前发声期嗓音参数参考标准的制定及临床应用研究
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摘要
客观全面的嗓音评估是嗓音治疗的基础。随着计算机技术的发展和嗓音医学的进步,针对嗓音功能的主观和客观测量手段日渐丰富,尤其是嗓音的客观测量技术,在嗓音疾病的诊断和治疗中发挥着重要作用。
本论文在国内外嗓音客观测量研究的基础上,首次采用能对瞬态和稳态声波进行提取分析的“发声测量仪”(Phonation)为测量工具,选择F0、Jitter、OQ. SQ、STF和AQ作为研究参数,对前发声期嗓音参数进行了系列研究。研究内容主要包括：前发声期与稳定期嗓音参数的比较,前发声期嗓音测试语料的选择,成人正常与病理嗓音的比较及学前儿童正常与病理嗓音的比较分析,正常成人与学前儿童前发声期嗓音参数的特征分析,前发声期嗓音参数参考标准的制订以及前发声期嗓音参数及其参考标准在临床中的应用。
通过本论文的实验研究,取得了以下阶段性研究成果：1.前发声期与稳定期的嗓音参数存在显著性差异：前发声期与稳定期之间的Jitter、OQ和SQ具有极显著差异(p<0.01), F0、STF和AQ具有显著性差异(p<0.05)。2.选择出了前发声期嗓音测试的最佳语料：成人为／ba／,儿童为／gu／。3.通过正常与病理嗓音的对比研究,发现成人及儿童正常和病理嗓音参数在前发声期及稳定期具有不同的特点：成人及儿童正常和病理嗓音前发声期参数F0、Jitter、OQ具有显著差异(p<0.05):OQ和FO正常值高于异常值,而Jitter正常值低于异常值。成人Jitter、SQ、AQ和STF四个参数在不同嗓音和发声阶段之间存在交互作用(p<0.05),儿童F0、Jitter和AQ三个参数在不同嗓音和发声阶段之间存在交互作用(p<0.05),其前发声期的变化比稳定期的变化表现更为明显。学前儿童性别和年龄段之间各个前发声期参数均无明显差异(p>0.05)。4.制订了成人及学前儿童前发声期嗓音参数的参考标准；5.发现不同类型的嗓音障碍其前发声期嗓音参数具有不同的特点：功能性和器质性嗓音障碍的FO值低于神经性嗓音障碍；功能性嗓音障碍的Jitter、STF值低于器质性和神经性嗓音障碍；功能性嗓音障碍在AQ上却高于器质性和神经性嗓音障碍,为嗓音障碍的鉴别诊断提供了新的思路和一定的参考价值。6.通过前发声期嗓音参数及其参考标准的临床应用,验证了嗓音治疗的有效性,并初步证实了前发声期嗓音参数参考标准在临床嗓音治疗及疗效监控中的重要作用。
通过本论文的研究,证明前发声期的嗓音参数及参考标准对于嗓音诊断和疗效监控具有重要意义,为嗓音功能的客观测量提供了新的途径和手段。在后继的研究中,将拓宽研究对象的年龄和病理嗓音的类型,增加样本量,进一步研究前发声期嗓音参数的生理和病理特点,完善前发声期嗓音参数参考标准的制订,以更好地应用于嗓音临床和研究工作。
Voice assessment Comprehensively is the basis of voice treatment. With the development of computer technology and voice medicine, more and more objective or subjective voice measurements are applied in voice clinic and researchs, especially objective voice measurement playing a very important role in the diagnosis and treatment for voice disorders.
This PH.D dissertation research on the voice function measurement of prephonation period first time, selecting F0、Jitter、OQ、SQ、STF and AQ as research parameters, using a new voice measurement instrument (Phonation) which can analyze the wave on the prephonation period and the stabilization period. The research contents include:the lab research of voice parameters contrast between the prephonation period and the stabilization period; The lab research about voice mesuring material selecting for prephonation period; The lab research about contrasts between normal and pathonogic voice in adult and preeducation-age children; The lab researchs about prephonation period parameters analysis for normal adult and preeducation children voice; The experiments of establishing reference standards of prephonation period parameters and the application of which in the voice clinic.
