Çocuklarda adenoidektominin ses ve yumuşak damak fonksiyonları üzerine etkinliğinin objektif ses analizi ve nazometre ile değerlendirilmesi
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Dosyalar
Tarih
2010
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Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ses ve konuşma insan sosyal yaşamında önemli bir iletişim aracıdır. Üst solunum yollarını ilgilendiren cerrahi operasyonlardan sonra sesin rezonans özelliklerinde değişiklikler olabilir. Kullanımı giderek yaygınlaşan ses analiz yöntemleri, sesin normal olup olmadığını saptamak, eğer patolojik ise patolojinin derecesini belirlemek ve mevcut olan patolojik durumun hangi mekanizmalar ile oluştuğunu daha iyi anlayabilmek için kullanılmaktadır. Nazal rezonans; velofarengeal fonksiyona, nazal ve oral kavitelerin rölatif impedansına ve nazofarenksin şekline bağlıdır. Çalışmamızda adenoid vejetasyon nedeniyle adenoidektomi ameliyatı yapılan hastalarda, bu ameliyatın ses kalitesi üzerine etkisinin akustik ses analizi, spektrografik analiz ve nazometre ile objektif olarak değerlendirilmesi amaçlanmıştır. Bu amaçla Selçuk Üniversitesi Meram Tıp Fakültesi Kulak Burun Polikliniğine 2008- 2009 yılları arasında başvuran, adenoid hipertofisi semptom ve muayene bulguları olan 6-12 yaş arasındaki çocuklarda çekilen lateral sefalometrik grafilerinde hesaplanan ANO değeri 0.60 ve üzerinde olan 40 çocuk hastaya adenoidektomi yapıldı. Postoperatif kontrollere gelen 36 hastanın (20 erkek, 16 kız) istatistik verileri değerlendirildi Adenoid semptom ve bulguları olmayan 6-12 yaş arasındaki 50 sağlıklı çocuk (23 erkek, 27 kız) kontrol grubu olarak alındı. Çalışma grubunun yaş ortalaması 8.22±1.86, kontrol grubunun yaş ortalaması 8,54±1.92 idi. Kontrol grubu ile çalışma grubu hastalarımız arasında yaş ve cinsiyet olarak istatistiksel anlamlı fark yoktu. (P>0.05) Lateral sefalometrik grafilerden elde edilen ANO değerleri çalışma grubunda (0.79±0.96), kontrol grubuna (0.45±0.14) göre anlamlı derecede yüksek olduğu görüldü. (P<0.05) Ses analizleri için; Kay Elemetrics Corp. tarafından geliştirilen MDVP (Multi Dimensional Voice Program) Model 5105, Real-Time Pitch Model 5121, Real-Time Spektrogram Model 5129 ve nazalans değerlendirmesi için Nazometre II-Model 6400 programları kullanıldı. Elde edilen veriler SPSS 13.0 for Windows (SPSS Inc., USA) veri analizi programında analiz edildi. İstatistiksel olarak anlamlılık seviyesi P<0.05 (Bonferroni düzeltmesinde p<0.017) olarak kabul edildi. Çalışma grubunun F0, Jitter %, RAP, Shimer %, APQ, NHR değerleri sağlıklı çocuklarla karşılaştırıldığında anlamlı fark olmadığı (P>0.05), adenoid hipertrofili çocuklarda adenoidektomi sonrası da bu değerlerde istatistiksel olarak anlamlı fark olmadığı (P>0.05) ve yine kontrol grubu değerleri ile çalışma grubunun postoperatif 3. ay değerleri arasında anlamlı fark olmadığı görüldü. (P>0.05) Real-Time Spektrogram programı ile F1, F2, F3, F4 frekansları değerlendirildi ve adenoid hipertrofisi olan çocukların preoperatif formant değerlerinin sağlıklı çocuklarla karşılaştırılmasında F2, F3, F4 değerinin istatistiksel olarak anlamlı yüksek olduğu bulunmuştur. (P<0.05) F3 ve F4 değerlerinin adenoidektomi öncesi ve sonrası değerleri karşılaştırıldığında istatistiksel olarak anlamlı bir artış olduğu saptanmıştır. (P<0.05) Yine adenoidektomi sonrası üçüncü ay kontrolleri ile sağlıklı çocukların F2, F3, F4 değerleri arasında anlamlı fark saptanmıştır. (P<0.05) Adenoid hipertofisi saptanan çocukların nazometre ile ölçülen nazalans değerleri, sağlıklı çocuklarla karşılaştırıldığında istatistiksel olarak anlamlı düşük olduğu görüldü. (P<0.05) Yine adenoid hipertrofili çocukların preoperatif nazalans değerleri ile postoperatif değerleri karşılaştırıldığında istatistiksel olarak anlamlı yükselme olduğu saptandı. (P<0.05) Çalışmamızda ölçülen minimum ve maksimum pitch değerleri açısından sağlıklı çocuklar ile adenoid grubunun preoperatif değerleri arasında ve adenoid grubunun preoperatif ve postoperatif değerleri arasında, çalışma grubu ile adenoid grubunun geç dönem sonuçları arasında istatistiksel olarak fark saptanmadı. (P>0.05) Adenoidektomi yapılan hastalarda akustik ses parametrelerinde değişiklik saptanmamış olmakla birlikte nazal rezonansta görülen değişiklikler açısından operasyon öncesi hasta yakınları bilgilendirilmelidir. Bu durum özellikle profesyonel ses kullanıcıları için önemlidir.
