【作者】 张龙芳；

【导师】 李贵泽；

【作者基本信息】 中国人民解放军第四军医大学 ， 耳鼻咽喉科学， 2003， 硕士

【摘要】 多年来，医学工作者一直探索用各种仪器和方法对喉的发音功能进行研究。随着医学技术的发展，人们对如何保留和提高喉发音功能越来越重视。对嗓音评估、发音功能检测方法的研究已成为耳鼻喉科医生、音声言语疾病学科医生共同关注的问题。近年来随着计算机技术向音声医学领域的渗透，各种语音频谱分析软件纷纷问世，嗓音的客观检测成为嗓音医学发展的客观要求，然而尚没有一个统一的评判标准。这一方面是由于声带振动的复杂性和精微的三维运动特点，以及振动时随机因素的诸多影响；另一方面由于各学者所用设备、采样程序，以及测试要求不同，测得各项指标有些出入，只能从中把握一种整体的变化趋势。随年龄增长，机体发声器官及其他各系统的发育、成熟、老化，体内性激素水平的变化，都对嗓音有相应影响，使得不同性别、年龄段嗓音各有特点。了解不同性别和年龄人群的嗓音特征，确定各嗓音参数正常参考值，对于正常嗓音的识别和嗓音疾病的诊治具有重要意义。本研究对正常成人不同性别和年龄段人群发不同元音的声学参数进行了对比分析，为建立正常人嗓音数据库提供第一手资料。在此基础上分析喉 第四用医大学项士学位论文狭窄及其它常见病理嗓音变化的特征及其解剖生理机制。 目 的 ＊）研究不同性别、年龄正常成人发不同元音时的嗓音特征，为本语音室建立语音数据库。 （2）研究喉狭窄患者嗓音的声学特征，为临床治疗提供更多喉狭窄功能状态评估的客观资料。 方 法1．正常成人嗓音分析参考值确立 正常成人 100名，年龄 20～69岁，每 10岁为一年龄段，男女各 10名。采用北京邮电大学开发研制的数字式通用语音频谱仪山iveral SignalSpectrum nalys，USSA）对各年龄段正常成人发持续胸声区元音＊入 ＊时的声音信号进行检测，分析各组嗓音的周期变异系数oeriod Vriation，PV卜相对平均微扰爪elative Average PertUbation，KAP卜 频率变动幅度（JitterRange，JR）、频率微扰商orequency Pe血bation Quotient，FPQ）、振幅微扰商（Amplitude Pe毗ation Quotient，APQ）、谐噪比（H一onic毗oise，H／N）和基频oundamental frequency，FO）等嗓音分析参数，同时观察语图谐波、共振峰oormant，FI、F卜FO及噪声成分特征及变化规律，提出本实验所需的正常参考值范围。2．喉狭窄患者嗓音特征 喉狭窄组：26例，为唐都医院耳鼻咽喉科住院患者，男14例，女12例，年龄20～56岁；正常对照组：采用实验一结果；常见嗓音疾病对照组：77例，为唐都医院耳鼻喉科就诊经喉镜检查确诊的喉疾病患者，年龄 ZI～60岁。其中声带小结24例，男8例，女16例，声带息肉33例，男15例，女 18例。喉肿瘤 20例，男 14例，女 6例。同法用 USSA采集［a］、［i庐样后记录分析结果，输入SPSS10刀进行统计分析，同时观察各病理嗓音在语 第3 页 第四罕医大学硕士学位论文图谐波、共振峰及噪声成分特征等方面表现，总结喉狭窄患者的语音分析特征。 结 果1．①同一元音各年龄段女性FO均高于男性；H／N值60～69岁组低于20～29岁组，有统计学差异，男女性别间无明显差异。②各共振峰频率女性大于男性，能量则表现为男性大于女性。共振峰F；频率女性大于男性，能量则表现男性大于女性。③＊音与口音相比，H川较低，有统计学意义；FO、PV、RA P、F阴、A叩及乃六个参数差异不显著：厂」音共振峰频率均高于＊幻音，h能量m音大于＊j音，FZ、F3能量贝【」音一于【3］音，表现元音特色。发＊音时男性分别在基频的 3．56倍、10．36倍、15．89倍处产生三个共振峰，女性分别在 0．53倍、10．03倍、13石3倍处产生三个共振峰；发＊」音时男性分别在基频的4．57倍、12．24倍、17．80倍处产生三个共振峰，女性分别在l．33倍、11．08倍、14．58倍处产生三个共振峰。④正常成人的声谱图由连续、规律、清晰的谐波波纹构成，低、中、高频区分别可见声能增强的第1、2、3共振峰 帜，FZ，F3X 高频区偶见极少量噪声成分。⑤自相关曲线平滑、规律；基音检测基线平稳。2．①喉狭窄患者与正常组比较，嗓音分析的各参数值均有显著性差异，F。、PV、RAP、FPQ、APQ及JR均升高，H／N下降，共振峰能量下降，较其它喉病组与正常组对比的差异大。＠发k］音时仍有明显代偿作用，突出表现为FPQ值降低及 H／N值升高（KO．of人＠喉狭窄患者的嗓音检测表现为声波曲线不规律、波折多，共振峰有峰簇现象，声图以＊、ill型为主，谐波被大量噪声取代。④自相关曲线紊乱，基音检测几乎无基线。 结 论1．正常嗓音具有年龄、性别及元音特征，嗓音分析可提供反映声带动能状态的客观定量指标。 第4 页更多还原

