声带良性增生性病变治疗

2000年10月～2003年9月,我科在电子鼻咽喉镜下对30例歌唱演员声带良性增生性病变采用喉显微外科治疗,效果显著,报告如下。     

儿童声嘶93例

儿童声嘶疾病的发病率近年来有增长趋势,由于儿童喉部解剖、认知、配合方面与成人存在差异,给临床诊断和治疗造成困难,我们对2004年2月～2007年10月经电子喉镜检查并确诊的93例声嘶患儿进行分析,旨在探讨其临床特征,进一步提高对本病的诊治水平.     

儿童声带小结的中西医结合治疗及嗓音声学动力分析

引起儿童声嘶的疾病中，以声带小结为多见，本组44例儿童声带小结治疗中，24例以喉康中药治疗，20例以声带内注射地塞米松及喉康中药治疗，并对治疗前后应用声图仪进行了嗓音声学分析．本文就儿童声带小结的病因、儿童心理行为特征．治疗前后声学动力分析及儿童声带小结的治疗方法．进行了客观的评估。     

儿童声嘶46例诊治体会

儿童声嘶４６例诊治体会王家福１李中秀１尤登月１自１９９１年以来，我们在临床工作中共诊治声嘶的儿童患者４６例，现将初步体会总结报告如下。１临床资料４６例中，男２９例，女１５例；最小年龄为５岁，最大年龄为１４岁，其中５～８岁１５例，８～１１岁２０例，１１...     

2 500例声嘶儿童及青少年电子喉镜检查结果分析

目的探讨儿童及青少年声嘶的病因及临床特点。方法对2500例声嘶患儿电子喉镜检查结果进行回顾性分析。结果男1746例,女754例,声带小结占44．2％（1105例）,声带肥厚占38．2％（955例）,急性及亚急性喉炎占6．5％（163例）,声带麻痹占5．6％（141例）,喉乳头状瘤占1．6％（40例）;以上5种疾病为引起儿童及青少年声嘶的常见该病,占总人数的97％（2404／2500例）;发病年龄主要以学龄前期为最高,占37．12％（928／2500）,男性多见,男：女之比为2．32：1;5种疾病在不同年龄组的分布不同,其中声带麻痹在〈1岁组所占比例最高（77．30％,109／141）,喉乳头状瘤在1～3岁组比例最高（50．00％,20／40）,差异有显著统计学意义（P〈0．01）。结论儿童声嘶疾病的发病年龄以学龄前期为主;男性明显高于女性;声带小结发病比例最高,声带麻痹和喉乳头状瘤分别在婴儿组和幼儿组多见。     

4668例声嘶儿童电子鼻咽喉镜检查结果分析

目的：探讨儿童声嘶的病因及临床特点。方法回顾性分析4668例以声嘶为主诉儿童的电子鼻咽喉镜检查结果,分析导致本组儿童声嘶的主要病因及不同年龄段患儿声嘶病因的分布。结果4668例声嘶儿童发病年龄以2～10岁为主,占65．81％（3072/4668）,男性多见,男：女为2．48：1;其中,慢性单纯性喉炎1817例（38．92％）,声带小结1494例（32．01％）,慢性肥厚性喉炎560例（12．0％）,声带麻痹373例（8．0％）,先天性声带沟149例（3．19％）,喉乳头状瘤140例（3．0％）,这6种疾病占总人数的97．1％（4533/4668）;声带麻痹在＜0．5岁组中所占比例最高（97．0％,289/298）,喉乳头状瘤在0．5～2岁组中比例最高（33．9％,134/395）,慢性单纯性喉炎在4～6岁组中比例最高（81．0％,611/754）,声带小结在8～10岁组中比例最高（51．4％,374/727）。结论本组儿童声嘶的发病年龄以学龄前期及学龄期为主,男性明显高于女性;慢性单纯性喉炎发病比例最高,声带麻痹和喉乳头状瘤分别在婴儿组和幼儿组多见,声带小结在学龄儿童组中比例最高。     

儿童声嘶病因分析及干预（附89例报告）

目的了解儿童声音嘶哑的发病原因及特点，探讨儿童声嘶的治疗方法和预防。方法对89例小儿声音嘶哑的临床资料进行回顾性分析。结果89例小儿声嘶发病年龄≥3岁，发病人群以激惹型性格为主，声带小结是儿童声嘶的主要病因。儿童声音嘶哑的干预主要包括药物、嗓音训练、手术、联合治疗等。结论儿童声嘶有别于成人，它不威胁儿童的生命，但却影响了生活质量，对儿童声嘶不应只限于治疗，更在于防范，纠正发音方法。     

