嗓音障碍指数量表简化中文版的研究

目的 对嗓音障碍指数(voice handicap index,VHI)量表中文版进行简化筛选研究.方法 对1 766例嗓音疾病患者的VHI评分行聚类分析,筛选简化版的条目;分析3 825例嗓音疾病患者及120例健康对照者的VHI简化版评分,并对其中424例嗓音疾病患者治疗前后VHI评分进行比较以评估简化版.结果 聚类分析筛选出10个条目(VHI-10)和13个条目(VHI-13)两个简化版,其内部一致性分别为0.939、0.936,重测信度分别为0.995、0.993,与VHI量表的相关性分别为0.972、0.973.不同嗓音疾病组患者VHI-10、VHI-13评分均明显高于对照组,差异有统计学意义(Z值分别为17.42、17.46,P值均为0.000),且VHI-10、VHI-13与VHI评分之比均大于期望值0.333、0.433(VHI-10、VHI-13与VHI条目数之比);按主观听觉评估总嘶哑度G(grade)分级分组比较,VHI-10、VHI-13评分各级间差异均有统计学意义(Z值范围5.735～9.861,P值均为0.000);治疗后量表评分显著下降,术前术后VHI-10、VHI-13评分差异有统计学意义(P值均＜0.05).结论 VHI-10、VHI-13量表均具有良好的信度和效度,可以作为嗓音障碍指数量表的简化中文版应用于发音障碍的自我评估,其中,VHI-10比VHI-13更加简洁,更易于推广使用.     

嗓音障碍指数主观评估与发音障碍严重程度指数客观检测的相关性分析

目的 探讨声带息肉患者嗓音障碍指数（voice handicap index,VHI）量表自我评估和发音障碍严重程度指数（dysphonia severity index,DSI）客观评估的相关性。 方法 取104例声带息肉患者,用VHI中文版量表进行自评及DIVAS2.5声学分析软件分析DSI,按性别、侧别、形状、大小分组比较,分析VHI和DSI的相关性。结果 声带息肉的大小、形状对VHI各指标差异均无统计学意义,但较大或广基底形息肉基频微扰较重;女性患者功能、生理和VHI总体评价高于男性,但DSI却低于男性;双侧息肉比单侧在生理方面影响较重,同时DSI也较重;VHI量表各指标与嗓音声学分析各参数之间无明显相关性。结论 目前临床上评估嗓音障碍程度的两种主客观方法都不理想,应进一步研究更好的评价方法。     

嗓音障碍指数对嗓音外科手术效果评估的价值

目的运用改良中文嗓音障碍指数量表,结合客观检查手段,评估嗓音障碍指数对嗓音疾病患者临床疗效分析的价值。方法 50例嗓音疾病患者手术前后分别进行自我评估、声学分析和喉镜检查。自我评估采用嗓音障碍指数(voice handicap index,VHI)量表中文版,包括功能(F)、生理(P)、情感(E)三方面评分,其总和记为T,其中,P+F=TvH;通过Dr.Speech嗓音分析软件对患者的嗓音样本进行声学分析,观察基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(normalized noise energy,NNE)三个指标。纤维喉镜检查主要观察声带闭合情况,记为C。结果 VHI量表中剔除了情感(E)方面后的嗓音自我评估分数,F、P、TvH之间的相关性良好,F、P、TvH与jit-ter、shimmer、NNE之间有良好的相关性,声带闭合程度(C)与VHI量表中的F、P、TvH以及jitter、shimmer、NNE之间有良好的相关性。结论改良的中文VHI量表,可有效地评估嗓音疾病严重程度及临床疗效,有较高的临床应用价值。     

ABCLOVE嗓音训练法治疗声带息肉的临床观察

目的观察应用ABCLOVE嗓音训练法治疗单侧声带息肉患者发音障碍的临床效果。方法选取2015年12月~2017年3月确诊为单侧声带息肉并伴有发音障碍的患者32例。所有患者均采用ABCLOVE嗓音训练法进行嗓音康复训练,每周1次,训练次数共6次。治疗前后应用电子喉镜、嗓音障碍指数量表（VHI）和计算机嗓音分析仪进行主客观嗓音障碍程度评估,以嗓音嘶哑指数（RAP%）、最长发声时间（MPT）、基础音频范围（Hz）和息肉大小等指标评判治疗效果。结果应用ABCLOVE嗓音训练法进行嗓音康复训练后,所有患者发音均有改善,总有效率达100%,治愈率86.3%。① 治疗后复查电子喉镜有9例患者声带息肉消失,11例声带息肉较治疗前缩小,12例声带息肉无明显改变患者因声嘶等症状明显缓解达到日常用声需求,从而避免了手术治疗;② 治疗后VHI评分（功能、生理、情感和总体评分）均较治疗前明显降低（P<0.05）;③ 嗓音分析结果提示,嗓音嘶哑指数（RAP）较治疗前显著下降（P<0.01）,最长发声时间（MPT）训练后较前显著延长（P<0.01）,基础音频范围（Hz）和音强（dB）等指标均较治疗前明显提高（P<0.05）。结论ABCLOVE嗓音训练法可针对声带息肉等临床常见喉部炎性病变造成的发音障碍进行有效的个体化治疗,从而改善发音、提高生活质量,同时避免不必要的常规手术,达到减少患者痛苦和治疗费用目的。     

