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PubMed1998

[Voice restoration and clinical outcome in patients undergoing laryngectomy with voice prostheses].

Since the introduction of the tracheoesophageal fistula (TEF) technique for restoration of voice in 1983, we performed voice restoration using primary tracheoesophageal fistula in 83 patients undergoing laryngectomy. The success rate for voice restoration with TEF was 80.6% (good voice; 69.8%, fair voice; 10.8%). Thirty-one patients out of 51 patients who have been followed for over 3 years had 34 problems with TEF (15 granulations of TEF, 7 difficulties in insertion of voice prostheses, 4 stenoses of the tracheal stoma, 5 other reasons). However, most patients could use TEF by following appropriate procedures. Our results suggest that the Blom Singer TEF procedure is a safe, simple and effective means of alaryngeal communication.

Aged↗
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

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↗
PubMed1999

Relationship between subjective voice complaints and acoustic parameters in female teachers' voices.

The aim of the study was to identify the acoustic correlates of female teachers' subjective voice complaints by recording their voices in their working environment. The subjects made recordings during lessons (N = 10) and breaks (N = 11). The subjects were divided into 2 groups: those with few voice complaints (FC group) and those with many voice complaints (MC group). The speech sample made in the breaks was maximally sustained /a/, from which fundamental frequency (F0), jitter, and shimmer were analyzed. The classroom samples were analyzed for F0, sound pressure level (SPL), and F0 time (the active vibration time of the vocal folds). Additionally, an index for assessing voice loading is presented. The results revealed a tendency of the MC group to have higher F0 and lower SPL and perturbation values than the FC group. The index values correlated moderately with the subjective vocal complaints.

Female↗
PubMed1999

Qualitative and quantitative analysis of voice onset by means of a multidimensional voice analysis system (MVAS) using high-speed imaging.

High-speed filming is one of the most informative methods for assessing voice physiology data. Tracing high-speed images of the glottis provides quantitative parameters such as the glottal area and the glottal width function. By way of example, a number of studies are discussed which extract quantitative data from high-speed images showing voice onsets. Furthermore, a new computer system (MVAS; multi-dimensional voice analysis system) is presented that synchronously displays a laryngoscopic high-speed film, the electroglottographical signal, and several acoustic analyses of the recorded voice sample. The automatic measurement of glottal width and glottal area from the laryngoscopic images is also provided. Looking at former studies and our analyses of voice onsets reveals a tremendous intersubject and even intrasubject variability (different prephonatory closure, different time span until full amplitude is reached, different open quotient).

Equipment Design↗
PubMed2003

Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy.

An important clinical issue concerns the efficacy of current voice therapy approaches in treating voice disorders, such as vocal nodules. Much research focuses on finding reliable methods for documentation of treatment results. In this second treatment study of ten patients with vocal nodules, who participated in a behaviorally based voice therapy program, 11 aerodynamic (transglottal air pressure and glottal waveform) and acoustic (spl, f0, and spectrum slope) measures were used. Three pretherapy baseline assessments were carried out, followed by one assessment after each of five therapy phases. Measurements were made of two types of speech materials: Strings of repeated /pae/ syllables and sustained /ae/ phonations in two loudness conditions: comfortable loudness and loud voice. The data were normalized using z-scores, which were based on data from 22 normal subjects. The results showed that the aerodynamic measures reflected the presence of vocal pathology to a higher degree than did the acoustic spectral measures, and they should be useful in studies comparing nodule and normal voice production. Large individual session-to-session variation was found for all measures across pretherapy baseline recordings, which contributed to nonsignificant differences between baseline and therapy data.

Adult↗
PubMed2005

Voice-related quality of life in organic and functional voice disorders.

The voice-related quality of life (V-RQOL) questionnaire was proposed as a disease specific measure of patients' subjective burden elicited by a voice disorder. The purpose of this study was to investigate the influence of gender and aetiology (benign organic versus functional) on V-RQOL results. Fifty-two German-speaking patients completed the questionnaire without prior information about their individual diagnosis. Results allow for the conclusion that women score lower indicating a poorer voice status. Differences between patients diagnosed with an organic or a functional voice disorder revealed no universal difference. This has to be investigated in future, especially against the degree of the voice disorder, the individual personality, health belief and social background.

