病态嗓音基频和音域的变化

目的：研究４种发音方式下基频（Ｆｏ）和真假声音域的关系。方法：用电子计算机分别测试真声最低音、舒适音、真声最高音、假声最高音的Ｆｏ值。结果：病态嗓音的真声最低音Ｆｏ值升高,假声最高音Ｆｏ值下降;真假声音域缩窄,假声音域变化更明显。结论：病态嗓音的假声最高音基频下降,假声音域变窄。     

声门闭合不良4种发声方式频率与正常人对比分析

目的 :了解声门闭合不良 4种发声方式 (最低音、舒适音、真声最高音和假声最高音 )和不同发音持续最大时间 (最大声时 )的频率变化参数。方法 :用 2 0 3 1型频谱分析仪检测 15 0例功能性声门闭合不良患者 4种发声方式的频率 ,并与正常男女各 3 0例作对比。结果 :从整体看 ,男女最低音的频率 ,闭合不良者明显高于正常人 ,假声最高音的频率则前者明显低于正常人 ;按最大声时不同与正常人比 ,总的趋势是随着最大声时延长 ,最低音和舒适音的频率下降 ,真声和假声最高音的频率上升 ,且有的组间对比差异显著。结论 :声门闭合不良患者发低音和高音的功能同时下降 ;其低音与高音功能随最大声时的延长而增强     

成人噪音的计算机测试及定量分析

目的 研究正常成人在四种发育方式下各声学参数的变化。方法 应用电子计算机语言分析系统对２０－５０岁男女各３０例正常成人分别用真声最低音，舒适音，真声最高音，假声最高音进行测试和分析。结果 男女性的四种发音方式中，真声最高音最优，依次为舒适音，假声最高音，真声最低音，发舒适音和真声最低音时男女间Ｊｉｔｔｅｒ值有差异。     

关于胸声,假声研究的概况

胸声音丰满宏亮，音调低；假声音色薄而高，两者的发音机制不同，假声发声发布在复杂的神经、肌肉的联合作用下完成，通过各种手段证实，在生理状态下环甲肌是假声发声的主导肌肉。甲杓肌能调节声带的形态和张力，使音调随其改变；环杓后肌及喉外肌也参与发声作用。但对疾病状态下，有关假声的研究尚不多见。     

成人嗓音的计算机测试及定量分析

目的　研究正常成人在四种发育方式下各声学参数的变化。方法　应用电子计算机语言分析系统对２０ ～５０ 岁男女各３０ 例正常成人分别用真声最低音、舒适音、真声最高音、假声最高音进行测试和分析。结果　男女性的四种发音方式中,真声最高音最优,依次为舒适音、假声最高音、真声最低音,发舒适音和真声最低音时男女间Ｊｉｔｔｅｒ 值有差异。结论　正常成人四种发音方式的声音质量是不同的,与喉肌的功能状态有关     

甲状舌骨肌-环甲肌接合术治疗喉上神经麻痹

1 临床资料。患者，男，16岁，因“声嘶1年余”于2002年7月22日收入住院。患者1年前无明显诱因出现声音低沉、不能发高音，病程中无明显呛咳。入院时检查：瘦高体型，颈部触诊右侧环甲肌处较左侧薄弱，环甲间隙稍宽；测声时(最大发声时程)为5—6秒；纤维喉镜检查见：右侧声带呈弧形，发音时左侧声带较右侧声带稍伸长，后连合稍偏向右侧，声门裂及后连合处留有缝隙，吸气时双侧杓状软骨运动正常。入院诊断：喉上神经麻痹(右)。     

舌骨上肌与喉内肌的同步肌电生理实验研究

目的对犬的舌骨上肌（二腹肌前腹、后腹,茎突舌骨肌,下颌舌骨肌和颏舌骨肌）与喉内肌（环杓侧肌和环杓后肌）进行同步肌电图研究。方法检测13只犬同步肌电图。结果①呼吸时环杓侧肌在呼气相放电,余各肌在吸气相放电。深呼吸时诸肌放电强度增加。②吞咽时诸肌和环杓侧肌呈同步放电。环杓后肌肌电抑制,间歇期可见肌电位发放。③发音时二腹肌前腹、后腹和环杓侧肌呈同步性密集型放电,环杓后肌在发音过程中持续放电,动作电位出现时间较迟。茎突舌骨肌和颏舌骨肌无明显肌电活动。结论①发音及吞咽时下颌舌骨肌与环杓侧肌同步且相似,可作为重建声门内收功能的备选肌肉;②吸气时颏舌骨肌与环杓后肌同步且相似,可作为重建声带外展功能的备选肌肉。     

