计算机嗓音声学检测对声带良性增生性病变的相关性研究

发布时间：2018-05-02 22:30

本文选题：声带良性增生性病变 + 计算机客观声学参数　；参考：《河北医科大学》2011年硕士论文

【摘要】：目的:①通过计算机嗓音声学检测对比正常成年人与声带良性增生性病变患者的嗓音客观多维参数值的差异;②主客观评估进行比较,探讨主客观的相关性及一致性,尝试建立嗓音客观的多维参数模型;③探讨声带良性增生性病变的程度及术后的转归情况,以期为临床嗓音工作者提供必要的指导。方法:(1)选择的对象:嗓音疾病组选取2010年2月～2010年12月在我院耳鼻喉科就诊的嗓音疾病患者共210例,年龄在20～60岁之间,所有病例均经过频闪喉镜,纤维喉镜确诊,术后病人均经病理确诊。对照组:选取240例正常成年人作为嗓音参数对照组,为无咽喉疾病,无烟酒嗜好,发音均正常、无嗓音障碍病史及呼吸系统疾病等,且均经频闪喉镜、纤维喉镜检查声带外观及运动正常者,其中男120例,女120例,年龄在23～58岁之间。(2)检测方法:①主观听感知测评:全部受检者的嗓音样本均在隔音室内录制,录制完整的一句话约10秒钟,并在隔音室内进行回放为听评委提供声样。选取3名有经验的经过培训的嗓音学专家依据日本言语医学会和嗓音医学会提出的GRBAS系统中的总嘶哑度(grade,G),按4级标准:0级正常;1级轻度嘶哑;2级中度嘶哑;3级重度嘶哑。全部嗓音样本均按随机的方式进行3次排列,并对每个嗓音样本进行3次评估,最后结果取3次评估的平均值。分别对嗓音正常组和声带病变组进行评估。②客观多参数测评:采用美国Kay公司的多维嗓音分析系统MDVP及电声门图EGG进行参数的测定。测试者均在安静的室内进行,环境噪音在45DB以下,以舒适自然发稳态的长元音/a:/,持续至少4秒,连续测试3次,截取中间平稳段作为分析声样,结果取每个参数的3次平均值。同时进行电声门图信号的采集,将两只金属圆盘电极置于受试者颈前两侧甲状软骨板处,实时调整电极圆盘的位置直至出现合适的波形,取声样的平稳段至少4秒钟。③嗓音的声学分析测试和电声门图测试参数有基频(F0)、最高基频( Fhi)、最低基频(Flo)、基频微扰( jitter )、绝对音调微扰(Jita)、振幅微扰( shimmer )、噪声/谐和比(NHR)、振幅扰动商(APQ)、接触商(EGG-CQ)。结果:表1表明:声带病变女性组中声带小结占50.67%,发病人数最多,其次是声带息肉占24.67%,女性无声带任克氏水肿患者。男性组中声带息肉占37.20%,发病人数最多,其次是慢性喉炎占27.91%,声带小结占16.28%,较女性减少,声带任克氏水肿病例全部为男性。在全部病例中男性嗓音障碍疾病人数较多;表2表明:正常成年男女嗓音基频随年龄增大数值逐渐降低,男性在51～60岁之间虽略有升高但总体呈下降趋势;女性组中D组与A组Fo、Fhi、Flo值p0.05有差异;男性组中C组与A组Fo、Fhi、Flo值差异有统计学意义,其余参数值在男女各年龄段间差异均无统计学意义。表3表明:Fo、Fhi、Flo、Jita、Jitt、Shim参数值在男女组间进行比较,结果p0.05,差异有统计学意义, APQ、NHR、EEG-CQ参数值差异无统计学意义;表4表明:慢性喉炎和声带小结Fo、Fhi、Flo参数值与正常嗓音组比较差异无统计学意义(P0.05),其余参数值在病理性嗓音组与正常嗓音组间差异均有统计学意义。慢性喉炎和声带息肉各参数值分别与声带小结比较除Fo、Fhi、Flo值差异有统计学意义外余各参数值差异均无统计学意义;表5表明:在主观听感知评估中慢性喉炎和声带小结以轻度嘶哑为主,声带息肉与声带囊肿均以中、重度嘶哑为主,任克氏水肿均为重度嘶哑;表6表明:各参数值的变化趋势与嗓音障碍程度呈一致性,随着声嘶病变程度的加重,各参数值逐渐增大。表7表明:Jita、Jitt、Shim、NHR值在相邻嗓音质量组间比较p0.05,差异有统计学意义;表8可以看出Fo、Fhi、Flo、CQ值术后1～4周逐渐增大,Jita、Jitt、APQ、Shim值术后1-4周逐渐降低,至术后第4周基本恢复正常;表9表明:术前与术后1周比较除Jita、Jitt值差异有统计学意义,余均P0.05。术前与术后2周比较各参数值差异均有统计学意义。正常对照组与术后2周除Fo、Flo、Shim差异无统计学意义外,余均有统计学意义。正常对照组与术后4周比较参数值差异均无统计学意义。表10表明:各客观参数间与总嘶哑度有高度相关性及各客观参数间均有中度相关性。表11表明:主客观的一至性达到87%。结论:①尝试建立了正常成年人的主客观多维参数模型,基频(F0)、最高基频(Fhi)、最低基频(Flo)在性别上有显著性的差异,因此嗓音声学检测应按性别分别对待。②计算机客观声学多维参数检测对声带良性增生性病变有很好的临床诊断价值,基频微扰Jitt、振幅微扰Shim、噪谐比NHR较为敏感,可判断声带良性增生性疾病的严重程度,为临床诊断和治疗提供了依据,应作为客观诊断指标。③对于病变术前、术后评估,基频微扰Jitt、振幅微扰Shim、噪谐比NHR及接触商CQ是分析嗓音障碍手术前后较为重要参数值,可作为声带显微外科手术治疗效果的评估及术后跟踪随访的客观依据。④嗓音疾病患者的主客观评估具有一定的相关性,客观的参数值可以很好的反映主观评价,且这种相关性随着嗓音障碍的严重程度而更加显著。
[Abstract]:Objective: To compare the differences of the objective multidimensional parameters of voice between normal adults and benign proliferative lesions of vocal cords by the sound of computer voice, and to compare the subjective and objective evaluation, to explore the correlation and consistency of the main objective, and to try to establish the multi-dimensional parameter model of the voice, and to explore the course of the benign hyperplasia of the vocal cords. And the prognosis after operation, in order to provide necessary guidance for clinical voice workers.
