Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Voice Disorders”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 919 records · Page 51Linked to original sources

Preliminary study of two methods of treatment for laryngeal nodules.

To date, a limited number of formal studies have assessed the efficacy of voice therapy for laryngeal nodules. The present study represents a preliminary stage of inquiry in a series of planned studies on this topic. Thirteen women with nodules participated as paid subjects. Some subjects received "confidential voice therapy," some received "resonant voice therapy," and some received no therapy (control condition) over a period of approximately 2 weeks. Pre- and post-therapy measures of phonatory effort, auditory-perceptual status of voice, and laryngeal appearance provided evidence of a benefit from therapy. Baseline measures were then repeated 2 weeks after therapy was terminated. The final results indicated that, for auditory-perceptual and phonatory effort measures, the likelihood of benefiting from therapy directly covaried with compliance scores (reflecting the reported extraclinical utilization of the therapy technique), but not with therapy type (confidential vs. resonant voice therapy). At this level, the results point to the importance of assessing not only therapy type but also compliance in future, larger studies. A series of other positive and negative factors in the present research design were identified based on the results. These should be considered in future studies.

Adolescent↗

Laryngeal webs: a new treatment for an old problem.

Laryngeal webs, both congenital and acquired, present a difficult therapeutic challenge for the laryngologist. A young trial attorney with an iatrogenic laryngeal web secondary to laser excision of anterior cordal papillomata presented with the double therapeutic challenge: on the one hand, he had recurrent papillomata and, on the other hand, he had a significant anterior web that was 7 mm long and extended to within 3 mm of the tips of the vocal processes and involved the full thickness of the vocal folds. A new/old treatment was tried in this patient and subsequently used on another patient involving old ideas from Chevalier Jackson coupled with newer technology using video laryngoscopy. Two patients underwent the procedure and had significant amelioration of their laryngeal pathology.

Adult↗

Congruence in personality between clinician and client: relationship to ratings of voice treatment.

This study examined relationships between ratings of voice therapy sessions and clinician and client personality characteristics as measured by the Myers-Briggs Type Indicator. Nineteen clinician-client pairs were rated on behaviors demonstrated in two therapy sessions. Results indicated that client variables of thinking-feeling and judgment-perception were related to amount of clinician feedback, client eye contact, ratio of clinician-client eye contact and amount of clinician explanation, clarity of explanation, clinician's initiative, and client eye contact, respectively. Clinicians' sensing-intuition was related to the amount of feedback to client and quality of the task sequence. Clinician's judgment-perception was related to amount of explanation and client's attention to clinician. Similarity in clinician-client sensing-intuition was related with task involvement of the client, clinician's attention to client, and clinician eye contact. Similarity in judgment-perception was related to greater use of counseling. Similarity in thinking-feeling was related to low amounts of clinician eye contact.

Humans↗

Vocal nodules, microwebs, and surgery.

Successful treatment of vocal nodules is primarily accomplished through the direction of voice-language pathologists and teachers of music and speech. Rarely is surgical treatment necessary, although recent reports have suggested a correlation between vocal nodules and failed voice training with anterior commissure microwebs. One hundred fifteen consecutive patients with vocal nodules were evaluated. Eight anterior commissure microwebs were identified (7%), four of these in performers. Of the 96 patients with sufficient follow-up, 65 (68%) had complete resolution of their nodules and 17 (18%) had sufficient improvement to return to normal vocalization without surgical treatment. Nine patients required surgery, two of these with anterior commissure microwebs. All eight patients with microwebs had resolution of their nodules with either nonsurgical or surgical therapy. In total, 94% of patients were able to return to normal voice function, while the 6% of failures either did not receive or were noncompliant with voice therapy. Microwebs were found to be uncommon in patients with vocal nodules. Microwebs and other laryngeal pathologies in patients with nodules may be associated with a higher incidence of patients failing conservative voice therapy treatment.

Adolescent↗

Average speaking fundamental frequency in soprano singers with and without symptoms of vocal attrition.

Nineteen trained soprano singers aged 18-30 years vocalized tasks designed to assess average speaking fundamental frequency (SFF) during spontaneous speaking and reading. Vocal range and perceptual characteristics while singing with low intensity and high frequency were also assessed, and subjects completed a survey of vocal habits/symptoms. Recorded signals were digitized prior to being analyzed for SFF using the Kay Computerized Speech Lab program. Subjects were assigned to a normal voice or impaired voice group based on ratings of perceptual tasks and survey results. Data analysis showed group differences in mean SFF, no differences in vocal range, higher mean SFF values for reading than speaking, and 58% ability to perceive speaking in low pitch. The role of speaking in too low pitch as causal for vocal symptoms and need for voice classification differentiation in vocal performance studies are discussed.

Adolescent↗

Consistency in clinicians' and clients' behavior in voice therapy: an exploratory study.

