INTRODUÇÃO: As queixas vocais e de deglutição podem ser apresentadas após o tratamento cirúrgico da doença de tireóide em pacientes com ou sem a mobilidade laríngea preservada. O objetivo do presente estudo foi avaliar e comparar a voz e a deglutição de pacientes com e sem mobilidade laríngea alterada após a tireoidectomia. MÉTODOS: Estudo prospectivo no qual foram avaliados pacientes com doença de tireóide divididos em dois grupos: GA, com mobilidade laríngea alterada após a tireoidectomia e GB, preservada. O protocolo de avaliação vocal perceptivo-auditiva e acústica e nasofibroscopia da deglutição foi aplicado no pré, pós-operatório recente e tardio. Ambos apresentaram percentual maior de mulheres, da faixa etária entre 46 a 65 anos e de tireoidectomia total. O número reduzido de tabagistas e da indicação de esvaziamento cervical também foi comum aos dois grupos. O carcinoma papilífero foi mais freqüente no GA e o bócio, no GB; e o volume do tecido ressecado foi menor no GA em relação ao GB. RESULTADOS: A avaliação da deglutição revelou que no GA, não houve alteração no pré-operatório (PRE). No pósoperatório recente (POR) foi observada em 87% e no pós-operatório tardio (POT), em 67%. Houve diferença estatística entre os períodos PRE e POR e PRE e POT (p<0,001). A penetração e aspiração com líquido foram identificadas em 33% da amostra no POR (p=0,014). A estase de alimento ocorreu em 87% no POR e 60% no POT(p<0,001). No GB, somente os resultados entre PRE e POR tiveram significância estatística para deglutição, com aumento de 44% no número de indivíduos com disfagia, apresentando estase e escape prematuro do alimento. Os resultados de voz indicaram que a disfonia em grau discreto caracterizada pela rugosidade esteve presente em 67% da amostra do GA no PRE. Houve diferença significativa entre PRE e POR, no grau geral, tensão, instabilidade, pitch, loudness e foco ressonantal. Entre PRE e POT, a significância ocorreu apenas no pitch e loudness. Os dados acústicos não apresentaram diferença relevante no GA. No GB, 87% foi classificado como disfônico no PRE, com rugosidade (85%) discreta (64%) e ressonância faringolaríngea (67%) como as características mais notadas. A comparação entre PRE e POR revelou piora com diferença significante no grau geral, tensão, pitch e loudness. Entre PRE e POT, houve diferença apenas no pitch e loudness. CONCLUSÕES: Pacientes com doença de tireóide apresentam disfonia mesmo antes da cirurgia. Após a tireoidectomia, apresentam disfonia e disfagia, mais evidentes no pós-operatório recente e mais graves nos indivíduos com mobilidade laríngea alterada. As disfunções estão associadas a fatores supraglóticos e faríngeos e não somente a mobilidade de pregas vocais e podem ocorrer devido a intubação orotraqueal, manipulação da musculatura extrínseca e danos do nervo laríngeo. / INTRODUCTION: The vocal and deglutition complaints can be presented after surgical treatment of thyroid disease in patients with or without preserved laryngeal mobility. The objective of this study was to evaluate and to compare the voice and swallowing function of patients with and without laryngeal mobility after thyroidectomy. METHODS: This prospective study evaluated patients with thyroid disease divided in two groups: GA with laryngeal mobility modified after surgery and GB, preserved. The perceptual and acoustical analysis and fiberoptic endoscope of swallowing evaluation protocol were applied at preoperatory, recent and late post operatory. Both groups had presented bigger percentage of women, with age between 46 and 65 years, and total thyroidectomy. Reduced numbers of smokers and indication of neck dissection was common to the two groups. Papillary carcinoma was more frequent in the GA, and the benign tumor in the GB; and resected tissue volume was smaller in the GA in relation to GB. RESULTS: The evaluation of the deglutition indicated that the GA did not have alteration at preoperatory (PRE). At recent postoperative (POR) it was observed in 87% and at late period (POT), in 67%. There was