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At least 397 records · Page 22Linked to original sources
PubMed1996

Bridging the gap between theory and practice: a multimedia tutorial for students of voice therapy.

A computer-based tutorial for speech and language therapy students is described in which a digitized video-recording of a diagnostic interview with a voice-disordered client was dynamically linked to an on-screen transcript window. A student-centered tutorial package, which provided guidance through questions, assessment tasks, and commentary from an experienced speech and language pathologist as well as the lecturer in voice disorder, was constructed. Evaluation of the tutorial as an aid to active learning, including feedback from students and supervising clinicians, is reported and the role of this type of program as a preparation for clinical practice is discussed.

Adult↗
PubMed2000

Behavioral management of pediatric dysphonia.

Children's voice disorders may be functional or organic in cause and a thorough evaluation by the otolaryngologist and speech-language pathologist is necessary to obtain the proper diagnosis, to understand the underlying etiologic factors, and to prepare a plan of treatment that is appropriate for the child. Because voice disorders may be present with developmental communication problems, treatment must include all factors that affect growth and development of the child.

Child↗
PubMed2004

Automatic detection of voice impairments by means of short-term cepstral parameters and neural network based detectors.

It is well known that vocal and voice diseases do not necessarily cause perceptible changes in the acoustic voice signal. Acoustic analysis is a useful tool to diagnose voice diseases being a complementary technique to other methods based on direct observation of the vocal folds by laryngoscopy. Through the present paper two neural-network based classification approaches applied to the automatic detection of voice disorders will be studied. Structures studied are multilayer perceptron and learning vector quantization fed using short-term vectors calculated accordingly to the well-known Mel Frequency Coefficient cepstral parameterization. The paper shows that these architectures allow the detection of voice disorders--including glottic cancer--under highly reliable conditions. Within this context, the Learning Vector quantization methodology demonstrated to be more reliable than the multilayer perceptron architecture yielding 96% frame accuracy under similar working conditions.

Algorithms↗
PubMed2001

[Analysis of voice function disorders using videostroboscopic techniques].

Clinical applications of videostroboscope in phoniatrics were investigated. Altogether 79 patients with functional lesions of the larynx and 20 with normal were examined. Measurements of vibration, amplitude, frequency and mucosal wave of vocal cords yielded cords objective information about vibration in the functional dysphonia. Videolaryngostroboscope can help identify the kind of functional diseases of the larynx.

Adult↗
PubMed2005

Changes in the prevalence of vocal symptoms among teachers during a twelve-year period.

Vocal symptoms and voice disorders among teachers were studied in 1988 using a questionnaire designed to obtain information on six vocal symptoms that had appeared during the past 2 years. Twelve percent of the 478 respondents reported vocal symptoms occurring weekly or more often. The study was repeated using the same questionnaire in 2001. The results of this second study (n=241) indicate that vocal symptoms had increased considerably. Twenty-nine percent of the teachers reported symptoms occurring weekly or more often, and 20% reported two symptoms or more occurring at least once a week, which is significantly more than in 1988. Accordingly, voice disorders are probably a growing problem among teachers. Several factors may explain these increases. In 2001, the teachers complained more often about increases in the size of their classes. Factors that disturbed normal work routines, such as noisy or misbehaving pupils, had also increased significantly. A growing number of misbehaving pupils probably cause increased background noise and stress and, thus, increase the vocal symptoms in teachers.

Adult↗
PubMed2002

Videostrobolaryngoscopy of mucus layer during vocal fold vibration in patients with laryngeal tension-fatigue syndrome.

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Adult↗
PubMed1998

Thyroarytenoid muscle activity associated with hypophonia in Parkinson disease and aging.

