摘要目的 利用主客观评估评价嗓音训练改善教师嗓音障碍患者嗓音质量及疗效.方法采用便利抽样法,选择47例有嗓音障碍但声带无器质性病变且随访资料完整的教师嗓音障碍患者作为研究对象,进行为期3个月的嗓音训练.训练内容包括缓解喉部肌肉、改善声带运动及重建发音方法等.训练前后用嗓音声学分析和嗓音障碍指数(VHI)量表中文版进行评估.结果教师嗓音障碍患者接受嗓音训练后嗓音声学参数基频微扰和振幅微扰显著下降,分别由1.06(0.79,1.38)％、2.71(2.16,3.24)％降至0.78(0.59,0.99)％、1.64(1.03,2.45)％,差异有统计学意义(Z=3.249、-4.121,P<0.05);嗓音障碍指数和最长发音时间明显上升,分别由-2.23±0.75、(9.87±2.61)s升至-0.43±1.65和(12.81±1.97)s,差异有统计学意义(t=-6.057、-5.273,P<0.05);VHI量表评分明显下降,总分由(37.41±4.96)分下降至(26.31±4.29)分,除情感功能外差异有统计学意义(t=12.715、5.881、11.483,P<0.05).结论嗓音训练可以减轻教师嗓音障碍的程度,增加发声过程中呼吸系统的动力支持,改善教师嗓音质量;主客观联合评估可以更加全面的评价患者的嗓音质量,为嗓音质量的好转提供参考依据.

abstractsObjective To explore the curative effectiveness of comprehensive voice training methods on teachers' voice disorders patients by using subjective and objective assessment. Methods Forty-seven teachers' voice disorders patients suffering from voice symptoms without organic disease and complete follow-up data as the research object were treated with a three-month comprehensive voice training program. Training content included relieving laryngeal muscle tension, improving the throat vocal cord movement and reconstruction methods of pronunciation. The use of voice acoustic analysis and voice handicap index(VHI) were compared before and after training. Results The jitter and shimmer were significantly decreased after comprehensive voice training from 1.06(0.79,1.38)％and 2.71(2.16,3.24)％to 0.78 (0.59, 0.99)％ and 1.64(1.03,2.45)％, the differences were significant (Z=3.249,-4.121, P<0.05). Maximum phonation time and dysphonia severity index were significantly increased obviously from (9.87 ± 2.61)s and-2.23±0.75 to (12.81±1.97)s and-0.43±1.65 respectively, the differences were significant (t=-6.057,-5.273, P<0.05). After the training, the VHI score of voice disorder index decreased from (37.41±4.96)points to (26.31± 4.29) points after the comprehensive voice training. In addition to emotional function, the difference was statistically significant(t=12.715, 5.881, 11.483, P<0.05). Conclusions Voice training can reduce the degree of voice disorders effectively, increase the power of the respiratory system, therefore improve the voice quality of teachers with voice disorders. The subjective and objective combination assessment can evaluate the quality of the patient′s voice more thoroughly and evaluate the clinical efficacy of voice training further.