视频喉频闪镜到治疗的转化框架：通过生物力学推断桥接喉部成像与嗓音治疗

文献信息

中文摘要

目的： 在嗓音诊疗中，视频喉频闪镜（VLS）检查结果与治疗决策之间存在鸿沟。本文提出一个转化框架，将VLS检查结果转化为基于生物力学信息的治疗靶点和候选嗓音治疗技术，无论检查是由耳鼻喉科医师报告还是由言语-语言病理学家操作。
研究设计： 临床框架开发，包含转化表格和合成示例病例。
方法： 该框架整合了2018年美国耳鼻喉科-头颈外科学会基金会指南（该指南推荐在嗓音治疗前进行喉镜检查）、2023年欧洲喉科学会与欧洲嗓音医学家联盟核心数据集，以及经典声带生物力学，并在所述之处辅以作者的“发声统一理论”。采纳了两个已发表的高速视频内窥镜生物标志物——声门边缘经验分布和喉振动图，并提出了一个原创指数——刚度/柔顺性指数。证据采用牛津循证医学中心证据等级进行分级。
结果： 一个转化矩阵将八项VLS检查结果与治疗靶点及五种技术相连接：半封闭声道练习、共鸣嗓音治疗、嗓音功能练习、喉部手法治疗和轻松发声。五种声门闭合模式被映射到不同的生物力学推断。一个生物力学推断三元组构建了床旁推理，提出了一个带有明确安全门控的决策算法，并用三个合成病例（声带小结、单侧麻痹、瘢痕）说明其应用。生物力学参考值作为临时追踪阈值提供，明确声明并非经过验证的最小临床重要差异。
结论： 该框架为临床医生提供了一种结构化、共享的语言，用于从VLS检查结果过渡到治疗计划。所有转化均为临床推断，而非对冲击力或组织刚度的直接测量；其指数、阈值和映射均为假设，在常规临床使用前需要信度测试和前瞻性验证。

英文摘要

OBJECTIVES: A gap separates videolaryngostroboscopy (VLS) findings from therapy decisions in voice care. This article proposes a translational framework that converts VLS findings into biomechanically informed therapeutic targets and candidate voice therapy techniques, whether the examination is reported by an otolaryngologist or performed by the speech-language pathologist.
STUDY DESIGN: Clinical framework development with translation tables and synthetic illustrative cases.
METHODS: The framework integrates the 2018 American Academy of Otolaryngology-Head and Neck Surgery Foundation guideline, which recommends laryngoscopy before voice therapy; the 2023 European Laryngological Society and Union of European Phoniatricians core dataset; and classical vocal fold biomechanics, complemented where stated by the author's Unified Theory of Phonation. Two published high-speed videoendoscopy biomarkers, the Empirical Distribution of Glottal Edges and the Laryngovibrogram, are adopted, and one original index, the Stiffness/Pliability Index, is proposed. Evidence is graded with Oxford Centre for Evidence-Based Medicine levels.
RESULTS: A translation matrix links eight VLS findings to therapeutic targets and five techniques: semi-occluded vocal tract exercises, resonant voice therapy, vocal function exercises, manual circumlaryngeal therapy, and easy phonation. Five glottic closure patterns are mapped to distinct biomechanical inferences. A biomechanical inference triad structures bedside reasoning, a decision algorithm with an explicit safety gate is proposed, and three synthetic cases (nodules, unilateral paralysis, scar) illustrate its use. Biomechanical Reference Values are offered as provisional tracking thresholds, explicitly not validated minimal clinically important differences.
CONCLUSIONS: The framework gives clinicians a structured, shared language for moving from VLS findings to therapy plans. All translations are clinical inferences, not direct measurements of impact force or tissue stiffness; its indices, thresholds, and mappings are hypotheses that require reliability testing and prospective validation before routine clinical use.