单侧声带麻痹患者嗓音主、客观评估及其相关性分析

Subjective and Objective Evaluation of Unilateral Vocal Cord Paralysis

张明星;温武;周水淼;郑宏良;耿丽萍;

1:第二军医大学长海医院耳鼻咽喉科

摘要

目的以两种主观评估方法和嗓音声学分析法评估54例单侧声带麻痹患者的嗓音特征,并探索其相关性。方法对54例单侧声带麻痹患者和30例健康对照者分别进行嗓音声学分析以及简化嗓音障碍指数(VHI-10)和GRBAS主观评估,分析三种评估方法各指标间的相关性。结果嗓音声学分析显示,声带麻痹组的最大声时(maximum phonatory time,MPT)仅为对照组的1/3左右,基频微扰(jitter)、振幅微扰(shimmer)及标准化噪声能量(NNE)均较对照组为高,差异有统计学意义,二者间F0差异不明显。不同GRBAS分级中,VHI-10分值在1、2级间差异无统计学意义,但在1、3级间和2、3级间差异有统计学意义。在相关性方面,F0与其余各指标皆不相关;jitter、shimmer与除F0外的各主客观指标均相关;NNE除与jitter、shimmer相关外,与主观指标R和VHI-10的相关系数分别为0.347和0.331;MPT除与jitter、shimmer相关外,与主观指标的相关性均较高,与VHI-10和G的相关系数分别为-0.528和-0.466;GRBAS系统中,G与除F0、NNE外的各项指标均显著相关;R与除F0外的各项指标均显著相关;B与G类似,与除F0、NNE外的各项指标均有显著的相关性;VHI-10与除F0外的各指标均显著相关,但以MPT和G、R最显著。结论单侧声带麻痹患者的三种嗓音评估方法间有一定的相关性,全面的嗓音评估需采用综合的方法。

关键词

单侧声带麻痹;嗓音声学分析;嗓音障碍指数;主观听感知评估

基金项目(Foundation):

作者

张明星;温武;周水淼;郑宏良;耿丽萍;

参考文献

1Rosen CA,Lee AS,Osborne J,et al.Development and valida-tion of the voice handicapindex-10[J].Laryngoscope,2004,114:1549.

2徐文,李红艳,胡蓉,等.嗓音障碍指数量表中文版信度和效度评价[J].中华耳鼻咽喉头颈外科杂志,2008,43:670.

3韩仲明.嗓音声学检测分析[J].中国耳鼻咽喉头颈外科,2006,13:351.

4杨式麟.嗓音医学基础与临床[M].沈阳:辽宁科学技术出版社,2001.169~397.

5Patel P,Parsram KS.Acoustic analysis of subjects with vocal cord paralysis[J].Indian J Otolaryngology&Head and Neck Surg,2005,57:48.

6Sanderson RJ,Maran AG.The quantitative analysis of dys-phonia[J].Clin Otolaryngol Allied Sci,1992,17:440.

7Oguz H,Demirci M,Safak MA,et al.Effects of unilateral vo-cal cord paralysis on objective voice measures obtained by Praat[J].Eur Arch Otorhinolaryngol,2007,264:257.

8Hirano M,Tanaka S,Fujita M,et al.Fundamental frequency and sound pressure level of phonation in pathological states[J].Journal of Voice,1991,5:120.

9陈世彩,郑宏良,周水淼,等.神经肌电检测对单侧喉返神经损伤预后的评价[J].中华耳鼻咽喉科杂志,2004,39:410.

10王志颐,郑宏良,陈世彩,等.神经修复术治疗单侧喉返神经损伤的疗效分析[J].第二军医大学学报,2007,28:909.

11Garrel R,Nicollas R,Chapus E,et al.Voice i mprovement in unilateral laryngeal paralysis duringloud voicing:Theoretical i mpact[J].Eur Arch Otorhinolaryngol,2007,264:1201.

12Michaelis D,Frohlich M,Strube HW.Selection and combi-nation of acoustic features for the description of pathologic voices[J].J Acoust Soc Am,1998,103:1628.

13徐洁洁,祁沁红,乔宗海.单侧声带麻痹嗓音计算机声学分析[J].听力学及言语疾病杂志,2000,8:80.

14Bielamowicz S,Stager SV.Diagnosis of unilateral recurrent laryngeal nerve paralysis:Laryngeal electromyography,sub-jective rating scales,acoustic and aerodynamic measures[J].Laryngoscope,2006,116:359.

15Schindler A,Bottero A,Capaccio P,et al.Vocal i mprove-ment after voice therapy in unilateral vocal fold paralysis[J].J Voice,2008,22:113.

16Miyauchi A,Inoue H,Tomoda C,et al.I mprovement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve[J].Surgery,2009,146:1056.

17Xu JJ,Chen X,Lu MP,et al.Perceptual evaluation and a-coustic analysis of pneumatic artificial larynx[J].Otolaryngol Head Neck Surg,2009,141:776.

18韩仲明.喉发音功能的检测及其临床意义[J].中华耳鼻咽喉科杂志,1998,33:380.

19Webb AL,Carding PN,Deary IJ,et al.The reliability of three perceptual evaluation scales for dysphonia[J].Eur Arch Otorhinolaryngol,2004,261:429.

20Hartl DA,Hans S,Vaissiere J,et al.Objective acoustic and aerodynamic measures of breathiness in paralytic dysphonia[J].Eur Arch Otorhinolaryngol,2003,260:175.

21Bhuta T,Patrick L,Garnett JD.Perceptual evaluation of voice quality and its correlation with acoustic measurements[J].J Voice,2004,18:299.

22于萍,王荣光.嗓音障碍主观听感知评估研究现状[J].听力学及言语疾病杂志,2009,17:1.

23李红艳,徐文,胡蓉,等.嗓音障碍疾病GRBAS听主观评估特点分析[J].听力学及言语疾病杂志,2009,17:147.

24Franic DM,Bramlett RE,Bothe AC.Psychometric evalua-tion of disease specific quality of life instruments in voice dis-orders[J].J Voice,2005,19:300.

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