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At least 433 records · Page 24Linked to original sources
PubMed1998

Assessing outcomes for dysphonic patients.

This study was designed to evaluate a disease-specific outcome measure for patients with selected voice disorders and to relate this instrument to a standardized quality of life measurement. In addition, the study attempts to document the degree of handicap for dysphonia patients globally, between different vocal pathologies, and in comparison to other chronic diseases. In this prospective, observational study, 260 adult patients evaluated for alterations of voice completed a general quality of life measure (the Medical Outcomes Trust Short Form 36-Item[SF-36]) and a voice-specific instrument (Voice Handicap Index [VHI]) pretreatment. The highest correlation was between the social functioning score of the SF-36 and the total score of the VHI and the physical, emotional, and functional subscales (p < 0.001) of the VHI. Significant correlation was also obtained for the SF-36 domains mental health (p < 0.01), general health (p < 0.01), and role functioning emotional (p < 0.017) with the three VHI domains and the total VHI score. Patients had significantly lower scores than the general U.S. population in five of the eight domains of SF-36. Patients with vocal fold paralysis had the highest level of pretreatment disability as measured on both the VHI and SF-36 among voice patients. The patients with dysphonia had a lower level of physical functioning than the patients with chronic sinusitis (p < 0.01), reflecting a greater handicap. In addition, the dysphonia group had lower levels of social functioning than the angina (p < 0.01) and sciatica (p < 0.01) groups and a lower score for mental health than the angina group (p < 0.01). The SF-36 correlates with the VHI in the domains of social functioning, mental health, and role functioning emotional. The baseline handicap for voice disorders represents a significant disability even in comparison to conditions such as angina pectoris, sciatica, and chronic sinusitis.

Adolescent↗
PubMed2004

G. Paul Moore Lecture: Unifying the disciplines of our voice smorgasbord.

A look at the many disciplines working with voice over the past 50 years is provided from the perspective of a speech-language pathologist (SLP). Some of the earliest collaborations between medicine and speech-language pathology were seen in the management of cleft palate and velopharyngeal inadequacy problems and observed, also, in laryngectomee rehabilitation. The earlier concern of the SLP for the emotional and psychological aspects of patients with voice disorders appeared replaced with the rise of symptomatic therapy. Dramatic improvement in instrumentation assisted by computer analyses increased our awareness and understanding of both normal and disordered phonation. Although instrumentation today allows for many forms of visual feedback in voice training and therapy, this may be often at the expense of providing needed kinesthetic-proprioceptive and auditory feedback. Particular voice therapy approaches (cognitive, gestalt-holistic, imagery, resonant therapy, muscle training, and symptomatic therapy) used today are described. Suggestions are given for improving educational requirements and clinical experience in voice for SLPs.

Cleft Palate↗
PubMed2006

Symptoms of extraesophageal reflux in a community-dwelling sample.

OBJECTIVES: Extraesophageal reflux disease (EERD) is linked with serious and varied health concerns. The authors' goal was to determine the prevalence of EERD and the effect on health-related quality of life in adults within a large community-based sample. STUDY DESIGN: Survey study conducted in a community setting. METHODS: In the Madison, Wisconsin area, 1845 adult subjects were surveyed. Main outcome measures were frequently of GERD and laryngeal symptoms, the Medical Outcomes Trust Short Form 12 (SF-12), Voice Handicap Index (VHI), and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. RESULTS: More than 66% of subjects reported either GERD or laryngeal symptoms, and 26% reported both GERD and laryngeal symptoms (which reflect symptoms commonly reported for EERD). In addition, 39% of our sample took medicine for heartburn. Forty-four percent of subjects with both GERD and laryngeal symptoms reported occasional breathing difficulties, and 38% of these subjects reported a voice disorder. Significant reductions in perceived quality of general health, digestive health, and voice-related quality of life were found in subjects with both GERD and laryngeal symptoms, in comparison with subjects manifesting each symptom group alone, or in subjects with no symptoms. CONCLUSIONS: The presence of GERD and laryngeal symptoms, and their concurrence, was identified in a substantial number of subjects. The GERD and laryngeal symptoms surveyed represent those most commonly reported for EERD. Because EERD has been linked with tissue damage and reductions in health-related quality of life, it is important to identify these persons and provide treatment before progression of the condition.

Adolescent↗
PubMed1994

Respiratory and laryngeal measures of children and women with bilateral vocal fold nodules.

Simultaneous assessment of laryngeal and respiratory function was completed on 8 children and 10 women with bilateral vocal fold nodules and compared to that of 8 children and 10 women with normal voice production. Laryngeal function for the individuals with bilateral vocal fold nodules was characterized by significantly higher peak, alternating, and minimum glottal airflow. The presence of the high glottal airflow was accompanied by a significantly larger lung volume excursion. Both the children with nodules and those with normal voice showed laryngeal and respiratory function differences when compared to adults. All subject groups demonstrated appropriate laryngeal and respiratory function when increasing intensity from comfortable to loud speech. Simultaneous measurement of laryngeal and respiratory function using a multidimensional analysis of voice production is advocated in the evaluation of voice disorders because it can provide specific information regarding which of the subsystems of voice production are compromised.

Adolescent↗
PubMed1994

Group differences in measures of voice production and revised values of maximum airflow declination rate.

