声带息肉及小结患者最小声门面积与声学及空气动力学指标的相关性研究

摘要

目的 探讨声带息肉及声带小结患者发声时最小声门面积(minimum glottal area,MGA)与声学及空气动力学指标的相关性.方法 对50例正常人(正常组,女30例,男20例)、35例声带息肉患者(息肉组,女20例,男15例)及36例声带小结患者(小结组,均为女性)进行频闪喉镜检查,应用配套KIPS软件计算发/i:/音时MGA;采用计算机语音工作站(Computerized Speech Lab 3700,CSL3700)及空气动力学嗓音功能分析仪(Aerophone Ⅱ Voice Function Analyzer)测试息肉组和小结组患者的基频微扰(jitter)、振幅微扰(shimmer)、谐噪比(harmony to noise ratio,HNR)、平均气流率(mean airflow rate,MFR)、声门阻力(glottal resistance,Rg)、声门下压力(subglottal pressure,SGP),并分别与发声时MGA进行相关性分析.结果正常女性发声时MGA为258.85±116.19,明显小于小结组(463.86±135.25)(P＜0.05)；正常组发声时MGA为308.25±158.53,明显小于声带息肉组(592.03±299.20)(P＜0.05).小结组发声时MGA与声门下压力无明显相关性(r=0.060,P＞0.05)；息肉组发声时MGA与声门下压力呈正相关关系(r=0.997,P＜0.05).息肉组及小结组发声时MGA分别与基频微扰(r=0.968,P＜0.05和r=0.990,P＜0.05)、振幅微扰(r=0.981,P＜0.05和r=0.996,P＜0.05)及平均气流率(r=0.995,P＜0.05和r=0.996,P＜0.05)呈正相关,与声门阻力(r=-0.998,P＜0.05和r=-0.992,P＜0.05)及谐噪比(r=-0.996,P＜0.05和r=-0.992,P＜0.05)呈负相关.结论 声带息肉及声带小结患者发声时MGA增大,声门闭合不良是其声嘶的重要原因之一.%Objective To investigate the correlation between the minimum glottal area(MGA) when the patients phonate and some of the voice and aerodynamic parameters. Methods 50 normal adults and 36 patients with vocal fold nodules and 35 patients with vocal fold polyps were examined with stroboscopy and calculate minimum glottal area with KIPS affiliated to it. Jitter, shimmer and HNR with CSL3700 were estimated; the parameters like MFR.Rg and SGP with Aerophone II Voice Function Analyzer and the software affiliated to it were measared; and the minimum glottal area with other parameters above were compared. Results There was significant difference on MGA between 30 normal women and the patients with nodules(P<0.05) and also between all of the normal adults and the patients with polyps(P<0.05). In group with polyps the MGA had positive correlationship with jitter(r= 0. 968, P<0. 05), shimmer (r = 0.981,P<0.05)and MFR (r = 0.995,P<0.05)and had negative correlationship with Rg (r=-0.998,P<0.05)and HNR(r= -0. 996,P<0. 05) ,and samilar in nodule group(r=0. 990,P< 0.05; r=0. 996,P<0. 05; r=0. 996,P<0. 05; r=- 0. 992,P<0. 05; r= - 0. 992,P<0. 05). The MGA in group of vocal polyps had positive correlationship with SGP(r=0. 997,P<0. 05), but the group of nodules had not anyobvious correlationship with it(r=0. 060,P>0. 05). Conclusion The increase in MGA and incomplete closure of glottis cause much increase in jitter,shimmer,MAF and noise, which is an important reason of hoarseness caused by vocal fold polyp and nodule.