Diagnosis of Vocal Cord Paralysis in Anaesthesia

Vocal cord paralysis can occur as a complication o surgery or anaesthesia,if permanent is a significant clinica problem.Early detection is important to optimize the chance o repair,and avoid complications associated with an impaired swallow.An algorithm to detect altered vocal cord function was presented based on wavelet packet analysis(WPA) and suppor vector machines(SVM),and compared with the Hoarseness Diagram method(HDm),which was reported as an objective voice quality evaluation approach and could be used for pathological voice discrimination.Experiments using voice signals recorded from subjects before and after the procedure show high classification accuracy with the new algorithm,whereas HDm fails in the detection of a hoarse voice.This finding would help to develop a screening tool to detect the vocal structure damage during surgery.

Vocal Cord Paralysis Secondary to Carotid Artery Dissection: A Case Report

Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.

Hoarseness Due to Right Vocal Cord Paralysis Associated with Aortic Diverticulum from Right Aortic Arch—A Rare and Unusual Vascular Etiology of Right Vocal Cord Paralysis

Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiology of hoarseness and is extremely rare. Because of this rarity, the practicing otolaryngologist may miss this finding while evaluating a case of idiopathic right vocal cord paralysis. Thus, the authors feel that idiopathic or unexplained right vocal cord paralysis should be routinely investigated with a CT or MRI of neck and chest with or without contrast to avoid such shortcomings. There is only one such case of right vocal cord paralysis by right aortic which has been reported earlier in literature.

Experience of Cervical Plexus Reinnervation for Patients with Unilateral Recurrent Laryngeal Nerve Invasion or Injury

OBJECTIVE To explore the clinical and therapeutic effects ofcervical plexus reinnervation for infiltrated or injured unilateralrecurrent laryngeal nerve (URLN).METHODS Functional neck dissection for removal ofdifferentiated thyroid carcinoma (DTC) in patients was performed,in which cervical plexus reinnervation was adopted for patientswith stage Ⅰ disease and URLN with injury or with tumorinvasion.Outcomes of surgery were evaluated by examinationunder fibrolaryngoscope,and the patients'voices were evaluatedbefore and after surgery.RESULTS All cases were followed up for 3 mon-2 years(average 8 mon).Abductory motion of the vocal cords of 15patients was completely or partly restored,but 3 patients'vocalcords were immovable.The recovery rate of abductory motionof the paralyzed vocal cords was 83.33% (15/18).The functionof phonation in the 16 patients was restored to normal or nearnormal limits,and their hoarseness was improved significantly.CONCLUSION Cervical plexus-URLN reinnervation shouldbe considered when treating patients with unilateral vocal cordparalysis.Removing the tumor simultaneously with cervicalplexus reinnervation during surgery for repair of unilateralrecurrent laryngeal nerve injury was convenient and easy toperform with less functional damage compared with othermethods of reinnervation.The abductory motion of vocal cordcould be satisfactorily restored by this reinnervation.Surgicalperformance skills and application of neurotrophic drugs wereimportant for the success of the surgery.

Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1st 2008 and March 31st 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.

Pitfalls in internal jugular vein cannulation

Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the increased safety profile and insertion convenience,it has complications.Herein,we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.

Nasogastric tube syndrome:A Meta-summary of case reports

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.

甲状腺术后单侧声带麻痹神经电刺激治疗的初步研究

目的回顾性分析甲状腺术后单侧声带麻痹患者接受选择性喉神经电刺激治疗的远期疗效,探讨喉神经电刺激在甲状腺术后单侧声带麻痹治疗中的作用。方法选取2020年1月~2023年5月就诊于西安交通大学第二附属医院耳鼻咽喉头颈外科门诊,既往行甲状腺切除手术并经频闪喉镜及喉肌电图检查诊断为单侧声带麻痹的患者42例,病程为15 d~6年,喉肌电图检查时给予喉神经电刺激治疗,检查前后均完善频闪喉镜及主客观嗓音参数检查,并录音频保存,于治疗后1年进行随访,评估患者声嘶恢复情况。结果电刺激治疗后,28例患者声嘶立刻改善,自觉发音费力明显缓解,且声门闭合较前改善,频闪喉镜下可观察到黏膜波。嗓音评分ΔR、ΔB、ΔH的改变有明显统计学差异(P<0.05)。嗓音障碍严重指数(dysphonia severity index,DSI)较刺激前明显增高,差异有统计学意义;最长发音时间(maximum pronunciation time,MPT)较刺激前延长,但差异无统计学意义;基频微扰(Jitter)和振幅微扰(Shimmer)未见明显改变。电刺激治疗后1年随访,失访6例,随访36例,痊愈为58.3%(21/36),好转13.9%(5/36),未愈27.8%(10/36)。电刺激治疗有效28例,失访2例,随访时痊愈19例,好转4例,有效率为88.5%(23/26)。结论喉神经电刺激治疗可以改善甲状腺术后单侧声带麻痹患者的声嘶,对其神经恢复期间的声音质量具有明显的改善作用。

