单侧声带囊肿与声带息肉患者手术前后嗓音声学的对比研究

目的 探讨单侧声带囊肿与声带息肉患者手术前后的嗓音声学分析指标变化特点。方法 单侧声带囊肿和声带息肉患者各25例，嗓音显微外科手术前1天、术后1周、术后1个月行嗓音主观评分及客观声学检测，比较结果。结果 手术前，声带囊肿组的最长发声时间(MPT)较声带息肉组小(P<0.05),两组患者嗓音障碍指数(VHI-10评分)、嗓音嘶哑度评分(GRBAS)及基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)差异无统计学意义(P>0.05);术后1周，声带囊肿组GRBAS评分及jitter、shimmer和NHR比声带息肉组高(P<0.05),两组患者VHI-10分级、MPT和F0差异无统计学意义(P>0.05);术后1个月，两组患者VHI-10评分、GRBAS分级、MPT、F0、jitter、shimmer及NHR等差异均无统计学意义(P>0.05)。结论 单侧声带囊肿对患者声门闭合功能的影响较单侧声带息肉大，手术后声带息肉患者的嗓音嘶哑度及粗糙度较声带囊肿患者恢复快。     

教师声带息肉患者的嗓音声学分析与嗓音障碍指数相关性研究

目的 探讨教师声带息肉患者的嗓音声学分析与嗓音障碍指数的相关性.方法 对70例教师声带息肉患者(教师息肉组,男30例,女40例)和70例嗓音正常者(对照组,男28例,女42例)进行嗓音声学分析和嗓音障碍指数(voice handicap index,VHI)评估.嗓音声学分析指标包括基频(F0)、基频微扰(jitter...     

嗓音声学分析在声带息肉手术疗效评估中的应用

目的探讨嗓音声学分析在评估声带息肉手术疗效中的作用。方法采用Dr.speech软件,对86例声带息肉病人手术前及手术后1周进行嗓音声学分析,并与40例正常人对照。结果声带息肉组比正常对照组有较高的基频微扰(jitter)、振幅微扰(shimmer)、噪声能量(NNE)和较低的谐噪比(HNR),各指标的差别均有统计学意义(P<0.01)。声带息肉术后1周和术前比较,jitter、shimmer和NNE均下降,HNR升高,差别有统计学意义(P<0.01)。其中NNE指标的敏感性最高。结论嗓音声学分析可客观、定量地分析嗓音质量,评价手术疗效。     

声带显微微瓣手术后发声功能恢复和嗓音训练时间的初步探讨

目的探讨声带显微微瓣手术后发声功能恢复的规律和嗓音训练最佳时机。方法 48例声带息肉患者行喉显微微瓣声带息肉切除术,于术前、术后3、4、5天行频闪喉镜检查及嗓音声学分析。分析比较声带粘膜波及振动、嗓音基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(NHR)等特征。结果术后3天患者嗓音声学分析中的基频微扰、振幅微扰、噪谐比与术前相比差异无统计学意义,术后4、5天患者的嗓音基频微扰、振幅微扰及噪谐比均较术前明显下降,差异有统计学意义(P<0.05),术后3、4及5天与术前相比,患者的声带黏膜波增强,声带无振动部位减少(均为P<0.001)。结论显微微瓣声带息肉切除术后4天患者嗓音功能好转,声带粘膜波及振动已恢复,可开始嗓音训练。     

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。     

会厌逐瘀汤加减对声带良性肿物术后嗓音恢复的研究

目的探讨会厌逐瘀汤加减在声带良性肿物术后嗓音恢复中的影响。方法 50例声带良性肿物患者,随机分为治疗组25例,对照组25例,对照组术前术后采用雾化吸入,治疗组除了雾化吸入,再加入会厌逐瘀汤加减治疗,两组均采用全麻直达喉镜下声带良性肿物摘除术的手术方式,观察两组临床疗效,对其嗓音分析结果中的基频微扰(jitter)、振幅微扰(shimmer)、嗓音障碍指数(DSI)、VHI量表的各参数进行比较。结果对照组和治疗组术后基频微扰(jitter)、振幅微扰(shimmer)及VHI量表的各参数均有所降低,嗓音障碍指数(DSI)也有一定改善。术后治疗组的基频微扰(jitter)、振幅微扰(shimmer)、嗓音障碍指数(DSI)、VHI量表的各参数的改变比对照组显著。结论围手术期联合会厌逐瘀汤加减治疗声带良性肿物,疗效好,值得临床推广和应用。     

