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PubMed2006

[On the auditory evaluation of voice quality].

BACKGROUND: For routine clinical purposes, dysphonic voices are assessed perceptually using the GRBAS scale or analogues. For clinical application, the crucial question is the interrater reliability (IRR) of the auditory perceptual assessment of voice quality. Therefore, the IRR of the four point RBH (roughness, breathiness, hoarseness vs overall grade) scale was studied. Other parameters, e.g. validity and intrarater reliability were not considered. METHODS: A total of 78 patients read a standard text "Der Nordwind und die Sonne". These samples were evaluated by 19 speech and voice therapy students according to the degree of roughness, breathiness and hoarseness. Data were subjected to reliability analysis. RESULTS: Our data indicate a high IRR with a Cronbach's alpha of 0.94. No single rating of the 19 raters could be omitted without decreasing the IRR. DISCUSSION: The data indicate that the perceptual assessment of hoarseness for running speech is highly reliable. The application of the RBH scale is suitable for clinical purposes. It should be considered as an outcome measure.

Adolescent↗
PubMed2004

Laryngotracheal application of lidocaine spray increases the incidence of postoperative sore throat after total intravenous anesthesia.

PURPOSE: To determine the effect of laryngotracheal application of different doses of lidocaine spray on postoperative sore throat and hoarseness, we evaluated the incidence and severity of these complications in 168 ASA I-III patients aged 15-92 years in a placebo-controlled study. METHODS: After induction of anesthesia with propofol, ketamine, fentanyl, and vecuronium, the laryngotracheal area was sprayed immediately before intubation with lidocaine spray either 5 times (L5 group, n = 47) or 10 times (L10 group, n = 48) or with normal saline 1 ml (placebo group, n = 51). Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. RESULTS: The incidence of sore throat was significantly higher in the L10 group than in the placebo group on both the day of and the day after surgery. The severity of sore throat was significantly higher in the L5 and L10 groups than in the placebo group on the day of surgery. On the day after surgery, the severity of sore throat remained significantly higher in the L10 group than in the placebo group. Although the incidence and severity of sore throat increased in a dose-dependent manner, these were not significantly different between the L5 and L10 groups. In addition, the incidence and severity of hoarseness did not differ at all among the three groups. CONCLUSION: We recommend that applications of lidocaine spray to the laryngotracheal area should be avoided to help eliminate unnecessary postoperative sore throat, thereby leading to improvement in patient satisfaction.

Adolescent↗
PubMed2004

Dental erosion, gastro-oesophageal reflux disease and saliva: how are they related?

AIMS: The purpose of this study was to assess the prevalence of tooth wear, symptoms of reflux and salivary parameters in a group of patients referred for investigation of gastro-oesophageal reflux disease (GORD) compared with a group of control subjects. MATERIALS AND METHODS: Tooth wear, stimulated salivary flow rate and buffering capacity and symptoms of GORD were assessed in patients attending an Oesophageal Laboratory. Patients had manometry and 24-h pH tests, which are the gold standard for the diagnosis of GORD. Tooth wear was assessed using a modification of the Smith and Knight tooth wear index. The results were compared to those obtained from a group of controls with no symptoms of GORD. RESULTS: Patients with symptoms of GORD and those subsequently diagnosed with GORD had higher total and palatal tooth wear (p<0.05). The buffering capacity of the stimulated saliva from the control subjects was greater than patients with symptoms of GORD (p<0.001). Patients with hoarseness had a lower salivary flow rate compared with those with no hoarseness. CONCLUSIONS: Tooth wear involving dentine was more prevalent in patients complaining of symptoms of GORD and those diagnosed as having GORD following 24-h pH monitoring than controls. Patients had poorer salivary buffering capacity than control subjects. Patients complaining of hoarseness had lower salivary flow rate than controls.

Adult↗
PubMed2001

[Psychoacoustic scaling of acoustic voice parameters by multicenter voice ratings].

