听障儿童声带小结个案研究

目的 探讨听障儿童声带小结发声训练的有效方法.方法 对一名患有声带小结的听障患儿进行发声训练,采用单一被试法分析治疗前后声学参数F0、jitter、shimmer、NNE,监控其训练效果.结果 基线期与处理期的F0有显著性差异(P<0.05),NNE有极显著性差异(P<0.01),jitter、shimmer的改善无显著性差异(P>0.05).结论 喉部按摩、声带放松训练、哈欠-叹息法等综合发声训练对改善听障儿童声带小结有着较好的效果.     

嗓音训练联合甘桔冰梅片治疗声带小结的疗效观察

目的探讨嗓音训练联合口服甘桔冰梅片治疗声带小结的疗效。方法将符合纳入标准的68例声带小结患者随机分为A、B两组,A组34例,采用单纯口服甘桔冰梅片4周;B组34例,采用嗓音训练联合口服甘桔冰梅片治疗4周。治疗前后行电子动态喉镜检查,并进行最大音量最长发声时间(maximum loudest phonation time, MLPT)和最长发声时间(maximum phonation time, MPT)测试及嗓音障碍指数量表(voice handicap index, VHI)评估,比较两组的结果。结果 A组治愈11例,好转16例,无效7例;B组治愈17例,好转14例,无效3例;B组治愈率(50.00%)高于A组(32.35%)(P<0.05)。治疗后B组MLPT和MPT均长于A组(P<0.05),VHI评估各项得分及总分均低于A组(P<0.05)。结论嗓音训练联合口服甘桔冰梅片治疗声带小结的疗效优于单纯口服甘桔冰梅片的疗效。     

半封闭声道训练结合共鸣嗓音疗法在声带小结患者中的应用

目的 探讨半封闭声道训练(semi-occluded vocal tract exercises, SOVTE)结合共鸣嗓音疗法对声带小结患者的治疗效果。方法 选取门诊60例声带小结患者,接受为期12周的SOVTE及共鸣嗓音疗法,于训练前和训练12周后分别进行嗓音声学分析、嗓音听感知评估(GRBAS)和嗓音障碍指数(voice handicap index,VHI)评估,分析训练后效果。结果 训练后患者嗓音声学分析结果示jitter、shimmer、NHR值均比训练前减小,MPT值较训练前延长(P<0.01);VHI评分、总嘶哑度、粗糙声、气息声评分较训练前均明显降低(P<0.01)。结论 SOVTE结合共鸣嗓音疗法能够有效提高患者发声效率,对发声方式不当所致的声带小结患者有良好的治疗效果。     

金嗓散结丸和金嗓开音丸对声带息肉及声带小结的疗效观察

目的：观察金嗓散结丸和金嗓开音丸对声带息肉、声带小结的疗效。方法：对250例声带息肉、声带小结患者应用金嗓散结丸、金嗓开音丸治疗,其中88例早期声带息肉患者和115例声带小结患者单用金嗓散结丸和金嗓开音丸治疗;另47例声带息肉患者于术后配合金嗓散结丸、金嗓开音丸治疗。结果：88例早期声带息肉患者的有效率为88．6％,115例声带小结患者的有效率为98.3％;47例声带息肉患者的总有效率为100．0％。结论：金嗓散结丸、金嗓开音丸治疗声带息肉及声带小结有较好的临床疗效,值得推广。     

综合护理干预联合药物治疗对声带良性病变患者嗓音恢复的影响

目的观察综合护理干预联合药物治疗对声带良性病变患者嗓音恢复的影响。方法随机将2019年1月—2019年11月在天津医科大学第二医院耳鼻咽喉科诊断为声带良性病变的82例患者分成A、B两组，A组（41例），单纯口服金嗓散结胶囊1个月；B组（41例），在A组的基础上实施综合护理干预，包括心理干预、情绪及行为干预、禁烟酒、休声、嗓音训练等。通过Xion声学分析软件对两组患者治疗前后的嗓音基频微扰（jitter）、振幅微扰（shimmer）、噪谐比（NHR）进行测试，并比较两组结果。采用嗓音障碍指数 30(VHI 30)量表评估A、B两组患者治疗前后的嗓音情况，并比较两组评分情况。通过纤维喉镜检查比较两组患者的治疗有效率。结果两组患者治疗1个月后jitter、shimmer、NHR值及VHI 30评分均较治疗前改善，B组患者较A组改善更明显（P<0.05）。纤维喉镜检查发现B组患者治疗有效率高于A组。结论综合护理干预联合药物能显著改善声带良性病变患者的嗓音质量。     

