声带息肉手术前后嗓音声学分析及心理听觉评价

为建立嗓音主、客观综合检测方法，对３０例声带息肉患者手术前后测试嗓音频率微扰商、振幅微扰商、标准化噪声能量级；喉平均呼气流率；频闪喉镜下观察声带振动的规则性、对称性、闭合状态、粘膜波动、等质性。心理听觉评价分为音哑总分度、粗糙型、气息型、无力型、紧张型。经统计学相关分析检验证明：嗓音微扰值增大与声带振动的不规则有显著性相关；心理听觉评价中的粗糙型、气息型与声带振动的规则性、声门关闭状况及喉平均呼气流率有显著性相关。实验证明多参数嗓音综合检测分析方法对嗓音疾病的疗效评价是一种简单、实用、有效的方法。     

杓状软骨内移术对改善声带麻痹患者发音功能的作用

目的 :评价杓状软骨内移术对声带麻痹患者发音功能的疗效。方法 :用喉空气动力学检查及嗓音分析方法 ,对 5 6例杓状软骨内移术患者手术前后最大发声时 (MPT)、平均呼气流率 (MFR)、声强 (SPL )、发音时呼气压 (EP) ,以及用 GRBAS法进行的嗓音听觉评价的嘶哑度 (G)进行了比较。结果 :术后 :MPT平均值男延长了3.1倍 ,女延长了 2 .7倍 ;MFR平均值显著下降 ,男从 82 7.3ml/ s下降到 34 0 .3ml/ s,女从 477.1m l/ s下降到 15 8ml/ s(P <0 .0 1) ;SPL平均值升高 ;EP平均值下降 ;G的平均值从 2 .8下降到 1.7(P <0 .0 1) ,改善程度在 1级以上的占 71%。结论 :杓状软骨内移术可使喉的发音功能得到显著改善 ,是非常安全、有效的手术方法之一。     

单侧声带息肉患者喉显微手术后嗓音特征的动态观察

目的 通过分析单侧声带息肉患者喉显微手术后不同阶段的嗓音变化规律及形态学转归特点,探讨声带息肉术后早期禁声及后期声休最佳时间.方法 对30例非广基单侧声带息肉患者于喉显微手术前和手术后1、2、3、4周行纤维喉镜检查,进行声带形态学评估,同时以CSL model4150(美国Kay Elemetrics)行嗓音声学分析,以60例(男女各30例)嗓音正常成年人作为对照组.结果 术后第1周63.33%(19/30)患者术侧声带轻度充血,边缘齐,声门闭合良好;术后第2周86.67%(26/30)患者术侧声带充血水肿消退,外观基本正常.术后1周声带息肉组的基频微扰百分比(jitter percent,jitt)、基频扰动商(PPQ)、振幅微扰百分比(shimmer percent,shim)、振幅扰动商(APQ)、噪/谐比(NHR)测试结果与术前比较差异无统计学意义(P＞0.05),明显高于对照组(P＜0.01);术后2～3周jitt、PPQ值较术前降低(P＜0.05),但仍高于对照组(P＜0.05),而shim、PPQ、NHR值与术前比较差异无统计学意义(P＞0.05),仍明显高于对照组(P＜0.01);术后第4周jitt、PPQ值与术前比较明显降低(P＜0.01),shim、APQ、NHR值与术前比较亦减小(P＜0.05),jitt、PPQ、shim、APQ、NHR值与对照组比较差异无统计学意义(P＞0.05).结论 非广基单侧声带息肉患者术后声带外观恢复正常至少需2周;而发声功能恢复正常水平至少需1个月.建议声带息肉患者术后严格声休2周;术后2周至术后1个月为相对声休期.     

