倒谱峰值突出与音高强度作为儿童发声障碍声学指标的研究

文献信息

中文摘要

目的： 本研究考察了平滑倒谱峰值突出（CPPS）和音高强度在持续元音和连续言语中区分健康儿童与发声障碍儿童声音的程度。
方法： 采集了100名4至12岁儿童（均值=7.8，标准差=2.4，48%为女性）的语音样本。42名儿童存在良性声带病变，58名无嗓音主诉史。在持续元音和连续言语上计算CPPS和音高强度。采用单变量和多变量逻辑回归模型评估声学指标与嗓音障碍状态之间的关联。受试者工作特征分析量化了分类准确性并确定了最佳阈值。
结果： 与嗓音健康对照组相比，发声障碍儿童在持续元音和连续言语上的CPPS和音高强度值均显著更低。持续元音上的CPPS是嗓音状态的最强预测因子；然而，所有指标均能有效区分有和无发声障碍的儿童。尽管存在显著的组间差异，组内变异性较大限制了明确诊断截断值的建立。区分有和无发声障碍儿童的最佳阈值分别为：持续元音CPPS为11.19 dB（95% CI=10.58-12.29），连续言语CPPS为9.48 dB（95% CI=8.98-10.06），元音音高强度为0.30（95% CI=0.27-0.35），连续言语音高强度为0.28（95% CI=0.25-0.28）。
结论： 研究结果支持在常规儿童嗓音评估中使用CPPS，并将音高强度确定为有前景的辅助指标。将简短的倒谱和音高分析纳入标准临床方案，可在减少儿童测试负担的同时提高客观性。

英文摘要

OBJECTIVE: This study examined the extent to which Cepstral Peak Prominence Smoothed (CPPS) and pitch strength differentiate between healthy and dysphonic pediatric voices using sustained vowels and connected speech.
METHODS: Voice samples were collected from 100 children between the ages of 4 and 12 years (mean = 7.8, SD = 2.4, 48% female). Forty-two children presented with benign vocal fold lesions, and 58 had no history of voice complaint. CPPS and pitch strength were calculated on sustained vowels and connected speech. Univariable and multivariable logistic regression models assessed associations between acoustic measures and voice-disorder status. Receiver operating characteristic analyses quantified classification accuracy and identified optimal thresholds.
RESULTS: Children with voice disorders demonstrated significantly lower CPPS and pitch strength values on sustained vowel and connected speech when compared to vocally healthy controls. CPPS on sustained vowel was the strongest predictor of voice status; however, all measures effectively separated children with and without voice disorders. Despite significant group-level differences, substantial within-group variability limited the establishment of clear diagnostic cutoffs. Optimal thresholds for differentiating children with and without voice disorders were 11.19 dB for CPPS on sustained vowel (95% CI = 10.58-12.29), 9.48 dB for CPPS on connected speech (95% CI = 8.98-10.06), 0.30 for pitch strength on vowel (95% CI = 0.27-0.35), and 0.28 for pitch strength on connected speech (95% CI = 0.25-0.28).
CONCLUSIONS: Findings support the use of CPPS in routine pediatric voice assessment and identify pitch strength as a promising adjunctive metric. Incorporating brief cepstral and pitch-based analyses into standard clinical protocols may enhance objectivity while minimizing testing burden in children.