半喉发音的研究

设计一套研究喉发育的方法，对半喉发音的运动和空气力学的资料进行分析和对照。试验用的狗再重25～30kg，共9只，在麻醉状态下手术切取半离体喉，检测后再将左侧声带切除并用一块垂直的有机玻璃板代替，将其固定后用lugersoll（30型）常规空气压缩机输入空气，温度要求35～38”C，湿度要求95～IO0％。通过改变声门下压力测定并记录发声闽值压力级，平均声门气流率、基频、声带振动幅等资料。发现声带振动发生子声门下压力超过0．78kpa时，它随着基频改变，在暂短的停顿发音时振动仍存在，声门下压力同时保持在O．2～0．4kpa。随着声门下…     

嗓音的声学检测(5)

5 .3　病态嗓音的频谱分析除艺术嗓音外 ,临床上主要是病态嗓音的应用 ,这个范畴的应用 ,既是多方面的又是有限定的 ,某些方面可以利用 ,而某些方面又不应利用 ,应选择性地、能说明问题地加以利用。为了说明问题 ,选择一部分临床病例叙述如下。5 .3.1　嗓音嘶哑疾患的声学评价　以声带麻痹及沟状声带为例。声带麻痹 :我们进行了男女各 8名的频谱检查 ,主要检查了基频 (舒适发音 )、最低音、最高音及假声 ,算出了真声音域及假声音域 ,见表 2 1。表 2 1　不同性别声带麻痹患者嗓音频谱检测 (ｘ±ｓ)性别例数舒适发音 (Ｈｚ)真声音域 (Ｏｃｔ)…     

声门闭合不全的喉肌电图和声门形态变化

目的：探讨声门闭合不全的原因、喉肌电图变化以及两者与声门形态变化的可能内在联系。方法：对24例声门闭合不全患者行喉镜及双侧环甲肌及环杓侧肌肌电图检测。结果：24例声门闭合不全患者中，仅6例为正常喉肌电图，其中声门呈梭形裂隙4例，三角形及矩形裂隙各1例；9例环甲肌出现纤颤电位，声门形态分别为梭形裂隙4例，矩形裂隙3例，三角形及半月形裂隙各1例；9例环杓侧出现纤颤电位，声门形态分别为俊形裂隙7例，三角形裂隙2例。结论：绝大多数声门闭合不全患者的原因不明，且存在喉上或／和喉返神经的不全麻痹。在原因不明、喉肌电图正常或环杓侧出现失神经电位等情况下，声门呈梭形裂隙者占绝大多数，而在某些诱因作用下或环甲肌出现失神经电位情况下发生的声门闭合不全，声门裂隙可表现为多种形态。     

Smooth muscle in the annulus fibrosus of the tympanic membrane in bats, rodents, insectivores, and humans

The annulus fibrosus and its attachment to the bony tympanic ring were studied in a series of mammals. In the pallid bat, Antrozous pallidus, there is an extensive plexus of large interconnected blood sinuses in the part of the annulus that borders the tympanic bone. The spaces between the sinuses are packed with smooth muscle cells. Most of the cells have a predominately radial orientation; they extend from the bony tympanic sulcus to a dense collagenous matrix (apical zone) where radially oriented fibers of the pars tensa are confluent with the annulus. The muscles and vessels constitute a myovascular zone. A structurally similar myovascular zone is also present in the European hedgehog. In rodents, the annulus lacks the large interconnected blood sinuses but many small vessels are present. Smooth muscle is concentrated in the broad area of attachment of the annulus to the tympanic bone. In the gerbil, smooth muscle seems to be concentrated in the central part of the width of the annulus where it is attached to bone and radiates toward the tympanic membrane. In humans collections of radially oriented smooth muscle cells were found in several locations. The smooth muscle in all species studied appears to form a rim of contractile elements for the pars tensa. This arrangement suggests a role in controlling blood flow and/or creating and maintaining tension on the tympanic membrane.     

