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At least 847 records · Page 47Linked to original sources
PubMed2004

Evidence-based treatment of paralytic dysphonia: making sense of outcomes and efficacy data.

The criteria used to determine the success or failure of a given treatment for vocal fold paralysis are fundamental components of routine clinical practice and treatment outcomes research for the surgeon and voice therapist. The purpose of this article is to offer a guide to the critical interpretation of available measures of out-come and efficacy for this patient population. Such data form the basis for the practice of evidence-based medicine and voice therapy,essential if the standard of care is to evolve to the benefit of the patient. A better understanding of the potentials and limitations of each measure is important for treatment planning and patient counseling and, ultimately, for the conception of future well-designed clinical research. The complex issues regarding outcomes measurement are addressed here within the context of current treatment literature on vocal fold paralysis. Particular emphasis is placed on realistic data gathering within clinical practice.

Acoustics↗
PubMed2004

Recurrent laryngeal nerve paralysis: anatomy and etiology.

Etiologies of adult vocal paralysis are varied by the site of the lesion as well as the extent and cause of the damage. Most large series point to surgery and neoplastic causes for recurrent nerve paralysis. A detailed history is important when working up a patient with this voice disorder. Knowledge of the anatomy of the head, neck, and chest as well as the mechanisms behind vocal fold paralysis is essential in the evaluation and treatment of recurrent nerve paralysis. Many of the surgical and traumatic causes of hoarseness are from compression type injuries. Recovery is dependent on the type, extent, and site of nerve lesion. Familiarity with this data allows the otolaryngologist to tailor management to suit each patient with vocal fold paralysis.

Cervical Vertebrae↗
PubMed2004

The superior laryngeal nerve: function and dysfunction.

Despite long-standing clinical interest in SLN dysfunction, most aspects of this entity continue to require clarification. The replacement of the laryngeal mirror by flexible fiberoptic and rigid rod-lens laryngoscopy (including stroboscopy) and the resulting improvement in laryngeal visualization and documentation of examination has not resulted in a better definition of characteristic signs. Symptoms are often vague, and most are shared with other voice disorders. Under the circumstances, there is good reason to suppose that SLN dysfunction yields a clinical picture at least as heterogeneous as recurrent laryngeal nerve injury and a good deal more subtle. Faced with significant inconsistencies in clinical presentation, the clinician is hard-pressed to draw conclusions regarding prevalence, patterns of dysfunction, natural history, treatment, and even about its overall significance. EMG. used judiciously and complemented by frequency range testing, seems to hold more promise as a means of reliable diagnosis than laryngoscopic examination and may serve to resolve some of the confusion surrounding SLN dysfunction. It is equally important that the otolaryngologist guard against falling into the easy habit of attributing vocal disturbance that cannot be otherwise explained to SLN dysfunction in the absence of EMG evidence. If ambiguities surrounding SLN paralysis and paresis are to be clarified, diagnostic rigor is essential.

Chemoreceptor Cells↗
PubMed2000

Perceptual and laboratory assessment of dysphonia.

The voice laboratory is an essential tool in the voice clinic. It provides a functional diagnosis of disturbed voice production, demonstrating the deviant characteristics, limitations, and possibilities for change. As voice is multidimensional, several aspects need to be documented, quantified, and analyzed: perception, stroboscopy, aerodynamics, acoustics, self-evaluation by the patient, and in specific cases, physiologic signals, such as electroglottography, flow glottography, nasometry, and electromyography. Effectiveness and outcome studies rely on such data.

Electromyography↗
PubMed2000

Evaluation of professional singers.

Professional voice users present interesting challenges for laryngologists and speech-language pathologists. Many of these patients place olympic demands on their voices and must meet standards of near-perfection to succeed as vocal artists. Through systematic treatment combining the traditional art of medicine with modern technology, the physician should generally be able to care for the premier voice professional. The expertise gained improves the standard of care for all voice patients.

Humans↗
PubMed2000

Vocal education for the professional voice user and singer.

Providing education on voice-related anatomy, physiology, and vocal hygiene information is the responsibility of every voice care professional. This article discusses the importance of a vocal education program for singers and professional voice users. An outline of a vocal education lecture is provided.

Humans↗
PubMed2000

Impairment, disability, and other medical-legal aspects of dysphonia.

As awareness of the importance of the human voice has grown, so too have legal issues surrounding voice dysfunction. Otolaryngologists must be familiar with principles of impairment and disability and with appropriate medical-legal management for voice patients.

