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At least 613 records · Page 34Linked to original sources
PubMed2004

Botulinum toxin injections for the treatment of spasmodic dysphonia.

BACKGROUND: The use of botulinum toxin for the treatment of spasmodic dysphonia is currently the treatment of choice for management of this neurological voice disorder. Over the past 20 years, botulinum toxin has been used to treat both adductor and abductor forms of the disorder, with vocal improvement noted after treatment for both. A large number of studies have attempted to document the efficacy of botulinum toxin for improvement of vocal symptoms in individuals with spasmodic dysphonia. OBJECTIVES: To determine the effectiveness of botulinum toxin for treating spasmodic dysphonia. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to July 2003), EMBASE (1974 to July 2003 ), CINAHL (through July 2003), Dissertation Abstracts International (1975 to July 2003) and PsycINFO (1975 to July 2003). The search engine FirstSearch was also used (July 2003). Reference lists for all the obtained studies and other review articles were examined for additional studies. SELECTION CRITERIA: All studies in which the participants were randomly allocated prior to intervention and in which botulinum toxin was compared to either an alternative treatment, placebo or non-treated control group were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated all potential studies meeting the selection criteria noted above for inclusion. One study met the inclusion criteria and was included in the final analysis. MAIN RESULTS: Only one study in the literature met the inclusion criteria. This was the only study identified which reported a treatment/no treatment comparison. It reported significant beneficial effects for fundamental frequency (Fo), Fo Range, spectrographic analysis, independent ratings of voice severity and patient ratings of voice improvement. REVIEWERS' CONCLUSIONS: The evidence from randomized controlled trials does not allow firm conclusions to be drawn about the effectiveness of botulinum toxin for all types of spasmodic dysphonia, or for patients with different behavioral or clinical characteristics.

Botulinum Toxins↗
PubMed2006

Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review.

BACKGROUND: Spasmodic dysphonia is a neurological voice disorder characterized by involuntary adductor (towards midline) or abductor (away from midline) vocal fold spasms during phonation which result in phonatory breaks. Botulinum toxin is currently the gold standard of treatment. OBJECTIVE: To determine the efficacy of botulinum toxin therapy for the treatment of spasmodic dysphonia. DESIGN: Systematic Cochrane review. SEARCH STRATEGY: The search strategy for this review complied with Cochrane standards. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL (through February 2005), Dissertation Abstracts International (1975 to February 2005) and PsycINFO (1975 to February 2005). The search engine FirstSearch was also used (February 2005). Reference lists for all the obtained studies and other review articles were examined for additional studies. SELECTION CRITERIA: All randomized control trials where the participants were randomly allocated prior to intervention and in which botulinum toxin was compared to an alternative treatment, placebo or non-treated control group were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated all potential studies meeting the selection criteria noted above for inclusion. MAIN RESULTS: Only one study in the literature met the inclusion criteria. This was the only study identified which reported a treatment/no treatment comparison. It reported significant beneficial effects for fundamental frequency (Fo), Fo range, spectrographic analysis, independent ratings of voice severity and patient ratings of voice improvement. REVIEWER'S CONCLUSIONS: The evidence from randomized controlled trials supporting the effectiveness of botulinum toxin for management of spasmodic dysphonia is deficient. The lack of supporting evidence from randomized controlled trials results in an inability to draw unbiased generalized conclusions regarding the effectiveness of botulinum toxin for all types of spasmodic dysphonia.

Adult↗
PubMed2001

Occult laryngeal pathology in a community-based cohort.

BACKGROUND: Little information is available regarding the prevalence of laryngeal pathology in adults. PURPOSE: To estimate the prevalence of occult laryngeal pathology in a community-based cohort of adults over 40 years of age. METHODS: One hundred consecutive volunteers over age 40 with no history of voice disorders were enrolled. All completed a self-administered laryngeal symptom questionnaire and underwent a comprehensive head and neck examination including transnasal fiberoptic laryngoscopy. RESULTS: The mean age of the cohort was 61 years. Vocal fold bowing (presbylaryngis) was present in 72% of the patients, and findings of laryngopharyngeal reflux were present in 64% of the cohort. In addition, other laryngeal pathology were identified in 21%. Only 12% had a completely normal laryngeal examination. CONCLUSIONS: Occult laryngeal pathology is very common in persons over 40. Findings suggestive of laryngopharyngeal reflux are present in 64%, and vocal fold bowing is present in 72% of persons over 40.

