Holmberg E B, Hillman R E, Hammarberg B, Södersten M, Doyle P
Department of Logopedics and Phoniatrics, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
J Voice. 2001 Sep;15(3):395-412. doi: 10.1016/S0892-1997(01)00041-8.
The aim of this study was to assess the effects on vocal function of voice therapy for vocal nodules. Perceptual and physiological progressive changes were examined during a strictly structured, behaviorally based voice therapy protocol in which 11 women with vocal nodules participated. Randomized audio recordings from pretherapy and from each of the therapy approaches (vocal hygiene, respiration, direct facilitation, carryover) were used for perceptual evaluations. Six speech-language pathologists rated ten voice quality parameters. Two evaluation procedures were performed and compared. Interlistener reliability was sufficiently high in both tests. Significant effects of therapy were found for decreased overall dysphonia, press, instability, gratings, roughness, vocal fry, and "scrape." Nonsignificant group effects were found for breathiness, aphonic instances, and lack of sonority. No significant parameter changes occurred between baseline assessment and the completion of the initial (vocal hygiene) phase of therapy. Significant changes were found following the direct facilitation and respiration phases of therapy. Videostroboscopic evaluations made by two laryngologists showed that in no case were the nodules completely resolved. However, the nodules had decreased in size and edema was reduced after therapy for all clients, but one. Combined results suggest: (1) Alterations in vocal function were reflected in perceptual parameters, and (2) the voice therapy had a positive effect on voice quality, vocal status, and vocal function for the majority of the vocal nodule clients.
本研究的目的是评估嗓音治疗对声带小结患者嗓音功能的影响。在一项严格结构化、基于行为的嗓音治疗方案中，对11名声带小结女性患者在治疗期间的感知和生理方面的渐进变化进行了检查。治疗前以及每种治疗方法（嗓音卫生、呼吸、直接促进、迁移）阶段的随机录音用于感知评估。六名言语语言病理学家对十个嗓音质量参数进行了评分。进行并比较了两种评估程序。两次测试中听者间的可靠性都足够高。发现治疗对总体发声困难、压迫感、不稳定性、摩擦音、粗糙音、发声破碎音和“刮擦音”的减轻有显著效果。对于呼吸声、失声情况和缺乏响度，未发现显著的组效应。在基线评估与治疗初始（嗓音卫生）阶段结束之间，未发生显著的参数变化。在治疗的直接促进和呼吸阶段之后，发现了显著变化。两位喉科医生进行的频闪喉镜评估表明，在任何情况下小结都未完全消退。然而，除一名患者外，所有患者治疗后小结大小均减小，水肿减轻。综合结果表明：（1）嗓音功能的改变反映在感知参数中；（2）嗓音治疗对大多数声带小结患者的嗓音质量、发声状态和嗓音功能有积极影响。
