嗓音障碍主观听感知评估现状

嗓音关系着人们的生活质量和幸福指数,如何对嗓音障碍患者的嗓音进行恰如其分的评价,判断其病变程度和评价治疗效果至关重要。目前国内的嗓音主观听感知评估才刚起步,尚缺乏规范化的评估方法以及标准化培训系统,导致对嗓音疾病准确的评估无法实现,限制了嗓音疾病诊疗工作的广泛开展。本文就嗓音障碍主观听感知评估的现状予以综述,并对未来的发展方向进行展望。     

嗓音障碍主观听感知评估研究现状

在嗓音质量的许多评估方法中,最基本也是被广泛应用的方法是主观听感知评估。主观听感知评估被定义为是依靠专业人员的专业知识进行评估而不依赖于仪器的测试,即通过听觉来评估嗓音障碍的程度或分析嗓音质量[1]。在研究领域,听评委的评估结果是评价嗓音客观测试参数有效性和敏感性的参考标准[2～6]。因此,建立规范科学的嗓音主观评估方法,是实现嗓音客观评估的前提。然而,尽管人耳听觉对音质相当敏感,对于一个嗓音,特别是病理性嗓音的描述是非常困难的,     

嗓音障碍主观听感知评估研究现状

嗓音异常是患者就诊于嗓音门诊的主要原因,通过听觉判断嗓音质量是临床上最占老、最普遍用于诊断嗓音疾病和判断治疗效果的方法.嗓音的主观听感知分析也被国际上用来作为检验嗓音客观检测有效性的参考方法.在目前缺少病理性嗓音发生机制模式或理论指导的情况下,嗓音的客观参数如声学参数、空气动力学参数和生理学参数的可靠性和有效性,只能以嗓音的主观听感知评估结果作为参考来检验.因此,嗓音主观听感知评估方法的研究就成为嗓音分析的重点和中心问题.     

嗓音障碍RBH听感知评估系统的应用研究

目的 研究RBH听感知评估系统的可靠性及与客观嗓音参数的相关性,为其在我国的临床应用提供依据.方法 以10种常见的嗓音障碍疾病为研究对象,每种10例,并选取15例健康人,共115例作为受试者.参照德语版RBH主观听感知评估系统中粗糙声(roughness,R)、气息声(breathiness,B)和嘶哑声(hoarseness,H)的4个等级评分标准对受试者进行评分,检验5位评委间一致性和评委自身稳定性;分析受试者3个主观评估参数每相邻两个等级之间的客观参数的差异性;并将R、B、H与客观参数进行相关性分析.结果 每个评委前后两次评估的自身稳定性分析Kappa系数值为0.428～0.608,稳定性均比较好;5位评委间一致性分析的组内相关系数(intraclass correlation coefficient,ICC),前后两次分别为0.741 ～0.797和0.689 ～0.762,评委间一致性好.主观听感知评估参数R、B、H的4个等级中每相邻2个等级之间的基频微扰、振幅微扰、谐噪比、最长声时和发音障碍严重指数差异均具有统计学意义(P值均＜0.05).主观听感知评估参数R、B、H与客观评估参数基频微扰、振幅微扰、谐噪比、最长声时和发音障碍严重指数之间具有相关趋势(r值在0.360 ～0.551和-0.472 ～-0.620范围内,P值均＜0.01).结论 RBH主观听感知评估系统的可靠性好,等级分度合理,与客观参数评估的结果相关性好,临床应用前景广阔.     

