Lyapunov系数在嗓音障碍评估中的意义

目的探讨Lyapunov系数在嗓音障碍客观分析中的意义,完善嗓音障碍的客观测试方法。方法声音样本采自132例嗓音障碍患者和47例嗓音正常者。采用法国开发的“EVA”嗓音工作站,选择2秒平稳段长元音/α/声信号作为分析样本,测试基频微扰(jitter)和计算Lyapunov系数。主观听感知评估采用日本言语音声学会制定的嗓音障碍评估系统GRBAS中的总嘶哑度(grade,G),4级评估标准。结果Lyapunov系数在不同的嗓音障碍分级组间均有统计学差异,jitter只在中度和重度嗓音障碍组间有统计学差异;Lyapunov系数与听感知评估结果的一致性达到46%,jitter的一致性为36%。回归分析结果显示,Lyapunov系数和jitter之间既有相关性,但又有不同(r2=0.582,P<0.001)。结论Lyapunov系数对嗓音障碍的测试优于jitter;非线性动态系统(相位图)的引入,为嗓音的客观分析开辟了新的研究领域。     

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.     

嗓音障碍RBH听感知评估系统的应用研究

目的 研究RBH听感知评估系统的可靠性及与客观嗓音参数的相关性,为其在我国的临床应用提供依据.方法 以10种常见的嗓音障碍疾病为研究对象,每种10例,并选取15例健康人,共115例作为受试者.参照德语版RBH主观听感知评估系统中粗糙声(roughness,R)、气息声(breathiness,B)和嘶哑声(hoarseness,H)的4个等级评分标准对受试者进行评分,检验5位评委间一致性和评委自身稳定性;分析受试者3个主观评估参数每相邻两个等级之间的客观参数的差异性;并将R、B、H与客观参数进行相关性分析.结果 每个评委前后两次评估的自身稳定性分析Kappa系数值为0.428～0.608,稳定性均比较好;5位评委间一致性分析的组内相关系数(intraclass correlation coefficient,ICC),前后两次分别为0.741 ～0.797和0.689 ～0.762,评委间一致性好.主观听感知评估参数R、B、H的4个等级中每相邻2个等级之间的基频微扰、振幅微扰、谐噪比、最长声时和发音障碍严重指数差异均具有统计学意义(P值均＜0.05).主观听感知评估参数R、B、H与客观评估参数基频微扰、振幅微扰、谐噪比、最长声时和发音障碍严重指数之间具有相关趋势(r值在0.360 ～0.551和-0.472 ～-0.620范围内,P值均＜0.01).结论 RBH主观听感知评估系统的可靠性好,等级分度合理,与客观参数评估的结果相关性好,临床应用前景广阔.     

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。     

嗓音声学分析和电声门图的比较研究

目的比较嗓音声学分析和电声门图在嗓音障碍客观评估中的意义。方法声样采自153例嗓音障碍患者和80名嗓音正常者。客观检测采用Dr．Speech for Windows嗓音评估软件，在长元音／α：／上检测下列参数：基频(Fo)、基频微扰(jitter)、振幅微扰(shimlner)、基频标准差(FoSD)、基频震颤、振幅震颤、最大基频、最小基频、标准化噪声能量(NNE)、谐噪比(HNR)和信噪比(SNR)。主观听感知评估参数采用日本言语语音学会声音嘶哑评估GRBAS系统中的总嘶哑度，4级评估标准。结果除基频震颤和振幅震颤外，声学分析的基频微扰、振幅微扰、基频标准差、标准化噪声能量、谐噪比和信噪比的可靠性和敏感性高于电声门图。两种测试方法的基频、最大基频和最小基频基本一致。结论嗓音障碍的客观评估应选择声学分析参数。     

