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At least 811 records · Page 45Linked to original sources
PubMed2006

Subjective and objective evaluation of voice quality in patients with asthma.

OBJECTIVES: To evaluate the voice quality in patients with mild-to-moderate asthma by subjective and objective methods. STUDY DESIGN: Comparative, controlled, cross-sectional study. METHODS: Patients with mild-to-moderate asthma (n=40) and age- and sex-matched healthy controls (n=40) were included. Acoustic analyses were performed by the Multi-Dimensional Voice Program (MDVP; Kay Elemetrics Corporation, Lincoln Park, NJ) and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). In addition, the duration of illness, maximum phonation time, "s/z" values, and vital capacity were evaluated. Voice Handicap Index (VHI) and GRB scales were used for subjective evaluations. RESULTS: Maximum phonation time values were significantly shorter both in male and female asthma patients compared with controls (P<0.0001). Also, average shimmer values in MDVP were higher for both sexes in the patient group compared with controls (P=0.002 and P=0.04, respectively). There was a significant difference between female patients and sex-matched controls with regard to mean noise-to-harmonic ratio values (P=0.006). Female patients with asthma had higher average jitter values compared with sex-matched controls (P<0.0001). A significant difference was noted between asthma and control groups with regard to GRB scale (P<0.0001, P<0.001, and P<0.0001, respectively). The VHI score was above the normal limit in 16 (40%), and VLS findings were abnormal in 39 (97.5%) asthmatics. CONCLUSION: In asthmatic patients, maximum phonation time, frequency, and amplitude perturbation parameters were impaired, but the vital capacity and the duration of illness did not correlate with these findings.

Adult↗
PubMed2006

Evolution of vocal fold nodules from childhood to adolescence.

SUMMARY: Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Society-protocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n=91) had voice complaints persisting into postpubescence with a statistically significant difference (P <or= 0.001) between boys (8%) and girls (37%). VFNs were still present in 47% of the girls and 7% of the boys of the clinically evaluated group (n=34). Analysis of the data before and after puberty shows that the variables gender, allergy, and degree of dysphonia ("G") in childhood enable a fairly correct prediction of persisting voice complaints in adolescence (sensitivity of 89% and specificity of 67%). The results of this study show a clearly different evolution for both sexes, with significant higher long-term risks for dysphonic girls with allergy.

Adolescent↗
PubMed2006

The voice handicap of student-teachers and risk factors perceived to have a negative influence on the voice.

A cross-sectional questionnaire survey was performed. The objectives of the study were to assess the psychosocial impact of current voice complaints as perceived by student-teachers with voice complaints in comparison with student-teachers without voice complaints, and to observe the pattern of risk factors in relation to their voice handicap. Subjects in the general population without a voice-demanding profession were selected as a reference group for limited comparison with the total group of student-teachers (future professional voice users). The respondents to the questionnaires were anonymous. Among the student-teachers, 17.2% reported current voice complaints in comparison with 9.7% of the reference group, and the odds ratio was 1.94, which showed the relative risk. Student-teachers had significantly greater total Voice Handicap Index (VHI) scores than the reference group (P = 0.034). The VHI subscale scores were not significantly different (P > 0.05). Student-teachers who reported current voice complaints had a significantly higher total VHI and subscale scores than student teachers without voice complaints (P < 0.001). Of the student-teachers without voice complaints, 17.0% had VHI scores greater than the 75th percentile. These persons may be neglecting their voice handicap and probably represent the false-negative cases in the estimation of voice complaints. Logistic regression analysis of each of the given risk factors with the VHI as the independent variable showed that the perceived negative influence of the given risk factors on their voices was significantly greater with increasing VHI scores across the VHI range. A significant correlation was observed between the number of perceived risk factors and increasing VHI scores across the VHI range. An increased awareness of risk factors in relation to their voice handicap would serve to motivate student-teachers to change factors that contributed to their voice problem. Attention to all risk factors, which the subjects perceive to be a risk, would aid in effective management of their voice handicap.

Adult↗
PubMed2006

Psychosocial impact of the teacher's voice throughout the career.