Adult↗
PubMed2000

Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.

Unilateral vocal fold paralysis is a common clinical problem which frequently causes severe dysphonia. Various treatment options exist for this condition, with the type I thyroplasty being one of the more commonly performed surgical procedures for vocal rehabilitation. The Voice-Related Quality of Life (V-RQOL) Measure is a validated outcomes instrument for voice disorders. This study measured the V-RQOL of patients with unilateral vocal fold paralysis who had undergone a type I thyroplasty and compared these scores to those of patients with untreated and uncompensated unilateral vocal fold paralysis and to normals. Treated patients had significantly higher domain and overall V-RQOL scores than untreated patients, but also scored lower than normals. These differences were true across gender and age. Patients who were more distant from surgery had lower V-RQOL scores than those who had more recently been treated. It is concluded that type I thyroplasty leads to a significantly higher V-RQOL for patients with unilateral vocal fold paralysis. This study also demonstrates further the utility of patient-oriented measures of treatment outcome.

Female↗
PubMed1998

Deformation analysis of the vocal folds from videostroboscopic image sequences of the larynx.

Videostroboscopy is an examination which yields a permanent record of the moving vocal folds. Thus, it allows the diagnosis of abnormalities which contribute to voice disorders. In this paper, in order to find and quantify the deformation of the vocal folds in videostroboscopic recordings, an active contours- (snakes) based approach is used to delineate the vocal folds in each frame of the videostroboscopic image sequence. After this delineation, a new elastic registration algorithm is used to register the vocal fold contours between adjacent frames of the video sequence. This algorithm is based on the regularization principle and is very effective when large deformations are present. A least-squares approach is used to fit an affine model to the displacement vectors found by elastic registration. The parameters of this model, rotation, translation, and deformation along two principle axes, quantify the deformation and allow the succinct characterization of the videostroboscopic recordings based on the deformations that occurred. Experiments are shown with synthetic and real videostroboscopic data that demonstrate the value of the proposed approach.

Humans↗
PubMed1987

Spasmodic dysphonia subsequent to head trauma.

Spasmodic dysphonia (SD) is a low-incidence voice disorder of unknown origin. A subgroup of seven patients with SD from our larger pool of 70 report vocal symptoms subsequent to head injury. This article is a case report of the neurodiagnostic findings, including computed tomography, magnetic resonance imaging, auditory brain-stem response, brain electrical activity mapping, and single photon emission computed tomography for three such patients. For each patient, two or more tests revealed positive neurologic findings. Each test, except computed tomography, demonstrated abnormalities in one or more patients. Two principles of clinical management are derived: (1) information regarding head trauma sustained before SD symptom onset is significant; (2) the absence of neuropathology on a single measure of central nervous system function should not be considered conclusive evidence that no neurologic lesions exist.

Adult↗
PubMed2000

24 hours prior to curtain.

A retrospective review was conducted of 40 singers presenting with acute voice problems prior to performance. The purpose of this study was to determine the reasons for seeking emergent voice treatment, the types of acute voice disorders, and the performance outcome. The patients were assessed by age, singing style, years of experience, chief complaint, laryngovideostroboscopic findings, and treatment regimens. The outcomes were classified as full, restricted, or no performance. The majority of patients were classical singers. Laryngovideostroboscopy frequently revealed a pattern of early glottic contact at the mid-portion of the membranous vocal fold in patients with acute laryngitis. Experienced singers uniformly sought treatment many days before their performance compared with inexperienced singers who presented closer in time to performance. Six patients initially withheld information, which had a bearing on their acute management. The results of this study suggest that there is a need to accurately diagnose and treat the singer's emergent problem and educate singers regarding early evaluation of medical problems. With modern evaluation techniques and multi-modality treatment, 85% of the singers proceeded to full performance without negative sequelae.

Acute Disease↗
PubMed2004

[The Voice Handicap Index: impact of the translation in French on the validation].

