腭裂语音声学特性分析及临床应用研究
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摘要
目的：
建立稳定可靠的语音资料收集方法,为研究腭裂语音的声学特性提供可靠的基础。研究腭裂患者语音声学特性,研究腭裂术后不同腭咽闭合状况下声门系统及声腔系统的声学特性,为临床评价腭咽闭合功能筛选可靠声学参数指标。研究腭裂患者在语音中的能量分布特点,对腭裂患者的语音声学特性进行全面探讨。应用多个语音声学参数通过统计学分析建立评价腭咽闭合功能的判别函数,对应用语音声学特性评价腭咽闭合功能进行初步的探讨和研究。
方法：
1.选取正常发音儿童与I。腭裂儿童为研究对象,判听研究对象的语音清晰度及鼻音度,并进行重复实验。观察重复实验的稳定性,并检测两名判听者的一致性,比较不同性别及不同年龄段的腭裂儿童的语音差异,比较正常儿童与腭裂儿童语音清晰度及鼻音度的差异,分析语音清晰度与鼻音度之间的相关性。研究腭裂患者语音声学特性,对比腭裂与正常儿童语音声学特性的差异。
2.选取正常发音儿童及Ⅲ°腭裂儿童、腭裂术后VPC和VPI儿童为研究对象,观察腭裂儿童的语图特点。对比正常儿童及腭裂术后儿童元音/a/、/i/、/u/的共振峰F1、F2、F3,作出声学元音图,并比较声学元音三角的面积(S)之间的差异。比较腭裂术后VPC和VPI患者语音声学特性之间的差异。
3.以嗓音参数(jitter、shimmer和HNR)、基频(FO)和平均倒谱峰值(CPPs)为目标参数,对比正常儿童及腭裂术后儿童之间的差异,并比较腭裂术后VPC和VPI患者之间的差异。
4.对各组儿童发元音/a/、/i/、/u/的能量分布进行分析。利用长时平均分析对研究对象的语句能量分布特点进行对比分析。
5.对前期试验结果进行分析,筛选出对评价腭裂术后腭咽闭合功能有意义的指标(元音/i/F2、F3、元音三角面积S值、jitter值、HNR和CPPs),对这些指标评价腭咽闭合功能的灵敏度和特异度进行分析,分析各指标ROC曲线。利用这些指标建立判别函数。通过判别函数对20名腭裂术后儿童的腭咽闭合功能进行分析评价。
结果：
1.与正常儿童相比较,Ⅲ°腭裂儿童语音清晰度明显降低,鼻音度明显升高。鼻音度与语音清晰度之间呈中度负相关,r=-0.615。重复性实验结果无明显差异,组内两名判听者判听结果相关系数ICC=0.87。男童和女童腭裂患者语音清晰度、鼻音度和语音声学参数无明显差异,6-7岁组和8-9岁组腭裂儿童语音清晰度、鼻音度和语音声学参数无明显差异。和正常儿童相比,腭裂儿童发元音/i/时F2、F3均明显降低,Jitter值升高,HNR、CCPs值降低。
2.腭裂儿童语图特点主要表现为弱化、代偿和替代。发元音/i/时各组儿童共振峰频率F1无显著性差异。VPC组元音/i/的F2低于对照组,VPI组元音/i/的F2、F3均明显低于对照组。VPI组的元音/i/的F2、F3均明显低于VPC组。对照组S值明显大于VPC组与VPI组, VPI组S值明显小于VPC组。腭裂组各语音声学参数与VPI组相近。
3各组之间的基频(FO)、Shimmer值无显著性差异。VPI组和VPC组的Jitter值均高于对照组, VPI组和VPC组HNR、CCPs值均低于对照组。VPI组Jitter值高于VPC组,VPI组的NHR、CCPs值低于VPC组。腭裂组各语音声学参数与VPI组相近。
4.各组之间单元音的能量分布的能量重心、偏态系数及峰度系数无明显差异。语句长时平均分析表明,低频区(低于2720Hz)能量衰减走势各组基本相似,正常儿童的中频区(2720Hz-4000Hz)有明显的平台期,正常儿童的高频区(高于4000Hz)能量明显高于腭裂组及腭裂术后VPI组和VPC组。
5.单一参数评价腭咽闭合功能的效果不理想。利用统计分析建立的线性判别函数为：Y=-15.635+0.682X1+2.982X2+0.023X3+0.589X4-0.066X5+0.035X6。判别函数ROC曲线面积为0.951,灵敏度为100%,特异度为82.90%,Kappa值为0.884。对20名待判定患者的判定结果与鼻咽镜检查结果的一致性为85%。
结论：
1.语音清晰度与鼻音度呈中度负相关,本研究采用的语音资料收集的方法稳定可靠,6-9岁儿童可作为一组研究对象进行语音研究。
2.元音/i/的F2、F3、元音三角面积S值可作为评价腭咽闭合功能的声学指标。
3. jitter值、HNR和CPPs可作为评价腭咽闭合功能的声学指标。
4.腭裂儿童单元音能量分布与正常儿童近似。语句中正常儿童中频区的平台期对能量衰减有明显的缓冲作用,保证了高频区能量的分布。
5.单一声学参数评价腭咽闭合功能的效果较差,综合多个参数建立判别函数是一种比较有效的评价腭咽闭合功能的方法。
Objectives:
To establish a stable and reliable voice data collection methods. Thus, to provide a reliable basis for the study of the acoustic characteristics of children with cleft palate. The acoustic characteristics of glottal system and vocal system in alternative pharyngeal closure status were studied for screening reliable acoustic parameters to evaluate the velopharyngeal state. To study the energy distribution of cleft palate patients in sentences. The speech acoustic characteristics of cleft palate patients were fully explored. Discriminate function was established with application of multiple voice acoustic parameters by statistical analysis to evaluate velopharyngeal state. The application of the acoustic characteristics of speech analysis for evaluation of velopharyngeal state was studied preliminarily.
