KISEP Original Articles 臨床耳鼻 : 第 12 卷第 1 號 2001 J Clinical Otolaryngol 2001;12:65-79 양성후두질환에서후두미세수술전후음성의비교분석 백무진 1 황부현 1 엄재욱 1 권순복 2 이병주 2 왕수건 2 Comp

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1 KISEP Original Articles 臨床耳鼻 : 第 12 卷第 1 號 2001 J Clinical Otolaryngol 2001;12:65-79 양성후두질환에서후두미세수술전후음성의비교분석 백무진 1 황부현 1 엄재욱 1 권순복 2 이병주 2 왕수건 2 Comparison of Voice before and after Surgery in Benign Laryngeal Diseases Moo-Jin Baek, MD 1, Boo-Hyun Hwang, MD 1, Jae-Wook Eom, MD 1, Soon-Bok Kwon, MD 2, Byung-Joo Lee, MD 2 and Soo-Geun Wang, MD 2 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Pusan Paik Hospital, Pusan, 2 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University, Pusan, Korea - ABSTRACT - Background and ObjectiveIn benign laryngeal diseases, voice quality is major concern to both patients and clinicians. The purpose of this study is to identify the acoustic parameters that can represent preoperative pathologic and postoperative improved voice and to investigate quantitative changes of them. Using these data, We intend to disclose the mechanisms of voice change and apply to programs that can predict postoperative voice using preoperative voice data. Material and MethodsWe examined 47 patients who experienced laryngeal microsurgery due to pathologic voice with benign laryngeal diseases and 50 normal controls. The voice was analysed by Multi-Dimensional Voice Program in Computerized Speech Lab 4300 B. ResultsAll preoperative parameter s values except NHR and VTI were higher than control group. Among them, the values of frequency and amplitude perturbation related parameters increased most highly. Most parameter's values after operation showed statistically no significant difference from those of control group. Postoperative parameter s values reduced above 50% of PPQ, RAP, sppq, Jitt, ShdB, Jita and Shim than preoperative state. ConclusionThe results showed that Jitter and Shimmer represented well the pathologic voice of benign laryngeal disease and very closely related between improvements of both these parameters and voice quality after operation. We also considered that these data will be available in the program of postoperative predictive voice synthesis using preoperative voice data. J Clinical Otolaryngol 2001;12:65-79 KEY WORDSPathologic voice Benign laryngeal diseases Quantitative voice change. 서 론 65

2 J Clinical Otolaryngol 2001;12:65-79 대상및방법 대상 방법 66

3 Table 1. Short and long term frequency perturbation measurements Jita us Jitt % RAP % PPQ % sppq % vfø % JitaAbsolute Jitter, JittJitter percent, RAPRelative Average Perturbation, PPQPitch Period Perturbation Quotient, sppqsmoothed Pitch Period Perturbation Quotient, vføfundamental Frequency Variation Kay 27) Table 2. Short and long term amplitude perturbation measurements ShdB db Shim % APQ % sapq % vam % ShdBShimmer in db, ShimShimmer Percent, APQAmplitude Perturbation Quotient, sapqsmoothed Amplitude Perturbation Quotient, vampeak Amplitude Variation Kay 27) Table 3. Voice break related measurements DVB % DVBDegree of voiceless Kay 27) 결과 Ø 67

4 J Clinical Otolaryngol 2001;12:65-79 Table 4. Noise related measurements NHR VTI 704,500 Hz 15004,500 Hz ,500 Hz 2,8005,800 Hz. VTI ,600 Hz 1,600 SPI 4,500 Hz. SPI. SPI. NHRNoise to Harmonic Ratio, VTIVoice Turbulence Index, SPISoft Phonation Index Kay 27) Table 5. Tremor measurements FTRI % FØ. FØ. ATRI % Fftr Hz FØ. FTRI. Fatr Hz. ATRI. FTRIF Ø Tremor Intensity Index ATRIAmplitude Tremor Intensity Index FftrF Ø Tremor Frequency FatrAmplitude Tremor Frequency Kay 27) 0.95 Table 6. Fundamental frequency information measurements Fhi Hz. Flo Hz. FØ Hz. PFR semi-tones. FhiHighest Fundamental Frequency, FloLowest Fundamental Frequency, FØAverage Fundamental Frequency, PFRPhonatory Fundamental Frequency Ø Ø Ø Ø Ø 68

5 Ø Table 7. Absolute Jitter us % p-value % // // * // // // Ratio Ratio. Kay 83.2 Statistically significant between * or and the other vowelsp0.05 Table 8. Jitter Percent % % p-value % // // * // * // // Ratio Ratio, Kay 1.04 Statistically significant between * or and the other vowelsp0.05 Table 9. Pitch perturbation quotient % % p-value % // * // // // * // * Ratio Ratio, Kay 0.84 Statistically significant between * & p

