室带肥厚的噪音参数分析

目的 探讨室带肥厚患者的噪音参数，包括频率微扰百分值，基频等，分析室带是否参与发音。方法 应用频谱仪和电子计算机对３０例声带无明显病变的室带肥厚者和３０例室带无明显病变的志愿者，测定基频，低音，音域和频率微扰百分值。结果 试验组的基频和低音明显降低，随室带肥厚程度的加重，微扰百分值的检出率有增高的倾向，而基频和低音频率则有下降的倾向。     

CO2激光治疗室带肥厚导致的发音障碍

目的　探讨显微支撑喉镜下CO2激光治疗室带肥厚导致的发音障碍的临床疗效。方法　2011年12月～2013年12月因室带肥厚导致发音障碍就诊于我科的40例经保守 治疗无效的患者,所有患者均经动态喉镜和嗓音分析检查（包括基频、基频微扰、振幅微扰和谐燥比）,并在全身麻醉下行显微支撑喉镜CO2激光手术切除肥厚的室带,术后再次查动态喉镜和嗓音分析,并与术前进行对比。结果  40例患者术后声嘶明显改善,室带恢复正常水平,基频微扰、振幅微扰均降低,基频和谐燥比升高 ,声带黏膜波恢复正常,无并发症发生。结论　显微支撑喉镜CO2激光治疗室带肥厚导致的发音障碍是安全、可靠的,实用性强。     

声带小结及声带局部肥厚患儿嗓音声学及电声门图分析

目的 研究声带小结、声带局部肥厚患儿及正常儿童嗓音声学及电声门图参数之间的差异,为临床诊治提供依据.方法对342例正常儿童及76例声带局部肥厚患儿、52例声带小结患儿进行嗓音声学测试及电声门图分析,对三组参数进行方差分析并作两两比较.结果声带小结与声带局部肥厚患儿的嗓音声学分析的标准化噪声能量（NNE）与基频方差（SDFo）无显著差异,频率微扰（jitter）、振幅微扰（shimmer）在两组间差异有显著统计学意义;声带小结与声带局部肥厚患儿的电声门图频率微扰（jitter）、振幅微扰（shimmer）差异无统计学意义,NNE和SDFo在两组间差异有统计学意义.结论 jitter、shimmer、NNE、SDFo四项参数在区分正常嗓音和病理性嗓音时非常重要而且非常敏感;在病理性嗓音中以上四项参数各有异同;嗓音声学参数较电声门图参数更有意义.     

老年喉形态学改变与嗓音变化之间的关系

目的探讨老年喉形态学改变与嗓音变化之间的关系。方法对54例60岁以上健康老年人（男性29例，女性25例）的喉形态改变与嗓音声学特征进行了观察分析。健康青年对照组为21—22岁在校大学生46例，男女各23例。结果老年男性声带萎缩16例（55．2％），声门闭合不良18例（62．1％），声门下黏膜水肿16例（55．2％），室带超越（指发音时室带遮盖声带的部分或全部）12例（41．4％）。老年女性杓间区水肿15例（60．0％），声门闭合不良14例（56．0％），声带萎缩12例（48．0％），声带水肿8例（32．0％）。老年嗓音男性基频升高、女性基频下降，频率微扰、振幅微扰及噪谐比增大，嗓音的颤抖强度指数增加，特别是老年男性嗓音具有软发声特征。除老年女性频率微扰、振幅微扰及软发声指数升高无统计学意义外，其他参数与健康青年对照组比较，两者之间的差异均有统计学意义（P值均小于0．05或0．01）。结论老年人在喉形态和嗓音声学特征上均出现了明显变化，除声带萎缩、声带水肿外，声门下黏膜水肿与杓间区水肿的发生率也很高。     

