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12.DepartmentofOtolaryngology,NanjingMedicalUniversity1.VoiceResearchLaboratory,DivisionofSpeech&HearingSciences,TheUniversityofHongKong4.CollegeofPhysicians&Surgeons,ColumbiaUniversity3.DepartmentofSurgery,TheUniversityofHongKongCollaborationbetween合作機構香港大學言語及聽覺科學部聲線研究所南京醫科大學香港大學外科學系美國哥倫比亞醫學院21.VoiceResearchLaboratory,DivisionofSpeech&HearingSciences,TheUniversityofHongKong2.DepartmentofOtolaryngology,NanjingMedicalUniversity3.CollegeofPhysicians&Surgeons,ColumbiaUniversity4.DepartmentofSurgery,TheUniversityofHongKongEdwinYiu1PhDJieJieXu2MDTomMurry3PhDWilliamWei4FRCSMingYu2EstellaMa1PhDWeiHuang2MSc&ElaineYee-lanKwong1BSc偉霖教授姚文禮博士徐潔潔教授黃偉醫生鄺伊蘭小姐俞明醫生馬佩文博士3Background背景About6%ofpopulationhavevoiceproblems人口中有大概百分之六（6%）有聲線毛病Mostarecausedbyvocalmisusesandabuseswithpathologicalchangesinthevocalfolds(e.g.vocalnodules,ployps)大部份是由用聲不當或濫用引起的聲帶病變(如小結和息肉)Teachers,housewivesareparticularlypronetovoiceproblems教師和家庭主婦是最容易患聲線毛病4Background背景Surgicaltreatmentforthesefunctionalvoiceproblemsisusuallynotsuccessfulbecauseofrecurrence對這些病例，外科切割手術一般成效不大，主因是病變容易復發Thesefunctionalvoiceproblemscanusuallybetreatedbyconservativevoiceexercise聲線訓練是現時主要治療方法5Background背景20%ofpatientswithvoiceproblemsshownoimprovementaftervoiceexerciseandsurgery(Wooetal,1994)但外科手術或聲線訓練對百分之二十（20%）的患者沒有療效Also,voicetherapytakessometimetoachieveresults加上聲線訓練要一段時間才見療效Therefore,manyexploreforalternativetreatment,suchasTraditionalChineseMedicine所以有很多人轉向尋求傳統中醫療法，希望能在短時間見到療效6Objectives研究目的Thisstudyinvestigatestheeffectivenessofanintensiveacupunctureforvoiceproblem本項研究目的是探討針灸對治療聲帶病變的療效7Outcomemeasures成效指標Measurementsfordeterminingsuccess用來決定療效的指標Acousticanalysis-voicerangeprofile音域量度Perceptualanalysis-voicequalityratings聲線質量Patient’sperception-Activitylimitation&participationrestrictionbyVoiceActivity&ParticipationProfile(VAPP,Ma&Yiu,2001)患者自我評估8Voicerangemeasure音域測量9Methods研究方法CarriedoutattheNanjingFirstAffiliatedHospital,Nanjing研究地點：南京第一附屬醫院Studydesign研究設計:Randomized隨機Treatment-placebogroup治療-安慰對照Double-blind雙盲10Participants參與研究者54Chinesefemale(aged19to55)subjectswithvoiceproblems54個中國女性（19-55歲）Randomlyassignedto2groups隨機分配到:Treatmentgroup治療組Placebogroup安慰組11Participants參與研究者Selectioncriteria參與資格:Nohistoryofasthmaandupperrespiratorytractinfection沒有哮喘或呼吸系統問題Noneurologicaldisorder沒有腦神經問題Nohearingproblem沒有聽覺問題Noexperienceofformalvoicingorsingingtraining沒有唱歌或發聲練習經驗12Participants參與研究者24patientscompletedtheprogramwithfullsetofdataforanalysis二十四個病患者完成整個療程和有完整資料13Procedures過程Day