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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,2,2. Department of Otolaryngology, Nanjing Medica
2、l 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,3,1. Vo
3、ice 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 PhDJie Jie Xu2 MD Tom Murr
4、y3 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,4,Background 背景,About 6% of population have voice problems 人口中有大概百分之六（6%）有聲線毛病Most are caused by vocal misuses and abuses with pathological changes in the vocal folds (
5、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) Teachers, housewives are particularly prone to voice problems 教師和家庭主婦是最容易患聲線毛病,5,Background 背景,Surgical 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These functional v
6、oice problems can usually be treated by conservative voice exercise 聲線訓練是現時主要治療方法,6,Background 背景,20% of patients with voice problems show no improvement after voice exercise and surgery (Woo et al, 1994) 但外科手術或聲線訓練對百分之二十（20%）的患者沒有療效Also, voice therapy takes some time to achieve results 加上聲線訓練要一段時間才
7、見療效 Therefore, 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,7,Objectives 研究目的,This 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,8,Outcome measures 成效指標,Measurements for determinin
8、g success 用來決定療效的指標Acoustic analysis-voice range profile 音域量度Perceptual analysis-voice quality ratings 聲線質量Patients perception-Activity limitation & participation restriction by Voice Activity & Participation Profile (VAPP, Ma & Yiu, 2001) 患者自我評估,9,Voice range measure 音域測量,10,Methods 研究方法,Carried ou
9、t at the Nanjing First Affiliated Hospital, Nanjing 研究地點 ：南京第一附屬醫院Study design 研究設計 : Randomized 隨機 Treatment-placebo group治療-安慰對照 Double-blind 雙盲,11,Participants 參與研究者,54 Chinese female (aged 19 to 55) subjects with voice problems 54個中國女性（19-55歲） Randomly assigned to 2 groups隨機分配到 : Treatment group
10、 治療組 Placebo 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 沒有哮喘或呼吸系統問題 No neurological disorder 沒有腦神經問題 No hearing problem 沒有聽覺問題 No experience of formal voicing or singing training 沒有唱歌或發聲練習經驗,13,Participants 參與研究者,24 patients co
11、mpleted 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,14,Procedures 過程,Pre-treatment assessment治療前測試,Treatment,Post-treatment assessment 治療後測試,Follow-up assessment 治療後第二次測試,15,Procedures 過程,Treatment 治療程序10 acupuncture sessions 十次療程Once every 2 days 每兩天一次,16,Treatment Group 治療組,
12、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),17,Treatment group received acupuncture on:,Renying (人迎) (St 9),Lieque (列缺) (Lu 7),Zhaohai (照海) (Ki 6),18,19,Electrical stimulatio
13、n was applied to 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 結果,23,The Treatment Group showed statistical significant improvement after treatment 治療组-經治
14、療後音域擴闊,24,The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後能發更高音調,25,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),26,The Treatment Group showed statistical significant improvement after treatment 治療组-
15、經治療後情緒好轉(嚴重程度減少),27,The Treatment Group showed statistical significant improvement after treatment 治療组-經治療後限制減少,28,Improvement 進步,Deterioration 退步,29,Conclusion 結論,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，對聲帶病變患者有療效 Vo
16、cal functioning 發聲功能 Activity limitation 減少日常生活困難 Perceptual voice quality 音質改善,30,Conclusion 結論,Acupuncture is less invasive than surgical management 相對於手術，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,31,Conclusion 結論,Acupuncture 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。It needs to be supplement with voice exercise 要配合聲線練習才是唯一的治本方法,32,Key references 主要文獻,