嗓音训练联合中医综合疗法治疗声带小结的疗效观察

目的：观察嗓音训练联合中医综合疗法治疗声带小结的临床疗效。方法将符合纳入标准的80例声带小结患者随机分为A、B两组,A组40例,采用中医综合疗法（中药、针刺）,B组40例,采用嗓音训练联合中医综合疗法,比较两组治疗前后主观嗓音障碍指数（VHI）得分、客观嗓音声学分析变化,并行电子喉镜检查比较声带病变改善情况。结果 A组治愈8例,好转32例,无效0例;B组治愈17例,好转23例,无效0例,B组治愈率（42．50％）高于A组（20．0％）,差异有统计学意义（ P＜0．05）。治疗后B组V H I评分（30．28±17．65分）明显低于A组（45．22±18．66分）（P＜0．05）,B组的振幅微扰（shimmer）、基频微扰（jitter）及噪谐比（NHR）分别为0．32±0．09％、2．09±0．68％、0．11±0．02 dB ,均低于A组（分别为0．42±0．12％、3．25±1．08％、0．13±0．01 dB ）,差异有统计学意义（P＜0．01）。结论嗓音训练联合中医综合疗法治疗声带小结较单纯中医综合疗法效果更佳。     

四步训练嗓音矫治法在声带息肉术后的应用及体会

目的探讨四步训练嗓音矫治法在声带息肉术后的应用。方法将76例声带息肉术后患者分为A组(40例,手术联合嗓音矫治)和B组(36例,手术治疗)。A组于术后2周开始接受嗓音矫治治疗,为期4周。两组均于术前1天、术后2周、术后6周、术后3月、术后6月进行嗓音障碍指数(voice handicap index-10, VHI-10)评估、频闪喉镜检查及基频微扰(jitter)、振幅微扰(shimmer)、噪谐比(noise toharmonic ratio, NHR)、最大发声时间(maximum phonatory time, MPT)参数分析,比较两组的疗效。结果与术前相比,A、B两组术后6周、术后3月、术后6月的VHI-10、jitter、shimmer、NHR值均降低,A组MPT值提高,差异有统计学意义(P0.05)。两组术后同期比较,A组VHI-10(术后6周、术后3月、术后6月)和jitter、shimmer、NHR(术后6周、术后6月)较B组更低,MPT值则更高,差异有统计学意义(P0.05)。结论四步训练嗓音矫治法为声带息肉术后发音功能的恢复治疗提供了更积极的选择。     

嗓音训练治疗声带小结的疗效观察

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1~2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。     

功能性发声障碍职业用嗓者嗓音训练前后嗓音音域图及声学分析研究

目的评估发声训练的临床疗效及音域图(voice range profile,VRP)在嗓音评估中的作用。方法对100例功能性发声障碍职业用嗓者进行为期8周的发声训练,包括:放松训练、呼吸训练、共鸣及构音训练、振动训练及发声综合训练;训练前后采用德国XION DIVAS系统对受试者进行音域图测试及声学分析,比较训练前后最大声强、最小声强、最高基频、最低基频、基频微扰(jitter)、最长发声时间(maximum phonation time,MPT)及嗓音障碍严重指数(dysphonia severity index,DSI)的变化。结果 100例受试者发声训练后音域图各指标均有不同程度改善,最大声强均值由90.33 dB SPL增加至95.00 dB SPL;最小声强均值由47.26 dB SPL降低至43.71 dB SPL;最高频率均值由506.29 Hz增加至682.05 Hz;jitter均值由训练前的2.50%改善至0.73%;MPT均值由训练前的12.92±2.91 s改善至23.64±1.05 s,DSI从训练前的-2.89±1.86改善为5.43±0.79,差异均有统计学意义(均为P<0.05)。结论发声训练对改善职业用嗓者的功能性发声障碍切实有效,可改善其嗓音质量,音域图可作为职业用嗓者发声训练效果的评估手段。     

