Zusammenhang zwischen Selbsteinschätzung der Stimmfunktion und Stimmschallanalysen bei Patienten mit Stimmstörungen

Die Stimme als elementarer Bestandteil der verbalen Kommunikation ist von entscheidender Bedeutung für die soziale Interaktion, die persönliche Zufriedenheit und die berufliche Kompetenz. Die Berücksichtigung psychosozialer Aspekte gesundheitlicher Störungen gewinnt in den letzten Jahren zunehmend a...

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Bibliographic Details
Main Author: Lohmann, Anja
Contributors: Berger, Roswitha (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2011
Online Access:PDF Full Text
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The voice as a primary ingredient of the verbal communication has vital importance for the social interaction, personal satisfaction and career expertise. The consideration of psychosocial aspects of health disorders becomes more important in the last few years. That’s why the European Laryngologial Society recommends measuring the self-assessment of disorder supplement to examination of cause and dimension of dysphonia. The subjective experience of dysphonia is very important for indication and outcome control of therapy. The Voice Handicap Index (VHI) was used for documentation of the subjective experience. Aim of the study was to examine subjective symptoms of dysphonia and the influences on subjective experiences. Patients with different voice pathologies were analyzed to make a point on voice handicap. The VHI consists of different items. In order to understand what facets patients with dysphonia feel most burdening a rank order of items was rendered. Second objective was to survey the influence of objective acoustic parameters on the VHI. The Göttinger Heiserkeitsdiagramm (GHD) was used for the parameters of acoustic voice analysis. The assessment happened retrospective. 226 patients that came to the medical center for phoniatrics and paediatric audiology of Marburg with different types of dysphonia were included. The results of the VHI 12 reached nearly for the whole range of value (0 to 47 points). The mean score of the VHI 12 was 15, 78 (SD 9,869). The VHI 12 indicates no significant gender-specific disparity and there was no correlation with the age. Comparing the groups among each other only the group of vocal fold paralysis distinguished from the others significantly. The mean score of the VHI 12 (22,95) is higher than the mean score of all other groups. This applies to the acoustic paramters (Irregulariätskomponente and Rauschkomponente of the GHD) also. Comparing the VHI 12 and the parameters of the GHD significant pearson ‘s correlations arise as a result. The value for the correlation coefficient is rather low (0,166 to 0,360). The items of the VHI 12 were corresponding to frequency organized in a ranking. The most loading items represent the limitation of vocal performance and the self-awareness oft the voice during speech. The items of the lowest ranks reflect emotional reactions to dysphonia and a small self-acceptability in specific situations. The impairment seems to lie more in power range than in emotional range. The hypothesis – patients with different voice pathologies evaluate their dysphonia differently – can be abolished. Patients with vocal fold paralysis distinguish plainly from patients with not-neurogenic types of dysphonia. Judging from the fact, that most vocal fold paralysis occur after an operation - thus develop acutely – suggests the assumption, that not the pathology but the development influence the subjective impairment. The circumstance, that older patients don’t reach higher VHI-scores than younger ones, although the voice worsens in old age, supports this hypothesis. The outcomes prove a slight correlation between the parameters of the GHD and the VHI. Only few studies comparing the self-assessment of voice and acoustic voice analysis exist. These studies detected mostly no or weak correlation between the tools. By making statements about subjective impairment of patients with different types of dysphonia and about the relation of self-assessment and acoustic voice parameters, the aim of the study was achieved: Consistently limitations of subjective affections were found for all patients with dysphonia, whereas there are clear hints that patients with acute incipience of voice disorder feel affected in particular. The acoustic parameters of the GHD influence the subjective perception, but they explain the values for the voice handicap just in part. Both examination tools are unrenouncable in clinical practice. In addition to the individual situation they should have influence on therapy of voice disorders.