嗓音声学检测在部分声带疾病嗓音评估中的临床价值

发布时间：2018-02-12 04:50

本文关键词： 喉白斑声带息肉嗓音学检测嗓音分析电声门图临床意义　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的嗓音分析(Voice Acoustic Analysis)和电声门图(EGG)是近年来随着计算机技术发展而研制成的新仪器,是目前国内外最常用的嗓音客观评估方法,是一种无创的检查方法。声带疾病泛指发生在声带上的疾病,常见的声带疾病有声带息肉、声带小结、喉良性肿物和喉白斑等。随着嗓音医学的发展,通过嗓音声学分析,发现多种声带疾病的各项声学参数(如Jitter、Shimmer、NNE、HNR、SNR、MPT等)与正常嗓音者之间有明显的差异。声音嘶哑为声带疾病的早期症状,随病变发展而加重。然而对于声音嘶哑的程度长期缺乏客观的准则,不同的医师主观感觉不同,受主观影响较重。而发音质量作为衡量人类生活质量的重要指标之一,引起人们广泛关注。临床上迫切需要声带疾病的患者术前和门诊检查中有一明确的客观指标。本研究即从常用的嗓音声学参数入手,分析对比常见声带疾病患者的嗓音声学参数和正常嗓音声学参数的差别,为声音嘶哑程度提供客观指标,为嗓音声学检测在声带疾病临床上的嗓音评估和疗效评价方面的应用提供理论依据。方法采用上海泰亿格电子有限公司的Dr.Speech Science for Windows仪器对48例喉白斑患者和20例声带息肉患者进行嗓音分析和EGG同步化测试,并与50例正常人的嗓音声学参数进行对比比较,得出各组研究对象之间嗓音声学参数(Jitter、Shimmer、NNE、HNR、SNR、MPT)的差异以及EGG波形的形态差异,并通过比较各组的差异,为患者的声嘶程度提供客观指标和判断的理论依据。结果1.喉白斑和正常组比较:嗓音分析参数中,喉白斑组Jitter、Shimmer和NNE均高于正常组,HNR、SNR和MPT均低于正常组(均P0.05),其中NNE差异显著;EGG参数中,喉白斑组EGG-Jitter、EGG-Shimmer、EGG-NNE、CIP和CQP均高于正常组,EGG-HNR、EGG-SNR均低于正常组(均P0.05)。正常组EGG波形为光滑有规律的类正弦曲线,喉白斑组EGG波形渐开相速度加快,整个闭合相缩短,呈尖峰状,波形规律,波形异常率占72.9%(34/48)。2.声带息肉和正常组比较:嗓音分析参数中,声带息肉组Jitter、Shimmer和NNE均高于正常组,HNR、SNR和MPT均低于正常组(均P0.05);EGG参数中,声带息肉组EGG-Jitter、EGG-Shimmer、EGG-NNE、CIP和CQP均高于正常组,EGG-HNR、EGG-SNR均低于正常组(均P0.05)。声带息肉组EGG波形波峰降低,开放相时长延长,波形主要是渐开相陡直和渐闭相切迹两种。渐闭相较渐开相速度快,曲线坡度陡;声带闭合提前出现,渐闭相出现切迹,波形异常率占85%(17/20)。结论嗓音分析和EGG检测具有无创性,易接受,且操作简便,有利于大规模筛查,及时发现早期不明显的嗓音相关疾病;同步化测试可互相弥补各自的不足,结合病史、体征、电子喉镜等检查,可辅助诊断喉白斑、声带息肉等声带疾病;为声音嘶哑程度提供客观指标,为嗓音声学检测在声带疾病临床上的嗓音评估和疗效评价方面的应用提供理论依据;对声带疾病的预防、疗效评估、术后复发和发音矫治提供临床指导。
[Abstract]:Voice Acoustic Analysis and Acoustic Gate Analysis (EGG) are new instruments developed with the development of computer technology in recent years. They are the most commonly used voice objective evaluation methods at home and abroad. Vocal cord disease refers to diseases occurring on the vocal cord. Common vocal cord diseases include vocal cord polyps, vocal nodules, laryngeal benign masses and laryngeal leukoplakia. It was found that there were significant differences between the acoustic parameters of various vocal cord diseases (such as Jitteri ShimmerNNEHNRNRN MPT, etc.) and those with normal voice. Hoarseness is the early symptom of vocal cord disease. However, for the degree of hoarseness, there is no objective criterion for the degree of hoarseness. Different doctors have different subjective feelings and are heavily influenced by their subjective feelings. The quality of pronunciation is one of the important indicators to measure the quality of human life. There is a clear objective index in patients with vocal cord diseases before and after outpatient examination. This study begins with the commonly used voice acoustic parameters. The differences between the acoustic parameters of the voice and the normal voice of the patients with common vocal cord diseases were analyzed and compared to provide an objective index for the degree of hoarseness. Methods 48 patients with laryngeal leukoplakia and 20 patients with laryngeal leukoplakia were treated with Dr.Speech Science for Windows instrument of Shanghai Taiyag Electronics Co., Ltd. Voice analysis and EGG synchronization tests were performed in patients with vocal cord polyps. Compared with 50 normal subjects, the difference of voice acoustic parameters and the morphological differences of EGG waveforms among the subjects in each group were obtained, and the differences of the acoustic parameters and the shape of the EGG waveforms among the subjects in each group were also obtained by comparing the acoustic parameters of the voice and the shape of the EGG waveforms in each group, and the difference of the acoustic parameters between the three groups was obtained by comparing the acoustic parameters of the two groups. Results 1. Comparison of laryngeal leukoplakia and normal group: voice analysis parameters, The NNE and Jitterus Shimmer in the patients with leukoplakia were significantly higher than those in the normal controls (P 0.05), and the difference of NNE was significant among them. EGG-Jitterl EGG-ShimmerCIP and CQP were higher than those in normal group (P0.05). The EGG waveform of normal group was smooth and regular sinusoid curve, EGG waveform of laryngeal leukoplakia group was accelerated, the whole closed phase was shortened, and the wave form was sharp and regular. Comparison of vocal cord polyp with normal group: in the voice analysis parameters, the NNE and Jitter NNE in the vocal cord polyp group were higher than those in the normal control group (P 0.05), and the MPT of the vocal cord polyp group were lower than that of the normal group (P 0.05). EGG-Jittert EGG-ShimmerCIP and CQP in polyp group were higher than those in normal group (P0.05%, respectively). The peak of EGG wave in polyp group was decreased, and the open phase was prolonged. The curve slope is steep, the vocal cord closure appears ahead of time, the closed phase appears the notch, the waveform abnormal rate accounts for 85% of 20%. Conclusion the voice analysis and EGG test are noninvasive, easy to accept, and easy to operate, which is beneficial to large-scale screening. Synchronous testing can make up for each other's shortcomings, combining with history, physical signs, electronic laryngoscope and other examinations, it can help to diagnose vocal cord diseases such as leukoplakia and vocal cord polyp. To provide objective indicators for hoarseness, to provide theoretical basis for the application of voice acoustic measurement in the evaluation of vocal cord disease in clinical and curative effect evaluation, and to evaluate the prevention of vocal cord disease and the evaluation of curative effect. Postoperative recurrence and pronunciation correction provide clinical guidance.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R767.92

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