Disability Evaluation↗
PubMed2001

Acoustic analysis of voice in children with noduli vocales.

The acoustic tests of voice were carried out on 46 children with noduli vocales before the treatment and after its completion. Acoustic parameters of voice were compared with the control group of children without voice pathology. The results of the investigation were analysed acoustically. It has been proved that jitter, shimmer, Fo tremor and HNR values significantly differentiate the children with noduli vocales from the children without pathological changes in the larynx. These parameters during treatment tend to approach normal values. Therefore, the acoustic analysis of voice may be used in treatment monitoring.

Adolescent↗
PubMed2003

Inspiratory pressure threshold training in a case of congenital bilateral abductor vocal fold paralysis.

We present a non-surgical treatment option to decrease symptoms of dyspnea in a 6 year-old child with congenital bilateral abductor vocal fold paralysis. A respiratory muscle strength-training program was used to strengthen her inspiratory muscles for 8 months, 3 to 5 days per week. Inspiratory muscle strength increased over the course of training, resulting in reported decreases in dyspnea by both the child and parents during speech and exercise.

Breathing Exercises↗
PubMed1999

Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics.

A prospective, non-randomized study evaluated the effects of tonsillectomy and/or adenoidectomy (T +/- A) on acoustic and perceptual aspects of vocal function. Thirty-one children, ranging in age from 4 to 15 years participated and measurements were made prior to and 3 months following surgery. Twenty-three children had T +/- A and eight had adenoidectomy alone. Quantitative acoustic measures included: laryngeal (vocal fundamental frequency, FO) and supralaryngeal characteristics of sustained vowels (F1 and F2 formants, formant bandwidths, two-dimensional measures of vowel space) and temporal properties of consonant-vowel productions (diadochokinetic syllable rates). Perceptual measures were based on samples of continuous speech, using the Buffalo voice profile (BVP) and parental interviews/questionnaires were used to evaluate other aspects of surgery (i.e. subjective speech changes, protracted pain, difficulty swallowing, bleeding, etc.). Based on ANOVA, no significant post-surgical changes were detected for the majority of acoustic speech measures studied (vocal F0, formant bandwidths, measures of vowel space or diadochokinetic rates). However, the F2 formant frequency for vowels /i/ and /a/ increased and F1 decreased for /o/ following surgery. These changes had the largest effect on the structure of vowel /i/, which became more acute and diffuse following surgery. Furthermore, of the majority of perceptual measured studied with the BVP, 92% showed no change postoperatively. However, in the category of resonance, a significant decrease in hyponasality was detected. These results demonstrate that removing soft tissue from the oropharynx has only minimal impact on quantitative or qualitative (perceptual) aspects of vocal function, when measurements are made approximately 15 weeks post surgery.

Adenoidectomy↗
PubMed1999

Dysphonia in infants.

The definition of infant dysphonia is difficult because the physiological phonation itself may be extremely variable in newborns. In a wider sense, all voice utterings can be interpreted as dysphonia which deviate continuously in any of the parameters (timbre, pitch, intensity, or noise) from the normal. We differentiated 20 types of such pathological phonation. The most characteristic are: the hoarse (caused by inflammation or tumor of the vocal cords); the hollow (indicative of tracheal stenosis); the shrill (suggesting a CNS damage); the bleating (pathognostic of Down syndrome); the faint (a result of myogenic diseases); and the mewing cry (etiology: cri-du-chat syndrome). In a narrower sense dysphonia in infants is a kind of pathological phonation without evidence of neurological alteration or chromosomal aberration and without a verified laryngeal lesion. These infants utter pressed, harsh, or very high voice (hyperfunctional form) or a weak, inert cry (hypofunctional form). The dysphonic voice may be characterized also by sudden change in melody or in pitch (glide, shift, break, bitonality) and by turbulent noises. This type of newborn dysphonia is a result of the immature innervation of the larynx, it gradually improves and lateron spontaneously disappears. Perceptual evaluation, endoscopy, and acoustic analysis yield useful diagnostic information.

Crying↗
PubMed1999

Vocal fold nodules in children: preferable therapy.

