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PubMed1986

Pediatric videonasoendoscopy for speech and voice evaluation.

Many otolaryngologists and speech clinicians have found videofiberoptic evaluations to be invaluable for assessment of velopharyngeal and laryngeal function in adults. However, many professionals question the feasibility of routine use of these procedures in the pediatric population. This article describes a method for successful completion of videonasoendoscopic speech and voice evaluations of children as young as 3 years of age. The importance of the ENT/speech team is emphasized in both the collection and interpretation of data. In addition, contributions of videonasoendoscopic observations to diagnosis, medical treatment, and therapy for speech and voice disorders are discussed.

Child↗
PubMedDate not supplied

Pharmacological agents with effects on voice.

Pharmacological agents with the most notable effects on voice exert their influences on the vocal tract through the autonomic nervous system. These agents do not have a profound effect on laryngeal function. Their effects are subtle, but they are important in certain groups of patients, such as professional voice users. It is essential to take a thorough history of medications being used, both by prescription and nonprescription, when evaluating patients with voice disorders. It is also important to keep in mind that idiosyncratic variations may occur in response to medications, and careful monitoring is essential when patients with voice disorders are under treatment. The importance of adequate water intake should be emphasized for general hydration and for vocal tract lubrication. Understanding the autonomic nervous system and how it is influenced by pharmacological agents makes evaluating the effect of medicines on the vocal tract simpler.

Antihypertensive Agents↗
PubMed2006

Satisfaction with formal support and education for children with autism spectrum disorder: the voices of the parents.

INTRODUCTION: The aim of the present study was to identify and describe factors associated with variations in the level of parental satisfaction with formal support and education for children with autism spectrum disorder (ASD) in Flanders. METHODS: Participants were recruited by a mailing from a diagnostic centre for pre-schoolers and by advertisements dispersed in the Flemish parent organization for ASD and in services and special schools. The sample consisted of 244 parents of children with ASD (age range: 2.69-17.81 years, male/female sex ratio 4:1). The data were collected using a questionnaire on experiences with education and support, which was compiled for the purpose of this study. The data resulting from the questionnaire were supplemented with information obtained from semi-structured in-depth interviews with a stratified sample of 15 parents. RESULTS AND CONCLUSIONS: The study revealed that parents experienced difficulties with the diagnostic process, with support and education provided by mainstream settings and with the accessibility of autism-specific service provisions. Conversely, parents reported to be satisfied with the quality of autism-specific support and education. Predictors of overall satisfaction were parental involvement in formal support, knowledge of available service provisions and time between first consultation and final diagnosis. Practical implications of the results are discussed.

Adolescent↗
PubMedDate not supplied

Acoustic and perceptual indicators of normal and pathological voice.

The aim of this study was to obtain acoustic correlates to vocal quality of a group of men and women with and without voice disorders, based on evaluations of a group of judges experienced in the field of vocal rehabilitation. In male subjects, perceptual evaluation of normal, hoarse and rough voice qualities was related to the following acoustic features: frequency perturbation measures (JITA, RAP, and SPPQ), amplitude perturbation (SAPQ and VAM), soft phonation index (SPI) and fundamental frequency tremor intensity (FTRI). While these measures presented normal values for normal voice, hoarseness showed some deviations in perturbation frequency variables and very high SPI values, while rough voice showed deviations in all the measures. Qualities of female voices were perceived as normal, breathy and hoarse, but the acoustic correlates of these qualities were less conclusive.

Adult↗
PubMed2005

The feasibility of rigid stroboscopy in children.

OBJECTIVE: Voice disorders in children are common but ways of their analysis are limited. We conducted a prospective feasibility study of rigid stroboscopy in children. METHODS: All children referred for voice analysis during the years 2002-2003 were evaluated including subjective perception of voice, voice recording, flexible or rigid laryngoscopy and stroboscopy. Children were prepared by an explanation and visual demonstration. Local anesthesia was introduced through inhalation of Lidocaine (2%) solution prior to examination. Stroboscopy was performed either by a 70 degrees rigid laryngoscope or by a 3.0 mm fiberoptic-flexible endoscope. RESULTS: Forty-two children were analyzed. Rigid stroboscopy was feasible in 31 children of whom 7 were under 10 years of age. Short phonation time (7), gag reflex (6), impaired view due to high and posteriorly inclined epiglottis (4) were the main reasons of failure. CONCLUSIONS: Standard telescopic stroboscopy can be safely and effectively implemented in the majority of children over 10 years of age.

