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At least 19 recordsLinked to original sources
PubMed2005

Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia.

OBJECTIVES: Adductor spasmodic dysphonia (ADSD) has been characterized as a "task specific" laryngeal dystonia, meaning that the severity of dysphonia varies depending on the demands of the vocal task. Voice produced in connected speech as compared with sustained vowels is said to provoke more frequent and severe laryngeal spasms. This study examined the diagnostic value of "task specificity" as a marker of ADSD and its potential to differentiate ADSD from muscle tension dysphonia (MTD), a functional voice disorder that can often masquerade as ADSD. STUDY DESIGN: Case-control study. METHODS: Five listeners, blinded to the purpose of the study, used a 10 cm visual analogue scale to rate dysphonia severity of subjects with ADSD (n = 36) and MTD (n = 45) producing either connected speech or a sustained vowel "ah." RESULTS: In ADSD, dysphonia severity for connected speech (M = 6.22 cm, SD = 2.56) was rated significantly more severe than sustained vowel productions (M = 4.8 cm, SD = 2.8 [t (35) = 3.67, P < .001]). In MTD, however, no significant difference in severity was observed for the connected speech sample (M = 5.98 cm, SD = 2.83 versus the sustained vowel M = 5.86 cm, SD = 2.87 [t (44) = 0.378, P = .707]). The receiver operating characteristic (ROC) curve, an index of the accuracy of task specificity as a diagnostic marker, revealed that a 1 cm difference criterion correctly identified 53% of ADSD cases (sensitivity) and 76% of MTD cases (specificity) (chi2 (1) = 6.88, P = .0087). CONCLUSIONS: Reduced dysphonia severity during sustained vowels supports task specificity in ADSD but not MTD and highlights a valuable diagnostic marker whose recognition should contribute to improved diagnostic precision.

Adult↗
PubMed2000

Adductor spasmodic dysphonia and muscular tension dysphonia: acoustic analysis of sustained phonation and reading.

Acoustic phonatory events were identified in 10 women diagnosed with adductor spasmodic dysphonia (ADSD) and compared to 5 women and 5 men diagnosed with muscle tension dysphonia (MTD). The three acoustic parameters examined during sustained vowel production and reading included phonatory breaks, aperiodicity, and frequency shifts. Intra- and intermeasurer correlations showed high reliability for the measures. Findings indicated that those with ADSD produced a greater number of aberrant acoustic events than those with MTD. The results suggested that: (1) only those with ADSD show evidence of phonatory breaks during vocalization, albeit a sustained vowel or voicing during reading; (2) those with ADSD demonstrate greater variation in the type of aberrant acoustic events produced as a function of speech task. The latter point suggests that control of the larynx varies as a function of task demand, a finding not evident in the functionally based disorder of MTD. MTD is a disorder that often presents itself in a similar clinical manner to ADSD because of its perceptual commonalties and resembling laryngoscopic characteristics. The acoustic analysis presented in this study could be used as a method to assist in distinguishing between the two disorder types.

Acoustics↗
PubMed1999

Phonatory air flow characteristics of adductor spasmodic dysphonia and muscle tension dysphonia.

The purpose of this study was to determine if phonatory air flow characteristics differed among women with adductor spasmodic dysphonia (AdSD), muscle tension dysphonia (MTD), and normal phonation. Phonatory air flow signals were gathered during [pa] syllable repetitions. Mean phonatory air flow, coefficients of variation, and the presence of large air flow perturbations (75 ml/s or more) were examined for the three groups of speakers. There was no significant difference in mean phonatory air flow across groups, and very large intersubject variation in mean phonatory air flow occurred for both the AdSD and MTD groups. Coefficients of variation were similar for the groups of women with MTD and normal phonation but were significantly larger for the group with AdSD. Air flow perturbations were common with AdSD and rare with MTD. Relatively large coefficients of variation and air flow perturbations of at least 75 ml/s did occur for some women with normal voices who were 70 years of age or older. It appears that intrasubject variability in phonatory air flow may aid in the differentiation of AdSD and MTD when used in conjunction with other elements of a thorough voice evaluation. However, the potential contribution of aging to increased intrasubject variability in phonatory air flow must be considered when interpreting findings.

Adult↗
PubMed1996

Muscle tension dysphonia and spasmodic dysphonia: the role of manual laryngeal tension reduction in diagnosis and management.

