咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。

Investigation of dependability of laryngopharyngeal reflux and disorders of phonation

Objective:To investigate the voice features of laryngopharyngeal reflux(LPR),and analyze the effects of LPR to the life qualities of patients.To analyze the dependablity between objective and subjective ways.Method:One hundred and ninety-six of the patients who were suspected of LPR were received the surveys of general state,electronic nasopharyngolarygnoscope,evaluation of the reflux symptom index(RSI)and the reflux finding score(RFS).One hundred of patients whose RSI>13,RFS>7 were diagnosed as LPR and were received evaluation of voice handicap index(VHI),analysis of vocal acoustics and examination of glottogram.Result:The fundamental frequency included male and female depressed,the perturbation of fundamental frequency,the perturbation of amplitude and normalization noise energy increased.Differences were statistically significant(P<0.01)comparing with the normal control.The contiguity rate depressed,maximum phonation time shorten,the differences in which were statistically significant(P<0.01)comparing with the normal control.In the evaluation of VHI,the score of physiology was the highest,the function was second and the emotion was the lowest.The RSI and VHI had correlations(P<0.05),while RFS,RSI and VHI had not(P>0.05).Physiology,function and emotion had correlations in LPR.Conclusion:From the analysis of vocal acoustics and examination of glottogram,we knew that vocal function was effected because the vocal cord was injured by LPR.The fundamental frequency depressed and the vibrations of vocal cords were not instability,glottis wasn’t closed up well and contact time was depressed.Patients who had the reflux symptoms uncertainly had the reflux findings.