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EN
Aim of study: Evaluation of the speech therapy on voice quality in patients with unilateral vocal fold palsy. Material and methods: The study group included 11 patients, 8 women and 3 men, in age between 16 to 72 years, with unilateral vocal fold palsy, diagnosed in ENT Department of Warsaw Medical University between 2017-2018. Each person completed questionnaires: the voice disability self-assessment scale (VHI), the voice-based quality of life (VRQoL) scale, the vocal tract discomfort scale (VTD). All questionnaires were completed twice, before and after the voice therapy. In addition, the acoustic analysis of the voice, the assessment of the maximum phonation time and the breathing tract were performed twice in each patient. Each of the patients had a voice rehabilitation consisting of a series of 10 meetings. Results: Statistical analysis of the results of maximum phonation time, the self-assessment of voice disability, the quality of life depending on the voice, discomfort of the vocal tract voice acoustic analysis showed statistically significant differences in the results before and after rehabilitation (p <0.005). In addition, the improvement of the respiratory tract was observed in the majority of patients. Conclusions: Speech therapy significantly affects the voice quality of patients with unilateral laryngeal nerve palsy.
EN
Introduction: The most common cause of vocal fold paralysis (VFP) is iatrogenic injury. Patients with symptoms of VFP present to the specialist after a couple of weeks or even months since the onset of symptoms. In the literature, the data regarding speech impairment during the first days after a iatrogenic injury is lacking. Aim: to evaluate the quality of voice during first days of vocal fold paralysis following a iatrogenic injury. Materials and methods: Twenty-five patients with iatrogenic vocal fold paralysis who presented for phoniatric consultation at the Department of Otolaryngology of the Medical University of Warsaw between May 2015 and December 2016 were enrolled in the study. The patients were examined 1-2 days since the onset of speech deterioration. In all patients, laryngeal videolaryngostroboscopy was performed, based on which the following were assessed: vocal fold mobility, mucosal wave, phonation closure, simultaneity and amplitude of vocal fold vibration. Acoustic analysis was performed, and the following acoustic parameters were evaluated: DSI, F0, Shimmer, Jitter, NHR. Also, the maximal phonation time of [a] sound (MPT a) was assessed and the voice perception analysis with the GRBAS scale was performed. The patients self-evaluated their voice using a 10-point VAS scale. Results: Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.
EN
Introduction: Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. Aim: The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. Material and method: The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.
EN
Dysphonia is a prevalent symptom of some respiratory diseases that affects voice quality, even for prolonged periods. For its diagnosis, speech-language pathologists make use of different acoustic parameters to perform objective evaluations on patients and determine the type of dysphonia that affects them, such as hyperfunctional and hypofunctional dysphonia, which is important because each type requires a different treatment. In the field of artificial intelligence this problem has been addressed through the use of acoustic parameters that are used as input data to train machine learning and deep learning models. However, its purpose is usually to identify whether a patient is ill or not, making binary classifications between healthy voices and voices with dysphonia, but not between dysphonias. In this paper, harmonic-to-noise ratio, cepstral peak prominence-smoothed, zero crossing rate and the means of the Mel frequency cepstral coefficients (2-19) are used to make multiclass classification of voices with euphony, hyperfunction and hypofunction by means of six machine learning algorithms, which are: Random Forest, K nearest neighbors, Logistic regression, Decision trees, Support vector machines and Naive Bayes. In order to evaluate which of them presents a better performance to identify the three voice classes, bootstrap.632 was used. It is concluded that the best confidence interval ranges from 87% to 92%, in terms of accuracy for the K Nearest Neighbors model. Results can be implemented in the development of a complementary application for the clinical diagnosis or monitoring of a patient under the supervision of a specialist.
EN
Introduction: The most common cause of vocal fold paralysis (VFP) is iatrogenic injury. Patients with symptoms of VFP present to the specialist after a couple of weeks or even months since the onset of symptoms. In the literature, the data regarding speech impairment during the first days after a iatrogenic injury is lacking. Aim: to evaluate the quality of voice during first days of vocal fold paralysis following a iatrogenic injury. Materials and methods: Twenty-five patients with iatrogenic vocal fold paralysis who presented for phoniatric consultation at the Department of Otolaryngology of the Medical University of Warsaw between May 2015 and December 2016 were enrolled in the study. The patients were examined 1-2 days since the onset of speech deterioration. In all patients, laryngeal videolaryngostroboscopy was performed, based on which the following were assessed: vocal fold mobility, mucosal wave, phonation closure, simultaneity and amplitude of vocal fold vibration. Acoustic analysis was performed, and the following acoustic parameters were evaluated: DSI, F0, Shimmer, Jitter, NHR. Also, the maximal phonation time of [a] sound (MPT a) was assessed and the voice perception analysis with the GRBAS scale was performed. The patients self-evaluated their voice using a 10-point VAS scale. Results: Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.
