功能性发声障碍的临床特征及预后分析

Clinical Characteristics and Prognosis of Functional Dysphonia

崔卫新;徐文;程丽宇;

1:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科教育部耳鼻咽喉头颈科学重点实验室(首都医科大学)

摘要

目的探讨功能性发声障碍的诱因、临床特征及预后。方法回顾性分析104例功能性发声障碍患者的临床资料和频闪喉镜检查结果,并对所有患者进行共鸣发声疗法和重音治疗法发声训练,治疗前后行VHI评估和GRBAS评分,分析疗效。结果 104例中,无明显诱因34例(32.69%),诱发因素分别为上呼吸道感染29例(27.88%),情绪紧张22例(21.15%),用声过度10例(9.62%),其他因素9例(8.65%)。频闪喉镜检查见粘膜波正常43例(41.35%),黏膜波改变53例(50.96%,其中41例未引出黏膜波,12例黏膜波减弱),室带完全超越声带3例,不配合发声未引出黏膜波5例;发声时声门闭合不全65例(62.50%),声门上代偿性内收30例(28.85%),喉部挤压9例(8.65%)。随访67例,恢复正常53例(79.10%),其G评分、VHI评分均降为0分;6例发声明显好转但未完全恢复正常,G评分和VHI评分较治疗前降低;8例治疗后G评分和VHI评分无明显变化。结论功能性发声障碍诱因复杂,并非单一精神心理因素所致;喉镜检查多可见声带振动异常、声门闭合不良及声门上代偿;治疗可采取心理疏导、发声矫正和中医针灸相结合,多数患者预后较好。

关键词

功能性发声障碍;嗓音评估;影响因素;临床特征

基金项目(Foundation):

2014年北京市卫生系统高层次人才学科带头人项目资助(2014-2-2004)

作者

崔卫新;徐文;程丽宇;

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崔卫新徐文程丽宇