嗓音主观听感知评估稳定性的研究

目的 通过对嗓音质量主观听感知评估方法的标准化研究,探讨影响听评委评估结果稳定性的因素.方法 采用符合国际标准的录音设备对300例嗓音障碍患者和100例嗓音正常者进行录音,声音样本为话语声,6位来自不同医院的嗓音医学专家担任听评委,采用GRBAS嗓音评估系统中的总嘶哑度(grade,G)、粗糙声(rough,R)和气息声(breathy,B)作为评估参数.每位评委对3次不同排序嗓音样本的评估采用视觉模拟量表,结果取3次评估的平均值.采用改良分级量表将嗓音质量分为4级水平(0级正常,1级轻度障碍,2级中度障碍,3级重度障碍).采用κ值对评估结果的一致性进行统计学分析,采用回归分析探讨嗓音障碍程度对听评委评估稳定性的影响.结果 不管是评委之间还是评委自身都存在着评估结果的不一致性.评委自身的一致性均达到比较好、好、甚至非常好的水平,其中对参数G评估的一致性最好(κ值0.46～0.85),其次是参数R(κ值0.41～0.84),参数B相对较差(κ值0.41～0.81).评委之间的一致性相对较差,除去1位评委的一致性未达到要求而被剔除外,其他5位评委之间对参数G评估的一致性最好(κ值0.43～0.96),其次是参数R(κ值0.33～0.78),参数B的一致性最差(κ值0.002～0.45).听评委对正常嗓音和重度障碍评估的稳定性高于轻度障碍和中度障碍.结论 影响嗓音主观听感知评估稳定性的最主要因素是听评委之间的不一致性,不同评估参数和嗓音障碍程度影响听评委评估的稳定性.

Abstract：

Objective To explore the factors that influence the stability of evaluation results judged by a jury through a standard research on perceptual evaluation measurements of voice quality. Methods Voice samples from 300 patients with dysphonia and 100 control subjects with normal voice were recorded and assessed by a jury composed of 6 experienced listeners from different hospitals. The voice samples were discourse voices and ordered randomly 3 times, and the mean of 3 evaluations using visual analogue scale were the final results. The jury was instructed to classify voice samples according to the G ( grade) , R (rough) and B(breathy) components of the GRBAS scale on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. K value was used to analyze the concordance of evaluation results and regression analysis was used to research the effects of the extent of voice disorder to the stability of perceptual evaluation. Results The discordance of evaluation existed both between the jury and in listeners themselves. The concordance of listeners themselves of each evaluation parameter was not bad, good, or even very good, and the concordance of evaluation of G was the best (κ value: 0. 46 - 0. 85) , then R (κ value; 0.41 -0.84) and B(κ value: 0.41 -0.81). The concordance between the jury was worse than that in themselves. And except a listener whose concordance of evaluation was under the requirement, the concordance of evaluation of G was the best ( κ value: 0. 43 - 0. 96) , then R ( κ value: 0. 33 - 0. 78 ) and B ( κ value: 0. 002 - 0. 45 ). The stability of evaluation of normal voice and severe voice disorder was better than mild and moderate voice disorder. Conclusions The discordance between the jury was the main factor that influence the stability of perceptual evaluation. The evaluation parameters and extent of voice disorder will influence the stability of perceptual evaluation of the jury.     