statistical difference between PRE and POR, and PRE and POT (p< 0,001). Penetration and aspiration with liquid had been identified in 33% of the sample at POR (p=0,014). Residue of food occurred in 87% at POR and 60% at POT (p< 0,001). In the GB, the results between PRE and POR had significance only for deglutition, with increase of 44% in the number of individuals with dysphagia, presenting residue and premature escape of the food. Voice results had indicated light degree dysphonia characterized by the roughness in 67% of the sample of the GA at PRE. There was significant difference between PRE and POR, in the global grade, strain, instability, pitch, loudness and resonance focus. Between PRE and POT, the significance it occurred only in pitch and loudness. The acoustic data had not presented statistical difference in the GA. In GB, 87% was classified as dysphonic at PRE, with light (64%) roughness (85%) and pharyngolaryngeal resonance (67%) as the more observed characteristics. The comparison between PRE and POR showed worsening with significant difference in the global grade, strain, pitch and loudness. Between PRE and POT, it had difference only in pitch and loudness. CONCLUSIONS: Patients with thyroid disease present dysphonia before the surgery. After thyroidectomy, presents dysphonia and dysphagia, evidenced at POR and more severe in the individuals without laryngeal mobility. These dysfunctions are associated to pharyngeal and laryngeal factors and occur due to orotracheal intubation, manipulation of the extrinsic muscle and damage of the laryngeal nerve.

Made available in DSpace on 2016-04-27T18:11:57Z (GMT). No. of bitstreams: 1 Ana Carolina de Assis Moura Ghirardi.pdf: 1345817 bytes, checksum: bdd2edd16052f1795c01817766f2e654 (MD5) Previous issue date: 2012-10-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The voice is the main work tool for teachers. Correct identification of a disorder through eficiente methods of assessment and screening will contribute to planning actions and devising specific public policies for this population. Aim: to analyze the different methods of identification and assessment and to propose a screening instrument for voice disorders in teachers. Method: The subjetcs of the study are 252 female teachers of the public school system of São Paulo, who had their voices recorded and analyzed by three speech-language pathologists using the GRBASI scale to classify their voice qualities (with or without disorder). In the same day of voice recording, subjects underwent vocal fold examinations, and the responsible doctor classified the images (with or without disorder). The teachers also answered questions in the Vocal Aspects Domain of the Teacher Voice Production Conditions questionnaire (CPVP) and the Voice Handicap Index (VHI). The data were submitted to statistical analysis, conducted with two purposes: 1) to verify the agreement between voice perceptive-auditory and vocal fold assessment, and 2) to devise and validate a screening instrument for voice disorders in teachers. In order to study the agreement in between both assessments, Kappa s correlation coefficient was calculated with level of significance at p &#8804;0.05. To devise the screening instrument, the data of 130 teachers (sample A) with and without voice disorder were used. An exploratory factorial analysis was conducted from the list of 21 symptoms originally in the Vocal Aspects domain of the CPV-P, and the items with correlation coefficient greater than 0.50 were chosen. A ROC curve was plotted in order to identify the best cut-off point to select teachers who may have a voice disorder and Cronbach s alpha coefficient (&#945;) was calculated in order to assess the score- s internal consistency. The external validation of the instrument was conducted using the data of the 122 remaining subjects (Sample B). Each teacher s score was calculated and the internal consistency of the data was analyzed using Cronbach s alpha coefficient (&#945;). Next, the mean scores and 95% confidence intervals were