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At least 721 records · Page 40Linked to original sources
PubMed1989

New surgical techniques for voice improvement.

Laryngeal framework surgery for improving or changing the voice is a challenging development in phoniatric surgery. Basically two categories can be distinguished: (1) attempted medialization of the vocal fold, as for the treatment of paralytic dysphonias (arytenoid rotation technique and Isshiki's type I thyroplasty); (2) adjustment of the vocal fold's tension to produce changes in vocal pitch, as for the treatment of transsexuals or mutational dysphonia (cricothyroid approximation, Isshiki's type III thyroplasty and LeJeune's anterior commissure laryngoplasty). Both types of surgery are best performed with the patient under local anesthesia so that fine tuning of the voice is possible by monitoring the voice during the surgical procedure. The techniques of arytenoid rotation and Isshiki's type I thyroplasty are described in detail and the result of a combination of these procedures is illustrated by a case history of an aphonic patient with unilateral vagus nerve paralysis and subsequent severe incomplete glottal closure during phonation. In addition, the results achieved in several other patients are presented. Our current experience with laryngoplastic surgery and its variations is such that endolaryngeal Teflon or collagen injections are no longer used in our department. To date, we have seen no complications from the laryngoplasties and the voice results have been excellent.

Adult↗
PubMed1991

Laryngeal configuration of 99 dysphonic patients.

The aim of this investigation was to study a wide range of dysphonic patients and determine the best matches among the laryngeal configurations on phonation for each patient and those previously established for control data, which were obtained from a professional voice user producing the whole range of voice qualities. Ninety-nine patients were selected and laryngeal photographs were produced for each patient. Fifteen laryngeal parameters were quantified and normalized. The data were sorted, scalar values assigned and a measure of similarity between configurations applied. The best, second-best, third-best and worst matches between each patient separately and the control data were then examined. Although 41% of the patients did not have particularly unusual configurations, 59% exhibited a narrowing of the laryngeal vestibule caused by epiglottic retraction, cuneiform fronting and/or false fold adduction. This suggests that clinical reports for patients with dysphonia should contain information not only on any lesions present but also on laryngeal configurations and, in particular, vestibular narrowing.

Humans↗
PubMed1997

Effects of botulinum toxin on vocal tract steadiness in patients with spasmodic dysphonia.

Since laryngeal botulinum toxin (BTX) injections have become the treatment of choice for spasmodic dysphonia, the purpose of this study was to examine its effects on the stability of the upper vocal tract as compared to the effects on glottic stability. Two different acoustic methods were used to analyze voice samples from 16 patients with adductor-type spasmodic dysphonias before and after BTX therapy and from a normal control group. Independent acoustic analyses were used to determine laryngeal and upper vocal tract stability. The results showed significantly higher values for the standard deviation of fundamental frequency (SDF0), reflecting laryngeal instability, for the patient group than for the control group and an impressive improvement for the patients after BTX therapy. Further, the equally high values of SDF0 for the initial second and a second from the midsegment of phonation were differentially reduced by BTX therapy, resulting in a normal pattern of laryngeal stability during sustained phonation. The variability of the first and second formants, reflecting upper vocal tract instability, showed higher values for the patients compared with the control group, but this difference was not statistically significant. The present findings showed that BTX injections to the thyroarytenoid muscle had no discernible effect on stability of the upper vocal tract.

Adult↗
PubMed2006

Voice quality assessment after laryngeal cancer radiotherapeutic treatment at initial stages.