Adolescent↗
PubMed2002

Management of common voice problems: Committee report.

OBJECTIVE: This report provides the reader with a state-of-the-art update on a number of common voice problems that require phonosurgical intervention. STUDY DESIGN AND SETTING: This multiauthor review is not a position statement of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and may reflect institutional preference and/or bias. It arose from a panel discussion at the AAOHNS meeting in 2000. RESULTS: We provide a review of the genesis and management of papillomatosis, dysplastic glottal epithelium, arytenoid granulomas, Reinke's edema, and vocal-fold paralysis. CONCLUSIONS AND SIGNIFICANCE: In the past decade, there has been a dramatic expansion of knowledge regarding a variety of voice disorders and associated treatment. There has been a convergence of basic science investigations in anatomy, physiology, and pathology with clinical trials of treatment, both surgical and nonsurgical. This information should provide the reader with current insight into critical management issues of the aforementioned disorders.

Arytenoid Cartilage↗
PubMed2003

Historical approaches to the treatment of Adductor-Type Spasmodic Dysphonia (ADSD): review and tutorial.

Adductor-type spasmodic dysphonia (ADSD) is a voice disorder of uncertain, though likely neurogenic origin. Symptoms of the disorder include mild to profound "strain and strangle" sensations during voiced speech tasks that, in the most severe form, are physically and psychologically debilitating. Over the years, treatment approaches have evolved from behavioral attempts at voice modification, to surgical and, most recently, pharmacological treatments involving partial and temporary paralysis of muscle fibers within the larynx following injection of botulinum toxin or Botox. The most current research hints at the potential benefits of a multi-faceted approach to symptom management, combining behavioral with pharmacological treatments. The following is intended as a review and tutorial of treatment approaches for ADSD. The tutorial is intended for practicing clinical professionals with an interest in the treatment of neurogenic disorders of voice and speech.

Humans↗
PubMed1997

Treatment of ventricular dysphonia with botulinum toxin.

Ventricular dysphonia, traditionally known as dysphonia plica ventricularis, is a voicing disorder in which the false vocal folds are used as a vibratory source in addition to or instead of the true vocal folds. Traditional treatment of ventricular dysphonia has been voice therapy, which may be slow to produce results if the false fold activity masks an underlying problem of the true folds, is long standing, or has produced hypertrophy of the supraglottic structures. We present seven cases of ventricular dysphonia treated with botulinum toxin injection into the false vocal folds followed by speech therapy. The addition of botulinum toxin to the treatment regimen speeds recovery of normal voicing and allows immediate evaluation of dynamic true vocal fold function by the treating professional.

Anti-Dyskinesia Agents↗
PubMed1998

Role of surface EMG in diagnostics and treatment of muscle tension dysphonia.

In muscle tension dysphonia (MTD) excessive tension of both the internal and external laryngeal muscles is observed. In the present pilot study, 9 pairs of surface electrodes were used to determine the electromyographic (EMG) characteristics of different muscles in the perioral area and anterior neck before and during phonation. Eleven patients with MTD and 5 normal speakers were included within the study. The results show a 6-8-fold increase of EMG activity and/or an alternation of the EMG activity level in the perioral and supralaryngeal muscles before and during phonation in most of the patients with MTD. It is not clear whether these muscles are activated as compensation for excessive tension of internal laryngeal muscles, or whether they are responsible for some of the voice disorders.

Adolescent↗
PubMed2006

Voice problems of future speech-language pathologists.

