Impacto de la disfonía en la calidad de vida en la edad infantil / Impact of dysphonia on quality of life in childhood

Introducción: Los trastornos de la voz pueden afectar negativamente a la autoestima del niño y suponer un problema para su socialización. El Pediatric Voice Handicap Index (P-VHI) es un cuestionario de calidad de vida adaptado para su aplicación en niños que estudia la repercusión de la disfonía en los ámbitos funcional, físico y emocional. Métodos: Estudio retrospectivo, observacional y analítico sobre 87 pacientes con edades comprendidas entre los cinco y 14 años con diagnóstico de disfonía. El grupo control consta de 31 pacientes del mismo rango de edad en los que se descartó la presencia de patología a nivel otorrinolaringológico. Se revisan los datos de edad, sexo, entorno familiar y práctica de deporte de ambos grupos y se analiza su relación con la presencia de disfonía. Se estudia el impacto de la disfonía sobre la calidad de vida de los niños mediante el cuestionario P-VHI. Resultado: Encontramos una relación estadísticamente significativa entre la presencia de disfonía y el sexo masculino (65.5% en el grupo con disfonía vs. 29% en el grupo control), tener hermanos (89.7 vs. 71%) y tener historia familiar de alteraciones de la voz (33.3 vs. 3.2%). En el cuestionario P-VHI para todas las categorías se obtuvo una puntuación significativamente mayor en el grupo con disfonía respecto al grupo control. Conclusiones: La disfonía afecta negativamente al niño en las esferas física, emocional y social. Es conveniente una detección, diagnóstico y tratamiento temprano y proporcional al impacto que genera.(AU)

Introduction: Voice disorders can negatively affect the child's self-esteem and pose a problem for their socialization. The P-VHI (Pediatric Voice Handicap Index) is a quality of life questionnaire adapted for use in children that studies the impact of dysphonia on the functional, physical and emotional levels. Methods: Retrospective, observational and analytical study of a group of 87 patients aged between 5 and 14 years old with a diagnosis of dysphonia. The control group consisted of 31 patients same age range in whom was discarded the presence of otorhinolaryngological disease. We collected the data referred to age, sex, family environment and sport practice of both groups and analyzed their relationship with the presence of dysphonia. The impact of dysphonia on children's quality of life was studied using the Pediatric Voice Handicap Index (P-VHI) questionnaire. Results: We found a statistically significant relationship between the dysphonia and the male sex (65.5% in the group with dysphonia vs. 29% in the control group), having siblings (89.7% vs. 71%) and having a family history of voice disorders (33.3% vs. 3.2%). In the P-VHI questionnaire for all categories a significantly higher score was obtained in the group with dysphonia compared to the control group. Conclusión: Dysphonia negatively affects children in the physical, emotional and social spheres. It is convenient an early detection, diagnosis and treatment, proportional to the impact generated.(AU)

Análisis descriptivo del índice de discapacidad vocal pediátrico en niños con patología vocal benigna / Descriptive analysis of the pediatric voice handicap index in children with benign vocal fold pathology

Resumen Introducción: La disfonía infantil puede afectar negativamente la autoestima del niño y su calidad de vida relacionada con la voz. Objetivo: Describir los resultados del cuestionario Pediatric Voice Handicap Index (pVHI) en niños con patología vocal benigna. Material y Método: Se diseñó un estudio descriptivo en pacientes con patología vocal benigna entre 3 y 15 años en la Unidad de Voz del Hospital de Niños Dr. Luis Calvo Mackenna entre octubre de 2016 y febrero de 2020. La evaluación se realizó mediante un examen laringoscópico y el cuestionario pVHI para evaluar el impacto en la calidad de vida. Resultados: Se incluyeron 49 pacientes, 35 varones (71,4%) y 14 mujeres (28,6%). La edad media fue de 9,27 años. En el examen laringoscópico, el hallazgo más frecuente fueron los nódulos vocales. La puntuación media total en el pVHI fue de 38,77: 11,67 en la subescala o categoría funcional, 18,59 en la física y 8,42 en la emocional. En la evaluación de pVHI por género no existieron diferencias significativas. Conclusión: La patología vocal benigna en la edad pediátrica ocasiona un impacto negativo en la calidad de vida relacionada con la voz. El cuestionario pVHI es un valioso instrumento para evaluar dicha repercusión.

