山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (3): 14-19.doi: 10.6040/j.issn.1673-3770.1.2020.119

• 临床研究 • 上一篇    下一篇

痉挛性发声障碍的病因及发病机制探讨

于萍1,屈歌2   

  1. 1. 中国人民解放军总医院 耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心, 北京 100853;
    2. 首都师范大学 音乐学院, 北京 100048
  • 发布日期:2021-05-14
  • 通讯作者: 于萍. E-mail:yuping1207@aliyun.com
  • 基金资助:
    国家自然科学基金面上项目(61273288)

The etiology and pathogenesis of spasmodic dysphonia

YU Ping1, QU Ge2   

  1. 1. Department of otorhinolaryngology & Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital/National Clinical Research Center for Otolaryngologic Diseases, Beijing 100853, China;
    2. Music college of Capital Normal University, Beijing 100048, China
  • Published:2021-05-14

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摘要： 目的 回顾性分析痉挛性发声障碍(SD)患者的人口学特点、发生背景、嗓音障碍特点及不同治疗方法的效果,探讨痉挛性发声障碍的病因及发病机制。 方法 受试者为68例痉挛性发声障碍患者,病程5个月~8年,男6例,女62例;调查患者的职业、受教育程度、家庭或(和)工作状况、嗓音障碍出现的背景、病程、嗓音障碍的表现形式等。录音文字为朗读一首短诗及发长元音［a:］。采用三种不同方式发声:正常说话声、耳语声、提高声调发声。根据患者的嗓音障碍程度、病史、年龄及意愿,按照下列原则治疗:(1)注射肉毒素;(2)放松训练;(3)音乐治疗;(4)药物治疗;(5)发声训练。 结果 SD的高发年龄段位于30~49岁,女性显著高于男性,性别比为1∶10.3。嗓音障碍发生在重要困难时期29例,发生在精神创伤后15例,经历过不良事件5例,无明确心理背景19例。治疗效果:22例接受过1~5次肉毒素治疗的患者中,治愈1例,缓解14例,无效7例;接受音乐治疗4例,治愈1例,缓解3例;23例接受发声训练治疗,缓解8例,无效15例;口服抗焦虑类药物12例,缓解2例,无效10例;自我放松训练7例,治愈4例,无效3例。 结论 多种治疗方法的选择及相同治疗方法产生不同的治疗效果,提示SD病因的多维性和发病机制的复杂性。负性生活事件或(和)长期的精神压力与SD的发生有高度相关性,提示心理背景是导致出现SD和影响治疗效果的一个重要因素。

关键词: 嗓音, 发声障碍,痉挛性, 人口学特点, 负性生活事件, 精神压力

Abstract: Objective To retrospectively analyze the demographic characteristics, occurrence background, characteristics of voice disorders, and effects of different treatment methods in patients with adduction spasmodic dysphonia(SD), as well as to explore the etiology and pathogenesis of SD. Methods Sixty eight SD patients aged 5 months to 8 years were enrolled, including 62 women and 6 men. We investigated the patient's occupation, education, family or/and work status, background, onset mode and course of disease, manifestation of voice disorder, and others. The recorded text was a short poem and long vowel ［a:］. It was produced in three different ways: normal speech, whispering, and high-pitched voice. The anatomical morphology of the bilateral vocal cords was normal on electronic laryngoscopy. According to the patient's age, degree of voice disorder, course of disease, and willingness to choose the treatment: injection of Botox, voice training and/or self-regulating relaxation therapy, music therapy, and anti-anxiety drugs. Results The age range of the SD patients was 30-49 years, and the number of females was significantly higher than that of males, with a sex ratio of 1:10.3. Voice disorders occurred in 29 cases of important difficult periods, 15 cases of mental trauma, 5 cases of adverse events, and 19 cases of no clear psychological background. Therapeutic effect: Among the 22 patients who received botulinum toxin treatment 1-5 times, 1 case was cured, 14 cases were relieved, and 7 cases were invalid; 4 cases were treated with music therapy, of which 1 case was cured and 3 cases were relieved; 23 cases were treated with vocal training, of which 8 cases were relieved and 15 cases were invalid; 12 cases were treated with oral anti-anxiety drugs, of which 2 cases were relieved and 10 cases were invalid; and 7 cases were treated with self-relaxation training, of which 4 cases were cured and 3 cases were invalid. Conclusion The diversity of therapeutic methods resulted in different therapeutic effects, suggesting a multidimensional etiology and the complexity of the pathogenesis of SD. Unhealthy living events or long-term mental stress are highly correlated with the occurrence of SD, suggesting that it is an important factor affecting SD patients.

