[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.

[Grading of the Voice Handicap Index]. / Graduierung des Voice-Handicap-Index.

BACKGROUND: The Voice Handicap Index (VHI) questionnaire is currently regarded as the gold standard for the measurement of subjective suffering caused by dysphonia. The object of this study was to show how to weight or grade the result yielded by the VHI. To this end, the result obtained with the VHI was graded against the external criterion of health-related quality of life and also compared with the VHI results obtained in persons not affected by dysphonia. PATIENTS AND METHODS: A total of 101 patients (61 women, 40 men) aged between 19 and 86 (48.4 +/- 14.6) years and suffering from benign dysphonia (organic in 62%, functional in 38%: 62% and 38%, respectively in the women, 63% and 37%, respectively, in the men) took part in the study. The instruments used were a German version of the VHI and the SF-36 Health Survey on health-related quality of life, which is commercially available. RESULTS: There are two subscales to the SF-36, but only the values for physical health were significantly reduced and correlated significantly with the results on the VHI scale. This subscale was therefore used as the external standard for grading of the VHI results. Following the separation of the VHI results recorded in the nondysphonic test subjects a four-point grading of the VHI results emerged. CONCLUSIONS: VHI values of 0-11 are classified as grade 0 suffering (almost certainly not noticeable), while values of 12-28 reflect grade 1 (more likely unnoticeable than conspicuous) suffering; values of 29-56 reflect grade 2 suffering (more probably noticeable than not), and values of 57-120 suggest a classification of certainly noticeable and are graded as grade 3 suffering.

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine]. / "Voice Handicap Index" (VHI) in der stationären Stimmrehabilitation.

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

[Social orientation of parents of children with cleft lip and palate]. / Soziale Orientierung der Eltern von Kindern mit Lippen-Kiefer-Gaumen-Spalten.

BACKGROUND: Cleft lip and palate are the most common malformation in the orofacial region. The type and dimension of the cleft determine the functional limitations of respiration, swallowing, speech, articulation and hearing. In addition, cosmetic and communicative restrictions influence the cognitive, social and educational progress and the wellbeing of the children affected. Their parents face a difficult and lasting task: They have to cope with their child's handicap and the current standardised treatment procedures which start in early infancy. To guarantee optimum therapeutic success parents must be included as co-therapists. Therefore more information about parents' concerns and coping strategies are required. METHOD: To assess the strain put on parents of children with cleft lip and palate as well as the parents' coping strategies, a standardised questionnaire for the German-speaking parents was used during consultation in the out-patient clinic. RESULTS. In comparison with parents of children with other handicaps, the parents of children with cleft lip and palate feel less stressed out and adopt strategies of coping such as intensification of partnership, use of social support, as well as self-respect and fulfillment. Working mothers are less preoccupied and less at risk of being focussed on the handicapped child only. In comparison, the parents of children with Orofacial clefts focus less on the handicapped child in general than those parents whose children suffer from additional behavioural disorders. DISCUSSION: Though several functional, behavioural and psychological disorders may occur in children with cleft lip and palate their parents feel comparatively little stress. They do use a variety of coping strategies and tend to adopt a rather positive approach. Certainly, additional disorders of the child lead to more parental stress and likewise requiring more attention to the child which may even accentuate existing behavioural disorders. CONCLUSION: Parents of children with cleft lip and palate experience less stress in comparison with parents of children with other handicaps. Therapeutic efforts and regular check of the child's progress might support parents' coping strategies. Therapists should also ask for additional disorders such as behavioural disorders and initiate adequate support.

[Expert phoniatric assessment of voice adaptation in male to female transsexualism]. / Phoniatrische Begutachtung vor der Stimmangleichung bei Mann-zu-Frau-Transsexualismus.

Sex change surgery for patients with gender identity disorders has been performed successfully during the last decade, especially for males becoming females. A troublesome problem for some of these individuals is the retention of a male voice. Castration and estrogen therapy may produce only minor changes in pitch, with patients requiring further surgical treatment. Techniques used include glottoplasty, crico thyroid approximation and/or anterior commissure advancement. Although the voice is highly gender-specific, the standards of care for transsexuals do not cover guidelines for a diagnostic approach and surgical therapy. For medical jurisprudence, questions concerning specific aspects of German social law are answered in a representative case of a male-to-female transsexual. A review of the literature shows that there is no common thought about whether and when a specific surgical procedure should be performed in a gender-transforming process and which method should be used for long-term results and patient satisfaction. Although worldwide experience with these operations and overall good results are assumed, further reports by phonosurgeons performing these operations are required concerning actual results. We propose that medical scientific societies should offer phonosurgery as an optional treatment for male-to-female transsexuals in their guidelines and standards of care.