Sulica Lucian, Behrman Alison
The Center for the Voice, Department of Otolaryngology, The New York Eye and Ear Infirmary, New York, New York, USA.
Ann Otol Rhinol Laryngol. 2003 Oct;112(10):827-33. doi: 10.1177/000348940311201001.
Empirical data are often not available to guide clinical practices in the treatment of benign mucosal lesions of the vocal folds. The purpose of this report is to describe opinions and practices in order to identify areas of consensus and discrepancy and thus guide future inquiry. A 16-item survey mailed to all active US members of the American Academy of Otolaryngology-Head and Neck Surgery (n = 7,321) included questions on the use of voice therapy; diagnostic testing; perioperative use of steroids, antibiotics, and antireflux medications; and use of lasers. Responses used a Likert 5-point scale with end anchors of 1 equaling "never" and 5 equaling "always" and were stratified according to lesion (nodules, polyps, cysts). A 16.5% response rate (n = 1,208) was obtained. A lack of consensus was most evident in the use of voice therapy for lesions other than nodules; antireflux medication; and intravenous steroids. Disagreement was also noted regarding the use of lasers, oral steroids, and antibiotics. Other than voice therapy as initial intervention for nodules, no statistically significant differences by lesion type exist regarding use of voice therapy, laser, or any medication. Prospective clinical trials addressing voice therapy, antireflux medications, steroids, and antibiotics are needed to inform clinical practice. Furthermore, treatment practices appear to be largely independent of lesion type. Therefore, traditional diagnostic categories do not seem to be useful guides to treatment, and may need to be reevaluated in light of improvements in diagnostic technology and surgical technique.
在声带良性黏膜病变的治疗中，往往缺乏实证数据来指导临床实践。本报告的目的是描述相关观点和实践，以确定共识和分歧领域，从而为未来的研究提供指导。一项向美国耳鼻咽喉 - 头颈外科学会所有活跃会员（n = 7321）邮寄的包含16个项目的调查问卷，涵盖了嗓音治疗的使用、诊断测试、类固醇、抗生素和抗反流药物的围手术期使用以及激光的使用等问题。回答采用李克特5级量表，两端锚定为1代表“从不”，5代表“总是”，并根据病变类型（结节、息肉、囊肿）进行分层。获得了16.5%的回复率（n = 1208）。在除结节以外的病变的嗓音治疗、抗反流药物以及静脉注射类固醇的使用方面，缺乏共识最为明显。在激光、口服类固醇和抗生素的使用上也存在分歧。除了将嗓音治疗作为结节的初始干预措施外，在嗓音治疗、激光或任何药物的使用方面，不同病变类型之间不存在统计学上的显著差异。需要进行针对嗓音治疗、抗反流药物、类固醇和抗生素的前瞻性临床试验，为临床实践提供依据。此外，治疗实践似乎在很大程度上与病变类型无关。因此，传统的诊断类别似乎并非治疗的有用指南，可能需要根据诊断技术和手术技术的改进进行重新评估。
