与"正常老年人嗓音变化的观察与分析"一文的商榷

拜读了梁莺等〔1〕撰写的“正常老年人嗓音变化的观察与分析”(简称“梁文”) ,发觉该文中有两处值得商榷。1　关于元音共振峰频率值的正确性元音音色是由声腔的共振决定的。发元音时首先是声带振动 ,产生一准周期性的声带音 ,频谱谐波的频率越高 ,振幅就越小 ,频谱的振幅曲线从高到低呈明显的斜坡 (图 1 ,左 ) 〔2〕。声带音通过声腔时产生共振作用 ,和声腔固有频率相同或相近的一些谐波的振幅得到加强 ,另外一些谐波的振幅则减弱甚至消失 (图 1 ,右 )。声腔形态的改变使得它的固有频率发生变化 (图 1 ,中 ) ,声带音通过声道时所产生的共振…     

嗓音检测中阶数的选取

老年语音作为一个特殊语音群体 ,随着年龄增大 ,发音器官逐步发生老化 ,具有其特有的发音特征。这也就是为什么仅听一个人讲话 ,就可知道这个人的大概年龄。黄强等〔1〕提出的Ｐ数问题 ,作为一般的分析是无可非议的 ,我们完全同意其观点。现代语音学Ｐ数的选取是参照文成义等 (1 990 )Ｐ =ｆ/1 0 0 0 +γ的公式选取 (Ｐ =阶数 ,ｆ =采样频率 ,γ=系数 ,γ为 2或 3 )。实际Ｐ数的选取也可根据被分析语音的条件、分析目的和特殊需要作适当调整 ,设置不同的Ｐ数是为了逼近我们要分析获取的结果。在“正常老年人嗓音变化的观察与分析”一文中 ,…     

嗓音频率微扰的检测及临床意义

报告对60例20－40岁正常人嗓音和45例患者的病态嗓音进行了频率微扰检测。结果：正常人嗓音频率微扰Jitter值，男性均值为0．036ms，女性为0．027ms；JR值，男性均值为94％，女性为98％。Jitter值和JR值性别间无显著性差异。正常嗓音频率微扰的特点是：周期间频率相同者较多，不同者甚少，频率微扰值较小。病态嗓音的Jitter值和JR值，慢性喉炎与正常嗓音无显著性差异，声带癌、喉癌术后明显高于正常嗓音（P＜0．01）。提示频率微扰可作为喉病声学常规检测中的一项定量客观指标。     

喉部分切除术的发声客观声学评价

目的:探讨计算机辅助声学分析在诊断喉癌及评价喉癌术后发声客观声学上的应用价值.方法:以18～65岁经检查无喉疾病50例为正常组.以40例喉癌患者为喉癌组,手术方式有声带切除术,垂直喉部分切除术,次全喉切除术和近全喉切除发音管成形术,分别于术前及术后1～2个月测试.以各种原因引起的喉返神经麻痹20例为对照组,各组均用声图谱分析仪检测.结果:发i音时喉癌组术前、术后声学参数,如频率均值,平均微扰、频率微扰商、振幅微扰商、谐噪比、音调微扰系数与正常组差异有显著性(P＜0.05),喉返神经麻痹组除频率均值与正常组差异有显著性(P＜0.05)外,余无明显差异.发a音时,除喉癌组术前音调微扰系数外,余者差异均有显著性(P＜0.05).结论:喉癌患者发音参数的频率均值、平均微扰、频率微扰商、振幅微扰商、谐噪比及音调微扰系数与正常组差异有显著性(P＜0.05).发声参数是评价喉癌患者发声客观声学的敏感指标.     

不同发声方式下正常儿童嗓音的声学分析

目的　研究正常儿童三种发声方式下嗓音声学参数的特点。方法　对 2 4 0例正常儿童的自然舒适音、真声最高音、真声最低音进行声学分析。结果　正常儿童的微扰值、规范化声门噪声能量值均为真声最低音 >舒适音 >真声最高音 ;基频标准差值为真声最高音 >真声最低音 >舒适音 ;谐噪比、信噪比与性别、年龄及发声方式无关。结论　正常儿童三种发声方式下的嗓音质量是不同的 ,嗓音声学测试结果的判断应结合受试者的发声方式。     