INTRODUCTION: The voice quality resulting from the radiotherapeutic treatment is a relevant factor to take into consideration at the time of evaluating the results. In this study the results of an objective assessment in relation to the vocal function and the patients' voice self-evaluation are presented. MATERIALS AND METHODS: 18 glottic tumour patients, at initial stage, treated with radiotherapy, were studied. There were made an objective analysis on the voice and a study on the perceived quality both by the examiners and the patients. RESULTS: Normal voices were observed in the 11%, slight dysphonias in 44.4%, moderate dysphonias in 27.8% and severe dysphonias in 16.7% of the cases. Spectrographically, the 18 samples were classified as Grade I one case (5.5%), Grade II 7 (38.8%), Grade III 5 (27.7%) and Grade IV 5 (27.7%). The questionnaire Voice Handicap Index which was completed by the patients themselves, gave out results values very close to normality. CONCLUSIONS: the patients voice acoustic analysis of the series shows the damage thereof after the radiotherapeutic treatment is minimum as well as the handicap feeling of the T1 laryngeal carcinoma patients treated with radiotherapy.

Aged↗
PubMed2003

[Reinke edema--helpful in unilateral recurrent laryngeal nerve paralysis?].

We report on a 57-year-old teacher who consulted us for her known unilateral recurrent nerve paralysis subsequent to strumectomy. Video laryngoscopic and stroboscopic examinations revealed Reinke's edema in addition to the left-sided immobile vocal fold with maintenance of good vocal function. Because of the left-sided Reinke's edema, complete glottal closure was possible although the left vocal ligament remained slack. Surgical removal of the vocal fold edema in this case would presumably result in considerable impairment of vocal function. This example illustrates that in selected cases Reinke's edema can contribute to maintenance of phonation in unilateral vocal fold paralysis. In these cases, indication for edema surgery should be very restrictive and should always take the vocal function into consideration.

Female↗
PubMed2006

[On the auditory evaluation of voice quality].

BACKGROUND: For routine clinical purposes, dysphonic voices are assessed perceptually using the GRBAS scale or analogues. For clinical application, the crucial question is the interrater reliability (IRR) of the auditory perceptual assessment of voice quality. Therefore, the IRR of the four point RBH (roughness, breathiness, hoarseness vs overall grade) scale was studied. Other parameters, e.g. validity and intrarater reliability were not considered. METHODS: A total of 78 patients read a standard text "Der Nordwind und die Sonne". These samples were evaluated by 19 speech and voice therapy students according to the degree of roughness, breathiness and hoarseness. Data were subjected to reliability analysis. RESULTS: Our data indicate a high IRR with a Cronbach's alpha of 0.94. No single rating of the 19 raters could be omitted without decreasing the IRR. DISCUSSION: The data indicate that the perceptual assessment of hoarseness for running speech is highly reliable. The application of the RBH scale is suitable for clinical purposes. It should be considered as an outcome measure.

Adolescent↗
PubMed2007

[Long-term results after microlaryngoscopic removal of Reinke's edema].

BACKGROUND: In the case of Reinke's edema, the usual aim of microlaryngoscopic vocal fold stripping is an improvement of voice quality. Long-term results concerning functional voice quality in the literature vary widely. Whether and to what degree surgical intervention leads to the desired postoperative results is therefore still an open question. Therefore we conducted a follow-up study to review our own treatment results. MATERIALS AND METHODS: We questioned 88 patients treated for Reinke's edema, either orally or by means of a written questionnaire, 6 months to 7 years (mean: 3.5 years) after the operation (longitudinal incision, removal of the edema by suction, resection of surplus vocal cord mucosa), asking about postoperative voice quality and subjective impression of how successful the operation had been. In all 63 patients answered the questionnaire; 16 agreed to undergo follow-up laryngostroboscopy. RESULTS: 51 patients (81%) reported a postoperative improvement in voice quality, 8 patients (13%) rated their voice quality as unchanged, and 4 patients (6%) complained of deterioration in their voice quality. Among the patients whose voices were subject to professional strain (n=27) a lower proportion experienced successful results (voice quality improved: 71%; unchanged: 21%; worse: 8%) than among patients without vocal strain (n=36; improved: 86%; unchanged: 11%; worse: 3%). Postoperative elimination or restriction of such etiological factors as smoking and vocal strain also improved the long-term results. Follow-up examination in 16 patients revealed a good correlation between the patients' subjective reports and the stroboscopic and auditory findings. CONCLUSION: Patients should be selected very carefully for surgical treatment of Reinke's edema. The elimination of etiological factors is of highly significant in terms of the prognosis. Before surgery patients should be fully informed of how uncertain the prognosis is.