It is generally accepted that vocal performance decreases with age. This decrease can be expected to be more pronounced in voice loading professions, which may lead to occupational dysphonia. The aim of this study was to investigate the course of voice complaints, experienced handicap, and absenteeism of work due to voice problems throughout the teaching years. Questionnaires were distributed among teachers of primary and secondary education, and 1875 were analyzed. The questionnaire was designed in such a way that personal aspects and questions about periods with symptoms and absence from work were included. The Voice Handicap Index (VHI) developed by Jacobson et al was sent along with the questionnaire. Surprisingly, a significant decrease of voice complaints during the career of the teachers was observed. The expectation that the percentage of teachers with a history of voice problems should experience more psychosocial impact, measured with the VHI, along their professional career could not be confirmed by this study. These results indicate that serious attention has to be paid to teachers with voice complaints. The fact that teachers in the beginning of their career complain more than in the end of their career emphasizes the importance of adequate aimed prevention programs for future teachers and for starting teachers with regard to their voice.

Adult↗
PubMed2006

The psychosocial consequences of BOTOX injections for spasmodic dysphonia: a qualitative study of patients' experiences.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to examine the psychosocial consequences of BOTOX (Allergan, Inc. Irvine, CA) treatment for spasmodic dysphonia (SD). This article also explores how patients judge the success of treatment and make decisions about future treatment based on psychosocial issues relevant to them. STUDY DESIGN: This study follows the phenomenological tradition of qualitative inquiry in which the objective is to explore the lived experiences of a group of persons who share a common phenomenon, in this case receiving BOTOX injections for SD. METHODS: Six adults with SD who had been receiving BOTOX injections on a long-term basis participated in face-to-face interviews. The interviews were recorded, transcribed, and analyzed according to phenomenological guidelines to identify consistent themes as well as differences among participants' experiences. RESULTS: The results are summarized in three primary themes that suggest (1) participants' experiences vary over time based on changes in factors such as lifestyle and personal priorities; (2) BOTOX has multidimensional psychosocial implications in physical, personal, and social domains; and (3) participants individualize their treatment regimens, taking into consideration the burden of treatment, scheduling priorities, and other strategies to maximize the benefits of BOTOX. CONCLUSIONS: Based on this study, suggestions are provided for future research into a psychosocial outcome measurement, including longitudinal evaluations that accommodate changing patient priorities over time; multidimensional evaluations that incorporate physical, personal, and social issues; evaluations that include a measure of the burden of treatment; and evaluations that support a shared decision-making model with the voice clinicians.

Aged, 80 and over↗
PubMed2006

Effect of fasting on voice in women.

OBJECTIVE/HYPOTHESIS: To study the effect of fasting on voice in women: abstinence from food and water intake between 14 and 18 hours. STUDY DESIGN: A prospective study on female subjects. MATERIAL AND METHOD: A total of 28 female subjects were included in this study. Their age ranged between 21 and 45 years. Subjects with vocal symptoms or vocal fold lesions were excluded. The subjects were tested when they were not fasting and while fasting after the first week of intermittent fasting during Ramadan. Each subject was first asked about her vocal symptoms and the ease of phonation or phonatory effort. Then each underwent acoustic analysis and laryngeal video-endostroboscopy. RESULTS: Vocal fatigue was the most common reported complaint (53.6%) followed by deepening of the voice (21.4%) and harshness (10.2%). Self-reported phonatory effort was significantly affected by fasting (P value < 0.001). Out of the 28 subjects, 23 had an increase in their phonatory effort. Vocal acoustic parameters did not change markedly except for the maximum phonation time, which decreased significantly. Laryngeal video-endostroboscopy did not reveal any significant changes during fasting. All stroboscopic parameters were the same except for a decrease in the amplitude of the mucosal waves in one subject and the presence of a posterior chink in three subjects. CONCLUSION: Fasting affects voice. There is an increase in the phonatory effort, and vocal fatigue is the most common symptom.

Adult↗
PubMed2006

Protocol challenges for on-the-job voice dosimetry of teachers in the United States and Finland.

