Department of Audiology and Phoniatrics, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Adv Ther. 2018 Jul;35(7):1069-1086. doi: 10.1007/s12325-018-0725-x. Epub 2018 Jun 15.
Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM).
In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic-aerodynamic analysis, and patients' self-assessment (e.g., Singing Voice Handicap Index).
While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p < 0.001), and the VEM from 113 ± 20 to 124 ± 14 (p < 0.001). Both parameters correlated significantly with each other (r = 0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities.
Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.
歌唱者在嗓音医学和喉科学科中常出现的与发声功能相关的嗓音障碍，主要包括功能性和器质性嗓音损伤，这些问题会对歌唱者的职业生涯造成威胁。本研究旨在评估嗓音外科手术、言语矫治和声乐教学在常见的器质性和功能性嗓音问题中的疗效，包括对最近引入的参数“嗓音范围测量（VEM）”的研究。
在一项前瞻性临床研究中，对 76 名歌唱者（57 名女性，19 名男性；年龄 38±11 岁）的治疗效果进行了分析，该研究基于治疗前后的嗓音功能诊断和频闪喉镜检查。检查仪器包括听觉感知嗓音评估、嗓音声域图（VRP）、从 VRP 的面积和形状计算得出的 VEM、声学空气动力学分析以及患者自我评估（例如，歌唱者嗓音障碍指数）。
28%（21/76）的歌唱者表现为功能性发声障碍，72%（55/76）被诊断为器质性声带病变，其中边缘性水肿（25 例）、小结（9 例）和息肉（8 例）是最常见的病理改变。76 名歌唱者中，57%（43 名）接受了嗓音外科手术，43%（33 名）接受了保守的教学法（14 名）和言语矫治法（19 名）治疗。治疗 3 个月后，大多数参数均有显著改善。嗓音障碍严重指数（DSI）平均从 6.1±2.0 增加到 7.4±1.8（p<0.001），VEM 从 113±20 增加到 124±14（p<0.001）。这两个参数之间存在显著相关性（r=0.41）。嗓音外科手术对嗓音功能的改善影响最大。保守疗法虽然对嗓音功能的改善程度较小，但也能从质量上恢复嗓音的艺术表现力。
根据个体的医学指征，嗓音外科手术、言语矫治和声乐教学都是改善受损歌唱嗓音的有效治疗方法，在客观和主观上均能令人满意。在功能性和器质性发声障碍患者中使用 VEM 可以客观、定量地评估他们的嗓音能力，这在 VRP 中得到了体现。补充现有的 DSI，将 VEM 引入到实际的客观嗓音诊断中是合适的，也是有必要的，特别是对歌唱者的治疗。