儿童双侧声带麻痹诊治的现状与进展

双侧声带麻痹(BVCP)是指双侧支配咽喉部肌肉运动的神经传导通路受损引起的双侧声带运动障碍,占儿童先天性喉部异常疾病的第二位。主要症状为上气道梗阻、喘鸣、声音嘶哑等。其病因包括神经性、医源性、特发性及其他病因。临床可行病因评估、声带运动振动评估、影像学检查、喉肌电图及喉超声等检查评估。缓解呼吸道阻塞为治疗的主要目的,恢复喉的生理功能为治疗的最终目标。治疗方法有无创正压通气、气管切开术、环状软骨裂开术、杓状软骨切除术、声带后端切断术、声带外移固定术、选择性喉神经修复术、肉毒杆菌毒素注射喉内肌及其他新兴治疗方法。

Atypical presentation of a posterior fossa tumour:A case report

BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

Reversible Paclitaxel-Induced Bilateral Vocal Fold Paresis

Introduction: Chemotherapy is a rare cause of iatrogenic vocal fold dysfunction. It has been reported in three main classes of chemotherapy agents and often occurs during the treatment interval. We present a case of bilateral vocal cord paresis with delayed presentation after completion of chemotherapy. Methods: One case, managed with observation and serial exams, is presented. A review of previous case reports of chemotherapy-induced vocal cord paresis and possible mechanisms of injury was performed. Results: Patient improved both symptomatically and through objective findings over the one-year course of observation. Conclusion: Diagnosis of chemotherapy-induced vocal cord paresis is dependent on a thorough history and physical exam. Management is predicated in that the dysfunction is often dose dependent and reversible, necessitating both cessation of the offending agent and the knowledge that any treatment is likely needed for only a temporary time. Chemotherapy-induced vocal fold paresis should be in the differential for patients presenting with hoarseness, dysphonia, stridor and a positive chemotherapy

甲状腺术后单侧声带麻痹病人早期嗓音训练的效果观察

目的:探讨甲状腺术后单侧声带麻痹病人实施早期嗓音训练的应用效果。方法:采用便利抽样法选取2021年1月—2022年6月医院收治的68例甲状腺切除术后单侧声带麻痹病人为研究对象,按照随机数字表法分为对照组与试验组各34例;对照组给予嗓音卫生宣教;试验组给予早期嗓音训练。两组干预阶段为甲状腺切除术后第3天至术后1个月,共4周。收集两组病人干预前后简化版嗓音障碍指数量表评分、声门闭合程度、最长发声时间、最大音量、洼田饮水试验评级等主客观指标。结果:干预后,试验组病人声门闭合程度、最长发声时间、最大音量及洼田饮水试验评级显著优于对照组(P<0.05)。结论:甲状腺术后单侧声带麻痹病人早期介入嗓音训练,可促进声门闭合、延长发声时间、提高音量、改善饮水呛咳,有效促进病人康复。

