沟状声带的诊断和治疗进展

沟状声带（sulcus vocalis），又有称声带沟、声带萎缩纹，是指位于一侧或双侧声带上下缘的中央、延及部分或整个声带膜部、与声带游离缘相平行的沟状凹陷，长短和深浅不定，妨碍声带内收，改变声带振动模式，引起特征性变调性发声困难和声门闭合不全等临床表现。随着影像技术的提高和嗓音外科学的发展，沟状声带作为一种病理状态逐渐被认知，其病理特征、临床特点和治疗措施亦逐步被临床医生所重视。本文综述沟状声带的诊断和治疗进展。     

小儿声带沟的研究

目的：探讨小儿先天性声带沟的临床特征、诊断、治疗方法。方法：对56例声带沟患儿术前行电子喉镜检查,应用声带沟切开整复术治疗,不附加缝合及用组织或其他外物充填。结果：声带沟占同期嗓音障碍患儿的5．09％（56/1100）,5岁以前占80．04％。总有效率96．40％。结论：声带沟在小儿嗓音障碍中不罕见;出生时即有嗓音异常;多呈裂隙型和凹陷型,常有声带表皮样囊肿或息肉共存;声带沟切开整复术不失为一安全、有效、简捷的手术方式。     

声带沟临床近况

声带沟是指声带上有一条与声带游离缘相平行的沟,可位于双侧或单侧,其病因有后天性及先天性两种假说,现多认为属声带的先天性发育异常。本病可出现不同程度的发声障碍,症状常可追溯至幼年。临床上应对本病有清晰的概念,借助间接喉镜、喉动态镜、悬吊喉镜及喉显微镜仔细俭查,方可发现而不致误诊。通常是采用喉显微外科加嗓音训练治疗,才能获得较好效果。     

声带沟的诊断及治疗

目的探讨声带沟的分型及治疗方法。方法29例声带沟患者按有无声嘶及沟的形态分为3型：Ⅰ型：生理型，11例(无声嘶)；Ⅱ型：裂线型，13例；Ⅲ型：局凹型，5例；后两种为病理型声带沟，有声嘶。对有声嘶18例进行了手术及术后嗓音训练治疗，手术方法有：①黏膜下分离自体脂肪注射术(Ⅱ型9例，Ⅲ型2例，其中1例为术式②疗效不佳再手术者)；②黏膜切开挖槽自体脂肪注射术(Ⅱ型4例、Ⅲ型1例)；③声带沟切除术(Ⅲ型4例，包括1例术式①疗效不佳再手术者)。所有患者均随访6个月以上，平均为15．3个月。结果喉镜及嗓音分析发现，13例Ⅱ型患者中10例(其中6例为黏膜下分离自体脂肪注射术，占该术式6／9；4例为黏膜切开挖槽自体脂肪注射术，占该术式4／4)，术后3个月声带沟消失，发音良好，声带振动恢复；另3例单行黏膜下分离自体脂肪注射术者，术后声带沟变浅，仍稍声嘶。5例Ⅲ型患者中3例行声带沟切除术后4～5个月声带沟消失，发音时声门闭合好，声带振动恢复；另2例先单行黏膜下分离自体脂肪注射术或黏膜切开挖槽自体脂肪术者，术后10d～3个月声带沟再现，再次手术后好转。结论对声带沟患者应分型后采用不同治疗方法，黏膜切开挖槽自体脂肪注射术对Ⅱ型治疗效果最好，声带沟切除术对Ⅲ型治疗最合适。     

咽喉科学

喉咽反流，声带沟的手术治疗，阻塞性睡眠呼吸暂停低通气综合征与夜间咽喉反流的相关性研究，嗓音声学参数与嗓音音质的相关研究。     

声带沟的手术治疗

目的探讨声带沟的手术修复手段,以提高疗效.方法对经喉动态镜检查确诊的26例声带沟患者,采用喉显微外科手术加嗓音训练的综合方法治疗.其中单纯声带沟切除术9例,黏膜微瓣整复术11例,自体阔筋膜加脂肪声带注射术4例,阔筋膜声带植入术2例.术后10天进行嗓音训练,持续4～6个月.所有患者术前、术后定期行喉动态镜检查及嗓音学分析.结果术后仍有5例患者症状无明显改善,总有效率为80.8%(21/26).有效病例术后1周喉动态镜检查显示声带形态基本恢复正常,声带沟消失;术后1个月声带振动恢复.术后3个月嗓音声学分析显示声学参数较术前明显改善.行自体阔筋膜加脂肪声带注射术和阔筋膜声带植入术的6例患者中,最长观察时间28个月,声带黏膜波动良好.未出现任何并发症.结论喉显微外科手术加嗓音训练的综合治疗方法治疗声带沟效果满意.     