最长最响发声时间评价单侧声带麻痹患者声门闭合情况的研究

目的:探讨最长最响发声时间(MLPT)在单侧声带麻痹患者中的嗓音评价作用.方法:检测17例单侧声带麻痹患者,交替随机记录所有患者MLPT、最长舒适发声时间(MCPT),并从两者中选出最长发声时间记为最长发声时间(MPT),另外记录MLPT同MCPT的比值.同时用动态喉镜主观评价、嗓音评价师主观评价以及患者嗓音自我评价问卷评价患者的嗓音.对这几个指标进行相关分析.结果:患者嗓音MLPT为(5.0±4.0)s、MCPT为(5.4±4.1)s、MPT为(6.1±4.5)s,其中MPT值有4个值选于MLPT,13个值选于MCPT.MLPT/MCPTa值为1.08±0.47.MLPT同MCPT正相关(r=0.679,P<0.01).MLPT同MPT正相关(r=0.878,P<0.01),MCPT同MPT正相关(r=0.993,P<0.01).MLPT、MCPT和MPT同GRBAS分级中的G分级均呈负相关(r=-0.620,P<0.05;r=-0.564,P<0.05;r=-0.665,P<0.01).而MLPT/MCPTa比值同患者主观问卷中的反映吞咽功能的问题4呈正相关(r=0.534,P<0.05).MLPT、MCPT和MPT同患者嗓音主观评分、GRBAS分级总分及频闪喉镜的黏膜波、振动幅度均没有明显相关.结论:对于单侧声带麻痹,MLPT、MCPT和MPT均可作为评价声带空气动力学的嗓音客观指标,而MLPT可操作性较好.且MLPT/MCPTa值在一定程度上客观反映了单侧声带麻痹患者吞咽困难的程度.     

单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的疗效观察

目的 探讨单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹的临床疗效.方法 回顾分析2007年1月至2011年4月5例双侧声带麻痹患者的临床资料,所有患者均在全麻下行颈外径路单侧杓状软骨切除术联合同侧声带外移,观察术后临床效果和术前、术后6月患者的声学参数(基频-F0,基频微扰-jitter,振幅微扰-shimmer,标准化噪声能量-NNE和最长声时(MPT).结果 患者术后呼吸功能均显著改善,5例患者均成功1次拔管,平均拔管时间(18.67±4.83)d,发音质量无显著下降,术后随访6月无严重误吸、创面肉芽、再狭窄发生.术后6月患者的F0、jitter、shimmer、NNE显著降低,而MPT显著延长,P<0.05.结论 单侧杓状软骨切除术联合同侧声带外移治疗双侧声带麻痹临床效果好,无明显并发症,显著改善患者的声学参数和最大声时.     

Nd:YAP激光杓状软骨切除术治疗双侧声带外展麻痹

目的 观察Nd：YAP激光杓状软骨切除术治疗双侧声带外展麻痹的疗效。方法2003年7月～2005年2月收治双侧声带麻痹患者9例，于支撑喉镜下应用Nd：YAP激光行右侧杓状软骨切除术，术前及术后3月以Dr．speech 4．0记录并分析嗓音频率微扰值（Jitter）、振幅微扰值（Shimmer）、标准声门噪声能量值（NNE）、最长声时（MPT）等4个主要参数，术后随访13-29月。结果 8例患者于术后1～3月拔管，1例于第二次手术后2月拔管。术后的噪声参数显示，Jitter与手术前相比差异无显著性意义（P≥0．05）；Shimmer、NNE、MPT等与手术前相比差异有显著性意义（P〈0．05）。结论 Nd：YAP激光杓状软骨切除术是治疗双侧声带外展麻痹的有效手段。     

人胶原声带注射治疗周围性单侧声带麻痹

目的：观察人胶原声带注射治疗周围性单侧声带麻痹的效果。方法：在强化局麻或全麻支撑喉镜下，对6例单侧声带麻痹病人行人胶原患侧声带注射。评估注射前后声带位置、声嘶改善状况及声学参数变化。结果：6例中5例术后声嘶明显改善，患侧声带移向正中位，声门关闭良好；1例声嘶改善不明显，患侧声带位置无变化。6例皆未出现不良反应。频率微扰(Jitter)、振幅微扰(Shimmer)及标准噪声能量(NNE)值术后明显下降，最大声时(MPT)延长，经统计学处理均有统计学意义；谐噪比(H/N)得到改善。结论：人胶原声带注射治疗单侧声带麻痹是一种方法简单、疗效确切、安全、病人痛苦小、价格低廉、易于临床推广的方法。     

