嗓音障碍主观听感知评估研究现状

在嗓音质量的许多评估方法中,最基本也是被广泛应用的方法是主观听感知评估。主观听感知评估被定义为是依靠专业人员的专业知识进行评估而不依赖于仪器的测试,即通过听觉来评估嗓音障碍的程度或分析嗓音质量[1]。在研究领域,听评委的评估结果是评价嗓音客观测试参数有效性和敏感性的参考标准[2～6]。因此,建立规范科学的嗓音主观评估方法,是实现嗓音客观评估的前提。然而,尽管人耳听觉对音质相当敏感,对于一个嗓音,特别是病理性嗓音的描述是非常困难的,     

嗓音障碍主观听感知评估研究现状

嗓音异常是患者就诊于嗓音门诊的主要原因,通过听觉判断嗓音质量是临床上最占老、最普遍用于诊断嗓音疾病和判断治疗效果的方法.嗓音的主观听感知分析也被国际上用来作为检验嗓音客观检测有效性的参考方法.在目前缺少病理性嗓音发生机制模式或理论指导的情况下,嗓音的客观参数如声学参数、空气动力学参数和生理学参数的可靠性和有效性,只能以嗓音的主观听感知评估结果作为参考来检验.因此,嗓音主观听感知评估方法的研究就成为嗓音分析的重点和中心问题.     

非线性动力学分析方法在嗓音医学中的应用进展

言语交流是人类社会生存的基本功能,生活质量与嗓音功能密切相关。伴随着日趋频繁的社会交往活动,嗓音疾病的患病率也逐年增加,因此,在治疗嗓音疾病时重视嗓音功能的保护有重要意义。目前,临床上对嗓音功能的评估主要包括：声带振动特征评价、发声质量的主客观评估、喉神经肌肉电生理评估、气流动力学评估等方面［1］。其中,因其客观性、方便性及实用性,声带振动特征评价和发声质量的客观评估在临床上应用广泛。正常声带发声时呈双侧对称的周期性振动,而病变声带可因声带的位置、形状、质量、张力、弹力及粘弹性等发生改变,导致声带产生不规则的振动,从而产生很强的非周期性嗓音声学信号。声带的位置、形状、质量、张力、弹力及粘滞性等因素均会对组织产生非线性影响,病变声带振动的过程不可能只按照某一因素的变化产生线性的变化,而是受多因素的影响产生非线性现象。本文对非线性动力学方法在嗓音医学中的应用进展及相关参数进行综述。     

我国嗓音医学研究现状

在现代社会中,发声质量已成为衡量人们生存质量的重要指标之一,嗓音医学有着巨大的研究空间和医疗市场。嗓音医学是研究发音的基本原理并探讨发音障碍的病因、发病机制、治疗及预防的学科。目前嗓音医学的研究热点包括正常嗓音、艺术嗓音及病理性嗓音的发音特征、影响因素及防护;病理性嗓音的致病因素、病理生理学基础及治疗选择;嗓音功能主、客观评价标准的选择;各类嗓音治疗及嗓音外科方法的探索与评价;吞咽障碍、胃食管反流性疾病与发音障碍的关系等[1]。1研究手段嗓音声学检测分析可对患者的发音状况进行监测,对喉部疾病作出辅助诊断,评…     

几种嗓音疾病的声学分析和听感知分级的评价

目的评价嗓音声学分析和主观听感知评估对几种嗓音疾病测试的客观性及科学性。方法①研究对象：嗓音障碍患者72例,正常对照组30例。②主观听感知评估：采用日本言语语音协会的声音嘶哑评估标准GRBAS系统中的总嘶哑度G、粗糙声R、气息声B主观评估受试者的嗓音质量。③嗓音的客观检测：以/e/音作声样,进行嗓音声学和电声门图测试。结果随声嘶程度加重,反映声带振动的稳定性的基频微扰（jitter）、振幅微扰（shimmer）、电声门图-基频微扰（E-jitter）、电声门图-振幅微扰（E-shimmer）增大;反映声门闭合程度的标准化噪声能量（NNE）、电声门图-标准化噪声能量（E-NNE）,接触商微扰（CQP）增大;谐噪比（HNR）减小。嗓音客观参数在主观听感知评估分析患者间的差异有显著统计学意义（P〈0.05）,能区分出不同的嗓音障碍组,但在不同的疾病组间缺乏特异性。结论本实验中所选客观参数可客观评价嗓音疾病,为临床治疗提供依据。     