嗓音障碍指数量表中文版信度和效度评价

目的 探讨自行翻译的中文版嗓音障碍指数(voice handicap index,VHI)量表信度和效度特征.方法 采用健康相关生活质量评价跨文化翻译法对VHI量表进行系统翻译.546例嗓音障碍患者及80例健康对照者共626例完成了中文版量表评估,其中30例患者及20例健康对照者还同时应用香港中文版量表进行评估.结果 VHI量表中文版总量表和3个分量表内部的一致性为0.8657～0.9517;重测信度为r=0.992(P＜0.001);总量表、分量表及3个分量表各自内部的r值为0.643～0.904(P＜0.01);与香港中文版比较,两者之间差异无统计学意义(Z=0.397,P=0.691),并且有很强的相关性(r=0.995,P＜0.001);因素分析特征根大于1的公因子6个,累计贡献率77.24%,各条目负荷大于0.4;不同嗓音疾病患者总量表及功能、生理、情感3个分量表评分均明显高于对照组,差异有统计学意义(Z值分别为17.69、14.14、17.68和15.50,P值均为0.000).结论 VHI量表中文版有很好的信度和效度,可以作为发音障碍自我评估工具应用.     

声带息肉患者的嗓音障碍客观指数测定

目的研究嗓音障碍客观指数(dysphonia severity index,DSI)测试在声带息肉患者嗓音分析中的临床应用.方法对31例声带息肉患者和12例正常受试者分别进行主观自我评估和客观嗓音声学检测.主观自我评估采用嗓音障碍指数(voice handicap index,VHI)量表进行评估,客观声学检测采用德国XION公司生产的嗓音分析软件DiVAS进行测试.结果声带息肉患者组DSI均低于正常对照组,差别有统计学意义(P<0.05);VHI高于正常对照组,结果具有统计学差异(P<0.05).声带息肉患者的DSI与VHI之间没有显著相关性.结论嗓音障碍客观指数(DSI)能够客观评估声带息肉患者的嗓音障碍程度.     

声带息肉患者的嗓音声学分析与VHI的相关性研究

目的 探讨嗓音声学分析与嗓音障碍指数(voice handicap index,VHI)用于嗓音质量评估的临床意义及其相关性,并进一步验证VHl的实用性.方法 对35名声带息肉患者(患者组)及35名嗓音正常人(对照组)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括振幅扰动商(amptitude perturbation quotient,APQ)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(NHR),VHI调查包括功能(F)、生理(P)、情感(E)三个范畴,记录三方面得分及总分(TVH)分值.结果患者组的APQ、jitter、shimmer、NHR均高于正常组,差异有统计学意义(P<0.05);患者组VHI的TVH平均值为43.32±4.66分,而正常组的平均值为12.51±1.88分,两组间差异有统计学意义(P<0.05).声带息肉患者嗓音声学分析参数与VHI之间无显著相关性.结论 临床上不能以嗓音声学分析为标准来判断或推测声带息肉患者症状轻重;VHI可主观反映患者嗓音障碍程度.     