OBJECTIVE: To compare electromyographic (EMG) amplitudes of the thyroarytenoid (TA) muscle in young and older individuals and individuals with idiopathic PD (IPD) under conditions of known vocal loudness (sound pressure level). BACKGROUND: Voice disorders frequently accompany aging and IPD, but it is unclear how laryngeal muscle physiology is affected by these processes and how changes in laryngeal muscle activity result in characteristic changes of the voice. METHODS: Absolute and relative (to maximum) EMG amplitudes of the TA muscle were compared during speech and nonspeech tasks. Corresponding sound pressure level (SPL) measures were obtained for the speech tasks. RESULTS: Absolute TA amplitudes were consistently the highest in the young individuals, lowest in the individuals with IPD, and intermediate in the older individuals. Relative TA amplitudes were generally the highest for the young individuals, lowest for the older individuals, and intermediate for the individuals with IPD. SPL findings showed the older individuals and individuals with IPD produced most of the speech tasks with comparable SPLs, and these levels were consistently lower than those of the young individuals. CONCLUSIONS: Reduced levels of TA muscle activity may contribute to the characteristic hypophonic voice disorders that frequently accompany IPD and aging.

Adult↗
PubMed2006

[The teachers health damage and pension related to occupational voice disease].

The current regulations allow in special cases for the acknowledgement of the occupational disease among teachers who suffer from voice disorders. The physician who acts as the adjudicator in ZUS (National Insurance System) usually consults a phoniatrician and determines the percent of the permanent or long-term health damage, which can vary between 10-40%. The aim of the paper was to analyze the evidence which is taken into consideration while determining the percent of health damage and granting the occupational disease pension. The authors present proposition in detail the rules which govern the process of health damage calculation due to advancement of voice disorders, which can be very useful to adjudicating physicians in government and commercial insurance companies.

Disability Evaluation↗
PubMedDate not supplied

[Function vocal examination and acoustic analysis of 905 teaching staff of La Rioja, Spain].

OBJECTIVE: Examination of the vocal function and acoustic analysis in 905 teachers in La Rioja. DESIGN: A case control study: 576 cases and 329 controls. PATIENTS: 905 teaching staff of La Rioja: 589 female and 316 male. METHODS: All teachers filled in a standard questionnaire, ENT and vocal function examination, videolaryngostroboscopy and acoustic analysis with MDVP. RESULTS: The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were: vocal overeffors (18%) nodular lesions (14%) and hyperfunctional dysphonia (8%). The prevalence of vocal symtoms was 79%. A pathological vocal function was found more frequent among dysphonic teachers than among normals. Frequency perturbations and amplitude perturbations were bigger among dysphonic teachers than among normals. Poor correlations were found between algorithms of acoustic análisis with MDVP and perceptual evaluation GRBAS. CONCLUSIONS: It is advisable to carry out a yearly clinical evaluation of all teaching staff because of the high prevalence of voice disorders among them.

Adult↗
PubMed2000

The role of cognitive cueing in eliciting vocal variability.

Variation in duration and frequency during three readings of each of eight sentences by 9 normal and 4 voice-disordered subjects are compared. Instructions to the subjects varied with respect to the amount and type of cognitive cueing presented in the trials, and the sentences were read in random order. Variability in fundamental frequency (F0) was greater when pitch variation was specifically cued. Also, the portion of the sentence that was cued had greater variability in F0 than other parts of the sentence. Variation in fundamental frequency was significantly greater in the cued versus uncued sentence trials for the voice-disordered subjects but not for the normal subjects. However, all subjects exhibited significantly greater duration for cued versus uncued readings of the same sentences. Implications for theory and practice are discussed.

Adult↗
PubMed1995

Psychogenic spasmodic dysphonia: a case study with expert opinions.

