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At least 703 records · Page 39Linked to original sources
PubMed1998

Laryngeal recovery following type I thyroplasty.

OBJECTIVE: To describe the pattern of laryngeal recovery and its relationship to voice improvement following thyroplasty. DESIGN: We used a 5-point scale to rate 5 laryngeal characteristics preoperatively and 1 day, 1 week, 1 month, and 3 months following thyroplasty. SETTING: A university-affiliated health center. PATIENTS: Forty-four patients who underwent thyroplasty to correct incomplete glottal closure. RESULTS: Improved glottal closure and reduced supraglottic activity followed thyroplasty. Although evidence of postoperative irritation (erythema, edema, or hematoma) was present in many patients, it resolved within the first 1 to 4 weeks postoperatively in 22 (73%) of the 30 subjects available for follow-up at 3 months following thyroplasty. CONCLUSIONS: Thyroplasty is an effective procedure in correcting incomplete glottal closure and works to reduce excessive supraglottic activity in some patients. Recovery from postoperative vocal-fold irritation occurs rapidly, typically between the first week to first month, depending on the type and severity of irritation. These findings may help explain variations in postoperative voice improvement.

Adult↗
PubMed2004

Longitudinal effects of Botox injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia: part II.

OBJECTIVE: To investigate the longitudinal effects of botulinum toxin type A (Botox) injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia. DESIGN: Prospective study. SETTING: Academic tertiary care referral center. PARTICIPANTS: Forty-two patients who presented to our institution with dysphonia and were diagnosed as having adductory spasmodic dysphonia during a 38-month period. INTERVENTION: Patients received Botox injections into both thyroarytenoid muscles via the cricothyroid membrane. The typical starting dose was 1.0 U per vocal fold. If necessary, the dosage was adjusted in subsequent injections to reduce adverse effects or to enhance duration of benefit. MAIN OUTCOME MEASURES: Patients filled out questionnaires, including the V-RQOL Measure and a self-assessed overall voice rating, before each injection. Postinjection questionnaires were completed 6 to 8 weeks after each treatment. Mean pretreatment and posttreatment scores were calculated for each treatment. RESULTS: The number of treatments per patient ranged from 1 to 7. Statistically significant improvements in mean total and domain V-RQOL scores were calculated for every injection (P<.01) (no postinjection questionnaires were available for the seventh injections). The magnitude of the effect remained constant for later injections. Eighty-two percent of the population recorded at least 1 category of improvement in overall self-assessed voice rating with each injection. CONCLUSIONS: Botox has a significant beneficial effect on V-RQOL for at least 6 injection cycles. This study demonstrates the efficacy of Botox for treating patients with adductory spasmodic dysphonia and further illustrates the usefulness and validity of the V-RQOL Measure in evaluating patients with dysphonia.

Adult↗
PubMed2006

The use of a screening questionnaire to determine the incidence of allergic rhinitis in singers with dysphonia.

OBJECTIVES: To report the incidence of allergic rhinitis in singers with nonspecific laryngeal examination findings and to correlate the incidence of allergic rhinitis with their vocal symptoms when present. DESIGN: A retrospective review of all the medical records of singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy between June 2002 and September 2005. SETTING: Specialty voice center. PARTICIPANTS: Forty-five singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy. MAIN OUTCOME MEASURES: A standardized validated questionnaire for evaluation of allergic rhinitis was filled out by all the subjects. A score above 0 was considered positive. RESULTS: The total prevalence of allergic rhinitis was 87% (39 of 45 subjects). The singers with vocal symptoms were approximately 15% more likely to have allergic rhinitis than those with no vocal symptoms (92% vs 84%). Singers with more than 2 vocal symptoms had a 25% higher likelihood of having allergic rhinitis. CONCLUSIONS: The incidence of allergic rhinitis in singers is extremely high. Hidden respiratory allergies may affect the professional voice. Proper awareness and a multidisciplinary approach are indispensable for proper diagnosis and treatment.

Adolescent↗
PubMed1984

Spastic dysphonia and essential (voice) tremor treated with primidone.

Primidone has been reported to be effective in reducing tremor in patients with benign essential tremor. There is at least one report that suggests that the medication may reduce voice tremor, a frequent component of the essential tremor syndrome. Three patients with spastic dysphonia of essential (voice) tremor and one with more typical essential (voice) tremor were treated with primidone and experienced no alleviation in the voice signs. The side effects experienced by all patients were consistent with those noted in previous reports. Primidone does not seem to be effective in treating essential voice tremor or spastic dysphonia of essential voice tremor.

