教师患嗓音疾病的危险因素与就诊态度的调查分析

目的 调查分析成都市教师患嗓音疾病的危险因素，了解教师患嗓音疾病后的就诊态度，为该地区教师嗓音疾病的防治提供理论依据。方法 共纳入360例教师患者，分为嗓音疾病组（177例）和无嗓音疾病组（183例），两组均完成调查表填写。结果 本组教师的嗓音疾病患病占比为49.2%，慢性喉炎（44.1%）和声带息肉（32.8%）是最常见的嗓音疾病，声嘶（81.9%）是最常见的嗓音症状。性别、学校类别、班级规模和语速是导致教师患嗓音疾病的危险因素（P<0.05）。61.6%教师患嗓音疾病后未寻求治疗。结论 教师易患嗓音疾病，性别、学校类别、班级规模、语速快是患嗓音疾病的危险因素。大多数教师患病后就诊态度不积极。因此，制定教师嗓音疾病防治方案十分必要。     

Vocal fold mucus aggregation in persons with voice disorders

Mucus aggregation on the vocal folds is a common finding from laryngeal endoscopy. Patients with voice disorders report the presence of mucus aggregation. Patients also report that mucus aggregation causes them to clear their throat, a behavior believed to be harmful to vocal fold mucosa. Even though clinicians and patients report and discuss mucus aggregation, we have a limited understanding of mucus aggregation in persons with voice disorders. The primary goal of this study was to provide an initial assessment of the presence and features of mucus aggregation in persons with voice disorders. The secondary goal of this study was to determine if there are differences in mucus aggregation between persons with and without voice disorders. To address these goals, four features of mucus aggregation were judged from laryngeal endoscopy recordings from 54 speakers with voice disorders and compared to judgments of these same features in persons without voice disorders. The results from this study showed: (1) 100% of dysphonic speakers had visible mucus aggregation on their vocal folds. (2) Persons with hyperfunctional voice disorders had different mucus characteristics than persons with hypofunctional voice disorders (p=0.002). (3) Dysphonic speakers did not differ in frequency of mucus identified on the vocal folds than non-dysphonic speakers. However, the two groups had different mucus characteristics (p=0.001). Future studies are warranted to determine if these differences in mucus aggregation between persons with and without voice disorders relate to specific aspects of laryngeal pathology or patient characteristics, such as age and gender. Once we understand these relationships, we may be able to use this information to improve our diagnosis and treatment of patients with atypical laryngeal mucus aggregation. LEARNING OUTCOMES: Readers will be able to: (1) describe why mucus aggregation may be an important feature to understand in persons with voice disorders, (2) describe the features of mucus aggregation that can be visually rated, and (3) explain the similarities and differences in mucus aggregation for persons with and without voice disorders.     

Diagnosis of non-organic dysphonia in adult

Non organic dysphonia or functional voice disorders are the consequence of a vocal misuse or overuse with inefficient oral communication. Any stage of voice production can be altered. A review of physiopathological, aerodynamic and biomechanical mechanisms will help to understand the onset of dysphonia. Organic lesions as a consequence of functional voice disorders are frequent but the link is not easy to establish. It is important to look for various physiologic, anatomic, environmental, behavioural and infectious factors that could induce or aggravate non organic dysphonia, as they can benefit from specific treatment. A thorough functional and organic assessment is the first step of the rehabilitation process, taking into account the patient's expectations about his voice handicap.     

Diversity in voice characteristics--interaction between genes and environment,use of microarray analysis

Genetic information is used by the cells to make proteins. These proteins are then used to perform cellular and tissue functions. This process is briefly reviewed. Research to identify genes and their expression patterns is a fruitful field in the area of voice disorders. Gene expression studies of vocal lesions illustrates why this type of research is important. The role of microarray analysis (MA) to find genes of interest is discussed. Gene expression may be influenced by various environmental factors. This interaction between environment and genes is constantly manifested in many vocal characteristics and disorders. Since the end result of the gene-environment interaction is the production of cellular and tissue proteins, the field of proteomics is relevant to voice disorders. Some voice disorders have been treated successfully through using proteomic approaches. LEARNING OUTCOMES: (a) Understand the factors that influence genetic expression; (b) display a knowledge of why the study of proteins is important to understand voice characteristics; (c) become familiar with MA, a powerful tool for the study of gene expression; and (d) describe the interaction between genes and environment.     

