Статті в журналах: "Vocal effort, dysphonia"

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Al-Helo, Sajad, Ahmed Al-Safi, and Rahma Aljanabi. "Role of videolaryngostroboscopy in the diagnosis of dysphonic patient with normal fiberoptic laryngoscopy." Iraqi National Journal of Medicine 3, no. 1 (January 15, 2021): 26–38. http://dx.doi.org/10.37319/iqnjm.3.1.3.

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Background: Dysphonia is altered voice quality, pitch, loudness, or vocal effort that impairs people’s quality of life. It is a very common complaint affecting nearly one-third of a population at some point in their life and could be caused by infection, tumor, trauma, vocal cord paralysis, etc . Indirect mirror or endoscopic laryngoscopy is used to assess the laryngeal condition in dysphonic patients seeking mainly for the cause, but frequently the findings were normal or unremarkable . Videolaryngoscopy (VLS) is very useful in dysphonic patients who have an otherwise normal indirect or flexible laryngoscopic examination. In addition to providing information regarding vocal fold vibrations, the image obtained through VLS can be magnified to make a more detailed assessment of the vocal cord anatomy than is possible with rigid of flexible laryngoscopy. Objective of study: To assess the videolaryngostroboscopic findings in dysphonic patients with normal fiber-optic laryngoscopy. Patient & Method: A cross-sectional study, Fifty patients were included in the study; They had complained of dysphonia, and the fiber-optic laryngoscopic examination was normal. Videostroboscopy were obtained for all patients to assess vocal fold vibration and seek any abnormal findings. Results: A total of 50 patients were enrolled in this study. Regarding the stroboscopic findings, 42% of the patients were normal, 15 (30%) had early soft singer’s nodules, 6 patients (12%) had intracordal lesions, 4 patients (8%)had vocal cord polypoidal changes, 2 patients (4%) had presbylaryngis, and the other 2 patients (4%) had sulcus vocalis. Conclusion: VLS is beneficial in detecting vocal cord lesions in patients with normal fiber-optic laryngoscopy. A high proportion (more than half) of dysphonic patients with normal fiber-optic laryngoscopy had abnormal findings. Keywords: Stroboscopy, Videolaryngoscopy, Fiberoptic laryngoscopy, Dysphonia.

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Buckley, Daniel P., Manuel Diaz Cadiz, Tanya L. Eadie, and Cara E. Stepp. "Acoustic Model of Perceived Overall Severity of Dysphonia in Adductor-Type Laryngeal Dystonia." Journal of Speech, Language, and Hearing Research 63, no. 8 (August 10, 2020): 2713–22. http://dx.doi.org/10.1044/2020_jslhr-19-00354.

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Purpose This study is a secondary analysis of existing data. The goal of the study was to construct an acoustic model of perceived overall severity of dysphonia in adductory laryngeal dystonia (AdLD). We predicted that acoustic measures (a) related to voice and pitch breaks and (b) related to vocal effort would form the primary elements of a model corresponding to auditory-perceptual ratings of overall severity of dysphonia. Method Twenty inexperienced listeners evaluated the overall severity of dysphonia of speech stimuli from 19 individuals with AdLD. Acoustic features related to primary signs of AdLD (hyperadduction resulting in pitch and voice breaks) and to a potential secondary symptom of AdLD (vocal effort, measures of relative fundamental frequency) were computed from the speech stimuli. Multiple linear regression analysis was applied to construct an acoustic model of the overall severity of dysphonia. Results The acoustic model included an acoustic feature related to pitch and voice breaks and three acoustic measures derived from relative fundamental frequency; it explained 84.9% of the variance in the auditory-perceptual ratings of overall severity of dysphonia in the speech samples. Conclusions Auditory-perceptual ratings of overall severity of dysphonia in AdLD were related to acoustic features of primary signs (pitch and voice breaks, hyperadduction associated with laryngeal spasms) and were also related to acoustic features of vocal effort. This suggests that compensatory vocal effort may be a secondary symptom in AdLD. Future work to generalize this acoustic model to a larger, independent data set is necessary before clinical translation is warranted.

