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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↗
PubMed1993

[The psychosomatic interview in diagnosis of functional voice disorders].

For the psychosomatic diagnosis of functional voice disorders, the concept of a semistructured psychosomatic interview is presented which follows the principles of psychoanalytic interviewing and of deep-psychological biographical anamnesis. It also takes into account the special features of dysphonic patients as psychosomatic patients, the characteristics of functional voice disorders, and the interrelationship of voice and psychosocial biography. The psychosomatic interview consists of the components interviewing situation, voice symptomatology and voice genesis, psychosocial biographical anamnesis and indication to psychotherapy. Beginning and end of the interview are fixed, whereas in the further course the selection of elements is fitted to the conflict constellations of the patient.

Humans↗
PubMed2005

The relationship between VHI scores and specific acoustic measures of mildly disordered voice production.

This study was designed to examine the relationship between the Voice Handicap Index (VHI) and acoustic measures of voice samples common in clinical practice. Fifty participants, 38 women and 12 men, ranging in age from 19 to 80 years, with a mean age of 49 years, served as participants. Of these 50 participants, 17 participants could be included in the acoustic analysis of voice based on measures of error calculated with the TF32 software. All participants completed the VHI and provided voice samples including three trials of the sustained vowel /A/ at a comfortable loudness level as well as a connected speech sample consisting of the Zoo Passage. Acoustic measures were made with TF32 and Cool Edit software and included fundamental frequency, jitter %, shimmer %, signal-to-noise ratio, mean root-mean-square intensity, fundamental frequency standard deviation, aphonic periods, and breath groups. Results indicate that these measures were not predictive of overall VHI score, and no cohesive or predictable pattern was identified when comparing individual measures with overall VHI or with each subscale item. Likely contributions to this lack of correlation and subsequent clinical implications are discussed, as well as the direction for further research.

Adult↗
PubMed1987

[Psychogenic voice disorders. Contribution of clinical psychology].

Only a few psychological papers deal with functional dysphonia. Even fewer empirical studies are concerned with the importance of variations in personality and neurotic behavioural patterns that are typical of functional dysphonia. The enumeration of other functional disorders is important. We suggest that difficulties in self-confidence, social competence, and social fear as well as an increase in control of emotions contribute to the genesis of functional dysphonia. In order to reveal the psychological factors in the diagnosis of dysphonia, every phoniatric diagnosis must be supplemented by a clinical and psychological one.

Humans↗
PubMed2006

Outcome of resonant voice therapy for female teachers with voice disorders: perceptual, physiological, acoustic, aerodynamic, and functional measurements.

Teachers have a high percentage of voice problems. For voice disordered teachers, resonant voice therapy is hypothesized to reduce voice problems. No research has been done on the physiological, acoustic, and aerodynamic effects of resonant voice therapy for school teachers. The purpose of this study is to investigate resonant voice therapy outcome from perceptual, physiological, acoustic, aerodynamic, and functional aspects for female teachers with voice disorders. A prospective study was designed for this research. The research subjects were 24 female teachers in Taipei. All subjects received resonant voice therapy in groups of 4 subjects, 90 minutes per session, and 1 session per week for 8 weeks. The outcome of resonant voice therapy was assessed from auditory perceptual judgment, videostroboscopic examination, acoustic measurements, aerodynamic measurements, and functional measurements before and after therapy. After therapy the severity of roughness, strain, monotone, resonance, hard attack, and glottal fry in auditory perceptual judgments, the severity of vocal fold pathology, mucosal wave, amplitude, and vocal fold closure in videostroboscopic examinations, phonation threshold pressure, and the score of physical scale in the Voice Handicap Index were significantly reduced. The speaking Fo, maximum range of speaking Fo, and maximum range of speaking intensity were significantly increased after therapy. No significant change was found in perturbation and breathiness measurements after therapy. Resonant voice therapy is effective for school teachers and is suggested as one of the therapy approaches in clinics for this population.

Adult↗
PubMed2004

Prevalence of voice disorders in African American and European American preschoolers.

Several studies have reported prevalence rates for voice disorders in school-aged children. Less is known, however, about such prevalence in preschoolers, and whether racial, ethnic, or cultural diversity may influence it. The presence of voice disorders in a total of 2445 African-American and European-American preschool children, 1246 males and 1199 females, from 2 to 6 years of age is reported here. Presence of a voice disorder characterized by hoarseness was identified by a three-prong approach including teacher identification, investigator screening, and parent identification. Speech-language pathologists listened individually to each child's speech as they engaged each child in play-conversation activities. A voice disorder was identified on the basis of the judgment of two speech-language pathologists. Voice disorders characterized by hoarseness were identified in 95 children or 3.9% of the total sample by the investigators. Statistical analysis revealed no significant differences for age, gender, or race.