BACKGROUND: The purpose of the study was to analyze if perceptual voice quality ratings of the well-known RBH rating procedure (a 4-point scale of roughness, breathiness, and hoarseness) covary with acoustical voice parameters. METHODS: 120 voice samples from subjects with healthy and hoarse voices were rated on the RBH-index in a multicenter study with 31 raters. Multivariate regression tree analysis classified the perceptual ratings as "gold standard". Voice samples were acoustically analyzed with a feature extraction method. Feedforward-networks were trained to selected acoustical parameters having highest "relative importance" in the regression trees. Based on the best classifier, a computer program consisting of 50 simultaneous working networks was developed. RESULTS: Mean probabilities for correct classifications were found at 0.65-0.85, implying a significance level over chance (0.25). Classifications of the program matched in 40% with a priori values in the categories roughness combined with breathiness, and in 65% in at least one domain. CONCLUSIONS: The new method described here provides a psychoacoustically based "objective" classification of hoarse voices, which seems to enable future analysis of new parameters (like GNE), which may even improve the present results.

Acoustics↗
PubMed1994

Local side-effects during 4-year treatment with inhaled corticosteroids--a comparison between pressurized metered-dose inhalers and Turbuhaler.

Local side-effects, such as hoarseness and oropharyngeal candidiasis, are often seen during treatment of patients with inhaled corticosteroids (ICS). We investigated whether changing from pressurized metered-dose inhalers (pMDI) to Turbuhaler influenced the type and frequency of local side-effects. Local side-effects were recorded for a 2-year period in which 154 patients used ICS pMDI with a spacer device. They were followed for an equally long period of time (26.2 +/- 5.7 months) while using Turbuhaler, as were 90 patients who received Turbuhaler as their first ICS preparation. After inhalation, all patients rinsed out their mouths with water. In experienced pMDI-users, the frequency of local side-effects decreased from 21% to 6%. The reduction was due to a lower incidence of hoarseness. Candidiasis or hoarseness was not seen in patients given Turbuhaler as their first ICS device. Our fear of an increased incidence of local side-effects when giving ICS in Turbuhaler was unwarranted.

Administration, Inhalation↗
PubMed2005

Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea.

BACKGROUND AND AIMS: This study estimated the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Asan-si, Korea, as the prevalence is believed to be lower than in Western countries. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed on randomly selected 2,240 Asan-si residents aged between 18 and 69 yr. All respondents were interviewed at their homes or offices by a team of interviewers. RESULTS: Of the 1,902 eligible subjects, 1,417 (78.4%: male 762; female 655) were surveyed. The prevalence of heartburn occurring at least once a month, at least once a week, and at least twice a week was 4.71% (95% confidence interval (CI), 3.6-5.8), 2.0% (95% CI, 1.2-2.7), and 1.3% (95% CI, 0.7-1.9), respectively. The corresponding figures for acid regurgitation were 4.4% (95% CI, 3.3-5.5) and 2.0% (95% CI, 1.3-2.8), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). No significant difference was detected between sexes. The prevalence of heartburn was associated with increasing age (p < 0.001). Nineteen percent of our population reported at least one of the atypical symptoms, for instance, chest pain, dysphagia, globus sensation, asthma, bronchitis, pneumonia, or hoarseness. The frequency of frequent GERD among subjects reporting any of the atypical symptoms was 12.6%, which was higher than that of the subjects without atypical symptoms. Patients with typical reflux symptoms were more common among those with atypical symptoms, compared to those without such symptoms (p < 0.001). Using a logistic regression model after adjusting for age and sex, typical reflux symptoms were associated with chest pain (odds ratio (OR), 9.3; 95% CI, 5.9-14.7), dysphagia (OR, 6.4; 95% CI, 2.8-14.7), globus sensation (OR, 3.9; 95% CI, 1.5-9.7), hoarseness (OR, 4.3; 95% CI, 1.4-13.1), asthma (OR, 2.6; 95% CI, 1.4-4.8), and bronchitis (OR, 1.2; 95% CI, 0.6-2.3). CONCLUSION: The prevalence of GERD was 3.5% in this Korean population. Heartburn and acid regurgitation were significantly associated with chest pain, dysphagia, globus sensation, hoarseness, and asthma.