Students training to be educators frequently exhibit voice disorders prior to employment. To date, there exist no similar studies of future speech-language pathologists (SLPs). The study is designed as a prospective, nonrandomized survey. The objective of this study is to determine the voice problems of first year graduate students training to be SLPs. Participants were 104 first year graduate students majoring in speech-language pathology at two universities. The Quick Screen for Voice was administered. Participants who failed completed a questionnaire regarding voice problems, medical history, daily habits, and voice use. When responses further indicated voice-related problems, endoscopic examination was completed. Fourteen percent (N=15) of the participants failed the screening by demonstrating two or more abnormal voice characteristics. These included persistent glottal fry (present in all who failed), low habitual pitch, juvenile resonance, hoarse, breathy, or strained phonation, abnormally low pitch on sustained vowels, and voice breaks during the frequency range. Twelve percent (N=12) failed both the screening and follow-up questionnaire. Responses included self-reported dysphonia, medical history with voice-related side effects, difficulty with excessive voice use, and voice problems occurring daily or weekly. Endoscopic evaluation showed one participant with bilateral vocal nodules. The results suggest that voice problems among future SLPs (12%) are more common than the 3-9% reported in the general population and similar to the 11% previously reported for teachers. However, future SLP voice problems are less frequent than those reported among education majors (21%) and all college students (17%). Faculty should identify students with voice problems and emphasize optimal voice use in classroom and clinical settings.

Adult↗
PubMed2004

Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis.

Injection laryngoplasty is one of the procedures for treating unilateral vocal fold paralysis. This is a preliminary report on modified injection laryngoplasty, ie, injection of liposuctioned autologous fat into the larynx and hypopharynx of patients who have aspiration and voice disorders after vocal fold paralysis. Lipoinjection was performed in 3 patients with these complaints with the endolaryngeal microsurgical technique under general anesthesia. The locations of fat injection were the vocal fold, the false vocal fold, the aryepiglottic fold of the larynx, and the medial wall of the pyriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold strengthened laryngeal closure. Lipoinjection, performed into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage, made arytenoid cartilage rotation possible, and consequently strengthened laryngeal closure. Lipoinjection into the medial wall of the pyriform sinus of the hypopharynx reduced its capacity; consequently, the amount of residual food retained in it was reduced and pharyngeal clearance on the affected side was improved. The longest follow-up among the 3 patients has been 24 months. Their aspiration and glottal incompetence have been improved by this operation. We conclude that modified injection laryngoplasty (laryngohypopharyngoplasty) is one of the surgical options for preventing aspiration after vocal fold paralysis.

Adipose Tissue↗
PubMed1975

[Ventricular cord hyperplasias of the larynx-pathogenesis and treatment (author's transl)].

Primary hyperplasia of the ventricular cords can produce voice disturbance or can be a secondary change caused by a primary voice disorder. Primary hyperplasia, besides inflammation or tumour, arises in aging people by a metaplastic process of the glandular epithelium of the ventricular cords. These lesions are called "grandular-cystic ventricular cord hyperplasias". Secondary hyperplasias are mainly of a fibrous nature. These "fibrous-vicarious hyperplasias" arise in hyperkinetic functional voice disorders, in pareses or in some cases of extensive chronic hyperplastic or oedematous laryngitis if the vocal cords can no more be used for normal phonation. Endolaryngeal microsurgical excision from the ventricular cords followed by voice exercises enables us to treat the "ventricular cord voice" successfully within a short time.

Aging↗
PubMed2004

Outcome of laryngeal manual therapy in four Dutch adults with persistent moderate-to-severe vocal hyperfunction: a pilot study.

