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At least 901 records · Page 50Linked to original sources
PubMed2002

Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux.

Pharyngoesophageal gastric acid reflux is thought to initiate chronic posterior laryngitis. The gold standard for measuring gastric reflux is dual-channel 24-hour pH monitoring. This is a time-consuming, inconvenient, expensive method that is not available in all areas. New therapeutic regimes that make use of proton pump inhibitors (PPIs) have proven to be therapeutically efficient for control of acid reflux. Twenty-four consecutive patients with chronic voice disorders and signs of posterior laryngitis were selected for therapy. Twenty-four hour pH monitoring was performed independently before the therapy. The trial therapy consisted of all patients receiving pantoprazole, 40 mg once daily for 6 weeks. Immediately following the therapy a statistically significant (p < 0.05) improvement was observed in all patients. This improvement was analyzed retrospectively by comparison with the results of 24-hour pH monitoring. In 71% of the patients the 24-hour pH-monitoring gave a positive result showing a high number of patients with extraesophageal reflux in our study group. Patients with positive results of pH-monitoring responded in a statistically significant manner (p < 0.05) to the pantoprazole therapy, whereas those patients without detected reflux did not. A 3-month follow-up of the patients with a positive result of the pH-monitoring confirmed the improvement. No patients reported adverse effects. A 6-week treatment with pantoprazole can be clinically justified. It helps to save time and reduce costs, allows for selection of reflux-negative patients for alternative therapy, and may prevent inadequate treatment of patients with false-negative pH monitoring. Twenty-four hour pH monitoring is still recommended for patients unresponsive to this trial therapy.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2002

Harmonics-to-noise ratio: an index of vocal aging.

Distinguishing between vocal changes that occur with normal aging and those that are associated with disease is an important goal of research in voice. Several acoustic measures have been used in an attempt to illuminate the integrity of the vocal mechanism, including harmonics-to-noise ratio (HNR), jitter, and fundamental frequency (F0). HNR is a measure that quantifies the amount of additive noise in the voice signal; jitter reflects the periodicity of vocal fold vibration. In this study, measures of HNR, jitter and F0 were used to compare vocal function in three groups of normally speaking women: young adults, middle-aged adults, and elderly adults. Significant differences in HNR emerged between the elderly women and the other two groups. F0 differences were also apparent between the elderly group and the two younger groups; there were no significant differences in jitter between the three groups. HNRwas found to be a more sensitive index of vocal function than jitter. The significant lowering of HNR evident in t he elderly speakers may be attributable in part to medications taken by the majority of these elderly subjects.

Adult↗
PubMed2002

Airway considerations for professional singers--a survey of expert opinion.

The objective of this study was to survey physician experts in voice disorders/treatment to establish consensus guidelines for translaryngeal intubation (TLI) and tracheotomy when treating professional singers or other voice professionals. A written survey was sent to all physician members of the Voice Foundation seeking opinions/recommendations about route of TLI, duration of TLI before tracheotomy, size of endotracheal and tracheotomy tubes, and special interventions during patient care as these might differ between professional singers and nonsingers. Fifty-five percent of the physicians responded, of whom 73% classified their experience in voice care as "extensive." A strong consensus (76%) favored a smaller endotracheal tube for singers (6-7 mm I.D. for males and 6.0 mm I.D. for females) via the oral (46%) versus nasal (36%) route. Intubation/extubation by the most expert/experienced personnel was emphasized so as to minimize direct trauma to the larynx. While intubated, strong recommendations were made to suppress gastric acid production and to minimize motion of the endotracheal tube, including patient sedation. Preferences for an early tracheotomy (6 days) versus their usual time (10 days) were approximately equal (44% vs. 50%, respectively) and most respondents (69%) recommended the same size tracheotomy tube (8.0 mm I.D. for males and 6.0 mm I.D. for females) for singers and nonsingers. Post extubation/decannulation care emphasized voice rest, retraining, continued gastric acid suppression, and the possibility of direct laryngoscopy to assess post-TLI or tracheotomy injuries.

Choice Behavior↗
PubMed2002

The ChatterVox portable voice amplifier: a means to vibration dose reduction?