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Eadie, Tanya L., and Cara E. Stepp. "Acoustic Correlate of Vocal Effort in Spasmodic Dysphonia." Annals of Otology, Rhinology & Laryngology 122, no. 3 (March 2013): 169–76. http://dx.doi.org/10.1177/000348941312200305.

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Eadie, Tanya L., Reyhaneh Rajabzadeh, Derek D. Isetti, Martin T. Nevdahl, and Carolyn R. Baylor. "The Effect of Information and Severity on Perception of Speakers With Adductor Spasmodic Dysphonia." American Journal of Speech-Language Pathology 26, no. 2 (May 17, 2017): 327–41. http://dx.doi.org/10.1044/2016_ajslp-15-0191.

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PurposeThe purpose of this study was to examine the effect of severity of adductor spasmodic dysphonia (ADSD) and information about it on unfamiliar listeners' attitudes about speakers' personal characteristics, perceived vocal effort, and listener comfort on the basis of ratings of speech recordings.MethodFifteen women with ADSD and 5 controls provided speech samples. Forty-five unfamiliar listeners were randomized into 3 groups. Listeners in Group 1 received no information, listeners in Group 2 were told that some speakers had voice disorders or had no voice concerns, and listeners in Group 3 were provided diagnostic labels for each speaker and information about ADSD. Listeners then rated speech samples for attitudes, perceived vocal effort, and listener comfort.ResultsSpeakers with ADSD were judged significantly worse than controls for attitudes related to “social desirability” and “intellect.” There was no effect of severity on “personality” attributes. However, provision of a diagnostic label resulted in significantly more favorable personality ratings than when no label was provided. Perceived vocal effort and comfort became significantly more negative as ADSD severity increased. Finally, most listener ratings were unaffected by provision of additional information about ADSD.ConclusionsListeners' perceptions about speakers with ADSD are difficult to change. Directions for counseling and public education need future study.

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Schwartz, Seth R., Seth M. Cohen, Seth H. Dailey, Richard M. Rosenfeld, Ellen S. Deutsch, M. Boyd Gillespie, Evelyn Granieri, et al. "Clinical Practice Guideline: Hoarseness (Dysphonia)." Otolaryngology–Head and Neck Surgery 141, no. 1_suppl (September 2009): 1–31. http://dx.doi.org/10.1016/j.otohns.2009.06.744.

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Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

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Farahani, Mojgan, Vijay Parsa, Björn Herrmann, Mason Kadem, Ingrid Johnsrude, and Philip C. Doyle. "An Auditory-Perceptual and Pupillometric Study of Vocal Strain and Listening Effort in Adductor Spasmodic Dysphonia." Applied Sciences 10, no. 17 (August 26, 2020): 5907. http://dx.doi.org/10.3390/app10175907.

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This study evaluated ratings of vocal strain and perceived listening effort by normal hearing participants while listening to speech samples produced by talkers with adductor spasmodic dysphonia (AdSD). In addition, objective listening effort was measured through concurrent pupillometry to determine whether listening to disordered voices changed arousal as a result of emotional state or cognitive load. Recordings of the second sentence of the “Rainbow Passage” produced by talkers with varying degrees of AdSD served as speech stimuli. Twenty naïve young adult listeners perceptually evaluated these stimuli on the dimensions of vocal strain and listening effort using two separate visual analogue scales. While making the auditory-perceptual judgments, listeners’ pupil characteristics were objectively measured in synchrony with the presentation of each voice stimulus. Data analyses revealed moderate-to-high inter- and intra-rater reliability. A significant positive correlation was found between the ratings of vocal strain and listening effort. In addition, listeners displayed greater peak pupil dilation (PPD) when listening to more strained and effortful voice samples. Findings from this study suggest that when combined with an auditory-perceptual task, non-volitional physiologic changes in pupil response may serve as an indicator of listening and cognitive effort or arousal.

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Marks, Katherine L., Alessandra Verdi, Laura E. Toles, Kaila L. Stipancic, Andrew J. Ortiz, Robert E. Hillman, and Daryush D. Mehta. "Psychometric Analysis of an Ecological Vocal Effort Scale in Individuals With and Without Vocal Hyperfunction During Activities of Daily Living." American Journal of Speech-Language Pathology 30, no. 6 (November 4, 2021): 2589–604. http://dx.doi.org/10.1044/2021_ajslp-21-00111.

