透過您的圖書館登入
IP:18.209.31.38
  • 期刊

單側聲帶麻痺患者之音域圖及神經肌肉控制

Voice Range Profile and Neuromuscular Control in Patients with Unilateral Vocal Fold Paralysis

摘要


背景:單側聲帶麻痺所導致之聲門閉合不全,臨床上會出現嗓音沙啞、音調單調、吞嚥障礙等症狀,進而影響患者生活品質。已知音域圖能藉由病患發出不同頻率、音量的嗓音,而推測神經肌肉控制不佳的嚴重度。然而,目前關於音域圖和不同聲帶肌群肌肉徵召之相關性的研究仍舊缺乏。因此,本研究主要探討不同聲帶肌群麻痺程度和音域圖之間的相關性。方法:本研究為回溯性研究,主要藉由喉頻閃內視鏡及喉肌電圖檢測受影響之喉部肌肉,包含甲杓-側環杓複合肌群和環甲肌,並在肌電圖完成兩週內進行音域圖分析。本研究目的在探討喉頻閃內視鏡影像及喉肌電圖檢查和音域圖之相關性。結果:本研究共納入186名單側聲帶麻痺病患。逐步迴歸分析顯示甲杓-側環杓複合肌群及環甲肌轉折比分別與最高音頻、音頻範圍、半音頻範圍都具有相關性。重要的是,最低音量與甲杓-側環杓複合肌群及環甲肌轉折比的交互作用相關,但卻與此二肌群之轉折比無獨立相關。結論:本研究發現音域圖中的最低音量參數會受到兩大聲帶肌群轉折比的交互作用影響,此結果指出最低音量調控受損受甲杓-側環杓複合肌群以及環甲肌之交互作用所影響,其可能之神經病理機轉為兩大聲帶肌群失去共同協調所致,此發現提供了最低音量評估的價值,可以從中設計合乎病人屬性之治療方式。

並列摘要


BACKGROUND: Unilateral vocal fold paralysis (UVFP) can cause incomplete glottic closure and clinical symptoms such as hoarseness, a monotonous tone and dysphagia, which affect quality of life. The voice range profile (VRP), which measures the range of the voice frequency and loudness, has been associated with the severity of neuromuscular control problems. However, the correspondence between the severity of laryngeal paralysis and VRP findings remains unclear. This study investigated the correlation between VRP and recruitment in laryngeal muscles in patients with UVFP. METHOD: This retrospective study included patients with UVFP, which was confirmed by videolaryngostroboscopy and laryngeal electromyography. Laryngeal muscles included the thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) and cricothyroid muscle (CT). VRP was performed within two weeks of laryngeal electromyography. RESULTS: A total of 186 patients with UVFP were included. In stepwise regression analysis, the turn ratios of the TA-LCA and CT were correlated with the maximal fundamental frequency, fundamental frequency range, and semitone range. Most importantly, there was correlation between the minimal voice intensity (mindB) and interaction of the turn ratios of the TA-LCA and CT, but a lack of correlation between the mindB and individual turn ratios of the TA-LCA and CT. CONCLUSIONS: The mindB is influenced by interaction of the turn ratios of the TA-LCA and CT, indicating that a loss of synergy movement between the TA-LCA and CT muscles can account for the neuropathological mechanism of impairment of voice control for low voice loudness.

延伸閱讀