Through a series of experiments about the prephonation period voice parameters, some results have achieved:(1) The voice parameters of the prephonation period are significantly different from the stabilization period; (2) Selecting the best material for the prephonation period assessment;(3)There are obviously differences between male and female at prephonation period voice parameters while no differences in preeducation children at age and gender. (4) Establishing the reference standards of the prephonation period for adults and preeducation children, which provide a new approach for voice clinic. (5) There are differences at the prephonation period voice parameters among different types of voice disorder. (6) Validating the useful of prephonation period voice parameters and the effect of their reference standards through experiments and one case study.
This paper proved that the research on prephonation period is very significant for voice disorders diagnosis and the monitor for voice treatment. In subsequent study, we'll add the specimen number in researchs and expend the types of voice diseases, further research the characters of the prephonation period voice parameters on normal and pathonogic voice. On the other hand, we should expend the application of these parameters in voice clinic and research.
本论文在国内外嗓音客观测量研究的基础上,首次采用能对瞬态和稳态声波进行提取分析的“发声测量仪”(Phonation)为测量工具,选择F0、Jitter、OQ. SQ、STF和AQ作为研究参数,对前发声期嗓音参数进行了系列研究。研究内容主要包括：前发声期与稳定期嗓音参数的比较,前发声期嗓音测试语料的选择,成人正常与病理嗓音的比较及学前儿童正常与病理嗓音的比较分析,正常成人与学前儿童前发声期嗓音参数的特征分析,前发声期嗓音参数参考标准的制订以及前发声期嗓音参数及其参考标准在临床中的应用。
通过本论文的实验研究,取得了以下阶段性研究成果：1.前发声期与稳定期的嗓音参数存在显著性差异：前发声期与稳定期之间的Jitter、OQ和SQ具有极显著差异(p<0.01), F0、STF和AQ具有显著性差异(p<0.05)。2.选择出了前发声期嗓音测试的最佳语料：成人为／ba／,儿童为／gu／。3.通过正常与病理嗓音的对比研究,发现成人及儿童正常和病理嗓音参数在前发声期及稳定期具有不同的特点：成人及儿童正常和病理嗓音前发声期参数F0、Jitter、OQ具有显著差异(p<0.05):OQ和FO正常值高于异常值,而Jitter正常值低于异常值。成人Jitter、SQ、AQ和STF四个参数在不同嗓音和发声阶段之间存在交互作用(p<0.05),儿童F0、Jitter和AQ三个参数在不同嗓音和发声阶段之间存在交互作用(p<0.05),其前发声期的变化比稳定期的变化表现更为明显。学前儿童性别和年龄段之间各个前发声期参数均无明显差异(p>0.05)。4.制订了成人及学前儿童前发声期嗓音参数的参考标准；5.发现不同类型的嗓音障碍其前发声期嗓音参数具有不同的特点：功能性和器质性嗓音障碍的FO值低于神经性嗓音障碍；功能性嗓音障碍的Jitter、STF值低于器质性和神经性嗓音障碍；功能性嗓音障碍在AQ上却高于器质性和神经性嗓音障碍,为嗓音障碍的鉴别诊断提供了新的思路和一定的参考价值。6.通过前发声期嗓音参数及其参考标准的临床应用,验证了嗓音治疗的有效性,并初步证实了前发声期嗓音参数参考标准在临床嗓音治疗及疗效监控中的重要作用。
通过本论文的研究,证明前发声期的嗓音参数及参考标准对于嗓音诊断和疗效监控具有重要意义,为嗓音功能的客观测量提供了新的途径和手段。在后继的研究中,将拓宽研究对象的年龄和病理嗓音的类型,增加样本量,进一步研究前发声期嗓音参数的生理和病理特点,完善前发声期嗓音参数参考标准的制订,以更好地应用于嗓音临床和研究工作。
Voice assessment Comprehensively is the basis of voice treatment. With the development of computer technology and voice medicine, more and more objective or subjective voice measurements are applied in voice clinic and researchs, especially objective voice measurement playing a very important role in the diagnosis and treatment for voice disorders.
