Indirect vs Direct Voice Therapy for Children With Vocal Nodules A Randomized Clinical Trial
Indirect vs Direct Voice Therapy for Children With Vocal Nodules A Randomized Clinical Trial
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DOI：
10.1001/jamaoto.2017.2618
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发表时间：
2018-02-01
影响因子：
7.8
通讯作者：
Bunting, Glenn
中科院分区：
文献类型：
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作者：
Hartnick, Christopher;Ballif, Catherine;Bunting, Glenn
良性声带小结影响12%至22%的儿科人群，95%的耳鼻喉科医生建议进行语音治疗。然而，没有随机临床试验，我们知道已经显示出其benefit. ObjectiveTo确定语音治疗的影响，在儿童声带小结根据治疗前和治疗后的分数对儿科语音相关的生活质量（PVRQOL）调查;次要目的包括发声参数的变化。设计、设置和参与者对于这个多中心随机临床试验，从门诊语音和言语诊所招募了114名年龄在6至10岁的声带结节、PVRQOL评分低于87.5、发声障碍超过12周的儿童。确定此年龄范围是因为这些患者没有经历喉的青春期变化，耐受频闪镜检查，并配合语音治疗。干预参与者接受间接或直接治疗8至12周。间接治疗的重点是教育和讨论的声音原则，而直接治疗使用的刺激，反应，先行paradigm.MAIN结果和措施的主要结果的措施是PVRQOL评分变化治疗前后。次要发声措施也compared.Results总体而言，114名儿童被招募的研究（平均[SD]年龄，8 [1.4]岁，83名男性[73%]），与57随机接受间接或直接治疗。直接和间接治疗方法治疗前和治疗后的PVRQOL评分均有显著差异。直接治疗组PVRQOL评分平均增加19.2，间接治疗组平均增加14.7（差异为4.5; 95.3% CI，-10.8至19.8）。在直接治疗组的44名参与者中，27名（61%）达到了有临床意义的PVRQOL改善，而间接治疗组的49名参与者中有26名（53%）达到了有临床意义的PVRQOL改善（差异，8%; 95%CI，-12至28）。事后分层显示，直接治疗组对大龄儿童（Cohen d = 0.50）和后三分之二的参与者（Cohen d = 0.46）有显著影响。声带结节的大小减少了31%（22 70），完全解决了11%（8 70）的参与者同意第二组图像后，通过recruitment process.CONCLUSIONS和RELEVANCE直接和间接的语音治疗改善声带结节的儿童语音相关的生活质量，虽然没有显着差异的方法。未来的研究可能会集中在哪些声音治疗方法在治疗年龄定义的人群是有效的。
IMPORTANCE Benign vocal fold nodules affect 12% to 22% of the pediatric population, and 95% of otolaryngologists recommend voice therapy as treatment. However, no randomized clinical trials that we are aware of have shown its benefits.OBJECTIVE To determine the impact of voice therapy in children with vocal fold nodules according to pretherapy and posttherapy scores on the Pediatric Voice-Related Quality of Life (PVRQOL) survey; secondary objectives included changes in phonatory parameters.DESIGN, SETTING, AND PARTICIPANTS For this multicenter randomized clinical trial, 114 children ages 6 to 10 years with vocal fold nodules, PVRQOL scores less than 87.5, and dysphonia for longer than 12 weeks were recruited from outpatient voice and speech clinics. This age range was identified because these patients have not experienced pubertal changes of the larynx, tolerate stroboscopy, and cooperate with voice therapy. Participants were blinded to treatment arm.INTERVENTIONS Participants received either indirect or direct therapy for 8 to 12 weeks. Indirect therapy focused on education and discussion of voice principles, while direct treatment used the stimulus, response, antecedent paradigm.MAIN OUTCOMES AND MEASURES The primary outcome measure was PVRQOL score change before and after treatment. Secondary phonatory measures were also compared.RESULTS Overall, 114 children were recruited for study (mean [SD] age, 8 [1.4] years; 83 males [73%]); with 57 randomized to receive either indirect or direct therapy. Both direct and indirect therapy approaches showed significant differences in PVRQOL scores pretherapy to posttherapy. The mean increase in PVRQOL score for direct therapy was 19.2, and 14.7 for indirect therapy (difference, 4.5; 95.3% CI, -10.8 to 19.8). Of 44 participants in the direct therapy group, 27 (61%) achieved a clinically meaningful PVRQOL improvement, compared with 26 of 49 (53%) for indirect therapy (difference, 8%; 95% CI, -12 to 28). Post hoc stratification showed robust effects in the direct therapy group for older children (Cohen d = 0.50) and the latter two-thirds of participants (Cohen d = 0.46). Vocal fold nodules reduced in size in 31% (22 of 70) and completely resolved in 11% (8 of 70) of participants who consented to a second set of images after going through the recruitment process.CONCLUSIONS AND RELEVANCE Both direct and indirect voice therapy improved voice-related quality of life in children with vocal fold nodules, although there was no significant difference between approaches. Future studies may focus upon which voice therapy approaches are effective in treating age-defined populations.