内收型痉挛性发声障碍患者的喉空气动力学特征分析

目的 分析内收型痉挛性发声障碍(adductor spasmodic dysphonia, ADSD)患者的喉空气动力学特征。方法 选取临床诊断为ADSD的患者18例为ADSD组，募集健康受试者30例为正常组。采用言语发声空气动力学测试系统(PAS)对受试者进行喉空气动力学评估，记录以下指标：声门下压(subglottal pressure, SGP)、发声阈压(phonation threshold pressure, PTP)、发声阈能(phonation threshold power, PTW)、声门阻力(glottal resistance, GR)及发声效率(vocal efficiency, VE)。对ADSD患者的嗓音进行主观听感知评估(consensus auditory perceptual evaluation of voice, CAPE-V),比较两组结果。结果 ADSD组的SGP、GR、VE、PTP大于正常组，差异有统计学意义(P<0.05);ADSD组的PTW与正常组间差异无统计学意义(P>0.05)。受试者工作特征曲线(receiver op...     

单侧神经性声带麻痹患者嗓音分析及动态喉镜记波扫描评估

目的以嗓音学分析方法评估单侧神经性声带麻痹患者的嗓音特征,探讨动态喉镜记波扫描（videostrobokymography,VSK）在评价声带麻痹患者声带振动功能中的应用价值。方法选择22例单侧神经性声带麻痹患者及30例嗓音正常对照者分别进行嗓音学检测,并进行动态喉镜检查生成喉记波图像,分析两种方法在诊断声带麻痹中的应用价值。结果嗓音学分析显示,单侧神经性声带麻痹患者的基频微扰（Jitter）、振幅微扰（Shimmer）均高于正常对照组,差异具有统计学意义（P<0.05）;基频（F0）较对照组低,但差异无统计学意义（P>0.05）;声谱图主要见中频、高频区谐波声能减弱或消失,二、三共振峰（F2、F3）基本消失,噪声成分明显增加;低频区谐波及共振峰（F1）仍存在,呈现不规则、中断现象;最长发声时间（maximun phonation time,MPT）,较对照组明显减小,差异具有统计学意义（P<0.05）。VSK图像中,正常对照组声带相位均基本对侧,黏膜波正常开放商为0.48;声带麻痹组的声带闭合相均未见声门闭合,开放商均为1。结论嗓音学分析可客观评估单侧声带麻痹患者嗓音特征。VSK是一种评价检查声带振动功能的有效方法,与正常组比较,差异具有统计学意义（P<0.05）。     

儿童声音嘶哑1285例调查分析

目的通过对儿童嗓音情况的调查分析,了解导致儿童嗓音疾病的主要原因及病变,为儿童嗓音保健及嗓音疾病早期干预治疗提供依据。方法选取2010年1月~2014年7月在吉林市中心医院喉科就诊的来自于15个社区、主诉为声音嘶哑的儿童1285名,应用间接喉镜进行检查,其中声门区不能完全暴露者235例,不能配合者351例,均在表麻下经鼻腔电子喉镜检查。对其发病特点、嗓音情况进行分析。结果引起儿童声音嘶哑最常见的病因是声带良性增生性病变,占66.61%,其中包括声带小结、声带息肉等,过度用嗓是造成儿童嗓音疾病的主要原因。结论积极开展社区儿童用嗓保健,加强对高危人群的监测,具有重要的意义。     

REDCap数据库在嗓音外科临床研究中的初步应用

目的探索REDCap数据库在嗓音外科临床研究中的作用，探讨其可行性及实用性。方法构建并设计REDCap嗓音疾病数据库结构，采集患者基本资料、个人及职业用声史、相关疾病、体格及电子喉镜检查、嗓音检测分析、嗓音障碍指数量表简化中文版、手术相关资料、病理结果、反流症状指数评分量表和反流体征评分量表。收集每位患者入组、手术、术后1周、术后3周、术后2个月及术后1年6个数据收集点。总结2016年7月~2017年1月首都医科大学附属北京友谊医院REDCap嗓音疾病数据库使用情况。结果REDCap嗓音疾病数据库包含10张工具表，3个随访模块、6个事件采集点构成，可实现多地点多终端同时输入，可实现医疗数据录入、质控及权限管理，可构建随访工作日历。104例行嗓音疾病患者资料录入到REDCap数据库，102例患者完成术后1周及3周随访，98例患者完成术后2个月随访，失访6例。98例患者临床资料完整无误。结论REDCap嗓音疾病数据库涵盖了嗓音疾病基本流程，可有效用于嗓音医学研究数据收集、整合，保证了临床资料完整性和及时性，并降低了患者失访率。     