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Objective The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day. Participants produced a vowel–consonant–vowel syllable string and rated the vocal effort needed to produce the task on a visual analog scale. Test–retest reliability was calculated for a subset using the intraclass correlation coefficient, ICC(A, 1). Construct validity was assessed by (a) comparing the weeklong vocal effort ratings between the patient and control groups and (b) comparing weeklong vocal effort ratings before and after voice rehabilitation in a subset of 25 patients. Cohen's d, the standard error of measurement ( SEM ), and the minimal detectable change (MDC) assessed sensitivity. The minimal clinically important difference (MCID) assessed responsiveness. Results Test–retest reliability was excellent, ICC(A, 1) = .96. Weeklong mean effort was statistically higher in the patients than in controls ( d = 1.62) and lower after voice rehabilitation ( d = 1.75), supporting construct validity and sensitivity. SEM was 4.14, MDC was 11.47, and MCID was 9.74. Since the MCID was within the error of the measure, we must rely upon the MDC to detect real changes in ecological vocal effort. Conclusion The ecological vocal effort scale offers a reliable, valid, and sensitive method of monitoring vocal effort changes during the daily life of individuals with and without vocal hyperfunction.

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Stachler, Robert J., David O. Francis, Seth R. Schwartz, Cecelia C. Damask, German P. Digoy, Helene J. Krouse, Scott J. McCoy, et al. "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary." Otolaryngology–Head and Neck Surgery 158, no. 3 (March 2018): 409–26. http://dx.doi.org/10.1177/0194599817751031.

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Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia

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Stachler, Robert J., David O. Francis, Seth R. Schwartz, Cecelia C. Damask, German P. Digoy, Helene J. Krouse, Scott J. McCoy, et al. "Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)." Otolaryngology–Head and Neck Surgery 158, no. 1_suppl (March 2018): S1—S42. http://dx.doi.org/10.1177/0194599817751030.

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Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia

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Hamdan, Abdul-Latif, Georges Ziade, Doja Sarieddine, Dollen Tabri, Fatima Allaw, Rachel Btaiche, and Sami Azar. "Effect of Vitamin D Deficiency on Voice." American Journal of Speech-Language Pathology 26, no. 3 (August 15, 2017): 865–72. http://dx.doi.org/10.1044/2017_ajslp-16-0010.

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Purpose The purpose of this article was to investigate the relationship between low level of vitamin D, phonatory symptoms, and acoustic findings. Method A total of 38 subjects presenting to the endocrinology clinic were enrolled in 2 groups: 19 with vitamin D deficiency who were not on treatment, and 19 with normal vitamin D level who were on treatment. Demographic data included age, gender, and history of smoking. All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. Acoustic analysis and perceptual evaluation using the grade, roughness, breathiness, asthenia, and strain scale were performed on all subjects. Results The mean age of the total group was 47.29 ± 13.52 years. The difference in the mean and frequency of phonatory effort, vocal fatigue, and dysphonia, and in the mean of the acoustic variables, perceptual parameters, and the score of the Voice Handicap Index-10 was not statistically significant between patients with low vitamin D levels compared with controls. Conclusion The results of this study revealed no significant difference in the prevalence of phonatory symptoms in patients with vitamin D deficiency compared with patients with no vitamin D deficiency. A larger study is needed to substantiate the difference in the prevalence of phonatory systems between the 2 groups.

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Stepp, Cara E., and Tanya L. Eadie. "Relative fundamental frequency as an acoustic correlate of vocal effort in spasmodic dysphonia." Journal of the Acoustical Society of America 129, no. 4 (April 2011): 2526. http://dx.doi.org/10.1121/1.3588363.

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Shoffel-Havakuk, Hagit, Katherine L. Marks, Mariah Morton, Michael M. Johns, and Edie R. Hapner. "Validation of the OMNI vocal effort scale in the treatment of adductor spasmodic dysphonia." Laryngoscope 129, no. 2 (October 12, 2018): 448–53. http://dx.doi.org/10.1002/lary.27430.

