声带萎缩的嗓音治疗与注射治疗结局比较

文献信息

中文摘要

目的： 声带萎缩是老年人发声困难的常见原因，其结构改变会损害声门闭合与振动。声带注射填充（VFIA）和嗓音治疗常用，但其相对疗效及最佳顺序仍不明确。
方法： 在一家三级学术中心开展为期5年的回顾性病历审查。患者分为四组：VFIA、嗓音治疗、联合治疗和观察。结局包括嗓音障碍指数-10（VHI-10）、Grade-Roughness-Breathiness-Asthenia-Strain（GRBAS）感知评分，以及治疗前后的配对频闪喉镜所见。采用参数和非参数检验分析组内和组间变化。探索性分析评估治疗顺序（VFIA→嗓音治疗 vs. 嗓音治疗→VFIA）。
结果： 共纳入80例患者（观察组 n = 32，VFIA组 n = 22，嗓音治疗组 n = 13，联合组 n = 12）。基线VHI-10在各组间差异显著（P < 0.001），VFIA组和联合组评分更高，而基线GRBAS评分相似。VHI-10在联合组（P = 0.041）和VFIA组（P = 0.045）内改善。组内感知改善见于联合治疗的粗糙度和气息声；VFIA的气息声；以及嗓音治疗的总体程度、粗糙度和紧张度。变化评分的组间比较在总体程度（P = 0.035）、粗糙度（P = 0.005）和气息声（P = 0.018）方面显著。在具有治疗前后频闪喉镜的患者中，VFIA和联合治疗后声门闭合不全减少，而观察组室带功能亢进增加。在顺序分析中，先嗓音治疗再VFIA与总体程度（P = 0.040）和紧张度（P = 0.022）的更大改善相关。
结论： VFIA和嗓音治疗在声带萎缩中可能提供互补获益。声门闭合的改善仅限于接受注射填充的队列，而嗓音治疗与粗糙度的更大改善相关。先进行嗓音治疗再进行VFIA可能改善感知结局，但亚组样本量小限制了推断。

英文摘要

OBJECTIVES: Vocal fold atrophy is a common cause of dysphonia in older adults due to structural changes that impair glottic closure and vibration. Vocal fold injection augmentation (VFIA) and voice therapy are commonly used, but their relative efficacy and optimal sequencing remain unclear.
METHODS: A retrospective chart review was conducted at a tertiary academic center over a 5-year period. Patients were categorized into four groups: VFIA, voice therapy, combined therapy, and observation. Outcomes included Voice Handicap Index-10 (VHI-10), Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) perceptual scores, and paired pre and post treatment stroboscopic findings. Within- and between-group changes were analyzed using parametric and nonparametric tests. An exploratory analysis evaluated treatment sequencing (VFIA→voice therapy vs. voice therapy→VFIA).
RESULTS: Eighty patients were included (observation n = 32, VFIA n = 22, voice therapy n = 13, combined n = 12). Baseline VHI-10 differed significantly across groups (P < 0.001), with higher scores in the VFIA and combined cohorts, while baseline GRBAS scores were similar. VHI-10 improved within the combined (P = 0.041) and VFIA (P = 0.045) cohorts. Within-group perceptual improvement was observed for roughness and breathiness with combined therapy; breathiness with VFIA; and grade, roughness, and strain with voice therapy. Between-group comparisons of change scores were significant for grade (P = 0.035), roughness (P = 0.005), and breathiness (P = 0.018). Among patients with pre and post treatment stroboscopy, glottic insufficiency decreased following VFIA and combined therapy, while supraglottic hyperfunction increased in the observation group. In the sequencing analysis, voice therapy followed by VFIA was associated with greater improvement in grade (P = 0.040) and strain (P = 0.022).
CONCLUSION: VFIA and voice therapy may provide complementary benefits in vocal fold atrophy. Improvement in glottic closure was confined to cohorts receiving injection augmentation, whereas voice therapy was associated with greater improvement in roughness. Sequencing voice therapy before VFIA may improve perceptual outcomes, though small subgroup sizes limit inference.