颞下颌关节紊乱病患者的嗓音相关结局：系统综述与叙述性综合。

文献信息

中文摘要

背景： 颞下颌关节紊乱病（TMD）可能通过影响下颌运动和声道构型而影响嗓音。本综述综合了TMD患者主观和客观的嗓音相关结局。
方法： 通过Ovid检索MEDLINE、PubMed、EMBASE、Scopus、Cochrane图书馆和Google Scholar，无日期限制。纳入标准为观察性研究，研究对象为TMD患者，并报告至少一项嗓音相关结局。使用乔安娜布里格斯研究所批判性评估工具评估方法学质量。数据采用叙述性综合。
结果： 检索共识别440条记录；去除重复、筛选和审查后，纳入10项研究，共3,467名TMD参与者。研究设计、TMD定义、对照组和嗓音结局测量指标差异很大。嗓音结局包括基于症状的发音困难或嗓音障碍报告、嗓音障碍指数、嗓音相关生活质量问卷、听觉感知评估、声学和倒频谱分析、频谱图以及发音困难严重程度指数。基于症状的研究报告，在1,000例TMD队列中发音困难或嗓音障碍占12.6%，在患有TMD的老年人中占73.1%，而同一样本中无TMD者占29.7%。患者报告结局不一，但多项研究显示，随着TMD严重程度增加，嗓音障碍更严重或嗓音相关生活质量更差。听觉感知评估显示，重度TMD患者响度降低。客观测量显示，TMD患者或TMD严重程度较高者响度降低、反共振增加、倒频谱峰值突出值降低以及发音困难严重程度指数评分降低。总体方法学质量：3项研究为高，6项为中等，1项为低。
结论： TMD患者中嗓音症状和异常嗓音发现频繁报告，并可能随着TMD严重程度增加而加重。然而，方法学异质性和主要为横断面设计限制了因果推断。未来研究应使用标准化的TMD定义、匹配对照和综合嗓音评估方法。

英文摘要

BACKGROUND: Temporomandibular disorders (TMD) may influence voice through effects on mandibular movement and vocal tract configuration. This review synthesized subjective and objective voice-related outcomes among patients with TMD.
METHODS: A systematic search of MEDLINE via Ovid, PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar was completed, with no date restrictions. Observational studies were eligible if they included patients with TMD and reported at least one voice-related outcome. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Data were synthesized narratively.
RESULTS: The search identified 440 records; after duplicate removal, screening, and review, 10 studies comprising 3,467 TMD participants were included. Study designs, TMD definitions, comparator groups, and voice outcome measures varied substantially. Voice outcomes included symptom-based reporting of dysphonia or voice disorder, Voice Handicap Index, voice-related quality of life questionnaires, auditory-perceptual assessment, acoustic and cepstral analyses, spectrography, and the Dysphonia Severity Index. Symptom-based studies reported dysphonia or voice disorder in 12.6% of a 1,000-patient TMD cohort and in 73.1% of older adults with TMD compared with 29.7% without TMD in the same sample. Patient-reported outcomes were variable, but several studies showed greater voice handicap or poorer voice-related quality of life with increasing TMD severity. Auditory-perceptual assessment showed reduced loudness among patients with severe TMD. Objective measures showed reduced loudness, increased antiresonance, lower cepstral peak prominence values, and lower Dysphonia Severity Index scores in patients with TMD or greater TMD severity. Overall methodological quality was high in three studies, moderate in six, and low in one.
CONCLUSION: Voice symptoms and abnormal voice findings are frequently reported among patients with TMD and may worsen with increasing TMD severity. However, methodological heterogeneity and predominantly cross-sectional designs limit causal inference. Future studies should use standardized TMD definitions, matched controls, and integrated voice assessment methods.