Brockmann-Bauser M, Bohlender J E, Mehta D D
Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
J Voice. 2018 Mar;32(2):162-168. doi: 10.1016/j.jvoice.2017.04.008. Epub 2017 May 18.
In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status.
This is a matched case-control study.
We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests.
In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR.
The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects.
在嗓音健康的儿童和成人中，说话声音响度差异会显著混淆声学扰动测量。本研究考察了嗓音声压级（SPL）对嗓音障碍成人及嗓音状态正常对照组的抖动、闪烁及谐波噪声比（HNR）的影响。
这是一项匹配病例对照研究。
我们评估了58名成年女性嗓音患者，根据年龄和职业与58名嗓音健康女性进行匹配。诊断包括声带小结（n = 39，67.2%）、息肉（n = 5，8.6%）和肌肉紧张性发声障碍（n = 14，24.1%）。所有参与者在轻柔、舒适和响亮的发声水平下持续发元音/a/。使用Praat计算嗓音声学SPL、抖动、闪烁和HNR。使用线性混合模型和Wilcoxon符号秩检验评估响度条件、嗓音SPL、病理、鉴别诊断、年龄和职业用嗓水平对声学扰动测量的影响。
在患者组和正常对照组中，嗓音SPL升高均与抖动和闪烁降低以及HNR升高显著相关（P < 0.001）。嗓音病理和鉴别诊断与系统性更高的抖动和闪烁并无关联。然而，在舒适发声水平下患者组的HNR水平在统计学上高于对照组。职业用嗓水平对抖动、闪烁和HNR有显著影响（P < 0.05）。
如果不控制说话声音SPL和职业用嗓水平的影响，声学抖动、闪烁和HNR的临床价值可能有限。有必要开展进一步研究，以调查在控制这些影响后扰动测量是否为有用的临床结局指标。
