肌紧张性发声障碍的临床特征及嗓音声学评估

Clinical Characteristics and Acoustics Evaluation in Patients with Muscular Tension Dysphonia

目的观察肌紧张性发声障碍(muscular tension dysphonia,MTD)患者的临床特点,探讨喉镜检查及计算机嗓音声学检测技术在此类发声障碍诊断中的应用价值。方法观察46例MTD患者发声特点及颈部体征,采用电子喉镜和计算机嗓音声学测试系统对46例MTD患者和40例正常成人进行检查,分析评估MTD患者临床表现、喉镜图像及嗓音声学特征。结果MTD患者发声呈过强、挤压、粗糙、嘶哑等特点;发声时呼吸表浅、颈部肌肉紧张、颈静脉怒张、喉结上移。喉镜显示喉腔缩小、声门前后径缩短、声门暴露差等,声带外观正常,张力增加,闭合过紧,假声带代偿性内收。嗓音声学检测显示患者嗓音具有正常和病理声学特征交替出现的特点。其特征为频率微扰(jitter)、振幅微扰(shi mmer)数值较正常升高(P<0.05),标准化噪声能量(NNE)变化不明显(P>0.05),声谱图高频区谐波及第2、3共振峰不规则、不连续、波纹抖动或消失。结论MTD患者发声过强及颈部肌肉紧张。喉镜检查声门过度闭合、声带正常。能检测到正常jitter、shi mmer、NNE及声谱图。

Objective To investigate the clinical features, glottal images and acoustic characteristics of patients with muscular tension dysphonia （MTD） and evaluate the value of laryngoscopy and acoustic measurement in the diagnosis of MTD. Methods The voice characteristics, cervical signs and laryngoscopic images of 46 cases with MTD were studied. The voice signals of sustained vowel/a/were measured with a software （Dr. Speech Science for Windows ） in 40 healthy adults and 46 patients, and the acoustic parameters and spectrographic characteristics were analyzed and compared. Results All patients presented a hoarse, husky and rough voice. The physical examination revealed shallow breath, tensioned cervical muscles, jugular varicosity and laryngeal protuberance shifting up. Laryngoscopic examinations showed reduced endolarynx, shorten anteroposterior diameter of the glottis, increased vocal cords tension with normal appearance, and the compensatory adduction of the false vocal cord. The acoustic examination of the patients with MTD indicated the parameters of jitter and simmer were significantly increased while there was no significant change in NNE. The spectrograph showed irregular, discontinuous or absence of harmonic waves at middle and high frequencies. The normal acoustic characteristics could be found in the patients with MTD. Conclusion The patients with MTD present excessive activities of phonation with tensioned cervical muscles. Laryngoscopy reveals increased adduction of glottis with normal appearance of vocal cords in these cases. Normal acoustic parameters （jitter, shimmer, and NNE） and spectrograph may be detected by acoustic technique in the patients with MTD.