超越群体结局：性别肯定性声门成形术与术后嗓音治疗

文献信息

中文摘要

目的： 描述跨性别女性接受性别肯定性声门成形术并辅以嗓音治疗的结局，并探讨嗓音的声学指标与患者报告指标之间的关系。
方法： 这项前瞻性、描述性及探索性研究纳入了58名跨性别女性，她们在单一多学科嗓音门诊接受声门成形术并接受随访。声学结局包括言语基频（sfo）、最低和最高sfo、发声范围，以及源自持续元音和连续言语的频谱指标。患者报告结局包括TWVQ和嗓音满意度指标。分析了声学指标与患者报告指标之间的关联。除协变量年龄及术前和术后嗓音治疗次数外，还使用线性混合效应模型（LMM）估计群体水平的干预效应。
结果： 声门成形术与群体水平的sfo升高相关，但声学和功能结局存在显著的个体间差异。LMM显示，干预前后sfo、最低和最高sfo、最高fo大幅增加，TWVQ评分改善，但AVQI、CPPS和发声范围恶化。年龄以及术前或术后嗓音治疗次数对结局没有显著影响。患者报告指标显示感知嗓音结局改善，但声学指标与患者报告结局之间的关联不一。
结论： 性别肯定性声门成形术辅以术后嗓音治疗可在群体水平改善关键声学和患者报告嗓音结局；然而，结局因个体而异。这些发现凸显了声门成形术后嗓音变化的多因素性质，以及在基频之外进行多维评估的重要性，因为结局反映的不仅仅是声带结构性缩短。

英文摘要

OBJECTIVE(S): To describe outcomes of gender-affirming glottoplasty with adjunctive voice therapy in trans women and explore relationships between acoustic and patient-reported measures of voice.
METHOD: A prospective, descriptive and exploratory study included 58 trans women undergoing glottoplasty performed and followed in a single multidisciplinary voice clinic. Acoustic outcomes included speaking fundamental frequency (sfo), min and max sfo, phonation range, and spectral measures derived from sustained vowels and connected speech. Patient-reported outcomes included the TWVQ and voice satisfaction measures. Associations between acoustic and patient-reported measures were analyzed. A linear mixed-effects model (LMM) was used to estimate the group-level intervention effect in addition to covariates age and number of prior and postoperative voice therapy sessions.
RESULTS: Glottoplasty was associated with group-level increases in sfo but substantial interindividual variability in acoustic and functional outcomes. LMM showed substantial pre- to post-intervention increase in sfo, min and max sfo, max fo, and improvement in TWVQ scores but deterioration in AVQI, CPPS, and in phonation range. Age and number of pre- or postoperative voice therapy sessions had no substantial effect on outcomes. Patient-reported measures indicated improvement in perceived voice outcomes, but associations between acoustic measures and patient-reported outcomes were variable.
CONCLUSION: Gender-affirming glottoplasty with adjunctive postsurgical voice therapy results in improved key acoustic and patient-reported voice outcomes at a group level; however, outcomes vary between individuals. These findings highlight the multifactorial nature of voice change following glottoplasty and the importance of multidimensional assessment beyond fundamental frequency, given outcomes reflect more than structural vocal fold shortening.