腭咽闭合功能不全语音清晰度评价

目的　研究腭咽闭合功能不全患者的语音清晰度。方法　 10 0例腭咽闭合功能不全患者 ,其中 15例为腭裂 ,2 1例为先天性腭咽闭合不全 ,5 6例为腭裂术后腭咽闭合不全 ,8例为咽成形术后腭咽闭合不全 ,对照组为 32名健康人。 3名语音专业人员共同评价汉语语音清晰度 ,并且分析语音障碍和语音清晰度的关系。结果　健康组的语音清晰度为 99 0 % ,腭咽闭合功能不全组为35 5 % ,其中未手术腭裂组为 19 9% ,先天性腭咽闭合不全为 32 8% ,腭裂术后腭咽闭合不全为4 0 3% ,咽成形术后腭咽闭合不全为 35 2 % ,统计分析显示健康组和病例组各类型之间差异有显著性 (P <0 0 1)。结论　①腭咽闭合功能不全异常语音的语音清晰度差 ,并伴过度鼻音 ;②腭咽闭合不全异常语音中 ,腭裂患者的语音清晰度最低 ,其余依次为先天性腭咽闭合不全、咽成形术后腭咽闭合不全和腭裂术后腭咽闭合不全     

腭裂术后腭咽闭合功能不全患者辅音声学特点的研究

目的：研究腭裂术后腭咽闭合不全患者辅音的声学特点。方法：66例腭裂术后腭咽闭合不全（velopharyngeal incompetence VPI）患者，男36例，女30例；年龄13～32岁，平均年龄17．79岁；不完全性腭裂22例．单侧完全性腭裂35例，双侧完全性腭裂9例。手术史为3～15a。对照组为正常语音、能熟练掌握普通话的在校大学生35例，均为上海人，其中男15例，女20例；年龄20～22岁，平均年龄20．43岁。被检音为／da／、／bo／、/ge／、／ji／、/ku／、／qn／。被检者取坐位，自然放松，距麦克风5cm，练习被检音后，直接输入计算机语音分析系统（CSIA400。美国KAY公司）。测量指标包括音节音长（Dur）、辅音音长（CD）、元音音长（VD）、嗓音起始时间（VOT）、第1强频区（VF1）、第2强频区（VF2）、第3强频区（VF3）、辅音音强（CE）、元音音强（VE）和声母音长比（RDCD）。用SPSS 11．5对数据进行t检验。结果：病例组的Dur、VD、VOT和CE与对照组相比有显著性差异（P〈0．05）。送气音的VF1、VF2和VF3与对照组相比有显著性差异（P〈0．05）。其语图特点为：无冲直条和乱纹或冲直条和乱纹的减少；VOT缩短、消失或变为负值：部分辅音缺如或被其他辅音取代。结论：VP1患者辅音的VOT较对照组明显降低，其强频区分布异常，能量衰减。语图有2大特点：辅音脱落或弱化，清音浊化。     

先天性腭咽闭合功能不全的语音清晰度评价

目的:本研究通过检测51例先天性腭咽闭合功能不全(CVPI)患者的语音清晰度,评定其异常语音的严重 程度,为其诊断提供重要的信息,也为其治疗计划的制定和估计预后提供了重要的依据。方法:由三名经验丰富 的语音病理师,按汉语语音清晰度测试字表对51例CVPI患者行语音清晰度的审听,并对其语音的严重程度进行 分类,将其结果同56例腭裂术后VPI患者,15例腭裂患者及30例正常者进行对照比较。结果:用汉语语音清晰 度测试字表,51例CVPI患者的语音清晰度均值为31.3％,其中43.1％为中度语音障碍,52.90k,为重度。结论:通 过上述研究方法可知CVPI虽没有明显的腭咽腔解剖异常,但其语音障碍程度主要集中在中度到重度,对改善其语 音所需的时间显然长,困难大。     

腭裂术后腭咽闭合不全患者异常语音的声学特点研究

目的 :研究腭咽闭合不全(velopharyngeal incompetence,VPI)患者异常语音的声学特点,定量分析特定语句,探索其发音规律。方法:选择66例腭裂术后VPI患者和35名正常人为研究对象,选取跑跑跳跳,宝宝最喜欢吃葡萄和明天他到街上去买冰糖为特定语句。在安静环境下,按照规范流程录音,使用计算机语音分析系统,分别测定其音长、基频、音强和停顿时长,并观察其语图的特点。结果:VPI患者语句的声调模式与对照组类似,音强模式与正常组有一定的差别,停顿次数和长度均大于对照组(P<0.05),语图共振峰模糊,各音节较孤立,停顿多。结论:VPI患者语句的流畅性较差,易停顿,其声调模式无异常,音强模式与对照组有一定的差别。     

