Istanbul Training and Research Hospital, Department of Otorhinolaryngology/Head and Neck Surgery, Istanbul, Turkey.
Istanbul Training and Research Hospital, Department of Otorhinolaryngology/Head and Neck Surgery, Istanbul, Turkey.
J Voice. 2020 May;34(3):451-455. doi: 10.1016/j.jvoice.2018.10.009. Epub 2018 Nov 16.
To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA).
Prospective clinical study.
Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux.
Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase.
RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.
揭示和比较类风湿关节炎（RA）不同阶段的嗓音病变和可检测的喉部发现。
前瞻性临床研究。
纳入我院物理治疗和康复诊所的 67 例连续 RA 患者。采用疾病活动评分-28 指数（DAS28）计算患者的疾病活动指数。采用嗓音障碍指数（VHI），患者回答 30 个功能、身体和情感方面的问题。所有患者均由同一名医生使用 70°刚性望远镜（Karl Storz，德国图特林根）进行视频喉镜检查，并进行声学嗓音分析（PRAAT 程序）。反流发现评分用于评估喉咽反流。
后连合肥厚（25.3%）和杓状软骨黏膜充血/水肿（22.3%）是最常见的发现。其他常见的发现是内喉黏液厚、声带静脉曲张。22 例患者有反流发现（32.8%）。在疾病活动期和缓解期，基频、抖动、最长发音时间和 VHI 值无显著差异（P>0.05）。在缓解期，抖动值和噪声与谐波比值显著高于活动期（P<0.05）。在活动期，异常的喉部发现更高（缓解期 28%，活动期 54%）。缓解期患者的 VHI 评分低于活动期。
RA 应纳入嗓音障碍患者的鉴别诊断。非特异性病变更为普遍。在疾病活动期，患者的客观发现和主观抱怨比缓解期更多。
