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PubMed1983

[Laryngeal changes following functional dysphonia].

Different clinical entities of functional voice disorders and their corresponding laryngoscopic findings are discussed. The visible changes must be regarded as functional consequences of muscular dystonia. The combination of laryngoscopic findings, auditive judgement and a complete history of the patient will allow the practitioner to establish a correct diagnosis without any need for special instruments. Conservative voice therapy however should be carried out by an experienced phoniatrician.

Humans↗
PubMed2007

[Glottal and supraglottal configuration during whispering].

BACKGROUND: The purpose of the study was to assess glottal and supraglottal configurations during whispering in comparison to habitual phonation and to visually estimate to what extent force is exerted onto the vocal fold epithelium during whispering. Is whispering a good compromise between preservation of epithelium and permission to communicate orally, e. g. postoperatively? PATIENTS AND METHODS: We investigated on 100 patients with organic or non-organic voice disorders. Patients with vocal fold immobility and patients with organic lesions large enough to impede glottal closure were excluded. Videolaryngoscopy and stroboscopy was performed via flexible endoscopy. During fiberoscopy the patients were asked (i) to phonate and then whisper a series of vowels in various loudness levels and (ii) to count to 10 voiced and whispered in various loudness levels. The extent of vocal fold adduction and supraglottal configuration were assessed and whispering compared with voiced phonation. RESULTS: Interindividual differences in glottal and supraglottal configuration during whispering were seen. The two different and most frequently seen glottal area patterns were determined by the position of the vocal processes - either adducted or abducted. Adduction resulted in sole cartilaginous triangle formation or 'kissing processes', abduction in ligamentous and cartilaginous triangle. Another surprising result was that with increasing loudness either a narrowing or widening of glottal and supraglottal structures was visible. CONCLUSIONS: There are different patterns of glottal and supraglottal configuration during whispering. Although the vocal folds can show partial or total contact over the membranous parts, the lack of additional vibration of the vocal folds suggests that epithelial forces are smaller than with additional vibratory shear stress. Thus, whispering may be considered and allowed for postoperative communication purposes, when patients follow instructions for low-effort whispering.

Adult↗
PubMed2005

Studying vocal fold vibrations in Parkinson's disease with a nonlinear model.

A nonlinear model is applied to study pathologic vocal vibratory characteristics and voice treatments of Parkinson's disease. We find that a number of pathologic vocal characteristics commonly observed in Parkinson's disease, including reduced vibratory intensity, incomplete vocal closure, increased phonation threshold pressure, glottal tremor, subharmonics, and chaotic vocal fold vibrations, can be studied with this nonlinear model. We also find that two kinds of clinical voice treatments for Parkinson's disease, including respiratory effort treatment and Lee Silverman voice treatment can be studied with this computer model. Results suggest that respiratory effort treatment, in which subglottal pressure is increased, might aid in enhancing vibratory intensity, improving glottal closure, and avoiding vibratory irregularity. However, the Lee Silverman voice treatment, in which both subglottal pressure and vocal fold adduction are increased, might be better than respiratory effort treatment. Increasing vocal fold thickness would be further helpful to improve these pathologic characteristics. The model studies show consistencies with clinical observations. Computer models may be of value in understanding the dynamic mechanism of disordered voices and studying voice treatment effects in Parkinson's disease.

Computer Simulation↗
PubMed1992

Dysphonia in the aging: physiology versus disease.

A chart review from 151 dysphonic patients over the age of 60 was done to define aging related voice disorders. Overwhelmingly, patients suffered from dysphonia due to disease processes associated with aging rather than to physiologic aging alone. These include: 1. central neurological disorders affecting laryngeal function (e.g., stroke, Parkinson's disease, essential tremor, Alzheimer's disease); 2. benign vocal fold lesions (e.g., Reinke's edema, benign and dysplastic epithelial lesions); 3. inflammatory disorders (e.g., laryngitis sicca, medication effect); 4. laryngeal neoplasia; and 5. laryngeal paralysis. Typical laryngeal findings of vocal fold bowing and breathiness consistent with presbylarynges were present in only six patients. Presbylarynges is not a common disorder and should be a diagnosis of exclusion made only after careful medical and speech evaluation.

