声门闭合不全的功能性嗓音障碍矫治的个案研究

目的：验证功能性嗓音障碍矫治方法的有效性。方法：对1例声门闭合不全的功能性嗓音障碍患者进行系统的嗓音矫治,采用声门噪声能量（NNE）作为声门闭合程度的检测和监控指标,分别采集基线期（A）和处理期（B）数据,用A-B设计的单一被试法进行统计分析。结果：通过系统的嗓音矫治后,患者的NNE值显著降低（P〈0．01）,主观评估患者的嘶哑声和气息声有明显改善。结论：系统的嗓音矫治方法对功能性嗓音障碍患者的嗓音功能恢复有效。     

嗓音训练治疗声门闭合不全所致功能性嗓音障碍的疗效分析

目的探讨嗓音训练对声门闭合不全的功能性嗓音障碍患者的疗效。方法对24例声门闭合不全的功能性嗓音障碍患者进行8周的嗓音训练,训练内容包括健康宣教、肌肉放松、喉部按摩、暖嗓、呼吸训练、嗓音训练和共鸣训练,训练前后对患者进行电子喉镜检查、GRBAS评估、嗓音障碍指数量表（VHI）评估、计算机嗓音声学分析,比较训练前后评估结果。结果24例患者训练后电子喉镜检查16例患者声门闭合良好（66.67%,16/24）,6例声门裂隙变小（25.00%,6/24）,2例声门裂隙无明显变化（8.33%,2/24）;GRBAS评分中总嘶哑度G(0.61±0.66)明显低于训练前(1.91±0.87)（P<0.05）,粗糙声Ｒ(0.51±0.58)明显低于训练前(1.41±0.52)（P<0.05）;VHI评分总分(29.21±21.02)分明显低于训练前的(52.35±23.45)分（P<0.05）;计算机嗓音声学分析最长发声时间（15.24±3.64）s比训练前（9.02±3.45）s明显延长（P<0.05）,基频微扰、最高基频、最低音强、嗓音障碍严重指数训练后分别为（0.21±0.08）%、（420.11±44.21）Hz、（54.21±3.20）dB、（1.62±0.82）比训练前的（0.92±0.12）%、（375.21±49.21）Hz、（56.81±3.42）dB、（0.21±1.02）有改善（P<0.05）。结论嗓音训练能改善声门闭合不全的功能性嗓音障碍患者的声门闭合及嗓音质量。     

声带下方收敛角度在声门闭合不全发声困难中可能的作用机理

目的 探讨喉三维CT重建下声带下方收敛角度的测量方法,探索声门闭合不全对声带下方收敛角度的影响,分析声门闭合不全发声疲劳可能的气流动力学原因.方法 采用双源薄层CT,嘱受试者发/i:/音时扫描10例正常人的20侧声带(声门闭合组),深吸气时扫描8例单侧声带麻痹患者的麻痹侧声带(声门闭合不全组),经深吸气时扫描另10例正常人的20侧声带(声带外展组);导入影像数据于Mimics软件,构建声带及气道的3D模型,联合这两模型测量声带下方收敛角度;采用单因素方差分析,比较3组受试者声带下方收敛角度的差异;并尝试采用材料的斜截面应力分配原理进行声门下压力分析,探讨声门下收敛角度对启动发声时声带振动可能的影响.结果 声门闭合组、声门闭合不全组及声带外展组的声带下方收敛角度分别为33.49°±3.75°、55.03°±2.61°及75.02°±7.32°,三组间差异有统计学意义(P<0.01),声带下方收敛角度随声门闭合不全程度增加而增加.结论 声带下方收敛角度可以通过声带及气道的3D模型进行有效测量,声门闭合不全程度增加会引起该角度增大,可能会导致声门下压力作用于声带下方的剪切力和正应力的分力发生变化,从而引起发声困难.     

