嗓音障碍患者各参数得分评估与咽喉反流分析

Observation and study of multi-parameter speech evaluation in patients with voice disorders

目的 利用客观声学参数,粗糙声、气息声和嘶哑声(RBH)主观听感知评估系统以及患者的嗓音障碍指数(VHI)自我评估量表建立多参数语音评估,探讨咽喉反流在声带疾病发生、发展中的作用。方法利用计算机嗓音声学分析系统检测25例对照组和180例嗓音疾病患者。对受试者进行RBH主观听感知评估,要求患者填写VHI自我评估量表,根据反流症状指数(RSI)和反流体征评分(RFS)分析咽喉反流特征。结果 各疾病组的VHI均高于对照组,发音障碍严重程度指数(DSI)均低于对照组。各疾病组与恶性组相比,振幅微扰(shimmer)差别均有统计学意义(P值均<0.05)。主观听感知评估参数中的H与客观评估参数基频微扰(jitter)、shimmer、DSI、最长发音时间(MPT)、VHI之间具有相关趋势(P值均<0.05),与平均基频(F0)之间的相关性较弱。对照组与嗓音疾病患者的咽喉反流发生率差异有统计学意义,而不同嗓音疾病患者之间的差异无统计学意义。结论 应建立多参数语音评估,以全面评估患者嗓音状况,并指导治疗决策。嗓音疾病的发生、发展可能与咽喉反流性疾病有关,而疾病进展又似乎与咽喉反流没有密切关系。

Objective To establish multi-parameter speech assessment by using the objective acoustic parameters, roughness breathiness hoarseness(RBH) perceptual evaluation system and the voice handicap index(VHI) self-assessment scale, and to explore the role of laryngopharyngeal reflux in the occurrence and development of vocal cord diseases. Methods One hundred and eighty patients with voice disorders and 25normal voice recruiters were evaluated by computer voice acoustic analysis system, RBH perceptual evaluation system and VHI self-assessment scale. The features of laryngopharyngeal reflux were analyzed by reflux symptom index(RSI) and reflux finding score(RFS). Results The VHI and dyhphonia severity index(DSI)of the disease groups were all higher than those of the control group. The difference in shimmer of each disease group and malignant group had statistical significance(P<0.05). There was a trend of correlation between H and jitter, shimmer, DSI, maximum phonation time(MPT) and VHI(P<0.05), but a weak correlation between H and average fundamental frequency(F0). There was statistical difference in laryngopharyngeal reflux rate between the control group and patients with voice diseases, but there was no statistical difference between patients with different voice diseases. Conclusions Multi-parameter voice assessment should be established to comprehensively assess patients’ voice status and guide treatment decisions. The occurrence and development of voice disease may be related to laryngopharyngeal reflux disease, but the disease progression seems to have no close relationship with laryngopharyngeal reflux disease.