일측 성대마비의 웃음 음성치료 효과
Efficacy of Laughing Voice Treatment in Unilateral Vocal Fold Paralysis
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초록
본 연구의 목적은 일측 성대마비(UVFP)의 치료에 적용된 웃음을 이용한 후두보정기법(SKLCT®)의 효능을 평가하는 것이다. 41명의 환자(남자 14명, 여자 27명)가 비디오스트로보스코피를 통해 UVFP로 진단되어 SKLCT® 치료가 시행되었다. 모든 환자는 4-17 세션 동안 일주일에 한 번 치료를 받았다. GRBAS 척도와 VHI를 이용하여 치료 전후의 음질 변화를 확인하였다. Fo, Jitter, Shimmer, NHR, SFF를 평가하기 위해 음향학적 분석을 수행하였고 MPT, MFR, Psub, Efficiency를 평가하기 위해 공기역학적 분석을 수행하였다. 치료 전후 후두 소견의 변화를 확인하기 위해 비디오스트로보스코피를 시행하였다. SKLCT® 사용 후 청지각적 평가 결과, G, B, A 척도가 유의하게 개선되었으며 VHI 점수가 개선되었다. 무엇보다 SKLCT® 이후 음향학적 및 공기역학적 평가를 통해 크게 개선되었음을 확인하였다. 비디오스트로보스코피 소견과 비교하여 성문 간격의 크기는 치료 후 감소하거나 사라졌다. 또한, 성문상부 압축 소견은 SKLCT® 후에 개선되었다. 이러한 결과는 SKLCT®가 UVFP 환자의 음질 개선에 효과적임을 시사한다. 결론적으로 웃음 음성치료는 비정상적인 성문상부 압축을 억제하고 후두 높이를 낮추어 과소기능을 동반한 발성의 회복에 효과가 있는 것으로 보인다.
Abstract
The purpose of this study was to evaluate the efficacy of laryngeal calibration technique (SKLCT®) using laughter for the treatment of unilateral vocal fold paralysis(UVFP). 41 patients(14 male, 27 female) diagnosed with UVFP through videostroboscopy were enrolled in SKLCT®. All patients were treated once a week for 4 to 17 sessions. The GRBAS scale and VHI were used to confirm the change of voice quality before and after the treatment. Acoustic analysis was performed to evaluate Fo, Jitter, Shimmer, NHR, SFF and aerodynamic analysis was performed to evaluate MPT, MFR, Psub, Efficiency. Videostroboscopy was performed to confirm changes of laryngeal features before and after treatment. After SKLCT®, the results of the perceptual evaluation showed that G, B, and A scales were significantly improved, and VHI score was improved. Most of all were significantly improved by acoustic and aerodynamic evaluation after SKLCT®. In comparison of videostroboscopic findings, the size of the glottal gap decreased or disappeared after treatment. In addition, the laryngeal findings of supraglottic compressions were improved after SKLCT®. These results suggest that SKLCT® is effective in improving the vocal quality of patients with UVFP. In conclusion, it seems that laughing voice treatment suppressed abnormal supraglottic compression and lowered laryngeal height, which seems to have the effect of improving hypofunctional phonation.
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