声带息肉手术联合抗酸治疗反流性咽喉疾病合并声带息肉的预后影响

目的探讨声带息肉手术联合抗酸治疗对咽喉反流病(LPR)合并声带息肉预后的影响,为LPR合并声带息肉的治疗提供理论基础。方法本探究研究对象选择2014年10月-2016年10月期间于我院行声带息肉手术治疗的100例LPR合并声带息肉患者,将声带息肉手术术后未进行抗酸治疗治疗的46例患者设为对照组,术后采用抗酸治疗的54例患者设为观察组。分别比较治疗前后相关声学参数、反流症状指数(RSI)、反流检查计分(RFS)以及嗓音障碍指数(VHI-10)。结果两组治疗前后振幅微扰(Shimmer)、频率微扰(Jitter)、最长声时(MPT)、谐噪比(HNR)、声门噪声能量(NNE)差异显著,治疗后观察组NNE、MPT与对照组差异显著,有统计学意义(P0.05);治疗前后RSI13、RFS7人数比例差异显著,观察组治疗后RSI13、RFS7人数比例差显著低于对照组(32.61%vs55.55%),观察组咽喉反流治疗有效率显著高于对照组(67.39%vs44.45%),有统计学意义(P0.05);两组治疗前后VHI-10差异显著,治疗后观察组显著低于对照组[(5.43±1.32)vs(14.32±2.31)]。结论声带息肉手术联合抗酸治疗咽喉反流病合并声带息肉能够显著改善患者的反流症状,降低嗓音障碍对生活质量造成的影响,提高嗓音质量。     

单侧声带麻痹患者嗓音主、客观评估及其相关性分析

目的以两种主观评估方法和嗓音声学分析法评估54例单侧声带麻痹患者的嗓音特征,并探索其相关性。方法对54例单侧声带麻痹患者和30例健康对照者分别进行嗓音声学分析以及简化嗓音障碍指数（VHI-10）和GRBAS主观评估,分析三种评估方法各指标间的相关性。结果嗓音声学分析显示,声带麻痹组的最大声时（maximum phonatory time,MPT）仅为对照组的1/3左右,基频微扰（jitter）、振幅微扰（shimmer）及标准化噪声能量（NNE）均较对照组为高,差异有统计学意义,二者间F0差异不明显。不同GRBAS分级中,VHI-10分值在1、2级间差异无统计学意义,但在1、3级间和2、3级间差异有统计学意义。在相关性方面,F0与其余各指标皆不相关;jitter、shimmer与除F0外的各主客观指标均相关;NNE除与jitter、shimmer相关外,与主观指标R和VHI-10的相关系数分别为0.347和0.331;MPT除与jitter、shimmer相关外,与主观指标的相关性均较高,与VHI-10和G的相关系数分别为-0.528和-0.466;GRBAS系统中,G与除F0、NNE外的各项指标均显著相关;R与除F0外的各项指标均显著相关;B与G类似,与除F0、NNE外的各项指标均有显著的相关性;VHI-10与除F0外的各指标均显著相关,但以MPT和G、R最显著。结论单侧声带麻痹患者的三种嗓音评估方法间有一定的相关性,全面的嗓音评估需采用综合的方法 。     

Montgomery假体植入治疗单侧声带麻痹的疗效研究北大核心CSCD

目的初步探讨Montgomery假体植入的Ⅰ型甲状软骨成形术治疗单侧声带麻痹的效果。方法回顾性分析2015年5月至2019年3月在海军军医大学第一附属医院和广东省人民医院耳鼻咽喉头颈外科接受Montgomery假体植入的Ⅰ型甲状软骨成形术的46例单侧声带麻痹患者的临床病例资料,其中男24例,女22例,年龄23~77岁。评估方法包括GRBAS听感知评估、声学参数[包括基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)]以及最长发声时间(MPT)等。声学参数和MPT数据采用配对t检验进行统计学分析,GRBAS数据采用秩和检验进行分析。结果术后动态喉镜结果显示,44例患者的患侧声带明显向中线移位,发音时声门裂隙较术前明显减小;2例患者的声门裂缩小不明显。GRBAS听感知评估各参数除紧张声(S)外评分较术前明显降低,声学参数(Jitter、Shimmer、NHR)较术前也均明显减小,MPT较术前明显延长,差异均有统计学意义(P值均<0.001)。2例声门裂缩小不明显的患者行修正性手术。所有患者均未发生严重并发症。结论Montgomery假体植入的甲状软骨成形术可有效地改善单侧声带麻痹患者嗓音,安全性高,值得推广。     

Acoustic analysis of pathological voice. Some results of clinical application

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.     

