老年老年性嗓音障碍者言语呼吸运动学的特征研究

文献信息

中文摘要

背景： 喉部与呼吸系统的年龄相关变化可导致老年性嗓音障碍，但伴随或加重老年嗓音问题的言语呼吸行为仍缺乏充分描述。本研究考察了老年性嗓音障碍老年人的言语呼吸运动学，并与已发表的嗓音健康同龄人数据进行比较。
方法： 35名老年性嗓音障碍成人（20名男性，15名女性；平均年龄=79.8岁）在舒适条件和背景噪声条件下完成朗读和独白任务，同时记录感应式体积描记法和校准声学信号。主要结局为以肺容积起始（LVI）表示，即相对于呼气末水平的肺活量百分比（%VC）。次要指标包括肺容积终止（LVT）、肺容积变化幅度（LVE）、每音节LVE、呼气流量、吸气流量、发声长度、语速和声压级。采用双样本t检验和描述性比较，将组别和噪声条件与常模队列进行比较；采用混合效应模型评估发声长度的影响。
结果： 与典型老年人相比，老年性嗓音障碍参与者在各任务和响度条件下均以显著更低的LVI开始言语（独白平均差：-8.8 %VC和-15.4 %VC，p = .004和p < .001；响度独白平均差：-11.5 %VC，p = .008；朗读平均差：-7.8 %VC，p < .001）。他们还描述性地表现出更小的LVE、更短的发声、更快的语速、更高的呼气流量以及明显更低的吸气流量。在噪声条件下，老年性嗓音障碍者增加了LVI、LVE和吸气流量，而典型老年人则没有。发声长度影响两组的LVI、LVT、语速和呼气流量，但老年性嗓音障碍者从本已升高的基线水平表现出更大的呼气流量下降和更小的语速增加。
结论： 老年性嗓音障碍老年人表现出独特的言语呼吸特征：较低的LVI、减小的LVE、更短的发声和更快的语速、升高的呼气流量以及较低的吸气流量，这些在提高言语强度后部分趋于正常化。这些发现提示，呼吸运动学改变可能是老年性嗓音障碍症状的一部分。临床管理应在以喉部为重点的干预措施之外，同时考虑言语呼吸。未来研究应纳入同期、匹配良好的对照，并确定以呼吸为重点的疗法是否能改善言语呼吸模式和嗓音结局。

英文摘要

BACKGROUND: Age-related changes to laryngeal and respiratory systems contribute to presbyphonia, yet the speech breathing behaviors that accompany or exacerbate ageing voice problems remain poorly characterized. This study examined speech breathing kinematics in older adults with presbyphonia and compared them with published data from vocally healthy peers.
METHOD: Thirty-five adults with presbyphonia (20 men, 15 women; Mage = 79.8 years) completed reading and monologue tasks in comfortable and background noise conditions while inductive plethysmography and calibrated acoustics were recorded. Primary outcome was lung volume initiation (LVI) expressed as % vital capacity (%VC) relative to end-expiratory level. Secondary measures included lung volume termination (LVT), lung volume excursion (LVE), LVE per syllable, expiratory flow, inspiratory flow, utterance length, rate of speech, and sound pressure level. Group and noise condition comparisons were made against normative cohorts using two-sample t tests and descriptive comparisons; mixed-effects models assessed utterance length effects.
RESULTS: Compared with typical older adults, participants with presbyphonia initiated speech at significantly lower LVI across tasks and loudness conditions (mean difference monologue: -8.8 %VC and -15.4 %VC, p = .004 and p < .001; mean difference loud monologue: -11.5 %VC, p = .008; mean difference oral reading: -7.8 %VC, p < .001). They also showed descriptively smaller LVE, shorter utterances, faster speech, higher expiratory flows, and markedly lower inspiratory flows. In noise, presbyphonic speakers increased LVI, LVE, and inspiratory flow, whereas typical older adults did not. Utterance length influenced LVI, LVT, rate of speech, and expiratory flow in both groups, though presbyphonic speakers exhibited greater expiratory flow reductions and smaller speech rate increases from already elevated baselines.
CONCLUSIONS: Older adults with presbyphonia show a distinct speech breathing profile: lower LVI, reduced LVE, shorter utterances and faster rates of speech, elevated expiratory flow, and lower inspiratory flow, all of which partially normalize with increased speech intensity. These findings suggest that altered respiratory kinematics may be part of the symptomatology of presbyphonia. Clinical management should consider speech breathing alongside laryngeal-focused interventions. Future studies should include contemporaneous, well-matched controls and determine whether respiratory-focused therapies improve speech breathing patterns and voice outcomes.