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TAP CHi Y HOC VIET NAM TAP 454 - THANG 5 - SO 2 - 2017

MO T A TRIEU CHU'NG BENH ROI LOAN CANG CO GAP (y cAc CA Sl VA DANH GIA HIEU QUA P H U O N G P H A P LUYtN THANH

T O M TAT

Nghien cifu thgt hien tren 125 ca sT co thay doi giong noi dUdc chan doan la roi loan giong cang cd vdi bieu hien chinh la met moi giong man tinh, giong n6i_^khan, liay dut doan, dau hpng khi noi, kho dieu khien am dp, Soi hoat nghiem thanh quan ttiay co 4 dang hinh anh ciia roi loan giong cang cd: Type I (Khe hd sau): 46,3%, Type'll (Khep bang thanh that):

29,6%^ Type I I I (co keo tru'dc sau): 18,5% va Type IV (co that toan bp cau true tren thanh mon): 5,6%. Sau luyen thanh k i t qua tot sau 36 thang 74,7%, kha 21,1%, kem 4,2%. Danh gia theo thang diem chi so hoan thien ciia giong (VHI) cho ket qua: sau 36 thang 74,4% trd ve binh thu'dng.

Tu'khoa: Roi loan giong cang cd, met moi giong man tinh, khe hd sau, khep bang thanh that, cau triic trSn thanh mon, co keo tru'dc sau

SUMMARY

CHARACTERISnCS OF VOICE DISORDERS MUSCLE TENSION AMONG SINGER AND EFFECTIVE AFTER VOCAL TRAINING METHOD

Research conducted on 125 singers voice change is diagnosed voice disorders muscle tension is manifested chronic fatigue voice, hoarse voice, or broken, sore throat when speaking, hard to control audio dirty. Stroboscopic laryngeal Soi 4 saw an image of voice disorders muscle strain: type I (gap following): 46.3%, type I I (Closing tape interior bar):

29.6%, type I I I (traction sooner or later): 18.5% and type IV (spasm entire structure above the glottis):

5.6%. Afl:er good results vocal 74.4%, rather 21.4%

less 4.2%. Assessed according to a scale of perfection of tone index (VHI) for the results: 74.4% after 36 months to return to normal.

Keywords:'^olce disorders muscle strain, chronic fatigue voice, following openings, closing interior ice bar, a sbTjcture in the glottis, before the next pull.

I. OAT VAN o l

Thay ddi gipng ndi la van de ma cac ca sl thu'dng xuyen phai ddi^mat, mot trong nhiTng benh lam gipng thay ddi la roi loan giong cang c d [ l ] . Nam 1980, Aronson md ta bieu hien rdi loan gipng nhu'ng khong tim thay tdn thu'dng

*Tn/dng Dai hpc YHa Noi

**Hpc viin Am nhac Quoc gia VN Tac gia chinh: Pham Thj Bich Oao Email: [email protected] Ngay nhan bai: 19/1/2017 Ngay phan bien khoa hoc: 9/2/2017 Ngay duyet bai: 15/3/2017

Pham Thi Bich Dao , TrSn Ngoc Lan

thiTc the tai thanh quan, tac gia nhan manh vai trd ciia rdi loan cd che phat am trong benh nay [2]. Morrison va cdng sir du'a ra khai niem