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Marchant, H., F. Supiot, G. Choufani, and S. Hassid. "Bilateral vocal fold palsy caused by chronic motor axonal neuropathy." Journal of Laryngology & Otology 117, no. 5 (May 2003): 414–16. http://dx.doi.org/10.1258/002221503321626519.

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The authors report a first case of chronic motor axonal neuropathy involving ENT manifestations, in a 64-year-old male presenting with gait difficulties, effort dyspnoea and dysphonia. Eleven months after the first symptoms, he developed severe hypoventilation, limb weakness and bilateral vocal fold palsy and had to be intubated for respiratory failure. The diagnosis of chronic motor axonal neuropathy was suspected on clinical and electrophysiological grounds. The patient improved dramatically after a five-day course of 0.4 g/kg intravenous immunoglobulin. He is still being treated with methylprednisolone 0.5 mg/kg every other day and remains stable.We conclude the bilateral vocal fold palsy may be associated with chronic motor axonal neuropathy and that the immunosuppressive treatment may be effective in such cases.

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Park, Yeonggwang, Manuel Díaz Cádiz, Kathleen F. Nagle, and Cara E. Stepp. "Perceptual and Acoustic Assessment of Strain Using Synthetically Modified Voice Samples." Journal of Speech, Language, and Hearing Research 63, no. 12 (December 14, 2020): 3897–908. http://dx.doi.org/10.1044/2020_jslhr-20-00294.

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Purpose Assessment of strained voice quality is difficult due to the weak reliability of auditory-perceptual evaluation and lack of strong acoustic correlates. This study evaluated the contributions of relative fundamental frequency (RFF) and mid-to-high frequency noise to the perception of strain. Method Stimuli were created using recordings of speakers producing /ifi/ with a comfortable voice and with maximum vocal effort. RFF values of the comfortable voice samples were synthetically lowered, and RFF values of the maximum vocal effort samples were synthetically raised. Mid-to-high frequency noise was added to the samples. Twenty listeners rated strain in a visual sort-and-rate task. The effects of RFF modification and added noise on strain were assessed using an analysis of variance; intra- and interrater reliability were compared with and without noise. Results Lowering RFF in the comfortable voice samples increased their perceived strain, whereas raising RFF in the maximum vocal effort samples decreased their strain. Adding noise increased strain and decreased intra- and interrater reliability relative to samples without added noise. Conclusions Both RFF and mid-to-high frequency noise contribute to the perception of strain. The presence of dysphonia may decrease the reliability of auditory-perceptual evaluation of strain, which supports the need for complementary objective assessments. Supplemental Material https://doi.org/10.23641/asha.13172252

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Eadie, Tanya L., Christina Nicolici, Carolyn Baylor, Kimberly Almand, Patricia Waugh, and Nicole Maronian. "Effect of Experience on Judgments of Adductor Spasmodic Dysphonia." Annals of Otology, Rhinology & Laryngology 116, no. 9 (September 2007): 695–701. http://dx.doi.org/10.1177/000348940711600912.

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Objectives: We performed a prospective, exploratory study 1) to determine differences in judgments of overall severity (OS) and vocal effort (VE) in adductor spasmodic dysphonia (ADSD) when judgments are made by experienced listeners, naive listeners, and speakers with ADSD; 2) to determine differences in judgments of listener comfort (LC) in ADSD when judgments are made by experienced and naive listeners; and 3) to determine relationships between auditory-perceptual ratings of voice and speakers' voice handicap. Methods: Twenty speakers with ADSD provided speech recordings. They judged their own speech samples for OS and VE and completed the Voice Handicap Index (VHI). Twenty naive and 8 experienced listeners evaluated speech samples for OS, VE, and LC using rating scales. Results: No differences were found for judgments of OS, VE, or LC across the groups. However, the strategies used by the speakers seemed to differ from those used by the other listeners in making OS and VE judgments. The speakers' self-judged VE correlated moderately with voice handicap; experienced and naive listeners' judgments were only weakly related to VHI scores. Conclusions: Speakers with ADSD and listeners appear to use auditory-perceptual dimensions differently. Voice handicap is best predicted by patient-perceived VE, and not by clinician or naive listeners' judgments.

