声带结节(VFN)是小儿发声障碍的主要原因。建议将语音治疗作为儿童VFN的首选治疗选择。
本系统综述的目的是提供有关VFN患儿嗓音治疗效果的现有文献综述。
本系统文献综述是根据PRISMA(系统评价和荟萃分析的首选报告项目)指南进行的。Cochrane中央对照试验登记册(CENTRAL),搜索MEDLINE(通过PubMed)和Embase,并检查灰色文献。搜索策略基于三个概念:VFN,语音治疗和儿童。两名审查员独立确定文章的合格性,并从纳入的研究中提取所有相关数据。使用QualSyst工具评估纳入研究的方法学质量。
通过识别,评估和总结所有有关儿科VFN语音治疗的相关研究的结果,这项系统的审查使语音治疗师更容易获得可用的证据,耳鼻喉科医师和其他相关利益相关者。
本系统综述包括24项研究。8项研究(8/24)报告了语音治疗后至少一个结果参数的显着改善。然而,5篇论文(5/24)未显示语音治疗后的显著变化.所有没有检验显著性的研究(11/24)发现一个或多个结果参数的改善。纳入研究的总体质量是足够的(55%)。总之,有一些证据表明,语音治疗对VFN患儿有效,但是进一步精心设计的研究,尤其是随机对照试验,有必要确认这些结果。
在本主题中已知的语音疗法在患有VFN的儿童中是优选的,因为结节的声损伤性质和在声外科手术后相关的高复发率。大多数临床实践中的语音治疗师都提供折衷的语音治疗计划,由直接和间接语音治疗技术组成。这项研究对现有知识的补充这项系统评价提供了有关儿科VFNs语音治疗效果的现有证据的清晰概述。有一些证据表明,语音治疗是VFN患儿的有效治疗选择,但是在这个问题上设计良好的研究很少。这项工作的潜在或实际临床意义是什么?这篇综述表明,具有强大设计的有效性研究在患有VFN的儿童中非常稀缺。临床医生应该意识到,在该人群中很少对治疗技术进行彻底研究。然而,这篇评论可能会指导语音治疗师为VFN儿童制定治疗计划,因为它可以识别,评估并总结了所有有关儿科VFN语音治疗的相关个体研究的结果。嗓音疗法似乎对治疗患有VFN的儿科患者有效,考虑到相当数量的纳入研究报告语音治疗后有显著改善。直接和间接治疗方法似乎都对VFN患儿的发声产生积极影响。
Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children.
The aim of this systematic
review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs.
This systematic literature
review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool.
By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders.
24 studies were included in this systematic
review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results.
What is already known on the subject Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well-designed research is scarce on this subject. What are the potential or actual clinical implications of this work? This
review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this
review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs.