성대에어로빅치료 프로그램이 내전형 연축성발성장애 환자의 음성개선에 미치는 효과: 예비연구

유재연 한국언어치료학회 2024 言語治療硏究 Vol.33 No.3

목적: 본 연구의 목적은 총체적 음성치료법으로 개발된 성대에어로빅치료(VAT) 프로그램이 내전형 연축성발성장애를 가진 음성장애 환자의 음성개선에 미치는 효과를 알아보고자 하였다. 방법: 본 실험은 내전형 연축성발성장애(adSD)로 진단된 2명의 여성 환자를 대상자로 선정하여 실시되었다. 치료는 2명의 대상자에게 개별적으로 실시하였다. 음성치료는 매주 2회씩 3개월간 총 24회로 진행되었다. VAT 프로그램은 이완단계, 호흡단계, 발성단계, 발화단계, 총 4단계로 구성되어 있다. 음성개선 정도를 알아보기 위해, 음향학적 평가로, VOXplot를 사용하여 치료 전후의 음향학적 파라미터 값의 변화를 비교하였다. 그리고 음성설문조사지인 VHI와 청지각적 평가도구인 GRBAS를 사용하여 중재 전후의 음성평가를 실시했다. 결과: 첫째, 음향학적 평가 결과, 두 피험자 모두에서 음향학적 파라미터인 jitter, shimmer, HNR, GNE, CPPS, voice break, AVQI, ABI 등 모두에서 수치가 향상된 것으로 나타났다. 둘째, VHI 평가 결과, 음성장애지수 점수가 감소하였고 대상자의 음성만족도도 향상된 것으로 나타났다. 셋째, GRBAS 평가 결과, 2명의 대상자의 음질이 개선된 것으로 나타났다. 결론: 성대에어로빅치료 프로그램은 내전형 연축성발성장애 대상자의 음성을 향상시키는 데 효과적인 것으로 나타났다. 따라서, 성대에어로빅치료 프로그램은 연축성발성장애와 같이 발성 시 과도한 긴장을 수반하는 과기능적 음성장애의 음성치료에도 유용한 프로그램으로 간주될 수 있을 것이다. 차후 연구에서는 좀 더 많은 수의 연축성발성장애와 과긴장성 음성장애 환자들을 대상으로 한 실험이 이루어진다면, 성대에어로빅치료의 음성치료 효과에 대한 더욱 유용한 정보를 얻을 수 있을 것이다. Purpose: The purpose of this study was to investigate the effects of a vocal aerobic treatment (VAT) program developed for holistic voice therapy on voice improvement in patients with adductor spasmodic dysphonia. Methods: This experiment was conducted on two female subjects diagnosed with adductor spasmodic dysphonia (adSD). Treatment was conducted separately on two subjects. A total of 24 sessions were performed twice every week over a 3-month period. for The VAT program consists of a total of 4 stages including relaxation, breathing, and phonation exercises, as well as a speaking stage. In order to examine the degree of voice improvement, changes in the acoustic parameters were compared pre- and post- intervention using VOXplot. Voice questionnaires (VHI) and an auditory evaluation (GRBAS) were also evaluated in pre-post intervention. Results: First, all two subjects showed improvements in jitter, shimmer, HNR, GNE, CPPS, Voice break, AVQI, and ABI as a result of acoustic evaluation. Second, The Voice Handicap Index of the subjects decreased, and their voice satisfaction also improved. Third, the results of GRBAS Scale also showed improvement in voice quality in two patients. Conclusions: The VAT program can also be considered a useful program for voice treatment of hyperfunctional voice disorders that involve excessive tension during vocalization, such as spasmodic dysphonia. In future research, if experiments are conducted on a larger number of patients with spasmodic dysphonia and hyperfunctional voice disorders, more useful information on the voice treatment effects of VAT program will be obtained.

