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PubMed2002

Psychogenic voice disorders--heroes or hysterics? A brief overview with questions and discussion.

A brief overview of the field in relation to psychogenic voice disorders is given with reference to past and present terminology used, the common presentations seen, followed by the more subtle or ambiguous examples which may challenge our notions of psychogenic or clear-cut functional versus organic dichotomies. Issues related to aetiology, personality and psychological correlates are discussed, and a number of questions regarding the phenomenology of psychogenic dysphonia and its therapeutic resolution are raised. Since prevalence continues to be significantly in favour of women, it is suggested psychogenic voice disorder as a feminist issue might be worthy of our further consideration.

Female↗
PubMed2006

Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders.

This study examined the reliability of two methods for documenting voice quality by clinicians and compared the methods for documenting patients' perceptions of voice quality. It involved a prospective reliability study and a retrospective chart review. Reliability of two clinician-based voice assessment protocols-Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) and Consensus Auditory Perceptual Evaluation-Voice (CAPE-V)-was evaluated. These two protocols were then compared after use in voice assessments of 42 males and 61 females performed by a certified speech-language pathologist specializing in the assessment of voice disorders. In addition, two patient-based scales (Voice Related Quality of Life, or V-RQOL, and Iowa Patient's Voice Index, or IPVI) obtained from the same patients were compared with each other and with the clinician-based scales. Reliability of clinicians' ratings of overall severity of dysphonia using GRBAS and CAPE-V scales was very good (r>0.80). Agreement between V-RQOL Total scores and IPVI ratings of the patient's perceptions of impact of dysphonia was less strong (Spearman's r=-0.76). There was relatively weak agreement between patient-based and clinician-based scales. Clinician's perceptions of dysphonia appeared to be reliable and unaffected by rating tool, as indicated by the high level of agreement between the two rating systems when they were used together. The CAPE-V system appeared to be more sensitive to small differences within and among patients than the GRBAS system. The V-RQOL and IPVI approaches to documenting patient's perceptions of dysphonia agreed less well possibly due to differences in patient dependence on voice and on interpretation of the rating tool items. The differences between clinician-based and patient-based data support the conclusion that clinicians and patients experience and consider dysphonia very differently.

Adolescent↗
PubMed2002

Occupational voice disorders due to workplace exposure to irritants--a review of the literature.

The medical literature contains relatively few examples of reports of voice disorders that could be attributed to chemical exposure at work. General medical conditions such as gastro-oesophageal reflux and the use of medication such as inhaled steroids are well-recognized causes of laryngitis, but the occupational causes are less well documented. This paper describes the results of a literature review looking at the reporting of cases of occupationally acquired voice disorders due to exposure to irritants in the workplace.

Agricultural Workers' Diseases↗
PubMed1989

Speech therapy for psychogenic voice disorder: a survey of current practice and training.

A survey of speech therapists in the United Kingdom showed that they usually undertook the treatment of psychogenic voice disorders. Their pre-qualification education had provided advice that was usually reflected accurately in the experience they gained in practice, though during their education about a third had lacked any opportunity to treat or observe psychogenic voice disorders. The appropriate duration of treatment appears to be in doubt. At present, speech therapists acquire many of the psychological skills required for treatment after qualification. There is a substantial need for post-qualification courses, although more practical instruction on psychological treatment might advantageously be incorporated in initial education.

Humans↗
PubMed1996

The perceptual evaluation of voice disorders.

The consent about the necessity of perceptual evaluation in the assessment of patients with voice disorders is almost unanimous. This is not the case with regard to the method or scale. This article gives an outline of historical backgrounds and presents a survey of contemporary perceptual rating scales. Reliability and influencing factors are discussed and recommendations are made with respect to clinical use.

Adolescent↗
PubMed1990

The incidence of voice disorders.

This report summarizes the log book for patients with voice disorders treated at Washington University in St. Louis between 1984 and 1988. Our experience with these 764 patients is expressed as the number of visits for each problem type.

Humans↗
PubMed1984

[Differentiation of organic and functional voice disorders in slight adduction disorders of the larynx].