The aim of this prospective investigation was to validate a French version of the Voice Handicap Index (VHI). A population of 52 normal subjects and 63 patients with voice disorders replied to the questionnaire at the day of their first consultation and ten to thirty days after the consultation (before any treatment). Reproducing the methodology of the American authors, the test-retest reliability and the internal consistency reliability were measured. The validity and the sensibility related to a non dysphonic population were also analysed. Regarding the normal subjects, the maximum scores for total score and subscale scores were 20 (total), 12 (physical), 7 (functional), 6 (Emotional). These scores are statistically different when compared with pathological subjects (p < 0.00001). Test-Retest stability of the pathological subjects was found to be satisfactory for both total score and subscale scores (r > 0.87). From this data set, the critical difference scores were derived for the VHI total score (15 points), for the physical subscale (9 points) and for the functional and emotional.subscales (6 points each). As for as the internal consistency reliability, Cronbach's alpha is correct (r > 7) for the pathological subjects. Yet, the analysis of the validity reply by reply, reveals some abnormalities. In conclusion, the validity of the French translation of the VHI is confirmed but the results prompt us to improve the quality of the translation.

Adult↗
PubMed2002

Muscle tension dysphonia as a sign of underlying glottal insufficiency.

BACKGROUND: Hyperkinetic vocal function (muscle tension dysphonia) may be an indication of underlying glottal insufficiency. In the face of an organic voice disorder such as presbylaryngis or vocal fold paresis. Hyperkinetic laryngeal behaviors may be used to achieve glottal closure. Such compensatory laryngeal behaviors may mask the correct underlying diagnosis. OBJECTIVE: We sought to evaluate the association between vocal fold bowing due to presbylaryngis and abnormal muscle tension patterns (MTPs). METHODS: One hundred consecutive volunteers >40 years old were prospectively evaluated. All underwent a comprehensive head and neck examination that included transnasal fiberoptic laryngoscopy with videostroboscopy. Abnormal MTPs were compared in subjects with and without vocal fold bowing. RESULTS: The mean age of the cohort was 61 years. Eighty-four percent (42 of 50) of the male subjects and 60% (30 of 50) of female subjects had evidence of vocal fold bowing. Of the 72 patients with bowing, 94% (68 of 72) had abnormal MTPs. Compared with subjects without vocal fold bowing, persons with bowing were 17 times more likely to exhibit abnormal MTPs (P < 0.001). CONCLUSIONS: Abnormal MTPs are common in persons with underlying glottal insufficiency. Patients with vocal fold bowing are 17 times more likely to exhibit abnormal MTPs (95% confidence interval, 4.9 to 59.4). Clinicians should be aware that compensatory hyperkinetic laryngeal behaviors may mask an underlying organic condition.

Aged↗
PubMed2004

Cricoid chondrosarcoma presenting as arytenoid hypertelorism.

BACKGROUND: Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for Voice Disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid hypertelorism caused by cricoid chondrosarcoma may be aphonic even though the anterior membranous vocal folds make contact during attempted phonation. METHODS: Between 1991 and 2002, nine patients were diagnosed with cricoid chondrosarcoma. Patients' charts and video examinations were retrospectively evaluated for symptoms and the presence of arytenoid hypertelorism on endoscopic evaluation. Two were women, and seven were men, with a mean age of 70 (range 53-72) years at diagnosis. RESULTS: Eight (88%) patients had aphonia or dysphonia caused by arytenoid hypertelorism as their presenting symptom. Six were diagnosed after failed medialization laryngoplasty or other laryngeal rehabilitation surgery. All nine patients had a low-grade tumor. The initial treatment in eight patients was hemicricoidectomy, and one patient had a total laryngectomy. In four cases, a second procedure was needed 1 to 6 years later because of recurrence. Seven patients are alive without clinically significant disease; one is alive with moderate disease, and one has died from an unrelated cause. CONCLUSIONS: Severely dysphonic, elderly patients presenting with arytenoid hypertelorism of unknown cause should be evaluated by fiberoptic laryngoscopy and by computed tomography scan to rule out cricoid chondrosarcoma. Because these tumors behave so benignly, the authors recommend conservative surgery (unilateral hemicricoidectomy) as the diagnostic/treatment modality of choice.