嗓音主观评估中文测试文本的信度和效度研究

目的对已建立的嗓音主观评估中文测试文本进行信度和效度分析。方法随机选择以发声障碍就诊的患者196例(试验组),其中男92例,年龄22~75岁,平均45.6±10.3岁,女104例,年龄18~69岁,平均40.9±9.6岁;选择无嗓音障碍病史、无咽喉疾患、无吸烟饮酒史、喉镜检查声带无明显异常者24例作为对照组,其中男10例,年龄29~58岁,平均33.9±9.0岁,女14例,年龄23~71岁,平均38.0±12.4岁。对两组受试者的嗓音元音样本/a/进行声学分析,观察频率微扰、振幅微扰、信噪比、倒频谱峰值突出、关联维、二阶墒等指标,10名听评委通过已建立的主观评估中文测试文本对275例声音样本(包括55例重复样本)进行主观分析,信度分析包括评委自身稳定性及评委间一致性;效度分析为主观评估和声学分析的一致性,以及该测试文本对正常嗓音和病理嗓音的鉴别能力。结果评委自身稳定性较高,Pearson相关系数为0.687~0.748;评委间一致性较好,组内相关系数为0.589~0.685;主观分析结果与客观分析值显著相关(P<0.01);受试者操作特征曲线下面积为0.948~0.96,测试文本对正常及病理嗓音的鉴别力良好,相邻嗓音障碍等级的受试者其客观分析值差异有显著统计学意义(P<0.01)。结论所设计的主观评估中文测试文本具有较高的信度和效度,具有潜在临床应用价值。     

不同性别嗓音客观检测参数的对比分析

目的通过对比分析嗓音客观检测参数在性别中的差异性，指导嗓音多参数评估模型的建立。方法声样采自153例嗓音障碍患者和80名嗓音正常者。客观检测采用Dr．speech for windows嗓音评估软件，在长元音/α：／上检测下列参数：基频(F0)、基频微扰(jitter)、振幅微扰(shimmer)、基频标准差(F0SD)、最大基频、最小基频、标准化噪声能量(NNE)、谐噪比(HNR)、信噪比(SNR)和最大发声时间(MPT)。主观听感知评估参数采用日本言语语音学会声音嘶哑评估GRBAS系统中的总嘶哑度(grade，G)4级评估标准。结果参数F0、F0SD、最大基频、最小基频、NNE和MPT检测值在性别上有显著性差异，女性的F0、F0SD、最大基频、最小基频值高于男性，而男性的NNE和MFF值高于女性；参数jitter、shimmer、HNR和SNR的检测值在男女性之间无显著性差异。结论嗓音的客观检测参数存在性别上的差异；应按不同性别分别建立嗓音的客观多参数评估模式。     

嗓音主客观分析在嗓音疾病诊断中的应用

目的探讨嗓音主客观分析在嗓音疾病诊断中的应用。方法利用计算机嗓音声学分析系统及电声门图仪同步检测50例正常受试者、139例嗓音疾病患者(包括声带息肉73例、声带小结14例、慢性声带炎31例、声带囊肿10例、声带任克水肿11例)的嗓音声学分析与电声门图的参数值,并采用声音嘶哑评估标准GRBAS系统中的总嘶哑度G对所有受试者进行主观听感知评估。结果嗓音疾病组基频微扰(jitter)、振幅微扰(shim-mer)、标准化噪声能量(NNE)均较正常对照组增大,谐噪比(HNR)及信噪比(SNR)均较正常对照组减小,差异均有统计学意义(P<0.01);随主观听感知评估嗓音总嘶哑度加重,基频微扰、振幅微扰及NNE值逐渐增大,HNR和SNR值逐渐减少。结论嗓音客观分析参数与主观听感知评估具有一致性,客观评估能反映主观听觉印象。     

嗓音的客观多参数分析与主观听觉分析相关性的研究

目的 探讨嗓音的客观多参数检测与主观听觉评估的相关性,建立嗓音客观多参数评估模式,实现嗓音评估的客观化、数据化。方法 声音样本采自135例声音嘶哑患者和29例嗓音正常者。客观检测采用法国开发的“EVA”嗓音工作站,测试对象发长元音／a：／时,检测下列参数：基频(F0)、音强(intensity)、基频微扰(jitter)、信噪比(signal-to-noise ratio,SNR)、Lyapunov系数、口腔气流量(oral airflow,OAF)、音域(range)及最大发声时间(maximum phonalory time,MPT);发／pa/音时,检测声门下压(estimated subglottic pressure,ESGP)。主观听觉评估采用日本言语语音学会声音嘶哑评估GRBAS系统中的总嘶哑度(grade,G)4级评估标准。所有受试者以自然的音调及音强读一段统一的标准文字,听评委由4名嗓音学家组成。结果 应用判别分析方法,建立了7参数客观评估模式(音域、Lya-punov系数、声门下压、最大发声时间、口腔气流量、信噪比和基频)。客观评估结果与主观评估结果的一致性达到84％。结论 嗓音的客观检测是多参数的,客观评估能够反映出主观听觉印象。     