Abstract Introduction: Childhood dysphonia can negatively affect a child's self-esteem and voice-related quality of life. Aim: To describe the results of the Pediatric Voice Handicap Index (pVHI) questionnaire in children with benign vocal fold pathology. Material and Method: A descriptive study was designed in patients with benign vocal fold pathology between 3 and 15 years of age in the Voice Unit of the Dr. Luis Calvo Mackenna Children's Hospital between October 2016 and February 2020. The evaluation was carried out through a laryngoscopic examination and pVHI questionnaire to assess the impact on quality of life. Results: Forty-nine patients were included, 35 boys (71.4%) and 14 girls (28.6%). The mean age was 9.27 years. On laryngoscopic examination, the most frequent finding was vocal fold nodules. The total mean score on the pVHI was 38.77: 11.67 on the functional subscale, 18.59 on the physical subscale, and 8.42 on the emotional subscale. In the evaluation of pVHI by gender, no significant differences were found. Conclusion: Benign vocal fold pathology in pediatric age causes a negative impact on voice-related quality of life. The pVHI questionnaire is a valuable instrument to assess this repercussion.

Adaptación cultural y validación del índice de discapacidad vocal pediátrico al español chileno

Resumen Introducción: La prevalencia de patología vocal en niños fluctúa entre el 6% y el 23%. El cuestionario Pediatric Voice Handicap Index (pVHI) se ha transformado en el instrumento más utilizado a nivel internacional para determinar el impacto de la disfonía en la calidad de vida de los niños. Objetivo: Realizar la traducción, adaptación cultural y validación del Pediatric Voice Handicap Index al español chileno. Material y Método: Estudio transversal que incluyó a 151 niños y niñas entre 3 y 15 años. Se siguieron los 5 pasos recomendados por Beaton. La versión original del pVHI en inglés fue traducida al español por dos traductoras. Posteriormente, la versión traducida y unificada fue revisada por una lingüista chilena quien realizó la adaptación cultural al idioma español chileno. El cuestionario se aplicó a dos grupos de estudio, un grupo de niños con disfonía (n = 51) y un grupo control de niños sin alteraciones de la voz (n = 100) para obtener la versión final. Resultados: Se encontraron diferencias significativas entre el grupo de niños con disfonía y el grupo control en la puntuación global del pVHI y las diferentes subescalas (p < 0,001). Se encontró una consistencia interna óptima con un excelente alfa de Cronbach (α = 0,93), con una alta fiabilidad test-retest (puntuación de correlación de Pearson = 0,95). Conclusión: La versión chilena del cuestionario pVHI presenta un alto grado de validez y confiabilidad. Recomendamos su uso e implementación como protocolo estándar en la evaluación y seguimiento de la voz pediátrica.

Abstract Introduction: The prevalence of vocal pathology in children fluctuates between 6% and 23%. The pediatric voice handicap index (pVHI) questionnaire has become the most widely used instrument to determine the impact of dysphonia on the quality of life of children. Aim: Perform the translation, cultural adaptation, and validation of the pediatric voice handicap index into Chilean Spanish. Material and Method: Cross-sectional study that included 151 boys and girls between 3 and 15 years old. The 5 steps recommended by Beaton were followed. The original version of the pVHI in English was translated into Spanish by two translators. Subsequently, the translated and unified version was reviewed by a Chilean linguist who made the cultural adaptation to the Chilean Spanish language. The questionnaire was applied to two study groups, a group of children with dysphonia (n = 51) and a control group of children without voice disorders (n = 100) to obtain the final version. Results: Significant differences were found between the group of children with dysphonia and the control group in the global pVHI score and the different subscales (p < 0.001). Optimal internal consistency was found with excellent Cronbach's alpha (α = 0.93), with high test-retest reliability (Pearson's correlation score = 0.95). Conclusion: The Chilean version of the pVHI questionnaire presents a high degree of validity and reliability. We recommend its use and implementation as a standard protocol in the evaluation and monitoring of pediatric voice.