应用嗓音主客观参数评估不同大小 声带息肉显微手术的临床疗效

摘要：目的探讨不同大小声带息肉显微手术疗效的多参数评估方法。方法根据声带平行的息肉最大直径与同侧声带膜部的比例，将30例女性单发声带息肉患者分为两组，小息肉组（17例）和大息肉组（13例），分别进行喉显微手术，术后所有患者均休声2周；同期选取15例正常人群为对照组，术后分别进行总嘶哑度G、嗓音障碍指数量表(voice handicap index scale, VHI)、嗓音声学参数等指标的检测。分析上述指标间的差异性和相关性，同时分析手术疗效的主客观评估的一致性。结果①术前组总嘶哑度G和VHI评分（功能、生理、情感及总体评价）均高于术后组和对照组(P＜0.05)；②不同大小声带息肉术前组、术后组和对照组间基频微扰（jitter）、振幅微扰（shimmer）呈递增趋势,噪音障碍严重指数（dysphonia severity index, DSI）呈递减趋势(P＜0.05)；最长发声时间（maximum phonation time, MPT）术前组较术后组和对照组下降，且大息肉术前组较小息肉术前组降低(P＜0.05)；③功能、生理、总体评价之间呈正相关，情感与总体评价呈正相关；jitter与shimmer呈正相关(P＜0.05)；④总嘶哑度G的主观评级和DSI的客观分级总体一致性达82.67%，正常嗓音组一致性最高，达91.43%，中度嗓音障碍一致性最低，达71.43%。结论嗓音声学主客观检测参数可作为声带息肉病情严重程度和手术疗效的重要参考依据。     

电声门图与声学测试技术在病理性嗓音诊断中的运用

目的：探讨电声门图(EGG)和声学测试参数值与嗓音疾病诊断的相关性。方法：采用EGG及声学测试两种检测方法对207例正常人和296例喉部疾病患者进行测试。运用Dr．Speech 3．0软件，计算出嗓音声学分析参数，并对数据进行统计学分析。结果：声带息肉和声带小结患者的振幅微扰(shimmer)和频率微扰(jitter)变化率相近，但shimmer的敏感度较jitter更高。声带息肉、声带小结、喉鳞状细胞癌与对照组相比，习惯基频、jitter和shimmer增大，谐噪比减小。喉鳞状细胞癌患者接触幂值高于对照组，接触率与之比较差异无统计学意义。结论：EGG和声学测试参数值及波形的变化可为喉部疾病的诊断提供客观的量化指标。     

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。     

单侧环杓关节脱位患者嗓音声学分析与VHI-10的相关性研究

目的探讨嗓音声学分析与简化嗓音障碍指数(voice handicap index-10,VHI-10)用于单侧环杓关节脱位患者嗓音质量评估的临床意义及其相关性。方法对36例(男性20例,女性16例)单侧环杓关节脱位患者和50例(男性25例,女性25例)嗓音正常者进行嗓音声学分析和VHI-10调查。嗓音声学参数包括基频微扰(jitter)、振幅微扰(shimmer)、基频(F0)和噪谐比(NHR);VHI-10调查记录总分值Tvh。结果 (1)单侧环杓关节脱位组的jitter、shimmer、NHR、F0和VHI-10与对照组比较差异均有统计学意义。(2)男性单侧环杓关节脱位组患者嗓音声学分析参数jitter、shimmer、NHR和F0与VHI-10之间无相关性;女性患者组,除F0与VHI-10之间无相关性外,其余3个jitter、shimmer、NHR与VHI-10之间均有相关性,相关系数分别为0.556,0.719和0.793。结论计算机声学分析的各项参数均可作为衡量单侧环杓关节脱位患者嗓音音质的有效参数。单侧环杓关节脱位对患者生活质量具有显著影响,且不同性别的患者其生活质量所受影响的程度不同。     

Voice surgery

There have been many advances in microsurgery for voice professionals over the last three decades. Driven by a greater understanding of the anatomy and physiology of phonation, most of the advances provide greater surgical precision through improved exposure and more delicate instrumentation. Laryngologists who perform laryngoscopic surgery should be familiar with the current state-of-the-art and should use the latest techniques and technology for all voice patients and particularly for voice professionals. Video procedures for surgical management of voice disorders accompany this content online.     

