Stanton A E, Sellars C, Mackenzie K, McConnachie A, Bucknall C E
Department of Respiratory Medicine, Glasgow Royal Infirmary, Scotland, UK.
J Laryngol Otol. 2009 Jan;123(1):96-102. doi: 10.1017/S002221510800323X. Epub 2008 Jul 22.
Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer.
Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade-roughness-breathiness-asthenicity-strain system (GRBAS). Laryngoscopy was also performed.
The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0-21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 microg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy.
Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.
哮喘治疗可能会影响患者的嗓音。我们对一家难治性哮喘诊所的患者嗓音疾病进行了详细的特征描述，并确定了患者的认知与经验丰富的观察者的客观评估之间的关系。
43名患者参与了这项研究。受试者完成了自我管理的嗓音症状评分（VoiSS）问卷，并进行了数字录音。这些录音使用粗糙度-气息声-无力感-紧张度评分系统（GRBAS）进行评分。还进行了喉镜检查。
VoiSS的中位数为26（范围为3至83）。17名喉结构和功能正常的患者的VoiSS显著低于26名有功能性或结构性喉部异常的患者（范围分别为4至46；中位数为22，以及范围为3至83；中位数为33）（差异的95%置信区间为0.0至21.0；p = 0.044）。这两组之间GRBAS量表的总体评分没有差异，只有13名患者的GRBAS评分为1或更高，这被认为表明存在嗓音问题。相关的GRBAS评分与嗓音症状评分子量表之间存在正相关。虽然结构性和功能性异常患者的嗓音症状评分明显更异常，但该评分作为预测工具的表现仅为中等（敏感性54%；特异性71%）。然而，嗓音症状评分与更耗费人力的GRBAS评分表现相当（敏感性57%；特异性60%）。患者吸入糖皮质激素的剂量（中位剂量为1000微克丙酸倍氯米松或等效剂量）与他们GRBAS量表的总体评分有统计学上的显著关系（r = 0.56；p < 0.001），但与他们的VoiSS无关。只有一名患者有喉部念珠菌病的证据，只有两名患者有任何提示类固醇诱导性肌病的异常证据。
哮喘患者中嗓音疾病很常见，不应立即归因于类固醇相关的念珠菌病。VoiSS作为哮喘患者耳鼻喉科和/或言语及语言治疗转诊的筛查工具，值得进一步进行前瞻性验证。