Female↗
PubMedDate not supplied

Immediate effects of 'voice massage' treatment on the speaking voice of healthy subjects.

'Voice massage' (VM) treatment includes manipulation of muscles related to speech production and voice and breathing exercises. This study investigated the effects of VM in 10 healthy subjects (5 females, 5 males). They recorded repetitions of the word 'paappa' at normal loudness and as softly as possible and read a text sample before and after 1-hour (1) VM treatment, (2) fast walking, (3) sitting in a library and (4) lying on a bed. Subglottic pressure was estimated from oral pressure during [p]. Transglottal flow and glottal resistance were measured. Voice production was studied with electroglottography. Fundamental frequency, sound pressure level (SPL) and alpha ratio [(SPL of the range 1-5 kHz) - (SPL of the range 50 Hz-1 kHz)] were calculated from text samples, which were also evaluated by 7 voice experts. A questionnaire was used to record subjects' sensations. Changes after lying and sitting suggest lowered effort in phonatory muscles, while after fast walking effort seemed to increase. After VM no significant changes were observed in voice parameters or perceptual quality, but ease of phonation and reduced tension in the neck, shoulders and back were reported. The effects of VM may be partly psychological, partly related to a search of phonatory balance.

Adult↗
PubMed1997

Voice restoration after laryngectomy: experience with the Blom-Singer extended-wear indwelling tracheoesophageal voice prosthesis.

BACKGROUND: The Blom-Singer tracheoesophageal voice prosthesis has undergone continuous design modifications during the last 18 years to make it more effective, anatomically compatible, and easier to use. This evolution continues with the recent introduction of an indwelling-style voice prosthesis intended for use by individuals who are unable or disinclined to use a self-removable-style voice prosthesis. The a priori self-lifespan goal of the indwelling prosthesis was 180 days. METHODS: The present investigation describes the experience of 81 consecutive participants who used a total of 206 indwelling voice prosthesis. Selection criteria included total laryngectomy and either primary (n = 35) or secondary (n = 46) tracheoesophageal puncture. All participants had external-beam radiotherapy either pre- or postlaryngectomy. Specifically, lifespan of the prosthesis, the effects and clinical management of fungal colonization, and participant satisfaction with this style prosthesis were studied. RESULTS: A prosthesis use rate of 90% was observed. Group 1 prostheses (without fungal colonization and without Nystatin therapy) exhibited a lifespan significantly longer than did group 2 prostheses (with fungal colonization and prior to Nystatin therapy) (sample mean [mean] = 185.6 days versus 80.6 days; p < .05). Group 3 prostheses (following Nystatin therapy) also exhibited a lifespan significantly longer than that of group 2 prostheses (mean = 156.1 days versus 80.6 days; p < .05). Lifespans of group 1 and group 3 prostheses were not significantly different (p < .05). CONCLUSIONS: The extended-wear, indwelling voice prosthesis achieved its a priori lifespan goal of 180 days (6 months) with almost uniform patient preference and without risk of increased complications. When fungal colonization was present. Nystatin therapy significantly prolonged prosthesis lifespan.

Adult↗
PubMed2003

Application of the Voice Handicap Index in 45 patients with substitution voicing after total laryngectomy.

We tested the Voice Handicap Index (VHI) in 45 patients with substitution voicing (that is, without the use of two vocal folds), the majority of them using tracheo-oesophageal speech. We introduced a corrected VHI score (VHI(corr)) whose values are in the range from 0 to 100 and which can be expressed as a percentage. As such, the VHI(corr) is a handy and transparent tool, and it seems to be suited for representing the handicap caused by the voice disorder when some items are unanswered as experienced in patients with substitution voicing. Interestingly, our data reveal that the voice handicap severity of this particular category of patients is (1) moderate and in the range of "common" dysphonia and (2) not affected by additional radiotherapy. It seems that the E domain is overstated due to the number of problematic items in the P and F domains.

Adult↗
PubMed2006

Hands-free speech after surgical voice rehabilitation with a Provox voice prosthesis: experience with the Provox FreeHands HME tracheostoma valve system.

