GRBAS 음성평가와 음성장애지수

손진호,Sohn, Jin-Ho 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.2

Subjective voice evaluation is necessary and important to assess the voice disorders in addition to objective voice evaluation. Subjective voice evaluation is divided into examiner and examinee subjective voice assessment. The examiner assessment represents perceptual judgment to the patient's voice such as GRBAS scale, Buffalo voice profile, consensus auditory perceptual evaluation of voice (CAPE- V) and so on. The examinee assessment consists of indirect method including voice handicap index (VHI), voice outcome survey (VOS), voice symptom scale (VoiSS), voice related quality of life (V-ROQL) and direct method which is called patient's self-subjective voice rating. This review article describes a general rule, advantages and pitfalls about GRBAS scale, VHI and patient's self-subjective voice rating which are presently most representative voice assessment tools. 주관적 음성평가는 음향분석기기를 이용한 객관적 음성 평가와 함께 음성분석에 유용하고 의미있는 평가방법이며 현재 알려진 검시법정 중에서 GRBAS 음성평가, VHI, patient self-perceptual voice rating이 가장 널리 사용되고 있고 인정받는 방법이다. 주관적 음성평가는 음성의 상태를 모두 대변할 수은 없으며 객관적인 음성평가에 대한 보완적인 의미를 가진다. 현재 개발되어 있는 주관적 음성평가 방법들이 유용한 평가도구이긴 하지만 나름대로의 문제점과 제한점을 가지고 있기 때문에 이에 대한 개선과 보완을 위한 지속적인 연구와 개발이 요구된다.

기능성 음성장애의 병태생리

진성민,Jin, Sung Min 대한후두음성언어의학회 2014 대한후두음성언어의학회지 Vol.25 No.2

기능성 음성장애는 후두에 구조적 혹은 신경학적 병변이 없이 음성발성에 장애가 있는 질환으로, 의학적인 부분만으로 설명하기가 어려운 장애 요소들을 내포하고 있기 때문에 진단에 많은 혼란이 있을 수 있는 논쟁의 여지가 많은 음성질환이다. 기능성 음성장애의 중요한 부분 중의 하나인 muscle tension dysphonia는 후두 근육과 후두 주변 근육의 지나친 긴장에 의해서 발생하는 음성장애로, 비록 후두 내/외근의 운동이 제대로 조절되지 않는 것이 muscle tension dysphonia의 가장 첫 번째 원인이라고 알려져 있고, 특정의 개인적인 인성의 특징(personality traits)들도 발생에 있어서 상당히 중요한 부분을 차지 하는 것으로 연구되고 있지만, 이들 근육이 도대체 어떻게 문제가 되는 지에 대해서는 사실 아직까지 완전하게 설명하기에는 곤란한 점이 많다. 또한 최근 들어서는 muscle tension dysphonia를 하나의 질환으로 보기보다는 기능성 음성장애의 문제점들을 설명하는 진단적 지표(diagnostic label)로 보는 경향이 많으며, 기능성 음성장애와 기질적 음성장애(organic voice disorder)를 아우르는 위치에 있는 것으로 해석하는 경향도 있다. 따라서 기능성 음성장애에 대한 분류나 발생기전에 대한 의견들은 아직까지 논란이 되는 부분들이 많은 상태이고, 기능성 음성장애를 더 잘 이해하고 이 질환을 성공적으로 치료해 나갈 수 있는 중요한 요인들을 찾아낼 수 있도록 더 많은 연구들이 이루어 져야 할 것으로 생각된다. Functional dysphonia refers to a voice disturbance that occurs in the absence of structural or neurologic laryngeal pathological characteristics. Poorly regulated activity of the intrinsic and extrinsic laryngeal muscles is cited as the proximal cause of functional dysphonia (FD). Recently, the term functional dysphonia has been replaced in some clinical circles by diagnostic label muscle tension dysphonia (MTD), which serves to highlight excess, dysregulated, or imbalanced activity of the intrinsic and extrinsic laryngeal muscles as proximal cause of the observed dysphonia. And recent research evidence points to specific personality traits as important contributors to its development and maintenance. However, the origin of this dysregulated laryngeal muscle activity has not been fully elucidated. Further research is needed to better understand the pathogenesis of functional dysphonia, and factors contributing to its successful management.

예기치 못한 후두 입구 협착으로 인한 환기 부전 상황에서의 비디오 후두경의 유용성 1예

문정환,이선홍,강봉진,Moon, Jeong Hwan,Lee, Sun Hong,Kang, Bong Jin 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.