calculated. The association between the scores and assessment using GRBASI scale was calculated using the chi-square test (p&#8804;0,05), and concurrent validity was analyzed calculating Spearman s correlation coefficient (r) between the score of the proposed instrument and VHI results. Results: The gross agreement between voice quality and vocal fold assessment was 77.9, and Kappa agreement index between both assessments was k = 0.40 (p < 0.001). The 12 symptoms selected by the factorial analysis to compose the Screening Index for Voice Disorder (SIVD) were: hoarseness, voice loss, breaking voice, low-pitched voice, phlegm, dry cough, cough with secretion, pain when speaking, pain when swallowing, secretion in throat, dry throat and strained speech. Chronbach s alpha coefficient for Sample A was &#945; = 0,86. The score was defined as the simple sum of the number of present symptoms and the cut-off was five points. Chronbach s alpha coefficient for sample B was &#945; = 0.89. For this sample, the instrument s sensitivity with cut-off=5 was 92% and specificity 39%. There was a statistically significant association (p &#8804;0.001) between the SIVD score and voice quality assessment using the GRBASI scale. There was also statistically significant correlation (p &#8804;0.001) between the total VHI score and SIVD score, and the same was true for each VHI domain and SIVD score. Final Remarks: The association of perceptive-auditory vocal assessment and vocal fold evaluation should be considered the gold-pattern in voice disorder diagnosis. The SIVD is a valid instrument for screening with a high sensitivity level. Therefore, its use will aid in mapping voice disorders, and in planning public health actions and devising public policies regarding teachers / Professores têm na voz a sua principal ferramenta de trabalho. A correta identificação de um distúrbio por meio de métodos eficientes de avaliação e triagem contribuirá para o planejamento de ações e delineamento de políticas públicas específicas para essa população. Objetivo: analisar os diferentes métodos de identificação e avaliação do distúrbio de voz e propor um instrumento para triagem desse distúrbio em professores. Método: Os sujeitos deste estudo são 252 professoras da rede municipal de São Paulo, que tiveram suas vozes gravadas, e posteriormente analisadas por três fonoaudiólogas, que utilizaram a escala GRBASI para classificar a qualidade vocal dos sujeitos (com ou sem alteração). No mesmo dia da gravação os sujeitos realizaram exame perceptivo-visual das pregas vocais, e o médico otorrinolaringologista responsável classificou as imagens (com e sem alteração). As professoras responderam também às questões relativas ao domínio de Aspectos Vocais do questionário Condição de Produção Vocal do Professor (CPV-P), e ao Índice de Desvantagem Vocal (IDV). Os dados foram duplamente digitados e submetidos a análise estatística, realizada com dois objetivos: 1) - verificar a concordância entre a avaliação perceptivo-auditiva da voz e de pregas vocais apenas nas professoras com queixa vocal, e 2) desenvolver e validar um instrumento de triagem para o distúrbio de voz em professores. A fim de se estudar a concordância entre as duas formas de avaliação, foi calculado o coeficiente de correlação Kappa (k), com nível de significância p &#8804;0.05. Para desenvolver o instrumento de triagem foram utilizados os dados de 130 professoras (Amostra A) com e sem distúrbio de voz. Realizou-se uma análise fatorial exploratória a partir da lista de 21 sintomas vocais que compõem o domínio de Aspectos Vocais do CPV-P, e foram selecionados os itens que obtiveram coeficiente de correlação maior do que 0.50. Traçou-se uma curva ROC a fim de identificar o melhor ponto de corte para seleção de professoras que poderiam ter um distúrbio de voz, e calculou-se o coeficiente alfa de Cronbach (&#945;) para avaliar a consistência interna do escore. A validação externa do instrumento foi realizada a partir dos dados dos 122 sujeitos restantes (Amostra B). O escore de cada sujeito