单侧声带麻痹患者发声功能损害的客观特征及在言语治疗中的应用

The value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis

目的探讨单侧声带麻痹患者发声功能损害的客观声学特征在言语治疗中的应用.方法回顾性纳入2015年5月至2018年4月就诊于天津市第一中心医院耳鼻咽喉头颈外科的59例通过病史和频闪喉镜诊断为旁中位未代偿的单侧声带麻痹患者,作为单侧声带麻痹组;纳入同期来我院体检的51名健康志愿者作为对照组.应用配套KIPS软件计算患者发/i:/音时的最小声门面积(minimum glottal area,MGA);采用美国Kay公司的CSL4500多维嗓音分析软件测试习惯基频(Fundamental Frequency,F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR),并与发声时的MGA进行Pearson相关性分析.结果单侧声带麻痹组MGA较对照组显著高(男性:433.68±64.52比294.41±51.82,t=9.23,P=0.000;女性:498.80±73.42比302.03±76.54,t=13.21,P=0.000),显示声带闭合不全,言语治疗后发声质量明显改善,MGA(治疗后男性:288.48±55.09,女性:258.22±57.17)均低于治疗前(男性t=24.41,女性t=31.22,P值均=0.000).未治疗组MGA出现不同程度的代偿性下降,与言语治疗组相比,MGA降幅明显低(24.25±22.91比188.31±54.37,t=8.97,P=0.000).单侧声带麻痹组F0、Jitter、Shimmer和NHR均显著高于对照组,差异均有统计学意义(P值均<0.05).言语治疗后F0、Jitter、Shimmer和NHR四项指标均明显改善,与治疗前相比差异均有统计学意义(P值均<0.05).MGA与F0、Jitter、Shimmer、NHR具有相关性,相关系数r值分别为0.551、0.867、0.853、0.875,P值分别为0.001、0.000、0.000、0.000.结论嗓音声学参数和声门面积可以准确反映声带麻痹患者的声学特性,用于患者病情评估可为调整言语治疗方法提供参考.

Objective To investigate the value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis (UVCP). Methods From May 2015 to April 2018, 51 patients with UVCP and 59 healthy controls in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, were involved in this research retrospectively. The UVCP patients were diagnosed with stroboscopic laryngoscopy. The minimum glottal area (MGA) was calculated by KIPS software when the people were pronouncing/i:/. The fundamental frequency (F0), Jitter, Shimmer and NHR were detected by CSL4500 multiple acoustic voice analyzer. Results MGA of UVCP patients was much higher than that of healthy control (male:433.68 ± 64.52 vs. 294.41 ± 51.82, t=9.23, P=0.000;female:498.80 ± 73.42 vs. 302.03 ± 76.54, t=13.21, P=0.000), which meaned vocal cord insufficiency. After voice therapy, MGA reduced significantly (male:288.48±55.09, female:258.22±57.17, t=24.41 and 31.22, P=0.000 vs. pre-therapy). MGA of untreated patients decreased in varying degrees. Compared with the voice therapy group, the MGA decreased in a significantly lower extent (24.25 ± 22.91 vs. 188.31 ± 54.37, t=8.97, P=0.000). The F0, Jitter, Shimmer and NHR raised significantly in UVCP patients group (P=0.000 vs. healthy control group), and they were reduced by voice therapy (all P<0.05). Each of the four acoustic parameters was relative with MGA, r=0.551, 0.867, 0.853 and 0.875 in turn, P=0.001, 0.000, 0.000, and 0.000. Conclusion MGA and acoustic parameters can reflect the acoustic features of UVCP patients, which are useful tools in the UVCP assessment and voice therapy.