후두미세수술 전후 성대 용종의 크기 및 위치가 음성의 질의 변화에 미치는 영향

한원규,김민수,오경호,우정수,정광윤,권순영,Han, Won Gue,Kim, Min-Su,Oh, Kyung Ho,Woo, Jeung Soo,Jung, Kwang Yoon,Kwon, Soon Young 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2

Background and Objectives : Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. Methods : We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. Results : When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ${\leq}3mm$), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). Conclusion : All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

후두외상으로 발생한 일측 성대 마비의 감별진단으로서 후두근전도검사의 유용성 -증례보고-

최홍식,김한수,김정홍,장정현 대한후두음성언어의학회 2002 대한후두음성언어의학회지 Vol.13 No.2

Unilateral vocal cord palsy which is associated with laryngeal trauma is not uncommon event. In a 42-year-old male, a cricoid cartilage fracure had been developed after blunt trauma. The endoscopic findings showed contusion and diffuse swelling around the left arytenoid and false cord. During phonation, the mobility of left side true vocal cord was decreased. There were no level difference and displacement of the left side arytenoid. We used the laryngeal electromyography (LEMG) to make a differential diagnosis between the cricoarytenoid joint dislocation and the injury of recurrent laryngeal nerve. At the right thyroarytenoid muscle and cricothyroid muscle, the findings of LEMG were normal. But the amplitude and frequency during phonation were decreased (partial denervation) at the left thyroarytenoid muscle. LEMG is a very useful method to predict the diagnosis of vocal cord palsy.

한국어판 소아음성장애지수(pVHI-K : Pediatric Voice Handicap Index-Korean) : 표준화를 위한 예비연구

박성신,최성희,홍영혜,정년기,성명훈,김광현,권택균,Park, Sung-Shin,Choi, Seong-Hee,Hong, Young-Hye,Jeong, Nyun-Gi,Sung, Myung-Whun,Kim, Kwang-Hyun,Kwon, Tack-Kyun 대한후두음성언어의학회 2011 대한후두음성언어의학회지 Vol.22 No.2

Background and Objectives : The aim of this study is to introduce Korea version of pediatric VHI and to compare pVHI-K scores between children with dysphonia and children without voice problems before pVHI-K is developed as a preliminary study. Additionally, the relationship between pVHI and acoustic measures were investigated. Materials and Methods : pVHI-K scores in normal group were obtained from 15 parents who have children with no present or past history of a voice disorder, hearing loss, or related disability that can affect the their voice or speech. Dysphonia group consisted of 15 parents who have children with bilateral vocal fold nodule's at Department of Otolaryngology, the Seoul National University Hospital (SNUH). pVHI-K and acoustic parameters were measured in two group. Results : The mean pVHI scores (total, functional, physical, emotional) in normal group were 2.33 (T), 0.80 (F) 1.33 (P) and 0.27 (E), respectively whereas those of pVHI in children group with dysphonia were 23.13 (T), 11.07 (F), 5.73 (P) and 6.13 (E), respectively and significant differences were revealed in total pVHI score as well as in all of the sub-pVHI scores. Moreover, significant correlation between pVHI-K parameters (T, F, P) and acoustic measures [Shimmer(%)] were shown in children in dysphonia group. Conclusion : Reported by parents can be useful as a supplementary clinical tool for diagnosing and measuring treatment effectiveness in young children with dysphonia.

기능적 실성증에 대한 음성치료의 효과 분석: 기초 연구

김노을,김준석,오재환,김동영,우주현 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.2

Background and Objectives Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly.Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared.Results In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved.Conclusion The voice therapy was effective for the treatment of functional aphonia by restoring patient’s vocalization and improving voice quality, pitch and loudness.

가수 음성에 대한 언어재활사의 관점

유재연,Yoo, Jae Yeon 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.1

This article addresses the roles of the speech language pathologist (SLP) for singers who require prompt and effective treatment when a voice problem arises. The causes of voice problem are often vocal abuse/misuse/overuse, muscle tension dysphonia and inappropriate singing technique. The SLP should conduct voice counseling and voice assessment for maintaining healthy voice of singer constantly.

후두적출자의 음성재활 - 기관식도천자법 이외의 방법 -

김영호,Kim, Young-Ho 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1

The problem of voice restoration after total laryngectomy has existed ever since Billroth's first total laryngectomy in 1873. Since then, all the efforts to restore the voice was tried to divert the tracheal air to the pharynx to produce voice, which became the tracheo-esophageal shunt voice currently used. With the intact pharyngoesophagus, however, there are two basic options for speech rehabilitation : the artificial larynx and esophageal voice. The artificial larynx is an electrically driven buzzer or a sound transducer and its most common type is placed against a supple point on patient's neck and introduces a mechanical sound into the tissues and air spaces of the neck. This sound, emanating form the mouth, is articulated by the intact structures of the remaining vocal tract as understandable speech. Esophageal voice is a commonly recommended method for alaryngeal speech rehabilitation, which can be successfully done by regurgitating the air stored in the esophagus. Successful esophageal voice is preferable to the artificial larynx but, most patients usually adapt only one of those methods according to their needs and feasibility to learn.

장시간 지속된 기능적 실성증에 대한 음성치료 1예

김보람,우주현 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.2

Functional aphonia is a disease in which normal vocal ability is suddenly lost. When voice therapy is started at an early stage, the prognosis is good. However, if the functional aphonia persists for a long time, there is a possibility that the voice disorder may become fixed, though reports of these characteristics are rare. The authors experienced a patient with functional aphonia that occurred in adolescence and lasted for 7 months and reported the result of treatment.