神経性疾患における鼻咽腔閉鎖機能に関する研究

Abstract

Speech disorders confirmed in a number of neurological diseases are commonly dysarthria. The author took especial note of the velopharyngeal closure function in dysarthria of these diseases, and made a study of velopharyngeal closure function in patients with neurological diseases using the intelligibility rating examination, aerodynamic examination and nasopharyngeal fiberscopic examination. The subjects were 23 patients of neurological diseases and 15 controls with normal speech. Cases of the neurological diseases investigated in this study were 7 spinocerebellar degeneration, 5 myastenia gravis, 3 Parkinson's disease, 2 amyotrophic lataral sclerosis, and each 1 of myotonic dystrophy, motor neurone disease, pseudobulbar paralysis, oculopharyngeal dystrophy, mitochondrial myopathy, and brain tumor. The results were summarized as follows : 1. The score of the intelligibility rating examination of the neurological disease group (DG) was lower than that of normal group (NG) (p<0.05). 2. The score of the intelligibility rating examination on vowel, Ha-sounds, voiced and voiceless suonds and Ra-sounds of DG was lower than that of NG (p<0.01). That of nasal sounds was the same (p<0.05). On semivowel sounds, however, there was no difference between DG and NG. 3. In the aerodynamic examination, leakage of the air from nose was observed in 12 out of 15 cases when patient blew and pronounced monosyllable sounds. 4. In the aerodynamic examination, air volume of leakage from nose of DG was greater than that of NG and pressure of expiration from the mouth of DG were lower than NG. 5. The nasopharyngeal fiberscopic examination revealed that all 23 cases had some disorder of velopharyngeal closure function. 6. Eighteen out of 23 cases of DG corresponded to Yamaoka's classification. In these cases, 4 were type I c, 1 type II, 5 type III and 8 type IV. Other 5 cases did not correspond to this classification. 7. There was a considerable variety in the state and degree of closure even within each type of this classification. 8. A tremor in the velopharyngeal area at rest in 2 patients was found by the nasopharyngeal fiberscopic examination. The velopharyngeal area at rest in 2 patients was shaped something like a kidney bean. In other 2 patients, when this area moved to close, the paralyzed side of this area was covered by the other side.