支撑喉内镜下声带注射术治疗慢性肥厚性喉炎

目的 探讨全身麻醉支撑喉内镜下声带注射得宝松治疗慢性肥厚性喉炎的疗效。方法 对40例慢性肥厚性喉炎患者在全身麻醉支撑喉内镜下声带注射得宝松，术前、术后分别应用嗓音声学分析、嗓音障碍指数量表及纤维喉镜检查进行评估。结果 患者术后频率微扰（jitter）、振幅微扰（shimmer）、噪谐比（NHR）及噪音障碍指数（VHI）得分均较术前明显降低，差异有显著性（P <0.05）。纤维喉镜检查示声带充血、水肿、肥厚术后较术前比：无或仅有较轻者28例（28/40），明显减轻者10例（10/40）,变化不明显者2例（2/40）。术后未发现声带萎缩病例。结论　支撑喉内镜下声带注射得宝松治疗慢性肥厚性喉炎，疗效显著，并发症少，手术视野清晰，精细准确。     

脱细胞真皮基质黏膜补片填充治疗单侧声带麻痹

背景：脱细胞真皮基质黏膜补片作为一种新型的组织填充修复材料,具有良好的生物和结构相容性。目的：观察脱细胞真皮基质黏膜组织补片作为填充材料应用于声带内移的近远期疗效。方法：选择2009-01/2010-01解放军第三军医大学大坪医院野战外科研究所耳鼻咽喉-头颈外科收治的单侧声带麻痹患者20例,局麻下患侧甲状软骨板开窗,观察脱细胞真皮基质黏膜补片患侧声带下填充对改善声嘶等症状的疗效,术后1d、3,6,12个月各随访1次,通过纤维喉镜观察发音时声门闭合情况,嗓音分析评估音质,包括标准化噪声能量和最长声时。结果与结论：经患者主观评价及治疗前后各阶段嗓音声学参数分析（标准化噪声能量,最长声时）,证实手术近远期疗效满意,无特殊手术风险及不良反应。提示脱细胞真皮基质黏膜补片具有良好的组织相容性和易操作性,可作为声带麻痹手术治疗中声带内移的新型填充材料,临床应用疗效满意。     

甲状腺术后喉返神经损伤的分阶段康复治疗

目的:观察分阶段康复治疗对甲状腺术后暂时性喉返神经损伤恢复的临床疗效.方法:共选取32例甲状腺术后暂时性喉返神经损伤患者,将其随机分为治疗组及对照组.治疗组给予分阶段规范化康复治疗:第一康复阶段指术后至术后2周,行超短波治疗;第二康复阶段指术后2周至2个月,行红外线偏振光照射结合中频电治疗;第三康复阶段指术后2个月至3个月,行直流电离子导入结合中频电治疗.另外,在二、三阶段以及以后的康复中,结合发音训练治疗.对照组未给予物理康复治疗.以电子喉镜检查声带运动与声门闭合.结果:治疗组患者病程3个月内电子喉镜检查,声带运动恢复正常、声门闭合完全者达到11例(68.75％),高于对照组5例(32.25％),P＜0.05;随访至4个月,治疗组患者恢复达100％,对照组仅有11例(68.75％),P＜0.05;6个月时对照组患者完全恢复.2组的散点回归方程,治疗组斜率(4.0)大于对照组斜率(2.9),治疗组恢复快于对照组.主观嗓音评估中简化嗓音障碍指数(VHI-10)在第3、4、5个月,治疗组均明显好于对照组(P＜0.05).结论:规范化分阶段康复治疗对甲状腺术后暂时性喉返神经损伤患者的声音恢复具有显著疗效.     

术中RLN监测在甲状腺切除手术中的应用

目的 探讨甲状腺切除手术中喉返神经监测的意义.方法 46例甲状腺疾病患者(癌27例,腺瘤6例,结节性甲状腺肿13例)行双侧腺叶全切除36例,双侧腺叶近全切除6例,单侧腺叶切除4例.术中应用NIM-Neuro 3.0系统监测患者喉返神经肌电信号,观察喉返神经损伤发生率.结果 44例术前双侧声带活动正常者,术后1例出现暂时性声带麻痹,其余患者术后双侧声带活动正常,发音与术前无改变,永久性喉返神经损伤率为零.2例术前出现单侧声带麻痹者术后无对侧声带活动障碍.结论 在甲状腺切除手术中实时喉返神经肌电监测有助于对其快速识别和保护.     

