CAJ | 학술논문

目的：探讨嗓音训练对声带小结患者发声障碍的治疗效果。方法对21例声带小结患者进行嗓音训练，包括嗓音教育和发声训练，根据“呼吸－发声－共鸣”平衡原理，采用喉部按摩、无声练习及发大开口咽音的训练方法，每周训练一次，每次1～2小时，共5次。训练前后对患者进行嗓音障碍指数量表（VHI）评估、GRBAS评估、动态喉镜检查、空气动力学检测、计算机嗓音声学分析，比较治疗前后评估结果。结果21例患者治疗后VHI评分总分（29．48±21．21分）明显低于治疗前（52．95±24．30分）（P＜0．01）；GRBAS评分中总嘶哑度G（0．67±0．76）明显低于训练前（1．88±1．05）（P＜0．01），粗糙声R（0．52±0．58）明显低于训练前（1．36±0．55）（P＜0．01）；治疗后动态喉镜检查患者声带闭合、运动的对称性、粘膜波、振动规律性均改善（P＜0．01）；3例患者声带小结完全消失，13例患者声带小结缩小，5例与治疗前比较无明显变化；最长发声时间也由治疗前的8．87±3．75秒变为治疗后的12．54±3．68秒（ P＜0．01）；治疗后嗓音的频率微扰、振幅微扰、噪谐比（分别为0．18％±0．08％、2．10％±0．98％、0．0034±0．0022 dB ）均明显低于治疗前（分别为0．43％±0．31％、4．55％±1．80％、0．0184±0．028 dB ）（ P＜0．01或0．05）。结论嗓音训练对声带小结患者发声障碍有良好的治疗效果。
목적：탐토상음훈련대성대소결환자발성장애적치료효과。방법대21례성대소결환자진행상음훈련，포괄상음교육화발성훈련，근거“호흡－발성－공명”평형원리，채용후부안마、무성연습급발대개구인음적훈련방법，매주훈련일차，매차1～2소시，공5차。훈련전후대환자진행상음장애지수량표（VHI）평고、GRBAS평고、동태후경검사、공기동역학검측、계산궤상음성학분석，비교치료전후평고결과。결과21례환자치료후VHI평분총분（29．48±21．21분）명현저우치료전（52．95±24．30분）（P＜0．01）；GRBAS평분중총시아도G（0．67±0．76）명현저우훈련전（1．88±1．05）（P＜0．01），조조성R（0．52±0．58）명현저우훈련전（1．36±0．55）（P＜0．01）；치료후동태후경검사환자성대폐합、운동적대칭성、점막파、진동규률성균개선（P＜0．01）；3례환자성대소결완전소실，13례환자성대소결축소，5례여치료전비교무명현변화；최장발성시간야유치료전적8．87±3．75초변위치료후적12．54±3．68초（ P＜0．01）；치료후상음적빈솔미우、진폭미우、조해비（분별위0．18％±0．08％、2．10％±0．98％、0．0034±0．0022 dB ）균명현저우치료전（분별위0．43％±0．31％、4．55％±1．80％、0．0184±0．028 dB ）（ P＜0．01혹0．05）。결론상음훈련대성대소결환자발성장애유량호적치료효과。
Objective To investigate the effect of voice training therapy on the voice improvement in patients with vocal nodules .Methods Twenty one patients with vocal nodules were recruited and were evaluated by the GRBAS perpetual evaluation ,voice handicap index (VHI)-30 subjective assessment ,vocal laryngostroboscopy , maximum phonation time (MPT) and acoustic analysis pre- and post-therapy .These patients completed 5 cour‐ses of voice training .Results The VHI value(29 .48 ± 21 .21) of post-therapy was less than the value (52 .95 ± 24 . 30)of pre -therapy (P< 0 .01) .There were significantly differences in voice perpetual evaluation between pre -training and post-training ,especially for G (grade) (P<0 .01) and R (roughness) (P<0 .01) .The post-training laryngostrobescopy vocal vibration improved comparing with pre-therapy in the closure of vocal cords ,symmetry of vibration ,the mucosal wave and vibration regularity of the vocal cords .After therapy ,three patient nodules dis‐appeared ,thirteen patient nodules became smaller ,and five patient nodules remained the same .The maximum pho‐nation time (MPT) (12 .54 ± 3 .68)of post-therapy was longer than MPT(8 .87 ± 3 .75) of pre-therapy MPT(P<0 .01) .The jitter value (0 .18% ± 0 .08% ) of post -therapy was less than that of pre-therapy(0 .43% ± 0 .31% ) (P<0 .01) .The shimmer of post -therapy (2 .10% ± 0 .98% ) was less than that of pre -therapy (4 .55% ± 1 .80% )(P<0 .01) ,The ratio of noise to harmonic(NHR)(0 .0034 ± 0 .0022 dB) of post-therapy was significantly less than NHR(0 .0184 ± 0 .028 dB)(P<0 .05) of pre-therapy .Conclusion The voice therapy could significantlyimprove voice of patients with vocal nodules .