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Cevallos-Schnabel, Filipina T. "An Easy Guide for Voice Evaluation in the Clinic." Philippine Journal of Otolaryngology-Head and Neck Surgery 23, no. 2 (December 27, 2008): 52–54. http://dx.doi.org/10.32412/pjohns.v23i2.753.

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The past three years have seen an overwhelming increase in the number of dysphonic patients in our clinics. This phenomenon goes hand in hand with increased opening of call centers nationwide and increased demand for teachers, singers and performers abroad. This article discusses simple steps for the Otolaryngologist interested in evaluating these patients with different voice demands. It is important to recognize these common voice problems and address them promptly, or to refer them accordingly to Voice Centers if necessary. Chief Complaint The most common chief complaint is change in the quality of the voice or hoarseness. Hoarseness means a change in the perception of one’s voice, described as harsh, raspy, “paos” or “malat.” Other complaints include breathiness, throat pain, neck pain, inability and unrealibility to reach high notes. Inability to reach high notes suggests edema of the vocal folds making them more plump, as can be found in reflux laryngitis, allergies, or smoking. Lesions such as nodules, polyps and cysts cannot be discounted because they prevent vocal fold closure especially during high notes1 Throat and neck pain without an accompanying history of infection may suggest muscle tension dysphonia, especially in a voice professional who later develops maladaptive ways of talking that could strain other throat and neck muscles in an effort to speak.2 Frequent throat clearing, a sensation of phlegm in the throat and cough are also important chief complaints that may lead the otolaryngologist to the cause of the voice problem. In the absence of upper respiratory tract infections and post-nasal discharge, these could be suggestive of laryngopharyngeal reflux.3 History Does the hoarseness occur on and off? Was it sudden? After shouting in a basketball event? Is it becoming worse and permanent? What triggers or relieves it? Intermittent hoarseness could be due to voice abuse and misuse especially in a voice professional. Sudden hoarseness especially after watching a basketball event could be suggestive of vocal fold hemorrhage. A voice problem becoming worse and permanent could be a growing polyp or cyst, vocal fold paralysis in laryngeal cancer or thyroid cancer. A long lecture triggering the hoarseness and rest relieving it may suggest soft nodules, or Reinke’s edema due to vocal fold trauma of voice abuse and misuse. To begin with, it is important to know the occupation of our patient. Is our patient a voice professional- someone who uses his or her voice for a living? Voice demands at work contribute to voice change significantly and voice abuse and misuse is one of the most common causes of hoarseness. What are the other associated symptoms? Medical problems like a recent bout of upper respiratory tract infection and allergies are among the most common causes of hoarseness and should not be discounted immediately. Symptoms of hyperacidity are also significant.4 Is there a history of breathiness and difficulty of breathing? Voice fatigue, tremor, hypo or hypernasal voice? Choking, globus, odynophagia or dysphagia? Neck pain or head and neck trauma? These questions can give clues to the clinician regarding the possible cause of the problem. Past Medical History Asthma, COPD, pulmonary malignancy are associated with voice changes due to decreased airflow. Gastric ulcers and GERD can be suggestive of associated laryngopharyngeal reflux disease changing the vocal fold mucosa leading to voice change.3 Parkinsonism, myasthenia, traumatic brain injury and movement disorders can cause tremors, weakness or strained voice quality. Rheumatoid arthritis, SLE, and other autoimmune disorders can cause voice changes such as paralysis in RA. Endocrine problems such as hypothyroidism can cause edema of the vocal folds leading to decrease in pitch. Thyroid cancer can cause vocal fold paralysis. A history of radiation secondary to malignancies in the head and neck can cause vocal fold scarring leading to voice change.1 Personality and psychiatric disorders also lead to diagnosis. The outgoing, type A personality usually has vocal fold nodules; while inhibited and shy persons have functional dysphonias.5 Traumatic life events are also very important to take note of. History of surgery for neck trauma, thyroid nodules or malignancies, spine, cardiac, pulmonary and brain surgeries or previous endotracheal intubation can cause voice changes, usually related to vocal fold mobility problems. 