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УСПЕХИ В НАУКАХ О ЧЕЛОВЕКЕ / ACHIEVEMENTS IN HUMAN SCIENCES / FORTSCHRITTE IN DEN HUMANWISSENSCHAFTEN
Аветисян Э.Е., Гордеев Л.С.
Влияние хронического воспаления нёбных миндалин и тонзиллэктомии на акустические параметры голоса
Аветисян Эмиль Егишевич, аспирант кафедры болезней уха, горла и носа Первого Московского государственного медицинского университета им. И.М. Сеченова
ORCID ID https://orcid.org/0000-0002-1499-5593
E-mail: emil-e-avetisyan@j-spacetime.com; avetisyanemil@gmail.com
Гордеев Леонид Сергеевич, студент 5 курса педиатрического факультета Первого Московского государственного медицинского университета им. И.М. Сеченова
ORCID ID https://orcid.org/0000-0001-7807-9167
E-mail: leonid-s-gordeev@j-spacetime.com; leo95.95@mail.ru
Представлен анализ и систематизация содержащихся в российской и зарубежной медицинской литературе данных о влиянии хронического воспаления нёбных миндалин и их удаления на акустические характеристики голоса, и дана оценка изменений акустических параметров голоса у пациентов, перенесших двустороннюю тонзиллэктомию — одной из наиболее частых хирургических операций, выполняемых оториноларингологом, которая проводится при наличии декомпенсированного хронического тонзиллита, а также из-за обструкции дыхательных путей, связанной с гипертрофией нёбных миндалин, асимметричной гипертрофией и новообразованиями миндалин.
Ключевые слова: акустический анализ голоса; голос; тонзиллэктомия; хронический тонзиллит; гиперназальность; нёбно-глоточная недостаточность.
Цитирование по ГОСТ Р 7.0.11—2011:
Аветисян, Э. Е., Гордеев, Л. С. Влияние хронического воспаления нёбных миндалин на акустические параметры голоса [Электронный ресурс] / Э.Е. Аветисян, Л.С. Гордеев // Электронное научное издание Альманах Пространство и Время. — 2017. — Т. 15. — Вып. 1: Studia studiosorum: успехи молодых исследователей. — Стационарный сетевой адрес: 2227-9490e-aprovr_e-ast15-1.2017.24.
Avetisyan E.E., Gordeev L.S.
The Effect of Chronic Inflammation of Palatine Tonsils on Acoustic Voice Parameters
Emil E. Avetisyan, M.Med., postgraduate student at the Chair of ORL Diseases, I.M. Sechenov First Moscow State Medical University
ORCID ID https://orcid.org/0000-0002-1499-5593
E-mail: emil-e-avetisyan@j-spacetime.com; avetisyanemil@gmail.com
Leonid S. Gordeev, 5th year student at the Pediatric Department, I.M. Sechenov First Moscow State Medical University
ORCID ID https://orcid.org/0000-0001-7807-9167 E-mail: leonid-s-gordeev@j-spacetime.com; leo95.95@mail.ru
Tonsillectomy is one of the most frequent surgical operations performed by ENT-physicians. This operation is carried out in the presence of decompensated chronic tonsillitis, and in the case of obstruction of the respiratory paths, associated with hypertrophy of the tonsils, asymmetric hypertrophy and tumors of the tonsils. Postoperative complications may include bleeding, pain, wound infection, and voice changes. The frequency of complications among the adult population is 20—25%. One of the least studied complications of tonsillectomy is the change in acoustic parameters of voice. However, the question about the influence of chronic upper respiratory tract inflammatory processes, chronic tonsillitis and tonsillectomy on voice function is currently far from its final solution.
The subject matter of our study is impact of chronic inflammation of tonsils and tonsillectomy on the acoustic voice characteristics. For enquiring this issue, we, firstly, reviewed corresponding Russian and foreign scientific literature using source and problem analysis, as well as methods of classification. Secondly, we carried out our own investigation of tis matter. 24 patients (8 men and 16 women) aged 19 to 54 years engaged in voice-speech professions with the diagnosis ‘decompensated form of chronic tonsillitis.’ In this regard, all patients underwent bilateral tonsillectomy using traditional method. Our examination included: medical history, complaints assessment using Voice Handicap Index (VHI) scale from 0 to 4, examination of ORL organs, as well as video-laryngoscopy, endoscopy of nasopharyngeal cavity, spectrography, phonetography, and acoustic voice analysis using the computer program Ling Waves Voice Program 3.1 before and after tonsillectomy.
