本文關(guān)鍵詞： 喉白斑 聲帶息肉 嗓音學(xué)檢測 嗓音分析 電聲門圖 臨床意義　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的嗓音分析(Voice Acoustic Analysis)和電聲門圖(EGG)是近年來隨著計(jì)算機(jī)技術(shù)發(fā)展而研制成的新儀器,是目前國內(nèi)外最常用的嗓音客觀評(píng)估方法,是一種無創(chuàng)的檢查方法。聲帶疾病泛指發(fā)生在聲帶上的疾病,常見的聲帶疾病有聲帶息肉、聲帶小結(jié)、喉良性腫物和喉白斑等。隨著嗓音醫(yī)學(xué)的發(fā)展,通過嗓音聲學(xué)分析,發(fā)現(xiàn)多種聲帶疾病的各項(xiàng)聲學(xué)參數(shù)(如Jitter、Shimmer、NNE、HNR、SNR、MPT等)與正常嗓音者之間有明顯的差異。聲音嘶啞為聲帶疾病的早期癥狀,隨病變發(fā)展而加重。然而對于聲音嘶啞的程度長期缺乏客觀的準(zhǔn)則,不同的醫(yī)師主觀感覺不同,受主觀影響較重。而發(fā)音質(zhì)量作為衡量人類生活質(zhì)量的重要指標(biāo)之一,引起人們廣泛關(guān)注。臨床上迫切需要聲帶疾病的患者術(shù)前和門診檢查中有一明確的客觀指標(biāo)。本研究即從常用的嗓音聲學(xué)參數(shù)入手,分析對比常見聲帶疾病患者的嗓音聲學(xué)參數(shù)和正常嗓音聲學(xué)參數(shù)的差別,為聲音嘶啞程度提供客觀指標(biāo),為嗓音聲學(xué)檢測在聲帶疾病臨床上的嗓音評(píng)估和療效評(píng)價(jià)方面的應(yīng)用提供理論依據(jù)。方法采用上海泰億格電子有限公司的Dr.Speech Science for Windows儀器對48例喉白斑患者和20例聲帶息肉患者進(jìn)行嗓音分析和EGG同步化測試,并與50例正常人的嗓音聲學(xué)參數(shù)進(jìn)行對比比較,得出各組研究對象之間嗓音聲學(xué)參數(shù)(Jitter、Shimmer、NNE、HNR、SNR、MPT)的差異以及EGG波形的形態(tài)差異,并通過比較各組的差異,為患者的聲嘶程度提供客觀指標(biāo)和判斷的理論依據(jù)。結(jié)果1.喉白斑和正常組比較:嗓音分析參數(shù)中,喉白斑組Jitter、Shimmer和NNE均高于正常組,HNR、SNR和MPT均低于正常組(均P0.05),其中NNE差異顯著;EGG參數(shù)中,喉白斑組EGG-Jitter、EGG-Shimmer、EGG-NNE、CIP和CQP均高于正常組,EGG-HNR、EGG-SNR均低于正常組(均P0.05)。正常組EGG波形為光滑有規(guī)律的類正弦曲線,喉白斑組EGG波形漸開相速度加快,整個(gè)閉合相縮短,呈尖峰狀,波形規(guī)律,波形異常率占72.9%(34/48)。2.聲帶息肉和正常組比較:嗓音分析參數(shù)中,聲帶息肉組Jitter、Shimmer和NNE均高于正常組,HNR、SNR和MPT均低于正常組(均P0.05);EGG參數(shù)中,聲帶息肉組EGG-Jitter、EGG-Shimmer、EGG-NNE、CIP和CQP均高于正常組,EGG-HNR、EGG-SNR均低于正常組(均P0.05)。聲帶息肉組EGG波形波峰降低,開放相時(shí)長延長,波形主要是漸開相陡直和漸閉相切跡兩種。漸閉相較漸開相速度快,曲線坡度陡;聲帶閉合提前出現(xiàn),漸閉相出現(xiàn)切跡,波形異常率占85%(17/20)。結(jié)論嗓音分析和EGG檢測具有無創(chuàng)性,易接受,且操作簡便,有利于大規(guī)模篩查,及時(shí)發(fā)現(xiàn)早期不明顯的嗓音相關(guān)疾病;同步化測試可互相彌補(bǔ)各自的不足,結(jié)合病史、體征、電子喉鏡等檢查,可輔助診斷喉白斑、聲帶息肉等聲帶疾病;為聲音嘶啞程度提供客觀指標(biāo),為嗓音聲學(xué)檢測在聲帶疾病臨床上的嗓音評(píng)估和療效評(píng)價(jià)方面的應(yīng)用提供理論依據(jù);對聲帶疾病的預(yù)防、療效評(píng)估、術(shù)后復(fù)發(fā)和發(fā)音矯治提供臨床指導(dǎo)。
[Abstract]:Voice Acoustic Analysis and Acoustic Gate Analysis (EGG) are new instruments developed with the development of computer technology in recent years. They are the most commonly used voice objective evaluation methods at home and abroad. Vocal cord disease refers to diseases occurring on the vocal cord. Common vocal cord diseases include vocal cord polyps, vocal nodules, laryngeal benign masses and laryngeal leukoplakia. It was found that there were significant differences between the acoustic parameters of various vocal cord diseases (such as Jitteri ShimmerNNEHNRNRN MPT, etc.) and those with normal voice. Hoarseness is the early symptom of vocal cord disease. However, for the degree of hoarseness, there is no objective criterion for the degree of hoarseness. Different doctors have different subjective feelings and are heavily influenced by their subjective feelings. The quality of pronunciation is one of the important indicators to measure the quality of human life. There is a clear objective index in patients with vocal cord diseases before and after outpatient examination. This study begins with the commonly used voice acoustic parameters. The differences between the acoustic parameters of the