嗓音障碍主观听感知评估中标准化朗读文本的设计

目的 设计涵盖汉语普通话发音所有音素的短文,用于嗓音障碍主观听感知的评估.方法 设计原则为涵盖汉语拼音的21个声母和39个韵母的短文,包含汉语普通话发音的所有音素;其次短文要有一定的中心意思.结果 设计的短文<父母心>共155字,涵盖了21个声母和38个韵母.由于韵母(e)不常用,而对应的读音仅有1个字"欸",故未包括.另外,短文中包括了17个轻声和1个儿化音.短文中声母、韵母和声调的出现频率(构成比)大体符合汉语的出现规律.采用样本与总体相似性检验的方法,将短文与中国科学院声学研究所统计汉语中声母、韵母和声调的构成比进行相似性比较,声母、韵母的r值分别为0.742、0.844,P值均小于0.001,有高度相似性;声调的r值为0.731,P＞0.05,与汉语的相似程度无统计学意义.结论 设计的短文涵盖了汉语普通话发音的所有音素,声母、韵母的出现规律基本符合汉语的出现规律,其在嗓音障碍主观听感知评估的应用价值有待进一步研究.     

嗓音障碍客观多参数评估与主观评估的一致性分析

目的 探讨嗓音客观多参数分析与主观听感知评估的一致性,建立嗓音客观多参数评估模型,实现嗓音评估的客观化和数据化.方法 受试者为嗓音障碍患者271例,其中女性124例,男性147例;嗓音正常对照组69例,女性37例,男性32例.主观听感知评估采用GRBAS系统中的总嘶哑度( grade,G),采用4级改良分级量表.听评委为来自不同医院的5名嗓音医学家.语音材料为统一的语句.全部受试者嗓音按随机方式3次排序,分别进行3次评估.嗓音客观测试采用Dr.speech for windows嗓音评估软件,受试者发长元音[α:],取含起始段2s的嗓音样本,测试基频等7个参数.结果 单参数分析结果显示,除了基频不能反映出嗓音障碍程度外,其他6个参数的测试值随嗓音障碍程度的加重而发生相应的变化,并且在两相邻嗓音组之间的差异性有统计学意义(P值均＜0.05).借助于判别分析方法,按性别分别建立了由基频微扰、振幅微扰、基频标准差、标准化噪声能量、谐噪比和最长发声时间组成的客观多参数评估模型.客观评估与主观评估的一致性在男性达到81.6％,女性达到83.2％.正常嗓音组和重度嗓音障碍组的一致性高于轻度嗓音障碍组和中度嗓音障碍组.全部误判嗓音均被判到相邻的嗓音组.结论 嗓音的客观声学参数能够反映出嗓音障碍的主观听感知特性;客观多参数模型评估结果与主观听感知结果达到较好的一致性,为嗓音障碍的评估提供了一种客观的方法.     

嗓音主观评估研究进展

嗓音疾病最早依靠富有经验的喉科医生的主观判断,由于受经验、个人习惯等一些因素的影响,难免出现误诊、漏诊。随着人们对生活质量的要求提高及医学模式的变革,人们越来越关心自身的嗓音健康,尤其是职业用嗓者更是如此,这就促使嗓音研究工作者加大了对嗓音评价的研究。由于目前     

不同嗓音样本对嗓音听感知评估的影响

目的探讨不同声样对嗓音障碍听感知评估结果的影响,指导嗓音研究中语音材料的选择.方法受试者为60例嗓音障碍患者和20名嗓音正常者.对所有受试者录制3类声样话语声、完整长元音/α/、平稳段长元音/α/.所有声样随机排列3次,共进行9次评估(3个声样×3次).评估参数为日本言语语音学会制定的嗓音嘶哑评估标准GRBAS系统中的总嘶哑度(G)、粗糙度(R)、气息音(S).计算统计学上的Kappa系数值确定听评委评估结果的一致性.根据听评委对每一受试者评估的平均值比较3类声样的差异性.结果评委自身和评委之间评估结果的一致性好;评估参数以总嘶哑度(G)的一致性和稳定性最好;不同声样类型对评委评估的一致性无影响.3类声样的评估结果有高度的相关性(P<0.001);话语声与完整长元音/α/对嗓音障碍的评估结果基本一致,平稳段长元音/α/有过低评估嗓音障碍的倾向,且随着嗓音障碍程度的加重而更加明显.结论平稳段长元音对嗓音障碍的评估程度过低,完整长元音与话语声对嗓音障碍的评估基本一致.建议嗓音障碍的听感知分析选择话语声作为嗓音材料,客观检测选择完整长元音作为嗓音材料.     

