嗓音训练前后对女性肌紧张性发声障碍患者发声空气动力学结果分析

Influence of Voice Therapy on Vocal Aerodynamic Characteristics in Female Patients with Muscular Tension Dysphonia

目的分析嗓音训练治疗女性肌紧张性发声障碍(muscular tension dysphonia,MTD)前后患者发声空气动力学的变化,探讨空气动力学检测对噪音训练治疗MTD疗效评估的意义。方法对19例诊断为MTD的女性患者(病例组)进行12周嗓音训练,训练内容包括凸腹凹腹气息练习、凸腹控制膈肌练习、快速呼吸练习、放松舌根和喉部肌肉练习及诵读发声练习,于训练前、训练12周后采用言语发声空气动力学测试系统分别检测病例组的肺活量、舒适发声时的声门下压、空气动力能、平均气流率、声门阻力及最长声时,并与19例正常成年女性(对照组)进行对比分析。结果病例组训练前的中位声门下压(10.80cmH2O)、声门阻力[108.01cm H2O/(Lit/Sec)]及空气动力能(0.15watts)较正常对照组升高,中位肺活量(2.7L)及最长声时(12.51s)缩短,差异有统计学意义(P<0.05);训练12周后患者组中位声门下压(7.87cmH2O)、声门阻力[67.25cm H2O/(Lit/Sec)]及空气动力能(0.08watts)较训练前下降,中位肺活量(3.0L)及最长声时(20.85s)较训练前增加,差异有统计学意义(P<0.05);训练12周后病例组上述各指标与正常对照组相比差异均无统计学意义(P>0.05)。结论嗓音训练可降低MTD患者发声时的声门下压、声门阻力及空气动力能,增大肺活量,延长最长声时;通过发声空气动力学检测能定量评估嗓音训练治疗女性MTD的效果。

Objective To investigate the characteristics of vocal aerodynamics indicators before and after voice therapy in female patients with muscular tension dysphonia （MTD）. Methods The voice therapy was applied to 19 female MTD patients, consisting of the following 5 components of exercise： exercise with a convex and concave ab- domen; exercise for controlling the diaphragm with a convex abdomen, rapid breathing exercise, relaxation exercise for the muscles at the base of the tongue and throat and a reciting vocal exercise. Parameters included vital capacity （VC） , subglottal pressure （SGP）, aerodynamic power （AP）, mean expiratory airflow （MEA）, glottal resistance （GR） and maximum phonation time （MPT） were recorded and analyzed before and 12--week after voice therapy by phonatory aerodynamic system and compared with 19 female volunteers with normal voices （the control group）. Re- suits Before voice therapy, the median SGP（10.80 cmHzO）, AP（0.15 watts） and GR 1-108.01 cmH20/（Lit/Sec）] were higher than control group while median MPT （12.51 s） and VC（2.7 L） were shorter. The differences were statistically significant. After 12 weeks voice therapy, the median SGP（7. 87 cmH2 O）, AP（0. 08 watts）, GR [67.25 cmH20/（Lit/Sec）] decreased and the median MPT（20.85 s） and VC（3.0 L） increased, compared to the measurements obtained prior to therapy, and these differences were statistically significant. The differences of medi- an VC, SGP, AP, MEA, GR, MPT between MTD after 12 weeks therapy and control group were not statistically significant. Conclusion The voice therapy is an effective treatment for MTD patients. An aerodynamic analysis can effectively evaluate the vocal functional status of MTD patients before and after therapy, which is beneficial for treatment efficacy evaluation.