Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Departments of Communication Sciences and Disorders and Linguistics, and Department of Linguistics and Cognitive Science, College of Health Sciences, University of Delaware, Newark, Delaware.
J Voice. 2024 Nov;38(6):1377-1385. doi: 10.1016/j.jvoice.2022.04.002. Epub 2022 Aug 11.
The study investigated effects of laryngeal manual therapy on different types of primary muscle tension dysphonia (MTD-1).
Interventional pre-test post-test design.
Thirty-two traditional Iranian singers (mean age of 36.75 ± 9.34 years.) diagnosed with MTD-1, 8 female and 24 male, and recruited by convenience sampling completed the study. MTD-1 was classified as Morrison and Rammage's types 1-5, based on standardized criteria (1993). Pre-post-treatment measures were based on visual ratings of the larynx, acoustic analyses, auditory-perceptual assessments of voice (Auditory-Perceptual Rating Instrument for Operatic Singing Voice: EAI Scale Form), and the Persian Singing Voice Handicap Index (P-SVHI), reported before and after 10 sessions of laryngeal manual therapy (LMT).
The most notable finding was that the number of cases with MTD-1 types 1 and 2 actually increased after treatment, while the number of cases with MTD-1 types 3, 4 and 5 decreased. The data suggested that MTD-1 types 3, 4, and 5 tended to convert to types 1 and 2 with LMT. Acoustic analyses showed a significant decrease in F0 (males only; P = 0.011), a sharp decrease in HNR from 23.26 dB to 14.74 dB (P = 0.000), and an increase in shimmer from 4.18% to 6.90 % while no appreciable change was found in jitter (P = 0.57). Mean P-SVHI score decreased significantly from 52.03 to 41.16 (P = 0.002) and EAI score increased from 4.41 to 6.31 (P = 0.000) after treatment.
The primary finding was that the distribution of MTD-1 type changed after treatment in many cases, converting from one to another type. Acoustic as well as glottal closure measures for several participants revealed closure insufficiency after treatment, unveiled as hyperfunction was unloaded with LMT. For those participants, complementary treatments aimed at reinforcement of laryngeal closure functions would be appropriate.
本研究调查了喉手动疗法对不同类型原发性肌肉紧张性发音障碍（MTD-1）的影响。
干预前-后测试设计。
32 名传统伊朗歌手（平均年龄 36.75±9.34 岁）被诊断为 MTD-1，8 名女性和 24 名男性，通过便利抽样完成了研究。MTD-1 根据标准化标准（1993 年）分为 Morrison 和 Rammage 的 1-5 型。治疗前后的测量基于喉镜的视觉评估、声学分析、歌剧演唱声音的听觉感知评估（听觉感知歌剧演唱声音评估工具：EAI 量表）和波斯歌唱声音障碍指数（P-SVHI），治疗前和治疗后 10 次喉手动治疗（LMT）后报告。
最显著的发现是，MTD-1 类型 1 和 2 的病例数量实际上在治疗后增加，而 MTD-1 类型 3、4 和 5 的病例数量减少。数据表明，MTD-1 类型 3、4 和 5 倾向于通过 LMT 转化为类型 1 和 2。声学分析显示 F0 显著降低（仅男性；P=0.011），HNR 从 23.26dB 急剧下降至 14.74dB（P=0.000），Shimmer 从 4.18%增加至 6.90%，而 Jitter 没有明显变化（P=0.57）。治疗后，平均 P-SVHI 评分从 52.03 显著降低至 41.16（P=0.002），EAI 评分从 4.41 增加至 6.31（P=0.000）。
主要发现是许多病例的 MTD-1 类型在治疗后发生了变化，从一种类型转变为另一种类型。声学和几个参与者的声门闭合测量结果表明，治疗后闭合不足，表明 LMT 减轻了功能亢进。对于这些参与者，旨在加强喉闭合功能的补充治疗将是合适的。