By speaking loudly for extended periods, teachers are vulnerable to laryngeal and voice changes associated with vocal fold "vibration overdose." Voice clinicians frequently recommend voice amplification ostensibly designed to reduce vibration dose and improve voice. However, there are few data regarding the degree of vocal loudness attenuation achieved by specific amplification devices. The purpose of this investigation was to examine the effectiveness of the ChatterVox Portable Voice Amplification System (Siemens Hearing Instruments) for reducing the sound pressure level (SPL) of a speaker's voice during a simulated classroom lecture. Ten participants were instructed to continuously read one of two phonetically balanced passages while amplified and unamplified. Voice intensity measurements were obtained at three inches from the mouth (i.e., mouth level) and at the back of a classroom in both amplified and unamplified conditions. When amplified with the ChatterVox, speakers experienced an average decrease in vocal intensity at mouth-level of 6.03 dB SPL (p < 0.002). Furthermore, an average increase of 2.55 dB SPL (p < 0.038) at the back of the classroom was observed. Collectively, these results indicate that the ChatterVox amplification device reduced the speaker's vocal intensity level at the microphone, while it augmented the voice heard at the back of the classroom. By inference, this degree of vocal attenuation at mouth level should contribute to a desirable reduction in vibration dose, thus lowering the risk of vibration overdose.

Acoustics↗
PubMed2003

Vocal warm-up increases phonation threshold pressure in soprano singers at high pitch.

Vocal warm-up is thought to optimize singing performance. We compared effects of short-term, submaximal, vocal warm-up exercise with those of vocal rest on the soprano voice (n = 10, ages 19-21 years). Dependent variables were the minimum subglottic air pressure required for vocal fold oscillation to occur (phonation threshold pressure, Pth), and the maximum and minimum phonation fundamental frequency. Warm-up increased Pth for high pitch phonation (p = 0.033), but not for comfortable (p = 0.297) or low (p = 0.087) pitch phonation. No significant difference in the maximum phonation frequency (p = 0.193) or minimum frequency (p = 0.222) was observed. An elevated Pth at controlled high pitch, but an unchanging maximum and minimum frequency production suggests that short-term vocal exercise may increase the viscosity of the vocal fold and thus serve to stabilize the high voice.

Adult↗
PubMed2003

Gore-Tex Medialization Thyroplasty: objective and subjective evaluation.

Management of vocal fold paralysis and paresis continues to give rise to controversy and the use of numerous surgical techniques. The senior authors' (RTS, JRS) initial experience with fourteen patients using Gore-Tex Medialization Thyroplasty suggests that this technique has value. Evaluation included pre- and postoperative videostroboscopic assessment, aerodynamic measures, acoustic analysis, phonatory analysis, psychoacoustic evaluation, and patient self-evaluation. Stroboscopic and perceptual assessments were blinded. Statistical analysis supports the efficacy of this technique.

Adult↗
PubMed2003

Vocal fatigue: current knowledge and future directions.

Vocal fatigue is a complex multifaceted clinical phenomenon. Several hypotheses exist concerning its underlying mechanism, and a range of empirical studies have examined its manifestation. This article reviews the literature pertaining to the nature, underlying processes, and salient features of vocal fatigue. First, vocal fatigue is defined, its major symptoms are discussed, and hypotheses concerning its primary physiological and biomechanical mechanisms are considered. Second, studies of experimentally induced vocal fatigue in humans are evaluated. Third, research investigating the clinical and occupational manifestations of vocal fatigue is discussed. Fourth, directions for ongoing research in this area are offered.

Biomechanical Phenomena↗
PubMed2003

A new method to record subglottal pressure waves: potential applications.

Rapid subglottal pressure changes related to the glottal cycles influence the aerodynamics of phonation. Various methods to measure these have been developed, but are not practical for routine phoniatric use. For that reason, a noninvasive measurement tool is necessary. This article presents a technique that uses a microphone positioned at the skin of the jugular fossa to record the signal which arises in the subglottal spaces and is transmitted through the soft tissue to the surface of the skin. Using the program Glottal Segmentation of Voice and Speech, jugular microphone recordings from two healthy subjects were compared with simultaneously recorded direct intratracheal measurements during the same phonation. A systematic error arising from the transmission properties of the microphone and the soft tissue leads to phase and amplitude deviations. These must be taken into account and require correction. This correction procedure leads to high correlations and a good agreement between the two signals. Even without this correction the jugular microphone measurements proved to be useful as a diagnostic and a therapeutic tool in cases where chest resonance specific processes appear affected. In addition, they offer material for research purposes. Although based on a small number of subjects, the new method shows a good validity; testing on a larger number of subjects will probably strengthen the validity.

Adult↗
PubMed2003

Effect of hydration and vocal rest on the vocal fatigue in amateur karaoke singers.