Methods: (1) the selected subjects: voice disease group selected 210 cases of voice disease in the Department of ENT of our hospital from February 2010 to December 2010. The age was between 20~60 years old. All cases were diagnosed by stroma laryngoscopy, fiberoptic laryngoscopy, and all patients were diagnosed by pathology. The control group selected 240 normal adults as voice parameters. There were no throat diseases, smokeless alcohol addiction, normal pronunciation, no voice disorder history and respiratory system diseases, and all were examined by stroma and fiberoptic laryngoscopy, including 120 men, 120 women, and 23~58 years of age. (2) test methods: subjective auditory perception: all subjects' voice samples They were recorded in the sound insulation room, recorded a complete sentence for about 10 seconds, and replayed in the sound isolation room to provide sound samples to the hearing judges. 3 experienced and trained voice experts were based on the total hoarseness (grade, G) in the GRBAS system of the Japanese speech Medical Association and voice medical Association, according to grade 4 standard: grade 0 normal; 1 mildly hoarseness. Dumb; grade 2 moderately hoarse; grade 3 severe hoarseness. All voice samples were arranged in a random manner 3 times, and each voice sample was evaluated for 3 times. Finally, the average value of the 3 assessment was taken. The normal voice group and the vocal cords group were evaluated respectively. The parameters of the MDVP and the electroacoustic gate EGG were measured in the quiet room, the ambient noise was below 45DB, the long vowel /a:/, which was comfortable and natural steady state, lasted at least 4 seconds, and the intermediate stationary segment was intercepted as the analysis sound, and the 3 mean values of each reference were taken. Set, the two metal disc electrodes were placed at the front of the neck of the subjects on both sides of the thyroid cartilage. The position of the electrode disc was adjusted in real time until the appropriate waveform appeared, and the stationary phase of the sound sample was at least 4 seconds. 3. The acoustic analysis test and the electroacoustic gate test parameters were F0, the highest fundamental frequency (Fhi), the lowest fundamental frequency (Flo), and the fundamental frequency perturbation (Jitt Er), absolute tone perturbation (Jita), amplitude perturbation (shimmer), noise / harmonic ratio (NHR), amplitude perturbation quotient (APQ), contact quotient (EGG-CQ).
