嗓音训练治疗声带小结的疗效观察

The Effects of Voice Training Therapy on Dysphonia in Patients with Vocal Nodules

李艳;葛平江;彭莉佳;盛晓丽;许咪咪;任庆宜;陈少华;

1:广东省人民医院(广东省医学科学院)耳鼻咽喉科

2:星海音乐学院音乐学系

摘要
目的探讨嗓音训练对声带小结患者发声障碍的治疗效果。方法对21例声带小结患者进行嗓音训练,包括嗓音教育和发声训练,根据"呼吸-发声-共鸣"平衡原理,采用喉部按摩、无声练习及发大开口咽音的训练方法,每周训练一次,每次12小时,共5次。训练前后对患者进行嗓音障碍指数量表(VHI)评估、GRBAS评估、动态喉镜检查、空气动力学检测、计算机嗓音声学分析,比较治疗前后评估结果。结果 21例患者治疗后VHI评分总分(29.48±21.21分)明显低于治疗前(52.95±24.30分)(P<0.01);GRBAS评分中总嘶哑度G(0.67±0.76)明显低于训练前(1.88±1.05)(P<0.01),粗糙声R(0.52±0.58)明显低于训练前(1.36±0.55)(P<0.01);治疗后动态喉镜检查患者声带闭合、运动的对称性、粘膜波、振动规律性均改善(P<0.01);3例患者声带小结完全消失,13例患者声带小结缩小,5例与治疗前比较无明显变化;最长发声时间也由治疗前的8.87±3.75秒变为治疗后的12.54±3.68秒(P<0.01);治疗后嗓音的频率微扰、振幅微扰、噪谐比(分别为0.18%±0.08%、2.10%±0.98%、0.0034±0.0022dB)均明显低于治疗前(分别为0.43%±0.31%、4.55%±1.80%、0.0184±0.028dB)(P<0.01或0.05)。结论嗓音训练对声带小结患者发声障碍有良好的治疗效果。
关键词
声带小结;嗓音训练;嗓音评估
基金项目(Foundation):
广东省医学基金资助项目(A2013030)资助
作者
李艳;葛平江;彭莉佳;盛晓丽;许咪咪;任庆宜;陈少华;
参考文献

1 Karkos PD,McCormick M.The etiology of vocal fold nodules in adults[J].Curr Opin Otolaryngol Head Neck Surg,2009,17:420.

2 Leonard R.Voice therapy and vocal nodules in adults[J].Curr Opin Otolaryngol Head Neck Surg,2009,17:453.

3 彭莉佳.教师嗓音训练及保健[M].上海:华东师范大学出版社,2012.173~174.

4 徐文,李红艳,胡蓉,等.嗓音障碍指数量表中文版信度和效度评价[J].中华耳鼻喉头颈外科杂,2008,43:670.

5 Hirano M,Bless DM.Videostroboscopic examination of the larynx[M].San Diego:CA,Singular publishing group,Inc,1993.74~90.

6 陈秋桓,葛平江,苏小妹,等.最长最响发声时间评价单侧声带麻痹患者声门闭合情况的研究[J].临床耳鼻咽喉头颈外科杂志,2011,15:681.

7 刘平,张淑香.纤维喉镜下治疗声带良性病变[J].中国耳鼻咽喉头颈外科,2011,18:278.

8 Remacle L,Lawson G,Watelet JB.Carbon dioxide laser microsurgery of benign vocal fold lesions:indications,techniques,and results in 251patients[J].Ann Otolog,Rhinolog and Laryngolog,1999,108:156.

9 田勇泉,韩德民,孙爱华,等.耳鼻咽喉科头颈外科学[M].北京:人民卫生出版社,2008.198~199.

10 Chernobelsky SI.The treatment and results of voice therapy amongst professional classical singers with vocal fold nodules[J].Logoped Phoniatr Vocol,2007,32:178.

11 Holmberg E,Hillman R,Hammarberg B,et al.Efficacy of a behaviorally based voice therapy protocol for vocal nodules[J].J Voice,2001,15:395.

12 Holmberg E,Doyle P,Perkell J,et al.Aerodynamic and acoustic voice measurements of patients with vocal nodules:variation in baseline and changes across voice therapy[J].J Voice,2003,17:269.

13 Shah RK,Engel SH,Choi SS.Relationship between voice quality and vocal nodule size[J].Otolaryngol Head Neck Surg,2008,139:723.

14 闫燕,段静明,王丽,等.嗓音训练治疗声带小结的疗效观察[J].听力学及言语疾病杂志,2012,20:41.

15 Dejonckere PH,Bradley P,Clemente P,et al.A basic protocol for functional assessment of voice pathology,especially for investigating the efficacy of(phonosurgical)treatments and evaluating new assessment techniques[J].Eur Arch Otorhinolaryngol,2001,258:77.

16 段静明,闫燕,朱丽,等.嗓音训练改善职业用声者发音的疗效研究[J].中华耳鼻咽喉头颈外科杂志,2011,46:279.