先天性腭咽闭合不全的腭咽闭合状态及语音特点分析

目的研究先天性腭咽闭合不全（CVPI）患者的腭咽闭合模式、腭咽口各部分收缩情况及语音特点。方法回顾2009—2017年于四川大学华西口腔医院唇腭裂外科就诊的CVPI患者的病历资料，分析其共鸣状况、辅音构音表现及辅音正确率，采用鼻咽内镜观察患者的腭咽闭合模式以及软腭、咽侧壁和咽后壁的运动情况。结果共纳入47例CVPI患者，均接受了鼻咽内镜检查，29例（61.7%）为环状闭合，16例（34.0%）为冠状闭合，2例（4.3%）为矢状闭合；25例（53.2%）患者软腭动度中度，占比最高；22例（46.8%）患者咽侧壁动度弱，41例（87.2%）患者咽后壁无动度。所有患者均有不同程度的高鼻音表现，其中23例（48.9%）为中度高鼻音，占比最高。47例患者中5例（10.6%）构音正常，42例（89.4%）存在不同程度构音障碍。不同构音方法正确率的高低排序为：鼻辅音>边音>擦音>塞音>塞擦音。不同构音位置正确率的高低排序为：唇音>舌前音>舌后音>舌面音。结论环状闭合是CVPI患者最主要的腭咽闭合模式，辅音省略是最常见的构音障碍。     

先天性腭咽闭合功能不全和过度鼻音的研究

目的 对先天性腭咽闭合功能不合（ｃｏｎｇｅｎｉｔａｌ ｖｅｌｏｐｈａｒｙｎｇｅａｌ ｉｎｓｕｆｆｅｎｃｅ,ＣＶＰＩ）定量研究。方法 应用气流、气压测定仪对２７例ＣＶＰＩ患者测量口腔压力、鼻腔气流及腭咽闭合面积,比较ＣＶＰＩ患者在发ｈｅｍｐｅｒ和ｐａｐａ音时与正常语音者之间的变化值。结果 ＣＶＰＩ和正常语音两组间在口腔压力和腭咽闭合面积差异无显著性,但两组间的鼻腔气流量差异有显著性（Ｐ〈０．０７）。     

腭咽闭合功能不全的诊断与治疗

<正> 腭咽闭合功能不全(下简称VPI)是腭裂术后患者中最常见造成语音障碍或异常语音的原因,他常常与不良发音习惯相依为伴。纵观同内外学者的文献报道,尽管对腭裂患者的手术年龄有所提前,手术操作技能和全身麻醉的药物,术中和术后的监测仪器都有不断地改进和创新,但腭裂术后仍有5％～44％的患者出现腭咽闭合功能不全。换而言     

腭咽闭合不全患者异常声学特点的分析研究

目的:应用VS99-CSL计算机语音声学频谱分析评估系统对病理性语音中的部分元音、辅音音频语图特点进一步分析研究,给予先天性腭咽闭合不全的诊断与治疗提供理论及临床支持。方法:采集单纯性先天腭咽闭合不全患者22例。评估咽成形术后及腭裂术后26例,上述患者针对咽腔情况视诊、blowing test测验及雾镜实验测试综合分析,对较难判断的病例可结合CT进行诊断,单元音:[a、o、e、i、ü]辅音;擦音[s、x]、塞擦[z、j、c、q]实施语音评估对其单元音共振峰和额外共振峰及辅音和元音节的频谱特点进行分析、同时比较各组空白间隙、冲直条、噪音乱纹的出现率,并设定正常对照组。结果:比较发现[a]的共振峰普遍残缺,而[iü]会出现额外附加共振峰,其共振峰均值F1咽成形术后较高,先天性腭咽闭合不全则低。擦音[s、x]、塞擦音[z、j、c、q]实施语图对频谱特点进行分析、同时比较各组空白间隙、冲直条、噪音乱纹的出现频率,嗓音起始时间(voice onsettime,VOT)以及语音清晰度,P<0.01说明正常对照组与病例组有显著性差异。结论:CSAS能客观评价腭咽闭合不全,其获得的语图及相关物理声学参量对腭咽闭合不全临床治诊疗提供理论依据。     