Spasmodic (spastic) dysphonia (SD) is considered by some to be a neurologic syndrome and by others a symptom complex of multiple etiologies, neurologic and psychogenic. A case of a 26-year-old female psychiatric nurse with psychogenic SD (PSD) is presented. The dysphonia was alleviated within one session of voice therapy. Psychogenic etiology was established by the author, based on three diagnostic criteria--symptom incongruity, symptom reversibility, and symptom psychogenicity. Seven nationally recognized voice experts listened to audio-recorded samples of the patient's pre- and posttherapy voice during conversational speech. The experts agreed that the dysphonia was psychogenic and characterized it as staccato-like speech, effortful phonation, and interrupted flow of speech; six characterized it with intermittent voice arrests (voice stoppages); five with hoarse-harsh voice; and four with waxing and waning, strained-strangled phonation. These are often described as salient features of SD. Nevertheless, the experts disagreed among themselves as to whether the dysphonia was characteristic of SD and should be labeled as such. The author argues that as long as the voice characteristics and pathophysiologic findings that constitute SD are not well delineated, and as long as the diagnosis of SD is based on symptoms alone, patients with psychogenic or poorly understood voice disorders are likely to be misdiagnosed with organic (neurologic) SD and thus subjected to undue medical treatment. The author also argues that the debate over the etiology of SD can be resolved if SD is considered a neurologic syndrome, PSD a nonorganic phonatory disorder that mimics the syndrome, and if the voice symptoms and pathophysiologic characteristics of SD are well defined and agreed on.

Adult↗
PubMed1996

Episodic paroxysmal laryngospasm: voice and pulmonary function assessment and management.

Episodic paroxysmal laryngospasm (EPL) is a sign of laryngeal dysfunction, often without a specific organic etiology, which can masquerade as asthma, vocal fold paralysis, or a functional voice disorder. The intermittent respiratory distress of EPL may precipitate an apparent upper airway obstructive emergency, resulting in unnecessary endotracheal intubation, cardiopulmonary resuscitation, or tracheostomy. During 27 months, seven women and three men, age 30-76 years, were assessed by a high diagnostic index of suspicion, an intensive history including psychosocial factors, physical examination of the airways, provocative asthma testing, and swallowing studies. Videolaryngoscopy, stroboscopy, and pulmonary flow-volume loop testing were definitive. The classic appearance was paradoxic inspiratory adduction of the anterior vocal folds with a posterior diamond-shaped glottic gap. During an attack of stridor or wheezing, attenuation of the inspiratory flow rate as depicted by the flow-volume loop suggested partial extrathoracic upper airway obstruction. Swallowing evaluation by videolaryngoscopy and videosophagography may uncover gastroesophageal reflux disease. Hallmarks of management include patient and family education by observation of laryngoscopic videos, a specific speech therapy program, psychotherapy, and medical treatment of associated disorders. Electromyography may become a valuable future adjunct. Unlike laryngeal dystonia, patients with EPL do not benefit from botulinum toxin type A.

Adult↗
PubMed1991

Respiratory and laryngeal function during whispering.

Established procedures for making chest wall kinematic observations (Hoit & Hixon, 1987) and pressure-flow observations (Smitheran & Hixon, 1981) were used to study respiratory and laryngeal function during whispering and speaking in 10 healthy young adults. Results indicate that whispering involves generally lower lung volumes, lower tracheal pressures, higher translaryngeal flows, lower laryngeal airway resistances, and fewer syllables per breath group when compared to speaking. The use of lower lung volumes during whispering than speaking may reflect a means of achieving different tracheal pressure targets. Reductions in the number of syllables produced per breath group may be an adjustment to the high rate of air expenditure accompanying whispering compared to speaking. Performance of the normal subjects studied in this investigation does not resemble that of individuals with speech and voice disorders characterized by low resistive loads.

Adult↗
PubMed1996

[Psychological factors in spasmodic dysphonia].

BACKGROUND: Spastic dysphonia has usually been thought as a form of psychogenic dysphonia. A considerable number of authors now feel that this voice disorder is caused by neurological factors. PATIENTS: This study evaluates several psychological factors in 18 patients (9 males, 9 females; mean age: 52.6 years) who had been phoniatrically diagnosed as suffering from adductor spasmodic dysphonia. RESULTS: In standardized psychometric tests, clinical performance of the patients as a group did not deviate from published test norms with respect to emotional instability, hypochondriasis, somatization, or depression. Many patients had been psychosocially stressed to a mild to moderate degree by life events in the two-year period prior to onset of spasmodic dysphonia. These events included severe illness of their own or of near relatives, or death in the family. The personality structure of nearly half of the patients showed a tendency toward increased achievement orientation and certain trait anxieties. CONCLUSIONS: In summary, spasmodic dysphonia remains a phonation disorder of uncertain nosologic classification. It is probable that the disorder is the result of a combination of largely unknown neurological and psychosocial factors.