嗓音声学参数与嗓音音质的相关研究

目的:通过病理噪音合成器控制声学参数的变化,考察听觉感知判断的变化,寻找能够反映嗓音音质的有效声学参数.方法:采用6个声学参数(嗓音基频、基频微扰、振幅微扰、声门噪声能量、声门谱斜率、共振峰频率微扰),合成36个声学样本/ae/,并在每个参数维度上随机复制25%,总共45个样本,秩序随机化之后,再将样本编号;在室内将声学样本通过计算机播出,声音强度控制在70 dB,由8名耳鼻咽喉科专家参与听觉感知评估,针对GRBAS中的G、R、B进行等级评分,评分结果显示听感判断存在较高的内在一致性(P＜0.01).然后分别将声学参数的变化值与听觉感知得分进行等级相关分析.结果:6个声学参数中基频微扰、振幅微扰以及声门噪声能量与感知判断指标(嘶哑声、粗糙声、气息声)显著相关(P＜0.01).结论:基频微扰、振幅微扰以及标准化声门噪声能量是衡量嗓音音质的有效参数,并证明嗓音的多维性质.嗓音的听觉感知判断与音质声学分析相结合,是评估嗓音音质的最好方式.     

嗓音功能的检测与评估

嗓音的功能是多位功能,任何单一的测量都只能估计其中一部分功能,其发展经历了从主观判断到客观分析再到主客观结合评价的过程,目前国际上尚未制定出统一的评估标准.本文介绍了嗓音的客观评价,包括从检测仪器、检测手段、评估方法等方面,同时对主观评价方法,包括主观听感知评估及自身主观感觉评估进行综述.     

音质障碍测量与治疗的个案研究

目的通过嗓音音质治疗的个案研究,验证音质参数在嗓音测量中的临床评估与监控作用。方法测试者为1名音质障碍患儿,男性,2000年6月出生,采用“喉功能检测仪”对嗓音音质进行实时评估;嗓音治疗为期3个月,每周两次,将音质评估(Jitter,Shimmer,NNE等)贯穿于整个矫治过程中,并采用单一被试法进行统计分析;结果嗓音治疗前后的数据比较发现:Jitter,Shimmer,NNE均存在显著性差异(P<0.05);而嗓音F0无明显差异(P>0.05)。结论①音质评估在嗓音治疗过程中起着非常重要的作用,其中Jitter,Shimmer,NNE被证明是衡量嗓音音质的3个有效参数;②患儿接受的嗓音矫治方法是有效的。     

Longstanding recurrent laryngeal papillomatosis: impact on voice quality

Human papilloma virus (HPV) infection in the larynx often requires frequent surgical procedures in order to keep voice quality reasonable. The purpose of this study was to evaluate the speaking voice quality of patients with longstanding recurrent laryngeal papillomatosis (RLP). The patients were seven males with adult-onset RLP whose disease had lasted over 5 years, and who were free of papilloma at the time of examination. Each patient had an age- and gender-matched control with similar smoking habits. Voice samples were recorded and acoustic analysis as well as perceptual listening test were performed. In our series a perceptual test discriminates between normal and pathological voice quality more precisely than acoustical voice analysis. It appears that the voice of the papilloma patient, even after frequent phonosurgical operations, is not deviant from the normal when analyzed acoustically, but perceptual assessment shows that overall quality is less than optimal, and roughness and breathiness are increased.     

