성대 폴립 환자에 대한 후두미세수술과 음성 치료의 전, 후 결과 비교

김근효,임동원,천용일,신성찬,이병주,이연우 대한후두음성언어의학회 2024 대한후두음성언어의학회지 Vol.35 No.1

Background and Objectives The aim of this study is to compare the acoustic and auditory-perceptual assessment of patients with vocal fold polyps (VP) before and after laryngeal microsurgery (LMS) and voice therapy (VT).Materials and Method A retrospective cohort design was employed. Sustained vowels and continuous speech samples produced by 36 patients diagnosed with VP were analyzed. Treatment outcome measures included, cepstral peak prominence (CPP), smoothed cepstral peak prominence (CPPS), acoustic voice quality index (AVQI), acoustic breathiness index (ABI), auditory-perceptual (A-P) ratings (G of GRBAS scale and overall severity [OS] of consensus auditory-perceptual evaluation of voice), and voice handicap index-10 (VHI-10).Results Following LMS and VT, significant improvements in CPP, CPPS, AVQI, ABI (p<0.001) were observed. Additionally, A-P ratings (G and OS) and VHI-10 (p<0.001) significantly improved following LMS and VT. Acoustic analyses, A-P ratings and VHI-10 indicated that the voice quality has improved following LMS and VT.Conclusion Our study demonstrates that the concurrent application of LMS and VT in patients with VP leads to improvements in both voice quality and patient satisfaction. These findings underscore the importance of a multidisciplinary approach in the management of VP, integrating both surgical and therapeutic interventions for optimal outcomes.

성대마비 음성에 대한 유성음 분절 추출의 영향: 켑스트럼 분석 위주

김근효,이연우,차원재,이병주,권순복 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.3

Background and Objectives The purpose of this study was to investigate the effect of unvoicedsegments on the cepstral analysis in patients with vocal cord paralysis (VCP). Subjects and Method A total 302 subjects (173 subjects with VCP and 129 normal voicesubjects) participated in this study. The sustained vowel /a/ 2 seconds and one sentence of‘Sanchaek’ were edited, and analyzed by Praat script. The cepstral analyses were performedusing sustained vowel (SV), continuous speech (CS), and extracted continuous speech (EXT)samples. The auditory-perceptual (AP) rating was also completed by three raters. Results First, there were significant differences in all variables except low-to high spectral ratio(L/H ratio)_EXT between two groups. Second, cepstral peak prominence (CPP), smoothed cepstralpeak prominence (CPPS), and L/H ratio showed significant differences in SV, CS, and EXT samples. Third, cepstral measurements were highly correlated with the AP ratings. Finally, the level ofdiscrimination of dysphonia estimated from CPP and CPPS gotten from SV and CS values wasmore than area under the curve (AUC) of 0.941. AUC of 0.880 or more was also found in EXT. Conclusion In this study, we confirmed that both CS and EXT are highly predictive ofpathologic speeches. Further study will also need to be validated for a more diverse group ofvoice disorders

성대용종 환자의 후두미세수술 후 음성회복의 예측인자로서의 음향학적 및 청지각적 평가

김근효,이연우,이병주,권순복 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.7

Background and Objectives The purpose of this study was to investigate acoustic (acousticvoice quality index, AVQI) and auditory-perceptual evaluation (grade, rough, breathy, asthenic,strained; GRBAS and consensus auditory-perceptual evaluation of voice; CAPE-V) as apredictor of voice recovery after laryngeal microsurgery (LMS) in patients with vocal polyp. Subjects and Methods A total of 68 patients with vocal polyp participated in this study. Voice samples were analyzed for AVQI by Praat and auditory-perceptual ratings were performedby three speech language pathologists. Voice handicap index-10 (VHI-10) was evaluatedby patients themselves. Results Decreased AVQI, VHI-10, overall severity (OS), and increased smoothed cepstralpeak prominence (CPPS) values were measured and statistically significant changes were notedafter LMS. The ratio of Grade 0 and Grade 1 was increased. AVQI was correlated withCPPS, Grade, and OS, but not with VHI-10. The voice recovery of pedunculated polyp appearedin all vocal polyp sizes after LMS, but statistically significant differences were found only insmall and medium sizes. After LMS of sessile polyps, AVQI, VHI-10, and OS decreased whereasCPPS increased; however, statistically significant difference was confirmed only in VHI-10and OS. The receiver operating characteristic curve analysis showed the following results:AVQI [cutoff=5.5, sensitivity=61.8%, specificity=76.5%, area under the curve (AUC)=0.712],CPPS (cutoff=5.0, sensitivity=89.7%, specificity=48.5%, AUC=0.743), VHI-10 (cutoff=13.0,sensitivity=77.9%, specificity=89.7%, AUC=0.893), Grade (cutoff=2.0, sensitivity=70.6%,specificity=69.1%, AUC=0.728), and OS (cutoff=51.0, sensitivity=86.8%, specificity=66.2%,AUC=0.833). Conclusion Acoustic and auditory-perceptual variables showed significant positive changesand predicted recovery of voice. In this study, we believe that the acoustic and auditory-perceptualevaluations.