Dysphonia in children. Descriptive analysis of the factors involved, clinical parameters and impact on quality of life. / Disfonía en la edad pediátrica. Análisis descriptivo de los factores implicados, parámetros clínicos y repercusión en la calidad de vida.

INTRODUCTION: The prevalence of dysphonia in children is estimated at around 6%. Dysphonia in this age group is usually due to misuse of the voice that leads to the development of vocal fold injuries. This condition can negatively affect the child's self-esteem. The aim of the study is to describe the epidemiology of voice disorders in children in our area, perform an examination of the voice, as well as identify the impact of this pathology on quality of life. MATERIAL AND METHOD: We present a descriptive study with 87 patients aged between 5 and 14 years old, diagnosed with dysphonia. Data collection was carried out in our centre between January 2016 and April 2019. We analysed epidemiological and clinical factors. The impact on quality of life was studied using the Pediatric Voice Handicap Index questionnaire. RESULTS: 87 patients, 57 men (65.5%) and 30 women (34.5%) were included. Mean age 8.5 years (SD: 2.08; range 4-13). The most frequent phonatory disturbance was global muscle tension (88.5%). In the laryngoscopic examination, the most frequent finding was the presence of vocal nodules (45.9%). The average score on the Pediatric Voice Handicap Index was 24.3 points in total; 4.9 on the functional scale; 17.6 on the physical scale and 1.8 on the emotional scale. CONCLUSION: A correct anamnesis that includes the family environment and practice of team sport is essential. The physical examination should include a laryngoscopic examination. There is an impact on the quality of life of patients with dysphonia perceived by them and their families; the physical component is perceived to be most affected. We consider a multidisciplinary approach to this condition necessary.

Caracterización de los pacientes con disfonía evaluados en la unidad de voz pediátrica del Hospital Dr. Luis Calvo Mackenna / Characterization of patients with dysphonia evaluated in the pediatric voice unit of the Dr. Luis Calvo Mackenna Hospital

RESUMEN Introducción: La importancia del diagnóstico y manejo adecuado de los trastornos vocales en pacientes pediátricos, radica en que un mismo síntoma como la disfonía, puede tener etiologías de significación variable. Objetivo: Conocer la epidemiología y características de los pacientes pediátricos con disfonía crónica derivados a la Unidad de Voz del Hospital Dr. Luis Calvo Mackenna, y con ello generar un protocolo de diagnóstico y manejo coordinado entre fonoaudiólogos y otorrinolaringólogos. Material y método: Estudio prospectivo descriptivo con revisión de fichas clínicas y protocolos operatorios de pacientes que se controlan en la Unidad de Voz del Hospital Dr. Luis Calvo Mackenna. Resultados: En la unidad de voz hay en seguimiento 22 niños con una edad promedio de 10 años. Las lesiones diagnosticadas con mayor frecuencia mediante videonasolaringoscopía fueron los nódulos vocales (n =10) y el aumento de volumen asimétrico a nivel cordal (n =8). Se pudo realizar telelaringoscopía con videoestroboscopía en el 81,8% de los pacientes. Del total de pacientes en control, 10 requirieron laringoscopía directa. Conclusión: La disfonía en el niño suele ser un síntoma subestimado y, por ende, no tratado. Consideramos que una unidad de voz infantil debe preocuparse de evaluar sus pacientes con tecnología acorde a su edad y de realizar un seguimiento adecuado de los tratamientos.