The occupational voice use of teachers has been an important research topic over the last 10 years. However, data collection on vocal loading in teachers at and away from the workplace poses significant challenges to the research protocol. The challenges include recruitment of subjects, voice data collection on the job, and subject compliance and retention. The present article offers recommendations for coping with these protocol difficulties. The recommendations are based on the authors' experiences with long-term, on-the-job voice dosimetry of large subject groups of teachers in the United States and Finland.

Clinical Protocols↗
PubMed2006

Vocal evaluation in teachers with or without symptoms.

The aim of this study was to perform voice evaluation in teachers with and without vocal symptoms, identifying etiologic factors of dysphonia, voice symptoms, vocal qualities, and laryngeal lesions. Eighty teachers were divided into two groups: GI (without or sporadic symptoms, 40) and GII (with frequent vocal symptoms, 40). They answered a specific questionnaire, and were subject to a perceptual vocal assessment (maximum phonation time, glottal attack, resonance, coordination of breathing and voicing, pitch, and loudness), GIRBAS scale, and to videolaryngoscopy. Females were predominant in both groups, and the age range was from 36 to 50 years. Elementary teachers predominated, working in classes with 31-40 students. Voice symptoms and alterations in the perceptual vocal analysis and in the GIRBAS scale were more frequent in GII. In 46 teachers (GI-16; GII-30), videolaryngoscopy exams were abnormal with the vocal nodules being the most frequent lesions. These results indicate that a teacher's voice is compromised, and requires more attention including control of environmental factors and associated diseases, preventive vocal hygiene, periodic laryngeal examinations, and access to adequate specialist treatment.

Adult↗
PubMed2006

The voice handicap index: correlation between subjective patient response and quantitative assessment of voice.

The aim of this prospective study is to elucidate the relationship between the Voice Handicap Index (VHI) and several voice laboratory measurements in the network of the multidimensional voice assessment. Fifty-eight patients were included. Each patient replies to the questionnaire and performs a voice assessment during the same time. The following parameters were measured: minimum frequency, maximum frequency, range, minimum intensity, subglottic pressure, mean flow, maximum phonation time, jitter, and dysphonia severity index. Regarding the relationship with the scores of the VHI, poor correlations with the minimal frequency for all the scores except the emotional one (total and subscales) and with the range for only the physical one are found. Seventeen questions correlate with the voice laboratory measurements we performed, with a decreased distribution between physical, functional, and emotional subscales. We observe that acoustic parameter is correlated with the emotional subscale, the parameters of the profile range are more often involved in the emotional subscale, as is the minimal frequency, but never with the physical subscale, and all the subscales are interesting despite the smaller number of differences with the emotional one. The VHI and the laboratory measurements give independent informations in practice.

Adolescent↗
PubMed2006

Objective and subjective evaluation of voice quality in multiple sclerosis.

The aim of this comparative, controlled, cross-sectional study is to evaluate the voice quality in patients with multiple sclerosis (MS) by subjective and objective methods. Female patients with MS (n=27) and age- and sex-matched healthy controls (n=27) were included in this study. Vocal functions were evaluated by a multidimensional set composed of videolaryngostroboscopic examination, acoustic analysis, and subjective measurements (GRBAS and "Voice Handicap Index"). Jitter percent, shimmer percent, and soft phonation index (SPI) values were higher in MS patients compared to controls (Jitt, P=0.001; Shim, P=0.033; SPI P<0.0001). Maximum phonation time was significantly shorter for MS patients compared to controls (P<0.0001). Stroboscopic examination revealed that 16 out of 27 MS patients have a "posterior chink" as glottic closure pattern with higher SPI values (40%). Noise to harmonic ratio (NHR) and mean fundamental frequency (F0) values were similar for MS and control groups (NHR, P=0.737; F0, P=0.976). In this study, most of the MS patients had dysphonia due to weakness of voice. MS tends to worsen acoustic parameters including fundamental frequency, SPI, and jitter values. These results are consistent with the more asthenic voice quality observed in MS group.

Adult↗
PubMed2006

Effect of deep brain stimulation on different speech subsystems in patients with multiple sclerosis.

