用声不当或过度致发声障碍的基础与临床研究

用声不当或过度可引起发声器官的病理改变，导致发声障碍。近年来随着社会发展，人类交往增多，尤其职业用声人群的增加，此类患者有逐年增多趋势。这类疾病常以慢性单纯性及肥厚性喉炎、声带小结、声带息肉为多见。据木下等(1978)报告，声带小结和声带息肉有过度用声史者占45％。国外有学者对898名教师进行嗓音调查分析，结果显示慢性喉炎(包括慢性单纯性喉炎、慢性肥厚性喉炎、声带小结、声带息肉)共270例，占30．07％。而国内类似的调查发现仅声带小结、声带息肉患者占所有被调查者的42．59％。可见用声不当或过度与声带慢性炎症的发生有密切关系。本文综述该类发声障碍的基础与临床研究进展，为探讨其病因、发病机理及进行有效治疗提供参考依据。     

中西医结合治疗肥厚性喉炎的声学检测

过度用嗓及用嗓不当,特别是嗓音病变的早期,得不到合理的休息和治疗,使嗓音病发病率越来越高,严重影响他们的正常工作[1].嗓音疾病的防治在我国日益受到重视.这类疾病常以慢性喉炎、声带小结、声带息肉为多见.我们这次选择对肥厚性喉炎(hypertrophic laryngitis)进行中西医结合治疗,并利用嗓音声学分析进行治疗结果分析.现报告如下.     

喉良性增生性病变的嗓音学特点及治疗转归

目的 :探讨喉良性增生性病变对发声功能的影响及CO2 激光显微外科术后的转归特点。方法 :对2 92例喉良性增生性病变患者 (声带息肉、任克水肿、声带小结、囊肿、慢性肥厚性喉炎 )的流行病学、嗓音声学、形态及CO2 激光显微外科术后转归进行分析。结果 :声带小结患者均为青年女性 ,2 3.0 8%与职业有关 ;任克水肿为中老年患者。声带息肉及小结病变局限 ,手术仅涉及声带局部 ,术后改善明显 ,术后 1个月达正常状态 ;任克水肿患者术后 1个月改善明显 ,术后 3个月恢复最佳稳定 ;声带囊肿患者术后 1个月声音达最佳状态 ,但由于病变切除术后局部存在缺损 ,一定程度上影响预后 ;慢性肥厚性喉炎患者术后改善不满意。术后声门上代偿纠正均不明显。结论 :喉良性增生性病变主要累及声带被覆层 ,嗓音声障碍的程度及疗效与受累范围有关 ,激光显微外科手术可以保留良好结构及功能。除外科治疗外 ,还应及时矫正不良发声习惯等因素 ,以期获得最佳疗效。     

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。     

4668例声嘶儿童电子鼻咽喉镜检查结果分析

目的：探讨儿童声嘶的病因及临床特点。方法回顾性分析4668例以声嘶为主诉儿童的电子鼻咽喉镜检查结果,分析导致本组儿童声嘶的主要病因及不同年龄段患儿声嘶病因的分布。结果4668例声嘶儿童发病年龄以2～10岁为主,占65．81％（3072/4668）,男性多见,男：女为2．48：1;其中,慢性单纯性喉炎1817例（38．92％）,声带小结1494例（32．01％）,慢性肥厚性喉炎560例（12．0％）,声带麻痹373例（8．0％）,先天性声带沟149例（3．19％）,喉乳头状瘤140例（3．0％）,这6种疾病占总人数的97．1％（4533/4668）;声带麻痹在＜0．5岁组中所占比例最高（97．0％,289/298）,喉乳头状瘤在0．5～2岁组中比例最高（33．9％,134/395）,慢性单纯性喉炎在4～6岁组中比例最高（81．0％,611/754）,声带小结在8～10岁组中比例最高（51．4％,374/727）。结论本组儿童声嘶的发病年龄以学龄前期及学龄期为主,男性明显高于女性;慢性单纯性喉炎发病比例最高,声带麻痹和喉乳头状瘤分别在婴儿组和幼儿组多见,声带小结在学龄儿童组中比例最高。     

