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PubMed1993

[Indications for psychotherapeutic treatment of functional dysphonias].

Functional voice disorders require adequate psychiatric screening and treatment due to the complex etiologies of the psychic elements involved. While the diagnosis of dysphonia increasingly takes into account various emotional factors, considerations of indications for psychotherapy and for differing forms of psychotherapy are missing in the literature. To fill this gap, the aims and principles of a number of psychoanalytically based therapeutic methods are presented. Criteria for general indications for treatment and with respect to patients with functional voice disorders are outlined. Case reports of patients with functional voice disorders illustrate individual methods for diagnosis and treatment. Finally, the necessity, for the development of general criteria for differential indications for psychotherapy in functional voice disorders is pointed out.

Adult↗
PubMed2002

Vocal loading among day care center teachers.

Day care center teachers suffer from voice disorders more often than nurses do. Several risk factors may increase voice disorder prevalence of day care center teachers. The risk factors can be bound to their job content and manner of working i.e. having to raise their voice to attract the attention of the children and to offer them the possibility to perceive spoken information, or to the environment i.e. poor acoustics and excess background noise. The purpose of this study was to measure some of the risk factors for voice disorders of day care center teachers and of a control group (nurses); these were speaking times and speech levels. The background noise levels during activities and RASTI-values (Rapid Speech Transmission Index), i.e. measures of the acoustics of rooms, were also measured at the day care centers. It was found that day care center teachers use their voices more and with higher levels than nurses do. It was also found that the background noise levels are high, which is partly due to the poor acoustics (lack of sufficient attenuation) of the rooms. Control of excess background noise is of utmost importance both for speakers' speech production as well as children's speech recognition.

Adult↗
PubMed2002

Correlation between voice handicap index and voice laboratory measurements in dysphonic patients.

Factors underlying voice disorders can be categorized into three distinct domains: emotional, physical, and functional. The Voice Handicap Index (VHI) subjectively evaluates voice disorders in terms of these three factors. On the other hand, Voice Laboratory Measurements (VLM) use objective criteria to evaluate the severity of voice disorders. Use of these two different tests (VHI and VLM) on dysphonic patients has, however, tended to yield results that vary widely in their conclusions. This report reviewed 135 testing sessions on dysphonia patients. Seventy-nine of the tests were VHI, and 56 were VLM. All VHI and VLM parameters were entered into a statistical program and analyzed using a Pearson correlation. The results show that each VHI parameter provides a significant level of reliability (P < 0.01) when compared with other VHI parameters. Four VLM parameters also demonstrated significant reliability (P < 0.01) in comparison with other VLM parameters. However, when comparing across testing methods, VHI and VLM parameter reliability is shown to be poor (P > 0.05). With such a large discrepancy between the results of VHI and VLM testing, no objective parameter can yet be regarded as a definitive prognostic factor in a subjective evaluation of dysphonic patients.

Adolescent↗
PubMed2000

The effects of preventive vocal hygiene education on the vocal hygiene habits and perceptual vocal characteristics of training singers.

The purpose of the present study was to determine the effects of vocal hygiene education on the vocal hygiene behaviors and perceptual vocal characteristics of untrained singers. Eleven adult untrained singers served as subjects. They attended four 1-hour class sessions on vocal hygiene, including anatomy and physiology of the phonatory mechanism, vocally abusive behaviors, voice disorders commonly seen in singers, and measures to prevent voice disorders. Pre- and postinstruction surveys were used to record subjects' vocal abuses and their perceptions of their speaking and singing voice. They also rated their perceived value of vocal hygiene education. Results revealed minimal changes in vocal hygiene behaviors and perceptual voice characteristics. The subjects did report a high degree of benefit and learning, however.

Adolescent↗
PubMed2004

The relationship between ratings of voice quality and quality of life measures.