This PH.D dissertation research on the voice function measurement of prephonation period first time, selecting F0、Jitter、OQ、SQ、STF and AQ as research parameters, using a new voice measurement instrument (Phonation) which can analyze the wave on the prephonation period and the stabilization period. The research contents include:the lab research of voice parameters contrast between the prephonation period and the stabilization period; The lab research about voice mesuring material selecting for prephonation period; The lab research about contrasts between normal and pathonogic voice in adult and preeducation-age children; The lab researchs about prephonation period parameters analysis for normal adult and preeducation children voice; The experiments of establishing reference standards of prephonation period parameters and the application of which in the voice clinic.
Through a series of experiments about the prephonation period voice parameters, some results have achieved:(1) The voice parameters of the prephonation period are significantly different from the stabilization period; (2) Selecting the best material for the prephonation period assessment;(3)There are obviously differences between male and female at prephonation period voice parameters while no differences in preeducation children at age and gender. (4) Establishing the reference standards of the prephonation period for adults and preeducation children, which provide a new approach for voice clinic. (5) There are differences at the prephonation period voice parameters among different types of voice disorder. (6) Validating the useful of prephonation period voice parameters and the effect of their reference standards through experiments and one case study.
This paper proved that the research on prephonation period is very significant for voice disorders diagnosis and the monitor for voice treatment. In subsequent study, we'll add the specimen number in researchs and expend the types of voice diseases, further research the characters of the prephonation period voice parameters on normal and pathonogic voice. On the other hand, we should expend the application of these parameters in voice clinic and research.
引文
[1]黄昭鸣、杜晓新主编：《言语障碍的评估与矫治》,华东师范大学出版社,2006年。
[2]Nancy Tye-Murrayetc, Foundations of Aural Rehabilitation, Singular Publishing Group, SanDiego, California, USA,1998。
[3]Adriane Mesquita de Medeiros、Sandhi Maria Barreto, and Ada A vila Assuncao, Voice Disorders (Dysphonia) in Public School Female Teachers Working in Belo Horizonte:Prevalence and Associated Factors, Journal of Voice,2008,22 (6):1。
[4]楼正才、吴小红、陈怀华,经商人员嗓音疾病调查分析,中国耳鼻咽喉颅底外科杂志,2006年第12卷第3期：199。
[5]杨烨、王建群、高下,南京市中小学及幼儿园教师嗓音疾病的调查,南京医科大学学报,2008年第28卷第2期：270。
[6]李正廷、章波、郭茅,嗓音医学现状及发声显微外科相关问题,听力学及言语疾病杂志,2005,13(6)：390。
[7]黄昭鸣、杜晓新主编,《言语障碍的评估与矫治》,华东师范大学出版社,2006年。
[8]杨式麟主编,《嗓音医学基础与临床》,辽宁科学技术出版社,2001年。
[9]姜泗长、顾瑞主编,《临床听力学》,北京医科大学、中国协和医科大学联合出版社,1999年。
[10]于萍、王荣光主编,《嗓音疾病与嗓音外科学》,人民军医出版社,2009年。
[11]Hirano M, Psycho-acoustic evaluation of voice:GRBAS scale for evaluating the hoarse voice.In, Hirano M,ed. Clinical examination of voice[M], Wien, New York:Springer-Verlag, 1981:81-84。
[12]J acobson BH、Johnson A、Grywalsky C, et al, The voice handicap index (VHI):development and validation [J], Am J Speech Lang Pat hol,1997,6:66。
[13]Spector BC、Net terville JL、Billante C, et al, Quality of life assessment in patients with unilateral vocal cord paralysis [J], Otolaryngol Head Neck Surg,2001,125:176。
[14]Rosen CA、Lee AS、Osborne J, et al.Development and validation of the voice handicap index-10[J], Laryngoscope,2004,114:1549。
[15]Hogikyan ND, Set huraman G. Validation of an inst rument to measure voice related quality of life(V-RQOL)[J], Journalof Voice,1999,13:557。
[16]Gliklich RE、Glovsky RM、Montgomery WM, Validation of a voice outcome survey for unilateral vocal cord paralysis [J], Otolaryngol Head Neck Surg,1999,120:153。
[17]Ma EP、Yiu EM, Voice activity and participation profile:assessing the impact of voice disorders on daily activities[J], Speech Lang Hear Res,2001,44:511.
