加齢性音声障害に対するvocal function exerciseの治療効果と患者背景の検討

Patient factors and their relation to the effectiveness of vocal function exercises on presbyphonia

　加齢性音声障害の代表的疾患である高齢者の声帯萎縮に対してvocal function exercise(VFE)を用いた音声治療を実施し，音声治療効果と患者背景の比較検討を行った．対象は2016年7月〜2018年7月の間に杏林大学医学部附属病院音声専門外来にて声帯萎縮と診断された65歳以上の高齢者のうち，音声治療を完遂した35症例で，平均年齢は男性77.2歳，女性77.9歳であった．音声治療として声の衛生指導の後にVFEを8週間実施し，その効果を音声治療の前後で解析した．声門閉鎖およびGスコア，MPT，生理的声域，Shimmer，VHIは有意に改善し，音声治療効果の指標とした改善項目数が4項目以上改善した患者は約54.3％であった．改善項目数と患者の背景因子の関連を解析すると，われわれが過去に報告した年齢および病悩期間の他に，新たに握力および音声治療開始前のMPTが改善項目数との間に有意な弱い相関関係を認め，これら4つの因子が音声治療の効果予測因子と考えられた．

　We examined the impact of voice therapy using vocal function exercises (VFEs) on vocal fold atrophy in a group of elderly subjects who were each over 65 years old. Additionally, the impact of voice therapy and background factors of the patients were compared. The subjects were 35 patients comprising 19 males (mean age, 77.2 years) and 16 females (mean age, 77.9 years) who underwent voice therapy for their vocal fold atrophy between July 2016 and July 2018. They received vocal hygiene instruction, followed by 8 weeks of VFEs. Glottic closure, G score, maximum phonation time (MPT), vocal pitch range, jitter, shimmer, and Voice Handicap Index (VHI) were measured before and after voice therapy to assess the impact of the voice therapy on the vocal function of the patients. Nineteen patients achieved some improvement in at least 4 parameters of the 7 target parameters. Furthermore, age, duration of symptom, grasping power and pre-therapeutic MPT correlated significantly with the number of improved parameters. In the future, these findings should contribute to designing refined, tailor-made therapeutic programs to treat patients with presbyphonia.