Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.
Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.
Am J Otolaryngol. 2020 Jul-Aug;41(4):102455. doi: 10.1016/j.amjoto.2020.102455. Epub 2020 Mar 11.
There are no reliable outcome predictors for functional dysphonia (FD) patients.
To investigate if any clinical or phoniatric characteristics could identify FD patients at risk of negative outcome after speech therapy.
We retrospectively reviewed the results of 78 FD patients treated with the proprioceptive elastic method. Before and one-month after therapy, patients underwent endoscopy, acoustic analysis with Multi-Dimensional Voice Program, and Voice Handicap Index-10 questionnaire (VHI-10). Negative outcome was the persistence of VHI-10 ≥ 13.
26 FD patients had negative outcome (i.e. VHI-10 ≥ 13) after speech therapy. At univariate analysis, clinical variables (i.e. sex, age, comorbidities, dysphonia duration, and professional voice use) were not associated with the outcome. Elevated Jitter% (Jitt; p = 0.03), Shimmer% (Shim; statistical trend, p = 0.06), and Noise to Harmonics Ratio (statistical trend, p = 0.06) were found in patients with poor results. At multivariate analysis, higher Jitt was an independent negative prognostic factor (p = 0.02), while a statically trend was identified for Shim (p = 0.06). A panel of Jitt >1.5 and Shim >5.1 showed an acceptable discriminatory power (AUC [ROC] = 0.76) according to Hosmer and Lemeshow scale.
A panel of two acoustic analysis parameters could help in identifying FD patients at risk of speech therapy failure. Further studies in these patients are needed to evaluate the most efficient treatment protocol.
目前尚无可靠的方法来预测功能性嗓音障碍（FD）患者的预后。
探讨是否存在某些临床或语音学特征可以识别出在语音治疗后有不良预后风险的 FD 患者。
我们回顾性分析了 78 例接受本体感觉弹性治疗的 FD 患者的治疗结果。在治疗前和治疗后 1 个月，患者接受了喉镜检查、多维度嗓音分析程序（Multi-Dimensional Voice Program）声学分析以及嗓音障碍指数 10 问卷（Voice Handicap Index-10，VHI-10）评估。不良预后定义为治疗后 VHI-10≥13。
26 例 FD 患者在语音治疗后出现不良预后（即 VHI-10≥13）。单因素分析显示，临床变量（如性别、年龄、合并症、嗓音障碍持续时间和职业用嗓）与治疗结果无关。结果不良的患者存在更高的微扰（Jitter%，Jitt；p=0.03）、振幅微扰（Shimmer%，Shim；统计学趋势，p=0.06）和噪声与谐噪比（statistical trend，p=0.06）。多因素分析显示，更高的 Jitt 是独立的不良预后因素（p=0.02），Shim 也有统计学趋势（p=0.06）。Jitt>1.5 和 Shim>5.1 的联合预测能力（根据 Hosmer 和 Lemeshow 量表，ROC 曲线下面积为 0.76）尚可。
联合使用两个声学分析参数可以帮助识别语音治疗失败风险较高的 FD 患者。需要对这些患者进行进一步的研究，以评估最有效的治疗方案。
