No4-5(2) 2019
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DOI 10.37219/2528-8253-2019-4-27 |
Shydlovska T.A., Volkova T.V.
Clinical and instrumental characteristics of vocal apparatus condition of
patients suffering chronic functional hypotonic dysphonia
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Shidlovskaya Tetiana A.
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine.
Chief Researcher, Laboratory for Occupational Voice and Hearing Disorders
(with phoniatrics group)
Doctor of Medical Sciences, Professor
E-mail: doctor_sh@ukr.net
Orchid ID: https://orcid.org/0000-0002-7894-359X
Volkova Tetyana Vasilіvna
State Institution “Institute of otolaryngology named after Prof. O.S.
Kolomiychenko of the National Academy of Medical Sciences of Ukraine”; Kyiv,
Ukraine.
Laboratory for Occupational Voice and Hearing Disorders (with phoniatrics
group)
Junior Researcher
E-mail: amtc@kndio.kiev.ua
Orchid ID: https://orcid.org/0000-0002-7894-359X |
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Abstract
A lot of researchers are concerned about the problem of diagnosis of
functional diseases of vocal apparatus and their treatment. It is due to
diagnostic difficulty of these diseases, a fairly high prevalence of the
pathology among people of voice professions, untimely detection of voice
disorders. Besides, young people of working age can also suffer these
disorders.
In case of impaired function disorders associated with changes in timbre,
intensity,voice modulation, motor and vibration abilities of the vocal cords
come to the fore.
Moreover, almost a quarter of patients, suffering chronic functional
hypotonic dysphonia, CFHD, had frequent relapses, persistent voice disorders
and complicated course of the disease.
Purpose of the study is to give a detailed clinical and instrumental
characterization of vocal apparatus condition of patients suffering CFHD and
having various degrees of voice disorders.
Materials and methods: 123 patients aged 19 to 44, suffering CFHD and having
various degrees of voice disorders, have been examined. In the control group
there were included 15 healthy people aged 18 to 23, having not any voice
disorders. In total, 138 people were examined. A detailed anamnesis and
analysis of patients complaints were made. General clinical ENT and
specialized phoniatric examination were performed as well. Video
laryngological examination was performed with the help of a video
laryngoscope ,manufactured by Karl Shtorz, Germany.
Results and discussion: All the examined patients suffering CFHD were
divided into 4 groups depending on the degree of vocal disorders, according
to the results of specialized phoniatric examination and
videolaryngostroboscopy.
The patients, suffering functional hypotonic dysphonia and mild disorders in
functioning of vocal apparatus, were included to group 1. Group 2 included
patients having more severe laryngeal mobility disorders.
Group 3 was formed of 34 patients having severe disorders of voice apparatus
(like those in group 2), along with complicated course of the disease (prenodulus
state, vocal cords nodules, Mediale Edge thinning). Group 4 included
patients having severe disorders of voice apparatus, as well as various
degrees of hypertonicity of vestibular larynx, which in some cases was
transformed into pseudo-folded mechanism of voice formation. Due to the
analysis of otolaryngological and specialized phoniatric examination, the
data of patients suffering FHD were found to differ significantly according
to clinical condition and degree of voice disorders. This allows to form
groups of patients taking into account the data of clinical and instrumental
studies in order to determine treatment
tactics. Distribution of patients suffering CFHD into appropriate groups
provides more differentiated approach to their treatment.Besides, this makes
forecasting of further course of the disease and effectiveness of
therapeutic measures more objective. It is important for solving issues of
labor examination and professional suitability of people of voice
professions.
Conclusions:
1.Clinical signs and changes of laryngoscopic picture in
case of functional voice disorders can be unexpressed and variable. It
complicates the diagnosis, that is why, patients suffering functional
hypotonic dysphonia need to be examined thoroughly including usage of
additional instrumental methods.
2. In case patients suffering CFHD are not provided with specialized care on
time, a number of complications can develop (Mediale Edge thinning,
prenodulus state, hypertonicity of vestibular larynx, pseudo-folded
mechanism of voice formation etc.) It can complicate the treatment and
reduce its effectiveness.
3. In the presence of such signs, it is important to determine whether they
testify of independent nosology
or a complicated course of chronic functional hypotonic dysphonia. It proves
to be defining to determine treatment tactics, which in such cases does not
seem to be effective without correction of functional disorders of voice
formation.
4. Target data analysis during otolaryngological and specialized phoniatric
examination of patients suffering CFHD permits to create groups, based on
the results of clinical and instrumental studies. Such distribution of
patients into appropriate groups provides more differentiated approach to
their treatment, and makes both forecasting of the disease and therapeutic
measures more effective. It matters to solving issues of labor examination
and
professional suitability of people of voice profession. |
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Keywords
functional hypotonic dysphonia, video laryngoscopy, voice disorders. |
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