全喉切除食管音助发声器发音的客观声学分析

发布时间：2018-06-03 11:22

本文选题：喉切除术 + 言语　；参考：《宁夏医科大学》2010年硕士论文

【摘要】：目的全喉切除术后给患者带来的最大痛苦是失去发音功能。术后最常见的发音方法是食管音、气管食管造瘘发音和气管食管造瘘安装发音管发音,其成功率约为70%-80%;使用食管音助发声器可提高发音成功率,发音的主观评估已有报道,本研究通过客观声学分析来探讨食管音助发声器的发音质量。方法本研究所选择的实验组病例来自1994年3月至2005年7月在宁夏医科大学附属医院耳鼻咽喉-头颈外科就诊,诊断为喉癌,行全喉切除Blom-Singer术式发音重建患者共39例,其中健在24例,健在能联系到并自愿配合检查的仅此10例;安装发音管不能发音的4例与安装后能发音因长肉芽不得不去除发音管改用食管音助发声器患者1例;共5例为食管音助发声器组;安装发音管能发音的5例做为气管食管音组。选择12名年龄基本匹配的无嗓音疾病的正常男性作为对照组。进行声学参数:基频、频率微扰、振幅微扰、谐噪比,最大发音实时间及声强的检测。结果1.食管音助发声器发音组、气管食管音组和正常嗓音组的基频值分别为155.73Hz、147.52Hz和168.87Hz;食管音助发声器发音组和气管食管音组的基频较正常嗓音组低,差异有统计学意义(P0.05),食管音助发声器发音组与气管食管音组的基频差异无统计学意义(P0.05)。2.食管音助发声器发音组、气管食管音组和正常嗓音组的基频微扰值分别为1.89%、1.85%和0.17%,振幅微扰值分别为6.74%、6.57%和1.70%,谐噪比值分别为10.97dB、10.27dB和21.19dB,食管音助发声器发音组和气管食管音组的基频微扰及振幅微扰高于正常嗓音组,差异有显著性(P0.01),但谐噪比低于正常人有显著性差异(P0.01),食管音助发声器发音组和气管食管音组的基频微扰、振幅微扰和谐噪比的差异无统计学意义(P0.05)。3.食管音助发声器发音组、气管食管音组和正常嗓音组的声强值分别为77.40dB、76.85dB和83.30dB。与正常嗓音组相比,食管音助发声器发音组和气管食管音组的声强与之没有显著差异(P0.05)。4.语谱图显示食管音助发声器发音和气管食管音较粗糙,声音洪亮,发音清楚。5.食管音助发声器发音组、气管食管音组和正常嗓音组的最大发音时间分别为10.77秒、6.10秒和15.81秒。食管音助发声器发音组和气管食管音组最大发音时间低于正常嗓音组,有显著性差异(P0.01),但一口气音节数差异无统计学意义(P0.05)。食管音助发声器发音的最大发音时间高于气管食管音,差异有统计学意义(P0.05)。结论1.食管音助发声器发音和气管食管音患者基频较正常人低,提示该两组患者音调较正常人要低。2.食管音助发声器发音和气管食管音患者的基频微扰及振幅微扰高于正常人,但谐噪比低于正常人,这说明与正常嗓音相比,食管音助发声器发音和气管食管发音的声音更粗糙,且有较多噪音成分。3.与正常嗓音相比,食管音助发声器发音和气管食管音的声强与之没有显著差异,提示平稳发音的条件下声强没有差异。4.语谱图显示食管音助发声器发音和气管食管音音质清晰,响度大,发音质量较稳定,音色较浑厚,表明基本上能够满足日常会话需要。5.食管音助发声器发音和气管食管音患者最大发音时间虽低于正常人,但一口气音节数大多数己达I级,这表明食管音助发声器发音患者能够自如地运用声音进行日常交流,不易出现发音管发音组中个别患者发音中中途无声现象。食管音助发声器发音组的最大发音时间高于气管食管音组。说明食管音助发音器发音语音连贯性更好。通过以上结果,说明食管音助发声器发音的声音是较令人满意的,对于无喉患者来说,尤其是发音重建安装发音管发音失败患者无疑是一种较好的声音选择。
[Abstract]:Objective the greatest pain for patients after total laryngectomy is to lose pronunciation. The most common method of pronunciation after operation is esophageal sound, tracheoesophageal fistula pronunciation and tracheoesophageal fistula installation of pronunciation tube pronunciation, the success rate is about 70%-80%; the use of esophageal sound aids can improve the success rate of pronunciation, the subjective assessment of pronunciation has been reported, In this study, objective acoustic analysis was used to investigate the sound quality of the esophageal sound aid. Methods the cases selected from this study were from March 1994 to July 2005 at the otorhinolaryngology head and neck surgery in the Affiliated Hospital of Ningxia Medical University, diagnosed as laryngectomy, and 39 cases of total laryngectomy were performed by Blom-Singer. In 24 cases, only 10 of them were able to contact and voluntarily cooperate with the examination; 4 cases of articulation tubes that could not be articulation and 1 patients who had to pronounce the sound tube to the sound tube after the installation had to be pronounced with long granulation had to be removed from the esophagus sound aid group; 5 cases were used as the esophageal sound aid group; 5 cases of articulation tube can be used as the tracheoesophageal sound group. Select 12. The acoustic parameters: basic frequency, frequency perturbation, amplitude perturbation, harmonic noise ratio, maximum sound time and sound intensity were measured. Results the basic frequency of 1. esophageal sound aid sound apparatus, tracheoesophageal sound group and normal voice group were 155.73Hz, 147.52Hz and 168.87Hz, respectively; The basic frequency of the sound and tracheoesophageal sound group was lower than that of the normal voice group (P0.05). There was no significant difference in the basal frequency between the sound group and the trachea of the trachea and esophagus (P0.05).2. esophageal sound aid sound apparatus, and the basal frequency perturbation of the trachea and the normal voice group were respectively the basic frequency perturbation values of the trachea and the normal voice group. 