影响新生儿声带麻痹出院结局的回顾性队列研究

背景新生儿声带麻痹(VCP)的临床特点和近期预后的影响因素不确切。目的探讨新生儿VCP出院结局的影响因素。设计回顾性队列研究。方法新生儿VCP诊断根据病史、体征和支气管镜检查结果,纳入2013年4月至2022年1月在济南市儿童医院NICU确诊为新生儿VCP的病例,以出院时是否需有创通气和自行吸吮分为好转出院组和非好转出院组,采集如下临床资料用于本文单因素分析。①孕母资料:年龄、妊娠期高血压、妊娠期糖尿病、分娩方式、胎膜早破、脐带绕颈、脐带扭转、羊水情况;②新生儿资料:性别、胎龄、出生体重、1 min Apgar评分、伴发畸形、喉梗阻;③VCP病因:产伤、神经源性、医源性、特发性;④支气管镜下所见:单侧VCP和双侧VCP(完全麻痹和不全麻痹);⑤出院时预后。以单因素分析P<0.10的变量为自变量行多因素Logistics回归分析。主要结局指标影响好转出院的因素。结果133例新生儿VCP进入本文分析,首次行支气管镜检查日龄为6(4,12)d,入院日龄13.0(3.0,20.5)d,胎龄39.0(38.0,40.0)周,伴发畸形71例(53.4%,94例次),单侧VCP 43例(32.3%);双侧VCP 90例,其中不全麻痹57例,完全麻痹33例。好转出院组96例(72.2%)。非好转出院组37例,其中撤机困难28例,气管切开8例(双侧不全麻痹7例,双侧完全麻痹1例),气管切开后均成功脱离正压通气并出院,4例声带运动于9个月内恢复,4例失访;吸吮-吞咽-呼吸协调障碍37例。纳入单因素分析P<0.10的变量(剖宫产、羊水多、出生体重、低Apgar评分、神经源性损伤、喉梗阻、声带麻痹类型)行多因素Logistics回归分析,结果显示,双侧不全麻痹为新生儿VCP好转出院的不利因素(OR=6.785,95%CI:2.191~21.013,P=0.001)。结论双侧VCP、尤其是双侧声带不全麻痹新生儿的近期预后差,气管切开可以作为一种姑息治疗手段。

六字诀应用于老年甲状腺术后单侧声带麻痹患者嗓音矫治的疗效分析

目的 探讨传统气功六字诀应用于甲状腺术后单侧声带麻痹(UVCP)老年患者嗓音矫治的疗效。方法 56例符合纳入标准的甲状腺术后UVCP患者,采用六字诀进行嗓音矫治四周。评估治疗前后GRBAS量表、嗓音障碍指数量表(VHI)评分,基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、噪谐比(NHR)、最长发声时间(MPT)的变化。结果 治疗后的GRBAS评分和VHI量表评分显著下降,F0、 Jitter、 Shimmer、 NHR显著降低,MPT延长,存在统计学差异(P<0.05)。结论 老年甲状腺术后UVCP患者,采用传统气功六字诀进行嗓音矫治,可改善其嗓音功能。

内镜下双侧声带后端切断术治疗双侧声带的效果及Logistic分析

目的研究内镜下双侧声带后端切断术对双侧声带麻痹所致上气道阻塞患者的手术效果。方法将本院2017年1月~2021年10月收治的83例双侧声带麻痹所致上气道阻塞患者纳入研究。将其根据电脑随机数字表法分作观察组41例和对照组42例。对照组开展传统术式治疗,观察组则开展内镜下双侧声带后端切断术治疗。分析两组一次性成功拔除气管套管率、气道重建成功率,手术前后吞咽功能变化情况,术后并发症发生情况,术后发音满意率等方面的差异。此外,采用Logistic分析法明确双侧声带麻痹所致上气道阻塞患者术后预后不良的影响因素。结果观察组一次性成功拔除气管套管率、气道重建成功率分别为75.61%、90.24%,均明显高于对照组的53.66%、69.05%(均P<0.05)。手术后观察组及对照组的Pearson评分分别为(0.32±0.02)分、(0.86±0.07)分,均明显低于手术前的(2.12±0.33)分、(2.13±0.32)分,且观察组明显低于对照组(均P<0.05)。观察组术后发音满意率评价高于对照组(P<0.05)。经Logistic分析法可得:未实施内镜下双侧声带后端切断术、年龄以及术后并发症均是双侧声带麻痹所致上气道阻塞患者术后预后不良的危险因素(均P<0.05)。结论内镜下双侧声带后端切断术对双侧声带麻痹所致上气道阻塞患者的手术效果显著,有利于促进患者吞咽功能及发音的恢复,值得临床推广应用。

