Risk factors for the appearance of minimal pathologic lesions on vocal folds in vocal professionals

Abstract

Background/Aim. An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds - minimal pathological lesions - MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. Methods. There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). Results. The changes that occurred most often were identified as nodules (50%; n = 23/46) and polyps (24%; n = 11/46). Risk factors causing MAPLs in vocal professionals were as follows: age, which reduced the risk by 23.9% [OR 0.861 (0.786-0.942)] whereas the years of career increase the risk [OR 1.114 (1.000-1.241)], as well as the presence of a chronic respiratory disease [OR 7.310 (1.712- 31.218)], and the presence of gastro-oesophageal reflux disease [OR 4.542 (1.263-16.334)]. The following factors did not contribute to development of MAPLs in vocal professionals: sex, a place of residence, irritation, smoking, endocrinologic disease and the presence of poly-sinusitis. Conclusion. It is necessary to introduce comprehensive procedures for prevention of MAPLs, particularly in high-risk groups. Identification of the risk factors for MAPLs and prevention of their influence on vocal professionals (given that their income depends on their vocal ability) is of the highest importance.Uvod/Cilj. Prekomerna upotreba ili zloupotreba glasa kod vokalnih profesionalaca moze dovesti do pojave simptoma (slabosti glasa, promuklosti i gubitka glasa), kao i do razvoja organskih promena na glasnim zicama (MAPLs - minimal pathological lesions). Cilj rada bio je utvrditi vrstu MAPLs kod vokalnih profesionalaca, kao i faktore rizika koji dovode do njihove pojave. Metode. Ova prospektivna studija obuhvatila je 94 vokalna profesionalaca i to 46 sa MAPLs i 48 bez MAPLs, koji su cinili kontrolnu grupu. Kod svih bolesnika bilo je sprovedeno osnovno klinicko ispitivanje [anamneza, klinicki pregled, bakterioloski pregled nosa i zdrela, radiografija paranazalnih supljina, alergoloska obrada, fonijatrijski pregled, endovideostroboskopski pregled (Storz), kao i gastroenteroloski pregled, endokrinoloska i pulmoloska obrada]. Rezultati. Najcesce utvrdjene promene kod vokalnih profesionalaca bili su: noduli (50%, n = 23/46), a zatim polipi (24%, n = 11/46). Faktori koji su imali uticaja na pojavu MAPLs kod vokalnih profesionalaca su: godine starosti koje smanjuju rizik za 23,9% [OR 0,861 (0,786-0,942)], dok rizik povecavaju godine staza [OR 1,114 (1,000-1,241)], postojanje hronicne respiratorne bolesti [OR 7,310 (1,712-31,218)] i postojanje gastroezofagusne bolesti [OR 4,542 (1,263-16,334)]. Na pojavu MAPLs kod vokalnih profesionalaca nisu imali uticaja pol, mesto zivljenja, postojanje iritacije, pusenje, endokrinoloska bolest, kao i postojanje polisinuzitisa. Zakljucak. Neophodno je uvodjenje sveobuhvatnih preventivnih postupaka za sprecavanje nastanka MAPLs, posebno u visokorizicnim grupama. Narocito je vazno utvrdjivanje faktora rizika od nastanka MAPLs i otklanjanje njihovog uticaja u grupi vokalnih profesionalaca, s obzirom da je njihova sposobnost zarade u negativnoj vezi sa gubitkom kvaliteta glasa.