嗓音障碍疾病GRBAS听主观评估特点分析

目的 探讨嗓音障碍疾病GRBAS听主观评估特征.方法 对1 780例嗓音障碍患者行GRBAS评估,包括:听主观总嘶哑度G、粗糙度R、气息度B、无力度A、紧张度S 分级评估,根据疾病种类进行统计分析.结果 声带接触性肉芽肿、慢性单纯性喉炎、声带角化、声带小结、痉挛性发声障碍G、R评估以轻度异常为主,B评估多为正常和轻度异常,除痉挛性发声障碍S评估异常者达85%外,余几种嗓音障碍疾病A、S评估异常者少见;声带息肉、声带囊肿、声带任克水肿G、R、B评估以轻、中度异常为主,A、S评估异常者少见;声带良性肿瘤、声门癌、病理性声带沟、单侧声带麻痹、功能性发声障碍G、B评估以重度异常为主,声带良性肿瘤、声门癌R评估以重度为主,病理性声带沟、单侧声带麻痹R评估中度异常为主,而功能性发声障碍各级比例相近,这几种疾病的嗓音A评估虽然仍以正常者居多,但异常者明显增加,达23%～47%,S评估除功能性发声障碍异常者多达50%,余未见异常.所有嗓音障碍疾病中,声带接触性肉芽肿在G、R、A、S评估中最轻,痉挛性发声障碍在B评估中最轻,声门癌在G、R评估中最重,单侧声带麻痹在B、A评估中最重,痉挛性发声障碍在S评估中最重.从R、B、A、S与G的相关性看,痉挛性发声障碍S与G显著相关(r=0.717),其他各嗓音疾病均为R、B与G显著相关(r＝0.582～0.965),其中,声带接触性肉芽肿、慢性单纯性喉炎、声带角化、声带小结、声带息肉、声带囊肿、声带任克水肿、声带良性肿瘤、声门癌为R与G相关性最高(r＝0.885～0.965),病理性声带沟、单侧声带麻痹、功能性发声障碍则B与G相关性最高(r＝0.746～0.833).结论 GRBAS听主观评估嗓音障碍不仅可显示嗓音障碍的程度,而且可间接反映发声时声带的基本特征,不同嗓音疾病具有不同特点,与声带病变的病理生理改变具有一致性.     

咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。     

神经肌电图监测下经皮肉毒素A喉肌注射治疗痉挛性发音障碍

目的　探索神经肌电图监测下经皮肉毒素A注射治疗痉挛性发音障碍的效果和价值。方法　根据喉内镜、嗓音学检查后诊断为痉挛性发音障碍的患者18例,进 行神经肌电图监测下经皮肉毒素A,根据痉挛的部位,注射部位为甲杓肌、甲会厌肌、环杓后肌等,剂量为0.1～1.0U,注射频率为每月1次,行频闪喉镜检查和嗓音障碍指数（voice handicap index,VHI）主观评分以及客观嗓音分析,包括喉肌电图检查（EMG）、基频微扰（jitter）、振幅微扰（shimmer）以及最大发音持续时间（maxium phonationtime,MPT）测定等来评估患者的嗓音质量。结果　18例患者注射后24小时起效,发音震颤及中断症状明显改善,发音流利、平稳,无音质紧张,疗效均持续1个月,经过3次注射后,患者喉内镜下见声带震颤症状明显消失,患者发音流利,嗓音主观评估和客观嗓音分析明显改善,注射前声 带闭合时挤压明显,声门上区代偿;注射后声带闭合时节奏感,声门上区代偿减轻。喉肌电图和多维嗓音分析程序（MDVP）提示注射后比注射前改善明显。所有患者术后均并发程度不等的声嘶症状,一般在注射后2天出现,持续3~5天,3例患者出现饮水呛咳,所有患者无呼吸困难。所有患者随访6~36个月,发音良好。结论　神经肌电图监测下经皮肉毒素A喉肌注射是治疗痉挛性发音障碍的有效方法。     

The prevalence of major psychiatric pathologies in patients with voice disorders

We conducted a study of 47 patients with various voice disorders to determine the prevalence of concomitant psychopathology. The prevalence of psychiatric symptoms varied considerably among patients with the three most common voice disorders: 63.6% among patients with vocal fold paralysis, 29.4% among those with functional dysphonia, and 7.1% among those with spasmodic dysphonia. Levels of anxiety and depression correlated moderately with the severity of voice symptoms in patients with vocal fold paralysis, but not in those with functional or spasmodic dysphonia. Certain abnormal personality traits--including interpersonal sensitivity and distrust of others--were more common among patients with functional dysphonia. The low rate of psychopathology among patients with spasmodic dysphonia is consistent with rates reported in previous investigations. Our findings suggest that the prevalence of psychopathology in patients with voice disorders varies according to the specific voice diagnosis, as does the relationship between specific psychiatric and voice symptoms.     