仅表现声带麻痹的MuSK抗体阳性重症肌无力一例并文献复习

目的报道1例表现为双侧声带麻痹的肌肉特异性酪氨酸激酶(muscle skeletal receptor tyrosine kinase,MuSK)抗体阳性重症肌无力(myasthenia gravis,MG)患者的临床特点并进行文献复习。方法总结我院收治的1例主要累及双侧声带的MuSK抗体阳性MG患者的临床资料,同时检索中国知网、万方数据库、维普数据库、Pubmed、Cochrone图书馆、Embase数据库自建库以来至2022年6月公开发表的表现为声带麻痹的MuSK抗体阳性MG的个案报道,系统回顾伴声带麻痹的MuSK抗体阳性MG患者的临床特点、辅助检查、治疗及预后。结果共检索伴声带麻痹的MuSK抗体阳性MG患者5例,包括本文报道的病例共6例纳入研究。其中男性2例,女性4例。发病年龄22~55岁,平均(45.17±12.09)岁。出现声带麻痹的年龄24~59岁,平均(47.17±12.61)岁。喉镜检查结果均显示声带外展受限。重复神经电刺激检测显示,5例患者低频递减。4例患者行新斯的明试验,其中2例阴性。4例患者使用溴吡斯的明治疗效果均不佳。2例经丙种球蛋白治疗,其中1例效果不佳。5例经糖皮质激素治疗,其中4例改善。2例采用利妥昔单抗治疗,均有所改善。3例行气管插管或切开辅助治疗,均有所改善。结论MuSK抗体阳性MG患者发生双侧声带麻痹较为罕见,当患者出现伴疲劳现象的发音困难和喘鸣需要考虑抗MuSK阳性MG的可能。新斯的明试验阴性不能排除诊断,需要完善MG抗体、重复神经电刺激和单纤维肌电图检查进一步确诊。糖皮质激素、血浆置换和利妥昔单抗对抗MuSK阳性MG有一定疗效,多数患者需要辅助呼吸支持治疗。

初次甲状腺癌术后声带麻痹模型预测分析

目的 构建初次行甲状腺癌手术患者术后声带麻痹情况的预测模型,预测声带麻痹发生几率。方法 回顾性分析2012年1月—2022年2月收集的394例甲状腺癌患者的临床资料,根据术后有无声带麻痹分为声带麻痹组与无声带麻痹组。根据时间顺序,将2012年1月—2021年5月收集的358例患者作为建模组,2021年6月—2022年2月收集的36例患者作为验证组,运用单因素及多因素,分析两组临床患者基本资料,选择最合适的自变量构建Logistic回归模型,分析甲状腺癌术后声带麻痹的影响因素。内部通过十折交叉验证,外部验证通过比较建模组及验证组的区分度、校准度及临床有效性,绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线,评估Logistic回归模型预测价值,计算约登指数、灵敏度、特异度、预测概率P值,根据P=1/1+e-y,计算出Y值,最后绘制Nomogram图。结果 394例患者均一次完成甲状腺癌手术切除,术后41例患者发生声带麻痹,声带麻痹发生率为10.4%。Logistic回归模型可知喉返神经入喉处是否粘连(OR=11.804,95%CI为3.078~45.273)、术前Tg(OR=0.021,95%CI为0.002~0.202)、是否贴近喉返神经(OR=20.984,95%CI为2.058~214.007)、手术时间(OR=2.768,95%CI为1.122~6.829)是甲状腺癌术后声带麻痹的独立预测因素。十折交叉验证显示ROC曲线下面积为0.7284,建模组ROC曲线下面积为0.794 3(95%CI为0.716~0.872),验证组ROC曲线下面积为0.772 2(95%CI为0.526~1);Hosmer-Lemeshow拟合优度检测显示模型拟合较好,建模组Chi-Square=1.1,P=0.981 6,验证组Chi-Square=3.87,P=0.567 7;约登指数最大为0.188,此时灵敏度为0.57,特异度为0.62,ROC曲线下面积为0.59,P=0.216,为最佳临界值,根据P=1/1+e-y,此时Y=-1.25。结论 本回归模型预测准确度较好,对甲状腺癌术后预防声带麻痹的发生具有一定的参考意义。

