Ogawa Makoto, Inohara Hidenori
Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Auris Nasus Larynx. 2018 Aug;45(4):661-666. doi: 10.1016/j.anl.2017.08.003. Epub 2017 Aug 31.
To update our knowledge regarding the effectiveness of voice therapy for the treatment of vocal disturbance associated with benign vocal fold lesions, including vocal polyps, nodules and cysts, and for determining the utility of voice therapy in treating organic voice disorders, while highlighting problems for the future development of this clinical field.
We conducted a review of the most recent literature on the therapeutic effects of voice therapy, vocal hygiene education or direct vocal training on vocal quality, the lesion appearance and discomfort felt by patients due to the clinical entity of benign vocal fold mass lesions.
Although voice therapy is principally indicated for the treatment of functional dysphonia without any organic abnormalities in the vocal folds, a number of clinicians have attempted to perform voice therapy even in dysphonic patients with benign mass lesions in the vocal folds. The two major possible reasons for the effectiveness of voice therapy on vocal disturbance associated with benign vocal fold lesions are hypothesized to be the regression of lesions and the correction of excessive/inappropriate muscle contraction of the phonatory organs. According to the current literature, a substantial proportion of vocal polyps certainly tend to shrink after voice therapy, but whether or not the regression results from voice therapy, vocal hygiene education or a natural cure is unclear at present due to the lack of controlled studies comparing two groups with and without interventions. Regarding vocal nodules, no studies have investigated the effectiveness of voice therapy using proper experimental methodology. Vocal cysts are difficult to cure by voice therapy without surgical excision according to previous studies. Evidences remains insufficient to support the use of voice therapy against benign vocal fold lesions.
Evidences at present is therefore still insufficient to support the use of voice therapy for the treatment of benign vocal fold lesions.
更新我们关于嗓音治疗对与良性声带病变相关的嗓音障碍（包括声带息肉、小结和囊肿）的治疗效果的认识，确定嗓音治疗在治疗器质性嗓音障碍中的效用，同时突出该临床领域未来发展存在的问题。
我们对关于嗓音治疗、嗓音卫生教育或直接嗓音训练对嗓音质量、病变外观以及患者因良性声带肿物病变的临床情况所感受到的不适的治疗效果的最新文献进行了综述。
尽管嗓音治疗主要适用于治疗声带无任何器质性异常的功能性发声障碍，但许多临床医生甚至尝试对有声带良性肿物病变的发声障碍患者进行嗓音治疗。嗓音治疗对与良性声带病变相关的嗓音障碍有效的两个主要可能原因据推测是病变的消退以及发声器官过度/不适当肌肉收缩的纠正。根据当前文献，相当一部分声带息肉在嗓音治疗后确实有缩小的趋势，但由于缺乏比较干预组和非干预组的对照研究，目前尚不清楚这种消退是由嗓音治疗、嗓音卫生教育还是自然治愈导致的。关于声带小结，尚无研究采用适当的实验方法调查嗓音治疗的效果。根据先前的研究，声带囊肿在不进行手术切除的情况下很难通过嗓音治疗治愈。支持使用嗓音治疗对抗良性声带病变的证据仍然不足。
因此，目前的证据仍然不足以支持使用嗓音治疗来治疗良性声带病变。
