不同生理年龄期正常成年女性喉镜观察及嗓音主客观评估

发布时间：2018-03-05 19:57

本文选题：成年女性　切入点：喉镜检查　出处：《南京医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察正常成年女性不同年龄生理时期喉部形态结构特点及嗓音变化特征,探讨喉镜检查及嗓音主客观评估方法在成年女性嗓音评估中的应用价值。方法:正常成年女性受试者分为三组,青年组:青年女性48例,年龄20～43岁;更年期组:更年期女性59例,年龄45～55岁;老年组:老年女性52例,年龄60～88岁。受试者首先采用电子鼻咽喉镜检查,然后进行嗓音障碍视觉模拟量表(visual analog scale,VAS)评分、嗓音障碍指数(voice handicap index,VHI)量表简化中文版(VHI-13)评分、嗓音GRBAS主观听感知评估和嗓音声学检测。观察分析三组女性喉镜下喉部形态及声带闭合的改变,比较更年期组与老年组的嗓音主观评估结果,比较青年组、更年期组和老年组的嗓音声学检测结果,分析更年期组及老年组声带水肿及声带闭合不全与嗓音主客观评估的关系。结果:更年期组受试者喉镜检查主要表现为声带水肿、喉黏膜干燥等,老年组受试者喉镜检查主要表现为声带闭合不全、声带萎缩等改变。更年期组大多数受试者及老年组所有受试者嗓音VAS、VHI、总嘶哑度(grade,G)和粗糙度(roughness,R)评分有所升高,老年组VAS和VHI评分高于更年期组(P0.05),老年组G、R重度异常的比例高于更年期组(P0.05)。嗓音声学检测显示,与青年组比较,更年期组及老年组基频微扰(jitter)、振幅微扰(shimmer)均升高,基频(fundamental frequency,F0)、最长发声时间(maximum phonation time,MPT)和发音障碍指数(dysphonia severity index,DSI)则降低;老年组jitter、shimmer较更年期组更升高,而F0、MPT和DSI较之降低;更年期组及老年组声带水肿与声带无水肿受试者比较,G、R、jitter及shimmer值升高,F0及DSI值降低;声带闭合不全与声带完全闭合受试者比较,G、R、jitter及shimmer值升高,MPT及DSI值降低,以上差异均具有统计学意义(P0.05或0.01)。结论:更年期和老年期女性可出现喉部形态及声带结构的改变(声带水肿、喉黏膜干燥、声带闭合不全、声带萎缩等),嗓音功能可出现衰退改变,表现嗓音主观评估及声学参数的异常。应用嗓音主观评估及声学检测方法结合电子鼻咽喉镜检查可对成年女性嗓音进行综合全面的评价,为区别成年女性生理与病理性嗓音提供依据。
[Abstract]:Objective: to observe the morphological and structural characteristics of larynx and the change of voice in normal adult women at different ages. Methods: normal adult female subjects were divided into three groups: 48 young women aged 20 to 43 years old; The climacteric group consisted of 59 climacteric women aged 45 to 55 years old and 52 elderly women aged 6088 years. The subjects were examined by electronic nasopharyngeal laryngoscope, and then visual analog scale scale (VAS) was used to evaluate the voice disorders. Voice handicap index (VHI) scale simplified VHI-13) score, voice GRBAS subjective auditory perception evaluation and voice acoustic measurement. The changes of laryngeal morphology and vocal cord closure under laryngoscope in three groups were observed and analyzed. To compare the results of subjective evaluation of voice between menopausal group and senile group, and compare the results of voice acoustic test of young group, menopausal group and elderly group. To analyze the relationship between vocal cord edema and vocal cord insufficiency and subjective and objective evaluation of voice in climacteric group and senile group. Results: the laryngoscopy of climacteric group showed mainly vocal cord edema and dry laryngeal mucosa. The laryngoscopy of the elderly subjects mainly showed the changes of vocal cord closure and vocal cord atrophy. The scores of VAS-VHI, total hoarseness and roughness were increased in most subjects in climacteric group and all the subjects in the elderly group. The scores of VAS and VHI in the elderly group were higher than those in the climacteric group (P0.05), and the proportion of severe abnormal GGR in the elderly group was higher than that in the climacteric group. The fundamental frequency (F0), maximum phonation time (MPT) and dysphonia severity (DSI) were decreased, and the jittershimmer in the elderly group was higher than that in the climacteric group, while the F0 MPT and DSI were lower in the elderly group than in the climacteric group. Compared with non-edematous subjects, the scores of GG rjitter and shimmer increased and F0 and DSI decreased in climacteric group and aged group, and the values of GG rjitter and shimmer increased and DSI and DSI decreased in patients with incomplete vocal cord closure and complete vocal cord closure. Conclusion: the changes of laryngeal morphology and vocal cord structure (vocal cord edema, dry laryngeal mucosa, incomplete vocal cord closure) may occur in menopausal and elderly women. The vocal cord shrinks and so on, the voice function may appear the decline change, The subjective evaluation of voice and the abnormality of acoustic parameters can be used to evaluate the voice of adult women comprehensively by using the method of voice subjective evaluation and acoustic examination combined with electronic nasopharyngeal laryngoscopy. To provide the basis for distinguishing physiological and pathological voice of adult female.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767

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