Excellent results have been reported with the use of voice prostheses for the rehabilitation of laryngectomees. Patients, however, consider it a disadvantage that the tracheostoma must be closed manually for speech production. This limits their ability to simultaneously communicate by gesture or to work with both hands. An automatic tracheostoma valve helps patients overcome this problem. We describe a prospective clinical trial evaluating our experience with the Provox FreeHands HME Automatic Tracheostoma Valve system. Twenty-four laryngectomees were randomly selected from the patients who had undergone laryngectomy at the ENT Department. Immediately, after 4 weeks and 6 months later having been fitted with a Provox FreeHands HME, the patients were asked to complete a questionnaire in order to assess their satisfaction, voice quality, wearing comfort, fixation, potential problems, and the effectiveness of the HME cassette. In addition, we investigated relevant voice quality parameters including dynamics range, frequency range of the speaking voice, and maximum phonation time. Seven patients discontinued the study due to problems of securing the valve to the skin (four patients) or recurrent cancer (three patients). Ten of the remaining 17 patients wore the valve daily for an average of 8.4 h. A total of 88% of the patients considered it a great advantage to be able to speak without having to use their hands. With the Provox FreeHands HME, maximum phonation time was 8.7 (+/-6.2) s and the dynamic range was 21.9 (+/-5.8) decibels. The results show that the Provox FreeHands HME Automatic Tracheostoma Valve system not only allows hands-free speech but is also associated with excellent compliance and good voice rehabilitation.

Adult↗
PubMed2002

Correlation between voice handicap index and voice laboratory measurements in dysphonic patients.

Factors underlying voice disorders can be categorized into three distinct domains: emotional, physical, and functional. The Voice Handicap Index (VHI) subjectively evaluates voice disorders in terms of these three factors. On the other hand, Voice Laboratory Measurements (VLM) use objective criteria to evaluate the severity of voice disorders. Use of these two different tests (VHI and VLM) on dysphonic patients has, however, tended to yield results that vary widely in their conclusions. This report reviewed 135 testing sessions on dysphonia patients. Seventy-nine of the tests were VHI, and 56 were VLM. All VHI and VLM parameters were entered into a statistical program and analyzed using a Pearson correlation. The results show that each VHI parameter provides a significant level of reliability (P < 0.01) when compared with other VHI parameters. Four VLM parameters also demonstrated significant reliability (P < 0.01) in comparison with other VLM parameters. However, when comparing across testing methods, VHI and VLM parameter reliability is shown to be poor (P > 0.05). With such a large discrepancy between the results of VHI and VLM testing, no objective parameter can yet be regarded as a definitive prognostic factor in a subjective evaluation of dysphonic patients.

Adolescent↗
PubMed2004

Short, self-report voice symptom scales: psychometric characteristics of the voice handicap index-10 and the vocal performance questionnaire.

OBJECTIVE: Short, self-report symptom questionnaires are useful in routine clinical situations for assessing the progress of disorders and the influence of interventions. The Voice Handicap Index-10 (VHI-10) and Vocal Performance Questionnaire (VPQ) are brief self-reported assessments of voice pathology, apparently useful in the general voice clinic population. Little is known of the structure or internal consistency of either tool, nor whether they correlate. This study carried out a substantial, systematic evaluation of their performance in the Laryngology office setting. STUDY DESIGN AND SETTING: 330 adult (222 women, 108 men) voice clinic attenders completed the VHI and the VPQ. RESULTS: The VHI-10 and VPQ each had a large, single principal component, high internal consistency, and were highly correlated (disattenuated r=0.91). CONCLUSION: The VHI-10 and the VPQ are similar, short, convenient, internally-consistent, unidimensional tools. SIGNIFICANCE: The total VHI-10 or VPQ score is a good overall indicator of the severity of voice disorders.

Adult↗
PubMed2006

Estimation of the voice source from speech pressure signals: evaluation of an inverse filtering technique using physical modelling of voice production.