Aged↗
PubMed1998

Frequency of voice problems among teachers and other occupations.

This study describes the frequency of reporting vocal problems among a random sample of elementary and high school teachers (n = 554) compared to individuals working in other occupations (n = 220). Teachers were more likely to define themselves as ever having a voice problem (32% versus. 1%, p < .05); having a tired, weak, or effortful voice (p < .05 each); and having a higher frequency of symptoms of physical discomfort with speaking (p < .05). They also were more likely to perceive that their voice problem negatively affected current job performance (p < .05) and limited options regarding change in work (p < .05). About 20% of teachers but only 4% of nonteachers had missed work due to their voice. These findings suggest that teachers are at high-risk for disability from voice disorders and that this health problem may have significant work-related and economic effects.

Adult↗
PubMed2002

A comparison of the occurrence and nature of vocal symptoms in two groups of Icelandic teachers.

Research suggests that teaching activities involve a high risk of developing voice disorders. The aim of this study is to examine the possible difference in the occurrence and nature of vocal symptoms in two groups of teachers-head teachers (N = 43), including both principals and assistant head teachers, and teachers of physical education (N = 43)--and to investigate the possible role of gender. The questionnaire results indicate that demands on the voice for P.E. teachers and head teachers are different. The findings suggest that (i) demands influence the occurrence and nature of reported vocal symptoms, (ii) that teachers of physical education are at a greater risk of developing voice problems, and (iii) that female P.E. teachers are at particular risk.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging findings and correlations in spasmodic dysphonia patients.

A sample of 19 spasmodic dysphonia (SD) patients was selected from a larger population of such patients to undergo magnetic resonance imaging (MRI), auditory brain stem response (ABR) testing, speech analysis, and extensive physical examination. Six patients had abnormal spin-echo MRI findings, ranging from infarcts within the basal ganglia to demyelinating lesions within the supralateral angles of the lateral ventricles. A weakly positive correlation was noted between the abnormal MRI findings and an abnormal ABR. The lack of a significant correlation between the MRI findings and other predictors of brain stem and midbrain disease, and the current spatial resolution limitations of MRI, suggest that we are visualizing the associated lesions rather than the actual foci of SD. The range of MRI findings is consistent with the concept that SD is a voice disorder in a heterogeneous patient population.

Adult↗
PubMedDate not supplied

Perceptual-physiologic approach to evaluation and treatment of dysphonia.

The value of a perceptual-physiologic approach to both the evaluation and treatment of voice disorders is described and illustrated with an example of a patient with ventricular fold phonation. Objective measures are obtained to facilitate the understanding of the underlying pathophysiology and to document change over time. Evaluation data are recorded and interpreted collectively by a speech-otolaryngology team and may be valuable for medicolegal cases. Finally, the evaluation methods, particularly videolaryngoscopy, may be used for biofeedback purposes to facilitate voice therapy.

Adult↗
PubMed1998

Spasmodic dysphonia and vocal fold paralysis: outcomes of voice problems on work-related functioning.

Patients at a university voice disorder clinic diagnosed with spasmodic dysphonia (SD, n = 68) or vocal fold paralysis (VFP, n = 57) reported vocal symptoms and adverse work outcomes in contrast to a nondisordered group (ND, n = 68). Patients with SD most frequently cited symptoms of effortfulness (57%) and weakness (54%), VFP cited hoarseness (70%) and weakness (60%), while the nondisordered reported hoarseness (28%). SD and VFP produced greater (p< .05) adverse work outcomes than the nondisordered in the past (SD: 65%, VFP: 41%, ND: 3%), potential future (SD: 78%, VFP: 65%, ND: 19%), and current job performance (SD: 64%, VFP: 46%, ND: 2%). These disorders significantly disrupt socioeconomic outcomes and research is needed to improve functional ability and quality of life.

Adult↗
PubMed1995

Vocal load as measured by the voice accumulator.

