嗓音训练联合拳击动作治疗青春期假声的疗效观察

Clinical effect of voice training combined with boxing for mutational falsetto

目的观察嗓音训练配合拳击动作治疗青春期假声的临床疗效。方法收集2016年1月—2019年6月在中南大学湘雅医院耳鼻咽喉头颈科就诊的青春期假声患者21例,均为男性患者,年龄16~35岁,病程1~20年。所有患者均表现为青春变声期或变声期后说话时音调偏高或用假声,杂音明显,偶有声嘶及破音,其中19例患者喉镜下表现为声带闭合欠佳。对患者采用嗓音训练联合拳击动作的矫治治疗,根据即时效果反馈,语训1~4次不等,每次1~2 h,以上过程均由专业语训师对患者进行指导及追踪。治疗前后采用动态喉镜及嗓音分析系统记录患者的喉镜下表现及嗓音声学参数,并进行对比分析,评估治疗效果。结果21例青春期假声患者发声基频(F0)较训练前均下降明显,其中18例患者基频恢复至成年男性正常水平,嗓音障碍指数(DSI)较前明显改善,最长发音时间(MPT)较前明显延长,差异具有统计学意义(P均<0.05);19例声带闭合不全的青春期假声患者经治疗后声带闭合良好。结论嗓音训练配合拳击动作治疗青春期假声效果显著,有一定的临床应用价值。

Objective To observe the clinical effect of voice training combined with boxing for mutional falsetto.Methods A total of 21 patients with mational falsetto were treated with voice training combined with boxing in our department from Jan 2016 to June 2019.All the patients were male with age ranged from 16 to 35 years old and course of disease ranged from one to 20 years.Their clinical manifestions were higher voice pitch or falsetto during or after mutation with obvious noise and occasional hoarseness and cracking voice.Of them,laryngoscopy confirmed poor closure of vocal cords in 19.According to the immediate effect feedback,the voice training combined with boxing was conducted from 1 to 4 times,each voice training lasted 1 to 2 hours.The above process was guided and tracked by the professional voice trainer.Before and after treatment,strobolaryngoscope and voice analysis system were used to record the laryngoscopic findings and vocal acoustic parameters for comparative analysis to evaluate the therapeutic effect.Results Pre-and posttreatment comparisons revealed that fundamental frequency(F0)was significantly lower with significantly improved dysphonia severity index(DSI)and lengthened maximum pronunciation time(MPT)following treatment in all 21 patients.The differences were statistically significant(all P<0.05).The F0 values of 18 patients recovered to normal adult male values.Posttreatment strobolaryngoscopy confirmed good closure of vocal cords in 19 patients with incomplete closure of vocal cords.Conclusion With remarkable therapeutic effect,voice training combined with boxing has clinical practical value for the treatment of mutional falsetto.