脱细胞真皮基质黏膜补片填充治疗单侧声带麻痹

背景:脱细胞真皮基质黏膜补片作为一种新型的组织填充修复材料,具有良好的生物和结构相容性.目的:观察脱细胞真皮基质黏膜组织补片作为填充材料应用于声带内移的近远期疗效.方法:选择2009-01/2010-01 解放军第三军医大学大坪医院野战外科研究所耳鼻咽喉-头颈外科收治的单侧声带麻痹患者20 例,局麻下患侧甲状软骨板开窗,观察脱细胞真皮基质黏膜补片患侧声带下填充对改善声嘶等症状的疗效,术后1 d、3,6,12 个月各随访1 次,通过纤维喉镜观察发音时声门闭合情况,嗓音分析评估音质,包括标准化噪声能量和最长声时.结果与结论:经患者主观评价及治疗前后各阶段嗓音声学参数分析(标准化噪声能量,最长声时),证实手术近远期疗效满意,无特殊手术风险及不良反应.提示脱细胞真皮基质黏膜补片具有良好的组织相容性和易操作性,可作为声带麻痹手术治疗中声带内移的新型填充材料,临床应用疗效满意.     

系统性嗓音训练对甲状腺术后无喉返神经损伤患者语言功能的影响

目的:探讨系统性嗓音训练对甲状腺术后无喉返神经损伤患者语言功能的影响。方法:将2020年1月1日～2021年1月31日收治的84例行甲状腺手术治疗且术后无喉返神经损伤的患者随机分对照组和观察组各42例。对照组采用常规护理干预,观察组在对照组基础上采用系统性嗓音训练。比较两组客观嗓音声学参数和主观嗓音质量评分[采用嗓音障碍指数量表(VHI)]。结果:观察组基频(Fo)、嗓音障碍严重指数(DSI)、最长发音时间(MPT)高于对照组(P0.01),且基频微扰(jitter)、振幅微扰(shimmer)低于对照组(P0.05);观察组VHI各项评分及总分均低于对照组(P0.01)。结论:对甲状腺术后无喉返神经损伤患者采用系统性嗓音训练干预,可改善患者嗓音声学参数,提升患者主观嗓音质量,促进患者语言功能恢复。     

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。     

咽下缩肌入路解剖喉返神经在神经修复术中的应用

目的:探讨在喉返神经修复术中,经咽下缩肌入路解剖显露神经,以利于神经修复的可行性.方法:2007-2010年11例单侧喉返神经损伤患者,术中切断咽下缩肌,自入喉处向近心端显露喉返神经,继而行神经粘连松解术1例,神经断端吻合后表面自体静脉套接术10例.手术前后喉镜检查评价手术效果.结果:所有患者均顺利游离显露咽下缩肌后方喉返神经,行喉返神经修复术,术后8例患者(73%)发音接近正常,2例患者(18%)发高音时略有嘶哑,1例患者(9%)正常发音时有嘶哑.其中1例行喉返神经松解术,术后喉镜提示声带活动完全恢复,10例行喉返神经断端吻合术,术后仅1例完全恢复声带活动,2例部分恢复,其余7例无明显活动.结论:喉返神经修复术中,经咽下缩肌入路解剖显露神经,有利于神经修复.     

高压氧治疗甲状腺癌术后双侧喉返神经损伤一例护理

喉返神经损伤是甲状腺手术常见的并发症,其中永久性损伤占1%～2%,而暂时性损伤高达5%～6%[1]。双侧喉返神经损伤引起双侧声带麻痹造成气道阻塞,处理不当将造成严重后果。我科于2015年4月收治一例患者甲状腺癌术后出现双侧喉返神经损伤,采用高压氧等综合治疗后恢复。高压氧是神经康复治疗较常用手段之一, 其对受损神经恢复的积极作用已得到基础及临床证实。目前治疗双侧喉返神经损伤以手术修复神经为主,而鲜有采用高压氧综合治疗的报道[2],故将护理体会报道如下。     