小儿声嘶临床分析

小儿嗓音疾病发病率近年有增长趋势，已引起耳鼻咽喉科医师的重视。但因小儿解剖生理特点，给临床检查和治疗带来诸多不便，为此，我们回顾分析了2001年以来，经电子喉镜检查并确诊的76例小儿声嘶患者的临床资料，旨在了解本病的特点，寻求科学的检查方法，进而提高诊断水平和治疗效果，现报道如下。     

204例小儿声嘶的诊断及治疗

近年来，以声嘶为主诉就诊的患儿逐年增多，小儿声嘶疾病有别于成人，常被家长和临床医师忽视，有时延误诊治时机，造成不良后果。１９９６年１０月－２０００年１０月诊治声嘶患儿２４０例，本文对其临床资料进行分析，旨在探讨小儿声嘶疾病的临床特征及诊治原则，现报告如下。1 资料与方法1．１ 临床资料 ２４０例中，男１５６例，女８４例；年龄３－７岁者１０２例，８－1４岁者１３８例。全部病例均以声嘶为主诉。病程最短２天，最长达３年，以１－６个月者最多。 行间接喉镜检查７５例，直接喉镜检查３２例，纤维鼻咽喉镜检查１３３例…     

79例小儿声嘶临床分析

目的：探讨小儿声嘶疾病特点。方法：对小儿声嘶７９例的临床资料进行回顾性分析。结果：①发病年龄≥３岁;②发病人群以激惹型性格为主;③声带小结是小儿慢性声嘶的主要原因;④小儿声嘶应以保守治疗为主。结论：儿童声嘶疾病有别于成人,了解此种疾病的特点对促进小儿噪音疾病的康复具有一定的意义。     

Perceptual and acoustic parameters of vocal nodules in children

Vocal nodules constitute the major cause of dysphonia during childhood. Auditory-perceptual and acoustic vocal analyses have been used to differentiate vocal nodules from normal voice in children.     

纤维内镜检查儿童鼻咽喉疾病

目的探讨纤维内镜检查在儿童鼻咽喉疾病诊断中的意义。方法在表面麻醉下应用纤维内镜检查1112例患鼻咽喉疾病儿童。结果1112例患儿中,患腺样体中、重度肥大者702例,占63.13%;患慢性鼻窦炎、鼻息肉者59例,占5.31%;患喉部疾病者257例,占23.11%,以患声带小结和喉炎者为主,分别为132例(11.87%)和102例(9.17%),其次为声带息肉8例(0.72%)。结论儿童声嘶最常见的病因为慢性喉炎和声带小结,其次为声带息肉。纤维内镜检查能立体地展示儿童鼻咽部腺样体的大小,突入鼻腔或阻塞后鼻孔的程度。纤维内镜检查在诊断儿童鼻咽喉疾病中有积极的作用。     

嗓音声学分析与心理听觉评价的相关性研究

目的 :探讨嗓音声学分析参数与声嘶程度心理听觉评价之间的关系。方法 :对 178例受试者进行嗓音声学分析 ,按声嘶程度将 2 4例正常人及 15 4例病理嗓音患者分成四组 ,对各组的嗓音声学分析参数及其与声嘶程度的关系进行统计学处理。结果 :除 0级与 1级组 jitter值差异无显著性外 ,其余各参数在各组间差异均有显著性意义。NNE和 SNR为判别声嘶程度的最有意义的两个参数 ,5个参数 (jitter,shim mer,NNE,SNR,SDF0 )均与声嘶程度有良好的相关关系。结论 :嗓音声学分析参数可以较简便直观地评价声嘶程度 ,为临床诊断提供依据。     

嗓音声学参数与嗓音音质的相关研究

目的:通过病理噪音合成器控制声学参数的变化,考察听觉感知判断的变化,寻找能够反映嗓音音质的有效声学参数.方法:采用6个声学参数(嗓音基频、基频微扰、振幅微扰、声门噪声能量、声门谱斜率、共振峰频率微扰),合成36个声学样本/ae/,并在每个参数维度上随机复制25%,总共45个样本,秩序随机化之后,再将样本编号;在室内将声学样本通过计算机播出,声音强度控制在70 dB,由8名耳鼻咽喉科专家参与听觉感知评估,针对GRBAS中的G、R、B进行等级评分,评分结果显示听感判断存在较高的内在一致性(P＜0.01).然后分别将声学参数的变化值与听觉感知得分进行等级相关分析.结果:6个声学参数中基频微扰、振幅微扰以及声门噪声能量与感知判断指标(嘶哑声、粗糙声、气息声)显著相关(P＜0.01).结论:基频微扰、振幅微扰以及标准化声门噪声能量是衡量嗓音音质的有效参数,并证明嗓音的多维性质.嗓音的听觉感知判断与音质声学分析相结合,是评估嗓音音质的最好方式.     

