本文選題：聲帶良性增生性病變 + 計算機客觀聲學(xué)參數(shù)��； 參考：《河北醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:①通過計算機嗓音聲學(xué)檢測對比正常成年人與聲帶良性增生性病變患者的嗓音客觀多維參數(shù)值的差異;②主客觀評估進行比較,探討主客觀的相關(guān)性及一致性,嘗試建立嗓音客觀的多維參數(shù)模型;③探討聲帶良性增生性病變的程度及術(shù)后的轉(zhuǎn)歸情況,以期為臨床嗓音工作者提供必要的指導(dǎo)。 方法:(1)選擇的對象:嗓音疾病組選取2010年2月～2010年12月在我院耳鼻喉科就診的嗓音疾病患者共210例,年齡在20～60歲之間,所有病例均經(jīng)過頻閃喉鏡,纖維喉鏡確診,術(shù)后病人均經(jīng)病理確診。對照組:選取240例正常成年人作為嗓音參數(shù)對照組,為無咽喉疾病,無煙酒嗜好,發(fā)音均正常、無嗓音障礙病史及呼吸系統(tǒng)疾病等,且均經(jīng)頻閃喉鏡、纖維喉鏡檢查聲帶外觀及運動正常者,其中男120例,女120例,年齡在23～58歲之間。(2)檢測方法:①主觀聽感知測評:全部受檢者的嗓音樣本均在隔音室內(nèi)錄制,錄制完整的一句話約10秒鐘,并在隔音室內(nèi)進行回放為聽評委提供聲樣。選取3名有經(jīng)驗的經(jīng)過培訓(xùn)的嗓音學(xué)專家依據(jù)日本言語醫(yī)學(xué)會和嗓音醫(yī)學(xué)會提出的GRBAS系統(tǒng)中的總嘶啞度(grade,G),按4級標(biāo)準(zhǔn):0級正常;1級輕度嘶啞;2級中度嘶啞;3級重度嘶啞。全部嗓音樣本均按隨機的方式進行3次排列,并對每個嗓音樣本進行3次評估,最后結(jié)果取3次評估的平均值。分別對嗓音正常組和聲帶病變組進行評估。②客觀多參數(shù)測評:采用美國Kay公司的多維嗓音分析系統(tǒng)MDVP及電聲門圖EGG進行參數(shù)的測定。測試者均在安靜的室內(nèi)進行,環(huán)境噪音在45DB以下,以舒適自然發(fā)穩(wěn)態(tài)的長元音/a:/,持續(xù)至少4秒,連續(xù)測試3次,截取中間平穩(wěn)段作為分析聲樣,結(jié)果取每個參數(shù)的3次平均值。同時進行電聲門圖信號的采集,將兩只金屬圓盤電極置于受試者頸前兩側(cè)甲狀軟骨板處,實時調(diào)整電極圓盤的位置直至出現(xiàn)合適的波形,取聲樣的平穩(wěn)段至少4秒鐘。③嗓音的聲學(xué)分析測試和電聲門圖測試參數(shù)有基頻(F0)、最高基頻( Fhi)、最低基頻(Flo)、基頻微擾( jitter )、絕對音調(diào)微擾(Jita)、振幅微擾( shimmer )、噪聲/諧和比(NHR)、振幅擾動商(APQ)、接觸商(EGG-CQ)。 結(jié)果:表1表明:聲帶病變女性組中聲帶小結(jié)占50.67%,發(fā)病人數(shù)最多,其次是聲帶息肉占24.67%,女性無聲帶任克氏水腫患者。男性組中聲帶息肉占37.20%,發(fā)病人數(shù)最多,其次是慢性喉炎占27.91%,聲帶小結(jié)占16.28%,較女性減少,聲帶任克氏水腫病例全部為男性。在全部病例中男性嗓音障礙疾病人數(shù)較多;表2表明:正常成年男女嗓音基頻隨年齡增大數(shù)值逐漸降低,男性在51～60歲之間雖略有升高但總體呈下降趨勢;女性組中D組與A組Fo、Fhi、Flo值p0.05有差異;男性組中C組與A組Fo、Fhi、Flo值差異有統(tǒng)計學(xué)意義,其余參數(shù)值在男女各年齡段間差異均無統(tǒng)計學(xué)意義。表3表明:Fo、Fhi、Flo、Jita、Jitt、Shim參數(shù)值在男女組間進行比較,結(jié)果p0.05,差異有統(tǒng)計學(xué)意義, APQ、NHR、EEG-CQ參數(shù)值差異無統(tǒng)計學(xué)意義;表4表明:慢性喉炎和聲帶小結(jié)Fo、Fhi、Flo參數(shù)值與正常嗓音組比較差異無統(tǒng)計學(xué)意義(P0.05),其余參數(shù)值在病理性嗓音組與正常嗓音組間差異均有統(tǒng)計學(xué)意義。慢性喉炎和聲帶息肉各參數(shù)值分別與聲帶小結(jié)比較除Fo、Fhi、Flo值差異有統(tǒng)計學(xué)意義外余各參數(shù)值差異均無統(tǒng)計學(xué)意義;表5表明:在主觀聽感知評估中慢性喉炎和聲帶小結(jié)以輕度嘶啞為主,聲帶息肉與聲帶囊腫均以中、重度嘶啞為主,任克氏水腫均為重度嘶啞;表6表明:各參數(shù)值的變化趨勢與嗓音障礙程度呈一致性,隨著聲嘶病變程度的加重,各參數(shù)值逐漸增大。表7表明:Jita、Jitt、Shim、NHR值在相鄰嗓音質(zhì)量組間比較p0.05,差異有統(tǒng)計學(xué)意義;表8可以看出Fo、Fhi、Flo、CQ值術(shù)后1～4周逐漸增大,Jita、Jitt、APQ、Shim值術(shù)后1-4周逐漸降低,至術(shù)后第4周基本恢復(fù)正常;表9表明:術(shù)前與術(shù)后1周比較除Jita、Jitt值差異有統(tǒng)計學(xué)意義,余均P0.05。術(shù)前與術(shù)后2周比較各參數(shù)值差異均有統(tǒng)計學(xué)意義。正常對照組與術(shù)后2周除Fo、Flo、Shim差異無統(tǒng)計學(xué)意義外,余均有統(tǒng)計學(xué)意義。正常對照組與術(shù)后4周比較參數(shù)值差異均無統(tǒng)計學(xué)意義。表10表明:各客觀參數(shù)間與總嘶啞度有高度相關(guān)性及各客觀參數(shù)間均有中度相關(guān)性。表11表明:主客觀的一至性達到87%。 結(jié)論:①嘗試建立了正常成年人的主客觀多維參數(shù)模型,基頻(F0)、最高基頻(Fhi)、最低基頻(Flo)在性別上有顯著性的差異,因此嗓音聲學(xué)檢測應(yīng)按性別分別對待。②計算機客觀聲學(xué)多維參數(shù)檢測對聲帶良性增生性病變有很好的臨床診斷價值,基頻微擾Jitt、振幅微擾Shim、噪諧比NHR較為敏感,可判斷聲帶良性增生性疾病的嚴(yán)重程度,為臨床診斷和治療提供了依據(jù),應(yīng)作為客觀診斷指標(biāo)。③對于病變術(shù)前、術(shù)后評估,基頻微擾Jitt、振幅微擾Shim、噪諧比NHR及接觸商CQ是分析嗓音障礙手術(shù)前后較為重要參數(shù)值,可作為聲帶顯微外科手術(shù)治療效果的評估及術(shù)后跟蹤隨訪的客觀依據(jù)。④嗓音疾病患者的主客觀評估具有一定的相關(guān)性,客觀的參數(shù)值可以很好的反映主觀評價,且這種相關(guān)性隨著嗓音障礙的嚴(yán)重程度而更加顯著。