Voice following radiotherapy

This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients. Normal to near-normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease. Data on mean speaking fundamental frequency seem to indicate a trend toward lower frequencies in irradiated patients as compared with normals. A trend was also noted in both irradiated and control groups for lower speaking fundamental frequencies in heavy smokers compared with non-smokers or previous smokers. These trends would indicate some vocal cord thickening or edema in irradiated patients and in heavy smokers. It is suggested that the study of irradiated patients' voices before, during and following treatments by means of audio, aerodynamic and acoustic instrumentation would yield additional information of diagnostic value on recovery of laryngeal function. It is also suggested that the voice pathologist could assist in evaluating and guiding patients in vocal usages during and following treatments.     

Voice Handicap Index

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.     

Voice dysfunction in dysarthria: application of the Multi-Dimensional Voice Program

Phonatory dysfunction is a frequent component of dysarthria and often is a primary feature noted in clinical assessment. But the vocal impairment can be difficult to assess because (a). the analysis of voice disorder of any kind can be challenging, and (b). the voice disorder in dysarthria often occurs along with other impairments affecting articulation, resonance, and respiration. A promising assessment tool is multi-parameter acoustic analysis, such as the Multi-Dimensional Voice Program (MDVP). Part 1 of this paper recommends procedures and standards for the acoustic analysis of voice, including (1). selection of the sample to be analyzed, (2). signal quality requirements, (3). availability of normative data for both genders and different ages of speakers, (4). reliability of analysis, and (5). correlation of acoustic results with results from other methods of analysis. In Part 2, acoustic data are reviewed for the dysarthria associated with Parkinson disease (PD), cerebellar disease, amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), unilateral hemispheric stroke, and essential tremor. Tentative profiles of voice disorder are described for these conditions. These profiles may serve as hypotheses for future research. Although several issues remain to be resolved in the acoustic analysis of voice disorder in dysarthria, steps can be taken now to promote the reliability, validity, and clinical utility of such analyses. (1). As a result of this activity, the participant will be able to describe ways in which an optimal multi-dimensional analysis of voice can be performed with modern acoustic analysis systems. (2). As a result of this activity, the participant will be able to apply multi-dimensional acoustic analysis of voice to individuals who have a dysarthria-related voice disorder. (3). As a result of this activity, the participant will be able to identify major sources of normative data on the Multi-Dimensional Voice Program.     

咽音治疗嗓音疾病的初步临床观察

对49例嗓音病患者进行了为期一个月的咽音训练，通过对自觉症状、体症及最大声时观察，认为咽音对于一些嗓音病如炎症、声带小结等有一定的治疗作用．对咽音的治疗原理进行了分析，认为值得在防治用声职业病中推广。     

Voice characteristics of acromegaly

Acromegaly’s effect on voice is still indefinite. We aimed to define acoustic characteristics of patients with acromegaly. Cross-sectional case–control study was designed. Thirty-seven patients with acromegaly and 30 age- and sex-matched healthy controls were included. Fundamental frequency (F₀) and measurements related to frequency, amplitude, noise and tremor of the obtained voice sample were analyzed using Multi-Dimensional Voice Program. Absolute jitter (Jita) and jitter percent (Jitt), shimmer in decibel and shimmer percent, noise to harmonic ratio and soft phonation index, fundamental frequency tremor frequency and frequency tremor intensity index represented the parameters related to frequency, amplitude, noise and tremor of the voice sample, respectively. Patients with acromegaly, especially the uncontrolled patients, exhibited significant differences in frequency perturbation measurements. Jitt of all patients and Jita of uncontrolled patients were significantly higher than that of control group (p = 0.044 and p = 0.043, respectively). Jitter which is a measure of frequency perturbation can be assumed as an indicator of hoarse and deepened voice. Jita of all patients and Jitt of uncontrolled patients were elevated, but not reaching a statistical significance. Controlled and active patients had similar analysis of acoustic parameters. In the correlation analysis, shimmer and IGF-1 (insulin like growth factor 1) was found to be positively correlated in all patients with acromegaly and in female patients. When the p value is adjusted according to Bonferroni correction regarding the use of ten parameters for acoustic analysis (so adjusted p is <0.005), all the statistically significant findings become insignificant. Considering the parameters test different properties of voice, it is reasonable to pay attention to the findings. Patients with acromegaly have increased frequency perturbations measures, but this increase is non-significant according to Bonferroni correction. This may be perceptually sensed as hoarse voice. Amplitude perturbations within the voice of the patients with acromegaly are positively correlated with IGF-1 levels, this correlation is also non-significant according to Bonferroni correction.     

嗓音音质障碍的矫治

本文从嗓音音质障碍的临床表现和针对嗓音音质障碍常用的促进治疗法的设计原理出发，探讨如何选择恰当的方法有效地矫治此类问题，为切实提高临床嗓音音质障碍的矫治效果提供参考。