语音训练对改善轻度腭咽闭合不全患者发音的研究

目的研究语音训练对轻度腭咽闭合不全（VPI）患者发音的影响。方法选择经咽腔造影检查显示的腭咽部间隙为1～5 mm并且经语音评估诊断为轻度VPI的患者30例设为VPI组,均为在四川大学华西口腔医院唇腭裂外科行腭帆提肌重建术的非综合征型腭裂复诊患者,均于术后进行了3～6个月的语音训练。采用VS-99语音频谱分析系统测定患者在语音训练前和训练后发［i］音时第2、3共振峰的数值F2、F3,并与30例对照组（C组）的测定结果进行比较。结果VPI组语音训练前的F2、F3分别为（1 958.95±431.40）、（3 059.84±330.09）Hz,训练后分别为（2 322.95±213.02）、（3 293.84±215.08）Hz;C组的F2、F3分别为（2 430.47±223.05）、（3 345.97±180.83）Hz。VPI组语音训练前与C组的差异有统计学意义（P<0.05）,语音训练后与C组的差异无统计学意义（P＞0.05）;语音训练前后VPI组组内比较的差异有统计学意义（P<0.05）,语音训练后高于训练前。结论对于年龄很大才进行腭裂修复的患者,建议术后先实施语音训练,能显著改善腭咽闭合不全,有可能避免再次手术。     

语音辅助器(Speed-Aid)治疗腭咽闭合不全的临床应用研究

目的 探讨S-A治疗腭咽闭合不全（VPI）的临床应用价值。方法 应用纤维鼻咽内窥镜及鼻咽腔造影X线侧位片评价腭咽闭合功能改善程度,应用汉语语音字表评价治疗前后的语音变化,并以鼻咽腔造影X线侧位片来确定咽塞的放置位置。结果13例VPI患者接受S-A治疗,治疗后VPI均得到满意的矫正。结论1.S-A是一种有效矫正VPI的治疗手段;2.S-A治疗后语音有所改善,正常的语音恢复还需进一步的语音治疗。     

大龄腭裂患者术前辅音构音特点的初步研究

目的 研究大龄腭裂患者术前的辅音构音状态。方法 选择8岁以上腭裂一期患者100例,评估其辅音构音,并从构音方法、构音位置等角度分析各辅音的正确率、错误类型及其发生率。结果 100例患者中,14例（14%）患者辅音构音正常,86例（86%）患者存在不同程度的构音障碍,其中66例（66%）患者有代偿性构音。按照构音方法比较,构音正确率高低排序为鼻辅音、边音、擦音、塞音、塞擦音,塞音和塞擦音的错误类型均以代偿常见;按照构音位置比较,构音正确率高低排序为唇音、舌前音、舌面音、舌根音。结论 代偿、省略和替代依次为大龄腭裂患者最常见的构音错误,可发生在所有的塞音、擦音和塞擦音;送气音正确率高于不送气音;送气音最常见错误为代偿性错误,不送气音更容易省略和弱化;弱化现象集中在不送气辅音。擦音和塞音随发音位置后移代偿性错误加重,塞擦音随位置后移省略性错误增加。     

全口义齿初戴前后辅音的声学分析

目的：研究全口义齿初戴前后辅音的音声特征。方法：应用计算机语音分析系统测量30例全牙列缺失患在全口义齿初戴前、初戴时、初戴后1周、2周、4周、8周时，／zi、／ji／的F1、F3值。结果：F1值大多在义齿初戴后逐渐降低，F3值在两组变化趋势不同。结论：减少全口义齿基托厚度，重建腭皱形态有助于牙列缺失患语音功能的恢复，计算机语音分析系统可对全口义齿初戴前后患语音变化特征进行定量分析，对临床修复有较好的指导意义。     

A cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation

Five patients who displayed both glottal stop compensations and normal articulatory placement and production during connected speech and also had weak pressure articulatory consonants and hypernasal resonance had cineradiographic study of their velopharyngeal movements. The results showed that velopharyngeal movements were impaired during weak pressure consonants whereas velopharyngeal valving was maximal when articulation was not impaired. Velopharyngeal movements were the worst when glottal stop substitutions were produced. Poor quality or absence of velopharyngeal movements in connection with deviant articulation could be erroneously interpreted as weakness or incapability of motor activity if nondeviant articulation is not observed in individual patients.     

学龄前期与大龄腭裂患者术前辅音构音位置特点的比较研究

目的：通过对腭裂患者术前辅音状况的主观判听,对比分析学龄前期与大龄腭裂患者术前辅音构音特点,为其术后语音治疗提供更为明确的治疗方案方法将腭裂患者按照年龄分为学龄前组（4~7岁）和大龄（8~18岁）各40例,利用主观判听对音节、词组和句子进行判听评估,交叉对比分析在不同构音位置上辅音的正确率、错误类型的发生率有无差异。结果两组腭裂患者在舌尖音、舌面音、舌根音、双唇音及唇齿音的发音正确率上均有差异;除舌根音,两组腭裂患者的代偿错误率在其他构音位置均无差异;两组腭裂患者在舌尖音、舌面音及舌根音的构音位置上,省略错误率均有差异,而在双唇音及唇齿音上无差异。结论学龄前期与大龄腭裂患者术前的辅音发音情况在不同构音位置的正确率与构音障碍的发生率上存在差异,因此对预测术后的语音状况恢复有指导性作用,在进行术后语音训练时,有目的地制定不同的训练计划,使患者得到更有针对性语音训练。     

Factors affecting articulation skills in children with velocardiofacial syndrome and children with cleft palate or velopharyngeal dysfunction: a preliminary report.