1 Medications such as inhalational steroids for asthma can cause fungal laryngitis. ARB and ACE inhibitors for hypertension can cause non specific vocal fold masses. Antitussives, decongestants, antihistamines and Vitamin C are known to cause dryness of the vocal folds. Pills with sexual hormones can cause either elevations or decreases in pitch.6 Smoking can cause polypoid conditions in the vocal folds, pre-malignant or malignant changes. Intake of alcohol, diet and lifestyle can contribute to reflux problems and dysphonia. Physical Examination Hearing the patient and forming a subjective impression of the patient’s voice should automatically be part of the interview process. Ranking the voice according to a standard scale is subjective but becomes increasingly reproducible and precise with training and experience. Voice can be evaluated according to pitch, loudness, and vocal quality. Pitch is the highness or lowness of the voice. Is the speaking voice too low for the soprano? This could be the problem why a trained singer would have dysphonia. Does the woman sound like a man over the phone? This could be Reinke’s edema, maybe she is a smoker as well. Does the adult male suddenly speak with elevated pitch? This could be vocal fold paralysis. Loudness is the power of the voice. This is due to the source of power, the lungs. Posture, type of breathing, technique or training can affect this. Systemic problems like generalized weakness and cachexia are contributory. Of course pulmonary problems can contribute to decreased power. Voice quality can be evaluated using the GRBAS system.7 Just hearing the voice and using this system is helpful in making an impression. G- grade R- roughness B- breathiness A- asthenia S- strain GRBAS uses a 0 to 3 scale (0= normal or absence of deviance; 1=slight deviance; 2=moderate deviance; 3= severe deviance). Grade relates to the overall voice quality, integrating all deviant components GRBAS Sounds Probable Conditions Roughness Grainy quality; diplophonic Vocal fold masses such as nodules, polyps, cysts, laryngitis Breathiness Airy Unilateral paralysis, bowing, atrophy, abductor spasmodic dysphonia Asthenia No voice Bilateral paralysis in paramedian position, vocal fold atrophy Strain Tight quality Abductor spasmodic dysphonia, muscle tension dysphonia Head and Neck Examination Palpating the neck, especially the base of the tongue, and neck muscles which are tense and tender can be suggestive of an ongoing muscle tension dysphonia as a cause of the voice change.8 Thyroid masses, neck nodes, etc can be helpful in leading the clinician to a diagnosis. Visualizing the larynx has evolved as advances in technology have improved the understanding of vocal fold anatomy, physiology and voice production. At present, there is no single laryngeal examination tool that is superior to the others. What is important is that it gives a thorough visualization of the anatomy and a good functional evaluation of the larynx. Selecting the appropriate instrumentation will be possible if we recognize the advantages and limitations of the diagnostic tool we are using.9 Sometimes, a combination of these tools is important to make an accurate diagnosis. Advantages and Limitations of the Different Instruments to Visualize the Larynx Instrument Advantages Limitations Indirect Mirror Laryngoscopy Readily available; inexpensive Gives a gross idea of the anatomy; mobility; mucus; and mass (if big enough) Limited in patients who are hypergag; patient is not in a normal physiologic position; hard to detect paresis and small lesions Transnasal Flexible laryngoscopy Helpful for hypergag patients; patients physiology involving the tongue, pharynx and palate are well visualized; can assess paresis from paralysis; can be recorded for review Small lesions are hard to differentiate; color might not be reliable depending on the camera; may be expensive Rigid 70 or 90 degrees laryngoscope Extremely clear and magnified view; less expensive; can be recorded for review Limited in patients who are hypergag; patient is not in a normal physiologic position; hard to detect paresis and muscle tension dysphonia Videostroboscopy10 Provides a slow motion evaluation of vocal fold vibratory pattern, closure, mucosal wave; can differentiate benign vocal fold lesions Expensive; requires additional training Some helpful vocal tasks when using a flexible scope: Task Endoscopic Findings /ii/ Adduction Sniff Abduction Hee-hee-hee Either decreased adduction or abduction Sniff then /ii/ Fatigues the vocal folds; detects paresis/ weakness /ii/ glide form low to high pitch ability to lengthen the vocal folds Despite technological advances in laryngology, a good history and physical examination are still crucial in the diagnosis of voice disorders. Certain clues can be provided by a good history that especially point to a hoarse patient. Because no single instrument is superior for visualization of the larynx, it is important to recognize the advantages and limitations of each.