Adult↗
PubMed1996

[Acoustic voice analysis. On documentation of voice rehabilitation after laser surgery laryngeal carcinoma resection].

Following curative minimal-invasive laser resection of T1-T3 laryngeal carcinomas, patients were subjected to an intensive voice rehabilitation. Therapy was effected twice a day for approximately 2 months, utilizing the concept of functional voice therapy. Before and after rehabilitation, acoustic analyses were made by using two different computer-supported measuring systems: (1) the "multidimensional voice program" (Kay Elementrics Corp.) and (2) a novel software program developed in Göttingen that includes a new voice quality parameter based on correlations between frequency bands. Acoustic analyses showed superiority of the glottal versus supraglottal compensatory phonation. Findings showed that not all acoustic parameters equally documented voice improvement after rehabilitation. The standard deviation of fundamental frequency was the only parameter showing a significant post-therapeutic improvement. A further suitable acoustic method proved to be the voice quality parameter that has been newly introduced by us. In contrast to analogous parameters of other methods, this approach is independent of the exact periodicity of the glottal excitation function, thus permitting reliable results to be obtained even with aphonic or heavily dysphonic voices.

Aged↗
PubMed1996

[Computer-assisted 3D phonetography].

Profiles of fundamental frequency sound pressure levels and voice duration are measured separately in clinical practice. It was the aim of the present study to combine the two examinations, in order to estimate the relationship between pitch, sound pressure level and voice duration and to develop a new computer-assisted graph. A three-dimensional (3D) wireframe phonogram was constructed based on SPL profiles to obtain a general view of the parameters recorded. We have termed this "phonetography". Variable further projections were selected for the analysis of different aspects of parametric relationships. The results in 21 healthy volunteers and 4 patients with hyperfunctional dysphonias demonstrated that there were three typical figures of the 3D phonograms produced, depending on the relationship between voice duration when soft ("piano") compared to loud ("forte"). In one-third of the healthy volunteers, the values of the piano voice duration were greater than those of forte for almost all pitches examined. In two-thirds of the healthy subjects the values of forte voice duration were partly greater, as were those of piano voice duration. All of the patients showed voice duration values greater for forte than for piano. The results of the study demonstrate that the 3D phonogram is a useful tool for obtaining new insights into various relationships of voice parameters.

Adolescent↗
PubMed1999

[Phoniatric studies in myasthenia gravis patients].

The authors have for the first time evaluated the basic parameters of the voice using computed voice analysis in patients with myasthenia gravis (MG). The aim of the study was to introduce an objective method suitable for the assessment of dysphonic symptoms, which predominate in bulbar, oculobulbar and generalized MG. Voice profile studies included the evaluation of the singing voice range, voice dynamics, maximum phonation time, and mean fundamental frequency and intensity during speech. The characteristic of the stroboscopic picture was also determined. Investigations were carried out before and after the intake of Mestinon, a reversible cholinesterase inhibitor, and healthy subjects were used as a control group. In MG, the voice range and dynamics are badly impaired, maximum phonation time is shortened, the mean fundamental frequency during speech is increased, while the intensity is decreased. Mestinon resulted in an improvement in all these parameters, however, they were still impaired in comparison to the control subjects. Most changes were found to be statistically significant. The authors emphasize the role of the otolaryngologist and objective phoniatric methods in the evaluation of MG and other myasthenia-like neurological diseases. The use of these methods for the assessment of phoniatric symptoms in neurological diseases is highly recommended.

