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PubMed2004

Dysphonia and laryngopharyngeal reflux.

The correlation between laryngo-pharyngeal reflux and dysphonia has been evaluated in patients without significant laryngoscopic findings and without vocal misuse. Studies were performed, using a validated questionnaire on typical reflux symptoms as well as instrumental means, e.g. videolaryngoscopy, multi-electrode 24-hr oesophageal pH monitoring, vocal acoustic analysis, gastro-oesophagoscopy, on 62 patients (51 male, 11 female) with dysphonia for > or = 3 months, selected from 350) consecutive patients presenting with voice disorders. Standard criteria were: absence of laryngeal neoformation (benign or malignant) and correct use of voice. Anti-reflux treatment was prescribed in all selected patients. A group of 62 selected patients without laryngo-pharyngeal disease were studied as controls. Mean values of the harmonic to noise ratio and maximum phonation time were pathological in all patients with dysphonia and significantly correlated (p = 0) with the entity of the larynx alteration. The 24-hour pH monitoring revealed gastro-oesophageal reflux in all cases with a clear prevalence of episodes in the upright, compared to supine, position. From a multiple regression analysis of pH-metric values, considered important in predicting maximum phonation time and harmonic to noise ratio alteration. the significant predictors (p < 0.01) were those parameters indicating the existence of a laryngo-pharyngeal reflux disease: in an upright position, the prevalence of the number of refluxes and of time of pH < 4. In conclusion, the association between electro-acoustic reliefs and laryngoscopic data, as well as an alteration in maximum phonation time and harmonic to noise ratio in patients with pH-metric indicative parameters of laryngo-pharyngeal reflux disease led to the hypothesis of a possible correlation between entity and duration of the reflux and dysfunction of the arytenoid muscles, upon which chronic vocal fatigue, with consequent laryngeal compensatory stress, depends.

Adult↗
PubMed2001

Outcomes of botulinum toxin treatment for patients with spasmodic dysphonia.

BACKGROUND: Spasmodic dysphonia (SD) is a focal dystonia of the larynx. Although individuals with SD have variable degrees of difficulty in everyday communication and speaking, many report significant impairments. The impact of SD on the quality of life of people with the disorder has not been well measured. OBJECTIVES: To assess the impact of SD using a voice-specific, validated outcomes instrument, the Voice Handicap Index (VHI), and to evaluate the effect of botulinum toxin treatment on quality of life. METHODS: The VHI measures 3 subscales (physical, functional, and emotional) of impact of a voice disorder as well as a total impact score. The VHI was completed by 30 consecutive patients with SD before receiving botulinum toxin injection and 2 to 4 weeks after injection. Pretreatment scores on the VHI were compared with posttreatment scores. RESULTS: Pretreatment scores on the VHI showed significant impairment in all 3 subscales (physical, 25.5; functional, 21.4; and emotional, 20.4) and the total score (67.6). Statistically significant improvements occurred in all 3 subscale scores and the total score (P =.001) for the 22 patients who completed the posttreatment survey. CONCLUSIONS: Spasmodic dysphonia has a significant impact on patients' perception of quality of life as measured by the VHI. Significant improvements in all 3 subscale scores and the total score on the VHI occur after treatment with botulinum toxin.

Adult↗
PubMed1989

New laryngeal surgery may improve voice.

Laryngeal framework surgery has increased the options the otolaryngologists have available to treat voice disorders ranging from unilateral vocal cord paralysis to pitch disorders.

Humans↗
PubMed2003

Use of acupuncture for the treatment of adductor spasmodic dysphonia: a preliminary investigation.

Ten subjects with adductor spasmodic dysphonia participated in a study examining the effects of an acupuncture treatment protocol on their voice disorder. Treatment consisted of eight sessions, and it was designed and performed by two physicians certified in acupuncture. Voice characteristics were evaluated pretreatment and posttreatment using the CSL Motor Speech Profile (MSP), Unified Spasmodic Dysphonia Rating Scale, and Voice Handicap Index (VHI). Subjects also answered a posttreatment questionnaire regarding their experience. Significant pretreatment and posttreatment differences occurred for some MSP measures. Significant differences were found on all three subtests of the VHI, and the average total scores pretreatment and posttreatment differed by 17 points (considered significant according to VHI standardization). Seven of 10 subjects reported improvements in voice production, although expert raters did not detect perceptual changes in voice quality. Possible reasons for the discrepancies between objective measures and self ratings, and implications for further research, are discussed.

