摘要
目的探讨嗓音训练治疗儿童声带小结患者的临床疗效,并对临床疗效的不同评估方法进行适用性分析。方法选取2023年1月—2025年1月就诊于厦门大学附属中山医院嗓音科的37例声带小结患者为研究对象。训练师以一对一单独授课的形式对患者进行为期2个月的嗓音训练,包括嗓音卫生宣教、放松训练、共鸣嗓音疗法(RVT),每周1次,每次45 min,并嘱患者每天进行1次家庭作业练习,每次30 min。分别于训练前、训练1个月后及训练2个月后采用儿童嗓音障碍指数(pVHI)评估嗓音障碍对儿童生活质量的影响;采用GRBAS评分进行嗓音质量主观听感知评估;采用频闪喉镜检查声带小结形态及声门闭合情况、声带运动的对称性、声带黏膜波及声带振动的规律性;采用客观声学指标(基频、基频微扰、振幅微扰)评估嗓音质量。结果与训练前比较,训练1个月后pVHI总分、生理及情感评分均下降(P<0.05),训练2个月后pVHI总分、功能、生理、情感评分均下降(P<0.05);与训练1个月后比较,训练2个月后pVHI总分、功能及情感评分均下降(P<0.05)。与训练前比较,训练1个月及训练2个月后G、R、B评分均下降(P<0.05);与训练1个月后比较,训练2个月后G、R、B评分均下降(P<0.05)。与训练前比较,训练1个月后声带小结不同等级人数分布占比差异无统计学意义(Z=-1.908,P=0.056);训练2个月后声带小结不同等级人数分布占比差异具有统计学意义(Z=-5.024,P<0.001)。与训练前比较,训练1个月后频闪喉镜下声门闭合情况、声带黏膜波及声带振动规律性评分均下降(P<0.05);训练2个月后声门闭合情况、声带运动对称性、声带黏膜波及声带振动规律性评分均下降(P<0.05);与训练1个月后比较,训练2个月后声带运动对称性评分下降(P<0.05)。与训练前比较,训练1个月后和训练2个月后基频微扰、振幅微扰值均下降(P<0.05);与训练1个月后比较,训练2个月后振幅微扰值下降(P<0.05)。结论嗓音训练能有效改善儿童声带小结患者的嗓音质量,但声带小结形态改善滞后于声学的主客观评估结果。在儿童声带小结的嗓音训练疗效评估中,声音的听感觉评估及声学客观分析方法优于喉镜评估,作为一种无创性评估手段,声学分析可在嗓音训练过程中作为监测疗效的重要工具。
Objective To investigate the clinical efficacy of voice therapy in children with vocal nodules and to analyze the applicability of different assessment methods for evaluating the therapeutic outcomes.Methods A total of 37 patients with vocal cord nodules who visited the Voice Department of Zhongshan Hospital,Xiamen University between January 2023 and January 2025 were selected as the study participants.The patients received a two-month voice therapy program provided by a therapist in a one-onone individual training format.The therapy included vocal hygiene education,relaxation training,and resonant voice therapy(RVT),conducted once weekly for 45 minutes per session.Patients were instructed to perform daily home exercises once a day,30 minutes per session.Assessments were conducted before training,after one month of training,and after two months of training using the following tools:the Pediatric Voice Handicap Index(pVHI)to evaluate the impact of the voice disorder on the children's quality of life;the GRBAS scale for subjective auditory perceptual evaluation of voice quality;stroboscopic laryngoscopy to examine the morphology of the vocal cord nodules,glottal closure,symmetry of vocal fold movement,mucosal wave,and regularity of vocal cord vibration;and objective acoustic parameters(fundamental frequency,jitter,shimmer)to assess voice quality.Results Compared with pre-training,the total pVHI score,as well as the physical and emotional domain scores all decreased after 1 month of training(P<0.05);after 2 months of training,the total pVHI and functional,physical,and emotional domain scores all decreased(P<0.05);When comparing the results at 2 months after training with those at 1 month after training,the total pVHI score,as well as the functional and emotional domain scores all decreased(P<0.05).Compared with pre-training,the G,R,and B scores in the GRBAS Scale all decreased after 1 month and 2 months of training(P<0.05);compared with those after 1 month of training,the G,R,and B scores all decreased(P<0.05)after 2 months of training.There was no statistically significant difference in the distribution of different grades of vocal nodules among the number of patients before and after one month of training(Z=-1.908,P=0.056);after 2 months of training the distribution proportion of the number of patients with different grades of vocal cord nodules showed statistically significant difference(Z=-5.024,P<0.001).Compared with pre-training,the scores for glottal closure,vocal fold mucosal wave,and regularity of vocal fold vibration under stroboscopic laryngoscopy after 1 month of training all decreased(P<0.05);after 2 months of training the scores for glottal closure,symmetry of vocal fold movement,vocal fold mucosal wave,and regularity of vocal fold vibration all decreased(P<0.05);compared with that after 1 month of training,the score for symmetry of vocal fold movement decreased after 2 months of training(P<0.05).Compared with pre-training,the values of jitter and shimmer after 1 month and after 2 months of training all decreased(P<0.05);compared with that after 1 month of training,the value of shimmer after 2 months of training decreased(P<0.05).Conclusion Voice therapy effectively improves vocal quality in pediatric vocal cord nodules,although morphological changes lag behind the subjective and objective acoustic assessment results.Auditory-perceptual assessments and acoustic analysis exhibit superior clinical applicability compared to laryngoscopic evaluation.As a noninvasive tool,acoustic analysis is particularly valuable for monitoring therapeutic efficacy during voice rehabilitation.
作者
邹嵩
高绫
石蒙选
庄佩耘
ZOU Song;GAO Ling;SHI Mengxuan;ZHUANG Peiyun(Jinjiang Municipal Hospital(Shanghai Sixth People's Hospital Fujian Hospital),Jinjiang,Fujian 362200,China;Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,China;Xiamen Key Laboratory of Voice Medicine,Xiamen,Fujian 361004,China;School of Medicine,Xiamen University,Xiamen,Fujian 361005,China)
出处
《康复学报》
2025年第5期477-484,共8页
Rehabilitation Medicine
基金
国家自然科学基金面上项目(NSFC82271155)。
关键词
声带小结
嗓音训练
临床疗效评估
声学分析
频闪喉镜
vocal cord nodules
voice therapy
clinical efficacy evaluation
acoustic analysis
stroboscopic laryngoscopy
