嗓音声学检测的临床应用王明方1 常捷燕1 李宁1 摘 要 目的 应用声谱图对喉科临床嗓音疾病进行嗓音声学检测和分析，探讨嗓音声学分析在喉科及嗓音方面应用的规律。方法 共检610例，其中正常85人，声带息肉162例，声带小结40例，慢性喉炎57例，环杓关节区肿胀86例，环杓关节错位46例，声带麻痹13例，声带炎肿64例，喉部肿物21例，其他病变36例。声谱图检测参数有：基频、第一、二、三共振峰、基音周期、平均微扰、频率均值、频率微扰商、频率变动幅度、振幅微扰商、谐噪比、音调微扰系数等十二个参数。结果 病变各组与正常组比较，谐噪比全部9组，振幅微扰商6组，频率均值、频率微扰商、音调微扰系数4组有统计学差异。结论 表明谐噪比、频率微扰商、振幅微扰商、音调微扰系数可以作为对病变嗓音进行判定的指标，另外对声带息肉手术前后疗效判定有一定帮助。关键词 嗓音 疾病 声学检测Measurement of voice acoustic to clinical applied Wang Mingfang Chang Jieyan Li ning(Department of Otolaryngology, the Peoples Hospital, Guilin, 541002)Abstract Objective: measure and analyse spectrograms parameters of the sound samples from voice disease in laryngologic clinic. Investigate the role and rule in application of spectrogram in vocal disease at clinical practice. Methods: Conduction review and analysis of 610 voice samples with 85 cases of normal person and 525 cases suffering from differential vocal disorder, such as 162 cases of vocal polyps, 40 cases of vocal module, 57 cases of chronic inflammation, 86 cases of swelling arytenoid area, 46 cases of disproportion of arytenoid at phonation. 13 cases of laryngoparalysis, 64 cases of vocal inflammatory swelling, 21 cases tumor of larynx, 36 cases others. Use of 12 spectrogram1s parameters compared 9 laryngopathy. Groups with normal group as Fundamental frequency, F1,F2,F3 Forman, Fundament cycles, Average perturbation, Average Frequency, Frequency perturbations quotient, Amplitude perturbation quotient. Ratio of Harmonic/Noise, pitch perturbation coefficient etc. Result: After 9groups of differential laryngopathy have compared normal Group with 12 spectrograms parameters, there are very significant differentiation or significant differentiation of statistic: Ratio of Harmonic/Noise in total 9 groups of laryngologic disease, Amplitude perturbation quotient in 6 groups, average frequency, Frequency perturbation quotient，pitch perturbation quotient in 4 groups. Conclusion: Demonstration of these parameters of ratio Harmonic/Noise, Frequency perturbation quotient, Aptitude perturbation quotient ,and Pitch perturbation quotient are the targets to estimate for voice disease. Otherwise, it is certainly helpful to judge effect before and after operation of vocal polyps.Key words: Voice Disease Acoustic measurement 嗓音是人们进行相互交往的重要手段，嗓音疾病妨碍人们的社交活1 桂林市人民医院耳鼻咽喉科 541002动。因此对嗓音进行分析，诊断嗓音疾病是喉科学者的重要任务之一。声谱图是近年来喉科学者及嗓音工作者对嗓音声学进行检测和分析的新技术，为嗓音分析和嗓音病变的诊断提供了一个客观的手段。 以往对嗓音的评价只能是凭主观听觉进行估价，缺乏客观指标。利用嗓音声学分析可以对嗓音的基频、三个共振峰、谐噪比以及频率、音调、振幅微扰进行分析，对嗓音声谱中的噪音成份做一个客观分析，客观的评价嗓音质量。1.材料及方法1.1 临床资料1.1.1 喉病组：嗓音和喉部病变患者，均经过间接喉镜检查明确病变性质，525例，男191例，女334例，年龄 676岁，平均48岁。各病种见表1。表1 临床资料喉病组病种男女合计年龄平均年龄声带息肉44例118例162例1872岁37岁声带小结3例37例40例1655岁34岁慢性喉炎27例30例57例1767岁39岁环杓关节区肿胀23例63例86例1976岁40岁环杓关节错位21例25例46例2072岁40岁声带麻痹8例5例13例3474岁57岁声带炎肿17例47例64例1365岁37岁喉肿物19例2例21例675岁52岁其他29例7例36例1575岁50岁总计 191例334例525例676岁48岁1.1.2 手术组：26例声带息肉病人为经临床确诊并施行手术者，男8例，女18例，年龄2066岁，平均38岁，术后嗓音声学检测于手术后一个月进行。1.1.3 正常组： 经询问无嗓音改变及喉部不适病史(近一个月内)， 检查无喉部病变者85例，男39人，女46人，年龄1766岁，平均26岁。1.2 研究方法1.2.1 声谱检测：受检者在隔音、恒温的工作室中静坐， 用录音话筒先后发元音/a/、/i/各一次，每次三秒存入微机中待分析。1.2.2 使用北京邮电大学提供的 USSA (通用信号谱分析系统 Universal Signal Spectrum Analys)对存档的录音资料进行声谱分析并打印。2.结果2.1 检测声谱图各组参数数值见表 2。 表 2 声谱图各项参数检测值正 常声带息肉声带小结慢性喉炎环杓关节肿关节错位声带炎肿声带麻痹喉癌,肿物其 他例 数 851624057864664132136男394432723211781929女461183730632547527基 频222.7214.3232.9194.7212.8202.2213.7214.7190.4178第一共振峰849860.9926.3824.9875.7861.1887.5904.1833.2755.9第二共振峰22392293.32206.62330.62319.52552.82176.32574.12428.22248.3第三共振峰34973470.23479.33485.33503.43485.13364.53482.83619.83429.1基音周期0.00540.005390.0049240.0059870.0054140.0057840.0068030.0061080.0059850.006285平均微扰0.00440.006290.0073510.0069730.0047310.0047260.0042180.0161050.0136340.011403频率均值206.51204.203215.2385183.2056200.2966188.1549202.6496182.6856189.7582157.3516频率微扰商0.49930.88360.6371540.7315840.4558540.5172360.4613121.4576031.4226911.279441频率变动幅度23.39826.650728.5514428.2800323.8502920.9258120.4987246.0514539.6822140.7801振幅微扰商0.06750.145340.1226830.1112260.0981150.0853880.0907620.3116650.1965510.117366谐噪比12.8415.956826.0286526.2863926.3968236.203236.4594833.0404553.2301612.814158音调微扰系数0.04960.089790.1035460.0950110.059950.0652960.0515750.2227430.1764310.169036 病变各组与正常组比较结果如下： 声带息肉组：频率均值、频率微扰商P0.05, 有显著性差异；谐噪比P0.01, 有非常显著性差异。 声带小结组：基频、频率均值P0.05, 有显著性差异；谐噪比P0.01有非常显著性差异。 环杓关节错位组：第二共振峰、谐噪比P0.01，有非常显著性差异。