ORIGINAL RESEARCH
Effectiveness of Voice Therapy in Organic and Functional Voice Disorders
Organik ve Fonksiyonel Disfonilerde Ses Terapisinin Etkinliği
Received Date : 20 May 2023
Accepted Date : 17 Oct 2023
Available Online : 20 Oct 2023
Sibel YILDIRIMa, Zahide Çiler BÜYÜKATALAYa, Gürsel DURSUNa
aAnkara Üniversitesi Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları ABD, Ankara, Türkiye
Doi: 10.24179/kbbbbc.2023-98038 - Makale Dili: TR
Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi. 2024;32(1):8-15
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 aim of this study is to evaluate the effectiveness
of voice therapy in patients with organic and functional dysphonia
by using objective and subjective parameters. Material and
Methods: 110 patients who met the criteria were included in the study.
All patients underwent general ear-nose-throat (ENT) examinations.
Videolaryngostroboscopic and flexible nasopharyngolaringoscopic laryngeal
examinations were performed and image recordings were
taken. Acoustic and aerodynamic voice analyzes were performed. Fundamental
frequency (F0-Hz), jitter (%), shimmer (decibel-dB), harmonic
noise ratio (HNR-dB) and maximum phonation time (MBT sec)
were measured. The Voice-Related Quality of Life Questionnaire
(VRQOL) was used for subjective voice evaluation. Voice therapy was
given to the patients by the ENT physician who was conducting the research.
At the end of the therapy, all measurements were repeated and
the difference was analyzed. Results: Of the 110 patients, 76 were
women and 34 were men. The mean age was 43.17±13.67 years. The
median duration of dysphonia was 7 (minimum 1 to maximum 180)
months. Organic dysphonia was detected in 70 patients. 53 had functional
dysphonia. The distribution of organic dysphonias was 38.57%
vocal cord nodules, 48.57% vocal cord paralysis and 12.85% sulcus
vocalis. 42.5% of functional dysphonias were muscle tension dysphonia,
57.5% of them were psychogenic dysphonia. After the voice therapy
MBT and HNR were improved, jitter and shimmer values were
reduced and VRQOL scores increased in vocal cord paralysis and nodules.
In sulcus vocalis group there were no significant changes in the
acoustic, aerodynamic measurements and VRQOL scores. In functional
dysphonia group, positive changes were observed in acoustic analysis
parameters with voice therapy. Also there was a significant improvement
in quality of life scores. Conclusion: Voice therapy is an effective
treatment method in suitable patient groups. It improves both sound
quality and quality of life. When approaching patients with dysphonia,
it should be primarily considered as a treatment method that is lowcost,
easy to implement and allows close patient follow-up.
Keywords: Dysphonia; voice disorders; voice quality; voice training, voice therapy
ÖZET
Amaç: Disfoni şikâyeti ile başvuran organik ve fonksiyonel disfonili
hastalarda uygulanan ses terapisi yöntemlerinin etkinliğini objektif
ve subjektif parametreler kullanarak değerlendirmek amaçlanmıştır.
Gereç ve Yöntemler: Kriterlere uyan 110 hasta çalışmaya dâhil
edildi. Tüm hastaların genel kulak-burun-boğaz muayeneleri yapılıp
videolaringostroboskopik ve fleksibl nazofaringolaringoskopik larinks
incelemeleri yapılıp görüntü kayıtları alındı. Hastaların akustik ve aerodinamik
ses analizleri yapıldı. Temel frekans (F0-Hz), jitter (%),
shimmer (desibel-dB), harmonik gürültü oranı [harmonic noise ratio
(HNR-dB)] ve maksimum fonasyon zamanı (MFZ-sn) ölçüldü. Subjektif
ses değerlendirmesinde Sesle İlişkili Yaşam Kalitesi Ölçeği
(SİYKÖ) kullanıldı. Hastalara ses terapisi, araştırma yürütücüsü tarafınca
verildi. Terapi sonunda tüm ölçümler tekrarlanıp aradaki fark analiz
edildi. Bulgular: 110 hastanın 76’sı kadın, 34’ü erkekti. Ortalama
yaş 43,17±13,67 idi. Ortanca ses bozukluğu süresi 7 (minimum: 1-maksimum:
180) aydı. Hastaların 70’inde organik disfoni saptanırken;
53’ünde fonksiyonel disfoni mevcuttu. Organik disfonilerin dağılımı
%38,57 vokal fold nodülü, %48,57 vokal fold paralizisi, %12,85 sulkus
vokalis şeklindeydi. Fonksiyonel disfonilerin ise %42,5’ini kas gerilim
disfonisi, %57,5’ini psikojen disfoni oluşturmaktaydı. Vokal fold paralizilerinde
ve nodüllerde ses terapisine yanıt pertürbasyon parametrelerinde
düşme, MFZ’de uzama, HNR’de artış, SİYKÖ skorlarında
yükselme yönünde olmuştur. Sulkus vokaliste akustik, aerodinamik ölçümlerde
ve SİYKÖ skorlarında terapi sonrası anlamlı değişiklik saptanmamıştır.
Fonksiyonel disfonilerde tüm hasta gruplarında ses terapisi
ile incelenen parametrelerde olumlu yönde değişiklikler olduğu görülmüştür.
Özellikle yaşam kalitesi skorlarında belirgin iyileşme olmuştur.
Sonuç: Ses terapisi uygun hasta gruplarında etkili bir tedavi
yöntemidir. Hem ses kalitesini hem de yaşam kalitesini artırmaktadır.
Disfonili hastalara yaklaşımda maliyeti düşük, uygulanabilirliği kolay
ve yakın hasta takibine olanak sağlayan bir tedavi yöntemi olarak öncelikli
olarak değerlendirilmelidir.
Anahtar Kelimeler: Disfoni; ses bozuklukları; ses özelliği; ses eğitimi; ses terapisi
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