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Zainal Abidin, Siti Salwa, Thean Yean Kew, Mawaddah Azman, and Marina Mat Baki. "Pseudomonas laryngeal perichondritis: unexpected diagnosis." BMJ Case Reports 13, no. 12 (December 2020): e237129. http://dx.doi.org/10.1136/bcr-2020-237129.

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A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months’ duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa. The patient made a good recovery following treatment with oral ciprofloxacin.

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Jin, Jingyu Linna, Carolyn Baylor, and Kathryn Yorkston. "Predicting Communicative Participation in Adults Across Communication Disorders." American Journal of Speech-Language Pathology 30, no. 3S (June 18, 2021): 1301–13. http://dx.doi.org/10.1044/2020_ajslp-20-00100.

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Purpose The purpose of this study was to explore the extent to which communicative participation differs across diagnoses and if there are common predictor variables for communicative participation across diagnoses. Method Survey data on self-report variables including communicative participation were collected from 141 community-dwelling adults with communication disorders due to Parkinson's disease, cerebrovascular accident, spasmodic dysphonia, or vocal fold immobility (VFI). Analysis of covariance was used to determine communicative participation differences between diagnoses, with age, sex, and hearing status as covariates. Sequential entry linear regression was used to examine associations between communicative participation and variables representing a range of psychosocial constructs across diagnoses. Results The VFI group had the least favorable communicative participation differing significantly from Parkinson's disease and spasmodic dysphonia groups. Self-rated speech/voice severity, self-rated effort, mental health, perceived social support, and resilience contributed to variance in communicative participation when pooled across diagnoses. The relationship between communicative participation and the variables of effort and resilience differed significantly when diagnosis was considered. Conclusions The findings suggest that communicative participation restrictions may vary across some diagnoses but not others. People with VFI appear to differ from other diagnosis groups in the extent of participation restrictions. Effort and resilience may play different roles in contributing to communicative participation in different disorders, but constructs such as social support, severity, and mental health appear to have consistent relationships with communicative participation across diagnoses. The findings can help clinicians identify psychosocial factors beyond the impairment that impact clients' communication in daily situations.

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Long, Jennifer L., Dinesh K. Chhetri, Bruce R. Gerratt, and Gerald S. Berke. "R431 – Current Practice in Laryngeal Videostroboscopy." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P188—P189. http://dx.doi.org/10.1016/j.otohns.2008.05.586.

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Problem Videostroboscopy is a valuable diagnostic tool in laryngology and voice disorders, offering additional information about vocal fold vibration that standard examination cannot detect. However, videostroboscopic data reported in current literature varies widely between authors. This study summarizes the applications of stroboscopy in recent research, and identifies reported stroboscopic parameters. Given the apparent lack of consensus, we consider the indications for and meaningful interpretation of videostroboscopy. Methods Review of 133 articles obtained from a Pubmed search with keywords “stroboscopy” and “voice” and limited to the English language and human subjects. Results Stroboscopy was reported in diverse clinical situations including paralysis, sulcus, benign glottic lesions, dysphonia, and in normal subjects. Most studies did not use a validated stroboscopy evaluation scale, instead choosing unique evaluation points. The numerous descriptive terms could be grouped into a few general parameters. The only parameter addressed in all articles was vocal fold closure, but with various differing criteria rating the quality or configuration of closure. Other common parameters included the mucosal wave, supraglottic effort, and vibration. However, mucosal wave symmetry and regularity of vibration were not universally addressed. Voice outcomes, if measured, were commonly reported without correlation to stroboscopic findings. Conclusion Recent literature presents diverse approaches to videostroboscopy. Some studies conducted a thorough examination of stroboscopic parameters, but others neglected key points. Stroboscopy was performed in several reports of glottic mass lesions or unilateral paralysis, even though vibratory dysfunction may be dwarfed relative to those greater derangements in causing dysphonia. Significance We submit a set of parameters for thorough videostroboscopy evaluation. We stress that videostroboscopy must be considered in the context of the voice and standard laryngeal exam.

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Remacle, Marc, Georges Lawson, Jean-Christophe Degols, Isabelle Evrard, and Jacques Jamart. "Microsurgery of Sulcus Vergeture with Carbon Dioxide Laser and Injectable Collagen." Annals of Otology, Rhinology & Laryngology 109, no. 2 (February 2000): 141–48. http://dx.doi.org/10.1177/000348940010900206.

