ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
kulak burun boğaz
ve baş boyun cerrahisi dergisi
http://dergi.kbb-bbc.org.tr
Koşulsuz Destek Verenler
Kayıtlı İndeksler





ORIGINAL RESEARCH

Vokal Nodülü Olan Çocuklarda Objektif ve Subjektif Ses Değerlendirmesi
Evaluation of Objective and Subjective Voice Analysis in Children with Vocal Nodule
Received Date : 22 Sep 2021
Accepted Date : 09 Nov 2021
Available Online : 22 Nov 2021
Doi: 10.24179/kbbbbc.2021-85758 - Makale Dili: TR
KBB ve BBC Dergisi. 2022;30(1):17-22
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: The study aimed to evaluate the voices of the pediatric group with vocal cord nodules using acoustic, aerodynamic sound analysis methods. Material and Methods: This study included 35 subjects diagnosed with vocal cord nodule as a study group and 34 children as a control group between 6 and 12 years (Patient group average age 9.77±2.197, average age of healthy group 9.06±2.059). Voice analysis was evaluated using the Multi-Dimensional Voice Program (MDVP) and the Maximum Phonation Time (MPT) and s/z times were measured for aerodynamic evaluation. In addition, parents were required to fill out the Pediatric Voice Handicap Index to identify the social, emotional effects of voice deterioration on children. Results: Significant differences were found in MDVP data, MPT, and s/z ratio between subjects in the study and control group (p<0.05). S/Z ratios were increased while MPT values were shortened in the group with vocal cord nodules. It was observed that the study group scores were significantly higher in all parts of the index (p<0.05). Conclusion: Vocal cord nodules were found to occur mainly in male children with a higher and excessive intensity of speaking tendency. It was observed that the presence of vocal cord nodule adversely affected the voice quality. Because of the difficulty in the assessment of larynx with noninvasive methods in children, it is important to assess the acoustic characteristics of the voice by using objective and subjective methods. It was thought that voice analysis, aerodynamic assessment, and handicap index results are helpful in diagnosing for children with the vocal nodule.
ÖZET
Amaç: Bu çalışma, vokal kord nodülü olan pediatrik grubun seslerini akustik, aerodinamik ses analiz yöntemleri ile değerlendirmek amacıyla gerçekleştirildi. Gereç ve Yöntemler: Çalışma yaşları 6 ile 12 arasında değişen, vokal kord nodülü tanısı almış 35 olgu ve kontrol grubu olan 34 çocuktan oluşmaktadır (Olgu grubu yaş ortalaması 9,77±2,197, kontrol grubu 9,06±2,059). Olgulara “Multi Dimensional Voice Program (MDVP)” kullanılarak ses analizi değerlendirmesi yapıldı ve aerodinamik değerlendirme için Maksimum Fonasyon Zamanı (MFZ) ve s/z süreleri ölçüldü. Ses bozukluğunun çocuk üzerindeki sosyal, duygusal vb. etkilerini belirlemek için Pediatrik Ses Handikap İndeksi (Pediatric Voice Handicap Index (PSBİ) ebeveynler tarafından dolduruldu. Bulgular: Çalışmaya katılan olgu ve kontrol grubu arasında MDVP verilerinde, MFZ ve s/z oranında anlamlı farklılık gözlendi (p<0,05). Olgu grubunda, MFZ değerinde kısalma gözlenirken, s/z oranında artış gözlendi. İndeksin tüm bölümlerinde, çalışma grubu puanlarının anlamlı derecede yüksek olduğu gözlendi (p<0,05). Sonuç: Vokal kord nodülünün daha aşırı ve yüksek şiddette konuşma eğiliminde olan erkek çocuklarda daha sık oluştuğu sonucuna ulaşıldı. Vokal kord nodülünün varlığı, ses kalitesini olumsuz yönde etkilediği gözlendi. Çocuklarda larinksin noninvaziv yöntemlerle değerlendirilmesindeki güçlükten dolayı, sesin akustik özelliklerini objektif ve subjektif yöntemlerle değerlendirmek son derece önemlidir. Vokal nodüllü çocuklarda ses analizinin, aerodinamik değerlendirmenin ve handikap indeksinin sonuçlarının hastalığın tanısında yardımcı olacağı düşünülmektedir.
KAYNAKLAR
  1. Çevik S. Koro Eğitimi Yönetimi ve Teknikleri. 2. Baskı. Ankara: Yurt Renkleri Yayınevi; 1999. [Link] 
  2. Franz P, Aharinejad S. The microvasculature of the larynx: a scanning electron microscopic study. Scanning Microsc. 1994;8(1):125-30; discussion 131. [PubMed] 
  3. Boone DR, McFarlane SC. The Voice and Voice Therapy. 6th ed. Boston: Allyn and Bacon; 2000. [Link] 
  4. DM, K. A. R. C. B. (1997). Heisy D. Resolving the battle between internal and external standards for visual perceptual ratings of laryngeal images: an essential step towards reliable research protocol. In Meeting of the ASHA.
  5. Wilson DK. Voice Problems of Children. 3rd ed. Baltimore: Williams& Wilkins; 1987. [Link] 
  6. Aronson AE. Clinical Voice Disorders. 3rd ed. New York: Thieme; 1990. [Link] 
  7. Wolfe V, Fitch J, Cornell R. Acoustic prediction of severity in commonly occurring voice problems. J Speech Hear Res. 1995;38(2): 273-9. [Crossref]  [PubMed] 
  8. Yücetürk AV, Günhan K. Multidimensional assessment of voice and speech after supra cricoid laryngectomy with cricohyoidopexy. J Laryngol Otol. 2004;118(10):791-5. [Crossref]  [PubMed] 
  9. Öğüt, F. Ses analiz yöntemleri. T Klin KBB, (In Turkish).2002;2(3 Suppl 1):18-21.
