Gandhi Sachin, Remacle Marc, Mishra Prasun, Desai Vrushali
Department of ORL-Head Neck Surgery, Deenanath Mangeshkar Hospital and Research Centre, Pune, 411004, India,
Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3249-54. doi: 10.1007/s00405-014-3129-9. Epub 2014 Jun 12.
Spasmodic dysphonia (SD) remains one of the most difficult of laryngeal pathologies to treat. With limited role for speech therapy, various surgical modalities have been tried with various success rates. The objective of the study is to report the results of vocal outcome after thyroarytenoid myoneurectomy in patients of adductor spasmodic dysphonia (ASD). 15 patients of ASD were selected. GRBAS, and voice handicap index (VHI) were used for perceptual evaluation of voice. Thyroarytenoid myoneurectomy was performed by vaporizing the muscular layer of the vocal fold with CO2 laser, at an intensity of 6 W with 1.2 mm diameter in scanner mode. Voice analysis was repeated at 12, 24 and 48 months follow-up. Preoperative GRBAS scores and VHI score of all the patients were poor. At 12 months 12/15 (80 %) patients having strain score of 0. There was marked improvement in VHI scores at 6 months. 10/15 (67 %) patients have been followed up for 24 months. 5/10 (50 %) patients have strain (S) value of 0. VHI scoring of 5/10 (50 %) patients was <30. Two of the four patients completed 48 months follow-up had a strain (S) value of 0, one patient has strain value of 1 and one patient had strain value of 2. 2/4 patients had VHI score of <30; one patient had that of 40. Trans-oral CO2 laser thyroarytenoid myoneurectomy shows significant long-term improvement in voice quality in terms of reduced speech brakes, effort and strain in voice.
痉挛性发音障碍（SD）仍然是最难治疗的喉部疾病之一。由于言语治疗的作用有限，人们尝试了各种手术方式，成功率各不相同。本研究的目的是报告内收型痉挛性发音障碍（ASD）患者行甲杓肌神经切除术术后的嗓音结果。选取了15例ASD患者。采用GRBAS和嗓音障碍指数（VHI）对嗓音进行感知评估。使用二氧化碳激光以6W的强度、1.2mm的直径在扫描模式下汽化声带的肌肉层，进行甲杓肌神经切除术。在术后12个月、24个月和48个月进行随访时重复进行嗓音分析。所有患者术前的GRBAS评分和VHI评分都很差。在12个月时，15例患者中有12例（80%）的紧张度评分为0。在6个月时VHI评分有显著改善。15例患者中有10例（67%）接受了24个月的随访。10例患者中有5例（50%）的紧张度（S）值为0。10例患者中有5例（50%）的VHI评分为<30。4例完成48个月随访的患者中有2例紧张度（S）值为0，1例患者紧张度值为1，1例患者紧张度值为2。4例患者中有2例VHI评分为<30；1例患者评分为40。经口二氧化碳激光甲杓肌神经切除术在减少言语中断、发声努力和紧张度方面显示出对嗓音质量有显著的长期改善。
