乌鲁木齐市11689名中学教师咽喉疾病调查分析

目的:了解乌鲁木齐市中学教师咽喉疾病的患病情况。方法:对乌鲁木齐市109所中学的11 689名教师进行二阶段随机抽样,从11 689名教师中抽取3 217名进行嗓音自我评估问卷调查及咽喉部常规检查,对常规检查异常者进行频闪喉镜检查。结果:乌鲁木齐市中学教师咽喉疾病的总患病率为28.23%,男女教师咽喉疾病患病率差异无统计学意义(P>0.05),不同教龄及民族的教师咽喉疾病患病率差异有统计学意义(P<0.05),教龄在5～15年者咽喉疾病的患病率最高;调查涉及的8个民族中,哈族的患病率最高。患病教师与无咽喉疾病的教师嗓音障碍指数评估结果,总分差异有统计学意义(P<0.05),在生理和情感范畴差异有统计学意义(P<0.05),在功能方面差异无统计学意义(P>0.05)。咽部疾病发病类型主要为慢性咽炎、舌根扁桃体增生;喉部疾病发病类型女性主要为慢性喉炎、声带小结,男性主要为慢性喉炎、声带息肉。结论:乌鲁木齐市中学教师咽喉疾病的患病率无明显性别差异,教龄在5～15年的教师患病率最高,不同民族中哈族教师的患病率最高,咽喉部疾病的患病与嗓音障碍指数有相关性。     

咽喉反流与发声障碍的相关性研究

目的:探讨咽喉反流的嗓音学特征及其对患者生活质量的影响,分析主客观评估方法的相关性。方法:对196例可疑有咽喉反流的患者行一般情况调查、电子鼻咽喉镜检查、反流症状指数量表(RSI)和反流检查计分量表(RFS)评估,将其中RSI评分>13分、RFS评分>7分定为阳性。将2个量表评分均为阳性的100例患者作为研究对象,进一步进行嗓音障碍指数量表(VHI)评估、嗓音声学分析及电声门图检查,并与健康对照组比较。结果:男女基频均比健康对照组降低,基频微扰、振幅微扰及标准化噪声能量增高,接触率降低,最大发声时间缩短,与健康对照组比较,差异均有统计学意义(均P<0.01)。VHI量表评估生理P评分最高,其次为功能F评分,情感E评分最低。咽喉反流患者的RSI与VHI有一定相关性(P<0.05),而RFS与RSI、VHI无明显相关性(P>0.05)。咽喉反流患者的嗓音障碍指数评估示生理、功能和情感之间明显相关。结论:嗓音声学分析及电声门图检测从客观上提示咽喉反流相关的嗓音障碍疾病严重影响了喉的发声功能,使基频下降、声带振动不稳定、声门闭合不良及声门接触时间缩短。主客观评估方法的相关性结果提示具有明显咽喉反流症状的患者并不一定具有明显的咽喉反流体征。     

嗓音疾病自我评估特点及影响因素

目的 探讨嗓音障碍疾病嗓音障碍自我评估特点及影响因素.方法 对1766例嗓音障碍患者及120例健康对照者行嗓音障碍指数(voice handicap index,VHI)量表评估,并对其中227例嗓音治疗后效果进行评估.结果 各种嗓音疾病患者VHI评分均明显高于对照组(z值范围8.039～17.043,P值均为0.000).不同嗓音疾病患者之间评分也有差异,量表总分自高而低依次为痉挛性发音障碍、声带麻痹、功能性发音障碍、声带沟、声带良恶性肿瘤、声带囊肿、声带任克水肿、声带息肉、声带角化与慢性喉炎、声带小结.痉挛性发音障碍组情感部分评分最高,其次为功能性发音障碍,而其他组生理部分评分均高于功能及情感评分.嗓音治疗后患者量表评分显著下降,术前术后VHI量表总评分差异有统计学意义(P值均<0.05).不同教育程度、年龄分组间量表总分差异有统计学意义(F值范围8.701～27.371,P值均为0.000),受教育程度越高,VHI评分越高;少年组VHI的各项最低,青年组最高,之后随年龄增长VHI逐渐下降.结论 VHI量表评估作为嗓音疾病严重程度及治疗效果评估的有益补充,可以从患者角度通过生理、机能及情感三方面综合评估嗓音障碍对日常生活影响及治疗前后变化,但具有一定主观性,可能受到教育程度及年龄因素影响.     