The primary purpose of this study was to investigate consistency in clinicians' behaviors during two voice therapy sessions. The secondary purpose was to examine relationships between ratings of clinicians' and clients' behaviors. Each clinician (n = 7) was observed working with two different clients. Two experienced evaluators, using the Adjective Checklist and five-point semantic differential scales, rated clinicians and clients. Results indicated that 6 of 10 aspects of therapy studied were found to be relatively inconsistent, with the pace of therapy being the least stable. Ratings of individual clinician traits (e.g., favorable, unfavorable, intraception) were the most stable.

Adult↗

Treatment of sulcus vocalis: auditory perceptual and acoustical analysis of the slicing mucosa surgical technique.

Sulcus vocalis is a furrow in the mucosa of the vocal folds that causes glottic insufficiency, irregular vibrations, and a distinctive dysphonia of variable severity. Treatment of sulcus vocalis needs to achieve anatomical and functional improvements that satisfy the behavior of the larynx and vocal quality. We suggest a combined approach, which includes vocal fold mucosal surgery through a technique called slicing mucosa, followed by intensive vocal rehabilitation. The aim of the surgery is to detach the mucosa of the sulcus and to interrupt the longitudinal fibrotic tension lines. The results of this procedure in 10 patients were analyzed through visual, auditory, and acoustical methods, and the data lead us to conclude that the treatment proposed offered a good anatomical result, a better vibratory pattern, and an improvement in overall vocal quality.

Adolescent↗

Botulinum toxin in the treatment of recalcitrant mutational dysphonia.

Mutational falsetto is the failure of the normal drop in vocal pitch at puberty. Voice therapy almost always achieves an appropriate pitch; however, in cases of failure, surgical treatment has also been recommended. We report a case of a 47-year-old man with an above-average fundamental frequency and a thin voice quality in the absence of any signs of androgen insufficiency. Laryngeal examination revealed atrophy of the vocalis muscle. Voice therapy was unsuccessful in achieving a stable voice. Injection of 15 units of botulinum toxin into each cricothyroid muscle initially resulted in aphonia, but the voice returned by 1 week. Average fundamental frequency was 84 Hz at 1 week, 104 Hz at 1 month, and 100 Hz at 1 year. We hypothesize that mutational dysphonia is an habitual dysfunction of the voice with inappropriate activation of the cricothyroid muscle and disuse of laryngeal adductor muscles. Temporary deactivation of the cricothyroid muscle enforces adoption of a more appropriate vocal mechanism. Botulinum toxin as an adjunct to voice therapy should be considered before surgical alteration of the glottis in patients with recalcitrant mutational falsetto.

Botulinum Toxins↗

Nonspecific laryngeal granuloma: a case study of a professional singer.

A professional singer with laryngeal granuloma underwent surgery following failed response to conservative treatments. Two primary findings emerged. First, although a sizable lesion was present initially, presurgical voice measures were largely normal or superior. The exception was elevated phonatory effort during singing. Second, postsurgical voice functions were entirely normal or superior (including phonatory effort), despite demanding singing performances a few weeks following surgery. The results add to the limited corpus of quantitative, normative-referenced data on voice in patients with granulomas and are inconsistent with previous reports of voice abnormalities in such patients and poor functional response to surgery.

Adult↗

The perceptual features of vocal fatigue as self-reported by a group of actors and singers.

Performers (10 actors/10 singers) rated via a self-report questionnaire the severity of their voice-related changes when vocally fatigued. Similar frequency patterns and perceptual features of vocal fatigue were found across subjects. Actors rated "power" aspects (e.g., voice projection) and singers rated vocal dynamic aspects (e.g., pitch range) of their voices as most affected when vocally fatigued. Vocal fatigue was evidenced by changes in kinesthetic/proprioceptive sensations and vocal dynamics. The causes and context of vocal fatigue were vocal misuse, being "run down," high performance demands, and using high pitch/volume levels. Further research is needed to delineate the perceptual features of "normal" levels of vocal fatigue and its possible causes.

Adult↗

Relations between voice range profiles and physiological and perceptual voice characteristics in ten-year-old children.

Pitch and intensity range of 60 children were recorded and plotted in voice range profiles (VRPs). Different aspects were investigated: minimum phonation threshold, pitch range, and maximum dynamic range. Vocal fold status was determined via laryngoscopic examination. Ten percent of the children had vocal nodules, 23% glottal chinks. Seven voice experts listened to the voices recorded on two separate occasions and rated their properties along 16 parameters including hoarseness. Fourteen percent were rated as hoarse on both recordings and were thus classified as being chronically hoarse. Departures from normal in VRP characteristics were found for children suffering from chronic hoarseness, nodules, and glottal chinks. Children in general seem to have somewhat compressed VRP contours compared with adults, reflecting restricted dynamic vocal capabilities; however, children with mutational voices exhibited an approximation to adult upper VRP contours.

Auditory Perception↗

Does the voice improve with vocal hygiene education? A study of some instrumental voice measures in a group of kindergarten teachers.