声带瘫痪225例报告

本文报告了225例声带瘫痪。从一般资料，发病季节、发病原因、声带瘫痪表现及治疗五个方面进行了报告。本病发病原因以手术损伤、肿瘤侵犯或压迫者多见，特发性声带瘫痪约占52％。声带瘫痪表现以左侧旁中位多见．治疗分病因治疗与综合治疗。综合治疗包括音频治疗仪和电子嗓音治疗仪治疗、发音训练、针灸治疗、中医辨证施治及手术治疗。     

相干光断层扫描技术与嗓音医学

摘要：相干光断层扫描技术（optical coherence tomography，OCT），又称为光学相关断层扫描技术，是近年发展起来的非接触式、无损、实时、高分辨率的影像诊疗技术，首先主要应用于眼科视网膜沟的检测，以及心血管疾病中对于冠状动脉内膜不稳定粥样斑块的探查。同时还应用于泌尿外科及消化内科对于黏膜上皮疾病的诊断。由于OCT能够准确检测声带的分层结构，目前逐渐成为嗓音医学中十分重要的临床检查手段之一，应用于声带结构的检测，良恶性疾病的鉴别诊断，嗓音显微外科手术以及对声带振动形态的观察等方面。     

第二届嗓音医学研讨班圆满结束

由解放军总医院耳鼻咽喉一头颈外科主办的第二届嗓音医学研讨班于2005年9月8日-10日在总医院耳研究所举办。研讨班邀请了国内嗓音医学领域的知名专家及学者。授课内容涵盖嗓音医学的基础与临床，主要内容有：我国嗓音医学的现状与展望，发声的解剖与生理基础，艺术嗓音，嗓音障碍的检查，嗓音疾病及嗓音障碍的评估，声门闭合不良的治疗，喉肌电图的临床应用，喉支架外科，声带麻痹的外科治疗，嗓音显微外科手术及手术录像，喉癌功能外科手术，全喉切除术后食管发声训练，咽音训练与嗓音矫治。     

声带瘢痕的概念与对策

声带瘢痕是喉科医师面临的最大挑战之一，要改善或恢复由声带瘢痕引起的发声障碍，目前尚无明确有效的治疗方法。各种原因的喉腔损伤都会形成声带瘢痕，包括外伤、嗓音手术(phonosurgery)、放疗、炎症和气管插管的损伤。明确声带瘢痕与发声障碍的关系，需要系统的病史回顾、临床嗓音评估、多种方法的试验性治疗。声带瘢痕导致发声障碍的过程非常复杂，现就声带瘢痕研究近况做一介绍。     

Patients’ perceptions of vocal problems: results from a survey in the Tokyo area

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician’s viewpoint, not the patient’s. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become ‘It is only a vocal problem and does not significantly affect the patient’s well-being,’ knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study ‘a survey for sulcus vocalis’ and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.     

New operation for sulcus vocalis--laser vaporization of the sulcus with fat injection

Although several treatments for sulcus vocalis have been reported, the condition continues to be known as an extremely intractable vocal disorder even now. We report the good outcome of a new treatment for sulcus vocalis. The operation was performed under intubated general anesthesia. We aspireted abdominal fat using an 18-gauge needle and a 20 = cc disposal syringe first. After collection of the fat, laryngomicrosurgery and laser vaporization of the sulcus bilaterally was performed using a KTP laser. Then, the collected fat was injected into the thyroarytenoid muscle bilaterally (about 1cc on each side). Seven patients underwent this surgery. The voice, as evaluated auditorily, improved in all the cases and the maximum phonation time increased in 6 of the 7 cases. We attribute the vocal improvement to the formation of new free edges of the vocal folds after this surgery.     

