O tema deste estudo e a Sindrome de tensao musculoesqueletica, musculatura laringea extrinseca e postura corporal. Tem como objetivo descrever, a partir de revisao de literatura,as caracteristicas da musculatura extrinseca da laringe; postura corporal; Sindrome de tensao musculoesqueletica e suas implicacoes vocais; avaliacao e tratamento fisioterapeutico e fonoaudiologico. Foi realizado levantamento bibliografico dos ultimos 13 anos em que foram incluidos artigos cujo objetivo e/ou corpo do texto estivessem em consonância com os objetivos do estudo. A pesquisa foi realizada nos bancos de dados das bases Literatura Latino-Americana e do Caribe em Ciencias da Saude, Biblioteca Regional de Medicina, PublicMedline, Medical Literature Analysis and Retrieval System on Line, Scientific Electronic Library Online e Google Schoolar. Estabeleceram-se relacoes importantes do âmbito fisioterapeutico e fonoaudiologico, dentre as quais se destacam as relacoes musculares, posturais e funcionais na sinergia do aparato vocal. Na fisioterapia para reducao da tensao muscular, a literatura aponta uso de eletroterapia transcutânea, laser de baixa intensidade, laser acupuntura, crioterapia, bem como terapia manual com tracao, massagens, manipulacoes e mobilizacoes cervicais, associadas ou nao a exercicios, alongamentos, relaxamento isometrico, mobilizacao assistida dos tecidos moles, exercicios terapeuticos visando a correcao e equilibrio muscular, reeducacao respiratoria diafragmatica e terapia com flexao craniocervical. Na fonoaudiologia, foram encontrados apenas estudos com a manipulacao digital da laringe e exercicios de trato vocal semiocluido.

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Síndrome de tensão musculoesquelética, musculatura laríngea extrínseca e postura corporal: considerações teóricas

Immediate effects of humming on computed electroglottographic parameters in patients with muscle tension dysphonia.

Investigation of the Immediate Effects of Humming on Vocal Fold Vibration Irregularity Using Electroglottography and High-speed Laryngoscopy in Patients With Organic Voice Disorders

Aims: To verify whether humming corrects supraglottic compression in muscle tension dysphonia (MTD) patients. Methods: We enrolled 23 MTD participants (13 male, 10 female) showing supraglottic compression. Each individual was instructed to perform 3 types of phonation under transnasal laryngofiberscopy: natural phonation, humming phonation without pitch change and subsequent um-hum phonation, i.e. humming with pitch glide up as if agreeing with someone. The degree of supraglottic compression was estimated with 2 parameters. The false vocal fold and anterior-posterior indices (the FVF and AP indices) were calculated by normalizing the lateral width and AP length of the visible vocal cords at phonation normalized to the mean vocal cord length at inspiration, respectively. These indices were compared among the tasks. Results: All the MTD participants but 5 females accomplished decreases in the vocal roughness scores upon the phonatory tasks. The whole MTD group showed significant increases in the FVF and AP indices even after humming without pitch change with a dominance of the AP index. The humming-responsive MTD subgroup showed greater increases in both indices than the humming-resistant subgroup. Conclusion: These data demonstrate that humming corrects both the lateral and AP components of supraglottic compression in most MTD patients.

Immediate Effectiveness of Humming on the Supraglottic Compression in Subjects with Muscle Tension Dysphonia

The theme of this study is the musculoskeletal stress syndrome, extrinsic laryngeal muscles and body posture. The purpose is to describe, from the literature review, the characteristics of the extrinsic muscles of the larynx; posture; vocal implications of musculoskeletal stress syndrome; evaluation and physical therapy and voice therapy. We performed a literature review of the last 13 years which included articles aimed and/or body textwere in line with the objectives of this study. The research was conducted in the databases of Literatura Latino-Americana e do Caribe em Ciencias da Saude, Biblioteca Regional de Medicina, Public Medline, Medical Literature Analysis and Retrieval System on Line, Scientific Electronic Library Online and Google Schoolar. Were established important relationships within the physical therapy and voice therapy, among which stand out the relationships muscular, postural and functional synergy in the vocal apparatus. In physical therapy to reduce muscle tension, the literature indicates use of transcutaneous electrical stimulation, low level laser, laser acupuncture, cryotherapy, manual therapy and traction, massage, cervical manipulations and mobilizations, associated or not to exercise, stretching, isometric relaxation , assisted soft tissue mobilization, therapeutic exercises aimed at correcting balance and muscle, diaphragm and respiratory rehabilitation therapy craniocervical flexion. In speech therapy, studies found only through digital manipulation of the larynx and semi-ocluded vocal tract exercises.