Methods:
1. Children with normal pronunciation and children with cleft palate were selected for the study. Intelligibility and nasality were evaluated by two listeners. The experiment was repeated to observe the stability and consistency of the two listeners. To compare the acoustic characteristics of speech across gender and age. To compare the difference of intelligibility, nasality and acoustic characteristics of speech between control group and clinical group. To study the relationship between intelligibility and nasality.
2. Children with normal pronunciation, children with cleft palate, VPC and VPI children after cleft palate repaired were selected for the study. Sonagraph characteristics were observed. The formants (F1, F2, F3) of vowel/a/,/i/,/u/were analyzed for comparison of normal children and children with or without cleft palate repaired. Making acoustic vowel chart, the areas(S) of acoustic vowel triangle were compared between the normal children and children with or without cleft palate repaired. Comparison was also made between VPC and VPI patients.
3. Jitter, shimmer, HNR, fundamental frequency (FO) and smoothed cepstral prominence peak (CPPs) were analyzed for comparison of normal children and children with or without cleft palate repaired. Comparison was also made between VPC and VPI patients.
4. Energy distribution of vowel/a/,/i/,/u/was analyzed in each group. The energy distribution characteristics in statement were analyzed by long-term average spectra.
5. Meaningful indicators (F2, F3, vowel triangle area, value of Jitter, HNR and CPPs) were selected to evaluate the state of velopharyngeal on preliminary results. Sensitivity, specificity and ROC curve of these indicators were analyzed. Discriminate function was established on these indicators. The states of velopharyngeal of20children with cleft palate surgery were analyzed by discriminate function.
Results:
1. Compared with normal children, children with cleft palate are significantly lower in speech intelligibility, and higher in nasality. There is a moderate negative correlation between nasality and intelligibility (r=-0.615). There is no significant difference in results of repeat test. The Intra-class Correlation Coefficient of the listeners is0.87(ICC=0.87). There is no significant difference across gender and age. F2, F3of vowel/i/of VPI group were significantly lower than those of the control group. The values of Jitter of children with cleft palate are significantly higher than those of control group. The values of HNR and CCPs of children with cleft palate are significantly lower than those of control group.
