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PubMed2003

Interpersonal relating and voice hearing: to what extent does relating to the voice reflect social relating?

The experience of hearing voices (auditory hallucinations) has been construed as that of relating to an interpersonal 'other'. This preliminary study utilized Birtchnell's (1996, 2002) theory of relating to investigate the hypothesis that people who hear voices relate to the voices and to people within their social environment in similar ways. A correlational design was adopted and 27 people provided information about the characteristics of their voice-hearing experience, relating to the voice and relating socially. Significant correlations were found between relating to the voice and relating socially in terms of the 'dominant' and 'submissive' forms of power and the 'clinging' form of proximity: these associations were independent of beliefs about the voices and mood-linked appraisals. However, relating from a position of 'withdrawal' was found to be unique to the experience of voice hearing, and was most extreme when relating to voices that were perceived to have no identity. This study offers further evidence in support of the hypothesis that people who hear voices relate to them in ways that reflect more pervasive patterns of social relating. The clinical implications of these findings for assessment and intervention are discussed.

Adult↗
PubMed2005

The effect of a 'voice course' on the voices of people with and without pathologies: preliminary observations.

Several institutions provide voice practice for their teaching staff. These 'voice courses' provide a unique treatment situation, in which some participants have a diagnosed laryngeal pathology, while others have no vocal complaints. Therefore, these voice courses can be viewed as group voice therapy as well as preventive voice treatment. The present study was aimed at providing a preliminary voice evaluation of participants in such a group, prior to and following treatment, using perceptual and acoustic analyses. Sixteen male teachers, who enrolled in a voice course, participated in eight consecutive sessions. Of this group, seven teachers were diagnosed with laryngeal pathologies, while the others had none. All participants were recorded before and after treatment. Recordings were analyzed acoustically, and also evaluated perceptually by ten experienced speech pathologists. Results indicated that: (i) voice quality improved after the voice course, (ii) vocal improvement was more pronounced in the pathological group than in the nonpathological group, and (iii) the acoustic analysis paradigm yielded results that were not always readily related with those of the perceptual paradigm.

Adult↗
PubMed2003

Voice beyond choice: hesitant voice in public debates about genetics in health care.

The rise of genetic techniques presents a great promise as well as some difficult dilemma's about how genetics will affect the way we will be able to live our lives. For this reason, in many countries, public debates are organized to reflect upon the development of predictive medicine. In this essay we focus on economist A. Hirschman's work on "exit, voice and loyalty" to analyse and enrich these public debates. We first introduce Hirschman's triad of concepts and focus on the concept of "voice," which refers to an institution's ability to allow clients to give feedback about products or services, and its ability to listen to the feedback given. We argue that voice is particularly important for the health care system in which predictive medicine is developing. Voice is crucial because how predictive medicine will become institutionalised is now in the process of becoming determined. However, in public debates about predictive medicine, voice tends to be reduced to providing people with the option of making a choice whether to use genetic techniques or not. We argue that this reduction of voice to choice is not very informative about predictive medicine and suggest an amendment of Hirschman's concept of voice, which we call "hesitant voice." Hesitant voice attempts to be informative about the uncertainty people experience in addressing predictive medicine and topicalises the gradual, the embodied, the tentative character of voice in developing situations like that of predictive medicine.

Choice Behavior↗
PubMed2005

Voice recognition and cross-modal responses to familiar speakers' voices in prosopagnosia.

Recognizing the voices of people we know does not only activate "voice areas" in the temporal lobe but also extraauditory areas including the fusiform "face area" (FFA). This cross-modal effect could reflect that individual face and voice information become specifically associated when becoming acquainted with a person. Here, we addressed whether the ability to have individual face representations 1) plays a role in voice recognition and 2) is required to observe cross-modal responses to voices in face areas. We compared speaker recognition performance and neuroimaging responses during the processing of familiar and nonfamiliar speakers' voices in a developmental prosopagnosic subject (SO) with the respective findings obtained in a group of 9 control subjects. Despite scoring worse than controls on recognition of familiar speakers' voices, SO had normal cross-modal responses in the FFA and normal connectivity between FFA and the voice regions. However, she had reduced activations in areas that usually respond to familiarity with people. An indication for the malfunctioning of her FFA was reduced connectivity of the FFA to a subset of these supramodal areas. In combination these data suggest that 1) voice recognition benefits from the ability to process faces at an individual level and 2) cross-modal association of voices and faces in the brain is achieved by a sensory binding and does not depend on a top-down mechanism subsequent to successful person recognition.

Acoustic Stimulation↗
PubMed2004

[Significance of voice constitution as a predisposition for occupational voice disorders].

