Clinical implementation of a multidimensional basic protocol for assessing functional results of voice therapy. A preliminary study

摘要

45 patients with various kinds of organic benignant voice pathology (vocal fold nodules, polyp, Reinke's oedema, unilateral paralysis, sulcus/scar) and / or with muscle tension disorders, for which a (pre-operative) functional voice therapy was indicated, were evaluated before and after this short period of voice therapy (4-26 sessions), in order to check a basic multidimensional protocol for assessing functional results of voice treatments, developed by the Committee on Phoniatrics of the ELS. Perception : Grade, Breathiness and Roughness from the GRBAS-scale, as rated by two experienced judges (0 = normal or absent ; 3 = severely deviant or present). Acoustics : Jitter % and Shimmer % as computed by the MDVP program of Kay Elemetrics~® on a /a:/, at comfortable loudness and pitch. Also Fo-range and softest possible intensity were registered. Videostroboscopy : Glottal closure, regularity, mucosal wave and symmetry, as rated separately on visual analog scales of 10 cm by 2 experienced laryngologists. Phonation quotient : computed by dividing the vital capacity (ml) by the maximum phonation time (s) (best value of 2x3 trials). Self rating by the patient: voice quality in itself and general social/occupational handicap due to the voice problem were rated on 2 visual analog scales. Results show that there is a large variation in the interindividual and interdimensional results of the voice therapy : in a same patient, one dimension may be significantly improved while another one is significantly worsened. The 5 considered dimensions may be considered as low redundant.%Les effets thérapeutiques ont été quantifiés chez 45 patients présentant une grande variété de pathologies vocales tant organiques que dysfonctionnelles (cancers exclus) selon la directive élaborée par le Comité de Phoniatrie de la Sociét╚? Européenne de Laryngologie. Ce protocole de base comporte 5 dimensions : perceptive, vidéostroboscopique, aérodynamique, acoustique et auto-évaluative. La présente étude considère isolément le résultat du traitement fonctionnel (4 à 26 s╚nces), le cas échéant limité à la période préopératoire. Une première analyse des résultats met en évidence la grande variabilité interindividuelle et interdimensionnelle des effets obtenus. Chez un même patient, il peut y avoir amélioration significative pour une dimension, et évolution significativement péjorative pour une autre. Les 5 dimensions apparaissent comme peu redondantes, et permettent une réflexion critique sur le mécanisme d'action thérapeutique.