2. The sonogram of children with cleft palate is mainly charactered by weakening, compensatory and replacement. There are no significant differences on the first formant of vowel/i/in each group. F2, F3of VPI group were significantly lower than the control group and VPC group. The VPI group was significantly lower than VPC group and control group on the value of S. And the value of S of VPC group was significantly lower than that of control group. The acoustic characteristics of children with cleft palate are similar to those of VPI children.
3. There are no significant differences on the FO and Shimmer in each group. The values of Jitter of VPI group and VPC group are significantly higher than those of control group. The values of HNR and CCPs of VPI group and VPC group are significantly lower than those of control group.
4. The centre of gravity, skewness and kurtosis of single vowel show no significant difference in each group. There is no significant difference in the low frequency zone (below2720Hz) about the energy distribution analyzed by long-term average spectra. There is an obvious platform in the intermediate frequency zone (2720Hz-4000Hz) in normal children. The energy in the high frequency zone (above4000Hz) of normal children was significantly higher than that of children with or without cleft palate repaired.
5. The sensitivity and specificity are not ideal to evaluate the state of velopharyngeal by single acoustic parameters. The linear discriminate function is: Y=-15.635+0.682X1+2.982X2+0.023X3+0.589X4-0.066X5+0.035X6. The area under the ROC curve of discriminant function is0.951. The sensitivity is100%. And the specificity is82.9%. The value of Kappa is0.884. Consistency of20patients determined by the discriminate function is85%to the nasopharyngoscopy.
Conclusions:
1. There is a moderate negative correlation between nasality and intelligibility. The method to collect the data used in this study is reliable and stable. The children aged from6years to9years can be studied as one group.
2. The F2, F3of vowel/i/and the value of S can be used to evaluate the state of velopharyngeal.
3. The value of jitter, HNR and CPPs can be used to evaluate the state of velopharyngeal.
4. The energy distribution of single vowel is similar in children with cleft palate and normal children. Normal children have higher energy distribution in the high frequency zone ascribe to the buffer of the platform in the intermediate frequency zone.
5. It is less effective for single acoustic parameters to evaluate velopharyngeal state. It is more effective to evaluate velopharyngeal state by discriminate function integrated multiple parameters.
建立稳定可靠的语音资料收集方法,为研究腭裂语音的声学特性提供可靠的基础。研究腭裂患者语音声学特性,研究腭裂术后不同腭咽闭合状况下声门系统及声腔系统的声学特性,为临床评价腭咽闭合功能筛选可靠声学参数指标。研究腭裂患者在语音中的能量分布特点,对腭裂患者的语音声学特性进行全面探讨。应用多个语音声学参数通过统计学分析建立评价腭咽闭合功能的判别函数,对应用语音声学特性评价腭咽闭合功能进行初步的探讨和研究。
方法：
1.选取正常发音儿童与I。腭裂儿童为研究对象,判听研究对象的语音清晰度及鼻音度,并进行重复实验。观察重复实验的稳定性,并检测两名判听者的一致性,比较不同性别及不同年龄段的腭裂儿童的语音差异,比较正常儿童与腭裂儿童语音清晰度及鼻音度的差异,分析语音清晰度与鼻音度之间的相关性。研究腭裂患者语音声学特性,对比腭裂与正常儿童语音声学特性的差异。