MUSCULOSKELETAL STRESS SYNDROME, EXTRINSIC LARYNGEAL MUSCLES AND BODY POSTURE: THEORETICAL CONSIDERATIONS Síndrome de tensão musculoesquelética, musculatura laríngea extrínseca e postura corporal: considerações teóricas

Muscle tension dysphonia (以下MTD) は, 喉頭筋の緊張の調節不良によって喉頭の姿勢や声門の形状に変化が生じて嗄声を来す音声障害である. 本報告においては, 声門上部の圧迫所見を認めるMTDにおける, 音声治療の経過にわたる喉頭所見と音声所見との変化と両者間の相関性について検討を行った. それぞれの評価については, 喉頭腔の絞扼の程度をスコア化した「MTDスコア」とGRBASスコアを用いた. その結果, ほとんどの症例において, 音声治療の経過とともに, MTDスコアとG/R/B/Sスコアとの両者がともに経時的に減少した. 声門上部圧迫の2つの要素である仮声帯部の圧迫と披裂喉頭蓋部の圧迫に関しては, 前者の方が, 後者と比較して改善しやすい傾向があった. さらに, MTDスコアとG/R/B/Sスコアとの相関性について検討したところ, 初診時における両者のスコア間には相関性があまり認められなかった. その一方で, 音声治療前後のG/R/Sスコアの変化量とMTDスコアの変化量との間には有意な相関性が認められた (p<0.05). 以上のことから, 声門上部圧迫所見が音質の悪化において重要な因子となっていること, さらに, MTDスコアが音声治療効果の良い指標となることが示唆された.

Association between Laryngeal Findings and Vocal Qualities in Muscle Tension Dysphonia with Supraglottic Contraction

muscle tension dysphonia (以下MTD) は, 発声時に, 喉頭の筋肉の過剰な緊張が原因で喉頭内腔が押し潰されることによる発声の異常のことを意味しており, 喉頭の内視鏡検査では, 仮声帯の過内転, 披裂部の喉頭蓋基部への前後方向への圧迫の所見を示す.また, 音声訓練による治療が奏功しやすいといわれている.しかしながら, 音声訓練が実際に喉頭所見を改善するか否かということについては不明であった.われわれは, 経鼻ファイバースコープ検査より, 持続母音発声時の喉頭内3部位の圧迫の程度から算定する「MTDスコア」を開発し, MTD症例に対する音声訓練の治療効果を明らかにするために, 治療経過を通じてのMTDスコアの変化について検討した.対象症例は, 男性25例, 女性6例であり, 年齢分布では60代後半にピークを認めた.問診による発症に先行するエピソードの解答は多様であった.音声訓練による治療の経過において, 全31例中24例で, 音声訓練の回数を経るにつれて, 経時的に過緊張発声障害スコアの減少が認められた.そのなかの21例においては, スコア0となり, 同時に嗄声の消失が認められた.3例においては, 数度の増悪の後, 最終的にスコア0となった.残りの4例は不変または増悪した.結果として, MTDに対して, 音声訓練による治療が有効であることが強く示唆された.

https://www.jstage.jst.go.jp/article/jjlp1960/44/4/44_4_292/_pdf

Evaluation of Therapeutic Effect of Voice Therapy on Muscle Tension Dysphonia Using Scoring of Endoscopic Laryngeal Findings during Phonation of Sustained Vowels

学校教師における嗄声の現状について調査するため, 3年間に公立学校共済組合直営の病院の人間ドックを利用した公立学校教師利用者11413名について検討を行った.アンケート調査により, 全公立学校教師利用者の924人 (8.5%) が「声がかすれる」という訴えを有することが判明した.さらにそのなかで, 実際に耳鼻咽喉科を受診し, その結果音声障害と診断されたのは180人であった.その音声障害疾患の内訳は, 多い順で, 声帯結節が85人 (46%) , muscle tension dysphonia (以下MTD) は34人 (20%) , 慢性声帯炎21人 (11%) , 声帯ポリープ8人 (4.4%) であり, 前2疾患について検討したところ, 声帯結節群のほとんどが女性で, 一方MTDの群においては男性が優位であり, 明確な性差が認められた.両疾患の年齢分布とも母集団とほぼ同様に50歳代をピークとしていた.喫煙との関連についての検討の結果, 男性の声帯結節の群のみでそのほとんどが喫煙者で構成されており, 喫煙と男性教師における声帯結節の形成の問に関連があることが示唆された.以上の結果は, 今後の学校教師に対する音声疾患の治療のみでなくその予防のために意義のある情報と考えられる.

https://www.jstage.jst.go.jp/article/jjlp1960/45/1/45_1_1/_pdf

Investigation of Voice Disorders in Public School Teachers Hospitalized for Complete Physical Examination

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Papers

Association between Laryngeal Findings and Vocal Qualities in Muscle Tension Dysphonia with Supraglottic Contraction

Evaluation of Therapeutic Effect of Voice Therapy on Muscle Tension Dysphonia Using Scoring of Endoscopic Laryngeal Findings during Phonation of Sustained Vowels

Investigation of Voice Disorders in Public School Teachers Hospitalized for Complete Physical Examination