垂直部分喉切除术后声功能的客观定量评价

为客观定量评价喉癌生趣部分喉切除术后患者的发音功能，采用喉声气流仪分别对行垂直半喉切除术后的喉癌患者３０例（按术后２年，３￣１０年分为Ａ、Ｂ两组），和正常男性（Ｃ组）３０例进行声功能测试。结果显示：Ａ、Ｂ组与Ｃ组比较平均气流率（ＭＦＲ）、声强、最长发音时间（ＭＰＴ）有极显著性差异（Ｐ〈０．０１）；发声频率之间有显著性差异（Ｐ〈０．０５）；Ａ组与Ｂ组比较其声强、ＭＦＲ、ＭＰＴ有极显著性差异（Ｐ〈０．     

嗓音客观评价的探讨

通过对36名正常组和30名中、轻度病态嗓音组成年女性的频域相对信噪比进行分析,结果表明:正常嗓音的频域相对信噪比呈一个稳定的分布,而病态嗓音的相对信噪比在大于1700Hz频段与正常对照组有显著性差异(P<0.01).在此基础上,引入模糊数学的隶属函数(μ)来描述颇域相对信噪比的分布,此函数能够准确直观的定量表示噪声分布情况,可以认为(μ)函数可作为客观定量评价嗓音素质的有效参数.     

嗓音客观评估的研究进展

嗓音是一个复杂的多维现象,它是通过肺气流驱动声带振动继而被听者感知到的声音。嗓音疾病最早依靠富有经验的喉科医生的主观判断,由于受临床经验、个人习惯等一些主观因素的影响,难免出现误诊、漏诊。后来出现了嗓音的客观检测方法,随着现代计算机技术、电子技术的飞速发展,催生了一系列新的嗓音检测手段,计算机仿生功能检     

语前聋成人人工耳蜗植入者嗓音的声学分析

目的观察成人语前聋人工耳蜗植入者嗓音的特点,为这类患者的植入及嗓音矫治提供依据。方法分别对28例语前聋成人人工耳蜗植入者、18例语前聋者和10例正常听力者的元音[a ]3s稳定段进行声学分析,分析内容包括基频、第一、第二共振峰、嗓音声学参数频率微扰商、振幅微扰商、谐噪比。对3组结果进行比较。结果人工耳蜗组的基频为(175 42±25 31)Hz,较耳聋组的(210 84±54 30)Hz有下降(P=0 02)。人工耳蜗组共振峰位置[F2 =(1264 64±152 19)Hz]比耳聋组[F2=(1422 44±232 37)Hz]更接近于正常听力组(P=0 02)。频率微扰商在人工耳蜗组(2 09±1 15)较耳聋组(5 32±4 29)更接近于正常听力组(P=0 006)。人工耳蜗组和耳聋组的嗓音表现出较大的个体差异。结论从嗓音声学特点的角度而言,成人语前聋人工耳蜗植入者可以有限地获益于人工耳蜗植入。由于他们的语言识别能力远远差于儿童和成人语后聋人工耳蜗植入者,其总体效果有限,对这类患者的植入应该慎重开展。     

声带息肉与声带小结患者发声空气动力学研究

目的探讨声带息肉、声带小结患者发声时空气动力学指标的变化。方法采用嗓音功能分析仪（Aerophone II Voice Function Analyzer）对30例声带息肉、28例声带小结患者及30例正常人进行发声空气动力学检测,对平均气流率（mean airflow rate）、口腔压（intraoral pressure）、声门阻力（glottal resistance）、声门效率（glottal efficiency）进行分析、比较。结果声带息肉、声带小结患者的平均气流率、声门阻力、声门效率分别为254．50&#177;36．02ml／s、33．55&#177;4．63cmH2O／（L&#183;S）、2．46&#177;1．49和177．45&#177;25．93ml／s、38．83&#177;8．88cmH20／（L&#183;S）、7．75&#177;3．71,与正常人118．44&#177;29．98ml／s、53．04&#177;8．64cmH2O／（L&#183;S）、9．17&#177;3．87比较,差异有统计学意义（P〈0．01）;声带息肉患者声门下压力为8．97&#177;1．36cmH2O,与正常人6．24&#177;0．99cmH2O比较,差异有统计学意义（P〈0．01）;声带息肉与声带小结患者平均气流率、声门下压力和声门效率比较,差异有显著统计学意义（P〈0．01）。结论声带息肉患者的声门闭合程度、发声时的效率比声带小结患者更差,空气动力学检测可以对声带息肉、声带小结患者的嗓音功能作出量化的、客观的评价。     