喉返神经修复重建术的围手术期护理

目的：总结喉返神经修复重建术围手术期的护理配合。方法：我科2007年10～11月手术治疗双侧喉返神经麻痹患者3例,手术前加强患者的心理护理、密切观察病情变化,及时处理声带麻痹引起的喉梗阻、误吸、呛咳等症状。术后重视体位护理、呼吸道的管理、保证药物及时准确使用,协助患者进行正确的吞咽进食训练、声带协调运动训练等康复护理。结果：3例患者术后均获完整随访,3月后均顺利拔除气管套管,无吸气性呼吸困难,无发音困难,嗓音质量较术前明显改善。结论：良好的围手术期护理有助于手术的成功。     

Utility of laryngeal electromyography in predicting recovery after vocal fold paralysis

OBJECTIVES: To determine the value of laryngeal electromyography in predicting recovery after vocal fold paralysis and to determine what elements of laryngeal electromyography are most predictive of outcome. DESIGN: Cohort study with retrospective data review. SETTING: University voice center. PARTICIPANTS: Consecutive sample of 31 patients with vocal fold paralysis diagnosed by indirect laryngoscopy, using either nasal insertion with a flexible nasopharyngoscope or peroral with a 70 degrees Hopkins rod. Inclusion criteria were that laryngeal electromyography had to have been performed between 21 days and 6 months from the onset of symptoms and patients must have been followed a minimum of 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Vocal fold motion at 6 months from onset of symptoms. RESULTS: Nine subjects (29%) had resolved vocal fold motion, whereas 22 (71%) had persistent vocal fold paralysis. By using our laryngeal electromyography paradigm, 4 of 6 patients with a laryngeal electromyography prognosis of excellent resolved. The predictive value for a negative test was 66.7%. For patients with a fair or poor prognosis, 5 of 25 resolved. The predictive value for a positive test was 80%. Only 8 of 22 patients with persistent vocal fold paralysis had fibrillations, and spontaneous activity was not significantly related to outcome. Patients with absent or greatly decreased motor unit recruitment had a significantly higher proportion of permanent vocal fold paralysis (P<.05). Stepwise forward logistic regression determined that prognosis by laryngeal electromyography and onset time were significant predictors of outcome (P<.01). The model predicted 44.4% of resolved cases, which represents a moderate prediction. CONCLUSIONS: This study confirms the utility of laryngeal electromyography in assessing prognosis for recovery of vocal fold motion after laryngeal nerve injury. The results support our hypothesis that preset decision rules based on laryngeal electromyography data can be effectively used to determine a prognosis for recovery of vocal fold motion.     

Laryngeal myxoma: A case report

BACKGROUNDMyxomas are benign tumors of mesenchymal origin that rarely occur in the larynx.CASE SUMMARYWe report a case of a laryngeal myxoma that presented as a right vocal cord mass in a 54-year-old man.CONCLUSIONLaryngeal myxoma is a rare benign tumor in the larynx. It is difficult to distinguish glottis myxoma from vocal cord polyps on laryngoscopy. We recommend that otolaryngologists acquire a better understanding of this disease. If a laryngeal myxoma is suspected, dynamic laryngoscopy, acoustic voice analysis, and pathological biopsy should be performed.     

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。     

四部矫治康复训练在声带良性病变手术患者中的应用研究

目的 探讨四部矫治康复训练在声带良性病变手术患者中的应用效果.方法 便利选取2020年4月—2021年3月在天津市某三级甲等医院耳鼻喉科,首次行全麻支撑喉镜下显微手术治疗的106例声带良性病变患者为研究对象,采用随机数字表法分为试验组55例和对照组53例.试验组在常规护理基础上进行四部矫治康复训练,对照组接受常规护理方...     

Application of Transcutaneous Laryngeal Ultrasonography in the Diagnosis of Vocal Fold Polyps

The aim of this study was to explore the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps. From December 2016 to June 2019, 87 patients with vocal fold polyps diagnosed pathologically in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled and examined by electronic laryngoscopy and percutaneous laryngeal ultrasound on the same day before operation. To observe the effect of calcification length as a percentage of thyroid cartilage at the glottic level on vocal fold display, the characteristics of ultrasound images of vocal fold polyps and the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps were assessed. Among 87 patients, the calcification rate of thyroid cartilage at the glottic level was 33.3%. The differences in calcification rate and percentage of calcification length between males and females were statistically significant. The rate of detection of vocal folds decreased gradually with an increase in calcification length percentage. Imaging features of vocal fold polyps were hypo-echoic with a clear boundary and regular shape. The detection rates for circular and non-circular polyps were 92.0% and 70.6%. Ultrasound was more likely to detect circular than non-circular polyps; however, the difference was not significant. Transcutaneous laryngeal ultrasonography can identify the morphology and location of vocal fold polyps and is non-invasive and highly accurate. Therefore, it has the potential to be an effective supplement to laryngoscopy for initial screening and post-operative review of vocal fold polyps.     

