嗓音训练改善早期声带息肉患者发声功能的效果

doi:10.3969/j.issn.1006-9771.2020.08.012

摘要/Abstract

摘要：

目的探讨嗓音训练改善早期声带息肉患者发声功能的临床效果。方法 2016年5月至2018年5月,本院早期单侧广基型声带息肉患者80例随机分为对照组(n = 40)和试验组(n = 40)。两组均进行嗓音卫生宣教,试验组增加嗓音训练,每次40 min,每周1次,共12周。比较两组干预前后纤维喉镜下声带息肉大小、嗓音障碍指数(VHI)和嗓音客观分析等指标。结果对照组5例、试验组7例脱落。治疗后,试验组声带息肉治愈率和好转率显著高于对照组(χ² = 24.608, P < 0.001);试验组VHI各范畴评分均显著改善( t/Z >11.701, P < 0.001),且显著优于对照组( t/Z >7.027, P< 0.001);试验组基频微扰、振幅微扰和最长发声时间较治疗前显著改善(|t/Z| >5.012, P < 0.001),且试验组均显著优于对照组( t/Z >4.596, P < 0.001)。结论嗓音训练可以改善早期声带息肉患者的发声功能,降低嗓音嘶哑程度,改善患者的嗓音质量。

关键词: 声带息肉, 嗓音训练, 发声功能

Abstract:

Objective To investigate the clinical effect of voice training on the vocal function of patients with early vocal fold polyps. Methods From May, 2016 to May, 2018, 80 patients with unilateral wide-based vocal fold polyps were randomly divided into control group (n = 40) and experimental group (n= 40). Both groups underwent voice hygiene education, and the experimental group accepted voice training, 40 minutes a week for twelve weeks in addition. They were evaluated with fiber laryngoscope, voice handicap index (VHI) and the computer phonatory detection before and after training. Results Five in the control group and seven in the experimental group were dropped out. After training, the cure rate and the improvement rate of vocal fold polyps were significantly higher in the experimental group than in the control group ( χ² = 24.608, P < 0.001). The scores of VHI significantly improved in the experimental group ( t/Z >11.701, P < 0.05), and were better than those in the control group ( t/Z >7.027, P< 0.001). The scores of jitter, shimmer, and maximum phonation time improved (|t/Z| >5.012, P < 0.001) after training in the experimental group, and were better than those in the control group ( t/Z >4.596, P < 0.001). Conclusion Voice training could improve the vocal function of patients with early vocal fold polyps, reduce hoarseness, and improve the voice quality.

Key words: vocal fold polyps, voice training, vocal function

中图分类号:

R767.92

彭静,李旭红,邹密,谭敏. 嗓音训练改善早期声带息肉患者发声功能的效果[J]. 《中国康复理论与实践》, 2020, 26(8): 936-940.

PENG Jing,LI Xu-hong,ZOU Mi,TAN Min. Effect of Voice Training on Vocal Function for Patients with Early Vocal Fold Polyps[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(8): 936-940.

