RESUMEN
The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.
Asunto(s)
Evaluación de la Discapacidad , Contracción Muscular , Hipertonía Muscular/diagnóstico , Enfermedades Profesionales/diagnóstico , Postura , Enseñanza , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Adulto , Femenino , Humanos , Músculos Laríngeos/fisiopatología , Contracción Muscular/fisiología , Hipertonía Muscular/fisiopatología , Músculos del Cuello/fisiopatología , Enfermedades Profesionales/etiología , Enfermedades Profesionales/fisiopatología , Postura/fisiología , Valores de Referencia , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Calidad de la Voz/fisiologíaRESUMEN
In 76 teachers with persisting voice problems, the maintaining factors and coping strategies were examined. Physical, functional, psychological and socioeconomic factors were assessed. A parallel was drawn to a psychological cascade model designed for patients with chronic back pain. The majority of the patients were found to be in a deadlocked situation (phase 1 of the cascade model), for which the combination of externalization and unawareness of the situation is the main risk factor. Subjective rating of the voice problem was assessed by the Voice Handicap Index (VHI) and a visual analogue scale (VAS). Patients in phase 1 of the cascade model showed higher VHI and VAS scores compared with the other patients. For a high VHI score, the combination of socioeconomic factors and being in phase 1 was the most important risk factor. Socioeconomic factors were the most important risk factors for a high VAS score. We introduce the term 'chronicity', which means that the problems are maintained, the patient finds himself in a deadlocked situation, and is sliding down into a chronic disease. 'Chronicity' is essentially different from 'chronic', which refers only to the duration of the disease. We consider maintaining factors and (inadequate) coping factors, which consist of emotional/psychological, physical and socioeconomic aspects, as indicators for chronicity.
Asunto(s)
Dolor de Espalda/psicología , Enseñanza , Trastornos de la Voz/etiología , Adaptación Psicológica , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/terapia , Calidad de la VozRESUMEN
In a prospective study the Groningen, Nijdam, and Provox voice prostheses were evaluated with respect to speech and voice rehabilitation. At approximately 1, 4, and 10 months after operation, patients were submitted to a standardized speaking task to evaluate phonatory skills (phrase length, phonation duration, dynamics on tone, dynamics on sentence, speech rate and availability of sound), speech quality (fluency and overall intelligibility), voice quality and stoma technique (stoma noise). Tracheoesophageal speech rehabilitation proved to be successful in 94-100% of patients, as measured at approximately 10 months after operation. Furthermore, no significant overall differences were found between the three prostheses. There was a significant improvement in time for speech rate and stoma noise. As for the time effects (e.g. improvement in performance over time) no differences between the three prostheses were found.
Asunto(s)
Laringectomía , Laringe Artificial , Trastornos del Habla/terapia , Logopedia/métodos , Trastornos de la Voz/terapia , Entrenamiento de la Voz , Humanos , Estudios ProspectivosRESUMEN
Prosthesis-assisted tracheo-esophageal speech has proven its value in post-laryngectomy voice rehabilitation, although manual occlusion of the tracheostoma during speech is necessary. In contrast a tracheostoma valve enables hands-free speech. We have now had experience with 30 patients using the Blom-Singer tracheostoma valve for more than 6 months and have found that most patients prefer prosthesis-assisted speech with the tracheostoma valve. Measurement of several speech parameters with digital and valve occlusion of the tracheostoma did not show any significant differences between the two speaking conditions. Problems included maintenance of an airtight seal, outward forcing of the valve diaphragm during forced expiration and subjective increased airflow resistance.
Asunto(s)
Diseño de Equipo , Laringectomía , Laringe Artificial , Trastornos del Habla/rehabilitación , Traqueostomía , Entrenamiento de la Voz , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de la VozRESUMEN
The Groningen, Nijdam and Provox voice prostheses (VP) are all low-pressure, indwelling voice prostheses. Although there are differences concerning the valve mechanism, they have a similar design and are therefore interchangeable. In a prospective study, 845 consecutive replacements were evaluated in 158 patients. Average device lifetime differed significantly from 13 weeks for the Provox VP and 15.8 weeks for the Groningen VP, to 19 weeks for the Nijdam device. Leakage through or around a voice prosthesis was the main replacement indication. Leakage occurred significantly more often with the Provox VP (80.2%) than with the Groningen VP (58.8%) or the Nijdam VP (55%). Increased airflow resistance as a replacement indication occurred significantly more often with the Groningen VP (45.4%) and the Nijdam VP (45.9%) than with the Provox VP (22.7%). Complications during the replacement procedure were rare and usually mild. Replacement was usually an easy outpatient procedure; general anaesthesia was only necessary in 3.0% of 845 replacements, without any significant difference between the three devices. Granulation tissue and hypertrophic scar tissue formation were the most frequent local complications. They occurred in less than 10% of our patients but were significantly more common in patients with a Nijdam VP.