支撑喉镜下声带息肉切除术后嗓音声学评估

选取2013年1月~2014年12月在我院耳鼻喉科接受治疗的声带息肉患者30例和30例嗓音正常成年人作为对照组。检测30例声带息肉患者在支撑喉镜下CO2激光手术前后和30例嗓音正常成年人的嗓音声学参数值,电子喉镜采集其形态的改变。结果(1)对30例声带息肉患者手术前后和对照组进行比较,声带息肉组术前元音的Jitter、Shimmer均高于正常组,DSI值低于正常组,差异具有统计学意义;(2)声带息肉术后各元音的Jitter、Shimmer值降低,DSI值术后升高,与术前各参数值相比,差异均具统计学意义;(3)术后的Jitter、Shimmer仍高于正常,与正常组比较差异无统计学意义,DSI值术后仍旧低于正常组,与正常组比较差异有统计学意义。嗓音声学分析可以作为声带息肉手术疗效评价、术后嗓音恢复情况判定的一个客观的参考依据。嗓音声学测试结合电子喉镜检查可作为声带息肉术后复查较为全面的复查手段。     

显微支撑喉镜与纤维喉镜治疗声带息肉及小结的比较

临床上引起声嘶的病种较多，但以声带息肉及声带小结多见。我科于1995～1997年，对90例声带息肉及小结分别在显微支撑喉镜及纤维喉镜下手术治疗，治疗后进行了3个月～2年的随访观察，现报道如下。1资料与方法1．1一般资料：90例中，声带息肉58例（其中双侧声带息肉12例），声带小结32例，男47例，女43例，最大56岁，最小17岁，平均35．8岁。1．2手术方法：50例在显微支撑喉镜下进行手术，40例在纤维喉镜下手术。1．21显微支撑喉镜下手术方法；手术在全身麻醉、支撑喉镜和显微镜下进行，术前8小时禁食，术前半小时前给予鲁米那及阿托品肌注镇…     

支撑喉镜下喉显微手术治疗声带息肉患者的疗效评价

声带息肉是发生在声带固有层浅层的良陛增生性病变,也是一种特殊类型的慢性喉炎,其最主要的临床症状为声嘶。近年来,声带息肉的发病率愈来愈高,通过喉镜检查便可做出临床诊断,治疗方式主要为手术切除治疗。经过治疗好转后,患者若存在用声过度、用声不当、吸烟等不良行为,则易引发声带息肉复发,因此术后要继续避免可能的致病因素引3。本研究回顾性分析2009年3月-2012年2月本院收治的328例声带息肉患者的临床资料,其中164例声带息肉患者在支撑喉显微镜下行显微手术方法治疗,取得了显著效果,现报告如下。     

声带息肉患者在支撑喉镜下显微手术后嗓音康复训练的研究进展

综述声带息肉患者在支撑喉镜下显微手术后嗓音康复训练的研究进展,包括康复训练的时机、方法 和疗效等,认为科学、个性化的嗓音康复训练,不仅可以改变声带息肉患者错误的发声习惯,提高正确的发音技巧,还可以使声带张弛有度,缓解喉部肌肉疲劳,有效避免发生声带及喉部的其他病变.     

显微支撑喉镜与纤维喉镜治疗声带息肉及小结的比较

对９０例声带息肉及声带小结分别行显微支撑喉镜下手术切除和纤维喉镜下手术摘除，其中５０例在显微支撑喉镜下进行，４０例在纤维喉镜下进行，经随访３个月～２年，将两种治疗方法进行了比较，结果显示：显微支撑喉镜下手术效果明显优于纤维喉镜下手术（χ２＝１８．３０，Ｐ＜０．０５），认为对声带息肉及声带小结，如无特殊疾病，应优先采用显微支撑喉镜下手术切除。     

显微支撑喉镜下与间接喉镜下声带息肉手术疗效观察比较

目的 比较显微支撑喉镜下与间接喉镜下声带息肉摘除术的疗效.方法 将302例声带息肉分别在间接喉镜下利用旋转式声带息肉钳摘除息肉和显微喉镜下利用显微器械摘除声带息肉,观察远期疗效及复发情况.结果 显微喉镜下声带息肉钳摘不易残留,复发率低.结论 显微喉镜下声带息肉手术效果好,不易损伤声带,复发率低,效果满意.     

