單側聲帶麻痺患者之喉部肌電圖變化

Serial Electromyographic Evaluations in Patients with Unilateral Vocal Fold Paralysis

胡鈺薇(Yu-Wei Hu) ； 方端仁(Tuan-Jen Fang) ； 陳盈勳(Ying-Hsun Chen) ； 王思恒(Szu-Heng Wang) ； 陳煒森(Wei-Sen Chen) ； 許韶芝(Shao-Chih Hsu) ； 裴育晟(Yu-Cheng Pei)

《台灣復健醫學雜誌》 47卷1期 (2019/06) Pp. 49-57

https://doi.org/10.6315/TJPMR.201906_47(1).0005

摘要

目的：單側聲帶麻痺可能會導致喉部聲門閉合不全，臨床表現為嗓音沙啞及進食時嗆咳，影響生活品質甚鉅。本研究為回溯性研究，藉追蹤單側聲帶麻痺病人發病後六個月初次評估及初次評估後六個月後追蹤評估之喉部肌電圖及音聲改變情況，了解病人在不同評估時間之肌電圖結果的差異，並作為評估回復情況之依據。設計：回溯性研究（retrospective study）。方法：本研究針對單側聲帶麻痺的病患安排兩次評估，依序是發病後六個月的「初次評估」及初次評估後六個月的「追蹤評估」。兩次評估內容包含兩側甲杓－側環杓複合肌群（thyroarytenoid- lateral cricoarytenoid muscle complex，TA-LCA muscle complex）和環甲肌（cricothyroid muscle，CT muscle）喉部肌電圖及甲杓－側環杓複合肌群定量肌電圖（quantitative electromyography）用以分析神經損傷修復程度。並且量測聲門間隙面積及進行聲學分析評估嗓音品質、使用嗓音結果調查問卷評定因嗓音障礙導致日常生活及社交的限制程度及利用生活品質三十六題簡短版量表評估生活品質的影響程度。結果：本研究共分析十二位單側聲帶麻痺病患，分別接受兩次評估且追蹤期間未接受手術或填充物治療。一般定性喉部肌電圖顯示甲杓－側環杓複合肌群之自發性運動電位異常表現（p＝0.371）、多相波表現（p＝0.667）以及神經肌肉徵召減少（p＝1.0），在兩次評估中無統計上顯著差異。然而在甲杓－側環杓複合肌群定量肌電圖中的轉折分析（turn and amplitude analysis）顯示，追蹤時之最高轉折頻率在追蹤時顯著上升（p＝0.046），顯示神經肌肉徵召之自發性恢復。其他參數顯示，追蹤評估相較於初次評估，病人之聲學分析之最大發聲時間上升（p＝0.011）及諧和音與噪音的比值升（p＝0.021）有達顯著差異，而未達顯著差異的參數包含S／Z比值、基本頻率、頻率擾動度及振幅擾動度。嗓音結果調查問卷顯示進步（p＝0.011）。生活品質三十六題簡短版量表次量表之活力（p＝0.038）、一般健康狀況（p＝0.036）、及身體生理問題角色受限（p＝0.045）等亦顯著進步。結論：單側聲帶麻痺病患之甲杓－側環杓肌定量肌電圖經一段時間後有神經肌肉徵召之增加，合併有病人之音聲及生活品質改善。

關鍵字

單側聲帶麻痺（unilateral vocal fold paralysis） ； 喉部肌電圖（laryngeal electromyography） ； 定量肌電圖（quantitative electromyography） ； 甲杓－側環杓複合肌群（thyroarytenoid-lateral cricoarytenoid muscle complex） ； 喉返神經（recurrent laryngeal nerve）

並列摘要

Background: Unilateral vocal fold paralysis causes incomplete closure of the glottis. Clinical manifestations include hoarseness and dysphagia, thus hindering the patients' quality of life. To characterize chronological laryngeal electromyographic changes, this prospective study evaluated laryngeal electromyography and voice at two time points in patients with unilateral vocal fold paralysis. Study design: A retrospective study. Methods: In this study, 12 patients with unilateral vocal fold paralysis who did not receive surgical treatment or injection therapy were recruited. Laryngeal electromyography was performed on the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex and cricothyroid (CT) muscle, and quantitative analysis was conducted on the TA-LCA muscle complex. The patients received initial and follow-up assessments at a 6-month interval. Each assessment included a videolaryngostroboscopy that yielded a normalized glottal gap area (NGGA), an acoustic voice analysis, a voice outcome survey (VOS), and a 36 item short form survey (SF-36). Results: The laryngeal electromyography for the TA-LCA muscle complex did not show a significant difference between the initial and follow-up assessments for their spontaneous activity (p=0.371) or polyphasic waves (p=0.667). However, quantitative laryngeal electromyography revealed an increased peak turn frequency in the follow-up assessment as compared with that in the initial assessment (p= 0.046). Compared with the initial assessment, the follow-up assessment revealed improved maximal phonation time (p=0.011) and harmonic-to-noise ratio (p=0.021), but no improvement in S/Z ratio, fundamental frequency, jitter, or shimmer. The scores in the VOS and several SF-36 items, including vitality (p=0.038), general health perception (p=0.036), and role limitation due to physical health (p= 0.045), all improved at the follow-up assessment. Conclusion: Quantitative EMG study of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex in patients with unilateral vocal fold paralysis showed gradual recovery of neuromuscular recruitment over time, this is accompanied by improvement in voice and quality of life.

並列關鍵字

unilateral vocal fold paralysis ； laryngeal electromyography ； quantitative electromyography ； thyroarytenoid-lateral cricoarytenoid muscle complex ； recurrent laryngeal nerve

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