声带小结患者发音矫治前后电声门图参数变化

目的 比较分析声带小结患者发音矫治前后电声门图参数变化，评价发音矫治对声带小结的疗效。方法 对48例声带小结（软性小结）患者发音矫治（3～6个月）前后分别进行电声门图检测，并对其主要参数进行比较分析。结果 发音矫治后平均基频、接触率较矫治前有显菩性升高（P〈0．05），基频微扰、振幅微扰、噪声能量较矫治前有显著性下降（P〈0．05）。结论 发音骄治前后电声门圈参数变化结果提示，发音矫治对声带小结具有一定的治疗效果。     

声带息肉与喉癌的声学特征

目的 寻求用噪音分析法鉴别声带良，恶性病变的方法。方法 比较声带息肉及喉癌患者的主要噪音声学参数基频微扰，振幅微扰，规度化噪声能量，并行统计学检查，提出以计分法描述声带病变程度的方法。结果 喉癌患者主要噪音声学参数基频微扰，振幅同扰，规度化噪声能量均明显高于声带息肉患者（P＜0．01）；其计分值也明显偏高（P＜0．01）。声带息肉的特征性指标为嘶哑声：轻度，粗糙声：正常－轻度，气息声：中度－重度。结论 噪音声学分析对声带息肉及喉癌的临床诊断有辅助参考价值。     

三种声带疾病在喉显微手术前后的声学评估

目的 分析声带息肉、声带囊肿和声带白斑喉显微手术前后声学特征的改变。方法 对上述三种声带病变患者施行喉显微手术的300例进行术前和术后声学测试,分析参数频率微扰、振幅微扰、NNE和F0。结果 显微喉镜术后,声带息肉和囊肿患者嗓音的频率微扰、振幅微扰和NNE均降低,而声带白斑患者无改善。三种病变术后F0值均无变化。结论 喉显微手术在清除病灶方面疗效肯定：声带息肉和囊肿患者术后发声功能改善,声带白斑患者术后声学参数短期内（一周）无改善。     

多维嗓音分析检测儿童嗓音的临床分析及应用

目的研究6~12岁正常儿童嗓音多维嗓音分析(Multi Dimensional Voice Program,MDVP)各项声学参数阈值,有助于为小儿声带异常提供诊断依据,为儿童嗓音结果分析提供参考。方法运用CSL model 4150系统嗓音分析软件对130例6-12岁儿童检测MDVP各项参数,经纤维喉镜确诊的20例6~12岁声带小结患儿病例作为对照。结果正常儿童MDVP中基频最为稳定,与成人差异明显;基频微扰、振幅微扰、噪音参数稳定性处于可接受范围,儿童与成人之间没有明显差异;正常组和声带小结组基频微扰,振幅微扰,噪音相关参数经统计差异明显。结论 MDVP是评估儿童发音障碍的重要手段之一;正常儿童嗓音数据库的建立有利于提高嗓音评估的可靠性。     

倍他米松声带注射术治疗慢性肥厚性喉炎

目的为了寻找更有效的方法，提高治疗慢性肥厚性喉炎声音嘶哑的疗效。方法自2001年7月—2002年12月底，用倍他米松(得宝松注射液)对46例长期声音嘶哑的慢性肥厚性喉炎患者进行声带注射术治疗，并用嗓音疾病评估仪进行术后疗效观察。对基频、基频微扰、振幅微扰和声门噪声能量声学参数进行自身对照的t检验，对术后1个月和6个月的嗓音质量评估综合评分进行单因素方差分析和两两比较。结果8例在门诊表面麻醉后间接喉镜下注射，38例是在全身麻醉显微喉镜下注射。经6个月以上的随访观察，患者自觉声音嘶哑明显改善，检查见讲话较前轻松；检查见声带充血或水肿明显减轻，声带边缘变锐。嗓音质量明显改善，基频、基频微扰、振幅微扰、声门噪声能量和嗓音疾病综合评估结果显示，注射后6个月时有效8例(17．39％)，显效22例(47．83％)，治愈10例(21．74％)，无效6例(13．04％)，总有效率40例(86．96％)。结论得宝松声带内注射术是治疗慢性肥厚性喉炎声音嘶哑的较为有效方法。     

