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Porównanie wyników skali dyskomfortu traktu głosowego z obiektywnymi i instrumentalnymi parametrami badania foniatrycznego u nauczycieli rehabilitowanych z powodu zaburzeń głosu

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Woźnicka E., Niebudek-Bogusz E., Wiktorowicz J., Śliwińska-Kowalska M.
Medycyna Pracy
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2013
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vol. 64
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issue 2
199-206
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
2
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Laryngeal manual therapy palpatory evaluation scale: A preliminary study to examine its usefulness in diagnosis of occupational dysphonia

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Woźnicka E., Niebudek-Bogusz E., Morawska J., Wiktorowicz J., Śliwińska-Kowalska M.
Medycyna Pracy
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2017
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vol. 68
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issue 2
179-188
EN
Background The aim of this study has been to assess the larynx and soft tissue around the vocal tract in a group of people with healthy voice, and in a group of patients with occupational dysphonia using the new laryngeal manual therapy palpatory evaluation scale (LMTPE). Material and Methods The examinations were performed in a study (dysphonic) group of professional voice users who had developed voice disorders (N = 51) and in the control group of normophonic subjects (N = 50). All the participants underwent perceptual voice assessment and examination by means of the LMTPE scale. Additionally, phoniatric examination including VHI (Voice Handicap Index) questionnaire, GRBAS (the Grade of hoarseness, Roughness, Breathiness, Asthenic, Strained) perceptual evaluation, maximum phonation time (MPT) measurement and videostroboscopy was performed in the study group. Results The comparison of the LMTPE total score showed that the results of the study group were significantly poorer than those of controls (p < 0.001). In the study group, correlations were found between the LMTPE results and the VHI scores (p < 0.05), perceptual evaluation by the GRBAS (p < 0.05) and the objective parameter MPT (p < 0.05). Conclusions The study has proven that the LMTPE scale is characterized by the high score of Cronbach’s α ratio estimating the reliability of the test. The results have confirmed that the LMTPE scale seems to be a valuable tool, useful in diagnostics of occupational dysphonia, particularly of hyperfunction origin. Med Pr 2017;68(2):179–188
3
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Assessment of the influence of osteopathic myofascial techniques on normalization of the vocal tract functions in patients with occupational dysphonia

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Marszałek S., Niebudek-Bogusz E., Woźnicka E., Malińska J., Golusiński W., Śliwińska-Kowalska M.
International Journal of Occupational Medicine and Environmental Health
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2012
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vol. 25
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issue 3
225-235
EN
Objectives: Occupational voice disorders are accompanied by increased tension of the external laryngeal muscle which changes the position of the larynx and consequently disturbs the conditions of functioning of the vocal tract. The aim of the study is to assess the use of osteopathic procedures in the diagnosis and treatment of occupational dysphonia. Material and Methods: Study subjects included 40 teachers with chronic diseases of the voice organ (38 women and 2 men) aged from 39 to 59 (mean age: 48.25). Before and after the voice therapy the osteopathic examination according to Libermann’s protocol was performed as well as phoniatric examination including laryngovideostroboscopy (LVSS), assessment of the maximum phonation time (MPT) and the Voice Handicap Index (VHI) score. The voice therapy, scheduled and supervised by a laryngologist-phoniatrician and conducted by a speech-language pathologist, was supplemented with osteopathic myofascial rehabilitation of the larynx. The chisquare McNemar test and non-parametric Wilcoxon matched pairs test were applied in the statistical assessment. Results: The applied interdisciplinary treatment including osteopathic and vocal therapy resulted in a statistically significant decrease in tenderness of muscles raising the larynx (cricothyroid ligament, sternocleidomastoid muscles, and pharyngeal constrictor muscles) and in lowering the tonus (geniohyoid muscles, pharyngeal constrictor muscles and sternocleidomastoid muscles). A significant improvement was also observed in the case of dysfunction of the cricothyroid joint examined during glissando and yawning, as well as in asymmetry of the thyrohyoid apparatus. Moreover, the therapy resulted in significantly better normalization of the head position and better control of the centre of gravity of the body. Statistically significant post-therapy improvement was observed in the phoniatric examination, including VHI scores, MPT results and parameters of videostroboscopic examination. Conclusions: The use of osteopathic therapy helps significantly improve the functions of the vocal tract in patients with occupational dysphonia.
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