"rdi loan giong cang cd" (I^LGCC) cho loai benh tren vao nam 1983 [ 3 ] . RLGCC cd the xay ra do cd che bil trir, trong dd viem nhiem du'dng ho hap thu'dng la nguyen nhan chinh gay tinh trang phat am bii trir. Ngoai ra, tinh trang gipng yeu, gipng cd chat Iu'dng khdng tdt cung la yeu to lam cho benh nhan cd xu hu'dng cd phat am va du^ den I^LGCC. Mdt sd tac gia cho rang cd che benh sinh gay RLGCC la do hoat dpng qua mu'c ciia thanh quan khi phat am lam cac cd thanh quan tang tru'dng Iu'c lan tda [5]. Koufman va Blalock de xuat mdt he thdng phan loai ciia RLGCC du'a vao cac dac diem ve thanh mon va tren thanh mdn [ 4 ] . Cac dac diem tren thanh mdn la cac hinh thai co keo ben (la su' khep bang thanh that trong khi phat am) va co keo tru'dc sau (la su' co riit ciia sun nap thanh thiet ve phia sun pheu). Type I: khe hd sau tren thanh mon, type I I : khep bang thanh that, type I I I : co keo trirdc sau mpt phan, type IV: co that toan bo cac cau triic tren thanh mdn. Nam 1991, Koufman md ta chi tiet trieu chu'ng RLGCC ddng thdi duS ra bang phan loai 4 type hinh thai thanh quan [4]. Nhieu nghien ciru cung chi ra ty le RLGCC gap tdi 4 0 % cac roi loan gipng [5]. Tai Viet Nam nam 2013, Nguyen Duy Du'dng [6] danh gia dac diem cua RLGCC tren giao vien la roi loan gipng ndi va khdng cd ton thu'dng thu'c the cua niem mac day thanh, ket hdp vdi roi loan khep day thanh khi phat am va danh gia sir anh hu'dng ciia RLGCC ddi vdi phat am thanh dieu tieng Viet. Tran Ngpc lan cung nhan xet neu qua trinh rdi loan cang cd keo dai s i lam cho cd day thanh rdi vao tinh trang bat dn dinh (nhu'dc cd day thanh), ngu'di ca sT nay se liic hat dddc luc khdng hat du'dc, co hong hp luon thay met va cam giac yeu di lam anh hu'dng rat nhieu tdi tam ly [1]. Nghien cu'u nay du'dc tien hanh nham md ta cac bieu hien/di loan cang cO gap d cac ca srtai Hpc vien Am nhac Quoc gia tir thang 10/2014 - 10/2016 va danh gia hieu qua ciia phu'dng phap luyen thanh trong loai benh li nay.

11. OOI T l / g N G VA PHLTONG PHAP NGHIEN COXJ 1 . Ooi tu'dng nghien cu'u: Ca sT cd thay doi gipng noi dddc chan doan la rdi loan giong cang

19

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VIETNAM MEDICAL JOURNAL N°2 - MAY • 2017 Cd. Tieu chuan lu^ chpn: du'dc chan doan la roi

loan gipng cang ai vdi cac trieu chirng lam sang, soi hoat nghiem thanh quan, du'dc luyen thanh theo b i i tap ciia Tran Ngpc Lan va du'dc theo ddi dii 6 giai doan trong 36 thang. Tieu chuan loai trir: benh nhan rdi loan gipng khong do cang cd, hoac du'dc luyen thanh theo bai tap khac, khdng theo doi theo quy djnh, khdng dong y tham gia nghien ciru.

2. Phu'dng phap nghien cihj:

•Thiet ke nghien cu'u: thd nghiem lam sang khong cd nhom chirng, danh gia ket qua tru'dc va sau dieu trj.

* M I U n g h i i n cifu: 125 ca sT co thay ddi gipng ndi du'dc chan doan la roi loan gipng cang cd diTa tren trieu chiTng lam sang, soi hoat nghiem thanh quan.

* 0 | a diem va thdi gian nghien cu'u: tai Hpc vien Am nhac Quoc gia tir thang 10/2014 - 10/2016.

•Bien phap dfeu trj: Luyen thanh theo bai tap cua Tran Ngpc Lan[l];Ky thuat hat not cao - Ky thuSt "chay nhanh" - passage -Ky thuat III. K i r QUA

Staccato - Tai nghe - Am thanh nghet mui (gipng mui) - Am thanh bdp, danh ciitig - Am thanh rung cham d co - Am thanh vd.

- Oanh gia ket qua dieu tri qua trieu chuYig lam sang, soi hoat nghiem thanh quan va chi sd VHItheo tirng giai doan: 3 thang, 6 thang, 12 thang, 24 thang va 36 thang.Theo thang diem VHI cd tdng diem la 120 [ 6 ] : Thang diem du'dc xay dirng tren 4 bang vdi so diem tir 0-4 (0 - khong bao gid, 1- hau nhd khdng bao gid, 2- thinh thoang, 3- Hau nhu" thu'dng xuyen, 4- ludn ludn). Thang diem: 0 diem: mu'c binh thu'dng; 1- 30 diem: mu'c nhe; 31-60 diem: mirc vii^; 61-90 diem: miTc nang; 91-120 diem: mu'c rat nang.

