甲狀腺手術與胸腔手術所致單側聲帶麻痺患者音域圖與嗓音聲學分析之比較

Comparison of Voice Range Profile and Acoustic Analysis between Patients with Unilateral Vocal Fold Paralysis Caused by Thyroid Surgery and Thoracic Surgery

何長軒(Chan-Shien Ho) ； 裴育晟(Yu‐Cheng Pei) ； 莊秀鳳(Hsiu-Feng Chuang) ； 辛立仁(Li-Jen Hsin) ； 張舒婷(Shu-Ting Chang) ； 江芝儀(Chih-Yi Chiang) ； 方端仁(Tuan‐Jen Fang)

《台灣耳鼻喉頭頸外科雜誌》 56卷2期 (2021/06) Pp. 78-86

https://doi.org/10.6286/jtohns.202106_56(2).078

摘要

背景：單側聲帶麻痺為頸部及胸腔部手術後常見之併發症，可能導致發聲單調、嗓音沙啞或吞嚥障礙等症狀而影響病人術後生活品質。音域圖和嗓音聲學能評估音聲相關神經肌肉之受損之嗓音表現，前者可分析病患發出不同頻率、音量之嗓音之範圍，後者以電腦化的言語實驗室系統分析嗓音。目前甲狀腺手術及其他術式所導致之單側聲帶麻痺致之音域圖差異相關研究較少。方法：本研究為回溯性研究，共納入99名單側聲帶麻痺病患，45名於甲狀腺手術組及54名於胸腔手術組，藉由音域圖和嗓音聲學分析手術後單側聲帶麻痺患者之嗓音，配合喉頻閃內視鏡及定量喉肌電圖參數對照，以區分甲狀腺手術和胸腔手術病患之臨床表現差異，並以定量喉肌電圖針對可能受影響之喉部肌肉，包含甲杓－側環杓複合肌群和環甲肌進行分析。結果：喉肌電圖顯示接受甲狀腺手術組患側環甲肌群最大轉折頻率較胸腔手術組低（p＝0.01，獨立樣本t檢定）；喉頻閃內視鏡檢查中閉合時聲門間隙區域在甲狀腺手術組較低（p＜0.05，獨立樣本t檢定）。在音域圖分析中，所有分析參數二組間皆無顯著差異；嗓音聲學分析中甲狀腺手術組之最大發聲時間較胸腔手術組長（p＜0.05，獨立樣本t檢定），頻率擾動率和振幅擾動度皆較低（p＜0.05和p＜0.05，獨立樣本t檢定）。結論：不同手術後之單側聲帶麻痺有不同之定量喉肌電圖以及嗓音聲學分析表現，可反映其不同之神經肌肉及氣流機轉。

關鍵字

acoustic voice analysis ； laryngeal electromyography ； thyroid surgery ； unilateral vocal fold paralysis ； voice range profile（嗓音聲學分析 ； 喉肌電圖 ； 甲狀腺手術 ； 單側聲帶麻痺 ； 音域圖）

並列摘要

BACKGROUND: Unilateral vocal fold paralysis (UVFP) is a common complication of neck and thoracic surgery, causing monotonicity, hoarseness, and dysphagia and affecting the patient's quality of life. Voice range profile (VRP) and acoustic voice analysis can both evaluate voice in patients with UVFP, with the former characterizing the range of voice frequency and intensity and the latter using computer programs to analyze the voice acoustics. No studies have yet compared VRP between UVFP patients caused by thyroid and other surgeries. METHODS: This retrospective study compared between UVFP patients caused by thyroid and thoracic surgery in their VRP and voice acoustic analysis, videostroboscopy, and quantitative laryngeal electromyography for the thyroarytenoidlateral cricoarytenoid muscle complex and thyroarytenoid muscle. RESULTS: Ninety-nine surgery-related UVFP patients were included, with 45 and 54 in the thyroid surgery and thoracic surgery groups, respectively. As compared with the thoracic surgery group, the thyroid surgery group had a lower peak turn frequency ( p = 0.01) in laryngeal electromyography and smaller closed-phase glottal gap in videostroboscopy ( p ＜ 0.05). VRP parameters did not differ between the two groups. Voice acoustic analysis showed that thyroid surgery had a greater maximum phonation time ( p ＜ 0.05), lower jitter ( p ＜ 0.05), and lower shimmer ( p ＜ 0.05). CONCLUSIONS: Compared with voice acoustic analysis, VRP showed no advantage in differentiating voice between the thyroid and thoracic surgery groups. Different surgery induced difference performance in laryngeal electromyography and voice acoustic analysis, implying a different presentation in their neuromuscular control and airflow.

並列關鍵字

acoustic voice analysis ； laryngeal electromyography ； thyroid surgery ； unilateral vocal fold paralysis ； voice range profile