기능성 음성장애의 진단을 위한 음향학적, 청지각적 평가

김근효,이연우,배인호,이재석,이창윤,박희준,이병주,권순복 대한이비인후과학회 부산,울산,경남 지부회 2018 임상이비인후과 Vol.29 No.2

Background and Objectives:The purpose of this study was to compare the measured values of acoustic and auditory perceptual assessments between normal and functional dysphonia (FD) groups. Materials and Methods:102 subjects with FD and 59 normal voice groups were participated in this study. Mid-vowel portion of the sustained vowel /a/ and two sentences of ‘Sanchaek’ were edited, concatenated, and analyzed by Praat script. And then auditory-perceptual (AP) rating was completed by three listeners. Results:The FD group showed higher acoustic voice quality index version 2.02 and version 3.01 (AVQIv2 and AVQIv3), slope, Hammarberg index (HAM), grade (G) and overall severity (OS), values than normal group. Additionally, smoothed cepstral peak prominence in Praat (PraatCPPS), tilt, low-to high spectral band energies (L/H ratio), long-term average spectrum (LTAS) in FD group were lower than normal voice group. And the correlation among measured values ranged from -0.250 to 0.960. In ROC curve analysis, cutoff values of AVQIv2, AVQIv3, PraatCPPS, slope, tilt, L/H ratio, HAM, and LTAS were 3.270, 2.013, 13.838, -22.286, -9.754, 369.043, 27.912, and 34.523, respectively, and the AUC of each analysis was over .890 in AVQIv2, AVQIv3, and PraatCPPS, over 0.731 in HAM, tilt, and slope, over 0.605 in LTAS and L/H ratio. Conclusions:In conclusion, AVQI and CPPS showed the highest predictive power for distinguishing between normal and FD groups. Acoustic analyses and AP rating as noninvasive examination can reinforce the screening capability of FD and help to establish efficient diagnosis and treatment process plan for FD.

Effects of Injection Laryngoplasty with Hyaluronic Acid in Patients with Vocal Fold Paralysis

김근효,이재석,이창윤,이연우,배인호,박희준,이병주,권순복 질병관리본부 2018 Osong Public Health and Research Persptectives Vol.9 No.6

Objectives The purpose of this study was to explore the effects of injection laryngoplasty (IL) with hyaluronic acid in patients with vocal fold paralysis (VFP). Methods A total of 50 patients with VFP participated in this study. Pre- and post-IL assessments were performed, which included analyzing the sustained vowel /a/ phonation, and the patient reading 1 Korean sentence from the “Walk” passage that comprised 25 syllables in 10 words. To investigate the effect of IL on vocal fold function, acoustic analysis (acoustic voice quality index, cepstral peak prominence, maximum phonation time, speaking fundamental frequency) was conducted and auditory-perceptual (grade and overall severity), visual judgment (gap), and self-questionnaire (voice handicap index-10) assessments were performed. Results The patients with VFP showed statistically significant differences between pre-and post-IL assessments for acoustic and auditory-perception, visual judgment, and self-questionnaire assessments. Conclusion The patients with VFP showed positive change in vocal fold function between pre- and post-IL measurements. The findings showed that IL with hyaluronic acid is an effective method to improve vocal fold function in patients with VFP.

노인성 음성장애의 중증도 지표로 Acoustic Voice Quality Index(AVQI)의 유용성

김근효,이연우,배인호,박희준,왕수건,권순복 대한이비인후과학회 부산,울산,경남 지부회 2018 임상이비인후과 Vol.29 No.1

The purpose of this study was to explore the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in aging voice population. Materials and Methods:292 subjects with aging voice and 121 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text ‘‘Walk’’. A 2second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were edited, concatenated, and analyzed according to Praat script. And then auditory-perceptual assessment was performed by three raters. Results:The aging voice group showed higher AVQI, G and OS values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.827 to 0.902. In ROC curve analysis, cutoff values of AVQI, G, and OS were <4.22, <0.00, and <30.00, respectively, and the AUC of each analysis was over .90. Conclusions:AVQI and auditory evaluation can improve the early screening ability of aging voice and help to establish effective diagnosis and treatment plan for age-related dysphonia.