Occupational voice disorders have been increasing for years. The aim of this study was to examine whether a constitutionally weak voice should be regarded as a risk factor for developing such voice disorders. In a prospective study, 15 female teacher students with a normal vocal constitution were compared with 18 students with constitutionally weak voices during teaching practice. There was a significant difference in the mean fundamental frequency of both groups after teaching for 30 min. Students with constitutionally weak voices tended to have increased values. Taking into consideration the physiological aspects of an increasing fundamental frequency as a sign of vocal fatigue, a constitutionally weak voice has to be regarded as a potential risk factor for developing a voice disorder in vocally intensive occupations. To prevent future vocal problems by appropriate prophylactic intervention (i.e. voice therapy, introduction to vocal hygiene), a phoniatric examination of vocal constitution and endurance is recommended at the beginning of a voice dependent professional career.

Adolescent↗
PubMed2006

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma.

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.

Aged↗
PubMed2004

[Results of voice therapy in functional voice disorders].

OBJECTIVES: To determine the efficacy of voice therapy techniques in 37 patients with functional dysphonia. PATIENTS AND METHODS: The patients were divided into three groups according to the type of functional voice disorder, including mutational falsetto (n=16), vocal nodule (n=17), and muscle-tension dysphonia (n=4). All the patients received voice therapy which varied according to the frequency of visits, time, and techniques for the type of functional voice disorder. Voices of the patients were evaluated subjectively by a questionnaire and the GRBAS scale, and objectively by videolaryngostroboscopy and computed voice analysis before and after the therapy. RESULTS: Fifteen patients with mutational falsetto (93%), eight patients with vocal nodules (47%), and all the patients with muscle-tension dysphonia were cured by voice therapy techniques. Vocal nodules were reduced in 35% of the patients and were stable in three patients (18%). CONCLUSION: Successful results can be obtained by voice therapy techniques in functional voice disorders, which are common in otolaryngology practice, causing difficulties in diagnosis and management.

Adolescent↗
PubMed2003

Measurement and validation of the voice handicap index in voice-disordered patients in Taiwan.

Voice disorders can cause problems for patients emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations are able to evaluate such factors adequately. For this study, a retrospective analysis of 79 dysphonic cases was conducted using the voice handicap index (VHI) to gather comprehensive data across a variety of voice disorders. Of the 79 cases, 41 involved glottic insufficiency, 26 involved vocal polyps or mass, and 12 involved functional voice disorders. Cases were assessed with the VHI using physical (P), functional (F), emotional (E) parameters and a total (T) of the three. P, F, E and T variables were entered into a statistical programme and analysed using one-way analysis of variance (ANOVA). Mean +/-SE values for P, F, E and T, respectively, in glottic insufficiency cases were 31.61 +/- 1.10, 26.49 +/- 1.43, 26.06 +/- 1.54, and 84.20 +/- 4.21. Mean +/-SE values for P, F, E and T, respectively, in vocal mass cases were 30.69 +/- 1.73, 25.23 +/- 1.90, 23.96 +/- 1.82, and 79.88 +/- 5.08. The mean +/-SE values of P, F, E and T, respectively, in functional voice disorders were 20.92 +/- 2.06, 18.33 +/- 1.82, 16.83 +/- 1.86, and 56.08 +/- 5.23. We found the mean glottic insufficiency was significantly greater than functional voice disorders for each measure. There were significant differences between vocal mass and functional voice disorders means for P and T. Glottic insufficiency and vocal mass means were not significantly different for any measure. Problems in the physical realm were identified as the most severe amongst all patients. Glottic insufficiency patients were found to suffer the most in every VHI value. Although VHI is a relatively new method by which to measure discomfort in voice-disordered patients, it provides a mechanism for patients to define their discomfort and for therapists to better target recovery programmes to patient's needs.

Adolescent↗
PubMedDate not supplied

Professional voice users: the evaluation of voice disorders.

Substantial advances in understanding the anatomy and physiology of phonation, and the new technology that has improved voice measurement and voice surgery, have led to marked improvement in the standard-of-care for patients with voice disorders. Expert voice care is essential for all patients, but especially crucial for voice professionals. Professional voice users include not only singers and actors, but also clergy, teachers, receptionists, sales personnel, physicians, and anyone else whose ability to earn a living is impacted negatively by loss of vocal quality and endurance. Physicians should be familiar with the latest concepts in voice diagnosis and treatment, and with the management of common voice disorders.

Aging↗
PubMed2005

[Quality of life and voice handicap of laryngectomees using tracheoesophageal substitute voice].

