No5(4) 2021
Back to the issue
DOI 10.37219/2528-8253-2021-5-19 |
Shydlovska TA, Kovalchuk PM
Values of laryngeal stroboscopy in patients with chronic laryngitis exposed
to occupational factors |
Shidlovskaya Tetiana A.
State Institution “O.S. Kolomiychenko Institute of Otolaryngology of
National Academy of Medical Science of Ukraine”; Kyiv, Ukraine.
Head of the laboratory of voice and hearing
Doctor of Medical Sciences, Professor
E-mail: lorprof3@ukr.net
Orchid ID: https://orcid.org/0000-0002-7894-359X
Kovalchuk Petro
Cherkasy 219 Gogolya str.
Doctor Kovalchuk family clinic
Orchid ID: https://orcid.org/0000-0002-8275-4986
0091103@gmail.com |
Abstract
Topicality: Chronic laryngitis occupies one of the leading positions
in the structure of laryngeal pathology.
Among other things in the etiology of chronic laryngitis, occupational
factors, including a chemical exposure, play an important role. Laryngeal
storoboscopy is one of the most informative methods of examination of the
vocal apparatus in phoniatrics that allows observing rapid oscillating
motion of the vocal folds during phonation, which cannot be seen without
instrumental methods.
Aim: to investigate the functional condition of the vocal apparatus
based on the values of laryngeal storoboscopy in patients with chronic
laryngitis who were exposed to chemical factors.
Materials and methods: Seventy-five patients with chronic laryngitis
and 15 healthy individuals of the control group were examined. The patients
were divided into groups based on the type of chronic laryngitis (group 1
one was made up of those who had a catarrhal type, group 2 had subatrophic
type patients) and the intensity of chemical factors in the production of
nitrogen compounds (subgroup A included patients who worked in manufacturing
workshops where the level of chemicals in the air did not exceed maximum
allowable levels, whereas subgroup B experienced an exposure to elevated
chemical levels). Groups 1A and 2A included 23 and 20 patients,
respectively; groups 1 B and 2B were composed of 17 and 15 patients,
respectively. The patients underwent a specialized phoniatric examination
and they were determined the maximum phonation time (MPT). We performed a
video laryngeal stroboscopic examination on the equipment complex of «Karl
Storz» (Germany). The results were evaluated by calculating the integrated
score of phonator oscillations recorded during a stroboscopic study.
Results and discussion: Patients with chronic laryngitis – employees
of the public joint-stock company «AZOT» were examined. This is a large
chemical production with several manufacturing workshops involved into
various technological processes. According to the intensity of the influence
of chemical factors, the manufacturing workshops differ significantly;
therefore the intensity of the influence of the factors of the production
environment on the upper respiratory tract varies in those working in the
production of nitrogen-containing compounds. We compared the results of the
survey of patients included in subgroups A and B. The MPT in patients of
group 1A was 18.6±1.6 sec versus 13.6±1.2 sec in group 1B; in group 2A, it
was 13.4±1.1 sec versus 10.8±0.8 sec in group 2B and 21.2±1.6 sec in the
control group. Values in all study groups significantly (p<0.05) differed
from the control. Also in groups 1B, 2A and 2B, the MPT was significantly
lower than in group 1A. Thus, in patients with chronic laryngitis, who
worked in conditions of increased exposure to chemicals present in the air
of the production environment, the recorded MPT was significantly lower than
in the controls, which is indicative of the impaired function of the vocal
apparatus.
Based on laryngeal stroboscopy findings, voice dysfunction revealed in
patients with chronic laryngitis was more often manifested by changes in the
vibratory cycle, desynchronized vocal apparatus and weakened amplitude of
oscillations. According to the average score of video laryngeal stroboscopy
in all groups of examined patients with chronic laryngitis, a significant (p
<0.05) difference was revealed in comparison with controls, as well as
between some groups. In particular, in group 1A the integrated score of
laryngeal stroboscopy data was 7.9±0.2, in 1B – 8.8±0.6, in 2A – 10.5±0.8
and in 2B – 12.1±1.0. The normal value is 5.010±0.001. Patients with higher
scores had more severe laryngeal impairments and disease course. In group 2
(both A and B subgroups), changes according to video laryngeal stroboscopy
were significantly more pronounced than in group 1A. In group 2B, the
impairments were more severe as compared with both subgroups of group 1 and
group 2A. Thus, in all studied groups of patients with chron ic laryngitis
there are seen significant impairments of the vocal apparatus. At the same
time, based on the findings of clinical methods and objective instrumental
examination, there is a tendency to the deterioration in the functional
condition of the vocal apparatus with increased chemical exposure in
production. In particular, in groups B, compared with groups A, there is a
marked increase in the desynchronization of vibrational oscillations, the
number of cases with lack of stroboscopic comfort increases, the number of
cases of hypertonia of the vestibular larynx increases. Similar trends apply
to other parameters of video laryngeal stroboscopy in groups.
On the whole, a quantitative assessment with the help of scores of
integrated laryngeal stroboscopy allows accurate determining the severity of
changes in the phonatory activity of the vocal apparatus and objectifying
the diagnosis of chronic laryngitis against the background of chemical
factors.
The obtained data will be useful for improving the quality of diagnosis of
voice disorders in chronic laryngitis, they can also be beneficial for
vocational selection and addressing issues of occupational examination.
Conclusions:
1. An impaired voice function according to laryngeal stroboscopy in patients
with chronic laryngitis was manifested by changes in the vibratory cycle,
mainly by desynchronized vocal apparatus and weakened amplitude of
oscillations.
2. With the help of video laryngeal stroboscopy it is possible to objectify,
quantify and determine the severity of phonatorial disorders in chronic
laryngitis against the background of the exposure to chemical factors.
3. The degree of voice dysfunction according to laryngeal stroboscopy in
patients with chronic laryngitis depends on the level of chemical exposure. |
Keywords
chronic laryngitis, chemical factors, video laryngostroboscopy,
maximum phonation time. |
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