语谱图在鼻内镜术后语音特征评估中的应用

The application of spectrogram in the evaluation of postoperative articulation characteristics under nasal endoscopy

刘雪莱;陈知己;刘恒鑫;方红雁;胡娅琴;李晓晓;陈红江

1:重庆市人民医院耳鼻咽喉头颈外科

2:国家儿童医学中心/首都医科大学附属北京儿童医院耳鼻咽喉头颈外科

摘要
目的 探讨鼻内镜术后患者语音特征的客观变化,并分析手术与声道结构变化的关系。方法 前瞻性纳入2023年6~12月行鼻内镜手术患者45例,其中鼻中隔偏曲矫正术和/或鼻息肉切除术和/或鼻甲成形术组(G1组)13例,单纯鼻窦开放术组(G2组)11例,鼻窦开放+鼻中隔偏曲矫正术和/或鼻息肉切除术和/或鼻甲成形术组(G3组)21例。三组均在术前和术后1月完善语谱图检测,分析不同声任务(口化元音、鼻化元音及含鼻元音的词组和短句)下的鼻阻力(Refft值)、声学指标共振峰频率(F1~F4)、带宽(bandwidths, B1~B4)、F1振幅与鼻杂音共振峰振幅的差值(A1-P0)及F1振幅与鼻共振峰振幅的差值(A1-P1)。结果 各组术后嗓音声学指标无明显改变,Refft值均显著下降,口化元音共振峰变化不明显,但带宽多显著下降。各组术后A1-P1均存在上升趋势,A1-P0均存在下降趋势。其中,G1组A1-P1在发/ma/、/na/、/mi/、/ni/时较术前明显上升;A1-P0在发/ma/、/na/时较术前明显下降;G2组A1-P0在发/ma/、/na/时较术前明显下降;G3组A1-P1在发/mi/、/ni/时较术前明显上升;A1-P0在发/ma/、/na/时较术前明显下降。结论 鼻内镜手术会对患者语音产生可测量的影响。语谱图可用于鼻内镜术后发音特征的评估,其中A1-P1对于高元音/i/、A1-P0对于非高元音/a/是更好的测量指标。
关键词
鼻内镜手术;语音特征;语谱图
基金项目(Foundation):
重庆市科卫联合医学科研项目(2022QNXM004)
作者
刘雪莱;陈知己;刘恒鑫;方红雁;胡娅琴;李晓晓;陈红江
参考文献

[1] KIM S D,PARK H J,KIM G H,et al.Changes and recovery of voice quality after sinonasal surgery[J].Eur Arch Otorhinolaryngol,2015,272(10):2853-2859.

[2] 黄海云,黄永望,傅德慧,等.功能性内镜鼻窦手术前后Ⅱ型慢性鼻窦炎患者鼻腔共鸣特性分析[J].听力学及言语疾病杂志,2014,22(1):45-47.

[3] 丹静静,陶树东,黄永望.功能性鼻内镜鼻窦手术对慢性鼻窦炎男性患者鼻音的影响[J].听力学及言语疾病杂志,2021,29(3):292-294.

[4] SHETTY V,THEJASWI D,BINIYAM K,et al.The effect of functional endoscopic sinus surgery on nasal resonance[J].World J Otorhinolaryngol Head Neck Surg,2022,16(3):269-273.

[5] NARUEKON J,KASEMSIRI P,THANAVIRATANANICH S,et al.Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps[J].Sci Rep,2022,8(1):212-225.

[6] 徐丽娜,贾志阳,李峰.功能性构音障碍患者异常塞擦音的语音特点及语音训练效果[J].听力学及言语疾病杂志,2020,28(3):247-252.

[7] DA SILVA A C F,DE ARA■JO LIMA-FILHO L M,ALMEIDA A A,et al.Spectrographic voice analysis protocol (SAP):convergent,concurrent,and accuracy validity[J].J Voice,2023,18(23):283-287.

[8] XIAO C C,LUETZENBERG F S,JIANG N,et al.Does nasal surgery affect voice outcomes?A systematic review with meta-analyses[J].Ann Otol Rhinol Laryngol,2020,129(12):1174-1185.

[9] AMER H S,ELAASSAR A S,ANANY A M,et al.Nasalance changes following various endonasal surgeries[J].Int Arch Otorhinolaryngol,2017,21(2):110-114.

[10] 曹春婷,韩德民,张罗.四相鼻阻力测量法评估健康成人鼻腔通气状况的初步研究[J].中华耳鼻咽喉头颈外科杂志,2009,44(2):122-125.

[11] SATALOFF R T,HEMAN-ACKAH Y D,HAWKSHAW M J.Clinical anatomy and physiology of the voice[J].Otolaryngol Clin North Am,2007,40(5):909-929.

[12] ACAR A,CAYONU M,OZMAN M,et al.Changes in acoustic parameters of voice after endoscopic sinus surgery in patients with nasal polyposis[J].Indian J Otolaryngol Head Neck Surg,2014,66(4):381-385.

[13] OZBAL KOC E A,KOC B,ERCAN I,et al.Effects of septoplasty on speech and voice[J].J Voice,2014,28(3):393-311.

[14] WONG E H C,CHONG A W.Objective and subjective changes in voice after endoscopic sinus surgeries in patients with and without nasal polyps[J].Am J Otolaryngol,2020,41(2):102-107.

[15] LIAPI A,HIRANI S,RUBIN J.Changes in nasal resonance following septoplasty in adults:acoustic and perceptual characteristics[J].Logoped Phoniatr Vocol,2016,41(3):93-100.

[16] SUBRAMANIAM V,YOONUS R,NARRA M.Effects of septoplasty:on the acoustic parameters of voice[J].Egypt J Ear Nose Throat,2015,16(3):259-263.

[17] MORA R,JANKOWSKA B,DELLEPIANE M,et al.Acoustic features of voice after septoplasty[J].Med Sci Monit,2009,15(6):269-273.