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 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

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

Table 1. Short and long term frequency perturbation measurements Jita us. 83.2 Jitt %. 1.04 RAP %. 3. 0.68 PPQ %. 5. 0.84 sppq %... 55. 1.02 vfø %.. 1.10 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. 0.35 Shim %. 3.81 APQ %. 11 3.07 sapq %.. 55. 4.23 vam %. 8.20 ShdBShimmer in db, ShimShimmer Percent, APQAmplitude Perturbation Quotient, sapqsmoothed Amplitude Perturbation Quotient, vampeak Amplitude Variation Kay 27) Table 3. Voice break related measurements DVB %. 1.00 DVBDegree of voiceless Kay 27) 결과 Ø 67

J Clinical Otolaryngol 2001;12:65-79 Table 4. Noise related measurements NHR VTI 704,500 Hz 15004,500 Hz... 704,500 Hz 2,8005,800 Hz. VTI... 701,600 Hz 1,600 SPI 4,500 Hz. SPI. SPI. NHRNoise to Harmonic Ratio, VTIVoice Turbulence Index, SPISoft Phonation Index Kay 27) 0.19 0.061 14.12 Table 5. Tremor measurements FTRI % FØ. FØ. ATRI %.. 4.37 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

Ø Table 7. Absolute Jitter us % p-value % // 63.0 36.1 230.3192.3 88.5 57.8 61.5 0.001 37 79 // 73.452.8 271.3192.1 151.9 100.3* 43.6 0.001 38 81 // 98.0104.8 216.4176.7 118.4 86.1 45.2 0.001 36 77 // 63.8 41.6 170.4135.4 74.9 63.5 56.0 0.0001 40 85 // 71.4 44.2 203.3200.9 114.1 180.8 43.8 0.044 37 79 73.9 14.2 218.3132.9 109.8 66.0 49.7 37.6 80 Ratio 1 0.9 2.95 2.6 1.48 1.3 Ratio. Kay 83.2 Statistically significant between * or and the other vowelsp0.05 Table 8. Jitter Percent % % p-value % // 0.90.6 3.12.8 1.2 0.8 62.7 0.0003 36 77 // 1.00.7 3.72.6 1.830.9* 49.9 0.0004 36 77 // 1.51.9 3.12.6 1.7 1.5* 44.1 0.003 36 77 // 0.90.5 2.42.4 0.8 0.6 64.1 0.0003 41 87 // 1.00.5 3.03.0 1.4 1.7 54.1 0.006 37 79 1.10.2 3.02.2 1.4 0.7 54.4 37.2 79 Ratio 1 1.0 2.8 2.9 1.3 1.3 Ratio, Kay 1.04 Statistically significant between * or and the other vowelsp0.05 Table 9. Pitch perturbation quotient % % p-value % // 0.50.3 1.81.7 0.60.6* 67.2 0.0002 39 83 // 0.60.4 2.11.5 1.00.9 53.6 0.0002 37 78 // 0.80.9 1.61.2 0.90.9 40.7 0.0035 36 77 // 0.50.4 1.21.5 0.40.4* 66.4 0.0011 43 91 // 0.60.3 1.61.7 0.60.6* 61.8 0.002 38 81 0.60.1 1.71.2 0.70.4 57.6 38.6 82 Ratio 1 0.7 2.8 2.0 1.2 0.8 Ratio, Kay 0.84 Statistically significant between * & p0.05 69

J Clinical Otolaryngol 2001;12:65-79 Table 10. Relative average perturbation % % p-value % // 0.90.4 1.81.4 0.60.5 66.2 0.0001 40 85 // 0.60.4 2.11.5 1.00.6* 52.1 0.0003 40 85 // 0.91.1 1.71.3 0.90.7* 47.5 0.0006 36 77 // 0.50.3 1.31.5 0.40.3 69.3 0.0005 42 89 // 0.60.3 1.71.6 0.81.1 54.0 0.0055 41 87 0.60.2 1.71.1 0.70.4 57.0 39.8 85 Ratio 1 0.9 2.7 2.5 1.2 1.1 Ratio, Kay 0.68 Statistically significant between * or and the other vowelsp0.05 Table 11. Smoothed pitch perturbation quotient % % p-value % // 0.80.3 1.51.0 1.10.5* 23.4 0.281 37 78 // 0.80.5 1.70.1 1.30.8* 21.6 0.229 34 72 // 1.00.5 2.12.5 0.80.4 64.1 0.129 40 85 // 1.22.6 1.41.9 0.60.3 58.3 0.237 45 96 // 0.80.6 3.95.5 0.80.3 80.2 0.054 40 85 0.90.2 2.11.1 0.90.3 57.0 39.2 83 Ratio 1 0.9 2.4 2.1 1.0 0.9 Ratio, Kay 1.02 Statistically significant between * & p0.05 Table 12. Fundamental frequency variation % % p-value % // 1.60.9 4.23.0 2.52.5 40.2 0.005 37 78 // 1.70.8 4.33.8 2.82.8 36.6 0.026 35 74 // 2.31.7 3.93.0 3.23.2 16.9 0.299 30 64 // 2.22.8 3.93.1 2.502.5 36.4 0.036 37 78 // 2.21.7 6.39.1 2.42.4 61.6 0.012 36 77 2.00.3 4.52.8 2.71.7 40.8 35 74 Ratio 1 1.8 2.3 4.1 1.3 2.4 Ratio, Kay 1.10 70