Association Between Subjective Voice Assessment and Psychological Distress After Thyroidectomy

PurposeThis study aimed to determine the association between postoperative subjective voice function and psychological distress in patients without laryngeal nerve injury after thyroidectomy.DesignA prospective cohort study.MethodsWe investigated the factors associated with subjective voice function in patients who underwent thyroidectomy without laryngeal nerve injury between October 2018 and July 2020. The Voice Handicap Index was used to assess subjective voice function, the GRBAS (grade, roughness, breathiness, asthenia, strain) scale to assess objective voice, and the Hospital Anxiety and Depression Scale to assess psychological distress.FindingsAmong 39 patients who underwent thyroidectomy, 32 had no postoperative laryngeal nerve injury. Postoperative Voice Handicap Index was significantly associated with Hospital Anxiety and Depression Scale-Anxiety score after surgery (rs = 0.448, P = .010).ConclusionsIn this study, an association was observed between subjective voice function and anxiety following surgery. The finding suggested that nurses and medical practitioners need to consider postoperative anxiety when evaluating patients’ voice function after thyroidectomy.     

Role of Ultrasonography in Upper Airway Assessment for Decannulating Tracheostomy in Acquired Brain Injury—A Pilot Study

ObjectiveTo compare the findings of ultrasonography of the upper airway with flexible fiberoptic laryngoscopy and determine the efficacy of transcutaneous laryngeal ultrasonography for decannulation.DesignProspective cross-sectional study.SettingTertiary care referral center in South India.ParticipantsTwenty-four patients with acquired brain injury (N=24).Main Outcome MeasuresParticipants underwent an airway assessment by ultrasonography followed by assessment of airway by flexible laryngoscopy done within the next 72 hours.ResultsVocal cord assessment by ultrasonography revealed a sensitivity of 81.2% and specificity of 87.5%. A statistically significant association between vocal cord mobility as assessed by ultrasonography and decannulation was observed (sensitivity of 81.25%, specificity of 87.5%, P=.002). Although aspiration was not assessed by ultrasonography, a statistically significant association was observed between vocal cord mobility on ultrasonography and aspiration as assessed by laryngoscopy (sensitivity of 81.25%, specificity of 87.5%, P=.011).ConclusionLaryngeal ultrasonography is an emerging diagnostic modality with a potential role for assessing vocal cord mobility and airway prior to decannulation in centers that lack the expertise and the infrastructure to perform a flexible laryngoscopy.     

甲状腺手术后声嘶的临床分析

目的 探讨甲状腺手术后声嘶的原因。方法 分析l363例各类甲状腺手术方法，并解剖和显露116例(174条)喉返神经的走行及其变异。结果 l363例中仅有12例在术后发生声嘶，发生率0．88％(12／1363)，其中l0例于1年内恢复，永久性声带麻痹者仅2例。结论 良好的手术野显露便于手术的进行，可减少术中可能导致喉返神经损伤的盲目钳夹与结扎或缝扎。喉返神经的解剖与显露在甲状腺手术中可有效地避免其损伤。     

全喉切除后发音功能重建术式探讨

Totallaryngectomieswereperformedon２９patientswithmiddleorlatestageoflaryngealcarcinoma．Underwenttracheo－esophagealvocalreconstructionofGriffithtracheostomaenlargementandfirststagemucosalvalvular犤１犦．Followupover１year，vocalfunctionre－sumedinnearly９０％patients．１Subjectsandmethods１．１Subjects２９patients，２７malesand２femaleswiththemeanageof５５yearsold．In２９patients，becauseofnoinvasivenessinop－positevocalcord，３caseswereperformed２／３laryngectomy，butre－lapsedafter６and８…