动态发声计算机断层扫描用于与临床表现不相称的发声困难

文献信息

中文摘要

目的： 当视频频闪喉镜因解剖结构改变、声门上功能亢进或后部声门病变而受限时，对发声困难成人声门解剖的准确评估可能具有挑战性。我们旨在评估动态发声计算机断层扫描（DVCT）在既往接受过喉框架手术或疑似后部声门功能不全（PGI）的复杂成人嗓音患者中的临床效用。
方法： 回顾性队列研究，纳入2025年2月至2026年2月期间在一家三级喉科诊所因发声困难评估而接受DVCT的15例成人患者。收集人口学资料、既往手术史、标准化嗓音测量指标、视频频闪喉镜检查结果。
结果： 15例成人接受了DVCT（平均年龄62.8岁；40%为女性）。10例既往接受过甲状软骨成形术，5例存在已知或疑似PGI。所有患者的声学及感知嗓音测量指标均异常，且异常程度与频闪喉镜表现不相称。分析了DVCT影像学表现及临床处理。DVCT在所有患者中均提供了超出视频频闪喉镜的额外临床相关解剖信息。影像学最常发现后部声门功能不全、垂直高度不匹配、植入物位置异常或杓状软骨位置异常，这些在频闪喉镜下未被充分识别。CT结果影响了大多数患者的手术决策：确认手术适应证占47%，改变计划手术方式占33%，避免手术占13%。
结论： DVCT是评估既往接受过喉框架手术或存在PGI的发声困难成人的有用工具，可提供对声门解剖的补充性特征描述，从而为手术决策提供依据。

英文摘要

OBJECTIVES: Accurate evaluation of glottic anatomy in adults with dysphonia can be challenging when videostroboscopy is limited by altered anatomy, supraglottic hyperfunction, or posterior glottic pathology. We sought to evaluate the clinical utility of Dynamic Voice Computed Tomography (DVCT) in complex adult voice patients with prior laryngeal framework surgery or suspected posterior glottic insufficiency (PGI).
METHODS: Retrospective cohort study of 15 adult patients undergoing DVCT for evaluation of dysphonia at a tertiary laryngology practice between February 2025 and February 2026. Demographics, prior surgical history, standardized voice measures, videostroboscopy findings.
RESULTS: Fifteen adults underwent DVCT (mean age 62.8 years; 40% female). Ten had prior thyroplasty, and five had known or suspected PGI. All had abnormal acoustic and perceptual voice measures out of proportion to stroboscopy appearance. DVCT imaging findings and clinical management were analyzed. DVCT provided additional clinically relevant anatomic information beyond videostroboscopy in all patients. Imaging most commonly identified posterior glottic insufficiency, vertical height mismatch, implant malposition, or arytenoid malposition not fully appreciated on stroboscopy. CT findings influenced surgical decision-making in the majority of patients, confirming candidacy in 47%, altering planned procedures in 33%, and avoiding surgery in 13%.
CONCLUSIONS: DVCT is a useful tool in the evaluation of dysphonic adults with prior laryngeal framework surgery or PGI, providing complementary characterization of glottic anatomy that informs surgical decision making.