Nasal septal surgery: evaluation of symptomatic and general health outcomes

Although septoplasty and submucous resections are common procedures, there have been very few studies on the outcome of nasal septal surgery. This prospective study of two hundred patients undergoing septal surgery used the Fairley nasal symptom score, the Nottingham health profile, a general health questionnaire and clinical examination of nasal cavities to assess the outcome. A wide range of baseline severity scores was observed. Almost 40% of patients failed to attend for review. Analysis of the outcomes in the remaining 121 patients revealed significant improvement in (a) nasal obstruction in 74%, (b) facial pain in 72%, and (c) catarrh in 64% of patients. There was a lack of correlation between observed postoperative reduction in the number of nasal septal areas deviated and improvement in nasal obstruction. The Nottingham health profile and general health questionnaire scores remained unchanged in a large majority of patients. Postoperative improvement in nasal obstruction was independent of grade of surgeon or concomitant lateral nasal wall surgery. The principal benefits of septal surgery relate to improvement in nasal symptoms. The generic quality‐of‐life measures such as the Nottingham health profile and general health questionnaire did not show significant improvement in quality of life. Our results support the use of disease‐specific instruments to evaluate the outcome of septal surgery.     

Crooked nose: outcome evaluations in rhinoplasty

A crooked nose is the result of deformities that might involve the bony nasal pyramid, the upper and lower lateral cartilages, and nasal septum, causing complaints of aesthetic and/or functional nature.PurposeTo evaluate how satisfied are those patients who underwent rhinoplasty to correct crooked nose, through the questionnaire Rhinoplasty Outcomes Evaluation (ROE).Material and methodA longitudinal study with retrospective analysis of preoperative satisfaction and prospective analysis of postoperative satisfaction of patients who underwent rhinoplasty. ROE questionnaire was applied twice in the same visit aiming at measuring patient satisfaction in both pre and postoperative periods. Nineteen patients who underwent rhinoplasty answered the ROE.ResultsFor all patients who underwent rhinoplasty, the average preoperative satisfaction score was of 24.6±11.3, while the average postoperative score was of 76.1±19.5 (p<0.0001). Average differences between pre and postoperative satisfaction scores in patients younger than 30 years of age were lower than those reported by ≥30-year-old patients (p=0.05).ConclusionFrom the Rhinoplasty Outcomes Evaluation questionnaire, it is possible to demonstrate the impact that rhinoplasty to correct a crooked nose determines the quality of life of patients. Approximately 90% of patients undergoing rhinoplasty believed they achieved a good or excellent postoperative result.     

A prospective single‐blind randomized‐controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy

The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single‐blind, randomized‐controlled trial. Eighty‐three patients entered the trial. After a mean follow‐up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98–36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93–2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.     

Self‐assessment of voice therapy for chronic dysphonia

Self‐assessment of voice therapy for chronic dysphonia The effects of voice therapy in a group of chronically dysphonic patients are determined using two quality‐of‐life (QOL) instruments: the Voice Handicap Index (VHI), and a simple three‐item outcome scale (three visual analogue scales). Both instruments measure changes in the quality of the voice itself and in the extent of impairment resulting from the dysphonia as experienced by the patient in social and occupational settings. Statistical tests conducted on pre‐ and post‐treatment data indicated significant improvements on both instruments for the group as a whole. At the individual level, however, the effects were diverse. For roughly 50% of the subjects, a significant improvement could be established. The positive changes as measured with the three‐item scale were greater than those measured with the VHI. The results suggest that the two QOL instruments measure slightly different aspects of the subjective perception of the therapy effects. In order to obtain a general evaluation of the patient's handicap, it may suffice to ask some simple questions.     

A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques

The proposal of this basic protocol is an attempt to reach better agreement and uniformity concerning the methodology for functional assessment of pathologic voices. The purpose is to allow relevant comparisons with the literature when presenting / publishing the results of voice treatment, e.g. a phonosurgical technique, or a new / improved instrument or procedure for investigating the pathological voice. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. A multidimensional set of minimal basic measurements suitable for all “common” dysphonias is proposed. It includes five different approaches: perception (grade, roughness, breathiness), videostroboscopy (closure, regularity, mucosal wave and symmetry), acoustics (jitter, shimmer, Fo-range and softest intensity), aerodynamics (phonation quotient), and subjective rating by the patient. The protocol is elaborated on the basis of an exhaustive review of the literature, of the experience of the Committee members, and of plenary discussions within the European Laryngological Society. Instrumentation is kept to a minimum, but it is considered essential for professionals performing phonosurgery. Received: 18 May 2000 / Accepted: 17 October 2000     

Hearing aids reduce overestimation in pre-fitting self-assessment

Objective

When asking about hearing disability, the self-reported answers are not always equivalent to those of their family and neighbors. It is often experienced that family and neighbors indicate more severe hearing disability. Hearing difficulty itself may prevent hearing impaired subjects from understanding the degree of their own hearing disability. If their hearing impairment interferes with self-assessment of unaided hearing ability, it may change after a non-hearing aid user begins using hearing aids.

