Ali Ihsan, Hussain Raj Tajamul, Wagay Fayaz Ahmad, Ahmad Rauf
Department of Otorhinolaryngology, Government Medical College, Srinagar, J&K India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2082-2087. doi: 10.1007/s12070-020-02007-4. Epub 2020 Aug 4.
We sought to explore the frequency of stress among OPD attending Kashmiri public diagnosed as muscle tension dysphonia (MTD) and determine the subjective consequences of voice therapy in management of muscle tension dysphonia. 72 subjects that attended to ENT and HNS OPD with change of voice were prospectively evaluated and also underwent an extensive otolaryngological examination. Patients identified as MTD were provided a questionnaire which was split into 3 parts: First part dealt with the identification of the subject (age, geography, gender, profession) and also provided evaluation of perceived anxiety using Perceived Stress Scale-10. In the next part the individuals needed to assess their vocal quality based on parameters of GRBAS 4-point score scale before and also after the treatment. In the final component the subjects also needed to answer the VHI-10 (Voice Handicap Index) and also the outcome was compared with those acquired at the assessment before the beginning of the treatment. The mean age of the cohort was 30.31 ± 07.43 (age range, 12-71) and every subject was an indigenous Kashmiri. As expected, vast majority of subjects were females (43 patients). In the pooled information set, women had numerically higher PSS-10 scores than males. For women, the typical stress score was M = 18.6 and for men the average stress score was M = 16.65. In a healthy population, the typical PSS stress score is described to be 13.7 (SD = 6.6) for women and 12.1 (SD = 5.9) for men. At the Wilcoxon test for paired data, we observed a significant difference between the VHI pretreatment (mean = 19.7) and VHI post-treatment, that's at time of the research (mean = 9.73; P = 0.017). The grade (G) was assessed in terms of improvement of the vocal quality as opposed with before treatment and also the individuals demonstrated a high level of satisfaction (mean = 0.65). When looking at roughness (R) as well as breathiness (B), the individuals remember that their speech is seldom rough (mean = 0.62) and also less breathy (median = 0.44). Patients likewise noted improvement in other variables of GRBAS scale. Stress is persistent, pervasive and nearly unavoidable in contemporary life. The decades old perplexing and mind baffling pandemonium hovering around the Kashmiri population has had a tremendous impression on the psychological development of people in this region. A careful conclusion is the fact that emotional stress might play a major role in the upkeep of MTD. MTD has to be approached in a multidisciplinary environment in which closer cooperation between a laryngologist, a speech language pathologist and also a psychologist is likely.
我们试图探讨在被诊断为肌肉紧张性发音障碍（MTD）的克什米尔公立门诊患者中压力出现的频率，并确定嗓音治疗在肌肉紧张性发音障碍管理中的主观效果。对72名因嗓音改变而前来耳鼻喉科和头颈外科门诊就诊的患者进行了前瞻性评估，并进行了全面的耳鼻喉科检查。被确定为MTD的患者收到一份问卷，该问卷分为三个部分：第一部分涉及患者识别（年龄、地域、性别、职业），并使用感知压力量表-10评估感知到的焦虑。在下一部分中，个体需要根据GRBAS 4分评分量表的参数在治疗前后评估其嗓音质量。在最后一部分，受试者还需要回答嗓音障碍指数-10（VHI-10），并将结果与治疗开始前评估时获得的结果进行比较。该队列的平均年龄为30.31±7.43（年龄范围12 - 71岁），每位受试者均为克什米尔本地人。正如预期的那样，绝大多数受试者为女性（43例患者）。在汇总信息集中，女性的PSS-10得分在数值上高于男性。女性的典型压力得分为M = 18.6，男性的平均压力得分为M = 16.65。在健康人群中，女性的典型PSS压力得分为13.7（标准差 = 6.6），男性为12.1（标准差 = 5.9）。在配对数据的Wilcoxon检验中，我们观察到VHI治疗前（平均值 = 19.7）与治疗后（即研究时，平均值 = 9.73；P = 0.017）之间存在显著差异。根据嗓音质量相对于治疗前的改善情况对等级（G）进行了评估，患者表现出较高的满意度（平均值 = 0.65）。在观察粗糙度（R）和气息声（B）时，患者记得他们的语音很少粗糙（平均值 = 0.62）且气息声也较少（中位数 = 0.44）。患者同样指出GRBAS量表的其他变量也有改善。压力在当代生活中持续存在、普遍存在且几乎不可避免。困扰克什米尔人群数十年的令人费解和令人困惑的混乱局面，对该地区人们的心理发展产生了巨大影响。一个谨慎的结论是，情绪压力可能在MTD的维持中起主要作用。必须在多学科环境中处理MTD，其中喉科医生、言语语言病理学家和心理学家之间的密切合作很有必要。
