声带注射在矫正声门闭合不全中的应用

声门闭合不全导致的发声困难和误吸等症状影响到患者的生存质量,甚至对生命造成潜在的威胁。单侧声带麻痹是引起声门闭会不全的最常见原因。目前治疗单侧声带麻痹的方法主要有以下几种：（1）喉结构外科（laryngealframeworksurgery）（2）神经再支配术（reinnervation）（3）电起搏治疗（electricalpacing）（4）声带注射术（injectionlampgopasty）。其中,声带注射术相对而言有着实用、简便、安全、经济的优越性,被广泛应用于声门闭会不全的矫治。除单侧声带麻痹外,声带注射还应用于其它原因引起的声门闭合不全的矫正,包括声带缺损、…     

经环甲间隙自体脂肪声带注射矫治声门闭合不全的实验研究

目的：观察家兔声带自体脂肪注射后急、慢性期喉局部反应、声带大体形态及组织学转归，探讨这一方法在矫治声门闭合不全中的应用价值。方法：8只家兔建立声带缺损动物模型后分4组，取腹部自体脂肪经环甲间隙注射入损伤侧声带，分别于注射后急性期（24小时内）及慢性期（1、3、5个月）行直接喉镜及喉组织学检查，观察喉局部反应、声带形态和声门闭合情况以及声带组织学改变。结果：所有家兔声带自体脂肪注射后急性期均无喉水肿发生；慢性期无肉芽肿、结节等改变；急、慢性期均未发生过敏及排斥反应。注射后3个月内声带体积渐缩小，声门闭合程度略降低，3个月后上述声门形态改变不明显。组织学证实注射后急性期可有轻度炎症反应；自体脂肪能在声带组织内存活，3个月内可发生部分脂肪吸收，3个月后脂肪吸收减少，在声带内保持相对稳定的体积。结论：自体脂肪声带注射具有无过敏、无排斥、无异物反应等特点。注射后虽可发生部分吸收，但3个月后吸收减少。该技术是一较为安全、有效的矫治声门闭合不全的方法。     

单侧声带麻痹所致声门闭合不全的治疗进展

声带是形成嗓音的重要结构,其功能障碍会不同程度的影响发声、呼吸及吞咽功能。声门闭合不全在临床上较为常见,其病因以单侧声带麻痹最为多见,可导致声嘶、误吸及呛咳等并发症,严重影响患者的生活质量,甚至危及生命,因此明确声门闭合不全的病因并选择合适的治疗方式非常重要。目前,针对单侧声带麻痹所致声门闭合不全的治疗方式多种多样,但治疗效果尚未达到理想状态,论文对单侧声带麻痹引起的声门闭合不全的治疗进展进行综述。     

声门闭合不全的喉肌电图和声门形态变化

目的：探讨声门闭合不全的原因、喉肌电图变化以及两者与声门形态变化的可能内在联系。方法：对24例声门闭合不全患者行喉镜及双侧环甲肌及环杓侧肌肌电图检测。结果：24例声门闭合不全患者中，仅6例为正常喉肌电图，其中声门呈梭形裂隙4例，三角形及矩形裂隙各1例；9例环甲肌出现纤颤电位，声门形态分别为梭形裂隙4例，矩形裂隙3例，三角形及半月形裂隙各1例；9例环杓侧出现纤颤电位，声门形态分别为俊形裂隙7例，三角形裂隙2例。结论：绝大多数声门闭合不全患者的原因不明，且存在喉上或／和喉返神经的不全麻痹。在原因不明、喉肌电图正常或环杓侧出现失神经电位等情况下，声门呈梭形裂隙者占绝大多数，而在某些诱因作用下或环甲肌出现失神经电位情况下发生的声门闭合不全，声门裂隙可表现为多种形态。     

声带闭合不全17例治疗分析

声带闭合不全１７例治疗分析吴江１储九圣１蔡雷２采用电脑超声同步叠加中频电水杨酸钠离子透入疗法选择性治疗声带闭合不全患者，能使声音嘶哑减轻或消失，现报告如下。１资料与方法１．１资料１７例中，男４例，女１３例；年龄１９～５８岁，平均３７岁；病程３天～５个...     

