多学科嗓音门诊中的儿童嗓音障碍：一项回顾性观察研究。

文献信息

中文摘要

背景： 儿童嗓音障碍涵盖广泛的诊断谱系，但关于多学科嗓音门诊病例构成、评估和管理的当代描述仍然有限。
方法： 我们对来自英国一家四级多学科儿童嗓音门诊常规收集的临床数据进行了一项回顾性观察研究。纳入2024年1月至2025年12月期间就诊的4-17岁儿童和青少年。患者层面的变量包括人口统计学资料、症状持续时间、转诊至首次门诊的等待时间和主要诊断。就诊层面的变量包括患者报告结局指标的记录、门诊信件中报告的内镜发现、管理结局和操作完成情况。
结果： 在111个已安排的预约中，96个被实际就诊（74个初诊和22个复诊），15个未就诊。这些实际就诊的预约代表87名患者；首次就诊时的中位年龄为12岁（范围4-17岁），其中51/87（58.6%）为男性。发声困难是83/87（95.4%）的主要就诊症状。转诊时症状的中位持续时间为6.3年（范围0.12-17.0年），转诊至首次门诊的中位等待时间为154天（范围16-1032天）。最常见的诊断是声带麻痹（19/87，21.8%）、声带小结（11/87，12.6%）和肌紧张性发声障碍（9/87，10.3%）。在声带麻痹/轻瘫亚组（n=20）中，15/20为左侧，13/20继发于心脏手术后/动脉导管未闭结扎术后。
结论： 儿童在专科评估前通常经历较长的症状持续时间，诊断谱系异质，且声带活动障碍常见。需要标准化的结局采集和更长期的随访来评估干预措施并为转诊指南提供依据。

英文摘要

BACKGROUND: Paediatric voice disorders encompass a broad diagnostic spectrum, but contemporary descriptions of multidisciplinary voice clinic case-mix, assessment and management remain limited.
METHODS: We performed a retrospective observational study of routinely collected clinical data from a quaternary multidisciplinary paediatric voice clinic in the United Kingdom. Children and adolescents aged 4-17 years who were seen between January 2024 and December 2025 were included. Patient-level variables included demographics, symptom duration, referral-to-first clinic waiting time, and primary diagnosis. Appointment-level variables included documentation of patient-reported outcome measures, endoscopic findings reported in clinic letters, management outcomes, and procedure follow-through.
RESULTS: Of 111 listed appointments, 96 were attended (74 new and 22 follow-up) and 15 were non-attendances. These attended appointments represented 87 patients; median age at first appointment was 12 years (range 4-17 years), and 51/87 (58.6%) were male. Dysphonia was the main presenting symptom in 83/87 (95.4%). Median symptom duration at referral was 6.3 years (range 0.12-17.0 years), and median referral-to-first clinic waiting time was 154 days (range 16-1032 days). The most common diagnoses were vocal cord palsy (19/87, 21.8%), vocal cord nodules (11/87, 12.6%), and muscle tension dysphonia (9/87, 10.3%). In the vocal cord palsy/paresis subgroup (n = 20), 15/20 were left-sided and 13/20 were secondary to post-cardiac surgery/patent ductus arteriosus ligation.
CONCLUSIONS: Children commonly experienced prolonged symptoms before specialist review, with a heterogeneous diagnostic spectrum and frequent vocal fold immobility. Standardised outcome capture and longer follow-up are needed to evaluate interventions and inform referral guidance.