Wyniki wyszukiwania - Biblioteka Nauki

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Diagnosis in Muscle Tension Dysphagia

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Krasnodębska P. , Jarzyńska-Bućko A. , Szkiełkowska A. , Miaśkiewicz B. , Skarżyński H.

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nr 1

16-22

EN

Introduction: Patient-reported outcome measures have been used within the otorhinolaryngologic disorders’ field for many years to compare patient’s perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term – dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation. Aim: Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia. Material and method: The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist’s examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms. Results: The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function. Conclusions: The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.

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Charakterystyka zaburzeń połykania u osób z zaburzeniami głosu

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Krasnodębska P. , Szkiełkowska A. , Jarzyńska-Bućko A. , Włodarczyk E. , Miaśkiewicz B.

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2020

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tom 74

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nr 2

17-22

PL

Wstęp: Współwystępowanie zaburzeń połykania z dolegliwościami ze strony głosu jest tematem rzadko podejmowanym w literaturze. Szczególną uwagę zwraca się na aspekt czynnościowej dysfunkcji w obrębie mięśni gardła i krtani. C el: Celem niniejszej pracy była analiza przypadków pacjentów z dysfonią pod kątem współwystępowania dysfunkcji procesu połykania. Materiał i metoda: Materiał pracy stanowiło 515 pacjentów hospitalizowanych z powodu zaburzeń głosu w roku 2018. Chorzy, których wywiad wskazywał na dolegliwości związane z połykaniem, zostali poddani dodatkowej diagnostyce w kierunku dysfagii (FEES, rozszerzone badanie logopedyczne, SEMG). Wyniki: 11,8% osób wymagających leczenia z powodu zaburzeń głosu zgłaszało współwystępowanie problemów z połykaniem. Na podstawie przeprowadzonych badań dysfagię rozpoznano u 9,3%. Odsetek osób ze stwierdzoną dysfunkcją połykania różnił się w zależności od rodzaju choroby zasadniczej i był najwyższy w grupie z zaburzeniami neurologicznymi. Analiza korelacji pomiędzy nasileniem dysfagii (zgodnie z ocenionym stopniem, wynikami DHI, EAT-10) a nasileniem stopnia niepełnosprawności głosowej VHI pokazała: słabą korelację pomiędzy VHI i EAT-10 (p = 0,1) oraz istotne statystycznie korelacje pomiędzy: VHI a RSI u osób z rozpoznaną chorobą neurologiczną; VHI a DHI u osób z dysfonią hiperfunkcjonalną; VHI a BMI i EAT-10 u osób z przewlekłym zapaleniem krtani. Ponadto uzyskano istotne statystycznie korelacje pomiędzy stopniem nasilenia dysfagii a EAT-10 i DHI (p < 0,05). Badanie logopedyczne przeprowadzone u pacjentów wskazało na współistniejący problem występowania nienormatywnego wzorca połykania. Badanie elektromiograficzne wykazało największe średnie różnice pomiędzy stronami w zapisie średniej i maksymalnej amplitudy z mm. żwaczy. Wnioski: Opieka nad pacjentami z zaburzeniami głosu musi mieć charakter interdyscyplinarny. Wywiad w kierunku zaburzeń połykania u tych osób powinien stanowić dopełnienie wywiadu odnoszącego się do zaburzeń głosu. Zaburzenia połykania występujące u osób z dysfonią mają różny charakter w zależności od przyczyny zaburzeń głosu, a ich współwystępowanie dotyczy średnio 9,3% pacjentów. Współwystępowanie czynnościowych zaburzeń połykania u osób z zaburzeniami głosu wymaga oddzielnego protokołu diagnostycznego. Procedura logopedyczna w interdyscyplinarnej opiece nad osobami z zaburzeniami czynnościowymi połykania powinna być elementem obowiązkowym.

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Mucosal wave measurements in the diagnosis of functional dysphonia

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Szkiełkowska A. , Krasnodębska P. , Miaśkiewicz B. , Włodarczyk E. , Domeracka-Kolodziej A. , Skarżyński H.

