不同声状态下嗓音疾病空气动学研究

发布时间：2018-04-11 15:18

本文选题：声带 + 室带　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的研究舒适发声与响亮发声状态下,部分临床常见嗓音疾病患者声门下压、平均气流率、声门阻力和发声效率等空气动力学参数的变化特点,比较不同嗓音疾病间空气动力学差异,探讨声带病变对发声中通过声门气流的影响,以及空气动力学检查在嗓音疾病的诊断和评估中的重要作用。方法随机选取133名受试者,排除受试者呼吸系统、神经系统、听力疾病等障碍,根据病史、体征以及电子喉镜结果分为正常对照组(男25例,女27例),声带小结组(女12例),声带息肉组(女17例,男13例),声带白斑组(男12例),声带瘢痕组(女8例),声带Ⅲ型切除术后双侧室带代偿发声组(男9例),声带Ⅲ～Ⅳ型切除术后单侧室带代偿发声组(男10例),采用言语发声空气动力学系统6600进行空气动力学测量,比较分析各组受试者在舒适发声、响亮发声状态下的平均气流率、声门下压、声门阻力和发声效率的差异,并通过ROC曲线和logistic分析明确各种嗓音疾病的特征性空气动力学参数。结果声门下压：声带息肉组男性高于女性(P=0.005)。在声带息肉、(男)、声带白斑、双侧室带发声和声带瘢痕情况下升高(P=0.001,P=0.005,P=0.000,P=0,000)。平均气流率：正常对照与声带息肉组男性高于女性(P=0.000,P=0.005)。在声带白斑、双侧室带发声、声带小结、声带息肉(女)、声带瘢痕情况下升高(P=0.000,P=0.000,P=0.003,P=0.001,P=0.008),单侧室带发声低于正常对照组(P=0.000)。声门阻力：正常对照与声带息肉男性低于女性(P=0.000,P=0.001)。单侧室带发声声门阻力升高(P=0.000),在双侧室带发声、声带小结、声带息肉(女)、声带瘢痕情况下降低(P=0.000,P=0.000,P=0.011,P=0.002)。发声效率：在双侧室带发声、声带小结、声带息肉(女)、声带瘢痕情况下降低(P=0.025,P=0.001,P=0.016,P=0.003)。声门下压变化率：单侧室带发声高于正常对照(P=0.000)。声带息肉(女)、声带瘢痕较正常对照小(P=0.001,P=0.005)。平均气流率变化率：正常对照与声带息肉男、女性受试者相比,男性高于女性(P=0.005,P=0.035)。单侧室带发声高于正常对照(P=0.008),声带白斑低于正常对照(P=0.000)。声门阻力变化率：正常对照女性高于男性(P=0.005),声带息肉女性低于男性(P=0.023)。声带息肉(男)高于正常对照(P=0.001),在双侧室带发声、单侧室带发声、声带息肉(女)、声带瘢痕情况下降低(P=0.027,P=0.001,P=0.000,P=0.000)。发声效率变化率：正常对照、声带息肉中女性高于男性(P=0.000,P=0.000)。在声带白斑、声带瘢痕情况下降低(P=0.001,P=0.002),声带息肉(女)高于正常对照(P=0.000) 声带息肉(男)：声门阻力变化率曲线下面积0.822,数值为0.55时,灵敏度0.769,特异度0.875,88.4%的患病率。声带白斑：发声效率变化率曲线下面积0.864,数值为1.55时,灵敏度0.917,特异度0.842,75.4%的患病率。双侧室带发声：平均气流率、声门阻力、发声效率曲线下面积均为1.000,当数值分别为0.78L/s、15.21cmH2O/(L/s)、24.88ppm,灵敏度1.000,特异度1.000,患病率为100%。单侧室带代偿发声：声门阻力曲线下面积为0.976,数值为42.16cmH20/(L/s)时,灵敏度1.000,特异度0.932,95.7%的患病率。声带小结：声门阻力曲线下面积0.776,数值为43.09cmH2O/(L/s)时,灵敏度0.917,特异度0.769,患病率为81.3%。声带息肉(女)：发声效率变化率曲线下面积0.810,数值为10.94时,灵敏度0.765,特异度0.830,有81.3%的患病率。声带瘢痕：发声效率变化率曲线下面积1.000,数值为1.75时,灵敏度1.000,特异度1.000,100%的患病率结论正常人群平均气流率、声门阻力存在性别差异,与男、女性喉部解剖结构和声带生理特性有关,可能是嗓音疾病女性高发的原因。在响亮发声状态下,发声效率显著提升,高发声效率与发声损伤密切相关,响亮发声更易患嗓音疾病。声带疾病、室带发声情况下空气动力学参数发生显著改变,对发声响度的调节能力有不同程度的下降,这与各种病理状太下声门面积、声带质量、硬度、黏滞度和弹性等因素的改变密切相关。本次研究涉及的各类疾病,各具特征性的空气动力学参数改变,空气动力学检查在嗓音疾病和声带病变的辅助诊断、功能评估等方面具有一定的意义。
[Abstract]:Objective to study the sound of loud sound and comfortable state, part of patients with common voice disorders subglottic pressure, mean airflow rate, changes of resistance and glottal vocal efficiency of aerodynamic parameters, comparison of different voice aerodynamic differences among the diseases of vocal cord disease, affect the sound through the glottal air flow, and the important role of aerodynamics in the diagnosis and evaluation of voice diseases.
Methods 133 subjects were randomly selected, excluding subjects with respiratory system, nervous system, hearing disorders, diseases based on history, signs and results of electronic laryngoscope were randomly divided into normal control group (male 25 cases, female 27 cases), a small group of vocal cord (12 women), polyps (17 females. 13 cases were male), vocal cord leukoplakia group (12 male), vocal scar group (8 women), vocal cord type III after resection of bilateral vocal chamber with compensatory group (9 men), vocal cord type III ~ IV after resection of unilateral vocal chamber with compensatory group (10 men), with the sounds of speech the aerodynamic system 6600 aerodynamic measurement, comparison and analysis of each group of subjects in a comfortable voice, loud sound average flow rate, subglottic pressure difference, glottal resistance and phonatory efficiency, and through the ROC curve and logistic parameter analysis of aerodynamic characteristics of various clear voice diseases.