男声女调患者与正常男性嗓音参数的对比分析及临床意义

目的探讨男声女调患者嗓音参数与正常男性嗓音参数的区别,为临床诊疗提供参考依据。方法收集30例男声女调及30例正常男性的动态喉镜及嗓音资料,对比分析其嗓音参数。结果26例（86.67%）男声女调患者动态喉镜下表现为声门闭合不全。男声女调患者发音时的基频(F0)为（243.3±42.1）Hz,显著高于正常人的（146.2±25.4）Hz(P<0.01);男声女调患者及正常人发音时的响度分别为（80.0±8.3）dBA、（82.2±9.1）dBA,两者经比较无统计学意义(P>0.05);男声女调患者发音时的振幅微扰(shimmer)为(2.6±1.4)%,与正常人的(1.9±0.7)%比较无统计学意义(P>0.05);男声女调患者及正常人发音时的基频微扰(jitter)均值分别为(0.5±0.2)%、(0.6±0.2)%,两者经比较无统计学意义(P>0.05);男声女调患者的嗓音障碍指数(voice handicap index,VHI)为-0.5±1.6,显著低于正常人的3.8±1.6(P<0.01);男声女调患者的最长发音时间(maxmum phonation time,MPT)为（16.0±7.5）s,较正常人的（32.0±4.9）s显著缩短(P<0.01);音域（range）测量男声女调患者为（288.4±140.8）Hz,显著小于正常人的（611.1±226.1）Hz(P<0.01)。结论大部分男声女调患者存在声门闭合不全。男声女调患者发音时的基频高于正常人,嗓音障碍指数低于正常人,最长发音时间较正常人缩短,音域较正常人变窄,而响度、振幅及基频微扰值与正常人相比无显著差异。     

The effects of frequency and intensity level on glottal closure in normal subjects

The degree of glottal closure during phonation has an influence on voice quality and it is related to the robustness of the voice source. To quantify glottal closure a frame of reference was created by investigating 47 healthy men and 92 healthy women with no vocal complaints using videolaryngostroboscopy. Observing recorded images the degree of glottal closure was rated with a percentage. Results indicate that men have better glottal closure than women (P < 0.001). An increase in vocal intensity is related to improved glottal closure (P < 0.001), and in women a negative relationship was established between pitch and glottal closure (P < 0.001). Normal glottal closure in men is a complete closure, whereas in women a closure of at least 90% should be attained. If these percentages cannot be established during loud phonation, it suggests the presence of a less robust larynx. To evaluate and quantify the function of the voice source, in clinical practice the larynx should not be observed at only one intensity level, but at a variety of intensity and frequency levels.     

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.     

耳外科手术患者全麻气管插管前后的嗓音声学分析

目的 探讨全麻气管插管对耳外科手术患者嗓音的影响.方法 对2017年1月—2017年10月河北医科大学第二医院耳鼻咽喉一科行耳外科手术治疗且均全麻下行气管插管术的成年患者52例插管前1 d、插管后第1天、插管后第3天进行嗓音声学分析,比较患者插管前后的基频(F0)、基频微扰(Jitter)、绝对音调微扰(Ji-ta)、...     

梅尔频率倒谱系数在声带息肉手术前后嗓音分析中的价值研究

目的 本研究拟通过提取患者嗓音中的梅尔频率倒谱系数(MFCC)指标,探讨其在声带息肉手术前后嗓音分析中的临床价值。方法 回顾性分析于2018年1月—2019年8月行声带息肉手术且术前及术后1个月均行嗓音评估的患者41例,男31例,女10例;平均年龄(42.9±11.4)岁。另选取无声嘶且无声带病变的正常受试者21例作为基线对照。使用基于Python编程语言的librosa语音处理包进行MFCC特征提取,分别提取每位患者的MFCC均值,MFCC方差与MFCC标准差,使用配对样本t检验比较声带息肉手术前后上述各MFCC特征的差异。结果 声带息肉患者术后MFCC均值1.25±1.01、MFCC方差561.34±154.98及MFCC标准差21.74±4.03比术前MFCC均值6.81±2.05、MFCC方差1 019.66±295.87及MFCC标准差34.37±6.63显著下降,差异具有统计学意义(t=18.596,P=0.000;t=10.338,P=0.000;t=11.852,P=0.000)。声带息肉组患者术后1个月其MFCC均值、MFCC方差及MFCC标准差与正常受试者相比差异均无统计学意义,表明绝大部分声带息肉患者术后嗓音得到良好的恢复。结论 本研究首次探索了MFCC在声带息肉手术前后嗓音分析中的价值, MFCC各特征可作为评估声带息肉术后嗓音恢复的指标。     

Profiles and predictors of onset based differences in vocal characteristics of adults with auditory neuropathy spectrum disorder (ANSD)