Valedictory--why pediatric otorhinolaryngology is important

The importance of the care given by the pediatric otolaryngologist to the individual child encompasses the traditional purposes of medicine. This field has its special focus on interventions that preserve, restore and/or otherwise improve hearing, speech, voice, gustation, olfaction, deglutition, respiration, appearances, etc. The value-added dimension of pediatric otolaryngology is of essential importance because it enhances communication-language--through the vehicles of hearing, voice, and speech. This critical role is manifest in two ways. The first relates to the economic bases of society. Comparison of the consequences of communications disorders in three different countries ranging, currently, from one very highly dependent upon communication skills (The Netherlands), to one highly dependent upon communication skills (the United States), to a developing nation less dependent upon communication skills (the Philippines) is presented. All three nations are adversely affected economically and socially by communication disorders. It is estimated that the United States loses between 2.5 and 3% of its gross domestic product from the economic sequel of communication disorders. It also appears that communication disorders contribute to crime, since the prevalence of communication disorders is many times greater in populations of juvenile delinquents than in the general population. Communication disorders may act synergistically with diminished economic and social resources and other factors in the causes of violent behavior and crime.     

An update in thinking about nonorganic voice disorders

OBJECTIVE: To describe and evaluate psychosocial factors in nonorganic voice disorders (NVDs). Nonorganic voice disorders are presumed to be the result of increased muscular tension that is caused to varying extents by vocal misuse and emotional stress. It is therefore necessary to include both of these in the diagnosis and treatment of patients with voice disorders. DESIGN: Clinical survey. SETTING: Academic tertiary referral center. PATIENTS: To evaluate psychosocial factors in NVDs, a sample of 74 patients with NVDs was examined psychologically using the Giessen Test and Picture Frustration Test. The results were compared with a control group of 19 patients with an organic dysphonia (vocal cord paralysis). MAIN OUTCOME MEASURES: Six scales of the Giessen Test (social response, dominance, control, underlying mood, permeability, and social potency), 3 reaction types of the Picture Frustration Test (obstacle dominance, ego defense, and need persistence), and 3 aggression categories of the Picture Frustration Test (extrapunitivity, intropunitivity, and impunitivity). RESULTS: The most striking significant difference between the 2 groups was that in conflict situations, patients with NVDs sought a quick solution or expected other people to provide one, which prevented them from understanding the underlying causes of the conflict. CONCLUSIONS: Only if the psychosocial aspects are taken into account can patients with NVD be offered a therapy that treats the causes of the voice disorder. It must be decided individually whether and when a voice training approach or a more psychological-psychotherapeutical approach is preferable.     

Voice disorders in the general population: prevalence, risk factors, and occupational impact

OBJECTIVES: Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare. The purpose of this investigation was to 1) determine the prevalence of voice disorders, 2) identify variables associated with increased risk of voice disorders, and 3) establish the functional impact of voice disorders on the general population. STUDY DESIGN: Cross-sectional telephone survey. METHODS: A random sample (n = 1,326) of adults in Iowa and Utah was interviewed using a questionnaire that addressed three areas related to voice disorders: prevalence, potential risk factors, and occupational consequences/effects. RESULTS: The lifetime prevalence of a voice disorder was 29.9%, with 6.6% of participants reporting a current voice disorder. Stepwise logistic regression identified specific factors that uniquely contributed to increased odds of reporting a chronic voice disorder including sex (women), age (40-59 years), voice use patterns and demands, esophageal reflux, chemical exposures, and frequent cold/sinus infections. However, tobacco or alcohol use did not independently increase the odds of reporting of a chronic voice disorder. Voice disorders adversely impacted job performance and attendance, with 4.3% of participants indicating that their voice had limited or rendered them unable to do certain tasks in their current job. Furthermore, 7.2% of employed respondents reported that they were absent from work 1 or more days in the past year because of their voice, and 2% reported more than 4 days of voice-related absence. CONCLUSIONS: The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders, factors that contribute to voice disorder vulnerability, and the functional impact of voice problems on the general population.     

Outcome measurements and quality of life in voice disorders

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patient's perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patient's perceived severity and need to recover vocal function may determine treatment.     

The local and sensual conditions of delay of voice breaking in adolescent boys

Disorders of voice breaking in adolescent boys (mutational dysphonia) could be a result of local, hormonal, neuropsychiatric or sensual factors. The aim of this paper was the voice assessment of three subjects with incomplete mutation with particular additional factors, disturbing hearing, voice and speech: like hearing loss, hyperfunctional childhood dysphonia and speech dysfluency. Diagnostics included complete phoniatric examination with perceptive estimation, videostroboscopy and acoustic voice analysis, done before and after treatment. Rehabilitation process results were well seen in perceptive and objective voice analysis except significant improvement of fundamental frequency average. Analysis of incomplete mutation etiological factors need special attention due to coexist with another voice, speech and hearing disorders, which undergo with high tension of voice organ muscles or with the lack of phonation auditory feedback.     

Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges

Spasmodic dysphonia is a rare voice disorder that is most successfully treated by injection of botulinum toxin (i.e., BOTOX) into the affected laryngeal muscles. BOTOX is currently available for use by professionals outside of metropolitan voice centers who may be unfamiliar with this rare disorder. Patients may seek assessment and treatment locally from clinicians who are unfamiliar with the speech symptoms for adductor-type (ADSD) or abductor-type (ABSD) spasmodic dysphonia. Although these disorders have been described in the literature, the symptoms have not been well defined and may appear similar to those of vocal tremor or muscle tension dysphonia (MTD). Thus, patients with spasmodic dysphonia might not be easily identified by local clinicians for treatment. The purpose of the current study was to determine whether voice clinicians with infrequent exposure to patients with spasmodic dysphonia could learn to identify speech symptoms for ADSD and ABSD comparable to voice clinicians with extensive experience with these disorders. The ratings of five nonexpert judges were compared to the ratings obtained from three expert judges. The results of this study demonstrated that nonexpert judges could be trained to identify the speech symptoms associated with ADSD, ABSD, and vocal tremor. While the nonexpert judges tended towards false positive judgements for the speech symptoms of interest, the overall speech symptom profiles for each type of voice disorder appeared comparable to those obtained from the expert judges. The symptom identificationscales used, therefore, have potential for use by clinicians unfamiliar with these disorders for correctly identifying persons with symptoms of ADSD and ABSD. Educational objectives: Readers will be able to (1) define the predominant speech symptoms reflective of the voice disorder categories of ABSD, ADSD, and vocal tremor; and (2) describe the methods utilized in a new perceptual training protocol for teaching clinicians how to identify predominant speech symptoms associated with the voice disorder categories of ABSD, ADSD, and vocal tremor.     

Epidemiology of voice disorders in the elderly: preliminary findings

OBJECTIVES: Epidemiologic studies of the prevalence and risk factors of voice disorders in the elderly, nontreatment seeking population are nonexistent. The purpose of this preliminary investigation was to 1) estimate the prevalence of voice disorders, 2) identify variables associated with increased risk of voice disorders, and 3) measure the socioemotional impact of voice disorders on the elderly who live independently. STUDY DESIGN: Prospective, cross-sectional survey. METHODS: One hundred seventeen seniors (39 males and 78 females; mean age, 76.1 yr; SD, 8.5 yr; range, 65-94 yr), residing in Utah and Kentucky, were interviewed using a questionnaire that addressed three areas related to voice disorders: prevalence, potential risk factors, and socioemotional consequences/effects. RESULTS: The lifetime prevalence of a voice disorder was 47%, with 29.1% of participants reporting a current voice disorder. The majority of respondents (60%) reported chronic voice problems persisting for at least 4 weeks. Seniors who had experienced esophageal reflux, severe neck/back injury, and chronic pain were at increased risk. Voice-related effort and discomfort, combined with increased anxiety and frustration and the need to repeat oneself, were specific areas that adversely affected quality of life. CONCLUSIONS: This preliminary epidemiologic study confirmed that voice disorders are common among the elderly, and further research is needed to identify additional risk factors contributing to voice disorder vulnerability.     

嗓音医学的范畴和疾病分类

随着生活水平的提高,大众对于嗓音的要求也随之提升,进而为嗓音医学的相关从业人员提出了更高的要求.但是目前在嗓音医学的范畴以及嗓音疾病、嗓音障碍分类等问题方面,仍存在一定程度的混乱,也为临床工作带来了困难.针对目前这种情况,对嗓音医学的范畴进行了界定,并在以往嗓音障碍分类基础上,根据对嗓音疾病的理解,提出了嗓音疾病的分类...     

Voice disorders in childhood

Voice disorders in the pediatric population are relatively common. The education of families, teachers and clinical staff on etiology and treatment of pediatric voice disorders have led to greater attention being paid to hoarseness in childhood and improving early detection of pediatric voice disorders. Pediatric voice problems can have a number of causes. Most commonly, childhood dysphonia is caused by vocal fold nodules due vocal ab- and misuse. Other reasons might be congenital laryngeal dysplasia, vocal fold cysts and laryngeal papilloma. Medical examination is necessary in order to initiate appropriate treatment. In the case of vocal fold cysts and laryngeal papilloma, phonosurgery is indicated. Vocal fold nodules should be treated by voice therapy in order to change vocal behaviour. If voice therapy fails, phonosurgical intervention is recommended, since vocal fold nodules can persist into adulthood with a negative impact on voice quality.     