OBJECTIVE: To examine the influence of speech perception, cognition, and implicit phonological learning on articulation skills of children with velocardiofacial syndrome (VCFS) and children with cleft palate or velopharyngeal dysfunction (VPD). DESIGN: Cross-sectional group experimental design. PARTICIPANTS: Eight children with VCFS and five children with nonsyndromic cleft palate or VPD. METHODS AND MEASURES: All children participated in a phonetic inventory task, speech perception task, implicit priming nonword repetition task, conversational sample, nonverbal intelligence test, and hearing screening. Speech tasks were scored for percentage of phonemes correctly produced. Group differences and relations among measures were examined using nonparametric statistics. RESULTS: Children in the VCFS group demonstrated significantly poorer articulation skills and lower standard scores of nonverbal intelligence compared with the children with cleft palate or VPD. There were no significant group differences in speech perception skills. For the implicit priming task, both groups of children were more accurate in producing primed nonwords than unprimed nonwords. Nonverbal intelligence and severity of velopharyngeal inadequacy for speech were correlated with articulation skills. CONCLUSIONS: In this study, children with VCFS had poorer articulation skills compared with children with cleft palate or VPD. Articulation difficulties seen in the children with VCFS did not appear to be associated with speech perception skills or the ability to learn new phonological representations. Future research should continue to examine relationships between articulation, cognition, and velopharyngeal dysfunction in a larger sample of children with cleft palate and VCFS.     

Speech with maxillary implant prostheses: ratings of articulation

Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French language speech battery were recorded after each prosthesis had been worn for two months. The percentages of stops, fricatives, and vowels correctly perceived by lay judges were calculated. Subjects produced a significantly higher percentage of sounds correctly with overdentures than with fixed prostheses. Between-treatment differences were significant for stops and fricatives (p < 0.01), but not for vowels. There were no significant differences in error rates between the two overdentures. In conclusion, maxillary implant overdentures with and without palates enable patients to produce more intelligible speech than fixed prostheses.     

Longitudinal evaluation of articulation and velopharyngeal competence of patients with pharyngeal flaps

In this study, 129 patients with cleft palate who had pharyngeal flaps were evaluated longitudinally. Articulation scores improved approximately 15 percent following surgery, and by age 16 the majority of subjects achieved velopharyngeal competence and 90 percent correct articulation. The findings also demonstrated that the risk of requiring secondary management increased with the severity of the cleft. In addition, a higher percentage of patients who had received a primary Von Langenbeck procedure required secondary management than did patients who had the Wardill primary palatoplasty. Age at time of the pharyngeal flap operation did not emerge as a critical factor in speech outcome.     

腭裂患者喉塞音的声学特征初探

目的:探讨腭裂患者喉塞音的声学特征。方法:检测存在病理性喉塞音的男性腭裂患儿及正常男性儿童各20名发含口塞音的语句时的语图,观察患者喉塞音声学特征并与正常对照组相比较。结果:腭裂患者喉塞音出现与原塞音的伴随情况不同,可以表现出包括冲直条、嗓音起始时间(VOT)、共振峰转接、冲直条频谱等各种声学指标的异常。结论:塞音的声学特征复杂,应该结合语图形态及各参数的数值共同诊断。     

Speech adaptation: an aerodynamic study of adults with a childhood history of articulation defects

Three groups of subjects were studied; former lispers, persons with a history of /l/ or /r/ distortion, and normal subjects with no history of speech defects. All were normal-sounding adult speakers of English at the time of participation. Subjects were asked to wear an experimental removable dental prosthesis that provided 4 mm of thickness in the alveolar region. Measurements of oral air flow and intraoral pressure during the reading of sentence material were made, with the focus on the consonants /s/ and /t/. The sibilant /s/ was experienced as the greatest problem for speech adaptation, regardless of the type of former articulation defect. Both groups of subjects with a history of articulation defects showed evidence of slower adaptation and use of compensatory strategies for /s/. They tended as a group to have the same minimum airflow values for /s/ after 2 weeks of practice speaking with the prosthesis as after 1 day of practice. Aerodynamic calculation of the size of the constriction for /s/ also showed little or no change for most of the former speech-defective subjects. Evidence based on intraoral pressure indicated that particular effort was expended for /s/ even after 2 weeks of practice in speaking with the prosthesis.