EN
Introduction: Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. Aim: The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. Material and method: The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p < 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p < 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.
EN
ntroduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. R esults: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.
8
Content available Objectification of vocal folds mucosal wave
88%
EN
The work assessed clinical utility of open quotients measured during laryngovideostroboscopy and electroglottography. Values of the parameters were analyzed according to clinical diagnosis. An algorithm based on direct and indirect mucosal wave measurement is presented, which allows for differentiation of voice disorders. The method developed for the objectification of glottal functions in various voice pathologies is characterized by high sensitivity and specificity.
PL
Wprowadzenie: Porażenie krtani pogarsza wszystkie funkcje tego narządu. Z tego powodu proces terapeutyczny powinien obejmować przywrócenie funkcji oddechowej, obronnej i głosowej. Dobór właściwej ścieżki rehabilitacyjnej odgrywa kluczową rolę. Odpowiedni protokół badań, który obejmuje obiektywne metody oceny głosu, jest ważnym elementem monitorowania powrotu sprawności głosu. Wydajność głosu jest ważna dla pacjenta szczególnie ze względów psychologicznych i społecznych. Cel: Celem pracy była ocena krótkoterminowej funkcjonalnej terapii głosu (functional voice therapy; FVT) u pacjentów z jednostronnym porażeniem krtani, z wykorzystaniem obiektywnych parametrów opisujących aparat głosowy krtani i jakość głosu. Materiał i metody: W ciągu ostatnich 10 lat w Klinice Audiologii i Foniatrii Instytutu Fizjologii i Patologii Słuchu z powodu dysfonii hospitalizowano 355 pacjentów z porażeniem krtani. Wszyscy chorzy zostali poddani 5-dniowej FVT. Od 2015 roku ujednolicono parametry pomiaru protokołów diagnostycznych uzyskiwane z wideostrobokimografii (videostrobokymography; VSK), elektroglottografii (electroglottography; EGG) oraz percepcyjnej i akustycznej analizy głosu przed i po 5 dniach hospitalizacji. Wyniki: U pacjentów po FVT uzyskano poprawę jakości głosu i kompensacji aparatu głosowego krtani. Większość pacjentów osiągnęła statystycznie istotną poprawę w VSK, EGG, MDVP oraz analizie percepcyjnej. Grupa pacjentów z niezadowalającą poprawą głosu po terapii wymagała przedłużonej rehabilitacji lub została zakwalifikowana do mikrochirurgii krtani. Analizowano potencjalne czynniki, które mogły powodować niedostateczne efekty FVT. Wnioski: Złożoność rehabilitacji głosu jest kluczowa dla powodzenia terapii. Interdyscyplinarny zespół terapeutyczny odgrywa istotną rolę w rehabilitacji głosu u pacjentów z porażeniem fałdów głosowych.
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.
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.