The effect of deep brain stimulation on articulation and phonation subsystems in seven patients with multiple sclerosis (MS) was examined. Production parameters in fast syllable-repetitions were defined and measured, and the phonation quality during vowel productions was analyzed. Speech material was recorded for patients (with and without stimulation) and for a group of healthy control speakers. With stimulation, the precision of glottal and supraglottal articulatory gestures is reduced, whereas phonation has a greater tendency to be hyperfunctional in comparison with the healthy control data. Different effects on the two speech subsystems are induced by electrical stimulation of the thalamus in patients with MS.

Adult↗
PubMed2006

Voice-related Quality of Life in laryngectomees: assessment using the VHI and V-RQOL symptom scales.

The primary purpose of this study was to investigate the effect of the voice impairment across the physical, emotional, and functional domains in patients using valved speech following total laryngectomy with the help of two symptom specific scales. The study design used was a cross-sectional cohort. The setting was the Head and Neck Oncology Unit of a tertiary referral centre. Subjects were 54 patients who had undergone total laryngectomy. Two voice-specific questionnaires, the Voice-Related Quality of Life (V-RQOL-short form) Measure, and the Voice Handicap Index (VHI-long form) were used. The main outcome measure was patient perception of the voice following total laryngectomy in response to specific questions correlated with sociodemographic/treatment factors. Responses were received from 40 males and 14 females (response rate of 85.7%) with a median age of 63.4 years (range: 37-84). The V-RQOL overall analysis showed that 3 patients (5.6%) scored "excellent," 29 patients (53.7%) "fair to good," 14 patients (25.9%) "poor to fair," and 8 patients (14.8%) "poor." Analysis of the VHI revealed that 20 patients (37.0%) had a minimal handicap, 20 patients (37.0%) a moderate handicap, and 14 patients (25.9%) had a serious voice handicap. The individual domain or subscale scores for the VHI revealed a mean (SD) functional score of 15.8 (7.7), a physical score of 13.6 (7.2), and finally an emotional score of 11.6 (8.9). Functional aspects of the voice were significantly affected by age, radiotherapy, and chemotherapy (Spearman rho, P=0.01; Mann-Whitney, P=0.04 and P=0.01). The physical aspects of the voice were significantly affected by age and chemotherapy (Spearman rho, P=0.004; Mann-Whitney, P=0.04). Only age significantly affected the emotional aspects of the voice (Spearman rho, P=0.002). We found a strong correlation (Spearman rho, P<0.001) between the V-RQOL and VHI questionnaires. Our study revealed that the V-RQOL and VHI scores in our series of patients following voice restoration in laryngectomees were consistent with that reported in the literature. Only age, radiation, and chemotherapy were seen to influence the voice handicap scores. In addition, both symptom scales had good correlation between them and either one could be used with reliability in laryngectomees with a few modifications.

Adult↗
PubMed2006

Functional analysis of voice using simultaneous high-speed imaging and acoustic recordings.

We present a comprehensive, functional analysis of clinical voice data derived from both high-speed digital imaging (HSDI) of the larynx and simultaneously acquired acoustic recordings. The goals of this study are to: (1) correlate dynamic characteristics of the vocal folds derived from direct laryngeal imaging with indirectly acquired acoustic measurements; (2) define the advantages of using a combined imaging/acoustic approach for the analysis of voice condition; and (3) identify new quantitative measures to evaluate the regularity of the vocal fold vibration and the complexity of the vocal output -- these measures will be key to successful diagnosis of vocal abnormalities. Image- and acoustic-based analyses are performed using an analytic phase plot approach previously introduced by our group (referred to as 'Nyquist' plot). Fast Fourier Transform (FFT) spectral analyses are performed on the same data for a comparison. Clinical HSDI and acoustic recordings from subjects having normal and specific voice pathologies, including muscular tension dysphonia (MTD) and recurrent respiratory papillomatosis (RRP) were analyzed using the Nyquist plot approach. The results of these analyses show that a combined imaging/acoustic analysis approach provides better characterization of the vibratory behavior of the vocal folds as it correlates with vocal output and pathology.

