Identificação das alterações na voz após cirurgia ao nervo laríngeo recorrente
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2010
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Embora pouco frequente e por acidente, o nervo laríngeo recorrente
pode ser seccionado durante a cirurgia tiroideia, o que ocasiona paralisia da corda
vocal homolateral. Até hoje não há um método eficaz para o reconstruir, porque o
nervo tem características únicas, uma vez que possui fibras adutoras e abdutoras. Se for feita a sua reconstrução com sutura dos topos, algumas fibras adutoras unem-se a abdutoras do outro lado, o que provoca movimentos discinérgicos e descoordenados das cordas vocais. Através de uma nova técnica cirúrgica pretende-se ultrapassar este problema tendo sido para isso escolhida a cabra como modelo animal. As cabras foram operadas e antes e após a cirurgia foram realizados registos do balido para identificar o momento de uma eventual regeneração das fibras nervosas com a consequente recuperação da voz da cabra. Uma das principais contribuições deste trabalho, para além do estudo de um conjunto de métodos e parâmetros que normalmente se utilizam na voz humana, prende-se na contribuição como um auxiliar tecnológico para validar a técnica cirúrgica.
Na identificação das alterações na voz das cabras ao longo do período de recobro
foram utilizadas avaliações objetivas e subjetivas com a adaptação de uma norma
aplicada à voz humana: Comparison Category Rating (CCR). Dada a quantidade
de dados envolvidos e a falta de referências na área no que diz respeito ao som da cobaia estabelecida para validar a técnica cirúrgica, o balido da cabra, optou-se por tentar procurar semelhanças a partir da abordagem subjectiva de forma a encontrar uma classe de amostras cujos resultados da avaliação objectiva fossem congruentes com os resultados do método subjectivo seguido. O software Praat serviu para estudar as características da voz das cabras, como o Jitter e o Harmonics to Noise Ratio (HNR). Como resultados da cabra de reconstrução 49, conclui-se que o maior número de sujeitos inquiridos (93,5%) respondeu que a 3ª amostra pós-operatória é a que mais se assemelha com a amostra pré-operatória e a maioria dos indivíduos inquiridos (87,09%) afirma que a voz evolui no sentido da amostra pré-operatória.
Referente à cabra 47, não se obteve uma ”melhor” amostra, como esperado pelos
resultados médicos.
Although infrequent, and by accident, the recurrent laryngeal nerve can be sectioned during thyroid surgery, causing paralysis of the ipsilateral vocal cord. Nowadays, there is not an effective method to reconstruct, because the nerve has unique characteristics, because it has fiber and water mains abductors. If its reconstruction will be made with suture of the tops, some adductor fibers join the abductors on the other side, resulting in uncoordinated movements and dyssynergia of the vocal cords. Through a new surgical technique aims to overcome this problem have been chosen for this goat as animal model. The goats were operated and before and after surgery were performed bleating records to identify the timing of a possible regeneration of nerve fibers with consequent recovery of voice of the goat. A major contribution of this work beyond the study of a set of methods and parameters are normally used in the human voice, concerns the contribution as a processing aid to validate the technique. In identifying the changes in the voice of the goats during the period of recovery room were used objective and subjective evaluations with adaptation of a standard applied to the human voice: Comparison Category Rating (CCR). Given the amount of data involved and the lack of references in the field with regard to the sound of the goats established to validate the surgical technique, it was decided to try to find similarities from the subjective approach in order to find a class sample results of objective evaluation were congruent with the subjective results of the method followed. The Praat software was used to study the characteristics of voice of the goats, like Jitter and the Harmonics to Noise Ratio (HNR). The results of reconstruction of goat 49, concludes that the greater number of subjects surveyed (93.5%) responded that the 3rd postoperative sample that is most similar to the sample pre-operative and most of those interviewed (87.09%) states that voice heading in the direction of the sample pre-operative. Referring to the goat 47, there was no one ”best”sample, as expected by the medical outcomes.
Although infrequent, and by accident, the recurrent laryngeal nerve can be sectioned during thyroid surgery, causing paralysis of the ipsilateral vocal cord. Nowadays, there is not an effective method to reconstruct, because the nerve has unique characteristics, because it has fiber and water mains abductors. If its reconstruction will be made with suture of the tops, some adductor fibers join the abductors on the other side, resulting in uncoordinated movements and dyssynergia of the vocal cords. Through a new surgical technique aims to overcome this problem have been chosen for this goat as animal model. The goats were operated and before and after surgery were performed bleating records to identify the timing of a possible regeneration of nerve fibers with consequent recovery of voice of the goat. A major contribution of this work beyond the study of a set of methods and parameters are normally used in the human voice, concerns the contribution as a processing aid to validate the technique. In identifying the changes in the voice of the goats during the period of recovery room were used objective and subjective evaluations with adaptation of a standard applied to the human voice: Comparison Category Rating (CCR). Given the amount of data involved and the lack of references in the field with regard to the sound of the goats established to validate the surgical technique, it was decided to try to find similarities from the subjective approach in order to find a class sample results of objective evaluation were congruent with the subjective results of the method followed. The Praat software was used to study the characteristics of voice of the goats, like Jitter and the Harmonics to Noise Ratio (HNR). The results of reconstruction of goat 49, concludes that the greater number of subjects surveyed (93.5%) responded that the 3rd postoperative sample that is most similar to the sample pre-operative and most of those interviewed (87.09%) states that voice heading in the direction of the sample pre-operative. Referring to the goat 47, there was no one ”best”sample, as expected by the medical outcomes.
Descrição
Dissertação de Mestrado em Engenharia Electrotecnica e de Computadores
Palavras-chave
Cirurgia tiroideia , Balido , Voz das Cabras , Praat , MOS , Comparison Category Rating (CCR) , Jitter , Harmonics to Noise Ratio (HNR)