喉内显微电离子手术治疗声带良性赘生物

目的探讨电离子手术治疗声带良性赘生物的效果。方法在局麻支撑喉镜下利用电离子治疗仪,对55例声带小结和息肉等良性病变进行治疗,并利用频闪喉镜和声学的主客观评价进行手术前后比较。结果所有良性病变均完整切除,频闪喉镜术后观察声带运动的对称性、规则性、振幅,闭合状态、粘膜波动五项指标较术前明显改善（P＜0．05或P＜0．01）。术后心理听觉评价,粗糙型、气息型声嘶者均较术前明显改善（P＜0．05）。最长发声时间均技术前显著延长（P＜0．05）。结论喉内显微电离子手术治疗声带良性病变,效果良好,值得推广使用。     

Transcutaneous intrafold injection for unilateral vocal fold paralysis: functional results

This paper presents the technique of transcutaneous intrafold silicone injection and the functional results of 44 procedures in 42 patients. The injection is given under local anesthesia with the patient in a supine position. The needle is inserted through the cricothyroid space. The location of the needle as well as the effect of injection is monitored by means of a fiberscope connected to a television camera and screen. The preoperative and postoperative vocal function was multidimensionally evaluated with the use of a test battery consisting of the maximum phonation time (MPT), mean airflow rate (MFRc), fundamental frequency (F0) range and sound pressure level (SPL) range of phonation, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and normalized noise energy (NNEa). In the majority of the patients, MPT, F0 range, and SPL range increased and MFRc, PPQ, APQ, and NNEa decreased postoperatively. In the overall evaluation based on the test values of these parameters, the result was excellent for 16 procedures, good for 16, fair for 7, and poor for 5. The most frequent cause of failure was an insufficient amount injected.     

声带振动体被覆层病变对声带振动模式影响的探讨

目的 探讨声带振动体被覆层病变对声带振动模式的影响。方法 对５０例成人声带息肉患者手术前和术后５￣７天进行了电视录像硬管望远喉动态镜观察和电声门图检测。结果 声带的振动模式随声带息肉的基底、形态、体积及单双侧的不同而变化，同时其振动参数及电声门图出现相应的变化、所有声带息肉均不同程度地影响声带振动规则性、振幅（ＡＭＰ）、声门闭合度（ＧＬＯ）及粘膜波动度（ＭＵＣ）、单侧息肉影响对称性（ＳＹＭ）显著，     

声带癌T1的激光与放射治疗对喉发声机能的影响

目的 探讨声带癌Ｔ１的ＣＯ２激光治疗与放射治疗对喉发声机能有何不同影响。方法 ２４例声带癌Ｔ１患者,９例行ＣＯ２激光治疗,７例放射治疗,８例ＣＯ２激光与放射联合治疗。于治疗前后行频闪喉镜检查,噪音声学分析（ＡＰＱ,ＰＰＱ,ＮＮＥｂ,ＮＮＥａ）,喉平均呼气流率（ＭＦＲ）检测及噪音听觉评价分析。结果 放射加激光联合治疗对发声功能较单独应用激光或单独应用放射的影响大。ＣＯ２激光治疗组噪音音质改变为粗糙型     

CO_2激光与喉显微手术治疗声带息肉的疗效对比

目的 比较ＣＯ２激光与喉显微手术治疗声带息肉的治疗效果。方法 ６０例声带息肉患者分为激光组和喉显微手术组，每组各３０例。患者手术后行间接喉镜声带检查、嗓音声学分析、主观听觉评价分析。结果激光组术后声带形态的恢复时间要长于喉显微手术组；激光组术后声学参数中的ＰＰＱ值大于而Ｈ／Ｎ值小于显微手术组；激光组术后的嗓音主观听觉评价以粗糙型和紧张型为主，而喉显微手术组仅以粗糙型为主。结论 对声带息肉的治疗喉显微手术方法优于激光手术，喉显微手术较激光手术对组织损伤小，术后愈合时间短，术后嗓音恢复快，同时也减轻了患者的经济负担。     

Surgical effects of type-I thyroplasty and fat injection laryngoplasty on voice recovery

