신경성 발성장애와 기능성 발성장애의 감별 진단

김소연,이상혁,Kim, So Yean,Lee, Sang Hyuk 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Voice disorder is classified into three categories, structural, neurogenic and functional dysphonia. Neurogenic dysphonia refers to a disruption in the nerves controlling the larynx. Common examples of this include complete or partial vocal cord paralysis, spasmodic dysphonia. Also it occurs as part of an underlying neurologic condition such as Parkinson's disease, myasthenia gravis, Lou Gehrig's disease or disorder of the central nervous system that causes involuntary movement of the vocal folds during voice production. Functional dysphonia is a voice disorder in the absence of structual or neurogenic laryngeal characteristics. A near consensus exist that Muscle tension dysphonia (MTD) is functional voice disorder wherein hyperfunctional laryngeal muscle activity whereas Spasmodic dysphonia (SD) is neurogenic, action-induced focal laryngeal dystonia including several subtype. Both Adductor type spasmodic dysphonia (AdSD) and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. It makes these two disorders extremely difficult to differentiate based on clinical interpretation alone. Because treatment for AdSD and MTD are quite different, correct diagnosis is important. Clinician should be aware of the specific vocal characteristics of each disease to improve therapeutic outcome.

스펙트로그램을 이용한 내전형 연축성 발성 장애와 근긴장성 발성 장애의 감별

노승호,김소연,조재경,이상혁,진성민,Noh, Seung Ho,Kim, So Yean,Cho, Jae Kyung,Lee, Sang Hyuk,Jin, Sung Min 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. Materials and Methods : From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0-3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. Results : Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p<0.01). Well defined formants were not found different between two groups. Conclusion : The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.

기능성 음성장애에서 보툴리늄 독소의 임상적 적용

김한수 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.1

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient’s voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.

기능성 음성장애로 오인된 폐결핵 1예

이진,장은정,김동현,진영주 대한후두음성언어의학회 2023 대한후두음성언어의학회지 Vol.34 No.3

Functional dysphonia (FD) refers to a voice disorder without any anatomical or neurologic pathology affecting the larynx. The beginning of a diagnosis of FD is to differentiate the patient’s voice symptoms from other organic voice disorders and other functional voice problems. Pulmonary tuberculosis initially presented by voice change is very rare. This atypical presentation might cause some confusion due to other more common diseases. We report a case of pulmonary tuberculosis as initial presentation of dysphonia in a 16-year-old girl. The patient was referred to our hospital with a gradually worsening dysphonia for 6 months. At first, it was misdiagnosed as FD because there was no specific finding on stroboscopy. One month later, she was finally diagnosed as pulmonary tuberculosis due to fever and pleuritic pain. After antituberculous therapy, her symptoms and voice have improved.

내전형 연축성 발성장애 감별진단 문항 개발과 임상적 유용성 평가

조재경,최성희,이상혁,진성민 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.2

Background and Objectives The purpose of this study was to develop the differential diagnosis scale containing items from adductor spasmodic dysphonia (ADSD) to muscle tension dysphonia (MTD) and the determine clinical utility of newly developed items. Materials and Method The four parts of pitch, redirected phonation, automatic speech and voiced sound were selected for analyzing the characteristics of ADSD in the literature. One part of tense voiceless sound was developed according to the Korean manner of articulation. The content validity was evaluated based on 5 scales (1–5 point) analysis from 30 experts. One hundred patients (50 ADSD and 50 MTD) were recorded in reading a sentence and sustained phonation. The two speech language pathologist evaluated recorded voices through a blind test using 4 scales (0–3 point) for newly developed items. Results As a result of verifying the content validity of items with experts, it was identified that the differentiated items were valid with 4.2 out of 5. Through the differential diagnosis between two groups according to the items, the correlation between sub-domains and total scores was shown as higher than 0.710. The result of analyzing the reliability on each diagnosis domain was 0.840–0.893, which showed the internal consistency of items was great. Newly developed five parts of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). The reliability among the evaluators was analyzed as high with 0.892. Conclusion In this study, the differential diagnosis scale of ADSD was revealed as having validity and reliability. It is considered that it will be useful for differentiating ADSD and MTD in the clinical field.

정상으로 보이는 후두에서 음성변화의 감별진단

손호진,최승호,Son, Ho Jin,Choi, Seung Ho 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2

Voice is a physical phenomenon, generated by vocal fold and expiratory airflow. Dysphonia should come from abnormal vocal fold and airflow. Occassionally larynx looks normal in show, but it is actually not. There should be undetected structural or functional abnormalities. So when ENT doctors face dysphonia patients who looks normal larynx, should make a diagnosis through close observation. In this review article we present some dysphonia diseases which looks normal larynx. For example vocal fatigue, vocal fold paresis, posterior glottic diastasis, muscle tension dysphonia and psychogenic dysphonia.