乌鲁木齐市中学教师咽喉疾病及嗓音疲劳分析与防治对策

目的 分析乌鲁木齐市中学教师咽喉疾病的患病情况及嗓音疲劳的特点,提出教师嗓音疲劳的防治对策.方法 对乌鲁木齐市109所中学的11 689名教师进行二阶段随机抽样调查,抽取3 217名教师进行嗓音疲劳测试及咽喉部常规检查,对常规检查异常者进行频闪喉镜检查.结果 乌鲁木齐市中学教师咽喉疾病的总患病率为28.23%(908/3 217),咽部疾病主要为慢性咽炎、舌根扁桃体增生,喉部疾病女性主要为慢性喉炎、声带小结,男性主要为慢性喉炎、声带息肉.3 217名中学教师嗓音疲劳测试中不同时段失败率差别有统计学意义(P＜0.05),不同咽喉疾病组之间嗓音疲劳测试失败率差别有统计学意义(P＜0.05).结论 乌鲁木齐市中学教师普遍存在嗓音疲劳现象,应通过科学有效的预防控制措施,改善嗓音疲劳,降低中学教师咽喉疾病的患病率.     

嗓音障碍指数对嗓音外科手术效果评估的价值

目的运用改良中文嗓音障碍指数量表,结合客观检查手段,评估嗓音障碍指数对嗓音疾病患者临床疗效分析的价值。方法 50例嗓音疾病患者手术前后分别进行自我评估、声学分析和喉镜检查。自我评估采用嗓音障碍指数(voice handicap index,VHI)量表中文版,包括功能(F)、生理(P)、情感(E)三方面评分,其总和记为T,其中,P+F=TvH;通过Dr.Speech嗓音分析软件对患者的嗓音样本进行声学分析,观察基频微扰(jitter)、振幅微扰(shimmer)、标准化噪声能量(normalized noise energy,NNE)三个指标。纤维喉镜检查主要观察声带闭合情况,记为C。结果 VHI量表中剔除了情感(E)方面后的嗓音自我评估分数,F、P、TvH之间的相关性良好,F、P、TvH与jit-ter、shimmer、NNE之间有良好的相关性,声带闭合程度(C)与VHI量表中的F、P、TvH以及jitter、shimmer、NNE之间有良好的相关性。结论改良的中文VHI量表,可有效地评估嗓音疾病严重程度及临床疗效,有较高的临床应用价值。     

天津市47796名中、小学及幼儿园教师嗓音健康现状调查

目的：调查教师的嗓音健康现状,探讨诱发幼儿园、小学及中学教师嗓音疾病的相关风险因子。方法对天津市47796例中小学及幼儿园教师进行问卷调查及咽喉部、嗓音检查,对结果进行描述性统计及单因素和多因素logistic回归分析。结果天津市幼儿园、小学及中学教师嗓音疾病的总体患病率为33．81％（16160／47796）,其中患病率最高为肥厚性声带炎19．80％（9456／47796）,其次是血管性声带炎14．790％（7064／47796）,声门闭合不全6．64％（3174／47796）,声带小结2．58％（1234／47796）,声带息肉1．93％（920／47796）。多因素lo‐gistic回归分析结果提示,嗓音疾病与教师性别、学区、教龄、日授课学时、班容量、教师对讲话响度的主观评估、吸烟等因素有关。结论天津市中、小学及幼儿园教师嗓音疾病患病率高,应展开针对教师的咽喉嗓音健康教育和嗓音保健活动,预防嗓音疾病的发生。     

天津市中小学教师咽喉疾病及嗓音状况调查分析

目的 了解天津市中小学教师职业用嗓情况,为制定嗓音疾病防治和康复计划提供科学依据.方法 对天津市71所中小学校及幼儿园的3 555名教师进行了咽喉疾病及嗓音健康状况普查(包括问卷调查及耳鼻咽喉专科检杳).结果 教师咽喉及嗓音疾病总患病率为46.6%,其中慢性咽炎占28.0%,其次为慢性喉炎(17.2%)和慢性扁桃体炎(...     