空气动力学在测试呼吸与发声关系中的临床应用

目的 研究正常人呼吸与发声关系。测定正常人的各项空气动力学指标,以期建立一种无创伤性的噪音检查方法,能够对噪音功能做出正确的评估。方法 应用空气动力学方法,使用噪音功能分析仪（Ａｅｒｏｐｏｎｅ Ⅱ Ｍｏｄｅｌ ６８００）和可视音调仪（Ｖｉｓｉｐｉｔｃｈ６０９７）,先记录下受试者的肺活量,再嘱受试者在自然舒适的音调和声音强度下,尽可能地发元音／ａ：／,同时记录最长发声时间、平均气流率、平均音调、声音     

Comparative Histology and Vibration of the Vocal Folds: Implications for Experimental Studies in Microlaryngeal Surgery

Objectives/Hypothesis To determine the most suitable animal model for experimental studies on vocal fold surgery and function by a histological comparison of the microflap surgical plane and laryngeal videostroboscopy (LVS) in different species of animals. A second goal was to determine how the layered vocal fold structure in humans and three different animal species affects surgical dissection within the lamina propria. Study Design Prospective laboratory. Methods Three larynges each from dogs, monkeys, and pigs were compared with three ex vivo human larynges. Microflap surgery was performed on one vocal fold from each larynx. Both the operated and nonoperated vocal folds were examined histologically using stains specific for elastin, mature collagen, and ground substance. Based on the histological results, LVS was performed on two dogs and two pigs after first performing a tracheotomy for ventilation and airflow through the glottis. Arytenoid adduction sutures were placed to facilitate vocal fold adduction. Results The distributions of the collagen and elastin fibers were found to differ among the species with concentrations varying within species. Unlike the human vocal fold, which has a higher elastin concentration in the deeper layers of the lamina propria, both the pig and the dog had a thin band of elastin concentrated just deep to the basement membrane zone in the superficial layer. Just deep to this thin band, the collagen and the elastin were less concentrated. The monkey vocal fold had a very thin mucosal layer with less elastin throughout the mucosa. The microflap dissections in each of the dog, pig, and human vocal folds were similar, being located within that portion of the superficial lamina propria where the elastin and mature collagen are less concentrated. The microflap plane in the monkey vocal fold was more deeply located near the vocalis fibers. Despite the differences in elastin concentration, the microflap plane in both the dog and the pig was found to be similar to that in humans. The dog anatomy was much more suitable for microsuspension laryngoscopy and stroboscopic examination. The dog vocal folds vibrated in a similar fashion to human vocal folds with mucosal waves and vertical phase differences, features not seen in the pig vocal folds. Conclusions Based on both the histological and stroboscopic results, the dog was believed to be a more suitable animal model for studies on vocal fold surgery, acknowledging that no animal's laryngeal anatomy is identical to that of the human. The dog LVS model presented allows for longitudinal laryngeal studies requiring repeated examinations at multiple time periods with histological correlation applied at sacrifice.     

早期声门型喉癌激光术后发音功能的客观声学分析

目的：探讨声门型喉癌半导体激光各型手术后发音功能恢复状况。方法：应用计算机嗓音声学测试系统（Dr.speech for Windows）对66例声门型喉癌行半导体激光手术治疗后的患者进行嗓音测试,并对所测的声学参数值进行定量分析,判断所测的嗓音质量。结果：各型激光手术后其声学参数值中,jtter值变化不大,各型比较差异无统计学意义（P＞0.05）。Ⅱ型术后3个月,shimmer NNE值变小,嗓音质量开始出现改善,6个月后,嗓音质量明显改善,并呈现稳定状态,与其余各型比较,差异有统计学意义（P＜0.01)。Ⅲ型术后6个月嗓音质量亦有改善,与Ⅳ、Ⅴ比较,差异有统计学意义(P＜0.05),Ⅳ、Ⅴ型比较,差异无统计学意义,且嗓音质量1年内无明显改善。结论：早期声门型喉癌激光治疗后,各型术后嗓音恢复的时间、质量不尽相同。手术切除的范围、深度对恢复喉的结构及发音功能有影响。     