声门闭合不全的功能性嗓音障碍矫治的个案研究

目的：验证功能性嗓音障碍矫治方法的有效性。方法：对1例声门闭合不全的功能性嗓音障碍患者进行系统的嗓音矫治，采用声门噪声能量（NNE）作为声门闭合程度的检测和监控指标，分别采集基线期（A）和处理期（B）数据，用A-B设计的单一被试法进行统计分析。结果：通过系统的嗓音矫治后，患者的NNE值显著降低（P〈0．01），主观评估患者的嘶哑声和气息声有明显改善。结论：系统的嗓音矫治方法对功能性嗓音障碍患者的嗓音功能恢复有效。     

声门闭合不全52例治验

目的观察和探讨声门闭合不全的治疗方法和疗效。方法:采用中医辨证分型的方法,运用中药内服进行治疗观察。结果:52例患者经过中药26疗程的治疗,总有效率为75%。结论:中医辨证治疗声门闭合不全有较好的临床疗效,治疗贵在持之以恒。     

嗓音训练治疗声门闭合不全所致功能性嗓音障碍的疗效分析

目的探讨嗓音训练对声门闭合不全的功能性嗓音障碍患者的疗效。方法对24例声门闭合不全的功能性嗓音障碍患者进行8周的嗓音训练,训练内容包括健康宣教、肌肉放松、喉部按摩、暖嗓、呼吸训练、嗓音训练和共鸣训练,训练前后对患者进行电子喉镜检查、GRBAS评估、嗓音障碍指数量表（VHI）评估、计算机嗓音声学分析,比较训练前后评估结果。结果24例患者训练后电子喉镜检查16例患者声门闭合良好（66.67%,16/24）,6例声门裂隙变小（25.00%,6/24）,2例声门裂隙无明显变化（8.33%,2/24）;GRBAS评分中总嘶哑度G(0.61±0.66)明显低于训练前(1.91±0.87)（P<0.05）,粗糙声Ｒ(0.51±0.58)明显低于训练前(1.41±0.52)（P<0.05）;VHI评分总分(29.21±21.02)分明显低于训练前的(52.35±23.45)分（P<0.05）;计算机嗓音声学分析最长发声时间（15.24±3.64）s比训练前（9.02±3.45）s明显延长（P<0.05）,基频微扰、最高基频、最低音强、嗓音障碍严重指数训练后分别为（0.21±0.08）%、（420.11±44.21）Hz、（54.21±3.20）dB、（1.62±0.82）比训练前的（0.92±0.12）%、（375.21±49.21）Hz、（56.81±3.42）dB、（0.21±1.02）有改善（P<0.05）。结论嗓音训练能改善声门闭合不全的功能性嗓音障碍患者的声门闭合及嗓音质量。     

自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

目的 探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法 对26例单 侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射(A组),20例采用自体腹直肌前鞘筋膜加脂肪注射(B组).术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果 两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析:两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义(P值均＞0.05);A组术后3个月显著改善(P值均＜0.01),6及24个月较术前改善(P值＜0.05或＜0.01),但较术后3个月音质下降(P值＜0.05或＜0.01);B组术后6个月显著改善(P值均＜0.01),6、12及24个月各参数差异均无统计学意义(P值均＞0.05);术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义(P值＜0.05或＜0.01).B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义(P值均＜0.01).结论 自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.

Abstract：

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.     

自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.     

声带息肉患者术后声休方案探讨

目的探讨声带息肉患者喉显微手术后声休方案。方法85例声带息肉患者随机分为两组,A组48例,B组37例,均在显微支撑喉镜下行声带息肉切除术,A组术后严格声休1周,B组术后严格声休2周,其余治疗相同。两组均于手术前和手术后1、2、3、4周行嗓音基频微扰（jitter）、振幅微扰（shimmer）、噪谐比（NHR）检测和纤维喉镜检查,比较两组术后发声功能及声带手术创面恢复情况。结果术后1周时A、B两组jitter、shimmer、NHR值均与术前比较差异无统计学意义（P＞0．05）;术后2周时,A组仅jitter较术前降低（P＜0．05）,shimmer、NHR值仍与术前无差异,而B组jitter、shimmer、NHR值均较术前降低（P＜0．05）,且B组shimmer值较 A组低（P＜0．05）;术后3周时B组jitter、shimmer、NHR值均低于A组;术后4周时两组jitter、shimmer、NHR值均恢复至正常水平。纤维喉镜检查显示术后1周时两组患者术侧声带均有不同程度充血水肿,部分患者创面可见少许伪膜;术后2周时声带充血水肿逐渐消退,伪膜脱落;至术后4周时,两组患者术侧声带外观完全恢复正常。结论声带息肉患者术后2周应严格声休,术后3～4周应相对声休,以利于声带创面的愈合及发声功能的恢复。     