小学教师嗓音质量评估的研究

目的探讨嗓音声学分析与嗓音障碍指数（voicehandicapindex,VHI）用于小学教师嗓音质量评估的临床意义。方法30例嗓音正常教师（G1组）与同一学校年龄、性别、教龄相匹配的30例嗓音障碍教师（G2组）均行间接喉镜检查、嗓音声学分析、V…量表自我评估,两组结果进行比较分析。结果嗓音障碍组（G2）中慢性喉炎占77％（23／30）、声带息肉占1O％（3／30）。声带小结占13％（4／30）。嗓音障碍组（G2）的Jitter．Shimmer、噪谐比（NHR）均高于嗓音正常组（G1）,差异有统计学意义（p〈o．05）。嗓音障碍组（G2）与嗓音正常组（G1）的功能（functional,F）、生理（physical,P）．情感（emotional,E）三方面得分及VHI总分（totalscoresoftheVHl,Tvh）分值两组间差异有统计学意义（P〈0．05）。嗓音障碍组（G2）VHI量表中除E外,F、P、Tvh与Jitter、Shimmer、NHR之间有良好的相关性。结论临床上可以用嗓音声学分析中各项指标判断教师嗓音障碍的严重程度,VHI可主观反映教师嗓音疾病的严重程度,二者在嗓音质量评估中具有一定的临床应用价值。     

嗓音疾病患者手术前后的自我评估、声学分析、喉镜检查及其相关性研究

目的:研究嗓音疾病患者手术前后的自我评估、声学分析、喉镜检查及其相关性.方法:对50例嗓音疾病患者手术前后分别进行自我评估、声学分析和喉镜检查3项内容.自我评估采用嗓音障碍指数(VHI)量表中文版,包括功能(F)、生理(P)、情感(E)3个方面,其总和记为T.声学分析通过嗓音分析软件Dr. Speech对患者的声音样本进行分析,选取基频微扰(J)、振幅微扰(S)、标准化噪声能量(NNE)3个参数.喉镜检查为客观的形态学检查,主要观察声带的闭合情况.结果:VHI量表中除E外,F、P、TVH(TVH=F+P)之间的相关性良好,声学分析J、S、NNE 3个参数之间相关性良好,VHI量表中除E外,F、P、TVH与声学分析参数J、S、NNE之间有良好的相关性,闭合程度与VHI量表中除E外的F、P、TVH以及声学分析参数J、S、NNE之间有良好的相关性,以上均应用Pearson相关检验.结论:VHI量表中文版以患者的主观感受为中心,对嗓音疾病的生活影响进行自我评估,受东西方文化差异、年龄、教育程度等影响,存在一定的局限性.声学分析则从客观方面详细地分析了患者的嗓音质量,评估手术疗效.喉镜检查从形态学方面提供了极好的佐证.三者结合的一致性能对嗓音疾病起到综合评估作用.     

嗓音障碍指数量表简化中文版的研究

目的 对嗓音障碍指数(voice handicap index,VHI)量表中文版进行简化筛选研究.方法 对1 766例嗓音疾病患者的VHI评分行聚类分析,筛选简化版的条目;分析3 825例嗓音疾病患者及120例健康对照者的VHI简化版评分,并对其中424例嗓音疾病患者治疗前后VHI评分进行比较以评估简化版.结果 聚类分析筛选出10个条目(VHI-10)和13个条目(VHI-13)两个简化版,其内部一致性分别为0.939、0.936,重测信度分别为0.995、0.993,与VHI量表的相关性分别为0.972、0.973.不同嗓音疾病组患者VHI-10、VHI-13评分均明显高于对照组,差异有统计学意义(Z值分别为17.42、17.46,P值均为0.000),且VHI-10、VHI-13与VHI评分之比均大于期望值0.333、0.433(VHI-10、VHI-13与VHI条目数之比);按主观听觉评估总嘶哑度G(grade)分级分组比较,VHI-10、VHI-13评分各级间差异均有统计学意义(Z值范围5.735～9.861,P值均为0.000);治疗后量表评分显著下降,术前术后VHI-10、VHI-13评分差异有统计学意义(P值均＜0.05).结论 VHI-10、VHI-13量表均具有良好的信度和效度,可以作为嗓音障碍指数量表的简化中文版应用于发音障碍的自我评估,其中,VHI-10比VHI-13更加简洁,更易于推广使用.     

