Development and validation of the vocal tremor scoring system
Development and validation of the vocal tremor scoring system
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DOI：
10.1097/01.mlg.0000233255.57425.36
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发表时间：
2006-09-01
期刊：
影响因子：
2.6
通讯作者：
Gartner-Schmidt, Jackie
中科院分区：
文献类型：
--
作者：
Bove, Michiel;Daamen, Nicole;Gartner-Schmidt, Jackie
背景：约 4% 的人群发生特发性震颤 (ET)，25% 的 ET 患者有声道受累，称为特发性声音震颤 (ETV)。声带震颤的治疗成功率参差不齐，很可能是由于对受影响区域的识别不准确造成的。开发了声带震颤评估系统来标准化声带震颤的评估和分级。在临床上应用该系统可以帮助确定谁将从肉毒毒素注射治疗中受益最大。声带震颤评分系统 (VTSS) 还可用作确定 ETV 所有治疗方式（包括手术、药物和植入设备）治疗效率的工具。研究设计：作者研究了仪器开发和验证。方法：召开临床共识会议，开发一种对声带震颤位置和严重程度进行标准化评级的评估工具。然后使用视频感知分析测试评估工具的可靠性。经过验证后，该评估工具被应用于 10 名接受过甲杓肌注射肉毒毒素 A (BtxA) 治疗的声带震颤患者的检查，以确定评分仪器预测治疗结果的能力。结果：VTSS 基于声道内不同解剖部位的严重程度评分。 VTSS 的评估区域是上颚、舌根、咽壁、喉、声门上和真声带。对视频感知分析结果的统计分析表明，参与者间一致性最好的解剖部位是真声带、上颚、舌根和声门上。总体而言，VTSS 在所有站点都表现出至少 0.914 的测试者间可靠性水平。评估者内部的可靠性非常好。共识小组还分析了 10 项标准化考试，然后比较了两个评审组的分数，发现每个地点的可靠性至少为 0.6。然后将 10 名接受 BtxA 治疗的 ETV 患者的治疗前 VTSS 评分与治疗反应进行比较。当真实声带的评分等于或大于其他部位评分的平均值时，VTSS 100% 预测有利的治疗结果。结论：VTSS 代表了第一个用于评估声带震颤的解剖部位和严重程度的标准化系统。该工具将改善耳鼻喉科医生之间的沟通，促进声带震颤治疗的研究，并建立用于评估声带震颤的描述系统。对声带震颤患者使用此评估工具可以增加最佳患者选择和喉内肉毒毒素治疗的成功率。
Background: Essential tremor (ET) occurs in approximately 4% of the population, and 25% of patients with ET have vocal tract involvement referred to as essential tremor of voice (ETV). Treatment of vocal tremor has a variable success rate most likely as a result of inaccurate identification of the affected area(s). A vocal tremor assessment system was developed to standardize the evaluation and scaling of vocal tremor. Applying this system clinically can help determine who will benefit most from botulinum toxin injection treatment. The Vocal Tremor Scoring System (VTSS) can also be used as a tool to determine treatment efficiency for all treatment modalities of ETV, including surgery, medications, and implantable devices. Study Design: The authors studied instrument development and validation. Methods: A clinical consensus conference was conducted to develop an assessment tool for standardized rating of vocal tremor location and severity. The assessment tool was then tested for reliability using video-perceptual analysis. Once validated, the assessment tool was applied to 10 examinations of patients with vocal tremor who had been treated with botulinum toxin A (BtxA) injections of the thyroarytenoid muscle(s) to determine the ability of the scoring instrument to predict treatment outcome. Results: The VTSS is based on severity scores for different anatomic sites within the vocal tract. The assessment areas of the VTSS are the palate, base of tongue, pharyngeal walls, larynx, supraglottis, and true vocal cords. Statistical analysis of the video-perceptual analysis results showed that the anatomic sites with the best interrater agreement were the true vocal folds, palate, base of tongue, and supraglottis. Overall, the VTSS demonstrated a level of interrater reliability of at least 0.914 at all sites. Intrarater reliability was excellent. The consensus group also analyzed 10 standardized examinations and the scores from both reviewer groups were then compared and found to have a reliability of at least 0.6 at each site. Pretreatment VTSS scores of 10 patients with ETV who underwent BtxA therapy were then compared with treatment response. The VTSS predicted the favorable treatment outcome 100% of the time when the score given to the true vocal folds was equal or greater to the mean of the scores given to the other sites. Conclusion: The VTSS represents the first standardized system for rating anatomic site(s) and severity of vocal tremor. This tool will allow improved communication between otolaryngologists, facilitate research in vocal tremor treatments, and establish a descriptive system for assessing vocal tremor. Using this assessment tool for patients with vocal tremor increases optimal patient selection and success rate for intralaryngeal botulinum toxin treatment.