Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
J Voice. 2024 Sep;38(5):1256.e9-1256.e15. doi: 10.1016/j.jvoice.2022.02.027. Epub 2022 Apr 1.
Laryngopharyngeal reflux (LPR) causes laryngopharyngeal hypersensitivity and laryngeal muscle hyperfunction, which may result in hard voice onset in patients with LPR. The purpose of this study is to examine the incidence of hard voice onset in patients with LPR and the effects of hard voice onset on objective voice function in patients with LPR.
Forty patients with confirmed LPR were enrolled in the LPR group, and 40 healthy subjects were enrolled in the non-LPR group. Subjects underwent laryngeal high-speed videoendoscopy, and the presence or absence of hard voice onset in each subject was determined by two experienced laryngologists based on whether glottal closure was complete or incomplete before vocal fold vibration. Based on the results, the subjects with LPR were divided into a hard voice onset group and a non-hard voice onset group. The voice onset time (VOT) was measured and compared between the hard and non-hard voice onset groups within the LPR group. Laryngeal aerodynamic assessment was also carried out on the LPR group, and subglottal pressure, phonation threshold pressure (PTP), glottal resistance, and mean flow rate were measured. The voice acoustic signals of subjects were additionally analyzed in the LPR group, and the fundamental frequency, jitter, shimmer, and noise-harmony ratio were determined. The kappa statistic, chi-square test and independent-samples t test in SPSS were used for statistical analysis.
The two laryngologists had substantial inter-rater consistency on the evaluation of hard voice onset and non-hard voice onset, with a kappa statistic of 0.71. In the LPR group, 42.5% of patients had hard voice onset (17/40), significantly more than in the non-LPR group (8/40, 20%) (P < 0.05). The VOT in the LPR group was significantly longer than in the non-LPR group (P < 0.05). Within the LPR group, the VOT, PTP and shimmer were significantly greater in the hard voice onset group than in the non-hard voice onset group (all P < 0.05). The other laryngeal aerodynamic parameters and acoustic parameters were not significantly different between the hard voice onset group and the non-hard voice onset group (P > 0.05).
Changes in vocal production may occur in LPR patients, causing them to be more susceptible to hard voice onset. The patients with hard voice onset require longer VOT and greater PTP to initiate phonation.
咽喉反流（LPR）可引起咽喉敏感性增加和喉肌功能亢进，这可能导致 LPR 患者出现硬起音。本研究旨在探讨 LPR 患者硬起音的发生率以及硬起音对 LPR 患者客观嗓音功能的影响。
将 40 例确诊为 LPR 的患者纳入 LPR 组，将 40 例健康受试者纳入非 LPR 组。受试者接受喉高速视频内镜检查，由两位有经验的喉镜专家根据声带振动前声门是否完全或不完全闭合来判断每位受试者是否存在硬起音。根据结果，将 LPR 组患者分为硬起音组和非硬起音组。测量 LPR 组内硬起音组和非硬起音组的嗓音起始时间（VOT）并进行比较。还对 LPR 组进行了喉气动评估，测量了声门下压、发音阈值压（PTP）、声门阻力和平均流量。此外，还对 LPR 组受试者的嗓音声学信号进行了分析，确定了基频、抖动、颤动和噪声-和谐比。采用 SPSS 中的卡方检验、kappa 统计量和独立样本 t 检验进行统计分析。
两位喉镜专家在评估硬起音和非硬起音方面具有较高的组内一致性，kappa 统计量为 0.71。在 LPR 组中，42.5%的患者（17/40）出现硬起音，明显多于非 LPR 组（8/40，20%）（P<0.05）。LPR 组的 VOT 明显长于非 LPR 组（P<0.05）。在 LPR 组中，硬起音组的 VOT、PTP 和颤动明显大于非硬起音组（均 P<0.05）。硬起音组和非硬起音组的其他喉气动参数和声学参数差异无统计学意义（P>0.05）。
LPR 患者的发声方式可能发生变化，导致其更容易出现硬起音。硬起音患者需要更长的 VOT 和更大的 PTP 来启动发音。