Voice disorders related to occupation and work environment are often observed in ENT consultations. Advising these patients requires not only the investigation of their vocal capacities but also knowledge about their vocal load. The patient will name extreme demands as the reason for vocal problems whereas the employer will want to know if the patient is capable of doing the work required of him. For an objective measurement of vocal load, a voice accumulator has been developed. This portable instrument records total speaking time and sound level over a period of several hours. The data can be transferred to a personal computer which analyses voiced time (s) between 60 and 112 dB(A)s. Thus, more precise and objective documentation of vocal demands in some professions can finally be obtained. With these results, it is possible to monitor vocal ability or disability during vocal rehabilitation.

Equipment Design↗
PubMedDate not supplied

[Suitability of the Munich List of Quality of Life Dimensions (MLDL) for use in logopedic therapy research].

Public health policy increasingly focuses on criteria of cost and cost-effectiveness for health care financing. However, tools for assessing the effects of logopedic therapy are largely missing. This study investigated the suitability of the Munich List of Quality-of-Life-Dimensions (MLDL) for use with patients with dysphonia. Twenty-five adults with voice disorders were administered the MLDL at the beginning and at the end of therapy (about 20 sessions). Results were that, although most patients expressed high satisfaction with the therapy received, MLDL scores did not reflect this. Only 2 out of 19 items of the scale indicated a significant improvement in the quality of life after therapy ("ability to relax", p < 0.05, and "satisfaction with the treatment of the disorder", p < 0.01). The MLDL is not sensitive enough to detect all effects of logopedic therapy. The development of specific scales for the detection of effects of logopedic intervention is discussed.

Humans↗
PubMedDate not supplied

A method to measure speaking time and speech sound pressure level.

Many voice disorders are associated with vocal loading, but easy measurement of the vocal load has not been possible so far. To fulfil this need, an easily accessible method was developed and tested. Speaking time and speaking sound level can be recorded during normal work, and measurement can be made in a noisy environment. The measurement is made with a pair of modern noise exposure analysers from which the data is transferred to a personal computer, and the voice speaking time and the related sound pressure levels are calculated with a spreadsheet program. Suitable meters are available from various manufacturers. The method may be applied to measure the need of voice use in different professions, assessing a person's performance in his or her work or evaluating the effects of voice therapy on speaking performance.

Humans↗
PubMed2005

"Silent event-related" fMRI reveals reduced sensorimotor activation in laryngeal dystonia.

OBJECTIVE: To study with fMRI the pattern of sensorimotor activation in patients with spasmodic dysphonia (laryngeal dystonia) compared to healthy controls. METHODS: The authors performed fMRI measurements during vocal motor tasks in 12 patients with laryngeal dystonia and compared them with those of 12 healthy volunteers. Patients were scanned before (pre) and after (post) treatment with local injections of botulinum toxin (BTX). They examined two different motor tasks: simple vocalization inducing dystonia and whispering without appearance of dystonic symptoms. To avoid movement artifacts with oral motor tasks, the authors used a silent event-related fMRI approach involving noncontinuous sampling with no data acquisition during task performance. RESULTS: They found reduced activation of primary sensorimotor as well as of premotor and sensory association cortices during vocalization in patients with laryngeal dystonia pre-BTX. This was partly observed also during the asymptomatic whispering task. BTX treatment did not result in reversal of reduced cortical activation. CONCLUSION: fMRI signal is reduced in sensorimotor cortices associated with movement of the affected body part in laryngeal dystonia, supporting a dystonic basis for this voice disorder.

Adult↗
PubMed2002

Validity and reliability of the reflux symptom index (RSI).