中耳肌肉生理及病理

中耳肌肉是耳部“降噪系统”中最为关键的部分,其在持续监测声学输入和动态调节听觉灵敏度方面发挥着重要的保护作用。当中耳肌肉收缩时, 它们将镫骨推入卵圆窗, 并增加内耳膜迷路内液体的压力。如果中耳肌肉失去调节内耳压力的能力, 如强直、痉挛或肌张力障碍, 产生的异常压力将对内耳压力产生影响, 并导致许多问题, 如耳鸣、梅尼埃病和感音神经性听力损失等。综述中耳肌肉的生理构造及各自所起的作用,讨论中耳肌肉功能紊乱与耳部疾病的联系。     

Evidence for recurrent laryngeal nerve contribution in motor innervation of the human cricopharyngeal muscle.

OBJECTIVE: To study the functional motor nerve supply of the upper esophageal sphincter in humans. STUDY DESIGN: Intraoperative electromyographic study. METHODS: The contribution of the recurrent laryngeal nerve and the pharyngeal plexus in the motor nerve innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle was examined intraoperatively. RESULTS: Electromyography showed that there is a considerable overlap in the innervation of the cricopharyngeal muscle and the inferior pharyngeal constrictor muscle. The recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal muscle in all patients and contributes to the motor innervation of the inferior pharyngeal constrictor muscle in most patients. The pharyngeal plexus functionally contributes to the motor innervation of the inferior pharyngeal constrictor muscle but does not always contribute to the motor innervation of the cricopharyngeal muscle. CONCLUSIONS: This is the first report which provides evidence that the recurrent laryngeal nerve functionally contributes to the motor innervation of the cricopharyngeal and inferior pharyngeal constrictor muscle. Furthermore, this study shows that intraoperative electromyography in humans is a feasible method to analyze the physiology of the motor innervation of the upper esophageal sphincter.     

The location of the upper oesophageal sphincter and its behaviour during bolus propagation - a simultaneous cineradiographic and manometric investigation

By means of simultaneous cineradiographic and manometric examinations using closely positioned microtransducers the maximal pressure of the upper oesophageal sphincter was found at a level 20 mm below the plane of the vocal folds and 6 mm above the level of the cricoid arch. The sum of these 2 distances is in accordance with the distance between the vocal fold level and the lower border of the cricoid arch given in the literature. This implies that the high pressure zone of the upper oesophageal sphincter corresponds to the pars fundiformis of the cricopharyngeus muscle. The lower part of the inferior pharyngeal constrictor and the upper circular muscle fibres of the oesophagus contribute to the sphincter. When the bolus approached the sphincter, the phincter, the pressure decreased and during bolus passage the pressure was below or well below half of the resting pressure. The pressure profile disclosed no signs of muscular dyscoordination or discontinuity of the upper oesophageal sphincter.     

下睑缩肌腱膜修复联合皮肤轮匝肌切除术治疗老年性下睑内翻

目的 评价下睑缩肌腱膜修复联合皮肤轮匝肌切除术治疗老年性下睑内翻的疗效。方法 将老年性下睑内翻64例（84眼）分为两组：A组24例（30眼）,采用单纯皮肤轮匝肌切除术矫正;B组40例（54眼）,采用下睑缩肌腱膜修复联合皮肤轮匝肌切除术矫正。比较两种手术方法的近、远期疗效。结果 术后7d拆线时所有病例内翻矫正良好。随访1～2年,A组6例复发,B组1例复发。结论 下睑缩肌腱膜修复联合皮肤轮匝肌切除术治疗老年性下睑内翻疗效确切,复发率低。     

神经肌蒂移植同时恢复麻痹声带内收及外展功能的实验研究

目的 探索一种能同时恢复麻痹声带内收及外展功能的治疗方法。方法 对狗一侧喉返神经及喉上神经运动支联合麻痹的喉内肌,采用颈袢胸骨甲状肌肌蒂移植于麻痹环杓后肌,颈袢甲状舌骨肌肌蒂移植于麻痹侧环杓侧肌作为实验组,并仅用颈袢胸骨甲状肌肌蒂移植于麻痹侧环杓后肌作为对照组。术前及术后４个月行声带录像、喉肌电图检测、组织学检查。结果术后４个月所有动物均不同程度地恢复了麻痹声带的生物功能。实验组术侧声带内运动明显     

The vagal nerve stimulation outcome,and laryngeal effect: Otolaryngologists roles and perspective

Introduction

Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12 years.VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively.