非手术治疗声带小结患者发声训练护理干预

目的探讨发声训练对声带小结非手术患者嗓音康复的效果。方法将确诊为双侧声带小结患者60例随机分为对照组和干预组各30例,两组均予非手术治疗和常规护理,干预组在此基础上实施3个月的发声训练护理干预。结果干预3个月后两组临床疗效、患者自我评估及医护人员主观评估得分比较,差异有统计学意义(均P0.01)。结论发声训练可改善声带小结患者的发声质量,促进患者康复。     

脑卒中吞咽障碍患者嗓音功能及心理状态研究

目的 比较吞咽障碍与吞咽正常的脑卒中患者嗓音功能及心理状态,为制订针对性康复策略提供参考。 方法 便利选取337例脑卒中患者,通过洼田饮水试验和标准吞咽功能评估分为吞咽障碍组122例与吞咽正常组215例。采用嗓音障碍指数量表、GRBAS法、Praat声学软件进行主、客观嗓音功能评估,采用医院焦虑抑郁量表评估心理状态。 结果 与吞咽正常组比较,吞咽障碍组GRBAS法中的总嘶哑度、粗糙度、气息度、无力度评分及嗓音障碍指数量表评分、客观声学指标差异有统计学意义（均P＜0.05）;吞咽障碍组与吞咽正常组焦虑、抑郁评分比较,差异有统计学意义（均P＜0.05）。 结论 脑卒中吞咽障碍患者嗓音功能受损及焦虑抑郁情绪显著高于吞咽正常患者,需开展吞咽-嗓音-心理联合康复。     

二腹肌针刺电刺激联合嗓音训练治疗主动脉弓部手术后吞咽及嗓音障碍的随机对照试验

目的探讨二腹肌针刺电刺激联合嗓音训练对主动脉弓部手术后吞咽障碍患者吞咽功能康复的影响。方法将我院2014年10月至2017年11月连续42例主动脉弓部手术后吞咽障碍患者采用分层随机化分成观察组和对照组,每组各21例。其中观察组中男17例、女4例,年龄(51.0±6.5)岁。对照组中男18例、女3例,年龄(49.8±7.3)岁。观察组进行二腹肌针刺电刺激联合嗓音训练(2周,每天一次,每次各20 min),对照组进行吞咽健康宣教及康复指导,比较两组患者干预前后纤维喉镜、经口摄食功能评估量表(functional oral intake scale,FOIS)进食量表及计算机嗓音分析等客观评估指标。结果观察组经过二腹肌针刺电刺激联合嗓音训练后患者呛咳明显减少,纤维喉镜下左侧声带闭合程度较治疗前显著性提高;患者FOIS进食量表分数较治疗前显著性提高(6.30 vs.4.60,P0.05),声门闭合程度较治疗前显著性改善(1.00 vs.1.70,P0.05);两组患者嗓音嘶哑各项指标均较治疗前明显改善,观察组基频微扰(0.60%±0.96%vs.1.99%±1.86%,P=0.033)、振幅微扰(2.47%±4.26%vs.5.89%±3.66%,P=0.043)、最长发声时间[(15.31±9.10)s vs.(3.72±8.83)s,P=0.006]、最长最大音发声时间[(9.30±5.73)s vs.(2.32±2.99)s,P=0.039]、噪谐比(23.99±10.17 vs.9.98±9.37,P=0.006)以及谐噪比(0.03±0.02 vs.0.17±0.23,P=0.019)6项指标改善情况明显优于对照组。结论二腹肌针刺电刺激联合嗓音训练可以明显改善主动脉弓部手术后吞咽障碍患者的吞咽功能,促进嗓音恢复,提高患者进食及交流能力。     

非语言沟通训练在声带息肉摘除术患者中的应用

目的:探讨对声带息肉摘除术患者进行非语言沟通训练对嗓音康复的影响。方法:将46例患者随机分为两组,每组各23例。对照组术前进行常规的术前宣教;实验组在进行常规宣教的基础上配合手势、书写的非语言沟通训练,并据此沟通。术后两周对实验组和对照组的休声效果和恢复程度进行评价。结果:两组患者的休声效果和恢复程度差异有统计学意义(P>0.05)。结论:非语言沟通训练对声带息肉摘除术患者的嗓音康复有效。     

