气管食管裂隙状瘘发音重建术的声学分析

目的　客观评价气管食管裂隙状瘘发音重建术后的发音效果 ,并以此指导临床工作。方法　对喉全切除术后Ⅰ期与Ⅱ期气管食管裂隙状瘘发音患者、食管发音患者、安装Blom Singer发音钮患者以及健康人分别进行语音测试 ,分析 7项客观声学参数 ,比较发音效果。结果　经统计学t检验 ,气管食管裂隙状瘘语音最长发音时间短于健康人 ,明显长于食管音 ,但和Blom Singer发音钮语音差异无显著性 ;其声音的强度和健康人及Blom Singer发音钮差异无显著性 ,明显高于食管音 ;其基频明显低于健康人 ;其频率微扰和振幅微扰明显高于健康人 ,而明显低于食管发音 ,与Blom Singer发音钮语音差异无显著性 ;其共振峰频率和能量仅在F1共振峰能量上明显高于食管音 ,其余各频率上差异均无显著性。虽然喉全切除Ⅰ期气管食管裂隙状瘘发音重建术中制作帽状气室 ,而Ⅱ期发音重建术中不制作帽状气室 ,但两者语音声学分析各参数间差异均无显著性。结论　气管食管瘘语音比食管音接近健康人语音 ,能满足日常生活需要。气管食管裂隙状瘘发音重建术中不制作帽状气室不影响术后的发音。     

影响Blom-Singer发音管发声质量的原因分析

目的 了解影响Blom-Singer发音管发声障碍的各种相关因素。方法 回顾性分析1996年4月～2006年10月108例喉全切除术后行Blom-Singer发音管重建喉发声功能患者的临床资料,其中施行Ⅰ期Blom-Singer发声重建术96例,Ⅱ期Blom Singer发声重建术12例,并对其发声效果进行追踪观察。结果 96例行Ⅰ期发音管重建术中,22例发声质量差（22/96,23%）;12例行Ⅱ期发音管重建术中,8例发声质量差（8/12,67%）。两种术式的总失败率为（30/108,28%）。结论 Ⅰ期Blom-Singer发声重建术较Ⅱ期Blom-Singer发声重建术成功率高。术后发声质量的效果与环咽肌的处理、气管食管壁的完整性、气管造瘘口的大小、咽瘘、食管下咽腔狭窄及肺功能等因素密切相关。     

喉全切除发音重建术后严重误吸的预防与处理

喉全切除气管食管裂隙状孔发音重建术方法简便,发音效果良好,但存在误吸。本文总结78例术后出现误吸病人的处理情况,效果满意,并分析误吸原因和预防措施,现报道如下。1资料与方法1.1临床资料我科1985年7月~2000年12月行喉全切除发音重建术(气管食管裂隙状发音孔发音)210例,为李     

食管吹气试验的临床意义

食管吹气试验（esophagealinsufflationtest简称EIT）最早由VandenBerg等[1]和Seeman[2]所提出，采用这种方法来预测全喉切除患者获得食管发音的可能性。有些患者不能获得发音的原因是食管被气体膨胀后，咽食管段反射性痉挛，气流难以通过食管口进入咽部。Blom等[3]将原来的EIT加以改进，并将其作为无喉者发音重建术前的常规试验，以提高发音重建术后成功率。我们对全喉切除术后行正期Blom－Singer发音重建术患者常规进行此试验。现报道此项试验方法及初步体会。一、改良的EIT方法1．所需设备：14号50cm长胃管（于25。m处作一标记）、…     

咽食管括约肌切开术在喉全切除术后发音重建中的作用

目的　探讨咽食管括约肌切开术对减少咽食管括约肌失弛缓对喉全切除术后安装Blom Singer发音管发音重建的影响。方法　喉全切除术后 ,咽食管括约肌收缩或是痉挛都会不同程度地影响食管的气流并阻碍发音。咽食管括约肌的解剖位置是环咽肌以及其上的下咽缩肌的一部分和颈段食管上段的一部分。手术操作是在喉全切除术中、术后于气管造瘘口外上方切除长 5cm ,宽 1cm的咽食管括约肌。结果　 3 3例喉全切除术的患者进行咽食管括约肌切开术后有 3 2例发音成功 ,发音重建的成功率是 97%。其中包括 12例喉全切除术中I期进行环咽肌切开术 ,2 1例是Ⅱ期进行咽食管括约肌切开术的 ,后者又有 9例是安装Blom Singer发音管后发音不能再行咽食管括约肌切开术的。患者 3年存活 2 5例 ,5年存活 18例。同期行喉全切除术和咽食管括约肌切开术的 12例患者 ,Kaplan Meier法统计 3年生存率 81 82 % ,5年生存率 42 86%。结论　咽食管括约肌切开术能提高Blom Singer发音管发音重建的成功率。     

