Application of videostrobokymography in analyzing factors affecting voice after surgery
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摘要: 目的 探讨动态喉镜记波扫描图在评估声带术后声带振动精细特征方面的价值。方法 对7例喉显微镜下CO2激光声带肿物切除术后嗓音参数进行分析, 同时动态喉镜检查生成动态喉镜记波扫描图, 分析声带振动特征。结果 2例患者嗓音参数均较术前升高; 2例患者嗓音参数较术前部分升高(其中1例Jitter较术前下降, 其余参数较术前升高, 另1例Shimmer较术前下降, 其余参数较术前升高); 其余患者嗓音参数均较术前下降。动态喉镜检查除1例复发外, 其余病例声带表面光滑, 未见明确新生物。进一步动态喉镜记波扫描图显示, 嗓音参数升高的患者分别存在声带振动传递障碍、振动部分缺失、振动轴偏斜及振动相位差等异常。结论 通过动态喉镜记波扫描图可以发现动态喉镜视频影像中不易发现的微小改变, 从而更精确地分析声带黏膜振动特性。Abstract: Objective To elucidate the value of videostrobokymography in the evaluation of the characteristics of vocal cord vibration after the surgery.Methods To analyze the spectrum of the voice before and after the microsurgery of the vocal folds. Using the videostrobokymography to reveal the changes of vibration, especially in the cases with poor spectrum elevation but without obvious recurrence.Results Two patients were with elevated vocal parameters; 2 patients were with partially elevated vocal parameters(one with Jitter decreased while others elevated; one with Shimmer decreased while others elevated); the other 3 patients were with decreased vocal parameters. The videostrobokynmography showed the recurrence in 1 patient, but not in others. In 4 cases with elevated vocal parameters, the videostrobokymography showed cycle-to-cycle variability of the amplitude, absence of vibration of vocal fold, glottal axis shift and phase difference.Conclusion There are certain value of videostrobokymography in analyzing the minor changes of characteristic of vibration of vocal fold.
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Key words:
- videostroboscopy /
- kymography /
- voice /
- microsurgery
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表 1 7例患者一般情况
例序 性别 年龄/岁 主诉 既往史 吸烟史 饮酒史 1 女 36 间断声嘶10年 无 无 无 2 男 59 间断声嘶5个月 无 40年，30支/d 无 3 女 46 间断声嘶1年，加重2个月 无 无 无 4 男 42 间断声嘶2个月 无 无 无 5 女 38 间断声嘶半年，加重1个月 声带息肉手术史 无 无 6 女 59 持续声嘶2个月 胃大部切除、子宫肌瘤手术史，贫血 30年，20支/d 无 7 男 39 间断声嘶1年 无 20年，10支/d 无 
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表 2 7例病变类型、侧别、大小及随访时间
例序 病变类型 病变侧别 病变大小/mm 随访时间/月 1 声带小结 双 1/1(左/右) 3 2 声带白斑 右 3×1 4 3 声带息肉 左 2 6 4 声带息肉 左 3 6 5 声带小结 双 1/1(左/右) 4 6 声带息肉 双 3/5(左/右) 7 7 声带息肉 右 4 3
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表 3 术前后嗓音声学参数对比
例序 Jitter/% Shimmer/% NHR 术前 术后 术前 术后 术前 术后 1 3.32 1.43 6.01 4.65 0.154 0.143 2 1.05 1.03 3.65 4.55 0.120 0.148 3 1.38 3.07 5.61 6.37 0.154 0.182 4 4.41 0.86 13.43 7.93 0.247 0.145 5 2.29 1.02 10.99 6.82 0.257 0.150 6 0.55 1.27 2.46 3.41 0.140 0.148 7 1.36 2.64 8.75 7.26 0.167 0.179
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