男性变声后假声的康复治疗

Rehabilitation for male mutational falsetto

目的 探讨变声后假声 (MF)的可能病因及康复治疗方法。方法 对 16例男性变声后假声患者进行了详细的病史调查及体检 ,治疗前、后均行纤维喉镜及动态喉镜检查、嗓音声学分析 ,并检测血清雌二醇 (E2 )和睾酮 (T)含量。对 14例患者采用发声矫治方法治疗 ,其中 2例血清E2 异常升高患者同时口服甲基睾丸素片 ;2例行III型甲状软骨成形术。结果 14例发声矫治训练者 1～ 2月个治愈 ;2例手术患者术后音调恢复正常。全部病例嗓音基频 (F0 )由治疗前的 (2 62 .15± 3 0 .91)Hz下降到治疗后的 (12 2 .2 5± 8.67)Hz ,治疗前、后比较差异有显著性 (P <0 .0 1)。结论 MF为非器质性改变 ,属功能性发声障碍。变声期喉肌弱导致代偿性发假声而后形成错误的发声习惯可能为其主要原因 ;性激素、内分泌失调、心理因素亦可能与其有关 ;发声矫治是治疗MF的有效方法 ,应为首选。

Objective To investigate the etiology and explore the rehabilitation strategy for patients with male mutational falsetto(MF). Methods Sixteen subjects were included in this study. The clinical data including the findings of fiberlaryngoscopy, laryngostroboscopy and computer-based analysis of voice were retrospectively analyzed, the blood levels of estradiol(E 2) and testosterone(T) were determined.14 patients were treated by voice modification in which 2 patients with high level of E 2 were treated by methyltestosterone . Thyroplasty III was carried out for another 2 patients. Results Voice restoration was obtained in 14 patients after the rehabilitation training including the voice modification for 1 to 2 months. Pitch of 2 patients restored after thyroplasty III. Fundamental frequency(F 0) declined from an average of (262.15±30.91)Hz to (122.25±8.67)Hz,the difference was statistically significant( P <0.001). Conclusion MF is one kind of functional vocal disorder,the main etiological factor may attribute to incorrect vocal habit formed due to compensatory false voice caused by weakness of laryngeal muscle in mutation period.Endocrine dysfunction and psychological factors may be related to the disease. Voice modification is an effective and the preferable option for the management of MF.