ObjectiveType-I thryroplasty, also known as medialization thyroplasty (MT) and autologous fat injection laryngoplasty (FIL) are one of the main surgical treatments for unilateral vocal fold paralysis (UVFP). Both procedures have the same concept of completing the glottal closure by medializing the vocal fold, although the surgical approaches are quite different. In order to assess these surgical effects, we examined the treatment outcomes and benefits of the two surgeries.MethodsWe collected data from the 135 phonosurgeries that we performed out of 375 patients with UVFP at Osaka Voice Center, Osaka Kaisei Hospital from January 2009 to February 2013. After excluding cases with glottal level differences on phonation, either MT or FIL were performed on 80 cases. The inclusion criteria for the present study were: (1) patients had no history of previous phonosurgery, and (2) functional evaluations were available before/after surgery. Consequently, 43 participants (12 for MT and 31 for FIL) were enrolled in this study. Surgical effects were evaluated by means of the maximum phonation time (MPT), pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and harmonic to noise ratio (HNR) just before, one month, and 6 months after surgery.ResultsBoth MT and FIL showed significant improvement in MPT (MT, p = 0.005; FIL, p < 0.001) and PPQ (MT, p = 0.047; FIL, p = 0.041) at 1 month postoperation. We also compared the variation of each variable between the two procedures, but there were no significant differences in these parameters. However, MPT, APQ, and HNR at the post-MT after 6 months worsened compared to those at 1 month posttreatment, whereas MPT showed only a slight decrease from the 1st month to the 6th month in those with FIL.ConclusionBoth MT and FIL were effective for the voice recovery in patients with UVFP. Our findings suggest that surgical results in FIL might be better than those in MT 6 months after surgery, although there were no significant differences between these two procedures 1 month postoperation.     

Long-term outcomes of basic fibroblast growth factor treatments in patients with vocal fold scarring,aged vocal fold,and sulcus vocalis

ObjectiveFibrotic changes in the vocal fold mucosa have been observed in patients with vocal fold scarring, aged vocal fold, and sulcus vocalis, which often lead to severe voice disorders. Previous research suggests that the basic fibroblast growth factor (b FGF) improves variations in vocal fold properties [1,2]. Although clinical studies on b FGF treatments have been conducted [3,4,5], these studies only demonstrated the efficacy of this drug over a short period. The present study is the first to investigate the long-term efficacy of b FGF treatment.Methodsb FGF injections were performed in six patients from January of 2016 to December of 2017 at our institution. Patient follow-up continued for at least two years after the last injection. Three patients had vocal fold scarring, two had aged vocal fold atrophy, and one patient had sulcus vocalis. Each vocal fold was injected with 10 µg of b FGF four times. Voice and stroboscopic examinations were performed after surgery (at one month, three months, six months, one year, two years). Fundamental frequency, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), pitch perturbation quotient (PPQ), and noise-to-harmonic ratio (NHR), and voice handicap index-10 (VHI-10) were examined and compared statistically between the pretreatment time and at each posttreatment time point.ResultsThe speaking F0 had an obvious decreasing tendency, with significant differences suggesting the increase in volume in the vocal folds. Aerodynamic parameters also showed small improvements. The most remarkable improvement was observed in the acoustic parameters, indicating that the treatment could improve the vocal fold to make vibrations symmetrically and regularly for a long period. Achievement of symmetry and regularity on vocal fold vibrations suggested the property changes had happened in the vocal folds. Consequently, the score of VHI-10 had improved, indicating high patient satisfaction with this treatment.Conclusionb FGF injections could be a reliable treatment option for diseases that deteriorate the property of vocal fold.     

Clinical analysis of presbylarynx—Vocal fold atrophy in elderly individuals

Objective

The proportion of elderly Japanese is increasing significantly and aging society greatly influences the medical services. The number of elderly patients who visited out Voice Outpatient Clinic has been increasing in recent years. The aim of the present study was to analyze the trend in the number of patients with aging-related vocal fold atrophy, and to assess the characteristics of senile change of vocal function.

Methods

A retrospective review of the 1999–2005 medical records of patients aged ≥65 years was conducted, and patients with presbylarynx were analyzed. We evaluated age, sex, occupation, maximal phonation time (MPT), and mean airflow rate (MFR) during comfortable phonation to assess the physiological characteristics of senile change of vocal function. We compared MFR of presbylarynx with those of normal elderly person.

Results

The number of patients aged ≥65 who visited our clinic in the 7-year study period was 361, and 72 (20%) were diagnosed with vocal fold atrophy. They included 47 (65%) men and 25 (35%) women, with a mean age of 71 years (range, 65–89). Among these patients, 27 (38%) were still employed at the time of consultation, while 17 (24%) were retired, at least 26 jobs required voice skills; and 15 patients (21%) were involved in singing and recitation of poems. MPT correlated negatively with age, while MFR correlated positively with age.

Conclusion

The number of elderly patient with vocal fold atrophy increased gradually almost every year. The male patients account for 65%. Thirty-three percent of patient of the present study with presbylarynx were still in the workforce. MFR correlated positively and significantly with age. MFR was higher in presbylarynx than normal elderly person.