GRBAS 음성평가와 음성장애지수

손진호,Sohn, Jin-Ho 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.2

Subjective voice evaluation is necessary and important to assess the voice disorders in addition to objective voice evaluation. Subjective voice evaluation is divided into examiner and examinee subjective voice assessment. The examiner assessment represents perceptual judgment to the patient's voice such as GRBAS scale, Buffalo voice profile, consensus auditory perceptual evaluation of voice (CAPE- V) and so on. The examinee assessment consists of indirect method including voice handicap index (VHI), voice outcome survey (VOS), voice symptom scale (VoiSS), voice related quality of life (V-ROQL) and direct method which is called patient's self-subjective voice rating. This review article describes a general rule, advantages and pitfalls about GRBAS scale, VHI and patient's self-subjective voice rating which are presently most representative voice assessment tools. 주관적 음성평가는 음향분석기기를 이용한 객관적 음성 평가와 함께 음성분석에 유용하고 의미있는 평가방법이며 현재 알려진 검시법정 중에서 GRBAS 음성평가, VHI, patient self-perceptual voice rating이 가장 널리 사용되고 있고 인정받는 방법이다. 주관적 음성평가는 음성의 상태를 모두 대변할 수은 없으며 객관적인 음성평가에 대한 보완적인 의미를 가진다. 현재 개발되어 있는 주관적 음성평가 방법들이 유용한 평가도구이긴 하지만 나름대로의 문제점과 제한점을 가지고 있기 때문에 이에 대한 개선과 보완을 위한 지속적인 연구와 개발이 요구된다.

기능성 음성장애의 병태생리

진성민,Jin, Sung Min 대한후두음성언어의학회 2014 대한후두음성언어의학회지 Vol.25 No.2

기능성 음성장애는 후두에 구조적 혹은 신경학적 병변이 없이 음성발성에 장애가 있는 질환으로, 의학적인 부분만으로 설명하기가 어려운 장애 요소들을 내포하고 있기 때문에 진단에 많은 혼란이 있을 수 있는 논쟁의 여지가 많은 음성질환이다. 기능성 음성장애의 중요한 부분 중의 하나인 muscle tension dysphonia는 후두 근육과 후두 주변 근육의 지나친 긴장에 의해서 발생하는 음성장애로, 비록 후두 내/외근의 운동이 제대로 조절되지 않는 것이 muscle tension dysphonia의 가장 첫 번째 원인이라고 알려져 있고, 특정의 개인적인 인성의 특징(personality traits)들도 발생에 있어서 상당히 중요한 부분을 차지 하는 것으로 연구되고 있지만, 이들 근육이 도대체 어떻게 문제가 되는 지에 대해서는 사실 아직까지 완전하게 설명하기에는 곤란한 점이 많다. 또한 최근 들어서는 muscle tension dysphonia를 하나의 질환으로 보기보다는 기능성 음성장애의 문제점들을 설명하는 진단적 지표(diagnostic label)로 보는 경향이 많으며, 기능성 음성장애와 기질적 음성장애(organic voice disorder)를 아우르는 위치에 있는 것으로 해석하는 경향도 있다. 따라서 기능성 음성장애에 대한 분류나 발생기전에 대한 의견들은 아직까지 논란이 되는 부분들이 많은 상태이고, 기능성 음성장애를 더 잘 이해하고 이 질환을 성공적으로 치료해 나갈 수 있는 중요한 요인들을 찾아낼 수 있도록 더 많은 연구들이 이루어 져야 할 것으로 생각된다. Functional dysphonia refers to a voice disturbance that occurs in the absence of structural or neurologic laryngeal pathological characteristics. Poorly regulated activity of the intrinsic and extrinsic laryngeal muscles is cited as the proximal cause of functional dysphonia (FD). Recently, the term functional dysphonia has been replaced in some clinical circles by diagnostic label muscle tension dysphonia (MTD), which serves to highlight excess, dysregulated, or imbalanced activity of the intrinsic and extrinsic laryngeal muscles as proximal cause of the observed dysphonia. And recent research evidence points to specific personality traits as important contributors to its development and maintenance. However, the origin of this dysregulated laryngeal muscle activity has not been fully elucidated. Further research is needed to better understand the pathogenesis of functional dysphonia, and factors contributing to its successful management.