We statistically analyzed all data using SPSS 13.0 software recording quantitative data as an average (+/-) of standard deviation, and describing qualitative data by percentages. We compared pre- and postoperative data with each other using a t-paired test. When comparing the results, we considered differences as significant when the obtained value of p (for the compared criterion) was below the critical significance level a = 0.05.
After 3 months after tonsillectomy, multidirectional dynamics was noted in all the main acoustic parameters: the average parameters after the operation changed. The results of acoustic voice analysis showed that after surgical treatment, parts of the objective acoustic parameters of the voice change statistically significantly: the intensity of quiet speech (p < 0.05), the intensity of the cry (p < 0.05), the time of maximum phonation (p < 0.05) , the degree of frequency voice instability (jitter, p < 0,05), C/З ratio (p < 0,05). Based on the analysis of vowel spectrogram, we divided the spectrograms into groups according to the Yanagihara classification with Wilson modifications. Before tonsillectomy, in all 24 patients the vowel spectrogram according to the above classification was of type II (with pronounced noise components in all or several spectra of vowels). After the treatment (3 months later), we classified the spectrograms of 21 patients to type I (with non-expressed noise components in all or several spectra of vowels). In three patients, the vowel spectrogram remained of type II.
At endoscopy of the nasopharyngeal cavity before surgery, incomplete closure of the soft palate was determined in 8 patients and after tonzillectomy only in two. In VLS before tonsillectomy, signs of a hypotone of the vocal folds (oval or triangular slit in phonation, blinking of the blinking ventricles, concavity of the free margin of vocal folds on inspiration, increase in the amplitude of oscillations) were found in 12 patients and after tonsillectomy in four. The average score on the VHI scale decreased after surgery from 18 to 5.
Based on our study we allowed drawing the following conclusions:
tonsils chronic inflammation affects voice quality;
tonsillectomy, if it not burdened with severe scarring in the region of the oropharynx, leads to the improvement of the main acoustic voice parameters, to expand the tonal and dynamic range of the voice;
conservative treatment of simple forms of chronic tonsillitis leads to improvement in the basic acoustic parameters of voice, to expand the tonal and dynamic range of the voice;
tonsillectomy has a positive effect on the state of the vocal folds;
(v).conservative treatment of chronic tonsillitis positive impacts on the state of the vocal folds.
Keywords: acoustic voice analysis, voice, tonsillectomy, chronic tonsillitis, hyper-nasality, velopharyngeal insufficiency.
Cite MLA 7:
Avetisyan, E. E., and L. S. Gordeev. "The Effect of Chronic Inflammation of Palatine Tonsils on Acoustic Voice Parameters." Electronic Scientific Edition Almanac Space and Time15.1 (Studia Studiosorum: Achievements of Young Researchers) (2017). Web. <2227-9490e-aprovr_e-ast15-1.2017.24>. (In Russian).
Список литературы / References
Литература
Анготоева И.Б., Рудин Л.Б. Влияние хронического тонзиллита на качество голоса // Голос и речь. 2012. № 1(6). С. 36—41.
Быкова В.П. Структурные основы мукозального иммунитета верхних дыхательных путей // Российская ринология. 1999. № 1. С. 5—8.
Василенко Ю.С. Голос. Фониатрические аспекты. М.: Инфополиграф, 2013. 390 с.
Джафек Б.У., Старк Э.К. Секреты оториноларингологии. СПб.: Невский диалект, 2001. 624 с.
Лойт А.А., Каюков А.В. Хирургическая анатомия головы и шеи. СПб.: Питер, 2002. 224 с.
Романенко С.Г., Павлихин О.Г. Лечебная тактика при хроническом тонзиллите у вокалистов // Вестник оториноларингологии. 2010. № 2. С. 60—62.