voice and the normal voice of the patients with common vocal cord diseases were analyzed and compared to provide an objective index for the degree of hoarseness. Methods 48 patients with laryngeal leukoplakia and 20 patients with laryngeal leukoplakia were treated with Dr.Speech Science for Windows instrument of Shanghai Taiyag Electronics Co., Ltd. Voice analysis and EGG synchronization tests were performed in patients with vocal cord polyps. Compared with 50 normal subjects, the difference of voice acoustic parameters and the morphological differences of EGG waveforms among the subjects in each group were obtained, and the differences of the acoustic parameters and the shape of the EGG waveforms among the subjects in each group were also obtained by comparing the acoustic parameters of the voice and the shape of the EGG waveforms in each group, and the difference of the acoustic parameters between the three groups was obtained by comparing the acoustic parameters of the two groups. Results 1. Comparison of laryngeal leukoplakia and normal group: voice analysis parameters, The NNE and Jitterus Shimmer in the patients with leukoplakia were significantly higher than those in the normal controls (P 0.05), and the difference of NNE was significant among them. EGG-Jitterl EGG-ShimmerCIP and CQP were higher than those in normal group (P0.05). The EGG waveform of normal group was smooth and regular sinusoid curve, EGG waveform of laryngeal leukoplakia group was accelerated, the whole closed phase was shortened, and the wave form was sharp and regular. Comparison of vocal cord polyp with normal group: in the voice analysis parameters, the NNE and Jitter NNE in the vocal cord polyp group were higher than those in the normal control group (P 0.05), and the MPT of the vocal cord polyp group were lower than that of the normal group (P 0.05). EGG-Jittert EGG-ShimmerCIP and CQP in polyp group were higher than those in normal group (P0.05%, respectively). The peak of EGG wave in polyp group was decreased, and the open phase was prolonged. The curve slope is steep, the vocal cord closure appears ahead of time, the closed phase appears the notch, the waveform abnormal rate accounts for 85% of 20%. Conclusion the voice analysis and EGG test are noninvasive, easy to accept, and easy to operate, which is beneficial to large-scale screening. Synchronous testing can make up for each other's shortcomings, combining with history, physical signs, electronic laryngoscope and other examinations, it can help to diagnose vocal cord diseases such as leukoplakia and vocal cord polyp. To provide objective indicators for hoarseness, to provide theoretical basis for the application of voice acoustic measurement in the evaluation of vocal cord disease in clinical and curative effect evaluation, and to evaluate the prevention of vocal cord disease and the evaluation of curative effect. Postoperative recurrence and pronunciation correction provide clinical guidance.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R767.92

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