Humans↗
PubMed2006

Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL).

The purpose of this study was to investigate the correlation between the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL), and to test conversion of scores between the two instruments. Understanding the relationship between instruments will facilitate comparison of voice outcome studies using different measures. A retrospective medical chart review of 140 consecutive patients with a chief complaint related to their voice presenting for speech pathology voice evaluation following laryngology evaluation and diagnosis was adopted. Each patient who filled out the VHI and V-RQOL within a 2-week period with no intervening treatment was included in the study. Correlation analysis for total scores was performed for the patients meeting inclusion criteria (n=132). Correlations were also performed as a function of diagnosis. Calculated VHI score based on measured V-RQOL score was compared to measured VHI score. Pearson correlation between scores on the VHI and V-RQOL was -0.82. There was no significant difference between the mean measured and mean calculated VHI scores. For individual scores, however, regression analysis did reveal a significant difference between calculated and measured VHI. The VHI and V-RQOL are highly correlated; however, this study suggests that the two instruments are not interchangeable for individuals.

Disability Evaluation↗
PubMed2006

Fundamental frequency change during offset and onset of voicing in individuals with Parkinson disease.

SUMMARY: After years of treatment with the medication levodopa, most individuals with Parkinson disease (PD) experience fluctuations in response to their medications. Although relatively consistent perceptual voice improvements have been documented to correspond with these fluctuations, consistent quantitative data to support this finding are lacking. This mismatch may have occurred because most of this phonation research has centered on long-term phonatory measures (ie, across speaking samples and prolonged vowel tasks). The current study examined short-term phonatory behavior in individuals with PD, specifically examining fundamental frequency (F0) at the offset and onset of phonation, before and after a voiceless consonant. The F0 analysis at phonatory offset supported the conclusion that individuals with PD have difficulty with the rapid offset of voicing, and that they are stopping vocal fold vibration primarily through vocal fold abduction (without adding tension). The F0 analysis at phonatory onset revealed that all groups use some laryngeal tension at the initiation of voicing. The tension was lowest for the PD participants who were in their OFF medication state, and it was highest for the age-matched control participants and the PD participants in their ON medication states.

Aged↗
PubMed2006

Vocal improvement after voice therapy in unilateral vocal fold paralysis.

Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.

Adolescent↗
PubMed2006

Changes in objective acoustic measurements and subjective voice complaints in call center customer-service advisors during one working day.

SUMMARY: The aim of this study was to investigate how different acoustic parameters, extracted both from speech pressure waveforms and glottal flows, can be used in measuring vocal loading in modern working environments and how these parameters reflect the possible changes in the vocal function during a working day. In addition, correlations between objective acoustic parameters and subjective voice symptoms were addressed. The subjects were 24 female and 8 male customer-service advisors, who mainly use telephone during their working hours. Speech samples were recorded from continuous speech four times during a working day and voice symptom questionnaires were completed simultaneously. Among the various objective parameters, only F0 resulted in a statistically significant increase for both genders. No correlations between the changes in objective and subjective parameters appeared. However, the results encourage researchers within the field of occupational voice use to apply versatile measurement techniques in studying occupational voice loading.

Adult↗
PubMed2006

The effect of tonal changes on voice onset time in Mandarin esophageal speech.

SUMMARY: The present study investigated the effect of tonal changes on voice onset time (VOT) between normal laryngeal (NL) and superior esophageal (SE) speakers of Mandarin Chinese. VOT values were measured from the syllables /pha/, /tha/, and /kha/ produced at four tone levels by eight NL and seven SE speakers who were native speakers of Mandarin. Results indicated that Mandarin tones were associated with significantly different VOT values for NL speakers, in which high-falling tone was associated with significantly shorter VOT values than mid-rising tone and falling-rising tone. Regarding speaker group, SE speakers showed significantly shorter VOT values than NL speakers across all tone levels. This may be related to their use of pharyngoesophageal (PE) segment as another sound source. SE speakers appear to take a shorter time to start PE segment vibration compared to NL speakers using the vocal folds for vibration.

Aged↗