Aged↗
PubMed1986

A new computer-analyzing system for clinical use with a strobo-videoscope.

We introduce a new method for using the computer-analyzing system that deals with a display on a television screen of moving picture frames of the vibrations of vocal folds taken by a stroboscopic videoscope in various voice disorders. The principle of the analyzing system is based on discrimination between the first and second videoscopic images by means of the different intensities of colors. We describe the usefulness of this system in measuring the excursion of the right and left vocal folds, where the glottal transverse diameter and the glottal area are computed and displayed as a function of time.

Computers↗
PubMed1989

Office-based system for voice analysis.

There has been recent growing interest in the analysis of various electronically recorded signals as potential tools for objective assessment of vocal dysfunction. In the past, analysis of such signals required an expensive multitrack FM recorder, mainframe computer system, customized software, and significant time commitment. This report describes an adaptation of commercially available components that allow digital recording of multiple electronic signals, storage of data, and subsequent signal analysis using an inexpensive personal microcomputer system. Commercially available software for manipulation and examination signals is discussed as adapted for examination of glottographic and acoustic signals. The relatively inexpensive availability of similar computer systems will, hopefully, encourage assessment of the clinical applications of objective techniques of voice quality.

Analog-Digital Conversion↗
PubMed1993

Laryngeal reconstruction in children. Assessment of vocal quality.

During the past decade, the outcome of laryngotracheal reconstruction in children has improved substantially regarding airway patency. Now that we feel comfortable with airway results, attention should be directed toward vocal quality. The aims of this article are to present our evaluation process, which has been developed during the past 3 years, and our assessment of results. Six patients who underwent successful laryngotracheal reconstruction and could be examined preoperatively and postoperatively were studied. Information about disease and reconstruction techniques was recorded. Vocal quality assessment was done using psychoacoustic evaluation and objective techniques, including acoustic analysis. Children offer a specific challenge, especially when their chronological or developmental age is younger than 3 years. Objective assessment still lacks the ability of using cooperative patients, and adequate samples for acoustic analysis are difficult to obtain and standardize. Preoperative abnormalities continued to persist postoperatively. Laryngotracheal reconstruction is instrumental in making oral communication possible, but the vocal quality is disturbed in most patients.

Child↗
PubMedDate not supplied

Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.

OBJECTIVE: To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. METHODS: We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. RESULTS: At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). CONCLUSION: Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Adult↗
PubMed2000

Experience with Barton button and peristomal breathing valve attachments for hands-free tracheoesophageal speech.

BACKGROUND: Tracheostoma breathing valves permit hands-free tracheoesophageal (TE) speech production; however, few laryngectomees routinely use them because of problems with attachment. METHODS: We retrospectively reviewed the charts of 45 TE speakers to determine the success rate and factors associated with successful breathing valve use based on attachment. All patients attempted to use a tracheostoma breathing valve with either a standard or customized peristomal housing, or a standard or customized Barton button. Device selection was based on inspection of the patient's neck and peristomal contour. Six to eight consecutive hours of attachment defined success. RESULTS: Overall, 9% of subjects succeeded with any peristomal attachment as compared to 68% with either a standard (57%) or customized (85%) Barton button. Smooth stomal contour, a contiguous stomal lip, and correct button length were important for successful Barton button use. CONCLUSIONS: Standard or customized Barton buttons offer excellent alternatives to peristomal housing attachments for hands-free TE speech in select patients.

Equipment Design↗
PubMed2006

Acid reflux treatment for hoarseness.

BACKGROUND: Acid reflux is a common problem, and is thought to occur in 4% to 10% of patients presenting to ENT clinics. A recent study of reflux and voice disorders suggests that up to 55% of patients with hoarseness (dysphonia) have laryngopharyngeal reflux. Anti-reflux therapy is often used empirically in treating patients with hoarseness, where no other cause has been identified by examination. OBJECTIVES: The aim of the review was to assess the effectiveness of anti-reflux therapy for patients with hoarseness, in the absence of other identifiable causes, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. This was assessed by evaluation of prospective randomised controlled studies that were identified by a systematic review of the literature. Both medical and surgical treatments were evaluated. SEARCH STRATEGY: The Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1974 to 2005) and conference proceedings were searched with prespecified terms. The date of the last search was September 2005. SELECTION CRITERIA: Randomised controlled trials recruiting patients with hoarseness in the absence of other identifiable causes, such as malignancy, cord palsy or nodules, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. DATA COLLECTION AND ANALYSIS: Three reviewers examined the search results and identified studies before deciding which would be included in the review. MAIN RESULTS: 302 potential studies were identified by the search strategy. No trials were identified which met our inclusion criteria. Six randomised controlled trials were identified in which some, but not all patients presented with hoarseness, and were treated with proton pump inhibition. As we could not determine with certainty whether all these patients had hoarseness among the other laryngeal symptoms, these were excluded. However, these studies suggest a significant placebo response, which is comparable to the benefit derived from anti-reflux therapy in some studies. As no trials met our criteria, we are unable to reach any firm conclusions regarding the effectiveness of anti-reflux treatment for hoarseness. AUTHORS' CONCLUSIONS: There is a need for high quality randomised controlled trials to evaluate the effectiveness of anti-reflux therapy for patients with hoarseness which may be due to laryngopharyngeal and gastro-oesophageal reflux.