综合护理干预联合药物治疗对声带良性病变患者嗓音恢复的影响

目的观察综合护理干预联合药物治疗对声带良性病变患者嗓音恢复的影响。方法随机将2019年1月—2019年11月在天津医科大学第二医院耳鼻咽喉科诊断为声带良性病变的82例患者分成A、B两组，A组（41例），单纯口服金嗓散结胶囊1个月；B组（41例），在A组的基础上实施综合护理干预，包括心理干预、情绪及行为干预、禁烟酒、休声、嗓音训练等。通过Xion声学分析软件对两组患者治疗前后的嗓音基频微扰（jitter）、振幅微扰（shimmer）、噪谐比（NHR）进行测试，并比较两组结果。采用嗓音障碍指数 30(VHI 30)量表评估A、B两组患者治疗前后的嗓音情况，并比较两组评分情况。通过纤维喉镜检查比较两组患者的治疗有效率。结果两组患者治疗1个月后jitter、shimmer、NHR值及VHI 30评分均较治疗前改善，B组患者较A组改善更明显（P<0.05）。纤维喉镜检查发现B组患者治疗有效率高于A组。结论综合护理干预联合药物能显著改善声带良性病变患者的嗓音质量。     

支撑喉镜显微镜下微瓣显微缝合技术在喉良性病变中的应用

目的探讨支撑喉镜显微镜下微瓣显微缝合技术在喉良性病变中的应用效果。方法46例患者,其中声带任克氏水肿12例,声带广基息肉24例,声带囊肿10例,手术中利用微瓣技术,在切除病变组织的同时,保留声带微瓣并进行支撑喉镜显微镜下声带黏膜的显微缝合。术前、术后1个月和术后3个月对患者进行频闪喉镜检查,并进行嗓音GRBAS评估、嗓音障碍指数（voice handicap index, VHI） 主观评分及客观嗓音分析,主要为基频微扰(Jitter)、振幅微扰(Shimmer)、最长发声时间(maximun phonation time,MPT)及嗓音障碍严重程度指数（dysphonia severity index,DSI）等。结果所有患者手术顺利,安全切除病变组织后,保留声带黏膜微瓣,均成功的进行了支撑喉镜显微镜下的显微缝合声带黏膜,术后患者声带黏膜光滑,声带闭合情况良好,黏膜波接近于正常;主客观嗓音分析提示患者嗓音质量较术前明显改善。结论对于声带良性病变合适的病例,支撑喉镜显微镜下微瓣显微缝合技术有利于患者声带黏膜的保护,术后患者嗓音质量及患者满意度得以提高。     

相干光断层扫描技术与嗓音医学

摘要：相干光断层扫描技术（optical coherence tomography，OCT），又称为光学相关断层扫描技术，是近年发展起来的非接触式、无损、实时、高分辨率的影像诊疗技术，首先主要应用于眼科视网膜沟的检测，以及心血管疾病中对于冠状动脉内膜不稳定粥样斑块的探查。同时还应用于泌尿外科及消化内科对于黏膜上皮疾病的诊断。由于OCT能够准确检测声带的分层结构，目前逐渐成为嗓音医学中十分重要的临床检查手段之一，应用于声带结构的检测，良恶性疾病的鉴别诊断，嗓音显微外科手术以及对声带振动形态的观察等方面。     