Laryngopharyngeal reflux (LPR) is present in up to 50% of patients with voice disorders. Currently, there is no validated instrument that documents symptom severity in LPR. We developed the reflux symptom index (RSI), a self-administered nine-item outcomes instrument for LPR. The purpose of this investigation was to evaluate the psychometric properties of the RSI. For validity assessment, 25 patients with LPR were evaluated prospectively before and six months after b.i.d. treatment with proton pump inhibitors (PPI). Each patient completed the RSI as well as the 30-item voice handicap index (VHI). For reliability assessment, the study patients were given the RSI on two separate occasions before the initiation of treatment. Normative RSI data were derived from 25 age-matched and gender-matched controls taken from an existing database of asymptomatic individuals without any evidence of LPR. The mean RSI (+/- standard deviation) of patients with LPR improved from 21.2 (+/- 10.7) to 12.8 (+/- 10.0), and the mean VHI improved from 52.2 (+/- 24.7) to 41.5 (+/- 25.0) after 6 months of therapy (p = 0.001 and 0.065, respectively). Of the three VHI subscales (emotional, physical, functional), only the functional subscale improved significantly (p = 0.037). Patients who experienced a five point or better improvement in RSI were 11 times more likely to experience a five-point improvement in VHI (95% confidence interval = 1.7, 76.8). For reliability assessment, the first and second pretreatment RSIs were 19.9 (+/- 11.1) and 20.9 (+/- 9.6), respectively (correlation coefficient = 0.81, p < 0.001). The single-item correlation coefficients ranged from 0.41 to 0.91 (p < 0.05 for all items). The mean pretreatment RSI in patients with LPR was significantly higher than controls (21.2 versus 11.6; p < 0.001). The mean RSI of patients with LPR after 6 months of PPI therapy approached that of asymptomatic controls (p > 0.05). The RSI is easily administered, highly reproducible, and exhibits excellent construct and criterion-based validity.

Adult↗
PubMed1992

Time series analysis of glottal airflow in normal and pathological phonation.

Time series analysis of glottal airflow was carried out on 26 normal controls and 40 patients with voice disorders, using a modification of Isshiki's original technique which uses a hot-wire flowmeter, taking cycle-by-cycle fluctuations into consideration. The mean flow rate and mean AC/DC were shown to have significant differences among normal and patient groups. The standard deviations of AC/DC and AC/DC perturbation were calculated from the AC/DC value of 50 cycles and shown not to vary significantly among the normal and patient groups. The relationship between AC/DC and perceptual impression of voice was also studied among 20 selected patients with breathy voices. Using Spearman's rank correlation coefficient, this relationship was found to have statistical significance (P < .05).

Glottis↗
PubMed2005

[Spontaneous dislocation of the arytenoid cartilage].

Dislocation of the arytenoid cartilage occurs following medical instrumentation involving the laryngeal cavity or laryngeal injury from outside the larynx. We reported a case of spontaneously posterior dislocation of the arytenoid cartilage. A 53 year-old man suffering from suddenly recurring aphonia and its improvement many over 3 months without laryngeal injury or inducement eventually ceased to improve. Laryngoscopic findings showed that the left vocal fold was tensely prolonged and the vocal process of the arytenoid cartilage on the left side was dislocated posterolaterally. X-ray videofluorography of the larynx on repetitive phonation of /he/ showed abnormally high and diagonal displacement of the vocal fold and the upper structure of the arytenoid cartilage on the left side. Palpating the cricoarytenoid joint on the left side showed abnormal swelling with tenderness. Electomyography of the intrinsic laryngeal muscle on the left side showed normal action potential. From these findings, we diagnosed his voice disorder as spontaneously posterior dislocation of the arytenoid cartilage. We manually reduced it by pulling up a balloon inserted from the piriform sinus of the affected side to the esophagus.

Arytenoid Cartilage↗
PubMed2004

Laryngeal structure and function in the pediatric larynx: clinical applications.

This article presents an overview of the normal anatomy and physiology of the pediatric larynx, followed by some examples of pediatric voice disorders that were chosen to exemplify the alterations to the laryngeal anatomy and the subsequent modifications to laryngeal function. Vocal fold nodules are primarily reviewed due to their high incidence in the pediatric population. Three other disorders, including laryngeal hyperfunction, unilateral vocal fold paralysis, are discussed because of their more common occurrence and the uniqueness of their etiology and intervention, particularly for the case of bilateral abductor vocal fold paralysis.

Age Factors↗