儿童声嘶及良性增生性声带疾病的嗓音频谱分析

目的分析儿童声嘶的特点,并对良性增生性声带疾病患儿的嗓音频谱检查及诊治进行分析研究。方法分析152例声嘶患儿(其中良性增生性病变98例,占64.47%)发病特点、嗓音声学特点及治疗转归情况。结果①儿童声嘶疾病中,声带良性增生性疾病较多;其中男性约66.3%;病变多为双侧,以声带息肉为最多,慢性肥厚性喉炎次之;②患儿嗓音分析结果为:变声期前,声带息肉和慢性肥厚性喉炎患儿的基频微扰和振幅微扰、标准化噪声能量、谐噪比均明显异常;③声带小结和声带息肉患者预后较好,慢性肥厚性喉炎预后最差。结论在儿童声嘶疾病中,声带良性增生性疾病所占比例最大,以声带息肉最多,如保守治疗不能恢复,可手术治疗。     

Assessment of effectiveness of acoustic analysis of voice for monitoring the evolution of vocal nodules after vocal treatment

In the present study, we report the results of acoustic analysis of voice in 97 patients diagnosed with vocal nodules before and after the vocal logopedic treatment, to evaluate its effectiveness in monitoring the evolution. We analyzed five parameters: the mean fundamental frequency (F0) and its standard deviation, jitter, shimmer, and normalized noise energy (NNE). Our results indicate that most patients showed a reduction of fundamental frequency, an increase of perturbation (jitter and shimmer), and an increase of NNE before the treatment. We did not find any statistically significant relationship between previous values of the five parameters analyzed and the clinical course. We did not find significant differences between the two groups (with and without clinical improvement) in the evolution of any of the five parameters, although these differences were greater in the case of jitter. We conclude that the acoustic analysis of voice can be useful as a complementary tool in the diagnosis of vocal nodules, but the parameter values analyzed before treatment did not correlate with the clinical course and we believe that its usefulness in the evaluation of results after the vocal treatment is limited.     

The effect of the heartbeat on vocal fundamental frequency perturbation

Signal-averaging and autocorrelation analysis revealed that the cardiovascular system exerts a modest but consistent influence on vocal fundamental frequency (Fo), accounting for approximately 0.5% to 20% of the absolute Fo perturbation (jitter) measured during a sustained phonation. There was also a marked trend for this percentage to decrease with increasing vocal Fo. Estimated mean "deterministic jitter" (Jd) values of 3.7 microsec (SD = 3.2) and 0.9 microsec (SD = 0.5) were derived from 6 normal male and 6 normal female subjects, respectively, with an overall mean of 2.3 microsec (SD = 2.7). These values represent approximately 6.9% of the mean total jitter for men and 2.4% of the mean total jitter for women, or about 4.6% for all subjects. The results are discussed in terms of their significance regarding more reliable vocal jitter measurement.     

Praat软件及DSI对改良杓状软骨内收术治疗单侧声带麻痹的疗效评估

目的探讨Praat软件及嗓音障碍严重程度指数(dysphonin severity index,DSI)对改良杓状软骨内收术治疗单侧声带麻痹疗效评估的意义。方法 65例单侧声带麻痹患者均于患侧行改良杓状软骨内收术。全部病例于手术前及术后3月、12月分别行DSI分析及以Praat软件分析基频(fundamental frequency,F0)、声音强度(intensity)、噪谐比(NHR)、基频微扰[包括:局部基频微扰(jitter local)、局部绝对基频微扰(jitter local absolute)、基频微扰间期系数5(jitter ppq5)]、振幅微扰[包括:局部振幅微扰(shi mmer local)、局部振幅微扰dB(shi mmer localdB)、振幅微扰间期系数5(shi mmer apq5)]。结果术后3月、12月患者F0、NHR、jitter local、jitter local absolute、jitter ppq5、shi mmer local、shi mmer local dB、shi mmer apq5较术前明显下降,差异均有统计学意义(均为P<0.05)。术后3月、12月声音强度(intensity)分别与术前相比差异均无统计学意义(均为P>0.05)。术后3月、12月DSI值较术前均有显著提高(均为P<0.05)。术后12月上述所有指标与术后3月相比,差异均无统计学意义(均为P>0.05)。结论 Praat软件及DSI可客观、有效地评估改良杓状软骨内收术治疗单侧声带麻痹的疗效,该术式治疗单侧声带麻痹远期效果稳定。     