PurposeOnset-based differences are understudied in Auditory Neuropathy Spectrum Disorder (ANSD) in dimensions such as voice, which is addressed in the study. The study aimed to profile and predict the best metrics of onset-related differences in acoustic vocal characteristics of early and late-onset ANSD patients.Methods31 participants (15 early and 16 late-onset) aged 15–30 years diagnosed with ANSD were included in the study. The sustained phonation of vowel /i/ recorded by the participants using android based smartphones of selected configuration was sent over email to the experimenter. Acoustic parameters (fundamental frequency, harmonic frequencies, jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence -CPP, and pitch sigma) were analysed using Praat software.ResultsResults revealed significantly increased (p < 0.05) fundamental frequency along with decreased F2 and F3 of /i/ in the early-onset ANSD compared to the late-onset group, which can be explained based on differences in the pathophysiology of the disorder. Although not statistically significant, mean perturbations (jitter and shimmer), harmonic-to-noise ratio, cepstral peak prominence, and pitch sigma were more affected in the early-onset group, reflective of lowered auditory feedback and periodicity in their voice samples. Results of discriminant analysis marked the emergence of F2, F3, and CPP as the most sensitive metrics for onset-based group differences in voice characteristics.ConclusionsThe findings from the study highlight the role of acoustical voice evaluation (especially CPP, F2 & F3) in verifying the onset of ANSD disorder. The insights from the onset-based differences seen in vocal characteristics can indirectly help audiologists in deciding the management options for ANSD.     

非综合征型听神经病患者前庭上下成分功能障碍定位研究与频率特征

目的 探讨听神经病伴发前庭功能障碍的可能性,并分析其部位和频率特征。 方法 以眼肌前庭诱发肌源性电位(oVEMP)、颈肌前庭诱发肌源性电位(cVEMP)、视频头脉冲试验(vHIT)、头脉冲抑制试验(SHIMP)和冷热试验对20例(40耳)非综合征型听神经病患者进行前庭功能评估,对统计学处理结果进行客观分析。 结果 20例患者(40耳)接受oVEMP和cVEMP测试,oVEMP异常率为85%,cVEMP异常率为95%,差异无统计学意义。11例(22耳)接受vHIT和SHIMP测试,外、上、后半规管vHIT和SHIMP的异常率分别为14%、18%、9%和9%,组间差异无统计学意义。19例患者行冷热试验,异常率为74%。11例接受vHIT和SHIMP测试的患者,冷热试验异常率为82%,显著高于vHIT和SHIMP异常率,差异有统计学意义。 结论 听神经病患者存在前庭功能障碍,前庭上下成分(包括感受器和前庭上下神经)受累概率相当,耳石器和半规管均可受累,各半规管受累概率相当,半规管功能损伤主要累及低频。     

Three-dimensional analysis of human locomotion in normal subjects and patients with vestibular deficiency

The purpose of this study was to clarify the role of the vestibular system in human locomotion. The subjects were nine healthy controls, nine patients with unilateral vestibular deficiency (UVD) and nine patients with bilateral vestibular deficiency (BVD). The UVD subjects were Ménière's disease patients who were being treated with administration of gentamicin into the tympanic cavity. BVD subjects were hearing-impaired individuals who showed no response to the ice-water caloric test. A total of 13 markers were attached to the head, trunk (C7), hip and foot in order to measure translational and rotational motions with the aid of a video image processing system. All subjects were instructed to restrict their stride length to approximately 80 cm while walking on a treadmill and watching a visual target. However, walking speed varied depending on the ability of the subject to maintain body equilibrium. The results showed that walking speed and step frequency were significantly lower for the UVD and BVD groups than for the normal group. Analysis of head movements in the sagittal plane showed a counteracting motion between pitch rotations and vertical translation as previously reported. We also found head counteracting motions between yaw rotation and lateral translation in the horizontal plane. These mechanisms are thought to help stabilize the gaze during walking. When the head fixation point was calculated by projecting the naso-occipital axis line during walking, the head counteracting motion was found to assist the vestibulo-ocular reflex in stabilizing the gaze. In addition, normal subjects seemed to use head stabilization as a space strategy in order to minimize head yaw movement. In contrast, UVD and BVD subjects adopted head stabilization as a trunk strategy.     

Examination and classification of human olfactory mucosa in patients with clinical olfactory disturbances

Summary To determine objectively the degree of olfactory disturbance, we biopsied the olfactory mucosa from patients who complained of anosmia. The olfactory disturbances in this study were caused by choanal atresia, chronic sinusitis, viral inflammation, and head trauma, as well as by congenital and idiopathic anosmia. The biopsy specimens were examined by light microscopy and the degree of mucosal degeneration present was classified according to five grades. The clinical courses of the patients studied paralleled the changes found in the olfactory mucosa.