Table 13. Shimmer in db db % p-value % // 0.30.1 1.00.6 0.50.6 45.4 0.101 41 87 // 0.30.1 0.70.5 0.60.7 23.1 0.243 37 78 // 0.30.5 0.70.7 0.40.5 33.9 0.118 32 68 // 0.30.3 0.60.4 0.30.4 39.7 0.014 36 77 // 0.20.1 1.70.5 0.30.3 80.4 0.0009 38 81 0.30.1 0.91.6 0.40.4 52.3 36.8 78 Ratio 1 0.8 3.3 2.6 1.57 1.3 Ratio, Kay 0.35 Table 14. Shimmer Percent % % p-value % // 3.71.4 8.25.7 4.42.3 46.1 0.0004 42 89 // 3.31.2 8.24.9 4.63.2 43.6 0.0005 38 81 // 2.91.3 6.96.7 3.82.2 45.7 0.0105 33 70 // 2.21.4 6.14.5 3.12.5 48.6 0.0009 39 83 // 2.51.1 7.87.0 3.12.8 60.5 0.0001 40 85 2.90.6 7.44.8 3.81.8 48.9 38.4 82 Ratio 1 0.8 2.56 2.0 1.31 1.0 Ratio, Kay 3.81 Table 15. Amplitude perturbation quotient % % p-value % // 2.60.9 5.85.2 3.51.7 40.9 0.011 34 72 // 2.30.7 5.44.0 4.35.6* 20.6 0.341 36 77 // 2.20.7 5.16.8 3.02.9 40.6 0.108 35 74 / 1.91.1 4.54.4 2.62.3 41.6 0.024 37 78 // 1.70.9 4.63.6 2.12.0 53.5 0.0004 36 77 2.20.4 5.14.6 3.11.8 38.9 35.6 76 Ratio 1 0.7 2.4 1.7 1.4 1.0 Ratio, Kay 3.07 Statistically significant between * or and the other vowelsp0.05 71

J Clinical Otolaryngol 2001;12:65-79 Table 16. Smoothed amplitude perturbation quotient % % p-value % // 4.82.2 5.82.4 6.75.8* 15.4 0.734 36 77 // 3.71.5 6.02.1 4.82.4* 20.6 0.190 39 83 // 3.21.4 5.86.3 3.01.5 40.6 0.193 37 78 // 3.41.9 5.65.9 3.11.7 41.6 0.130 40 85 // 3.51.7 6.03.3 3.01.5 53.5 0.006 40 85 3.70.6 5.84.7 4.12.6 38.9 38.4 82 Ratio 1 0.9 1.6 1.4 1.1 1.0 Ratio, Kay 4.23 Statistically significant between * & p0.05 Table 17. Peak-amplitude variation % % p-value % // 10.94.9 13.96.4 10.810.8 22.6 0.050 33 70 // 10.55.1 12.76.9 10.810.8 14.6 0.282 37 78 // 9.44.8 12.17.7 10.210.1 16.3 0.202 33 70 // 10.46.7 12.17.2 9.4 9.4 21.7 0.055 29 62 // 10.56.0 12.57.5 7.8 7.8 37.8 0.005 37 78 10.30.6 12.65.6 9.8 4.7 22.6 33.8 72 Ratio 1 1.3 1.2 1.5 1.0 1.2 Ratio, Kay 8.20 Table 18. Degree of voice breaks % % p-value % // 0 9.017.9 3.67.9* 60.5 0.090 26 55 // 0 10.721.0 0 100 0.003 23 49 // 0 1.6 5.6 1.34.2 18.2 0.825 13 28 // 0.42.6 5.411.9 1.24.4 77.7 0.010 21 45 // 0 11.822.7 0.72.2 94.0 0.003 23 49 0.10.2 7.710.2 1.42.0 82.4 21.2 45 Ratio 1 0.1 85.5 7.7 15 1.4 Ratio, Kay 1.00 Statistically significant between * & the other vowelsp0.05 고찰 72

