Personality, Psychological Factors, and Behavioral Tendencies in Children With Vocal Nodules: A Systematic Review.

OBJECTIVES: This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies. METHODS: Four electronic databases-PubMed, Scopus, ScienceDirect, EBSCO Host-as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist. RESULTS: Four studies were rated as "good quality" and four were "fair". The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed. CONCLUSIONS: Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed.

Patients' preferences in the evaluation of postmenopausal bleeding.

OBJECTIVE: To assess patients' preferences for diagnostic management of postmenopausal bleeding (PMB). DESIGN: A structured interview. SETTING: A teaching hospital with office hysteroscopy facilities. POPULATION: Thirty-nine women with PMB and with a completed work-up including an office hysteroscopy. METHODS: A structured interview was taken from 39 women who had had an office hysteroscopy in the diagnostic work-up for PMB. Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e. expectant management after ultrasound or complete diagnostic work-up, including invasive procedures. MAIN OUTCOME MEASURES: Women were informed about the probability of endometrial carcinoma versus benign disease and about advantages and disadvantages of different diagnostic strategies, i.e., expectant management after ultrasound or complete diagnostic work-up including invasive procedures. Women were asked to make a trade-off between different options. RESULTS: Most women wanted to be 100% certain that carcinoma could be ruled out. Only 5% of the women were willing to accept more than 5% risk of false reassurance. If the risk of recurrent bleeding due to benign disease exceeded 25%, the majority of women would prefer immediate diagnosis and treatment of benign lesions. CONCLUSION: Women with PMB are prepared to undergo hysteroscopy to rule out any risk on cancer. This finding implicates that the measurement of endometrial thickness with transvaginal ultrasound as a first-line test in the assessment of PMB should be reconsidered.

Coping strategies, personality, and voice quality in patients with vocal fold nodules and polyps.

Emotional state affects the physiological mechanism involved in phonation. Differences in acoustical parameters of the voice under stress have been attributed to the coping mechanism used, which is based on the individual's perception of the situation. This study examines the relationship between coping strategies, personality, and voice in female subjects, ranging in age from 19.3-55.7 years, diagnosed with vocal nodules or polyps. The differences between coping strategies and personality are examined and compared with another group with no history of voice pathology. The relationship of personality and coping strategies to voice quality variables is reported. Results show that patients use emotional coping strategies more and cognitive coping strategies less than the comparison group. Type of voice pathology was found to be related to dominance, and a number of coping and personality variables were found to correlate significantly with voice quality.

Silence as resistance to medical intervention.

A group of 47 individuals initially silent about their physical symptoms and/or dysfunction were studied after they finally had come to medical attention. They were then interviewed, using the associative anamnesis technique, to evaluate the psychologic aspects of their silence. It was found to be a key element in the defensive complex directed against intense neurotic feelings activated by the patient's current physical condition. The tendency toward silence appeared to have been reinforced by emotionally traumatic experiences involving physical illness or injuries in early life. Also found associated with silence were such different factors as a series of ostrich-like denying rationalizations, a fanatic commitment to cultist beliefs, a conviction that emotional conflict is the primary cause of organic illness, and motivations linked to retention of power in reality situations. Clinical examples drawn from these categories are given. Means of increasing the awareness that such silence exists and methods of dealing with it are discussed.

Personality factors in pathogenesis of polyps and nodules of vocal cords.

Patients who were diagnosed as polyps or nodules of vocal cords (PN group), and two control groups were tested with Japanese version of Maudsley Personality Inventory to evaluate the personality characteristics of patients with these behavior-induced vocal cord diseases. PN group showed significantly higher E (extraversion-introversion) scores than each control group. This extraversive tendency had no relation to their age, sex, polyp or nodule, and occupation. N (neuroticism) scores were not significantly different between PN group, and each control group. L (lying) scores of PN group were significantly lower than a control group. It was suggested that extraversive personality was one of the important factors relating to the pathogenesis of vocal cord polyp and nodule.