Morphometric Study of the Paranasal Sinuses in Normal and Pathological Conditions

Prospective and retrospective morphometric CT (axial and coronal) research was performed with 100 healthy persons and 163 patients (145 males, 118 females, mean age 50 years, range 1-88 years). The patients were classified into the following groups: chronic sinusitis (n=85), polyposis (n=25), mucoceles (n=13), benign tumors (n=20) and malignant tumors (n=20). After initial calibration with the scale (in cm) displayed on the CT image, each paranasal sinus was outlined following its bone inner surface. The data were processed with a high-resolution analysis system, and volumes were calculated using an integration areas rule. The ethmoid, maxillary and sphenoid sinuses exhibited an increase in volume for a period of up to 15 years, afterwards maintaining similar values. The frontal sinus grows in a monomodal pattern (peak at 30 years). The volumetric results (mean and standard deviation) in the normal adult group were as follows: maxillary sinus 13.07 cm³ (6.8), ethmoid 5.5 cm³ (2.0), sphenoid 3.5 cm³ (2.6) and frontal 3.7 cm³ (3.6). Primary frontal and maxillary sinus hypoplasia appeared in 3.9% and 1.3% of cases, respectively. The anatomic variations were as follows: concha bullosa 8.3%, Haller cells 3.2% and Onodi cells 8.3%. The sinusitis values (adults) were greater than those in the normal group: 14.4 cm³ (7.3), 6.8 cm³ (2.9), 2.9 cm³ (1.9) and 4.2 cm³ (5.2), with the exception of the sphenoid, but the difference was not statistically significant. Finally, we propose a new classification for paranasal sinus tumors (benign and malignant), volumetric T (vT), taking into account the morphometric tumoral volume and the mean volumetric value of normal sinuses.     

Effects of 532 nm pulsed-KTP laser parameters on vessel ablation in the avian chorioallantoic membrane: implications for vocal fold mucosa

OBJECTIVES: Selective vascular ablation (photoangiolysis) using pulsed lasers that target hemoglobin is an effective treatment strategy for many vocal fold lesions. However, vessel rupture with extravasation of blood reduces selectivity for vessels, which is frequently observed with the 0.45-ms, 585-nm pulsed dye laser. Previous studies have shown that vessel rupture is the result of vaporization of blood, an event that varies with laser pulse width and pulse fluence (energy per unit area). Clinical observations using a 532-nm wavelength pulsed potassium-titanyl-phosphate (KTP) laser revealed less laser-induced hemorrhage than the pulsed dye laser. This study investigated settings for the pulsed KTP laser to achieve selective vessel destruction without rupture using the avian chorioallantoic membrane under conditions similar to flexible laryngoscopic delivery of the laser in clinical practice. STUDY DESIGN: The chick chorioallantoic membrane offers convenient access to many small blood vessels similar in size to those targeted in human vocal fold. Using a 532-nm pulsed KTP laser, pulse width, pulse energy, and working distance from the optical delivery fiber were varied to assess influence on the ability to achieve vessel coagulation without vessel wall rupture. METHODS: Third-order vessels (n = 135) were irradiated: Energy (471-550 mJ), pulse width (10, 15, 30 ms), and fiber-to-tissue distance (1 mm, 3 mm) were varied systematically. RESULTS: Selective vessel destruction without vessel wall rupture was more often achieved by increasing pulse width, increasing the fiber-to-tissue distance, and decreasing energy. Vessel destruction without rupture was consistently achieved using 15- or 30-ms pulses with a fiber-to-tissue distance of 3 mm (pulse fluence of 13-16 J/cm). CONCLUSIONS: This study substantiates our clinical observation that a 532-nm pulsed KTP laser was effective for ablating microcirculation while minimizing vessel wall rupture and hemorrhage.     

安徽省喉全切除术后生活质量及喉功能康复现状评估

目的 评估安徽省喉全切除术后患者的生活质量,喉功能康复情况以及相关的影响因素,以提出相应治疗策略.方法 采用生活质量综合评定问卷和喉全切除后喉功能康复情况调查表,对我省58例行喉全切除术患者和40位健康人的生活质量及喉功能情况进行回顾性调查分析并评分.结集喉全切除术后患者的生活质量,在躯体、心理、社会功能方面显著差于健...