声带息肉患者嗓音分析全程取样与分段取样的比较

目的 :探讨全程取样与分段取样对嗓音分析结果的影响。方法 :比较全程 3s取样与平稳段 1s、样本的前 1s及后 1s取样时 ,嗓音分析结果并行统计学检验。结果 :分段取样可使各参数明显更接近正常值。结论 :分段取样行嗓音分析会掩盖患者病情的程度 ,不宜采用。     

The laryngeal vestibule and voice quality

Summary Most of the literature on voice quality focuses on the vocal folds while six other gestures involving the laryngeal entry and epilaryngeal structures are largely ignored. Whole organ tracer series histograms of the larynx are examined and suggestions are made as to which muscles and/or forces might cause these gestures. An examination of photographs of the larynx indicates that the latter must be described in three dimensions: (1) medio-lateral, (2) antero-posterior, and (3) vestibule cross-sectional area. The article is aimed at laryngologists in general, not surgeons in particular, and has implications for laryngology (being a putative model of diagnostic procedures), physiology (what forces create epilaryngeal configurations?), neuroscience (does the motor cortex control single muscles or whole gestures?), speech pathology (what is the ragbag called hypertenseness?), linguistics (how is one to describe lower pharynx phenomena?) and paralinguistics (what is the extrasystemic laryngeal component of voice quality?).     

Immediate effects of cochlear implantation on voice quality

Summary Seminal quantitative group acoustic data are presented on voice quality changes following electrical stimulation (ES) of the auditory nerve via a single-channel cochlear implant (CI). It was found that the fundamental frequency (F_o) of our patients was significantly lower after the first day of ES, while intensity and speaking duration were not significantly different from pre-CI values. These results suggest that the CI provides enough frequency information < 300 Hz to permit immediate and independent alterations in voice F_o towards normal-hearing speakers values. Our findings also indicate that intensity and speaking duration require additional time before differences found become significant. Longitudinal data are still needed to determine if F_o continues to lower and if intensity and/or speaking duration change significantly to approximate values observed in normal-hearing individuals.     

声带不同CO2激光术式对嗓音功能的影响

目的 :探讨在喉部支架完整保留状态下 ,以CO2 激光手术对声带多种疾病行不同术式治疗后的嗓音功能改变。方法 :以CO2 激光对 5 0例喉角化症及白斑病患者行局部病变粘膜切除 ;对 90例声门癌行声带粘膜剥脱 30例 ,声带切除 6 0例。比较不同术式的嗓音声学、气流动力学及频闪喉镜下嗓音功能特点。结果 :局部病变粘膜切除术后 ,嗓音声学检测接近正常 (P >0 .0 5 ) ,声带剥脱术后 ,基频、基频微扰、振幅微扰与正常比较差异有显著性意义 (P <0 .0 5 ) ,谐噪比与正常比较差异有非常显著性意义 (P <0 .0 1) ;声带切除术后 ,嗓音声学参数与正常比较差异有非常显著性意义 (P <0 .0 1)。结论 :随着CO2 激光治疗深度的渐进 ,声带体层受累加重时 ,声带振动功能逐渐丧失 ,但代偿机制逐渐发挥作用 ,嗓音功能发生本质变化。     

The reliability of three perceptual evaluation scales for dysphonia

Perceptual rating scales are widely used in voice quality assessment, yet apart from the GRBAS scale, their reliability has been poorly demonstrated. There are no studies that have compared the optimal reliability of experienced judges using different auditory rating scales in a controlled experimental environment. This study aimed to assess the reliability of three common scales (The Buffalo Voice Profile , The Vocal Profile Analysis Scheme (VPA) and GRBAS. Sixty-five varyingly dysphonic and five normal voices were recorded onto CD in random order. Thirty voices were recorded twice. Seven experienced and trained speech and language therapists rated all voices on the three scales. Only the overall grade was found to be reliable for the Buffalo Voice Profile. The reliability of the VPA scheme was found to be poor to moderate. The VPA may have a use as a multi-dimensional and in-depth evaluation of voice types, but its greater scope is at the expense of reliability. The GRBAS was reliable across all parameters except Strain. Our detailed reliability analysis comparing performance of three commonly used rating scales provides further evidence to support the GRBAS as a simple reliable measure for clinical use.