Department of Clinical Sciences L. Sacco, University of Milan, Italy.
Acta Otorhinolaryngol Ital. 2012 Oct;32(5):304-8.
Benign vocal fold lesions are common in the general population, and have important public health implications and impact on patient quality of life. Nowadays, phonomicrosurgery is the most common treatment of these lesions. Voice therapy is generally associated in order to minimize detrimental vocal behaviours that increase the stress at the mid-membranous vocal folds. Nonetheless, the most appropriate standard of care for treating benign vocal fold lesion has not been established. The aim of this study was to analyze voice changes in a group of dysphonic patients affected by benign vocal fold lesions, evaluated with a multidimensional protocol before and after voice therapy. Sixteen consecutive patients, 12 females and 4 males, with a mean age of 49.7 years were enrolled. Each subject had 10 voice therapy sessions with an experienced speech/language pathologist for a period of 1-2 months, and was evaluated before and at the end of voice therapy with a multidimensional protocol that included self-assessment measures and videostroboscopic, perceptual, aerodynamic and acoustic ratings. Videostroboscopic examination did not reveal resolution of the initial pathology in any case. No improvement was observed in aerodynamic and perceptual ratings. A clear and significant improvement was visible on Wilcoxon signed-rank test for the mean values of Jitt%, Noise to Harmonic Ratio (NHR) and Voice Handicap Index (VHI) scores. Even if it is possible that, for benign vocal fold lesions, only a minor improvement of voice quality can be achieved after voice therapy, rehabilitation treatment still seems useful as demonstrated by improvement in self-assessment measures. If voice therapy is provided as an initial treatment to the patients with benign vocal fold lesions, this may lead to an improvement in the perceived voice quality, making surgical intervention unnecessary. This is one of the first reports on the efficacy of voice therapy in the management of benign vocal fold lesions; further studies are needed to confirm these preliminary data.
良性声带病变在普通人群中很常见，对患者的生活质量和公共健康有重要影响。目前，声带显微手术是治疗这些病变最常用的方法。通常会联合语音治疗，以最大限度地减少增加声带中膜张力的有害发声行为。然而，尚未确定治疗良性声带病变的最佳护理标准。本研究旨在分析一组患有良性声带病变的发音障碍患者的嗓音变化，通过多维方案评估患者在语音治疗前后的嗓音变化。纳入 16 名连续患者，12 名女性和 4 名男性，平均年龄为 49.7 岁。每位患者均由经验丰富的言语治疗师进行 10 次语音治疗，为期 1-2 个月，并在语音治疗前和治疗结束时使用多维方案进行评估，该方案包括自我评估量表以及频闪喉镜、感知、空气动力学和声学评估。频闪喉镜检查显示没有任何病例的初始病变得到解决。在空气动力学和感知评估中没有发现改善。Wilcoxon 符号秩检验显示，Jitt%、噪声与谐波比（NHR）和嗓音障碍指数（VHI）评分的平均值有明显改善。即使在语音治疗后，良性声带病变的嗓音质量可能仅能得到轻微改善，但康复治疗似乎仍然有用，这一点可以从自我评估量表的改善中得到证明。如果对良性声带病变患者提供语音治疗作为初始治疗，可能会改善他们对嗓音质量的感知，从而避免不必要的手术干预。这是关于语音治疗治疗良性声带病变疗效的首批报告之一；需要进一步的研究来证实这些初步数据。
