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PubMed1992

The pharmacological treatment of voice disorders.

The increasing diversity of purpose-built, synthetic and biogenetically engineered pharmaceuticals has led to a revival of interest in the pharmacological possibilities for the treatment of voice disorders. Where dysphonias arise as a part of a pathophysiological process, the pharmacological treatment of either the pathology or its associated symptoms may improve dysphonic voicing patterns. The treatment of symptoms such as cough and vocal fatigue are discussed together with treatment of allergic and other causes of inflammation or stiffening of the vocal tract. The pharmacological logical treatment of dysphonia due to defective neuromuscular control in dyskinetic and dystonic conditions is also discussed. Dysphonic voicing patterns are commonly multifactorial, and the author wishes to highlight problems encountered when attempting to adjust the performance of the vocal tract: imprecise targeting of the pathophysiological problems either by the physician or by the drug employed, and the systemic and attendant side-effects of drugs which may be thought to be appropriate.

Age Factors↗
PubMedDate not supplied

Vocal efficiency and aerodynamic aspects in voice disorders.

The variation of vocal efficiency for the mean values for normal subjects was investigated in patients with laryngeal disease. The relative contributions of mean flow rate and intrapulmonic pressure to the variation of efficiency were explored to explain aerodynamic aspects in voice disorders. Vocal efficiency was determined by use of expressions involving simultaneous values of sound pressure level, mean flow rate, and intrapulmonic pressure. The intrapulmonic pressure was noninvasively obtained by plethysmographic and pneumotachographic methods. Values of vocal efficiency were generally abnormally low for the types of larynges studied. An aerodynamic-biomechanical classification of laryngeal disease was inferred from the data: 1) large chink of glottis, associated with high flow rate; 2) mass on vocal fold, associated with high values of both flow rate and intrapulmonic pressure; and 3) high stiffness of vocal fold, associated with high values of intrapulmonic pressure.

Adult↗
PubMed1995

Psychological processes in psychogenic voice disorder.

Using Freud's hysterical conversion model as a basis for reviewing the psychological features in psychogenic voice disorder, this paper describes research findings which show that individuals with this condition are not usually suffering from severe psychopathology but tend to be women who are experiencing high levels of stress (commonly associated with interpersonal relationship conflicts, low self-esteem, the burden of responsibility and feelings of powerlessness), and have above-average musculoskeletal tension as well as difficulties in voicing their feelings or views. The review indicates that the psychoanalytic interpretation of psychogenic voice loss continues to have relevance. However, it is suggested that in most cases Freud's hysterical conversion model should be reformulated, reducing the core focus to unconscious conflicts, repression, denial and secondary gains, in order to emphasise the psychosocial causes and maintenance of intrapsychic conflict and physical dysfunction. It is also suggested that a reformulated psychoanalytic interpretation of psychogenic voice loss has a lot in common with a cognitive-behavioural conceptual model. A psychoanalytic approach may be valuable when focused on early trauma and repressed experiences or feelings, whereas cognitive-behavioural treatment strategies, such as stress management and assertiveness training, appear to be particularly relevant in this condition. The paper concludes by briefly considering some areas of future research.

Affect↗
PubMed1998

Emotional symptoms are secondary to the voice disorder in patients with spasmodic dysphonia.

The aims of this study were to evaluate the emotional status and life quality of the patients with spasmodic dysphonia (SD) before and after botulinum toxin treatment, and to ascertain whether SD is a somatoform disorder. Ten patients with spasmodic dysphonia were injected unilaterally into the vocal cord with botulinum toxin. Before botulinum toxin treatment, two clinician's rating scales--Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), and three self-rating psychometrics--Zung's Self-Rating Depression Scale (SDS), Life Quality Scale (GHQ/QL-12), and Symptom Distress Checklist (SCL-90) were applied. Self-rating scales were also administered in 20 matched normal controls. The patients were reevaluated 1 month after botulinum toxin treatment. The Clinical Global Impression Scale (CGI) was also rated by the patients themselves and a speech pathologist. The mean scores of SD patients were significantly higher than that of controls in SDS, and subscales of somatization, obsessive-compulsive symptoms, depression, anxiety, and psychoticism in SCL-90. The mean score of GHQ/QL-12 was significantly higher in the control group. The scores of HDRS, SDS, GHQ/QL-12 and subscales of somatization, depression, and anxiety in SCL-90 showed significant improvement after botulinum treatment. In CGI, seven patients were rated as improved by patients themselves and the speech pathologist. The patients with SD had more anxiety, depression and somatization symptoms, and poor life quality than normal controls. Their emotional status and life quality improved after botulinum toxin treatment. The results suggest that the emotional symptoms of patients with SD are mainly secondary to voice disorder.

Adult↗
PubMed1989

[Studies of voice stress in teachers with functional voice disorders caused by teaching activity].

30 female teachers of ten-years technical schools-15 with functional voice-disturbance an 15 with healthy voice-have been examined while teaching in respect of their strain. Duration of speech, intensity of their teachers voice an background noise, the frequency of heart rate and the arterial blood pressure were measured on the teaching day. Between both research groups no statistically significant differences were shown. There were no correlations between the durations of speech, intensity and vegetative parameters.

Adult↗
PubMed2006

Musculoskeletal patterns in patients with voice disorders.

This study correlated the ear, nose, and throat (ENT) and physiotherapy input on 26 patients who presented with voice problems and were found by the ENT surgeon to have a degree of musculoskeletal issues. It also looked for patterns of musculoskeletal findings. Although all patients referred were found by the physiotherapist to have musculoskeletal abnormalities, the correlation proved to be excellent among the subgroup of performers, but only fair-to-good among the other voice professionals. Certain patterns of musculoskeletal abnormalities were frequently encountered, including a high held larynx, a shortening or contraction of the stylohyoid and sternocleidomastoid muscles, and a weak deep flexor mechanism. In this small group, most patients seemed to improve, although it must be noted that management was not limited to physiotherapy. In summary, physiotherapy input proved helpful in the evaluation and management of this group of patients presenting with voice problems.

Adult↗
PubMed1997

Categorization of voice disorders with six perceptual dimensions.

To obtain a perceptual reference for acoustic feature selection, 94 male and 124 female voices were categorized using the ratings of 6 clinicians on visual analog scales for pathology, roughness, breathiness, strain, asthenia, and pitch. Partial correlations showed that breathiness and roughness were the main determinants of pathology. The six-dimensional ratings (the six median scores for each voice) were categorized with the aid of the Sammon map and the self-organizing map. The five categories created differed with respect to the breathiness/roughness ratio and the degree of pathology.

Adult↗