Sułkowski Wiesław J, Kowalska Sylwia
Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lódź, Poland.
Int J Occup Med Environ Health. 2005;18(4):341-9.
It has been decided to identify the most frequent diseases of the larynx in people occupationally exposed to a considerable voice load and to assess the feasibility of using videostroboscopy to diagnose voice disorders and their organic effects in order to improve the reliability of certification of occupational vocal organ diseases as well as to evaluate the functioning of new regulations on diagnosing and certifying occupational vocal organ diseases and to assay the conformity of clinical diagnoses made at voivodeship (provincial) centers (level I) with those made at scientific research institutes (level II).
The study involved an analysis of 1261 cases (1042 women and 219 men) with the vocal organ disorders referred to the ENT Unit, Nofer Institute of Occupational Medicine, Lódź, by voivodeship centers during 1999-2004 for consultation or under the appeal procedure (if applicants were denied the right to be included in the category of patients with occupational disease of the vocal organ). The majority of the patients (65.7%) were primary school teachers, and those aged 51-60 years made 54.8%. Laryngological, phoniatric and videostroboscopic examinations, when necessary, supplemented with other testing procedures (paranasal sinus imaging, allergenic tests) were taken to assess the clinical state of the patients.
As a result of these comprehensive examinations, organic changes in the larynx were detected in 161 (12.7%) cases, including 139 (11.0%) women and 22 (1.7%) men. According to current diagnostic/certifying criteria those pathologies could be classified into the category of occupational disease of the vocal organ. Paresis of vocal folds due to the insufficiency of vocal fold adductor and tensor muscles with permanent dysphonia was found in 97 (7.6%) patients, vocal nodules in 53 (4.2%) and secondary hypertrophy changes in vocal folds in 11 (0.87%) patients. The most frequent reasons for excluding the occupational etiology of the disease were functional disorders of the voice observed in 82.3% of patients in the form of hyperfunctional dysphonia (64.3%), hypofunctional dysphonia (17.0%) and dysfunctional dysphonia (about 1.0%). In 9.0% of patients, the functional disorders of the voice were accompanied by organic changes in the larynx caused by non-occupational factors.
The analysis showed that due to new Polish regulations, the number of certified occupational disease of the vocal organ was reduced; videostroboscopic tests proved to be a very helpful tool for discriminating between the functional and organic disorders of the vocal organ; and good agreement between clinical diagnoses issued at both levels (I and II) was also revealed.
已决定确定职业性承受较大嗓音负荷人群中最常见的喉部疾病，并评估使用频闪喉镜诊断嗓音障碍及其器质性影响的可行性，以提高职业性发声器官疾病认证的可靠性，评估职业性发声器官疾病诊断和认证新规定的运作情况，并分析省（一级）中心与科研机构（二级）所做临床诊断的一致性。
该研究分析了1999年至2004年间由省中心转至罗兹诺费职业医学研究所耳鼻喉科的1261例发声器官疾病病例（1042名女性和219名男性），这些病例是为了咨询或通过上诉程序而来（如果申请人被剥夺了被列入职业性发声器官疾病患者类别的权利）。大多数患者（65.7%）是小学教师，年龄在51 - 60岁的占54.8%。进行了喉镜、发声学和频闪喉镜检查，必要时辅以其他检查程序（鼻窦成像、变应原测试）以评估患者的临床状况。
经过这些全面检查，在161例（12.7%）病例中检测到喉部器质性改变，其中包括139例（11.0%）女性和22例（1.7%）男性。根据现行诊断/认证标准，这些病变可归类为职业性发声器官疾病。97例（7.6%）患者存在因声带内收肌和张肌功能不全伴永久性发音障碍导致的声带麻痹，53例（4.2%）有声带小结，11例（0.87%）有继发性声带肥厚改变。排除疾病职业病因的最常见原因是82.3%的患者存在嗓音功能障碍，表现为功能亢进性发音障碍（64.3%）、功能减退性发音障碍（17.0%）和功能性发音障碍（约1.0%）。9.0%的患者嗓音功能障碍伴有非职业因素引起的喉部器质性改变。
分析表明，由于波兰的新规定，职业性发声器官疾病的认证数量有所减少；频闪喉镜检查被证明是区分发声器官功能和器质性障碍的非常有用的工具；还揭示了两个级别（一级和二级）所做临床诊断之间具有良好的一致性。
