_for voice disorder 针灸治疗声带病变课件

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. 此研究計畫經費由香港大學研究基金資助 Voice Research Laboratory 聲線研究所 Division of Speech & Hearing Sciences 言語及聽覺科學部 Faculty of Education 教育學院 1 2. Department of Otolaryngology, Nanjing Medical University 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 2 1. Voice Research 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 PhD 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 黃偉醫生 鄺伊蘭小姐 俞明醫生 馬佩文博士 3 Background 背景 nAbout 6% of population have voice problems 人口中有大概百分之六（6%）有聲線毛病 nMost are caused by vocal misuses and abuses with pathological changes in the vocal folds (e.g. vocal nodules, 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) nTeachers, housewives are particularly prone to voice problems 教師和家庭主婦是最容易患聲線毛病 4 Background 背景 nSurgical treatment for these functional voice problems is usually not successful because of recurrence 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 nThese functional voice problems can usually be treated by conservative voice exercise 聲線訓練是現時主要治療方法 5 Background 背景 n20% of patients with voice problems show no improvement after voice exercise and surgery (Woo et al, 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 nAlso, voice therapy takes some time to achieve results 加上聲線訓練要一段時間才見療效 nTherefore, many explore for alternative treatment, such as Traditional Chinese Medicine 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 6 Objectives 研究目的 nThis study investigates the effectiveness of an intensive acupuncture for voice problem 本項研究目的是探討針灸對治療聲帶病變 的療效 7 Outcome measures 成效指標 nMeasurements for determining success 用來決定療效的指標 nAcoustic analysis-voice range profile 音域量度 nPerceptual analysis-voice quality ratings 聲線質量 nPatients perception-Activity limitation & participation restriction by Voice Activity & Participation Profile (VAPP, Ma & Yiu, 2001) 患者自我評估 8 Voice range measure 音域測量 9 Methods 研究方法 nCarried out at the Nanjing First Affiliated Hospital, Nanjing 研究地點 ：南京第一附屬醫院 nStudy design 研究設計 : nRandomized 隨機 nTreatment-placebo group治療-安慰對照 nDouble-blind 雙盲 10 Participants 參與研究者 n54 Chinese female (aged 19 to 55) subjects with voice problems 54個中國女性（19-55歲） nRandomly assigned to 2 groups隨機分配 到 : nTreatment group 治療組 nPlacebo group 安慰組 11 Participants 參與研究者 nSelection criteria 參與資格: nNo history of asthma and upper respiratory tract infection 沒有哮喘或呼吸系統問題 nNo neurological disorder 沒有腦神經問題 nNo hearing problem 沒有聽覺問題 nNo experience of formal voicing or singing training 沒有唱歌或發聲練習經驗 12 Participants 參與研究者 n24 patients completed the program with full set of data for analysis 二十四個病患者完成整個療程和有完整資 料 13 Procedures 過程 Day 1 (before session1) 第一天 Day 1-19 一至十九天 Day 19 (After session 10) 第十九天 Day 33 (2 weeks after session 10) 第三十三天 （治療後兩星期） 療程 Pre-Pre- treatment treatment assessmentassessment 治療前測治療前測 試試 TreatmentTreatment Post-Post- treatment treatment assessmentassessment 治療後測 試 Follow-up Follow-up assessmentassessment 治療後第二次 測試 14 Procedures 過程 Treatment Treatment 治療程序治療程序 10 acupuncture sessions 10 acupuncture sessions 十次療程十次療程 Once every 2 days Once every 2 days 每兩天一次每兩天一次 15 Treatment Group 治療組 Neck頸 Renying (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) 16 Treatment group received acupuncture on: Renying (人迎) (St 9) Lieque (列缺) (Lu 7) Zhaohai (照海) (Ki 6) 17 18 Electrical stimulation was applied to Renying (人迎) (St 9)人迎穴位加電流刺激 19 Lieque (列缺) (Lu 7)Zhaohai (照海) (Ki 6) 20 Placebo group 安慰組 nWrist- Houxi (Small intestine channel 3) 後溪（手腕） nAnkle- Kunlun (Bladder channel 60) 昆侖（腳） 21 Results 結果 22 The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後音域 擴闊 23 The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後能發 更高音調 24 The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後患者 覺得聲線質素有改善( 嚴重程度減少) 25 The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後情緒 好轉(嚴重程度減少) 26 The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後限制 減少 27 Improvement 進步 Deterioration 退步 28 Conclusion 結論 nIntensive 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，對聲帶病變 患者有療效 nVocal functioning 發聲功能 nActivity limitation 減少日常生活困難 nPerceptual voice quality 音質改善 29 Conclusion 結論 nAcupuncture is less invasive than surgical management 相對於手術，針灸是比較溫和 nAcupuncture takes relatively a shorter time (20 days) than voice exercise (usually 2 months) to achieve results 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 30 Conclusion 結論 nAcupuncture is a symptomatic treatment option 針灸對聲線病變能治標，但仍未能確定是 否治本。 nIt needs to be supplement with voice exercise 要配合聲線練習才是唯一的治本方法 31 Key references 主要文獻 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