母的韵母组合时置换成舌尖中音／d／,分别为35例（32．71％）、28例（26．17％）;／z／与／i／组合时置换成／j／有33例（30．84％）、／s／与／i／组合时置换成／x／有43例（40．19％）;／c／的构音错误形式主要是与／a／、／o／、／e／、／u／或以其为介母的韵母组合时置换成／d／（6例,5．61％）和／t／（27例,25．23％）,／c／与／i／组合时分别置换成／q／（45例,42．06％）、／j／（15例,14．02％）;另／z／、／c／、／s／还分别置换成／zh／（15例,14．02％）、／ch／（17例,15．89％）、／sh／（14例,13．08％）及侧化（分别为11、10、12例）。32例患者经过语音康复训练后,舌尖前音构音错误的个数从训练前的34．53±6．08个减少到训练后的7．97±2．52个,差异有统计学意义（t＝30．035,P＜0．001）。结论本组患者舌尖前音构音障碍错误形式主要为置换及侧化;本研究针对舌尖前音异常患者的训练方法效果显著,值得推广。     

人工耳蜗植入术后听觉言语效果的影响因素

目的〓〖HTK〗探讨影响人工耳蜗植入术后听觉言语恢复效果的相关因素。〖HTW〗方法〓〖HTK〗对24例双耳重度或极重度感音神经性耳聋患者,术前进行智力、听力学、影像学检查,配带助听器评估,并严格掌握手术适应证,经乳突－面隐窝进路行人工耳蜗植入术,记载术中情况,术终测电极电阻,术后1个月开机调试,语前聋者进行听觉语言培训,术后追踪随访疗效满意度和言语可懂度,对所得临床资料进行分析。〖HTW〗结果〓〖HTK〗23例耳蜗植入手术一次成功,1例电极移位二次手术成功,术后暂时性面瘫2例、眩晕1例,两周X线颞骨拍片证实耳蜗电极位于耳蜗内,1个月开机调试,全部病例获取听力。3例语后聋患者听觉言语恢复,其他语前聋患者均行半年以上的听觉语言培训,随访4～6年,半开放式言语识别率＞80％,全部患者及家属达到术前的期望值。〖HTW〗结论〓〖HTK〗人工耳蜗是治疗重度极重度感音神经性耳聋及全聋的有效方法,术后效果主要与人工耳蜗植入时的年龄、术前听力与言语基础、听神经及其传导功能、智力、植入电极在规定的部位、术后调机与康复的有效性等关系密切。     

Value of the promontory stimulation test in predicting speech perception after cochlear implantation

BACKGROUND AND OBJECTIVES: To determine the role of the promontory stimulation test (PST) in cochlear implantation (CI), we evaluated the correlations between PST parameters and the results of speech perception tests after CI. SUBJECTS AND METHOD: With use of a retrospective review of the medical records of 58 patients, the GAP50, GAP100, TDL50, and TDL100 parameters of the PST were compared with the results of speech perception tests at fixed time points after CI. Spearman's rank-order correlation coefficient was used in statistical analyses. RESULTS: GAP100 scores were correlated with all results of speech perception tests at all time points after CI (r = 0.309-0.509, P = .001-0.010), and TDL100 scores were correlated with the results of open set one- and two-syllabic word tests at 1 month after CI (r = 0.288, P = .028); no other significant correlations were found. The GAP100 scores for postlingually deaf patients, especially for gap intervals up to 100 ms, were correlated with all results of speech perception tests after CI. A stepwise multiple regression analysis revealed that the GAP100 score is the only variable that was significantly correlated with the results of speech perception tests. The duration and onset age of deafness did not significantly affect the results. CONCLUSION: The PST may be a useful tool for predicting the prognosis of CI. The GAP100 score, especially for gap intervals up to 100 ms, might be useful in predicting the results of speech perception tests after CI as well as in determining the optimal site for CI in postlingually deaf patients without residual hearing.     

