山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (3): 37-41.doi: 10.6040/j.issn.1673-3770.1.2020.114

• 临床研究 • 上一篇    下一篇

功能性发声障碍患者嗓音及心理状态评估分析

张凯婷1,刘杰1,许贞菊1,张晓雪1,曹松丽2,韩敏1   

  1. 1. 青岛大学附属医院 耳鼻咽喉头颈外科, 山东 青岛 266071;
    2. 青岛大学附属医院 手术室, 山东 青岛 266071
  • 发布日期:2021-05-14
  • 通讯作者: 韩敏. E-mail:hanminjn@163.com

Evaluation of voice and mental state in patients with functional dysphonia

ZHANG Kaiting1, LIU Jie1, XU Zhenju1, ZHANG Xiaoxue1, CAO Songli2, HAN Min1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266071, Shandong, China;
    2. Operating Room, the Affiliated Hospital of Qingdao University, Qingdao 266071, Shandong, China
  • Published:2021-05-14

摘要: 目的 通过对功能性发声障碍患者进行嗓音和心理状态评估,探讨其在功能性发声障碍诊疗中的临床意义。 方法 选取72例功能性发声障碍患者(实验组)和无嗓音障碍的正常人(对照组)40例。其中功能性发声障碍组中功能增强型发声障碍 50 例,功能减弱型发声障碍22例。所有患者均进行计算机嗓音评估、GRBAS评估、嗓音障碍指数量表(VHI)、动态喉镜检查、焦虑自评量表(SAS)及抑郁自评量表(SDS)评估,对比两组之间各项指标评估结果。 结果 实验组GRBAS评分为(1.92±1.03)分,VHI自评分为(58.43±23.17)分,频闪喉镜检查实验组声带闭合、黏膜波、对称性及周期性评分与对照组差异均有统计学意义;计算机嗓音评估中,实验组频率微扰、振幅微扰及最长声时与对照组差异有统计学意义;SAS评分及SDS评分实验组与对照组差异有统计学意义。 结论 完善的嗓音和心理状态评估对功能性发声障碍患者的诊治具有重要的指导意义。

关键词: 功能性发声障碍, 嗓音评估, 抑郁自评量表, 焦虑自评量表, GRBAS评估

Abstract: Objective We aimed to explore the clinical importance of voice and mental state assessment in the diagnosis and treatment of functional speech disorders. Methods We selected 72 patients with functional dysphonia(experimental group)and 40 individuals without dysphonia(control group)from the Department of Otolaryngology, Affiliated Hospital of Qingdao University, from August 2017 to October 2020. In the functional dysphonia group, 50 individuals had enhanced dysphonia and 22 had diminished dysphonia. All patients underwent voice assessment, evaluation using the Grade, Roughness, Breathiness, Asthenia, Strain(GRBAS)scale and voice handicap index(VHI)scale, dynamic laryngoscopy, and evaluation of anxiety(Self-Rating Anxiety Scale, SAS)and depression(Self-Rating Depression Scale, SDS). We compared evaluation results of the various indicators between the two groups. Results In the experimental group, the GRBAS score was 1.92±1.03 and the VHI score was 58.43±23.17. Vocal cord closure, mucosal wave, symmetry, and periodicity scores in the experimental group were significantly different from those of the control group, in stroboscopic examination. In computer voice evaluation, the frequency perturbation, amplitude perturbation, and maximum sound time in the experimental group were significantly different from these values of the control group. We found significant differences in SAS and SDS scores between the experimental and control groups. Conclusion Voice and mental state assessment are important for guiding the diagnosis and treatment of patients with functional phonation disorder.

