咽喉反流与嗓音疾病相关性初步评估

Throat voice diseases associated with reflux preliminary assessment

目的探讨嗓音疾病与咽喉反流（LPR）的相关性。方法选取2015年3月至2016年3月就诊于该科的疑似LPR的成年患者107例，进行反流体征量表、反流症状量表评分，24h双探头食道pH值监测，其中嗓音疾病患者93例（嗓音疾病组），按嗓音疾病情况分组，声带肉芽肿组19例，慢性咽喉炎组21例，声带息肉组18例，声带白斑组19例，声带任克水肿组16例，无嗓音症状14例设为对照组。将确诊LPR者设为反流组，无LPR者设为非反流组，进行嗓音障碍指数量表评分与嗓音声学分析。结果107例患者中LPR患者49例（45．79％）。嗓音疾病组、声带任克水肿组、声带肉芽肿组患者LPR阳性率均明显高于对照组，声带肉芽肿炎组、声带任克水肿组患者反流症状量表评分均明显高于对照组，声带任克水肿组患者反流体征量表评分明显高于对照组，声带肉芽肿组患者立、卧位与总酸反流次数、立位酸与总酸反流时长均明显高于对照组，声带任克水肿组患者立位与总酸反流次数、立位与总酸暴露比例、立位酸与总酸反流时长均明显高于对照组，差异均有统计学意义（P〈0．05）；反流组患者噪声能量、发声时间等各嗓音声学参数及嗓音障碍指数量表分值与非反流组比较差异均有统计学意义（P〈0．05）；且嗓音障碍指数与反流症状指数呈正相关，差异有统计学意义（P〈0．05）。结论声带任克水肿和肉芽肿与LPR的关系更密切，患者反流频率更高，时长更长。LPR能明显干扰发音情况，LPR症状严重的患者其嗓音疾病对心理与社会能力的影响更加严重。

Objective Analysis to explore the correlation between voice and throat reflux disease. Methods 107 patients treated in our hospital and diagnosed as suapected LPR were involved in this study. The reflux symptoms scoring scale and the reflux symptoms index scale score were conducted and the 24 h double probe esophageal pH was monitored. Among them, there were 93 cases of voice diseases, and according to patient＇s voice disease situation, they were divided into vocal cord granulomas group （19 ca- ses） ,chronic angina group （21 cases） ,vocal cord polyp group （18 cases） ,vocal cords leukoplakia group （19 cases） ,she edema vocal cords group （16 cases） ,and 14 cases of no voice of a total were set as control group. Then set the throat reflux patients diagnosed to reflux group, no throat reflux is set to the reflux group, the voice disorders index rating scale and the voice acoustic analysis were conducted. Results among all the 107 cases of patients,the pharyngeal reflux positive rate was 45.79% （49/107） ,in the voice dis- orders in patients with pharyngeal reflux the positive rate was 70.97 % （66/93）, while she edema group throat reflux positive rate was 87.50% （14/16） ,the granuloma group throat reflux positive rate was 68.42%（13/19） ,significantly increased than in the con- trol group 35.71% （5/14）（P〈0.05）. The reflux symptoms of strep throat and she edema group scale scores than the control group significantly increased（P〈0. 05） ;compared with the control group, she edema group of reflux symptoms scale scores significantly increased（P〈0.05）, compared with the control group,Granuloma group of stand,recumbent position and number of total acid re- flux, acid and total acid reflux time were significantly increased（P〈0.05） ;She edema group stand number and total acid reflux, and exposed the proportion of total acid, stood a acid and total acid reflux time were significantly increased than patients in the control group（P〈0.05）. Reflux group of noise energy, voice the voice acoustic parameters, such as time and voice disorders index rating scale score and the reflux group, there were significant differences（P〈0. 05） ,and voice disorders and reflux symptoms index were positively correlated（P〈0.05）. Conclusion The vocal she swelling and granuloma were closely corelated with throat reflux, and there was a higher frequency of reflux, and longer length. Pharyngeal reflux can pronunciation obvious disturbance, symptoms of se- vere patients voice diseases affect their physical, psychological and social ability are more serious.