PL
Wprowadzenie: Porażenie krtani pogarsza wszystkie funkcje tego narządu. Z tego powodu proces terapeutyczny powinien obejmować przywrócenie funkcji oddechowej, obronnej i głosowej. Dobór właściwej ścieżki rehabilitacyjnej odgrywa kluczową rolę. Odpowiedni protokół badań, który obejmuje obiektywne metody oceny głosu, jest ważnym elementem monitorowania powrotu sprawności głosu. Wydajność głosu jest ważna dla pacjenta szczególnie ze względów psychologicznych i społecznych. Cel: Celem pracy była ocena krótkoterminowej funkcjonalnej terapii głosu (functional voice therapy; FVT) u pacjentów z jednostronnym porażeniem krtani, z wykorzystaniem obiektywnych parametrów opisujących aparat głosowy krtani i jakość głosu. Materiał i metody: W ciągu ostatnich 10 lat w Klinice Audiologii i Foniatrii Instytutu Fizjologii i Patologii Słuchu z powodu dysfonii hospitalizowano 355 pacjentów z porażeniem krtani. Wszyscy chorzy zostali poddani 5-dniowej FVT. Od 2015 roku ujednolicono parametry pomiaru protokołów diagnostycznych uzyskiwane z wideostrobokimografii (videostrobokymography; VSK), elektroglottografii (electroglottography; EGG) oraz percepcyjnej i akustycznej analizy głosu przed i po 5 dniach hospitalizacji. Wyniki: U pacjentów po FVT uzyskano poprawę jakości głosu i kompensacji aparatu głosowego krtani. Większość pacjentów osiągnęła statystycznie istotną poprawę w VSK, EGG, MDVP oraz analizie percepcyjnej. Grupa pacjentów z niezadowalającą poprawą głosu po terapii wymagała przedłużonej rehabilitacji lub została zakwalifikowana do mikrochirurgii krtani. Analizowano potencjalne czynniki, które mogły powodować niedostateczne efekty FVT. Wnioski: Złożoność rehabilitacji głosu jest kluczowa dla powodzenia terapii. Interdyscyplinarny zespół terapeutyczny odgrywa istotną rolę w rehabilitacji głosu u pacjentów z porażeniem fałdów głosowych.
EN
Introduction: Laryngeal cancer and its treatment are associated with both short- and long-term side effects, affecting laryngeal functions and having an impact on the quality of life. Material and methods: Retrospective analysis of the medical records of patients receiving surgical or non-surgical, larynx- -preserving treatment for laryngeal cancer. Results: After termination of the treatment, the highest proportion of patients with bad voice quality was in the glottic carcinoma group (both in early and late phase), with swallowing dysfunction in the transglottic carcinoma group. Compared to the situation before the treatment, the proportion of patients with impaired voice quality (bad voice quality and loss of voice) initially decreased among all groups (except for supraglottic carcinomas), and during the first post-treatment year either increased or did not change. The proportion of patients with no swallowing dysfunction increased in the supraglottic, subglottic and transglottic carcinoma groups. D iscussion: We consider necessary the implementation of a standard pre- and post-treatment monitoring of the voice and swallowing function in the management of patients with laryngeal cancer.
EN
Chronic irritation of the laryngeal mucosa by external factors can lead to the development of dysphonia: hoarseness, change of the voice tone or weakening of its strength. Patients who additionally report alarming symptoms, such as dyspnea, dysphagia, or odynophagia require urgent diagnosis and treatment. Long-term exposure to irritants may lead to the development of numerous recurrent hypertrophic laryngeal lesions requiring continuous otorhinolaryngological care and multiple surgical procedures, as it was in the presented case.
15
Content available Objectification of vocal folds mucosal wave
88%
EN
The work assessed clinical utility of open quotients measured during laryngovideostroboscopy and electroglottography. Values of the parameters were analyzed according to clinical diagnosis. An algorithm based on direct and indirect mucosal wave measurement is presented, which allows for differentiation of voice disorders. The method developed for the objectification of glottal functions in various voice pathologies is characterized by high sensitivity and specificity.
EN
Background Given the growing number of occupational voice users, easy and quick broad-scale screening is necessary to provide prophylaxis of voice disorders. The aim of the study was to assess applicability of the Voice Related Quality of Life questionnaire (V-RQOL) to screening occupational voice disorders. Material and Methods The research comprised 284 subjects divided into 3 groups: 0 – the control group of normophonic subjects, non-professional voice users (N = 60), 1 – occupational voice users with objectively confirmed voice disorders (N = 124), 2 – the non-randomized group of occupational voice users with and without voice problems (N = 100). Self-assessment of voice was performed by means of the V-RQOL in comparison to the Voice Handicap Index (VHI). The relation between the V-RQOL and VHI was determined by means of linear regression. Receiver Operating Characteristic (ROC) curves were constructed and the cut-off point of the V-RQOL was determined to discriminate between normophonic and dysphonic subjects. Results The relationship between the VHI and V-RQOL scores indicated a satisfactory coefficient of determination: R² = 0.7266. High values of Cronbach’s α confirmed high reliability of the V-RQOL test (0.867). Voice-Related Quality of Life questionnaire (V-RQOL) results were significantly worse in the study group than for normophonic controls (p < 0.001). The cut-off point for the test was set at 79 points. The determined area under the curve (AUC) = 0.910 (p < 0.001) showed high diagnostic accuracy of the V-RQOL. Results of the V-RQOL differed for diagnose-based subgroups of dysphonic patients. Conclusions The study gives grounds for application of the V-RQOL as a reliable tool for screening occupational voice disorders. Med Pr 2018;69(2):119–128
EN
Voice disorders are the most frequently diagnosed occupational disease in recent years, making it reasonable to consider the need for and methodology of voice screening in voice workers. This article addresses the issue of the effectiveness of voice screening assessment using a pilot study in a group of teachers (n = 22) and choristers (n = 14) as an example. The results of the study indicate the diagnostic effectiveness of a combined voice self‑assessment (using the VHI) and assessment of the phonation time parameter (MCF) and listening assessment according to the GRBAS scale categories.
