气管食管裂隙状发声孔发声机制研究

目的：探讨气管食管裂隙状发声孔的发声机制。方法：用大功率遥控X线机和动态频闪喉镜观察40例行全喉切除，Ⅰ期或Ⅱ期发声重建术患者发声时的贮气相、送气相、发声相。结果：患者吸气时肺部膨隆，食管黏膜闭拢；食管入口黏膜内翻呈环形缩小；随之，下咽腔增大呈一尖端向下的三角锥形；食管上端迅速膨大。发声开始时，食管上端扩张如球，食管人口黏膜以冠状位呈唇样外翻，气体从咽食管部冲出；黏膜、黏液发生振动，发出基音。后胸廓缩小，食管入口黏膜再次内翻，发声结束。结论：气管食管音发声的动力器官是肺，气管-食管造瘘口的通畅对发声至关重要。发声时，下咽黏膜、食管口黏膜与黏液均参与振动。     

喉全切除后食管音助发声器发音的客观声学分析

目的通过客观声学分析了解喉全切除术后食管音助发声器发音的发音质量。方法应用上海泰亿格公司的Dr.speed嗓音声学分析软件对7例食管音助发声器发音的患者(食管音助发声器发音组)及5例气管食管音患者(气管食管音组)的基频、基频微扰、振幅微扰、谐噪比、声强及最大发声时间进行检测,并与12名正常男性(对照组)进行比较。结果食管音助发声器发音组、气管食管音组的基频、基频微扰、振幅微扰、谐噪比,最大发声时间与对照组比较差异有统计学意义(P<0.05或P<0.01),三组间声强比较差异无统计学意义(P>0.05),食管音助发声器发音组最大发声时间比气管食管音组长(P<0.05),其余指标与气管食管音组比较差异无统计学意义(P>0.05)。结论食管音助发声器发音的声音的声强可达77.40 dB、最大发声时间可达10.77秒,基本能够满足日常交流的需要。     

无喉者发不同元音时的声学参数及气管内压力比较

目的　比较无喉者发不同元音时的声学参数及气管内压的异同。方法　检测了 2 4例喉全切除气管断端膜样部食管吻合分流发声重建术后患者和 16例喉全切除术后食管音患者分别发元音 a 和 i 时的声学参数 ,测定了 2 0例发声重建术后患者分别发 a 和 i 时的气管内压 ,并进行统计学分析。结果　两组无喉患者发不同元音 a 和 i 时 ,其声学参数无显著性差异 (P >0 .0 5 ) ,发声重建术后患者的气管内压发 i 音时较发 a 音时高 ,有显著性差异 (P <0 .0 5 )。结论　应用元音 a 和 i 在评价无喉者发声的声学参数有一致的临床意义 ;而发声重建术后患者在发不同元音时 ,气管内压值不同     

一种气管—食管分流音的发声机制及其声学和语言评价

文中对全喉切除气管断端膜样部－食管造口吻合发音的发声机制进行了研究，并对其语言作了评价，利用频闪动态喉镜观察了新声门的运动特征，用声谱仪分析了气管－食管分流音的声学特点。并从可懂度和流利度方面对其语言进行了评价。结果显示：新声源是食管入口周围的粘膜和肌层，环咽肌上，下三角是主要振动部位，这种气管－食管分流音的基频比正常音低，平均噪音比正常音高。这种气管－食管分流语言不如正常喉语言流利，但其可懂度和     

一种气管－食管分流音的发声机制及其声学和语言评价

文中对全喉切除气管断端膜样部－食管造口吻合发音的发声机制进行了研究，并对其语言作了评价。利用频闪动态喉镜观察了新声门的运动特征，用声谱仪分析了气管。食管分流音的声学特点。并从可懂度和流利度方面对其语言进行了评价。结果显示：新声源是食管人口周围的粘膜和肌层，环咽肌上、下三角是主要振动部位。这种气管－食管分流音的基频比正常音低、平均噪音比正常音高。这种气管－食管分流语言不如正常喉语言流利，但其可懂度和正常喉语言一样。     

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。     

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。     

全喉切除改良气管-咽吻合Ⅰ期发声重建术

目的：探讨全喉切除Ⅰ期发声重建术的改进术式。方法：采用低位气管切开，全喉切除，食管前壁黏膜重建声门，气管切口处造瘘．颈段气管上提并缩窄吻合于舌根的方法行全喉切除及Ⅰ期发声重建木35例。结果：33例(94．29％）术后获得了不同程度的发声功能．不能发声者仅2例(5．71％)。全部患者术后均可经口进食，未出现严重的影响生存质量的误咽。结论：与以往的发声重建术相比，本术式具有发声成功率高、发声质量良好、误咽率低等优点，且无须置人人工发声装置．值得推广。     

