Schindler A, Capaccio P, Maruzzi P, Ginocchio D, Bottero A, Otraviani F
Department of Clinical Sciences L. Sacco, University of Milan, Italy.
Acta Otorhinolaryngol Ital. 2007 Feb;27(1):22-6.
Dysphonia is a common paediatric condition. Adult voices are usually evaluated using a set of minimal basic measurements including: endoscopic examination, aerodynamics, perception, acoustics, and self-assessment by the patient. The Voice Handicap Index is the most widely used self-assessment tool, but its use in the paediatric setting has never been reported. Aim of this study was to report Voice Handicap Index ratings in a group of dysphonic children, multi-modally assessed before and after voice therapy. The study involved 28 children (16 female, 12 male, mean age 10.9 years (range 6-12)) presenting chronic hoarseness due to vocal fold nodules (18 cases), unilateral localised oedema (6 cases) or recurrent laryngeal paralysis (4 cases). All received voice therapy for 5-6 months, and underwent voice assessments based on video-endoscopy ratings (size of nodule/ oedema or glottic closure in the case of recurrent laryngeal paralysis), maximum phonation time, GIRBAS scale, spectrograms and a perturbation analysis. All patients also completed the Voice Handicap Index. Aerodynamic, acoustic, perceptual and self-assessment data, before and after voice therapy, were compared using Wilcoxon's test and Student's t test. Correlations between the Voice Handicap Index domains were measured by means of Pearson's correlation coefficient. Post-treatment measurements showed that the nodules/oedema had decreased in size in 18 children following therapy, and two subjects with recurrent laryngeal paralysis showed improved glottic closure. Mean maximum phonation time increased slightly, but the difference was not significant. There was a general reduction in perceptual severity, but this was only significant for parameters G, B and A. Spectrographic analysis showed no significant improvement and, although the mean perturbation analysis values improved, only the difference in jitter values was significant (p = 0.016). Voice Handicap Index was applicable in all cases, and showed a clear and significant improvement (p = 0.0006). The correlations between the three Voice Handicap Index factors were close; no correlation was found between the functional domain and the physical and emotional domains. The Voice Handicap Index is a useful tool in children with dysphonia, but an adapted version validated for paediatric patients is essential.
发声障碍是一种常见的儿科疾病。成人嗓音通常使用一组基本的最小测量指标进行评估，包括：内镜检查、空气动力学、感知、声学以及患者自我评估。嗓音障碍指数是使用最广泛的自我评估工具，但它在儿科环境中的应用从未有过报道。本研究的目的是报告一组发声障碍儿童在嗓音治疗前后进行多模式评估时的嗓音障碍指数评分。该研究纳入了28名儿童（16名女性，12名男性，平均年龄10.9岁（范围6 - 12岁）），他们因声带小结（18例）、单侧局限性水肿（6例）或喉返神经麻痹（4例）而出现慢性声音嘶哑。所有儿童均接受了5 - 6个月的嗓音治疗，并基于视频内镜评分（对于喉返神经麻痹患者为小结节/水肿大小或声门闭合情况）、最长发声时间、GIRBAS量表、声谱图和微扰分析进行嗓音评估。所有患者还完成了嗓音障碍指数评估。使用Wilcoxon检验和学生t检验比较了嗓音治疗前后的空气动力学、声学、感知和自我评估数据。通过Pearson相关系数测量嗓音障碍指数各领域之间的相关性。治疗后测量结果显示，18名接受治疗的儿童声带小结/水肿大小减小，两名喉返神经麻痹患者的声门闭合情况有所改善。平均最长发声时间略有增加，但差异不显著。感知严重程度总体有所降低，但仅在参数G、B和A方面具有显著性。声谱分析未显示出显著改善，尽管平均微扰分析值有所改善，但只有抖动值的差异具有显著性（p = 0.016）。嗓音障碍指数在所有病例中均适用，且显示出明显且显著的改善（p = 0.0006）。嗓音障碍指数的三个因素之间相关性密切；功能领域与身体和情感领域之间未发现相关性。嗓音障碍指数是发声障碍儿童的有用工具，但针对儿科患者进行验证的适配版本至关重要。