Aged↗
PubMed2001

Quantitative analysis of videostroboscopic images in presbylarynges.

OBJECTIVE/HYPOTHESIS: Age-related dysphonia, or presbylarynges, is often identified as the cause of voice disorders in older individuals. It is a diagnosis of exclusion that typically includes the subjective videostroboscopic findings of vocal fold bowing or atrophy and incomplete glottal closure. We hypothesize that vocal fold bowing correlates directly with glottal gap in patients with presbylarynges and that these characteristics may be quantified objectively using measures obtained from videostroboscopic images. STUDY DESIGN: Retrospective analysis of patient data and prospective analysis of control subjects. METHODS: The quantitative measures of bowing index and normalized glottal gap, as well as a novel measure, normalized laryngeal outlet, were calculated from the videostroboscopic examinations of 46 patients with presbylarynges and 20 normal control subjects. RESULTS: The mean bowing index values from the presbylarynges and control groups differed significantly, although there was overlap of individual values between groups. Bowing index values did not consistently predict normalized glottal gap values. Mean normalized laryngeal outlet values of the patients with presbylarynges were significantly smaller than those of the control group. CONCLUSIONS: Bowing does not consistently predict the extent of glottal gap. Therefore, other presbylaryngeal changes are probably contributing to incomplete glottal closure, which are not well-visualized stroboscopically, so the finding of bowing is not sufficiently specific to identify presbylarynges. The significantly smaller normalized laryngeal outlet values suggest that this identifies a compensatory strategy for glottal gap to optimize vocal function. This is a novel finding that contrasts with medial ventricular fold squeezing, which is more routinely sought and is typically considered a maladaptive compensatory strategy. Despite the advantages of quantitative stroboscopic measures, limitations in reliability limit their clinical utility.

Aging↗
PubMed1999

Ex juvantibus approach for chronic posterior laryngitis: results of short-term pantoprazole therapy.

The aim of this study was to investigate whether patients with chronic posterior laryngitis and symptoms of gastro-pharyngeal reflux benefit from a six-week therapy with pantoprozole. Twenty-nine out-patients with voice disorders (case history of at least two months) and simultaneous symptoms of gastro-pharyngeal reflux were recruited for this study. At the entry to the study a symptom questionnaire and a video-laryngo/stroboscopy were completed. The symptom questionnaire and the video-laryngo/stroboscopy were repeated after the six weeks of therapy with pantoprazole 40 mg once a day and again six weeks and three months after this follow-up, during which time the patient was without therapy. Hoarseness, globus pharyngeus, sore throat, heartburn, and coughing were the symptoms which showed a significant (p < 0.05) recovery at the follow-ups (mean of hoarseness index: 7.28 to 0.92; mean of globus pharyngeus index: 3.14 to 0.58; mean of heartburn index: 2.86 to 0.5; mean of cough index: 1.72 to 0.25; mean of throat soreness index: 1.72 to 0.15). Laryngoscopy scores of the posterior laryngeal region, the glottic and the supraglottic region showed statistically significant improvement (p < 0.05) after the treatment with pantoprazole. The therapeutic effect exceeded the drug administration until the last follow-up (after three months). The medication was tolerated without side-effects in all patients. A primary (ex juvantibus) therapy with proton pump inhibitors seems to be a therapeutic option for patients with long-lasting chronic inflammation of the larynx not responding to common therapy. In this case a six-week course of treatment has been shown to be sufficient.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Vocal fold augmentation with calcium hydroxylapatite.

