Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Voice Disorders”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 343 records · Page 19Linked to original sources
PubMed1998

Assessment of two objective voice function indices.

In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage "The North Wind and the Sun," and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

Adult↗
PubMed2003

Dysphonia: medical treatment and a medical voice hygiene advice approach. A prospective randomised pilot study.

For many years all patients with dysphonia referred to in the literature as resulting from non-organic (functional) voice disorders were sent to speech therapy. Medical diagnoses were not taken into account. In our earlier Cochrane review on vocal cord nodules we discovered that evidence-based research in the area of benign voice disorders with dysphonia, and with or without slight benign swellings including nodules on the vocal cords, was lacking at that time. Therefore, a prospective randomised pilot study based on our Cochrane review has been made on dysphonic patients with non-organic (function provoked?) voice disorders as the basis for further evidence-based studies. Medical treatment was based on the scientific approach that once a micro-organic disorder caused by reflux, infection, allergy or environmental irritatants (e.g., dust or noise in the workplace) was discovered by very careful anamnesis and systematic objective routine analyses and was treated effectively, with documentation, the non-organic voice disorder disappeared, as, e.g., in the case of a diagnosis and treatment of helicobakter pylori. The reason is that the mucosal swelling/dysfunction of the vocal cords is secondary. In order to try to understand why the recommendation to all these patients for many years was only voice therapy, which the speech therapists "felt to be effective", updated voice-hygiene advice (for posture, accents of the diaphragm, intonation pattern and resonance) was given by experienced laryngologists, randomised with the updated medical diagnosis/therapy in order to elucidate what effect the training might have. No evidence-based studies in the literature document any effect. The crucial point seemed to be that doctors mostly did not examine any other diagnoses other than the "dysphonia" and did not dig down to any of the medical reasons when the vocal fold diagnosis of "non- organic disorders" was made. This should be changed in the future. This pilot study was based on a comparison of ten dysphonic patients with stroboscopic non- organic (functional) voice disorders, where a micro-organic diagnosis was searched for and treated systematically in a medical regime (for infections, allergies, gastrooesophageal reflux and environmental irritants such as dust, noise, etc.) versus ten dysphonic patients with stroboscopically confirmed non-organic (functional) voice disorders, having only the traditional but optimal voice advice, which we can call medical voice-hygiene advice, including the use of the Accent method. A retrospective group of ten patients treated medically was included, too. A demand cannot be made that the functional group being treated by randomisation with voice advice should also be medically treated at once, the medical approach being the new one. On the other hand, it is strange that no evidence-based research was made before. All patients were measured two times with stored videostroboscopy, a quality-of-life questionnaire and phonetograms with 1-month intervals. All patient groups improved. There was no statistical improvement in favour of the medical group with the voice-related quality-of-life score, also not for the group who received voice-hygiene advice. The geometrical mean values of the phonetogram areas in decibels times semitones were better in all groups, but a statistical difference was not found between the medically treated group and the voice-hygiene advice group. The pilot study showed that both medical treatment and medical voice-hygiene advice had a positive effect on dysphonia in non-organic (functional) voice disorders. There is need of an extensive prospective randomised trial on dysphonia including vocal cord nodules to find out which treatment should be used for this group of patients. It is suggested that an eventual randomisation for microsurgical treatment or regular voice therapy should be made after a period of systematic medical diagnosis and treatment including medical voice-hygiene advice.

Adult↗
PubMed2005

Validity and reliability of the glottal function index.