中国艺术嗓音医学现状与未来

摘要：艺术嗓音医学是声乐表演艺术和嗓音医学相互融合交叉而形成的一门独立的分支学科，它不但对歌唱表演人才的选拔、训练、声部鉴定具有重要的指导作用，而且在预防和保护演员、歌手的艺术生命及维护其他职业用嗓者的嗓音健康方面也发挥出了十分重要的作用。本文从六大方面阐述了我国艺术嗓音医学的发展现状，从七大方面提出了对艺术嗓音医学发展未来的设想和建议。     

嗓音客观分析在喉科疾病鉴别诊断中的作用

摘要：目的通过对嗓音元音分析及嗓音障碍严重指数的研究,评估其是否可以用于鉴别诊断临床常见嗓音疾病。方法对811例嗓音疾病患者的持续元音测试和音域测试结果进行统计学分析,根据诊断将受试者分成8个疾病组。在对数据进行初步分析后,选择方差分析中的Dunnett T3检验方法进行组间的两两对比分析,检验标准α=0.05。结果对数据进行单因素方差分析,结果显示男性受试者F0min、Jitter、Shimmer、SPLmax各组间存在统计学差异（P<0.05）。女性受试者F0、Jitter、F0max、F0min、SPLmax、SPLmin各组间存在显著的统计学差异（P<0.05）。进一步对各组进行两两比较,男性受试者除喉癌组与任克间隙水肿组、声带息肉组与任克间隙水肿组的Jitter和F0max,声带白斑组与任克间隙水肿组的F0max,息肉组与喉癌组的SPLmax存在统计学差异外（P<0.05）,其余各参数在任意两组间的差异均无统计学意义（P>0.05）。女性受试者除囊肿组与声带麻痹组、声带小结组与声带麻痹组的SPLmax,声带息肉组与声带小结组的DSI存在统计学差异外,其余各参数在任意两组间的差异均无统计学意义（P>0.05）。结论嗓音分析可用来评估发声的障碍程度,但以目前所用参数尚不能有效鉴别诊断喉部疾病。     

嗓音训练联合拳击动作治疗青春期假声的疗效观察

目的观察嗓音训练配合拳击动作治疗青春期假声的临床疗效。方法收集2016年1月—2019年6月在中南大学湘雅医院耳鼻咽喉头颈科就诊的青春期假声患者21例，均为男性患者，年龄16~35岁，病程1~20年。所有患者均表现为青春变声期或变声期后说话时音调偏高或用假声，杂音明显，偶有声嘶及破音，其中19例患者喉镜下表现为声带闭合欠佳。对患者采用嗓音训练联合拳击动作的矫治治疗，根据即时效果反馈，语训1~4次不等，每次1~2 h，以上过程均由专业语训师对患者进行指导及追踪。治疗前后采用动态喉镜及嗓音分析系统记录患者的喉镜下表现及嗓音声学参数，并进行对比分析，评估治疗效果。结果21例青春期假声患者发声基频（F0）较训练前均下降明显，其中18例患者基频恢复至成年男性正常水平，嗓音障碍指数(DSI)较前明显改善，最长发音时间(MPT)较前明显延长，差异具有统计学意义（P＜0.05）； 19例声带闭合不全的青春期假声患者经治疗后声带闭合良好。结论嗓音训练配合拳击动作治疗青春期假声效果显著，有一定的临床应用价值。     

Reliability of the perceptual evaluation of adductor spasmodic dysphonia

OBJECTIVES: Although perceptual assessment by experienced voice clinicians remains the gold standard for the diagnosis and assessment of severity of adductor spasmodic dysphonia (ADSD), the interrater reliability of voice experts for this task has not been assessed. In addition, it is unknown whether telephone-recorded or -transmitted voice samples could be used for this task. The aims of this study were (1) to assess the reliability of perceptual analysis of ADSD severity by voice experts and (2) to compare the results between digitally recorded voice samples and those recorded over the telephone. METHODS: Five laryngologists randomly selected voice samples from 46 ADSD patients and rated the severity of ADSD on a 5-point rating scale. A set of digital voice recordings and a set of telephone voice recordings made from filtering the digital set via the telephone were rated, and each voice set was rated twice. Measures of intrarater and interrater reliability, as well as a measure of the probability of agreement among the raters, were calculated. RESULTS: There was a high level of agreement on ADSD severity, with excellent interrater and intrarater reliability (Cronbach's alpha, .93 to .96). The probabilities of rater agreement on the digitally recorded and telephone-filtered voice samples were similar (chi2, p = .07). The ratings of digital versus telephone voice samples were highly correlated (Pearson r, 0.99; p < .001). CONCLUSIONS: These results demonstrate that voice experts are reliably able to judge and agree on the severity of ADSD. Telephone-filtered voices appear to convey adequate ADSD perceptual cues for expert listeners to judge the severity of spasmodic dysphonia.     

Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection.

Acoustic analysis of a reading passage was used to identify the abnormal phonatory events associated with adductor spasmodic dysphonia (ADSD) pre- and postinjection of Botulinum Toxin A (Botox). Thirty-one patients (age 22 to 74 years) diagnosed with ADSD were included for study. All patients were new recipients of Botox, and the examination of their voice occurred before and after their initial injection of Botox. Acoustic events were identified from reading samples of the Rainbow Passage produced by each of the patients. These events were examined from sentences containing primarily voiced sound segments. Dependent variables included the number of phonatory breaks, frequency shifts, and aperiodic segments--all variables previously defined by the investigators. Additionally, calculated variables were made of the percentage of time these events occurred relative to the duration of the cumulative voiced segments. A sex- and age-matched control group (+/-2 years) was included for statistical comparison. Results indicated that those with ADSD produced more aberrant acoustic events than the controls. Aperiodicity was the predominant acoustic event produced during the reading, followed by frequency shifts and phonatory breaks. Within the ADSD group, the number of atypical acoustic events decreased following Botox injection. It is important that the occurrence of specific abnormal acoustic events was sufficient to differentiate the disordered speakers from the controls following as well as preceding initial Botox injection, as indicated by discriminant function analysis. This paper complements our previous work using this acoustic analysis method for defining the abnormal events present in the voice of those with ADSD and further suggests that these measures can be used in conjunction with perceptual impressions to differentiate speakers on the basis of initial severity.     

Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges

Spasmodic dysphonia is a rare voice disorder that is most successfully treated by injection of botulinum toxin (i.e., BOTOX) into the affected laryngeal muscles. BOTOX is currently available for use by professionals outside of metropolitan voice centers who may be unfamiliar with this rare disorder. Patients may seek assessment and treatment locally from clinicians who are unfamiliar with the speech symptoms for adductor-type (ADSD) or abductor-type (ABSD) spasmodic dysphonia. Although these disorders have been described in the literature, the symptoms have not been well defined and may appear similar to those of vocal tremor or muscle tension dysphonia (MTD). Thus, patients with spasmodic dysphonia might not be easily identified by local clinicians for treatment. The purpose of the current study was to determine whether voice clinicians with infrequent exposure to patients with spasmodic dysphonia could learn to identify speech symptoms for ADSD and ABSD comparable to voice clinicians with extensive experience with these disorders. The ratings of five nonexpert judges were compared to the ratings obtained from three expert judges. The results of this study demonstrated that nonexpert judges could be trained to identify the speech symptoms associated with ADSD, ABSD, and vocal tremor. While the nonexpert judges tended towards false positive judgements for the speech symptoms of interest, the overall speech symptom profiles for each type of voice disorder appeared comparable to those obtained from the expert judges. The symptom identificationscales used, therefore, have potential for use by clinicians unfamiliar with these disorders for correctly identifying persons with symptoms of ADSD and ABSD. Educational objectives: Readers will be able to (1) define the predominant speech symptoms reflective of the voice disorder categories of ABSD, ADSD, and vocal tremor; and (2) describe the methods utilized in a new perceptual training protocol for teaching clinicians how to identify predominant speech symptoms associated with the voice disorder categories of ABSD, ADSD, and vocal tremor.     