BACKGROUND: The purpose of this paper is to know the preferable treatment for vocal fold nodules in children. METHODS: Two hundred and fifty nine patients with vocal fold nodules (176 males and 83 females) were retrospectively reviewed. Age ranged from 2 to 18 years with a mean age of 9 years. In addition, questionnaire survey was carried out, asking about their present voice. RESULTS: Sixteen percent of the patients showed improvement by vocal hygiene advice. Fifty two percent of patients receiving voice therapy showed some improvement. Eighty nine percent of patients showed some improvement by endolaryngeal microsurgery. With respect to the influence of puberty upon the voice, there was no significant difference among vocal hygiene, voice therapy, and no-treatment for pre-puberty cases. Surgical treatment was the only reliable method to acquire voice improvement for pre-puberty cases. In contrast, following puberty there was no significant difference in voice improvement among treatment modalities. CONCLUSION: If the patient needs immediate improvement of voice, surgery is preferable. If they need the improvement of voice but do not hurry up, voice therapy should be carried out. If patients have no motivation, vocal hygiene is recommended.

Adolescent↗
PubMed1999

Dysphonia and delayed food allergy: a provocation/neutralization study with strobovideolaryngoscopy.

In most cases the cause of intermittent dysphonia remains undiagnosed. This descriptive study explores the relationship between this problem and delayed food allergy. Double-blind intradermal provocation/neutralization skin tests to food antigens were used to do 12 tests in 10 subjects with food allergies. Strobovideolaryngoscopy was used to document changes in the vocal folds and in the quality of the voice. Double-blind measurements of signs and symptoms, digital audio recordings of the voice for perceptual and acoustic analysis, and aerodynamic laryngeal airflow and resistance measurements were done. The cause of dysphonia appeared to be associated with an increase in thick mucus production and irregular and asymmetric glottic edge edema of the vocal folds. Elimination of the positive specific foods resulted in cessation of dysphonia in all the test subjects. Statistical analysis was not done because of the lack of parametric data for paired analysis, lack of sufficient data points for resampling statistics, and the small sample size.

Adult↗
PubMed1999

Validation of a voice outcome survey for unilateral vocal cord paralysis.

Current methods to assess voice outcomes in patients with unilateral vocal cord paralysis (UVCP) are limited by expense, reliability, or lack of a true patient-relevant focus. The purpose of this study was to develop and validate a patient-based, disease-specific instrument, the Voice Outcome Survey (VOS), that is brief, reliable, and sensitive to real clinical change in patients with UVCP. Fifty-six consecutive patients with uncompensated UVCP and without complicating comorbid illness received the VOS, the Medical Outcome Study Short Form 36-Item Health Survey (SF-36), and a voice laboratory analysis before and 6 months after type I thyroplasty. Overall, reliability of the VOS was excellent (r = 0.87, P < 0.0001). The VOS index was significantly (P < 0.05) correlated to subscales of the SF-36 including social functioning (SF) (r = 0.56) and physical role functioning (r = 0.35), as well as changes in objective voice measures such as phonation time (r = 0.51) and average intensity (r = 0.44). The VOS index was the most sensitive measure to clinical change after surgery (standardized response means: VOS, 1.92; phonation time, 0.68; SF, 0.58; physical role functioning, 0.53; intensity, 0.51). The VOS is a brief, valid, reliable, and highly sensitive measure of disease-specific health status in patients with UVCP.

Adolescent↗
PubMed2000

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery.

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias. Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx. Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.

Biomechanical Phenomena↗
PubMed1996

Laryngeal biomechanics of the singing voice.

By transnasal fiberoptic laryngoscopy, patients with functional voice often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption.

Adult↗
PubMed1981

Professional singers: the science and art of clinical care.

Voice complaints of serious singers are usually not imaginary, and rational diagnosis and treatment can be achieved through systematic inquiry and analysis based on anatomy, physiology, psychology and psychoacoustics of voice production. Good vocal habits should be encouraged from childhood. Measures to aid in voice conservation include avoiding singing in noisy, dry, dusty, and smoky environments and learning to control the voice in circumstances in which auditory monitoring of the intensity of vocalization cannot be done effectively. The dangers of cheerleading, choir-conducting, and other forms of abuse of the speaking voice for the serious singer are emphasized. Young singers should be enthusiastically encouraged to sing music suitable for their ages and voices, and should be discouraged from taking on difficult roles prematurely. Smoking must be avoided. Thorough training and regular practice are essential for maintenance of a healthy singing voice. Close cooperation among laryngologist, speech pathologist and voice teacher is emphasized. Treatments for reflux laryngitis, anxiety, muscle spasm, voice abuse, vocal nodules, and infectious laryngitis in the professional singer are detailed.

Adolescent↗