声带息肉手术前后嗓音功能评估的研究
发布时间：2018-12-06 16:33
【摘要】：目的:通过对60例就诊于我科的声带息肉患者的临床资料进行回顾性研究,着重探讨嗓音障碍指数量表(the voice handicap index,VHI)、嗓音声学分析(acoustic analysis)、音域图(Voice range profile,VRP)的变化与患者手术治疗前后声音质量变化的趋势及相关性。方法:收集2015年4月~2016年4月因声带息肉就诊于我科的患者,根据《临床诊疗指南-耳鼻喉科分册》(中华医学会编著名,人民卫生出版社),《临床技术操作规范-耳鼻喉科分册》(中华医学会编着,人民军医出版社)制定诊断标准,将符合以下条件者纳入研究:1.主诉:声音嘶哑;2.体征:内镜检查可见单侧或双侧声带带蒂或广基的息肉样增生物。共60例患者纳入研究,在首诊时均完善嗓音障碍指数量表、频闪喉镜、嗓音声学分析及音域图检查。所有患者均无其他基础疾病,所有患者均由同一耳鼻喉科医师及麻醉科医师在相同设备下完成显微支撑喉镜手术。所有患者于术后1周、4周均再次回院随访,完善嗓音障碍指数量表、频闪喉镜、嗓音声学分析及音域图检查,并与首诊时各项结果比较。所有患者于随访期间避免连续、高强度用声。所有术前及术后检查均由同一医师完成。所有统计均应用SPSS19.0软件完成。结果:1.VHI:患者术后VHI结果明显优于术前水平,差异具有统计学意义(P0.05)。由于术后1周术区仍有轻微肿胀,且患者精神较紧张,故术后4周VHI改善最明显,差异具有统计学意义(P0.05)。2.嗓音声学分析:(1)基频微扰(Jitter)方面,患者术后1周、4周Jitter值均低于术前Jitter值,差异具有统计学意义(P0.05);术后4周Jitter值较术后1周更低,差异具有统计学意义(P0.05)。(2)振幅微扰(Shimmer)方面,术后1周、4周Shimmer值较术前小,差异具有统计学意义(P0.05);术后4周Shimmer值较术后1周更低,差异具有统计学意义(P0.05)。(3)标准化噪声能量(normalized noise energy,NNE)方面,术后1周、4周NNE绝对值均高于患者术前水平,差异具有统计学意义(P0.05);术后4周NNE绝对值高于术后1周水平,差异具有统计学意义(P0.05)。(4)噪谐比(Harmonica-noise ratio,NHR)方面,术后1周、4周NHR均有不同程度的下降,其中术后4周NNE值低于术后1周NNE值,差异具有统计学意义(P0.05)。3.VRP:(1)在频率方面,患者术后1周最大频率、最小频率、频率范围较术前无明显差别(P0.05);患者术后4周最大频率较手术前有所升高,最小频率较术前有所降低,频率范围也较手术前显著扩大,差别有统计学意义(P0.05)。(2)就强度而言,患者手术后1周与术前在最大声强、最小声强、强度范围无明显差别(P0.05);而患者术后4周最大声强、最小声强值较手术前降低,而平均声强范围比扩大,差别有统计学意义(P0.05)。结论:通过比较患者手术前、手术后的VHI、嗓音声学分析及VRP相关参数指标之间的差异,我们认为VHI、嗓音声学分析及VRP具有嗓音量化评定功能,能有效对声带息肉手术进行疗效评估,是嗓音功能检测的重要手段。
[Abstract]:Objective: to study retrospectively the clinical data of 60 patients with vocal cord polyps in our department, and to discuss the voice disturbance index scale (the voice handicap index,VHI) and voice acoustic analysis of (acoustic analysis), range map (Voice range profile,). The change of VRP and the change trend and correlation of sound quality before and after operation. Methods: patients with vocal cord polyps were collected from April 2015 to April 2016. According to the guidelines for Clinical diagnosis and treatment-Otorhinolaryngology, (the name of the Chinese Medical Association, people's Health Publishing House), (Chinese Medical Association, the people's military Medical Publishing House) to formulate diagnostic criteria, the following conditions will be included in the study: 1. Complaint: hoarseness; 2. Signs: endoscopic examination of unilateral or bilateral vocal cord pedicle or wide-base polyp-like hyperplasia. A total of 60 patients were included in the study. At the first visit, the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram were all improved. All patients had no other underlying diseases, and all patients underwent microscopical laryngoscope surgery with the same otolaryngologist and anesthesiologist under the same equipment. All the patients were followed up again at 1 week and 4 weeks after operation to perfect the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram examination, and to compare the results with those of the first visit. All patients were followed up to avoid continuous, high-intensity sound use. All preoperative and postoperative examinations were performed by the same physician. All statistics were completed by SPSS19.0 software. VHI: postoperative VHI results were significantly better than the preoperative level, the difference was statistically significant (P0.05). 2. Because there was still slight swelling in the operation area at 1 week after operation, and the patients were nervous, the improvement of VHI at 4 weeks after operation was the most obvious, the difference was statistically significant (P0.05). Voice acoustic analysis: (1) fundamental frequency perturbation (Jitter), patients 1 week, 4 weeks after the Jitter values were lower than the preoperative Jitter value, the difference was statistically significant (P0.05); The Jitter value at 4 weeks after operation was lower than that at 1 week after operation, the difference was statistically significant (P0.05). (2) in terms of amplitude perturbation (Shimmer), and the Shimmer value at 1 week and 4 weeks after operation was smaller than that before operation (P0.05). The Shimmer value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). (3) standardized noise energy (normalized noise energy,NNE. The absolute values of NNE at 1 week and 4 weeks after operation were higher than those before operation. The difference was statistically significant (P0.05). The absolute value of NNE at 4 weeks after operation was higher than that at 1 week after operation, and the difference was statistically significant (P0.05). (4) the ratio of noise to harmonic (Harmonica-noise ratio,NHR) was significantly lower than that at 1 week and 4 weeks after operation, and the NHR decreased to some extent at 1 week and 4 weeks after operation. The NNE value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). 3. VRP: (1) in terms of frequency, the maximum frequency and minimum frequency of 1 week after operation were found in the patients. The frequency range was not significantly different from that before operation (P0.05). The maximum frequency of 4 weeks after operation was higher than that before operation, the minimum frequency was lower than that before operation, and the frequency range was significantly larger than that before operation. The difference was statistically significant (P0.05). (2) in terms of intensity. There was no significant difference in the range of maximum intensity and minimum intensity between one week and one week after operation (P0.05). The maximum sound intensity and the minimum sound intensity were lower than those before operation, but the mean range of sound intensity was enlarged, the difference was statistically significant (P0.05). Conclusion: by comparing the differences between VHI, voice acoustic analysis and VRP parameters before and after operation, we believe that VHI, voice acoustic analysis and VRP have the function of quantitative voice evaluation. It is an important method to evaluate the effect of vocal polyp surgery.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767.91