6 J Clinical Otolaryngol 2001;12:65-79 Table 10. Relative average perturbation % % p-value % // // * // * // // Ratio Ratio, Kay 0.68 Statistically significant between * or and the other vowelsp0.05 Table 11. Smoothed pitch perturbation quotient % % p-value % // * // * // // // Ratio Ratio, Kay 1.02 Statistically significant between * & p0.05 Table 12. Fundamental frequency variation % % p-value % // // // // // Ratio Ratio, Kay

7 Table 13. Shimmer in db db % p-value % // // // // // Ratio Ratio, Kay 0.35 Table 14. Shimmer Percent % % p-value % // // // // // Ratio Ratio, Kay 3.81 Table 15. Amplitude perturbation quotient % % p-value % // // * // / // Ratio Ratio, Kay 3.07 Statistically significant between * or and the other vowelsp

8 J Clinical Otolaryngol 2001;12:65-79 Table 16. Smoothed amplitude perturbation quotient % % p-value % // * // * // // // Ratio Ratio, Kay 4.23 Statistically significant between * & p0.05 Table 17. Peak-amplitude variation % % p-value % // // // // // Ratio Ratio, Kay 8.20 Table 18. Degree of voice breaks % % p-value % // * // // // // Ratio Ratio, Kay 1.00 Statistically significant between * & the other vowelsp0.05 고찰 72

9 Table 19. Voice turbulence index % p-value % // * * // * * // * * // // Ratio Ratio, Kay Statistically significant between * & p0.05 Table 20. Soft phonation index % p-value % // * // * // * // // Ratio Ratio, Kay Statistically significant between * &, * &, & p0.05 Table 21. Noise to harmonic ratio % p-value % // * // // // // Ratio Ratio, Kay 0.19 Statistically significant between * & the other vowelsp

10 J Clinical Otolaryngol 2001;12:65-79 Ø Table 22. Fo-Tremor intensity index % % p-value % // // // // // Ratio Ratio, Kay 0.95 Table 23. Amplitude tremor frequency Hz % p-value % // // // // // Ratio Ratio Table 24. Fo tremor frequency Hz % p-value % // // // // // Ratio Ratio 74

11 Ø Ø Table 25. Amplitude tremor intensity index % % p-value % // // // // // Ratio 1 0.6) Ratio, Kay 4.37 Table 26. Phonatory fundamental frequency range semi-tones % p-value % // // // // // Ratio Ratio Table 27. Comparison of formant between preoperative and postoperative state // // // // // Hz Hz Hz *There is no statistical difference between pre and postoperative formant value each phonation 75

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14 J Clinical Otolaryngol 2001;12:65-79 Ø 결 중심단어 REFERENCES 1) Koike Y, Takahashi H, Calcatera TC. Acoustic measurements for detecting laryngeal pathology. Acta Otolaryngol ) Wang SG, Baek MJ, Yang BG, Jo CW, Park HM, Kweon SB, et al. Acoustic parameters for the early detection and differential diagnosis of pathologic voice. Korean J Otolaryngol ) Jo CW, Wang SG, Yang BG. A study on the diagnosis of laryngeal diseases by acoustic signal analysis. Korean J of Speech Science ) von Leden H, Moore P, Timoke R. Laryngeal vibrations Measurement of the glottal wave part III, the pathologic larynx. Acta Otolaryngol ) Iwata S, Leden H. Phonation quotient in patient with laryngeal diseases. Folia Phoniatr ) Iwata S. Periodicities of pitch perturbations in normal and pathologic larynges. Laryngoscope ) Horii Y. Vocal Shimmer in sustained phonation. J Speech Hear Res ) Liebermann P. Some acoustic measurements of the fundamental periodicity of normal and pathologic larynx. J Acoust Soc Am ) Koike Y, Hirano M. Glottal-area time function and subglottal pressure variation. J Acoust Soc Am ) Operations manual Multi-Dimensional Voice Program MDVPModel 4305, Kay Elemetrics Corp ) Yanagihara N. Significance of harmonic changes and noise 론 78

15 components in hoarseness. J Speech Hear Res ) Yumoto E, Gould WJ, Baer T. Harmonics-to-noise ratio as an index of the degree of hoarsness. J Acoust Soc Am ) Kasuya H, Ogawa S, Mashima K, Ebihara S. Normalized noise energy as an acoustic measure to evaluate pathologic voice. J Acoust Soc Am ) Mashima K, Ebihara S, Kasuya H. Acoustic screening for laryngeal cancer. Jpn J Clin Oncol ) Yang BG. An acoustical study of Korean monophthongs produced by male and female speakers. J Acoust Soc Am

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KISEP Original Articles 臨床耳鼻 : 第 12 卷 第 1 號 2001 J Clinical Otolaryngol 2001;12:65-79 양성후두질환에서후두미세수술전후음성의비교분석 백무진 1 황부현 1 엄재욱 1 권순복 2 이병주 2 왕수건 2 Comp

KISEP Original Articles 臨床耳鼻 : 第 12 卷第 1 號 2001 J Clinical Otolaryngol 2001;12:65-79 양성후두질환에서후두미세수술전후음성의비교분석 백무진 1 황부현 1 엄재욱 1 권순복 2 이병주 2 왕수건 2 Comp