发声、发音和发音障碍

书刊中常有将“发音”一词和“发声”一词通用、混用的情况。“发音”(articulation)和“发声”(phonation)有不同含义。“phonation”在《英汉耳鼻咽喉科学词汇》中和《语音学和音系学词典》中译为‘发声’。“发声”指“在气流帮助下 ,利用喉产生可听声的声源 ,这个声源的声能量 ,可受声道的调制。”“某些时候特别作为voicing的同义词”(《语音学和音系学词典》)。发声是在呼出气流的同时 ,声门区与之作相关活动的行为。声门区不同类型的动作 ,使“发声”可分为不同的类型 ,如清音发声 (nilphonation)、气音 (breath)、耳语、挤喉音、正…     

嗓音医学进展

本文主要从嗓音医学研究及嗓音治疗等方面概述近10年来嗓音医学领域的研究探索。     

“咽音”练声法矫治男声女调的机理探讨

本文对２１例男声女调患者用“咽音”练声法第一至四步骤进行训练，均在１－２个月内恢复男性音调，随对今均无复发，对“咽音”练声法矫治男声女调的机理进行探讨。     

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     

痉挛性发音障碍的研究进展

本对近年来痉挛性发音障碍的研究进行综述。回顾了本病的基本概念，发生机制的研究进展，收集了有关诊断方面的信息，并着重介绍了本病的治疗现状，尤其是对肉毒杆菌素的治疗情况进行详述。     

论嗓音医学发展

20世纪以来，人类交流的广度及深度不断增加，对嗓音质量的要求也不断提高。如何有效治疗发音障碍，矫正不良发音习惯，控制“易感人群”发病的研究引起人们的重视，并逐渐成为热点。为了促进我国嗓音医学水平的发展，2007年5月19日中华耳鼻咽喉头颈外科杂志编委会在北京组织召开了小型专题座谈会——2007年全国嗓音医学专家论坛。会议安排紧凑，重点突出，讨论热烈。虽然在具体问题上各位专家还有不同的观点和意见，但对国内嗓音医学发展中存在的问题和发展方向取得共识。第一，积极推进嗓音主客观评估标准化，我们要借鉴国外经验，结合我国的特点，在广泛征求各方面专家意见的基础上制订相关标准；第二，嗓音内科治疗没有受到应有的重视，通过这次会议，要宣传嗓音疾病综合治疗的重要性，以引起全国同道的重视；第三，我国嗓音外科技术水平与发达国家还有差距，开展率很低，还有很大发展空间，应该向全国同道介绍和推广。逐步完善嗓音医学专业体制，建立专业化的培训体系，是今后努力发展的方向。本刊一贯提倡广泛开展学术交流，鼓励“百花齐放”、“百家争鸣”，这份会议记录也保留了国内学者的不同学术观点。现将讨论内容按照重点议题分类整理，并根据讨论热点作了点评，以引起读者的思考。[编者按]     

控制用声导致的功能性发声障碍的临床特点研究

目的 探讨不当的控制用声、禁声导致的功能性发声障碍患者的临床特点.方法 回顾性分析94例有不当的控制用声、禁声且确诊为功能性发声障碍患者的初始诱因、病程、控制用声时间、临床表现、声嘶程度、既往治疗史及频闪喉镜下表现.结果 94例患者中男性23例(24.5％)、女性71例(75.5％),初始发病诱因包括上呼吸道感染(28...     

应用发音钮发音重建出现发音障碍的原因分析

喉癌病人施行喉全切除术后,恢复发音功能的方法很多。临床证明其各有所长,但亦有不足。我们以医用硅橡胶研制的发音钮,又叫发音管(图1),1900年2月至1994年5月,临床应用于75例本病患者发音重建,其中12例不能发音。为提高发音钮的临床应用效果,现对应用发音钮后出现发音障碍的原因进行分析,报告如下。     