Романова Ж.Г. Комплексное лечение постоперационной гипотонии мягкого нёба // Медицинский журнал. 2008. № 2. С. 113—114.
Рудин Л.Б. Влияние хронического тонзиллита на функциональное состояние голосовых складок и его значение для возникновения дисфоний // Голос: междисциплинарные проблемы. Теория и практика. Доклады II Конгресса Российской общественной академии голоса. М.: Граница, 2009. С. 124—127.
Шадыев Х.Д., Хлыстов Ю.В., Хлыстов Ю.А. Практическая оториноларингология: руководство для врачей. М.: Медицинское информационное агентство, 2002. 288 с.
Шиленкова В.В. Акустический анализ голоса. Ярославль: Аверс Плюс, 2015. 176 с.
Atan D., Apaydın E., Özcan K.M., İkincioğulları A., Çetin M.A., Dere H. "Does Tonsillectomy Affect Voice in Early or Late Postoperative Periods in Adults?." Journal of Voice 31.1 (2017): 131.e5—131.e8.
Brosch S., Haase S. "Open Nasal Speech and Velopharyngeal Insufficiency in Adenoidectomy and Tonsillectomy." Laryngo–Rhino–Otologie 86 (2007): 666—676.
Ceballos A.G.C., Carvalho F.M., de Arau´jo T. M., Farias Borges dos Reis E. J. "Diagnostic Validity of Voice Handicap Index-10 (VHI-10) Compared with Perceptive-Auditory and Acoustic Speech Pathology Evaluations of the Voice." Journal of Voice 24.6 (2010): 715—718.
Celebi S., Yelken K., Celik O., Taskin U., Topak M. "Thermal Welding vs. Cold Knife Tonsillectomy: A Comparison of Voice and Speech." International Journal of Pediatric Otorhinolaryngology 75.1 (2011): 114—117.
Chitkara P., Yeh M., Forbis C. "Background on Formants." OpenStax CNX. Dr. Richard Baraniuk, n.d. Web. <http://cnx.org/content/m11733/latest/>.
Chuma A.V, Cacace A.T., Rosen R., Feustel P., Koltaii P.J. "Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics." International Journal of Pediatric Otorhinolaryngology 47.1 (1999): 1—9.
Devakanta N., Biram T., Lungleng N. "Effects of Tonsillectomy on Voice Assessment." Journal of Evolution of Medical and Dental Sciences 4.102 (2015): 16769—16771.
Dworkin J.P., Marunick M.T., Krouse J.H. "Velopharyngeal Dysfunction: Speech Characteristics, Variable Etiologies, Evaluation Techniques, and Differential Treatments." Lang. Speech Hear. Serv. Sch. 35.4 (2004): 333—52.
"Forming the Vowel Sounds, Vocal Formants." HyperPhysics. Georgia State University, Department of Physics and Astronomic, and C.R. Nave, 2016. Web. <http://hyperphysics.phyastr.gsu.edu/Hbase/music/vowel.html>.
Gibb A.G., Stewart I.A. "Hypernasality Following Tonsil Dissection — Hysterical Aetiology." Journal of Laryngology and Otology 89.7 (1975): 779—781.
Haapanen M.L., Ignatius J., Rihkanen H., Ertama L. "Velopharyngeal Insufficiency Following Palatine Tonsillectomy." European Archives of Oto–Rhino–Laryngology and Head & Neck 251.3 (1994): 186—189.
Han D., Xu W., Hu R., Zhang L. "Voice Function Following Han’s Uvulopalatopharyngoplasty." Journal of Laryngology and Otology 126.1 (2012): 47—51.
Ilk H.G., Erogul O., Satar B., Özkaptan Y. "Effects of Tonsillectomy on Speech Spectrum." Journal of Voice 16.4 (2002): 580—586.
Kandoğan T., Özüer M.Z. "Effects of Tonsillectomy on Acoustic Parameters." KBB-Forum 5.4 (2006): 141—144.
Khami M., Tan S., Glicksman J.T., Husein M. "Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy." Otolaryngology–Head and Neck Surgery 153.6 (2015): 1051—1055.
