單側聲帶麻痺患者接受可調整式咽喉植入物之嗓音品質成效

Voice Outcomes of Type I Thyroplasty Using APrevent® VOIS for Patients With Unilateral Vocal Fold Paralysis

蔡茗溱(Ming-Jhen Tsai) ； 張靜文(Chin-Wen Chang) ； 謝麗君(Li-Chun Hsieh)

《台灣聽力語言學會雜誌》 45期 (2021/12) Pp. 65-76

https://doi.org/10.6143/JSLHAT.202112_(45).0004

摘要

背景：單側聲帶麻痺乃因喉部神經受損或神經病變，而造成肌肉喪失收縮能力，使得聲門閉鎖不全。然而並非所有患者均能在行為嗓音治療後獲得到令人滿意的治療效果，因此第一型甲狀軟骨成型術是一項臨床常見的治療選擇。第一型甲狀軟骨成型術是以植入填充物將聲帶內推，達到聲帶復位效果。有別於過去固定式的填充物，APrevent® Vocal Implant System（VOIS）為一種可調整式咽喉植入物，依照聲帶閉合狀況不同，VOIS可在術中及術後進行填充物調整，以達最佳聲帶閉合效果。方法：本研究納入8位永久性單側聲帶麻痺，且伴隨有明顯嗓音障礙之患者。於植入VOIS前、植入後1週和7週，進行最長發聲時間、聲學參數頻率擾動度、振幅擾動度、訊號雜訊比、聽知覺Grade, Roughness, Breathiness, Asthenia, Strain（GRBAS）量表及嗓音自評量表等，嗓音客觀與主觀評估。結果：個案在治療後1週及7週，在最長發聲時間由術前平均3.1秒明顯進步到6.2秒，頻率擾動度從術前的4.2%顯著下降至0.9%，振幅擾動度從術前的1.5%顯著下降至0.6%，訊號雜訊比則由術前的0.7%顯著上升至0.9%，聽知覺、嗓音障礙指數量表也均有顯著進步。結論：使用VOIS植入後1週至7週，對單側聲帶麻痺患者之嗓音問題及生活品質滿意度提升。VOIS目前仍在第三期人體試驗階段，未來仍需更多個案及更長時間追蹤，瞭解個案在長期植入VOIS後嗓音相關問題之成效。

關鍵字

單側聲帶麻痺 ； 第一型甲狀軟骨成型術 ； 可調整式咽喉植入物 ； 嗓音品質

並列摘要

Background: Unilateral vocal fold paralysis (UVFP) is caused by damage to the laryngeal nerves or neuropathy, which in turn causes the muscles to lose its ability to contract and resulting in incomplete glottis closures. The complications include hoarseness, weakness, difficulty in vocalization, penetration, or aspiration. Therefore, type I thyroplasty has become a common clinical treatment option. Traditionally, the sizes and suture tensions of implants cannot be adjusted intraoperatively and postoperatively. This drawback is overcome by the APrevent® Vocal Implant System (VOIS), an adjustable implant that can be manipulated both intraoperatively and postoperatively, depending on the specific needs. The objective of this study is to evaluate the clinical outcomes of VOIS in patients with UVFP. Methods: Patients with permanent UVFP without previous laryngeal framework surgery were enrolled. Pre- and post-operative conditions of glottis efficiency (maximum phonation time, acoustic parameters), voice quality (Grade, Roughness, Breathiness, Asthenia, Strain [GRBAS]-Scale), and self-evaluation (Voice Handicap Index, VHI) were evaluated, compared, and statistically analyzed with Wilcoxon sign rank. Results: A total of 8 patients were enrolled. The age ranged from 42 to 71 years. All patients showed significant improvement of acoustic parameters after VOIS implantation. Comparison of selected voice parameters at 1 week and 7 weeks post-operation showed (1) statistically significant increase in the maximum phonation time values and signal-to-noise ratio values, (2) statistically significant decrease in the jitter and shimmer, (3) statistically significant decrease in the mean GRBAS scores, and (4) statistically significant decrease in VHI scores. Conclusion: The preliminary results of APrevent® VOIS implant for UVFP patients support an improvement in subjective and objective voice outcomes. Postoperative adjustments can also be done smoothly. VOIS is considered to be a safe and feasible implant for type I thyroplasty.

並列關鍵字

Unilateral vocal fold paralysis ； Type I thyroplasty ； Vocal Implant System ； Voice quality

參考文獻

D’Alatri, L., Galla, S., Rigante, M., Antonelli, O., Buldrini, S., & Marchese, M. R. (2008). Role of early voice therapy in patients affected by unilateral vocal fold paralysis. The Journal of Laryngology & Otology, 122, 936-941. doi:10.1017/S0022215107000679。

Desuter, G., Dedry, M., Schaar, B., van Lith-Bijl, J., van Benthem, P. P., & Sjögren, E. V. (2018). Voice outcome indicators for unilateral vocal fold paralysis surgery: A review of the literature. European Archives of Oto-Rhino-Laryngology, 275, 459-468. doi:10.1007/s00405-017-4844-9。

Franco, R. A., & Andrus, J. G. (2009). Aerodynamic and acoustic characteristics of voice before and after adduction arytenopexy and medialization laryngoplasty with Gore-Tex in patients with unilateral vocal fold immobility. Journal of Voice, 23, 261-267. doi:10.1016/j.jvoice.2007.09.009。

Ho, G.-Y., Leonhard, M., Denk-Linnert, D.-M., & Schneider-Stickler, B. (2020). Pre- and intraoperative acoustic and functional assessment of the novel APrevent® VOIS implant during routine medialization thyroplasty. European Archives of Oto-Rhino-Laryngology, 277, 809-817. doi:10.1007/s00405-019-05756-3。

Isshiki, N., Morita, H., Okamura, H., & Hiramoto, M. (1974). Thyroplasty as a new phonosurgical technique. Acta Oto-Laryngologica, 78, 451-457. doi:10.3109/00016487409126379。