Yu Ping, Wang Gang, Zhang Gui-juan, Tang Ai-rong, Wang Rong-guang
Department of Otorhinolaryngology, Chinese People's Liberation Army General Hospital, Beijing, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Oct;47(10):817-22.
Through exploring the concordance of objective multi-parameters analysis and perceptual evaluation, to establish an objective multi-parameters evaluation protocol of voice disorder and to make the evaluation of voice objectification and quantification.
Voice samples from 271 patients (124 female and 147 male)with dysphonia and 69 control subjects with normal voice (37 female and 32 male)were recorded and assessed by a jury composed of 5 experts in phoniatrics from different hospitals. The jury was instructed to classify voice samples according to the G (grade) component of the GRBAS scale on a visual analogue scale secondarily transformed in a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. The voice samples were unified sentences and ordered randomly 3 times, the mean of 3 evaluation scores were the final results. The objective parameters, including fundamental frequency (F0), jitter, shimmer, fundamental frequency standard deviation (F0SD), normalized noise energy (NNE), harmonic-to-noise ratio (HNR) and maximal phonatory time (MPT), were measured on a 2-second sustained vowel/a/including its initial segment, using the software Dr. Speech for Windows. The data were analyzed using SPSS11.0.
All objective parameters except for F0 had high correlation with G and the variance tendency of these parameters values was coherent with the extent of voice disorder. And there were statistical differences between adjacent voice disorder groups. Male and female objective multi-parameters protocols were established respectively consisting of jitter, shimmer, F0SD, NNE, HNR and MPT using discriminant analysis (P < 0.05). The concordance between perceptual evaluation and objective multi-parameters evaluation was 81.6% in male and 83.2% in female. The concordance of evaluation of normal voice and severe voice disorder groups were better than that of mild and moderate voice disorder groups. All mis-grading voices were judged in the adjacent voice group.
The objective parameters of voice are able to reflect the characteristic of its perceptual evaluation and the concordance between perceptual evaluation and objective multi-parameters evaluation is good. The objective multi-parameters evaluation protocol we established could provide an objective and quantitative evaluation method for voice disorders.
通过探讨客观多参数分析与主观评估的一致性，建立嗓音障碍客观多参数评估方案，实现嗓音评估的客观化和量化。
记录271例嗓音障碍患者（女性124例，男性147例）及69例嗓音正常对照者（女性37例，男性32例）的嗓音样本，由来自不同医院的5名小儿耳鼻咽喉科专家组成的评审团进行评估。评审团被要求根据GRBAS量表的G（等级）成分，在视觉模拟量表上对嗓音样本进行分类，该量表经二次转换为4级量表，从正常的0级到重度嗓音障碍的3级。嗓音样本为统一语句，随机排序3次，3次评估分数的平均值为最终结果。使用Windows版Dr. Speech软件，在包含初始段的2秒持续元音/a/上测量客观参数，包括基频（F0）、抖动、闪烁、基频标准差（F0SD）、归一化噪声能量（NNE）、谐波噪声比（HNR）和最大发声时间（MPT）。数据采用SPSS11.0进行分析。
除F0外，所有客观参数与G均具有高度相关性，这些参数值的变化趋势与嗓音障碍程度一致。相邻嗓音障碍组之间存在统计学差异。采用判别分析分别建立了男性和女性客观多参数评估方案，包括抖动、闪烁、F0SD、NNE、HNR和MPT（P<0.05）。主观评估与客观多参数评估的一致性在男性中为81.6%，在女性中为83.2%。正常嗓音组和重度嗓音障碍组的评估一致性优于轻度和中度嗓音障碍组。所有分级错误的嗓音均被判定在相邻嗓音组。
嗓音客观参数能够反映其主观评估特征，主观评估与客观多参数评估的一致性良好。我们建立的客观多参数评估方案可为嗓音障碍提供客观、定量的评估方法。
