嗓音训练对儿童顽固性声嘶康复个案分析

A Case Analysis of Voice Therapy in the Rehabilitation of Stubborn Hoarseness in Children

目的对1例顽固性声嘶患儿进行嗓音训练,探究训练方法的有效性。方法患儿7岁,女性,主诉声音嘶哑4年,曾在外院多次药物治疗及声休均无效,诊断为声带小结,肌紧张性发声障碍,训练内容包括嗓音卫生、放松练习、呼吸练习、共鸣训练、半封闭声道训练等。结果干预8周后,患儿声门挤压改善,听感知评估由重度转为轻度,基频从治疗前191.06 Hz提升至治疗后229.41 Hz;基频微扰(jitter)治疗前2.24%降至治疗后0.24%;振幅微扰(shimmer)治疗前12.12%降至治疗后8.2%,治疗前S/Z比值2.04降至治疗后1.02。Jitter和Shimmer较训练前降低,提示声带的不规律性振动减少;S/Z比值降低提示患儿发声效率提高。结论嗓音训练是目前治疗儿童发声困难的首选方式,对于声音滥用、误用引起声音嘶哑等症状的儿童有良好的疗效。

Objective A patient with persistent hoarseness was trained and the effectiveness of the training method was explored.Methods A 7-year-old,female child with hoarseness for 7 years was enrolled,and had been treated for many times with drugs and vocal rest in the hospital ineffectively.The diagnosis is vocal cord nodules and muscle tone vocal disorder(MTD),and training contents are as follows:vocal hygiene,relaxation exercises,breathing exercises,resonance training,semi-closed vocal training,ect.Results After eight weeks of intervention,the glottic squeezing was improved,and the auditory perception assessment changed from severe to mild,and F0 increased from pre-treatment 191.06 Hz to 229.41 Hz after treatment,and the Jitter decreased from 2.24% to 0.24% after treatment;The Shimmer decreased from 12.12% before treatment to 8.2% after treatment,and the S/Z ratio decreased from 2.04 before treatment to 1.02 after treatment;Jitter and Shimmer decreased compared with pre-treatment,suggesting irregular vocal cord vibration movement decreases.A decrease in the S/Z ratio indicates an increase in vocal efficiency.Conclusion Voice training is currently the preferred way to treat vocal difficulties in children,and have good efficacy,especially for children with hoarseness and other symptoms caused by excessive voices use and misuse.