[18]Deary IJ、Wilson JA、Carding PN, Voiss:a patient-derived Voice Symptom Scale, J Psychosom Res,2003,54(5):483。
[19]Estella P.-M.Ma and Edwin M.-L.Yiu, Multiparametric Evaluation of Dysphonic Severity, Journal of voice:official journal of the Voice Foundation (J Voice),2005,20(1):132-224。
[20]王慧,180名女性教师嗓音参数及嗓音障碍指数分析,天津医科大学学报,2008,15(3)：379-381。
[21]贾弘光、王琪,嗓音障碍指数量表中文版信度和效度评价,中国医学文摘耳鼻咽喉科学,2008,23(6)：332。
[22]于萍、王国建、韩冰等,成人女性嗓音障碍的客观多参数分析,临床耳鼻咽喉科杂志,2004年第12期：751。
[23]Yu Zhang and Jack J.Jiang, Acoustic Analyses of Sustained and Running Voices From Patients With Laryngeal Pathologies, Journal of Voice,2008, Vol.22, No.1:1-9。
[24]Janai'na Mendes Laureano、Marcos Felipe S. Sa'、Rui A. Ferriani, and Gustavo S. Romao, Variations of Jitter and Shimmer Among Women in Menacme and Postmenopausal Women, Journal of Voice,2009, Vol.23, No.6:687-689。
[25]Rehan Kazi、Jeeve Kanagalingam、Ramachandran Venkitaraman、Vyas Prasad、Peter Clarke、 Christopher M. Nutting、Peter Rhys-Evans, and Kevin J. Harrington, Electroglottographic and Perceptual Evaluation of Tracheoesophageal Speech, Journal of Voice,2009,23 (2):247-254。
[26]Giovanni A, Ouaknine M, Guelfucci B, et al. Non-linear behavior of vocal fold vibration the role of coupling between the vocal folds[J] J Voice,1999,13:456。
[27]Alku P、Airas M、Bjorkner E, etc, An amplitude quotient based method to analyze changes in the shape of the glottal pulse in the regulation of vocal intensity. The Journal of the Acoustical Society of America (J Acoust Soc Am),2006,120(2):1052-1062。
[28]Alku P、Vilkman E, Amplitude domain quotient for characterization of the glottal volume velocity waveform estimated by inverse filtering [J].Speech Commucation:1996 (2):18。
[29]Alku, p、Vilkman E, A comparison of glottal voice source quantification parameters in breathy, normal and pressed phonation of female and male speakers[J], Folia Phoniatrica et Logopaedica: 1996,48 (55):240-254。
[30]Hanson DG、Gerratt BR、Kanin RR、Berke GS, Giottographic measures of vocal fold vibrations:an examination of laryngeal paralysis, Laryngoscope,1988,98:541-9。
[31]David H、Thomas V. McCaffrey, Open Slope Quotient:A New Glottographic Parameter, Journal of Voice,1995,1:86-94。
[32]Christine M、Sapienza, Elaine T. Stathopoulos、Christopher Dromey, Approximations of Open Quotient and Speed Quotient from Glottal Airflow and EGG Waveforms:Effects of Measurement Criteria and Sound Pressure Level, Journal of Voice,1998,1:31-43。
[33]Matthias Echternach、Sebastian Dippold, Johan SundBerg, High-Speed Imaging and Electroglottography Measurements of the Open Quotient in Untrained Male Voices Register Transitions, Journal of Voice,2009,3:1-7。
[34]Wuyts FL、De Bodt MS、Molenberghs G, et al. The Dysphonia Severity Index:an objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res,2000,43: 796-809.