Excessive activity of the extralaryngeal muscles affects laryngeal function and contributes to a spectrum of interrelated symptoms and syndromes including muscle tension dysphonia and spasmodic dysphonia. Recognition of the role of extralaryngeal tension is helpful in ensuring proper diagnosis and selection of appropriate treatment. This report demonstrates the application of manual laryngeal musculoskeletal tension reduction techniques in the diagnosis and management of laryngeal hyperfunction syndromes. The manual technique consists of focal palpation to determine 1) extent of laryngeal elevation, 2) focal tenderness, 3) voice effect of applying downward pressure over the superior border of the thyroid lamina, and 4) extent of sustained voice improvement following circum-laryngeal massage. The clinical utility of this innovative approach is discussed.

Adult↗
PubMedDate not supplied

[Classification of dysphonias based on the primary etiologic factor (part I)].

INTRODUCTION: Phonation is a complex integral function of the organism. Regular phonation is characterized by: clarity and adequate pitch. Dysphonia is a disorder of phonation. It may have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena are caused by: aperiodicity of vocal vibration, turbulent air flow in the glottis and incomplete glottis closure. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: organic dysphonias and functional dysphonias. On the 8th Congress of Union of European Phoniatricians, in Koszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification, made according to the primary etiologic factor in dysphonias. In this paper, we shall consider the first four. I DYSPHONIAS CAUSED BY PRIMARY FUNCTIONAL DISORDERS: This group includes: 1. Hyperkinetic dysphonia grade I 2. Hyperkinetic dysphonia grade II 3. Hypokinetic dysphonia 4. Contact hyperplastic dysphonia 5. Dysodic dysphonia II DYSPHONIAS CAUSED BY PRIMARY NEUROGENIC DISORDERS: This group includes: 1. Central dysphonias 2. Spasmodic (spastic) dysphonia 3. Dysphonia caused by myasthenia gravis 4. Dysphonia within skull base syndromes 5. Dysphonia caused by unilateral palsy of the inferior laryngeal nerve 6. Dysphonia caused by bilateral palsy of the inferior laryngeal nerve 7. Dysphonia caused by palsy of the superior laryngeal nerve III DYSPHONIAS CAUSED BY PRIMARY PSYCHOGENIC DISORDERS: This group includes: 1. Psychogenic aphonia 2. Psychogenic dysphonia 3. False mutation IV DYSPHONIAS CAUSED BY PRIMARY SOMATIC DISORDERS: This group includes: 1. Dysphonia caused by insufficiency of vocal cords 2. Dysphonia caused by oedema of vocal cords 3. Dysphonia caused by laryngitis (secondary functional) 4. Cord-ventricular voice 5. Posttraumatic dysphonia 6. Arthrogenic dysphonia 7. Presbyphonia CONCLUSION: Dysphonia is a disorder of phonation which originates at the glottis level. When disorders of phonation are concerned it is necessary to study the organism as a whole as well as all mechanisms which take part in voice production. In that case the damaged part of the phonation system can be diagnosed, which enables efficient medical treatment of the disorder.

Humans↗
PubMedDate not supplied

[Classification of dysphonias based on the primary etiologic factor (part II)].

INTRODUCTION: Phonation is a complex integral function of an organism. Regular phonation is characterized by: clearness and adequate pitch. Dysphonia is a disorder of phonation. It can have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena in regard to voice are caused by: irregularities in vocal cord vibration, turbulent airflow in the glottis and obstruction of glottis. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: 1. organic dysphonias and 2. functional dysphonias. On the 8th Congress of the Union of European Phoniatrists, in Köszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification according to the primary etiologic factor of dysphonias. In this paper, we shall consider four gropus: from the fifth to eighth. V DYSPHONIAS CAUSED BY PRIMARY ENDOCRINE DISORDERS: This group includes: 1. Dysphonia caused by pituitary disorders 2. Dysphonia caused by thyroid gland disorders 3. Dysphonia caused by parathyroid glands disorders 4. Dysphonia caused by pancreatic function disorders 5. Dysphonia caused by suprarenal function disorders 6. Dysphonias caused by sexual glands function disorders 7. Intersexuality. VI DYSPHONIAS CAUSED BY COMPLEX PROFESSIONAL REASONS: This group includes: 1. Permanent hyperkinetic dysphonia 2. Permanent hyperkinetic dysphonia with vocal cord nodules 3. Dysphonia caused by myogenic imperfect closure of vocal cords 4. Phonastenia. VII DYSPHONIAS CAUSED BY PRIMARY DISPLASTIC DISORDERS: This group includes: 1. Dysphonia caused by laryngeal hypoplasia 2. Dysphonia caused by laryngeal asymmetry 3. Dysphonia caused by epiglottal anomalies 4. Dysphonia caused by laryngeal diaphragm. VIII DYSPHONIAS CAUSED BY LARYNGEAL TUMORS: This group includes: 1. Dysphonia caused by benign tumors 2. Dysphonia caused by malignant tumors. CONCLUSION: Dysphonia is a disorder of phonation which originates from glottal level. Disorders of phonation require observation of an organism as a whole and studying all mechanisms which take part in voice production. This provides examination of voice disorders, their establishment and adequate treatment.

