Pediatrik Ses Bozukluklarının Sınıflandırılması ve Klinik Özellikleri
Özet
İnsan sesi, düşünce ve duyguların aktarılmasını sağlayan en temel iletişim araçlarından biridir. Sağlıklı bir ses, solunum, işitme, dil ve konuşma mekanizmalarının nörolojik sistemlerle uyumlu çalışmasıyla gelişir. Bu yapılardan herhangi birini etkileyen aksaklıklar, çok faktörlü bir etiyolojiye ve değişken klinik görünümlere sahip pediatrik ses bozukluklarına zemin hazırlayabilir. Bu bozukluklar, erken dönemde fark edilip uygun biçimde yönetilmediğinde çocuğun iletişim becerilerini, akademik başarısını, sosyal etkileşimini ve özgüvenini olumsuz etkileyebilmekte, hatta erişkin döneme kadar sürebilmektedir. Bu nedenle söz konusu bozuklukların sistematik biçimde sınıflandırılması hem altta yatan mekanizmaların anlaşılması hem de doğru klinik yaklaşımın belirlenmesi açısından önem taşır. Bu doğrultuda bölümde, çocuklarda en sık görülen dört temel bozukluk grubu ele alınmıştır. Bunlar; vokal nodül, kist, polip, granülom, sulkus vokalis ve skarları içeren yapısal larinks patolojileri; laringofaringeal reflü ve eozinofilik özofajit gibi inflamatuar ve medikal tablolar; tek ve çift taraflı vokal kord paralizilerinden oluşan nörolojik bozukluklar; kas gerilim disfonisi, puberfoni ve paradoksal vokal kord hareketini kapsayan fonksiyonel ve davranışsal tablolardır. Her bozukluğun etiyolojisi, klinik bulguları, endoskopik özellikleri ve tedavi yaklaşımları ele alınarak pediatrik ses bozukluklarına bütüncül bir bakış sunulmaktadır.
The human voice is one of the most fundamental tools of communication, enabling the expression of thoughts and emotions. A healthy voice develops through the coordinated functioning of the respiratory, auditory, language, and speech mechanisms together with the neurological systems. Disruptions affecting any of these structures may give rise to pediatric voice disorders, which have a multifactorial etiology and variable clinical presentations. When not recognized early and managed appropriately, these disorders can adversely affect a child's communication skills, academic achievement, social interaction, and self-confidence, and may even persist into adulthood. For this reason, a systematic classification of these disorders is important both for understanding the underlying mechanisms and for determining the appropriate clinical approach. Accordingly, this chapter addresses the four main groups of disorders most frequently encountered in children. These are: structural laryngeal pathologies, including vocal nodules, cysts, polyps, granulomas, sulcus vocalis, and scars; inflammatory and medical conditions, such as laryngopharyngeal reflux and eosinophilic esophagitis; neurological disorders, consisting of unilateral and bilateral vocal fold paralysis; and functional and behavioral conditions, encompassing muscle tension dysphonia, puberphonia, and paradoxical vocal fold movement. By examining the etiology, clinical findings, endoscopic features, and treatment approaches of each disorder, a comprehensive perspective on pediatric voice disorders is provided.
Referanslar
Sataloff RT. Vocal health and pedagogy: Science, assessment, and treatment. Plural Publishing; 2017 Sep 7.
Kelchner LN, Brehm SB, Weinrich B. Pediatric voice: a modern, collaborative approach to care. Plural Publishing; 2014.
Boyle B. Voice disorders in children. Support for Learning. 2000 May;15(2):71-5. https://doi.org/10.1111/1467-9604.00149
Deal RE, McClain B, Sudderth JF. Identification, evaluation, therapy, and follow-up for children with vocal nodules in a public school setting. J Speech Hear Disord. 1976;41(3):390-397. https://doi.org/10.1044/jshd.4103.390
Silverman EM, Zimmer CH. Incidence of chronic hoarseness among school-age children. Journal of Speech and Hearing Disorders. 1975 May;40(2):211-5. https://doi.org/10.1044/jshd.4002.211
Connor NP, Cohen SB, Theis SM, Thibeault SL, Heatley DG, Bless DM. Attitudes of children with dysphonia. Journal of Voice. 2008 Mar 1;22(2):197-209. https://doi.org/10.1016/j.jvoice.2006.09.005
Castrogiovanni A. Incidence and prevalence of communication disorders and hearing loss in children. American Speech-Language-Hearing Association; 2008.
Verdolini K, Rosen CA, Branski RC. Classification manual for voice disorders-I. Psychology Press; 2014.
Von Leden H. Vocal nodules in children. Ear Nose Throat J. 1985;64(10):473-480.