Laser-assisted voice adjustment (LAVA) in transsexuals

OBJECTIVE: The objective of this study was to evaluate results of laser-assisted voice adjustment (LAVA) surgery in male-to-female (MTF) transsexual patients with androphonia. METHODS: The authors conducted a prospective case-control study of MTFs who underwent CO2 laser vocal fold vaporization between 1997 and 2003. Thirty-one patients were self-referred for voice feminization. Pre- and postoperative evaluations were completed. Patients' voices were recorded to obtain Fo before and after surgery. Voice Handicap Index (VHI) questionnaires were completed by post-LAVA patients. A panel of blinded listeners identified patients as male or female based on samples of connected speech recorded over the telephone. RESULTS: Mean follow-up (23 weeks) revealed pitch increases averaging 26 Hz. Self-evaluations revealed increases in voice femininity, congruity with self-image, and satisfaction. However, the evaluations also showed decreased vocal quality, loudness, and vocal range. Mean VHI was consistent with VHI scores associated with Reinke's edema. Six of 10 patients were consistently perceived as female. CONCLUSION: LAVA provides a conservative treatment for androphonia. Postoperative voice therapy may optimize outcomes.     

嗓音训练应用于声带息肉术后的效果评价

目的 探讨嗓音训练应用于声带息肉术后的疗效.方法 选取92例接受声带息肉切除术患者作为研究对象,所有患者随机分为实验组(n=46)与对照组(n=46)两组.两组患者均行喉显微声带息肉切除术,对照组术后给予金嗓散结丸口服治疗4周,实验组在对照组基础上术后1周起联合嗓音训练治疗3周,术后4周两组同时结束治疗.比较两组患者治...     

Measurement and validation of the voice handicap index in voice-disordered patients in Taiwan

Voice disorders can cause problems for patients emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations are able to evaluate such factors adequately. For this study, a retrospective analysis of 79 dysphonic cases was conducted using the voice handicap index (VHI) to gather comprehensive data across a variety of voice disorders. Of the 79 cases, 41 involved glottic insufficiency, 26 involved vocal polyps or mass, and 12 involved functional voice disorders. Cases were assessed with the VHI using physical (P), functional (F), emotional (E) parameters and a total (T) of the three. P, F, E and T variables were entered into a statistical programme and analysed using one-way analysis of variance (ANOVA). Mean +/-SE values for P, F, E and T, respectively, in glottic insufficiency cases were 31.61 +/- 1.10, 26.49 +/- 1.43, 26.06 +/- 1.54, and 84.20 +/- 4.21. Mean +/-SE values for P, F, E and T, respectively, in vocal mass cases were 30.69 +/- 1.73, 25.23 +/- 1.90, 23.96 +/- 1.82, and 79.88 +/- 5.08. The mean +/-SE values of P, F, E and T, respectively, in functional voice disorders were 20.92 +/- 2.06, 18.33 +/- 1.82, 16.83 +/- 1.86, and 56.08 +/- 5.23. We found the mean glottic insufficiency was significantly greater than functional voice disorders for each measure. There were significant differences between vocal mass and functional voice disorders means for P and T. Glottic insufficiency and vocal mass means were not significantly different for any measure. Problems in the physical realm were identified as the most severe amongst all patients. Glottic insufficiency patients were found to suffer the most in every VHI value. Although VHI is a relatively new method by which to measure discomfort in voice-disordered patients, it provides a mechanism for patients to define their discomfort and for therapists to better target recovery programmes to patient's needs.     

Quality-of-life outcomes following laryngeal endoscopic surgery for non-neoplastic vocal fold lesions

Preservation of the vocal fold cover during laryngeal surgery should optimize vocal outcomes for patients with benign glottal lesions. The aim of this study was to evaluate changes in the quality of life, perceptual voice evaluation, and acoustic and aerodynamic measures of patients before and after endoscopic laryngeal microsurgery for true vocal fold cysts, polyps, and scarring. Preoperative and postoperative Voice Handicap Index (VHI) scores, Short Form 36 scores, and perceptual, acoustic, and aerodynamic voice measures were obtained prospectively from 42 patients who underwent phonomicrosurgery from February 2000 through May 2003. The mean (+/-SD) preoperative VHI was 49.6 +/- 21. The mean postoperative VHI score at a minimum of 3 months after surgery decreased to 26.8 +/- 21 (p < .001). When divided by lesion type, VHI scores improved significantly after surgery for vocal fold polyps and cysts. Although patients with vocal fold scarring demonstrated improvement in VHI scores after surgery, statistical significance was not achieved. For the entire group, the Short Form 36 scores were not significantly different from US norms either before or after operation. The acoustic data showed statistically significant decreases in jitter (2.05% to 1.26%), shimmer (7.06% to 4.03%), and noise-to-harmonics ratio (0.18 to 0.13) after surgery (p < .05) in female patients. The upper pitch limit increased after surgery in women (495.3 Hz to 654.9 Hz, p < .001). These results indicate that the voice-related quality of life and some acoustic parameters improve significantly for patients who have undergone laryngeal microsurgery for vocal fold cysts and polyps. Vocal fold scarring remains a difficult clinical problem with less favorable outcomes following surgical treatment in this patient set.     

Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy

Objective

To evaluate through a multidimensional protocol voice changes after voice therapy in patients with benign vocal fold lesions.

Methods

65 consecutive patients affected by benign vocal fold lesions were enrolled. Depending on videolaryngostroboscopy the patients were divided into 3 groups: 23 patients with Reinke's oedema, 22 patients with vocal fold cysts and 20 patients with gelatinous polyp. Each subject received 10 voice therapy sessions and was evaluated, before and after voice therapy, through a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Data were compared using Wilcoxon signed-rank test. Kruskal–Wallis test was used to analyse the mean variation difference between the three groups of patients. Mann–Whitney test was used for post hoc analysis.

Results

Only in 11 cases videolaryngostroboscopy revealed an improvement of the initial pathology. However a significant improvement was observed in perceptual, acoustic and self-assessment ratings in the 3 groups of patients. In particular the parameters of G, R and A of the GIRBAS scale, and the noise to harmonic ratio, Jitter and shimmer scores improved after rehabilitation. A significant improvement of all the parameters of Voice Handicap Index after rehabilitation treatment was found. No significant difference among the three groups of patients was visible, except for self-assessment ratings.

Conclusion

Voice therapy may provide a significant improvement in perceptual, acoustic and self-assessed voice quality in patients with benign glottal lesions. Utilization of voice therapy may allow some patients to avoid surgical intervention.     

Factors predicting patient perception of dysphonia caused by benign vocal fold lesions

OBJECTIVES/HYPOTHESIS: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. We hypothesize that 1) level of vocal demand; 2) auditory-perceptual evaluation of dysphonia severity; and 3) vocal function, as defined by phonatory glottal closure and mucosal wave vibration, are the most significant predictors of VHI score. STUDY DESIGN:: Retrospective review of 100 patients with benign vocal fold lesions. METHODS: Variables assessed for predictive value to VHI score are level of vocal demands, auditory-perceptual evaluation of dysphonia severity, integrity of mucosal wave vibration and phonatory glottal closure, lesion type, duration of current complaint, smoking, age, and sex. Harmonic to noise ratio was assessed in a subset of 50 patients. RESULTS: Patients with routine voice use had significantly lower VHI scores than those with more intensive (nonsinging/acting) vocal demands. Patients who quit smoking had greater VHI scores than those who currently smoke or never started. Patients with long-standing dysphonia tended to have lower VHI scores than those with shorter duration vocal complaints. Auditory-perceptual assessment of dysphonia severity and harmonic to noise ratio were weak predictors of VHI score. Age, sex, lesion type, phonatory glottal closure, and mucosal wave vibration were not significant predictors of VHI score. CONCLUSIONS: Patient perception of dysphonia severity is independent of many factors commonly assessed during the evaluation of voice disorders. It appears to be an important independent element in the assessment of the effect of a benign vocal fold lesion and critical to therapeutic decision-making.     

小学教师嗓音质量评估的研究

目的探讨嗓音声学分析与嗓音障碍指数（voicehandicapindex,VHI）用于小学教师嗓音质量评估的临床意义。方法30例嗓音正常教师（G1组）与同一学校年龄、性别、教龄相匹配的30例嗓音障碍教师（G2组）均行间接喉镜检查、嗓音声学分析、V…量表自我评估,两组结果进行比较分析。结果嗓音障碍组（G2）中慢性喉炎占77％（23／30）、声带息肉占1O％（3／30）。声带小结占13％（4／30）。嗓音障碍组（G2）的Jitter．Shimmer、噪谐比（NHR）均高于嗓音正常组（G1）,差异有统计学意义（p〈o．05）。嗓音障碍组（G2）与嗓音正常组（G1）的功能（functional,F）、生理（physical,P）．情感（emotional,E）三方面得分及VHI总分（totalscoresoftheVHl,Tvh）分值两组间差异有统计学意义（P〈0．05）。嗓音障碍组（G2）VHI量表中除E外,F、P、Tvh与Jitter、Shimmer、NHR之间有良好的相关性。结论临床上可以用嗓音声学分析中各项指标判断教师嗓音障碍的严重程度,VHI可主观反映教师嗓音疾病的严重程度,二者在嗓音质量评估中具有一定的临床应用价值。