Quick screen for voice and supplementary documents for identifying pediatric voice disorders

Three documents are provided to help the speech-language pathologist (SLP) identify children with voice disorders and educate family members. The first is a quickly administered screening test that covers multiple aspects of voice, respiration, and resonance. It was tested on 3000 children in kindergarten and first and fifth grades, and on 47 preschoolers. The second document is a checklist of functional indicators of voice disorders that could be given to parents, teachers, or other caregivers to increase their attention to potential causes of voice problems and to provide the SLP with information pertinent to identification. The final document is a brochure with basic information about voice disorders and the need for medical examination. It may be used to help the SLP educate parents, particularly about the need for laryngeal examination for children who have been identified as having a voice problem.     

Comprehensive management of psychogenic dysphonia: A case illustration

Psychogenic dysphonia refers to the loss of voice, in the absence of apparent structural or neurological pathology. It is a disorder seen more often in women and is usually associated with significant life events and emotional difficulties that may lead to conflict over speaking. Therapeutic interventions in voice disorders recommend the adoption of a multidisciplinary approach to treatment. The following is a case illustration of a 50-year-old married lady with dysphonia and significant marital difficulties.Learning outcomes: The case demonstrates the psychological issues in the onset and maintenance of psychogenic voice disorders. It also emphasizes the use of a multidisciplinary approach consisting of cognitive behavioural strategies, pharmacological inputs and voice therapy. The case illustration will also help the reader to focus on cultural issues relevant in the development of problems and the need to address these in psychotherapeutic interventions, as well as difficulties that are likely to be encountered in therapeutic interventions.     

Psychosomatische Aspekte bei der Behandlung der S?ngerstimme

Voice and person form a unity and consequently, psychological factors always play a role in the treatment of voice disorders, especially in the area of the arts. This fact has to be taken into account in musician's medicine and it leads to integrating psychosomatic principles within the medical consultation, such as sufficient time, open structured communication, as well as empathy in the doctor-patient relationship. Furthermore, another important aspect of the treatment of singers is the understanding, based on musical expertise, towards the emotional requirements of the profession. If there is a distinct psychological component in the voice disorder it has to be included as a cofactor in the diagnostics. In such a case, the decision of the otorhinolaryngologist should be to include the treatment of the psychological factors within the voice therapy or to initiate parallel treatment in close cooperation with a specialist in psychosomatic medicine or a clinical psychologist specialized in musician's medicine. For singers, performance anxiety represents the additional frequent diagnosis and it should also be treated in this cooperation.     

Prevalence of voice disorders in teachers and the general population.

Over 3 million teachers in the United States use their voice as a primary tool of trade and are thought to be at higher risk for occupation-related voice disorders than the general population. However, estimates regarding the prevalence of voice disorders in teachers and the general population vary considerably. To determine the extent that teachers are at greater risk for voice disorders, 2,531 randomly selected participants from Iowa and Utah (1,243 teachers and 1,288 nonteachers) were interviewed by telephone using a voice disorder questionnaire. Prevalence-the number of cases per population at risk at a specific time-was determined. The prevalence of reporting a current voice problem was significantly greater in teachers compared with nonteachers (11.0% vs. 6.2%), chi(2)(1) = 18.2, p <.001, as was the prevalence of voice disorders during their lifetime (57.7% for teachers vs. 28.8% for nonteachers), chi(2)(1) = 215.2, p <.001. Teachers were also significantly more likely than nonteachers to have consulted a physician or speech-language pathologist regarding a voice disorder (14.3% vs. 5.5%), chi(2)(1) = 55.3, p <.001. Women, compared with men, not only had a higher lifetime prevalence of voice disorders (46.3% vs. 36.9%), chi(2)(1) = 20.9, p <.001, but also had a higher prevalence of chronic voice disorders (>4 weeks in duration), compared with acute voice disorders (20.9% vs. 13.3%), chi(2)(1) = 8.7, p =.003. To assess the association between past voice disorders and possible risks, adjusted odds ratios (ORs) were estimated using multiple logistic regression. The results identified that being a teacher, being a woman, being between 40 and 59 years of age, having 16 or more years of education, and having a family history of voice disorders were each positively associated with having experienced a voice disorder in the past. These results support the notion that teaching is a high-risk occupation for voice disorders. Important information is also provided regarding additional factors that might contribute to the development of voice disorders.     

Neurolaryngology

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function.     

Stimm?rztliche Betreuung und Behandlung von S?ngern

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequent voice problems in professional singers.     

Treatment of voice disorders in children

Children with voice disorders do respond to treatment, with vocal hyperfunction being the predominant disorder on the caseload of the pediatric voice clinician. This article reviews the literature in describing what is known about these children and typical disorders, prevention of voice disorders, the need for treatment, the referral patterns of teachers and others, and typical management programs and their settings. Good online resources are offered and brief highlights about voice therapy with children are reviewed.