Methods

Thirty-four adults who had almost no experience with using hearing aids participated in this study. Unaided hearing disability was assessed with visual analog scale (VAS) and ten 5-point category scales. The assessment was performed not only by the subject (pre-fitting self-assessment) but also by his/her family members, presumed to be understanding persons regarding the degree of his/her hearing disability (family-assessment). For evaluating the effect of amplification on self-assessment, re-assessment was performed more than three months later (post-fitting self-assessment). The overestimation in the pre-fitting self-assessment and the effect of amplification were investigated in comparison to the family- and post-fitting self-assessments.

Results

The pre-fitting self-, family- and post-fitting self-VAS values for total hearing abilities were 50.5 ± 15.6, 45.1 ± 14.7 and 34.3 ± 18.8, respectively. The pre-fitting self-VAS value was significantly higher than the family- and post-fitting self-VAS values (p < 0.05 and p < 0.01, respectively). For the 5-point category scale, the pre-fitting self-assessment was better than the family- and post-fitting self-assessments. Significant differences were observed in 1 and 2 situations, as compared with the family- and post-fitting self-assessments, respectively. These findings suggest the involvement of overestimation in pre-fitting self-assessment and its reduction after amplification with hearing aids. Although the pre-fitting self- and the family-VAS values were independent of the results of audiometric tests, the post-fitting self-VAS value was significantly related to the pure tone threshold and maximum speech recognition score (p < 0.05). Regarding the changes in self-VAS values after amplification, the higher the pre-fitting self-VAS value, the larger the decrease in the self-VAS value. Thus, amplification with hearing aids may reduce overestimation and change self-assessment to reflect the audiometric assessments.

Conclusion

The pre-fitting self-assessment of hearing disability involves over estimation which is exacerbated by hearing difficulty. A high pre-fitting VAS value may reflect a large overestimation in hearing ability. This overestimation can be improved by the amplification with hearing aids.     

896例成人嗓音声学参数的计算机采集分析

目的　通过研究获得有关嗓音医学的数据标准及各种嗓音疾病的特征性客观指标 ,建立嗓音临床检测系统 ,为临床诊断与治疗提供有效的参考标准和方法。方法　应用Dr.Speech(DSS)软件的先进技术 ,按卫生部(司 ) :“语音、语言测试和矫治行业标准”的研究要求 ,采集、分析上海地区成人 5 0 0例正常嗓音以及 396例临床常见嗓音疾病的病理性嗓音的声学样本。结果　正常人的各嗓音声学参数 :基频微扰、振幅微扰、声门噪声、频率颤动、共振峰等值均在DSS软件提供的正常范围内 ,而病理性嗓音声学参数超出该范围 ,并具有各不同的特点。结论　我国成人嗓音声学参数与欧美的相似 ,应用Dr.Speech软件可对各种嗓音疾病进行临床客观检测和评估     

电声门图参数与声嘶的心理听觉评价的相关关系研究

目的 研究电声门图参数与声嘶程度心理听觉评价之间的关系。方法 对134例受试者进行电声门图(EGG)检查,按心理听觉评估结果,根据GRBAS分级,将36例正常人及98例病理嗓音患者分成四组,对各组的电声门图参数及其与声嘶程度的关系进行统计学处理。结果 各组EGG参数均有显著性差异,标准化噪声能量(NNE)与接触率(CQ)是判别声嘶程度最有意义的两个参数,5个参数(jittter,shimmer,NNE,CQ,CQP)均与声嘶程度心理听觉评价有良好的相关关系,且频率微扰与粗糙声(R),NNE、CQ与气息声(B)相关性较好。结论 电声门图作为一种反映声带振动模式的方法,它和心理听觉评价声嘶的分级和程度有显著相关性,两者皆为临床应用提供诊断依据,但前者更为客观精确。     

A tool for assessing case history and feedback skills in audiology students working with simulated patients

Objective: To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP). Design: Single observation, single group design. Study sample: Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators. Results: The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α?=?0.91–0.97; mean inter-item r?=?0.64–0.85) and fair-to-moderate agreement between evaluators (29.2–54.2% exact and 79.2–100% near agreement; κ_weighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r?=?0.35–0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r?=?0.62–0.81). Factor analysis showed the ASPIRS’ 12 items fell into two components, one containing all feedback items and one containing all case history items. Conclusion: The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.     

试论言语功能评估的标准及方法

本文旨在讨论言语功能评估标准及方法，阐述言语功能评估的一个基本理念：夯实基础，循序渐进，螺旋上升，即言语评估、测量与矫治是一个动态的过程。言语矫治以言语评估和测量为起点，在言语矫治中或训练一个阶段后，应再次进行言语评估和测量，从而监控言语矫治方案的有效性，调整言语矫治方案或提出更高的言语矫治目标。