Combination of fascia transplantation and fat injection into the vocal fold for sulcus vocalis: long-term results

Fat injection and fascia transplantation alone have been used to treat patients with sulcus vocalis. No information is available on the effectiveness of these two procedures used in concert to treat sulcus vocalis. The objectives of this study were to conduct the two procedures together and report the long-term results. This article assesses, retrospectively, the effectiveness of the combination treatment of fascia transplantation and fat injection (FTFI) in patients with sulcus vocalis (n = 22). Perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after FTFI treatment in 18 patients. The mean follow-up time was 16.6 months. Sixteen patients had excellent results, 3 reported improvement, and 3 indicated no change. Phonatory function improved significantly in terms of phonation time, grade, roughness (p < .05), and breathiness (p < .001). The videolaryngostroboscopic rating showed significant improvement in vocal fold vibration amplitude and excursion of the mucosal wave (p < .05). Type 3 sulcus responded better to this treatment than did type 2 (sulcus vergeture). No postoperative complications were noted. The FTFI technique consists of an autogenous implant and delivers positive results. It may be considered as an option for patients with sulcus vocalis. It has been demonstrated to achieve excellent results in a majority of patients and to deliver a better prognosis than fat injection alone. Although resorption of fat and fascia is associated with FTFI, the FTFI procedure may be repeated multiple times.     

Fat augmentation for nonparalytic glottic insufficiency

While autogenous fat augmentation for glottic insufficiency has been used before, relatively little information is currently available on the effectiveness of fat injection in patients with nonparalytic glottic insufficiency resulting from problems such as various defects of vocal atrophy or sulcus vocalis. This paper compares retrospectively the efficiency of fat injection after surgery in patients with vocal atrophy (n = 16) and sulcus vocalis (n = 8). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation in 24 patients. The mean follow-up time was 19.5 months. Fifteen patients displayed excellent results; 1 showed some improvement; 6 experienced postprocedure failure, and 2 were not available for follow-up analysis. Perceptual rating showed significant improvement in grade, roughness and breathiness (p < 0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude and mucosal wave excursion (p < 0.05). More improvement in vocal atrophy was observed compared with sulcus vocalis following fat injection procedures. Our research showed that middle defects improved more compared to those in the anterior and posterior area. Fat injection is an effective autogenous implant and may be considered as an option in the treatment of patients with vocal atrophy or sulcus vocalis. Although fat reabsorption was a problem, repeating the procedure could be considered.     

Sulcus vocalis in monozygotic twins

Sulcus vocalis is the presence of a groove extending along the vibratory surface of a vocal fold and may result in dysphonia. Depending on the level of severity, this condition may require treatment involving complicated surgical techniques. Cases of sulcus vocalis are classified as physiological, vergeture, or pouch type. A clear explanation of the etiology has not been established, and the currently proposed congenital origin, as described in the literature, remains controversial. This paper presents findings from monozygotic twin sisters with bilateral sulcus vocalis; these patients had similar morphologies, vibratory characteristics, and vocal quality measurements, which support the theory of a congenital etiology.     

Communication disorders associated with motor neuron disease: MND

The aim of the paper was to present voice and speech disorders associated with motor neuron disease-MND. Two cases of MND were described. Communication problems--dysphonia and dysartria were one of their early manifestations. It is supposed that sulcus vocalis, which is the result of the degeneration process of the vocal muscle, is the laryngeal presentation of MND.     

Voice handicap evaluation of patients with pathologic sulcus vocalis

OBJECTIVES: The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). METHODS: The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. RESULTS: The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. CONCLUSIONS: These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.     

Sulcus configurations of vocal folds during phonation

Conclusion: A detailed understanding of clinical and voice characteristics will help to differentiate sulcus configuration and plan rational management strategies for each type. Objectives: To investigate the clinical and voice characteristics of patients with sulcus configuration of vocal folds during phonation. Patients and methods: A total of 146 patients with bilateral sulcus configuration of vocal folds were enrolled in this study. Based on videostroboscopic findings, patients were classified into three groups: physiologic sulcus configuration group (type I), pathologic sulcus configuration group, including sulcus vergeture (type II), and sulcus vocalis (type III). Voice analyses were obtained from a recorded speech sample. Results: Thirty-two patients (21.9%) were type I, 61 (41.8%) were type II, and 53 (36.3%) were type III. Different sulcus configuration groups had significantly different roughness and mean fundamental frequency. Type III was significantly different from type I and type II in grade, breathiness, mean flow rate, subglottic pressure, maximum phonation time, Jitter%, and harmonics to noise ratio. The pathologic sulcus showed distinctive features in electroglottograph waveform.