嗓音训练治疗声带小结的疗效观察  

The Effects of Voice Training Therapy on Dysphonia in Patients with Vocal Nodules

作　　者：李艳[1,2] 葛平江[1] 彭莉佳[2] 盛晓丽[1] 许咪咪[1] 任庆宜 陈少华[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)耳鼻咽喉科,广州510080 [2]星海音乐学院音乐学系

出　　处：《听力学及言语疾病杂志》2015年第3期261-264,共4页Journal of Audiology and Speech Pathology

基　　金：广东省医学基金资助项目(A2013030)资助

摘　　要：目的探讨嗓音训练对声带小结患者发声障碍的治疗效果。方法对21例声带小结患者进行嗓音训练,包括嗓音教育和发声训练,根据＂呼吸-发声-共鸣＂平衡原理,采用喉部按摩、无声练习及发大开口咽音的训练方法,每周训练一次,每次1~2小时,共5次。训练前后对患者进行嗓音障碍指数量表（VHI）评估、GRBAS评估、动态喉镜检查、空气动力学检测、计算机嗓音声学分析,比较治疗前后评估结果。结果 21例患者治疗后VHI评分总分（29.48±21.21分）明显低于治疗前（52.95±24.30分）（P〈0.01）;GRBAS评分中总嘶哑度G（0.67±0.76）明显低于训练前（1.88±1.05）（P〈0.01）,粗糙声R（0.52±0.58）明显低于训练前（1.36±0.55）（P〈0.01）;治疗后动态喉镜检查患者声带闭合、运动的对称性、粘膜波、振动规律性均改善（P〈0.01）;3例患者声带小结完全消失,13例患者声带小结缩小,5例与治疗前比较无明显变化;最长发声时间也由治疗前的8.87±3.75秒变为治疗后的12.54±3.68秒（P〈0.01）;治疗后嗓音的频率微扰、振幅微扰、噪谐比（分别为0.18%±0.08%、2.10%±0.98%、0.0034±0.0022dB）均明显低于治疗前（分别为0.43%±0.31%、4.55%±1.80%、0.0184±0.028dB）（P〈0.01或0.05）。结论嗓音训练对声带小结患者发声障碍有良好的治疗效果。Objective To investigate the effect of voice training therapy on the voice improvement in patients with vocal nodules .Methods Twenty one patients with vocal nodules were recruited and were evaluated by the GRBAS perpetual evaluation ,voice handicap index （VHI）-30 subjective assessment ,vocal laryngostroboscopy , maximum phonation time （MPT） and acoustic analysis pre- and post-therapy .These patients completed 5 cour‐ses of voice training .Results The VHI value（29 .48 ± 21 .21） of post-therapy was less than the value （52 .95 ± 24 . 30）of pre -therapy （P〈 0 .01） .There were significantly differences in voice perpetual evaluation between pre -training and post-training ,especially for G （grade） （P〈0 .01） and R （roughness） （P〈0 .01） .The post-training laryngostrobescopy vocal vibration improved comparing with pre-therapy in the closure of vocal cords ,symmetry of vibration ,the mucosal wave and vibration regularity of the vocal cords .After therapy ,three patient nodules dis‐appeared ,thirteen patient nodules became smaller ,and five patient nodules remained the same .The maximum pho‐nation time （MPT） （12 .54 ± 3 .68）of post-therapy was longer than MPT（8 .87 ± 3 .75） of pre-therapy MPT（P〈0 .01） .The jitter value （0 .18% ± 0 .08% ） of post -therapy was less than that of pre-therapy（0 .43% ± 0 .31% ） （P〈0 .01） .The shimmer of post -therapy （2 .10% ± 0 .98% ） was less than that of pre -therapy （4 .55% ± 1 .80% ）（P〈0 .01） ,The ratio of noise to harmonic（NHR）（0 .0034 ± 0 .0022 dB） of post-therapy was significantly less than NHR（0 .0184 ± 0 .028 dB）（P〈0 .05） of pre-therapy .Conclusion The voice therapy could significantlyimprove voice of patients with vocal nodules .

关 键 词：声带小结 嗓音训练 嗓音评估 

分 类 号：R764.41[医药卫生—耳鼻咽喉科]