中醫痰證患者之音聲分析－－以鼻竇炎患者為例

THE VOICE ANALYSIS ON PHLEGM SYNDROME IN TRADITIONAL CHINESE MEDICINE - A STUDY OF RHINOSINUSITIS PATIENTS

中醫聞診主要以患者的聲音作為診斷依據，但此傳統辨證方式缺乏客觀記錄，亦無法量化評估。本項研究以鼻竇炎患者為例，探討痰證之聞診見證，利用現代化之語音分析技術，分析患者之音聲，並與非痰證者之音聲比較，以探討其差異。由耳鼻喉科門診篩選鼻竇炎患者82 人（女性30 人，男性52 人）為痰證組；另外於健康檢查門診篩選無耳鼻喉疾病者60 人（女性30 人，男性30 人）為對照組。測試對象在隔音室發 /a/ 及 /m/ 二音，擷取開始發音第1 秒後至第4 秒前之音聲，並以多面向音聲分析系統與音聲共鳴等40 項參數進行分析。研究結果顯示：女性患者與對照組間，共有22 項參數有顯著差異（p < 0.05 ）；男性則有20 項。由此推測：鼻竇炎應會影響音聲之品質，原因可能與其改變聲道形態及聲帶黏稠度有關。另以Fisher’s 線性判別函數與逐步判別分析方式，求得痰證之判別函數，在女性患者之正確率為86.7% ，男性則為93.9%。 鼻竇炎之診斷一般需以x 光或電腦斷層檢查來確立，若能使用音聲分析之方式輔助診斷，可減少輻射線之暴露，本項研究結果應能提供醫師作為診斷鼻竇炎之參考。鼻竇炎只是痰證之一例，其他疾病痰證之音聲，則有待進一步研究。Listening examination is one of the major diagnostic methods in traditional Chinese medicine; however, it needs objective documentation and quantitative evaluations. In this study, we assessed the voice in patients with phlegm syndrome (rhinosinusitis) versus non-phlegm controls by means of computerized acoustic analysis system. Eighty-two (30 female, 52 male) patients and sixty (30 female, 30 male) controls were enrolled for voice analysis. Subjects were asked to phonate /a/ and /m/ for at least 4 seconds at their conversational pitch and intensity in a voice-isolated room. Approximately 2 seconds from the first second of each recording was subjected to analysis. Thirty acoustic parameters of multidimensional voice program (MDVP) and another ten of resonance were assessed. There were 22 significantly different (p < 0.05) parameters in female group and 20 in male group. Rhinosinusitis possibly affected the voice quality by altering the shape of voice tract and the viscosity of vocal folds. By using linear discriminant function, we could distinguish rhinosinusitis from non-rhinosinusitis with 86.7% in female group and 93.9% in male group. Voice analysis may be a simple, noninvasive procedure in conventional diagnosis instead of the radiation exposure. Our results suggested that it is a potential method in both diagnosis and outcome evaluation for rhinosinusitis. For other phlegm syndrome in traditional Chinese medicine other than rhinosinusitis, the sensitivity and feasibility of voice analysis allow further evaluation.