Karaoke singing is a very popular entertainment among young people in Asia. It is a leisure singing activity with the singer's voice amplified with special acoustic effects in the backdrop of music. Music video and song captions are shown on television screen to remind the singers during singing. It is not uncommon to find participants singing continuously for four to five hours each time. As most of the karaoke singers have no formal training in singing, these amateur singers are more vulnerable to developing voice problems under these intensive singing activities. This study reports the performance of 20 young amateur singers (10 males and 10 females, aged between 20-25 years) on a series of phonatory function tasks carried out during continuous karaoke singing. Half of the singers were given water to drink and short duration of vocal rests at regular intervals during singing and the other half sang continuously without taking any water or rest. The subjects who were given hydration and vocal rests sang significantly longer than those who did not take any water or rest. The voice quality, as measured by perceptual and acoustic measures, and vocal function, as measured by phonetogram, did not show any significant changes during singing in the subjects who were given water and rest during the singing. However, subjects who sang continuously without drinking water and taking rests showed significant changes in the jitter measure and the highest pitch they could produce during singing. These results suggest that hydration and vocal rests are useful strategies to preserve voice function and quality during karaoke singing. This information is useful educational information for karaoke singers.

Adult↗
PubMed2003

Vibrato rate adjustment.

The goal of the present study was to document the acoustic changes that occur as singers attempt to increase or decrease their vibrato rate to match target stimuli. Eight advanced singing students produced vowels with vibrato in three registers, both naturally and while attempting to match faster or slower rate stimuli. Slower rates were associated with lower intensity and less steady vibrato. Faster rates involved increased vibrato extent in the chest register and increased intensity in the head register. Singers whose spontaneous vibrato rates were naturally either slower or faster tended to also be relatively slower or faster when matching target rates. This ability to modify rate may have beneficial effects on the artistic quality of the voice for performance.

Glottis↗
PubMed2004

The impact of preventive voice care programs for training teachers: a longitudinal study.

The teaching profession puts vocal health at a higher risk than other professions, causing what is referred to as "occupational dysphonia." There is a need for primary prevention of "occupational dysphonia" among the teaching profession, where good vocal health is promoted before a problem occurs. To investigate the primary prevention of occupational dysphonia among teachers, this study uses a sample population of 55 training teachers, in the postgraduate certificate of education (PGCE) course at the University of Ulster, Northern Ireland, who were randomly assigned to three training groups: control, indirect, and direct. The vocal performance of the three groups was measured at two points over the year of the PGCE course: first before any teaching or training began, and again after the first teaching practice. The training for the indirect and direct groups was provided before the teaching practices. Acoustic and self-perceptual measurements were used to assess the multidimensional outcomes. The results demonstrate interesting trends, that although not found to be significant, are approaching significance. Their voices will be reevaluated at a third point of measurement. The acoustic measurement reflects deterioration from time 1 to time 2 for the control group, improvement for the direct group, and no change for the indirect group, indicating that the training has proved beneficial. The self-rating scores vary in agreement with the acoustic results, presenting interesting findings. The findings of this study will be of benefit to teachers, their educators, voice therapists, health promoters, and human resource personnel.

Adult↗
PubMed1993

Vocal attrition in voice students: survey findings.

A questionnaire designed in part to survey symptoms of vocal attrition and possible factors contributing to it was administered to 79 university female voice students. Of the 74 students (94%) completing the questionnaire, 10 (13%) were free of symptoms, 19 (26%) had few (one or two), and 45 (61%) had multiple (three or more) symptoms. Thirty-five students (47%) had sought medical help for voice problems since they began their singing career. Students with multiple symptoms were significantly more likely to (a) be bothered, frustrated, worried, depressed, or anxious about their voice; (b) quit performance, forgo audition, limit their repertoire, or quit singing altogether; (c) speak in a voice that is too low in pitch; and (d) have a general tendency to worry, be depressed or anxious, or have mood swings. The clinical implications of these and other findings are discussed.

Adult↗
PubMed1993

Sarcoidosis of the larynx: preserving and restoring airway and professional voice.

Professional voice users may present with disastrous dysponia and life-threatening upper airway disturbances due to a rare condition. Two teachers demonstrated extrathoracic obstructive laryngeal lesions by videolaryngoscopy and pulmonary function flow-volume loops. A characteristic "honking" voice and edematous, pink, diffuse turban-like enlargement of the supraglottic structures are considered pathognomonic of laryngeal sarcoidosis. Diagnosis was confirmed by biopsies, and clinical and radiologic findings. Sarcoidosis is a variable, disseminated disease involving many body organs, self-limited or progressive, with frequent exacerbations and remissions, affecting the larynx in 0.5-1.4% of patients. Spinal cord involvement demonstrated by new magnetic resonance imaging techniques can be heralded by voice changes detected in professional voice users. Systemic corticosteroid therapy combined with intralesional steroid injections and microendoscopic surgery, with or without tracheostomy, preserved and restored both professional voice and airway.

