摘要
目的:探讨心理干预并语言训练在治疗变声后假声中的应用。方法:选择2000-09/2003-10在第四军医大学唐都医院耳鼻咽喉科就诊的变声后假声患者23例,并选择50名同年龄段正常发音男性青年作为对照。患者在接受治疗前对其进行适当的心理干预,采用认知疗法让患者了解发病原因、影响因素、治疗及预后等相关知识,指导患者掌握音乐疗法、行为疗法及放松疗法等,使患者达到自我心理疏导调节,以稳定的心理状态积极配合语言训练治疗。语训方法:由专业语言师结合主观听觉与声谱图客观描述对患者进行指导。患者在接受语训前、后利用语图仪在发“a”及“i”音状态分别记录基频数值、共振峰频率。发声训练分4个阶段进行,语训1次/d,1h/次。训练过程中注意解除患者心理障碍,给予适当鼓励。应用嗓音分析系统对治疗前后的声样作声学分析,获取有关声谱图,并对嗓音质量作客观评估。结果:23例患者均随访1年以上,无脱落。①治疗后23例患者的声谱图波形较治疗前均有不同程度改变,声学分析参数接近成人正常参考值。②6例患者经正规有效语训无需手术发音得到矫正,发“a”音、“i”音基频与矫治前相比明显下降犤(203.5±32.8),(259.9±31.7)Hz;(198.4±32.9),(248.8±31.6)Hz,P<0.01犦,与正常男性青年相比差异不显著犤(191.2±30.5),(180.1±29.1)Hz,P>0.05犦。③17例患者因病史长,经语训1周无明显改变,行手术矫正治疗后发音混有频繁破音,经语言训练指导,均在3d内达到正常连续发音。结论:对变声后假声患者进行心理治疗可使患者认识到变声是生长发育过程中的一种正常的生理现象。结合语训师的主观听觉与嗓音分析系统的客观描述对患者发音进行指导,为患者提供了关键性的反馈信息,便于患者寻找和及时校正发音部位与方法,使其基频迅速得以控制,且患者可随时看到自己的成绩,有利于其增强进一步训练的信心。变声后假声患者,无论其是功能性的还是器质性的,无论保守治疗还是手术治疗,均应进行有效的言语训练。
AIM ：To discuss the application of psycho-intervention and speech training in the treatment of mutational falsettos METHODS： Twenty-three patients with mutational falsettos in Department of Otolaryngology, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from September 2000 to October 2003 were selected. Fifty healthy adult males were selected as control group. Psycho-intervention was conducted in patients with mutational falsettos before treatment to comprehend onset reason, effect factor and relative knowledge of treatment and prognosi, make patients grasp music therapy, behavior therapy and relaxation therapy etc. to achieve self-psyche adjustment and hold stable mental state to fit actively speech training therapy. Method of speech training： Subjective audition and tonspectrogram with professtional language teachers were conducted to make objective description in patients. Radical frequent numeric value and resonanc frequency of “a”and “i”sound was recorded by language-chart apparatus before and after training. Giving off sound training was divided into 4 stages with one time per day and one hour per time. Psychologic obstacle was decreased during training and the patients were given appropriately encouragement. Before and after the treatment, voice sample were collected and analyzed with USSA （Univeral Signal Spectrum Analys） and quality was measured objectively.RESULTS： Totally 23 patients were followed-up more than one year without abscission. ① After phonation training in regulation, tonspectrogram wave form had changed in different degree. Acoustics analysis parameter neared to adult normal amount. ② six patients phonation were corrected without operation. Radical frequency of “a”and“i” sound had reduced obviously [（203.5±32.8）, （259.9±31.7） Hz; （198.4±32.9）, （248.8±31.6） Hz ,（P〈 0.01）], while it was insignificant difference compared with healty adult male [（191.2±30.5）, （ 180.1±29.1 ）Hz, （P 〉 0.05）]. ③Other seventeen patients needed operation, because of the long hlstory. After one week training there was insignificant difference. After operation theirs phonation mixed with breaking sound, so combined with 3 days language training theirs phonation reached normal.CONCLUSION： Psychological treatment in patients with mutational falsettos makes patients realize that mutation is a normal physiologic phenomenon in the process of growth and development. Objective description of subjective audition and voice analysis provided by language instructor has instruction on phonation, which offers key feedback message to find and correct the part of phonation for patients. By this way radical frequency is controlled rapidly, and achievement can be seen by patients at any time. It has advantages on improving training confidence. No matter treated by functional, organic, conservative therapy or operation, the effective phonation training is needed.
出处
《中国临床康复》
CSCD
北大核心
2005年第20期55-57,共3页
Chinese Journal of Clinical Rehabilitation