嗓音障碍客观多参数评估与主观评估的一致性分析

目的 探讨嗓音客观多参数分析与主观听感知评估的一致性,建立嗓音客观多参数评估模型,实现嗓音评估的客观化和数据化.方法 受试者为嗓音障碍患者271例,其中女性124例,男性147例;嗓音正常对照组69例,女性37例,男性32例.主观听感知评估采用GRBAS系统中的总嘶哑度( grade,G),采用4级改良分级量表.听评委为来自不同医院的5名嗓音医学家.语音材料为统一的语句.全部受试者嗓音按随机方式3次排序,分别进行3次评估.嗓音客观测试采用Dr.speech for windows嗓音评估软件,受试者发长元音[α:],取含起始段2s的嗓音样本,测试基频等7个参数.结果 单参数分析结果显示,除了基频不能反映出嗓音障碍程度外,其他6个参数的测试值随嗓音障碍程度的加重而发生相应的变化,并且在两相邻嗓音组之间的差异性有统计学意义(P值均＜0.05).借助于判别分析方法,按性别分别建立了由基频微扰、振幅微扰、基频标准差、标准化噪声能量、谐噪比和最长发声时间组成的客观多参数评估模型.客观评估与主观评估的一致性在男性达到81.6％,女性达到83.2％.正常嗓音组和重度嗓音障碍组的一致性高于轻度嗓音障碍组和中度嗓音障碍组.全部误判嗓音均被判到相邻的嗓音组.结论 嗓音的客观声学参数能够反映出嗓音障碍的主观听感知特性;客观多参数模型评估结果与主观听感知结果达到较好的一致性,为嗓音障碍的评估提供了一种客观的方法.     

嗓音的计算机客观评价

人们一直想寻找一种客观的方法来评价嗓音,迄今为止,由于嗓音的主观特性,始终没有一种客观评价方法替代主观评价。但是,计算机嗓音分析能够通过软件模拟真实的嗓音,并计算出这些模拟嗓音的特征及其差别,从而能够在一定程度上评价嗓音。同时在喉科医师、嗓音师和音乐学家共同努力下,借助现代计算机技术使计算机嗓音分析快速发     

成人女性嗓音障碍的客观多参数分析

目的：探讨嗓音客观多参数分析与主观听感知评估的相关性，建立嗓音客观多参数评估模型，实现嗓音评估的客观化和数据化。方法：声音样本采自83例嗓音障碍患者和40例嗓音正常者，全部受试者均为女性。客观检测采用Dr．Speech Science for Windows嗓音评估软件，在长元音/α：/上测试下列参数：基频、基频微扰(jitter)、振幅微扰(shimmer)、基频标准差、基频震颤、振幅震颤、标准化噪声能量(NNE)、谐噪比(HNR)、信噪比和最大发声时间(MPT)。主观听感知评估参数采用日本言语音声学会声音嘶哑评估GRBAS系统中的总嘶哑度，4级评估标准。结果：应用逐步判别分析方法，建立了5个参数(MPT、jitter、NNE、HNR和shimmer)的嗓音客观评估模型。客观评估结果与主观评估结果的一致性达到79．8％。结论：嗓音的客观评估是多参数的；嗓音的客观多参数评估模型与主观听感知结果有较好的一致性。     