A relatively new management strategy for the treatment of voice disorders is the use of laryngeal manual therapy. The main purpose of the present pilot study is to document the outcome of vocal quality after a well-defined laryngeal manual therapy (LMT) program. Four Dutch professional voice users with a persistent moderate or severe muscle tension dysphonia were studied pretreatment (1 week before LMT) and posttreatment (1 week) after completion of manual therapy (25 sessions). These subjects had received several months of traditional voice therapy, without any success. To measure and compare, the effect of LMT objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population was modeled by means of the Dysphonia Severity Index (DSI). All of the subjects selected for LMT showed improvement in perceptual vocal quality and DSI values. As the DSI is a weighted variable including aerodynamic and acoustic measures, small improvements (closer to 5) are very indicative of vocal quality improvement. The use of LMT in professional voice users with persistent moderate-to-severe muscle tension dysphonia, especially in some subjects who have not responded to traditional voice therapy, is supported by this pilot study.

Adult↗
PubMed1997

Speech breathing during reading in women with vocal nodules.

This study examined speech breathing patterns during reading by women with bilateral vocal fold nodules judged as mildly dysphonic and by women without vocal nodules. Although it might be predictable that the speech breathing patterns of individuals with laryngeal dysfunction will differ from those without laryngeal dysfunction, there is a lack of empirical data to support such assumptions. The results of the current study indicated that glottal airflow was greater during reading for the women with vocal nodules and that a larger volume of air was expended both per syllable and per breath group during reading. The rate of speech did not significantly differ between the two groups of women. There was no significant difference for the average duration of the breath groups and no significant difference for the number of syllables spoken per breath group. Additionally, both groups of women demonstrated a similar pattern of inspiratory pause location during the reading. The results suggest that speech breathing patterns associated with dysphonia be examined independently to distinguish specifically the nature of the interaction between the laryngeal dysfunction and the speech breathing pattern. Certainly, more information on how the severity of a voice disorder influences speech breathing is necessary.

Adolescent↗
PubMed2005

[Association between laryngeal findings and vocal qualities in muscle tension dysphonia with supraglottic contraction].

Muscle tension dysphonia (MTD) is a voice disorder associated with abnormal laryngeal posture or glottic configuration induced by excessive contraction of the laryngeal muscles, and supraglottic contraction is one of the characteristic findings in MTD. In recent study we investigated the changes in laryngeal findings and voice quality and the association between them in the course of voice therapy for MTD with supraglottic contraction. The effects of voice therapy on the laryngeal and the vocal findings were assessed by two rating methods: the MTD score and the conventional GRBAS scores and both scores were gradually improved. Of the two components of supraglottic contraction, false vocal cord compression was more curable than anterior-posterior compression at the aryepiglottic level. Little correlation was found between the scores at the first examination, but significant associations (p < 0.05) were found between the differences of MTD score and G/R/S scores but not B/A scores before and after the series of voice therapy. These results suggest that supraglottic contraction is a crucial factor worsening voice quality and that MTD score is useful to assess the efficacy of voice therapy for MTD.

Glottis↗
PubMed2003

Ventricular dysphonia: clinical aspects and therapeutic options.

OBJECTIVE/HYPOTHESIS: Ventricular dysphonia, also known as dysphonia plica ventricularis, refers to the pathological interference of the false vocal folds during phonation. Despite its low incidence and prevalence, Vd is a well-known phenomenon in voice clinics. The present report reviews symptoms, etiology, diagnosis, and therapeutic options regarding this voice disorder. STUDY DESIGN: Literature review and case studies. METHODS: The literature pertaining to all clinical aspects of V(D) was reviewed to define diagnostic and therapeutic clinical decision making. RESULTS: Ventricular dysphonia is characterized by a typical rough, low-pitched voice quality resulting from false vocal fold vibration. Ventricular dysphonia may be compensatory when true vocal folds are affected (resection, paralysis). Noncompensatory types may be of habitual, psychoemotional, or idiopathic origin. Because perceptual symptoms may vary considerably, diagnosis should rely on a meticulous voice assessment, including laryngeal videostroboscopic, perceptual, aerodynamic, and acoustic evaluation. Various therapeutic approaches for the noncompensatory type of ventricular dysphonia may be considered: voice therapy, psychotherapy, anesthetic or botulinum toxin injections, or surgery. CONCLUSION: The study presents the state of the art with respect to ventricular dysphonia and may be helpful in diagnosis and therapeutic decision-making.

Adolescent↗