人体转移因子穴位封闭治疗慢性咽喉炎初探

人体转移因子（TF）是近10多年来发展的一种新的免等调节剂与促进剂．国内已广泛应用于临床．在烟、喉疾病中的应用亦早有报道．均采用直接喷于患处或滴于喉腔之方法。本科曾采用这种方法治疗，其疗效不尽如意，且药物浪费大．我科自1989年以来，采用人体转移因于穴位封闭治疗慢性咽炎，慢性喉炎共32例，随访18例，获较好疗效，现报告如下：一、临床资料1‘慢性咽炎17例。没住咽喉炎8例。慢性候炎7例，（声带无小结，息肉等其他病变）．2病程均在半年以上，均经多种治疗（中西药物，多种理疗、针灸等）无效．3．年龄在20～55岁．二、治疗方…     

声带良性增生性病变行声带整复术前后的声学检测

近年 ,我科对声带良性增生性病变施行声带整复术 ,在手术前后进行嗓音声学分析检测 ,观察术后嗓音恢复情况 ,旨在对声带整复术治疗声带良性病变、恢复嗓音功能方面疗效评价提供客观依据。1　资料与方法1.1　测试对象经临床确诊的声带良性增生性病变患者共 4 0例 ,男 2 6例 ,女 14例 ,年龄 19～ 5 2岁 ,平均 36 .7± 8.7岁。其中带蒂或较小声带息肉 2 6例 (A组 ) ,单侧 18例 ,双侧 7例。广基声带息肉 (B组 ) 8例 ,单侧 2例 ,双侧 6例。声带小结 (C)组 3例 ,肥厚性喉炎 (D组 ) 3例。全部病例均在表面麻醉下行纤维喉镜检查 ,记录声带病变形态…     

动态喉镜记波图对声带病变的分析

目的 探讨声带不同病变的动态喉镜记波图的特点.方法 对正常声带、声带小结、声带息肉、慢性喉炎、声带白斑、声带癌患者各10例行动态喉镜检查、录像,选择声带的前、中、后1/3作为观察位点,导出记波图,计算开放商、速度商、相位对称指数(PAI),同时观察记波图特征.结果 不同的声带病变均能利用动态喉镜记波图计算出开放商、速度商、相位对称指数,不同病变其记波图表现不同.正常声带振幅相位一致,侧峰角较锐利,声带上、下缘平滑;声带小结声带振幅对称,相位一致,侧峰角较正常变钝,小结前后开放相延长,小结处开放相缩短;声带息肉声带病变前后振动的开放相延长,而病变处明显缩短;慢性喉炎声带中1/3开放相较其他组延长,双侧声带振动相位基本对称;声带白斑病变处振幅减小,侧峰角度变钝;声带癌病变声带各段振动不对称.结论 动态喉镜记波图可以对动态喉镜图像进行进一步观察、分析,并可以对某些指标进行定量分析.     

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.     

声带粘膜下吸切术并注射疗法治疗声带息肉及小结

随着微创外科手术的发展 ,我科近 2年来采用硬管鼻内窥镜加全套视频控制系统 ,声带粘膜下吸切病变组织并注射康宁克通 -Ａ治疗声带小结及声带广基型息肉共 32例 ,疗效满意。现报告如下。1　资料与方法1.1　临床资料　本组 32例中 ,男 14例 ,女 18例 ;年龄 2 0～4 6岁 ,平均年龄 37岁。病程 2个月～ 5年。其中声带小结 2 0例 (均为双侧水肿型 ) ,声带广基型息肉 12例 (单侧 8例 ,双侧4例 )。选择病例为声带早期病变或以声带水肿为主的病变。主要症状为反复声嘶 ,逐渐加重 ,讲话不能持久 ,易疲劳。1.2　手术方法　患者仰卧位 ,在全麻下经鼻气…     

Influence of Size and Etiology of Glottal Gap in Glottic Incompetence Dysphonia

This study investigates the relationship between glottal gap and vocal function in patients with glottic incompetence dysphonia. Twenty patients with vocal fold paralysis (VFP), 17 patients with vocal fold atrophy (VFA), and five patients with sulcus vocalis (SV) were examined. Glottal gap area at the most closed point of vibration was measured using digitized videostroboscopic images. Glottal gap area was correlated with acoustic and aerodynamic measures of vocal function. Patients with VFP had the largest glottal gaps and had significantly worse vocal function than did the patients with VFA or SV. Regardless of groups, however, where glottal gap size was similar, there was no difference in vocal function. Therefore vocal function was mainly influenced by glottal gap size, not by whether glottic incompetence was the result of VFP, VFA, or SV.     