Patients with organic or functional voice disorders show a considerable agreement between the individual aerodynamic phonatory pattern and the appearances on indirect laryngoscopy during phonation. Both groups were characterized by incomplete dorsal glottic closure. The aerodynamic data (subglottal pressure and transglottal flow) and the laryngeal efficiency support a pathophysiological explanation of abnormal and breathy voicing. Division of the transglottal flow into modulated and unmodulated parts explains how a better voice will be obtained with equal or lower flow values by relaxation of the musculature. The decreased tension of the muscles also produces phonation with a lower subglottal pressure. The onset of fatigue is therefore delayed. It is concluded that mild adduction disorders are neither organic nor functional disorders. Rather there is a continuum of organic alterations with different laryngeal functional disturbances.

Humans↗
PubMed1994

[A vocal treatment plan for voice disorders after phonosurgery--a preliminary study].

In this study, twenty-five subjects have received phonosurgery of benign vocal pathology but persistent voice disorders postoperatively, characterized by a hoarse, low-pitched, soft voice or efforted phonation. Each subject had filled out a self-evaluation questionnaire of vocal behaviors before surgery and his vocal cords examined by ENT doctor with indirect laryngoscope or direct fiberscope. Voice evaluations was done based on perceptual and acoustic parameters preoperatively and postoperatively. Twenty-five subjects were grouped into three post-operative vocal rehabilitation programs: voice rest group, vocal hygiene group, and direct voice therapy group. The criteria in grouping were according to the subjects' amount of vocal use, environmental pressures, vocal abuse or misuse behaviors and time flexibility. The therapy strategies included reducing amount of vocal use, changing life style, analyzing environmental pressures and treating voice problems with established facilitating techniques. The post-surgical vocal rehabilitation program lasted three to six months. Each subject's voice parameters were reevaluated six months after surgery. The results of three vocal rehabilitation groups were compared with those before rehabilitation. The implication of this study is to provide a holistic voice treatment plan and obtain better surgical intervention results.

Adult↗
PubMed1987

An evaluation of residue features as correlates of voice disorders.

Two experiments were conducted to assess the correlations of residue features with some perceptual properties of voice disorders. First, 90 samples of the vowel /a/ produced by patients with various vocal pathologies were analyzed to obtain the residue features, and severity judgments of these vowel samples were obtained. The results of linear multiple regression analysis indicated that the features were highly correlated with the severity ratings. Second, an attempt was made to correlate the residue features with voice qualities. The features were calculated for the vowel /a/ produced by patients with vocal nodules, vocal fold paralysis, and vocal polyps and by normal talkers. Each vowel sample was rated on ten scales of voice quality. The results revealed high correlations among the quality scales so that discrete subject groups could not be formed. Thus, residue features may be useful in assessing the degree of vocal impairment, but their use as correlates of voice quality must await further research.

Adolescent↗
PubMed1998

Etiology and treatment of psychogenic voice disorder: results of a follow-up study of thirty patients.

It is generally accepted that psychogenic voice disorder (PVD) is a result of psychosocial stress; however, systematic studies of etiological factors in this condition are few. Furthermore, although immediate effects of therapy are estimated to be good, relapses are frequent, and the long-term effects of therapy are not known. The present prospective and longitudinal study on 30 patients was thus focused on possible etiological factors, the course of therapy, and the long-term results of therapy for PVD. The results indicate that interpersonal conflicts related to family and work are of basic importance in precipitating this condition. PVD is interpreted as a specific disorder of verbal emotional expression. Our therapy model in which vocal exercises are performed, together with training of communicative skills, seems rewarding. Relapses were not reported in 88% of the patients during the followup period of 1.9-8.4 years after therapy.

Adolescent↗
PubMed2000

Personality and voice disorders: a superfactor trait analysis.

To determine whether personality factors play causal, concomitant, or consequential roles in common voice disorders, a vocally normal control group and four groups with voice disorders-functional dysphonia (FD), vocal nodules (VN), spasmodic dysphonia (SD), and unilateral vocal fold paralysis (UVFP)-were compared on measures of personality and psychological adjustment. Superfactor group comparisons revealed that the majority of FD and VN subjects were classified as introverts and extraverts, respectively. Comparisons involving the SD, UVFP, and control subjects did not identify consistent personality differences. The disability hypothesis, which suggests that personality features and emotional maladjustment are solely a negative consequence of vocal disability, was not supported. Personality variables and their behavioral consequences may therefore contribute to FD and VN. Results are presented within the context of a dispositional theory offered by Roy and Bless (2000a).