Blom-Singer发音管在喉全切除术后的临床应用

目的观察喉全切除术后应用Blom-Singer发音管重建喉发声功能的效果。方法回顾性分析1994年9月～2003年8月15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。结果15例患者中12例行Ⅰ期发音管重建术，10例手术成功(10／12，83．33％)；3例行Ⅱ期发音管重建术，其中2例手术成功，两种术式的总成功率为80％(12／15)。Ⅰ期手术失败2例，与气管食管壁分离过多有关；Ⅱ期手术失败1例，系环咽肌切断不完全所致。结论喉全切除术后应用Blom-Singer发音管重建喉发声功能是一种有效的发声重建方法，环咽肌切断及保留气管食管壁的完整是手术成功的美键。     

功能性发声障碍的语言训练

目的探讨功能性发声障碍的临床特点及康复治疗。方法对功能性发声障碍儿童48例及功能性发声障碍成人20例进行语言评价及语言训练,比较并分析儿童及成人功能性发声障碍患者的特点及疗效。结果发声检查,儿童与成人的发音主要错误方式为歪曲、置换,主要的错误声为舌尖前声、舌尖后声、舌根声、舌面声和舌尖声;儿童与成人平均错误声差异无显著性(P>0.05)。训练时引出每个目标声正确发声平均需时儿童较成人长(P<0.001),而每个目标声较熟练应用所需时间儿童较成人短(P<0.001);经训练后,48例儿童患者中有40例完成纠正,8例部分纠正,治愈率为83.3%;20例成人患者全部纠正,成人患者治愈率为100.0%;总治愈率为88.2%。结论儿童与成人功能性发声障碍的临床特点差别不大,均以歪曲、置换的错误方式为主;语言训练效果好,但开始训练的时机应该适当,并非越早训练效果越好。     

嗓音训练改善职业用声者发音的疗效研究

目的 应用嗓音训练方法改善职业用声者发音并验证其有效性.方法 选择31例有嗓音症状但无声带器质性病变的职业用声者作为研究对象接受为期4周的嗓音训练.训练的内容包括嗓音卫生教育、改善呼吸支持及增强共鸣等.应用嗓音障碍指数量表、最长发声时间测量及嗓音声学分析进行训练前后的评估.结果 受试者接受嗓音训练后嗓音障碍指数值((-x)±s,以下同)由(33.7±19.2)分降至(18.8±18.4)分,差异具有统计学意义(t=6.14,P＜0.05).受试者接受嗓音训练后最长发声时间由(15.5±5.8)s延长至(18.6±6.0)s,差异具有统计学意义(t=-3.43,P＜0.05).受试者接受嗓音训练后基频微扰有显著性下降,由0.42%[0.36%;0.62%](中位数[25分位数;75分位数])降至0.35%[0.29%;0.47%],Z=-2.51,P＜0.05;而噪谐比、振幅微扰变化无统计学意义.结论 嗓音训练能够减轻职业用声者嗓音障碍症状,降低嗓音障碍程度并增加发音过程呼吸支持的效率,改善嗓音质量.

Abstract：

Objective To explore the effectiveness of voice training on professional voice users with voice disorders. Methods Thirty one professional voice users suffering from voice symptoms without organic disorder were treated with a four-week voice training program, including vocal hygiene education, respiratory training and resonant therapy. Voice handicap index, maximum phonation time, noise to harmonic ratio,jitter and shimmer were compared before and after the training. Results The voice handicap index ((-x) ± s)decreased from 33.7 ± 19. 2 to 18. 8 ± 18.4 after the training and the difference was significant (t =6. 14,P ＜ 0. 05 ). Maximum phonation time ( (-x) ± s) increased significantly from ( 15. 5 ± 5. 8 ) s to ( 18.6 ± 6.0) s (t = - 3.43, P ＜ 0. 05 ). jitter ( M [P25; P75] ) decreased significantly after the training from 0. 42%[0.36%; 0.62%] to0.35% [0.29%; 0.47%] (Z= -2.51, P＜0.05), while there was no significant change in shimmer and noise to harmonic ratio. Conclusion Voice training can effectively reduce the vocal symptoms in professional voice users, decrease the handicap degree and increase the respiratory support during phonation, thus improve the voice quality.     

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.     

