Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules

The aim of this study was to analyze the efficiency of the voice therapy in children with vocal nodules by using the acoustic analysis and subjective assessment. Thirty-nine patients with vocal fold nodules, aged between 7 and 14, were included in the study. Each subject had voice therapy led by an experienced voice therapist once a week. All diagnostic and follow-up workouts were performed before the voice therapy and after the third or the sixth month. Transoral and/or transnasal videostroboscopic examination and acoustic analysis were achieved using multi-dimensional voice program (MDVP) and subjective analysis with GRBAS scale. As for the perceptual assessment, the difference was significant for four parameters out of five. A significant improvement was found in the acoustic analysis parameters of jitter, shimmer, and noise-to-harmonic ratio. The voice therapy which was planned according to patients’ needs, age, compliance and response to therapy had positive effects on pediatric patients with vocal nodules. Acoustic analysis and GRBAS may be used successfully in the follow-up of pediatric vocal nodule treatment.     

鼻中隔穿孔患者手术前后鼻腔通气功能的变化

目的探讨鼻中隔穿孔患者手术前后鼻腔主客观通气功能的变化。方法对1 8例鼻中隔穿孔患者术前、术后分别行鼻阻力测量（Rhinomanometry,RM）、鼻呼吸量测量（Nasalspirometry,NS）,并同时利用视觉评分系统（visual analogue scale,VAS）对患者的鼻塞症状进行评分。采用SPSS 16.0统计软件,对手术前后的数据进行配对t检验,并对VAS评分和RM、鼻呼吸量比率（nasal partitioning of airflow ratio,NPR）进行相关性分析。结果术前RM、NPR和VAS评分分别为（0.365±0.124）kPa.s/L、0.28±0.14、3.46±1.02,术后分别为（0.32±0.112）kPa.s/L、0.18±0.1 2、1.7 4±0.64;手术前后的VAS评分差异有统计学意义（P〈0.01）,RM、NPR无统计学意义（P〉0.0 5）。手术前后VAS评分和RM、NPR相关系数分别为0.638、0.687,但无统计学意义上的相关性;手术前后RM、NPR之间差异有统计学意义（P〈0.01）,其相关系数为0.864。结论鼻中隔穿孔患者鼻阻力、鼻呼吸量客观通气功能和主观通气功能VAS评分具有一定的相关性,对选择手术侧别和制定手术方案具有一定的指导意义。     

Pediatric vocal nodules: correlation with perceptual voice analysis

OBJECTIVE: To present the epidemiology and correlation with perceptual analysis of vocal nodules in pediatric patients. METHODS: Retrospective review of patients seen in a tertiary care pediatric hospital's voice center from 1996 to 2003. Six hundred and forty-six patients were evaluated with videostroboscopic examinations and perceptual analysis of voice characteristics by speech pathologists. Appropriate treatment was based on the pathology identified. RESULTS: Two hundred and fifty-four patients (40%) with an average age of 7.7 years (range 0.1-19.3 years) were identified as having vocal nodules. Of these, 72% were male. Six patients (2%) were under the age of 7 months. Nodules were most commonly found in males, aged 3-10 years old. Evidence of gastro-esophageal reflux disease was found in one-quarter of patients; hyperfunction of the larynx was seen in three-fourths. Hyperfunction of the larynx correlates with the size of vocal nodules. Distortion of the vocal fold mucosal wave was not present. Perceptual analysis revealed positive correlation of the severity of hoarseness, breathiness, straining and aphonia with the size of vocal nodules. CONCLUSION: The epidemiology and correlation with perceptual voice analysis in pediatric patients with vocal nodules is presented. Hyperfunction of the larynx correlates with nodule size, while the presence of reflux disease does not. The severity of hoarseness, breathiness, straining and aphonia correlates with the size of vocal nodules.     