本文编号：2366321
[Abstract]:Objective: to study retrospectively the clinical data of 60 patients with vocal cord polyps in our department, and to discuss the voice disturbance index scale (the voice handicap index,VHI) and voice acoustic analysis of (acoustic analysis), range map (Voice range profile,). The change of VRP and the change trend and correlation of sound quality before and after operation. Methods: patients with vocal cord polyps were collected from April 2015 to April 2016. According to the guidelines for Clinical diagnosis and treatment-Otorhinolaryngology, (the name of the Chinese Medical Association, people's Health Publishing House), (Chinese Medical Association, the people's military Medical Publishing House) to formulate diagnostic criteria, the following conditions will be included in the study: 1. Complaint: hoarseness; 2. Signs: endoscopic examination of unilateral or bilateral vocal cord pedicle or wide-base polyp-like hyperplasia. A total of 60 patients were included in the study. At the first visit, the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram were all improved. All patients had no other underlying diseases, and all patients underwent microscopical laryngoscope surgery with the same otolaryngologist and anesthesiologist under the same equipment. All the patients were followed up again at 1 week and 4 weeks after operation to perfect the voice disorder index scale, stroboscopic laryngoscope, voice acoustic analysis and phonogram examination, and to compare the results with those of the first visit. All patients were followed up to avoid continuous, high-intensity sound use. All preoperative and postoperative examinations were performed by the same physician. All statistics were completed by SPSS19.0 software. VHI: postoperative VHI results were significantly better than the preoperative level, the difference was statistically significant (P0.05). 2. Because there was still slight swelling in the operation area at 1 week after operation, and the patients were nervous, the improvement of VHI at 4 weeks after operation was the most obvious, the difference was statistically significant (P0.05). Voice acoustic analysis: (1) fundamental frequency perturbation (Jitter), patients 1 week, 4 weeks after the Jitter values were lower than the preoperative Jitter value, the difference was statistically significant (P0.05); The Jitter value at 4 weeks after operation was lower than that at 1 week after operation, the difference was statistically significant (P0.05). (2) in terms of amplitude perturbation (Shimmer), and the Shimmer value at 1 week and 4 weeks after operation was smaller than that before operation (P0.05). The Shimmer value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). (3) standardized noise energy (normalized noise energy,NNE. The absolute values of NNE at 1 week and 4 weeks after operation were higher than those before operation. The difference was statistically significant (P0.05). The absolute value of NNE at 4 weeks after operation was higher than that at 1 week after operation, and the difference was statistically significant (P0.05). (4) the ratio of noise to harmonic (Harmonica-noise ratio,NHR) was significantly lower than that at 1 week and 4 weeks after operation, and the NHR decreased to some extent at 1 week and 4 weeks after operation. The NNE value at 4 weeks after operation was lower than that at 1 week after operation, and the difference was statistically significant (P0.05). 3. VRP: (1) in terms of frequency, the maximum frequency and minimum frequency of 1 week after operation were found in the patients. The frequency range was not significantly different from that before operation (P0.05). The maximum frequency of 4 weeks after operation was higher than that before operation, the minimum frequency was lower than that before operation, and the frequency range was significantly larger than that before operation. The difference was statistically significant (P0.05). (2) in terms of intensity. There was no significant difference in the range of maximum intensity and minimum intensity between one week and one week after operation (P0.05). The maximum sound intensity and the minimum sound intensity were lower than those before operation, but the mean range of sound intensity was enlarged, the difference was statistically significant (P0.05). Conclusion: by comparing the differences between VHI, voice acoustic analysis and VRP parameters before and after operation, we believe that VHI, voice acoustic analysis and VRP have the function of quantitative voice evaluation. It is an important method to evaluate the effect of vocal polyp surgery.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767.91
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