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参考文献 31

[1]	尤慧华, 诸葛盼, 王翰青, 等. 声带息肉患者的主客观嗓音评估特征[J]. 听力学及言语疾病杂志, 2016, 24(1):85-87.
	You H H, Zhuge P, Wang H Q, et al. Characteristics of subjective and objective voice assessment in patients with vocal cord polyps[J]. J Audiol Speech Pathol, 2016, 24(1):85-87.
[2]	Vasconcelos D, Gomes A, Araújo C. Vocal fold polyps: literature review[J]. Int Arch Otorhinolaryngol, 2019, 23(1):116-124. doi: 10.1055/s-0038-1675391
[3]	Sulica L, Behrman A. Management of benign vocal fold lesions: a survey of current opinion and practice[J]. Ann Otol Rhinol Laryngol, 2003, 112(10):827-833. doi: 10.1177/000348940311201001
[4]	Öcal B, Tatar E Ç, Toptaş G, et al. Evaluation of voice quality in patients with vocal fold polyps: the size of a polyp matters or does it[J]. J Voice, 2020, 34(2):294-299. doi: 10.1016/j.jvoice.2019.04.009
[5]	Dursun G, Karatayli-Ozgursoy S, Ozgursoy O B, et al. Influence of the macroscopic features of vocal fold polyps on the quality of voice: a retrospective review of 101 cases[J]. Ear Nose Throat J, 2010, 89(3):E12-E17.
[6]	Jeong W J, Lee S J, Lee W Y, et al. Conservative management for vocal fold polyps[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(5):448-452. doi: 10.1001/jamaoto.2014.243
[7]	de Vasconcelos D, Gomes A O, de Araújo C M. Treatment for vocal polyps: lips and tongue trill[J]. J Voice, 2017, 31(2): 252.e27-252.e36.
[8]	Hosoya M, Kobayashi R, Ishii T, et al. Vocal hygiene education program reduces surgical interventions for benign vocal fold lesions: a randomized controlled trial[J]. Laryngoscope, 2018, 128(11):2593-2599. doi: 10.1002/lary.v128.11
[9]	Zhuge P, You H, Wang H, et al. An analysis of the effects of voice therapy on patients with early vocal fold polyps[J]. J Voice, 2016, 30(6):698-704. doi: S0892-1997(15)00189-7 pmid: 26403648
[10]	Lee Y S, Lee D H, Jeong G E, et al. Treatment efficacy of voice therapy for vocal fold polyps and factors predictive of its efficacy[J]. J Voice, 2017, 31(1): 120.e9-120.e13.
[11]	Sahin M, Gode S, Dogan M, et al. Effect of voice therapy on vocal fold polyp treatment[J]. Eur Arch Otorhinolaryngol, 2018, 275(6):1533-1540. doi: 10.1007/s00405-018-4962-z
[12]	Wang H, Zhuge P, You H, et al. Comparison of the efficacy of vocal training and vocal microsurgery in patients with early vocal fold polyp[J]. Braz J Otorhinolaryngol, 2019, 85(6):678-684. doi: 10.1016/j.bjorl.2018.03.014
[13]	Barillari M R, Volpe U, Mirra G, et al. Surgery or rehabilitation: a randomized clinical trial comparing the treatment of vocal fold polyps via phonosurgery and traditional voice therapy with "voice therapy expulsion" training[J]. J Voice, 2017, 31(3): 379.e13-379.e20.
[14]	Ogawa M, Inohara H. Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions[J]. Auris Nasus Larynx, 2018, 45(4):661-666. doi: 10.1016/j.anl.2017.08.003
[15]	田勇泉. 耳鼻咽喉头颈外科学[M]. 北京: 人民卫生出版社, 2013: 184-185.
	Tian Y Q. Otorhinolaryngology, Head and Neck Surgery [M]. Beijing: People's Medical Publishing Press, 2013: 184-185.
[16]	Klein A M, Lehmann M, Hapner E R, Johns M M 3rd. Spontaneous resolution of hemorrhagic polyps of the true vocal fold[J]. J Voice, 2009, 23(1):132-135. doi: 10.1016/j.jvoice.2007.07.001 pmid: 18191376
[17]	黄永望, 傅静慧, 潘静. 实用临床嗓音疾病矫治学[M]. 天津: 天津科技翻译出版公司, 2018: 337-393.
	Huang Y W, Fu J H, Pan J. Practice Clinical Voice Therapy [M]. Tianjin: Tianjin Science and Technology Translation Publishing Company, 2018: 337-393.
[18]	Mailänder E, Mühre L, Barsties B. Lax Vox as a voice training program for teachers: a pilot study[J]. J Voice, 2017, 31(2): 262.e13-262.e22.
[19]	Fadel C B, Dassie-Leite A P, Santos R S, et al. Immediate effects of the semi-occluded vocal tract exercise with LaxVox^® tube in singers[J]. Codas, 2016, 28(5):618-624. doi: 10.1590/2317-1782/20162015168
[20]	Hakkesteegt M M, Brocaar M P, Wieringa M H. The applicability of the dysphonia severity index and the voice handicap index in evaluating effects of voice therapy and phonosurgery[J]. J Voice, 2010, 24(2):199-205. doi: 10.1016/j.jvoice.2008.06.007 pmid: 19185461
[21]	Boersma P, Weenink D. PRAAT: Doing phonetics by computer[J]. Ear Hear, 2011, 32(2):266.
[22]	Akbari E, Seifpanahi S, Ghorbani A, et al. The effects of size and type of vocal fold polyp on some acoustic voice parameters[J]. Iran J Med Sci, 2018, 43(2):158-163.
[23]	Jiang J J, Titze I R. Measurement of vocal fold intraglottal pressure and impact stress[J]. J Voice, 1994, 8(2):132-144. pmid: 8061769
[24]	Robieux C, Galant C, Lagier A, et al. Direct measurement of pressures involved in vocal exercises using semi-occluded vocal tracts[J]. Logoped Phoniatr Vocol, 2015, 40(3):106-112. doi: 10.3109/14015439.2014.902496
[25]	Meerschman I, Van Lierde K, Ketels J, et al. Effect of three semi-occluded vocal tract therapy programmes on the phonation of patients with dysphonia: lip trill, water-resistance therapy and straw phonation[J]. Int J Lang Commun Disord, 2019, 54(1):50-61. doi: 10.1111/1460-6984.2019.54.issue-1
[26]	Horáček J, Radolf V, Laukkanen A M. Impact stress in water resistance voice therapy: a physical modeling study[J]. J Voice, 2019, 33(4):490-496. doi: 10.1016/j.jvoice.2018.01.025
[27]	Dargin T C, Searl J. Semi-occluded vocal tract exercises: aerodynamic and electroglottographic measurements in singers[J]. J Voice, 2015, 29(2):155-164. doi: 10.1016/j.jvoice.2014.05.009
[28]	秦辉. 支撑喉镜和纤维喉镜下声带息肉切除术疗效分析[J]. 中国耳鼻咽喉头颈外科, 2016, 23(8):487-489.
	Qin H. Clinical effects of vocal cord polyp surgery under microlaryngoscope and fiberoptic laryngoscope[J]. Chin Arch Otolaryngol Head Neck Surg, 2016, 23(8):487-489.
[29]	欧阳杰, 黄永望, 高晓葳, 等. 手术联合围手术期嗓音训练治疗声带息肉的疗效分析[J]. 听力学及言语疾病杂志, 2018, 26(5):492-495.
	Ouyang J, Huang Y W, Gao X W, et al. The clinical efficacy of voice training on patients with vocal fold polyps during perioperative period[J]. J Audiol Speech Pathol, 2018. 26(5):492-495.
[30]	刘阳, 黄永望, 潘静, 等. 四步训练嗓音矫治法在声带息肉术后的应用及体会[J]. 中国中西医结合耳鼻咽喉科杂志, 2019, 27(4):259-263.
	Liu Y, Huang Y W, Pan J, et al. Application of four steps method about voice therapy on patients with vocal polyps after surgery[J]. Chin J Otorhinolaryngol Integ Med, 2019, 27(4):259-263.
[31]	何梦月, 徐岱松, 秦玉斌. 手术联合嗓音训练对伴肌紧张性发声障碍声带息肉患者的疗效分析[J]. 中国医学文摘(耳鼻咽喉科学), 2019, 34(1):47-48.
	He M Y, Xu D S, Qin Y B. Analysis of the effect of operation combined with voice training on vocal cord polyps with muscular tonic dysphonia[J]. Chin Med Digest (Otorhinolaryngol), 2019, 34(1):47-48.