The first case of osteoma in the false vocal fold

Objectives

This article reports the first evidence of a larynx osteoma of the false vocal fold.

Study design

Case report and literature review.

Methods

Case report and review of previously published cases of larynx osteomas.

Results

A 79-year-old patient was referred to our institution for dysphagia and hoarseness. Fibrolaryngoscopy showed a regular surface tumefaction of the false fold and the left ventricle, with preserved cordal motility. Patient underwent direct laryngoscopy with CO₂ laser excision of the lesion. Pathologic examination of the lesion (1.6 cm × 1 cm) showed features consistent with an osteoma. Complete regression of symptoms was observed after surgery, with no lesions found on routine 1-year follow-up.

Conclusions

Osteomas are benign, slow growing tumors of the craniofacial bone area, very rarely located in the larynx. Although the etiology is unknown, accepted theories point to embryologic, post-traumatic and infectious causes. Surgical excision is indicated only in symptomatic cases. This case report is the fourth evidence of laryngeal osteoma and, to our knowledge, the first finding of a false vocal fold osteoma.     

The role of laryngeal electromyography in the diagnosis of vocal fold immobility in children

INTRODUCTION: Pathology may affect the muscles that control vocal function directly by affecting peripheral function or indirectly by affecting the central nervous system. Clinically, muscle function can be assessed by observing the movements of the structures themselves or by recording the electrical activity of the muscles (electromyography, EMG). Since EMG is an invasive technique, it has enjoyed limited use in the diagnosis and management of voice disorders, especially in children. Laryngeal EMG may be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: The purpose of this paper is to study the role of laryngeal EMG in the clinical evaluation of unilateral vocal fold immobility in children. MATERIALS AND METHODS: Twenty-five children with unilateral vocal fold paralysis were studied. Twenty-five patients with vocal pathologies secondary to vocal abuse and misuse were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. Additionally, nine patients with traumatic arytenoid dislocation were also studied. All patients were subjected to laryngeal EMG. EMG showed a sensitivity of 100%, and specificity of 92%. Only two patients, present with a functional voice disorder, showed abnormalities in the EMG recordings. In the nine patients with arytenoid dislocation, EMG showed normal parameters. CONCLUSION: EMG seems a safe and reliable test for evaluating patients with vocal fold immobility. Moreover, the EMG recordings were helpful in differentiating vocal fold paralysis from arytenoid dislocation. EMG can provide useful data concerning muscle denervation, and more importantly, reinnervation. Besides its utility for the diagnosis, serial EMG can be useful for monitoring recovery and for establishing a reliable prognosis, and hence, an adequate treatment plan.     

The effects of frequency and intensity level on glottal closure in normal subjects

The degree of glottal closure during phonation has an influence on voice quality and it is related to the robustness of the voice source. To quantify glottal closure a frame of reference was created by investigating 47 healthy men and 92 healthy women with no vocal complaints using videolaryngostroboscopy. Observing recorded images the degree of glottal closure was rated with a percentage. Results indicate that men have better glottal closure than women (P < 0.001). An increase in vocal intensity is related to improved glottal closure (P < 0.001), and in women a negative relationship was established between pitch and glottal closure (P < 0.001). Normal glottal closure in men is a complete closure, whereas in women a closure of at least 90% should be attained. If these percentages cannot be established during loud phonation, it suggests the presence of a less robust larynx. To evaluate and quantify the function of the voice source, in clinical practice the larynx should not be observed at only one intensity level, but at a variety of intensity and frequency levels.     