This study investigated the efficacy of a program of vocal hygiene education designed for an occupational group at risk for dysphonia, namely, kindergarten teachers. Twelve female teachers explored concepts and knowledge of vocal abuse and vocal hygiene in a workshop session and attempted to practice vocal hygiene for 2 months. They showed significant voice improvement as assessed instrumentally in terms of three acoustic and electroglottographic parameters. There was no significant change of voice in a control group of 13 teachers. The results suggest that teachers were able to improve their voices if they significantly reduced vocal abuses in daily life and practiced specific strategies to maintain classroom order and reduce the use of voice in teaching.

Adult↗

High-frequency components of normal and dysphonic voices.

The analysis of high-frequency energy levels can presently be considered as being more influenced by the characteristics of the speaker than by the phonetic material, serving as an indicator of the quality of the voice. In this study the energy levels in the frequency intervals of 6-10 and 10-16 kHz were evaluated, both in dysphonic voices and in subjects with no voice problems. The material consisted of consonant-vowel syllables formed by stop phonemes and the basic Spanish vowels, analyzing the vocal segment. The results indicate that the energy, found from the power spectrum average, in both frequency areas, is significantly bigger in the group with dysphonic voices. The analysis in the 10-16 kHz regions shows additional significant differences of energy between the vowels, progressively decreasing from front to back vowels.

Adult↗

Aerodynamic and stroboscopic findings before and after microlaryngeal phonosurgery.

Acoustic, aerodynamic, and laryngo-video-stroboscopy (LVS) studies were done on 50 patients before and after microlaryngeal surgery for benign vocal fold lesions. Perceptual pre- and postratings were also obtained. After microlaryngeal surgery, statistically significant differences between pre- and posttreatment conditions included postoperative findings of (a) a lowering of mean flow rate, (b) an increase in glottal efficiency, and (c) an increase in maximum sound pressure level. There was no significant improvement in maximum phonation time. Stroboscopy findings showed changes of glottal configuration, linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, and periodicity. Acceptable perceptual voice quality appeared to depend on a straight vocal fold edge, good vibratory amplitude, and good mucosal wave. Improved understanding of vocal function after phonosurgery should help us refine surgical principles and techniques. The combined use of LVS and phonatory function measures is advocated.

Glottis↗

Arytenoid adduction and type I thyroplasty in the treatment of aphonia.

Arytenoid adduction is a procedure used to medialize the paralyzed vocal fold, closing the posterior glottis. Isshiki type I thyroplasty allows medialization of the anterior membranous vocal fold. Using the arytenoid adduction, in combination with Isshiki type I thyroplasty as needed, five patients were treated for aphonia. Surgical results were evaluated with voice recordings, electroglottography, and photoglottography. Jitter ratio, shimmer ratio, and signal-to-noise ratio were measured. Laryngeal stroboscopy and glottography were used to assess the mucosal wave and vibratory nature of the vocal folds. After operation, vocal function was restored. Analysis of data from these five aphonia patients revealed improved glottic phonatory function. The arytenoid adduction in combination with the Isshiki type I thyroplasty is an effective technique for aphonia caused by a significant posterior glottic gap with unilateral vocal-cord paralysis.

Arytenoid Cartilage↗

Pushing exercise program to correct glottal incompetence.

A voice therapy program using pushing exercises to correct glottal incompetence is described. The program utilizes various types of instrumentation to determine whether or not a given patient is likely to benefit from the treatment. The program also provides feedback of target voices. Three cases with incomplete glottal closure and subsequent vocal dysphonia characterized by an asthenic breathy quality are used to illustrate the program. Details of the program, termination criteria, and problems and precautions learned from treating 29 patients over a 3-year period are presented.

Aged↗

Quantitative evaluation of phonetograms in the case of functional dysphonia.

According to the laryngeal clinical findings, figures making up a scale were assigned to vocally trained and vocally untrained persons suffering from different types of functional dysphonia. The different types of dysphonia--from the manifested hypofunctional to the extreme hyperfunctional dysphonia--were classified by means of this scale. Besides, the subjects' phonetograms were measured and approximated by three ellipses, what rendered possible the definition of phonetogram parameters. The combining of selected phonetogram parameters to linear combinations served the purpose of a phonetographic evaluation. The linear combinations were to bring phonetographic and clinical evaluations into correspondence as accurately as possible. It was necessary to use different kinds of linear combinations for male and female singers and nonsingers. As a result of the reclassification of 71 and the new classification of 89 patients, it was possible to graduate the types of functional dysphonia by means of computer-aided phonetogram evaluation with a clinically acceptable error rate. This method proved to be an important supplement to the conventional diagnostics of functional dysphonia.

Female↗

Intervention with young voice users: a clinical perspective.

This diverse group is described in relation to life stage, short- and long-range performance objectives, and lifestyle factors pertinent to vocal health. Physical, behavioral, cognitive, and psychosocial issues relevant to assessment and intervention will be addressed. The possible dissonance between a clinician's developmental perspective and a client's immediate pragmatic concerns is discussed. In addition, the specific challenges of dealing with adolescents (e.g., the influence of the peer group, the emergence of autonomy, the redefinition of relationships with significant adults, and the vulnerability of the mechanism) are related to clinical problem solving.

Child↗