BACKGROUND: Health-related quality of life (QoL) and subjective health have become popular constructs for the evaluation of both efficacy and efficiency of diagnostic and therapeutic procedures in medicine. QoL is considered a multidimensional construct encompassing physical, mental and social facets of life. It is an accepted outcome parameter not only in international classification systems such as ICIDH and ICF, but as well in clinical guidelines and disease management programs. Measuring quality of life allows for comparison of different diseases though it certainly lacks disease specific aspects. Thus, it has to be assumed that in patients with distinct functional deficits QoL cannot cover all aspects that are important for the individual patient. This study focuses on laryngectomies and their self-evaluation of post-laryngectomy speech. It is well known that these patients experience a decreased QoL compared to patients after partial laryngectomy or healthy persons. In this study, the impact of voice restoration on the laryngectomies' QoL was evaluated. PATIENTS AND METHODS: In 20 male laryngectomies aged 62 +/- 8 years, relations between QoL and voice handicap were evaluated using two instruments as proposed in the international literature, i. e. the Short-Form Health Survey (SF-36) and the Voice Handicap Index (VHI). All patients had successfully been using tracheoesophageal substitute voice for at least one year. Complete data sets were available from all patients. Data were analysed using Microsoft Excel and Sigma Plot, Jandel Corp. software packages. RESULTS: Results of both the SF-36 and the VHI reveal wide interindividual ranges. There are statistically significant correlations (p < 0.05) between the SF-36's scales General Health and Vitality and the VHI, whereas no correlations were found between social and psychological scales and the voice handicap. DISCUSSION: Wide ranges of the data obtained reveal that obviously both health related quality of life and voice handicap are not affected in a group specific way. So, both tests are of clinical value to depict individual aspects of wellbeing after laryngectomy. The combination of VHI and SF-36 illuminates correlations between general and special subjective aspects. Strikingly, the laryngectomies' social and psychological status is not related to their voice handicap. Data allow for conclusion that laryngectomies' substitute voice problems do not affect social aspects of quality of life in a disease specific way, at least as long as voice restoration was successful at all.

Aged↗
PubMed2006

[The custom-fit voice prosthesis, for treatment of periprothetic leakage after tracheoesophageal voice restoration].

BACKGROUND: Leakage around an indwelling voice prosthesis is detected during 13% up to 27% of all replacement procedures of voice prosthesis and causes serious complications in further voice restoration of the laryngectomee. Lots of therapeutic options to stop periprothetic leakage have been described (Injection of Bioplastique, autologous fat or collagen, suture techniques, spacer therapy) without convincing success rates. METHODS: Custom-fit voice prostheses are ordinary indwelling voice prostheses (Blom-Singer low pressure Indwelling 20 fr) with enlarged flanges and reduced shaft length that are individually sized for the shunt of the laryngectomee. Especially enlarging the esophageal flange provides a tight sealing of leakage around the prosthesis. PATIENTS: In a one year lasting clinical trial 692 voice prostheses were changed. In 77 cases periprothetic leakage was detected and fistulas were fitted with individually sized voice prostheses. RESULTS: In 76 cases total control of leakage was achieved without any specific complications taking place. Moreover two types of leaking tracheoesophageal fistulas were distinguished, a dilated-atrophic and an infected-necrotic type. 57% of the fistulas were dilated-atrophic type and 43% of the fistulas were classified infected-necrotic type. Infected-necrotic fistulas needed enlarged flanges tracheal an esophageal for tight sealing in 91% of the cases whereas dilated-atrophic fistulas needed double flanges only in 45%. 70% of infected-necrotic type fistulas needed only one singular history of a custom-fit prosthesis and could be changed back to ordinary indwelling prostheses after healing had taken place. CONCLUSIONS: As the insertion of a modified prosthesis is only slightly more effort than an ordinary voice prosthesis insertion, the success rate is high und complications are rare we recommend the custom-fit voice prosthesis for treatment of periprothetic leakage.

Aged↗
PubMed1992

[Voice rehabilitation after laryngectomy with voice prostheses. Results of a prospective follow-up study].

Although the results of surgical rehabilitation by means of voice prostheses are on the average better than rehabilitation via oesophageal speech, the tracheoesophageal puncture (TEP)-technique has so far not been widely used in Germany. The majority of hospitals still prefer the "traditional" method of voice rehabilitation using oesophageal speech. The present prospective study was undertaken to compare the results of postlaryngectomy vocal rehabilitation, if patients were offered the surgical voice rehabilitation via voice prosthesis as an alternative to oesophageal speech. Taking into account all the patients who underwent laryngectomy from 1989 until 1990 in Tübingen, primary surgical voice rehabilitation was performed in 44 out of 54 patients (81.5%). Interestingly enough, 34 patients who underwent laryngectomy were able to perform communication via the telephone on the day of their discharge. Moreover, one-third of the laryngectomised patients showed a significant increase in speech intelligibility within the first six months after laryngectomy. 36 patients with laryngectomy were able to attain proficiency 6 months after surgery. In 12 patients the prosthesis had to be removed, since either phonation was impossible or patients successfully learned and preferred oesophageal speech. In conclusion, independent of the method of voice rehabilitation (prosthesis, electrolarynx, oesophageal speech), our results support the hypothesis that a voice rehabilitation regimen will yield a higher rehabilitation rate of patients if rehabilitation via surgical voice is offered as an alternative to learning the oesophageal voice. Therefore, it seems to be advisable that patients are allowed to have the choice between surgical rehabilitation and oesophageal speech restoration.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1999

Consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer: voice quality, vocal function, and vocal performance.