ABSTRACT Introduction: Adequate diagnosis and proper management of voice disorders in pediatric patients lies in that the symptom dysphonia, can have etiologies of variable significance. Aim: To evaluate the epidemiology and characteristics of pediatric patients with chronic dysphonia that are referred to the voice unit of Dr. Luis Calvo Mackenna Hospital, and thereby generate a diagnostic protocol and coordinated management strategy between speech pathologist and otolaryngologist. Material and method: Prospective descriptive study with review of clinical files and operative protocols of patients followed-up at the voice unit of the Dr. Luis Calvo Mackenna Hospital. Results: In the voice unit, there are 22 children being followed up. The most frequently diagnosed lesions with videonasolaryngoscopy were vocal nodules (n=10) and asymmetric volume on the vocal cord (n=8). We performed telelaryngoscopy with videostroboscopy in 81.8% of patients. Of all the patients, 10 required direct laryngoscopy. Conclusions: Dysphonia in children is usually an underestimated symptom and, therefore, not treated. We believe that a children's voice unit should evaluate their patients with the appropriate technology according to the patients age, and to carry out an adequate follow-up of the treatments administered.

Disfonia por nódulos vocais na infância / Dysphonia due to vocal cord nodules in children

O tema principal deste artigo são a ocorrência e as características da disfonia infantil provenientes de nódulos vocais nos primeiros anos escolares.Teve-se por objetivo caracterizar a disfonia infantil decorrentede nódulos vocais. O método utilizado foi a revisão da literatura. Com relação aos resultados, a maioria dos trabalhos científicos aponta os usos incorretos da voz como causadores de nódulos vocais em crianças a patologia mais frequente nessa população. Os nódulos vocais são a principal causa de disfonia infantil, tornando-se importante a intensificação dos programas de prevenção da disfonia infantil.

Topic: how vocal nodules affect dysphonic children during the first scholars years; how it happens and what their characteristics are. Objective: to characterize dysphonic children affected by vocal nodules. Method: Revise literature. Results: most of the scientific work points to the incorrect use of voice as the main aspects to cause vocal nodules in children, the most frequent pathology in such population. Conclusion: Vocal nodules are the main cause for having dysphonic children, be coming relevant the intensification of programmes to prevent it.

Desvios vocais e presença de sinais e sintomas do transtorno de déficit de atenção/hiperatividade - TDAH / Vocal deviation and presence of signs and symptoms of attention deficit and hyperactivity disorder – ADHD

A disfonia infantil é um distúrbio da comunicação que dificulta a emissão e produção natural da voz. Crianças com o transtorno de déficit de atenção/hiperatividade (TDAH) têm sido vistas como mais falantes, muitas vezes se comportando de uma forma inadequada e inapropriada em diversas situações de comunicação. O TDAH é uma dificuldade do controle de impulsos. Caracteriza-se, também, pela presença de problemas com atenção e hiperatividade. O objetivo do presente trabalho foi verificar a relação entre desvios vocais e presença de sinais e sintomas do transtorno em meninos, por apresentarem maior incidência tanto de disfonia como de TDAH. Participaram do estudo 71 crianças da faixa etária entre 8 e 11 anos de idade, do sexo masculino, sendo 40 com sinais e sintomas do TDAH (grupo experimental) e 31 sem sinais e sintomas do TDAH (grupo de controle). Para a análise da voz das crianças, foram coletados registros de emissão sustentada da vogal /ε/, na emissão habitual. A qualidade vocal foi analisada por avaliação perceptivo-auditiva, pela escala GIRBAS. Na avaliação acústica foi utilizado o software Dr. Speech (versão 3.1) módulo Vocal Assessment (Tiger DRS, Inc., EUA) e selecionados os parâmetros: freqüência fundamental; jitter APQ; shimmer PPQ, e energia de ruído glótico (NNE). Para verificação de sinais e sintomas do TDAH, foi utilizada a escala de Benczik. Os resultados demonstraram que não há relação estatisticamente significativa entre desvios vocais e o TDAH. Porém, as crianças do grupo experimental apresentaram maior grau de desvio e alteração de voz em relação às crianças do grupo de controle.(AU)