foi calculado, e a consistência interna dos dados foi analisada por meio do coeficiente alfa de Cronbach (&#945;). A seguir, foram calculados os escores médios e Intervalos de Confiança de 95%. A associação entre os escores obtidos e o resultado da avaliação pela escala GRBASI foi calculada por meio do teste do quiquadrado (p&#8804;0,05), e a validade concorrente foi analisada por meio do cálculo do coeficiente de correlação de Spearman (r) entre o escore do instrumento proposto e os resultados do IDV. Resultados: A concordância bruta entre a avaliação da voz e avaliação das pregas vocais foi 77,9, e o índice de concordância Kappa entre as duas avaliações foi k = 0,40 (p < 0,001). Os 12 sintomas selecionados pela análise fatorial para compor o índice de triagem para distúrbio de voz (ITDV) foram: rouquidão, perda da voz, falha na voz, voz grossa, pigarro, tosse seca, tosse com secreção, dor ao falar, dor ao engolir, catarro na garganta, garganta seca, e cansaço ao falar. O coeficiente alfa de Cronbach para a amostra A foi &#945; = 0,86. O escore foi definido como a somatória simples do número de sintomas presentes e o ponto de corte estabelecido foi de cinco pontos. O coeficiente alfa de Cronbach para a amostra B foi &#945; = 0,89. Para essa amostra, a sensibilidade do instrumento com o ponto de corte = 5 foi 92% e especificidade 39%. Foi encontrada associação estatisticamente significativa (p &#8804;0,001) entre o escore no ITDV e a avaliação da qualidade vocal realizada por meio da escala GRBASI. Também houve correlação estatisticamente significativa (p &#8804;0,001) entre o escore total do IDV e a pontuação no ITDV e o mesmo também ocorreu quando comparados cada domínio do IDV e o escore do ITDV. Considerações Finais: A associação entre avaliação perceptivo-auditiva da voz e avaliação de pregas vocais deve ser considerada padrão ouro no diagnóstico de distúrbio de voz. O ITDV é um instrumento válido para triagem e possui alto grau de sensibilidade. Assim, seu uso deve auxiliar no mapeamento do distúrbio de voz do professor, bem como no planejamento de ações de saúde pública e delineamento de políticas públicas referentes à saúde vocal dessa categoria profissional

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-03-11T12:06:31Z No. of bitstreams: 1 arquivototal.pdf: 2216127 bytes, checksum: 4cf211add733544c2525d4cf2794aecc (MD5) / Made available in DSpace on 2016-03-11T12:06:31Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2216127 bytes, checksum: 4cf211add733544c2525d4cf2794aecc (MD5) Previous issue date: 2015-02-27 / Engagement and continuity in voice treatment is still a field to bewidely discussed because the frequent abandonment and resistance to change behavior are impediments to occur success in voice therapy. It has been the assumption that group therapy provides an opportunity to individual exchange of experiences and the sharing of their anguish and frustrations. Given this, it is proposed to check the stage of readiness voice therapy to pre and post group therapy in patients with behavioral dysphonia. For this, it was performed an intervention research, field, descriptive in nature. The population consisted of 60 subjects, divided into two groups, group therapy (GT, n = 35) and individual therapy (IT, n = 25), seeking speech therapy in Clinical School Voice Therapy at UFPB in the city of João Pessoa - PB. We used the URICA-Voice protocol to assess the patient's pre and post stage of readiness voice therapy. For data analysis, we used statistical analysis descriptive and inferential such as the Student's T test, and tests to verify the association between the variable compromise with age, sex, education and laringeal report. How characterization of the research, most, 71.7% (n = 43) were female; with respect to education, in GT 31.4% were in elementary school incomplete, while in IT 40% completed high school; laringeal report both groups showed a higher percentage in the injury category in the membranous portion the vocal folds, with 42.9% and 68% in GT IT; on the stage of