Key words: Functional dysphonia, Voice assessment, Self-rating anxiety scale, Self-rating depression scale, GRBAS evaluation

中图分类号: 

  • R767.92
[1] Kotby MN, Titze IR, Saleh MM, et al. Fundamental frequency stability in functional dysphonia[J]. Acta Otolaryngol, 1993, 113(3): 439-444. doi:10.3109/00016489309135841.
[2] Fex B, Fex S, Shiromoto O, et al. Acoustic analysis of functional dysphonia: before and after voice therapy(accent method)[J]. J Voice, 1994, 8(2): 163-167. doi:10.1016/s0892-1997(05)80308-x.
[3] 李红艳, 徐文, 胡蓉, 等. 嗓音障碍疾病GRBAS听主观评估特点分析[J]. 听力学及言语疾病杂志, 2009, 17(2): 147-151. doi:10.3969/j.issn.1006-7299.2009.02.016. LI Hongyan, XU Wen, HU Rong, et al. Analysis of the characteristics of GRBAS as the subjective auditory assessment in patients with voicing disorders[J]. J Audiol Speech Pathol, 2009, 17(2): 147-151. doi:10.3969/j.issn.1006-7299.2009.02.016.
[4] Hirano M. Clinical examination of the voice [M]. New York: Springer-Verlag, 1981: 81-84.
[5] Wheeler KM, Collins SP, Sapienza CM. The relationship between VHI scores and specific acoustic measures of mildly disordered voice production[J]. J Voice, 2006, 20(2): 308-317. doi:10.1016/j.jvoice.2005.03.006.
[6] 徐文, 李红艳, 胡蓉, 等. 嗓音障碍指数量表中文版信度和效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(9): 670-675. doi:10.3321/j.issn: 1673-0860.2008.09.008. XU Wen, LI Hongyan, HU Rong, et al. Analysis of reliability And validity of the Chinese version of voice handicap index(VHI)[J]. Chin J Otorhinolaryngol Head Neck Surg, 2008, 43(9): 670-675. doi:10.3321/j.issn: 1673-0860.2008.09.008.
[7] Hirano M, Bless DM. Videostroboscopic examination of the larynx [M]. San Diego: CA, Singular publishing group, Inc, 1993: 74-90.
[8] 黄卫, 徐洁洁, 陈曦, 等. 功能性发声障碍的喉镜观察及声学、空气动力学研究[J]. 听力学及言语疾病杂志, 2005, 13(3): 167-169. doi:10.3969/j.issn.1006-7299.2005.03.007. HUANG Wei, XU Jiejie, CHEN Xi, et al. Research of functional dysphonia by laryngoscopy acoustic analysis and aero-dynamic measurement[J]. J Audiol Speech Pathol, 2005, 13(3): 167-169. doi:10.3969/j.issn.1006-7299.2005.03.007.
[9] 陆美萍, 徐洁洁, 陈曦, 等. 计算机声学测试在功能性发音障碍诊断和治疗中的应用[J]. 南京医科大学学报(自然科学版), 2008,(11): 1465-1467,1473. LU Meiping, XU Jiejie, CHEN Xi, et al. Application of acoustic analysis by computer in diagnosis and voice therapy of functiona dysphonia[J]. Acta Univ Med Nanjing Nat Sci, 2008,(11): 1465-1467,1473.
[10] 沈敏, 屈季宁, 姜义道. 客观嗓音分析比较CO2激光术与传统剥脱术治疗声带白斑患者的疗效[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 67-70. doi:10.6040/j.issn.1673-3770.0.2019.349. SHEN Min, QU Jining, JIANG Yidao. Evaluation the efficacy of a CO2 laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020, 34(1): 67-70. doi:10.6040/j.issn.1673-3770.0.2019.349.
[11] 杜建群, 杨宝琦. 患者心理因素对嗓音疾病发声矫治的影响[J]. 中国中西医结合耳鼻咽喉科杂志, 2010, 18(4): 205-207. doi:10.3969/j.issn.1007-4856.2010.04.008. DU Jianqun, YANG Baoqi. An influence effect of patient's psychological factors on phonation therapy in voice diseases[J]. Chin J Otorhinolaryngol Integr Med, 2010, 18(4): 205-207. doi:10.3969/j.issn.1007-4856.2010.04.008.
[12] 姚树桥. 医学心理学[M]. 6版. 北京: 人民卫生出版社, 2013.