Reconstruction of the mobile tongue malignant tumor excision: quality-of-life assessment in 19 patients

INTRODUCTION: Tumor tongue excision leads to anatomical and functional defects (chewing, swallowing, oral and prosthetic hygiene). The extension of the resection depends on tumor size and surgical radicality. MATERIAL AND METHOD: In our department, 72 cases of lingual tumor were treated between may 1987 and January 1997. 73% of these cases were infiltrating squamous cell carcinomas. 71% were male. Most of the tumors were located at the ventral (45%) and lateral side (36%). 25% of the tumors crossed the midline. Staging was most often pT(2) (46%) and pN(0) (62%). Reconstruction with radial free flap occurred in 37%, with pedicled pectoralis major muscle flap in 13% and with pedicled latissimus dorsi muscle flap in 25% of cases. 51% of the patients were irradiated. All the patients were asked about their quality of live by an 11 questions questionnaire. The questions concerned the different oral and lingual functions and the social, familial, affective and professional life. RESULTS: 19 patients (that means 26%) answered the questionnaire. 9 of them were reconstructed with a flap (6 free radial flaps, 2 pedicled pectoralis major flaps, 1 pedicled latissimus dorsi flap) and were irradiated. In the 10 other patients wounds were closed by simple sutures of the margins. 1 of these 10 patients was irradiated. There was no correlation between scores of the questions and neither pT nor age of patients. We observed a parallelism between scores of the questions about speech and swallowing. Scores of the questions about swallowing were higher when a flap was used for reconstruction, whatever was the type of flap. DISCUSSION: A questionnaire was drawn up from the UW QOL questionnaire. It was a simplified questionnaire with reduced number of questions and simple words. Lesser tongue immobility leads to a better swallowing. Swallowing and speech were worst when tongue resection was large. In this quality of life study, there was a few number of patients that answered the questionnaire so that it is impossible to make a difference between the different flaps.     

舌异位甲状腺的诊断与治疗

目的探讨舌异位甲状腺的诊断与治疗.方法分析我院12例舌异位甲状腺患者的临床治疗资料,其中采用异位甲状腺全切除4例,部分切除5例,次全切除加带蒂移植1例,次全切除加游离移植1例,次全切除加部分带蒂移植加游离移植1例.所有病人经半年以上随访.结果甲状腺功能低下1例,复发3例,其余8例术后情况良好.结论作者强调同位素扫描在舌异位甲状腺诊断中的作用,活检应谨慎,术前应了解甲状腺功能及颈部正常位置有无甲状腺的存在.治疗上,如患者无症状,异位甲状腺无恶变,可不予治疗;如患者有明显症状,颈部尚存正常甲状腺,可作全切除术;若颈部无正常腺体,同时进行带蒂移植和游离移植是最合理的手术方法.     

Interarticulator coordination in dysarthria: an X-ray microbeam study.

Articulatory discoordination is often said to be an important feature of the speech production disorder in dysarthria, but little experimental work has been done to identify and specify the coordination difficulties. The present study evaluated the coordination of labial and lingual gestures for /u/ production in persons with Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), and in control participants. Both tongue backing/raising and reduction of the area enclosed by the lips can produce the characteristic low F2 of /u/. The timing of these articulatory gestures with respect to the acoustic target of a low F2 was inferred from X-ray microbeam data. Pellet motions of the tongue dorsum and lips revealed the timing of the lingual and labial gestures to be strongly linked together (synchronized), predictive of the temporal location of the lowest F2 within the vocalic nucleus, and scaled proportionately to the overall vowel duration in control participants. Somewhat surprisingly, essentially the same findings were obtained in the speakers with dysarthria. These relationships were noisier among the speakers with dysarthria, but the global synchronization patterns applied to all 3 groups. Further analyses revealed the synchronization to be less well defined and more variable across speakers with ALS, as compared to speakers with PD and the controls. Results are discussed relative to concepts of coordination in dysarthria.     

