Krival Kate, Kelchner Lisa N, Weinrich Barbara, Baker Susan E, Lee Linda, Middendorf Janet H, Zur Karen B
Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267-0379, USA.
Int J Pediatr Otorhinolaryngol. 2007 Aug;71(8):1261-9. doi: 10.1016/j.ijporl.2007.04.018. Epub 2007 May 30.
Surgeons who perform pediatric laryngotracheal reconstruction (LTR) have traditionally measured outcomes based on successful airway restoration. Additional information regarding post-surgical vocal function may help guide outcomes toward optimal voice. This investigation documented the relationship between the site of vocal tract vibratory source (glottic versus supraglottic versus mixed) and vocal function in children following LTR.
Endoscopic evaluation of voice source was completed in 16 participants who had LTR as children. Three judges rated vocal quality using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Acoustic analysis was completed to obtain fundamental frequency and determine the periodicity of the vibratory signal.
Seven participants were identified to have glottic vibration and nine had supraglottic or mixed-source vibration for voice. All participants were rated as having some degree of voice disorder. Those who used primarily supraglottic/mixed phonation exhibited significantly worse overall severity, roughness, and pitch deviance ratings than did those who used primarily glottic phonation. Significant differences in strain were also noted; however, poor inter-rater reliability rating of strain confounded this result. No significant differences in breathiness or loudness ratings were exhibited. Periodic vibration was observed in 10 of 16 participants (5 of 7 in the glottic group and 5 of 9 in the supraglottic/mixed group). Three of the five participants who had periodic supraglottic phonation had fundamental frequency measures (F(0)) that were below normative ranges, 1 approximated normal, and 1 was above normal range. Two of the five participants who had periodic glottic phonation had lower than expected F(0)s, 1 was within normal range, and 2 were high.
As observed in earlier studies, voices produced with supraglottic phonation were generally less acceptable than those with glottic phonation. However, phonation with supraglottic structures yielded highly variable voice that may be amenable to change. Some children achieved periodic vibration with alternate structures, suggesting inherent flexibility and adaptability in the tissues used to make sound.
传统上，进行小儿喉气管重建术（LTR）的外科医生根据气道恢复是否成功来衡量手术效果。有关术后嗓音功能的更多信息可能有助于将手术效果导向最佳嗓音状态。本研究记录了小儿LTR术后声道振动源部位（声门型、声门上型、混合型）与嗓音功能之间的关系。
对16名儿时接受过LTR的参与者进行了嗓音源的内镜评估。三名评判员使用嗓音的共识听觉-感知评估（CAPE-V）对嗓音质量进行评分。完成声学分析以获取基频并确定振动信号的周期性。
7名参与者被确定为声门振动，9名参与者为声门上或混合型嗓音振动。所有参与者都被评定为有某种程度的嗓音障碍。主要使用声门上/混合发声的参与者在总体严重程度、粗糙度和音高偏差评分方面明显比主要使用声门发声的参与者差。在紧张度方面也发现了显著差异；然而，评判员之间紧张度评分的可靠性较差使这一结果受到影响。在呼吸音或响度评分方面未发现显著差异。16名参与者中有10名观察到周期性振动（声门组7名中的5名，声门上/混合组9名中的5名）。5名有周期性声门上发声的参与者中有3名的基频测量值（F(0)）低于正常范围，1名接近正常，1名高于正常范围。5名有周期性声门发声的参与者中有两名的F(0)低于预期，1名在正常范围内，2名偏高。
如早期研究中所观察到的，声门上发声产生的嗓音通常不如声门发声产生的嗓音可接受。然而，声门上结构发声产生的嗓音变化很大，可能易于改变。一些儿童通过其他结构实现了周期性振动，表明用于发声的组织具有内在的灵活性和适应性。
