| Objective By comparing the multidimensional voice analysis and vocal aerodynamics test results of normal adults,patients with laryngopharyngeal malignancy before total laryngectomy and patients with esophagus pronunciation who underwent total laryngectomy,the voice changes of patients before and after total laryngectomy were understood,the characteristics of related indicators of voice and vocal aerodynamics of esophageal articulation were discussed,so as to help patients with esophageal pronunciation to understand their own pronunciation,guide the reconstruction and rehabilitation of esophageal vocalization and improve the quality of life of patients.Method The results of multi-dimensional voice analysis and vocal aerodynamics of 60 normal adults,60 cases of laryngeal cancer before total laryngectomy and these 60 patients with esophagus pronunciation who underwent total laryngectomy were collected.Esophageal articulation was the main mode of postoperative articulation in all patients with carcinoma of larynx.The acoustic parameter analysis used the MDVP multidimensional voice analysis system of Kay inc in the United States to extract the acoustic parameters of /a:/ sound for 3 seconds in patients with laryngeal carcinoma,patients with esophageal pronunciation and normal adults.The model 6600 audible aerodynamics testing system produced by Kay Pentax in the United States was used for the aerodynamic inspection.Appropriate sound samples were taken from the three groups of test subjects,and the instructions of longest continuous sound,comfortable continuous sound and sound efficiency were used for automatic analysis.The main parameters selected for the two detection results included average fundamental frequency(F0),frequency perturbation(jitter),amplitude perturbation(shimmer),noise to harmonic ratio(NHR)and aerodynamic indexes including maximum phonation time(MPT),mean flow rate(MFR),subglottal pressure(SGP),glottal resistance(GR)and vocal efficiency(VE)will be received,statistical treatment and contrastive analysis of above parameters and indexes of the three groups were performed.Result There was no significant difference in F0 between preoperative group and normal control group(P>0.05),while F0 in esophageal articulation was significantly decreased,which was obviously different from the other two groups(P<0.05).Jitter,shimmer and NHR were significantly different between the three groups and any two groups(P<0.05).Voice perturbation and noise parameters were notably increased in laryngeal cancer patients.The average level of jitter and shimmer was 6.5~7.5 and 3.5~4 times higher than the normal reference value respectively,and NHR could be increased to about 2~2.5 times of the normal range.The results of the three parameters of esophageal articulation were more deviated from the normal values,which could be increased to twice the preoperative value.The jitter,shimmer and NHR were respectively increased to 13~14,6~7 and 5~6 times of the normal values,the voice quality was greatly reduced.The ROC curves of the acoustic parameters of MDVP in esophageal articulation group and the other two groups were respectively made.It can be seen that the area under jitter,shimmer and NHR was over 0.5,the area under the latter two parameters was over 0.95.The variation range of esophageal articulation in terms of sound frequency,intensity and noise content was obvious.MPT and SGP were significantly different between three groups and any two groups(P<0.05),MFR,GR and VE were statistically significant(P<0.05),and there were significant differences between any two groups(P<0.017).The value of MPT and VE in laryngeal carcinoma patients was significantly lower than that in normal adults,with a decrease of more than 50%,while SGP,MFR and GR were significantly higher than that in normal patients,which could be increased to about 1.5~3 times of normal value.The change trend of all the other aerodynamic parameters except MFR in esophageal articulation was consistent with preoperative detection results and was more different from the normal adult group than the preoperative one.SGP increased to 4~4.5 times of the normal value,MFR decreased to half of the normal value,GR was up to 7~9 times of the normal value,MPT and VE decreased by about 70%~90% compared with the normal value.Compared with the preoperative group and the normal group,the area under the SGP and GR curves of esophageal pronunciation was more than 0.5,especially the difference was more significant compared with the normal group,the area under the curve was up to 1.The area under MPT,MFR and VE was less than 0.5.The changes of subglottic pressure and glottic resistance of esophageal pronunciation were significantly abnormal.Conclusion The voice perturbation and noise parameters of patients with laryngeal cancer were significantly higher than normal,presenting as hoarseness,roughness and obvious breath sound.The overall stability,synchronicity and movement control of esophageal pronunciation were poor,the results showed that the parameters related to sound frequency,intensity and noise were more deviated from the normal value than that before surgery.The noise component of esophageal sound was far more than that of homophonic component,the sound was rougher than that before surgery and normal pronunciation,and the articulation was significantly decreased.Compared with preoperative and normal the F0 goes down,the voice of male patients is more low,blunt and rough,and the voice of female patients is masculine,the overall voice quality is greatly reduced.In laryngeal cancer patients,the sound production time is significantly shortened,the sound production efficiency is markedly decreased,the parameters related to glottis closure are abnormally increased.The average airflow rate of esophageal pronunciation was remarkably reduced.Other glottis closure related parameters were significantly increased.However,the indexes related to vocal duration and sound energy conversion were observably decreased.The aerodynamic characteristics are as follows: the decrease of airflow rate and increase of resistance result in the prominently lower duration and fluency of the voice than normal,and the language is not easy to understand.Multidimensional voice acoustic analysis and aerodynamics measurement can provide the basis for the standardized objective evaluation of the voice quality of patients with esophageal pronunciation.The longer the training time,the better the sound quality of esophageal pronunciation.As reflected in the quantitative evaluation of voice,the corresponding acoustic and aerodynamic parameters will change.Objective voice test results can be used to evaluate the pronunciation quality and training effect of patients with esophageal pronunciation during esophageal language training,guide the reconstruction of esophageal speech and improve the quality of life of patients after total laryngectomy. |
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