2.选取正常发音儿童及Ⅲ°腭裂儿童、腭裂术后VPC和VPI儿童为研究对象,观察腭裂儿童的语图特点。对比正常儿童及腭裂术后儿童元音/a/、/i/、/u/的共振峰F1、F2、F3,作出声学元音图,并比较声学元音三角的面积(S)之间的差异。比较腭裂术后VPC和VPI患者语音声学特性之间的差异。
3.以嗓音参数(jitter、shimmer和HNR)、基频(FO)和平均倒谱峰值(CPPs)为目标参数,对比正常儿童及腭裂术后儿童之间的差异,并比较腭裂术后VPC和VPI患者之间的差异。
4.对各组儿童发元音/a/、/i/、/u/的能量分布进行分析。利用长时平均分析对研究对象的语句能量分布特点进行对比分析。
5.对前期试验结果进行分析,筛选出对评价腭裂术后腭咽闭合功能有意义的指标(元音/i/F2、F3、元音三角面积S值、jitter值、HNR和CPPs),对这些指标评价腭咽闭合功能的灵敏度和特异度进行分析,分析各指标ROC曲线。利用这些指标建立判别函数。通过判别函数对20名腭裂术后儿童的腭咽闭合功能进行分析评价。
结果：
1.与正常儿童相比较,Ⅲ°腭裂儿童语音清晰度明显降低,鼻音度明显升高。鼻音度与语音清晰度之间呈中度负相关,r=-0.615。重复性实验结果无明显差异,组内两名判听者判听结果相关系数ICC=0.87。男童和女童腭裂患者语音清晰度、鼻音度和语音声学参数无明显差异,6-7岁组和8-9岁组腭裂儿童语音清晰度、鼻音度和语音声学参数无明显差异。和正常儿童相比,腭裂儿童发元音/i/时F2、F3均明显降低,Jitter值升高,HNR、CCPs值降低。
2.腭裂儿童语图特点主要表现为弱化、代偿和替代。发元音/i/时各组儿童共振峰频率F1无显著性差异。VPC组元音/i/的F2低于对照组,VPI组元音/i/的F2、F3均明显低于对照组。VPI组的元音/i/的F2、F3均明显低于VPC组。对照组S值明显大于VPC组与VPI组, VPI组S值明显小于VPC组。腭裂组各语音声学参数与VPI组相近。
3各组之间的基频(FO)、Shimmer值无显著性差异。VPI组和VPC组的Jitter值均高于对照组, VPI组和VPC组HNR、CCPs值均低于对照组。VPI组Jitter值高于VPC组,VPI组的NHR、CCPs值低于VPC组。腭裂组各语音声学参数与VPI组相近。
4.各组之间单元音的能量分布的能量重心、偏态系数及峰度系数无明显差异。语句长时平均分析表明,低频区(低于2720Hz)能量衰减走势各组基本相似,正常儿童的中频区(2720Hz-4000Hz)有明显的平台期,正常儿童的高频区(高于4000Hz)能量明显高于腭裂组及腭裂术后VPI组和VPC组。
5.单一参数评价腭咽闭合功能的效果不理想。利用统计分析建立的线性判别函数为：Y=-15.635+0.682X1+2.982X2+0.023X3+0.589X4-0.066X5+0.035X6。判别函数ROC曲线面积为0.951,灵敏度为100%,特异度为82.90%,Kappa值为0.884。对20名待判定患者的判定结果与鼻咽镜检查结果的一致性为85%。
结论：
1.语音清晰度与鼻音度呈中度负相关,本研究采用的语音资料收集的方法稳定可靠,6-9岁儿童可作为一组研究对象进行语音研究。
2.元音/i/的F2、F3、元音三角面积S值可作为评价腭咽闭合功能的声学指标。
3. jitter值、HNR和CPPs可作为评价腭咽闭合功能的声学指标。
4.腭裂儿童单元音能量分布与正常儿童近似。语句中正常儿童中频区的平台期对能量衰减有明显的缓冲作用,保证了高频区能量的分布。
5.单一声学参数评价腭咽闭合功能的效果较差,综合多个参数建立判别函数是一种比较有效的评价腭咽闭合功能的方法。
Objectives:
To establish a stable and reliable voice data collection methods. Thus, to provide a reliable basis for the study of the acoustic characteristics of children with cleft palate. The acoustic characteristics of glottal system and vocal system in alternative pharyngeal closure status were studied for screening reliable acoustic parameters to evaluate the velopharyngeal state. To study the energy distribution of cleft palate patients in sentences. The speech acoustic characteristics of cleft palate patients were fully explored. Discriminate function was established with application of multiple voice acoustic parameters by statistical analysis to evaluate velopharyngeal state. The application of the acoustic characteristics of speech analysis for evaluation of velopharyngeal state was studied preliminarily.
Methods:
1. Children with normal pronunciation and children with cleft palate were selected for the study. Intelligibility and nasality were evaluated by two listeners. The experiment was repeated to observe the stability and consistency of the two listeners. To compare the acoustic characteristics of speech across gender and age. To compare the difference of intelligibility, nasality and acoustic characteristics of speech between control group and clinical group. To study the relationship between intelligibility and nasality.
