Clinical and instrumental characteristics of vocal apparatus condition of patients suffering chronic functional hypotonic dysphonia

Abstract

A lot of researchers are concerned about the problem of diagnosis of functional diseases of vocal apparatus and their treatment. It is due to diagnostic difficulty of these diseases, a fairly high prevalence of the pathology among people of voice professions, untimely detection of voice disorders. Besides, young people of working age can also suffer these disorders. In case of impaired function disorders associated with changes in timbre, intensity,voice modulation, motor and vibration abilities of the vocal cords come to the fore. Moreover, almost a quarter of patients, suffering chronic functional hypotonic dysphonia, CFHD, had frequent relapses, persistent voice disorders and complicated course of the disease. Purpose of the study is to give a detailed clinical and instrumental characterization of vocal apparatus condition of patients suffering CFHD and having various degrees of voice disorders. Materials and methods: 123 patients aged 19 to 44, suffering CFHD and having various degrees of voice disorders, have been examined. In the control group there were included 15 healthy people aged 18 to 23, having not any voice disorders. In total, 138 people were examined. A detailed anamnesis and analysis of patients complaints were made. General clinical ENT and specialized phoniatric examination were performed as well. Video laryngological examination was performed with the help of a video laryngoscope ,manufactured by Karl Shtorz, Germany. Results and discussion: All the examined patients suffering CFHD were divided into 4 groups depending on the degree of vocal disorders, according to the results of specialized phoniatric examination and videolaryngostroboscopy. The patients, suffering functional hypotonic dysphonia and mild disorders in functioning of vocal apparatus, were included to group 1. Group 2 included patients having more severe laryngeal mobility disorders. Group 3 was formed of 34 patients having severe disorders of voice apparatus (like those in group 2), along with complicated course of the disease (prenodulus state, vocal cords nodules, Mediale Edge thinning). Group 4 included patients having severe disorders of voice apparatus, as well as various degrees of hypertonicity of vestibular larynx, which in some cases was transformed into pseudo-folded mechanism of voice formation. Due to the analysis of otolaryngological and specialized phoniatric examination, the data of patients suffering FHD were found to differ significantly according to clinical condition and degree of voice disorders. This allows to form groups of patients taking into account the data of clinical and instrumental studies in order to determine treatment tactics. Distribution of patients suffering CFHD into appropriate groups provides more differentiated approach to their treatment.Besides, this makes forecasting of further course of the disease and effectiveness of therapeutic measures more objective. It is important for solving issues of labor examination and professional suitability of people of voice professions. Conclusions: 1.Clinical signs and changes of laryngoscopic picture in case of functional voice disorders can be unexpressed and variable. It complicates the diagnosis, that is why, patients suffering functional hypotonic dysphonia need to be examined thoroughly including usage of additional instrumental methods. 2. In case patients suffering CFHD are not provided with specialized care on time, a number of complications can develop (Mediale Edge thinning, prenodulus state, hypertonicity of vestibular larynx, pseudo-folded mechanism of voice formation etc.) It can complicate the treatment and reduce its effectiveness. 3. In the presence of such signs, it is important to determine whether they testify of independent nosology or a complicated course of chronic functional hypotonic dysphonia. It proves to be defining to determine treatment tactics, which in such cases does not seem to be effective without correction of functional disorders of voice formation. 4. Target data analysis during otolaryngological and specialized phoniatric examination of patients suffering CFHD permits to create groups, based on the results of clinical and instrumental studies. Such distribution of patients into appropriate groups provides more differentiated approach to their treatment, and makes both forecasting of the disease and therapeutic measures more effective. It matters to solving issues of labor examination and professional suitability of people of voice profession.