1.89%, 1.85% and 0.17%, the amplitude perturbation values were 6.74%, 6.57% and 1.70%, and the harmonic noise ratios were 10.97dB, 10.27dB and 21.19dB respectively. The basal frequency perturbation and the amplitude perturbation of the sound and tracheoesophageal sound group were higher than those of the normal voice group (P0.01), but the harmonic noise ratio was significantly different (P0.01), the esophagus was lower than the normal person (P0.01). The basic frequency perturbation of the sound and tracheoesophageal sound groups, the difference of the amplitude perturbation and the noise ratio is not statistically significant (P0.05).3. esophagus sound aid sound apparatus, the sound intensity of the tracheoesophageal sound group and the normal voice group is 77.40dB, 76.85dB and 83.30dB. are compared with the normal voice group, and the sound group and the Qi of the esophageal sound aid sound aid apparatus are compared with the normal voice group. The sound intensity of the esophageal sound group was not significantly different (P0.05).4. spectrum showed that the pronunciation of the esophageal sound aid and the tracheoesophageal sound were rough, the sound was bright, the pronunciation of the.5. esophagus sound aid sound apparatus was clear, the maximum pronunciation time of the trachea and esophagus sound group and the normal voice group was 10.77 seconds, 6.10 seconds and 15.81 seconds respectively. The maximum pronunciation time of the articulatory group and the trachea and esophagus group was lower than the normal voice group. There was a significant difference (P0.01), but the difference of one tone syllables was not statistically significant (P0.05). The maximum pronunciation time of the sound apparatus in the esophagus was higher than that of the trachea and esophagus (P0.05). Conclusion the pronunciation and trachea of the 1. esophagus sound aid sound apparatus and the trachea The basic frequency of the patients with esophageal sound is lower than that of the normal person, suggesting that the tone of the two groups of patients is lower than that of the normal person. The basic frequency and amplitude perturbation of the.2. esophageal sound aid and the tracheoesophageal sound are higher than those of the normal people, but the harmonic ratio is lower than that of the normal people, which shows that the sound of the esophagus sound and the sound of the tracheoesophageal pronunciation is compared with the normal voice. More rough and more noisy, compared with the normal voice, there was no significant difference between the sound and the sound of the trachea and esophagus, suggesting that there was no difference between the sound intensity of the esophageal sound aid and the tracheoesophageal sound, suggesting that there was no difference between the sound intensity of the sound and the sound quality of the trachea and esophagus, the sound quality of the esophagus, the sound sound quality, the sound sound quality, and the sound quality of.3.. The color of the.5. esophagus sounds and the tracheoesophageal sound is less than the normal person, but the number of the one tone syllables is I, which indicates that the patients with the sound of the sound are able to use the sound for daily communication, and the pronunciation tube is not easy to appear. A few patients in the pronunciation group have no sound in the middle of pronunciation. The maximum pronunciation time of the voice group of the esophageal sound AIDS is higher than that of the trachea and esophagus. It shows that the pronunciation of the esophageal sound AIDS is better. It is pronunciation reconstruction, installation of articulation tube, failure of voice is undoubtedly a better choice of voice.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R767

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