Black or African American↗
PubMed2003

The prevalence of major psychiatric pathologies in patients with voice disorders.

We conducted a study of 47 patients with various voice disorders to determine the prevalence of concomitant psychopathology. The prevalence of psychiatric symptoms varied considerably among patients with the three most common voice disorders: 63.6% among patients with vocal fold paralysis, 29.4% among those with functional dysphonia, and 7.1% among those with spasmodic dysphonia. Levels of anxiety and depression correlated moderately with the severity of voice symptoms in patients with vocal fold paralysis, but not in those with functional or spasmodic dysphonia. Certain abnormal personality traits--including interpersonal sensitivity and distrust of others--were more common among patients with functional dysphonia. The low rate of psychopathology among patients with spasmodic dysphonia is consistent with rates reported in previous investigations. Our findings suggest that the prevalence of psychopathology in patients with voice disorders varies according to the specific voice diagnosis, as does the relationship between specific psychiatric and voice symptoms.

Adult↗
PubMed2001

An evaluation of the effects of two treatment approaches for teachers with voice disorders: a prospective randomized clinical trial.

Teachers commonly report voice problems and often seek medical assistance for voice-related complaints. Despite the prevalence of voice disorders within this occupation, there are no studies evaluating the effectiveness of treatment programs designed to remedy the voice problems of teachers. To assess the functional effects of two voice therapy approaches, 58 voice-disordered teachers were randomly assigned to 1 of 3 groups: vocal hygiene (VH, n = 20), vocal function exercises (VFE, n = 19), and a nontreatment control group (CON, n = 19). Subjects completed the Voice Handicap Index (VHI)-an instrument designed to appraise the self-perceived psychosocial consequences of voice disorders-before and following a 6-week treatment phase. The VFE and VH subjects also completed a posttreatment questionnaire regarding the perceived benefits of treatment. Only the group who adhered to the VFE regimen reported a significant reduction in mean VHI scores (p <.0002). Furthermore, when compared to the VH group, the exercise group reported more overall voice improvement (p < .05) and greater ease (p < .02) and clarity (p < .01) in their speaking and singing voice after treatment. These findings suggest that the VFE should be considered as a useful alternative or adjunct to vocal hygiene programs in the treatment of voice problems in teachers.

Adult↗
PubMed1989

[Differential diagnosis of functional voice disorders].

In phoniatrics the differential diagnosis of functional voice disorders is mainly based on the medical history of the patient, laryngoscopic and stroboscopic findings. On the one hand the typical laryngoscopic picture must be stressed, on the other hand the central significance of stroboscopy for the functional diagnosis of the larynx has to be mentioned. Only the detailed assessment of the stroboscopic signs and symptoms described by Schönhärl allows a therapy-relevant differentiation between cause-related diagnosis and compensatory secondary symptoms with a necessary distinction of psychosomatic disorders.

Diagnosis, Differential↗
PubMed2001

The prevalence of voice disorders among day care center teachers compared with nurses: a questionnaire and clinical study.

The acceptance of voice disorders by day care center teachers as an occupational disease is not an invariably established practice. This is due to the lack of reliable evidence of a higher risk for voice disorders in this profession. To find out the risk of voice disorders, an epidemiological study was conducted among day care center teachers (n = 262), using hospital nurses (n = 108) as a control group. Symptoms were charted by a questionnaire. In a clinical examination made by a laryngologist, the voice quality was assessed and the laryngeal status noted. Teachers at day care centers had significantly more voice disorders than did nurses. Vocal nodules and laryngitis findings appeared significantly more frequently among day care center teachers than among those in the control group. The results prove voice disorders to be more frequent among day care center teachers than among control group subjects, and also that the main cause for this may be a higher vocal loading among day care center teachers than among control group subjects.

Adult↗
PubMedDate not supplied

Identification and remediation of pediatric fluency and voice disorders.

Early identification of pediatric disfluency and voice disorders is advisable because these disorders may progress to lifelong communicative impairments if left untreated. Especially with disfluency or stuttering, it is critical that an informed differential diagnosis be made to determine whether a speech pattern represents normal disfluency or actual stuttering. Voice disorders can be overlooked as laryngitis, when in fact the problem may be organic in origin. This article describes characteristics of both disorders, etiologic factors, and checklists to assess children for referral to an otolaryngologist and/or speech-language pathologist. Medical and therapeutic treatment recommendations also are discussed.

Child↗
PubMed2001

A fast and easy screening method for voice disorders among teacher students.