Acupuncture Therapy↗
PubMed2003

The dysphonic voice heard by me, you and it: differential associations with personality and psychological distress.

Voice production is subject to and indicative of psychological status. The precise relationships of voice disorders and psychological variables remain unclear. We compared the correlations of self-reported and more objective measures of voice quality in dysphonic patients with personality, coping, affect and somatization. Two hundred and four subjects participating in a randomized, controlled trial of speech therapy underwent self-report, observer rating and computer acoustic analysis of voice quality. These three indices of voice quality were compared with regard to their correlations with individual differences in neuroticism, alexithymia, negative emotion coping, anxiety, depression, neurotic symptoms, medically unexplained symptoms and quality of life. Significant correlations were observed between self-reported voice problems and all of the personality/coping and clinical psychological distress measures. People who reported more voice problems had: higher neuroticism and alexithymia; a tendency to use emotion-oriented coping; more psychological distress; poorer quality of life; and more past medically unexplained symptoms. Expert voice rating correlated weakly with neurotic disturbance, quality of life and previous medically unexplained symptoms. Objective voice assessment (amplitude perturbation) showed no significant associations with any psychological measure. The strongest associations of psychological variables and voice measures are with self-report measures. This suggests that it is in part the patients' perception of their own voice quality which accounts for the association of voice production and psychological factors in subjects presenting to voice clinics.

Adolescent↗
PubMed2005

Stroboscopy as a research instrument: development of a perceptual evaluation tool.

Laryngeal stroboscopy is arguably the most important clinical tool for the evaluation and treatment of patients with voice disorders. Unfortunately, at present, laryngeal stroboscopy is strictly a clinical tool and has no definitive use in the area of voice research. The limitation with laryngeal stroboscopy is the subjective nature of the interpretation of the video examination. A video stroboscopy research tool was developed using 10 stroboscopic parameters selected from the literature and clinical practice. The stroboscopy research tool was validated with the results of 18 reviewers using the instrument to rate 21 unique "cases" and 6 repeated "cases." The results of this video perceptual analysis study identified which parameters were the most robust and reliable across a wide range of reviewers and validated power analysis curves for future similar research. Furthermore, findings from this study revealed that a greater than 80% intra-rater reliability is the preferred method for the selection of a valid and reliable reviewer. Future research using this instrument will most likely increase the reliability and utility of the instrument with the use of prestudy reviewer training and/or the use of video examples to serve as anchors or external references.

Humans↗
PubMed1985

Difficulty in high-pitched phonation by laryngeal trauma.

We treated a case of laryngeal trauma in which difficulty in high-pitched phonation was the main feature of a voice problem. We emphasize the importance of phonatory function tests in determining the mechanism of voice disorders and in monitoring the effects of treatment. Physical examination, phonatory function tests, computed tomographic scan, and electromyogram disclosed that the voice problem was caused by a fracture of the thyroid cartilage and its fixation against the cricoid cartilage. An open reduction yielded recovery of the phonatory function.

Adult↗
PubMed2000

Voice handicap index in singers.

The Voice Handicap Index (VHI) was developed to assess patients' perception of the severity of their voice disorder. The purpose of this study was to determine the degree of handicap expressed by professional and recreational presenters with a voice complaint. Singers (n = 106) and nonsingers (n = 369) with voice symptoms were studied. The results of the VHI for singers indicate that singers score significantly lower (less severe) on the VHI compared to nonsingers. Singers with vocal fold nodules had a lower mean VHI than singers with vocal fold cysts or polyps. Singers who perform classical music had the lowest mean VHI of all types of singers studied. A low VHI in singers may represent a significant handicap and should not be ignored when considering the severity of a singer's voice problem.

Adolescent↗
PubMed1998

Psychological profiles of patients with laryngeal contact granulomas.