防治小学教师咽喉慢性炎症性疾病及健康教育效果评价

目的评价小学教师咽喉慢性炎症性疾病防治及健康教育的效果.方法采用自行设计健康教育与保健方案在某市郊区小学教师中进行调查研究.结果干预3年后,小学教师对咽喉慢性炎症性疾病的防治知识掌握程度提高,患病率下降,两项评价指标比较差异有显著性意义.结论健康教育对提高小学教师防治咽喉慢性炎症性疾病的意识及降低发病率有着十分重要的意义.     

中学教师嗓音疲劳测试分析

目的 探讨乌鲁木齐市中学教师嗓音疲劳与咽喉患病的状况.方法 对乌鲁木齐市教研中心提供的109所中学的11 689名教师进行二阶段随机抽样,抽取3217名教师进行嗓音疲劳测试、咽喉部常规检查,对常规检查异常者进行频闪喉镜检查.结果 3217名中学教师嗓音疲劳测试中不同时段失败率差异有统计学意义(采用两因素设计的一元定量资料方差分析,下同,F=202.653,P＜0.01).咽喉正常组2 309例及患病组908例中不同性别、不同时段间嗓音疲劳测试失败率差异有统计学意义(P值均＜0.01),女教师比男教师嗓音疲劳测试的失败率高,男女教师嗓音疲劳测试音量要求高时失败率高.不同咽喉疾病组之间嗓音疲劳测试失败率差异有统计学意义(F=9.516,P＜0.01).嗓音疲劳测试中不同性别、不同时段之间平均声压级(mean value sound pressure level)、平均基频(mean value fundamental frequency)差异有统计学意义(P值均＜0.01),男教师的平均声压级大于女教师,女教师的平均基频大于男教师.不同民族教师嗓音疲劳测试不同时段的失败率差异有统计学意义(P值均＜0.05),维吾尔族教师失败率最高,汉族最低,两两比较证实汉族和维吾尔族教师各时间段差异均有统计学意义(P值均＜0.05),其他族别教师间比较差异无统计学意义(P值均＞0.05).结论 嗓音疲劳在中学教师的工作中普遍存在,音量要求高时更容易发生嗓音疲劳,女教师更易发生嗓音疲劳,维吾尔族教师更易发生嗓音疲劳.     

小学教师嗓音疲劳测试结果分析

目的：分析成都市某区小学教师嗓音疲劳状况及嗓音疾病患病情况。方法采用二阶段随机抽样调查方法抽取成都市某区小学教师389名,填写咽喉部症状调查表并行嗓音疲劳测试（观察嗓音疲劳测试失败率、平均声压级、平均基频）及频闪喉镜检查。结果①本组教师咽喉不适症状以声音嘶哑最常见,其次为咽痛、咽干及发声易疲劳;②本组教师中189例患嗓音疾病,患病率为48．58％（疾病组）,以慢性喉炎最常见,其次为声带息肉;余200例教师无明显嗓音疾病及发声功能障碍（嗓音正常组）;③两组教师嗓音疲劳测试80 dB SPL 音量时失败率均明显高于75 dB SPL 时,且第1、2、10分钟嗓音疾病组的失败率高于嗓音正常组,差异有统计学意义（P ＜0．05）;在第3分钟时,嗓音正常组平均声压级低于嗓音疾病组,第9分钟时,嗓音正常组平均声压级高于嗓音疾病组（均为 P ＜0．05）;在第1、3、4、6、7、10分钟嗓音疾病组平均基频高于嗓音正常组,差异有统计学意义（P ＜0．05）。结论嗓音疲劳在小学教师中普遍存在,且音量要求高时更易发生,其嗓音疾病的患病率也较高,应加强小学教师的嗓音保健,以改善嗓音疲劳症状,有利于降低罹患嗓音疾病的几率。     

Does the prevalence of otolaryngological diseases in deaf children differ from children without hearing impairment?