Endocrine System Diseases↗
PubMed2002

Risk factors and demographics in patients with spasmodic dysphonia.

OBJECTIVES: Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia. STUDY DESIGN: Retrospective patient survey of 168 patients with a known diagnosis of spasmodic dysphonia who completed questionnaires at the time of interval botulinum toxin injection. METHODS: Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first-degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of chi2 values. RESULTS: In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty-five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P =.0001). Thirty percent of patients directly associated onset of spasmodic dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic dysphonia. Twenty-six percent of patients had an essential tremor compared with 4% of first-degree relatives (P =.0001), and 11% had associated writer's cramp compared with 2% of relatives (P =.02). Less than 1% of patients described a history of toxic exposure or electrical injury. CONCLUSIONS: The majority of patients with spasmodic dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic dysphonia. Patients with spasmodic dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.

Adolescent↗
PubMedDate not supplied

The relevance of stroboscopy in functional dysphonias(1).

OBJECTIVES: Functional dysphonias are disorders of the voice characterized by sound and efficiency disturbances of the voice without any organic changes of structures being detectable. At present, functional dysphonias are generally subclassified into hyper- and hypofunctional dysphonias in clinical practice. STUDY DESIGN: The study was designed for a critical evaluation of the relevance of stroboscopy to the diagnostics and classification of functional dysphonias. METHODS: 45 patients were examined (27 hyperfunctional, 15 hypofunctional and 3 mixed type) using videostroboscopy. Several stroboscopic parameters were taken into consideration. Three geometrical and three time-dependent parameters were first analyzed in a uni- and multidimensional way, then cluster analyses were performed. RESULTS: We could not confirm the clinical subdivision into hyper- and hypofunctional dysphonias as based on anamnestic data, perceptual evaluation of voice sound, voice profile measurements and videostroboscopy. Quantitative measurements of selected parameters did not correlate with qualitative subjective stroboscopic assessment. In addition to this, it was not possible to identify separate clusters of stroboscopic findings. CONCLUSIONS: The results do not deny the clinical relevance of stroboscopy to the diagnostics of functional dysphonias as a very useful tool to exclude organic lesions. However, a reliable subclassification into different types of functional dysphonias was not possible.

Adolescent↗
PubMed2002

Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy.

OBJECTIVE: To describe a condition that is referred to as steroid inhaler laryngitis, a clinical entity that is caused by the use of inhaled fluticasone propionate and manifested by dysphonia, throat clearing, and fullness. DESIGN: Case series. SETTING: An outpatient clinic of an academic referral center. PATIENTS: The study population consisted of 20 patients with reactive airway disease and dysphonia who were receiving inhaled fluticasone therapy and who were diagnosed as having steroid inhaler laryngitis during the period from January 1998 to June 2000. INTERVENTION: Cessation of inhaled fluticasone therapy when possible, as well as treatment of other underlying causes of dysphonia, such as laryngopharyngeal reflux and infectious processes. MAIN OUTCOME MEASURE: The resolution of dysphonia with cessation of inhaled fluticasone therapy. RESULTS: Patients with steroid inhaler laryngitis were found to have laryngeal findings ranging from mucosal edema, erythema, and thickening to leukoplakia, granulation, and candidiasis. Patients with more severe mucosal findings were more likely to have laryngopharyngeal reflux as well. Resolution of dysphonia occurred only after discontinuation of the inhaled fluticasone therapy. CONCLUSIONS: Steroid inhaler laryngitis is a form of chemical laryngopharyngitis induced by topical steroid administration. Symptoms and physical findings mimic laryngopharyngeal reflux, but only respond completely to discontinuation of the inhaled steroid therapy. The otolaryngologist should be familiar with this cause of dysphonia.

Administration, Inhalation↗
PubMed2003

Ventricular dysphonia: clinical aspects and therapeutic options.