readiness, the two groups had a higher percentage in the contemplation stage, with 80% and 71.4% in GT; and 84% and 72% in IT, in pre and post moments respectively. The results revealed no statistical difference among the groups. Only in the association between post-therapy gain with education in individual therapy group showed significant (P = 0.035) in all other variables showed no significance. / A adesão e a continuidade no tratamento de voz ainda é um campo a ser bastante discutido, pois o frequente abandono e a resistência à mudança de comportamento são impeditivos para que ocorra o sucesso na terapia fonoaudiológica. Tem-se como premissa que a terapia de grupo oportuniza ao indivíduo troca de experiências e o compartilhamento das suas angústias e frustrações. Diante disto, propõe-se verificar o estágio de prontidão ao tratamento fonoaudiológico pré e pós terapia de grupo em pacientes com disfonia comportamental. Para isto, realizou-se uma pesquisa de intervenção, de campo, de natureza descritiva. A população foi composta de 60 sujeitos, divididos em dois grupos, terapia de grupo (TG, n=35) e terapia individual (TI, n=25), que procuram o atendimento fonoaudiológico na Clínica Escola de Fonoaudiologia da UFPB, na cidade de João Pessoa – PB. Foi utilizado o protocolo URICA–Voz para avaliar o estágio de prontidão do paciente pré e pós terapia fonoaudiológica. Para análise dos dados, utilizou-se análise estatística descritiva, bem como inferencial, como o Teste T de Student, além de testes para verificar a associação entre a variável adesão com a idade, sexo, escolaridade e laudo otorrinolaringológico. Como caracterização da pesquisa, a maioria, 71,7% (n=43) era do sexo feminino; com relação a escolaridade, na TG 31,4% estavam no ensino fundamental incompleto, enquanto que na TI 40% no ensino médio completo; o laudo otorrinolaringológico ambos os grupos apresentaram maior percentual na categoria de lesão na porção membranosa das pregas vocais, com 42,9% na TG e 68% TI; relativo ao estágio de prontidão, os dois grupos apresentaram maior percentual no estágio de contemplação, com 80% e 71,4% na TG; e 84% e 72% na TI, nos momentos PRÉ e PÓS respectivamente. Os resultados obtidos não revelaram diferença estatística entre os grupos analisados. Apenas na associação entre o ganho pós-terapia com a escolaridade no grupo terapia individual apresentou significância (p=0,035), em todas as outras variáveis analisadas não apresentaram significância.

INTRODUÇÃO: As queixas vocais e de deglutição podem ser apresentadas após o tratamento cirúrgico da doença de tireóide em pacientes com ou sem a mobilidade laríngea preservada. O objetivo do presente estudo foi avaliar e comparar a voz e a deglutição de pacientes com e sem mobilidade laríngea alterada após a tireoidectomia. MÉTODOS: Estudo prospectivo no qual foram avaliados pacientes com doença de tireóide divididos em dois grupos: GA, com mobilidade laríngea alterada após a tireoidectomia e GB, preservada. O protocolo de avaliação vocal perceptivo-auditiva e acústica e nasofibroscopia da deglutição foi aplicado no pré, pós-operatório recente e tardio. Ambos apresentaram percentual maior de mulheres, da faixa etária entre 46 a 65 anos e de tireoidectomia total. O número reduzido de tabagistas e da indicação de esvaziamento cervical também foi comum aos dois grupos. O carcinoma papilífero foi mais freqüente no GA e o bócio, no GB; e o volume do tecido ressecado foi menor no GA em relação ao GB. RESULTADOS: A avaliação da deglutição revelou que no GA, não houve alteração no pré-operatório (PRE). No pósoperatório recente (POR) foi observada em 87% e no pós-operatório tardio (POT), em 67%. Houve diferença estatística entre os períodos PRE e POR e PRE e POT (p<0,001). A penetração e aspiração com líquido foram identificadas em 33% da amostra no POR (p=0,014). A estase de alimento ocorreu em 87% no POR e 60% no POT(p<0,001). No GB, somente os resultados entre PRE e POR tiveram significância estatística para deglutição, com aumento de 44% no número de indivíduos com