内收型痉挛性发声障碍和肌肉紧张性发声障碍在高速数字成像上的差异振动特征

Differential vibratory characteristics of adductor spasmodic dysphonia and muscle tension dysphonia on high-speed digital imaging.

作者信息

Patel Rita R, Liu Li, Galatsanos Nikolaos, Bless Diane M

机构信息

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA.

出版信息

Ann Otol Rhinol Laryngol. 2011 Jan;120(1):21-32. doi: 10.1177/000348941112000104.

DOI:10.1177/000348941112000104

PMID:21370677

Abstract

OBJECTIVES

The purpose of this study was to quantify disorder-specific signature kinematic disturbances of vibratory motion in adductor spasmodic dysphonia (AdSD) and muscle tension dysphonia (MTD), in voice disturbances of a severe nature, with the use of high-speed digital imaging (HSDI). A secondary hypothesis of the study was to investigate the sensitivity and specificity of the signature kinematic features obtained from HSDI, in differentiating between AdSD and MTD.

METHODS

We used vibratory features from automated extraction of vocal fold motion waveforms and glottal cycle montage analysis from HSDI for differential kinematic profiling of AdSD and MTD.

RESULTS

Novel features of motion irregularities and micromotions (as small as 27 ms) were greater in number for AdSD, whereas reduced motion irregularities, absence of oscillatory breaks, absence of micromotions, and increased hyperfunction characterized the MTD group. Oscillatory breaks (as small as 8 ms), although present only in the AdSD group, were not statistically significant because of their reduced number of occurrences compared to the other features. Further montage analysis of successive glottal cycles of oscillatory breaks in the AdSD group revealed 3 different kinematic patterns within the AdSD group, indicative of likely AdSD with: 1) possible predominant thyroarytenoid muscle involvement, 2) possible predominant cricothyroid muscle involvement, and 3) possible combined involvements of the thyroarytenoid and lateral cricoarytenoid muscles. Four consistent but unique kinematic patterns were identified within the MTD group: 1) diplophonia, 2) vocal fry, 3) breathy phonation, and 4) pressed phonation. Sensitivity and specificity analysis revealed that only motion irregularity was a significant predictor of the presence of AdSD.

CONCLUSIONS

Fine kinematic analysis from HSDI can be used to aid detailed clinical profiling of the source characteristics of AdSD and MTD.

摘要

目的

本研究的目的是利用高速数字成像（HSDI）量化内收性痉挛性发音障碍（AdSD）和肌肉紧张性发音障碍（MTD）中特定疾病的标志性振动运动的运动学紊乱，这两种发音障碍都具有严重的嗓音紊乱。本研究的第二个假设是研究从HSDI获得的标志性运动学特征在区分AdSD和MTD方面的敏感性和特异性。

方法

我们利用从HSDI自动提取的声带运动波形的振动特征和声门周期蒙太奇分析，对AdSD和MTD进行差异运动学分析。

结果

AdSD中运动不规则和微运动（小至27毫秒）的新特征数量更多，而MTD组的特征是运动不规则减少、无振荡中断、无微运动以及功能亢进增加。振荡中断（小至8毫秒）虽然仅出现在AdSD组中，但由于其出现次数与其他特征相比减少，因此无统计学意义。对AdSD组振荡中断的连续声门周期进行进一步的蒙太奇分析，发现AdSD组内有3种不同的运动学模式，提示可能的AdSD伴有：1）可能主要累及甲杓肌，2）可能主要累及环甲肌，3）可能同时累及甲杓肌和环杓侧肌。在MTD组中识别出4种一致但独特的运动学模式：1）双声，2）发声粗糙，3）呼吸音，4）紧压音。敏感性和特异性分析表明，只有运动不规则是AdSD存在的显著预测指标。