言语治疗师使用喉部超声评估健康幼儿和婴儿声带运动的可行性研究

文献信息

中文摘要

背景： 声带运动障碍（VFMI）是婴幼儿常见的喉部疾病，可能影响呼吸、发声和吞咽。柔性鼻内窥镜（FNE）是目前评估的金标准；然而，其侵入性可能限制其在常规筛查中的应用。近期研究报告了喉部超声（LUS）相比FNE具有良好的敏感性和特异性，是一种微创替代方法。然而，言语治疗师（SLT）在儿科人群中的应用仍未被充分探索。
目的/假设： 本研究旨在评估一种由SLT主导的新型LUS方案在婴幼儿中的可行性，并检验既定喉部测量的可靠性。
方法： 在这项混合方法可行性研究中，11名参与者（9名3岁和4岁儿童以及2名2个月大婴儿）接受了由SLT主导的LUS方案，包括平静呼吸和功能任务。分析完成率和可视化率作为可行性的指标。由两名评估者在选定的静态图像中识别喉部标志并量化喉部测量。使用组内相关系数（ICC）评估评估者间和评估者内可靠性。对LUS操作者的现场笔记进行归纳主题分析，以识别执行方案的经验和未来改进领域。
结果： 该方案显示出高可行性，完成率和可视化率良好。不同任务之间存在差异，平静呼吸和吞咽时的可视化率高于发声时。对LUS操作者经验的归纳主题分析突出了未来方案改进的领域。定量分析显示评估者间在喉部测量方面具有极好的可靠性，置信区间为中等至优秀。
结论： 这项可行性研究为SLT主导的LUS方案评估儿科喉功能提供了初步证据。LUS可能通过实现无创筛查和监测来增强临床路径，同时也可作为发声和吞咽的研究工具。需要更大规模和更多样化样本（包括VFMI患者）的进一步研究来确定临床实用性和普遍性。

英文摘要

BACKGROUND: Vocal fold motion impairment (VFMI) is a common laryngeal disorder in infants and young children and may impact respiration, phonation and swallowing. Flexible nasendoscopy (FNE) is the current gold standard for assessment; however, its invasive nature may limit its use for routine screening. Recent studies reported good sensitivity and specificity of laryngeal ultrasound (LUS), a minimally invasive alternative compared to FNE. However, its application by Speech and Language Therapists (SLTs) in the paediatric population remains underexplored.
OBJECTIVES/HYPOTHESIS: This study aimed to evaluate the feasibility of a novel SLT-led LUS protocol for infants and young children and to examine the reliability of defined laryngeal measurements.
METHODS: In this mixed-methods feasibility study, eleven participants (nine children aged 3- and 4-years-old and two 2-month-old infants) underwent an SLT-led LUS protocol incorporating quiet breathing and functional tasks. Completion and visualisation rates were analysed as an indicator of feasibility. Laryngeal landmarks were identified and laryngeal measurements were quantified in selected static images by two raters. Inter- and intra-rater reliability were evaluated using intraclass correlation coefficients (ICC). Inductive thematic analysis of the LUS operator's field notes was used to identify experiences of conducting the protocol and areas for future refinement.
RESULTS: The protocol demonstrated high feasibility, with good completion and visualisation rates. Differences were noted across tasks, with a higher visualisation rate in quiet breathing and swallowing than in phonation. Inductive thematic analysis of the LUS operator's experience highlighted areas for future refinement of the protocol. Quantitative analysis showed excellent reliability between raters across laryngeal measures, with moderate to excellent confidence intervals.
CONCLUSION: This feasibility study provides initial evidence for an SLT-led LUS protocol to assess paediatric laryngeal function. LUS may enhance clinical pathways by enabling non-invasive screening and monitoring, while also serving as a research tool for phonation and swallowing. Further studies with larger and more diverse samples, including those with VFMI, are needed to establish clinical utility and generalisability.