OBJECTIVE/HYPOTHESIS: Ventricular dysphonia, also known as dysphonia plica ventricularis, refers to the pathological interference of the false vocal folds during phonation. Despite its low incidence and prevalence, Vd is a well-known phenomenon in voice clinics. The present report reviews symptoms, etiology, diagnosis, and therapeutic options regarding this voice disorder. STUDY DESIGN: Literature review and case studies. METHODS: The literature pertaining to all clinical aspects of V(D) was reviewed to define diagnostic and therapeutic clinical decision making. RESULTS: Ventricular dysphonia is characterized by a typical rough, low-pitched voice quality resulting from false vocal fold vibration. Ventricular dysphonia may be compensatory when true vocal folds are affected (resection, paralysis). Noncompensatory types may be of habitual, psychoemotional, or idiopathic origin. Because perceptual symptoms may vary considerably, diagnosis should rely on a meticulous voice assessment, including laryngeal videostroboscopic, perceptual, aerodynamic, and acoustic evaluation. Various therapeutic approaches for the noncompensatory type of ventricular dysphonia may be considered: voice therapy, psychotherapy, anesthetic or botulinum toxin injections, or surgery. CONCLUSION: The study presents the state of the art with respect to ventricular dysphonia and may be helpful in diagnosis and therapeutic decision-making.

Adolescent↗
PubMed2004

Factors predicting patient perception of dysphonia caused by benign vocal fold lesions.

OBJECTIVES/HYPOTHESIS: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. We hypothesize that 1) level of vocal demand; 2) auditory-perceptual evaluation of dysphonia severity; and 3) vocal function, as defined by phonatory glottal closure and mucosal wave vibration, are the most significant predictors of VHI score. STUDY DESIGN: : Retrospective review of 100 patients with benign vocal fold lesions. METHODS: Variables assessed for predictive value to VHI score are level of vocal demands, auditory-perceptual evaluation of dysphonia severity, integrity of mucosal wave vibration and phonatory glottal closure, lesion type, duration of current complaint, smoking, age, and sex. Harmonic to noise ratio was assessed in a subset of 50 patients. RESULTS: Patients with routine voice use had significantly lower VHI scores than those with more intensive (nonsinging/acting) vocal demands. Patients who quit smoking had greater VHI scores than those who currently smoke or never started. Patients with long-standing dysphonia tended to have lower VHI scores than those with shorter duration vocal complaints. Auditory-perceptual assessment of dysphonia severity and harmonic to noise ratio were weak predictors of VHI score. Age, sex, lesion type, phonatory glottal closure, and mucosal wave vibration were not significant predictors of VHI score. CONCLUSIONS: Patient perception of dysphonia severity is independent of many factors commonly assessed during the evaluation of voice disorders. It appears to be an important independent element in the assessment of the effect of a benign vocal fold lesion and critical to therapeutic decision-making.

Adolescent↗
PubMed1983

Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality.

Nine of 14 asthmatic patients who presented with persistent dysphonia while taking inhaled corticosteroids had a bilateral adductor vocal cord deformity with bowing of the cords on phonation. This causes the dysphonia and usually occurs without candidiasis. It was seen with beclomethasone dipropionate (in both pressurised aerosol and dry powder preparations), betamethasone valerate, and budesonide. It was related to the dose and potency of inhaled steroid and may represent a local steroid myopathy. It was reversed when the inhaled steroid was stopped, although resolution sometimes took weeks. Laryngeal candidiasis may have contributed to the vocal cord abnormality in two of these nine patients. Of the five patients without vocal cord deformity, laryngeal candidiasis was the sole cause of dysphonia in three. In the remaining two dysphonia was thought to be psychogenic. The vocal cord deformity may exist subclinically. Of nine patients who started to take aerosol steroid and who were examined monthly for one year, three developed vocal cord deformity but only one had persistent dysphonia. Vocal abuse did not appear to contribute to dysphonia.

Adult↗
PubMed1991

[Treatment of spasmodic dysphonia with botulinum toxin].

Spasmodic dysphonia is a focal laryngeal dystonia, a rare form of dystonia. Videostroboscopy, acoustic analysis, computerized voice analysis and over all electrophysiological analysis allow for the study of the different muscles involved in this dysphonia. There are two types of spasmodic dysphonia: adductor spasmodic dysphonia and abductor spasmodic dysphonia. The most efficient therapy nowadays is the injection of botulinum toxin into the thyroarytenoid muscle under fiberoptic visualization. We report 6 patient's cases of spasmodic dysphonia that we have been treating for about 2 years by direct injection of botulinum toxin in the vocal cords.

Adult↗
PubMed2004

Longitudinal effects of Botox injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia: part II.