PURPOSE: To assess consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer, by means of a multidimensional analysis protocol including voice quality, vocal function, and vocal performance measures. METHODS AND MATERIALS: A total of 60 men treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers filled in questionnaires on vocal performance. Furthermore, perceptual analyses of voice quality and stroboscopic measures of vocal function were performed. There was a longitudinal group of 10 patients from whom data were collected before, as well as 6 months and 2 years after, radiation. Furthermore, data were collected on 5 separate groups of 10 patients each: before, 6 months after, 2 years after, 3-7 years after, and 7-10 years after radiation. RESULTS: High correlations were found between self-ratings of vocal performance and several voice measures. Patients before radiotherapy experienced poor voice characteristics that improved 6 months to 10 years after treatment, and became comparable to vocal performance of control speakers in 50% of the patients. Following radiotherapy, deviant voice characteristics and consequences in daily life occurred significantly more often for patients in whom initial diagnosis consisted of stripping the vocal cord instead of biopsies and for patients who continued smoking after treatment. CONCLUSION: Voice characteristics of patients diagnosed with early glottic cancer improved after radiotherapy, and became normal in half of our patients. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased deviant voice characteristics.

Aged↗
PubMed2006

Diagnostic value of voice acoustic analysis in assessment of occupational voice pathologies in teachers.

It has been shown that teachers are at risk of developing occupational dysphonia, which accounts for over 25% of all occupational diseases diagnosed in Poland. The most frequently used method of diagnosing voice diseases is videostroboscopy. However, to facilitate objective evaluation of voice efficiency as well as medical certification of occupational voice disorders, it is crucial to implement quantitative methods of voice assessment, particularly voice acoustic analysis. The aim of the study was to assess the results of acoustic analysis in 66 female teachers (aged 40-64 years), including 35 subjects with occupational voice pathologies (e.g., vocal nodules) and 31 subjects with functional dysphonia. The acoustic analysis was performed using the IRIS software, before and after a 30-minute vocal loading test. All participants were subjected also to laryngological and videostroboscopic examinations. After the vocal effort, the acoustic parameters displayed statistically significant abnormalities, mostly lowered fundamental frequency (Fo) and incorrect values of shimmer and noise to harmonic ratio. To conclude, quantitative voice acoustic analysis using the IRIS software seems to be an effective complement to voice examinations, which is particularly helpful in diagnosing occupational dysphonia.

Adult↗
PubMed2002

[Effect of voice emission training on the improvement in voice organ function among students attending the college of teachers].

One of the major causes of frequent voice disorders in teachers is incorrect vocal emission technique. The aim of the study was to assess the effect of logopedic training on voice emission parameters and vocal organ disorders in students attending the college for teachers. The study group comprised 45 female students who experienced vocal abnormalities after excessive vocal effort. Questionnaire surveys, phoniatric and videostroboscopic examinations were performed in all subjects before starting and after completing the logopedic training. The training was preceded by a theoretical seminar on voice organ anatomy, physiology, and hygiene. The logopedic training lasting two-three months contributed to the improvement in voice characteristics and the condition of voice organ in the majority of students, as well as in phoniatric parameters, including the increase in the maximum phonation time, the frequency range of voice, the reduction of the glottal insufficiency and the elimination of "soft" vocal nodules. The results of the study indicate that the implemented voice emission training improved significantly voice quality and allowed for providing an efficient therapy of already existing functional disorders of the larynx.

Adult↗
PubMed2005

[Assessment of voice acoustic parameters in female teachers with diagnosed occupational voice disorders].

BACKGROUND: Laryngovideostroboscopy is the method most frequently used in the assessment of voice disorders. However, the employment of quantitative methods, such as voice acoustic analysis, is essential for evaluating the effectiveness of prophylactic and therapeutic activities as well as for objective medical certification of larynx pathologies. The aim of this study was to examine voice acoustic parameters in female teachers with occupational voice diseases. MATERIALS AND METHODS: Acoustic analysis (IRIS software) was performed in 66 female teachers, including 35 teachers with occupational voice diseases and 31 with functional dysphonia. RESULTS: The teachers with occupational voice diseases presented the lower average fundamental frequency (193 Hz) compared to the group with functional dysphonia (209 Hz) and to the normative value (236 Hz), whereas other acoustic parameters did not differ significantly in both groups. CONCLUSIONS: Voice acoustic analysis, when applied separately from vocal loading, cannot be used as a testing method to verify the diagnosis of occupational voice disorders.

Adult↗