disfagia, apresentando estase e escape prematuro do alimento. Os resultados de voz indicaram que a disfonia em grau discreto caracterizada pela rugosidade esteve presente em 67% da amostra do GA no PRE. Houve diferença significativa entre PRE e POR, no grau geral, tensão, instabilidade, pitch, loudness e foco ressonantal. Entre PRE e POT, a significância ocorreu apenas no pitch e loudness. Os dados acústicos não apresentaram diferença relevante no GA. No GB, 87% foi classificado como disfônico no PRE, com rugosidade (85%) discreta (64%) e ressonância faringolaríngea (67%) como as características mais notadas. A comparação entre PRE e POR revelou piora com diferença significante no grau geral, tensão, pitch e loudness. Entre PRE e POT, houve diferença apenas no pitch e loudness. CONCLUSÕES: Pacientes com doença de tireóide apresentam disfonia mesmo antes da cirurgia. Após a tireoidectomia, apresentam disfonia e disfagia, mais evidentes no pós-operatório recente e mais graves nos indivíduos com mobilidade laríngea alterada. As disfunções estão associadas a fatores supraglóticos e faríngeos e não somente a mobilidade de pregas vocais e podem ocorrer devido a intubação orotraqueal, manipulação da musculatura extrínseca e danos do nervo laríngeo. / INTRODUCTION: The vocal and deglutition complaints can be presented after surgical treatment of thyroid disease in patients with or without preserved laryngeal mobility. The objective of this study was to evaluate and to compare the voice and swallowing function of patients with and without laryngeal mobility after thyroidectomy. METHODS: This prospective study evaluated patients with thyroid disease divided in two groups: GA with laryngeal mobility modified after surgery and GB, preserved. The perceptual and acoustical analysis and fiberoptic endoscope of swallowing evaluation protocol were applied at preoperatory, recent and late post operatory. Both groups had presented bigger percentage of women, with age between 46 and 65 years, and total thyroidectomy. Reduced numbers of smokers and indication of neck dissection was common to the two groups. Papillary carcinoma was more frequent in the GA, and the benign tumor in the GB; and resected tissue volume was smaller in the GA in relation to GB. RESULTS: The evaluation of the deglutition indicated that the GA did not have alteration at preoperatory (PRE). At recent postoperative (POR) it was observed in 87% and at late period (POT), in 67%. There was statistical difference between PRE and POR, and PRE and POT (p< 0,001). Penetration and aspiration with liquid had been identified in 33% of the sample at POR (p=0,014). Residue of food occurred in 87% at POR and 60% at POT (p< 0,001). In the GB, the results between PRE and POR had significance only for deglutition, with increase of 44% in the number of individuals with dysphagia, presenting residue and premature escape of the food. Voice results had indicated light degree dysphonia characterized by the roughness in 67% of the sample of the GA at PRE. There was significant difference between PRE and POR, in the global grade, strain, instability, pitch, loudness and resonance focus. Between PRE and POT, the significance it occurred only in pitch and loudness. The acoustic data had not presented statistical difference in the GA. In GB, 87% was classified as dysphonic at PRE, with light (64%) roughness (85%) and pharyngolaryngeal resonance (67%) as the more observed characteristics. The comparison between PRE and POR showed worsening with significant difference in the global grade, strain, pitch and loudness. Between PRE and POT, it had difference only in pitch and loudness. CONCLUSIONS: Patients with thyroid disease present dysphonia before the surgery. After thyroidectomy, presents dysphonia and dysphagia, evidenced at POR and more severe in the individuals without laryngeal mobility. These dysfunctions are associated to pharyngeal and laryngeal factors and occur due to orotracheal intubation, manipulation of the extrinsic muscle and damage of the laryngeal nerve.