食管发音患者的语音学分析

目的 观察喉全切除食管发音患者的语音声学特征。方法对16例喉全切除食管发音患者进行语音声学分析及最大发声时程的测定，并以健康男性作对照。同时比较食管发音者和健康人的声波周期性。结果同健康男性比较，食管发音患者的语音声学参数除振幅外，基频、基频微扰、振幅微扰、谐噪比、标准化噪声能量均有统计学差异，且声波周期性差。结论食管发音的声学特性与正常男性相比有显著差别，声音稳定性差、声时短、音调低钝，但食管发音仍是喉全切除术后患者获得发音的一种重要途径。     

喉环上部分切除带蒂软骨膜环杓连接声门重建术后嗓音分析

目的:观察喉环上部分切除带蒂软骨膜环杓连接声门重建术与其他行喉部分切除术术后1年以上 患者的发声质量进行比较。方法:采用上海泰亿格电子有限公司提供的Dr.Speech嗓音及语音分析,测试在环境 噪声控制在45dB以下的实验室中进行。测试前受试者进行发声训练,测试声样选择元音[ ],评估参数为:基频 微扰,振幅微扰,噪声能量。结果:观察喉环上部分切除带蒂软骨膜环杓连接声门重建术嗓音各项声学参数值均 较正常值明显增高,差异有统计学意义;与其他喉部分切除术后相比,参数明显降低,发声质量明显提高。结论: 喉环上部分切除带蒂软骨膜环杓连接声门重建术提高了发声质量,嗓音声学分析可作为评价喉癌术后发声质量 的定量指标,有助于术后发声质量的客观评价。     

Vibratory analysis of the neoglottis after surgical intervention of cricopharyngeal myotomy and implantation of tracheal cartilage

OBJECTIVE: To examine the effect of a new surgical intervention, consisting of cricopharyngeal myotomy and tracheal cartilaginous implantation on the anterior wall of the esophagus, for tracheoesophageal shunt and esophageal phonation. DESIGN: We examined the vibration of the neoglottis of tracheoesophageal shunt and esophageal speakers after total laryngectomy using a high-speed video camera (frame rate, 1000 per second). PATIENTS: Twenty-one alaryngeal patients were involved: 13 who had undergone the present procedure and 8 who had not. RESULTS: The regularity of neoglottal vibration and the degree of neoglottal closure were significantly (P<.01) better in patients who had undergone the procedure than in those who had not. These effects on neoglottal vibration induced easier phonation. CONCLUSIONS: Cricopharyngeal myotomy was useful for avoiding reconstructed esophageal spasm, and tracheal cartilaginous implantation was effective for maintaining a wide subneoglottal space. This combination of procedures is useful for obtaining optimal vibration of the neoglottis in tracheoesophageal shunt and esophageal speakers.     

两种无喉言语的比较研究

目的：比较无假体气管食管分流音与食道音在最大发声时间，可懂度和阅读时间等方面的差异，方法，研究对象包括年龄，性别和术后发声时间相当的两组无喉言语者，其中，食管音组21名，无假体气管食管音组30名，采集了两组的最大发声时间，可懂度和阅读时间的数据，用t检验分析最大发音时间和阅读时间（P＜0．05），H检验分析言语可懂度（P＜0．05），结果：食管音在这三个项目上均较气管食管分流音差；言语可懂度略差于气管食管分流音；言语流利度和最大发声时间均明显差于气管食管分流音。结论：无假体管食管音的言语效果优于食管音，而且其手术方法简单，容易训练，利于推广。     

Acoustical analysis of Spanish vowels produced by laryngectomized subjects.

The purpose of this study was to describe the acoustic characteristics of Spanish vowels in subjects who had undergone a total laryngectomy and to compare the results with those obtained in a control group of subjects who spoke normally. Our results are discussed in relation to those obtained in previous studies with English-speaking laryngectomized patients. The comparison between English and Spanish, which diFfer widely in the size of their vowel inventories, will help us to determine specific or universal vowel production characteristics in these patients. Our second objective was to relate the acoustic properties of these vowels to the perceptual data obtained in our previous work (J. L. Miralles & T. Cervera, 1995). In that study, results indicated that vowels produced by alaryngeal speakers were well perceived in word context. Vowels were produced in CVCV word context by two groups of patients who had undergone laryngectomy: tracheoesophageal speakers (TES) and esophageal speakers. In addition a control group of normal talkers was included. Audio recordings of 24 Spanish words produced by each speaker were analyzed using CSL (Kay Elemetrics). Results showed that F1, F2, and vowel duration of alaryngeal speakers differ significantly from normal values. In general, laryngectomized patients produce vowels with higher formant frequencies and longer durations than the group of laryngeal subjects. Thus, the data indicate modifications either in the frequency or temporal domain, following the same tendency found in previous studies with English-speaking laryngectomized speakers.     