3. Xit ly va phan tich sdi li§u:nhap va quan ly so lieu tren chu'dng trinh SPSS 16.6. Xif ly so lieu theo thuat toan thong ke.

4. Oao du'c n g h i i n cihi: tuan thu cac nguyen tac ve dao du'c trong nghien ciili y sinh. Cac ddi tuWng nghien ciili txf nguyen dong thuan tham gia nghien cu\j va cd the riit lui bat ky liic nao trong qua binh nghien cud neu khong dong y. Thdng tin ve ddi tu'dng nghien cu\j du'dc giu' bi mat.

1 _{M^t mdi} ^{• • •} • ^100%

giong man tfnh

55%

•1 Noi dau 100%

B ^ 9

^ ^ n

Kh6ng digu tiet dugc cao

do

100%

m •

K h ^ tieng

Bie'u do 1 . Bieu hien cua roi loan giong cang cd d ca sT

Alhan xet: Cac bleu hien rdi loan gipng cang cd thu'dng gap la met mdi giong man tinh 100%, khdng dieu khien dddc cao dp gipng 100%, khan tieng 100%, ndi dau 55%.

• Type I

• Type n

• Type 111

• Type IV

Bi€u do 2. Ccic the RLGCC tren soi hoat nghiem thanh quan

flihan xet: Type 1 (Khe hd sau): 46,3%, Type I I (Khep bang thanh that): 29,6%, Type I I I (co keo tru'dc sau): 18,5% va Type IV (co that toan bp cau true tren thanh mdn): 5,6%.

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TAP CHl Y HOC VIET NAM TAP 454 - THANG 5 - SO 2 - 2017

Banq 1 . Danh qia chi so V H I sau tu'no Mu-c do VHI

Binh ttiLrdng Nile ViiS Nanq

Tru'dc lap 0 20(16%) 87 (69,6%) 18 (14,4%)

Sau 3 tiianq 0 53(42,4%) 54(43,2%)

qiai doan luyen tap Sau 6 thang

2 ( l j 6 % ) 74(59,2%) 34(27,2%) 18(14,4%) 15(12%)

Sau 12 thang 11(8,8%) 76 (60,8%) 32 (25,6%) 6(4,8%)

Sau 24 thang 91(72,8%J^

10(7,8%) 19 (15,2%)

5(4,2%)

Sau 36 thang 93 (74,4%)^

22(17,2%)_

5 (4,2%) 5 (4,2%) Nhan xet: ket qua cho thay truidc tap khdng cd benh nhan nao cd mu'c dp VHI binh thu'dng (0%), ty le nay tang dan theo thdi gian: sau 6 thang la 1,6%, sau 12 thang la 8,8%, sau 24 thang la 72,8% va sau 36 thang la 74,4%. Ty le cd miTc dd VHI nang giam dan theo thdi gian va sau 36 thang cdn 4,2%.

Bieu do 3. So sanh mu'c do hoi phuc giong va cac type RLGCC

IVhan xefType I (Khe hd sau): 46,3%, Type I I (Khep IJang thanh that): 29,6%, Type I I I (co keo tru'dc sau): 18,5% va Type IV (co that toan bo cau triic tren thanh mdn): 5,6%. Sau 36 thang, Type I tot 78,6%, type I I toots 5 2 , 1 % , type I I I tot 34,8%, type IV tdt la 17,8%.

