喉高速摄影结合声门区波形分析痉挛性发声障碍的声带振动特征

Analysis of vocal fold vibration characteristics of spasmodic dysphonia by laryngeal high speed photography combined with glottis area wave

目的喉高速摄影结合声门区波形(glottal area wave,GAW)分析健康受试者和痉挛性发声障碍(spasmodic dysphonia,SD)患者发声时的声带振动特征。方法本研究为前瞻性研究,于2019年10月至2020年12月纳入20名[男性10名,女性10名,年龄20~53(32±2.5)岁]健康受试者;经厦门大学附属中山医院嗓音科确诊的12例(男性2例,女性10例)内收型SD患者(adductor spasmodic dysphonia,AdSD组)和2例(男性)外展型SD患者(abductor spasmodic dysphonia,AbSD组),年龄19~72(38±12.5)岁;根据AdSD组的性别进行配比,选取12名(男2名,女10名)健康受试者为对照组。对所有健康受试者和痉挛性发声障碍患者进行喉高速摄影检查,选取受试者影像中发声稳定的10个振动周期,分析声门区波形图,获得声门面积变化指数及声带振动参数[速度商(speed quotient,SQ)、开放商(open quotient,OQ)及关闭商(close quotient,CQ)]。采用SPSS 22.0软件进行统计学分析,以P<0.05为差异有统计学意义。结果①声门面积变化指数在健康受试者中较稳定(0.19~0.42),SQ、CQ及OQ值在健康受试者男性及女性间的差异均有统计学意义(t=12.28,5.59,5.59,P<0.05);②声门面积变化指数在AdSD患者中波动范围较大(0.31~0.62);与对照组相比,AdSD组SQ值较小,且差异有统计学意义(t=4.246,P<0.05),两组的OQ及CQ值间差异无统计学意义(t=1.064,1.332,P>0.05);与对照组相比,AbSD组的SQ有增大趋势。结论喉高速摄影结合GAW对研究SD患者的声带振动特征具有一定的参考价值,其中SQ参数具有较好的特异性。

Objective To analyze the characteristics of vocal fold vibration of normal people and patients with spasmodic dysphonia(SD)using laryngeal high speed videoendoscopy combined with glottal area wave analysis.Methods This prospective study examined twenty healthy subjects(10 males and 10 females),12 patients with adductor spasmodic dysphonia(AdSD)(2 males,10 females)as AdSD group and 2 patients with abductor spasmodic dysphonia(AbSD)(2 males)as AbSD group.Twelve of healthy subjects(2 males,10 females)were selected as control group according to AdSD group gender match.All the subjects were recruited from the Department of Voice,Zhongshan Hospital,Xiamen University from October 2019 to December 2020.All subjects underwent laryngeal high speed videoendoscopy and 10 vibration periods were selected from each recording and were used to quantitatively analyze the change of glottal area and vocal fold vibration parameters(Speed Quotient(SQ),Open Quotient(OQ)and Close Quotient(CQ)).Results 1.There were statistically significant differences in SQ,CQ and OQ between males and females in the healthy subjects(t=12.28,5.59,5.59,P<0.05).The change of the glottal area during each vibration period in healthy subjects was relatively stable(0.19-0.42).2.The change of the glottal area during each vibration period in AdSD subjects had larger fluctuations,with the glottal area change index fluctuating in the range of 0.31 to 0.62.The SQ value of the AdSD group was significantly lower than that of control group(t=4.246,P<0.05).There were no significant differences in OQ and CQ between AdSD group and normal group(t=1.064,1.332,P>0.05);The SQ value of the AbSD group tended to increase compared to normal group.Conclusions Laryngeal high speed videoendoscopy combined with glottal area wave analysis has a certain reference value in the studying the vibration characteristics of SD patients.SQ has good specificity.