Gastroesophageal Reflux↗
PubMed2006

The efficacy of voice therapy in patients after treatment for early glottic carcinoma.

BACKGROUND: After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. METHODS: Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. RESULTS: Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. CONCLUSIONS: Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters.

Adult↗
PubMed2005

Normalization of voice in spasmodic dysphonia during transient global amnesia.

We report on the case of a 69-year-old woman with Parkinson's disease and long-standing history of spasmodic dysphonia that reversed during an episode of transient global amnesia (TGA). To our knowledge, this phenomenon has not been reported before. We suggest possible mechanisms by which the pathophysiology of dystonia could reverse during TGA.

Aged↗
PubMed1990

Electroglottogram waveform types of untrained speakers.

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 different groups of speakers. This report compares the electroglottogram waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequencies, intensities and voice qualities with those obtained from 52 untrained non-professional speakers.

Adult↗
PubMed1993

A comparison of bilateral and unilateral botulinum toxin treatments for spasmodic dysphonia.

To assess the efficacy of bilateral or unilateral botulinum treatments for spasmodic dysphonia we injected botulinum toxin (type A) into the thyroarytenoid muscle of 24 patients with adductor type spasmodic dysphonia. Eleven patients underwent unilateral procedures and 13 bilateral procedures. Samples of sustained phonation were analyzed acoustically by a computer-assisted method and the air flow rates determined. All tests were conducted 1 week before injection and 1 week and 1 month after treatment. With unilateral injection, improvements in acoustic parameters occurred as early as 1 week after treatment. With bilateral injections, only the voice break factor was significantly reduced after 1 week, while standard deviations of fundamental frequency, jitter, shimmer and signal-to-noise-ratios were reduced 1 month after treatment. In comparison with unilateral injections, the mean air flow rate was twice as high 1 week after bilateral injections, with no significant differences found 1 month after treatment. Clinically, both injection modes resulted in the reduction of laryngeal spasms as early as within 48 h after injection.

Adult↗
PubMed1978

Physiological model analysis of involuntary human-voice tremor.

Frequency variations in the human voice result from voluntary and involuntary changes in the parameters of the vocal system. The present work deals with involuntary frequency perturbations from two theoretical aspects: 1) the influence of pitch period variations on frequency changes in the band-limited signal which results from the resonant characteristics of the vocal tract; 2) the physiological parameters of the vocal system which are potentially able to govern involuntary frequency changes. It is shown that the modulation function of the vocal-cord wave can theoretically be derived from its harmonics using FM demodulation techniques, and that higher distortion may appear at higher harmonics. It is also shown that involuntary geometirical changes of the vocal tract and its terminal impedance as well as tension and initial-area changes of the vocal cord--changes well within the physiological range--can influence frequency changes in the human voice. The present results are correlated with our reported experimental findings on involuntary voice tremor, used in psychological stress evaluation. The role of the central nervous system, and possible mechanisms for these phenomena, are discussed.

Humans↗
PubMed1986

The laryngeal vestibule and voice quality.

Most of the literature on voice quality focuses on the vocal folds while six other gestures involving the laryngeal entry and epilaryngeal structures are largely ignored. Whole organ tracer series histograms of the larynx are examined and suggestions are made as to which muscles and/or forces might cause these gestures. An examination of photographs of the larynx indicates that the latter must be described in three dimensions: medio-lateral, antero-posterior, and vestibule cross-sectional area. The article is aimed at laryngologists in general, not surgeons in particular, and has implications for laryngology (being a putative model of diagnostic procedures), physiology (what forces create epilaryngeal configurations?), neuroscience (does the motor cortex control single muscles or whole gestures?), speech pathology (what is the ragbag called "hypertenseness"?), linguistics (how is one to describe lower pharynx phenomena?) and paralinguistics (what is the extrasystemic laryngeal component of voice quality?).

Humans↗