反流性咽喉病患者嗓音声学特征分析

The Voice Acoustic Analysis of Patients with Laryngopharyngeal Reflux Disease

吴修法;徐洁洁;乔明哲;杨翠方;孙荣荣;胡环宇;吴虹;

1:南京医科大学第一附属医院耳鼻咽喉科

摘要
目的观察反流性咽喉病(laryngopharyngeal reflux disease,LPRD)患者的嗓音声学特征。方法对耳鼻咽喉科门诊就诊的反流症状指数(reflux symptom index,RSI)量表评分总分≥13分的45例LPRD患者和36例正常成人进行硬管喉镜检查,并用德国XION DIVAS嗓音测试分析系统对两组受试者的持续元音信号进行检测分析,计算嗓音障碍指数(dysphonia severity index,DSI),比较两组结果,并分析LPRD患者RSI量表评分及声嘶症状评分与DSI值的相关性。结果 45例LPRD患者RSI评分均值为17.7±5.15分,喉镜检查表现为杓状软骨区红斑、充血、水肿、糜烂、溃疡,声门后区增生肥厚、肉芽肿和声带水肿、肥厚;LPRD组的基频微扰(jitter)及振幅微扰(shimmer)均值比正常对照组增高,最长发声时间(MPT)和DSI的均值LPRD组较正常对照组降低,差异均有统计学意义(P<0.01)。LPRD患者DSI值与RSI量表评分和声嘶症状评分呈负相关,相关系数分别为-0.344和-0.447(P<0.05)。结论 LPRD患者可出现嗓音异常,提示反流性咽喉病可能导致声带病理改变而造成嗓音损害。
关键词
反流性咽喉病;嗓音声学分析;嗓音障碍指数
基金项目(Foundation):
江苏省“科教兴卫工程”医学重点学科研究基金(XK200719);; 江苏高校优势学科建设工程资助项目;; 江苏省人民医院临床诊疗新技术新项目联合资助
作者
吴修法;徐洁洁;乔明哲;杨翠方;孙荣荣;胡环宇;吴虹;
参考文献

1 Koufman JA,Amin MR,Panetti M.Prevalence of reflux in133consecutive patients with laryngeal and voice disorders[J].Otolaryngol Head Neck Surg,2000,123:385.

2 Book DT,Rhee JS,Toohill RJ,et al.Perspectives in laryngo-pharyngeal reflux:an international survey[J].Laryngoscope,2002,112:1 399.

3 Oelschlager BK,Eubanks TR,Hillel A,et al.Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gas-troesophageal laryngeal reflux[J].J Gastrointest Surg,2002,6:189.

4 Ricardo L,Aliaa K.Validation of a quality-of-life instru-ment for laryngopharyngeal reflux[J].Arch Otolaryngol Head Neck Surg,2005,131:315.

5 Peter C,Belafsky PC,Gregory N,et al.Validity and reliabili-ty of the reflux symptom index(RSI)[J].Journal of Voice,2002,16:274.

6 Alexios S,Alexander D,Katerina D,et al.Molecular path-ways and genetic factors in the pathogenesis of laryngopharyn-geal reflux[J].Eur Arch Otorhinolaryngol,2009,266:795.

7 Jonaitis L,Pribuisiene R,Kupcinskas L,et al.Laryngeal ex-amination is superior to endoscopy in the diagnosis of the la-ryngopharyngeal form of gastroesophageal reflux disease[J].Scand J Gastroenterol,2006,41:131.

8 Shaker R,Milbrath M,Ren J,et al.Esophagopharyngeal dis-tribution of refluxed gastric acid in patients with reflux laryn-gitis[J].Gastroenterology,1995,109:1 575.

9 Pritchett JM,Aslam M,Slaughter JC,et al.Efficacy of on and off therapy[J].Clin Gastroenterol Hepatol,2009,7:743.

10 Farrokhi F,Vaezi MF.Extra-esophageal manifestations of gastroesophageal reflux[J].Oral Diseases,2007,13:349.

11王晓晔,叶京英,韩德民.全天咽喉PH监测在诊断反流性咽喉部疾病中的作用[J].中华耳鼻咽喉头颈外科杂志,2007,42:834.

12 Fass R,Noelck N,Willis MR,et al.The effect of esome-prazole 20mg twice daily on acoustic and perception parame-ters of the voice in laryngopharyngeal reflux[J].Neurogas-troenterology and Motility,2010,22:134.

13 Belafsky PC,Postma GN,Koufman JA.Validity and reliatility of the reflux finding score(RFS)[J].Laryngoscope,2001,111:1 313.

14 Childer DG.Assessment of the acoustics of voice production[M].NIH Monograph,1991.63~83.

15余永真,张兵.正常人及喉病患者音调扰动的研究[J].中华耳鼻咽喉科杂志,1988,23:360.

16陈小玲,王薇,陈锋.电脑技术在声带息肉疗效评估中的应用[J].中国眼耳鼻喉科杂志,1996,1:52.

17 Martin D,Fitch J,Wolfe V.Pathologic voice type and the acous-tic prediction of severity[J].Speech Hear Res,1995,38:8 765.

18 Wuyts FL,De Bodt MS,Molenberghs G,et al.The Dys-phonia severity index:an objective measure of vocal quality based on a multiparameter approach[J].J Speech Lang Hear Res,2000,43:796.

19 PribuiienёR,Uloza V,aferis V.Multidimensional voice a-nalysis of reflux laryngitis patients[J].Eur Arch Otorhino-laryngol,2005,262:35.

20 Jeffrey P,Clark A,Margaretha L,et al.Comparison of pedi-atric voice outcome survey,reflux symptom index,reflux find-ing score,and esophageal biopsy results[J].Arch Otolaryn-gol Head Neck Surg,2008,134:8 837.