Watts Christopher R, Hamilton Amy, Toles Laura, Childs Lesley, Mau Ted
Department of Communication Sciences & Disorders, Texas Christian University, Fort Worth.
Clinical Center for Voice Care, Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas.
J Speech Lang Hear Res. 2019 Feb 26;62(2):272-282. doi: 10.1044/2018_JSLHR-S-18-0118.
Purpose The aim of this study was to test the hypothesis that stretch-and-flow voice therapy (SnF) is noninferior to resonant voice therapy (RVT) for speakers with muscle tension dysphonia. Method Participants with primary muscle tension dysphonia were randomly assigned to 1 of 2 treatment groups. Participants received 6 sessions of either SnF or RVT for 6 weeks (1 session per week). Pretreatment and posttreatment audio recordings of sustained vowels and connected speech were acquired. Response to treatment was assessed using the voice handicap index (VHI) as the primary outcome measure. Secondary outcome measures included the acoustic voice quality index, the smoothed cepstral peak prominence, and scales from the Consensus Auditory-Perceptual Evaluation of Voice instrument. Data were analyzed for 21 participants who completed the study (12 in the SnF group, 9 in the RVT group). Results Direction of change for the primary outcome measure and all 3 secondary outcome measures at posttreatment was in the direction of improvement for both SnF and RVT. Confidence intervals for VHI measures did not cross the null effect line on forest plots, suggesting significant effects for both treatments on the primary outcome measure. The effect sizes for pretreatment to posttreatment changes in VHI were large for both treatment groups. Similar results were found for the secondary acoustic outcome measures. There were statistically significant pretreatment to posttreatment changes in the primary and secondary outcome measures for patients receiving both treatments, indicating significant improvement in response to both RVT and SnF. There were no statistically significant differences in pretreatment to posttreatment changes in the primary outcome measure or any secondary outcome measure between the two groups. The within-group pretreatment to posttreatment changes in Consensus Auditory-Perceptual Evaluation of Voice scales did not reach statistical significance for either RVT or SnF. Conclusions Both SnF and RVT produced positive treatment response in speakers with muscle tension dysphonia, with no statistically significant difference in the outcome measures between the two treatments. This suggests that SnF is noninferior to RVT and that both are effective options for treating vocal hyperfunction. Results from this study also support previous findings documenting the sensitivity of multidimensional acoustic measurements to treatment response.
目的 本研究旨在验证以下假设：对于患有肌肉紧张性发声障碍的患者，伸展-流动嗓音疗法（SnF）不劣于共振嗓音疗法（RVT）。方法 患有原发性肌肉紧张性发声障碍的参与者被随机分配到两个治疗组中的一组。参与者接受为期6周的SnF或RVT治疗，共6次（每周1次）。采集治疗前和治疗后持续元音和连贯言语的音频记录。使用嗓音障碍指数（VHI）作为主要结局指标评估治疗反应。次要结局指标包括嗓音声学质量指数、平滑谐波峰值突出度以及嗓音共识听觉-感知评估工具的量表。对完成研究的21名参与者（SnF组12名，RVT组9名）的数据进行了分析。结果 治疗后主要结局指标和所有3个次要结局指标的变化方向均显示SnF和RVT两组均有改善。VHI测量的置信区间在森林图上未穿过无效效应线，表明两种治疗方法对主要结局指标均有显著效果。两个治疗组从治疗前到治疗后VHI变化的效应量都很大。次要声学结局指标也得到了类似结果。接受两种治疗的患者在主要和次要结局指标上从治疗前到治疗后均有统计学显著变化，表明对RVT和SnF均有显著改善。两组在主要结局指标或任何次要结局指标从治疗前到治疗后的变化上均无统计学显著差异。对于RVT或SnF，嗓音共识听觉-感知评估量表在组内从治疗前到治疗后的变化均未达到统计学显著水平。结论 SnF和RVT对患有肌肉紧张性发声障碍的患者均产生了积极的治疗反应，两种治疗方法在结局指标上无统计学显著差异。这表明SnF不劣于RVT，且两者都是治疗嗓音功能亢进的有效选择。本研究结果还支持了先前的研究发现，即多维声学测量对治疗反应具有敏感性。