项目	对照组 (n = 40)	试验组 (n= 40)	t/Z/χ²值	P值
性别(男/女,n)	13/27	12/28	0.058^a	0.809
年龄(岁)	39.42±12.25	40.61±16.67	0.375^b	0.707
病程(月)	3.67±1.67	3.91±1.76	-0.647^b	0.518
基频微扰(jitter) (%)	4.006±1.085	3.867±2.949	-1.135^b	0.256
振幅微扰(shimmer) (%)	10.709±1.657	11.120±4.041	-0.526	0.602
MPT (s)	12.620±1.083	11.786±4.895	-1.037	0.308
VHI	60.20±7.161	59.64±12.47	0.236	0.815

项目	对照组(n = 35)		试验组(n = 33)		t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c
项目	治疗前	治疗后	治疗前	治疗后	t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c
功能(F)	17.63±4.479	18.23±3.515	19.21±4.519	6.06±3.690	1.602	0.109	20.948	< 0.001	-14.419	< 0.001
生理(P)	27.66±4.905	26.51±4.865	24.06±7.437	11.42±5.607	-2.323	0.020	11.701	< 0.001	9.910	< 0.001
情感(E)	15.31±2.471	14.94±2.869	16.36±4.212	6.18±3.157	-0.976	0.329	14.754	< 0.001	7.027	< 0.001
总分(T)	60.20±7.161	59.00±6.949	59.64±12.475	23.67±10.200	1.314	0.189	20.289	< 0.001	15.198	< 0.001

项目	对照组(n = 35)		试验组(n = 33)		t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c
项目	治疗前	治疗后	治疗前	治疗后	t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c
MPT(s)	12.620±1.083	13.007±1.239	11.786±4.895	17.167±4.155	-1.869	0.070	-12.727	< 0.001	-5.991	< 0.001
jitter(%)	4.006±1.085	3.929±1.047	3.867±2.949	2.125±1.456	0.605	0.549	-5.012	< 0.001	4.596	< 0.001
shimmer(%)	10.709±1.657	9.754±1.731	11.120±4.041	5.877±1.944	5.288	< 0.001	10.384	< 0.001	9.088	< 0.001