喉癌与声带息肉患者嗓音的计算机定量评估

目的比较喉癌及声带息肉患者主要嗓音参数在不同检测方法中的变化,探讨喉癌与声带息肉对发声功能的影响。方法采用Dr．SpeechScienceforWindows（4．0）软件对正常成人、喉癌患者、声带息肉患者作嗓音声学分析和电声门图检测,并比较其主要参数的变化,分析各自嗓音质量评估的特点。结果①在喉癌和声带息肉患者中,两种嗓音检测方法的嗓音参数,基频微扰、振幅微扰、声门噪声能量均是有价值的,两者的基频微扰、振幅微扰、声门噪声能量可以互相替代,两种方法各参数间比较无统计学差异;②正常成人、喉癌患者、声带息肉患者平均基频之间无统计学意义,基频微扰、振幅微扰、声门噪声能量数值由低到高排列依次为正常成人组、声带息肉组、喉癌组,两两比较均有显著性差异（P〈O.05）;③嗓音质量由好到差排列为正常成人组、声带息肉组、喉癌组。结论计算机声学分析的各项参数可作为嗓音定量评价的客观指标,判断嗓音损害程度。     

歌唱艺术嗓音声学参数分析

目的探讨我国歌唱艺术嗓音声学参数特点。方法采用电脑多媒体技术,使用泰亿格公司生产的Dr.Speech软件采样分析,对166名18~22岁音乐学院的各专业学员自然舒适状态下发长元音/a:/进行声学参数的检测和分析,并以嗓音健康普通人群做对照。结果Jitter值男、女通俗组和民族组与对照组相比无显著性差异(P>0.05);Shimmer值的差异存在于各组(P<0.05);NNE值男美声组高于通俗组、民族组和对照组,有显著性差异(比为P<0.05),而女民族组高于通俗组、美声组和对照组,有显著性差异(P<0.05)。结论歌唱艺术嗓音声学参数有其自身特点,在正常范围内参数的差异有无意义,或对嗓音质量的评估有无价值,有待进一步探讨。     

The speaking fundamental frequency and the singing voice type

The objective of this study was to determine the speaking fundamental frequency (SFO) in professional opera singers and its dependence on their voice type, if any. A total of 75 persons were available for observation using a special computer clinical program. Male voices were categorized into three groups (viz, tenor, baritone, and bass), female ones into 2 groups (soprano and mezzo-soprano). It was shown that borderlines between SFO types varied within a wide range in all study groups. Significant differences in SFO were documented between tenors, baritones, and basses and between sopranos and mezzo-sopranos; the differences were insignificant between baritones and basses. It is concluded that the speaking fundamental frequency depends on the type of the singing voice; however this characteristic may serve only as an auxiliary tool but can not be used for the classification of singing voices.     

Stimmleistungsparameter bei Kindern und Jugendlichen

The influence of physical development and singing activity on vocal efficiency in children and adolescents is well known from clinical experience. There is, however, no comparative study between singing and non-singing children which also considers the influence of age and gender. Therefore, standard values for evaluation in clinical practice are missing. We examined the following parameters in 164 healthy children and adolescents (90 boys, 74 girls; 11-16 years), 86 without singing activity (group A) and 78 members of children's and youth choirs (group B): frequency and dynamic range of voice and its borders with a voice range profile, mean fundamental frequency (normal and loud phonation), maximum voice intensity, and maximum duration of intonation. The statistical analysis was performed using three-way ANOVA. We found significantly higher ranges of frequency and intensity in singing children and adolescents (p<0.0001). The borders of the dynamic range and the upper border of the frequency range were significantly higher in group B (p<0.0001). The boys in group B used a higher mean fundamental frequency during loud phonation. There were no significant differences between groups in maximum voice intensity (p=0.051) but a tendency towards higher values in singing children. As an unexpected result, we found significantly higher values in maximum duration of intonation in group A (p<0.0001) independent of age and gender, which seems to be related to the methods used. Regular training of the singing voice results in positive effects on several voice parameters in children as well as adolescents. Our results can be used for estimating standard values in professional clinical and educational care of young singing voices and non-singing children. For this purpose, voice range profile is particularly suitable.     

Acoustic markers to differentiate gender in prepubescent children's speaking and singing voice

Objectives

Investigation sought to determine whether there is any acoustic variable to objectively differentiate gender in children with normal voices.