OBJECTIVE: The goal of the study is to use physical modelling of voice production to assess the performance of an inverse filtering method in estimating the glottal flow from acoustic speech pressure signals. METHODS: An automatic inverse filtering method is presented, and speech pressure signals are generated using physical modelling of voice production so as to obtain test vowels with a known shape of the glottal excitation waveform. The speech sounds produced consist of 4 different vowels, each with 10 different values of the fundamental frequency. Both the original glottal flows given by physical modelling and their estimates computed by inverse filtering were parametrised with two robust voice source parameters: the normalized amplitude quotient and the difference (in decibels) between the levels of the first and second harmonics. RESULTS: The results show that for both extracted parameters the error introduced by inverse filtering was, in general, small. The effect of the distortion caused by inverse filtering on the parameter values was clearly smaller than the change in the corresponding parameters when the phonation type was altered. The distortion was largest for high-pitched vowels with the lowest value of the first formant. CONCLUSIONS: The study shows that the proposed inverse filtering technique combined with the extracted parameters constitutes a voice source analysis tool that is able to measure the voice source dynamics automatically with satisfactory accuracy.

Glottis↗
PubMed1996

The Nijdam voice prosthesis: a self-retaining valveless voice prosthesis for vocal rehabilitation after total laryngectomy.

Voice prosthesis-assisted speech rehabilitation after total laryngectomy has proven to be successful in the majority of patients and exceeds the results of traditional oesophageal speech. Nevertheless 10-30% failure rates are still reported. In part this is due to prosthesis-related problems, in particular ingrowth of Candida species in the valve-bearing parts of the devices. A new indwelling, low-resistance and valveless voice prosthesis is described; the Nijdam voice prosthesis. The device has an average device lifetime of 19 weeks which appears to be superior to other indwelling voice prostheses. Replacement indications mainly comprise leakage or increased airflow resistance. Most frequent local complications are granulation tissue and hypertrophic scar tissue formation. These occur in 12% of the patients and can easily be treated. Replacement is a simple outpatient procedure. The prosthesis is interchangeable with other types of indwelling voice prosthesis.

Equipment Design↗
PubMed2003

Voice restoration with low pressure blom singer voice prosthesis after total laryngectomy.

The main problem after total laryngectomy is permanent loss of voice. Current methods of vocal rehabilitation after total laryngectomy include development of esophageal speech, use of artificial larynx, tracheoesophageal shunt operations and more recently surgical restoration of the voice with prosthesis. Primary voice restoration using Blom- Singer voice prosthesis after total laryngectomy and pharyngeal myotomy was performed in 187 patients between October 1992 and July 2000. There were 184 male and 3 female patients of average age 63.7 years (range 42-76). Mean follow up period was 62 months. Satisfactory speech was achieved in 156 patients (83.5%). During the follow-up period, we experienced complaints of insufficient voice in 31 (16.5%) patients, due to partial spasm in 17 and total spasm in the pharyngoesophageal segment in 14. Furthermore, 24 (12.8%) patients preferred esophageal speech or electro larynx because of low socioeconomic level. The overall success rate was 70.7%. In this study the results of the surgical technique and prosthesis insertion, as well as the associated complications and socioeconomic levels of the patients, are discussed.

Adult↗
PubMed1998

[Voice rehabilitation with a voice prosthesis. Study of 62 patients with 5 years follow-up].

UNLABELLED: From December 1987 to February 1998, 270 patients underwent a total laryngectomy with voice restoration by a voice prosthesis. The analysis is focused on the 62 live patients with a 5 year follow-up. Tracheoesophageal speech had a success rate of 81% after 1 year and 73% after 5 years. The daily use of the voice prosthesis is only 68% after 1 year and 61% after 5 years. During the 5 year follow up (for all patients) 16 (26%) presented an enlarged fistula with leakage around the fistula and 17 (27%) needed a removal of the prosthesis. CONCLUSION: Tracheoesophageal speech with a voice prosthesis appears interesting for laryngectomized patients with: a high success rate, the quality and precocity of the voice obtained. However, it requires extensive care and the results deteriorate with time.

Adult↗
PubMed1998

[The application of frequency-domain harmonics-to-noise ratio in the acoustic analysis of the normal voice and the abnormal voice].

The frequency-domain relative harmonics-to-noise ratios were analysed in 36 normal women and 30 patients who had suffered from abnormal voice. The result indicated: the frequency-domain relative harmonics-to-noise ratios of the normal voice were distributed stably and the relative harmonics-to-noise ratios of the diseased voice differed obviously from that of the normal one above 1,700 Hz (P < 0.01). The frequency-domain relative harmonics-to-noise ratio was considered as a valuable parameter in distinguishing normal voice and diseased voice.

Adult↗