基于喉肌电图定量分析的声带麻痹患者嗓音功能评估

Vocal function evaluation of patients with vocal fold paralysis based on quantitative analysis of laryngeal electromyography

摘要:

目的 探究喉肌电图(LEMG)募集相转折数与嗓音声学评估参数之间的相关性，评估LEMG募集相转折数在嗓音功能评估中的应用价值，以全面评估声带麻痹(VFP)患者嗓音状况，并指导治疗决策。方法 回顾性分析2023年8月—2025年2月山西医科大学第一医院耳鼻咽喉头颈外科确诊为单侧VFP的75例患者。根据LEMG结果将患者分为喉上神经功能异常组(31例)和喉返神经功能异常组(44例)，所有患者接受嗓音声学基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、最长发音时间(MPT)、嗓音障碍严重程度指数(DSI)分析和LEMG检查，测量健侧与患侧喉内肌募集相转折数。结果 喉上神经与喉返神经功能异常组健侧与患侧募集相转折数差异具有统计学意义(P＜0.001)。随着嘶哑声(H)评分增加，喉返神经功能异常组和喉上神经功能异常组的Jitter和Shimmer相应升高，MPT和DSI相应降低，差异具有统计学意义(P＜0.05)，而平均F0差异无统计学意义(P>0.05)。LEMG募集相转折数与Jitter、Shimmer呈负相关(P＜0.05)，与MPT和DSI呈正相关(P＜0.05)。不同喉内肌的募集相转折数对嗓音声学参数的相关性存在一定特异性，环甲肌(CT)与Jitter相关性最强(r=-0.550)，而甲杓肌(TA)和环杓后肌(PCA)与MPT的相关性较高(r=0.623和r=0.657)。结论 LEMG募集相转折数能够客观反映VFP患者的嗓音功能损伤程度，与嗓音声学分析参数具有相关性。将LEMG参数与声学分析结合，可为VFP的全面评估和精准诊断提供新的客观依据，为个体化治疗方案的制定提供科学依据。

Abstract:

Objective To investigate the correlation between the number of recruitment turns in laryngeal electromyography (LEMG) and acoustic voice evaluation parameters, and to assess the application value of the number of recruitment turns in the vocal function evaluation, so as to comprehensively assess the vocal status of vocal fold paralysis (VFP) patients and guide treatment decisions.Methods A retrospective analysis was conducted on 75 patients diagnosed with unilateral VFP from August 2023 to February 2025 at the Department of Otolaryngology Head and Neck Surgery, the First Hospital of Shanxi Medical University. According to LEMG results, all the patients were classified into the superior laryngeal nerve dysfunction group and recurrent laryngeal nerve dysfunction group. They all underwent acoustic voice analysis (fundamental frequency, F0), Jitter, Shimmer, maximum phonation time (MPT), and dysphonia severity index (DSI)) and LEMG examination to measure the recruitment turn numbers of laryngeal muscles on the affected and healthy sides.Results Significant differences in the number of recruitment turns between the affected and healthy sides were observed in both the superior laryngeal nerve dysfunction and recurrent laryngeal nerve dysfunction groups (P<0.001). As the hoarseness scores (H) increased, the Jitter and Shimmer values increased accordingly, while MPT and DSI values decreased accordingly in both groups (P<0.05). Their differences were statistically significant, while the difference in average F0 was statistically insignificant (P>0.05). The number of recruitment turns of LEMG was negatively correlated with Jitter and Shimmer (P<0.05), and positively correlated with MPT and DSI (P<0.05). The correlation between recruitment turn numbers of different laryngeal muscles and acoustic parameters exhibited certain specificity, with the cricothyroid muscle showing the strongest correlation with Jitter (r=-0.550), and the thyroarytenoid muscle and posterior cricoarytenoid muscle showing relatively high correlations with MPT (r=0.623 and r=0.657).Conclusion The number of recruitment turns in LEMG can objectively reflect the degree of vocal function impairment in VFP patients and is correlated with acoustic voice evaluation parameters. The combination of number of recruitment turns in LEMG and acoustic analysis parameters can provide new objective evidence for the comprehensive evaluation and precise diagnosis of VFP, and offer a scientific basis for the formulation of individualized treatment plans.