应用嗓音主客观参数评估不同大小 声带息肉显微手术的临床疗效

摘要：目的探讨不同大小声带息肉显微手术疗效的多参数评估方法。方法根据声带平行的息肉最大直径与同侧声带膜部的比例,将30例女性单发声带息肉患者分为两组,小息肉组（17例）和大息肉组（13例）,分别进行喉显微手术,术后所有患者均休声2周;同期选取15例正常人群为对照组,术后分别进行总嘶哑度G、嗓音障碍指数量表(voice handicap index scale, VHI)、嗓音声学参数等指标的检测。分析上述指标间的差异性和相关性,同时分析手术疗效的主客观评估的一致性。结果①术前组总嘶哑度G和VHI评分（功能、生理、情感及总体评价）均高于术后组和对照组(P＜0.05);②不同大小声带息肉术前组、术后组和对照组间基频微扰（jitter）、振幅微扰（shimmer）呈递增趋势,噪音障碍严重指数（dysphonia severity index, DSI）呈递减趋势(P＜0.05);最长发声时间（maximum phonation time, MPT）术前组较术后组和对照组下降,且大息肉术前组较小息肉术前组降低(P＜0.05);③功能、生理、总体评价之间呈正相关,情感与总体评价呈正相关;jitter与shimmer呈正相关(P＜0.05);④总嘶哑度G的主观评级和DSI的客观分级总体一致性达82.67%,正常嗓音组一致性最高,达91.43%,中度嗓音障碍一致性最低,达71.43%。结论嗓音声学主客观检测参数可作为声带息肉病情严重程度和手术疗效的重要参考依据。     

Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy

Objective

To evaluate through a multidimensional protocol voice changes after voice therapy in patients with benign vocal fold lesions.

Methods

65 consecutive patients affected by benign vocal fold lesions were enrolled. Depending on videolaryngostroboscopy the patients were divided into 3 groups: 23 patients with Reinke's oedema, 22 patients with vocal fold cysts and 20 patients with gelatinous polyp. Each subject received 10 voice therapy sessions and was evaluated, before and after voice therapy, through a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Data were compared using Wilcoxon signed-rank test. Kruskal–Wallis test was used to analyse the mean variation difference between the three groups of patients. Mann–Whitney test was used for post hoc analysis.

Results

Only in 11 cases videolaryngostroboscopy revealed an improvement of the initial pathology. However a significant improvement was observed in perceptual, acoustic and self-assessment ratings in the 3 groups of patients. In particular the parameters of G, R and A of the GIRBAS scale, and the noise to harmonic ratio, Jitter and shimmer scores improved after rehabilitation. A significant improvement of all the parameters of Voice Handicap Index after rehabilitation treatment was found. No significant difference among the three groups of patients was visible, except for self-assessment ratings.

Conclusion

Voice therapy may provide a significant improvement in perceptual, acoustic and self-assessed voice quality in patients with benign glottal lesions. Utilization of voice therapy may allow some patients to avoid surgical intervention.     

早期嗓音训练对改善甲状腺术后声带麻痹患者嗓音质量的疗效观察

目的 探讨早期发声训练对改善甲状腺术后声带麻痹患者嗓音质量的效果.方法 选取西安交通大学第一附属医院耳鼻咽喉头颈外科甲状腺术后声带麻痹的48例患者为研究对象,随机分为实验组及对照组(各24例).实验组自术后1周开始进行系统嗓音训练,对照组不进行干预.对两组术后1周、12周及24周的嗓音主客观评估及频闪喉镜评估数据进行对...     

Assessment of effectiveness of acoustic analysis of voice for monitoring the evolution of vocal nodules after vocal treatment

In the present study, we report the results of acoustic analysis of voice in 97 patients diagnosed with vocal nodules before and after the vocal logopedic treatment, to evaluate its effectiveness in monitoring the evolution. We analyzed five parameters: the mean fundamental frequency (F0) and its standard deviation, jitter, shimmer, and normalized noise energy (NNE). Our results indicate that most patients showed a reduction of fundamental frequency, an increase of perturbation (jitter and shimmer), and an increase of NNE before the treatment. We did not find any statistically significant relationship between previous values of the five parameters analyzed and the clinical course. We did not find significant differences between the two groups (with and without clinical improvement) in the evolution of any of the five parameters, although these differences were greater in the case of jitter. We conclude that the acoustic analysis of voice can be useful as a complementary tool in the diagnosis of vocal nodules, but the parameter values analyzed before treatment did not correlate with the clinical course and we believe that its usefulness in the evaluation of results after the vocal treatment is limited.     

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery

Objective Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery.

Material and Methods Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery.

Results Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia.

Conclusions Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.     