[Abstract]:Objective: To compare the differences of the objective multidimensional parameters of voice between normal adults and benign proliferative lesions of vocal cords by the sound of computer voice, and to compare the subjective and objective evaluation, to explore the correlation and consistency of the main objective, and to try to establish the multi-dimensional parameter model of the voice, and to explore the course of the benign hyperplasia of the vocal cords. And the prognosis after operation, in order to provide necessary guidance for clinical voice workers.
Methods: (1) the selected subjects: voice disease group selected 210 cases of voice disease in the Department of ENT of our hospital from February 2010 to December 2010. The age was between 20~60 years old. All cases were diagnosed by stroma laryngoscopy, fiberoptic laryngoscopy, and all patients were diagnosed by pathology. The control group selected 240 normal adults as voice parameters. There were no throat diseases, smokeless alcohol addiction, normal pronunciation, no voice disorder history and respiratory system diseases, and all were examined by stroma and fiberoptic laryngoscopy, including 120 men, 120 women, and 23~58 years of age. (2) test methods: subjective auditory perception: all subjects' voice samples They were recorded in the sound insulation room, recorded a complete sentence for about 10 seconds, and replayed in the sound isolation room to provide sound samples to the hearing judges. 3 experienced and trained voice experts were based on the total hoarseness (grade, G) in the GRBAS system of the Japanese speech Medical Association and voice medical Association, according to grade 4 standard: grade 0 normal; 1 mildly hoarseness. Dumb; grade 2 moderately hoarse; grade 3 severe hoarseness. All voice samples were arranged in a random manner 3 times, and each voice sample was evaluated for 3 times. Finally, the average value of the 3 assessment was taken. The normal voice group and the vocal cords group were evaluated respectively. The parameters of the MDVP and the electroacoustic gate EGG were measured in the quiet room, the ambient noise was below 45DB, the long vowel /a:/, which was comfortable and natural steady state, lasted at least 4 seconds, and the intermediate stationary segment was intercepted as the analysis sound, and the 3 mean values of each reference were taken. Set, the two metal disc electrodes were placed at the front of the neck of the subjects on both sides of the thyroid cartilage. The position of the electrode disc was adjusted in real time until the appropriate waveform appeared, and the stationary phase of the sound sample was at least 4 seconds. 3. The acoustic analysis test and the electroacoustic gate test parameters were F0, the highest fundamental frequency (Fhi), the lowest fundamental frequency (Flo), and the fundamental frequency perturbation (Jitt Er), absolute tone perturbation (Jita), amplitude perturbation (shimmer), noise / harmonic ratio (NHR), amplitude perturbation quotient (APQ), contact quotient (EGG-CQ).