<p>In Sweden surgical treatment of vocal fold lesions in children is fairly uncommon. At Falun hospital they have adapted a more generous attitude towards phonosurgery of children’s vocal folds. The purpose of the present study was to evaluate surgical treatment of organic vocal fold lesions in children and to assess the phonosurgical patient utility. The study was carried out at the Ear-, Nose- and Throat clinic, Falun hospital, Sweden. Based on case sheets, data was collected regarding the different vocal fold lesions that were surgically treated. The most frequent vocal fold abnormalities were vocal fold nodules, vocal fold cysts and sulcus/vergeture. Further on, assessment of pre- and postoperative voice recordings and stroboscopic examinations were carried out. The general tendency was that vocal fold closure and mucosal wave was estimated as normal or less abnormal following surgery in most patients. Postoperatively, hoarseness, breathiness and roughness were estimated to be significantly lower. For hyperfunction, only a tendency to lower occurrence was observed. The estimation of high pitch was similar pre- and postoperatively. A mail questionnaire showed that most patients/parents estimated a high degree of perceived voice related problems preoperatively. Most patients rated their own vocal function at the time of the study as highly functional. The majority were satisfied with the choice of undergoing surgical treatment. The conclusion was that surgical treatment may be a good option in organic vocal fold lesions in children.</p> / <p>I Sverige är kirurgisk behandling vid stämbandsförändringar hos barn relativt ovanligt. Vid Falu lasarett har man en generösare inställning till fonokirurgi av barns stämband. Syftet med föreliggande studie var att utvärdera kirurgisk behandling vid organiska stämbandsförändringar hos barn för att bedöma vilket värde fonokirurgi har för patienten. Studien genomfördes vid Öron-, Näs- och Halskliniken, Falu lasarett. Journaluppgifter inhämtades angående vilka olika stämbandsförändringar som åtgärdats kirurgiskt. De vanligast förekommande stämbandsförändringarna var knottror, cystor samt sulcus/vergeture. Vidare genomfördes bedömning av pre- och postoperativa röstinspelningar och stroboskopiska undersökningar. Den generella tendensen var att stämbandsslutning och slemhinnevåg i större utsträckning skattades normal eller mindre avvikande efter operation i jämförelse med före operation. Förekomst av röstparametrarna heshet, läckage och skrovlighet bedömdes vara signifikant lägre efter kirurgi. För press kunde endast tendens till lägre förekomst observeras medan det generellt höga röstläget skattades lika före och efter operation. Genom en enkät framkom att flertalet patienter/patienters målsmän skattade förhållandevis höga värden av upplevda röstbesvär före operation. Flertalet skattade höga värden angående hur väl rösten fungerade vid studiens genomförande. Majoriteten var nöjd med valet att genomgå operation. Slutsatsen var att kirurgisk behandling kan vara ett bra behandlingsalternativ vid organiska stämbandsförändringar hos barn.</p>

In Sweden surgical treatment of vocal fold lesions in children is fairly uncommon. At Falun hospital they have adapted a more generous attitude towards phonosurgery of children’s vocal folds. The purpose of the present study was to evaluate surgical treatment of organic vocal fold lesions in children and to assess the phonosurgical patient utility. The study was carried out at the Ear-, Nose- and Throat clinic, Falun hospital, Sweden. Based on case sheets, data was collected regarding the different vocal fold lesions that were surgically treated. The most frequent vocal fold abnormalities were vocal fold nodules, vocal fold cysts and sulcus/vergeture. Further on, assessment of pre- and postoperative voice recordings and stroboscopic examinations were carried out. The general tendency was that vocal fold closure and mucosal wave was estimated as normal or less abnormal following surgery in most patients. Postoperatively, hoarseness, breathiness and roughness were estimated to be significantly lower. For hyperfunction, only a tendency to lower occurrence was observed. The estimation of high pitch was similar pre- and postoperatively. A mail questionnaire showed that most patients/parents estimated a high degree of perceived voice related problems preoperatively. Most patients rated their own vocal function at the time of the study as highly functional. The majority were satisfied with the choice of undergoing surgical treatment. The conclusion was that surgical treatment may be a good option in organic vocal