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tom 73

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nr 6

1-7

EN

ntroduction: The publication describes the characteristics of the glottis in FDs objectified by OQ, measured with VSK and EGG. Aim: The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. Material and Method: The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. Results: All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P < 0.05). Significant differences were found between patients with hypofunctional – 0.584 and hyperfunctional dysphonia – 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P < 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. Conclusions: Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

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Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx

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Krasnodębska P. , Domeracka-Kołodziej A. , Szkiełkowska A. , Panasiewicz A. , Mularzuk M. , Sokołowska-Łazar D. , Wilhelmsen K.

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nr 2

36-44

EN

Introduction: Laryngeal paralysis deteriorates all laryngeal functions. Therefore the therapeutic process must include restoration of respiratory, defensive and vocal function. Selection of a proper rehabilitation path plays a key role. Appropriate research protocol that includes objective methods of voice evaluation is an important element of monitoring the return of vocal efficiency. Voice efficiency is important for the patient particularly due to psychological and social reasons. Aim: The aim of the study was the assessment of short-term functional voice therapy (FVT) in patients with unilateral paralysis of the larynx with the use of objective parameters describing the glottis and voice quality. Material and Method: In the last 10 years 355 patients with laryngeal paralysis were hospitalized in the Audiology and Phoniatrics Clinic due to dysphonia. All patients underwent a 5-day FVT. In 2015 we unified the diagnostic protocol measuring parameters obtained from videostrobokymography (VSK), electroglottography (EGG), perceptual and acoustic voice analysis before and after 5-day hospitalization. Results: After FVT patients showed improved voice quality and glottal compensation. The majority of patients achieved a statistically significant improvement in VSK, EGG, MDVP, and perceptual analysis. The group of patients with unsatisfactory voice improvement after therapy required a prolonged rehabilitation or was qualified for laryngeal microsurgery. Potential causes of insufficient effects of FVT were analysed. Conclusions: The complexity of voice rehabilitation is crucial for the success of therapy. An interdisciplinary therapeutic team plays a significant role during voice rehabilitation in patients with vocal fold paralysis.

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Analysis of the relationship between emotion intensity and electrophysiology parameters during a voice examination of opera singers

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Krasnodębska P. , Szkiełkowska A. , Pollak A. , Romaniszyn-Kania P. , Bugdol M. N. , Bugdol M. , Mitas A. W.

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nr 1

84-97

EN

Objectives Emotions and stress affect voice production. There are only a few reports in the literature on how changes in the autonomic nervous system affect voice production. The aim of this study was to examine emotions and measure stress reactions during a voice examination procedure, particularly changes in the muscles surrounding the larynx. Material and Methods The study material included 50 healthy volunteers (26 voice workers – opera singers, 24 control subjects), all without vocal complaints. All subjects had good voice quality in a perceptual assessment. The research procedure consisted of 4 parts: an ear, nose, and throat (ENT)‑phoniatric examination, surface electromyography, recording physiological indicators (heart rate and skin resistance) using a wearable wristband, and a psychological profile based on questionnaires. Results The results of the study demonstrated that there was a relationship between positive and negative emotions and stress reactions related to the voice examination procedure, as well as to the tone of the vocal tract muscles. There were significant correlations between measures describing the intensity of experienced emotions and vocal tract muscle maximum amplitude of the cricothyroid (CT) and sternocleidomastoid (SCM) muscles during phonation and non-phonation tasks. Subjects experiencing eustress (favorable stress response) had increased amplitude of submandibular and CT at rest and phonation. Subjects with high levels of negative emotions, revealed positive correlations with SCMmax during the glissando. The perception of positive and negative emotions caused different responses not only in the vocal tract but also in the vegetative system. Correlations were found between emotions and physiological parameters, most markedly in heart rate variability. A higher incidence of extreme emotions was observed in the professional group. Conclusions The activity of the vocal tract muscles depends on the type and intensity of the emotions and stress reactions. The perception of positive and negative emotions causes different responses in the vegetative system and the vocal tract.