声带息肉患者的嗓音声学分析与VHI的相关性研究

目的 探讨嗓音声学分析与嗓音障碍指数(voice handicap index,VHI)用于嗓音质量评估的临床意义及其相关性,并进一步验证VHl的实用性.方法 对35名声带息肉患者(患者组)及35名嗓音正常人(对照组)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括振幅扰动商(amptitude perturbation quotient,APQ)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(NHR),VHI调查包括功能(F)、生理(P)、情感(E)三个范畴,记录三方面得分及总分(TVH)分值.结果患者组的APQ、jitter、shimmer、NHR均高于正常组,差异有统计学意义(P<0.05);患者组VHI的TVH平均值为43.32±4.66分,而正常组的平均值为12.51±1.88分,两组间差异有统计学意义(P<0.05).声带息肉患者嗓音声学分析参数与VHI之间无显著相关性.结论 临床上不能以嗓音声学分析为标准来判断或推测声带息肉患者症状轻重;VHI可主观反映患者嗓音障碍程度.     

Defibrinogenation Therapy for Idiopathic Sudden Sensorineural Hearing Loss in Comparison with High-dose Steroid Therapy

Objective--The efficacy of defibrinogenation therapy for idiopathic sudden sensorineural hearing loss was studied in comparison with high-dose steroid therapy.

Material and methods--Eighty-eight consecutive patients with hearing levels &gt;40 dB and who had suffered hearing loss for ≤30 days were enrolled: 40 patients for high-dose steroid therapy (PSL group) and 48 for defibrinogenation therapy (BX group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear.

Results--The overall hearing outcomes of the two groups were roughly equivalent. However, with regard to patients with initial hearing levels &lt;80 dB, the hearing improvement rate of the BX group was significantly worse than that of the PSL group (61.2%±7.3% vs 88.7%±8.9%; p&lt;0.05), whereas in patients with initial hearing levels ≥80 dB, the hearing outcomes did not differ between the 2 groups. Three patients in the PSL group manifested hyperglycemia while no serious side-effects were observed in the BX group.

Conclusion--These results indicate that high-dose steroid therapy should be employed in preference to defibrinogenation therapy for patients with moderate hearing loss, whereas defibrinogenation therapy has an advantage for those with severe hearing loss, in view of its lower frequency of side-effects.     

Therapy of hyperacusis in patients with tinnitus

BACKGROUND: Patients with tinnitus very often suffer from hyperacusis also. METHODS AND PATIENTS: In the present study a possible treatment for patients with bilateral hyperacusis is introduced and the therapeutical results of 41 patients suffering from bilateral hyperacusis combined with a uni- or bilateral tinnitus are discussed. Twenty-one of them also had a cochlear hearing loss. By means of white noise generators or hearing aids and a specific acoustic training the auditory input to the central nervous system was increased. All patients were taught a method to reduce stress (Progressive muscle relaxation according to Jacobson). Uncomfortable loudness levels were analysed before as well as 3 weeks and 6 months after beginning of the treatment. RESULTS: By the time of 3 weeks the discomfort from ordinary sounds was distinctly reduced and the reduction progressed further after 6 months of treatment. In more than 50% of the participants the uncomfortable loudness levels could be raised to a normal range. Interestingly the improvement of hyperacusis was independent of an existing hearing loss. CONCLUSIONS: The described method of treatment seems to be helpful for patients with hyperacusis and will be compared to other therapeutical regimes.     

Therapy of Frey's syndrome with an anhidrotic gel]

In recent years we treated 53 patients suffering from Frey's syndrome with an antihidrotic gel. The active ingredient we used was aluminiumtrichloridhexahydrate. In addition to presenting a historic review we will also demonstrate and discuss our results. The study concludes, that this gel is effective in treating Frey's syndrome.     

Therapy of facial paralysis in herpes zoster oticus with acyclovir

In the present study patients suffering from facial nerve palsy caused by a herpes zoster oticus were treated with aciclovir. After therapy all patients could be controlled via clinical grading system and electromyographic observations. Aciclovir therapy did not yield any results superior to those obtained with other forms of therapy presented in the literature.