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ID naloge: 130 Letnik: 2002 Predmet: otorinolaringologija
Hripavost med šolarji
Avtor: Rober Šifrer
Mentor: doc. dr. Irena Hocevar Boltežar
Izhodišce: Hripavost ali disfonija pomeni spremembo akusticnih lastnosti glasu, kar poslušalec zazna s sluhom kot poslabšanje kvalitete glasu. Vzroki za njen nastanek so organski in funkcionalni. Pogostnost hripavosti med šolsko mladino v svetu je med 7% in 23% in je pogostejša pri ucencih nižjih razredov osnovne šole. Podatki o pogostnosti hripavosti v adolescenci so zelo razlicni.
Namen: Želeli smo ugotoviti pogostnost in vzroke za hripavost med slovenskimi šolarji pred in med mutacijo glasu, ter ugotoviti akusticne znacilnosti glasovnih vzorcev hripavih otrok in otrok s cistim glasom.
Hipoteza: Hripavih je med 7% in 23% šolarjev. Pri 10-letnikih (4. razred) kot vzroki za hripavost prevladujejo funkcionalne glasovne motnje in infekcije dihal, pri 14-letnikih (8. razred) pa mutacijske motnje. Med hripavimi prevladujejo 14-letni fantje. Glasovi hripavih otrok in otrok s cistim glasom se ne razlikujejo glede pac pa glede perturbacije frekvence (JIT) ter amplitude (SH).
Metode: Raziskava je bila prospektivna. V raziskavo smo zajeli 202 ucenca treh mestnih in primestnih osnovnih šol. Sto ucencev 4. razredov (starost 10 let), in 102 ucenca 8. razredov (starost 14 let) so izpolnili vprašalnik o boleznih in navadah, ki neugodno vplivajo na glas. Ucencem smo posneli glasovne vzorce (spontani govor, branje standardnega besedila, samoglasnik /a/). Spontani govor in branje sta foniater in študent neodvisno ocenjevala z vizualno analogno lestvico in ugotavljala morebitno hripavost. Samoglasniške vzorce smo akusticno analizirali in dolocili perturbacijo frekvence (JIT) in amplitude (SH). Hripave ucence smo 1-3 mesece po snemanju povabili na otorinolaringološki pregled in ugotovili vzroke za hripav glas. Rezultate smo statisticno obdelali z Mann-Whitneyevim testom in testom.
Rezultati: Na podlagi subjektivne ocene posnetih glasovnih vzorcev smo ugotovili 34,2% hripavih otrok. Prevladovali so fantje (60,9%) in 10-letniki (52,2%). Ob pregledu cez 1 do 3 mesece je bilo hripavih samo še 14,9% otrok. Najpogostejši vzroki za hripavost so bili akutni respiratorni infekt, alergijski kataralni laringitis, mišicno tenzijska disfonija, ki je pri nekaterih povzrocila nastanek vozlicev na glasilkah, mutacijska glasovna motnja in refluksni laringitis. V skupini dolgotrajno hripavih otrok smo znacilno pogosteje ugotovili hiter govorni tempo in astmo kot v skupini otrok brez dalj casa trajajoce hripavosti. Za glasove hripavih otrok sta bili znacilni nižja temeljna grlna frekvenca ter višji perturbacija višine in glasnosti kot pri otrocih s cistim glasom.
Zakljucki: Hripavost predstavlja dokaj pomemben problem med šolsko mladino, saj je obcasno hripavih tretjina, stalno pa šestina osnovnošolcev. Za nastanek hripavosti pri otrocih je potrebno sodelovanje vec neugodnih dejavnikov in sicer organskih bolezni dihal in funkcionalnih glasovnih motenj. Najbolj primeren cas za zdravljenje hripavosti je obdobje pred in med mutacijo, ko se na novo ustvarjajo pravilni vzorci fonacije. To pa je tudi obdobje poklicnega usmerjanja, zato je zdrav glas nujen za nemoteno izbiro željenega poklica.
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[Abstract / English version]
Hripavost med šolarji
Author: Rober Šifrer
Mentor: doc. dr. Irena Hocevar Boltežar
Background: Dysphonia is characterised by changes of the acoustic properties of voice which are subjectively percepted as worsening of voice quality. The causes for dysphonia can be of organic and functional origin. The incidence of dysphonia in school-age children is reported to be from 7% to 23%. The children from lower classes of elementary school are more often affected. The data on incidence of dysphonia in adolescents differ between available studies.
Aim: The aim of the study was to establish the incidence of dysphonia in school children in Slovenia before and after voice mutation, and to find out the causes for voice disorders. The acoustic properties of the hoarse voices and healthy voices were determinated.
Hypothesis: The incidence of dysphonia in school-age children in Slovenia ranges between 7% and 23%. The causes for dysphonia in 10-year-old children are functional voice disorders and respiratory infections, while in 14-year-old children is mutational voice disorder. Fourteen year-old boys represent the majority of hoarse school children. The dysphonic voice and healthy voice do not differ in F0. The frequency perturbation (JIT) and amplitude perturbation (SH) are expected to be higher in the group of dysphonic children.
Methods: This research was prospective. The studied group consisted of 202 children from three elementary schools. One hundred children were 10 years old (graders) and 102 children were 14 years old (graders). They answered the questionnaires on diseases and habits affecting voice. The voice samples (spontaneous speech, text reading, vowel /a/) were recorded and analysed independently by a phoniatrician and a student using an analogue visual scale. Acoustic analysis of the vowel samples was performed and JIT and SH measured. One to 3 months after the voice recording, the hoarse children were examined by an otorhinolaringologist and the causes of dysphonia were assessed. The results were statistically analysed with Mann-Whitney's test and ÷2 -test.
Results: Both listeners assessed the voices of 34,2% children as dysphonic of all recorded samples. Boys (60.9%) and 10-year-old children (52.2%) were more often affected. After 1 to 3 months there were still 14.9% dysphonic children. The most important causes for dysphonia were respiratory infection, allergic catarrhal laryngitis, muscle tension dysphonia, mutational voice disorder and reflux laryngitis. In the group of children with persistent dysphonia there were significantly more children with fast speaking rate and asthma than in the children without persistent dysphonia. Lower higher JIT and SH were significant for dysphonic voices.
Conclusions: Dysphonia is a serious problem in school-aged children. In one third of children periodic dysphonia and in one sixth of children persistent dysphonia was assessed. Dysphonia is result of a co-operation of many adverse factors including organic diseases and functional disorders. The best period for dysphonia treatment in children is before and during mutation. In this period new phonation patterns are developing. This period is also important for the professional decision for further education and profession. Healthy voice is a necessary condition for undisturbed choice of the future profession.
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