患者对“音高理解”的认知对声带沟患者嗓音治疗后嗓音结局改善是否关键？

文献信息

中文摘要

背景： 音高感知是个体根据每个声音的基频（F0）区分声音高低的能力。在我们的嗓音门诊，所有患者均常规测量F0和最长发声时间（MPT）。然而，许多以嗓音障碍就诊的患者表现出较差的“音高理解”。嗓音治疗是大多数良性声带病变（如声带沟）的一线治疗。我们的假设是研究“音高理解”在嗓音治疗后嗓音结局中的作用，尤其是在声带沟这类音高受到影响的病变中。
目的： 评估理解音高概念与不理解音高概念的声带沟患者在接受嗓音治疗后嗓音结局指标（MPT和F0）的改善情况。
方法： 对声带沟患者进行了一项为期6个月的回顾性研究。选择声带沟患者作为研究组，因为该疾病通常表现为声音嘶哑和音高升高。根据门诊记录，患者被分为两组：A组为理解音高概念的患者，B组为不理解音高概念的患者。所有患者均在4-6周内接受四次嗓音治疗。在治疗前后记录MPT和F0。分析结局指标的变化，并进行组内和组间比较。
结果： A组包括10例理解音高概念的患者，该组50%（5/10）为歌手。B组包括10例不理解音高概念的患者，0/10为歌手。这一观察具有统计学显著性（P = 0.033，P < 0.05）。在A组内，分析提示治疗前后MPT存在显著差异（t = 3.29，P = 0.009）；F0无统计学显著性。B组分析显示治疗后MPT和F0均无显著性。A组与B组之间比较显示MPT和F0均无统计学显著性，但A组MPT的效应量较大（Cohen's d = 0.98），提示该组具有临床意义的效应。
结论： 音乐知识和训练似乎显著影响对音高概念的理解。理解音高概念的声带沟患者在治疗后MPT较不理解者显著改善。将音高感知训练纳入嗓音治疗可能提高该组患者的治疗效果和嗓音康复成功率。

英文摘要

BACKGROUND: Pitch perception is an individual's ability to distinguish sounds as high or low based on each sound's fundamental frequency (F0). In our voice clinic, F0 and maximum phonation time (MPT) are routinely measured in all patients. However, many of our patients presenting with voice disorders demonstrate poor 'pitch understanding'. Voice therapy is the first-line management for most benign vocal fold lesions, such as vocal fold sulcus. Our hypothesis is to study the role of "pitch understanding" in vocal outcomes following voice therapy, especially in a pathology like vocal fold sulcus where pitch is impacted.
AIM: To assess the improvement in vocal outcome measures (MPT and F0) after voice therapy in patients with vocal fold sulcus who understood the concept of pitch versus those who did not.
METHODS: A 6-month retrospective study was conducted on patients with vocal fold sulcus. Patients with vocal fold sulcus were selected as the study group, as this condition typically presents with hoarseness and elevated pitch. Based on clinic records, patients were divided into two groups: Group A: patients who understood the concept of pitch, and Group B: patients who did not understand the concept of pitch. All patients underwent four sessions of voice therapy over 4-6 weeks. MPT and F0 were recorded before and after therapy. Data were analyzed for changes in outcome measures and compared within and between groups.
RESULTS: Group A included 10 patients who understood pitch concept, 50% (5/10) in this group were singers. Group B included 10 patients who did not understand the concept of pitch, and 0/10 were singers. This was a statistically significant (P = 0.033, P < 0.05) observation. Within Group A, analysis suggested that there was a significant difference in pre vs. post therapy MPT (t = 3.29, P = 0.009); F0 was not statistically significant. Group B analysis showed no significance for both MPT and F0 post therapy. Between Group A and Group B, comparison revealed no statistical significance for MPT and F0, but the effect size (Cohen's d = 0.98) was large for MPT in Group A, suggesting a clinically meaningful effect in this group.
CONCLUSION: Musical knowledge and training appear to significantly influence the understanding of the concept of pitch. Patients with vocal fold sulcus who understood the concept of pitch had a significant improvement in MPT following therapy as compared to the patients who did not. Incorporating pitch perception training into voice therapy may improve treatment effectiveness and vocal rehabilitation success in this group.