OBJECTIVE: To investigate the longitudinal effects of botulinum toxin type A (Botox) injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia. DESIGN: Prospective study. SETTING: Academic tertiary care referral center. PARTICIPANTS: Forty-two patients who presented to our institution with dysphonia and were diagnosed as having adductory spasmodic dysphonia during a 38-month period. INTERVENTION: Patients received Botox injections into both thyroarytenoid muscles via the cricothyroid membrane. The typical starting dose was 1.0 U per vocal fold. If necessary, the dosage was adjusted in subsequent injections to reduce adverse effects or to enhance duration of benefit. MAIN OUTCOME MEASURES: Patients filled out questionnaires, including the V-RQOL Measure and a self-assessed overall voice rating, before each injection. Postinjection questionnaires were completed 6 to 8 weeks after each treatment. Mean pretreatment and posttreatment scores were calculated for each treatment. RESULTS: The number of treatments per patient ranged from 1 to 7. Statistically significant improvements in mean total and domain V-RQOL scores were calculated for every injection (P<.01) (no postinjection questionnaires were available for the seventh injections). The magnitude of the effect remained constant for later injections. Eighty-two percent of the population recorded at least 1 category of improvement in overall self-assessed voice rating with each injection. CONCLUSIONS: Botox has a significant beneficial effect on V-RQOL for at least 6 injection cycles. This study demonstrates the efficacy of Botox for treating patients with adductory spasmodic dysphonia and further illustrates the usefulness and validity of the V-RQOL Measure in evaluating patients with dysphonia.

Adult↗
PubMed2003

Dysphonia: medical treatment and a medical voice hygiene advice approach. A prospective randomised pilot study.

For many years all patients with dysphonia referred to in the literature as resulting from non-organic (functional) voice disorders were sent to speech therapy. Medical diagnoses were not taken into account. In our earlier Cochrane review on vocal cord nodules we discovered that evidence-based research in the area of benign voice disorders with dysphonia, and with or without slight benign swellings including nodules on the vocal cords, was lacking at that time. Therefore, a prospective randomised pilot study based on our Cochrane review has been made on dysphonic patients with non-organic (function provoked?) voice disorders as the basis for further evidence-based studies. Medical treatment was based on the scientific approach that once a micro-organic disorder caused by reflux, infection, allergy or environmental irritatants (e.g., dust or noise in the workplace) was discovered by very careful anamnesis and systematic objective routine analyses and was treated effectively, with documentation, the non-organic voice disorder disappeared, as, e.g., in the case of a diagnosis and treatment of helicobakter pylori. The reason is that the mucosal swelling/dysfunction of the vocal cords is secondary. In order to try to understand why the recommendation to all these patients for many years was only voice therapy, which the speech therapists "felt to be effective", updated voice-hygiene advice (for posture, accents of the diaphragm, intonation pattern and resonance) was given by experienced laryngologists, randomised with the updated medical diagnosis/therapy in order to elucidate what effect the training might have. No evidence-based studies in the literature document any effect. The crucial point seemed to be that doctors mostly did not examine any other diagnoses other than the "dysphonia" and did not dig down to any of the medical reasons when the vocal fold diagnosis of "non- organic disorders" was made. This should be changed in the future. This pilot study was based on a comparison of ten dysphonic patients with stroboscopic non- organic (functional) voice disorders, where a micro-organic diagnosis was searched for and treated systematically in a medical regime (for infections, allergies, gastrooesophageal reflux and environmental irritants such as dust, noise, etc.) versus ten dysphonic patients with stroboscopically confirmed non-organic (functional) voice disorders, having only the traditional but optimal voice advice, which we can call medical voice-hygiene advice, including the use of the Accent method. A retrospective group of ten patients treated medically was included, too. A demand cannot be made that the functional group being treated by randomisation with voice advice should also be medically treated at once, the medical approach being the new one. On the other hand, it is strange that no evidence-based research was made before. All patients were measured two times with stored videostroboscopy, a quality-of-life questionnaire and phonetograms with 1-month intervals. All patient groups improved. There was no statistical improvement in favour of the medical group with the voice-related quality-of-life score, also not for the group who received voice-hygiene advice. The geometrical mean values of the phonetogram areas in decibels times semitones were better in all groups, but a statistical difference was not found between the medically treated group and the voice-hygiene advice group. The pilot study showed that both medical treatment and medical voice-hygiene advice had a positive effect on dysphonia in non-organic (functional) voice disorders. There is need of an extensive prospective randomised trial on dysphonia including vocal cord nodules to find out which treatment should be used for this group of patients. It is suggested that an eventual randomisation for microsurgical treatment or regular voice therapy should be made after a period of systematic medical diagnosis and treatment including medical voice-hygiene advice.

Adult↗