The association between laryngeal contact granuloma and demographic/psychological variables was examined by using a psychosomatic approach to health research. A stepwise procedure of logistic regression analyses was utilized to get a final multivariate model of variables associated with the clinical finding of a laryngeal contact granuloma. The subjects consisted of 47 patients with contact granulomas and 110 patients with voice disorders due to other causes. Our analysis of 22 variables uncovered the following statistically significant factors for developing a contact granuloma: male gender (P = 0.0001), low achievement orientation (P = 0.0007), fear of physical lesions (P = 0.0038), impulsiveness (P = 0.0016), age > 60 years (P = 0.0012), low extraversion (P = 0.004), high achievement orientation (P = 0.0079), fear of appearing in public (P = 0.0216) and strain (P = 0.03). These results show that a variety of variables are important for predicting the development of a laryngeal contact granuloma. The usefulness of this set of risk variables for predicting a contact granuloma remains to be proved in a prospective study. It is possible that not only the nature but the number of risk factors are the prime determinants of outcome.

Achievement↗
PubMed2005

Revisiting the pitch controversy: changes in speaking fundamental frequency (SFF) after management of functional dysphonia.

Speaking fundamental frequency (SFF) and its perceptual correlate "habitual pitch" have been considered important and contentious parameters in voice assessment and treatment. In clinical circles, disagreement exists regarding the role of habitual pitch in the development, maintenance, and treatment of disordered voices. Despite these divergent opinions, few studies have objectively evaluated SFF changes associated with voice improvement after therapy. To determine whether consistent directional and magnitude changes in SFF occur after management, pretreatment and posttreatment audio recordings of 40 women with functional dysphonia were analyzed. All subjects were treated with manual circumlaryngeal therapy, a treatment approach that does not directly target pitch as a perceptual entity to be manipulated. Results indicated that, as a group, no significant change in mean SFF was observed after successful management. Although no consistent directional pattern was identified, 80% of the subjects experienced pitch changes greater than one semitone; this suggests that voice improvement is often accompanied by a shift in SFF. Clinical implications of the data are discussed.

Adult↗
PubMed2004

Pediatric video laryngo-stroboscopy.

OBJECTIVE: Laryngo-stroboscopy remains as the clinical gold standard for assessing properties of the glottal phonatory and valvular function. This includes deficits of closure as well as mucosal wave irregularities secondary to abnormal zones of pliability and symmetry. Per-oral stroboscopy has technical limitations in children due to the size of the telescope and issues of patient compliance. However, flexible laryngoscopy is readily performed in newborns and young children. This paper describes the use of a new trans-nasal, digital flexible laryngoscope, which allows for laryngo-stroboscopy in children. METHODS AND RESULTS: A prospective longitudinal series was done on 25 children ages 19 months-13 years (mean age, 7.0 years) with this new technology. All 25 were successfully examined. CONCLUSIONS: New technological advancements in the design of digital flexible endoscopes has allowed for laryngo-stroboscopy, and therefore, provides the potential for expanding the population of children with vocal disorders in whom stroboscopic imaging is possible. Larger studies will be necessary to determine its limitations related to age, development, and disease. As the study of pediatric voice disorders continues to evolve, accurate diagnosis is essential to apply state of the art non-operative and phonosurgical interventions. Further longitudinal studies are currently underway to continue to refine techniques of pediatric voice assessment and to define limitations of this new technology.

Adolescent↗
PubMedDate not supplied

[Parameters of phoniatric examination of solo vocalists].

INTRODUCTION: A phoniatrist analyzes the professional's voice at the beginning of his vocal studies or career but also later, in cases of voice disorder. Phoniatric examination of professional singers must be done according to "all inclusive" protocols of examination. Such protocols must establish the status of basic elements of phonatory system: activator, generator and resonator of voice and articulatory space. ANAMNESIS: All patients requiring phoniatric examination no matter if they are candidates for professional singers, need to provide anamnestic data about their previous problems regarding voice or singing. CLINICAL EXAMINATION: This examination is necessary and it must include: examination of nose, cavum oris, pharynx, ears and larynx. SUBJECTIVE ACOUSTIC ANALYSIS: This analysis is based on evaluation of physiological and pathophysiological manifestations of voice. MUSICAL VOICE RANGE: Determination of musical voice range during phoniatric examination does not intend to make any classification of voice, nor to suggest to vocal teacher what he should count upon from future singers. Musical range can be determined only by a phoniatrist skilled in music or with musical training, but first of all vocal teacher. OBJECTIVE ACOUSTIC ANALYSIS: These methods are used for examination of phonatory function, or laryngeal pathology. They are not invasive and give objective and quantitative information. They include: laryngostroboscopy, spectral analysis of voice (sonography) and fundamental parameters of voice signal (computer program). SPEECH EXAMINATION: Articulation is very important for solo singers, because good articulation contributes to qualitative emission of sound and expression of emotions. HEARING TESTS: Tonal-threshold audiometry is performed as a hearing test. ADDITIONAL TESTS: They include rhinomanometry, vital capacity measurements, maximal phonation time and phonation quotient. CONCLUSION: Phoniatric examination is a necessary proceeding which must be performed before admission to the academy of solo singing, and then during singers' education and career. The phoniatric protocol must include a minimal number of parameters, which can be increased if required. All parameters of phoniatric examination must be adequately evaluated by experts.

