Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
J Voice. 2019 May;33(3):317-324. doi: 10.1016/j.jvoice.2017.11.014. Epub 2018 Feb 1.
The validity and sensitivity to change of instrumental acoustic measurements in patients with functional dysphonia have been controversially discussed. This work examines combined voice therapy effects on standard acoustic measurements, and if these agree with perceptual and subjective voice outcomes.
Retrospective study.
Thirty-nine patients (26 women, 13 men) aged 20-70 years (mean: 46.3, standard deviation 12.8) with functional dysphonia were investigated before and after combined voice therapy. Instrumental parameters included mean and range of speaking fundamental frequency (f) and intensity (SPL (dBA)); maximum SPL and mean f of calling voice; minimum, maximum, range of singing voice f and SPL, jitter (%), and the Dysphonia Severity Index. Voice Handicap Index-9 international was used for subjective and Grading-Roughness-Breathiness-Asthenia-Strain scale for perceptual assessment. Differences were investigated by Wilcoxon signed ranks test and coherences by Spearman rank correlation coefficient.
After treatment, the speaking voice f range (7-8.13 semitones) and SPL range (12.9-14.85 dB(A)) were significantly larger (P < 0.05). Both parameters were highly correlated (P < 0.001). Subjective symptoms were significantly reduced from a mean Voice Handicap Index-9 international of 15.6-8.6, and all perceptual Grading-Roughness-Breathiness-Asthenia-Strain scale parameters were significantly improved (G: 1.05-0.51) after therapy (P < 0.05). These findings were not associated with any acoustic parameter (P > 0.05).
Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger f and SPL speaking voice range after treatment indicate an altered voice technique. These instrumental measures may be clinical indicators of therapy success and transfer effects.
关于功能性发音障碍患者的仪器声学测量的有效性和敏感性一直存在争议。本研究旨在探讨综合嗓音治疗对标准声学测量的影响，以及这些测量结果是否与感知和主观嗓音结果一致。
回顾性研究。
对 39 名年龄在 20-70 岁之间的功能性发音障碍患者（26 名女性，13 名男性，平均年龄 46.3 岁，标准差 12.8 岁）进行了综合嗓音治疗前后的调查。仪器参数包括平均和范围的基频（f）和强度（SPL（dBA））；呼叫语音的最大 SPL 和平均 f；最小、最大、歌唱语音 f 和 SPL 范围、抖动（%）和嗓音障碍指数。国际嗓音障碍指数-9 用于主观评估，Grading-Roughness-Breathiness-Asthenia-Strain 量表用于感知评估。使用 Wilcoxon 符号秩检验比较差异，Spearman 秩相关系数评估相关性。
治疗后，患者的说话声音 f 范围（7-8.13 个半音）和 SPL 范围（12.9-14.85 dB（A））显著增大（P<0.05）。这两个参数高度相关（P<0.001）。治疗后，国际嗓音障碍指数-9 的平均得分从 15.6 降至 8.6，主观症状明显减轻，所有感知 Grading-Roughness-Breathiness-Asthenia-Strain 量表参数均显著改善（G：1.05-0.51）（P<0.05）。这些发现与任何声学参数均无关联（P>0.05）。
显著改善的主观和感知发现证实了功能性发音障碍患者的综合嗓音治疗效果良好。治疗后，说话声音 f 和 SPL 范围的增大表明患者改变了发声技巧。这些仪器测量可能是治疗成功和转移效应的临床指标。
