Pathophysiological Study on Phonatory Function after Phonosurgery

本项目研制了高速数字成像系统，可用于评价患者的声带功能。对喉部分切除术患者的声源进行了调查，发现会厌折可以振动发声。这一发现为提高术后患者的嗓音质量提供了新的思路。通过使用高速数字成像系统，明确了导致嗓音障碍的一些因素。尤其是发声方式不仅对发声开始有影响，而且对后续的平稳发声也有影响。说明发声攻击可能是声带肥大的重要因素之一。这也为制定语音外科术后康复的临床方案提供了新的认识。近年来，功能性发音障碍患者的数量呈上升趋势，尤其是在专业发音用户中。痉挛性发音困难是难治性功能性发音障碍之一。我们一直在使用肉毒毒素。治疗前后评价声带振动、心理声学印象和声学参数。神经背景作为病因被强烈建议。也评估了声音外科手术后的吞咽功能。很明显，发声功能和吞咽功能都得到了改善。从教育和医学的角度来看，儿童的声音和言语障碍都是重要的。我们已经开始了一项试点研究，以找出儿童语音和言语障碍的评估体系。

In this project, the high speed digital imaging system has been developed and can be used to evaluate the vocal folds function of the patient. The sound source of the partial laryngectomized patient was investigated to find that the ary-epiglottic fold can vibrate to generate the voice. This finding gives us a new idea to improve the voice quality to the post operative patient.By using the high speed digital imaging system, some causative factors of the voice disorders have been clarified. Especially, the mode of the onset of the phonation has an effect not only at the beginning of the phonation but at the following stationary phonation. It means that the voice attack should be one of the most important factor for the vocal hyginene. This also provides the new knowledge to make a clinical program of the rehabilitation after phonosurgery.Recently, the number of the patients with functional dysphonia tends to be increasing especially, among the professional voice users. Spasmodic dysphonia is one of the functional dysphonia which is difficult to treat. We have been using the botulinum toxin. Vocal fold vibration, psychoacoustic impression and acoustic parameters were evaluated pre and post treatment. The neurological back ground as an etiologic factor was strongly suggested.Swallowing function after phonosurgery was also evaluated. It becomes clear that the phonatory function and the swallowing function improves together.Voice and speech disorders in the children are important from educational point of view as well as medical point of view. We have started a pilot study to find out the evaluation system for the voice and speech disorders in children.