反流性咽喉病患者嗓音声学特征分析

摘要

目的 观察反流性咽喉病(laryngopharyngeal reflux disease,LPRD)患者的嗓音声学特征.方法 对耳鼻咽喉科门诊就诊的反流症状指数(reflux symptom index,RSI)量表评分总分≥13分的45例LPRD患者和36例正常成人进行硬管喉镜检查,并用德国XION DIVAS嗓音测试分析系统对两组受试者的持续元音信号进行检测分析,计算嗓音障碍指数(dysphonia severity index,DSI),比较两组结果,并分析LPRD患者RSI量表评分及声嘶症状评分与DSI值的相关性.结果 45例LPRD患者RSI评分均值为17.7±5.15分,喉镜检查表现为杓状软骨区红斑、充血、水肿、糜烂、溃疡,声门后区增生肥厚、肉芽肿和声带水肿、肥厚;LPRD组的基频微扰(jitter)及振幅微扰(shimmer)均值比正常对照组增高,最长发声时间(MPT)和DSI的均值LPRD组较正常对照组降低,差异均有统计学意义(P<0.01).LPRD患者DSI值与RSI量表评分和声嘶症状评分呈负相关,相关系数分别为-0.344和-0.447(P＜0.05).结论 LPRD患者可出现嗓音异常,提示反流性咽喉病可能导致声带病理改变而造成嗓音损害.%Objective The aim of the study was to investigate the voice acoustic characteristics of patients with 1aryngopharyngcal reflux disease (LPRD) , to analyze whether laryngopharyngcal reflux can cause voice damage, and to assess the clinical value of the voice acoustic detection in diagnosis of LPRD. Methods Patients were chosen randomly and grouped with reflux symptom index (RSI). Forty-five patients with RSI score ^ 13 were enrolled in this study and examined by the rigid magnifying laryngoscope. The xion acoustic analysis software was used to measure the sustained vowel signals of 45 LPRD cases and 36 normal controls. Then the related acoustic parameters were analysed and the dysphonia severity index (DSD was determined. The difference of acoustic parameters between LPRD patients and normal controls was compared and the association of DSI with socrcs of RSI and hoarseness of patients was analysed. Results The mean scores of RSI were 17. 7. Laryngoscopy revealed erythema, hypcracmia, edema, erosion and ulcer of the arytcnoids area. Hypertrophy or granuioma was also seen on the posterior glottis. There was often edema or hypertrophy of the vocal folds. The means of jitter and shimmer of LPRD patients were significantly higher than that of controls and the means of MPT and DSI of LPRD patients were significantly lower (P<0. 01). There was a significant relationship between DSI and the scores of RSI and hoarseness, as higher scores of RSI and hoarseness associated with lower level of DSI (P<0. 05). Conclusion The acoustic parameters of LPRD patients were different from healthy controls, suggesting that laryngopharyngcal reflux may cause the vocal cord pathological change and voice damage.