Adductor spasmodic dysphonia versus muscle tension dysphonia: examining the diagnostic value of recurrent laryngeal nerve lidocaine block

OBJECTIVES: Differentiating adductor spasmodic dysphonia (ADSD) from muscle tension dysphonia (MTD) can be difficult. This investigation examined the precision of response to unilateral lidocaine block of the recurrent laryngeal nerve (RLN block) as a potential diagnostic test to discriminate ADSD from MTD. METHODS: Patients with ADSD (n = 23) and MTD (n = 20) were audio-recorded before and during RLN block. The patients completed self-ratings of dysphonia severity, vocal effort, and laryngeal tightness, and blinded listeners completed auditory-perceptual ratings of overall severity, breathiness, and strain of voice samples before and during the block. RESULTS: Repeated-measures analysis of variance, with "group" (ADSD/MTD) as the between-subjects variable and "time" (before block/during block) as the within-subjects variable, confirmed significant "time" effects, but no significant "group-by-time" interaction effects, indicating that both disorder groups responded favorably to RLN block, according to patient- and listener-based ratings. Furthermore, low estimates of sensitivity and specificity and weak receiver operating characteristic curves confirmed that a positive response to the RLN block test did not distinguish ADSD from MTD. CONCLUSIONS: We conclude that RLN block offers little discriminatory value in the differential diagnosis of ADSD versus MTD, and a positive response to RLN block should not be considered confirmatory of ADSD.     

Laryngeal Muscle Activity During Speech Breaks in Adductor Spasmodic Dysphonia

To determine the laryngeal muscle activation abnormalities that are associated with speech symptoms in adductor spasmodic dysphonia (ADSD), electromyographic measures of extrinsic and intrinsic laryngeal muscles during speech compared 1) muscle activity when ADSD patients had breaks in words with when they produced the same words without breaks; and 2) muscle activity in ADSD patients during speech without voice breaks with normal controls producing phonetically similar words. Simultaneous electromyographic recordings were made from the thyroarytenoid (TA), cricothyroid (CT), sternothyroid (ST), thyrohyoid(TH) and the posterior cricoarytenoid (PCA) muscles during speech testing in 11 ADSD patients and 10 control subjects. Speech breaks were identified and mean muscle activity measured starting 100 ms preceding a voice break and for the remainder of the word. Mean muscle activity level was significantly greater on break than non break words in ADSD patients only for the thyroarytenoid muscle(p<.001). No significant differences were found between the ADSD and control subjects during non break words for any of the laryngeal muscles studied. The results demonstrated that 1) only the thyroarytenoid, of the muscles tested, was affected in ADSD, 2) that muscle activation abnormalities were spasmodic, only appearing when symptoms occurred and 3) no imbalances of muscle tone were evident when speech disruptions did not appear.     

Electrocochleographic findings in cases of autoimmune disease with sensorineural deafness

Objectives: To present electrocochleographic findings in patients with autoimmune disease (AD) with sensorineural deafness (ADSD), and to discuss the etiologies of sensorineural hearing loss (SNHL) in cases of ADSD. Methods: Study design is a retrospective review of electrocochleographic results of 26 patients with ADSD. To evaluate the electrocochleographic results, average SP/AP ratios were compared between ADSD and normal subjects. In the ADSD group, audiologic pattern, fluctuations in hearing and results of the glycerol test were also reviewed. Electrocochleography (ECoG) was recorded using the extratympanic method, and the SP to AP ratio (SP/AP ratio) was analyzed. Results: The mean of average SP/AP ratios in the ADSD groups (0.46) was significantly higher than that in normal subjects (0.27). Further, 17 of 29 affected ears in patients with ADSD showed fluctuating hearing loss. Eighteen ears showed low tone loss (rising and peak audiologic patterns). Only 5 of 26 ears (19.2%) showed positive results on glycerol test. There was no correlation between glycerol test results and hearing fluctuation or between glycerol test results and the SP/AP ratio on χ²-test. There was no tendency between audiologic pattern and glycerol test results or between audiologic pattern and the SP/AP ratio. Conclusion: These results suggest the etiologies of SNHL in cases of ADSD remain unclear. However, some cases showed clinical findings similar to endolymphatic hydrops. We should bear in mind that clinical Meniere’s syndrome involves ADSD. Further investigation is needed to resolve the etiology of SNHL of ADSD.     

