腭裂术后语音障碍患儿的语音清晰度及言语康复治疗效果分析

Acoustic analysis of phonetic intelligibility and speech rehabilitation in children with cleft palate after palatoplasty

目的:探讨腭裂(cleft palate,CP)术后嗓音障碍(voice disorder,VD)患儿的语音特点及言语康复治疗效果。方法:选取我院2018年1月—2018年12月收治的40例行CP修复术的患儿,所有患儿均在CP修复术后1个月接受言语康复治疗,对比言语康复治疗前后/a/音声学特点参数和临床疗效。结果:腭裂修补术后,患儿经言语康复治疗后,其发/a/音时的基频(F0)值,与治疗前差异无统计学意义(t=0.661,P>0.05);言语康复后,谐噪比(harmonic-noise ratio,HNR)值明显大于治疗前,标准化噪声能量(normalized noise energy,NNE)、振幅微扰(Shimmer)、基频微扰(Jitter)值明显小于治疗前(t=1.690、3.974、2.287、24.558,P<0.05);言语康复治疗前,重度VD患儿语音清晰度(phonetic intelligibility,PI)明显低于轻度患儿(F=3.452,P<0.05),治疗后,不同程度术后VD患儿PI值均显著提升,组间对比,差异无统计学意义(F=1.153,P>0.05)。CP术后重、中、轻度VD患儿临床治疗有效率分别为88.89%、100.00%、100.00%。结论:CP修复术后常存在VD,言语康复治疗可有效提升CP患儿嗓音音质;临床应重视腭裂术后的VD训练。

Objective:To investigate the voice characteristics and the effect of speech rehabilitation in children with voice disorder(VD)after cleft palate(CP)plastic surgery.Methods:We selected 40 children who underwent CP repair in our hospital(January 2018 to December 2018),and all of them received speech rehabilitation one month after CP repair.The/a/sound acoustic characteristic parameters and clinical efficacy were compared before and after speech rehabilitation treatment.Results:After the CP plastic surgery,there was no significant difference in the F0 value of/a/sound before and after the speech rehabilitation(t=0.661,P>0.05).After speech rehabilitation,the harmonic-noise ratio(HNR)value was significantly higher than that before treatment,and the normalized noise energy(NNE),amplitude perturbation(Shimmer)and fundamental frequency perturbation(Jitter)values were significantly lower than those before treatment(t=1.690,3.974,2.287,24.558,P<0.05);before speech rehabilitation treatment,the phonetic intelligibility(PI)value of children with severe VD was significantly lower than that of children with mild VD(F=3.452,P<0.05).After treatment,the PI value of children with different postoperative VD severity increased significantly,and there was no difference among the groups(F=1.153,P>0.05).The effective rates of clinical treatment for severe,moderate and mild children were 88.89%,100.00%and 100.00%respectively.Conclusions:VD often exists after CP palatoplasty,and speech rehabilitation can effectively improve the voice quality of children with CP.VD training after CP surgery should be emphasized in clinical practice.