내전형 연축성 발성장애와 근육긴장성 발성장애의 감별에 있어 물저항빨대발성의 유용성

김지성 한국언어청각임상학회 2022 Communication Sciences and Disorders Vol.27 No.1

배경 및 목적: 내전형 연축성 장애(AdSD)와 근육긴장성 발성장애(MTD)는 유사한 음성학적 증상을 보이지만, 그 원인과 치료법이 다르기 때문에 두 질환의 적절한 치료를 위해 정확한 감별이 필요하다. 본 연구는 두 질환의 감별을 위한 진단적 치료로서 물저항빨대발성의 유용성을 알아보기 위한 것이다. 이를 위해, AdSD와 MTD를 대상으로 물저항빨대발성을 실시하고 수행 전과 후의 음성을 비교하였다. 방법: 연구 대상자는 AdSD로 진단받은 성인 9명과 MTD로 진단받은 성인 18명이다. AdSD 집단은 남 2명, 여 7명으로 평균연령은 30.01세이며, MTD 집단은 남 4명, 여 14명, 평균연령은 31.03세이다. 대상자들은 진단적 치료의 절차로 물저항빨대발성(90초 소요)을 실시하였다. 진단적 치료에 따른 음성변화를 측정하기 위해 수행 전과 후의 음향학적 분석과 청지각적인 평가를 실시하고 이를 비교하였다. 결과: AdSD 집단은 물저항빨대발성을 이용한 진단적 치료 수행 전과 후 유의한 음성변화가 없었다. 반면, MTD 집단은 Jitter (p=.003), PPQ (p=.007), vF0 (p=.004), Shimmer (p=.010), APQ (p=.012), vAm (p=.005)과 청지각적 음성의 전반적 심각도(p=.007)가 유의하게 감소한 것으로 나타났다. 논의 및 결론: 물저항빨대발성 이후 즉각적인 음성개선은 후두 과긴장이 이완된 결과이다. 진단적 치료 이후 음성개선이 나타나는 경우는 후두 과긴장이 이완되었음을 의미하는 것으로 MTD의 가능성이 높음을 시사한다. 반면, 음성문제의 개선이 없거나 심해지는 경우는 AdSD로 확증하는 것이 아니라, 최소한 MTD가 아닐 가능성을 제시한다. 이와 같은 관점에서 물저항빨대발성을 이용한 진단적 치료는 두 질환의 감별을 위한 음성평가 방법 중 하나로 다른 검사들과 함께 음성평가에서 유용하게 사용될 수 있을 것이다.

신경성 발성장애와 기능성 발성장애의 감별 진단

김소연,이상혁,Kim, So Yean,Lee, Sang Hyuk 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Voice disorder is classified into three categories, structural, neurogenic and functional dysphonia. Neurogenic dysphonia refers to a disruption in the nerves controlling the larynx. Common examples of this include complete or partial vocal cord paralysis, spasmodic dysphonia. Also it occurs as part of an underlying neurologic condition such as Parkinson's disease, myasthenia gravis, Lou Gehrig's disease or disorder of the central nervous system that causes involuntary movement of the vocal folds during voice production. Functional dysphonia is a voice disorder in the absence of structual or neurogenic laryngeal characteristics. A near consensus exist that Muscle tension dysphonia (MTD) is functional voice disorder wherein hyperfunctional laryngeal muscle activity whereas Spasmodic dysphonia (SD) is neurogenic, action-induced focal laryngeal dystonia including several subtype. Both Adductor type spasmodic dysphonia (AdSD) and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. It makes these two disorders extremely difficult to differentiate based on clinical interpretation alone. Because treatment for AdSD and MTD are quite different, correct diagnosis is important. Clinician should be aware of the specific vocal characteristics of each disease to improve therapeutic outcome.

연축성발성장애의 청지각적 평가 및 공기역학적 특성

박선영,김재옥,임성은,남도현,최홍식,Park, Sun-Young,Kim, Jae-Ock,Lim, Sung-Eun,Nam, Do-Hyun,Choi, Hong-Shik 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1

Background and Objectives : This study was performed to investigate the perceptual and aerodynamic characteristics and the relation between vocal efficiency and the severity of strained voice. of adductor spasmodic dysphonia. Materials and Methods : 13 female patients with adductor spasmodic dysphonia were examined and compared with 10 normal female control group. MPT, MFR, Psub, Sound Intensity, VE(vocal efficiency) were obtained using PAS(Phonatory Aerodynamic System). GRBA(S) scale was used for Perceptual evaluation. Results : Psub(subglottic pressure) of SD was significantly higher than normal group. MPT, MFR, Sound Intensity, VE were not significantly different between two groups. Correlation between VE and 'S'(strained) was not significant. Conclusion : The results of this study show that certain aerodynamic parameters(Psub) distinguish adductor spasmodic dysphonia from normal voice.

스펙트로그램을 이용한 내전형 연축성 발성 장애와 근긴장성 발성 장애의 감별

노승호,김소연,조재경,이상혁,진성민,Noh, Seung Ho,Kim, So Yean,Cho, Jae Kyung,Lee, Sang Hyuk,Jin, Sung Min 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. Materials and Methods : From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0-3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. Results : Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p<0.01). Well defined formants were not found different between two groups. Conclusion : The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.

선택적 갑상피열분지 및 측윤상피열분지의 절단과 경신경고리 신경재지배 방법을 이용한 연축성발성장애의 수술적 치료 1례

박영학,배성천,이석은,조승호,Park, Young-Hak,Bae, Seong-Cheon,Lee, Seok-Eun,Cho, Seune-Ho 대한후두음성언어의학회 2006 대한후두음성언어의학회지 Vol.17 No.2

Spasmodic dysphonia is a voice disorder characterized by involuntary voice breaks during speech. Adductor spasmodic dysphonia is most common and characterized by strained and strangled voice breaks. The current standard of treatment of therapy for adductor spasmodic dysphonia is chemodenervation of thyroarytenoid muscle with botulinum toxin(Botox). However, Botox is a temporary treatment with each injection lasting approximately 3 months on average and require repeated injections. In this study, we report our experience with surgical treatment for adductor spasmodic dysphonia. In this procedure, the thyroarytenoid branch and lateral cricoarytenoid branch of recurrent laryngeal nerve is selectively denervated unilaterally, and its distal nerve stump of thyroarytenoid branch is reinnervated with branch of the usa cervicalis nerve. And lateral cricoarytenoid muscle partial myotomy was done unilaterally. After 6 months of treatment, voice fluency had improved and no period of breathiness or dysphagia was noted.

