控制用声导致的功能性发声障碍的临床特点研究  

Clinical characteristics of functional dysphonia secondary to inadequate voice rest

作　　者：程丽宇 徐文[1] CHENG Liyu;XU Wen(Department of Otorhinolaryngology&Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《山东大学耳鼻喉眼学报》2021年第3期10-13,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：北京市医院管理局临床技术创新项目“扬帆计划”(XMLX201848)。

摘　　要：目的探讨不当的控制用声、禁声导致的功能性发声障碍患者的临床特点。方法回顾性分析94例有不当的控制用声、禁声且确诊为功能性发声障碍患者的初始诱因、病程、控制用声时间、临床表现、声嘶程度、既往治疗史及频闪喉镜下表现。结果94例患者中男性23例(24.5%)、女性71例(75.5%),初始发病诱因包括上呼吸道感染(28例,29.8%)、过度用声(21例,22.3%)、无明显诱因(29例,30.9%)、精神压力大或情绪激动(12例,12.8%)、其他因素(4例,4.2%)。病程1周~12年,中位数为6个月。控制用声时间为1周~5年,中位时间为3个月。94例患者中82例(87.2%)有发音疲劳、79例(84.0%)有声嘶、27例(28.7%)有发音咽痛。轻度声嘶23例(24.5%)、中度声嘶38例(40.4%)、重度声嘶31例(33.0%)、2例(2.1%)无声嘶。VHI评分总分为(63.0±23.5)分,其中功能部分(23.1±7.5)分,生理部分(22.4±10.5)分,心理部分(17.7±9.5)分;三部分评分比较,功能、生理评分差异无统计学意义(P=0.749),功能、生理评分均高于心理评分(P=0.010,P<0.001)。频闪喉镜结果:53例(56.4%)患者无明显声门上代偿,41例(43.6%)患者有不同程度的声门上代偿;声门闭合完全26例(27.7%),闭合呈不同程度裂隙66例(70.2%);黏膜波正常或轻度减低61例(64.9%),中重度减低及消失31例(32.9%)。患者恢复正常用声、部分患者辅助发音训练后,VHI评分、jitter、shimmer均较前减小(P均<0.05)。结论不当的控制用声、禁声可继发功能性发声障碍,女性多见,患者多伴有发音疲劳等主观症状。患者明确诊断后,首先应恢复正常用声,部分患者需辅助进行发音训练,发声障碍可明显改善。Objective To analyze the clinical characteristics of functional dysphonia secondary to inadequate voice rest.Methods This study included 94 patients diagnosed with functional dysphonia secondary to inadequate voice rest.We retrospectively analyzed the initial predisposing factors,course of disease,duration of voice rest,degree of hoarseness,previous history,treatment,and performance under strobolaryngoscopy.Results Twenty-three men(24.5%)and 71 women(75.5%)were included.The causes included upper respiratory infection(28 cases,29.8%),voice abuse(21 cases,22.3%),emotional tension(12 cases,12.8%),and other factors(4 cases,4.2%).Twenty-nine patients(30.9%)had no obvious causes.The duration ranged from 1 week to 12 years,and the median duration was 6 months.The duration of voice rest ranged from 1 week to 5 years,and the median duration was 3 months.Among the 94 patients,82(87.2%)had vocal fatigue,79(84.0%)had hoarseness,27(28.7%)had sore throat during phonation.Hoarseness was categorized into three levels:mild(24.5%),moderate(40.4%),and severe(33.0%).Two patients(2.1%)had no hoarseness.The total score of the VHI was 63.0±23.5,the functional score was 23.1±7.5,the physical score was 22.4±10.5,and the emotional score was 17.7±9.5.There was no significant difference between the functional and physical scores(P=0.749).Both functional and physical scores were higher than the psycho score(P=0.010,P<0.001).Strobolaryngoscopy showed that 53 patients(56.4%)had no obvious supraglottic compensation,and 41 patients(43.6%)had varying degrees of supraglottic compensation.Twenty-six patients(27.7%)had complete glottis closure,and 66 patients(70.2%)had different degrees of glottis insufficiency.There were 61 cases(64.9%)of normal or mild reduction of the mucosal wave,and 31 cases(32.9%)of moderate or severe reduction and the disappearance of the mucosal wave.Glottis closure and mucosal wave could not be observed in two patients due to the severe supraglottic compensation.Conclusion Inodeguate voice rest can lead to functional dy

关 键 词：发声障碍 功能性 声嘶 上呼吸道感染 控制用声 发音疲劳 发音训练 

分 类 号：R767.92[医药卫生—耳鼻咽喉科]