声带息肉患者对嗓音质量的自我评估分析

目的:分析声带息肉患者应用嗓音症状量表(voice symptom scale,VoiSS)对嗓音质量进行自我评估,找出声带息肉患者在嗓音方面存在的问题;探讨嗓音症状量表是否可作为嗓音障碍患者主观评估嗓音质量的评定工具。方法:对56例声带息肉患者(患者组)在入院当天、术后3d及术后2周应用VoiSS量表进行问卷调查,随机抽取了50例嗓音正常者(正常组)也采用VoiSS量表进行问卷调查。结果:患者组入院当天缺陷、生理、情感因子分及总分明显高于正常组(P<0.05);女性声带息肉患者生理、情感因子分及总分高于男性患者(P<0.05),而缺陷分无差异;声带息肉患者术后3 d缺陷、生理因子分及总分明显高于入院当天及术后2周(P<0.01),而情感因子分无明显差异。结论:声带息肉患者的嗓音质量在缺陷、生理、情感方面存在问题;女性声带息肉患者更关注嗓音障碍方面的主观感受;术后不同时间的评分结果反映了手术的疗效及嗓音的康复情况;VoiSS量表可作为评估嗓音障碍患者的评估工具之一。     

显微支撑喉镜下声带手术的护理

声带疾患是由于用声不当或用声过度所引起,其手术通常采用直接喉镜或间接喉镜的方法.目前较先进的治疗方法就是显微支撑喉镜下进行声带手术.它能节约人力,充分暴露手术野,操作极为方便,提高手术成功率,特别是对直接喉镜下不易操作手术,或病人对喉部麻醉不敏感的病例.我科自2000年8月～2001年3月行显微支撑喉镜下声带手术63例,通过精心的护理,效果满意.     

显微支撑喉镜下治疗喉良性增生性病变(附95例报告)

目的 探讨联合应用显微镜和支撑喉镜治疗喉部良性增生性病变的手术方法和优越性。方法 回顾性分析该科1998年6月～2003年6月间95例显微支撑喉镜下喉部良性病变手术的病例。结果 95例患者术后嗓音均恢复良好，术中无声带损伤及并发症，平均住院5d，术后嗓音恢复时间较其他手术方法治疗的患者缩短。术后随访1、2a均无复发。结论 喉良性增生性病变主要累及声带被覆层，嗓音声障碍的程度及疗效与受累范围有关。显微喉外科手术可以保留良好结构及功能，避免其他手术方法所致的创伤和并发症，具有术后嗓音功能恢复快、住院时间短等优越性。     

支撑喉镜联合鼻内镜下内侧微瓣法切除声带息肉对嗓音声学指标的影响

目的探讨支撑喉镜联合鼻内镜下内侧微瓣法切除声带息肉对患者嗓音声学指标的影响。方法回顾性分析2016年1月至2017年8月于该院就诊的80例声带息肉患者的临床资料,其中33例在直视支撑喉镜下行声带息肉切除术治疗的患者为对照组,47例在支撑喉镜联合鼻内镜下行内侧微瓣法治疗的患者为研究组。比较两组患者术前、术后的嗓音声学指标[基频微扰(Jitter)、振幅微扰(Shimmer)、标准化噪声能量(NNE)和谐噪比(H/N)],临床疗效及并发症的发生率。结果两组患者术前嗓音声学指标Jitter、Shimmer、NNE及H/N比较,差异无统计学意义(P>0.05);两组患者术后2、4周的Jitter、Shimmer、NNE水平均较术前降低(P<0.05),H/N水平较术前升高(P<0.05),且研究组患者术后2、4周嗓音声学指标均优于对照组,差异有统计学意义(P<0.05);研究组患者治愈率高于对照组(P<0.05);研究组患者并发症发生率明显低于对照组(P<0.05)。结论支撑喉镜联合鼻内镜下内侧微瓣法切除声带息肉术后患者嗓音功能恢复良好,疗效显著,并发症少,值得在临床推广应用。     

支撑喉镜下声带外展术治疗双侧声带麻痹的体会

目的 探讨支撑喉镜下声带外展术对声带麻痹的疗效。方法 对22例双侧声带麻痹患者行支撑喉镜下声带外展术。结果 17例行单侧声带外展术后，气管套管成功拔除，5例经双侧手术成功拔除套管。结论 支撑喉镜下声带外展术是一种通过对声带的减少容量手术并通过瘢痕向外牵拉声带使声门扩大。是一种操作简便、有效的术式。     

