儿童腺样体切除术后腭咽闭合功能及语音声学研究

The Effects of Adenoidectomy on Children's Speech and Velopharyngeal Functions

目的研究儿童腺样体切除术后腭咽闭合功能及语音声学的变化。方法对15例因腺样体肥大而行腺样体切除术的患儿(患者组)分别于术前、术后1周、术后1个月进行主观语音测试、腭咽闭合功能检测(吹泡试验、语音对测试)及计算机语音声学分析,并与15例正常儿童(对照组)进行比较。结果腺样体切除术后1周,15例患儿中7例(46.67%)出现语音改变、鼻音过重,4例(26.67%)进食鼻咽返流;术后1周吹泡平均时间较术前短(P<0.01),术后1个月时恢复正常(P>0.05);术后1周,语图显示辅音残缺,共振峰残缺弱化及鼻化元音改变,嗓音起始时间(voice onset time,VOT)缩短,元音/i/的第三共振峰(F3)频率较术前明显降低(P<0.01),术后1个月时F3有所回升,VOT接近正常值,但与术前比较仍有差异(P<0.05)。结论儿童腺样体切除术后1周时会出现鼻音加重的语音改变,大部分表现为一过性腭咽闭合功能不全,术后1个月时恢复正常。

Objective To study the effects of adenoidectomy on children＇s speech and velopharyngeal functions.Methods 15 patients were tested for speech,velopharyngeal functions and speech analysis before operation and one week,and one month after operation,respectively in comparison to normal children.Results The perceptual speech analysis showed that 7 in 15 cases（46.67%） presented hypernasality and 4 children（26.67%） presented nasal back streaming 1 week after operation.The objective velopharyngeal function evaluation showed there were significant differences in blowing soak time 1 week post-adenoidectomy（P0.01）,and later became normal within 1 month.The computerized speech analysis showed abnormal spectrograms such as consonantal mutilation,heavy nasal vowel and reduced formants 1 week after operation.The values of F3 in /i/ decreased after operation,especially within 1 week,and increased 1month after operation.But F3 was lower than before operation（P0.05）.Conclusion Hypernasality can occur to children 1 week after adenoidectomy,mostly noticeable as transient velopharyngeal insufficiency.But hypernasality became normal within 1 month.