Schyberg Ylva Margareta, Bork Kristian Hveysel, Sørensen Martin Kryspin, Rasmussen Niels
Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark.
Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark.
J Voice. 2018 Mar;32(2):244-248. doi: 10.1016/j.jvoice.2017.04.020. Epub 2017 Jun 5.
"Cold-steel" phonosurgery (PS) of Reinke edema is challenging, as the delicate structures of the vocal folds are difficult to preserve. This study aimed to evaluate the results of PS using the Multidimensional Voice Program (MDVP) .
From 2003 to 2007, 76 consecutive patients with Reinke edema were treated with PS for the first time. Reliable MDVP data were available in 37 female patients with both pre- and postoperative values in 14 patients. Voice quality and outcome after PS were evaluated by jitter, shimmer, soft phonation index, and fundamental frequency (f) using MDVP, videostroboscopy, and a five-step voice outcome score.
In the 14 patients, the mean f increased from 172 to 222 (P = 0.01), and jitter decreased from 2.03 to 1.17 (P = 0.04) 3 months postoperatively. Vocal fold grading based on videostroboscopy correlated significantly with jitter (P = 0.01). Patients with high preoperative values of jitter, shimmer, or soft phonation index had larger reductions than those with normal values. All had a postoperative reduction of the edemas. The mean voice outcome score increased postoperatively. None of the 37 patients reported complications, but seven patients were reoperated. Preoperatively, 95% of the 37 patients were smokers and only 9 (24%) changed smoking habits. Pre- or postoperative voice therapy was used in 23 (62%) patients.
f and jitter by MDVP adequately reflected the postoperative voice improvement and reduction of the edema. Removal of large amounts of edematous tissue, many years of vocal abuse, and unchanged smoking habits may prevent optimal results.
“冷刀”嗓音外科手术（PS）治疗任克氏水肿具有挑战性，因为声带的精细结构难以保留。本研究旨在使用多维度嗓音程序（MDVP）评估PS的效果。
2003年至2007年，76例连续的任克氏水肿患者首次接受PS治疗。37例女性患者有可靠的MDVP数据，其中14例患者有术前和术后值。使用MDVP、频闪喉镜检查和五步嗓音结果评分，通过抖动、闪烁、软起音指数和基频（f）评估PS后的嗓音质量和结果。
14例患者术后3个月时，平均f从172增至222（P = 0.01），抖动从2.03降至1.17（P = 0.04）。基于频闪喉镜检查的声带分级与抖动显著相关（P = 0.01）。术前抖动、闪烁或软起音指数值高的患者比正常值患者的降低幅度更大。所有患者术后水肿均减轻。平均嗓音结果评分术后增加。37例患者均未报告并发症，但7例患者再次手术。术前，37例患者中有95%为吸烟者，只有9例（24%）改变了吸烟习惯。23例（62%）患者术前或术后接受了嗓音治疗。
MDVP的f和抖动充分反映了术后嗓音改善和水肿减轻情况。切除大量水肿组织、多年的嗓音滥用以及不变的吸烟习惯可能会妨碍获得最佳效果。