PL
Zaburzenia głosu są w ostatnich latach najczęściej orzekaną chorobą zawodową, dlatego zasadne jest rozważenie potrzeby i metodyki przeprowadzania badań przesiewowych głosu u osób pracujących głosem. Artykuł podejmuje problematykę skuteczności oceny przesiewowej głosu na przykładzie pilotażowych badań w grupie nauczycieli (n = 22) i chórzystów (n = 14). Wyniki badań wskazują na efektywność diagnostyczną połączonej samooceny głosu (przy pomocy VHI) oraz oceny parametru maksymalnego czasu fonacji (MCF) i oceny odsłuchowej według kategorii skali GRBAS.
18
Content available Ocena prozodii mowy u pacjentów z dysfonią
63%
EN
The article is an attempt to organize the issues related to the diagnosis of prosodic skills in people with dysphonia. The tasks it deals with concern the features of prosodic characteristics of speech, mainly in relation to the Polish language, the functions performed by prosody in communication, the relationship of certain features of phonation to the speaker’s realisation of these functions and the disorders of their realisation in people with dysphonia. It also presents the methods and tools used in the description and evaluation of prosodic expression, which can be used in clinical practice.
PL
Artykuł stanowi próbę uporządkowania problematyki związanej z diagnozą sprawności prozodycznych u osób z dysfonią. Zagadnienia w nim poruszane dotyczą cech charakterystyki prozodycznej mowy, głównie w odniesieniu do języka polskiego, funkcji pełnionych przez prozodię w komunikacji, związku określonych cech fonacji z realizowaniem przez mówcę tych funkcji oraz zaburzeniami ich realizacji u osób z dysfonią. Wymieniono w nim również metody i narzędzia wykorzystywane w opisie i ocenie ekspresji prozodycznej, które można wykorzystać w praktyce klinicznej.
EN
Background: Diagnostic and therapeutic procedures of occupational dysphonia play a major role in voice self-assessment, which is one of the elements of a comprehensive evaluation of voice disorders. The aim of the study was to assess the applicability of the Vocal Tract Discomfort (VTD) scale to monitor the effectiveness of voice rehabilitation and compare the VTD results with objective and instrumental methods of phoniatric diagnosis. Materials and Methods: The study included 55 teachers (mean age, 47.2) with occupational dysphonia. A comprehensive diagnosis took into account self-assessment by VTD scale, phoniatric examination, including laryngovideostroboscopy (LVSS) and objective measurements of the aerodynamic parameter - the maximum phonation time (MPT). After 4 months of intense rehabilitation, post-therapy examination was performed using the methods specified above. Results: After the treatment, a significant improvement was obtained in the subjective symptoms measured on a VTD scale - assessed both for the frequency (p = 0.000) and the severity (p = 0.000) subscales. Positive effects of the therapy were also observed for the parameters evaluated in the phoniatric study (p < 0.01) and laryngovideostroboscopy (p < 0.01). After voice therapy, there was also an improvement in the objective parameter MCF, which was about 5 seconds longer. Studies have shown that the VTD scale is characterized by high reliability - Cronbach's alpha coefficient in the preliminary test was as follows: for the frequency subscale symptoms - 0.826, and severity - 0.845; similarly high reliability was achieved in the control test, 0.908 and 0.923, respectively. Conclusions: Vocal Tract Discomfort scale can be a valuable tool for assessing voice, and can also be used to monitor the effectiveness of therapy of the occupational dysphonia. Med Pr 2013;64(2):199–206
PL
