1、1,Acupuncture for voice disorder針灸治療聲帶病變,This project was funded by a grant from the Seed Grant University of Hong Kong 2001. 此研究計(jì)畫(huà)經(jīng)費(fèi)由香港大學(xué)研究基金資助,Voice Research Laboratory聲線(xiàn)研究所Division of Speech & Hearing Sciences言語(yǔ)及聽(tīng)覺(jué)科學(xué)部Faculty of Education教育學(xué)院,2,2. Department of Otolaryngology, Nanjing Medical Univ

2、ersity,1. Voice Research Laboratory, Division of Speech & Hearing Sciences, The University of Hong Kong,4. College of Physicians & Surgeons, Columbia University,3. Department of Surgery, The University of Hong Kong,Collaboration between 合作機(jī)構(gòu),香港大學(xué) 言語(yǔ)及聽(tīng)覺(jué)科學(xué)部聲線(xiàn)研究所,南京醫(yī)科大學(xué),香港大學(xué)外科學(xué)系,美國(guó)哥倫比亞醫(yī)學(xué)院,3,1. Voice Re

3、search Laboratory, Division of Speech & Hearing Sciences, The University of Hong Kong 2. Department of Otolaryngology, Nanjing Medical University 3. College of Physicians & Surgeons, Columbia University 4. Department of Surgery, The University of Hong Kong,Edwin Yiu1 PhD Jie Jie Xu2 MD Tom Murry3 Ph

4、D William Wei4 FRCS Ming Yu2 Estella Ma1 PhD Wei Huang2 MSc & Elaine Yee-lan Kwong1 BSc,偉霖教授,姚文禮博士 徐潔潔教授,黃偉醫(yī)生,鄺伊蘭小姐,俞明醫(yī)生,馬佩文博士,4,Background 背景,About 6% of population have voice problems人口中有大概百分之六（6%）有聲線(xiàn)毛病 Most are caused by vocal misuses and abuses with pathological changes in the vocal folds(e.g. v

5、ocal nodules, ployps)大部份是由用聲不當(dāng)或?yàn)E用引起的聲帶病變(如小結(jié)和息肉) Teachers, housewives are particularly prone to voice problems教師和家庭主婦是最容易患聲線(xiàn)毛病,5,Background 背景,Surgical treatment for these functional voice problems is usually not successful because of recurrence對(duì)這些病例，外科切割手術(shù)一般成效不大，主因是病變?nèi)菀讖?fù)發(fā) These functional voice pro

6、blems can usually be treated by conservative voice exercise聲線(xiàn)訓(xùn)練是現(xiàn)時(shí)主要治療方法,6,Background 背景,20% of patients with voice problems show no improvement after voice exercise and surgery (Woo et al, 1994)但外科手術(shù)或聲線(xiàn)訓(xùn)練對(duì)百分之二十（20%）的患者沒(méi)有療效 Also, voice therapy takes some time to achieve results加上聲線(xiàn)訓(xùn)練要一段時(shí)間才見(jiàn)療效 Theref

7、ore, many explore for alternative treatment, such as Traditional Chinese Medicine所以有很多人轉(zhuǎn)向?qū)で髠鹘y(tǒng)中醫(yī)療法，希望能在短時(shí)間見(jiàn)到療效,7,Objectives研究目的,This study investigates the effectiveness of an intensive acupuncture for voice problem 本項(xiàng)研究目的是探討針灸對(duì)治療聲帶病變的療效,8,Outcome measures 成效指標(biāo),Measurements for determining success 用來(lái)

8、決定療效的指標(biāo) Acoustic analysis-voice range profile 音域量度 Perceptual analysis-voice quality ratings 聲線(xiàn)質(zhì)量 Patients perception-Activity limitation & participation restriction by Voice Activity & Participation Profile (VAPP, Ma & Yiu, 2001) 患者自我評(píng)估,9,Voice range measure 音域測(cè)量,10,Methods研究方法,Carried out at the N

9、anjing First Affiliated Hospital, Nanjing研究地點(diǎn) ：南京第一附屬醫(yī)院 Study design 研究設(shè)計(jì) : Randomized 隨機(jī) Treatment-placebo group治療-安慰對(duì)照 Double-blind 雙盲,11,Participants參與研究者,54 Chinese female (aged 19 to 55) subjects with voice problems54個(gè)中國(guó)女性（19-55歲） Randomly assigned to 2 groups隨機(jī)分配到 : Treatment group 治療組 Placebo