Voice and speaking are the important means of communication in human social life. There may be changes in resonance features of the voice after surgical operations related to upper respiratory tract. The sound analysis methods the application of which is becoming widespread is used for detecting if the voice is normal, if it is pathologic, determining the level of pathology and for understanding better that with which mechanisms the existing pathologic situation was formed. Nasal resonance depends on velopharyngeal function, relative impedense of nasal and oral cavity and the shape of the nasopharynx. In our work, it is aimed that, on the patients who had adenoidectomy operation due to adenoid vegetation, the acoustic sound analysis of the effect of this operation on the quality of voice and spectrographic analysis should be performed and it should be evaluated objectively with the nasometer. With this aim, between 6-12 year old children who applied for Selcuk University Meram Faculty of Medicine Ear-Nose-Throat Polyclinic and who have adenoid hypertrophy symptom and examination findings, 40 children were performed adenoidectomy whose calculated ANO value in the lateral cephalometric graphies was 0.6 or over it. Statistic data of 36 patients ( 20 male,16 female) who came for postoperative controls were evaluated. 6-12 year old 50 healthy children who do not have adenoid symptoms or findings were used as the control group. The average of age of study group was 8.22±1.86 and of control group was 8,54±1.92. There were no statistical significant difference between our patients of study group and control group in terms of age and gender. (P>0.05) ANO values of lateral cephalometric graphies were found significantly high in study group with (0.79±0.96) compared to control group with (0.45±0.14). (P<0.05) For sound analysis, MDVP (Multi Dimensional Voice Program) Model 5105, Real-Time Pitch Model 5121, Real-Time Spectrogram Model 5129 which were developed by Kay Elemetrics Corp. and for nasalance evaluation Nasometer II-Model 6400 were used. The acquired data was analysed by data analysis program 13.0 for Windows (SPSS Inc., USA).Statistically the level of significancy was accepted as P<0.05(It is p<0.017 in Bonferroni correction). It was seen that the F0, Jitter %, RAP, Shimmer %, APQ, NHR values of study group had no significant difference compared to healthy children (P>0.05), there was no statistically significant difference of these values after adenoidectomy on children who had adenoid hypertrophy (P>0.05), and again there was no significant difference between the values of control group and the postoperative 3rd month values of study group. (P>0.05) With the Real Time Spectrogram Program F1, F2, F3, F4 frequencies were evaluated and in comparing preoperative formant values of the children with adenoid hypertrophy to healthy children F2, F3, F4 values were seen as statistically significant high. (P<0.05) It was determined that F3 and F4 values had a statistically significant increase when comparing before and after values of adenoidectomy. (P<0.05) And again it was determined that there was a significant difference when comparing 3rd month controls after adenoidectomy to F2, F3 and F4 values of healty children. (P<0.05) It was seen that the nasalance values of the children with adenoid hypertrophy determined by nasometer were statistically significant low when comparing these to healthy children. (P<0.05) And again it was determined that there was a statistically significant increase when comparing preoperative nasalance values of the children with adenoid hypertrophy to postoperative values. (P<0.05) In our work, it was determined that there is no statistically difference in terms of calculated minimum and maximum pitch values between healthy children and preoperative values of adenoid group, between preoperative and postoperative values of adenoid group, and between late term results of study group and adenoid group. (P>0.05) In patients performed by adenoidectomy,there was no change determined in acoustic sound parameters, but patient?s relatives should be informed in terms of changes in nasal resonance. This case is important especially for porfessionally voice users.