Understanding speech in noise after correction of congenital unilateral aural atresia: Effects of age in the emergence of binaural squelch but not in use of head-shadow

Objective

Unilateral hearing loss causes difficulty hearing in noise (the “cocktail party effect”) due to absence of redundancy, head-shadow, and binaural squelch. This study explores the emergence of the head-shadow and binaural squelch effects in children with unilateral congenital aural atresia undergoing surgery to correct their hearing deficit. Adding patients and data from a similar study previously published, we also evaluate covariates such as the age of the patient, surgical outcome, and complexity of the task that might predict the extent of binaural benefit - patients’ ability to “use” their new ear - when understanding speech in noise.

Methods

Patients with unilateral congenital aural atresia were tested for their ability to understand speech in noise before and again 1 month after surgery to repair their atresia. In a sound-attenuating booth participants faced a speaker that produced speech signals with noise 90 degrees to the side of the normal (non-atretic) ear and again to the side of the atretic ear. The Hearing in Noise Test (HINT for adults or HINT-C for children) was used to estimate the patients’ speech reception thresholds. The speech-in-noise test (SPIN) or the Pediatric Speech Intelligibility (PSI) Test was used in the previous study.

Results

There was consistent improvement, averaging 5 dB regardless of age, in the ability to take advantage of head-shadow in understanding speech with noise to the side of the non-atretic (normal) ear. There was, in contrast, a strong negative linear effect of age (r² = .78, selecting patients over 8 years) in the emergence of binaural squelch to understand speech with noise to the side of the atretic ear. In patients over 8 years, this trend replicated over different studies and different tests. Children less than 8 years, however, showed less improvement in the HINT-C than in the PSI after surgery with noise toward their atretic ear (effect size = 3). No binaural result was correlated with degree of hearing improvement after surgery.

Conclusions

All patients are able to take advantage of a favorable signal-to-noise ratio in their newly opened ear; that is with noise toward the side of the normal ear (but this physical, bilateral, head-shadow effect need not involve true central binaural processing). With noise toward the atretic ear, the emergence of binaural squelch replicates between two studies for all but the youngest patients. Approximately 2 dB of binaural gain is lost for each decade that surgery is delayed, and zero (or poorer) binaural benefit is predicted after 38 years of age. Older adults do more poorly, possibly secondary to their long period of auditory deprivation. At the youngest ages, however, binaural results are different in open- and closed-set speech tests; the more complex hearing tasks may involve a greater cognitive load. Other cognitive abilities (late evoked potentials, grey matter in auditory cortex, and multitasking) show similar effects of age, peaking at the same late-teen/young-adult period. Longer follow-up is likely critical for the understanding of these data. Getting a new ear may be - like multitasking - challenging for the youngest and oldest subjects.     

舌异位甲状腺的诊治

目的　探讨舌异位甲状腺临床特点、诊断及治疗。方法　回顾性分析6例舌异位甲状腺患者临床资料,分析其临床特征、影像学特点、治疗方案及预后。结果　6例舌异位甲状腺经Tc-99m甲状腺静态显像确诊,均位于舌根部。1例甲状腺素替代治疗,1例未行任何治疗。3例行舌根异位甲状腺转位术,术后均口服左旋甲状腺素片,咽部异物感和睡眠打鼾症状消失。1例舌根异位甲状腺乳头状癌行支撑喉镜下舌根肿物切除术,失访。结论　甲状腺静态显像对舌异位甲状腺诊断具有特异性。其手术适应证为异位甲状腺致气道阻塞、睡眠打鼾及咽部异物感等症状明显者,肿物出血、囊性变及癌变。治疗原则是尽量保留甲状腺功能,综合运用手术、甲状腺激素替代及碘放疗等方法改善症状、预防及治疗甲状腺功能减退。