IV. BAN L U A N

RLGCC thu'dng gap tren cac benh nhan cd cac trang thai tam ly tieu cu'c nhu' de bi kich ddng, cang thang, to lang, sd tiai, bi quan - vi the nghe ca sT la mpt trang nhutig nghe hay gap loai benh nay.Trieu chirng cua RLGCC gap tren 125 doi tu'dng nghien cu'u gap la: met mdi gipng man tfnh 100%, ndi dau 55%, khong dieu tiet du'dc cao dp 100%, khan tieng 100%. Cac trieu chu'ng nay cung la trieu chuTig- gap du'dc tren nhu'ng benh nhan RLGCC ma tac gia Pham Duy Du'dng dira ra[6]. Aranson gap trieu chiTng noi dau tren 36,7% cac doi tu'dng nghien ciru. Hp deu cho rang cac trieu chirng tren xuat hien la do siT co gang thu'dng xuyen ciia thanh quan de bii trir khi phat am ma sdng rung dpng cua day thanh lai giam d nhihig benh nhan RLGCC.Cac dac ti'nh ciia chu ky rung day thanh thay doi khi thay doi cao dp, cu'dng dp va khoang am (cac quang), chinh tir nhutig dac diem nay ma trong benh RLGCC ngu'di ta phan ra lam bon type de dda ra bai tap luyen thanh va danh gia kha nang hoi phuc. Khi soi boat nghiem thanh quan 46,3%

gap d type I, it nhat ia nhdm IV: 5,6%. Sau tuyen thanh 36 thang, so benh nhan dat ket qua kem chii yeu la d type IV, hien tu'dng co that toan bp cac cau true tren thanh mon d nhOtig benh nhan nay rat khd hoi phuc. Koufrnan trong nghien ciiXi cung cho rang, chirc nang thanh

quan bj thay doi trong benh RLGCC d type IV gan nhi/ khdng phuc do hien tu'dng thay doi trao ddi chat trong cac te bao cau true thanh quan[4]. Neu dddc luyen thanh bat ban, 74,4%

sd Iu'dng ca sT cd the hat du'dc trd ve binh thu'dng sau 36 thang.Rubin va Blake cung thay rang, viec luyen thanh phu hdp vdi sire khde cua day thanh cung giup sdng niem mac day thanh van dpng mem mai vdi tdc dp on d!nh[7]. Khi danh gia phu'dng phap dieu trj bang luyen gipng, r'lathieson da giai thich If do tai sao cae bai tap tang dan van ddng ciia day thanh tir tir chii yeu sir dung ntii^ng nguyen am trunq (a), luong hdi tir ptidi di qua day thanh se de dang lani day thanh rung dpng on dinh va ngu'di tap se de van hdi dieu hda cao dp am [ 4 ] . Kooijman d u ^ ra cae yeu to danh gia su" phuc hot ciia gipng qua ehi sd VHI [5], Chi sd VHI dung de danh gia kha nang trd lai vdi nghe ca sT tu'dng ddi chinh xac, vdi 30 cau hdi trong danh gia sir hoi phuc ciia miTc dp gipng ndi giiip giao vien thanh nhac cd the li/a chpn the loai nhac cho hpc trd minh de tranh lam thanh quan ton thu'dng trd lai, loat tro dddc cd che bil trir khi phai gang si^c, bai tap hat trong thdi gian dau nen la nhu'ng bai am tram doi vdi gipng nam va am cao doi vdi gipng n i i t l ] - Viec d u ^ ra cac nguyen li trong dieu tri RLGCC giup cho ngu'di benh, giao vien luyen thanh cung nhu* thay thuoc chuyen khoa phoi

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VIETNAM MEPICAL JOURNAL N°2 - MAY - 2017 hdp du'dc vdi nhau du'a ra du'dc the loai bai tap

thfch hdp cho tirng ngu'di benh.Nhdm tac gia Roy va Whitchurch lai phan tich tach rdi tiing am cua ngu'di RLGCC de xac djnh tiitig loai tir ma benh nay lam khd phat am va chi luyen am dd mang lai ty le thanh cdng tdi 89,5% [ 7 ] . Tuy nhien ngay ca vdi phu'dng phap nay hinh anh quan sat tren soi hoat nghiem thanh quan cijng khong bao gid trd ve binh thu'dng.

V. KET L U A N

Trieu chirng thu'dng gap trong RLGCC la; met mdi gipng man tfnh, giong ndi khan, hay dirt doan, dau hpng khi ndi, khd dieu khien am dp.

Soi hoat nghiem thanh quan thay ed 4 dang hinh anh ciia rdi loan gipng cang cd: Type I (Khe hd sau): 46,3%, Type I I (Khep bang thanh that):

29,6%, Type I I I (co keo tru'dc sau): 18,5% va Type IV (co that toan bp cau triic tren thanh mon): 5,6%. Ket qua tot sau luyen thanh tap ehung d type I, I I , I I I , tdt 74,4%, kha 21,4%.

