唇腭裂患者的嗓音治疗：一项叙述性综述。

文献信息

中文摘要

目的： 唇腭裂（CLP）作为儿童最常见的先天性异常之一，可导致嗓音障碍。CLP的发生率及其随之产生的影响可能导致声带喉部病变，症状可包括声音嘶哑、粗糙、气息声、响度降低和音调异常。鉴于关于嗓音治疗对CLP患者疗效的研究结果数量有限，本叙述性综述的目的是汇总既往研究的结果，探讨其发现与局限性，并识别研究空白，以提供关于嗓音治疗对CLP患者疗效的更合适数据。
方法： 两位作者独立在多个电子数据库（包括PubMed和Google Scholar）中进行了文献综述。根据作者的标准，仅关注外科手术、共鸣治疗或构音治疗的研究、综述文章、会议摘要、无全文的文章以及非英语文章被排除。评估嗓音治疗对CLP患者结局的研究被选入进行定性综合。
结果： 仅四项研究符合纳入标准，这些研究探讨了多种治疗技术，包括折衷法、症状法（气泡音）和生理法（吸管发声和VentiMask）。总体而言，无论使用何种嗓音治疗技术，嗓音评估的不同方面均有显著改善，包括声音嘶哑和鼻音过重减轻、腭咽闭合改善、jitter和shimmer降低，以及谐噪比（HNR）和倒谱峰值突出（CPP）升高。此外，VentiMask在健康相关生活质量（HRQoL）方面产生了具有临床意义且稳定的改善。
结论： 嗓音治疗可作为CLP多学科管理中有益且必要的组成部分，通过减轻继发性嗓音症状、改善声学特征并提高这些患者的生活质量。然而，方法学多样性、样本量小、参与者异质性以及技术差异的影响不应被低估，因为它们可能影响对研究结果的解释。因此，未来研究应采用严谨的设计，如样本量更大且具有长期随访的随机对照试验，以建立标准化临床方案并促进对结果的更好解释。

英文摘要

OBJECTIVES: Cleft lip and palate (CLP), as one of the most common congenital anomalies in children, can result in voice disorders. Incidence of CLP and its consequential impact may lead to laryngeal pathologies of the vocal cords, and symptoms may include hoarseness, harshness, breathiness, decreased loudness, and abnormal pitch. Considering the limited number of findings on the efficacy of voice therapy in patients with CLP, the purpose of this narrative review is to aggregate the results of previous studies, explore their findings and restrictions, and identify gaps to present more appropriate data regarding the efficacy of voice therapy in patients with CLP.
METHODS: A literature review was conducted independently by both authors across several electronic databases, including PubMed and Google Scholar. Based on the authors' criteria, studies focusing exclusively on surgical procedures, resonance therapy, or articulation therapy, review articles, conference abstracts, articles without full text, and non-English articles were excluded. Studies evaluating the outcomes of voice therapy in patients with CLP were selected for a qualitative synthesis.
RESULTS: Only four studies met the inclusion criteria, investigating diverse therapeutic techniques including eclectic, symptomatic (vocal fry), and physiologic approaches (straw phonation and VentiMask). Generally, regardless of the voice therapy techniques used, there was a significant improvement across different aspects of voice assessment, including reduced hoarseness and hypernasality, improved velopharyngeal closure, reduced jitter and shimmer, and increased Harmonics-to-Noise Ratio (HNR) and Cepstral Peak Prominence (CPP). Moreover, VentiMask yielded clinically meaningful, stable improvements in health-related quality of life (HRQoL).
CONCLUSION: Voice therapy can be a beneficial and essential component in the multidisciplinary management of CLP by mitigating secondary vocal symptoms, improving acoustic characteristics, and improving quality of life in these patients. However, the effects of methodological diversity, small sample sizes, participants' heterogeneity, and differences in techniques should not be underestimated, as they can affect the interpretation of findings. Therefore, future research should employ rigorous designs, such as randomized controlled trials with larger sample sizes and long-term follow-up, to establish standardized clinical protocols and facilitate better interpretation of results.