Acoustic and perceptual comparison of chronic and incipient spastic dysphonia

Vocal symptoms of patients with chronic and incipient spastic dysphonia were compared on a number of acoustic and perceptual parameters. Patients with incipient spastic dysphonia displayed less severe strain-strangle phonation, effort, rhythm, and stress. Harshness was the only perceptual parameter on which incipient spastic dysphonics were rated higher than chronic spastic dysphonics. Changes in the acoustic measures of laryngealization, harmonic change, mean vowel duration, and duration ratio between stressed and unstressed vowels accompanied changes in listeners' perception of strain-strangle phonation and effort. The variation in acoustic characteristics such as laryngealization and harmonic change as well as normal phonation indicated that both groups were characterized by a variety of phonatory modes.     

Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia

OBJECTIVES: Adductor spasmodic dysphonia (ADSD) has been characterized as a "task specific" laryngeal dystonia, meaning that the severity of dysphonia varies depending on the demands of the vocal task. Voice produced in connected speech as compared with sustained vowels is said to provoke more frequent and severe laryngeal spasms. This study examined the diagnostic value of "task specificity" as a marker of ADSD and its potential to differentiate ADSD from muscle tension dysphonia (MTD), a functional voice disorder that can often masquerade as ADSD. STUDY DESIGN: Case-control study. METHODS: Five listeners, blinded to the purpose of the study, used a 10 cm visual analogue scale to rate dysphonia severity of subjects with ADSD (n = 36) and MTD (n = 45) producing either connected speech or a sustained vowel "ah."RESULTS: In ADSD, dysphonia severity for connected speech (M = 6.22 cm, SD = 2.56) was rated significantly more severe than sustained vowel productions (M = 4.8 cm, SD = 2.8 [t (35) = 3.67, P < .001]). In MTD, however, no significant difference in severity was observed for the connected speech sample (M = 5.98 cm, SD = 2.83 versus the sustained vowel M = 5.86 cm, SD = 2.87 [t (44) = 0.378, P = .707]). The receiver operating characteristic (ROC) curve, an index of the accuracy of task specificity as a diagnostic marker, revealed that a 1 cm difference criterion correctly identified 53% of ADSD cases (sensitivity) and 76% of MTD cases (specificity) (chi2 (1) = 6.88, P = .0087). CONCLUSIONS: Reduced dysphonia severity during sustained vowels supports task specificity in ADSD but not MTD and highlights a valuable diagnostic marker whose recognition should contribute to improved diagnostic precision.     

Análisis cepstral de la voz normal y patológica en adultos españoles. Medida de la prominencia del pico cepstral suavizado en vocales sostenidas versus habla conectada

Introduction and objectives

In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia.

内收型痉挛性发音障碍的语音特征

目的 探讨内收型痉挛性发音障碍的语音特征.方法 采用嗓音和语音的声信号和三维语图分析及主观评价的方法对1O例内收型痉挛性发音障碍患者(女7例,男3例)的语音特征与10例健康志愿者(男5例,女5例)进行对比.结果 内收型痉挛性发音障碍主要表现为音质、音韵及语音的流畅性改变,在朗读文章时出现紧张性发音困难,语音颤抖,频率及响度瞬间起伏,嗓音挤卡、中断,语音延长,失去正常韵律.10例患者中表现为轻度障碍者(异常音节数<25%)1例,中度障碍(异常音节数占25%～49%)6例,重度(异常音节数占50%～74%)1例,极重度(异常音节数≥75%)2例.10例患者朗读时间中位数为49 S,声信号中间断出现无音区,无音比率中位数为42%;而健康对照组朗读时间中位数为30 S,无声音中断.在三维语图中不同的患者在各自症状音节中可以看到嗓音起始时间延长,元音共振峰不规则、断裂甚至消失,症状音节的辅音缺失,或塞擦音的擦音成分延长等.结论 内收型痉挛性发音障碍语音特征为音质、音韵及语音的流畅性改变,在症状音节的三维语图中可以看到相应的元音或辅音音素的特征性改变.     