Results: Table 1 showed that the vocal nodules accounted for 50.67% in the female group with vocal cord lesions, the largest number of vocal cords, 24.67% of vocal polyps, 24.67% of vocal cord polyps, 37.20% of the vocal polyps in the male group, the largest number of diseases, 27.91% of the chronic laryngitis, 16.28% of vocal nodules, the decrease of the vocal cords, and the vocal cork dropsy disease. All cases were male. In all cases, the number of male voice disorders was large; table 2 showed that the basic frequency of male and female voice in normal adults decreased with age, and the male was slightly higher in 51~60 years, but in the female group D and A group Fo, Fhi, Flo value P0.05 were different, and C group and A group Fo, Fhi, Flo in the male group. There was no statistically significant difference in the values of the other parameters in men and women. Table 3 showed that Fo, Fhi, Flo, Jita, Jitt, Shim were compared between women and men, and the results were statistically significant, APQ, NHR, EEG-CQ parameter values were not statistically significant; table 4 indicated that chronic laryngitis and vocal nodules were Fo, Fhi, There was no statistically significant difference in Flo parameters between the normal voice group and the normal voice group (P0.05). The other parameters were statistically significant between the pathological voice group and the normal voice group. The differences in the parameters of the parameters of the chronic laryngitis and vocal polyps were compared with the vocal nodules, except for the Fo, Fhi, and Flo values, and there was no statistical difference. Table 5 showed that in the subjective auditory perception assessment, chronic laryngitis and vocal cord nodules were mild hoarse, vocal polyps and vocal cysts were both moderate and severe hoarse, and all Kirschner's edema was severe hoarse; table 6 showed that the variation trend of each parameter was consistent with the voice obstacle course. With the aggravation of the degree of hoarseness, the parameters of each parameter were increased. The value gradually increased. Table 7 showed that Jita, Jitt, Shim, NHR values were compared between adjacent voice mass groups P0.05, the difference was statistically significant; table 8 can see Fo, Fhi, Flo, CQ values gradually increased 1~4 weeks after operation, Jita, Jitt, APQ, 1-4 weeks after the operation gradually decreased to fourth weeks after the operation; table 9 showed before and 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation, except for the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after the operation except the 1 weeks after the operation, except 1 weeks after the operation, except 1 weeks after the operation and 1 weeks after The difference of T value was statistically significant. The difference of parameters between P0.05. before and 2 weeks after operation was statistically significant. There was no statistically significant difference between the normal control group and the 2 weeks after the operation except Fo, Flo and Shim. There was no statistical significance between the normal control group and the 4 weeks after the operation. There was a high correlation between the hoarseness and the total hoarseness, and there was a moderate correlation between the objective parameters. Table 11 showed that the subjective and objective one reached 87%.
Conclusion: (1) the subjective and objective multidimensional parameter model of normal adults was established, the fundamental frequency (F0), the highest fundamental frequency (Fhi) and the minimum fundamental frequency (Flo) were significant differences in sex, so the voice acoustic detection should be treated by sex respectively. Value, fundamental frequency perturbation Jitt, amplitude perturbation Shim, noise harmonic more sensitive than NHR, can judge the severity of benign hyperplasia of vocal cords, provide basis for clinical diagnosis and treatment, and should be used as an objective diagnostic indicator. (3) for preoperative, postoperative evaluation, fundamental frequency perturbation Jitt, amplitude perturbation Shim, noise harmonic ratio NHR and contact CQ is an analysis of voice disorder. The value of the important parameters before and after the operation can be used as an objective basis for the evaluation of the effect of the vocal microsurgical treatment and the follow-up follow-up. 4. The subjective and objective assessment of the voice disease patients has some relevance, and the objective parameter values can reflect the subjective evaluation well, and this correlation is more serious with the severity of the voice disorder. Plus significant.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R767.92

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