OBJECTIVE: To evaluate a symptom-focused vocal impairment instrument for the evaluation of patients with voice disorders. DESIGN: Prospective, nonrandomized study of patients with voice disorders undergoing treatment with validation of a new symptom index, the Glottal Function Index (GFI). SETTING: Voice disorders clinic at an academic tertiary care hospital. PATIENTS: Consecutive patients undergoing therapy for glottal insufficiency, adductor spasmodic dysphonia, nodules, and granuloma (40 patients in each group) and 40 control patients. INTERVENTIONS: The Pearson correlation coefficient was used to evaluate GFI reproducibility and to compare it with the Voice Handicap Index (VHI). The paired-samples t test was used to compare pretherapy and posttherapy GFI values. MAIN OUTCOME MEASURES: Correlation of GFI with VHI; comparison of the GFI in normals, and in pretherapy and posttherapy GFI and VHI scores. RESULTS: The mean +/- SD normative GFI score was 0.87 +/- 1.32. The correlation coefficient for GFI between independent pretherapy measurements was 0.56 (P<.001). The correlation coefficient between total GFI and total VHI scores was 0.61 (P<.001). The mean posttherapy GFI scores improved among all groups as follows: glottal insufficiency: presenting GFI score, 12.7 +/- 4.1; posttherapy GFI score, 6.8 +/- 5.4; nodules: presenting GFI score, 12.9 +/- 4.2; posttherapy GFI score, 8.9 +/- 4.6; adductor spasmodic dysphonia: presenting GFI score, 13.2 +/- 4.1; posttherapy GFI score, 8.9 +/- 4.9; and granuloma: presenting GFI score, 7.8 +/- 4.6; posttherapy GFI score, 3.8 +/- 2.1. Relative to controls, the GFI score at presentation was significantly elevated and demonstrated significant reduction following treatment across each of these entities (P<.05). CONCLUSIONS: The GFI is a reliable, reproducible, 4-item, self-administered symptom index with excellent criterion-based and construct validity. Its advantages over existing indexes include brevity and ease of administration. The GFI is a useful adjunct in the evaluation and treatment of patients with glottal dysfunction.

Adult↗
PubMed2005

[Physical complaints in dysphonic patients].

BACKGROUND: In previous studies, patients with benign organic and functional voice disorders were shown to suffer from physical complaints. The present study focuses on a specific nosologic classification of these disorders in the sense of diagnosing a somatoform illness. PATIENTS AND METHODS: Eighty patients (50 women, 30 men) aged 44+/-11 years (18-60), suffering from various voice disorders (functional: n=18 women, n=13 men; organic: n=32 women, n=17 men), were examined after informed consent. Physical complaints were assessed using the Giessen Complaint Questionnaire GBB-24. Age and gender matched normal controls were taken from the literature. Data were analyzed using the non parametric two-by-two four-field-test. RESULTS: The individual diagnosis of dysphonic women showed pathologic values in all subscales except limb complaints. The individual diagnosis of men showed pathologic values in the limb complaints subscale (P<0.05). When comparing functional and organic disorders, no significant difference (P>0.05) was found in neither of the gender groups. DISCUSSION AND CONCLUSIONS: Depending on gender and type of voice disorder, dysphonic patients suffer from different physical complaints. Both patients with functional and organic disorders are affected. Therefore, it does not seem justified to classify functional voice disorders as somatoform disorders.

Adolescent↗
PubMedDate not supplied

Diversity in voice characteristics--interaction between genes and environment, use of microarray analysis.

UNLABELLED: Genetic information is used by the cells to make proteins. These proteins are then used to perform cellular and tissue functions. This process is briefly reviewed. Research to identify genes and their expression patterns is a fruitful field in the area of voice disorders. Gene expression studies of vocal lesions illustrates why this type of research is important. The role of microarray analysis (MA) to find genes of interest is discussed. Gene expression may be influenced by various environmental factors. This interaction between environment and genes is constantly manifested in many vocal characteristics and disorders. Since the end result of the gene-environment interaction is the production of cellular and tissue proteins, the field of proteomics is relevant to voice disorders. Some voice disorders have been treated successfully through using proteomic approaches. LEARNING OUTCOMES: (a) Understand the factors that influence genetic expression; (b) display a knowledge of why the study of proteins is important to understand voice characteristics; (c) become familiar with MA, a powerful tool for the study of gene expression; and (d) describe the interaction between genes and environment.

Education, Medical, Continuing↗
PubMed2000

Supraglottic activity: evidence of vocal hyperfunction or laryngeal articulation?