Kummer A.W., Billmire D.A., Myer C.M. 3rd. "Hypertrophic Tonsils: The Effect on Resonance and Velopharyngeal Closure." Plastic and Reconstructive Surgery 91.4 (1993): 608—611.
Lin P.T., Gould W.J., Fukazawa T., El-Assuooty A. "Acoustic Analysis of Voice in Tonsillectomy." Journal of Voice 3.1 (1989): 81—86.
Liu X., Zheng Y., Yang J., Zou H. "The Impact of Tonsillectomy with or without Adenoidectomy on Voice: Acoustic and Aerodynamic Assessments." Journal of Voice 29.3 (2015): 346—348.
Lundeborg I., Hultcrantz E., Ericsson E., McAllister A. "Acoustic and Perceptual Aspects of Vocal Function in Children With Adenotonsillar Hypertrophy–Effects of Surgery." Journal of Voice 26.4 (2012): 480—487.
MacKenzie-Stepner K., Witzel M.A., Stringer D.A., Laskin R. "Velopharyngeal Insufficiency Due To Hypertrophic Tonsils. A Report of Two Cases." International Journal of Pediatric Otorhinolaryngology 14.1 (1987): 57—63.
Maryn Y., Van Lierde K., De Bodt M., Van Cauwenberge P. "The Effects of Adenoidectomy and Tonsillectomy on Speech and Nasal Resonance." Folia Phoniatrica et Logopaedica 56 (2004): 182—191.
Misra U.C., Gill R.S., Lal M. "Tonsil Transposition into Posterior Pharyngeal Wall in Palato-pharyngeal Incompetence." Journal of Laryngology and Otology 95.7 (1981): 713—716.
Mora R., Jankowska B., Mora F., Crippa B., Dellepiane M., Salami A. "Effects of Tonsillectomy on Speech and Voice." Journal of Voice 23.5 (2009): 614—618.
Naraghi M., Adil S., Bastaninejad S., Dabiran S. "Evaluation of Pediatric Voice Handicap Index and Pediatric Voice Related Quality of Life before and after Adenotonsillectomy in Pediatric Population." International Journal of Pediatric Otorhinolaryngology 79.3 (2015): 388—391.
Peterson-Falzone S.J. "Velopharyngeal Inadequacy in the Absence of Overt Cleft Palate." Journal of Craniofacial Genetics and Developmental Biology Supplement 1 (1985): 97—124.
Ramos S.D., Mukerji S., Pine H.S. "Tonsillectomy and Adenoidectomy." Pediatric Clinics of North America 60.4 (2013): 793—807.
Saida H., Hirose H. "Acoustic Changes in Voice after Tonsillectomy." Acta Oto-laryngologica. Supplementum 523 (1996): 239—241.
Seshamani M., Vogtmann E., Gatwood J., Gibson T.B., Scanlon D. "Prevalence of Complications from Adult Tonsillectomy and Impact on Health Care Expenditures." Otolaryngology–Head and Neck Surgery 150.4 (2014): 574—581.
Shirley W.P, Wiatrak B.J., Woolley A.L. "Pharyngitis and Adenotonsillar Disease." Cummings Otolaryngology: Head and Neck Surgery. Philadelphia: Elsevier, 2010, volume 3, pp. 2782—2802.
Williamson G. "Objective Measurement of Voice".SLT Info: Speech and Language Therapy Information. N.p., 1 Feb. 2014. Web. <https://www.sltinfo.com/objective-measurement-of-voice/>.
Zagólski O., Stręk P., Gajda M. "Adult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality." Folia Phoniatrica et Logopaedica 66 (2014): 95—99.
References:
"Forming the Vowel Sounds, Vocal Formants." HyperPhysics. Georgia State University, Department of Physics and Astronomic, and C.R. Nave, 2016. Web. <http://hyperphysics.phyastr.gsu.edu/Hbase/music/vowel.html>.
Angotoeva I.B., Rudin L.B. "Chronic Tonsillitis Effect on Voice Quality." Voice and Speech 1 (2012): 36—41. (In Russian).
Atan D., Apaydın E., Özcan K.M., İkincioğulları A., Çetin M.A., Dere H. "Does Tonsillectomy Affect Voice in Early or Late Postoperative Periods in Adults?." Journal of Voice 31.1 (2017): 131.e5—131.e8.
