Department of Otorhinolaryngology, Division of Voice Clinic, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
Department of Otorhinolaryngology, Division of Voice Clinic, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
J Voice. 2019 Sep;33(5):812.e15-812.e18. doi: 10.1016/j.jvoice.2018.04.015. Epub 2018 Aug 28.
Muscle tension dysphonia (MTD) is generally diagnosed through clinical history and physical examination. Several diagnostic or classification systems exist, such as those of Van Lawrence, Morrison-Rammage, and Koufman, that delineate MTD and distinguish subtypes on the basis of laryngoscopic features. The aim of this study is to determine which of the clinical features included in these classifications are most related to the aerodynamic profile of MTD.
This is an analytic retrospective study.
This study evaluates a series of 30 consecutive patients, all over 18 years old, who attended the voice clinic consult of our department and were diagnosed with MTD. All subjects underwent fiberoptic nasal endoscopy, acoustic voice assessment, and aerodynamic voice assessment. The study only includes patients with a pathological aerodynamic profile. Presence or absence of each laryngoscopic feature in the full range of features in the Van Lawrence, Morrison-Rammage, and Koufman classification systems was evaluated independently by three experts. Cohen's kappa coefficient was calculated to indicate the degree of concordance between the experts. The chi-squared test was used to determine the degree of association between clinical features and mean value of the subglottic pressure peak (mmHO).
Clinical parameters that were found to have a statistically significant association (P < 0.05) with an alteration in mean subglottic pressure peak were those related to anteroposterior and lateral compression of the larynx in Van Lawrence, Morrison-Rammage, and Koufman classification systems.
While several studies have sought to clarify the laryngoscopic features of MTD, the current study is the first to evaluate these features in subjects who have been objectively diagnosed by means of aerodynamic voice assessment. The laryngoscopic features most strongly related to an aerodynamic profile of MTD were anteroposterior compression of the larynx, lateral compression of the larynx, and vestibular fold contribution to phonation.
肌肉紧张性发声障碍（MTD）通常通过临床病史和体格检查进行诊断。目前存在几种诊断或分类系统，如 Van Lawrence、Morrison-Rammage 和 Koufman 等分类系统，这些系统根据喉镜特征对 MTD 进行划分并区分亚型。本研究旨在确定这些分类中包含的哪些临床特征与 MTD 的气动特征最相关。
这是一项分析性回顾性研究。
本研究评估了连续 30 例年龄均超过 18 岁的患者，他们均因 MTD 到我科嗓音诊所就诊。所有患者均接受了纤维鼻内窥镜检查、声学嗓音评估和气动嗓音评估。本研究仅纳入气动特征异常的患者。由三位专家独立评估 Van Lawrence、Morrison-Rammage 和 Koufman 分类系统中所有特征的存在或缺失情况。计算 Cohen's kappa 系数以表示专家之间的一致性程度。采用卡方检验确定临床特征与声门下压峰值均值（mmHO）之间的关联程度。
与声门下压峰值均值改变有统计学显著关联（P < 0.05）的临床参数与 Van Lawrence、Morrison-Rammage 和 Koufman 分类系统中的喉前后向和侧向压缩有关。
尽管有多项研究试图阐明 MTD 的喉镜特征，但本研究是首次对经气动嗓音评估客观诊断的患者进行这些特征的评估。与 MTD 气动特征关系最密切的喉镜特征为喉前后向压缩、喉侧向压缩和杓状软骨声带突贡献发音。