ABCLOVE嗓音训练法治疗声带息肉的临床观察

目的观察应用ABCLOVE嗓音训练法治疗单侧声带息肉患者发音障碍的临床效果。方法选取2015年12月~2017年3月确诊为单侧声带息肉并伴有发音障碍的患者32例。所有患者均采用ABCLOVE嗓音训练法进行嗓音康复训练,每周1次,训练次数共6次。治疗前后应用电子喉镜、嗓音障碍指数量表（VHI）和计算机嗓音分析仪进行主客观嗓音障碍程度评估,以嗓音嘶哑指数（RAP%）、最长发声时间（MPT）、基础音频范围（Hz）和息肉大小等指标评判治疗效果。结果应用ABCLOVE嗓音训练法进行嗓音康复训练后,所有患者发音均有改善,总有效率达100%,治愈率86.3%。① 治疗后复查电子喉镜有9例患者声带息肉消失,11例声带息肉较治疗前缩小,12例声带息肉无明显改变患者因声嘶等症状明显缓解达到日常用声需求,从而避免了手术治疗;② 治疗后VHI评分（功能、生理、情感和总体评分）均较治疗前明显降低（P<0.05）;③ 嗓音分析结果提示,嗓音嘶哑指数（RAP）较治疗前显著下降（P<0.01）,最长发声时间（MPT）训练后较前显著延长（P<0.01）,基础音频范围（Hz）和音强（dB）等指标均较治疗前明显提高（P<0.05）。结论ABCLOVE嗓音训练法可针对声带息肉等临床常见喉部炎性病变造成的发音障碍进行有效的个体化治疗,从而改善发音、提高生活质量,同时避免不必要的常规手术,达到减少患者痛苦和治疗费用目的。     

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery

OBJECTIVE: Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery. MATERIAL AND METHODS: Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery. RESULTS: Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia. CONCLUSIONS: Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.     

声带小结患者发音矫治前后电声门图参数变化

目的 比较分析声带小结患者发音矫治前后电声门图参数变化，评价发音矫治对声带小结的疗效。方法 对48例声带小结（软性小结）患者发音矫治（3～6个月）前后分别进行电声门图检测，并对其主要参数进行比较分析。结果 发音矫治后平均基频、接触率较矫治前有显菩性升高（P〈0．05），基频微扰、振幅微扰、噪声能量较矫治前有显著性下降（P〈0．05）。结论 发音骄治前后电声门圈参数变化结果提示，发音矫治对声带小结具有一定的治疗效果。     

Long-term voice and swallowing modifications after supracricoid laryngectomy: objective, subjective, and self-assessment data

PURPOSE: The supracricoid laryngectomies (SCLs) are conservative surgical techniques for the treatment of selected laryngeal carcinomas. The advantage of SCL is that a permanent tracheostoma is not required, thus, maintaining the principal laryngeal functions. The aim of the study is to report objective, subjective, and self-assessment long-term results of voice and swallowing in a large group of patients who underwent SCL at least 2 years before this study was undertaken. METHODS: Twenty male subjects who underwent SCL with a mean age of 71 years (range, 51-82) were involved in a retrospective study on swallowing and vocal function. Videoendoscopic ratings were taken of neoglottic vibration patterns and bolus transit. The maximum phonation time and the syllable diadochokinesis were measured. Spectrograms were recorded. Voices were perceptually rated using the Grade, Instability, Roughness, Breathiness, Asthenicity, Strain (GIRBAS) scale. All of the subjects completed a self-assessment questionnaire for both voice and swallowing. RESULTS: Videoendoscopic ratings showed moderate to severe impairment of neoglottal vibration, whereas bolus transit appeared only mildly impaired. The mean values of the GIRBAS scale were 2.4, 2.6, 2.4, 0.8, 0.5, and 0.8. The mean maximum phonation time was 7.5 seconds, whereas the mean value of the Yanagihara scale was 3.7 for voice spectrograms. Mean syllable diadochokinesis appeared as 3.3 syllables per second. Voice and swallowing quality of life questionnaires revealed satisfied patients. CONCLUSIONS: Swallowing after SCL was satisfactory; on the contrary, endoscopic, aerodynamic, perceptual, and acoustic data showed a highly dysphonic voice after SCL. However, self-assessment results revealed relatively satisfied speakers on the emotional, physical, and functional levels.     

嗓音障碍指数主观评估与发音障碍严重程度指数客观检测的相关性分析

目的 探讨声带息肉患者嗓音障碍指数（voice handicap index,VHI）量表自我评估和发音障碍严重程度指数（dysphonia severity index,DSI）客观评估的相关性。 方法 取104例声带息肉患者,用VHI中文版量表进行自评及DIVAS2.5声学分析软件分析DSI,按性别、侧别、形状、大小分组比较,分析VHI和DSI的相关性。结果 声带息肉的大小、形状对VHI各指标差异均无统计学意义,但较大或广基底形息肉基频微扰较重;女性患者功能、生理和VHI总体评价高于男性,但DSI却低于男性;双侧息肉比单侧在生理方面影响较重,同时DSI也较重;VHI量表各指标与嗓音声学分析各参数之间无明显相关性。结论 目前临床上评估嗓音障碍程度的两种主客观方法都不理想,应进一步研究更好的评价方法。