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儿童声音嘶哑的常见病因

Authors
Craig H Zalvan, MD
Jacqueline Jones, MD
Section Editor
Glenn C Isaacson, MD, FAAP
Deputy Editor
Carrie Armsby, MD, MPH

引言

本文将总结儿童声音嘶哑的常见病因(表 1)以及其治疗概述。其他相关问题，包括喉的解剖、发声的生理学以及声音嘶哑儿童的评估将单独讨论。 (参见“Hoarseness in children: Evaluation”)

概述

“声音嘶哑”或“发音障碍”是用于描述音质变化的术语。音质可以表现为刺耳、带气息声、紧张、疲劳、粗糙、震颤或虚弱无力的。也可能出现音调改变、音域的限制、声音中断、吐音能力降低或共振异常。儿童声音嘶哑的患病率介于4%-23%[1-3]。任何影响喉部结构或功能的问题都可以引起声音嘶哑。 (参见“Hoarseness in children: Evaluation”, section on ‘Physiology’)

声音嘶哑的病因可以分为感染、炎症、创伤、梗阻或浸润，以及先天性异常(表 1)[4]。儿童声音嘶哑最常由良性或自限性原因造成，如上呼吸道病毒感染或声带滥用和误用，可通过教育、观察等待和语音疗法进行治疗。此外，声带和喉部器官的生长、习惯改变以及青春期激素环境发生变化往往会促进语音质量的改善。手术只适用于那些存在明显解剖改变的持久性病变。

黏膜病变

儿童声音嘶哑最为常见的原因是声带良性病变(如小结、息肉、出血、血肿)。

小结 — 声带小结是学龄儿童慢性声音嘶哑最常见的原因[5]。大多数这些病变发生在男孩，尤其是9岁[6]。声带小结通常位于声带振幅最大位置(声带前1/3和后2/3的交界处)的前游离缘上(图片 1)。这些小结的产生原因是声带受到反复创伤和滥用(如尖叫或大喊)，出现炎症反应伴纤维化愈合。声带小结是双侧性的，其大小从轻微隆起的角化过度病变到妨碍声带闭合的较大的广基病变不等。动态镜检查能够最佳检查并确定喉部病变的性质。有声带小结的情况下，黏膜波应保持完整。声带小结可能与声带中部纤维化病变以及伴对侧声带反应性病变的先天性病变相混淆。

                               

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Literature review current through: 2017-07 . | This topic last updated: 2017-05-02.
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