성대마비환자를 대상으로 시행한 후두근전도검사의 임상적 유용성

최홍식,최영준,문상우,김태만,최홍식,최영준,문상우,김태만 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.2

정상인과 일측성 성대마비환자의 읽기 시 호흡특성 비교

최예린 한국언어청각임상학회 2009 Communication Sciences and Disorders Vol.14 No.2

배경 및 목적: 성대가 마비되면 후두신경의 손상으로 인하여 성대가 불완전하게 폐쇄된 상태에서 발성을 하게 되어 폐에 있는 공기가 비효율적으로 빨리 소모되는 경향이 있다. 본 연구는정상인과 일측성 성대마비환자의 읽기 시 호흡특성을 비교하고 호흡특성의 차이에 영향을 미치는 요인들을 살펴보고자 하였다. 방법: 정상군과 일측성 성대마비군 각각 20명씩 총 40명을대상으로 폐활량, 최대발성지속시간(Maximum Phonation Time: MPT, 이하 MPT), 평균호기류율 및 성문하압, 표준화문단읽기 과제를 통해 1회 호흡당 음절수, 총 흡기 빈도 및 읽기속도,Kay Imaging Process System을 이용한 성문면적파형을 분석하였다. 결과: 정상군과 일측성성대마비군 간 폐활량과 읽기속도는 통계적으로 유의한 차이가 없었으나, MPT와 1회 호흡당음절수는 일측성 성대마비군이 정상군에 비해 통계적으로 유의하게 짧거나 적었다. 평균호기류율과 성문하압은 일측성 성대마비군이 정상군에 비해 통계적으로 유의하게 높았다. 표준화 된 최대성문면적은 일측성 성대마비군이 정상군 보다 통계적으로 유의하게 더 좁았으나, 표준화된 최소성문면적은 오히려 일측성 성대마비군이 정상군 보다 통계적으로 유의하게 더 넓었다. 문단 읽기 과제에서 1회 호흡당 음절수(음절수/1회 호흡)에 영향을 주는 변수들(MPT, 폐활량, 평균호기류율, 성문하압, 최소성문면적파형)에 대한 다중회귀분석 결과, 1회 호흡당 음절수총 변동의 약 65%를 MPT, 폐활량, 평균호기류율, 성문하압, 최소성문면적파형으로 설명할 수있었다. 1회 호흡당 음절수를 가장 잘 예견해주는 변수는 MPT였다. 논의 및 결론: 일측성 성대마비환자의 호흡특성과 1회 호흡당 음절수를 측정함에 있어 성문의 틈과 호흡기능을 객관적으로 측정한 상태에서 1회 호흡당 음절수와 다른 요인들과의 관련성을 살펴본 연구라는 측면에서임상적으로 의의가 있다고 사료된다. MPT, 성문면적, 평균호기류율, 성문하압 혹은 읽기과제에서 1회 호흡당 음절수, 흡기 빈도가 일측성 성대마비환자의 치료전후의 호전도를 평가할수 있는 지표가 될 수 있음을 시사한다. Background & Objectives: Patients with unilateral vocal fold palsy (UVFP) suffer from incomplete glottal closure and irregular vocal fold vibration, which interrupts the airflow needed for efficient voice production. This study investigated adult patients with UVFP, compared them to adult controls, and evaluated the differences between the two groups in the characteristics of glottal area waveform and phonation, as well as the relationship between glottal area waveform and respiratory and vocal function. Methods: Twenty control subjects and 20 adults with UVFP were studied. Respiratory and aerodynamic analysis and glottal area waveform (GAW) studies were performed. Results: There were no significant differences in respiratory function between the two groups. Subjects with UVFP had significantly shorter maximum phonation times (MPT) and fewer syllables per breath in a reading passage task than did control subjects. The frequency of inspiration, subglottic pressure (Psub), and mean airflow rate (MFR) were significantly higher in patients with UVFP than in control subjects. Multiple regression analysis was employed to examine the relationship between number of syllables per breath and four independent factors: MPT, Psub, MFR, and reading rate. Multiple regression analysis revealed that the number of syllables per breath was significantly influenced by MPT. Discussion & Conclusion: The results suggest that MPT, number of syllables per breath, and frequency of inspiration may be useful parameters in evaluating respiratory function in patients with UVFP.

