单侧神经性声带麻痹患者嗓音分析及动态喉镜记波扫描评估

摘要

Objective To explore the acoustic characteristics of neurogenic unilateral vocal cord paralysis with vocal acoustic analysis and study the application value of videostrobokymography (VSK) in the evaluation of vocal cord vibration in patients with vocal cord paralysis.Methods Voice acoustic analysis was applied to 22 patients of neurogenic unilateral vocal cord paralysis (paralysis group) and 30 healthy subjects (control group).Kymograms were created via stroboscopic video record in all the patients.The application values of the two methods in the diagnosis of vocal cord paralysis were analyzed.Results Voice acoustic analysis showed that the jitter and shimmer of the paralysis group were higher than those of the control group,and the differences were statistically significant (both P ＜ 0.05).The F0 of the paralysis group was slightly lower than that of the control group,but the difference was statistically insignificant (P ＞ 0.05).The pathologic spectrograph showed that the harmonic waves were decreased or absent at medium and high frequencies,the second and third formants (F2 and F3) almost disappeared with increased noise.At low frequencies,harmonic waves and the formant (F1) existed with irregularity and interruption.The maximum phonation time (MPT) of the paralysis group was obviously shorter than that of the control group,and the difference was statistically significant (P ＜ 0.05).VSK revealed that the vocal phase was symmetrical with regular mucosal waves in the control group and glottal closure could not be observed in the paralysis group.The value of open quotient (OQ) of the paralysis group was 1 which was much higher than that of the control group (0.48).Conclusions Voice acoustic analysis can be used to objectively evaluate the acoustic characteristics of neurogenie unilateral vocal cord paralysis.VSK is a valid means to estimate the vocal cord vibration in patients with vocal cord paralysis.%目的 以嗓音学分析方法评估单侧神经性声带麻痹患者的嗓音特征,探讨动态喉镜记波扫描(videostrobokymography,VSK)在评价声带麻痹患者声带振动功能中的应用价值.方法 选择22例单侧神经性声带麻痹患者及30例嗓音正常对照者分别进行嗓音学检测,并进行动态喉镜检查生成喉记波图像,分析两种方法在诊断声带麻痹中的应用价值.结果 嗓音学分析显示,单侧神经性声带麻痹患者的基频微扰(Jitter)、振幅微扰(Shim-mer)均高于正常对照组,差异具有统计学意义(P＜0.05);基频(F0)较对照组低,但差异无统计学意义(P＞0.05);声谱图主要见中频、高频区谐波声能减弱或消失,二、三共振峰(F2、F3)基本消失,噪声成分明显增加;低频区谐波及共振峰(F1)仍存在,呈现不规则、中断现象;最长发声时间(maximun phonation time,MPT),较对照组明显减小,差异具有统计学意义(P＜0.05).VSK图像中,正常对照组声带相位均基本对侧,黏膜波正常开放商为0.48;声带麻痹组的声带闭合相均未见声门闭合,开放商均为1.结论 嗓音学分析可客观评估单侧声带麻痹患者嗓音特征.VSK是一种评价检查声带振动功能的有效方法,与正常组比较,差异具有统计学意义(P＜0.05).