远程嗓音训练对咽喉反流性疾病嗓音症状的疗效研究

Effect of voice therapy via telepractice on voice symptoms of laryngopharyngeal reflux disease

目的探究远程嗓音训练对咽喉反流性疾病(LPRD)患者嗓音症状的疗效。方法前瞻性研究纳入2021年1月至2022年7月山西医科大学第一医院耳鼻咽喉头颈外科120例LPRD嗓音障碍患者,按照门诊就诊顺序通过计算机生成的随机数表将患者分为对照组(A组)、面对面嗓音训练组(B组)、远程嗓音训练组(C组),对比分析3组间治疗第8周(阶段1)、治疗第12周(阶段2)及治疗结束后第6周(阶段3)的各疗效指标(主客观嗓音功能评价、反流症状评估)。采用SPSS 22.0进行统计学分析。结果纳入研究的120例LPRD嗓音障碍患者(男63例,女57例,年龄18~65岁)。在阶段1时,3组间嗓音障碍指数(VHI)、反流症状指数(RSI)、反流体征评分(RFS)的差异具有统计学意义(F=13.72,P<0.05;F=62.50,P<0.05;F=3.78,P<0.05),B组及C组VHI、RSI显著小于A组,C组VHI、RSI显著小于B组;阶段2时,3组间最长发声时间(MPT)、嗓音障碍严重指数(DSI)、VHI、RSI、RFS的差异具有统计学意义(F=8.49,P<0.05;F=3.24,P<0.05;F=8.55,P<0.05;F=19.92,P<0.05;F=12.19,P<0.05),B组及C组MPT、DSI显著大于A组,B组及C组VHI、RSI、RFS显著小于A组,C组RFS显著小于B组;阶段3时,3组间基频微扰(Jitter)、MPT、DSI、VHI的差异具有统计学意义(F=3.19,P<0.05;F=19.37,P<0.05;F=43.56,P<0.05;F=11.05,P<0.05),3组间RSI、RFS的差异具有统计学意义(F=25.58,P<0.05;F=11.82,P<0.05),B组及C组MPT、DSI显著大于A组,B组及C组VHI、RSI显著小于A组,C组RFS显著小于A组及B组。结论远程嗓音训练可在特殊时期作为一种替代面对面嗓音训练的方式应用于LPRD。

Objective The purpose of this study was to investigate the effect of voice therapy via telepractice on voice function in laryngopharyngeal reflux disease(LPRD)patients.Methods The prospective study included 120 patients from January 2021 to July 2022 with dyspnea and LPRD diagnosed at the department of otolaryngology head and neck surgery of the First Hospital of Shanxi Medical University.These patients were then randomly divided into standard treatment group(group A),combined face-to-face voice therapy group(group B)and combined telepractice voice therapy group(group C).We collected and compared data on curative effect in patients with LPRD at the 8th week(Stage 1)and the 12th week of treatment(Stage 2)and the 6th week post-treatment(Stage 3).Statistical analysis was performed using SPSS 22.0.Results One hundred and twenty patients with LPRD and dyspnea were included in the study(63 men,57 women,18-65 years old).At stage 1,there were statistically significant differences among the three groups in Voice Handicap Index(VHI),Reflux Symptom Index(RSI)and Reflux Finding Score(RFS)(F=13.72,P<0.05;F=62.50,P<0.05;F=3.78,P<0.05).VHI and RSI in group B and C were significantly smaller than those in group A,VHI and RSI in group C were significantly smaller than those in group B,and RFS in group C was significantly smaller than that in group A and B.At stage 2,there were statistically significant differences between the three groups in Maximum Phonation Time(MPT),Dysphonia Severity Index(DSI),VHI,RSI and RFS(F=8.49,P<0.05;F=3.24,P<0.05;F=8.55,P<0.05;F=19.92,P<0.05;F=12.19,P<0.05).MPT and DSI in group B and C were significantly larger than those in group A.The scores of VHI,RSI and RFS in group B and C were significantly smaller than those in group A,and RFS in group C was significantly smaller than that in group B.At stage 3,there were statistically significant differences among the three groups in Jitter,MPT,DSI,VHI(F=3.19,P<0.05;F=19.37,P<0.05;F=43.56,P<0.05;F=11.05,P<0.05),and there were statistically significant differences among the three groups in RSI and RFS(F=25.58,P<0.05;F=11.82,P<0.05).MPT and DSI in group B and C were significantly larger than those in group A.The scores of VHI and RSI in group B and C were significantly smaller than those in group A,and RFS in group C was significantly smaller than those in group A and B.Conclusion Telepractice can be used in patients with LPRD and dyspnea as an alternative to face-to-face voice therapy with better long-term outcomes.