일측성 성대마비와 성대구증의 성문면적파형과 발성 특성 비교

최재남(Jae-Nam Choi),김향희(HyangHee Kim),남정모(Chung Mo Nam),최홍식(Hong-Shik Choi) 한국언어청각임상학회 2007 Communication Sciences and Disorders Vol.12 No.3

배경 및 목적: 성대마비와 성대구증은 조직병리학적 차이가 있음에도 불구하고 유사한 음성 특성을 보인다. 본 연구에서는 일측성 성대마비(unilateral vocal fold palsy: UVFP)와 성대구증(sulcus vocalis: SV)의 성문면적파형 및 발성 특성을 비교하고자 하였다. 방법: UVFP군 20명, SV군 21명, 그리고 정상군 20명을 포함한 총 61명을 대상으로 공기역학적 평가, 음향학적 평가, 성문면적파형 측정을 실시하여 각 특성을 분석하였다. 결과: 공기역학적 특성은 UVFP군과 SV군이 통계적으로 유의한 차이를 보이지 않았다. 음향학적 특성은 문단 읽기 과제에서 주파수불규칙성은 SV군이 UVFP군에 비해 유의하게 높았다(p<.05). 성문면적파형 측정에서 최소성문면적이 정상군에 비해 환자군에서 통계적으로 유의하게 더 넓었고, 정상군에 비해 UVFP군이 전반적 성문폐쇄속도가 더 느렸다. 성문면적파형과 발성에 대한 집단 간 동시적 평가 결과 상대적 평균변이와 주기간 주파수 변이가 UVFP군이 SV이나 정상에 비해 현저하게 증가한 패턴을 보였다. 논의 및 결론: UVFP군이 SV군에 비해 주파수 변이가 뚜렷하게 증가해 있다는 것은 UVFP군이 양측 성대 진동의 동시성에 어려움이 있다는 것을 반영해 주고 있다. 이것은 성문폐쇄부전의 원인에 따라 성대 기능의 차이가 있다는 것을 암시하고, 상대적․절대적 주파수 변이가 경도 및 중등도의 두 환자군을 변별해 주는 중요한 진단적 음성 지표가 될 수 있음을 시사하고 있다. Background & Objectives : Despite of their histopathological differences, unilateral vocal fold palsy (UYFP) and sulcus vocalis (SV) manifest similar vocal characteristics. This srudy investigated differences in the characteristics of gloual area waveform (GAW) and phonation in patients with UVFP or SV. Method:j: Subjects for the srudy consisted of20 individuals with normal vocal status (NL), 20 patients with UVFP, and 21 patients with SV. Aerodynamic and acoustic analyses and GA \V measurement were performed. Re:ju/I:j: Comparing with the NL group; (1) the two pati ent groups (UVFP and SV) had significandy larger mean air flow ra te; (2) the UVFP group had a s ignificandy larger phonation quotient; and (3) the SV group had a significa ndy lower vocal efficiency. Also comparing with the NL group, the two patienl groups showed in Ia! vowel prolongation task; (1) signi ficandy shorter maximum phonation time; (2) higher jitter, shimmer, noise-to-harmonic ratio, and re lative average perturbation; (3) larger frequency distribut ion mean, ampli tude quotient distribution mean, closed quotient distribution mean, pitch crossplot with irregu larity score, and amplitude crossplot with irregu larity score in a reading passage task; and (4) smaller closed quotient . The SV group had a significantly wider normalized baseline offSet than the other two groups. Gross closing rate was the s lowest in the UYFP group. Diclusion & Conclusion: Quantitative measurement of GA W may be a usefu l method to evaluate patients with glottic incompetence. Additiona lly, jitter and relative average perturbation might be important diagnostic parameters in patients with mild to moderate UVFP or SV.

