单侧声带小息肉患者术后声休时间对嗓音功能的影响

Effect of postoperative voice rest duration on voice function in patients with unilateral small polyp of vocal cord

摘要:

目的 探讨单侧声带小息肉患者术后声休时间对嗓音功能的影响。方法 筛选山西医科大学第一医院耳鼻咽喉头颈外科住院部中拟行单侧声带小息肉手术的患者120例，术前予以嗓音卫生宣教，指导患者发声方法训练，并完善相关嗓音声学分析，包括基频微扰(Jitter)、振幅微扰(Shimmer)、最长发声时间(MPT)、嗓音障碍严重指数(DSI)、粗糙声/气息声/嘶哑声(RBH)、嗓音障碍指数量表(VHI)等，所有患者术前各嗓音声学参数差异均无统计学意义(P＞0.05)。术后采用随机抽样法将患者分为3组，每组各40例。3组患者在常规治疗(健康教育、手术治疗、药物治疗)的基础上术后行绝对声休，其中A组术后声休3 d，B组术后声休7 d，C组术后声休2周；各组患者声休结束后予以8周的嗓音训练。术后3、6个月复查时对各组患者行嗓音声学分析，分析各组间嗓音声学参数的差异性，并与术前各嗓音声学参数进行对比。结果 ①术后3、6个月，各分组嗓音训练后Jitter、Shimmer、VHI、RBH均明显下降，MPT、DSI明显上升，与术前相比差异具有统计学意义(P<0.05)；②术后3个月，A组和B组的Jitter、Shimmer、MPT、RBH、DSI、VHI值差异具有统计学意义(P<0.05)，A组和C组的RBH、MPT、DSI、VHI值差异具有统计学意义(P<0.05)，B组和C组的DSI、VHI值差异具有统计学意义(P<0.05)，其余各项指标差异均无统计学意义(P＞0.05)；③术后6个月，A组和B组的Jitter、Shimmer、MPT、RBH、DSI、VHI值差异具有统计学意义(P<0.05)，A组和C组的Shimmer、RBH、MPT、DSI、VHI值差异具有统计学意义(P<0.05)，B组和C组的DSI、VHI值差异具有统计学意义(P<0.05)，其余各项指标差异均无统计学意义(P＞0.05)。结论 ①单侧声带小息肉患者在常规治疗的基础上，声休结合嗓音训练均可改善患者的嗓音质量；②单侧声带小息肉患者术后声休3 d，这样更有利于声带创面的愈合和发声功能的恢复。

Abstract:

Objective To explore the effect of postoperative voice rest duration on voice function in patients with unilateral small polyp of vocal cord.Methods A total of 120 patients undergoing surgical treatment of unilateral small polyp of vocal cord in our department were included. Before operation, all the patients were given voice hygiene education and guidance of vocalization training, as well as acoustic analysis including fundamental frequency perturbation (Jitter), fundamental frequency perturbation (Shimmer), maximum phonation time (MPT), dysphonia severity index (DSI), roughness, breathiness and hoarseness (RBH), voice handicap index (VHI), etc. They were randomly divided into 3 groups with 40 cases in each according to the postoperative voice rest duration on the basis of routine treatment (health education, surgical treatment, and medical treatment). The postoperative voice rest durations were 3 days, 7 days and 2 weeks in group A, B and group C respectively. All patients had voice training for 8 weeks after voice rest. At 3 and 6 months after operation, acoustic analysis was performed respectively. The post-treatment voice acoustic parameters were compared with the preoperative ones and among different groups, and their differences were analyzed.Results ①At 3 months and 6 months after surgery, the Jitter, Shimmer, VHI and RBH all decreased significantly compared with the preoperative ones in all groups, while the MPT, DSI increased significantly. The differences were statistically significant (P<0.05). ②At 3 months after surgery, the differences of Jitter, Shimmer, MPT, RBH, DSI, and VHI values between groups A and B, those of RBH, MPT, DSI, and VHI values between groups A and C, and those of DSI and VHI values between groups B and C were all statistically significant (all P<0.05). ③ In 6 months after surgery, the differences of Jitter, Shimmer, MPT, RBH, DSI, and VHI values between groups A and B, those of Shimmer, RBH, MPT, DSI, and VHI values between groups A and C, and those of DSI and VHI values between groups B and C were all statistically significant (all P<0.05).Conclusions On the basis of routine treatment, voice rest combined with voice training can improve the voice quality of patients. Postoperative voice rest with duration of 3 days is more conducive to the healing of vocal cord wound and the recovery of vocal function for patients with unilateral voice polyp.