노인성 음성장애에 대한 켑스트럼 분석에서의 무성음 분절 영향

김근효,이연우,배인호,박희준,이창윤,권순복 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Background and Objectives:The purpose of this study is to investigate the effect of unvoiced segments on cepstral analysis in patients with presbyphonia. Materials and Methods:A total of 381 participants (263 participants with presbyphonia and 118 with normal voices participated in this study. The sustained vowel /a/ 2 seconds and one sentence from ‘San-Chaek’ were edited and analyzed using the Praat script. Auditory-perceptual rating was also performed by three raters. Results:All parameters except LHRatio_V and extracted continuous speech (EXT) showed a significant difference between the normal and the dysphonia groups. The normal group showed higher cepstral peak prominence (CPP) and smoothed CPP (CPPS) than the dysphonia group. Additionally, AP ratings of the normal group were lower than that of the dysphonia group. The correlation within the measured values ranged from -0.86 to -0.66. In continuous speech (CS), there was a significant difference of area under the curve (AUC) between CPP and CPPS, but there was no significant difference in EXT. Conclusions: Through this study, we confirmed the effect of unvoiced segments on cepstral analysis. By removing the unvoiced segments, the measured values of the cepstral analysis showed an increase. Through further studies, we hope to increase the accuracy of discriminating dysphonia by extracting the unvoiced segments.

Recording Quality of Smartphone for Acoustic Analysis

김근효,강덕훈,이연우,김형순,권순복,조영석,박희준,최양규,신범주 대한이비인후과학회 부산,울산,경남 지부회 2016 임상이비인후과 Vol.27 No.2

Introduction:The U-health system supports health care services for prevention, diagnosis, medical treatment, and post-health management. Currently, various medical service systems such as telemedicine, emergent medical treatment, and private health monitoring are in use. Diagnosis of patient with glottic cancer using pathologic voice is one of private health monitoring. Aim:The purpose of this study was to compare the quality of pathologic voice in various recording methods using smartphone. Methods:Voice samples were collected simultaneously from 28 patients with glottic cancer using nine recording methods. Acoustic analysis was performed to assess the parameters including jitter, shimmer, noise to harmony, and cepstral prominence peak of voice quality using MDVP and ADSV. Results:Correlations were calculated among the various parameters. All of the measured acoustic parameters showed the highest correlation to CPP. The high correlation method used for the iPhone involved a combination of a professional recording app and a unidirectional microphone, while the high correlation method used for an Android phone involved a combination of a professional recording app and an internal microphone. Conclusions:The present findings indicate that the smartphone devices of both iPhone and Android phone were useful for recording and analyzing pathologic voice for evaluation in clinical practice. We confirmed the possibility of using smartphone-based recording for spectral and cepstral analysis of pathologic voice. The value of the mobile device and its applications may be in its ability to provide meaningful, accurate, and timely informative guidance to the clinician by improving the availability and quality of patient’s findings.

성대마비의 음성장애 측정을 위한 청지각적 및 음향학적 평가

김근효,이연우,박희준,배인호,이병주,권순복,Kim, Geun-Hyo,Lee, Yeon-Woo,Park, Hee-June,Bae, In-Ho,Lee, Byung-Joo,Kwon, Soon-Bok 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : The purpose of this study was to investigate the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in patients with vocal cord paralysis (VCP). Materials and Methods : Total 210 patients with VCP and 236 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text "Walk". A 2 second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were recorded. And then voice samples were edited, concatenated, and analyzed according to Praat script. Two standardized auditory-perceptual assessment (GRBAS and CAPE-V) were performed by three raters. Results : The VCP group showed higher AVQI, Grade (G) and Overall Severity (OS) values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.904 to 0.926. In ROC curve analysis, cutoff values of AVQI, G, and OS were <3.79, <0.00, and <30.00, respectively, and the AUC of each analysis was over .89. Conclusion : AVQI and auditory evaluation can improve the early screening ability of VCP voice and help to establish effective diagnosis and treatment plan for VCP-related dysphonia.

성문암과 후두백반증 음성의 켑스트럼 분석 및 청지각적 평가

김근효,박희준,배인호,이연우,왕수건,권순복 한국언어치료학회 2015 한국언어치료학회 학술발표대회 논문집 Vol.2015 No.12