Laryngoscopy,Voice Subjective And Objective Assessments Of Normal Adult Female In Different Physiological Periods

ObjectiveTo investigate the laryngeal morphologic characteristics and the voice changes of normal adult females in different physiological periods,to discuss the value of laryngoscopic observation and subjective and objective voice analysis in evaluating the adult female voice.MethodsNormal adult females were divided into three groups:the young female group(aged 20-43 years old,48 cases),the menopausal female group(aged 45-55 years old,59 cases),and the elderly female group(aged 60-88 years old,52 cases).The electronic laryngoscope,visual analog scale(VAS),simplified Chinese version of voice handicap index(VHI-13),GRBAS subjective assessment and voice acoustic analysis were performed in the subjects.The laryngeal morphology and the state of glottic closure were investigated in three groups.The differences of subjective voice assessments between menopausal group and elderly group and the differences of voice acoustic analysis among the three groups were compared separately.The relationship between the vocal cord edema or the state of glottic closure and the subjective and objective voice assessments were analysed separately in menopausal group and elderly group.ResultsThe laryngoscopic results revealed that the menopausal subjects mainly presented vocal fold edema and laryngeal mucosa dryness,and the elderly subjects mainly presented glottic incompetence and vocal fold atrophy.Generally the VAS scores,VHI scores,scales of grade(G)and roughness(R)were increased in most of the menopausal subjects and all of the elderly subjects(P<0.05).The VAS and VHI scores of elderly group were higher than those of menopausal group.The percentages of the cases with severe abnormal G and R were higher in elderly group than those in menopausal group(P<0.05).The voice analysis showed that,compared with the young group,jitter and shimmer were increased,while fundamental frequency(F0),maximum phonation time(MPT)and dysphonia severity index(DSI)were decreased in menopausal and elderly groups,which changed more in elderly group than those in menopausal group.The scales of G,R,jitter,shimmer were higher and F0,DSI were decreased in the menopausal and elderly subjects with vocal fold edema than those in the subjects without edema.The scales of G,R,jitter,shimmer were higher and MPT,DSI were decreased in the menopausal and elderly subjects with glottic incompetence than those in the subjects which completely closed.All of the differences in acoustic parameters were statistically significant(P<0.05或0.01).ConclusionMorphological changes(vocal fold edema,laryngeal mucosa dryness,glottic incompetence and vocal fold atrophy,ect.)and the abnormal voice assessments(subjective and objective analyses)were found in the menopausal and elderly subjects.The recession of voice function exists in the two groups.The study suggests that we should combine the voice subjective assessments,acoustic analysis with laryngoscopic observation to comprehensively evaluate the voice of normal adult females and provide a basis for the differentiation between physiological and pathological voice of the adult females.