False vocal fold (FVF) adduction and compression of the arytenoid cartilages to the petiole of the epiglottis in an anterior to posterior (A-P) direction have been thought to characterize voice disorders with abnormally increased muscle tension or effort, often termed hyperfunctional voice disorders. To further evaluate the association between hyperfunctional voice disorders and supraglottic activity, we compared the incidence of static and dynamic supraglottic activity in individuals with normal laryngeal mucosa, normal voice quality, and no voice complaints to two populations: subjects with vocal fold nodules and subjects with complaints of dysphonia without visible vocal fold lesions, glottal incompetence, or impairment of arytenoid cartilage motion ("hyperfunctional" group). Thirty-two subjects were assigned to one of these three groups (10 control, 12 nodule, and 10 hyperfunctional). Laryngeal movements were recorded using flexible videoendoscopy while a subject was performing speech tasks such as sustained phonation, syllable repetitions, sentence imitations, and conversation. Samples were randomized by subject and task and rated for presence or absence of A-P and FVF compression. Statistically significant group differences were found for FVF compression across speech tasks (chi-square, p<0.001). The control group had the smallest incidence (45%), nodule patients the next larger incidence (68%), and hyperfunctional patients the largest incidence (80%). Statistically significant group differences were found for A-P compression across speech tasks (chi-square, p<.05). The control group had the smallest incidence (74%), nodule patients the next larger incidence (78%), and hyperfunctional patients the largest incidence (92%). Statistically significant task differences were found for the presence of FVF compression in control subjects (chi-square, p<.005), hyperfunctional patients (chi-square, p<.025), and nodule patients (chi-square, p<.001), but not for A-P compression for any of the groups. A higher incidence of FVF compression was present for the speech tasks that included glottal stops. This context-specific variation in supraglottic activity suggested a dynamic component to FVF compression and also explained the high proportion of FVF compression in the control group. Each video sample was also rated for consistency of FVF or A-P compression to explore the static and dynamic nature of supraglottic activity. For samples on which raters agreed, A-P compression was typically present consistently, suggesting a static component, and FVF compression inconsistently, suggesting a dynamic component, for all three groups (chi-square, p<.001). These findings do not support previous suggestions that supraglottic activity may be a precursor to developing vocal fold nodules, as the nodule patients did not exhibit a higher incidence or consistency of A-P or FVF compression than patients with hyperfunctional voicing patterns in this study. Subjects in the hyperfunctional voice group were found to have static components of FVF and A-P compression. The presence of FVF compression in speech tasks that included glottal stops in the control group suggests an articulatory function at the laryngeal level.

Adolescent↗
PubMed1985

Quantitative spectral evaluation of shimmer and jitter.

A vowel [a]-like, synthesized speech wave was perturbated by defined and comparable jitter and shimmer levels. The signal-to-noise ratio was calculated from the speech wave spectra. Noise emerges in those spectral regions in which the harmonics have high amplitudes, that is, at low frequencies and in the formant regions. Jitter created noise levels significantly higher than shimmer. To verify the theoretical findings, the voices of 32 women with functional voice disorders were analyzed for shimmer and jitter. It was found that only jitter is relevant for differentiating between hypo- and hyperfunctional voice disorders. Jitter was reduced in hyperfunctional voice disorder. This is presumed to be an effect of the high vocal fold tension found in the disorder.

Adult↗
PubMed1984

[Comparative long-term spectral studies of the voice using the Lombard effect].

LTAS changes during Lombard conditions were analysed with regard to intensity level differences. Functional voice disturbances can be related to a more pronounced change of the intensity level, whereas organic voice disorders tend to display a rather limited spectral intensity change. Subjective judgement of voice quality during bilateral deafening reveals a better chance for improvement in cases with pronounced change of the spectral intensity level, i.e. primarily functional disorders. Voice changes during Lombard conditions are effected by control mechanisms compensating for the auditory feedback loss not only at the laryngeal level, but also in the supraglottic vocal tract. For clinical use the deafening procedure is of value for diagnosis as well as for therapy of voice disorders.

Adult↗
PubMed1984

Duration of sustained phonation in kindergarten children.

Maximum sustained phonations of the vowels [a], [u] and [i] were obtained from 160 kindergarten children with a mean age of approximately 6.2 years. Subjects were grouped by sex and by the presence or absence of a voice disorder. Stop watch measurements of each subject's maximum phonations were compared with graphic level recorder measurements of those phonations . The results indicated that (1) the factor of sex had no significant effect on maximum phonation times; (2) the factor of voice group (non-voice-disordered/voice-disordered) did result in a significant effect (P less than 0.01) with the voice-disordered group achieving shorter phonations than the non-voice-disordered group; (3) the phonation times obtained from the two measurement procedures correlate significantly (P less than 0.05). Results also suggest that the vowel effect on maximum phonation time was significant (P less than 0.05) for both groups. The vowel [i] was phonated significantly longer than either [a] or [u] for males and females in both groups.

Child↗
PubMed2006

Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders.