Brosch S., Haase S. "Open Nasal Speech and Velopharyngeal Insufficiency in Adenoidectomy and Tonsillectomy." Laryngo–Rhino–Otologie 86 (2007): 666—676.
Bykova V.P. "Structural Fundamentals of Upper Respiratory Mucosal Immunity." Russian Rhinology 1 (1999): 5—8. (In Russian).
Ceballos A.G.C., Carvalho F.M., de Arau´jo T. M., Farias Borges dos Reis E. J. "Diagnostic Validity of Voice Handicap Index-10 (VHI-10) Compared with Perceptive-Auditory and Acoustic Speech Pathology Evaluations of the Voice." Journal of Voice 24.6 (2010): 715—718.
Celebi S., Yelken K., Celik O., Taskin U., Topak M. "Thermal Welding vs. Cold Knife Tonsillectomy: A Comparison of Voice and Speech." International Journal of Pediatric Otorhinolaryngology 75.1 (2011): 114—117.
Chitkara P., Yeh M., Forbis C. "Background on Formants." OpenStax CNX. Dr. Richard Baraniuk, n.d. Web. <http://cnx.org/content/m11733/latest/>.
Chuma A.V, Cacace A.T., Rosen R., Feustel P., Koltaii P.J. "Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics." International Journal of Pediatric Otorhinolaryngology 47.1 (1999): 1—9.
Devakanta N., Biram T., Lungleng N. "Effects of Tonsillectomy on Voice Assessment." Journal of Evolution of Medical and Dental Sciences 4.102 (2015): 16769—16771.
Dworkin J.P., Marunick M.T., Krouse J.H. "Velopharyngeal Dysfunction: Speech Characteristics, Variable Etiologies, Evaluation Techniques, and Differential Treatments." Lang. Speech Hear. Serv. Sch. 35.4 (2004): 333—52.
Gibb A.G., Stewart I.A. "Hypernasality Following Tonsil Dissection — Hysterical Aetiology." Journal of Laryngology and Otology 89.7 (1975): 779—781.
Haapanen M.L., Ignatius J., Rihkanen H., Ertama L. "Velopharyngeal Insufficiency Following Palatine Tonsillectomy." European Archives of Oto–Rhino–Laryngology and Head & Neck 251.3 (1994): 186—189.
Han D., Xu W., Hu R., Zhang L. "Voice Function Following Han’s Uvulopalatopharyngoplasty." Journal of Laryngology and Otology 126.1 (2012): 47—51.
Ilk H.G., Erogul O., Satar B., Özkaptan Y. "Effects of Tonsillectomy on Speech Spectrum." Journal of Voice 16.4 (2002): 580—586.
Jafek B.W., Stark A.K. ENT Secrets. St. Petersburg: Nevsky dialekt Publisher, 2001. 624 p. (In Russian).
Kandoğan T., Özüer M.Z. "Effects of Tonsillectomy on Acoustic Parameters." KBB-Forum 5.4 (2006): 141—144.
Khami M., Tan S., Glicksman J.T., Husein M. "Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy." Otolaryngology–Head and Neck Surgery 153.6 (2015): 1051—1055.
Kummer A.W., Billmire D.A., Myer C.M. 3rd. "Hypertrophic Tonsils: The Effect on Resonance and Velopharyngeal Closure." Plastic and Reconstructive Surgery 91.4 (1993): 608—611.
Lin P.T., Gould W.J., Fukazawa T., El-Assuooty A. "Acoustic Analysis of Voice in Tonsillectomy." Journal of Voice 3.1 (1989): 81—86.
Liu X., Zheng Y., Yang J., Zou H. "The Impact of Tonsillectomy with or without Adenoidectomy on Voice: Acoustic and Aerodynamic Assessments." Journal of Voice 29.3 (2015): 346—348.
Loyt A.A., Kayukov A.V. Surgical Anatomy of Head and Neck. St. Petersburg: Piter Publisher, 2002. 224 p. (In Russian).
