嗓音疾病自我评估特点及影响因素

目的 探讨嗓音障碍疾病嗓音障碍自我评估特点及影响因素.方法 对1766例嗓音障碍患者及120例健康对照者行嗓音障碍指数(voice handicap index,VHI)量表评估,并对其中227例嗓音治疗后效果进行评估.结果 各种嗓音疾病患者VHI评分均明显高于对照组(z值范围8.039～17.043,P值均为0.000).不同嗓音疾病患者之间评分也有差异,量表总分自高而低依次为痉挛性发音障碍、声带麻痹、功能性发音障碍、声带沟、声带良恶性肿瘤、声带囊肿、声带任克水肿、声带息肉、声带角化与慢性喉炎、声带小结.痉挛性发音障碍组情感部分评分最高,其次为功能性发音障碍,而其他组生理部分评分均高于功能及情感评分.嗓音治疗后患者量表评分显著下降,术前术后VHI量表总评分差异有统计学意义(P值均<0.05).不同教育程度、年龄分组间量表总分差异有统计学意义(F值范围8.701～27.371,P值均为0.000),受教育程度越高,VHI评分越高;少年组VHI的各项最低,青年组最高,之后随年龄增长VHI逐渐下降.结论 VHI量表评估作为嗓音疾病严重程度及治疗效果评估的有益补充,可以从患者角度通过生理、机能及情感三方面综合评估嗓音障碍对日常生活影响及治疗前后变化,但具有一定主观性,可能受到教育程度及年龄因素影响.

Self-assessment characteristics of voice handicap index for voice disorders and its influencing factors

Objective To investigate the self-assessment characteristics of Voice Handicap Index (VHI) for voice disorders and its influencing factors. Methods One thousand seven hundred and sixty six dysphonic patients and 120 control subjects were included in this study. Two hundred twenty seven patients were treated with phonosurgery or Botulinumtoxin injection. VHI was used for self-assessment Results Dysphonic patients had worse VHI scores than control (z from 8.039 to 17.043, P=0.000). There was a significant difference among the VHI scores of different diseases. VHI scores were descending in order among spasmodic dysphonia, vocal fold paralysis, functional dysphoina, sulcus vocalis, benign and malignant tumor of vocal fold, vocal fold cyst, Reinke' s edema, vocal fold polyp, vocal fold keratosis and chronic laryngitis, vocal nodule. The emotional scores were the highest in spasmodic dysphunia, and followed by functional dysphoina. In another group, the physical scores were higher than functional scores and emotional scores. Treatment resulted in statistical improvement in VHI scores (P<0.05). The total scores were different significantly between different educational background and age groups(F from 8.701 to 27. 371, P=0.000). The higher the educational degree, the higher the VHI scores. As to age groups, the juvenile group' s scores were the lowest, while the youth' s group the highest, then the scores declined when ages increased. Conclusion As a useful supplementary instrument to measure the voice disorder severity and the treatment' s effect, VHI can comprehensively assess the voice handicap' s affect to the life quality and the difference after the treatment, especially in physical, functional and emotional aspects, but it is somehow subject to the educational degree and age.