Key words: Voice, Dysphonia, spastic, Demographic characteristics, Negative life, Mental stress

中图分类号: 

  • R767.92
[1] 陈世彩, 郑宏良, 周水淼, 等. 痉挛性发声障碍的研究进展[J]. 听力学及言语疾病杂志, 2013, 21(1): 12-16. doi:10.3969/j.issn.1006-7299.2013.01.004.
[2] 黄永望, 傅德慧. 痉挛性发声障碍发病机制研究及治疗新进展[J]. 听力学及言语疾病杂志, 2013, 21(1): 7-11. doi:10.3969/j.issn.1006-7299.2013.01.003.
[3] 王丽萍, 宁平, 杨扬, 等. 痉挛性发声障碍的临床特征[J]. 听力学及言语疾病杂志, 2013, 21(1): 17-18. doi:10.3969/j.issn.1006-7299.2013.01.005.
[4] 于萍. 痉挛性发声障碍的研究现状[J]. 听力学及言语疾病杂志, 2012, 20(6): 512-517. doi:10.3969/j.issn.1006-7299.2012.06.002.
[5] 高天. 接受式音乐治疗方法[M]. 北京: 中国轻工业出版社, 2011.
[6] Cyrus CB, Bielamowicz S, Evans FJ, et al. Adductor muscle activity abnormalities in abductor spasmodic dysphonia[J]. Otolaryngol Head Neck Surg, 2001, 124(1): 23-30. doi:10.1067/mhn.2001.112572.
[7] Schweinfurth JM, Billante M, Courey MS. Risk factors and demographics in patients with spasmodic dysphonia[J]. Laryngoscope, 2002, 112(2): 220-223. doi:10.1097/00005537-200202000-00004.
[8] Tisch SH, Brake HM, Law M, et al. Spasmodic dysphonia: clinical features and effects of botulinum toxin therapy in 169 patients-an Australian experience[J]. J Clin Neurosci, 2003, 10(4): 434-438. doi:10.1016/s0967-5868(03)00020-1.
[9] 王丽萍, 张玉富, 张澍, 等. 痉挛性发音障碍的喉功能特点[J]. 听力学及言语疾病杂志, 2001, 9(4): 199-200. doi:10.3969/j.issn.1006-7299.2001.04.003. WANG Liping, ZHANG Yufu, ZHANG Shu, et al. Laryngeal function features of spasmodic dysphonia[J]. J Audiol Speech Pathol, 2001, 9(4): 199-200. doi:10.3969/j.issn.1006-7299.2001.04.003.
[10] 徐文, 韩德民, 侯丽珍, 等. 痉挛性发音障碍诊断及治疗的研究[J]. 中华耳鼻咽喉头颈外科杂志, 2005, 40(4): 253-257. doi:10.3760/j.issn: 1673-0860.2005.04.004. XU Wen, HAN Demin, HOU Lizhen, et al. Patterns of spasmodic dysphonia and botulinum toxin injections[J]. Chin J Otorhinolaryngol Head Neck Surg, 2005, 40(4): 253-257. doi:10.3760/j.issn: 1673-0860.2005.04.004.
[11] Brodnitz FS. Spasmodic Dysphonia[J]. Ann Otol, 1976, 85: 210-214.
[12] Izdebski K, Dedo HH, Boles L. Spastic dysphonia: a patient profile of 200 cases[J]. Am J Otolaryngol, 1984, 5(1): 7-14. doi:10.1016/s0196-0709(84)80015-0.
[13] Ginsberg BI, Wallack JJ, Srain JJ, et al. Defining the psychiatric role in spastic dysphonia[J]. Gen Hosp Psychiatry, 1988, 10(2): 132-137. doi:10.1016/0163-8343(88)90099-0.
[14] Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia(laryngeal dystonia): a 12-year experience in more than 900 patients[J]. Laryngoscope, 2015, 125(8): 1751-1757. doi:10.1002/lary.25273.
[15] Schaefer SD. Neuropathology of spasmodic dysphonia[J]. Laryngoscope, 1984, 94(3): 414.
[16] Davis PJ, Boone DR, Carroll RL, et al. Adductor spastic dysphonia: heterogeneity of physiologic and phonatory characteristics[J]. Ann Otol Rhinol Laryngol, 1988, 97(2 Pt 1): 179-185. doi:10.1177/000348948809700216.
[17] Ludlow CL. Spasmodic dysphonia: a laryngeal control disorder specific to speech[J]. J Neurosci, 2011, 31(3): 793-797. doi:10.1523/JNEUROSCI.2758-10.2011.
[18] Blitzer A. Spasmodic dysphonia and botulinum toxin: experience from the largest treatment series[J]. Eur J Neurol, 2010, 17(Suppl 1): 28-30. doi:10.1111/j.1468-1331.2010.03047.x.
[19] Zwirner P, Murry T, Woodson GE. Perceptual-acoustic relationships in spasmodic dysphonia[J]. J Voice, 1993, 7(2): 165-171. doi:10.1016/s0892-1997(05)80347-9.
[20] Cannito MP, Woodson GE, Murry T, et al. Perceptual analyses of spasmodic dysphonia before and after treatment[J]. Arch Otolaryngol Head Neck Surg, 2004, 130(12): 1393-1399. doi:10.1001/archotol.130.12.1393.
[21] Cannito MP, Kahane JC, Chorna L. Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection[J]. Clin Interv Aging, 2008, 3(1): 131-151. doi:10.2147/cia.s1416.
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