2. Children with normal pronunciation, children with cleft palate, VPC and VPI children after cleft palate repaired were selected for the study. Sonagraph characteristics were observed. The formants (F1, F2, F3) of vowel/a/,/i/,/u/were analyzed for comparison of normal children and children with or without cleft palate repaired. Making acoustic vowel chart, the areas(S) of acoustic vowel triangle were compared between the normal children and children with or without cleft palate repaired. Comparison was also made between VPC and VPI patients.
3. Jitter, shimmer, HNR, fundamental frequency (FO) and smoothed cepstral prominence peak (CPPs) were analyzed for comparison of normal children and children with or without cleft palate repaired. Comparison was also made between VPC and VPI patients.
4. Energy distribution of vowel/a/,/i/,/u/was analyzed in each group. The energy distribution characteristics in statement were analyzed by long-term average spectra.
5. Meaningful indicators (F2, F3, vowel triangle area, value of Jitter, HNR and CPPs) were selected to evaluate the state of velopharyngeal on preliminary results. Sensitivity, specificity and ROC curve of these indicators were analyzed. Discriminate function was established on these indicators. The states of velopharyngeal of20children with cleft palate surgery were analyzed by discriminate function.
Results:
1. Compared with normal children, children with cleft palate are significantly lower in speech intelligibility, and higher in nasality. There is a moderate negative correlation between nasality and intelligibility (r=-0.615). There is no significant difference in results of repeat test. The Intra-class Correlation Coefficient of the listeners is0.87(ICC=0.87). There is no significant difference across gender and age. F2, F3of vowel/i/of VPI group were significantly lower than those of the control group. The values of Jitter of children with cleft palate are significantly higher than those of control group. The values of HNR and CCPs of children with cleft palate are significantly lower than those of control group.
2. The sonogram of children with cleft palate is mainly charactered by weakening, compensatory and replacement. There are no significant differences on the first formant of vowel/i/in each group. F2, F3of VPI group were significantly lower than the control group and VPC group. The VPI group was significantly lower than VPC group and control group on the value of S. And the value of S of VPC group was significantly lower than that of control group. The acoustic characteristics of children with cleft palate are similar to those of VPI children.
3. There are no significant differences on the FO and Shimmer in each group. The values of Jitter of VPI group and VPC group are significantly higher than those of control group. The values of HNR and CCPs of VPI group and VPC group are significantly lower than those of control group.
4. The centre of gravity, skewness and kurtosis of single vowel show no significant difference in each group. There is no significant difference in the low frequency zone (below2720Hz) about the energy distribution analyzed by long-term average spectra. There is an obvious platform in the intermediate frequency zone (2720Hz-4000Hz) in normal children. The energy in the high frequency zone (above4000Hz) of normal children was significantly higher than that of children with or without cleft palate repaired.
5. The sensitivity and specificity are not ideal to evaluate the state of velopharyngeal by single acoustic parameters. The linear discriminate function is: Y=-15.635+0.682X1+2.982X2+0.023X3+0.589X4-0.066X5+0.035X6. The area under the ROC curve of discriminant function is0.951. The sensitivity is100%. And the specificity is82.9%. The value of Kappa is0.884. Consistency of20patients determined by the discriminate function is85%to the nasopharyngoscopy.
Conclusions:
1. There is a moderate negative correlation between nasality and intelligibility. The method to collect the data used in this study is reliable and stable. The children aged from6years to9years can be studied as one group.
2. The F2, F3of vowel/i/and the value of S can be used to evaluate the state of velopharyngeal.
3. The value of jitter, HNR and CPPs can be used to evaluate the state of velopharyngeal.
4. The energy distribution of single vowel is similar in children with cleft palate and normal children. Normal children have higher energy distribution in the high frequency zone ascribe to the buffer of the platform in the intermediate frequency zone.
5. It is less effective for single acoustic parameters to evaluate velopharyngeal state. It is more effective to evaluate velopharyngeal state by discriminate function integrated multiple parameters.
引文
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