Voice and speaking are the important means of communication in human social life. There may be changes in resonance features of the voice after surgical operations related to upper respiratory tract. The sound analysis methods the application of which is becoming widespread is used for detecting if the voice is normal, if it is pathologic, determining the level of pathology and for understanding better that with which mechanisms the existing pathologic situation was formed. Nasal resonance depends on velopharyngeal function, relative impedense of nasal and oral cavity and the shape of the nasopharynx. In our work, it is aimed that, on the patients who had adenoidectomy operation due to adenoid vegetation, the acoustic sound analysis of the effect of this operation on the quality of voice and spectrographic analysis should be performed and it should be evaluated objectively with the nasometer. With this aim, between 6-12 year old children who applied for Selcuk University Meram Faculty of Medicine Ear-Nose-Throat Polyclinic and who have adenoid hypertrophy symptom and examination findings, 40 children were performed adenoidectomy whose calculated ANO value in the lateral cephalometric graphies was 0.6 or over it. Statistic data of 36 patients ( 20 male,16 female) who came for postoperative controls were evaluated. 6-12 year old 50 healthy children who do not have adenoid symptoms or findings were used as the control group. The average of age of study group was 8.22±1.86 and of control group was 8,54±1.92. There were no statistical significant difference between our patients of study group and control group in terms of age and gender. (P>0.05) ANO values of lateral cephalometric graphies were found significantly high in study group with (0.79±0.96) compared to control group with (0.45±0.14). (P<0.05) For sound analysis, MDVP (Multi Dimensional Voice Program) Model 5105, Real-Time Pitch Model 5121, Real-Time Spectrogram Model 5129 which were developed by Kay Elemetrics Corp. and for nasalance evaluation Nasometer II-Model 6400 were used. The acquired data was analysed by data analysis program 13.0 for Windows (SPSS Inc., USA).Statistically the level of significancy was accepted as P<0.05(It is p<0.017 in Bonferroni correction). It was seen that the F0, Jitter %, RAP, Shimmer %, APQ, NHR values of study group had no significant difference compared to healthy children (P>0.05), there was no statistically significant difference of these values after adenoidectomy on children who had adenoid hypertrophy (P>0.05), and again there was no significant difference between the values of control group and the postoperative 3rd month values of study group. (P>0.05) With the Real Time Spectrogram Program F1, F2, F3, F4 frequencies were evaluated and in comparing preoperative formant values of the children with adenoid hypertrophy to healthy children F2, F3, F4 values were seen as statistically significant high. (P<0.05) It was determined that F3 and F4 values had a statistically significant increase when comparing before and after values of adenoidectomy. (P<0.05) And again it was determined that there was a significant difference when comparing 3rd month controls after adenoidectomy to F2, F3 and F4 values of healty children. (P<0.05) It was seen that the nasalance values of the children with adenoid hypertrophy determined by nasometer were statistically significant low when comparing these to healthy children. (P<0.05) And again it was determined that there was a statistically significant increase when comparing preoperative nasalance values of the children with adenoid hypertrophy to postoperative values. (P<0.05) In our work, it was determined that there is no statistically difference in terms of calculated minimum and maximum pitch values between healthy children and preoperative values of adenoid group, between preoperative and postoperative values of adenoid group, and between late term results of study group and adenoid group. (P>0.05) In patients performed by adenoidectomy,there was no change determined in acoustic sound parameters, but patient?s relatives should be informed in terms of changes in nasal resonance. This case is important especially for porfessionally voice users.
Açıklama
Anahtar Kelimeler
Adenoidektomi, Adenoidectomy, Adenoidler, Adenoids, Damak, Palate
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kara, M. (2010). Çocuklarda adenoidektominin ses ve yumuşak damak fonksiyonları üzerine etkinliğinin objektif ses analizi ve nazometre ile değerlendirilmesi. Selçuk Üniversitesi, Yayımlanmış tıpta uzmanlık tezi, Konya.