A recent study concerning voice disorders among future teachers showed that about 20% of the students had a voice disorder. Most of the disorders were organic. In the current study, we describe a voice-screening method that can be administered by the health care personnel in order to select students for further examination by the speech language therapist and/or phoniatrician. The screening method consists of a perceptual assessment of voice quality and a questionnaire concerning vocal symptoms. As criterion for further medical investigation and voice therapy, we selected a score of 35 mm or above on a visual analogue scale assessing Grade, i.e. overall grade of hoarseness and/or two or more weekly or more often occurring vocal symptoms. The results showed that health care personnel with some training in assessing voices using the questionnaire are competent to perform a rough voice screening on students.

Adult↗
PubMed2002

Psychogenic voice disorders in performers: a psychodynamic model.

Psychogenic voice disorders are not infrequently encountered in the busy voice clinic. A clinician-friendly psychodynamic model and a multidisciplinary management approach are presented which have proven helpful for our voice team and our patients. In essence the formulation revolves around an "event" occurring, which may be either organic or psychological in nature. The ensuing dysphonia then leads to emotional consequences which in turn have physical consequences on the vocal tract. The situation can become reinforcing and illness behaviors develop. Elucidating this event/process to the patient improves the likelihood of a successful long-term outcome. The diagnostic and management roles of the various team members are discussed.

Adult↗
PubMed1991

Adolescents' perceptions of normal and voice-disordered children.

The purpose of this investigation was to compare adolescents' perceptions of the nonspeech characteristics of voice-disordered and normal speakers. Recordings of six three-word phrases produced by 16 speakers, eight voice-disordered and eight normal-speaking children, were presented to 19 adolescent students for judgments of nonspeech characteristics on a semantic differential scale containing 22 bipolar adjective pairs. Results of their ratings indicated that for 15 of the 22 pairs (68.2%) the normal speakers were judged more positively than the voice-disordered speakers. Moreover, for 9 of the 22 pairs (40.9%) the differences in listeners' ratings between the two speaker groups were statistically significant. Implications of these findings concerning developmental trends in the perception of voice disorders and their potential impact on mainstreaming in schools are discussed.

Adolescent↗
PubMed2004

Occupational risk factors associated with voice disorders among teachers.

PURPOSE: This study was designed to determine the occupational risk factors associated with voice disorders among schoolteachers, a high-risk population for developing voice problems. METHODS: Telephone interviews were completed by 1243 teachers from Utah and Iowa. Response rates were 98% and 95%, respectively. Bivariate analyses were computed and assessed using chi-square test and Cochran-Mantel-Haenszel test, and logistic regression analyses were performed and resulting odds ratios assessed using 95% confidence intervals. RESULTS: Teachers of vocal music, drama, other performing arts and chemistry were at significantly greater risk of having a voice disorder (OR=2.2, 95% CI: 1.2-4.0; OR=2.1, 95% CI: 0.9-4.8; OR=1.6, 95% CI: 1.0-2.4; OR=2.0, 95% CI: 1.1-3.4), while teachers of special and vocational education had a significantly lower risk (OR=0.5, 95% CI: 0.3-0.7; OR=0.6, 95% CI: 0.4-0.9). When adjusted for the intensity of vocalization, only teachers of chemistry were significantly at risk (OR=2.0, 95% CI: 1.1-3.5) while teachers of special education continued to have less of a risk (OR=0.5, 95% CI: 0.4-0.8). Chronic voice disorders were more prevalent among teachers of vocal music (OR=4.1, 95% CI: 2.2-7.9) and less prevalent among teachers of vocational education (OR=0.29, 95% CI: 0.09-0.95). CONCLUSIONS: These findings suggest that teachers of specific courses are at greater risk of developing a voice disorder.

Adult↗
PubMed1997

[Psychological classification of functional voice disorders].

In an explorative study the classification of a collective of patients with different voice disorders by discriminant and cluster analysis was tried. 21 variables, obtained from 128 patients with various diagnoses of voice disorders, were used. A first discriminant analysis on the basis of diagnoses-groups permitted no differentiation. A subsequent hierarchical cluster analysis indicated a four-cluster-solution. The clusters showed only little association with the phoniatric diagnoses. Cluster 1 is characterized by patients with non-organic voice disorders. Cluster 2 is marked by emotional unstable patients with organic dysphonia. Cluster 3 consists of patients with psychosomatic dysphonia by laryngeal contact granuloma, and cluster 4 contains emotional stable patients suffering from organic dysphonia and from spasmodic dysphonia. Thirteen psychological variables discriminated the clusters significantly: Anxiety about appearing in public, emotionality (neuroticism), life satisfaction, aggressiveness, anxiety, about physical injuries, extraversion.

Adult↗