经乳晕腔镜甲状腺手术对患者嗓音及吞咽功能的影响

目的： 探讨有效保护喉返神经情况下腔镜甲状腺手术对甲状腺肿瘤患者术后嗓音及吞咽功能的影响。 方法： 回顾性分析2017年1月—2018年6月205例行甲状腺手术患者的临床资料,其中115例行经乳晕腔镜甲状腺手术（腔镜组）,90例行开放甲状腺切手术（开放组）,两组患者均行单侧腺叶次/全切除+术中神经探测和保护,采用主观和客观评价指标分析两组患者手术前后嗓音及吞咽功能的变化,主观评价指标包括嗓音障碍指数量表（VHI）、嗓音GRBAS分级与吞咽障碍评分（SIS）;客观指标包括基频（F0）、基频微扰（jitter）、振幅微扰（shimmer）、最长发声时间（MPT）等嗓音声学分析。 结果： 主观评价指标方面,在术后1个月,两组均有部分患者出现嗓音与吞咽异常;术后3个月,开放组患者嗓音与吞咽均恢复正常,但腔镜组仍有部分患者吞咽功能未恢复;且腔镜组术后1、3个月时嗓音异常的发生率高于开放组（均P<0.01）。客观评价指标方面,两组术后1个月的F0均较术前降低（均P<0.05）,但3个月后两组均恢复正常;两组术后1、3个月jitter、shimmer、MPT与术前均无统计学差异（均P>0.05）。 结论： 腔镜与开放甲状腺手术后均会有部分患者发生嗓音改变及吞咽功能障碍,这种改变多在术后3个月内恢复;腔镜手术后吞咽障碍恢复时间较长,可能与术后颈部粘连固定有关。     

双侧膝关节置换术围手术期强化患者主动运动康复疗效的研究

目的探讨强化主动运动训练方式对双侧膝关节置换术后患者早期生活质量恢复的影响。 方法共选取广州军区广州总医院骨科医院双侧膝关节置换术后患者54例,简单随机抽样法将其分两组,分别采用不同运动方式训练,即常规运动训练组和强化主动运动训练组。两组患者康复周期均为术后1周。两组患者分别于术后1、3、5、7 d记录改良Barthel指数(MBI)、Berg平衡量表(BBS)进行评估,并采用t检验进行统计学分析比较。 结果两组患者术后7 d在MBI、Berg评分中强化主动运动训练组均比较常规运动训练组有明显提高(MBI：t＝－20.108, P<0.01;Berg：t＝－13.335, P<0.01);强化主动运动训练组主动关节活动度(AROM)/被动关节活动度(PROM)术后7 d均比常规运动训练组大(AROM：t＝－4.288, P<0.01; PROM：t＝－4.232, P<0.01)。 结论强化主动运动训练可明显改善双侧膝关节置换术后平衡功能、关节活动度、日常生活自理能力,有效促进膝关节功能恢复提高生活质量。     

机器人与腔镜手术治疗甲状腺癌对嗓音功能影响的回顾性病例对照研究

目的 比较机器人和腔镜手术治疗甲状腺癌对患者嗓音功能的影响。方法 回顾性分析2022年3月至2023年6月期间四川省攀枝花市中心医院收治的181例分化型甲状腺癌患者的临床资料，根据所实施的手术方式不同分为腔镜组（n=91）和机器人组（n=90），比较2组患者术前1 d及术后1周、1个月和3个月的声学参数和嗓音障碍指数（voice handicap index,VHI）评分（VHI-10评分）。结果 手术前后不同时相2组患者的VHI-10评分比较差异均无统计学意义（P>0.05）。机器人组内手术后各时相的VHI-10评分与术前1 d比较差异无统计学意义（P>0.05）；腔镜组术后各时相的VHI-10评分较术前1 d增高，差异有统计学意义（P<0.05）。嗓音功能障碍发生率（VHI-10评分≥8分）在术后1周、1个月和3个月机器人组分别为1.1%(1/90)、1.1%(1/90)和0.0%(0/90)，腔镜组分别为1.1%(1/91)、2.2%(2/91)和0.0%(0/91),2组间比较差异无统计学意义（P>0.05）。腔镜组患者术后1周的基频较术前1 d降低（P...     