Acoustic analysis of the tremulous voice: Assessing the utility of the correlation dimension and perturbation parameters

Acoustic analysis may provide a useful means to quantitatively characterize the tremulous voice. Signals were obtained from 25 subjects with diagnoses of either Parkinson's disease or vocal polyps exhibiting vocal tremor. These were compared to signals from 24 subjects with normal voices. Signals were analyzed via correlation dimension and several parameters from the Multi-Dimensional Voice Program (MDVP): percent jitter, percent shimmer, amplitude tremor intensity index (ATRI), frequency tremor intensity index (FTRI), amplitude tremor frequency (Fatr), and fundamental frequency tremor frequency (Fftr). No significant difference was found between the tremor and control groups for ATRI and Fatr. Percent jitter, percent shimmer, FTRI, Fftr, and correlation dimension values were found to be significantly higher in the tremor group than in the control group. We conclude that these parameters may have utility for the clinical quantification of tremor severity and treatment effects. Learning Outcomes: The reader will understand the utility of applying select perturbation parameters and the nonlinear measure of correlation dimension for the characterization of the tremulous voice.     

改良杓状软骨内收术治疗单侧声带麻痹

目的评估改良杓状软骨内收术治疗单侧声带麻痹的疗效。方法回顾性分析2001年2月～2007年12月22例行改良杓状软骨内收术的单侧声带麻痹患者的临床资料,对术前和术后3个月的误吸指数、主观听感知评估参数（GRBAS）、声学检测参数[基频（F0）、基频微扰（jitter）、振幅微扰（shimmer）、标准化噪声能量（NNE）]、最大声时（MPT）、平均气流率（MFR）进行统计学分析。结果22例患者术后误吸指数分值较术前明显下降,GRBAS评估各参数比术前明显下降,声学检测各参数（F0、jitter、shimmer、NNE）较术前明显降低,最大声时明显延长,平均气流率明显降低,差异均有统计学意义（均为P〈0.001）。结论改良杓状软骨内收术是一种治疗单侧声带麻痹有效的声带内移术,既可恢复良好的发声功能,又可缓解误吸。     

To study voice quality before and after thyroplasty type 1 in patients with symptomatic unilateral vocal cord paralysis

PURPOSE: The purpose of this study was to evaluate voice quality before and after thyroplasty type 1 in patients with symptomatic unilateral vocal cord paralysis. METHODS: Fifteen consecutive cases of unilateral symptomatic vocal cord paralysis of a known or idiopathic etiology with the duration of 6 months who have failed conventional speech therapy. The voice quality was assessed by perceptual evaluation, acoustic measures, and aerodynamic measures. The position of the cord was assessed by using fiberoptic laryngoscope. The procedure was done under local anesthesia. RESULTS: Among 15 patients, on the first postoperative day, 7 patients were changed to moderate dysphonia and 8 patients had a near-normal voice. On the 30th postoperative day, 3 patients had persistent moderate dysphonia, nine patients had near-normal voice, and 3 patients had normal voice. CONCLUSION: Thyroplasty type 1 successfully reduces glottic gap and improves voice quality in patients with unilateral vocal cord paralysis. Improved maximum phonation time, signal-to-noise ratio, shimmer, jitter, fundamental frequency, and intensity of voice appear to be directly related to medialization of the paralyzed vocal cord.     

