Yanagida Saori, Nishizawa Noriko, Hashimoto Ryusaku, Mizoguchi Kenji, Hatakeyama Hiromitsu, Homma Akihiro, Fukuda Satoshi
Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Hokkaido, Japan; Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Hokkaido, Japan.
J Voice. 2018 Sep;32(5):585-591. doi: 10.1016/j.jvoice.2017.06.022. Epub 2017 Aug 9.
The aim of this study was to evaluate speech in patients with adductor spasmodic dysphonia (ADSD) by perceptual evaluations and acoustic measures, and to examine the reliability and validity of these measures.
Twenty-four patients with ADSD and 24 healthy volunteers were included in the study. Speech materials consisted of three sentences constructed from serial voiced syllables to elicit abductor voice breaks. Three otolaryngologists rated the degree of voice symptoms using a visual analog scale (VAS). VAS sheets with five 100-mm horizontal lines were given to each rater. The ends of the lines were labeled normal vs severe, and the five lines were labeled as overall severity of each of the four speech symptoms (strangulation, interruption, tremor and strained speech). Nine words were selected for acoustic analysis, and abnormal acoustic events were classified into one of the three categories. To evaluate the intra- and inter-rater and intermeasurer reliabilities of the VAS scores or acoustic measures, Pearson r correlations were calculated. To examine the validity of perceptual evaluations and acoustic measures, the sensitivity and the specificity were calculated.
Pearson r correlation coefficients for overall severity showed the highest intra- and inter-rater reliabilities. For acoustic events, the intrameasurer reliabilities were r = .645 (frequency shifts), r = .969 (aperiodic segments), and r = 1.0 (phonation breaks), and the intermeasurer reliability ranged from r = .102 to r = 1.0. Perceptual evaluation showed high sensitivity (91.7%) and specificity (100%), whereas acoustic analysis showed low sensitivity (70.8%) and high specificity (100%).
Both perceptual evaluation and acoustic measures alone were found likely to overlook patients with true ADSD.
本研究旨在通过感知评估和声学测量来评估内收型痉挛性发声障碍（ADSD）患者的语音，并检验这些测量方法的可靠性和有效性。
本研究纳入了24例ADSD患者和24名健康志愿者。语音材料由三个由连续浊音音节构成的句子组成，以引出外展性破音。三名耳鼻喉科医生使用视觉模拟量表（VAS）对语音症状的程度进行评分。给每位评分者发放带有五条100毫米水平线的VAS表格。线条的两端分别标记为正常与严重，五条线分别标记为四种语音症状（勒喉感、中断、震颤和紧张性言语）各自的总体严重程度。选择九个单词进行声学分析，并将异常声学事件分为三类之一。为了评估VAS评分或声学测量的评分者内、评分者间和测量者间的可靠性，计算了Pearson相关系数r。为了检验感知评估和声学测量的有效性，计算了敏感性和特异性。
总体严重程度的Pearson相关系数r显示出最高的评分者内和评分者间可靠性。对于声学事件，测量者内可靠性分别为r = 0.645（频移）、r = 0.969（非周期性片段）和r = 1.0（发声中断），测量者间可靠性范围为r = 0.102至r = 1.0。感知评估显示出高敏感性（91.7%）和高特异性（100%），而声学分析显示出低敏感性（70.8%）和高特异性（100%）。
单独的感知评估和声学测量都可能会遗漏真正患有ADSD的患者。