Adult↗
PubMed1999

Acoustic evaluation of Isshiki type III thyroplasty for treatment of mutational voice disorders.

The goal of this study was to determine if there are acoustical differences between pre- and post-surgical voices and to evaluate the effectiveness of Isshiki type III thyroplasty in 11 male patients with mutational voice disorders. Acoustic measures were obtained both pre- and post-operatively. A comparison of pre- and post-operative fundamental frequency (Fo), voice frequencies, and vocal intensity obtained from a sustained vowel /i/ during different phonatory tasks was made. The results from the present study demonstrated that after operation the voice frequencies were significantly decreased (p < 0.05). The vocal intensity tended to reduce slightly as the voice frequency lowered. However, there were no statistically significant differences in the pre- and post-operative measures of vocal intensity (p > 0.5). The pre-operative high pitched voices of all the male patients were lowered up to the normal value by the type III thyroplasty.

Adolescent↗
PubMed1995

Voice disorders in children.

The pediatric otolaryngologist has an especially important role in the differential diagnosis and treatment of two voice disorders; these are the voice quality problems (dysphony) and the resonance problems (rhinophony). The first step in the examination is to preclude the organic causes. The functional dysphonia is mostly related to voice abuse/misuse, but may be present on a psychosomatic basis; environmental factors can also play a role in the etiology and the personality structure has been found to be very relevant. The perceptual evaluation of voice is of obvious importance. Endoscopy with a transnasal flexible scope makes it possible, in practically all cases, to identify the morphodynamic changes. Stroboscopy and phonetography can be carried out only in older children, sometimes a 'trial treatment' is of valuable help. The therapy can be divided into five groups (counselling, voice re-education, drug treatment, psychotherapy, surgery), but should be always individual. An open question: how to choose the preferable treatment of vocal nodules: surgery, conservative or wait-and-see? According to a detailed survey in Kurume University Hospital the following can be stated: if the patient is in trouble due to hoarseness, and immediate improvement of his voice is necessary, surgery should be indicated; if they need the improvement but do not need it urgently, voice therapy is recommended; without motivation vocal hygiene is proposed. No matter what treatment patients receive, their voices improve in the majority after puberty, but 15% of the patients do not show any improvement. In cases of hoarseness due to long-term postintubational glottic lesions logopedic treatment is the only therapeutic possibility. The delay of speech development of tracheotomized children can and should be avoided by applying proper cannula technique and by logopedic training. The physiological nasality which depends upon the undisturbed activity of the velopharyngeal closure, can become pathologic in four forms: closed, open, mixed and alternating nasality (rhinophonolalia). In the diagnosis of hyperrhinophony due to VPI X-ray procedures, supplemented with nasendoscopy, proved to be the most informative methods, the etiology (neuromyogen processes) may be revealed by electrophysiological methods; the voice and speech can be assessed and visualized by nasometry, but the detailed speech evaluation is indispensable. The basic possibilities of treatment are as follows: speech therapy, surgery, speech bulb, electrotherapy and medicines. The basis of operative treatment is flap surgery. The anatomical result of 1000 (velo) pharyngoplasties carried out in Madarász and Heim Pál Children's Hospital (Budapest) is good in 98%, the hyperrhinophony ceased or became minimal in 90% after surgery. The ideal age for operation is 4.5 years.

Adolescent↗
PubMed2002

Extrinsic laryngeal muscular tension in patients with voice disorders.