Methods

A total of 30 children, 15 boys and 15 girls, with perceptually normal voices were examined. They were between 7 and 10 years old (mean: 8.1, SD: 0.7 years). Subjects were required to perform the following phonatory tasks: (1) to phonate sustained vowels [a:], [i:], [u:], (2) to read a phonetically balanced text, and (3) to sing a song. Acoustic analysis included long-term average spectrum (LTAS), fundamental frequency (F0), speaking fundamental frequency (SFF), equivalent continuous sound level (Leq), linear predictive code (LPC) to obtain formant frequencies, perturbation measures, harmonic to noise ratio (HNR), and Cepstral peak prominence (CPP). Auditory perceptual analysis was performed by four blinded judges to determine gender.

Results

No significant gender-related differences were found for most acoustic variables. Perceptual assessment showed good intra and inter rater reliability for gender. Cepstrum for [a:], alpha ratio in text, shimmer for [i:], F3 in [a:], and F3 in [i:], were the parameters that composed the multivariate logistic regression model to best differentiate male and female children's voices.

Conclusion

Since perceptual assessment reliably detected gender, it is likely that other acoustic markers (not evaluated in the present study) are able to make clearer gender differences. For example, gender-specific patterns of intonation may be a more accurate feature for differentiating gender in children's voices.     

Acoustic correlates of vocal quality

We have investigated the relationship between various voice qualities and several acoustic measures made from the vowel /i/ phonated by subjects with normal voices and patients with vocal disorders. Among the patients (pathological voices), five qualities were investigated: overall severity, hoarseness, breathiness, roughness, and vocal fry. Six acoustic measures were examined. With one exception, all measures were extracted from the residue signal obtained by inverse filtering the speech signal using the linear predictive coding (LPC) technique. A formal listening test was implemented to rate each pathological voice for each vocal quality. A formal listening test also rated overall excellence of the normal voices. A scale of 1-7 was used. Multiple linear regression analysis between the results of the listening test and the various acoustic measures was used with the prediction sums of squares (PRESS) as the selection criteria. Useful prediction equations of order two or less were obtained relating certain acoustic measures and the ratings of pathological voices for each of the five qualities. The two most useful parameters for predicting vocal quality were the Pitch Amplitude (PA) and the Harmonics-to-Noise Ratio (HNR). No acoustic measure could rank the normal voices.     

Cambios acústicos de la voz como signos de fatiga vocal en locutores de radio: resultados preliminares

Introduction and objectivesVocal fatigue is one of the most common voice symptoms. It usually refers to the sensation of vocal tiredness after a long period of speaking or singing. The purpose of this study was to compare the acoustic characteristics of the voice before and after a long period of voice use in a group of radio broadcasters.MethodsEight radio broadcasters with normal voices were assessed. We used cepstrum, energy ratio, noise to harmonic ratio and soft phonation index as acoustic variables to assess the possible pre-post vocal loading changes objectively.ResultsThere were no statistically significant pre-post differences in any of the acoustic parameters. Although cepstrum at high pitch did not show a significant difference, it obtained the greatest difference among the acoustic variables.ConclusionsThe acoustic measurements used in the present study might not be sensitive enough or appropriate for detecting vocal changes after a long period of voice use, whether in reading (as reported in previous research) or speaking tasks. Moreover, a longer period of vocal loading would eventually reveal more evident and consistent acoustic voice changes.     

Normative values for singing voice handicap index – systematic review and meta-analysis

IntroductionThere are no official diagnostic protocols for singing voice assessment. In this publication, on the basis of a literature review, standards for the singing voice handicap index exclusively dedicated to voice disorders in singing have been given.ObjectiveThe study aims to determine the normative values for the singing voice handicap index.MethodsThe study is a systematic review and a meta-analysis. A systematic literature search was performed using PubMed to access relevant databases and to locate outcome studies. The “inclusion” criteria were as follows: English language, original papers and human studies retrospective and prospective papers, cross-sectional and case-control studies.ResultsEight articles were included for the final analysis. The normative value for the singing voice handicap index was 20.35 with a confidential range of 10.6–30.1 for a group of 729 healthy subjects whose voices were judged as normal, with an age range of 16–64 years.ConclusionThe mean normative value of the singing voice handicap index was 20.35 with the confidence levels between 10.6 and 30.1.     

