The Clinical Application Of Glottal Measurement In Normal Adults And Bilateral Vocal Cord Paralysis' Patients

The clinical application of glottal measurement in normal adults and bilateral vocal cord paralysis' patients Objective: The purpose of this study is threefly. The first is to acquireabsolute quantitative data of glottal parameters in normal adults under theend of the deepest inspiration with electronic laryngoscope andcomputer-assisted glottal imaging process, to establish the scope of normalvalue of glottal parameters. The second is to study minimal glottic areawhich can acquire sufficient airway to decannulate and maximal glotticarea which can maintain preoperative vocal function on adult bilateralvocal cord paralysis with unilateral arytenoidectomy, at the same time, toprovided objective and accurate pre-and post-operative quantitative data ofvocal acoustic parameters and glottal parameters within different operationincluding laser arytenoidectomy and recurrent laryngeal nervousreinnervation and Woodman's procedure. The third is to study the size ofglottic area on bilateral vocal cords paralysis near to dyspnea degreeⅠ,andthe basis of the glottic area of decannulation after tracheotomy forlaryngeal obstruction on bilateral vocal cords paralysis, and to explore thefeasibility of linear regression using glottal area and other parameters,furthermore, to measure glottal parameters(including glottal area and thewidth of post glottis and angle between bilateral vocal cords) of dyspnea indegree Ⅰand degreeⅡ. Methods: In this study, Glottic parameters were measured withelectronic laryngoscope, length meter, GME2000 software, picture card ofStudio DC Plus 10 and common personal computer. The GME2000software was made by Shanghai GME science and technology Inc andStudio DC Plus 10 was made by Germany Pinnacle Systems Inc. Dynamicglottal image was preserved with 25 frame image every second includingthree to five glottal cycle which constitute the end of the deepest 第 4 页第二军医大学博士论文inspiration and voice phase. The glottal picture of the end of the deepestinspiration was preserved. The glottal parameters were measured withGME2000 software. The main glottal parameters including the glottal area,the glottal length, the length of bilateral vocal cord, the angle betweenbilateral vocal cord,the largest width of posterior glottis. Glottal model fornormal adults and difference bilateral vocal cord paralysis' patients weremade. The condition involving in the distance of the eletrolaryngoscopebottom to glottal plane, the position of the length meter and the anglebetween electronic laryngoscope and glottal plane were simulated whenmeasuring difference suitable glottal model. Twenty frame model imageswere saved and were measured using GME2000 software. In order torectify the difference between individual actual glottal value and imagingmeasure value,the rectifying coefficient was provided according to themeasuring mean value and the calculating value with glottal model.Moreover, voice acoustic parameters including Jitter, Shimmer, NNE, MPT,HNR were quantified using Dr Speech software. In part one, glottalmeasurement was proceed in 120 normal adults. In part two, glottalmeasurement was done in 34 cases with bilateral vocal cord paralysis, ofwhich sixteen cases were performed arytenoidectomy with laser andsustained laryngoscope, nine cases were done phrenic nerve graftcombining with nerve muscular pedicle (NMP) technique or nervedecompression and other nine cases in Woodman's procedure. In part three,glottic area of fourteen patients from choosing dyspnea near to degreeⅠon bilateral vocal cords paralysis were measured. at the same time,twenty-two patients with dyspnea in degreeⅠand degreeⅡ(degreeⅠin 12cases and degreeⅡin 10 cases ) were finished glottal measurement. Results: The maximal glottal area in normal male and female adultsduring condition of the end of the deepest inspiration was 150.70 ±13.46(112.43 ～ 178.54)mm2 and 1...