嗓音训练改善早期声带息肉患者发声功能的效果

目的 探讨嗓音训练改善早期声带息肉患者发声功能的临床效果。方法 2016年5月至2018年5月,本院早期单侧广基型声带息肉患者80例随机分为对照组(n = 40)和试验组(n = 40)。两组均进行嗓音卫生宣教,试验组增加嗓音训练,每次40 min,每周1次,共12周。比较两组干预前后纤维喉镜下声带息肉大小、嗓音障碍指数(VHI)和嗓音客观分析等指标。结果 对照组5例、试验组7例脱落。治疗后,试验组声带息肉治愈率和好转率显著高于对照组(χ² = 24.608, P < 0.001);试验组VHI各范畴评分均显著改善( t/Z >11.701, P < 0.001),且显著优于对照组( t/Z >7.027, P< 0.001);试验组基频微扰、振幅微扰和最长发声时间较治疗前显著改善(|t/Z| >5.012, P < 0.001),且试验组均显著优于对照组( t/Z >4.596, P < 0.001)。 结论 嗓音训练可以改善早期声带息肉患者的发声功能,降低嗓音嘶哑程度,改善患者的嗓音质量。     

支撑喉镜治疗声带息肉的疗效与技巧

目的探讨支撑喉镜下手术治疗声带息肉的临床疗效与技巧。方法 78例行支撑喉镜手术治疗的声带息肉患者为观察组,76例行电子喉镜治疗的声带息肉患者为对照组,2组患者治疗后复查电子喉镜,了解声带恢复情况。结果2组治疗后,观察组和对照组总有效率为分别92.31%(72/78)、82.89%(63/76),差异无统计学意义(P0.05);观察组在广基型声带息肉的治愈率显著高于对照组,差异有统计学意义(P0.05)。对照组术后声带息肉残留者5例,声嘶较术前无明显改善者3例,并发支撑喉镜插管损伤口腔软腭黏膜者2例;观察组术后,声带息肉残留者3例,声带黏膜损伤者1例。随访1年,2组声嘶改善良好,无声带水肿复发。结论 2种术式各有优缺点,临床应根据患者实际病情及机体条件选择最合适的方法。     

Tracheal sounds and airflow dynamics in surgically treated unilateral vocal fold paralysis

The aim of this study was to investigate the changes in tracheal sounds and airflow dynamics in patients who underwent surgical medialization of a unilaterally paralysed vocal fold. Ten adults with unilateral vocal fold paralysis but no history of pulmonary diseases were included. Vocal fold medialization was performed by an injection of autologous fascia into the paralysed vocal fold. Recording of tracheal sounds, flow‐volume spirometry and body plethysmography were carried out before and 4–14 months after the operation. The mean number of inspiratory wheezes per respiratory cycle increased from 0·02 (range 0–0·10) to 0·42 (range 0–0·86) and the mean number of expiratory wheezes per respiratory cycle from 0·03 (range 0–0·20) to 0·36 (range 0–0·89). The increment was statistically significant (P=0·03 and P=0·04, respectively). The mean expiratory sound amplitude, in terms of root mean square (RMS), increased from 31·5 dB (range 24·0–38·0) to 34·9 dB (range 25–42) (P=0·03) and the average peak inspiratory flow (PIF) decreased from 4·63 l s^–1 (range 2·84–7·51) to 4·03 l s^–1 (range 2·27–6·68) (P=0·01). The results indicate that when the paralysed vocal fold is brought into midline by a surgical procedure, the prevalence of inspiratory and expiratory wheezes increases and sound intensity rises. According to this preliminary data tracheal sound analysis gives additional information for the assessment of the subtle changes in the larynx.     

The role of sensory dysfunction in the development of voice disorders,chronic cough and paradoxical vocal fold movement

Sensory function may be important in the pathogenesis of Chronic Cough (CC) and Paradoxical Vocal Fold Movement (PVFM). This paper aims to explore sensory issues related to the pathogenesis, classification, assessment and management of these conditions. Sensory disruption of the vagus nerve can occur through neural plasticity whereby a change occurs in the way a central neuron reacts to an incoming stimulus. Such disruption can be demonstrated through assessment of cough reflex sensitivity and extrathoracic airway hyperresponsiveness both of which may be increased in CC and PVFM. In addition, sensory function may be determined by measuring the laryngeal adductor reflex, however this phenomenon is yet to be explored in CC and PVFM. The similarity in sensory dysfunction between CC and PVFM provides support for a link between the two conditions. There are also similarities in underlying medical conditions and symptom profiles between CC/PVFM and voice disorders such as muscle tension dysphonia. Although coughing and throat clearing may be contributing factors in the development and maintenance of voice disorders, they may occur in response to extrathoracic airway hyperresponsiveness. Dysphonia can occur in CC/PVFM and may improve following behavioural treatment of CC.     

