分级嗓音训练在伴发音震颤的肌紧张性发声障碍中的应用

Application of graded voice training in muscle tension dysphonia with voice tremor

马佳良;林毓鸿;程丽宇;高磊;徐文

1:首都医科大学附属北京同仁医院康复医学科

2:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

摘要
目的 探讨分级嗓音训练治疗伴发音震颤的肌紧张性发声障碍(muscle tension dysphonia, MTD)的疗效。方法 回顾性分析2023年1月至2025年12月就诊的60例原发性MTD伴发音震颤患者的临床资料。参照Lederle等发音震颤分级标准,按震颤严重程度分为Ⅰ~Ⅲ级(分别为6、22、32例),实施阶梯式分级嗓音训练。训练前后以嗓音听感知评估共识(consensus auditory-perceptual evaluation of voice, CAPE-V)、嗓音障碍指数(voice handicap index-30,VHI-30)量表评估嗓音质量及生活质量,记录训练疗程并随访1年。结果 训练后,患者CAPE-V各维度评分及VHI-30总分均较训练前显著降低(P<0.05)。总体严重程度由训练前的60.17±23.14降至34.52±17.74,粗糙度由33.57±16.38降至18.48±13.98,紧张度由53.59±22.15降至28.85±13.52,震颤程度由60.47±23.44降至34.17±16.79;VHI-30总分由治疗前的41.03±10.07降至17.27±9.54。Ⅰ、Ⅱ级患者改善幅度优于Ⅲ级,Ⅲ级患者发音费力、震颤及紧张感亦显著缓解。随访显示,长病程患者坚持训练仍可获得持续改善。结论 分级嗓音训练可有效减轻MTD伴发音震颤患者喉肌紧张、降低发音震颤、提升嗓音稳定性与生活质量,对轻中度震颤患者效果尤为显著。
关键词
肌紧张性发声障碍;发音震颤;分级训练;嗓音康复
基金项目(Foundation):
作者
马佳良;林毓鸿;程丽宇;高磊;徐文
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