fold lesions in children. / I Sverige är kirurgisk behandling vid stämbandsförändringar hos barn relativt ovanligt. Vid Falu lasarett har man en generösare inställning till fonokirurgi av barns stämband. Syftet med föreliggande studie var att utvärdera kirurgisk behandling vid organiska stämbandsförändringar hos barn för att bedöma vilket värde fonokirurgi har för patienten. Studien genomfördes vid Öron-, Näs- och Halskliniken, Falu lasarett. Journaluppgifter inhämtades angående vilka olika stämbandsförändringar som åtgärdats kirurgiskt. De vanligast förekommande stämbandsförändringarna var knottror, cystor samt sulcus/vergeture. Vidare genomfördes bedömning av pre- och postoperativa röstinspelningar och stroboskopiska undersökningar. Den generella tendensen var att stämbandsslutning och slemhinnevåg i större utsträckning skattades normal eller mindre avvikande efter operation i jämförelse med före operation. Förekomst av röstparametrarna heshet, läckage och skrovlighet bedömdes vara signifikant lägre efter kirurgi. För press kunde endast tendens till lägre förekomst observeras medan det generellt höga röstläget skattades lika före och efter operation. Genom en enkät framkom att flertalet patienter/patienters målsmän skattade förhållandevis höga värden av upplevda röstbesvär före operation. Flertalet skattade höga värden angående hur väl rösten fungerade vid studiens genomförande. Majoriteten var nöjd med valet att genomgå operation. Slutsatsen var att kirurgisk behandling kan vara ett bra behandlingsalternativ vid organiska stämbandsförändringar hos barn.

Diagnostic and evaluative methods used in voice care are mostly designedfor the speaking voice, and are not necessarily directly applicable to thesinging voice. This thesis investigated the possibilities of fine tuning, improvingand quantifying the voice status assessment of the singer, focusingespecially on the Western operatic female voice. In Paper I, possible singer-specific Voice Range Profile (VRP) characteristicsand tasks were explored and VRP data for 30 professional female Western opera singers was collected. Vocal productions were controlled for a physiological VRP (VRPphys) and for a stage performance context (VRPperf) and outcome differences were identified. Task design was critical for the(VRPphys) but had very little effect on the VRPperf. Significant voice category differences (between soprano,mezzo-soprano and contralto) were limited to frequencyrelated metrics. Two new VRP metrics, the area above 90 dB (Perc90dB) and the sound pressure level extent (SPLext), were found to be key metrics to the study of VRPs for singers. Paper II investigated, in conjunction with the VRP, whether the sound pressure level (SPL) or the skin acceleration level (SAL) was more correlated to the subglottal pressure (Ps). SAL was much less F0 dependent than SPL and facilitated the interpretation of VRP data. However, the correlation between SAL and Ps was found to be weaker than that between SPL and Ps. Papers III and IV explored the mapping of self-perceived impairmentrelated difficulties into the VRP. A modified phonetograph was tested first with a healthy singer population and then with a singer-patient group. Subjects used a button device to communicate their self-perceptions while singing, and were consistent in task replications as well as across different tasks. Healthy singers pressed mostly at the extreme limits of the VRP, where loss of vocal control could be expected and their presses were mostly concentrated on the periphery of the VRP area. Singer patient button- press patterns were distinct from patterns observed in healthy singers. Singer patients pressed mainly inside the VRP boundaries, in the higher range and at intermediate intensities. In Paper V, the Voice Handicap Index for singers was translated and adapted to Swedish (Röst Handikap Index för sångare or RHI-s). The questionnaire was found to be a reliable and a valid instrument. High correlations between general perceptual patient VAS ratings and the questionnaire scores underscored the instrument’s internal coherence. Overall, patient scores (including subscales) were significantly higher than healthy singer scores. The results showed implicitly the necessity and usefulness of adapting clinical procedures to specific patient populations.Together, the results of these five papers can ultimately be of value tovoice clinicians who are treating singers. The results obtained also contributeto the understanding of the singing voice and underline the importance ofproperly documenting the singing voice. / QC 20100726

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