Table 19. Voice turbulence index % p-value % // 0.060.05 0.090.05* 0.060.04* 33.1 0.004 36 77 // 0.080.03 0.110.07* 0.070.03* 35.6 0.001 35 74 // 0.070.04 0.090.07* 0.070.05* 19.7 0.237 31 65 // 0.040.02 0.040.02 0.030.02 21.4 0.051 31 65 // 0.030.02 0.040.20 0.030.01 30.8 0.004 34 72 0.050.02 0.070.04 0.050.02 29.1 33.4 71 Ratio 1 0.9 1.4 1.2 1 0.9 Ratio, Kay 0.061 Statistically significant between * & p0.05 Table 20. Soft phonation index % p-value % // 9.9 5.8 14.0 5.2* 12.6 8.4 10.1 0.423 31 65 // 4.4 2.2 10.0 8.7* 9.4 7.2 6.0 0.731 29 62 // 7.1 4.0 16.4 9.1* 4.6 7.8 11.3 0.657 33 70 // 36.624.2 40.132.5 37.418.3 6.8 0.626 29 62 // 47.321.1 61.028.7 4.225.5 5.3 0.721 23 49 21.119.6 28.314.1 27.610.4 2.4 29 62 Ratio 1 1.5 1.3 2.0 1.3 2.0 Ratio, Kay 14.12 Statistically significant between * &, * &, & p0.05 Table 21. Noise to harmonic ratio % p-value % // 0.20.5 0.20.1 0.20.1* 9.3 0.319 34 72 // 0.10.0 0.20.1 0.10.1 21.8 0.002 37 78 // 0.10.0 0.20.1 0.10.1 12.4 0.087 35 74 // 0.10.1 0.20.0 0.10.1 10.5 0.225 33 70 // 0.10.0 0.20.1 0.10.1 33.5 0.0004 38 81 0.20.1 0.20.1 0.10.1 18.1 35.4 75 Ratio 1 0.8 1.13 0.9 0.9 0.7 Ratio, Kay 0.19 Statistically significant between * & the other vowelsp0.05 73

J Clinical Otolaryngol 2001;12:65-79 Ø Table 22. Fo-Tremor intensity index % % p-value % // 0.40.3 1.00.6 0.60.4 40.8 0.039 41 87 // 0.40.2 0.60.4 0.40.3 21.8 0.415 34 72 // 0.40.2 1.01.7 0.60.4 44.0 0.092 36 77 // 0.50.4 0.40.3 0.30.1 41.5 0.233 44 94 // 0.40.2 1.01.3 0.40.3 61.1 29 62 0.40.0 0.80.8 0.40.2 44.2 36.8 78 Ratio 1 0.4 1.9 0.8 1.1 0.5 Ratio, Kay 0.95 Table 23. Amplitude tremor frequency Hz % p-value % // 7.84.5 8.75.6 13.15.8 51.2 42 89 // 5.90.4 12.84.7 11.54.2 10.0 0.092 42 89 // 11.22.9 7.42.8 7.84.7 6.5 41 87 // 5.90.5 11.65.1 9.53.9 18.5 0.5 46 98 // 4.00.9 11.15.9 9.13.4 18.3 0.202 39 83 7.02.7 10.34.8 10.24.4 1.1 42 89 Ratio 1 1.5 1.5 Ratio Table 24. Fo tremor frequency Hz % p-value % // 6.64.3 10.55.7 12.26.9 16.8 0.844 12 74 // 9.14.9 11.55.4 13.16.4 14.0 0.179 9 81 // 8.66.0 8.75.5 10.86.0 24.6 0.748 7 85 // 7.65.0 1.06.2 10.35.1 2.92 0.679 6 87 // 7.04.0 11.87.5 8.74.4 26.2 0.067 42 89 7.81.1 10.56.1 11.05.8 5.13 39.2 83 Ratio 1 1.4 1.4 Ratio 74

Ø Ø Table 25. Amplitude tremor intensity index % % p-value % // 3.22.0 4.83.3 3.02.0 36.3 41 87 // 3.92.7 2.61.4 1.81.1 28.7 0.490 34 72 // 2.50.6 3.53.9 3.11.3 11.4 0.406 36 77 // 2.31.4 3.43.4 1.60.5 54.0 0.463 44 94 // 2.10.7 4.04.5 1.51.1 62.8 29 62 2.80.8 3.63.3 2.21.2 39.6 36.8 78 Ratio 1 0.6) 1.3 0.8 0.8 0.5 Ratio, Kay 4.37 Table 26. Phonatory fundamental frequency range semi-tones % p-value % // 2.61.0 52.5 3.20.7 36.5 0.001 40 85 // 3.01.3 4.62.2 3.40.1 25.8 0.005 36 77 // 3.31.4 4.32.5 3.50.2 18.7 0.054 34 72 // 3.54.2 4.22.3 2.60.2 37.3 0.002 41 87 // 2.91.4 5.24.3 3.10.1 41.6 0.003 38 81 3.00.4 4.61.9 3.11.1 32.4 37.8 80 Ratio 1 1.5 1 Ratio Table 27. Comparison of formant between preoperative and postoperative state // // // // // 1 653.0174.7 452.5115.7 267.4 49.6 435.7 60.7 299.6 36.6 Hz 674.5124.6 447.3 77.4 275.9 35.5 436.3 58.1 318.9 45.5 2 1385.5438.5 1748.3215.6 2165.9248.0 1031.7359.6 885.4230.9 Hz 1260.5214.0 1832.4179.0 2202.7271.2 921.3249.8 909.6378.6 3 2736.4267.0 2613.1215.6 2957.4225.0 2814.8223.2 2643.8247.6 Hz 2763.0156.0 2645.0196.2 2996.1246.7 2839.1177.2 2696.6304.7 *There is no statistical difference between pre and postoperative formant value each phonation 75

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