In the past several years, a number of scales have been developed that elicit a patient's self-assessment of the severity of his or her voice problem. The Voice Related Quality of Life Measure (V-RQOL) assesses a patient's perception of the impact of the voice problem on quality of life. Although this tool assesses the patient's perception of the voice disorder, it may not reflect the severity of dysphonia as perceived by a clinician. The GRBAS is an auditory-perceptual scale developed in Japan and used by clinicians to categorize the voice using five descriptive perceptual parameters: overall grade or severity (G), roughness of the voice (R), breathiness (B), asthenia (A), and strain (S). The purpose of this research is to determine the relationship between the patient's perception of voice related quality of life using the V-RQOL and the clinician's perception of voice severity using the GRBAS scale. Fifty patients with a complaint of a voice disorder completed the V-RQOL prior to their examination. In addition, 45 patients without voice complaints (controls) also completed the V-RQOL. All patients and control subjects were assessed by one of the voice clinicians using the GRBAS. For 25 of the subjects, both clinicians provided GRBAS perceptual ratings. Each of the two groups, were subsequently divided into subgroups consisting of those age 66 years and under and those over 66 years of age. The results indicate that the two clinicians were highly reliable in rating severity in the normal and voice disordered groups using the GRBAS scale. The results also indicate that perceived voice severity and voice-related quality of life are related; however, the relationship is a moderate one, which suggests that factors other than those directly related to voice quality may contribute to responses on voice assessment scales completed by patients. The relationship was stronger for the subgroup under 66 years old compared with the subgroup 66 years and older.

Adult↗
PubMed1984

Relation between voice profile ratings and aerodynamic and acoustic parameters.

The present study sought to examine the relation between Wilson Voice Profile ratings and certain aerodynamic and acoustic variables. Subjects in this study were 20 adults with voice disorders and five adults with no voice disorders. A series of stepwise multiple correlations were used. The variance in perceptual ratings accounted for by aerodynamic and acoustic variables included in the present study ranged from 29% for tension ratings of connected speech to 81% for pitch ratings of connected speech for the female speakers. It is clear from the present findings that ratings on the Wilson Voice Profile are only partially accounted for by the variables included in the present study.

Adolescent↗
PubMed2004

A comparison of the prevalence of vocal symptoms among teacher students and other university students.

Studies focusing on different groups of students show that the prevalence of vocal symptoms and voice disorder vary depending on the study populations. A previous study of vocal symptoms and voice disorders among teacher students has shown that 20% of the students studying to become teachers in comprehensive schools and upper secondary schools reported frequently occurring vocal symptoms, ie, two symptoms or more occurring weekly or more often during the past year, and that most of these students had an organic voice disorder. This raised the question of whether other university students would also report similar, frequently occurring vocal symptoms. A questionnaire was distributed to 220 students of several faculties at the University of Turku, Finland. The results were compared with the results of a study of vocal symptoms reported by 175 students studying to become teachers. This comparison showed that students in general reported frequently occurring vocal symptoms, whereas the students studying to become teachers reported a greater number of frequently occurring symptoms than did other students at the university.

Adolescent↗
PubMed2004

[Voice handicap in patients with organic and functional dysphonia].

BACKGROUND: The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. PATIENTS AND METHODS: Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3+/-15.1 years with benign organic ( n=69) or functional ( n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1+/-15.5 years, served as controls. RESULTS: Significant differences ( P<0.001) were found between all dysphonic patients and the control group. When comparing dysphonic patients according to their gender and diagnosis group (organic or functional) no significant differences were detected. CONCLUSION: It can no longer be assumed that patients with functional voice disorders over emphasize their disease. The data obtained in this study prove that there are no gender specific differences in the way a voice disorder is experienced. There are also no differences in the way patients with a different language background experience their voice handicap.

Adult↗
PubMedDate not supplied

Occupational safety and health aspects of voice and speech professions.

A well-functioning voice is an essential tool for one third of the labour force. Vocal demands vary to a great extent between the different voice and speech professions. In professions with heavy vocal loading (e.g. school and kindergarten teachers), occupational voice disorders threatening working ability are common. Vocal loading is a combination of prolonged voice use and additional loading factors (e.g. background noise, acoustics, air quality) affecting the fundamental frequency, type and loudness of phonation or the vibratory characteristics of the vocal folds as well as the external frame of the larynx. The prevention and treatment of occupational voice disorders calls for improved occupational safety and health (OSH) arrangements for voice and speech professionals. On the basis of epidemiological and acoustic-physiological research, the presence of risk to vocal health can be substantiated. From the point of view of the physical load on the vocal apparatus, loading-related physiological changes (adaptation) may play a role in the occupational risk. Environmental factors affect vocal loading changes. In teaching professions, the working environment is shared with children, who benefit from amendments of OSH legislation concerning their teachers.

Adolescent↗
PubMed2003

Effects of age, sex, and disorder on voice range profile characteristics of 230 children.

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.

Age Distribution↗
PubMed1997

Normal strobovideolaryngoscopy: variability in healthy singers.