Child dysphonia is a communication disorder that affects the natural voice production. Children with attention deficit and hyperactivity disorder (ADHD) are seen as talkative and many times as bad behaving or misbehaving kids during several different activities. The attention deficit and hyperactivity disorder is a difficulty to control impulses. It is also characterized by the presence of attention and hyperactivity problems. The purpose of the present study was to check the relation between vocal deviation and presence of signs and symptoms of ADHD in boys due to the greater incidence of both dysphonia and ADHD in the male population. A number of 71 male children, aged 8-11 years, 40 with signs and symptoms of ADHD (experimental group) and 31 without these signs and symptoms participated in this study. The sustained vowel /ε/ as in bed during habitual phonation was collected for the voice analysis. Vocal quality was assessed by means of perceptual analysis (GIRBAS scale). Dr. Speech, 3.1, Vocal Assessment Module (Tiger DRS Inc.) software was used for the acoustic analysis. The vocal parameters selected for the analysis were: fundamental frequency, jitter APQ, shimmer PPQ, and neutralized noise energy (NNE).In order to check signs and symptoms of ADHD the Benczik Scale was used. The results demonstrated that there is no statistically significant relation between vocal deviation and attention deficit and hyperactivity disorder. However, the experimental group showed higher degree of vocal deviation when compared to the control group.(AU)

Desvios vocais e presença de sinais e sintomas do transtorno de déficit de atenção/hiperatividade - TDAH / Vocal deviation and presence of signs and symptoms of attention deficit and hyperactivity disorder – ADHD

A disfonia infantil é um distúrbio da comunicação que dificulta a emissão e produção natural da voz. Crianças com o transtorno de déficit de atenção/hiperatividade (TDAH) têm sido vistas como mais falantes, muitas vezes se comportando de uma forma inadequada e inapropriada em diversas situações de comunicação. O TDAH é uma dificuldade do controle de impulsos. Caracteriza-se, também, pela presença de problemas com atenção e hiperatividade. O objetivo do presente trabalho foi verificar a relação entre desvios vocais e presença de sinais e sintomas do transtorno em meninos, por apresentarem maior incidência tanto de disfonia como de TDAH. Participaram do estudo 71 crianças da faixa etária entre 8 e 11 anos de idade, do sexo masculino, sendo 40 com sinais e sintomas do TDAH (grupo experimental) e 31 sem sinais e sintomas do TDAH (grupo de controle). Para a análise da voz das crianças, foram coletados registros de emissão sustentada da vogal /ε/, na emissão habitual. A qualidade vocal foi analisada por avaliação perceptivo-auditiva, pela escala GIRBAS. Na avaliação acústica foi utilizado o software Dr. Speech (versão 3.1) módulo Vocal Assessment (Tiger DRS, Inc., EUA) e selecionados os parâmetros: freqüência fundamental; jitter APQ; shimmer PPQ, e energia de ruído glótico (NNE). Para verificação de sinais e sintomas do TDAH, foi utilizada a escala de Benczik. Os resultados demonstraram que não há relação estatisticamente significativa entre desvios vocais e o TDAH. Porém, as crianças do grupo experimental apresentaram maior grau de desvio e alteração de voz em relação às crianças do grupo de controle.

Child dysphonia is a communication disorder that affects the natural voice production. Children with attention deficit and hyperactivity disorder (ADHD) are seen as talkative and many times as bad behaving or misbehaving kids during several different activities. The attention deficit and hyperactivity disorder is a difficulty to control impulses. It is also characterized by the presence of attention and hyperactivity problems. The purpose of the present study was to check the relation between vocal deviation and presence of signs and symptoms of ADHD in boys due to the greater incidence of both dysphonia and ADHD in the male population. A number of 71 male children, aged 8-11 years, 40 with signs and symptoms of ADHD (experimental group) and 31 without these signs and symptoms participated in this study. The sustained vowel /ε/ as in bed during habitual phonation was collected for the voice analysis. Vocal quality was assessed by means of perceptual analysis (GIRBAS scale). Dr. Speech, 3.1, Vocal Assessment Module (Tiger DRS Inc.) software was used for the acoustic analysis. The vocal parameters selected for the analysis were: fundamental frequency, jitter APQ, shimmer PPQ, and neutralized noise energy (NNE).In order to check signs and symptoms of ADHD the Benczik Scale was used. The results demonstrated that there is no statistically significant relation between vocal deviation and attention deficit and hyperactivity disorder. However, the experimental group showed higher degree of vocal deviation when compared to the control group.