[35]Shaheen N. Awan、Anysia J. Ensslen、Bloomsburg、Pennsylvania、Lexington、Kentucky, A Comparison of Trained and Untrained Vocalists on the Dysphonia Severity Index, Journal of Voice,2010 (22):1-6.
[36]Leonard R. Henry、Leah B. Helou、Nancy Pearl Solomon, et al, Functional voice outcomes after thyroidectomy:An assessment of the Dsyphonia Severity Index (DSI) after thyroidectomy, Surgery,2010 (21):1-10。
[37]R.D. Kent、H.K. Vorperian、J.F. Kent、J.R.Duffy, Voice dysfunction in dysarthria:application of the Multi-Dimensional Voice ProgramTM, Journal of Communication Disorders,2003(36): 281-306。
[38]雷科、杨旭、沈建中等,成人嗓音声学参数正常参考值的研究,临床耳鼻咽喉科杂志,2000,第6期：257。
[39]徐洁洁、黄昭鸣、祁沁红等,声带良恶性增生疾病嗓音的声学参数分析,江苏医药杂志,2001,第3期,170。
[40]徐洁洁、祁沁红、乔宗海,计算机声学测试在发声障碍鉴别诊断中的应用,听力学及言语疾病杂志,2000年第8卷第3期：156-158。
[41]安伟、林世龙、李江民,声带息肉340例嗓音声学参数的分析,贵州医学杂志,2004年第10期：900。
[42]韩仲明。嗓音声学检测分析。中国耳鼻咽喉头颈外科,2006年5月第13卷第5期：351-353。
[43]张志明、杨式麟,病态嗓音基频和音域的变化,临床耳鼻咽喉科杂志,2000,第6期：260。
[44]魏春生、王薇,三种声带疾病在喉显微手术前后的声学评估,听力学及言语疾病杂志,2001,9(3)：168-169。
[45]蔡青、周涛、陶泽璋等,发不同元音／(?)／／a：／／i：／时电声门图参数的比较,听力学及言语疾病杂志,2000年第8卷第1期：27。
[46]蔡青、陶泽璋、杨强,发不同元音时嗓音声学分析参数的比较,临床耳鼻咽喉科杂志,2001,第4期：167。
[47]侯丽珍、韩德民、徐文等,嗓音检测中元音声样的选择,听力学及言语疾病杂志,2002年第10卷第1期：16。
[48]叶青、杨毓梅、孙爱华等,不同元音嗓音分析敏感性的观察,听力学及言语疾病杂志,2002年第10卷第1期：82-83。
[49]黄昭鸣,万萍,嗓音声学参数与嗓音音质的相关研究。临床耳鼻喉头颈外科杂志,2008年3月第6期：251-254。
[50]于萍、韩冰、黄冬雁等,嗓音声学分析和电声门图的比较研究,听力学及言语疾病杂志,2005年第13卷第3期：160-163。
[51]于萍、Ouaknine Maurice、Giovanni Antoine, Lyapunov系数在嗓音障碍评估中的意义,听力学及言语疾病杂志,2006年第14卷第3期：175-178。
[52]于萍,Giovanni Antoine,嗓音的客观多参数分析与主观听觉分析相关性的研究。听力学及言语疾病杂志,2003年第11卷第3期：161-164。
[53]韩德民、RobertT.Sataloff主编,《嗓音医学》,人民卫生出版社,2007年。
[54]黄昭鸣、黄鹤年主编,《嗓音言语的解剖与生理学》,Tiger DRS, Seattle, Washington,USA,2003年。
[55]李革临、刘永祥、杨和均等,元音初始段声学分析在喉科应用初探,听力学及言语疾病杂志,2002年第12卷第3期：174-176。
[56]于萍、黄冬雁、Revis Joana等,不同嗓音样本对嗓音听感知评估的影响,听力学及言语疾病杂志,2004,第3期：164。
[57]TANNER K, RO Y N, ASH A, Spectral moments of the long-term average spectrum:sensitive indices of voice change after therapy, [J] J Voice,2005,19:211。
