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嗓音治療對聲帶溝患者之成效與探究

The Effective of Voice Therapy on Patients With Sulcus Vocalis

Abstracts


聲帶溝是指聲帶內緣(聲帶淺固有層)呈現紡錘狀的溝槽,此溝槽可能僅限黏膜表層,也可能深及聲帶韌帶和肌肉,會對嗓音音質帶來程度不一的影響,臨床上常見的嗓音特徵為最長發聲時間縮短、失聲、氣息聲、沙啞聲、嗓音疲憊等,症狀嚴重時會影響患者的生活品質與溝通效度。聲帶溝的治療多視其嚴重度而定,目前國外用於治療聲帶溝的方法多以聲帶注射改善密合度或顯微手術重建聲帶溝為主;然而嗓音治療雖常作為治療嗓音異常之第一線的處置方式,卻鮮少有文獻討論其對聲帶溝之功效。本研究採回溯性研究設計,篩選2018~2021年間至醫院接受嗓音治療之27名聲帶溝第一型患者。所有患者接受每週一次30分鐘的嗓音治療至少一個月,治療手法以半阻塞聲道運動搭配嗓音功能運動為主。結果發現,經過嗓音治療後,聽知覺評估(整體嗓音嚴重度[grade]、沙啞聲[roughness]、氣息聲[breathiness]、無力程度[asthenia]與拉緊聲[strain])、聲學分析(含jitter、shimmer、噪音諧音比[noise to harmonic ratio]與倒頻譜峰值[cepstral peak prominence])、氣動學測量(含最長發聲時間與聲門下壓)與自覺評估(Voice Handicap Index-10)等評估項目,均有顯著進步。顯示透過合併使用半阻抗聲道運動搭配嗓音功能運動可以有效改善聲帶溝患者之嗓音表現。

Parallel abstracts


Sulcus vocalis refers to a spindle-shaped groove on the inner edge of the vocal fold (superficial lamina propria). This groove may be limited to the mucosal surface, or deep into the vocal ligaments and muscles, which will have varying degrees of impact on the voice quality of the voice. Common clinical voice features are shortened maximum phonation time, loss of voice, breathy voice, hoarse voice, and voice fatigue. When symptoms are severe, it will affect the quality of life and communication validity of patients. The treatment of sulcus vocalis depends on its severity. At present, the methods used to treat the sulcus vocalis are mostly vocal fold injection to improve the tightness or microsurgery to reconstruct the vocal fold sulcus. Although voice therapy is often used as the first-line treatment for voice lesions, few literatures discuss its efficacy. In this study, a retrospective study was used to screen 27 patients with sulcus vocalis (type 1) and received voice therapy in the hospital from 2018 to 2021. All patients received a 30-minute voice therapy once a week for at least one month, and the treatment method was mainly semi-occluded vocal tract exercises (SOVTE) combined with vocal function exercises (VFEs). The results showed that it is signifficant improved in auditory perception evaluation (GRBAS Scale), acoustic analysis (including jitter, shimmer, noise to harmonic ratio, and cepstral peak prominence), aerodynamic measurement (including maximum phonation time and subglottic pressure), and self-reported assessment (Voice Handicap Index-10) after voice therapy. It shows that the combined use of SOVTE and VFEs can effectively improve the vocal performance of patients with sulcus vocalis.

References


王南梅、黃國祐、蘇茂昌、辛宗翰(2011)。華文版「嗓音障礙指數量表」(VHI-10)發展與驗證。台灣耳鼻喉頭頸外科雜誌,46,190-196。doi:10.6286/2011.46.4.190
Hsu, Y.-C., Lin, F.-C., & Wang, C.-T. (2017). Optimization of the minimal clinically important difference of the Mandarin Chinese version of 10-item Voice Handicap Index. The Journal of Taiwan Otolaryngology-Head and Neck Surgery, 52, 8-14. doi:10.6286/2017.52.1.8
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Ford, C. N., Inagi, K., Khidr, A., Bless, D. M., & Gilchrist, K. W. (1996). Sulcus vocalis: A rational analytical approach to diagnosis and management. Annals of Otology, Rhinology & Laryngology, 105, 189-200. doi:10.1177/000348949610500304
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