The subglottic pressure: vocal polyp group was higher in male than in female (P=0.005). In the vocal cord polyp, (male), bilateral vocal cord leukoplakia, chamber with vocal and vocal scar cases increased (P=0.001, P=0.005, P=0.000, P=0000). The average flow rate: normal control and vocal polyp group of male sex than women (P=0.000, P=0.005). In vocal leukoplakia, vocal, chamber with bilateral vocal nodules and vocal cord polyp (female), vocal scar cases increased (P=0.000, P=0.000, P=0.003, P=0.001, P=0.008), unilateral vocal chamber with lower than the normal control group (P=0.000). Glottal resistance: normal control and vocal cord polyps lower in males than in females (P=0.000, P=0.001). Unilateral vocal chamber with glottal resistance increased (P=0.000), in the room with bilateral vocal, vocal nodules and vocal cord polyp (female), vocal scar cases reduced (P=0.000, P=0.000, P= 0.011, P=0.002). The sound efficiency: in the room with bilateral vocal, vocal nodules and vocal cord polyp (female), vocal scar cases (P=0.025, P=0.001, P=0.016 decreased, P=0.003). The rate of pressure change: unilateral vocal subglottic chamber with higher than normal control (P=0.000). The vocal cord polyp of vocal scar (female), compared to the normal control of small (P=0.001, P=0.005). The average flow rate and the rate of change: normal control polyp of vocal cord compared to male, female subjects, men than women (P=0.005, P=0.035). Unilateral vocal chamber with higher than normal control (P=0.008), leukoplakia is lower than that of normal control (P=0.000). The rate of change of glottal resistance: normal control women than men (P=0.005), vocal cord polyp femaleunderthe male vocal cord (P=0.023). Polyp (male) was higher than that of normal control (P=0.001), in the room with bilateral vocal, vocal chamber with unilateral vocal polyp, vocal scar (female), lower (P=0.027, P=0.001, P=0.000, P=0.000). The sound efficiency rate of change: the normal female vocal cord polyp than males (P=0. 000, P=0.000). Lower (P=0.001, P=0.002) and vocal cord polyps (P=0.000) in vocal cords leukoplakia and soundscars.
Vocal cord polyp (male): glottal resistance change rate of the area under the curve of 0.822, value of 0.55, sensitivity of 0.769, specificity of 0.875,88.4%. The prevalence of vocal cord leukoplakia: vocal efficiency change rate of the area under the curve of 0.864, value of 1.55, sensitivity of 0.917, specificity of 0.842,75.4%. The prevalence of bilateral ventricular band sound: mean flow rate, glottal resistance, sound efficiency of the area under the curve was 1, when the values are 0.78L/s and 15.21cmH2O/ (L/s), 24.88ppm, sensitivity 1, specificity was 1, the prevalence rate was 100%. with unilateral ventricular compensatory sound: glottal resistance area under the curve is 0.976, the value for the 42.16cmH20/ (L/s), the sensitivity of 1 the specificity of 0.932,95.7%. The prevalence of vocal nodules: glottal resistance area under the curve of 0.776, the value for the 43.09cmH2O/ (L/s), the sensitivity was 0.917, specificity was 0.769, the prevalence of 81.3%. with polyps (female): Acoustic sounding efficiency curves When the area is 0.810, the value is 10.94, the sensitivity is 0.765, the specificity is 0.830, and there is a 81.3% prevalence rate. The scar area of the vocal cord: the area under the curve of the efficiency of voice efficiency is 1. When the value is 1.75, the sensitivity is 1, the prevalence of specificity 1.000100%.
Conclusion the normal population mean airflow rate, there are gender differences in male and female, glottal resistance, physiological characteristics and anatomical structure of laryngeal vocal cords, may cause the disease of high incidence. In the female voice loud sound sound condition, significantly enhance the efficiency of high sounding efficiency is closely related with the vocal injury, loud sound more susceptible to vocal voice disorders. Disease room with sounding kinetic parameters of air conditions changed significantly, have different degrees of decline in the ability to regulate the sound loudness, and the pathological condition of glottal area, vocal quality, hardness, viscosity and elasticity is closely related to factors such as the change of various kinds of diseases. This study involves the change of aerodynamics the characteristics of the parameters, the aerodynamic check in the auxiliary diagnosis of voice disorders and vocal cord lesions, which has a certain significance function evaluation and so on.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R767.92

【参考文献】