Adolescent↗
PubMed1995

[Cepstrum analysis in voice disorders].

Objective data and reproducible procedures are increasingly demanded for assessment and long-term comparison in voice disturbances. Well-known electroacoustic methods like formant analysis, autocorrelation and inverse filtering have been applied for this purpose, though without leaving experimental stage. The cepstrum analysis presented here permits an easy and distinct separation of glottal pitch and filter function of the vocal tract. In this study, 112 normal and hoarse voices were analyzed. The sum of amplitudes of the first cepstral pitch peaks differed significantly between the different degrees of hoarseness (0-3). Disturbances producing hoarseness, however, could not be sufficiently differentiated by the method in its present state.

Adult↗
PubMedDate not supplied

Vocal symptoms in Parkinson disease treated with levodopa. A case report.

This is a report of a patient with unusually severe hoarseness in the absence of vocal fold pathology demonstrating Parkinson disease as one of the neurological diseases in which vocal symptoms occur. Although it is classifiably a severe, progressive, degenerative disorder, the popularity of pharmacotherapy for Parkinson disease during the past decade has resulted in improved functionality for an undetermined course of time in most patients. The classically described deterioration of speech ad voice may develop in a variant manner difficult to distinguish as disease-related, as this case report illustrates. An explanation of the hoarseness based on dyssynchronous vocal fold motion related to the disease is suggested by the acoustic methods (spectrography, waveform analysis) used in this study, and supported by strobe light laryngoscopy. This conclusion is important because of the extremely high incidences of varying degrees of hoarseness reported in recent studies of Parkinson disease.

Aged↗
PubMed1999

[Postoperative sore throat and intracuff pressure: comparison among endotracheal intubation, laryngeal mask airway and cuffed oropharyngeal airway].

We studied which device is most useful to reduce postoperative sore-throat. We investigated the relationship between intracuff pressure and postoperative sore-throat in using endotracheal intubation (ET), the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA) in adult patients. We classified sore-throat into categories; pain at rest, hoarseness and dysphasia. We evaluated pain at rest by the score (0: no pain, 1: mild discomfort, 2: mild pain, 3: severe pain). Pain at rest (scores 1, 2, 3) was complained by 10 patients in ET group, 3 in LMA group, 5 in COPA group on the day of operation, showing significantly lower incidence of pain at rest in LMA group than in ET group. Hoarseness was complained by 15 patients in ET group, 2 in LMA group and 4 in COPA group, showing significantly lower incidence of hoarseness in LMA and COPA groups than in ET group. Dysphasia was complained by 3 in ET group, 1 in LMA group and 2 in COPA group, showing no significant difference. These results suggest that LMA is most appropriate to reduce postoperative sore-throat.

Adult↗
PubMed2000

[Use of narrow-band spectrogram in voice surgery].

Subjective voice qualities are difficult to transform into permanent objective visual patterns. Voice spectrography is not a new method of voice analysis. However, in spite of many contributions to the literature, few otolaryngologists have used this interesting method as a clinical tool for evaluating the voice before and after surgical voice procedures. We used the Yanagihara method for classifying degrees of hoarseness, witch is based on the appearance of noise components and loss of harmonic components as the major acoustic factors related to hoarseness. This classification is clinically useful because the severity of hoarseness can be numerically expressed. Changes in the harmonic components were analyzed by voice spectrographic analysis.

Hoarseness↗
PubMed1992

Cardiovocal (Ortner's) syndrome left recurrent laryngeal nerve palsy associated with cardiovascular disease.

Five patients with cardiovascular disease presented with hoarseness due to left recurrent laryngeal nerve palsy. One had secundum atrial septal defect, one had ventricular septal defect, two had mitral stenosis and the other had aortic aneurysm. All except the patient with aortic aneurysm had pulmonary artery dilatation and moderate to severe pulmonary hypertension. Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery. We postulate that the dilated pulmonary artery or aortic arch was responsible for the compression of the left recurrent laryngeal nerve.

Adult↗
PubMed1990

[An operative case of benign schwannoma originating in the intrathoracic vagal nerve].