  10. Sataloff RT. The professional voice: Anatomy, function, and general health. Part I J Voice. 1987;1(1):92-104. [Crossref] 
  11. Salturk Z, Ozdemir E, Kumral TL, Sayin İ, Yelken K, Sari H, et al. Reliability and Validation of the Turkish Version of the Pediatric Voice-Related Quality of Life Survey. J Voice. 2018; 32(4):514.e13-514.e17. [Crossref]  [PubMed] 
  12. Çinar R, Gökdoğan Ç, Kemaloğlu YK, Yılmaz M. Turkish Adaptation of the Pediatric Voice Related Quality of Life Survey: A validity and reliability study. Int J Pediatr Otorhinolaryngol. 2018;111:183-6. [Crossref]  [PubMed] 
  13. Hartnick CJ. Validation of a pediatric voice quality-of-life instrument: The pediatric voice outcome survey. Arch Otolaryngol Head Neck Surg. 2002;128(8):919-22. [Crossref]  [PubMed] 
  14. Zur KB, Cotton S, Kelchner L, Baker S, Weinrich B, Lee L. Pediatric Voice Handicap Index (pVHI): a new tool for evaluating pediatric dysphonia. Int J Pediatr Otorhinolaryngol. 2007; 71(1):77-82. [Crossref]  [PubMed] 
  15. Holmberg EB, Hillman RE, Hammarberg B, Södersten M, Doyle P. Efficacy of a behaviorally based voice therapy protocol for vocal nodules. J Voice. 2001;15(3):395-412. [Crossref]  [PubMed] 
  16. Titze IR. Mechanical stress in phonation. J Voice. 1994;8(2):99-105. [Crossref]  [PubMed] 
  17. Franco RA, Andrus JG. Common diagnoses and treatments in professional voice users. Otolaryngol Clin North Am. 2007;40(5):1025-61, vii. [Crossref]  [PubMed] 
  18. Hersan R, Behlau M. Behavioral management of pediatric dysphonia. Otolaryngol Clin North Am. 2000;33(5):1097-110. [Crossref]  [PubMed] 
  19. Kotby MN. The Accent Method of Voice Therapy. 1st ed. San Diego: Singular Publ; 1995. [Link] 
  20. Shearer WM. Diagnosis and treatment of voice disorders in school children. J Speech Hear Disord. 1972;37(2):215-21. [Crossref]  [PubMed] 
  21. Wilson FB. Emotional stres may cause voice anomalies in kids. JAMA. 1971;216:2085.
  22. Andrews ML, Summers AC. A clinical perspective: infants, toddlers and preschoolers. Voice treatment for children and adolescent. Canada: Singular Thomson Learning. 2002.p. 11-7.
  23. Whiteside SP, Hodgson C. Some acoustic characteristics in the voices of 6- to 10-year-old children and adults: a comparative sex and developmental perspective. Logoped Phoniatr Vocol. 2000;25(3):122-32. [Crossref]  [PubMed] 
  24. Busby PA, Plant GL. Formant frequency values of vowels produced by preadolescent boys and girls. J Acoust Soc Am. 1995;97(4): 2603-6. [Crossref]  [PubMed] 
  25. Hasek CS, Singh S, Murry T. Acoustic attributes of preadolescent voices. J Acoust Soc Am. 1980;68(5):1262-5. [Crossref]  [PubMed] 
  26. Wertzner HF, Schreiber S, Amaro L. Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders. Braz J Otorhinolaryngol. 2005; 71(5):582-8. [Crossref]  [PubMed] 
  27. Niedzielska G, Glijer E, Niedzielski A. Acoustic analysis of voice in children with noduli vocales. Int J Pediatr Otorhinolaryngol. 2001; 60(2):119-22. [Crossref]  [PubMed] 
  28. Holmberg EB, Doyle P, Perkell JS, Hammarberg B, Hillman RE. Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy. J Voice. 2003; 17(3):269-82. [Crossref]  [PubMed] 
  29. Mailänder E, Mühre L, Barsties B. Lax vox as a voice training program for teachers: A pilot study. J Voice. 2017;31(2):262.e13-262.e22. [Crossref]  [PubMed] 
  30. Eryılmaz A, Müjdeci B, Acar A. Vokal nodülü olan yetişkinlerde ses terapisi sonuçları [Results of voice therapy in vocal nodules in adults]. Bozok Tıp Dergisi. 2014;1(1):6-11. [Link] 
  31. Morrison M, Rammage L, Nichol H, Pullan B, May P, Salkeld L. Anatomy and Physiology of Voice Production. In: Morrison M, Rammage L, eds. The Management of Voice Disorders. 2nd. Boston: Springer; 1994. p.161-200. [Crossref] 
  32. Cox NB, Morrison MD. Acoustic analysis of voice for computerized laryngeal pathology assessment. J Otolaryngol. 1983;12(5):295-301. [PubMed] 
  33. Schindler A, Tiddia C, Ghidelli C, Nerone V, Albera R, Ottaviani F. Adaptation and validation of the Italian Pediatric Voice Handicap Index. Folia Phoniatr Logop. 2011;63(1):9-14. [Crossref]  [PubMed]