Strobovideolaryngoscopy has proven essential to accurate diagnosis of voice disorders. Clinical interpretation of stroboscopic images usually follows a standard assessment protocol. Features analyzed typically include symmetry of amplitude, symmetry of phase, regularity of periodicity, amplitudes and wave forms of individual vocal folds, presence or absence of adynamic segments, and other features. Speed and smoothness of abduction and adduction are also assessed. In order for stroboscopic data to be used meaningfully in a clinical setting, it is essential for the laryngologist to recognize the range of normal variability of these parameters. This may be particularly important when trying to establish diagnoses for subtle voice disorders in professional voice users. This study investigates strobovideolaryngoscopic findings in a population of normal professional singers without voice complaints. "Abnormal" strobovideolaryngoscopic findings occur in this asymptomatic population of "volunteers." These abnormalities might have been misinterpreted as causing voice complaints if seen for the first time when the singer sought medical care for a voice problem. Physicians must be aware of the range of laryngeal behavior that may be found among normal subjects and must be cautious when interpreting strobovideolaryngoscopic findings. This study also highlights the importance of obtaining "normal" baseline strobovideolaryngoscopic evaluations on professional voice users. The review of strobovideolaryngoscopy performed upon 65 healthy, asymptomatic professional singers revealed an incidence of 58% "abnormal" findings as six clinical entities.

Adult↗
PubMed1983

Speech timing of phonologically disordered children: voicing contrast of initial and final stop consonants.

Speech timing of nine phonologically disordered and nine normally developing children was investigated for the voicing contrasts of word-initial and word-final stop consonants. Measurements of voice onset time, vowel duration, consonant closure duration, and voicing during consonant closure were made from spectrograms. In addition, listener transcriptions were employed for perceptual analysis. Results indicated that some phonologically disordered subjects failed to differentiate VOT in word-initial voiced and voiceless stops, whereas others produced much longer VOTs for voiceless stops than did control subjects. In the word-final voicing contrast, the phonologically disordered children evidenced longer consonant closure durations and less voicing during consonant closure than did normal subjects. However, like normal subjects, they demonstrated differential vowel and consonant closure durations in voiced and voiceless contexts. Perceptual analysis indicated significantly more voicing errors in the initial final stops of phonologically disordered children. These various results are interpreted to mean that some phonologically disordered children may have less mature speech timing control. The implications of these data for the description of voicing errors also are discussed.

Articulation Disorders↗
PubMed1984

[Significance, necessity, indications and practical implementation of complex voice treatments within the scope of an inpatient treatment procedure (voice health cure)].

The decisive advantages of inpatient therapy for voice disorders are described. The purpose of these complex and intensive health resorts for voice disorders is to change the tuning of the voice, and to alter the behaviour of the individuals using a deficient voice sound, ie. it is a holistic voice therapy. The concept of treatment covers a large spectrum of voice disturbances including paralyses and organic disorders. The results of therapy were satisfactory particularly with professional voice users.

Combined Modality Therapy↗
PubMed2006

Reliability of speaking and maximum voice range measures in screening for dysphonia.

Speech range profile (SRP) is a graphical display of frequency-intensity occurring interactions during functional speech activity. Few studies have suggested the potential clinical applications of SRP. However, these studies are limited to qualitative case comparisons and vocally healthy participants. The present study aimed to examine the effects of voice disorders on speaking and maximum voice ranges in a group of vocally untrained women. It also aimed to examine whether voice limit measures derived from SRP were as sensitive as those derived from voice range profile (VRP) in distinguishing dysphonic from healthy voices. Ninety dysphonic women with laryngeal pathologies and 35 women with normal voices, who served as controls, participated in this study. Each subject recorded a VRP for her physiological vocal limits. In addition, each subject read aloud the "North Wind and the Sun" passage to record SRP. All the recordings were captured and analyzed by Soundswell's computerized real-time phonetogram Phog 1.0 (Hitech Development AB, Täby, Sweden). The SRPs and the VRPs were compared between the two groups of subjects. Univariate analysis results demonstrated that individual SRP measures were less sensitive than the corresponding VRP measures in discriminating dysphonic from normal voices. However, stepwise logistic regression analyses revealed that the combination of only two SRP measures was almost as effective as a combination of three VRP measures in predicting the presence of dysphonia (overall prediction accuracy: 93.6% for SRP vs 96.0% for VRP). These results suggest that in a busy clinic where quick voice screening results are desirable, SRP can be an acceptable alternate procedure to VRP.

Adult↗
PubMedDate not supplied

Voice handicap of laryngectomees with tracheoesophageal speech.

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox), aged 65.5 +/- 8.7 years. Their VHI was 45.5 +/- 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees' gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees' handicap.

Aged↗