Acoustical analysis of the underlying voice differences between two groups of professional singers: opera and country and western

An acoustical analysis of the speaking and singing voices of two types of professional singers was conducted. The vowels /i/, /a/, and /o/ were spoken and sung ten times each by seven opera and seven country and western singers. Vowel spectra were derived by computer software techniques allowing quantitative assessment of formant structure (F1-F4), relative amplitude of resonance peaks (F1-F4), fundamental frequency, and harmonic high frequency energy. Formant analysis was the most effective parameter differentiating the two groups. Only opera singers lowered their fourth formant creating a wide-band resonance area (approximately 2,800 Hz) corresponding to the well-known "singing formant." Country and western singers revealed similar resonatory voice characteristics for both spoken and sung output. These results implicate faulty vocal technique in country and western singers as a contributory reason for vocal abuse/fatigue.     

Evaluation of the mixing point in tinnitus sound therapy by a psychoacoustic matching protocol with a digital tinnitus evaluation system

Directive counseling and sound therapy have been reported to effectively alleviate tinnitus suffering. Without objective evaluation, researchers doubt the real effect of sound therapy. This study was designed to evaluate the frequency and intensity of the theoretical 'mixing point' (MP) in sound therapy and to investigate its relationship with the minimal masking level (MML) of tinnitus. The tinnitus tones of 133 patients were successfully matched in frequency (dominant in 4-10 kHz) and loudness (83.09 +/- 12.04 dB) using a psychoacoustic matching protocol and a newly designed tinnitus evaluation system. The matching rate was 83%. The relationship between the MP and MML is described by a linear regression equation: MP = 0.90 x MML + 1.98 (r2 = 0.82, p < 0.0001). The results of matching and correlation analysis confirmed the consistency of the MP in sound therapy. The psychoacoustic characteristics of tinnitus can be objectively evaluated with our matching protocol and evaluation system.     

Speech evaluation of partially implantable piezoelectric middle ear implants in vivo

OBJECTIVE: Cochlear microphonic responses (CMs) were measured in a rabbit model in the intact ear (CM1) and in ears with a partially implantable piezoelectric middle ear implant (P-MEI) (CM2) to investigate the characteristics of speech transmission of the P-MEI in vivo. DESIGN: The spectra of pure tones, voices, and elicited CM1 and CM2 obtained from the round window before and after the implantation of a P-MEI device were calculated by using fast Fourier transform. Frequency response functions of CM1 and CM2 were used to demonstrate the functional similarity between the implanted P-MEI and the normal ossicular chain. The coherence functions between the voices and CM1 and between CM1 and CM2 were evaluated to characterize speech transmission of the P-MEI in vivo. Ten rabbit ears were used in this study. Pure tones, six Chinese vowels, and six Chinese characters were the acoustic stimuli. The CMs elicited by a list of bisyllabic words were tape-recorded and then recognized by subjects with normal hearing. RESULTS: Using pure tones at the same intensity of 90 dB SPL, frequency response functions of the CMs between the two states (the intact ear with normal hearing and ears with a P-MEI device at the medium volume) were calculated showing great resemblance in shape. Compared with that at 1 kHz, gain factors were 10 and 20 dB, respectively, at higher frequencies. The correlation and spectral analyses of the vocalizations, CM1 and CM2, demonstrated that the harmonics of CM1 were approximately identical as those of the voices between 0.5 and 5.0 kHz with coherence functions of about 0.7 to approximately 1 at the formants' frequencies, whereas the harmonics of CM2 between 0.5 and 2.5 kHz were enhanced with the coherences near to unity at the formants' frequencies, and others <0.5 kHz and >2.5 kHz were attenuated. The recognition score of the CMs elicited by a list of bisyllabic words was >90% using subjects with normal hearing. CONCLUSIONS: Data from this study suggest that cochlear microphonic potentials can be used as an important tool to evaluate objectively whether the implantation of a P-MEI device is successful and whether the quality in speech transmission of the P-MEI is satisfactory. Thus, the method would be of significance to clinically ascertain the performance of the device in vivo.