Articulation Disorders↗
PubMed2005

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery].

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

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↗
PubMed1983

Neuropathology of spasmodic dysphonia.

Spasmodic dysphonia is a devastating voice disorder of unknown etiology, with a variable clinical presentation and response to treatment. Three independent evaluations of brain stem function were performed on spasmodic dysphonic patients, and age and sex-matched controls. Statistically significant (p less than 0.01 approximately 0.05) differences were noted between these groups, and the findings were consistent with impairment of somatic and visceral brain stem pathways. A significant correlation (p less than 0.05) was found between the severity of tested central nervous system impairment and vocal tremor, number of associated neurologic signs and duration of illness. Possible etiologies (viral or traumatic), age, and sex, did not correlate with the severity of brain stem impairment. Clinical signs and the brain stem findings appeared to stabilize 3 to 5 years after onset of dysphonia. The investigation of other spasmodic cranial nerve disorders afforded insight into the etiology and therapy for spasmodic dysphonia. Drawing upon previous observations and the results of the brain stem tests, two models are proposed for neuronal processing in spasmodic dysphonia, and future strategies are discussed. The evidence cited in this research project are consistent with spasmodic dysphonia being one of several spasmodic brain stem disorders with variable presentation which are known by the cranial nerve nuclei or pathways of major clinical involvement.

Adult↗
PubMed1993

Phonosurgery for voice improvement and restoration.

Recent advances in laryngology have occurred simultaneously in both the diagnostic and therapeutic realms. The advent of sophisticated voice laboratories with the ability for in-depth analysis of voice disorders has provided insights into their pathophysiology necessary to develop sophisticated procedures to treat them. Experience with these procedures has likewise provided new understanding of laryngeal function. Together these diagnostic and therapeutic modalities have allowed unprecedented advancement in treating laryngeal disorders, hitherto treated in a most unsatisfactory manner.

Humans↗
PubMed1988

Electroglottogram waveform types.

Electroglottography is a useful, non-invasive technique that can assist in the assessment of vocal fold dysfunction. However, if it is to become a useful clinical tool, there is a need for normative studies of the electroglottogram waveform types that characterize trained professional voice users, untrained non-professional speakers and patients with voice disorders and for a way of quantifying and objectively comparing similarities and differences. This report describes our methodology and an investigation into the waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequency, intensity and voice quality conditions. A number of strong tendencies were noted. In normal voice the lower frequencies and intensities represent one pole of a scale of a mode of phonation, while the higher frequencies and intensities depict the other pole. In these studies breathy voice data overlapped the lower end of the scale and tense voice data overlapped the upper end.

Electrodiagnosis↗
PubMed2004

Perceived phonatory effort and phonation threshold pressure across a prolonged voice loading task: a study of vocal fatigue.

Although the problem of vocal fatigue is not uncommon in people with voice disorders, research on objective quantifiable indicators of vocal fatigue is limited. It has been suggested that a speaker's perception of increased phonatory effort associated with periods of prolonged voice use is related to increased lung pressure required to initiate and sustain phonation. The purpose of this study was to examine the relationship among perceived phonatory effort (PPE), which was used as a subjective index of vocal fatigue, and phonation threshold pressure (PTP), a quantifiable measure defined as the minimal lung pressure required to initiate and sustain vocal fold oscillation. PTP and PPE were recorded before, during, and after five adult male and five adult female speakers engaged in a prolonged oral reading task designed to induce vocal fatigue. The results supported a direct, moderately strong relationship between PTP and PPE, particularly when PTP was measured during speech produced at comfortable and low-speaking pitch levels. No gender effects were found. PTP returned to baseline levels within 1 hour after the fatiguing task. PPE returned to baseline within 1 day. The data support the use of PTP as an objective index of vocal fatigue.

Adult↗