[58]龚齐、沈伟、黄昭鸣,896例成人嗓音声学参数的计算机采集分析,听力学及言语疾病杂志,2000,8(1)：34。
[59]肖永涛、郑钦、周静,《喉部按摩法治疗功能性嗓音障碍的临床研究》,中国听力语言康 复科学杂志,2009年第3期：41。
[60]黄昭鸣、黄鹤年、万萍,《嗓音言语的重读治疗法》,[M], Tiger DRS, Seattle, WA,2003年。
[2]Nancy Tye-Murrayetc, Foundations of Aural Rehabilitation, Singular Publishing Group, SanDiego, California, USA,1998。
[3]Adriane Mesquita de Medeiros、Sandhi Maria Barreto, and Ada A vila Assuncao, Voice Disorders (Dysphonia) in Public School Female Teachers Working in Belo Horizonte:Prevalence and Associated Factors, Journal of Voice,2008,22 (6):1。
[4]楼正才、吴小红、陈怀华,经商人员嗓音疾病调查分析,中国耳鼻咽喉颅底外科杂志,2006年第12卷第3期：199。
[5]杨烨、王建群、高下,南京市中小学及幼儿园教师嗓音疾病的调查,南京医科大学学报,2008年第28卷第2期：270。
[6]李正廷、章波、郭茅,嗓音医学现状及发声显微外科相关问题,听力学及言语疾病杂志,2005,13(6)：390。
[7]黄昭鸣、杜晓新主编,《言语障碍的评估与矫治》,华东师范大学出版社,2006年。
[8]杨式麟主编,《嗓音医学基础与临床》,辽宁科学技术出版社,2001年。
[9]姜泗长、顾瑞主编,《临床听力学》,北京医科大学、中国协和医科大学联合出版社,1999年。
[10]于萍、王荣光主编,《嗓音疾病与嗓音外科学》,人民军医出版社,2009年。
[11]Hirano M, Psycho-acoustic evaluation of voice:GRBAS scale for evaluating the hoarse voice.In, Hirano M,ed. Clinical examination of voice[M], Wien, New York:Springer-Verlag, 1981:81-84。
[12]J acobson BH、Johnson A、Grywalsky C, et al, The voice handicap index (VHI):development and validation [J], Am J Speech Lang Pat hol,1997,6:66。
[13]Spector BC、Net terville JL、Billante C, et al, Quality of life assessment in patients with unilateral vocal cord paralysis [J], Otolaryngol Head Neck Surg,2001,125:176。
[14]Rosen CA、Lee AS、Osborne J, et al.Development and validation of the voice handicap index-10[J], Laryngoscope,2004,114:1549。
[15]Hogikyan ND, Set huraman G. Validation of an inst rument to measure voice related quality of life(V-RQOL)[J], Journalof Voice,1999,13:557。
[16]Gliklich RE、Glovsky RM、Montgomery WM, Validation of a voice outcome survey for unilateral vocal cord paralysis [J], Otolaryngol Head Neck Surg,1999,120:153。
[17]Ma EP、Yiu EM, Voice activity and participation profile:assessing the impact of voice disorders on daily activities[J], Speech Lang Hear Res,2001,44:511.
