Pei Yu-Cheng, Chuang Hsiu-Feng, Chang Chia-Fen, Chang Tzu-Ling, Chiang Hui-Chen, Fang Tuan-Jen
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
J Voice. 2018 Sep;32(5):625-632. doi: 10.1016/j.jvoice.2017.07.019. Epub 2017 Dec 13.
Patients with unilateral vocal fold paralysis (UVFP) caused by nerve injury manifest with voice changes. This study investigated vocal performance measured by voice range profile (VRP) in patients with UVFP and changes in VRP in response to intracordal hyaluronate injection.
Eighty-five patients with UVFP were enrolled prospectively, among whom 68 received intracordal hyaluronate injections. The outcome measurements included VRP, acoustic and aerodynamic analyses, peak turn frequency of thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) measured by laryngeal electromyography, and normalized glottal gap area by videolaryngostroboscopy.
The peak turn frequency of the paralyzed TA-LCA showed a modest correlation with max fundamental frequency (F0) and F0 range. Closed-phase normalized glottal gap area showed modest negative correlations with max F0 and F0 semitone range. Regarding conventional acoustic and aerodynamic analyses, the paralyzed TA-LCA peak turn frequency was only correlated with maximal phonation time. Intracordal hyaluronate injection improved VRP performance by increasing max F0, decreasing min F0, increasing F0 range, and increasing semitone range (all P <0.01) with small or medium strength of effect size (Cohen d, 0.39-0.76).
Change in voice pitch in patients with UVFP can partly predict impairment of neuromuscular functions and glottal gap. VRP provides a more sensitive reflection of the severity of neuromuscular impairment, compared with conventional voice analysis. The validity of VRP is further supported by a robust response to voice improvements following injection laryngoplasty.
由神经损伤引起的单侧声带麻痹（UVFP）患者会出现声音变化。本研究调查了UVFP患者通过嗓音音域图（VRP）测量的嗓音表现以及声带内注射透明质酸盐后VRP的变化。
前瞻性纳入85例UVFP患者，其中68例接受了声带内透明质酸盐注射。结局指标包括VRP、声学和空气动力学分析、通过喉肌电图测量的甲杓肌-外侧环杓肌复合体（TA-LCA）的峰值转折频率，以及通过视频喉镜频闪检查得到的标准化声门间隙面积。
麻痹侧TA-LCA的峰值转折频率与最大基频（F0）和F0范围呈中度相关。闭相标准化声门间隙面积与最大F0和F0半音范围呈中度负相关。关于传统的声学和空气动力学分析，麻痹侧TA-LCA的峰值转折频率仅与最大发声时间相关。声带内注射透明质酸盐通过增加最大F0、降低最小F0、增加F0范围和增加半音范围来改善VRP表现（所有P<0.01），效应大小为小或中等强度（Cohen d，0.39-0.76）。
UVFP患者的音高变化可以部分预测神经肌肉功能和声门间隙的损害。与传统嗓音分析相比，VRP能更敏感地反映神经肌肉损害的严重程度。注射喉成形术后嗓音改善的显著反应进一步支持了VRP的有效性。