[13] Kollbrunner J, Seifert E. Encouragement to increase the use of psychosocial skills in the diagnosis and therapy of patients with functional dysphonia[J]. J Voice, 2017, 31(1): 132.e1-132132.e7. doi:10.1016/j.jvoice.2015.11.021.
[14] 张冉, 陈亚平, 徐文. 功能性失声的嗓音治疗分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2019,27(4): 256-258. doi:10.16542/j.cnki.issn.1007-4856.2019.04.004. ZHANG Ran, CHEN Yaping, XU Wen. Effect of voice therapy on functional aphonia[J]. Chin J Otorhinolaryngol Integr Med, 2019, 27(4): 256-258. doi:10.16542/j.cnki.issn.1007-4856.2019.04.004.
[15] Halawa WE, Muñoz IV, Perez SS. Effectiveness of laryngostroboscopy for monitoring the evolution of functional dysphonia after rehabilitator treatment[J]. Indian J Otolaryngol Head Neck Surg, 2013, 65(4): 322-326. doi:10.1007/s12070-013-0636-8.
[16] 崔卫新, 徐文, 程丽宇. 功能性发声障碍的临床特征及预后分析[J]. 听力学及言语疾病杂志, 2016, 24(6): 565-569. doi:10.3969/j.issn.1006-7299.2016.06.009. CUI Weixin, XU Wen, CHENG Liyu. Clinical characteristics and prognosis of functional dysphonia[J]. J Audiol Speech Pathol, 2016, 24(6): 565-569. doi:10.3969/j.issn.1006-7299.2016.06.009.
[17] 韩德民, Robert, Sataloff, 等. 嗓音医学[M]. 2版. 北京: 人民卫生出版社, 2017.
[18] 李泳鹏, 韦玉梅, 兰柳艳, 等. 嗓音疾病的病理生理及处理方法[J]. 系统医学, 2020, 5(5): 193-195,198. doi:10.19368/j.cnki.2096-1782.2020.05.193. LI Yongpeng, WEI Yumei, LAN Liuyan, et al. Pathophysiology and treatment of voice disease[J]. Syst Med, 2020, 5(5): 193-195,198. doi:10.19368/j.cnki.2096-1782.2020.05.193.
[19] 康沙沙. 嗓音质量评估研究进展[J]. 山东大学耳鼻喉眼学报, 2014, 28(1): 76-78. doi:10.6040/j.issn.1673-3770.0.2013.231. KANG Shasha. Development of evaluation on voice[J]. J Otolaryngol Ophthalmol Shandong Univ, 2014, 28(1): 76-78. doi:10.6040/j.issn.1673-3770.0.2013.231.
[20] 刘韵, 马清学, 李革临, 等. 纤维频闪喉镜图像分析对声带黏膜波的评价[J]. 中国中西医结合耳鼻咽喉科杂志, 2010, 18(4): 188-189,193. doi:10.3969/j.issn.1007-4856.2010.04.003. LIU Yun, MA Qingxue, LI Gelin, et al. Evaluation on mucosa wave of vocal cords by an analysis on the images collected during fibro-strobolaryngoscopy[J]. Chin J Otorhinolaryngol Integr Med, 2010, 18(4): 188-189,193. doi:10.3969/j.issn.1007-4856.2010.04.003.
[21] 卓姗姗, 任海棠, 黄永望, 等. 动态喉镜在功能减弱性嗓音疾病中的应用价值[J]. 重庆医学, 2020, 49(4): 557-560. ZHUO Shanshan, REN Haitang, HUANG Yongwang, et al. Application effect of dynamic laryngoscope in weakened functional voice disease[J]. Chongqing Med, 2020, 49(4): 557-560.
[22] 于振坤, 胡慧英. 嗓音功能的评估与诊断流程的建立[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(6): 401-404. doi:10.13201/j.issn.1001-1781.2018.06.001. YU Zhenkun, HU Huiying. The evaluation of voice function and the establishment of the diagnosis process[J]. J Clin Otorhinolaryngol Head Neck Surg, 2018,32(6): 401-404. doi:10.13201/j.issn.1001-1781.2018.06.001.
[23] 于萍,王刚,张贵娟, 等.嗓音障碍客观多参数评估与主观评估的一致性分析[J].中华耳鼻咽喉头颈外科杂志,2012,47(10):817-822. doi:10.3760/cma.j.issn.1673-0860.2012.10.006. YU Ping, WANG Gang, ZHANG Guijuan, et al. Study on the concordance of objective multi-parameters analysis and perceptual evaluation[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2012,47(10):817-822. doi:10.3760/cma.j.issn.1673-0860.2012.10.006.
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