난치성 연축성 발성장애 환자에서 갑상피열근 절제술 및 선택적 반회후두신경 절제술 1예: 장기 추적 관찰

이윤지,안유영,박기남,이승원 대한후두음성언어의학회 2020 대한후두음성언어의학회지 Vol.31 No.1

Spasmodic dysphonia is a disease presumed to be a form of focal laryngeal dystonia. The widely used first-line treatment is botulinum toxin injection to the thyroarytenoid muscles. In spite of the effectiveness and safety of this method, it has a temporary effect that lasts only several months, resulting the patients’ symptom fluctuating, called ‘Botox rollercoaster.’ Some surgical techniques had tried, but they had shown several limitations including high rate of recurrence. We tried thyroarytenoid myectomy with selective recurrent laryngeal nerve section in a patient with intractable spasmodic dysphonia. This procedure is an alternative treatment of spasmodic dysphonia to prevent recurrence and improve symptoms. During five years of follow-up, she has shown steady quality voice without any complication. To the best of our knowledgement, this is the longest follow-up case of this operation in South Korea.

연축성 발성장애 환자의 음향학적 및 공기역학적 양상

이주환,김인섭,고윤우,오종석,배정호,윤현철,최성희,최홍식 대한후두음성언어의학회 2000 대한후두음성언어의학회지 Vol.11 No.1

Background and Objectives : The etiology and pathophysiology of spasmodic dysphonia is yet unknown. This study was performed to determine if any laryngeal aerodynamic parameter distinguish the voice of patient diagnosed as having adductor spasmodic dysphonia from individuals with normal voice production and to investigate the pathophysiology of spasmodic dysphonia. Materials and Methods : fifteen women diagnosed as having adductor spasmodic dysphonia and fifteen normal control women participitated in this study Maximum phonation time, mean air flow rate, subglottic pressure, vocal efficiency, Vfo, NHR, VTI, FTRI, ATRI, Jitter percent, Shimmer percent were obtained from the participants using 'MDVP(multi-dimensional voice program)' of CSL(Computerized Speech lab, Kay Elemetrics, Co., Model No. 4300), and 'maximum sustained phonation' and 'IPIPI test' of AP II(Aerophone II, Kay Elemetrics, Co., Model 6800). Results : T-test statistical analysis revealed statistically different values for vocal efficiency, Vfo, NHR, MPT, litter percent, Shimmer percent between the spasmodic dysphonia group and the control group. Conclusions : Spasmodic dysphonia affects the ability of the laryngeal mechanism to function effectively. Results from our study demonstrate that certain aerodynamic and acoustic parameters distinguish adductor spasmodic dysphonia from normal voice.

내전형 연축성 발성장애의 비유창성 및 VOT 특성

김성태,김성수 대구대학교 특수교육재활과학연구소 2020 특수교육재활과학연구 Vol.59 No.3

The purpose of this study was to investigate the usefulness of spectroscopic analysis on the characteristics of non-fluency vocalization and VOT between patients with adductor spasmodic dysphonia and patients with developmental stuttering. Ten women diagnosed with ADSD were enrolled. The age distribution of the target group ranged from 20 to 54 years, with an average age of 37 years and an average duration of disease of 1.5 years. The control group included 7 males and 3 females with developmental stuttering in the same age group. The types of non-fluency were compared and analyzed using the items of normal disfluency (ND) and pathological disfluency (AD) presented in the Paradise Fluency Test (P-FA). VOT was measured as a test word for which the amorphous sound /ph/ was calculated among the recorded voice samples. VOT was measured using the oscillogram and spectrogram of the CSL program. As a result of the study, the stuttering group had abnormal interjection and partial word repetition, and the ADSD group had DPB findings with tension and block. These results are interpreted to show that ADSD has a form of non-fluency different from stuttering. In addition, the VOT of the ADSD group was statistically significantly shorter than that of the stuttering group. This is thought to be a result showing that spectrogram analysis is very useful in discriminating between two diseases.

연축성 발성장애 환자에서 레이저와 단극성 전기소작기를 이용한 갑상피열근신경 절제술 1예

이소정,정수연,정성민,김한수 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.2

Spasmodic dysphonia is a focal laryngeal dystonia that results in involuntary spasms during speech. The etiology of spasmodic dysphonia is not yet defined, but it is presumed to be a neurological abnormality of central nervous system motor function. The treatment of choice for spasmodic dysphonia is botulinum toxin injection directly at the laryngeal muscles. However botulinum toxin injection requires repeated procedures. Many different kinds of surgical treatments have been introduced but the recurrence rate is still high. So we performed myomectomy with LASER and neurectomy with specially designed electrical surgical knife which can cut recurrent laryngeal nerve branch selectively with its noble curved section. We report a case of a 43-year-old male patient with spasmodic dysphonia treated by thyroarytenoid myoneurectomy.