格鲁吉亚音乐学院学生声带小结的临床与视频频闪喉镜特征：病例系列研究

文献信息

中文摘要

背景： 嗓音障碍在专业用声人群中常见，尤其是面临高嗓音需求的歌手和声乐学生。声带小结是与嗓音创伤相关的最常见良性声带病变之一。然而，关于音乐学院学生声带小结的临床和功能特征的数据，尤其是在格鲁吉亚，仍然有限。
方法： 本描述性病例系列纳入10名在格鲁吉亚第比利斯一家耳鼻咽喉专科诊所因发声困难就诊的音乐学院声乐学生和应届毕业生。回顾性收集临床数据，包括人口学特征、嗓音背景、就诊症状、临床发现和处理。所有患者均接受视频频闪喉镜检查以评估声带结构和功能，并同时进行嗓音声学评估。
结果： 参与者年龄范围为17至28岁，60%为女性。所有病例均存在发声困难（100%），其中4例（40%）报告高音区发声困难。视频频闪喉镜检查显示双侧、对称的结节性病变，位于声带前中1/3交界处，部分病例可见声门闭合不全和黏膜波减弱。8例（80%）患者发现声学参数异常。4例（40%）报告提示反流相关喉部刺激的症状，2例（20%）诊断为反流性喉炎。所有患者因保守治疗后症状持续及其职业用声需求而接受喉显微手术，随后进行结构化术后嗓音康复和嗓音治疗。4例（40%）患者额外接受吸入性糖皮质激素治疗。术后观察到发声困难临床改善。
结论： 声带小结导致因嗓音相关主诉就诊的音乐学院声乐学生和应届毕业生出现发声困难。视频频闪喉镜与嗓音声学评估的联合使用可提供关于声带结构和嗓音功能的互补信息。在本病例系列中，对于症状持续且职业用声需求较高的患者，喉显微手术继以结构化术后嗓音康复与发声困难的临床改善相关。需要采用标准化治疗前后嗓音结局指标的大型前瞻性研究来进一步评估该人群的治疗结局。

英文摘要

BACKGROUND: Voice disorders are common among professional voice users, particularly singers and vocal students exposed to high vocal demands. Vocal fold nodules are among the most frequent benign vocal fold lesions associated with phonotrauma. However, data on the clinical and functional characteristics of vocal fold nodules among conservatory students, particularly in Georgia, remain limited.
METHODS: This descriptive case series included 10 conservatory vocal students and recent graduates presenting with dysphonia at a specialized otolaryngology clinic in Tbilisi, Georgia. Clinical data were collected retrospectively and included demographic characteristics, vocal background, presenting symptoms, clinical findings, and management. All patients underwent videostroboscopic examination to assess vocal fold structure and function, together with acoustic voice assessment.
RESULTS: Participants ranged in age from 17 to 28 years, and 60% were female. Dysphonia was present in all cases (100%), with high-register dysphonia reported in four patients (40%). Videostroboscopic examination demonstrated bilateral, symmetrical nodular lesions located at the junction of the anterior and middle thirds of the vocal folds, with incomplete glottic closure and reduced mucosal wave observed in several cases. Abnormal acoustic parameters were identified in eight patients (80%). Symptoms suggestive of reflux-related laryngeal irritation were reported in four patients (40%), and reflux laryngitis was diagnosed in two patients (20%). All patients underwent phonomicrosurgery because of persistent symptoms despite conservative management and their professional vocal requirements, followed by structured postoperative voice rehabilitation and voice therapy. Four patients (40%) additionally received inhaled corticosteroid therapy. Clinical improvement in dysphonia was observed following surgery.
CONCLUSION: Vocal fold nodules contribute to dysphonia among conservatory vocal students and recent graduates presenting with voice-related complaints. The combined use of videostroboscopy and acoustic voice assessment provides complementary information on vocal fold structure and vocal function. In this case series, phonomicrosurgery followed by structured postoperative voice rehabilitation was associated with clinical improvement in dysphonia among patients with persistent symptoms and substantial professional vocal demands. Larger prospective studies using standardized pre- and post-treatment voice outcome measures are needed to further evaluate treatment outcomes in this population.