A 50-years-old man was admitted with cough and abnormal shadow on the chest film. The tumor originated from the left vagal nerve in the antero-superior mediastinum. Subcapsular extirpation was performed to save the nerve function, since the tumor located in the site proximal to the branching point of the recurrence nerve. Pathological diagnosis was a benign schwannoma. Though H-E and Bodian stain did not show any nerve fibers in the schwannoma, postoperative hoarseness arose. In this country, 4 cases of subcapsular extirpation have been performed, but all of them had postoperative hoarseness. We think that postoperative hoarseness cannot be prevented by the subcapsular extirpation.

Cranial Nerve Neoplasms↗
PubMed2001

Dysphonia and dysphagia following the anterior approach to the cervical spine.

BACKGROUND: Speech and swallowing dysfunctions are common following the anterior approach to the cervical spine. Despite functional morbidity and legal implications, the incidence and etiologic factors of these complications have not been adequately elucidated. OBJECTIVE: To better define speech and swallowing dysfunction both in the quantitative and qualitative sense. METHODS: A questionnaire was mailed to 497 patients who had undergone anterior cervical fusion or anterior cervical discectomy at a university hospital (study group). One hundred fifty questionnaires were sent to a control group. RESULTS: The study group response rate was 46%; the control group response was 51%. The incidence of hoarseness in the study group was 51%; the incidence in the control group was 19%. The difference was statistically significant (P<.01). Dysphagia was present in 60% of study group patients vs 23% of control group patients (P<.01). Qualitative questions revealed that constant hoarseness, pain with talking, difficulty eating solid foods, and odynophagia were significantly more common following the anterior approach to the cervical spine. CONCLUSIONS: Our findings show a much higher incidence than previously reported of both voice and swallowing impairment following the anterior approach to the cervical spine. Hoarseness and dysphagia may adversely affect recovery and the patient's sense of well-being. Preoperative counseling and postoperative evaluation are essential.

Case-Control Studies↗
PubMed1982

Reversal of recurrent laryngeal nerve palsy following VP16-213 combination therapy in a patient with metastatic teratoma of the testis.

Two years after para-aortic node radiotherapy following removal of a non seminomatous germ cell tumour (NSGCT) of the left testis, M.R., a 32 year old caucasian male developed haemoptysis and a hoarse voice. Chest x-ray revealed a left hilar mass and serum alphafoetoprotein (AFP) and beta-human chorionic gonadotrophin (beta HCG) levels were elevated. In spite of VB3 [1] therapy plus cis-platinum and mediastinal radiotherapy his voice remained hoarse, although serum markers returned to normal, and the hilar mass was reduced in size. Four months after stopping therapy serum AFP levels began to rise, although no clinical evidence of recurrence could be discovered in abdomen, brain or chest. Chemotherapy was restarted using VP16-213 + bleomycin + cis platinum [2]. After the first course of therapy the serum AFP level fell to normal and his hoarse voice disappeared. The patient received five courses of the above regimen, following which complete remission has been maintained for 7 months to date. This case suggest that VP16-213 combined with bleomycin + cis-platinum has great activity against NSGCT of the testis and may have a different spectrum of activity from vinblastine, bleomycin, and cis-platinum, making it a valuable addition to the drugs available for the management of these tumours. In this patient it would seem the complete eradication of the metastatic mass allowed complete and immediate recovery of function of the trapped nerve in spite of it having been paralysed for 15 months.

Adult↗
PubMed2004

Multidimensional assessment of functional outcomes of medialization thyroplasty.

