针灸联合嗓音矫治治疗原发性肌紧张性发声障碍

目的探讨针灸联合嗓音矫治对原发性肌紧张性发音障碍患者的治疗效果。方法将40例原发性肌紧张性发音障碍患者随机分为嗓音矫治组及针灸联合嗓音矫治组(针灸联合治疗组),每组20例。嗓音矫治组采用放松训练、轻松发音、口腔共鸣及情景对话四阶段循环嗓音矫治方法治疗,针灸联合嗓音矫治组在嗓音矫治的基础上加用6处穴位的针灸治疗三周,比较两组治疗前后的基频微扰(jitter)、振幅微扰(shimmer)、最长发声时间(MPT)、嗓音障碍严重指数(dysphonia severity index,DSI)、频闪喉镜检查、嗓音障碍指数(VHI)评估、嗓音主观评分(GRBAS)、康复时间及3月后复发率。结果①治疗前上述指标两组之间无显著性差异(P>0.05);治疗后,两组患者jitter、shimmer、VHI及G评分均较治疗前显著减小(P<0.05),MPT及DSI较治疗前显著升高(P<0.05);但两组之间治疗后jitter、shimmer、MPT、DSI及G评分均无显著性差异(均P>0.05),针灸联合治疗组VHI评分低于嗓音矫治组,差异有统计学意义(P<0.05)。②两组患者至治疗结束时频闪喉镜检查均表现为声门上区挤压消失,室带收缩显著缓解,声带均可正常暴露并观察到正常粘膜波,声门后裂隙不同程度减小甚至消失。③针灸联合治疗组康复时间(中位数32.15天)显著短于嗓音矫治组(中位数41.07天)(P<0.01);针灸联合治疗组3月后复发5例(25.0%,5/20),嗓音矫治组3月后复发6例(30.0%,6/20),治疗后两组复发率比较差异无统计学意义(P>0.05)。结论针灸及嗓音矫治治疗原发性肌紧张性发声障碍均有良好的治疗效果,两者联合能够缩短疗程,更有利于改善患者的主观症状。

Application of Acupuncture Combined with Voice Therapy in the Treatment of Patients with Primary Muscle Tension Dysphonia

Objective To study the therapeutic effect of acupuncture combined with voice therapy on patients with primary muscle tension dysphonia.Methods A total of 40 patients with primary muscle tension dysphonia were randomly divided into the voice therapy group and the acupuncture combined voice therapy group.The voice therapy group was treated with the method of ladder-and-loop therapy,and the acupuncture combined voice therapy group was treated with acupuncture at 6 points on the basis of the voice therapy.Acoustic analysis,stroboscopic laryngoscope,jitter,shimmer,MPT,dysphenic severity index(DSI),vocal handicap index(VHI),subjective voice score(GRBAS)before and after treatment,as well as recovery time and recurrence rate at 3 months were compared between the two groups.Results①Before treatment,there was no significant difference between the two groups in the above indicators.②After treatment,the jitter,shimmer,VHI and G scores of the patients in the two groups were significantly decreased,while the MPT and DSI were significantly increased compared with the pre-treatment scores.After treatment,there was no significant difference in jitter,shimmer,MPT,DSI and G scores between the two groups,while the VHI of acupuncture group was significantly lower than the voice therapy group.③By the end of treatment,stroboscopic laryngoscope showed that the compression of the superior glottic region disappeared,the contraction of the ventricular band was significantly relieved,and the vocal cords could be exposed normally and normal mucosal waves were observed in all patients in both groups.The postglottic fissure decreased or even disappeared in different degrees.④Compared with the two groups,the recovery time of acupuncture combined voice therapy group(median 32.15 days)was significantly lower than that of the voice therapy group(median 41.07 days)(Z=-2.614,P=0.008).While there was no statistical differences in the recurrence rate between the two groups(χ^2=3.030,P=0.071).Conclusion Acupuncture and voice therapy can play a good role in the treatment of patients with primary muscle tension dysphonia.In terms of subjective feelings of patients,acupuncture combined with voice therapy can achieve better therapeutic effect.