Long-term effects of an intensive voice treatment for vocal fold nodules

Purpose: The purpose of the current study was to examine the long-term effects of intensive voice treatment for vocal fold nodules, compared to outcomes for patients treated with traditional voice therapy. It was hypothesised that intensive treatment would provide comparable maintenance of vocal function, voice quality, and patients’ perception of quality-of-life when compared with traditional treatment at 6 month follow-up.

Method: Thirty-six women diagnosed with bilateral vocal fold nodules who were treated with either traditional (n?=?20; once a week for 8 weeks) or intensive (n?=?16; eight sessions within 3 weeks) therapy. Each participant completed voice, stroboscopic, and acoustic assessments and the Voice Handicap Index before, immediately post and 6 months post-treatment.

Result: Results revealed most improved perceptual, stroboscopic and acoustic parameters were maintained in both groups at 6 months post-treatment, with no significant differences between the two groups. In addition, both groups maintained satisfaction on their perception of vocal function, with no significant difference between the two groups.

Conclusion: The investigation provided further evidence that individuals with vocal fold nodules are able to maintain improved voice quality and vocal health following intensive voice treatment to a similar degree to traditional voice treatment.     

Disturbances in airflow dynamics and tracheal sounds during forced and quiet breathing in subjects with unilateral vocal fold paralysis

Variable extra thoracic obstruction has been found in spirometric studies in subjects with unilateral vocal fold paralysis. The aim of the study was to further evaluate airflow dynamics in these subjects with body plethysmography and tracheal sound analysis. Ten patients with unilateral vocal fold paralysis without a history of chronic pulmonary diseases and 10 healthy control subjects were studied. Flow‐volume spirometry, body plethysmography and tracheal sound analysis were performed within 1 day. The study shows that peak inspiratory flow (PIF) and specific airway conductance (SG_aw) expressed as percentage of Finnish reference values were significantly lower and airway resistance (R_aw) was higher among the patients than among the controls (P=0·004, P=0·026 and P=0·004, respectively). The patients had higher sound amplitude of both inspiratory and expiratory tracheal sounds than the controls [root mean square (RMS) values of the power spectra were 31·5 and 25 dB, P=0·006 in inspiration and 31·5 and 26 dB, P=0·013 in expiration, respectively]. Quartile frequencies (F25 and F50) and RMS of expiratory tracheal sounds had significant negative correlation with PIF (P=0·02, P<0·001, P=0·02, respectively) and forced inspiratory volume in 1 s (FIV₁) (P=0·01, P<0·001, P=0·01, respectively). There was also an association between F50 and peak expiratory flow (PEF) (P=0·02). According to the present study, both quiet breathing and forced inspiration are disturbed in subjects with unilateral vocal fold paralysis. A close relationship between tracheal sounds and respiratory function tests exists.     

The management of vocal fold nodules in children: A national survey of speech-language pathologists

The purpose of this study was to determine the management options and voice therapy techniques currently being used by practicing speech-language pathologists (SLPs) to treat vocal fold nodules (VFNs) in children. The sources used by SLPs to inform and guide their clinical decisions when managing VFNs in children were also explored. Sixty-two SLPs completed a 23-item web-based survey. Data was analysed using frequency counts, content analyses, and supplementary analyses. SLPs reported using a range of management options and voice therapy techniques to treat VFNs in children. Voice therapy was reportedly the most frequently used management option across all respondents, with the majority of SLPs using a combination of indirect and direct voice therapy techniques. When selecting voice therapy techniques, the majority of SLPs reported that they did not use the limited external evidence available to guide their clinical decisions. Additionally, the majority of SLPs reported that they frequently relied on lower levels of evidence or non-evidence-based sources to guide clinical practice both in the presence and absence of higher quality evidence. Further research needs to investigate strategies to remove the barriers that impede SLPs use of external evidence when managing VFNs in children.