내전형 연축성 발성장애 여성 환자와 정상 성인 여성 화자 간 연속발화 시 공기역학적 특성 비교 = Comparison of Aerodynamic Characteristics During Continuous Speech Between Female Patients with Adductor Spasmodic Dysphonia and Normal Adult Females

다국어 초록 (Multilingual Abstract)

Spasmodic dysphonia (SD) is a neurological voice disorder of the central nervous system characterized by focal laryngeal dystonia and is known to substantially impair patients' occupational, social, and psychological quality of life. Adductor spasmodic dysphonia (ADSD), which account for approximately 80% of all SD cases, is the most prevalent subtype and directly affects airflow regulation during phonation due to repetitive hyperadduction of the vocal folds.
However, previous studies have primarily focused on sustained vowel phonation tasks, which have limitations in reflecting the dynamic characteristics of real-life communicative situations. Therefore, this study aimed to objectively analyze the phonatory patterns during connected speech in female patients with adductor spasmodic dysphonia (ADSD) using the Phonatory Aerodynamic System (PAS) and to identify pathological characteristics by comparing them with normal adult female speakers.
This study included with 22 female ADSD patients and 20 normal adult women. Aerodynamic assessment was performed using the Phonatory Aerodynamic System (PAS) during connected speech tasks. The outcome measures comprised running speech parameters and breath group-related measures, including the number of breath groups, duration per breath group, and mean number of syllables per breath group. Aerodynamic characteristics were compared between the two groups, and correlations between breath group-related measures and running speech parameters were analyzed within each group.
The results indicated that patients with adductor spasmodic dysphonia (ADSD) exhibited significantly higher values than the normal group in expiratory airflow duration, inspiratory airflow duration, inspiratory volume, expiratory volume, peak expiratory airflow, maximum SPL, pitch range, and number of breath groups. In addition, expiratory airflow duration, inspiratory airflow duration, peak expiratory airflow, expiratory volume, and phonation time were positive correlated with the number of breath groups and negatively correlated with the mean number of syllables per breath group.
These findings suggest that, due to spasmodic vocal fold adduction and irregular glottal movements, ADSD patients employ inefficient respiratory–phonatory strategies characterized by excessive respiratory and phonatory effort to sustain vocal output despite reduced phonatory efficiency.
These results can be utilized as objective indicators for accurate diagnosis of ADSD and verification of treatment effects in the future.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구의 배경 및 목적 1
• 2. 연구 문제 5
• Ⅱ. 이론적 배경 7
• 1. 연축성 발성장애 7
• 가. 감별진단의 필요성 10
• 나. 근긴장성 발성장애와의 감별진단 10
• 다. 음성진전과의 감별진단 11
• 2. 음성평가 13
• 3. 공기역학적 평가 15
• 4. 연속발화 19
• Ⅲ. 연구 방법 22
• 1. 연구대상 22
• 2. 연구절차 24
• 가. 사례력 조사 24
• 나. 공기역학적 측정 25
• 다. 공기역학적 분석 27
• 3. 결과처리 29
• Ⅳ. 연구 결과 30
• 1. ADSD환자군과 정상 대조군의 연속 발화 시 공기역학적 측정치 차이 30
• 1-1. 호기지속시간(Expiratory Airflow Duraion) 30
• 1-2. 흡기지속시간(Inspiratory Airflow Duration) 32
• 1-3. 최고 호기류율(Peak Expiratory Airflow) 33
• 1-4. 호기량(Expiratory Volume) 34
• 1-5. 최고 흡기류율(Peak Inspiratory Airflow) 35
• 1-6. 흡기량(Inspiratory Airflow) 36
• 1-7. 최대강도(Maximum SPL) 37
• 1-8. 평균음도(Mean Pitch) 38
• 1-9. 음도범위(Pitch Range) 39
• 1-10. 발성시간(Phonation time) 40
• 2. ADSD환자군과 정상 대조군의 연속 발화 시 호흡단락관련수치 차이 41
• 2-1. 호흡단락 수(Number of Breath Groups) 41
• 2-2. 호흡단락당 지속시간(Duration per Breath Group) 42
• 2-3. 호흡단락당 평균음절수(Mean Syllables per Breath Group) 43
• 3. ADSD환자군의 연속 발화 시 호흡단락관련수치와 공기역학적 측정치간 상관관계 44
• 4. 정상 대조군의 연속 발화 시 호흡단락관련수치와 공기역학적 측정치간 상관관계 46
• Ⅴ. 결론 및 논의 48
• 1. ADSD환자군과 정상 대조군의 연속 발화 시 공기역학적 측정치의 차이 48
• 2. ADSD환자군과 정상 대조군의 연속 발화 시 호흡단락관련수치의 차이 50
• 3. ADSD환자군의 연속 발화 시 호흡단락관련수치와 공기역학적 측정치간 상관관계 50
• 4. 정상 대조군의 연속 발화 시 호흡단락관련수치와 공기역학적 측정치간 상관관계 53
• 5. 연구의 의의 및 제한점 54
• 참고문헌 56