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EN
Psychogenic dysphonia is defined as disturbances in voice and speech quality with emotional background with lack of organic changes in the larynx. Mental condition has significant impact on the process of producing voice, functioning of respiratoryphonatory- articulation mechanism and speech prosody. The aim of the study was visual, acoustic, perceptual assessment as well as self-assessment of voice and speech quality using subjective and objective methods in patients with psychogenic dysphonia. The study included 50 patients with psychogenic dysphonia diagnosed in the Department of Clinical Fonoaudiology and Logopedics, Medical University of Białystok and treated at the Foniatric Outpatient Clinic, University Hospital in Białystok in 2017–2018. The control group consisted of 30 subjects with euphonic voice. All patients underwent subjective and objective assessment of voice and speech quality. The GRBAS scale, breathing pathway assessment, respiratory-phonatory-articulation analysis, voice and speech intensity evaluation have been performed. Speech prosody has also been examined. Patient selfassessment of voice has been conducted using Voice Handicap Index (VHI). Objective evaluation of larynx included vibrations of vocal folds visualization using High Speed Digital Imaging (HSDI). Acoustic analysis of voice quality has been performed using DiagNova Technologies. The maximum phonation time (MPT) has been determined. Hyperfunctional dysphonia is the most common clinical form of psychogenic dysphonia. Abnormal breathing pathway influence the reduction of MPT and disturbance of respiratory-phonatory-articulation coordination in patients with psychogenic dysphonia. In psychogenic dysphonia intonation and speech rate disorders are observed. Results of voice self-assessment in the majority of examined patients indicates a mild voice disability.
PL
Dysfonią psychogenną określa się zaburzenia jakości głosu i mowy o podłożu emocjonalnym przy braku pierwotnych zmian organicznych w obrębie krtani. Kondycja psychiczna człowieka w istotny sposób wpływa na proces tworzenia głosu, funkcjonowanie mechanizmu oddechowo-fonacyjno-artykulacyjnego oraz prozodię mowy. Celem pracy jest ocena wizualizacyjna, akustyczna, percepcyjna i samoocena jakości głosu oraz mowy z wykorzystaniem metod subiektywnych i obiektywnych u osób z dysfonią psychogenną. Badaniem objęto grupę 50 pacjentów z dysfonią psychogenną diagnozowanych w Zakładzie Fonoaudiologii Klinicznej i Logopedii UMB, leczonych w Poradni Foniatrycznej USK w Białymstoku w latach 2017–2018. Grupę kontrolną stanowiło 30 osób z głosem eufonicznym. U wszystkich badanych dokonano subiektywnej i obiektywnej oceny jakości głosu i mowy. Wykorzystano skalę GRBAS, wykonano ocenę toru oddechowego, badanie koordynacji oddechowo-fonacyjno-artykulacyjnej oraz natężenia głosu i mowy. Oceniano również prozodię mowy. Analizie poddano samoocenę głosu pacjentów przeprowadzoną przy użyciu kwestionariusza Voice Handicap Index (VHI). W ocenie obiektywnej narządu głosu przeprowadzono wizualizację wibracji fałdów głosowych przy użyciu techniki szybkiego filmu w sekwencji cyfrowej (High Speed Digital Imaging ; HSDI). Analizę akustyczną jakości głosu wykonano z wykorzystaniem oprogramowania firmy DiagNova Technologies. Określano także maksymalny czas fonacji (maximum phonation time ; MPT). Dysfonia czynnościowa hiperfunkcjonalna jest najczęstszą postacią kliniczną dysfonii psychogennej. Nieprawidłowy sposób i tor oddychania wpływają na skrócenie MPT oraz zaburzenie koordynacji oddechowo-fonacyjno-artykulacyjnej u pacjentów z dysfonią psychogenną. W zaburzeniach głosu o podłożu emocjonalnym występują nieprawidłowy przebieg konturów intonacyjnych wypowiedzi oraz zaburzenia tempa mowy. Analiza wyników samooceny jakości głosu u większości badanych wskazuje na poczucie małej niesprawności głosu.
EN
During pregnancy, voice quality disorders may occur in form of: edema, dryness, nervousness. The aim of the study is subjective and objective evaluation of voice quality in pregnant women. The study included 20 women in the third trimester of pregnancy, age of 20-31 diagnosed at the Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. Subjective assessment has been based on the GRBAS scale. Objective assessment of the vocal organ used the HSDI technique (High Speed Digital Imaging). In the laryngeal visualization, high-speed camera (HS) using rigid endoscope with 90 ° optics has been used. Vibration of vocal folds has been recorded during phonation of vowel "e" at 4000 frames / sec. The glottal closure (GTs), symmetry, regularity and synchronization of vocal folds vibration have been assessed. In estimating the degree of glottal insufficiency, kymography of the larynx has been performed by analyzing the value of Open Quotient (OQ). Objective acoustic evaluation of voice has been also conducted using DiagnoScope Specjalista Program. Hoarseness has been observed in 15 pregnant women, whereas voice fatigability in 20 patients. Using HSDI, the edema of vocal folds in part of the group has been observed. Decreased MPT has been found in all examined women in the third trimester of pregnancy. Hoarseness and fatigability of voice are the most frequent subjective symptoms of voice organ in the third trimester of pregnancy. Decreased MPT is recorded objectively, as well as edema and insufficiency of vocal folds using HSDI technique.
EN
Abstract Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia – phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.
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