【Abstract】 In many years, medical workers are constantly trying various kinds apparatus and methods to study laryngeal phonic function. Along with the development of medical techniques, people are attaching more and more importance to how to retain and improve phonatory function of larynx. Searching for the methods of acoustic evaluation and phonatory detection has become the focused problem by doctors in otorhinolaryngology and speech pathology. In recent years, along with the seeping of computer technique into voice medical domain, various kinds of software for speech spectrum analysis have come out, and detecting speech impersonally has become the objective demands for the development of phoniatrics. But there is no yet a united standard to judge. One side of the reasons is the characteristics of vocal cords’ vibration that is complicated and exquisite movement in three-dimension, and the vibration are more influenced by random factors. Another side of the reasons is that the apparatus and the sampling action and demands used by various researchers are different from each other, as a results, the markers acquired are discrepancy, only get some change tendency as a whole. Besides, along with the age growing, the developmental, maturation and aging of body’s phonic organs and other systemsas well the level change of gonadal hormone are all have influence on voice and make the voice characterized with sex and age. It is importance to find out these characteristics and definite the normal reference of acoustic parameters. In this study, in order to offer the firsthand information for the found of acoustic database, the normal adults in different sex and age were compared with their acoustic parameters when pronouncing in different vowels. Based on these studies, the voice of laryngostenosis patients and other common pathologic voice were analyzed to find these characteristics and anatomiphysiologic mechanism.Objective1. To investigate the acoustic characteristics of the normal adults in different sex and age pronouncing in different vowels and definite acoustic database for our Computerized Speech Lab (CSL).2. To investigate the acoustic characteristics of the laryngostenosis patients and offer more objective information about laryngeal functional evaluation for clinical therapies.Methods3. The definition of the acoustic analytic reference of the normal adults100 healthy adults, aged 20-69, were divided into 5 groups, every 10 years as a group, each involve 10 males and 10 female. With the Universal Signal Spectrum Analys (USSA) manufactured by Beijing University of Posts and Telecommunications, the voice date of every people were collected when they were pronouncing the vowel [a] and [i] with continuing bosom voice. Each acoustic parameters such as Coefficient of Period Variation(PV), Relative Average Pertubation(RAP), Jitter Range(JR), Frequency Pertubation Quotient(FPQ), Amplitude Perturbation Quotient(APQ), Harmonica/noise(H/N) and Fundamental frequency(Fo) were compared and analyzed with different vowels and sex and age stages as well. The results were input SPSS 10.0 to have statistical analysis. At the same time, the harmonic waves of sonogram and formants and noise were observed.2. The acoustic characteristics of the laryngostenosis patientsThe voices of laryngostenosis patients were compared with that of normal group and common disease groups of larynx. The results of normal group came from experiment 1. The laryngostenosis group held 26 cases in all, including 14 male and 12 female, aged 20 to 56. The common disease groups were divided into 3 groups, 77 cases in all, aged 21 to 60. Among them, the vocal nodule group held 24 cases, including 8 male and 16 female; the polyp of vocal cord group held 33 cases, including 15 male and 18 female; the laryngeal tumor group held 20 cases, including 14 male and 6 female. The voice date of every people were collected, analyzed and observed just as the way experiment 1.Results1. The definition of the acoustic analytic re更多还原