Temperament and Voice Quality in Patients With Vocal Fold Nodules

Emine Metin, Kemal Uygur, Erdoğan Okur, Bilge Metin, Bülent Gündüz

Vocal fold nodules are most common in women and patients with vocal fold nodules represent the largest group in voice clinics. The prevalence of vocal fold nodules is particularly high in professions where the voice is used on a regular basis. The quality of the voice is influenced by a number of factors, including temperament, stress, and emotional state. These factors can influence the physiological conditions of phonation. The objective of this study was to assess the acoustic parameters of voice in patients with vocal nodules in comparison to healthy controls, and to determine whether voice quality is influenced by emotional state and coping with stress. A total of 32 patients admitted to the ENT Department of the University Medical School with voice disorders between March and June 2007 constituted the study group. All patients were found to have a vocal nodule on physical and stroboscopic examination. The control group consisted of 30 healthy individuals who did not report any voice disorders. All subjects underwent voice recordings in the voice laboratory. Following the completion of the voice evaluation form, an aerodynamic assessment (a, s, and s/z-time), an index of vocal impairment, the Rosenbaum's Learned Resourcefulness Scale, and the Temperament and Characteristics Inventory (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire), all subjects underwent further assessment. Acoustic analysis was conducted using the CSL program in Multidimensional voice program analysis and the Vocal Assessment component of Dr. Speech. The decrease in maximum phonation time in the study group was statistically significant. There were statistically significant differences in the parameters Mean Fundamental Frequence, Jitter, Relative Avarage Perturbation, Pitch Perturbation Quotient, Shimmer in dB, Shimmer, Amplitude Perturbation Quotient, Noise Hormonic Ratio, Soft Phonation Index from the Multidimensional voice program analysis, Jitter, Shimmer% from the voice assessment, and the perceptual rating (H, R, and B) from Dr. Speech's voice assessment analysis. The differences in the dimensions of anxious temperament and the examination of stress problem-solving strategies were significant between the study group and the control subjects. Differences in aerodynamic and acoustic parameters were found between disordered and healthy groups, as well as between individuals with different personalities. Overall, those with nodules were less likely to manage stress well than those without nodules. The study group and the control subjects showed significant differences in anxious temperament dimensions and stress problem-solving strategies. There were also differences in aerodynamic and acoustic parameters between the disordered and healthy groups, as well as between the groups with and without personality temperament differences. Overall, those with nodules were less likely to manage stress well than those without nodules. This finding indicates that stress management options are not effectively utilized in patients with vocal fold nodules. So, it might be a good idea to look into some kind of therapeutic approach and patient education for stress management.