Medialization thyroplasty (MT) is the most widely used laryngeal framework phonosurgical procedure for managing glottic incompetence secondary to unilateral vocal fold paralysis (UVFP). The aim of the study was to evaluate the functional outcomes of MT in 32 UVFP patients, comparing multidimensional perceptual and instrumental measures of voice before and after surgery, and to evaluate how close to normal that postoperative voice measure became. Video laryngostroboscopy (VLS), auditory perceptive evaluation of voice, the patients' self-evaluation of hoarseness on the Visual Analogue Scale (VAS) and calculation of the Voice Handicap Index (VHI), analysis of objective acoustic voice parameters, quantitative assessment of phonetograms and measurement of maximum phonation time were conducted. Vocal function was evaluated before the surgery and for the period from 1 month to 3 years (Mo 1.0 month; Me 2.0 months) after MT. VLS confirmed remarkable medialization of the paralyzed vocal fold. As a consequence, hoarseness and breathiness were found to be significantly decreased after MT. Pitch and intensity range and phonetogram area were significantly increased. A significant decrease of jitter, shimmer and normalized noise energy reflected improvement of the stability of acoustic signal and a more efficient pattern of phonation. Thus, the perceptual and acoustic voice parameters studied showed statistically significant differences (P < 0.001) between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. A high degree of patient satisfaction with the MT was confirmed by a significant decrease of VHI and hoarseness on VAS. Thus, results of the present investigation confirm the functionality and effectiveness of MT in patient voice rehabilitation with UVFP. However, the means of acoustic voice parameters measured in the study did not reach normal limits, probably because of the remaining underlying condition of UVFP.

Adolescent↗
PubMed1977

Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol.

Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptons of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.

Adult↗
PubMed2004

Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia.

OBJECTIVES: The objective of this prospective study was to evaluate the incidence and distribution of cranial nerve injuries after carotid eversion endarterectomy (EEA) performed under regional anaesthesia using a transverse skin incision. PATIENTS AND METHODS: The study included 165 patients and 180 carotid arteries. All patients had a standard pre-operative assessment performed by a neurologist and ENT specialist. All carotid endarterectomies were performed by the eversion technique under regional anaesthesia. RESULTS: Ten cranial nerve injuries were observed. Seven patients had injuries of the marginal mandibular branch of the facial nerve, two patients had lesions of the hypoglossal nerve, and one patient had an injury of the recurrent laryngeal nerve. Eleven patients developed hoarseness without cranial nerve injury. Injuries of the marginal mandibular branch recovered after 3-8 months (mean 5.2 months). Both hypoglossal nerve injuries recovered after 4 months. The patient with the recurrent laryngeal palsy had no improvement after 19 months. Patients with hoarseness secondary to laryngeal haematoma recovered within 1 month. CONCLUSION: The incidence of cranial nerves injury after carotid EEA under regional anaesthesia is comparable to that reported for conventional carotid surgery. Postoperative hoarseness is most frequently due to laryngeal haematoma.

Aged↗
PubMed2006

Perceptual identification and acoustic measures of the resonant voice based on "Lessac's Y-Buzz"--a preliminary study with actors.

This study aimed to verify whether the resonant voice based on Lessac's Y-Buzz can be perceived by listeners as resonant and different from habitual voice and to compare them to determine whether this sound exploration improves the vocal production. Nine newly graduated actors, six men and three women without voice complaints, were the subjects. They received a session of Lessac's Y-Buzz training from the primary investigator. Before training, they were asked to sustain the vowel /i/ at comfortable frequency and habitual loudness. After training, they were requested to sustain the Y-Buzz they had learned at a comfortable frequency and habitual loudness. Three speech-language pathologists (SLP) trained in voice developed an auditory-perceptive analysis. The pre- and posttraining voice samples were randomly spliced together, edited, and presented in pairs to perceptual judges who were asked to identify the most resonant of the pair. The voice samples were also acoustically compared through the Hoarseness Diagram and acoustic measures using the VoxMetria Software (CTS, version 2.0s, Brazil). The Y-Buzz trials were identified as resonant voice in 74% of the comparisons. The acoustic measures showed a statistically significant decrease of irregularity (P = 0.002) and shimmer (P = 0.38). The Hoarseness Diagram demonstrated how the resonant voice moved toward the normality for irregularity and noise components. The results showed that the resonant voice based on the Y-Buzz can be identified as resonant and different from normal voicing in the same subject, and it apparently implies a better vocal production demonstrating a significant decrease of shimmer and irregularity through the Hoarseness Diagram evaluation.

Adolescent↗