声带息肉与声带小结患者发声空气动力学研究

目的探讨声带息肉、声带小结患者发声时空气动力学指标的变化。方法采用嗓音功能分析仪（Aerophone II Voice Function Analyzer）对30例声带息肉、28例声带小结患者及30例正常人进行发声空气动力学检测,对平均气流率（mean airflow rate）、口腔压（intraoral pressure）、声门阻力（glottal resistance）、声门效率（glottal efficiency）进行分析、比较。结果声带息肉、声带小结患者的平均气流率、声门阻力、声门效率分别为254．50±36．02ml／s、33．55±4．63cmH2O／（L·S）、2．46±1．49和177．45±25．93ml／s、38．83±8．88cmH20／（L·S）、7．75±3．71,与正常人118．44±29．98ml／s、53．04±8．64cmH2O／（L·S）、9．17±3．87比较,差异有统计学意义（P〈0．01）;声带息肉患者声门下压力为8．97±1．36cmH2O,与正常人6．24±0．99cmH2O比较,差异有统计学意义（P〈0．01）;声带息肉与声带小结患者平均气流率、声门下压力和声门效率比较,差异有显著统计学意义（P〈0．01）。结论声带息肉患者的声门闭合程度、发声时的效率比声带小结患者更差,空气动力学检测可以对声带息肉、声带小结患者的嗓音功能作出量化的、客观的评价。     

纤维内镜检查儿童鼻咽喉疾病

目的探讨纤维内镜检查在儿童鼻咽喉疾病诊断中的意义。方法在表面麻醉下应用纤维内镜检查1112例患鼻咽喉疾病儿童。结果1112例患儿中,患腺样体中、重度肥大者702例,占63.13%;患慢性鼻窦炎、鼻息肉者59例,占5.31%;患喉部疾病者257例,占23.11%,以患声带小结和喉炎者为主,分别为132例(11.87%)和102例(9.17%),其次为声带息肉8例(0.72%)。结论儿童声嘶最常见的病因为慢性喉炎和声带小结,其次为声带息肉。纤维内镜检查能立体地展示儿童鼻咽部腺样体的大小,突入鼻腔或阻塞后鼻孔的程度。纤维内镜检查在诊断儿童鼻咽喉疾病中有积极的作用。     

喉内显微电离子手术治疗声带良性赘生物

目的探讨电离子手术治疗声带良性赘生物的效果。方法在局麻支撑喉镜下利用电离子治疗仪,对55例声带小结和息肉等良性病变进行治疗,并利用频闪喉镜和声学的主客观评价进行手术前后比较。结果所有良性病变均完整切除,频闪喉镜术后观察声带运动的对称性、规则性、振幅,闭合状态、粘膜波动五项指标较术前明显改善（P＜0．05或P＜0．01）。术后心理听觉评价,粗糙型、气息型声嘶者均较术前明显改善（P＜0．05）。最长发声时间均技术前显著延长（P＜0．05）。结论喉内显微电离子手术治疗声带良性病变,效果良好,值得推广使用。     

Clinical applicability of the Ljubljana classification of epithelial hyperplastic laryngeal lesions

The diagnosis, prognosis, and choice of treatment of various laryngeal lesions depends almost entirely on the interpretation of changes in the covering epithelium. These abnormalities, referred to as epithelial hyperplastic laryngeal lesions, have been graded according to the Ljubljana classification into simple, abnormal and atypical (risky epithelium) hyperplasia and carcinoma in situ. The aim of this study was to evaluate the clinical applicability and prognostic value of this classification and to determine the incidence of malignant transformation. A retrospective clinical-pathological analysis was performed in a series of 4167 patients with 4574 biopsies, treated from 1979 to 1994. Simple (benign prickle cell) hyperplasia was the predominant grade in nodules, polyps, Reinke's oedema, granulomas, and papillomas, accounting for 37.6-68.6% of cases. In chronic laryngitis, abnormal (benign basal cell) hyperplasia was predominant with 43.9% of cases. Atypical ('risky') hyperplasia was observed almost exclusively in patients with chronic laryngitis (16.1%) and papillomas (10.1%), and only exceptionally in patients with vocal cord nodules (0.9%) and Reinke's oedema (0.3%). The percentage of malignant transformation in atypical hyperplasia was 11.6% (13/112 patients in 2-12 years), while in simple and abnormal hyperplasia, it was 0.3% (8/2920 patients in 1.5-11 years). The data support the concept of the Ljubljana classification dividing epithelial hyperplastic laryngeal lesions into benign (simple and abnormal hyperplasia), potentially malignant (atypical hyperplasia) lesions and carcinoma in situ.     

