内收型痉挛性发音障碍患者动态喉镜表现及嗓音学特点  

Strobolaryngoscope findings and voice characteristics of patients with adductor spasmodic dysphonia

作　　者：郭莹[1] 聂尔璇 刘超[1] 徐芳[1] 张欣[1] 张帅[1] 刘勇[1] 黄东海[1] GUO Ying;NIE Erxuan;LIU Chao;XU Fang;ZHANG Xin;ZHANG Shuai;LIU Yong;HUANG Donghai(Department of Otolaryngology Head and Neck Surgery,Otolaryngology Major Disease Research Key Laboratory of Hunan Province,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科,耳鼻咽喉重大疾病研究湖南省重点实验室,湖南省咽喉嗓音疾病临床医学研究中心,湖南长沙410008

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第4期387-391,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：湖南省自然科学基金面上项目(2019JJ40481)。

摘　　要：目的探讨内收型痉挛性发音障碍(SD)患者的动态喉镜下表现、嗓音学特点以及病因,并与正常人对比分析,为临床诊断及进一步治疗提供参考依据。方法收集61例内收型SD患者的嗓音参数以及30例正常对照者的嗓音参数,对比分析。结果61例患者中51例为女性患者;61例患者中35例(57.4%)患者的反流体征评分量表(RFS)的分值>7;有明显心理因素或心理创伤的患者7例(11.5%)。患者发音时存在一些颈部及全身肌肉过度紧张的表现,动态喉镜下所有患者均无器质性病变,主要表现为双侧声带紧张并过度内收、喉部震颤,部分患者可见声门上结构向中间挤压靠拢。嗓音测试时所有患者在朗读过程中存在紧张性发音,基频(F0)及响度瞬间起伏,语音颤抖、嗓音挤卡、失去韵律,42例(68.9%)患者出现嗓音中断:患者读一段话的嗓音平均中断次数(1.9±2.0)次显著高于正常人(0.0±0.0)次(P<0.01);所有患者读一段话的朗读时间均值(21.5±4.8)s较常对照组的朗读时间均值(16.2±3.7)s显著延长,差异具有统计学意义(P<0.01);患者的振幅微扰(shimmer)均值及基频微扰(jitter)均值为显著高于正常对照组(P<0.01);患者的嗓音障碍指数(DSI)均值显著低于正常对照组(P<0.05);患者的最长发音时间(MPT)较正常对照组显著缩短(P<0.01)。结论内收型SD患者大部分为女性,患者动态喉镜下会有一些特征性表现,患者的音质、音韵和流畅性较正常人有一定改变;患者的shimmer、jitter、DSI、MPT较正常人有显著差异。该疾病可能与胃酸反流有一定关系,少部分患者可能存在心理因素。Objective To investigate the strobolaryngoscope findings and voice characteristics of patients with adductor spasmodic dysphonia.Methods Voice data of 61 patients with adductor spasmodic dysphonia and 30 normal ones were collected and analyzed.Results Of the 61 patients,51 were females.Thirty-five patients(57.4%)had reflux finding score(RFS)more than 7 and 7 patients(11.5%)had psychological disorders.During phonation,the patients experienced excessive muscle tension.Strobolaryngoscope examination revealed tension and excessive adduction of bilateral vocal cords,laryngeal tremor without organic lesions.In the voice test,all the patients had tensive phonation during reading and interrupted voice occurred in 68.9%(42/61)of them.During reading a paragraph,the average number of interrupted voice in the patients was(1.9±2.0),which was higher than that in the normal ones(0.0±0.0),(P<0.01).The average time of reading a paragraph in the patients was(21.5±4.8)s,which was longer than that in the normal ones[(16.2±3.7)s](P<0.01).Compared with the normal persons,the patients with adductor spasmodic dysphonia had higher shimmer and jitter,lower dysphonia severity index(DSI)and shorter maximum phonation time(MPT).Conclusion Most patients with adductor spasmodic dysphonia are female.Interrupted voice usually occurs accompanied with changes of shimmer,jitter,DSI and MPT as well as characteristic strobolaryngoscope findings.This disease may have some relationship with regurgitation of gastric juice and psychological factors may influence a minority of them.

关 键 词：嗓音学 痉挛 发音障碍 嗓音参数 动态喉镜 

分 类 号：R767.92[医药卫生—耳鼻咽喉科]