Acoustic and aerodynamic measurement of speech production after supracricoid partial laryngectomy

BACKGROUND: Supracricoid partial laryngectomy (SCPL) results in laryngeal preservation in more than 95% of patients with T2 glottic carcinoma. After surgery, glottis function is characterized by an absence of vocal cords and poor glottis closure. Voice is an important postSCPL quality of life factor. OBJECTIVE: Enhance postSCPL vocal function. Obtain postsurgical acoustic and aerodynamic measurements and correlate multiple objective parameters with perceptual results. METHOD: Continuous speech voice samples from 61 patients who had undergone SCPL more than 1 year before were scored according to the global, roughness, breathiness, asthenia, and strain (GRBAS) scale by a jury of listeners. Acoustic and aerodynamic parameters were recorded: fundamental frequency (F0), intensity, jitter, shimmer, signal-to-noise ratio (SNR), signal-to-noise ratio greater than 1 kHz (SNR>1), oral airflow (OAF), maximum phonation time (MPT), and estimated subglottic pressure (ESGP). Nonparametric tests and logistic regression analysis were used to compare objective measurements and perceptual evaluations. RESULTS: All patients had various degrees of dysphonia: grade 1, 4.9%; grade 2, 55.7%; and grade 3, 39.4%. Correlations between perceptual grades and objective parameters were obtained for jitter, shimmer, SNR, SNR>1, ESGP, and OAF. No correlations were obtained between the different parameters and age, number of arytenoids, and time elapsed since surgery (TESS). Logistic regression analysis of jitter, SNR, ESGP, and OAF parameters revealed 92.6% agreement with the perceptual evaluation results.     

Quantitative analysis of voice quality in early glottic laryngeal carcinomas treated with radiotherapy

The quality of voice after radiotherapy is generally considered to be better than that after surgery for early glottic (Tla and Tlb) carcinomas. Studies concerning voice quality after radiotherapy are scarce, and results have been contradictory concerning actual normalization of voice following therapy. This study was designed to compare several voice parameters of patients successfully treated 1–12 years previously with radiotherapy (5750–7000 cGy) for early glottic carcinoma. Parameters involved an age- and sex-matched control group. Results showed that voice quality following radiotherapy was less than normal for maximum vocal intensity, dynamic vocal intensity range, jitter, and mean fundamental frequency. These findings showed that voice following radiotherapy could not be considered normal.     

双蒂肌转入充填联合杓状软骨内移喉成形术治疗单侧声带麻痹

目的 探讨双蒂胸骨舌骨肌瓣转入声门旁联合杓状软骨内移治疗单侧声带麻痹的疗效.方法 不适合行喉返神经探查修复术的单侧声带麻痹19例.在甲状软骨板正中旁开0.5 cm裂开甲状软骨板,在杓状软骨内收固定的同时将带双蒂的胸骨舌骨肌瓣转入患侧声门旁内.治疗前后以电子喉镜、频闪喉镜、嗓音听评委主观评估、声学参数客观分析等评价治疗效果.结果 所有患侧声带膜部及声带突部术后即刻均明显内移,声带体积增大,发声时增大更为明显.术后2个月声门后裂隙消失6例,缩小13例;12个月后嗓音总嘶哑度评估:恢复正常6例,轻度声嘶12例,中度声嘶1例,较术前明显好转,采用等级资料数据秩和检验,差异具有统计学意义(z值为-4.062,P＜0.01).术后12个月的声门后裂隙、嗓音总嘶哑度与术后2个月比较无明显区别(P值均＞0.05).术后2个月及12个月声学客观指标的4个参数(基础频率、频率微扰、振幅微扰和谐噪比)平均值均明显小于术前,最长声时明显长于术前,差异均有统计学意义(P值均＜0.05).术后12个月与2个月比较上述参数差异均无统计学意义(P值均＞0.05).结论 双蒂胸骨舌骨肌充填联合杓状软骨内移喉成形术治疗不适合行喉返神经探查修复术的单侧声带麻痹患者的创伤小,无排异反应,远期效果较稳定.