OBJECTIVES: Voice disorders affect more than 3% of the general population. Vocal fold atrophy is a part of the normal aging process, with up to 60% of 60-year-old individuals displaying evidence of glottal insufficiency. A safe, effective, and durable substance for injection augmentation of the vocal folds is not currently available. The purpose of this investigation was to describe our preliminary experience with calcium hydroxylapatite (CaHA) for vocal fold augmentation. METHODOLOGY: All patients undergoing injection augmentation of the vocal folds with CaHA between January 1, 2002 and June 1, 2003 were prospectively evaluated. Data concerning indications, technique, functional outcome, and complications were collected. In addition, the larynx donated from a woman who underwent vocal fold augmentation with CaHA and subsequently died from terminal cancer was histologically examined. RESULTS: A total of 39 vocal folds in 23 individuals were injected with CaHA. The mean age of the cohort was 62. Fifty-two percent were male. The indications for augmentation were unilateral vocal fold paralysis (9/23), unilateral vocal fold paresis (5/23), presbylarynx (3/23), Parkinson's (3/23), bilateral vocal fold paresis (2/23), and abductor spasmodic dysphonia (1/20). There were no adverse reactions. All individuals reported improvement on a self-administered disease-specific outcome measure (P < 0.001). The pathology from the donated larynx 3 months after injection revealed intact CaHA spherules in good position with a minimal, monocellular inflammatory reaction to the gel carrier and no evidence of implant rejection. CONCLUSIONS: Initial experience with vocal fold augmentation using CaHA is promising. Long-term safety and efficacy needs to be established.

Durapatite↗
PubMed2004

The effects of vowels on voice perturbation measures.

This study examines voice perturbation parameters of the sustained [a] in English and of the eight vowels in Turkish to discover whether any difference exists between these languages, and whether a correlation exists between voice perturbation parameters and articulatory and acoustic properties of the Turkish vowels. Eight Turkish vowels uttered by 26 healthy nonsmoker volunteer males who are native Turkish speakers were compared with a voice database that includes samples of normal and disordered voices belonging to American English speakers. Fundamental frequencies, the first and second formants, and perturbation parameters, such as jitter percent, pitch perturbation quotient, shimmer percent, and amplitude perturbation quotient of the sustained vowels, were measured. Also, the first and second formants of the sustained [a] in English were measured, and other parameters have been obtained from the database. When the voice perturbation parameters in Turkish and English were compared, statistically significant differences were not found. However, when Turkish vowels compared with each other, statistically significant differences were found among perturbation values. Categorical comparisons of the Turkish vowels like high-low, rounded-unrounded, and front-back revealed significant differences in perturbation values. In correlation analysis, a weak linear inverse relation between jitter percent and the first formant (r=-0.260, p<0.05) was found.

Adult↗
PubMed1997

Populations in the U.S. workforce who rely on voice as a primary tool of trade: a preliminary report.

The United States Bureau of Labor Statistics and other sources were consulted about the percentages of the working population that we identified as professional voice users. The largest percentage may be in sales and sales-related occupations (13%), but the exact breakdown of those who approach their clients vocally rather than by mail is still uncertain. The second largest population is teachers, who comprise 4.2% percent of the U.S. workforce (1994 statistic). Teachers have been identified as having the greatest incidence of voice disorders. Population data are also given for professional voice users who could present a significant hazard to public safety if their vocal communication skills were severely impaired.

Employment↗
PubMed2006

Vestibular folds configuration in vocal nodule.

UNLABELLED: Vocal nodules are among the most common laryngopathies that cause vocal functional disorders. The voice production mechanism is complex and demand interaction of different systems of the human body. The physiological role of the vocal folds as the glottic sound source is evident, however, there is no consensus regarding the vestibular folds' participation/influence in phonation. AIM: To verify if there is difference in the bidimensional configuration of the vestibular folds between two distinct groups of women, one with the diagnosis of vocal nodules and the other without vocal complaints and vocal fold lesions. STUDY DESIGN: Clinical with transversal cohort. MATERIAL AND METHOD: Ninety-six laryngeal images were evaluated, 48 from individuals without vocal complaints and 48 from patients with the diagnosis of vocal nodules. Angles were obtained and bilaterally measured in single frames of the vestibular folds during sustained phonation and those structures were morphologically classified as concave, linear or convex. RESULTS: Among the 96 vestibular folds evaluated in each group, there was predominance of the concave form, followed by the linear and the convex ones. In the control group, there was a single convex vestibular fold, 27 were linear and 68 were concave folds. In the group of vocal nodules, 8 were convex, 15 were linear and 73 were concave folds. However, the differences among groups were not statistically significant as well as those among the angles, whose average measures were proven quite similar. CONCLUSION: In the female gender, the vestibular folds presented similar behavior regarding the morphology in both patients with vocal nodules and women without vocal complaints.

Adolescent↗