후두외근 과긴장에 대한 음성피로도 검사의 유용성

김지성,이동욱 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.3

Background and Objectives This study compares Vocal Fatigue Index (VFI) scores according to the presence or absence of external laryngeal tension in hyperfunctional voice disorder. And through this, it is to confirm the usefulness of VFI to hypertension of extrinsic laryngeal muscles.Materials and Method The subjects were 61 female diagnosed with hyperfunctional voice disorder (hypertension group 41, non-hypertension group 20). The author palpated extrinsic laryngeal muscles for evaluation of hypertension and classified them as the presence or absence. The voice measurements were jitter, shimmer, Korean-Voice Handicap Index-10 (K-VHI-10), and Korean-Vocal Fatigue Index (K-VFI). The voice compared were according to the diagnosis and presence of hypertension only for patients with hyperfunctional voice disorder.Results As a result of comparing the voice measurement according to the presence or absence of hypertension, there was no significant difference in the acoustic variables, K-VHI-10 and K-VFI-Total, K-VFI-Fatigue. Whereas, K-VFI-Physical (p=0.006) and K-VFI-Rest (p=0.022) were significantly higher in the hypertension group.Conclusion These results indicate that the hypertension group has more physical discomfort and less voice recovery than the group without hypertension. It means that K-VFI can measure the physical discomfort and limitations of voice recovery due to hypertension of the external laryngeal muscle. The VFI can be used as one of the methods to evaluate the hypertension of the external laryngeal muscle in Hyperfunctional voice disorder.

후두질환에 따른 자음의 음성발현시간의 특성

홍기환,이화욱,김진성,이은정,소상수,최동일,양윤수,Hong, Ki-Hwan,Lee, Hwa-Uk,Kim, Jin-Sung,Lee, Eun-Jung,So, Sang-Soo,Choi, Dong-Il,Ynng, Yoon-Soo 대한후두음성언어의학회 2006 대한후두음성언어의학회지 Vol.17 No.2

Background and Objectives : Voice onset time(VOT) is defined as the time interval from oral release of a stop consonant to the onset of glottal pulsing in the following vowel. VOT is a temporal characteristics of stop consonants that reflects the complex timing of glottal articulation relative to supraglottal articulation. Stop consonants are characterized by creation of a pressure difference across a complete occlusion in the vocal tract, followed by a sudden release 'burst' due to opening that occlusion. The objects of this study is to evaluate a usefulness of voice onset time in the assessment of voice disorderd patients. Subjects : Subjects were 20 adults with normal voice and with benign laryngeal disorders. Subjects with voice disorders represented the following vocal pathologies : vocal polyp, vocal nodule, Reinke's edema and unilateral vocal fold paralysis(UVFP). Control subjects were matched for age (21-40 yews old) and sex(male) with the voice disorders subjects and had normal vocal qualities with no history of voice disorders. Methods : Each voice-disordered and matched control subject read the test passages containing three types of Korean bilabial consonants. VOT measures were made for the initial $/p/p^h/\;and\;/p'/$. VOT was measured using acoustic waveform or wide band spectrogram. Results : For each voiceless stop consonants, there was a significant difference in VOT between the voice disordered and normal subjects. The mean VOTs of the lax stops in UVFP was significantly shorter than those of control subjects in the UVFP. The mean VOTs of the aspirated stops in the vocal polyp and nodule were longer than those of control subjects, but not significant. The mean VOTs of the glottalized in voice disordered groups were longer than those of control subjects, and significant statistically in the UVFP. Conclusions : VOT may be a clinically useful acoustic parameter in the assessment of voice disordered patients, especially in the unilateral vocal fold paralysis.

수직후두부분절제술 및 점막 피판과 지방 이식을 통한 성대 재건술 후의 음성분석

주형로,최인자,김진환,안회영,노영수,Chu, Hyung-Ro,Choi, In-Ja,Kim, Jin-Hwan,Ahn, Hwoe-Young,Rho, Young-Soo 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.2

Background and Objectives: The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. It is generally believed that the reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve laryngeal function. The objective of this study is to evaluate of voice function after VPL with mucosal flap and fat graft reconstruction. Materials and Methods: From 1994 to 2006, 13 patients, who had been treated with VPL with mucosal flap and fat graft reconstruction. The voice characteristics, acoustic, aerodynamic parameter were measured in 13 patients after vertical partial laryngectomy with mucosal flap and fat graft reconstruction. Acoustic analysis was carried out using Computerized Speech Lab (CSL) and aerodynamic analysis were carried out using Aerophon II,3 months and 12 months after surgery. Results: The GRBAS scale, jitter, shimmer, NHR were improved as time goes on after surgery. But, maximum phonation time was shortened after surgery and there is no significant differences between before and after surgery in mean flow rate. Conclusion: The voice function of the mucosal flap and fat graft reconstruction after VPL were satisfactory. This can be an excellent reconstruction method after vertical partial laryngectomy.