In previous reports, aerodynamic and acoustic measures of voice production were presented for groups of normal male and female speakers [Holmberg et al., J. Acoust. Soc. Am. 84, 511-529 (1988); J. Voice 3, 294-305 (1989)] that were used as norms in studies of voice disorders [Hillman et al., J. Speech Hear. Res. 32, 373-392 (1989); J. Voice 4, 52-63 (1990)]. Several of the measures were extracted from glottal airflow waveforms that were derived by inverse filtering a high-time-resolution oral airflow signal. Recently, the methods have been updated and a new study of additional subjects has been conducted. This report presents previous (1988) and current (1993) group mean values of sound pressure level, fundamental frequency, maximum airflow declination rate, ac flow, peak flow, minimum flow, ac-dc ratio, inferred subglottal air pressure, average flow, and glottal resistance. Statistical tests indicate overall group differences and differences for values of several individual parameters between the 1988 and 1993 studies. Some inter-study differences in parameter values may be due to sampling effects and minor methodological differences; however, a comparative test of 1988 and 1993 inverse filtering algorithms shows that some lower 1988 values of maximum flow declination rate were due at least in part to excessive low-pass filtering in the 1988 algorithm. The observed differences should have had a negligible influence on the conclusions of our studies of voice disorders.

Air Pressure↗
PubMed1990

[Regulation of voice quality parameters at the beginning of phonation].

In 8 healthy probands, 6 patients with functional voice disorders, 3 singers and 3 deaf patients we studied the regulation of the voice parameters amplitude and fundamental frequency at the beginning of phonation. Analyses were performed under the following conditions: (1) normal conditions; (2) after troubling pharyngeal and/or glottic mucosal receptors by topical anaesthesia; (3) in the case of normal hearing during disturbance of the audiophonatory feedback mechanism by binaural masking, and (4) with a combination of the latter two situations. The results are discussed.

Deafness↗
PubMed1987

Laryngeal image biofeedback.

The proper treatment of many voice disorder patients includes modification of voice production. Laryngeal image biofeedback (LIB), a new technique to help selected patients modify vocal fold posture and thereby vocal production is described. The effectiveness of this technique as a learning tool is assessed in 20 subjects.

Biofeedback, Psychology↗
PubMed1979

Relation between voice sound pressure and subglottal pressure as a diagnostic cue.

Voice sound pressure and esophageal pressure amplitudes are measured for 120 subjects with and without laryngeal status. The esophageal pressure amplitudes are taken as a approximation of the subglottal pressure. The dependency of sound pressure on subglottal pressure is approximated by a nonlinear function. The slope of the function represents the pressure transformation from subglottal pressure to sound pressure at fixed vocal tract configuration. Therefore, the slope is taken as a characterization of the efficiency of the voice organ. This quantity allows rough statement about the efficiency of the voice organ (differentiation of normal, trained normal, and pathologic larynx) but does not separates voice disorders.

Adolescent↗
PubMed2006

A new generation videokymography for routine clinical vocal fold examination.

OBJECTIVE: This study aims to introduce a new-generation videokymographic system, which provides simultaneous laryngoscopic and kymographic image, for routine clinical vocal fold examination. STUDY DESIGN: The authors explored a new imaging method for diagnosis and evaluation of voice disorders. METHODS: The new-generation videokymographic system includes two charge-coupled device image sensors, a color area image sensor, and a monochromic high-speed line-scan image sensor. The high-speed line-scan image sensor is used to capture the kymogram, and the color area image sensor is used to obtain the laryngoscopic image. The two images can be displayed simultaneously on a video monitor or stored in a standard video recorder. Three subjects with nonpathologic voice were investigated in detail with the new videokymographic system. RESULTS: The high-quality laryngoscopic image and kymogram can be used directly for clinical purposes with no further postprocessing. The scan position of the kymogram is always indicated in the laryngoscopic image, which provides feedback for the operator to easily locate the expected scanning position. All varieties of vocal fold vibration, including irregular vibrations, phonation onset and offset, can be observed with the presented method. The continuous kymogram of the vocal fold vibration can be retrieved from a kymographic image sequence for quantitative analysis. CONCLUSIONS: The new-generation videokymography provides a simple, quick means to investigate vocal fold vibration, especially for voice disorders. It can emerge as an important tool for routine clinical vocal fold examination.

Data Display↗
PubMed1995

[Laryngeal tuberculosis in Antananarivo].

From September 1989 to December 1992, 49 patients had been observed at the Centre Hospitalier de Soavinandriana and 31 cases at the prison infirmary of Antananarivo from April 1990 to December 1992. The 31 laryngeal tuberculosis observed in prison existed among 9.1% of tubercular patients, were associated to 10.9% of pulmonary tuberculosis and represented 24.2% of extrapulmonary tuberculosis. The 49 laryngeal tuberculosis of the CENHOSOA were present among 4.6% of tubercular patients, were associated to 7.9% of pulmonary tuberculosis and represented 8.4% of all the extrapulmonary tubercular localizations. Voice disorders, even if always present, rarely represented (<30%) a reason for tuberculosis discovery. Comparison with the whole of tuberculosis cases showed that laryngitis was not most frequent in retreatments and that there was no statistically significant difference in death risk. Laryngeal tuberculosis being mostly in the shadow of pulmonary tuberculosis, it develops in the same way under the same treatment, except when a very ancient laryngitis has given rise to irreversible fiber lesions. Recall of this very early known localization is made in a didactic perspective: in a developing country, all chronical voice disorders must induce to research of tuberculosis.

Adult↗
PubMed1997

The "singing-acting" child: the laryngologist's perspective--1995.

A survey of pediatric otolaryngologists about voice disorders in children suggests that approximately 1% of children examined were noted to have voice problems, and in only one fifth of these children (0.2%) were the voice problems related to professional use of the voice, such as singing. Direct flexible laryngoscopy was the sole method of examination for 80% of the children examined by these pediatric specialists. Voice therapy for 6 months was generally recommended (88%). The survey represents an estimated clinical experience of > 160,000 children per year, and it achieved a response rate of 40% of pediatric otolaryngologists (48/120). Results suggest that the use of video and stroboscopy for examination of the pediatric voice would enhance understanding and assure correct diagnosis and treatment.

Child↗