| Objective:1.The purpose of this study is to explore the related risk factors of benign vocal fold hyperplastic and different risk factors for the intensity of the disease,so as to provide evidence for the prevention and treatment of vocal diseases.2.By comparing vocal acoustic parameters,GRBAS assessment,VHI-30 score and dynamic laryngoscope results before and after intervention,the research is aim to investigate the suitable time of vocal training for teachers with vocal cord benign lesions under dynamic laryngoscope,and to evaluate the effectiveness of vocal training for the vocal cord function recovery and the quality of life.Methods:Part one: 169 teacher patients with benign vocal fold hyperplastic disease in this study by using convenience sampling method,as well as 180 cases healthy teacher patients as the control group over the same period from October 2015 to May 2017,ENT,No.1 Hospital,Shanxi Medical University.In this paper,factors data possibly related collected by questionnaire which designs on the basis of consulting relevant literature,and the logistic regression analysis was performed.the 95% confidence interval and OR value were estimated by Mantal-Haenszel,and the correlation between the risk factors and the sound lesions of teachers' vocal cords was determined.Part two: 144 teachers with benign vocal fold hyperplastic disease were selected and divided into A group(n=48),B group(n=48)and control group(n=48)according to envelope method.the control group was given conventional therapy,Group A and Group B were given voice training on the basis of routine treatment for 2 months,voice training began at 2 and 1 weeks after the operation.The voice acoustic parameters were compared between three groups before 3,5,7 days,1 months after intervention and 2 months after intervention;The results of GRBAS assessment,VHI-30 scale and dynamic laryngoscopewere compared among three groups before intervention,1 month,2 months after intervention.the data were statistically analyzed by Card Square test,T-test,variance analysis of single factor,variance analysis of repeated measurement,rank test.Results:The first part: according to the questionnaire survey,14 risk factors of vocal cord benign hyperplasia were collected for single factor logistic regression.multiple factor logistics regression of single factor analysis screening results or may affect disease variables by stepwise regression method.occupational level,teaching age,alcohol consumption,allergic rhinitis,spicy stimulation of food,smoking,gastroesophageal reflux disease,teaching time in weeks,number of students in class were independent risk factor for disease.The second part: a total of 133 cases were collected,including 46 in Group A,45 in Group B and 42 in control group.there was no significant difference between the three groups of general data,voice acoustic parameters,VHI score,and GRBAS assessment before intervention.1.On the 3 day after operation,the values of Jitter and Shimmer in three groups were all increased,and the values of DSI and MPT decreased.there was no statistical significance compared with those before operation(P>0.05).after 5 days of operation,the acoustic parameters of Jitter and Shimmer decreased,the DSI and MPT increased,and that of Jitter was statistically significant(p<0.05).the difference of acoustic parameters between7 days after operation and preoperative was statistically significant(p<0.05).2.The acoustic parameters of three groups were analyzed by repeated measurement variance before intervention,1 month and 2 months after intervention.the results showed that there was interaction between the three groups(p<0.05).the comparison between three groups showed that the acoustic parameters of three groups were statistically significant in1 month and 2 months after intervention(P<0.05).LSD multiple comparison:1 months after intervention,the Jitter and Shimmer value in group A and B were significantly different from those in control group,the Shimmer and DSI values in group B were significantly different from those in A group and control group;2 months after intervention,the voice parameters in group A and group B were significantly different from those in control group.The values of Jitter,Shimmer and MPT in group A were significantly better than those in B group,and there are significant differences.the comparison within the group shows: thevalues of Jitter,Shimmer,DSI,MPT in group A and B and the values of Jitter,MPT in control group were statistically significant compared with 1 month after intervention(P<0.017).the values of Jitter,Shimmer,DSI and MPT in the three groups were statistically significant compared with 2 months after intervention.Compared with 1months after intervention,the values of Jitter,Shimmer,DSI and MPT in group A,the values of Jitter,DSI and MPT in group B and the values of Jitter,Shimmer in control group were statistically significant(P < 0.017).3.The comparison between groups showed that three groups of VHI-P,VHI-F and VHI-T scores were statistically significant in 2 months after intervention(P < 0.05).LSD multiple comparison: the difference of VHI-P score in group A was statistically significant compared with that group B and control group,the difference of VHI-F score and VHI-T score in group A and B was statistically significant compared with the control group(P <0.05).the comparison within the group shows: compared with 1 months after intervention,the scores of VHI-F,VHI-E and VHI-T in group A and B were statistically significant(P<0.017).the scores of VHI-P,VHI-F,VHI-E and VHI-T in group A and group B and the scores of VHI-F,VHI-E and VHI-T in control group were statistically significant before intervention and 2 months after intervention.the scores of VHI-P,VHI-F and VHI-T in group A,VHI-F and VHI-T score in group B,VHI-T scores in control group were statistically significant at 1 months after intervention compared with 2 months after intervention(P<0.017).4.Three groups of subjects before the intervention and after 1 months,2 months G,R,B values were compared using repeated measures variance analysis,the results showed that there was a interaction between time and group G values in three groups(P<0.05),R,B between time and group interaction does not exist(P> 0.05).the comparison within the group shows: there was significant difference between the three groups of G values in 1months and 2 months after intervention and the R value in 2 months after the intervention in addition to the value of B.LSD multiple comparison:1 months after intervention,the G value in group A and B were significantly different from those in control group,2 months after intervention,the G,R value in group A and B were significantly different from those in control group,the values of G in group A were significantly better than those in B group,and there are significant differences.the comparison within the group shows: the values of G,R,B in group A and G in group B were statistically significant before intervention compared with 1 months after intervention(P< 0.017),the values of G,R,B in group Aand G in group B and in control group were statistically significant before intervention compared with 2 months after intervention(P< 0.017),the values of G,R,B in group A and B in group B were statistically significant before1 months after intervention compared with 2 months after intervention(P<0.017).5.The Dynamic laryngoscopy showed that the treatment effect of group A and group B was superior to the control group in 2 months after intervention(P < 0.05).Conclusion:1.The risk factors of teachers benign vocal fold hyperplastic diseases in study including vocational categor,alcohol consumption,teaching age,spicy food,smoking history,allergic rhinitis,gastroesophageal reflux disease,teaching time in week,number of students in class.2.The vocal cord function began to improve 7 days after the operation under the dynamic laryngoscope,and it was helpful to improve the voice quality by starting the voice training after 2 weeks after surgery.3.Voice training can significantly improve the teachers' acoustic parameters,reduce the VHI-30 scale,and GRBAS index.it shows that voice training has a positive effect on the repair of the vocal mucosa,the improvement of vocal cord function and the quality of life after operation.4.It shows that there is a good consistency between voice acoustic analysis,GRBAS assessment,VHI-30 scale assessment and dynamic laryngoscopy.It can evaluate the quality of patient's voice more accurately and comprehensively,and provide therapeutic decisions for postoperative outcome. |
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