Adult↗
PubMed1990

Vocal dysfunction following cricothyroidotomy: a prospective study.

Voice dysfunction is a known consequence of cricothyroidotomy, but few detailed analyses have been published. This study reports an investigation of voice function in 19 patients who underwent cricothyroidotomy during a 12-month period (54 were patients operated on, 29 survived the primary disease or injury, and 19 agreed to participate in the investigation). The patients were interviewed regarding signs of dysfunction of the cricothyroid muscles, or a diminished external tensor effect on the vocal folds. Laryngoscopy with a magnifying-angled endoscope, stroboscopy, phonetography, determination of mean speaking fundamental frequency, perceptual analysis of the voice, and electromyogram of the cricothyroid muscle were all performed. Four patients had signs of diminished external tensor effect on the vocal folds (mild or moderate voice dysfunction), 5 patients had other voice disorders, and 10 were classified as having normal voice. Elective cricothyroidotomy should be avoided in patients with professional or other activities that place heavy demands on the voice.

Adult↗
PubMed1982

Biofeedback therapy for spastic dysphonia.

Spastic dysphonia is a disorder of phonation which is characterized by a strained, creaking, and choked vocal attack, a tense and squeezed voice sound. Spastic dysphonia in a functional voice disorder can be classified into two types from the viewpoint of activities of the extrinsic and intrinsic laryngeal muscle groups. A functional voice disorder pertaining to abnormal activities of the intrinsic and extrinsic laryngeal muscles results in spastic dysphonia. The adductor spastic dysphonia may be due to abnormal actions of the intrinsic laryngeal muscles as such is relieved by sectioning of the recurrent nerve, while spastic dysphonia mainly dealing with the extrinsic laryngeal muscles is relieved by relaxation on monitoring an electromyographic feedback system. Within 3 months we encountered two patients whose extrinsic laryngeal muscles were hyperactive on phonation. A trial on injection of lidocaine into extrinsic laryngeal muscles made their muscles relax. So, biofeedback therapy of relaxation was began using a monitoring system of EMG burst regarding to hypertonicity of the extrinsic laryngeal muscles. Normal vocal abilities were recovered using a biotrainer as a monitoring device of electromyographic feedback.

Adult↗
PubMed2006

Ear, nose and voice problems in children with orofacial clefts.

The purpose of this study was to compare the prevalence of ear, nose and particularly voice problems in groups of children with cleft palate (CP) and with unilateral cleft lip, alveolus and palate (UCLP). On the basis of history, regular otorhinolaryngological examinations and hearing tests, the prevalence of different pathologies was assessed in 80 CP children (35 boys and 45 girls) and 73 UCLP children (47 boys and 26 girls). Ear pathology was reported in 53.8 per cent of CP children and in 58.9 per cent of UCLP children. Nasal breathing was impaired in 14 CP (17.5 per cent) and 36 UCLP (49.3 per cent) children. Dysphonia was detected in 12.5 per cent of CP and 12.3 per cent of UCLP children. In 9.2 per cent of all cleft children, functional voice disorder caused a hoarse voice. Two-thirds of cleft children with functional dysphonia had protracted hearing loss. Therefore, ENT specialists must take an active role early in the treatment of children with clefts.

Articulation Disorders↗
PubMed2005

[Diagnosis of non-organic dysphonia in adult].

Non organic dysphonia or functional voice disorders are the consequence of a vocal misuse or overuse with inefficient oral communication. Any stage of voice production can be altered. A review of physiopathological, aerodynamic and biomechanical mechanisms will help to understand the onset of dysphonia. Organic lesions as a consequence of functional voice disorders are frequent but the link is not easy to establish. It is important to look for various physiologic, anatomic, environmental, behavioural and infectious factors that could induce or aggravate non organic dysphonia, as they can benefit from specific treatment. A thorough functional and organic assessment is the first step of the rehabilitation process, taking into account the patient's expectations about his voice handicap.

Adult↗