10、 group 安慰組,12,Participants參與研究者,Selection criteria 參與資格: No history of asthma and upper respiratory tract infection 沒(méi)有哮喘或呼吸系統(tǒng)問(wèn)題 No neurological disorder 沒(méi)有腦神經(jīng)問(wèn)題 No hearing problem 沒(méi)有聽(tīng)覺(jué)問(wèn)題 No experience of formal voicing or singing training 沒(méi)有唱歌或發(fā)聲練習(xí)經(jīng)驗(yàn),13,Participants參與研究者,24 patients completed the pr

11、ogram with full set of data for analysis二十四個(gè)病患者完成整個(gè)療程和有完整資料,14,Procedures過(guò)程,Pre-treatment assessment治療前測(cè)試,Treatment,Post-treatment assessment 治療後測(cè)試,Follow-up assessment 治療後第二次測(cè)試,15,Procedures過(guò)程,Treatment 治療程序 10 acupuncture sessions 十次療程 Once every 2 days 每?jī)商煲淮?16,Treatment Group 治療組,Neck頸 Renying (

12、人迎) (Stomach Channel 9) (with application of electrical stimulation)人迎穴位加電流刺激,Wrist手腕 Lieque (列缺) (Lung Channel 7),Ankle腳跟 Zhaohai (照海) (Kidney Channel 6),17,Treatment group received acupuncture on:,Renying (人迎) (St 9),Lieque (列缺) (Lu 7),Zhaohai (照海) (Ki 6),18,19,Electrical stimulation was applied t

13、o Renying (人迎) (St 9)人迎穴位加電流刺激,20,Lieque (列缺) (Lu 7),Zhaohai (照海) (Ki 6),21,Placebo group 安慰組,Wrist- Houxi (Small intestine channel 3)後溪（手腕） Ankle- Kunlun (Bladder channel 60)昆侖（腳）,22,Results結(jié)果,23,The Treatment Group showed statistical significant improvement after treatment 治療組-經(jīng)治療後音域擴(kuò)闊,24,The Trea

14、tment Group showed statistical significant improvement after treatment 治療組-經(jīng)治療後能發(fā)更高音調(diào),25,The Treatment Group showed statistical significant improvement after treatment 治療組-經(jīng)治療後患者覺(jué)得聲線(xiàn)質(zhì)素有改善(嚴(yán)重程度減少),26,The Treatment Group showed statistical significant improvement after treatment 治療組-經(jīng)治療後情緒好轉(zhuǎn)(嚴(yán)重程度減少),2

15、7,The Treatment Group showed statistical significant improvement after treatment 治療組-經(jīng)治療後限制減少,28,Improvement 進(jìn)步,Deterioration 退步,29,Conclusion 結(jié)論,Intensive acupuncture on the acupoints Renyin (人迎) , Lieque (列缺) and Zhaohai (照海) resulted in improvements in 針灸穴位人迎，列缺和照海，對(duì)聲帶病變患者有療效 Vocal functioning 發(fā)聲

16、功能 Activity limitation 減少日常生活困難 Perceptual voice quality 音質(zhì)改善,30,Conclusion 結(jié)論,Acupuncture is less invasive than surgical management相對(duì)於手術(shù)，針灸是比較溫和 Acupuncture takes relatively a shorter time (20 days) than voice exercise (usually 2 months) to achieve results相對(duì)於聲線(xiàn)練習(xí)（一般要兩個(gè)月），針灸只需較短的時(shí)間（20天）便達(dá)到療效,31,Conc

17、lusion 結(jié)論,Acupuncture is a symptomatic treatment option針灸對(duì)聲線(xiàn)病變能治標(biāo)，但仍未能確定是否治本。 It needs to be supplement with voice exercise要配合聲線(xiàn)練習(xí)才是唯一的治本方法,32,Key references主要文獻(xiàn),Yiu, E.M-L. (2003). Acupuncture for treating voice disorders. Invited plenary speaker, Fourth National Western and Chinese Medicine Ear, Nose and Throat Conference, Guilin, 17 - 21 Oct, 2003 Yiu, E., Xu, J.J., Murry, T., Yu, M., Ma, E., Huang,W. & Kwong, E. (2004). Acupuncture for hyperfunctio