单侧声带麻痹的临床疗效评估及研究进展

单侧声带麻痹(unilateral vocal cord paralysis,UVFP)是由多种原因引起单侧支配喉内肌的运动神经传导通路受损,引起单侧声带运动障碍、声门闭合不全的疾病,主要症状包括发音困难和吞咽困难,影响患者的生活质量。临床评估方法包括语音评估、吞咽功能评估、声带振动评估、影像学检测、实验室检查以及喉神经电生理检查等。UVFP的治疗方法包括保守治疗,如病因治疗、药物治疗、声音疗法,目前保守治疗尚未确立为标准治疗方法。手术治疗有注射喉成形术、喉返神经修复术,包括喉返神经减压术、喉返神经端端吻合术、替代神经转位喉返神经吻合术,其中颈襻-喉返神经吻合术效果最佳,以及喉成形声带接近术以及联合手术等。

声带脂肪注射术对单侧声带麻痹患者的疗效

目的:分析声带脂肪注射术对单侧声带麻痹患者的疗效。方法:选取100例单侧声带麻痹患者作为研究对象,按照治疗方法将患者不同分为研究组与对照组,每组各50例。对照组接受常规药物治疗;研究组接受声带脂肪注射术。对比两组患者治疗前、治疗后1、6及12个月后声门裂隙、麻痹侧声带表面积、频率微扰、振幅微扰、标准化声门噪声能量(NNE)、最长声时(MPT)、嗓音障碍指数量表(VHI)评分和嗓音嘶哑评估(GRBAS),记录两组并发症发生情况。结果:治疗后,两组麻痹侧声带面积均较治疗前增加,且研究组治疗后各时间点均高于对照组(P<0.05);声带闭合时声门裂隙均较治疗前缩小(P<0.05),且研究组治疗后各时间点均小于对照组(P<0.05)。治疗后,两组患者MPT均较治疗前延长,且研究组治疗后各时间点均长于对照组;NNE、频率微扰、振幅微扰较治疗前降低(P<0.05),且研究组治疗后各时间点均低于对照组(P<0.05)。治疗后,两组患者功能、生理、情感各维度评分及总分均低于治疗前,且研究组除生理维度治疗后1个月外,其余各维度治疗后各时间点均低于对照组(P<0.05)。治疗后,两组患者G、R、B评分较治疗前降低(P<0.05),且研究组治疗后各时间点均低于对照组(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论:声带脂肪注射术有助于消除单侧声带麻痹患者声门裂隙,提高患者嗓音质量,远期效果较药物治疗稳定,值得推广。

声带脂肪注射术联合CO_(2)激光治疗单侧声带麻痹的临床疗效及对患者嗓音功能影响分析

目的:分析声带脂肪注射术联合CO_(2)激光改善单侧声带麻痹嗓音功能的疗效。方法:选定2021年12月至2023年2月在柳州市工人医院耳鼻喉科就诊的106例单侧声带麻痹患者,根据治疗方法不同分为对照组和观察组,每组53例。对照组给予CO_(2)激光切除麻痹侧的部分杓状软骨,观察组在对照组基础上给予声带脂肪注射术治疗。比较两组声门裂隙、麻痹侧声带表面积、嗓音声学参数、嗓音嘶哑程度(GRBAS)量表评分、嗓音障碍指数量表(VHI-10)评分、动态喉镜指标评分、并发症总发生率。结果:治疗前,两组各项指标比较,差异均无统计学意义(均P>0.05)。治疗后,观察组声门裂隙、标准化噪音能量(NNE)、振幅微扰(Shimmer)、频率微扰(Jitter)、GRBAS评分、VHI-10评分、声带振动规律性、声带运动对称性、声带黏膜波、声带闭合评分均低于对照组,最长发声时间(MPT)和麻痹侧声带表面积均高于对照组(均P<0.05)。观察组和对照组并发症总发生率(3.77%vs.5.66%)比较,差异无统计学意义(P>0.05)。结论:声带脂肪注射术联合CO_(2)激光可有效改善单侧声带麻痹患者嗓音功能,且未增加并发症的发生。