UNLABELLED: Phonological Disorder is a disturbance of primary manifestation of undefined causes that makes speech become unintelligible. The analysis of vocal parameters becomes important in the process of diagnosis of this disorder, since voice disorders could interfere in the production of speech sounds. AIM: The objective of this study was to verify vocal characteristics related to the intensity and fundamental frequency--F0--and their disturbance indexes--jitter and shimmer--in children with phonological disorders. STUDY DESIGN: Clinical prospective with transversal cohort. MATERIAL AND METHOD: There were 40 children, 20 of them with phonological disorders and 20 with no speech and language disturbances. Phonological exams with the ABFW infantile language test and spontaneous speech were applied. The Computer Speech Lab was used to record and perform acoustic analyses of the vowels /a/, /e/, /i/, through the vocal parameters: fundamental frequency, intensity, jitter and shimmer. RESULTS: F0--vowel /e/ was smaller, on average, in the Phonological Disorder Group and it was 126 Hz in the Control Group. To shimmer and jitter there was no evidence that the means of the Phonological Disorder Group were different from the ones of the Control Group (p= 0.191, p= 0.865, respectively). As for intensity, there was evidence that the average did not differ in the Phonological Disorder Group and the Control Group (p= 0.002). CONCLUSION: The frequency of the vowel /e/ was smaller in the Phonological Disorder Group. There was difference between the two groups regarding the means of intensity of vowels /a/, /e/ and /i/, smaller in the Phonological Disorder Group. No differences between the groups were found regarding the averages of jitter and shimmer.

Case-Control Studies↗
PubMed1996

Classification of voice pathology.

A proper classification of voice pathology is required for didactic reasons, and also to assist a clinician in establishing the "primary diagnosis", i.e., an initial voice disorder in a particular patient. In spite of a frequent etiologic overlapping between organic and functional voice disorders, it is useful to keep these two basic pathologic categories in clinical practice. A revised clinical classification of voice disorders is suggested, including several newly described voice disturbances. These are the syndrome of inappropriate vocal pitch (organic), psychogenic superimposition and false placement of the voice (functional).

Diagnosis, Differential↗
PubMed2005

[The voice evaluation protocol of the European Laryngological Society (ELS) -- first results of a multicenter study].

INTRODUCTION: A multidimensional protocol has been established by the ELS in order to reach better agreement and standardisation for functional assessment of pathologic voices. In order to evaluate the validity, practicability and applicability of this protocol the experiences of 6 european voice centres have been analysed in a retrospective study. MATERIAL AND METHODS: The ELS protocol comprises 5 dimensions: perceptual voice evaluation, videostroboscopy, acoustics, aerodynamics and subjective rating by the patient. Results obtained in 94 patients with benign voice disorders were evaluated retrospectively in a multicenter study. RESULTS: According to our results, the validity, practicability and applicability of the ELS protocol was largely satisfactory. This was true for all "common" voice disorders, but not for extreme voice alterations (e. g. spasmodic dysphonia, aphonia, substitution voices). The 5 dimension proofed to be not redundant and were able to selectively differentiate pre- post changes among various etiologies of voice disorders, various types of treatment and genders.

Adolescent↗
PubMed1994

Acoustic analysis of functional dysphonia: before and after voice therapy (accent method).

Ten patients who were referred to a speech pathologist for functional voice disorders were treated with voice therapy using the accent method. The vocal folds were normal except in three females who had moderate bilateral nodules. The voices were analyzed acoustically before and after treatment. Of the parameters tested, pitch perturbation quotient, amplitude perturbation quotient, normalized noise energy for 1-4 kHz, and fundamental frequency showed significant improvement.

Adolescent↗
PubMed1980

Maximum duration of sustained /s/ and /z/ in children.

It has been proposed in the clinical literature that a ratio of the maximum duration of /s/ to /z/ may be useful in determining the possible contribution of the respiratory and vocal mechanisms to a disordered voice. The purpose of this study was to obtain preliminary normative data for the maximum phoneme duration (MPD) of /s/ and /z/ and to determine the ratio of /s/ to /z/ in five, seven, and nine year olds. The results indicated that while there were no significant differences in MPD for either /s/ or /z/ between males and females at any one age level, there was a significant increase in the MPD of /s/ and /z/ for both sexes as a function of age. When the ratio of /s/ to /z/ was computed for the subjects, there were no significant differences in these ratios between males and females nor were there significant differences as a function of age.

Age Factors↗
PubMed2003

Spectral models of additive and modulation noise in speech and phonatory excitation signals.