비위관 거치 환자에서 전신마취후 발생한 성대마비 : 중례보고

원유훙,김웅 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

저자들은 비위관 거치환자에서 전신마취후에 확인된 편측성 성대마비환자 2예를 후향적 관찰하였다.비위관삽입에 의한 합병증으로 성대마비가 초래될 수 있으며 본 증례에서와 같이 기관내 삽관마취와 연관되었을 경우 그 원인은 복합적인 것으로 여러 인자에 상호작용도 고려해야 한다. 본 증례에서 환자는 모두 일측성 성대마비를 보였으며 마비정도는 모두 정중위였고 파열이나 형태변화, 출혈은 관찰되지 않았으며 수술 후 60∼90일에 회복양상을 보였다. 반회신경마비는 원인 인자가 많고 복잡하여 불명한 점이 많으며 일측성 성대마비는 본 증례에서와 같이 특별한 치료없이 정상으로 회복되나 아주 드물게 양측성으로 초래될 경우 심각한 호흡장애와 합병증이 유발될 수 있으므로 비위관 거치환자에서 기관내 삽관을 통한 전신마취를 시행할 경우 술전 후두부에 감시와 더불어 마취후 애성이 지속될 경우 조기검사도 고려해야 된다고 사료된다. We have had two cases of unilateral vocal cord paralysis in the patients treated by insertion of a nasogastric tube after endotracheal anesthesia. The patients had the operation unrelated the course of recurrent laryngeal nerve. Anesthesia ended uneventfully. Following extubation, patients showed hoarseness and the symptom aggrevated. Laryngoscopic examination revealed left vocal cord paralysis with median fixed position and moderate post crycoid swelling found in one patient. The recovery was relatively good. 60-90 days after operation, the patient's vocal cord function had returned to the normal. The factor contributing vocal cord paralysis seemed to be inserted nasogastric tube and endotracheal tube or both. We considered the interaction of this combination responsible for the vocal cord paralysis.

Vocal Fold Palsy Induced by Seldinger Technique for Totally Implantable Venous Access Device

Hoon Park(박훈),Myung-Chul Lee(이명철),Young-Bum Kim(김영범),Guk-Haeng Lee(이국행) 대한두경부종양학회 2012 대한두경부 종양학회지 Vol.28 No.2

셀딩거 방법을 이용한 TIVAD 삽입 시 신경손상으로 인하여 성대마비가 발생할 가능성은 아주 낮은 것으로 알려져 있다. 본원에서 셀딩거 방법을 이용한 TIVAD 삽입 후 우측 성대마비가 발생한 18세 남아환자에서 초음파 검사를 시행하여 미주신경의 손상을 확인한 증례가 있어 보고하고자 한다

성대마비를 동반한 갑상선 종양으로 오인된 Zenker게실 치험 1예

이종대,박훈,신재민,고윤우 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.2

We usually consider the anterior neck mass associated with ipsilateral vocal cord paralysis as a thyroid tumor. Zenkers diverticulum (ZD) is classically defined as a pulsion diverticulum between the cricopharyngeal muscle and inferior constrictor muscle in an area of Killian's triangle. If ZD increases sufficiently, it might be presented as a anterior neck mass, or a thyroid tumor. In the literature, ZD has been rarely presented as a thyroid mass associated with ipsilateral vocal cord palalysis. ZD occurs predominantly in the elderly and induces non-specific symptoms such as dysphagia, regurgitaion, aspiration pneumonia, and halitosis. Vocal cord paralysis associated with ZD may be related to carcinoma occurring in ZD. We report, with a brief review of literature, a case of ZD mimicking the thyroid tumor associated with vocal cord paralysis and treated with surgery.. (Korean J Otolaryngol 2006;49:241-5)

성대마비 및 성대용종 환자의 수술 전과 후의 공기역학적 변수 비교

이다혜,김재옥,오재국,최홍식,Lee, Dahye,Kim, Jaeock,Oh, JaeKoon,Choi, Hong-Shik 대한후두음성언어의학회 2015 대한후두음성언어의학회지 Vol.26 No.2