Adult↗
PubMed2001

[Voice change and laryngeal obstruction caused by a median thyroglossal duct cyst].

Thyroglossal duct cysts are common primary neck tumors, resulting from remnants of the ductus thyroglossus. They can occur at any point along the migratory path of the thyroid gland anlage until the 2nd or 3rd decade of life. The usual symptoms leading to the diagnosis are painless midline neck masses orfistulas. Despite their close proximity, the cysts normally do not affect the larynx. We report on the eighth case mentioned in the world literature of a thyroglossal duct cyst invading the larynx in a 62-year-old patient. Preoperatively, the voice of the patient sounded metallic, and the frequency of the voice field was reduced. Postoperatively, the voice onset was physiological, and the voice increased by an octave in the higher frequencies. The intonation of the voice was steady. The analysis of formants of the vowels "a" and "i" showed that the fourth formant of the vowel "i" was lower in frequency postoperatively.

Follow-Up Studies↗
PubMed2003

Postlaryngectomy voice rehabilitation: state of the art at the millennium.

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced laryngeal/hypopharyngeal carcinoma, either as a primary procedure or as salvage following irradiation alone or concurrent chemoradiation therapy. Over the past 25 years there has been significant improvement in the rehabilitation of these patients, with speech restoration that has dramatically altered and improved their quality of life. This article reviews postlaryngectomy voice rehabilitation with a historical background as well as the present state-of-the-art tracheoesophageal shunt voice with an artificial valve. Finally, this article reviews and compares artificial valve prostheses as to their voice characteristics, patient satisfaction, complications associated with the procedure, and devices used at a center in Europe (The Netherlands Cancer Institute, Amsterdam) and a North American center (The Wharton Head and Neck Center, Princess Margaret Hospital, University of Toronto, Canada).

Female↗
PubMed2004

Evaluation of the patient with hoarseness.

Hoarseness has a broad range of etiologies, and in most cases a diagnosis can be made by recording an accurate history and by conducting a thorough physical examination. This paper will present an overview of the more common voice disorders and explain in which cases imaging studies such as computed tomography or magnetic resonance imaging are necessary. The essential imaging features will be discussed.

Adult↗
PubMed2002

Voice results in patients with T1a glottic cancer treated by radiotherapy or endoscopic measures.

Early squamous cell carcinomas of the glottis can be treated effectively by means of surgery or external beam radiotherapy. The curability rate is about the same for both treatment modalities, but differing results have been reported regarding functional results. We selected 24 patients from a larger group of patients who had been treated for T1a glottic laryngeal cancer without the involvement of the anterior commissure. Fifteen patients were treated endoscopically and nine by radiotherapy. During a routine control videolaryngostroboscopy at an outpatient clinic, an objective and a subjective voice analysis were performed. The objective and subjective voice analyses showed no differences between the two treatment modalities. Videolaryngostroboscopy showed a significantly more pronounced glottic wave at the side that was originally affected by the tumour in the radiotherapy group. This difference disappeared when we looked at both vocal cords. Significant differences between the two treatment modalities were not found in any of the other parameters. Thus, this study shows no difference in the voice quality of patients treated by irradiation or by endoscopy. Therefore, the post-treatment voice quality is not a reason to favour radiotherapy for small T1a glottic squamous cell cancers without involvement of the anterior commissure.

Carcinoma, Squamous Cell↗
PubMed2004

Objective evaluation of the quality of substitution voices.