The article presents spectral models of additive and modulation noise in speech. The purpose is to learn about the causes of noise in the spectra of normal and disordered voices and to gauge whether the spectral properties of the perturbations of the phonatory excitation signal can be inferred from the spectral properties of the speech signal. The approach to modeling consists of deducing the Fourier series of the perturbed speech, assuming that the Fourier series of the noise and of the clean monocycle-periodic excitation are known. The models explain published data, take into account the effects of supraglottal tremor, demonstrate the modulation distortion owing to vocal tract filtering, establish conditions under which noise cues of different speech signals may be compared, and predict the impossibility of inferring the spectral properties of the frequency modulating noise from the spectral properties of the frequency modulation noise (e.g., phonatory jitter and frequency tremor). The general conclusion is that only phonatory frequency modulation noise is spectrally relevant. Other types of noise in speech are either epiphenomenal, or their spectral effects are masked by the spectral effects of frequency modulation noise.

Fourier Analysis↗
PubMed2006

Immediate inflammatory response and scar formation in wounded vocal folds.

OBJECTIVES: Vocal fold scarring is the major cause of voice disorders after voice surgery or laryngeal trauma. The role of inflammatory factors in vocal fold wound healing and fibrosis has not been adequately investigated. Scarless wound healing has been associated with decreased inflammatory responses. To understand scar formation and develop reliable treatments, it is necessary to control extracellular matrix production and inflammation. Thus, we examined the inflammation profile and extracellular matrix production in wounded vocal folds in the acute phase of wound healing. METHODS: Vocal fold stripping was performed on 30 Sprague-Dawley rats. Vocal fold tissue was collected at 5 time points (4, 8, 16, 24, and 72 hours). We examined the in vivo messenger RNA expression profile of inflammatory factors interleukin 1beta, interferon gamma, tumor necrosis factor alpha, nuclear factor kappa beta, transforming growth factor beta, and cyclooxygenase 2, as well as hyaluronic acid synthases 1 and 2, procollagen subtypes I and III, and elastin synthase in scarred vocal folds after injury, compared to normal vocal folds, using real-time reverse transcription-polymerase chain reaction. RESULTS: The inflammatory factors showed a time-dependent sequence of expression peaks, starting with interleukin 1beta, nuclear factor kappa beta, tumor necrosis factor alpha (4 and 8 hours), and transforming growth factor beta (72 hours). Interferon gamma decreased at 24 hours. Correspondingly, hyaluronic acid synthase 1 expression peaked first (4 and 8 hours), whereas hyaluronic acid synthase 2 expression peaked at 16 hours and again at 72 hours. Procollagen I expression peaked at 72 hours, whereas procollagen III decreased from 8 to 16 hours but peaked at 72 hours. Cyclooxygenase 2 expression was elevated, whereas elastin expression remained constant. CONCLUSIONS: The results show a clear profile of vocal fold inflammation with corresponding changes in extracellular matrix production.

Animals↗
PubMedDate not supplied

[Anxiety disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association: diagnostic and statistical manual of mental disorders (DMS-IV -- options book].

In 1991 the American Psychiatric Association proposed a draft version of the IV edition of Diagnostic and Statistical Manual of Mental Disorders--the DSM IV Options Book. Authors of this version wanted to increase clarity of the criteria sets and to provide compatibility with the Tenth Edition of the International Classification of Diseases (ICD-10). The purpose of this Options Book is to propose some changes in wording, diagnostic divisions and to discuss various options concerning the placement of sections and disorders within the classification. The "Disorders of Infancy, Childhood or Adolescence" section was renamed "Disorders Usually First Evident in Infancy, Childhood or Adolescence" and moved to the front of the classification and also was expended to 11 groups of disorders. Several suggestions have been made about including new diagnostic groupings such as: Rett's Disorder, Eating Disorders and Voice Disorder. The Options Book introduces a superior category for Attention Deficit Disorders (with and without hyperactivity) and for Conduct Disorder/Oppositional Defiant Disorder. Several options are proposed regarding The Anxiety Disorders of Childhood or Adolescence. Since there is no evidence for distinction in this category according to the age criterion, one option would be to move these disorders into the adult anxiety section (similarly to the Mood Disorders and Schizophrenia). In the new version the title "Specific Developmental Disorders" is omitted. The suggestion is to include Phonological Disorder (Articulation Disorders) and Elective Mutism in the Speech and Language Disorders section.

Anxiety Disorders↗