Results: Table 1 showed that the vocal nodules accounted for 50.67% in the female group with vocal cord lesions, the largest number of vocal cords, 24.67% of vocal polyps, 24.67% of vocal cord polyps, 37.20% of the vocal polyps in the male group, the largest number of diseases, 27.91% of the chronic laryngitis, 16.28% of vocal nodules, the decrease of the vocal cords, and the vocal cork dropsy disease. All cases were male. In all cases, the number of male voice disorders was large; table 2 showed that the basic frequency of male and female voice in normal adults decreased with age, and the male was slightly higher in 51~60 years, but in the female group D and A group Fo, Fhi, Flo value P0.05 were different, and C group and A group Fo, Fhi, Flo in the male group. There was no statistically significant difference in the values of the other parameters in men and women. Table 3 showed that Fo, Fhi, Flo, Jita, Jitt, Shim were compared between women and men, and the results were statistically significant, APQ, NHR, EEG-CQ parameter values were not statistically significant; table 4 indicated that chronic laryngitis and vocal nodules were Fo, Fhi, There was no statistically significant difference in Flo parameters between the normal voice group and the normal voice group (P0.05). The other parameters were statistically significant between the pathological voice group and the normal voice group. The differences in the parameters of the parameters of the chronic laryngitis and vocal polyps were compared with the vocal nodules, except for the Fo, Fhi, and Flo values, and there was no statistical difference. Table 5 showed that in the subjective auditory perception assessment, chronic laryngitis and vocal cord nodules were mild hoarse, vocal polyps and vocal cysts were both moderate and severe hoarse, and all Kirschner's edema was severe hoarse; table 6 showed that the variation trend of each parameter was consistent with the voice obstacle course. With the aggravation of the degree of hoarseness, the parameters of each parameter were increased. The value gradually increased. Table 7 showed that Jita, Jitt, Shim, NHR values were compared between adjacent voice mass groups P0.05, the difference was statistically significant; table 8 can see Fo, Fhi, Flo, CQ values gradually increased 1~4 weeks after operation, Jita, Jitt, APQ, 1-4 weeks after the operation gradually decreased to fourth weeks after the operation; table 9 showed before and 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation, except for the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after The difference of T value was statistically significant. The difference of parameters between P0.05. before and 2 weeks after operation was statistically significant. There was no statistically significant difference between the normal control group and the 2 weeks after the operation except Fo, Flo and Shim. There was no statistical significance between the normal control group and the 4 weeks after the operation. There was a high correlation between the hoarseness and the total hoarseness, and there was a moderate correlation between the objective parameters. Table 11 showed that the subjective and objective one reached 87%.
Conclusion: (1) the subjective and objective multidimensional parameter model of normal adults was established, the fundamental frequency (F0), the highest fundamental frequency (Fhi) and the minimum fundamental frequency (Flo) were significant differences in sex, so the voice acoustic detection should be treated by sex respectively. Value, fundamental frequency perturbation Jitt, amplitude perturbation Shim, noise harmonic more sensitive than NHR, can judge the severity of benign hyperplasia of vocal cords, provide basis for clinical diagnosis and treatment, and should be used as an objective diagnostic indicator. (3) for preoperative, postoperative evaluation, fundamental frequency perturbation Jitt, amplitude perturbation Shim, noise harmonic ratio NHR and contact CQ is an analysis of voice disorder. The value of the important parameters before and after the operation can be used as an objective basis for the evaluation of the effect of the vocal microsurgical treatment and the follow-up follow-up. 4. The subjective and objective assessment of the voice disease patients has some relevance, and the objective parameter values can reflect the subjective evaluation well, and this correlation is more serious with the severity of the voice disorder. Plus significant.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R767.92

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