This paper describes our first attempts to develop a method for the objective assessment of quality in substitution voices. The objective analysis deals with acoustic parameters characterising short voice and speech samples like a sequence of isolated vowels, a sequence of VCV and CVCVCV syllables, a short sentence, etc. A database of 113 registrations from 68 patients (53 total laryngectomy patients with tracheo-esophageal speech, 14 total laryngectomy patients with esophageal speech and 5 patients with partial frontolateral laryngectomy) and 6 registrations from healthy control persons was collected. Each registration consisted of seven speech utterances and was subjected to an acoustic analysis as well as to a perceptual evaluation, the latter involving eight parameters like "overall impression", "tonicity", etc. Since the goal of our work is to find out the best acoustical measurement for supporting perception and making it precise, it seemed logical to strive for a perceptually based acoustic analysis. We therefore performed the analysis by means of a peripheral auditory model with a built-in fundamental frequency (pitch) extractor. From the frame-level outputs (a frame is 10 ms) of the analyser, global objective parameters, such as (1) the percentage of voiced frames, (2) the average voicing evidence, (3) the voicing length distribution and (4) the fundamental frequency jitter, were computed for the different speech utterances. So as to reduce the parameter variability arising from the nature of the speech utterances (e.g., the presence of pauses in the signal, errors caused by the pitch extractor, etc.), the objective parameters were computed using non-standard averaging schemes involving energy weighting and frame selection. A statistical analysis of the objective parameters confirms that the quality of tracheo-esophageal speech is superior to that of esophageal speech, but inferior to that of normal speech and speech with the preservation of one vocal fold. Correlations between the objective parameters and the perceptual parameters are moderate.

Follow-Up Studies↗
PubMed2004

Health status and voice outcome after treatment for T1a glottic carcinoma.

Radiotherapy as well as endoscopic laser surgery as the most widely used treatment modalities for T1a glottic carcinoma cause minor morbidity and negligible mortality and result in more or less comparable, excellent cure and larynx preservation rates. Therefore, other outcome measures such as voice-related problems and health status are important factors in the choice of treatment for T1a glottic cancer. The present study focuses on voice-related problems in the daily life of patients treated by radiotherapy or endoscopic laser surgery for T1a glottic cancer. Self ratings on health status assessed by means of COOP/WONCA health status charts and voice problems evaluated with a validated voice-specific questionnaire (the Voice Handicap Index) and overall judgment on voice quality were obtained. A total of 102 patients (56 treated by endoscopic laser surgery and 46 treated by radiotherapy) with at least 1-year follow-up were included. Response scores were high: 52 (93%) patients after endoscopic laser surgery versus 40 (87%) patients after radiation therapy completed and returned the questionnaires. A high percentage of patients reported voice problems in daily life: 58% of the patients following radiotherapy and 40% of the patients following endoscopic treatment had abnormal VHI scores. The difference between both treatment modalities proved to be significant. No significant differences were found concerning health status or overall judgment of voice quality. Moderate correlations were found between total VHI score and voice quality judgment and the COOP/WONCA social activities chart. This study reveals that treatment for T1a glottic cancer often does result in voice problems in daily life, negatively influencing patients social activities. Patients selected for endoscopic laser surgery on average report fewer voice-related problems than those who underwent radiotherapy.

Adult↗
PubMed2003

The reliability of three perceptual evaluation scales for dysphonia.

Perceptual rating scales are widely used in voice quality assessment, yet apart from the GRBAS scale, their reliability has been poorly demonstrated. There are no studies that have compared the optimal reliability of experienced judges using different auditory rating scales in a controlled experimental environment. This study aimed to assess the reliability of three common scales (The Buffalo Voice Profile, The Vocal Profile Analysis Scheme (VPA) and GRBAS. Sixty-five varyingly dysphonic and five normal voices were recorded onto CD in random order. Thirty voices were recorded twice. Seven experienced and trained speech and language therapists rated all voices on the three scales. Only the overall grade was found to be reliable for the Buffalo Voice Profile. The reliability of the VPA scheme was found to be poor to moderate. The VPA may have a use as a multi-dimensional and in-depth evaluation of voice types, but its greater scope is at the expense of reliability. The GRBAS was reliable across all parameters except Strain. Our detailed reliability analysis comparing performance of three commonly used rating scales provides further evidence to support the GRBAS as a simple reliable measure for clinical use.

Adolescent↗