气管食管裂隙状发声孔发声机制研究

目的：探讨气管食管裂隙状发声孔的发声机制。方法：用大功率遥控X线机和动态频闪喉镜观察40例行全喉切除，Ⅰ期或Ⅱ期发声重建术患者发声时的贮气相、送气相、发声相。结果：患者吸气时肺部膨隆，食管黏膜闭拢；食管入口黏膜内翻呈环形缩小；随之，下咽腔增大呈一尖端向下的三角锥形；食管上端迅速膨大。发声开始时，食管上端扩张如球，食管人口黏膜以冠状位呈唇样外翻，气体从咽食管部冲出；黏膜、黏液发生振动，发出基音。后胸廓缩小，食管入口黏膜再次内翻，发声结束。结论：气管食管音发声的动力器官是肺，气管-食管造瘘口的通畅对发声至关重要。发声时，下咽黏膜、食管口黏膜与黏液均参与振动。     

气管食管穿刺发音术的长期随访效果

自1980年Singer和Blom介绍用气管食管穿刺术（TEP）替代其他发音重建术已有10多年，对于全喉切除术后病人，无论是一期或二期发音重建，TEP都已证明是相对安全和有效的方法。目前对于此类手术最初语言功能再建的成功率报道不少，而关于TEP的远期效果及术后配合较差或酗酒?..     

应用人工发音钮发声重建78例报告

本文将因喉癌喉切除术后应用人工发音钮发声重建术78例的临床资料进行分析，其中一期安放66例，发音成功率95．7％；二期手术12，发音成功率50．0％。手术气管造瘘直径大于20mm，按放发音钮采用横切口，且与发音钮的通气管直径大小相同，可减少并发症，提高发音成功率。不发音者其原因考虑为（1）环咽肌和咽缩肌痉挛；（2）术中下咽粘膜和食管粘膜切除过多，术后咽腔和食管狭窄；（3）高龄和体弱患者。本手术方法简便易行，几乎所有喉全切除患者均可采用此技术，发音亦可保持原有的方言特点。     

气管食管音、食管音与喉音的某些声学特点

全喉截除术后一般多建议以发食管音来重建语言,但它所发之声音在强度、音调及讲话速度等均有一定限制,有50%以上患者不能发出食管音。1979年S inger与Blom提出以内窥镜经气管食管穿刺,安装硅胶发音装置的方法,既能产生由肺提供的单向气流的语音,又能防止食物误吸入气道。采用此法后,能使93%的全喉截除术患者,重建语言。作者对正常喉、食管、气管食管三种发音,在声音强度、频率及速度三方面进行分析比较。第一组受试者,为全喉术后以气管食管发音     

喉全切除后食管音助发声器发音的客观声学分析

目的通过客观声学分析了解喉全切除术后食管音助发声器发音的发音质量。方法应用上海泰亿格公司的Dr.speed嗓音声学分析软件对7例食管音助发声器发音的患者(食管音助发声器发音组)及5例气管食管音患者(气管食管音组)的基频、基频微扰、振幅微扰、谐噪比、声强及最大发声时间进行检测,并与12名正常男性(对照组)进行比较。结果食管音助发声器发音组、气管食管音组的基频、基频微扰、振幅微扰、谐噪比,最大发声时间与对照组比较差异有统计学意义(P<0.05或P<0.01),三组间声强比较差异无统计学意义(P>0.05),食管音助发声器发音组最大发声时间比气管食管音组长(P<0.05),其余指标与气管食管音组比较差异无统计学意义(P>0.05)。结论食管音助发声器发音的声音的声强可达77.40 dB、最大发声时间可达10.77秒,基本能够满足日常交流的需要。     

Selected acoustic features of tracheoesophageal, esophageal, and laryngeal speech

Voice samples of 15 laryngeal, esophageal, and tracheoesophageal speakers using the Blom-Singer voice prosthesis were analyzed for intensity, frequency, and rate. Results indicate that characteristic values for tracheoesophageal speech are more similar to laryngeal speech than esophageal speech, demonstrating the powerful advantage of this pulmonary-supported method of alaryngeal voice.     

Acoustic voice analysis in phonatory fistuloplasty after total laryngectomy

A comparative study was made of the voices of three groups of male patients by acoustic analysis of sustained phonation of the vowel /a/: 1) 20 patients who had undergone total laryngectomy and phonatory fistuloplasty, fitted with a Herrmann voice prosthesis, who had achieved successful prosthetic speech; 2) 20 laryngectomized patients with good quality esophageal speech, and 3) 20 subjects with normal voices. Statistical analysis of fundamental frequency disclosed significant differences between groups, the group with phonatory prostheses having the closest to normal voice of the fistuloplastic groups. There were no statistically significant differences in jitter, shimmer, and the harmonic-to-noise ratio between the esophageal and prosthetic voice groups, which suggests that the disturbances in the vibratory esophageal ring were similar.     

