In the theoretical part of the master's thesis, we identified and classified voice
disorders. We focused in more detail on the vocal cord nodules. We explained the
causes of their occurrence, described the voice of persons with the mentioned
pathology, discussed the influence of personality traits on the formation and
maintenance of nodules on the vocal cords, and checked the frequency of voice
disorder. The process of treating the nodules was divided into diagnostic procedures
and further treatment. In the individual parts we described the role of the phoniatrist,
speech therapist and psychologist.
In the empirical part, we tried to find out whether there are any differences in the
efficiency of removing the nodules on the vocal cords according to the different
treatment methods. We separated a group of children who received only voice
hygiene instructions and a group of children who also received further speech
therapy. The sample was also compared according to current voice quality; we
separated group of children with and without voice problems. As a limit for the
division of groups, we considered the parental assessment of the child's voice.
Since there is a lack of studies regarding the need for speech therapy in the
childhood period for the elimination of voice disorders in the professional literature,
we sought to determine the necessity by conducting a research. The sample included
70 children (or their parents) between the ages of 6 and 16 years, who visited the
phoniatric service between 2010 and 2016 and who underwent an otolaryngology
examination with the help of telelaryngoscopy and it was found out that they have a
functional voice disorder with vocal folds' mucosal lesions – nodules.
We sent the participating children or their parents the Questionnaire on Voice Habits
and Children’s Characteristics and a Sloveniam version of the Pediatric Voice
Handicap Index (pVHI). Both questionnaires were anonymous. If the parents also
signed a permission for obtaining information from the child's medical records, the
authorized person summarized some of the information needed to complete the
survey.
According to our results, we found differences between children who received only
voice hygiene instructions and those who were included in further speech therapy,
both in the physical (pVHIP; p = 0,019) and emotional part (pVHIE; p = 0,001) of the
pVHI questionnaire, as well as in the overall test result (tpVHI: p = 0,005). Higher
average rank was achieved in all cases by a group of children who also received
further speech therapy. We also noticed statistically significant differences regarding
the desire for otorhinolaryngological re-examination (p = 0,027). There were more
children, who received speech therapy than children with only instructions on voice
higiene in a group of those who wanted re-examination. In the first group, we also
observed significantly more accompanying diseases (p = 0,029) and poorer voice
quality based on parental assessment (p = 0,012).
When comparing children with and without dysphonia according to their parents'
evaluation, some significant differences were also noticed. The groups of children
significantly differed on all sub-questionnaires (pVHIF: p = 0002, pVHIP: p = 0,000,
pVHIE: p = 0,000), and on the total test result (tpVHI: p = 0,000). Higher rank
averages were observed in the group with voice problems than in the group where parents assessed their voices as normal or almost normal. The dysphonic children
also achieved significantly worse results when comparing children's speaking habits
(child’s loud speaking: p = 0,002, rest of the family’s loud speaking: p = 0,015,
imitation of the sounds: p = 0,047), and frequent ear infections (p = 0,032).
Statistically significant differences (p = 0,000) were noticed regarding the number of
first-, middle- or last-born in both groups. Only the first- and last-born children were
found in the group of children without voice problems; the group of children with voice
problems had the same number of middle- and last-born, and first-born children were
in the minority. Significant differences between these two groups were also noticed in
the attending speech therapies due to voice problems (p = 0,051), improvement of
voice (p = 0,006), desire for otorhinolaryngological re-examination (p = 0,001), and
treatment methods (p = 0,009).
Based on the present research, we can conclude that the need for speech therapy
treatment of children with nodules and voice disorders is generally much greater than
the available speech therapy services, what is an important information for health
planners and health network financers in the country. However, with regard to the
current state of affairs, pedagogical workers who come in contact with children on a
daily basis should also be educated about voice hygiene. The role of speech
therapists would thus be to create guidelines for preventive measures to help
pedagogical staff to prevent the occurrence of voice disorders in children.
|
