Dejavniki, ki vplivajo na pojav in uspeh zdravljenja otrok z vozliči

magistrsko delo

Urška Pijovnik (Avtor), Irena Hočevar-Boltežar (Mentor)

Povzetek

V teoretičnem delu magistrskega dela smo opredelili in klasificirali glasovne motnje. Podrobneje smo se osredotočili na vozliče na glasilkah. Pojasnili smo vzroke njihovega nastanka, opisali glas oseb z omenjeno patologijo, razpravljali o vplivu osebnostnih lastnosti na nastanek in vzdrževanje vozličev na glasilkah ter preverili pogostost glasovne motnje. Proces zdravljenja vozličev smo razdelili na diagnostične postopke ter nadaljnje zdravljenje. V posameznih delih smo opisali vlogo foniatra, logopeda ter psihologa. V empiričnem delu smo skušali ugotoviti, ali prihaja do razlik v uspešnosti odpravljanja vozličev na glasilkah glede na različne načine obravnave. Ločili smo skupino otrok, ki je bila deležna le navodil o glasovnih higieni, in skupino otrok, ki je bila deležna tudi nadaljnje logopedske glasovne terapije. Vzorec smo primerjali tudi glede na trenutno kakovost glasu, ob čemer smo ločili skupini otrok z glasovnimi težavami in brez njih. Kot kriterij za razdelitev skupin smo upoštevali oceno kakovosti otrokovega glasu, ki so jo podali starši. Ker v strokovni literaturi nismo zasledili raziskav o potrebi logopedske glasovne terapije za odpravljanje glasovnih motenj v otroštvu, smo nujnost te skušali ugotoviti z izvedbo raziskave. V vzorec smo zajeli 70 otrok (oz. njihovih staršev) v starosti 6– 16 let, ki so v obdobju 2010–2016 obiskali foniatrično ambulanto zaradi glasovne motnje in pri katerih so na otorinolaringološkem pregledu s pomočjo telelaringoskopije opazili funkcionalno glasovno motnjo z organskimi spremembami na sluznici grla – vozliče. Sodelujočim otrokom oziroma njihovim staršem smo poslali Vprašalnik o glasovnih navadah in otrokovih lastnostih ter slovensko različico Vprašalnika o oviranosti zaradi glasovnih težav za otroke (pVHI). Oba vprašalnika sta bila anonimna. V kolikor so starši pisno dovolili tudi vpogled v otrokovo zdravstveno dokumentacijo, je pooblaščena oseba iz nje povzela še nekatere podatke, potrebne za zaključek raziskave. Na podlagi raziskave smo ugotovili razlike med otroki, ki so prejeli le navodila o glasovni higieni, in tistimi, ki so bili vključeni tudi v nadaljnjo logopedsko glasovno terapijo, tako na fizičnem (pVHIP: p = 0,019) in emocionalnem delu (pVHIE: p = 0,001) vprašalnika pVHI, kot tudi pri skupnem rezultatu testa (p = 0,005). Višje povprečje rangov je v vseh primerih dosegla skupina oseb, ki je bila deležna tudi nadaljnje logopedske glasovne terapije. Prav tako smo opazili statistično pomembne razlike glede želje po ponovnem otorinolaringološkem pregledu (p = 0,027). Večji del otrok, ki je bil vključen tudi v nadaljnjo logopedsko glasovno terapijo, si je želel tudi ponovne kontrole. V slednji skupini smo opazili tudi pomembno več spremljajočih bolezni (p = 0,029) ter slabšo kakovost glasu glede na oceno staršev (p = 0,012). Statistično pomembne razlike smo opazili tudi v primerjavi otrok s še prisotnimi glasovnimi motnjami in tistih brez pomembne disfonije glede na starševsko oceno kakovosti glasu. P-vrednosti so bile statistično značilne na vseh podvprašalnikih (pVHIF: p = 0002, pVHIP: p = 0,000, pVHIE: p = 0,000) ter na skupnem rezultatu testa (tpVHI: p = 0,000). Višja povprečja rangov smo opazili pri skupini otrok z glasovnimi težavami. Prav ti otroci so dosegli tudi pomembno višje rezultate pri primerjanju govornih navad otrok (glasno govorjenje otroka: p = 0,002 in preostalih članov družine: p = 0,015, oponašanje zvokov: p = 0,047). Pogosteje so prebolevali tudi vnetja ušes (p = 0,032). Med skupinama smo opazili statistično pomembne razlike (p = 0,000) glede števila prvo-, srednje- ali zadnjerojenih. V skupini otrok brez glasovnih težav so bili le prvo- in zadnjerojeni otroci – slednjih je bilo nekoliko manj; v skupini otrok z glasovnimi težavami je bilo enako število srednje- in zadnjerojenih, prvorojeni pa so bili v manjšini. Mejno značilne razlike smo opazili tudi na postavkah o obiskovanju logopedskih terapij zaradi glasovnih težav (p = 0,051), izboljšanju glasu (p = 0,006), želji po ponovnem otorinolaringološkem pregledu (p = 0,001) ter pri načinu zdravljenja (p = 0,009). Na podlagi raziskave lahko ugotavljamo, da je potreb po logopedski obravnavi otrok z vozliči in glasovnimi motnjami nasploh bistveno več, kot jih lahko zagotavlja obstoječa logopedska oziroma specialistična logopedska služba, kar je pomemben podatek za načrtovalce in plačnike zdravstvene mreže v državi. Glede na obstoječe stanje bi se bilo dobro usmeriti tudi na pedagoške delavce, ki vsakodnevno prihajajo z otroki v stik, in jih izobraziti o glasovni higieni. Naloga logopedov bi bila tako oblikovanje smernic o preventivnih ukrepih, s pomočjo katerih bi pedagoški delavci lahko preprečili nastanek glasovnih motenj pri otrocih.

Ključne besede

glas;glasovna motnja;hripavost;kakovost glasu;glasovna higiena;logopedska obravnava;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2020
Tipologija:	2.09 - Magistrsko delo
Organizacija:	UL PEF - Pedagoška fakulteta
Založnik:	[U. Pijovnik]
UDK:	376(043.2)
COBISS:	28025347
Št. ogledov:	229
Št. prenosov:	29
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	Factors influencing the emergence and successful treatment of vocal fold nodules in children
Sekundarni povzetek:	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.
Sekundarne ključne besede:	speech therapy;logopedija;
Vrsta datoteke:	application/pdf
Vrsta dela (COBISS):	Magistrsko delo/naloga
Komentar na gradivo:	Univ. v Ljubljani, Pedagoška fak., Logopedija in surdopedagogika
Strani:	94 str., [7] str. pril.
ID:	12014631