Temporal and perceptual characteristics of tracheoesophageal voice

This study compared the temporal and perceptual characteristics of tracheoesophageal voice produced in four different prosthetic/occlusion conditions: 1. using the Blom-Singer duckbill prosthesis and digital occlusion of the tracheostoma; 2. using the Blom-Singer duckbill prosthesis and valve occlusion of the tracheostoma; 3. using the Blom-Singer low-pressure prosthesis and digital occlusion of the tracheostoma; and 4. using the Blom-Singer low-pressure prosthesis and valve occlusion of the tracheostoma. Characteristics of speech produced in each condition were also compared to those of normal speech. Results revealed significant differences between normal speech and tracheoesophageal speech (in all prosthetic/occlusion conditions) for several temporal and perceptual parameters. In addition, important trends were noted among tracheoesophageal prosthetic/occlusion conditions.     

Perceptual characteristics of tracheoesophageal voice produced using four prosthetic/occlusion combinations

This study examined and compared perceptual characteristics of tracheoesophageal (TE) voice produced using four different prosthetic/occlusion combinations in 15 tracheoesophageal speakers: 1. using the Blom-Singer duckbill prosthesis and digital occlusion of the tracheostoma; 2. using the Blom-Singer duckbill prosthesis and valve occlusion of the tracheostoma; 3. using the Blom-Singer low-pressure prosthesis and digital occlusion of the tracheostoma; and 4. using the Blom-Singer low-pressure prosthesis and valve occlusion of the tracheostoma. Characteristics of speech produced in each condition were also compared to those of 19 normal speakers. Differences in perceptual ratings made by judges who varied in knowledge about laryngectomees were examined. Results revealed a number of speaking parameters that discriminated among normals and the four TE speaking conditions, and that differed according to the judge's expertise level. Clinical implications are emphasized.     

Prospective randomized comparative study of tracheoesophageal voice prosthesis: Blom-singer versus provox

Objectives: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom Singer and Provox. Study Design: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom-Singer and Provox. Methods: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type of procedure was performed. In addition, patients were asked for their subjective assessment. Results: Overall, Blom-Singer and Provox prostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom-Singer prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. Conclusions: Given the equal and good results in terms of voice quality, other factors (e.g., costs, surgery-related factors, maintenance, patient preference) should be taken into account when deciding which type of tracheoesophageal voice prosthesis to use. Laryngoscope, 108:1561–1665, 1998     

帕金森病的噪音特征

目的研究帕金森病(Parkinsondisease,PD)嗓音特征。方法79例PD病例组、40例正常人对照组发持续元音/a/3次,每次发声维持三秒以上,声强控制在为70±4dB,记录嗓音,计算基频(F     

Aerodynamic assessment of the Henley-Cohn tracheoesophageal prosthesis

In vitro airway resistance measurements were performed for eight Henley-Cohn voice prostheses. The results of these measures demonstrated that the Henley-Cohn device offers substantially less resistance to the flow of air than either the Blom-Singer or Panje devices. The lower overall resistance of the Henley-Cohn device was shown to be due to both its larger inner cross sectional area and to an improved valve tip design. The lower airway resistance of the Henley-Cohn prosthesis should theoretically result in more "efficient" production of esophageal voice than would be the case when using the Blom-Singer or Panje devices. However, the results of this investigation also point to the need for the development of methods which will enable investigators to evaluate the in vivo performance of tracheoesophageal prostheses.     

后位聚焦口腔共鸣障碍对听障儿童嗓音的影响

目的 探讨后位聚焦口腔共鸣障碍对听障儿童嗓音的影响.方法 选取15例3~6岁存在后位聚焦口腔共鸣障碍的听障儿童(共鸣障碍组),20例3~6岁无口腔共鸣障碍的听障儿童(对照组),使用嗓音疾病评估仪分别对两组对象发/(ae)/音时的嗓音进行声学分析,比较两组的基频(F0)、基频标准差(F0SD)、基频微扰(jitter)、振幅微扰(shimmer)和标准化噪声能量(NNE).结果 对照组F0、F0SD、jitter、shimmer、NNE值分别为323.52±45.73 Hz、5.35±3.38 Hz、0.27%±0.16% 、2.53%±0.84%、-16.03±3.16 dB;共鸣障碍组分别为328.44±89.41 Hz、8.59±7.42 Hz、0.74%±0.79%、4.48%±1.44%、-14.92±7.27 dB,其中jitter、shimmer值显著大于对照组(P<0.05);共鸣障碍组儿童主要表现为功能亢进型嗓音障碍, shimmer值异常率最大(86.67%,13/15),其次是F0(66.67%,10/15)、jitter(53.33%,8/15)和F0SD的异常率(53.33%,8/15),异常率最小的是NNE(20%,3/15).结论 后位聚焦口腔共鸣障碍听障儿童的嗓音异常率较高,主要以jitter、shimmer值升高为主,主要表现为功能亢进型嗓音障碍.