Adult↗
PubMed1993

Voice research: so what? A clearer view of voice production, 25 years of progress; the speaking voice.

The past 25 years has yielded an impressive growth in our knowledge of vocal function. Interdisciplinary research cooperation in areas of laryngeal histology, vocal aerodynamics and acoustics, vocal fold vibratory characteristics, neurolaryngology, and phonatory models has led to a clearer view of voice production. This article offers a brief review of the progress that has been made in our understanding of the speaking voice and relates this knowledge to clinical practice. The importance of utilizing voice research to confirm traditional management techniques and to develop new physiologically based management approaches is also stressed.

Female↗
PubMed1995

"Compensatory falsetto": effects on vocal quality.

The term "compensatory falsetto", for the purpose of this investigation, refers to the development of an abnormally high-pitched voice in the presence of laryngeal pathology where more socially acceptable lower pitched voice production is possible. The purpose of this investigation was to compare laryngeal compensations and their effects on objective measures of vocal function during production of compensatory falsetto voice. Eighteen patients with abnormally high-pitched voice in the presence of underlying laryngeal pathology were evaluated in the Department of Otolaryngology at the University of Miami School of Medicine from January, 1988 through December, 1992 and were diagnosed with "compensatory falsetto". Vocal fold paralysis (n = 11) was the most common laryngeal pathology. Vibratory characteristics were evaluated through videostrobolaryngoscopic examination. Acoustic and aerodynamic parameters assessed included fundamental frequency, jitter rate, harmonic-to-noise ratio, glottal air flow, and maximum phonation time. Production of a higher-pitched voice appeared to improve glottic closure and decrease the amount of air loss during phonation. A corresponding increase in maximum phonation time and improvement in acoustic characteristics of jitter and harmonic-to-noise ratio was also observed.

Adult↗
PubMed1995

Intensive voice treatment in Parkinson disease: laryngostroboscopic findings.

As part of ongoing research to investigate and document the efficacy of intensive voice therapy to improve functional communication in patients with idiopathic Parkinson disease, 45 patients were enrolled in a controlled, randomized, prospective study. Pre- to posttreatment comparisons are presented here on 22 of those patients who underwent laryngeal imaging examination. Of the 22 patients, 13 patients received intensive therapy aimed at increasing vocal and respiratory effort (VR), whereas nine received intensive therapy aimed at increasing respiratory effort (R) only. All patients had a pretreatment evaluation that included two (but sometimes only one) voice recordings and an otolaryngologic examination with laryngostroboscopy. At the completion of 4 weeks of therapy (16 sessions), two voice recordings were made, and laryngostroboscopy was again performed. The pre- and posttherapy videolaryngostroboscopy tapes were then randomized and rated by four judges. Raters' findings were then compared with vocal intensity measured before and after therapy. The VR therapy group showed improvements on laryngostroboscopic variables: less glottal incompetence and no significant change in supraglottal hyperfunction after therapy. No differences were observed in the R-only group. The mean intensity increase in the VR therapy group was 12.5 dB, compared with a decrease of 1.9 dB in the R-only group. These findings suggest that in patients with Parkinson disease, intensive therapy focusing on phonatory effort improves adduction of the vocal folds as assessed by laryngostroboscopy. Differences in laryngeal function in these patients observed with fiberoptic laryngoscopy and rigid telescopic laryngoscopy are discussed.

Aged↗
PubMed1995

Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy.

A combined-modality treatment program consisting of botulinum toxin injection (Botox) and voice therapy was used to treat 17 subjects diagnosed with adductor spasmodic dysphonia (ADD SD). Ten subjects with ADD SD served as the control and were given Botox only. Voice therapy after Botox injection was directed toward reducing the hyperfunctional vocal behaviors, primarily glottal overpressure at voice onset and anterior-posterior squeezing. The results indicated that subjects who underwent combined-modality treatment maintained significantly higher mean airflow rates for significantly longer periods. Moreover, there was a carryover effect in these patients when they received Botox only. Adductor spasmodic dysphonia is treated most effectively when intrinsic laryngeal muscle spasms are reduced or eliminated by Botox injection and extrinsic hyperfunctional vocal behaviors are treated with voice therapy.

Adult↗
PubMed1995

Genetics of the voice.

Substantial advances have led to the evolution of voice as the newest subspecialty of otolaryngology. Nevertheless, little is known about the genetics of voice. Genetic research is needed to further elucidate the relationship between vocal tract structure (including ultrastructure) and function, mechanisms of voice dysfunction, and transmission of normal and abnormal voice characteristics.

Humans↗