[18]Deary IJ、Wilson JA、Carding PN, Voiss:a patient-derived Voice Symptom Scale, J Psychosom Res,2003,54(5):483。
[19]Estella P.-M.Ma and Edwin M.-L.Yiu, Multiparametric Evaluation of Dysphonic Severity, Journal of voice:official journal of the Voice Foundation (J Voice),2005,20(1):132-224。
[20]王慧,180名女性教师嗓音参数及嗓音障碍指数分析,天津医科大学学报,2008,15(3)：379-381。
[21]贾弘光、王琪,嗓音障碍指数量表中文版信度和效度评价,中国医学文摘耳鼻咽喉科学,2008,23(6)：332。
[22]于萍、王国建、韩冰等,成人女性嗓音障碍的客观多参数分析,临床耳鼻咽喉科杂志,2004年第12期：751。
[23]Yu Zhang and Jack J.Jiang, Acoustic Analyses of Sustained and Running Voices From Patients With Laryngeal Pathologies, Journal of Voice,2008, Vol.22, No.1:1-9。
[24]Janai'na Mendes Laureano、Marcos Felipe S. Sa'、Rui A. Ferriani, and Gustavo S. Romao, Variations of Jitter and Shimmer Among Women in Menacme and Postmenopausal Women, Journal of Voice,2009, Vol.23, No.6:687-689。
[25]Rehan Kazi、Jeeve Kanagalingam、Ramachandran Venkitaraman、Vyas Prasad、Peter Clarke、 Christopher M. Nutting、Peter Rhys-Evans, and Kevin J. Harrington, Electroglottographic and Perceptual Evaluation of Tracheoesophageal Speech, Journal of Voice,2009,23 (2):247-254。
[26]Giovanni A, Ouaknine M, Guelfucci B, et al. Non-linear behavior of vocal fold vibration the role of coupling between the vocal folds[J] J Voice,1999,13:456。
[27]Alku P、Airas M、Bjorkner E, etc, An amplitude quotient based method to analyze changes in the shape of the glottal pulse in the regulation of vocal intensity. The Journal of the Acoustical Society of America (J Acoust Soc Am),2006,120(2):1052-1062。
[28]Alku P、Vilkman E, Amplitude domain quotient for characterization of the glottal volume velocity waveform estimated by inverse filtering [J].Speech Commucation:1996 (2):18。
[29]Alku, p、Vilkman E, A comparison of glottal voice source quantification parameters in breathy, normal and pressed phonation of female and male speakers[J], Folia Phoniatrica et Logopaedica: 1996,48 (55):240-254。
[30]Hanson DG、Gerratt BR、Kanin RR、Berke GS, Giottographic measures of vocal fold vibrations:an examination of laryngeal paralysis, Laryngoscope,1988,98:541-9。
[31]David H、Thomas V. McCaffrey, Open Slope Quotient:A New Glottographic Parameter, Journal of Voice,1995,1:86-94。
[32]Christine M、Sapienza, Elaine T. Stathopoulos、Christopher Dromey, Approximations of Open Quotient and Speed Quotient from Glottal Airflow and EGG Waveforms:Effects of Measurement Criteria and Sound Pressure Level, Journal of Voice,1998,1:31-43。
[33]Matthias Echternach、Sebastian Dippold, Johan SundBerg, High-Speed Imaging and Electroglottography Measurements of the Open Quotient in Untrained Male Voices Register Transitions, Journal of Voice,2009,3:1-7。
[34]Wuyts FL、De Bodt MS、Molenberghs G, et al. The Dysphonia Severity Index:an objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res,2000,43: 796-809.
[35]Shaheen N. Awan、Anysia J. Ensslen、Bloomsburg、Pennsylvania、Lexington、Kentucky, A Comparison of Trained and Untrained Vocalists on the Dysphonia Severity Index, Journal of Voice,2010 (22):1-6.