Lundeborg I., Hultcrantz E., Ericsson E., McAllister A. "Acoustic and Perceptual Aspects of Vocal Function in Children With Adenotonsillar Hypertrophy–Effects of Surgery." Journal of Voice 26.4 (2012): 480—487.
MacKenzie-Stepner K., Witzel M.A., Stringer D.A., Laskin R. "Velopharyngeal Insufficiency Due To Hypertrophic Tonsils. A Report of Two Cases." International Journal of Pediatric Otorhinolaryngology 14.1 (1987): 57—63.
Maryn Y., Van Lierde K., De Bodt M., Van Cauwenberge P. "The Effects of Adenoidectomy and Tonsillectomy on Speech and Nasal Resonance." Folia Phoniatrica et Logopaedica 56 (2004): 182—191.
Misra U.C., Gill R.S., Lal M. "Tonsil Transposition into Posterior Pharyngeal Wall in Palato-pharyngeal Incompetence." Journal of Laryngology and Otology 95.7 (1981): 713—716.
Mora R., Jankowska B., Mora F., Crippa B., Dellepiane M., Salami A. "Effects of Tonsillectomy on Speech and Voice." Journal of Voice 23.5 (2009): 614—618.
Naraghi M., Adil S., Bastaninejad S., Dabiran S. "Evaluation of Pediatric Voice Handicap Index and Pediatric Voice Related Quality of Life before and after Adenotonsillectomy in Pediatric Population." International Journal of Pediatric Otorhinolaryngology 79.3 (2015): 388—391.
Peterson-Falzone S.J. "Velopharyngeal Inadequacy in the Absence of Overt Cleft Palate." Journal of Craniofacial Genetics and Developmental Biology Supplement 1 (1985): 97—124.
Ramos S.D., Mukerji S., Pine H.S. "Tonsillectomy and Adenoidectomy." Pediatric Clinics of North America 60.4 (2013): 793—807.
Romanenko S.G., Pavlikhin O.G. "Therapeutic Tactics for Chronic Tonsillitis in Vocalists." Bulletin of Otorhinolaryngology 2 (2010): 60—62. (In Russian).
Romanova Zh.G. "Combination Treatment of Soft Palate Postoperative Hypotension." Medical Journal 2 (2008): 113—114. (In Russian).
Rudin L.B. "Chronic Tonsillitis Effect on Vocal Folds Functional State and Its Importance for Emergence of Dysphonia." Voice: An Interdisciplinary Problem. Theory and Practice. Proceedings of the 2nd Congress of Russian Public Academy of Voice. Moscow: Granitsa Publisher, 2009, pp. 124—127. (In Russian).
Saida H., Hirose H. "Acoustic Changes in Voice after Tonsillectomy." Acta Oto-laryngologica. Supplementum 523 (1996): 239—241.
Seshamani M., Vogtmann E., Gatwood J., Gibson T.B., Scanlon D. "Prevalence of Complications from Adult Tonsillectomy and Impact on Health Care Expenditures." Otolaryngology–Head and Neck Surgery 150.4 (2014): 574—581.
Shadyev Kh.D., Khlystov Yu.V., Khlystov Yu.A. Guide for Physicians in Practical Otorhinolaryngology. Moscow: Medical Information Agency Publisher, 2002. 288 p. (In Russian).
Shilenkova V.V. Acoustic Voice Analysis. Yaroslavl': Avers Plyus Publisher, 2015. 176 p. (In Russian).
Shirley W.P, Wiatrak B.J., Woolley A.L. "Pharyngitis and Adenotonsillar Disease." Cummings Otolaryngology: Head and Neck Surgery. Philadelphia: Elsevier, 2010, volume 3, pp. 2782—2802.
Vasilenko Yu.S. Voice. Phoniatric Aspects. Moscow: Infopoligraf Publisher, 2013, 390 p. (In Russian).
Williamson G. "Objective Measurement of Voice".SLT Info: Speech and Language Therapy Information. N.p., 1 Feb. 2014. Web. <https://www.sltinfo.com/objective-measurement-of-voice/>.
Zagólski O., Stręk P., Gajda M. "Adult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality." Folia Phoniatrica et Logopaedica 66 (2014): 95—99.
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