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