Bio-feedback and the yawning breath pattern in voice therapy: a clinical trial

A breathing technique, or effective breath method is important for both singers and speakers for effective vocalization, and also useful for helping people with a voice problem. Here a diaphragm support breath pattern was used in voice therapy for patients with vocal nodules, recurrent laryngeal nerve paralysis, and incomplete glottal closure. Singing teachers use a technique, called the diaphragm breath support. This is called the yawning breath pattern (YBP) in our voice clinic and is used in teaching the patients with some kinds of voice disorder. In order to correct patients' breath pattern, an equipment system was designed to check their breath patterns conveniently in voice therapy practice. A respiratory kinematic sensor which connected to a TV monitor was attached to the patients' rib cage near the diaphragm, and by bio-feedback, patients could observe and adjust their breath pattern to the desired pattern during vocalization. In each of the 10 outpatient sessions, the patients performed for 20 to 30 min, and were instructed to practice at home for 3 or more times daily. The YBP method was applied to 91 patients, 17 males and 74 females, with ages ranging from 17 to 79 years. Of the 91 patients 41 had vocal nodules, 20 had recurrent laryngeal nerve paralysis and 30 had incomplete glottal closure associated with chronic laryngitis and sulcus vocalis. Most of the patients could master the YBP technique successfully. The higher the patients' ability to master the YBP was the better the results of both voice tests and subjective evaluation. The scientific background of the YBP method and its clinical effects in voice therapy was reviewed.     

Effects of thyroplasty type I on vocal fold vibration

OBJECTIVE: To ascertain effects of medialization thyroplasty on vocal fold vibration in glottic incompetence dysphonia. STUDY DESIGN: Quantitative videostroboscopic glottic measurements and vocal function study were perioperatively undertaken in 20 patients undergoing Isshiki's thyroplasty type I. METHODS: In digitized images, the glottal area, glottal width, posterior glottal width, and amplitude over an entire glottal cycle were measured and normalized by membranous vocal fold length. The ratio of closed phase to total phase of vibratory cycle was calculated from the data of the glottal area and the glottal width at the middle point of the membranous vocal fold. Well-accepted acoustic, aerodynamic, and perceptual measures analyzed vocal function. RESULTS: Glottal area and glottal width were reduced after surgery. While preoperative closure of glottal area was incomplete in all 20 patients, incomplete closure was obtained in 16 patients after surgery. In these 16 patients, closure of glottal width at the middle point of the membranous vocal fold was complete, whereas a posterior glottal gap remained in 14 patients. Closed phase over one cycle of glottal width waveform and amplitude of vocal fold vibration were increased after surgery. Glottal area, glottal width, posterior glottal width, and closed phase over one cycle of glottal width waveform correlated with vocal function measures. CONCLUSIONS: Thyroplasty type I reduces a glottal gap and increases closed phase over one cycle and amplitude of vocal fold vibration, although a posterior glottal gap remains. With the improved glottic vibration, thyroplasty type I provides more efficient phonation in patients with glottic incompetence dysphonia.     

2580例声嘶患者临床分析和诊断

目的：对不同年龄声嘶患者的发病原因及临床特点进行分析总结。方法对2580例声嘶患者进行电子喉镜检查,并对检查结果及声嘶病因进行分析。结果2580例声嘶患者的主要病因及其例数分别为：声带小结906例、声带息肉659例、急慢性喉炎519例、声带麻痹151例,喉癌121例、喉乳头状瘤89例、声带囊肿71例、其他64例,它们在各个年龄组的分布不尽相同（P〈0.01）。结论不同年龄组引起声嘶的原因各不相同：小儿以声带小结、急慢性喉炎和喉乳头状瘤多见;中青年以声带息肉、小结、急慢性喉炎为主;老年人以喉癌、声带麻痹为主;值得注意,声音嘶哑可涉及临床多个科室,需多方面检查,认真鉴别,这有助于我们在临床工作中更准确的诊治疾病。