Shah RK, Feldman HA, Nuss RC. A grading scale for pediatric vocal fold nodules. Otolaryngol Head Neck Surg. 2007;136(2):193-197. https://doi.org/10.1016/j.otohns.2006.11.003
Wohl DL. Nonsurgical management of pediatric vocal fold nodules. Arch Otolaryngol Head Neck Surg. 2005;131(1):68-70. https://doi.org/10.1001/archotol.131.1.68
Kiliç MA, Okur E, Yildirim I, Güzelsoy S. The prevalence of vocal fold nodules in school age children. Int J Pediatr Otorhinolaryngol. 2004;68(4):409-412. https://doi.org/10.1016/j.ijporl.2003.11.005
Nuss RC, Ward J, Huang L, Volk M, Woodnorth GH. Correlation of vocal fold nodule size in children and perceptual assessment of voice quality. Ann Otol Rhinol Laryngol. 2010;119(10):651-655. https://doi.org/10.1177/000348941011901001
Tezcaner CZ, Ozgursoy SK, Sati I, Dursun G. Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules. Eur Arch Otorhinolaryngol. 2009;266(12):1923-1927. https://doi.org/10.1007/s00405-009-1008-6
Barona-Lleo L, Fernandez S. Hyperfunctional voice disorder in children with Attention Deficit Hyperactivity Disorder (ADHD). A phenotypic characteristic?. Journal of Voice. 2016 Jan 1;30(1):114-9. https://doi.org/10.1016/j.jvoice.2015.03.002
Angelillo N, Di Costanzo B, Angelillo M, et al. Epidemiological study on vocal disorders in paediatric age. J prev med hyg. 2008 Mar 1;49(1):1-5.
Nemec JI. The motivation background of hyperkinetic dysphonia in children: a contribution to psychologic research in phoniatry. Logos. 1961;4:28-31.
Green G. Psycho-behavioral characteristics of children with vocal nodules: WPBIC ratings. Journal of Speech and Hearing Disorders. 1989 Aug;54(3):306-12. https://doi.org/10.1044/jshd.5403.306
Carding PN, Roulstone S, Northstone K, ALSPAC Study Team. The prevalence of childhood dysphonia: a cross-sectional study. Journal of voice. 2006 Dec 1;20(4):623-30. https://doi.org/10.1016/j.jvoice.2005.07.004
Nardone HC, Recko T, Huang L, Nuss RC. A retrospective review of the progression of pediatric vocal fold nodules. JAMA otolaryngology–head & neck surgery. 2014 Mar;140(3):233-6. https://doi.org/10.1001/jamaoto.2013.6378
Tuzuner A, Demirci S, Oguz H, Ozcan KM. Pediatric vocal fold nodule etiology: what are its usual causes in children? J Voice. 2017;31(4):506.e19-506.e19. https://doi.org/10.1016/j.jvoice.2016.10.007
Hartnick CJ, Boseley ME. Clinical management of children's voice disorders. Plural Publishing; 2010 Mar 1.
Sunter AV, Yigit O, Huq GE, Alkan Z, Kocak I, Buyuk Y. Histopathological characteristics of sulcus vocalis. Otolaryngology--Head and Neck Surgery. 2011 Aug;145(2):264-9. https://doi.org/10.1177/0194599811404639
Block BB, Brodsky L. Hoarseness in children: the role of laryngopharyngeal reflux. International Journal of Pediatric Otorhinolaryngology. 2007 Sep 1;71(9):1361-9. https://doi.org/10.1016/j.ijporl.2006.10.029
25.Dauer EH, Ponikau JU, Smyrk TC, Murray JA, Thompson DM. Airway manifestations of pediatric eosinophilic esophagitis: a clinical and histopathologic report of an emerging association. Annals of Otology, Rhinology & Laryngology. 2006 Jul;115(7):507-17. https://doi.org/10.1177/000348940611500705
McMurray JS. Medical and surgical treatment of pediatric dysphonia. Otolaryngologic Clinics of North America. 2000 Oct 1;33(5):1111-26. https://doi.org/10.1016/s0030-6665(05)70269-3
McMurray JS. Disorders of phonation in children. Pediatric Clinics. 2003 Apr 1;50(2):363-80.
Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases. Annals of Otology, Rhinology & Laryngology. 1976 Jul;85(4):428-36. https://doi.org/10.1177/000348947608500402
Rutter MJ. Congenital airway and respiratory tract anomalies. InThe respiratory tract in pediatric critical illness and injury 2008 Nov 15 (pp. 1-6). London: Springer London. https://doi.org/10.1007/978-1-84800-925-7_14
Stemple JC, Glaze L, Klaben B. Clinical voice pathology: theory and management. 4th ed. Plural Publishing; 2010.
Mathers-Schmidt BA, Brilla LR. Inspiratory muscle training in exercise-induced paradoxical vocal fold motion. Journal of Voice. 2005 Dec 1;19(4):635-44.
