功能性发声障碍的临床特征及预后分析

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、V H I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。

Clinical Characteristics and Prognosis of Functional Dysphonia

Objective To investigate the cause ,clinical characteristics and prognosis of functional dysphonia . Methods The clinical data and the laryngostroboscopic examination of 104 patients with functional dysphonia were retrospectively analyzed .All the patients underwent the resonant therapy and the accent therapy ,and finished the voice handicap index (VHI) and GRBAS score before and after the treatment .Results Among the 104 patients ,34 cases (32 .69% ) had no apparent cause ,29 cases (27 .88% ) caused by upper respiratory tract infection ,22 cases (21 .15% ) by emotional tension ,10 cases (9 .62% ) by excessive pronunciation ,and 9 cases (8 .65% )by other cau‐ses .The laryngostroboscopic examination showed 43 cases (41 .35% ) with normal mucosal wave ,53 cases (50 . 96% ) with unfavorable mucosal wave changes (41 cases were unable to elicit mucosal wave ,12 cases showed the de‐creased mucosal wave) .The false vocal cords were totally compensatory in 3 cases .5 cases couldn't cooperate .Dur‐ing phonating ,65 cases (62 .50% ) showed glottis insufficiency ,30 cases (28 .85% )showed the supraglottic com‐pensatory ,and 9 cases (8 .65% ) showed the larynx presssed .Of the 67 cases followed up ,53 (79 .1% ) cases scored down to 0 both in G and VHI ,6 cases got obvious voice improvement with decreased G and VHI score com‐pared to the pre-treatment ,8 cases showed no significant difference .Conclusion The causes of functional dyspho‐nia were complex ,not just by a single psychological factor .The majority of laryngoscopy showed abnormal vibration of vocal folds ,glottis insufficiency and supraglottic compensation .The treatment included the psychological counseling ,voice therapy and traditional Chinese medicine with acupuncture .Most patients can achieve a favorable outcome .