There is no enough data about the prevalence of otorhinolaryngological (ORL) diseases in deaf children. In this study, we aimed to determine the prevalence of ORL diseases among deaf children and compare children from a school for the deaf with those attending regular primary schools for the presence of ear, nose and throat (ENT) problems. The subjects were 1,282 children attending three primary schools in the province of Duzce and 572 hearing-impaired children from eight schools for the deaf. Following ENT examinations, ORL findings were statistically compared between two groups using a Chi-square test and P values less than 0.05 were considered significant. Upper airway pathologies including chronic tonsillitis, rhinitis, septal deviation and tubal dysfunction, and chronic otitis media (COM) were found to be statistically higher in deaf children than in children without hearing impairment. Although the incidence of middle ear effusion was found to be higher in deaf children, it was not statistically significant. On the other hand, the incidence of impacted wax was lower in deaf children than others. In conclusion, we should have enough data on the prevalence of ORL diseases in deaf children to give a clue to help prevent ORL diseases and if we can detect them early, we can solve the problems before they become more complicated and we can rehabilitate these children better.     

Three treatments for teachers with voice disorders: a randomized clinical trial.

Voice problems are a common occupational hazard of teaching school, yet few studies exist that have objectively evaluated treatment approaches aimed at rehabilitating these occupation-related voice disorders. This randomized clinical trial used patient-based treatment outcome measures to evaluate the effectiveness of three treatment programs. Sixty-four teachers with voice disorders were randomly assigned to 1 of 3 treatment groups: voice amplification using the ChatterVox portable amplifier (VA; n = 25), resonance therapy (RT; n = 19), and respiratory muscle training (RMT; n = 20). Before and after a 6-week treatment phase, all teachers completed (a) the Voice Handicap Index (VHI; B. H. Jacobson et al., 1997), an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders, and (b) a voice severity self-rating scale. Both intention-to-treat and as-treated analyses revealed that only the VA and RT groups reported significant reductions in mean VHI scores and in voice severity self-ratings following treatment. Furthermore, results from a posttreatment questionnaire regarding the perceived benefits of treatment showed that compared to RT and RMT, teachers in the VA group reported significantly more overall voice improvement, greater vocal clarity, and greater ease of speaking and singing voice following treatment. These findings replicate previous results from an earlier clinical trial confirming the efficacy of VA and provide new evidence to support RT as an effective treatment alternative for voice problems in teachers. The results are discussed in the context of uneven levels of self-reported compliance and disparate dropout rates among the treatment groups.     

Assessment of common otolaryngological diseases among children in rural primary schools in south eastern Nigeria

ObjectivesDespite a global improvement in health care delivery, rural areas in developing countries still have poor access to specialist care. This study aims to assess the occurrences of ear, nose, and throat (ENT) disorders among rural primary school children in south-eastern Nigeria.MethodsTwo rural primary schools were selected randomly from one of the rural regions of South Eastern State of Nigeria. All the pupils of the schools who gave consent were recruited. A structured study proforma investigating the pupils' biodata, otolaryngological symptoms, ear, nose and throat examination findings, was used to evaluate each pupil in the presence of the teachers.ResultsA total of 246 children participated in the study. 145(58.9%) were males while 101(41.1%) were females with a mean age of 8.5 ± 2.4 years. The commonest symptoms reported were nasal discharge (20%) followed by nasal obstruction (11.1%), itching of the ears (11.1%) and sneezing bouts (10%), while 3.7% had subjective hearing impairment. The commonest ENT finding was cerumen auris (43%) and this was observed in 43.4% of males and 42.4% of females, 11% had abnormal tympanic membranes and 20% had grades 3/4 tonsils(Brodsky grading).ConclusionENT disorders are still common in children in the rural areas of developing countries. To avoid the morbidity associated with these preventable and easily manageable disorders, community health workers should be trained to manage common ENT disorders and mobile clinics with scheduled visits made available in areas where ENT services remain inaccessible.     

Development and validation of the voice handicap index-10

OBJECTIVES/HYPOTHESIS: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI). STUDY DESIGN: Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI. METHODS: Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index-10 (VHI-10). Statistical analysis comparing the validity of the VHI-10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders. RESULTS: Statistical analysis of the VHI and VHI-10 scores from the study group showed no statistically significant differences between the VHI and the VHI-10. Irrespective of diagnosis, the correlation between the VHI and the VHI-10 was greater than .90 (P = .01). The ratios of the VHI-10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI-10 may be a more robust instrument than the VHI. CONCLUSION: The VHI-10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI-10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.