Chi sd VHI 74,4% trd ve binh thu'dng.

TAI Ll|U T H A M KHAO

1. Ph^m Thj Bich Dao, Tran Ngpc Lan (2014).

"Giu' gin giong hat cho ca sT", nha xuat ban Khoa hoc k9 thuat.

. Angsuwarangsee T, Morrison M (2002).

"Extnnsic laryngeal muscular tension in patients with voice disorders". J Voice; 16:333-343.

Rubin JS, Blake E, Mathieson L (2007).

"Musculoskeletal patterns in patients with voice disorders". J Voice; 21:477-484.

. Mathieson L, Hirani SP, Epstein R, Baken R], Wood G, Rubin ]S(2009). "Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia". J Voice; 23:353-365.

. Kooijman PG, de 3ong FI, Oudes MJ, Huinck W, van Acht H, Graamans K (2005). "Muscular tension and body posture in relation to voice handicap and voice quality in teachers with persistent voice complaints". Folia PhoniatrLogop;

57:134-147.

. Barbara H. Jacobson, Atex Johnson, et al (2001).

The Voice Handicap fridex (VHI): Development arid Validation. American Joumal of Speedi-Language Pathology, Vol 6(3), 66-70. COpynght Amencan Speedi- Ijnguage-Hearing Association.

. Roy N, Whitchurch M, Merrill RM, Houtz D, Smith ME (2008). Differential diagnosis of adductor spasmodic dysphonia and muscle tension dysphonia using phonatory break analysis.

Laryngoscope; 118:2245-2253.

KET QUA vA cAC YEU TO TIEN LITCTNG CUA PHAU THUAT GlAl EP TRONG CHAN THVffNG SO NAO NANG

TAI BENH VIEN DA KHOA XANH PON

T O M TAT

Mi^c tieu: M6 ta ket qua phau thuat giai phong chen ep nao trong chan thu'cfng sp nao nSng va mot so yeu to tien Iu'dng. Dol tu'dng: 66 benh nhan chan thuWng sp nao nang du'dc phau thuat giai phong chen ep nao tai benh vien da khoa Xanh - P6n tir thang 4 nSm 2010 den thci'ng 12 nSm 2015. Phu'dng phap;

Mo ta cat ngang. Ket qua: Ket qua^ sau phau thuat giai ep du'dc danh gia theo thang diem GOS theo doi sau 1 n3m': co 16,7% benh nhan tir vong, ti le song thu'c vat va di clitjmg nang chiem 36,1%. Ket qua phau tliuat tot khong phu thu6c vao_^loai ky thuat giai phong chen ep ma phu thupc vao diem Glasgow trUdc

* Benh vien xanh pon

**fnfdng Dal hoc Y Ha Npi

***Benh vien 103, Hpc vien quan y Chju trach nhiem chfnh: Nguyen Dinh Hung Email: [email protected] Ngay nhan bai: 14.2.2017 Ngay phan bien khoa hpc: 6.3.2017 Ngay duyet bai: 22.3.2017

Nguyen Dinh Hung*, Nguyen Cong T6**

Vu Van Hoe, Nguyen Van Himg

mo p= 0,012, dong tir con phan xa vdi anh sang 2 ben v6ip=0,007, mu'c do di lech qua dUdng giiTa <10 mm vdiOR = 3,64 (CI95%: 1,18 - 11,23) va khong co hinh anh xoa be day vdi OR = 6,85 (095%: 1,77 - 26,31). Ket luan: Ti le benh nhan tir vong vadi chirng nang chiem khoang mot nii^ so benh nhan.

Mpt so dac diem lam sang va hinh anh CLVT so nao tri/clc mo CO y nghTa tien Iu'dng ket qua phau thuat giai ep d benh nhan chan thu'dng so nao nang nhu': diem Glasgow, phan xa anh sang cua_ dong tir, mu'c do di lech du'dng giij'a,|iinh anh xoa be day.

Tu'khoa: Phau thuat giai ep nao, chan thu'dng so nao nang, yeu td tien Iu'dng