전신 마취하 후두 노출이 되지 않았던 후두 유두종 환자에 대하여 시도한 후두 마스크 전신 마취하 Pulsed Dye Laser 수술 치험 1예

정현필,박준희,김원식,최홍식,Chung, Hyun-Pil,Park, Jun-Hee,Kim, Won-Sik,Choi, Hong-Shik 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1

Non-visualization of larynx is one of the reasons for failure of vocal fold surgery. Many otorhinolaryngologists may have a trouble in choice of alternative treatment if they experience this situation. The laryngeal mask airway could be alternative approach for this situation. We report a glottal papillomatous patient who was treated by pulsed dye laser via laryngeal mask airway after failure of vocal fold surgery via endotracheal intubation. The patient was a 73-year-old man. Laryngoscopy revealed a severe diffuse papillomatous lesion on right true vocal cord, anterior commissure, and partial left true vocal cord. The patient was refered for difficult laryngeal exposure during laryngomicrosurgey under general endotracheal anesthesia.

음성장애 환자에서 시행되는 청지각적 평가에 대한 논의

이승진 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.3

The auditory-perceptual evaluation of speech-language pathologists (SLP) in patients with voice disorders is often regarded as a touchstone in the multi-dimensional voice evaluation procedures and provides important information not available in other assessment modalities. Therefore, it is necessary for the SLPs to conduct a comprehensive and in-depth evaluation of not only voice but also the overall speech production mechanism, and they often encounter various difficulties in the evaluation process. In addition, SLPs should strive to avoid bias during the evaluation process and to maintain a wide and constant spectrum of severity for each parameter of voice quality. Lastly, it is very important for the SLPs to perform a team approach by documenting and delivering important information pertaining to auditory-perceptual characteristics in an appropriate and efficient way through close communication with the laryngologists.

다기관 설문조사를 통한 국내 소아 음성질환 환자의 검사 및 치료 유형 연구

이종근,방승환,전재민,이정규,김연,우정수,조재구 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.1

Background and Objectives:Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. Materials and Method:An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. Results:Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pretreatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. Conclusion:Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.

선천성 후두개곡 낭종을 동반한 후두연하증의 성문상부교정술 2예

김희정,최나연 대한후두음성언어의학회 2023 대한후두음성언어의학회지 Vol.34 No.2

Vallecular cyst consisted of a unilocular cystic mass of variable size arising from the lingual surface of the epiglottis and containing clear fluid is a rare occurrence in children. Although a cyst is benign, it may cause serious airway obstruction and even death if not treated appropriately. Also, laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms typically begin to appear at around 2 to 3 weeks of age and become worse between 4 and 8 months. With a review of literature, we report two cases of vallecular cyst with symptomatic laryngomalacia in a 1-month-old female and a 2-month-old male. Both patients experienced symptom relief after undergoing endoscopic supraglottoplasty.

한국 아동의 언어발달

배소영 대한후두음성언어의학회 1996 대한후두음성언어의학회지 Vol.7 No.1

한 아이가 태어나서 말을 배우고 글을 읽고 쓰게 되기까지에는 여러 가지 요인들이 성공적으로 작용해야 한다. 아동이 해부학적으로 정상적 뇌, 조음 관련 기관, 감각-운동기관을 가져야 하며. 사회적으로 언어적 자극속에 노출되어야 하고. 또 문제 해결이나 의사소통을 위해 말 또는 글이라는 도구를 사용할 수 있어야 한다(Fletcher 1973 ; Kent 1976 ; Kent 1984 ; Spreen et al. 1984 ; Vygotsky 1978). 언어 발달의 기간도 매우 길어 기본적 말의 틀이 3년에서 5년 정도 걸려 완성된 이후 본격적으로 성인언어에 가까운 문법이나 조음 능력을 가지는 데에는 또 여러 해가 더 필요하다(Bloom 1970 ; Bloom 1991 ; Bloom and Lahey 1978 ; Bruner 1983 ; Pinker 1984 ; Radford 1990). (중략)