The shear modulus of the human vocal fold, preliminary results from 20 larynxes

Quantification of the elastic properties of the human vocal fold provides invaluable data for researchers deriving mathematical models of phonation, developing tissue engineering therapies, and as normative data for comparison between healthy and scarred tissue. This study measured the shear modulus of excised cadaver vocal folds from 20 subjects. Twenty freshly excised human larynxes were evaluated less than four days post-mortem. They were split along the saggital plane and mounted without tension. Shear modulus was obtained by two different methods. For method 1 cyclical shear stress was applied transversely to the mid-membranous portion of the vocal fold, and shear modulus derived by applying a simple shear model. For method 2 the apparatus was configured as an indentometer, and shear modulus obtained from the stress/strain data by applying an established analytical technique. Method 1 shear model for male larynxes yielded a range from 246 to 3,356 Pa, with a mean value of 1,008 and SD of 380. The range for female larynxes was 286–3,332 Pa, with a mean value of 1,237 and SD of 768. Method 2 indentometer model for male larynxes yielded a range from 552 to 2,741 Pa, with a mean value of 1,000 and SD of 460. The range for female larynxes was 509–1,989 Pa, with a mean value of 1,332 and SD of 428. We have successfully demonstrated two methodologies that are capable of directly measuring the shear modulus of the human vocal fold, without dissecting out the vocal fold cover tissue. The sample size of nine female and 11 male larynxes is too small to validate a general conclusion. The high degree of variability in this small cohort of subjects indicates that factors such as age, health status, and post-mortem delay may be significant; and that there is range of ‘normality’ for vocal fold tissue. This project received financial support from the Engineering Physics and Science Research Council of Great Britain (EPSRC) and the Eugene B Casey Foundation (JBK).     

自体脂肪及筋膜植入犬声门旁间隙及固有层的实验研究

目的探讨犬喉自体脂肪及筋膜植入后植入组织生长特性、填充机制及影响填充效果的因素。方法 16只犬32侧声带,除2侧声带作为正常对照组不作任何手术处理外,其余30侧声带通过切断喉返神经建立声带麻痹动物模型后,分为以下4组:脂肪注射组(10侧)、脂肪填充组(5侧)、筋膜注射组(8侧)、筋膜填充组(7侧),除筋膜填充组填充于犬声带的固有层外,其余三组脂肪和筋膜注射分别注射于犬喉的声门旁间隙,于术后第1周、1、3、6、12个月对犬喉植入的脂肪、筋膜分别进行大体及组织病理学观察及比较。结果脂肪植入组在脂肪植入部位可见炎性细胞浸润,于术后第3个月后消失,术后3月时开始有新生血管形成,12月时脂肪植入部位仍可见团状的成活脂肪细胞。筋膜植入组无明显炎性细胞反应,在筋膜植入部位,筋膜组织以密度较高的纤维组织形式存在,均于第1个月时观察到纤维母细胞,筋膜填充组术后第3个月后筋膜组织呈均匀排列,第6个月后椭圆形纤维母细胞密度增大,填充部位新生血管形成,术后12个月其密度与周围组织趋于一致。脂肪植入组纤维母细胞出现比例(4/15)小于筋膜植入组(9/15),而新生血管比例(7/15)大于筋膜植入组(3/15)。结论自体脂肪及筋膜作为声带填充材料具有良好的组织相容性,术后12月时仍在植入部位存活。填充物周围纤维包膜的形成及植入后纤维组织、纤维母细胞、自体血管等的生长,对保持填充效果长期稳定有影响。     

The utility of histopathology in identifying structural differences among layers of the lamina propria

Objective

The purpose of this study is to assess the modality of laryngeal histopathology in identifying 1, 2, or 3 layers in the lamina propria.

Methods

Blinded analysis was performed, with a set of histophathologic slides where the magnification and localized regions shown were all standardized. Two senior pathologists with experience reviewing laryngologic histophathology were asked to assess whether the vocal fold lamina propria they evaluated contained 1, 2, or 3 layers. Their ability to accurately assess this was calculated.

Results

The first pathologist correctly identified 13 of 25 (52%) specimens. The second identified 19 of 25 (76%) specimens after receiving gold referents before the test. No significant difference was seen between the pathologists’ interpretations (McNemar test; p = 0.0833).

Conclusion

Our results show the difficulty of using histopathology to distinguish layers in the lamina propria even when the reviewers are senior pathologists. These findings imply that more objective modalities for such analyses may be beneficial.