Adductor focal laryngeal Dystonia: correlation between clinicians' ratings and subjects' perception of Dysphonia.
Adductor focal laryngeal Dystonia: correlation between clinicians' ratings and subjects' perception of Dysphonia.
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DOI：
10.1186/s40734-017-0066-y
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发表时间：
2017
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影响因子：
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通讯作者：
Blitzer A
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文献类型：
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作者：
Stewart CF;Sinclair CF;Kling IF;Diamond BE;Blitzer A
尽管大量研究集中在内收肌局灶性喉肌张力障碍 (AD-FLD) 的病因学和症状学上，但对于临床医生的评分与患者对这种声音障碍的感知之间的相关性知之甚少。这项研究有五个目标：首先，确定受试者的症状严重程度与其对生活质量的影响之间是否存在关系；将临床医生的评分与受试者对 AD-FLD 的个体特征和严重程度的看法进行比较；记录受试者自诊断以来对发声困难变化的感知；记录连接语音期间声音停顿的频率；最后，根据统一痉挛性发声困难评定量表 (USDRS) 的结果计算临床医生间的可靠性（Stewart 等人，J Voice 1195-10，1997）。 60 名正在接受持续注射 BoNT 的 AD-FLD 受试者参与了这项研究。受试者的平均年龄为 60.78 岁，平均症状持续时间为 16.1 年。受试者完成了疾病症状问卷 (DSQ)（专门为本研究设计）和语音障碍指数 10 (VHI-10)（Jacobson 等人，Am J Speech Lang Pathol 6:66–70, 1997），以测量他们的发声障碍症状以及疾病对其生活质量的影响。两名言语病理学家和两名喉科医生使用语音阻滞测量 (VAM)（专门为本研究设计）和 USDRS 对 56/60 名受试者的语音记录进行独立评分。平均 VHI-10 评分为 21.3，具有临床意义。 DSQ 和 USDRS 的结果高度相关。受试者和临床医生发现的最严重的症状是粗糙、声音质量紧张和呼气用力增加。声音停止、失音和颤抖并不常见。受试者认为重新注射时（即研究时）当前的语音质量明显优于最初诊断 AD-FLD 时的语音质量 (p < 0.0001)。 USDRS 的临床医生间可靠性显着达到 0.001 水平。 VHI-10 的研究结果表明 AD-FLD 对生活质量具有深远影响。 DSQ 和 USDRS 的结果表明，受试者的感知和临床医生对个体症状和发声困难严重程度的评估之间存在很强的相关性。 VAM 的研究结果表明，在持续接受 BoNT 注射的 AD-FLD 受试者中，声音停止的情况很少见。 USDRS 的临床医生间强大可靠性表明，它是识别 AD-FLD 症状和严重程度的适当措施。本文的在线版本 (10.1186/s40734-017-0066-y) 包含补充材料，可供授权用户使用。
Although considerable research has focused on the etiology and symptomology of adductor focal laryngeal dystonia (AD-FLD), little is known about the correlation between clinicians’ ratings and patients’ perception of this voice disturbance. This study has five objectives: first, to determine if there is a relationship between subjects’ symptom-severity and its impact on their quality of life; to compare clinicians’ ratings with subjects’ perception of the individual characteristics and severity of AD-FLD; to document the subjects’ perception of changes in dysphonia since diagnosis; to record the frequency of voice arrest during connected speech; and, finally, to calculate inter-clinician reliability based on results from the Unified Spasmodic Dysphonia Rating Scale (USDRS) (Stewart et al, J Voice 1195-10, 1997). Sixty subjects with AD-FLD who were receiving ongoing injections of BoNT participated in this study. Subjects’ mean age was 60.78 years and their mean duration of symptoms was 16.1 years. Subjects completed the Disease Symptom Questionnaire (DSQ) (specifically designed for this study) and the Voice Handicap Index-10 (VHI-10) (Jacobson et al, Am J Speech Lang Pathol 6:66–70, 1997) to measure the symptoms of their dysphonia and the impact of the disease on their quality of life. Two speech-language pathologists and two laryngologists used the Voice Arrest Measure (VAM) (specifically designed for this study) and the USDRS to independently rate voice recordings of 56/60 subjects. The mean VHI-10 score was 21.3 which is clinically significant. The results of the DSQ and the USDRS were highly correlated. The most severe symptoms identified by both subjects and clinicians were roughness, strain-strangled voice quality, and increased expiratory effort. Voice arrest, aphonia, and tremor were uncommon. Subjects rated their current voice quality at the time of reinjection (i.e., at the time of the study) as significantly better than at the time of their initial AD-FLD diagnosis (p < 0.0001). Inter-clinician reliability on the USDRS was significant at the 0.001 level. The findings from the VHI-10 suggest that AD-FLD has a profound impact on quality of life. The results of the DSQ and the USDRS suggest that there is a strong correlation between subjects’ perception and clinicians’ assessment of the individual symptoms and the severity of the dysphonia. The findings from the VAM suggest that voice arrests are infrequent in subjects with AD-FLD who are receiving ongoing BoNT injections. The strong inter-clinician reliability on the USDRS suggests that it is an appropriate measure for identifying symptoms and severity of AD-FLD. The online version of this article (10.1186/s40734-017-0066-y) contains supplementary material, which is available to authorized users.