1(beforesession1)第一天Day1-19一至十九天Day19(Aftersession10)第十九天Day33(2weeksaftersession10)第三十三天（治療後兩星期）療程Pre-treatmentassessment治療前測試TreatmentPost-treatmentassessment治療後測試Follow-upassessment治療後第二次測試14Procedures過程Treatment治療程序•10acupuncturesessions十次療程•Onceevery2days每兩天一次15TreatmentGroup治療組Neck頸Renying(人迎)(StomachChannel9)(withapplicationofelectricalstimulation)人迎穴位加電流刺激Wrist手腕Lieque(列缺)(LungChannel7)Ankle腳跟Zhaohai(照海)(KidneyChannel6)16Treatmentgroupreceivedacupunctureon:Renying(人迎)(St9)Lieque(列缺)(Lu7)Zhaohai(照海)(Ki6)1718ElectricalstimulationwasappliedtoRenying(人迎)(St9)人迎穴位加電流刺激19Lieque(列缺)(Lu7)Zhaohai(照海)(Ki6)20Placebogroup安慰組Wrist-Houxi(Smallintestinechannel3)後溪（手腕）Ankle-Kunlun(Bladderchannel60)昆侖（腳）21Results結果22050100150200250300350TreatmentGroup治療组PlaceboGroup安慰組PitchRange音域Beforetreatment治療前Aftertreatment治療後TheTreatmentGroupshowedstatisticalsignificantimprovementaftertreatment治療组-經治療後音域擴闊230100200300400500TreatmentGroup治療组PlaceboGroup安慰組HighestPitch最高音Beforetreatment治療前Aftertreatment治療後TheTreatmentGroupshowedstatisticalsignificantimprovementaftertreatment治療组-經治療後能發更高音調24012345678910TreatmentGroup治療组PlaceboGroup安慰組Selfperceivedseverity嚴重程度自我評分Beforetreatment治療前Aftertreatment治療後TheTreatmentGroupshowedstatisticalsignificantimprovementaftertreatment治療组-經治療後患者覺得聲線質素有改善(嚴重程度減少)250510152025303540TreatmentGroup治療组PlaceboGroup安慰組EmotionalScore情緒Beforetreatment治療前Aftertreatment治療後TheTreatmentGroupshowedstatisticalsignificantimprovementaftertreatment治療组-經治療後情緒好轉(嚴重程度減少)2601020304050TreatmentGroup治療组PlaceboGroup安慰組Activitylimitation日常活動的困難Beforetreatment治療前Aftertreatment治療後TheTreatmentGroupshowedstatisticalsignificantimprovementaftertreatment治療组-經治療後限制減少27-1-0.8-0.6-0.4-0.200.20.40.60.81TreatmentGroup治療组PlaceboGroup安慰組Changesofperceptualvoicequalityratingfollowingtreatment 治療後沙啞聲音程度轉變Breathiness沙聲Roughness 啞聲Improvement進步Deterioration退步28Conclusion結論IntensiveacupunctureontheacupointsRenyin(人迎),Lieque(列缺)andZhaohai(照海)resultedinimprovementsin針灸穴位人迎，列缺和照海，對聲帶病變患者有療效Vocalfunctioning發聲功能Activitylimitation減少日常生活困難Perceptualvoicequality音質改善29Conclusion結論Acupunctureislessinvasivethansurgicalmanagement相對於手術，針灸是比較溫和Acupuncturetakesrelativelyashortertime(20days)thanvoiceexercise(usually2months)toachieveresults相對於聲線練習（一般要兩個月），針灸只需較短的時間（20天）便達到療效30Conclusion結論Acupunctureisasymptomatictreatmentoption針灸對聲線病變能治標，但仍未能確定是否治本。Itneedstobesupplementwithvoiceexercise要配合聲線練習才是唯一的治本方法31Keyreferences主要文獻Yiu,E.M-L.(2003).Acupuncturefortreatingvoicedisorders.Invitedplenaryspeaker,FourthNationalWesterna