背景:单侧声带麻痹(UVFP),以一个声带不动为特征,喉返神经损伤的结果。语音治疗是一种保守的干预措施,旨在解决这些症状,但是缺乏标准协议。在这项研究中,我们提供了过去3年对UVFP的语音治疗的最新综述,并从2023年欧洲喉科学会和欧洲心血管医师联盟指南建议的语音评估角度分析了语音治疗的效果.
方法:遵循系统评价和荟萃分析(PRISMA)2020声明的首选报告项目,我们搜索了数据库,包括PubMed,Embase,WebofScience,Cochrane图书馆,和Scopus,从最早的记录到2023年12月1日。在干预工具的非随机研究中,质量评估利用了Cochrane偏差风险和偏差风险。数据提取包括研究设计,参与者特征,治疗方案,和结果衡量标准,包括主观和客观评估。我们通过计算I2统计量进行异质性分析,并通过计算均值和加权均值差异的标准化差异进行荟萃分析。
结果:我们的系统评价和荟萃分析包括12项研究,包括459名患者。审查显示,在研究中女性参与者占主导地位。治疗方案主要包括呼吸控制,喉操纵,和共振训练,经常通过家庭锻炼来补充。结果测量显示主观参数有显著改善:语音障碍指数((标准平均差)SMD=-1.51,P<0.001),声学参数:基频(SMD=-0.38,P=0.003),抖动(SMD=-0.97,P<0.001),闪烁(SMD=-0.94,P<0.001),和噪声谐波比(SMD=-0.89,P<0.001),和空气动力学参数:最大发声时间(SMD=1.29,P<0.001),早期干预可提高声门完全闭合率。
结论:两项随机对照试验(RCT)涉及了解其分配给治疗组的患者,其余10项研究为回顾性研究,导致预期干预的偏差。观察到主观和空气动力学参数不一致,但在排除UVFP发病超过12个月的研究后,VHI评分的异质性降低。漏斗图在出版偏倚测试中是大致对称的。在主观方面注意到了显著的改善,声学,和干预后的空气动力学结果。此外,协议中有共同点,比如呼吸控制,喉操纵,和共振训练,经常通过家庭锻炼来补充。
背景:该方案于2024年3月28日在国际前瞻性系统审查登记册(PROSPERO)注册,注册号:CRD42024529750。
BACKGROUND: Unilateral vocal fold paralysis (UVFP), characterized by immobility of one vocal fold, results from injuries of recurrent laryngeal nerves. Voice therapy is a conservative intervention aiming to address these symptoms, but standard protocols are lacking. In this study, we provided an updated review of voice therapy for UVFP over the past 3 years and analyzed the effect of voice therapy from the perspective of voice assessment recommended by the guidelines of the European Laryngological Society and the Union of the European Phoniatricians in 2023.
METHODS: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement, we searched the databases, including PubMed, Embase, Web of Science, the Cochrane Library, and SCOPUS, from their earliest records to December 1, 2023. Quality assessment utilized Cochrane Risk of Bias and Risk Of Bias In Non-randomized Studies of Interventions tools. Data extraction encompassed study design, participant characteristics, therapy protocols, and outcome measures, including subjective and objective assessments. We performed heterogeneity analysis by calculating the I2 statistic and meta-analysis by calculating the standardized difference of means and weighted mean differences.
RESULTS: Our systematic review and meta-analysis included 12 studies encompassing 459 patients. The review revealed a predominance of female participants across studies. Therapy protocols primarily included breathing control, laryngeal manipulation, and resonance training, often supplemented by home exercises. Outcome measures demonstrated significant improvements in subjective parameter: Voice Handicap Index ((standard mean difference) SMD = -1.51, P < 0.001), acoustic parameters: fundamental frequency (SMD = -0.38, P = 0.003), jitter (SMD = -0.97, P < 0.001), shimmer (SMD = -0.94, P < 0.001), and noise-to-harmonic ratio (SMD = -0.89, P < 0.001), and aerodynamic parameters: maximum phonation time (SMD = 1.29, P < 0.001), with early intervention yielding enhanced rate of complete glottal closure.
CONCLUSIONS: Two randomized controlled trials (RCTs) involved patients aware of their allocation to the treatment group, and the remaining 10 studies were retrospective, leading to bias from deviations in the intended intervention. Subjective and aerodynamic parameter inconsistency was observed, but after excluding studies with the onset of UVFP greater than 12 months, the heterogeneity of VHI scores decreased. The funnel plot was grossly symmetrical in the publication bias test. Significant improvements were noted in subjective, acoustic, and aerodynamic outcomes after intervention. Besides, there were commonalities in protocols, such as breathing control, laryngeal manipulation, and resonance training, often supplemented by home exercises.
BACKGROUND: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on March 28, 2024, registration number: CRD42024529750.