声带息肉患者术后含水发声训练效果观察

目的 探讨含水发声训练法在声带息肉患者术后康复护理中的作用。方法将128例声带息肉术后患者随机分为对照组和干预组各64例。两组均按照耳鼻喉科术后给予常规气道管理、口腔护理、饮食护理及健康教育,干预组在此基础上于术后2周行含水发声训练。于术后3个月评价效果。结果两组术后喉发声能力自主评分比较,差异有统计学意义(P＜0.0...     

动态喉镜声带息肉术后嗓音康复训练时间研究

目的探讨动态喉镜声带息肉术后嗓音康复训练的适宜时间。方法将102例行动态喉镜声带息肉术患者随机分为A组和B组各51例,分别于术后1周和术后2周开始嗓音康复训练,持续3个月。于术前、术后3、5、7d及3个月行嗓音声学检查;于训练前及训练3个月后采用嗓音障碍指数量表(VHI)进行调查。结果 102例患者术后5d嗓音声学参数中的基频微扰与术前比较,差异有统计学意义(P0.05);术后7d嗓音声学参数基频、基频微扰、振幅微扰、嗓音障碍严重指数和最长发音时间与术前比较,差异有统计学意义(均P0.05)。训练3个月后,B组嗓音声学参数显著优于A组,VHI评分显著低于A组(均P0.01)。结论动态喉镜声带息肉术后7d声带功能开始好转,术后相对声休2周后开始嗓音康复训练有助于提高嗓音质量。     

老年股骨颈骨折患者全髋关节置换术后核心肌康复锻炼的效果研究

目的：分析并评价核心肌康复锻炼在老年股骨颈骨折患者全髋关节置换术后的效果。方法：选择2019年1月至2020年12月行全髋关节置换术的老年股骨颈骨折患者67例,经随机数字表法分为常规康复训练组（33例）和核心肌训练组（34例）。术后,常规康复训练组接受常规康复训练,在此基础上,核心肌训练组加入核心肌群训练,比较两组患者训练前后疼痛数字评价量表（NRS）评分、Harris髋关节评分、生活质量（GQOLI-74）评分、并发症发生率。结果：术前及术后1、3、6个月,两组NRS评分均呈逐渐降低趋势（P<0.05）;两组髋关节功能评分及生活质量评分均呈逐渐升高趋势（P<0.05）。核心肌训练组术后1、3个月NRS评分低于常规康复训练组（P<0.05）。核心肌训练组术后1、3、6个月髋关节功能评分高于常规康复训练组（P<0.05）。核心肌训练组患者干预期间及随访期间总并发症发生率低于常规康复训练组（P<0.05）。结论：股骨颈骨折患者全髋关节置换术后进行核心肌群锻炼可降低疼痛、促进髋关节功能恢复、减少术后并发症发生、促进生活质量提高,具有较好的干预效果。     

CO2激光经口微创手术治疗喉部良、恶性病变

目的观察经口显微镜支撑喉镜下CO2激光治疗喉部良恶性病变的临床疗效,探讨激光喉部手术适应证。方法回顾性分析2008年11月～2012年5月经CO2激光治疗的喉部良恶性病变33例。上海得邦得力公司DJL-40C CO2激光机,激光波长为10600nm,脉冲模式0．1s,功率3～8w,光斑直径O．7—1．0mm。CO2激光机通过耦合器与Leica F40手术显微镜连接。良性病变18例,其中声带息肉3例,声带角化1例,喉乳头状瘤6例,声带白斑5例,喉蹼2例,双侧声带麻痹1例。恶性病变15例,其中声门上型喉癌4例,声门型喉癌11例。均采用经口显微镜支撑喉镜下CO2激光治疗。结果良性病变术后随访3—6个月,除1例喉乳头状瘤术后复发行二次激光手术外,其余全部一期愈合。恶性病变术后随访11—28个月,平均19月。术后复发1例,声带粘连1例,其余术后病变清除彻底,喉功能保存良好,无严重并发症发生。结论显微镜支撑喉镜下CO2激光治疗喉部良、恶性病变疗效可靠,能较好地保留喉结构和功能,是治疗喉疾病的重要手段。     

Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery

The aim of this study is to evaluate the treatment outcome and analyze the associated factors of postoperative recurrence in patients who received transoral laser microsurgery for vocal cord leukoplakia. The demographic, histopathological data were retrospectively reviewed and the factors associated with recurrence of vocal leukoplakia after surgery were analyzed statistically. A total of 44 patients, including 36 males and 8 females, with a mean age of 50.4?±?13.4 years, were enrolled. All the patients received excision of the vocal leukoplakia by carbon dioxide laser (2–4 Watt, ultrapulse mode) under general anesthesia. No patients had malignant transformation after surgery. Postoperative recurrence occurred in 10 patients (22.7 %). Univariate analysis showed that patients who had the habit of cigarette smoking, alcohol drinking, and presence of gastroesophageal reflux disease tended to recur. Among these risk factors, presence of gastroesophageal reflux disease (odds ratio 8.43) was the independent prognostic factor for recurrence using multivariate logistic regression analysis. Carbon dioxide laser excision is effective for treating vocal leukoplakia that is still confined to dysplasia of any degree, with acceptable morbidity. This study suggests that the presence of gastroesophageal reflux disease is the prognostic indicator for postoperative recurrence of vocal leukoplakia. Aggressive treatment of reflux disease for those who have received surgical excision for vocal leukoplakia is indicated.     

Laser lateralization for bilateral vocal cord abductor paralysis

Unilateral laser excision of the thyroarytenoid muscle combined with suture lateralization of the vocal ligament was successful in 13 of 14 patients (93%) treated for bilateral abduction immobility sufficient to require tracheotomy. Among the four patients requiring revision surgery, three had cricoarytenoid fixation and one had vocal cord paralysis. All patients had a satisfactory voice after surgery. The anesthetic management of laser microsurgery is discussed.     

Voice target time in Parkinson's disease: A preliminary report.

A target-matching paradigm was developed to assess the vocal equivalents of reaction and movement time in Parkinson's disease. Six patients with Parkinson's disease and 6 age- and gender-matched control subjects were asked to enunciate /pa/ to reach a target frequency and intensity level in response to a light stimulus. The stimulus and acoustic responses were simultaneously recorded. Measures included laryngeal reaction time, time between stimulus and phonation onset; frequency voice target time, time from phonation onset to target level of frequency; and amplitude voice target time, time from phonation onset to target level of intensity. The 2 subject groups were significantly differentiated by laryngeal reaction time (t = 299.67, df = 10, P = 0.005) and frequency voice target time (t = 148, df = 10, P = 0.014). These data suggest voice target time is a viable tool for assessing the effects of neurologic disorders on voice execution in Parkinson's disease.     

Management of bilateral vocal fold paralysis: experience at the University of Athens.

The treatment of patients with vocal fold paralysis presents a challenge to the otolaryngologist-head and neck surgeon. Many techniques have been proposed to manage individuals with unilateral or bilateral vocal fold paralysis. We herein describe the experience of our department in dealing with bilateral vocal fold paralysis. At the University of Athens, patients presenting with symptomatic bilateral paralysis are treated with a posterior cordectomy by using the CO2 or KTP-532 laser. During the last 5 years, we have treated 20 patients (8 men and 12 women) presenting with symptomatic bilateral vocal fold paralysis. For augmentation of the glottic airway, a modification of Kashima's cordotomy was used, completing a partial posterior cordectomy of one or both true and false vocal folds with the CO2 laser (15 patients) and the KTP-532 laser (5 patients). An elective tracheotomy was done before the cordotomy. Complications, such as infection, stridor, or dyspnea, were minimal. Although no objective voice analysis was performed, all patients were able to communicate without any phonation device and were satisfied with the result of the surgery. When compared with other techniques, the advantages offered by the posterior cordectomy included rapidity and simplicity in concept, reliability of outcome, short hospitalization, low risk of complications, and the possibility for revision when necessary (posterior cordectomy). From the successful postsurgical results of this study, it can be concluded that the posterior cordectomy is a reliable treatment option for the management of patients with bilateral vocal fold paralysis.     

CO2 laser microsurgery: five years experience with long-term results

Techniques and results of CO2 laser microsurgery are reported from a series of 123 patients operated on between 1979 and 1983. Salpingostomy was carried out in 76 patients, reversal of sterilization in 16 patients, reanastomosis for pathologic disease in 12 patients, and combined procedures in 19 patients. Results compare favorably with conventional microsurgery. CO2 laser surgery appears to be a very effective technique and is very easy to achieve in microsurgery. Correct use of CO2 laser is required in order to obtain a good post-operative success rate. The surgeon must be competent in microsurgery and in laser technology.     

The influence of epilarynx area on vocal fold dynamics.

OBJECTIVE: This study investigated the influence of epilarynx area on an excised human vocal fold during phonation. STUDY DESIGN: A hemilarynx set-up using an excised human larynx was used. An artificial vocal tract with an epilarynx tube of variable cross-sectional area was attached. High-speed imaging was performed and standard phonatory variables were measured. RESULTS: Glottal airflow, fundamental frequency, and sound level increased as a function of subglottal pressure. A decrease in epilarynx area decreased phonation threshold pressure, glottal airflow, and vocal fold displacements and velocities. CONCLUSIONS: Preliminary experimental results confirm that narrowing the epilarynx area facilitates phonation by decreasing phonation threshold pressure, presumably through impedance matching of the glottal source and vocal tract. SIGNIFICANCE: As this phenomenon associated with epilarynx narrowing is further quantified and generalized, eventually new surgical alterations of the epilaryngeal structure may be suggested to facilitate phonation, in addition to standard phonosurgical procedures.     

Procedures for the selection of spastic dysphonia patients for recurrent laryngeal nerve section

Patients with spastic dysphonia were studied to identify the characteristics of patients benefiting from recurrent laryngeal nerve (RLN) surgery. Studies included laryngeal video recordings made during speech, measures of frequency and amplitude variations during extended phonation, the effects of altered auditory feedback on dysfluencies, and temporary unilateral RLN block. Two patients had vocal fold adductor spasms during connected speech, had increased acoustic phonatory tremor in frequency, were not benefited by altered auditory feedback, and responded favorably to nerve block. Subsequent RLN section improved the speech of both patients. Other patients had speech blocks, repetitions and prolongations, vocal fold tremors during phonation, reduced dysfluencies during altered auditory feedback, and were not benefited by temporary nerve block. Two subtypes of spastic dysphonic patients are proposed.     

The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer.

OBJECTIVE: To study the recovery in phonation after reconstruction of the recurrent laryngeal nerve (RLN) in patients whose thyroid cancer was invading the nerve, and to evaluate the role of ansa cervicalis to RLN anastomosis (ARA) in operations for thyroid cancer. DESIGN: Retrospective study. SETTING: University hospital and private thyroid clinic hospital, Japan. SUBJECTS: 34 patients with thyroid cancer who underwent reconstruction of unilateral RLN and 331 consecutive patients operated on for thyroid cancer. INTERVENTIONS: Reconstruction was direct anastomosis (DA), free nerve grafting (FNG), vagus-RLN anastomosis (VRA) or ARA, including anastomosis behind the thyroid cartilage. MAIN OUTCOME MEASURES: Maximum phonation time (34 normal subjects and 26 patients with vocal cord paralysis served as controls), laryngoscopic examination, and the ratio of reconstruction in patients who needed resection of the RLN. RESULTS: The maximum phonation time started to increase rapidly 2-5 months postoperatively in most cases as the patients' voices recovered, and 12 months after reconstruction was significantly longer than in those patients with vocal cord paralysis (P < 0.0001). It was comparable to that of the normal subjects, although the reinnervated cords were fixed in the median. The number of reconstructions in the series of 331 patients increased from 18% to 82% after we started doing ARA with the meticulous technique of anastomosis inside the thyroid cartilage. CONCLUSIONS: ARA is as effective as DA or FNG in improving phonation in patients who need resection of a unilateral RLN. As ARA has several advantages over FNG it has a definite place in operations for thyroid cancer.     

The endoscopic management of early squamous carcinoma of the vocal cord with the carbon dioxide surgical laser: clinical experience and a proposed subclassification

Sixteen patients with T1 vocal cord squamous cell carcinoma were treated with endoscopic laser excision during a 4-year period. Laser excision was the initial treatment in 11 patients, and it was used to treat 5 patients who had recurrence after radiotherapy. Postoperatively, 13 (81%) of the 16 patients had normal voices. Two patients with persistent postoperative hoarseness had had anterior commissure lesions and previous radiotherapy; the other patient had a subtotal cordectomy. One patient developed a subsequent new lesion 27 months after the initial laser treatment; he was successfully managed with a second endoscopic laser excision. Involvement of the anterior commissure or involvement of the vocal process with minimally invasive disease proved not to be a contraindication to laser excision. The overall results in this small series suggest that laser excision of T1 vocal cord carcinoma is an excellent method of treatment.