Acoustic variations in adductor spasmodic dysphonia as a function of speech task.

Acoustic phonatory events were identified in 14 women diagnosed with ADSD and compared to those of 14 women age-matched (+/-2 years) with no evidence of vocal pathology/dysfunction. The three acoustic parameters examined during sustained vowel production and reading included phonatory breaks, aperiodicity, and frequency shifts. Intra- and intermeasurer correlations showed high reliability for the measures. Findings indicated that those with ADSD produced a greater frequency of aberrant acoustic events than the controls during both tasks. For the group with ADSD, the amount and type of each event also varied with utterance type. The sustained vowel sample produced by those with ADSD consisted of a greater percentage of aperiodic segments followed by phonatory breaks and frequency shifts. During reading, frequency shifts were the predominant acoustic event, followed by phonatory breaks and aperiodicity. The advantage of segmenting the acoustic waveform into these measures and the relevancy of examining intertask performances by those with ADSD is discussed.     

3例累及邻近多部位的儿童鼻腔鼻窦胚胎型横纹肌肉瘤临床分析

目的探讨儿童横纹肌肉瘤（rhabdomyosarcoma,RMS）的临床特点、影像学检查及临床病理学特征,以期减少漏诊误诊,提高临床诊断和鉴别诊断水平。方法回顾性分析3例不典型学龄前期儿童RMS的详细临床资料并复习相关文献。结果2例以眼部症状为主诉收入院,1例罕见以反复鼻腔出血并睡觉打鼾为主诉收入院,相关影像学检查显示肿瘤多已广泛侵犯破坏周围结构,行相关手术病理确诊,均为胚胎性RMS。免疫组化显示3例患者Myogenin均为阳性,Ki 67（LIt分别约为90%、80%、70%）,其中2例VIM阳性,2例DES（部分或者局灶性）阳性,2例CD99阳性。后转入肿瘤科规律治疗。结论儿童RMS早期临床表现不典型呈现多样化,具有恶性程度高、侵袭性强、进展快等特点,需要根据临床特征结合影像学检查及免疫组化结果确诊。     

Speech intelligibility in severe adductor spasmodic dysphonia.

This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched healthy adults. This yielded 3 speaking conditions: pre-Botox injection, post-Botox injection, and normal control. Thirty phrases were extracted from the speech samples and arranged in a counterbalanced listening experiment. Thirty students, reporting little experience with distorted speech, served as listeners. Each listener's response was scored for words correctly identified using a liberal scoring criterion yielding a percentage of words correctly identified for each speaker. The results indicated that the speakers with ADSD were significantly more intelligible in the post-Botox condition than in the pre-Botox condition. The results also indicated that healthy speakers were significantly more intelligible than the speakers in both the pre- and post-Botox conditions. In general, these results indicated that intelligibility is affected in severe ADSD and that the use of Botox injection in ADSD improves intelligibility scores. However, the results also indicated that the use of Botox injection does not result in speech intelligibility similar to that of normal, non-ADSD speakers.     

鼻麻风的临床分析

目的通过总结鼻麻风的临床特征,为临床早期诊断和临床治疗提供依据与指导。方法报道一例鼻麻风,结合文献分析其临床特征、诊断和治疗。 结果鼻麻风是由麻风分枝杆菌感染鼻黏膜致病,主要病损包括鼻黏膜浸润性增生肥厚、鼻麻风结节占位、鼻部骨质破坏致残致畸、全身片状皮损、周围神经炎等。鼻腔分泌物与组织抗酸染色可查见麻风杆菌及组织病理检查确诊。鼻腔手术加联合化疗可临床治愈。结论鼻麻风是细菌感染性、慢性传染性、肉芽肿性疾病,可引起鼻腔多种症状体征、全身皮损、周围神经损害甚至致残致畸,但早期症状往往不典型,临床易误诊漏诊。早期诊断,手术治疗和联合化疗是临床治疗关键。