The objective of this study was to establish a standard clinical evaluation tool for assessment by palpation of extrinsic laryngeal muscular tension (ELMT) and investigate the relationship between ELMT and different voice disorder diagnosis categories, particularly muscle misuse dysphonia (MMD), and the presence or absence of gastroesophageal reflux (GER). A palpation technique and tension grading system for four separate muscle groups (suprahyoid, thyrohyoid, cricothyroid, and pharyngolaryngeal) were established. 465 patients, 65% female and 35% male, were assessed sequentially and ELMT results were analyzed in relation to diagnosis and reflux status. A strong relationship was found between thyrohyoid muscle tension and both GER and MMD (p < or = 0.01). Thyrohyoid muscle tension is the only group that demonstrated a significant relationship with MMD. No significant difference in the ELMT scores was found between GER and non-GER patients, although a possible causal relationship was found between MMD type 3 and reflux. It is postulated that palpation of extrinsic laryngeal muscles can yield important information about internal laryngeal postures and diagnosis of muscle misuse voice disorders, particularly MMD type 3 (anteroposterior supraglottic compression). Integration of this technique into routine laryngeal examination can be a significant aid to diagnostic accuracy.

Adolescent↗
PubMed2005

Occupational voice disorders: an analysis of diagnoses made and certificates issued in 1999-2004.

OBJECTIVES: It has been decided to identify the most frequent diseases of the larynx in people occupationally exposed to a considerable voice load and to assess the feasibility of using videostroboscopy to diagnose voice disorders and their organic effects in order to improve the reliability of certification of occupational vocal organ diseases as well as to evaluate the functioning of new regulations on diagnosing and certifying occupational vocal organ diseases and to assay the conformity of clinical diagnoses made at voivodeship (provincial) centers (level I) with those made at scientific research institutes (level II). MATERIALS AND METHODS: The study involved an analysis of 1261 cases (1042 women and 219 men) with the vocal organ disorders referred to the ENT Unit, Nofer Institute of Occupational Medicine, Lódź, by voivodeship centers during 1999-2004 for consultation or under the appeal procedure (if applicants were denied the right to be included in the category of patients with occupational disease of the vocal organ). The majority of the patients (65.7%) were primary school teachers, and those aged 51-60 years made 54.8%. Laryngological, phoniatric and videostroboscopic examinations, when necessary, supplemented with other testing procedures (paranasal sinus imaging, allergenic tests) were taken to assess the clinical state of the patients. RESULTS: As a result of these comprehensive examinations, organic changes in the larynx were detected in 161 (12.7%) cases, including 139 (11.0%) women and 22 (1.7%) men. According to current diagnostic/certifying criteria those pathologies could be classified into the category of occupational disease of the vocal organ. Paresis of vocal folds due to the insufficiency of vocal fold adductor and tensor muscles with permanent dysphonia was found in 97 (7.6%) patients, vocal nodules in 53 (4.2%) and secondary hypertrophy changes in vocal folds in 11 (0.87%) patients. The most frequent reasons for excluding the occupational etiology of the disease were functional disorders of the voice observed in 82.3% of patients in the form of hyperfunctional dysphonia (64.3%), hypofunctional dysphonia (17.0%) and dysfunctional dysphonia (about 1.0%). In 9.0% of patients, the functional disorders of the voice were accompanied by organic changes in the larynx caused by non-occupational factors. CONCLUSIONS: The analysis showed that due to new Polish regulations, the number of certified occupational disease of the vocal organ was reduced; videostroboscopic tests proved to be a very helpful tool for discriminating between the functional and organic disorders of the vocal organ; and good agreement between clinical diagnoses issued at both levels (I and II) was also revealed.

Adult↗
PubMed1993

Voice disorders.

Many other diagnoses and treatments are of particular importance in caring for voice patients. Those discussed in this article are among the most common. The exacting demands of a professional singer or actor, his or her acute ability to analyze the body's condition, and his or her professional athlete's need for a nearly perfect result provide special challenges and gratification for physicians. However, a great many of our non-singer/actor patients are also extremely dependent on voice quality and endurance. Consequently, every patient with a voice complaint should be treated as Pavaroti or Sutherland would be treated, and every voice evaluation should be carried out systematically until a diagnosis has been made on the basis of positive evidence. The emergence of interdisciplinary teams, advanced instrumentation, and voice laboratories has made dramatic improvements in the standard of voice care, and the rapid development of voice as a subspecialty promises continuing advances in the care of voice disorders.

Humans↗
PubMed2005

[Voice disorders in rheumatoid arthritis].

UNLABELLED: The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). RESULTS: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.

Adult↗