Human skull development and voice disorders

The hominisation of the skull comes with the bipedic posture, due to a network of muscular and aponevrotic forces applied to the cranio-facial skeleton. A brief sight of the morphogenetic origine and issues of these forces help to understand more clearly the postural statement of the larynx, his functions, and his many extrinsic biomechanical bounds; then further his most frequently dysfunctions. The larynx is surrounded by several effective systems of protection: active, activo-passive, passive. The architectural features of the components of the laryngeal system allows us to consider the laryngeal function as an auto-balanced system. All the forces engaged are auto-balanced in a continuum of tension. This lead us to the concept of tensegrity system, neologism coming from tensional integrity described by Buckminster Fuller. The laryngeal employement by extrinsic system is pathological in case of chronicity. Any osteopathic treatment, which aims to restore the losses of laryngeal mobility, has to release first the peripherical structures involved in the laryngeal defense, before normalising the larynx itself Finally, the larynx recovers his functions in a tensegrity system.     

内侧微瓣技术治疗声带良性病变手术前后嗓音主客观分析

目的探讨经支撑喉镜显微镜下内侧微瓣技术治疗声带良性病变的手术疗效及嗓音主客观分析在评价其疗效中的作用。方法对34例声带息肉、6例声带囊肿共40例患者行显微嗓音手术内侧微瓣技术切除病变,手术前后分别行动态喉镜检查、嗓音声学检测及嗓音障碍指数量表评估。以20例(男、女各10例)嗓音正常成年人作对照组。结果全组病例术后第4周行动态喉镜检查示声带黏膜光滑,活动好,开闭佳,手术前后各嗓音声学参数及嗓音障碍指数量表评分变化均有统计学意义(P<0.05),声学参数与嗓音障碍指数评分之间无明显相关性。结论内侧微瓣技术治疗局限声带内侧的良性病变具有安全、切除病变精确彻底、创伤小等优点,疗效满意,符合微创和功能外科的发展趋势;嗓音声学检测、动态喉镜检查及患者自我评估三者相结合可对手术疗效起到综合评估作用。     

Problems in speech sound production in young children. An inventory study of the opinions of speech therapists

Objective

Analysis of examination procedure and diagnosis of articulation problems by speech therapists.

Study design

Survey study.

Materials and methods

Eighty-five Dutch speech therapists (23% response), working in private practises or involved in language screening procedures in Youth Health Care, were questioned regarding the incidence of articulation problems in their practices, the manner of examination, the normative data used, and the importance attached to identifying articulation problems.

Results

According to the speech therapists, articulation problems are present in the majority of children (90%) in their practices. In children between 2 and 5 years of age, 45%; in children between 5 and 8 years of age, 36%; above age 8, about 14% of the children still have articulation problems. Despite their opinion that articulation problems often form a separate aspect of language development, all respondents indicated that they always investigate the speech sound development as part of a total speech and language examination. Frequently, more than one instrument is used. However, none of these instruments are standardised. The speech therapists prefer to examine the children at about 4 years of age, despite their opinion that the speech sounds develop until about 6 years of age. For them, this raises the problem to distinguish between articulation in development and articulation problems. They have the opinion that early treatment is important because of assumed relations with social-emotional development and reading and writing abilities later on.

Conclusion

The speech therapists taking part in this study have a good view of the speech sound development of young children. However, due to their concern about communication, social-emotional development, and reading and writing abilities later on, they prefer to identify and treat articulation problems at an early age. More detailed research into the variations in speech sound development, in relation to language development, is needed in order to arrive at effective normative data.     

喉近全切除发音管重建术

目的进一步探讨喉近全切除术在晚期喉癌、喉咽癌中的应用。方法参照唐平章Pearson改良法,1995年5月～2003年3月共治疗39例,其中喉癌30例(T3N0～T3N2 17例,T4N0～T4N2 13例),喉咽癌9例(T3N0～T3N1 6例,T4N0～T4N1 3例)。同期颈清扫16例。结果39例中36例(92.3％)获得较好发音。除1例饮水和进流体食物偶有轻微呛咳外,其余38例(97.4％)均可顺利进食。喉癌的3年生存率73.3％(22/30),5年生存率61.1％(11／18);喉咽癌3年生存率55.6％(5/9)。局部复发率2.56％(1/39)。结论喉近全切除术的应用可使部分晚期喉癌、喉咽癌患者免于喉全切除,并可获得良好的发音和吞咽功能。