[36]Leonard R. Henry、Leah B. Helou、Nancy Pearl Solomon, et al, Functional voice outcomes after thyroidectomy:An assessment of the Dsyphonia Severity Index (DSI) after thyroidectomy, Surgery,2010 (21):1-10。
[37]R.D. Kent、H.K. Vorperian、J.F. Kent、J.R.Duffy, Voice dysfunction in dysarthria:application of the Multi-Dimensional Voice ProgramTM, Journal of Communication Disorders,2003(36): 281-306。
[38]雷科、杨旭、沈建中等,成人嗓音声学参数正常参考值的研究,临床耳鼻咽喉科杂志,2000,第6期：257。
[39]徐洁洁、黄昭鸣、祁沁红等,声带良恶性增生疾病嗓音的声学参数分析,江苏医药杂志,2001,第3期,170。
[40]徐洁洁、祁沁红、乔宗海,计算机声学测试在发声障碍鉴别诊断中的应用,听力学及言语疾病杂志,2000年第8卷第3期：156-158。
[41]安伟、林世龙、李江民,声带息肉340例嗓音声学参数的分析,贵州医学杂志,2004年第10期：900。
[42]韩仲明。嗓音声学检测分析。中国耳鼻咽喉头颈外科,2006年5月第13卷第5期：351-353。
[43]张志明、杨式麟,病态嗓音基频和音域的变化,临床耳鼻咽喉科杂志,2000,第6期：260。
[44]魏春生、王薇,三种声带疾病在喉显微手术前后的声学评估,听力学及言语疾病杂志,2001,9(3)：168-169。
[45]蔡青、周涛、陶泽璋等,发不同元音／(?)／／a：／／i：／时电声门图参数的比较,听力学及言语疾病杂志,2000年第8卷第1期：27。
[46]蔡青、陶泽璋、杨强,发不同元音时嗓音声学分析参数的比较,临床耳鼻咽喉科杂志,2001,第4期：167。
[47]侯丽珍、韩德民、徐文等,嗓音检测中元音声样的选择,听力学及言语疾病杂志,2002年第10卷第1期：16。
[48]叶青、杨毓梅、孙爱华等,不同元音嗓音分析敏感性的观察,听力学及言语疾病杂志,2002年第10卷第1期：82-83。
[49]黄昭鸣,万萍,嗓音声学参数与嗓音音质的相关研究。临床耳鼻喉头颈外科杂志,2008年3月第6期：251-254。
[50]于萍、韩冰、黄冬雁等,嗓音声学分析和电声门图的比较研究,听力学及言语疾病杂志,2005年第13卷第3期：160-163。
[51]于萍、Ouaknine Maurice、Giovanni Antoine, Lyapunov系数在嗓音障碍评估中的意义,听力学及言语疾病杂志,2006年第14卷第3期：175-178。
[52]于萍,Giovanni Antoine,嗓音的客观多参数分析与主观听觉分析相关性的研究。听力学及言语疾病杂志,2003年第11卷第3期：161-164。
[53]韩德民、RobertT.Sataloff主编,《嗓音医学》,人民卫生出版社,2007年。
[54]黄昭鸣、黄鹤年主编,《嗓音言语的解剖与生理学》,Tiger DRS, Seattle, Washington,USA,2003年。
[55]李革临、刘永祥、杨和均等,元音初始段声学分析在喉科应用初探,听力学及言语疾病杂志,2002年第12卷第3期：174-176。
[56]于萍、黄冬雁、Revis Joana等,不同嗓音样本对嗓音听感知评估的影响,听力学及言语疾病杂志,2004,第3期：164。
[57]TANNER K, RO Y N, ASH A, Spectral moments of the long-term average spectrum:sensitive indices of voice change after therapy, [J] J Voice,2005,19:211。
[58]龚齐、沈伟、黄昭鸣,896例成人嗓音声学参数的计算机采集分析,听力学及言语疾病杂志,2000,8(1)：34。
[59]肖永涛、郑钦、周静,《喉部按摩法治疗功能性嗓音障碍的临床研究》,中国听力语言康 复科学杂志,2009年第3期：41。
[60]黄昭鸣、黄鹤年、万萍,《嗓音言语的重读治疗法》,[M], Tiger DRS, Seattle, WA,2003年。