Non-invasive assessment of benign vocal folds lesions in children by means of ultrasonography

Objectives

Flexible fiberoptic endoscopes have made pediatric laryngeal examinations an everyday practice, even though fiberoptic-flexible laryngoscopy (FFL) is not always well tolerated in young children because of limited cooperation. Laryngeal ultrasonography (LUS) has been applied to normal and pathological findings in infants and children, allowing the assessment of subglottic hemangiomas, laryngeal stenosis and paralysis. No previous study assessed benign vocal folds lesions by LUS in children. The aim of this study is to evaluate the possibility of LUS to detect benign vocal fold lesions in children by comparing the results of FFL in 16 children with those of LUS.

Methods

Sixteen children (9 males and 7 females) with a mean age of 7.5 ± 4.0 years were included in the study. Each child underwent FFL performed by a skilled phoniatrician and LUS performed blindly by an expert radiologist.

Results

On FFL bilateral vocal folds nodules were found in 9 patients, vocal fold cyst in 2 other patients, while in 2 children the vocal folds appeared normal. Laryngeal papyllomatosis, vocal fold polyp and vocal fold irregularity were found in only one patient. LUS enabled the diagnosis in all the 14 patients with vocal fold lesions. Bilateral hyperechoic lesions were visible in 10 patients, while hypoechoic lesions were found in three patients. No lesion were found in two children, while one patient presented with a monolateral hyperechoic lesion.

Conclusions

LUS was accurate, safe, well accepted and tolerated. LUS appears to be a useful diagnostic tool for supplementing FFL in the assessment of benign vocal fold lesions in children and may represent an interesting alternative in everyday clinical practice.     

Hyaluronan in vocal folds and false vocal folds in patients with recurrent respiratory papillomatosis

Abstract

Background: Hyaluronan (HA) is a glycosaminoglycan with viscoelastic properties necessary for vocal fold (VF) vibration and voice production. Changes in HAs molecular mass, possibly related to human papilloma virus, could affect formation/persistence of recurrent respiratory papillomatosis (RRP).

Aims/Objective: Describing mass and localization of HA and localization of HA receptor CD44 in VF and false vocal folds (FVF) in RRP.

Materials and Methods: Biopsies from VF and FVF from 24 RRP patients. Twelve were studied with histo-/immunohistochemistry for HA and CD44 in epithelium, stroma and RRP lesions. Twelve samples were analyzed for HA molecular mass distribution with gas-phase-electrophoretic-molecular-mobility-analyzer (GEMMA).

Results: Three of 23 stains (VF and FVF combined) showed faint HA staining in the epithelium; there was more extensive staining in the stroma. CD44 was present throughout all areas in FVF and VF, it did not concur with HA. GEMMA analysis revealed very high mass HA (vHMHA) with more varying amounts in VF.

Conclusions/Significance: HA was mainly distributed in the stroma. CD44 not binding to HA might explain the non-inflammatory response described in RRP. Possibly crosslinked vHMHA was seen in VF and FVF, with more variable amounts in VF samples. Counteracting HA crosslinking could become a treatment option in RRP.     

A new instrument for intraoperative assessment of individual vocal folds

OBJECTIVES: Intraoperative assessment of vocal fold vibration during phonomicrosurgery performed under general anesthesia may enhance surgical decision-making. We therefore developed and bench-tested a new device we refer to as the aerodynamic vocal fold driver (AVFD). MATERIALS AND METHODS: The AVFD comprises a hand-held probe that uses airflow to drive individual vocal folds into phonatory-like vibration. This permits stroboscopic visualization of mucosal waves with simultaneous control of subglottal air pressure. In initial experiments to validate the technique, AVFD driven phonation and conventional whole-larynx phonation were compared using excised canine larynges (n = 14). RESULTS: Single vocal fold phonation using the AVFD and whole larynx phonation yielded similar, positive correlations between subglottal pressure and both amplitude and frequency of vibration. Experiments simulating vocal fold scar-related mucosal stiffening by subepithelial injection of fixative showed the expected elevation of phonation threshold pressures as measured with the AVFD. Likewise, unilateral tissue compression injury disrupted vocal fold vibration, and the AVFD was useful for quantifying improvement in the damaged vocal fold after repair with injection of cross-linked hyaluronic acid gel. CONCLUSIONS: These results show that this new instrument has the potential to provide novel and useful information for laryngeal experimentation and to improve phonosurgery.