Wprowadzenie: W postępowaniu diagnostyczno-terapeutycznym w dysfoniach zawodowych ważną rolę odgrywa samoocena głosu, która jest jednym z elementów kompleksowej ewaluacji zaburzeń głosu. Celem pracy była ocena możliwości zastosowania skali Dyskomfortu Traktu Głosowego (Vocal Tract Discomfort - VTD) w monitorowaniu skuteczności rehabilitacji głosowej, a także porównanie wyników skali VTD z obiektywnymi i instrumentalnymi metodami diagnostyki foniatrycznej. Materiał i metody: Badaniami objęto 55 nauczycieli (średnia wieku: 47,2 lat) z dysfoniami o podłożu zawodowym. Przeprowadzono kompleksową diagnostykę uwzględniającą: samoocenę głosu według skali VTD, badanie foniatryczne z wideostroboskopią, a także pomiar obiektywnego parametru aerodynamicznego - maksymalnego czasu fonacji (MCF). Po 4-miesięcznej intensywnej rehabilitacji głosu wykonano badanie kontrolne z zastosowaniem ww. metod. Wyniki: Po leczeniu uzyskano istotną poprawę w odniesieniu do subiektywnych dolegliwości mierzonych za pomocą skali VTD - zarówno w podskali częstotliwości (p = 0,000), jak i nasilenia (p = 0,000). Pozytywne efekty terapii stwierdzono także dla parametrów ocenianych w badaniu foniatrycznym (p < 0,01) i wideostroboskopowym (p < 0,01). Po rehabilitacji głosu poprawił się też obiektywny parametr MCF, który wydłużył się średnio o 5 s. Badania wykazały, że Skala Dyskomfortu Traktu Głosowego cechuje się wysoką rzetelnością - współczynnik α-Cronbacha w badaniu wstępnym wynosił: dla podskali częstotliwości symptomów - 0,826, dla podskali nasilenia - 0,845. Analogicznie wysoki był w badaniu kontrolnym i wynosił odpowiednio: 0,908 i 0,923. Wnioski: Skala Dyskomfortu Traktu Głosowego może być wartościowym narzędziem oceny głosu, wykorzystywanym także do monitorowania skuteczności terapii dysfonii zawodowych. Med. Pr. 2013;64(2):199–206
PL
Artykuł w zakresie teoretycznym przedstawia dysfagię i dysfonię u dzieci z porażeniem fałdów głosowych w wyniku oddziaływań operacyjnych – przyczyny, objawy, możliwości diagnostyczne, a także wstępne rekomendacje terapeutyczne. W aspekcie praktycznym autorki ukazują sposoby badania zaburzeń głosu i połykania u pacjentów w wieku niemowlęcym, którzy brali udział w próbie eksperymentalno-klinicznej w Uniwersyteckim Szpitalu Dziecięcym w Krakowie. W artykule omówiono dwa studia przypadku, które miały posłużyć do opracowania standardu postępowania neurologopedycznego dedykowanego dla tego rodzaju pacjentów. Autorki skupiły się na przedstawieniu zależności diagnozy funkcjonalnej/miofunkcjonalnej z diagnozą umiejętności prelingwalnych i lingwlanych dziecka w aspekcie rozwoju kompetencji językowej oraz komunikacyjnej. Mioterapia w tym ujęciu ma stanowić podstawę działań, koniecznych w ramach wczesnej interwencji terapeutycznej, które mają posłużyć stymulacji rozwoju mowy dziecka. W podsumowaniu artykuł określa rekomendacje terapeutyczne, które zostały opracowane na podstawie zaprezentowanej procedury badawczej.
EN
The theoretical aspect of the article presents dysphagia and dysphonia in children with vocal fold paralysis caused by surgical interventions – the causes, symptoms, diagnostic possibilities, as well as initial therapeutic recommendations. In practical terms, the authors would like to show methods of examining the voice and swallowing disorders in toddler patients who participated in the experimental-clinical trial at the University Children’s Hospital in Krakow. The article discusses two case studies which were to be used to develop a standard of neurological therapy dedicated to this type of patients. The authors focused on presenting the relationship between the functional/ myofunctional diagnosis, and the diagnosis of the prelingual and linguistic skills in children in terms of the development of linguistic and communicative competence. In this approach, myotherapy is to form the basis of activities necessary in the framework of early therapeutic intervention, which are to stimulate the speech development in children. In conclusion, the article specifies the therapeutic recommendations that have been developed on the basis of the research procedures presented.
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