Effect of vowel type on reliability of nasality ratings

This study investigated the effects of high front (HF) vowels and low back (LB) vowels on inter-listener and intra-listener reliability in rating hypernasality. Audio recorded samples of two sentences, one containing only high front vowels and one containing only low back vowels, were judged by two expert listeners. Speakers were 25 children; 20 hypernasal and 5 with normal resonance. The inter-listener ratings for LB samples were more similar than the inter-listener ratings for HF samples (t = 3.20, (24), p = .004). The mean difference between the two listeners’ ratings for the LB samples was 46.32 (S.D. 49.66) and for the HF samples 85.39 (S.D. 85.81). For intra-listener reliability, the ratings for the LB vowels were significantly more similar for one listener but not for the other. Additionally, the HF samples were rated as significantly more nasal than the LB samples. These findings suggest that listener reliability can be influenced by the vowel content of the stimulus.

Learning outcomes: As a result of this activity, the participant will be able to (1) describe the general effects of phonemes on judgments of hypernasality; (2) describe the specific effects of vowel types on the reliability of inter-listener and intra-listener judgments of nasality; and (3) appreciate how this information might be used in clinical and research applications.     

极重度听障儿童单元音共振峰测量及分析

目的 探讨3～6岁极重度听障儿童单元音共振峰的平均值与健听儿童的差异,为指导听障儿童的语言康复训练提供参考.方法 使用语音工作站采样分析,让10名3～6岁的极重度听障儿童在自然舒适状态下发/a/、/o/、/e/、/i/、/u/、/ü/6个元音,每个音持续3 s以上,并截取各声样中的3 s平稳段进行声学参数的检测和分析.同时,与同年龄段健听儿童的数据做对照.结果 听障组6个单元音的3个共振峰与健听组相比较,所有元音的F1无显著性差异(P＞0.05);元音/o/和/u/的F2无显著性差异(P＞0.05),其余各元音的F2有显著性差异(P＜0.05);所有元音的F3都有显著性差异(P＜0.05).结论 极重度听障儿童的单元音共振峰与健听儿童有差异,这可能是引起听障儿童发这些元音不清楚的原因之一.     

Clinical significance of calculating the coefficients of Lyapunov in the objective assessment of dysphonia

Measurement of the vibration instability by means of jitter in cases of dysphonia fails to take into account certain features of the vocal signal, such as modulation or bitonatily. These abnormalities appear in jitter measurements as instability, without allowing any differentiation from random instability (to give 'true' instability). The authors suggest the use of the coefficient of Lyapunov, a measurement which is used for nonlinear dynamics. The vocal product of 179 normal and dysphonic subjects has been analysed. The coefficient of Lyapunov and the jitter were measured during the stable period of a sustained 'a' vowel. For the coefficient of Lyapunov, the authors used the algorythm which has been published previously [Giovanni et al, J. Voice 1999;13:341-354]. The measurements were compared with the perceptive analysis of the reading voice by a panel, and divided into four grade (G0 to G3). The coefficient of Lyapunov appeared to be more relevant than the jitter in distinguishing the various perceived grades. Precise recognition of the grade was obtained in 46% using the coefficient of Lyapunov as against only 36% using jitter. The addition of this new index to the existing puriparametric methods of voice analysis seems to be promising.