Background and Objectives : Aerodynamic analysis is an examination which provides information regarding various vocalization measures indicating laryngeal efficiency. Voice evaluation using such examination must be capable of distinguishing between normal to abnormal voice. It also observes variables on aerodynamic characteristics by gender in regards to patients of vocal disorders, especially of vocal cord paralysis and vocal polyp, and compares the conditions before and after surgery. This paper therefore, seeks to build a framework for establishing standard levels of aerodynamical characteristic on vocal disorders. Subjects and Methods : The study was intended for a total number of 20 patients with vocal polyp or unilateral vocal cord paralysis. Those with the vocal polyp underwent laryngomycroscopy surgery and the vocal cord paralysis, vocal fold injection using Restylane. Aerodynamic analysis fulfilled the Maximum sustained Phonation (MXPH) and Voicing Efficiency (VOEF) by using PAS Model 6600 (KayPENTAX, USA). Results : In MXPH, increase in PHOT were evident with vocal polyp after surgery. As for patients with vocal cord paralysis, MAXDB, MEADB, DHODB, PHOT all have increased and MEAP, PEF, MEAF decreased after surgery. In VOEF, patients with vocal cord paralysis who underwent surgery showed increase in MAXDB, MEADB, DHODB, FET100, ARES, but decreases in PEF, TARF. Conclusion : Overall, it can be concluded that patients with the vocal polyp and vocal cord paralysis seemed to get closer to the normal values after than before surgery in majority of measures. This confirms that the function of their vocal cord has improved nearly to normality through operations.

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.

실시간 광유도 성대주입술의 개발과 임상적 적용

허진,차원재 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.1

Vocal fold injection (VFI) is widely accepted as a first line treatment in treating unilateral vocal fold paralysis and other vocal fold diseases. Although VFI is advantageous for its minimal invasiveness and efficiency, the invisibility of the needle tip remains an essential handicap in precise localization. Real-time light-guided vocal fold injection (RL-VFI) is a novel technique that was developed under the concept of performing simultaneous injection with precise placement of the needle tip under light guidance. RL-VFI has confirmed its possibility of technical implementation and the feasibility in injecting the needle from various directions through ex vivo animal studies. Further in vivo animal study has approved the safety and feasibility of the procedure when various transcutaneous approaches were applied. Currently, RL-VFI device is authorized for clinical use by the Ministry of Food and Drug Safety in South Korea and is clinically applied to patients with safe and favorable outcome. Several clinical studies are currently under process to approve the safety and the efficiency of RL-VFI. RL-VFI is expected to improve the complication rate and the functional outcome of voice. Furthermore, it will support laryngologists in overcoming the steep learning curve by its intuitive guidance.

일측성 성대마비 환자 평가에서 Cepstral Peak Prominence의 유용성

이창윤,정희석,손희영,Lee, Chang-Yoon,Jeong, Hee Seok,Son, Hee Young 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : The purpose of this study was to compare the usefulness of Cepstral peak prominence (CPP) with parameter of Multiple Dimensional Voice Program (MDVP) in evaluating unilateral vocal fold paraylsis patients with subjective voice impairment. Materials and Methods : From July 2014 to August 2016, 37 patients with unilateral vocal fold paralysis who had been diagnosed with unilateral vocal fold paralysis and had received two or more voice tests before and after the diagnosis were evaluated for maximum phonation time (MPT), MDVP and CPP. Respectively. Voice tests were performed with short vowel /a/ and paragraph reading. Results : The CPP-a (CPP with vowel /a/) and CPP-s (CPP with paragraph reading) of the Cepstrum were statistically negatively correlated with G, R, B, and A before the voice therapy. Jitter, Shimmer, and NHR of MDVP were positively correlated with G, R, B. Jitter, Shimmer, and NHR of the MDVP were significantly correlated with the Cepstrum index. G, B, A and CPP-a and CPP-s showed a statistically significant negative correlation and a somewhat higher correlation coefficient between 0.5 and 0.78. On the other hand, in MDVP index, there was a positive correlation with G and B only with Jitter of 0.4. Conclusion : CPP can be an important evaluation tool in the evaluation of speech in the unilateral vocal cord paralysis when speech energy changes or the cycle is not constant during speech.