Acoustic analysis of tracheoesophageal speech in comparison to esophageal speech after total laryngectomy

In order to evaluate the vocal quality of tracheo-oesophageal (TE) and oesophageal (E) speech, several acoustic parameters were measured in the acoustic waveform (fundamental frequency, maximum phonation time, maximum intensity) and in the frequency spectrum: harmonicity-to-noise ratio [HNR], pitch perturbation [Jitter], Shimmer. Thirteen patients using tracheo-oesophageal speech (Provox 2 valve) and 11 good oesophageal speakers were evaluated. The control group consisted of 10 healthy men with normal speech. Digital recordings were obtained from examined subjects as they sustained the vowel "a". Maximum phonation time in TE samples was significantly longer than in E speech recordings and similar to the normal speech. The tracheo-oesophageal voices more often showed a detectable fundamental frequency which was fairly stable and lower than in oesophageal and normal speech. In our cohort of patients maximum voice intensity in both groups of alaryngeal speakers was similar and lower than in control group. The Jitter and Shimmer results of TE speech were similar to those of E speech and higher than in controls. HNR was significantly higher in TE speech than in E voice and three times lower in comparison to normal speech. The results of this investigation indicate that TE speech is more like normal speech than is E voice.     

Perception of stop consonants produced by esophageal and tracheoesophageal speakers

This preliminary study investigated the perceptual characteristics of stop consonants produced by two esophageal and two tracheoesophageal (TE) speakers, and one normal speaker. Speech stimuli consisting of CVCVC syllables were presented in the sound-field to nine naive, normal-hearing listeners who transcribed their perceptions of each stimulus. Listener responses for each speaker were collapsed into confusion matrices and analyzed for overall intelligibility, place, and voicing features. Error data were also quantified and analyzed. Results indicate that overall, stop consonants produced by TE speakers were significantly more intelligible than those produced by esophageal speakers. For all six stops investigated, intelligibility was greater for TE speakers. Findings are discussed in relation to existing aerodynamic, acoustic, and speech production data for alaryngeal speakers.     

Cineradiography of the pharyngoesophageal segment in postlaryngectomy patients

The use of tracheoesophageal voice prostheses has gained wide acceptance in the field of vocal rehabilitation after total laryngectomy. In a randomized study with 3 arms, alaryngeal speech proficiency was assessed in 60 postlaryngectomy patients: 20 patients underwent primary unilateral pharyngeal myotomy, 21 patients underwent neurectomy of the pharyngeal plexus in addition to pharyngeal myotomy, and 19 patients did not undergo an additional surgical procedure. Pharyngoesophageal (PE) dynamics were examined during esophageal and tracheoesophageal speech. A single vibrating PE segment was seen in good alaryngeal speakers. Hypertonicity, spasm, strictures, and hypotonicity of the PE segment were correlated significantly with poor or moderate alaryngeal speech. Unilateral myotomy with or without unilateral neurectomy prevented hypertonicity or spasm of the PE segment. The acquisition of alaryngeal speech did not differ significantly between the 2 groups who had undergone an additional surgical procedure. Evaluation of anatomic and physiological factors may be helpful in subsequent clinical management to achieve effective alaryngeal speech.     

Mechanism of esophageal speech after total laryngectomy]

OBJECTIVE: To evaluate the characteristics of esophageal speech after total laryngectomy. METHODS: Esophageal speech evaluation of 40 cases of esophageal phonation included acoustic parameters, intraesophageal pressures during phonation, speech intelligibility, fluency, communication, respiratory sound and cognate distinctions between voiced and voiceless sounds. RESULTS: In 8 poor speakers, the neoglottis was spasmodic and difficult to vibrate during phonation. In 32 good speakers, the neoglottis was relaxed and easy to vibrate during phonation. The training age, speech intelligibility, fluency, communication, respiratory sound, cognate distinctions between voiced and voiceless sounds and intraesophageal pressures during phonation were significantly different between good and poor esophageal speakers. Vocal characteristics of good speakers differed significantly from those in the normal (P < 0.05 or P < 0.01). The upper intraesphageal pressure during esophageal phonation was higher than that of the normal, especially for poor esophageal phonation. The middle to lower intraesphageal pressures was highest during poor esophageal phonation. CONCLUSIONS: Esophageal phonation was completely alaryngeal, and its activators also differ completely, so phonation could not maintain much longer. Patients with poor esophageal phonation could not drive the air through the neoglottis freely.     

喉全切除术食管发音机制研究

目的　探讨喉全切除术后食管言语的特点。方法　对北京同仁医院 40例训练食管发音患者的嗓音声学、言语、形态特征及发音时食管压力变化进行分析 ,以 5 0例健康男性作为对照。结果　食管发音不良 8例 ,发音良好 32例。发音不良者黏膜痉挛 ,气流无法送出 ;发音基频小于 6 0Hz无法评估。发音良好者食管入口黏膜松弛 ,振动明显 ;其嗓音声学特征与健康对照差异有显著性(P值 <0 0 5或 <0 0 1)。食管发音不良者训练发音年龄、言语清晰度、速度、呼吸发音协调程度与发音良好者差异有显著性 (P值 <0 0 5或 <0 0 1)。食管发音时食管上、中段压力明显高于健康对照组(P值 <0 0 5或 <0 0 1) ,其中发音不良者压力增加更为明显 ,特别是食管中段压力。结论　食管发音声道振动及动力器官均与正常发音存在本质区别 ,通过代偿机制瞬间发音可达良好效果 ,但在自然、持续言语交流中存在明显障碍