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Between January 1989 and June 1998, we operated on 45 patients for sulcus vergeture. The studied population encompassed 38 women (84%) and 7 men (16%). The median age was 36 (range 12 to 71 years). The surgical technique is based on a concept of Cornut and Bouchayer according to which the dissection of the epithelium adherent to the deep subepithelial plane improves the vocal fold vibration. Dissection is performed with a single-pulsed carbon dioxide laser at 2 to 3 W with a pulse duration of 0.1 second. We use the Super-pulse microwave. The Acuspot micromanipulator provides a spot size of 250 μm at 350-mm focal length. When the vocal fold is atrophic, surgery is completed with a bovine or autologous collagen injection; the median injected quantity is 0.3 mL (range 0.1 to 0.4 mL). The epithelial microflap is redraped with fibrin glue. Voice therapy is indispensable for correcting the associated hyperkinetic dysphonia. The median postoperative follow-up period is 5 months (range 1 to 18 months). In terms of median values, the maximum phonation time improved from 9 to 13 seconds, the phonation quotient improved from 296.5 to 228.5 mL/s, and the spectral analysis distribution improved by 1 class. Stroboscopic examination reveals an improvement of the vibratory symmetry, amplitude, and wave. Subjectively, the patients describe an improved ability for vocal effort and the regression or disappearance of vocal fatigue. Although the timbre is improved, the voice often remains breathy and hoarse.

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McKenna, Victoria S., Jennifer M. Vojtech, Melissa Previtera, Courtney L. Kendall, and Kelly E. Carraro. "A Scoping Literature Review of Relative Fundamental Frequency (RFF) in Individuals with and without Voice Disorders." Applied Sciences 12, no. 16 (August 13, 2022): 8121. http://dx.doi.org/10.3390/app12168121.

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Relative fundamental frequency (RFF) is an acoustic measure that characterizes changes in voice fundamental frequency during voicing transitions. Despite showing promise as an indicator of vocal disorder and laryngeal muscle tension, the clinical adoption of RFF remains challenging, partly due to a lack of research integration. As such, this review sought to provide summative information and highlight next steps for the clinical implementation of RFF. A systematic literature search was completed across 5 databases, yielding 37 articles that met inclusion criteria. Studies most often included adults with and without tension-based voice disorders (e.g., muscle tension dysphonia), though patient and control groups were directly compared in only 32% of studies. Only 11% of studies tracked therapeutic progress, making it difficult to understand how RFF can be used as a clinical outcome. Specifically, there is evidence to support within-person RFF tracking as a clinical outcome, but more research is needed to understand how RFF correlates to auditory-perceptual ratings (strain, effort, and overall severity of dysphonia) both before and after therapeutic interventions. Finally, a marked increase in the use of automated estimation methods was noted since 2016, yet there remains a critical need for a universally available algorithm to support widespread clinical adoption.

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Meerschman, Iris, Kristiane Van Lierde, Yvonne Gonzales Redman, Lidia Becker, Ayla Benoy, Imke Kissel, Clara Leyns, Julie Daelman, and Evelien D'haeseleer. "Immediate Effects of a Semi-Occluded Water Resistance Ventilation Mask on Objective and Subjective Vocal Outcomes in Musical Theater Students." Journal of Speech, Language, and Hearing Research 63, no. 3 (March 23, 2020): 661–73. http://dx.doi.org/10.1044/2019_jslhr-19-00042.

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Background Traditional semi-occluded vocal tract exercises (SOVTEs) are restricted to single-phoneme tasks due to the semi-occlusion at the mouth, which hinders full articulation, continuous speech, and singing. Innovative SOVTEs should overcome this limitation by creating the semi-occlusion outside the oral cavity. Purpose The purpose of this study was to investigate the immediate effects of a semi-occluded water resistance ventilation mask, which allows for continuous speech and singing, on objective (voice range, multiparametric voice quality indices) and subjective (auditory-perceptual, self-report) vocal outcomes in musical theater students. Method A pre-/posttest randomized controlled trial was used. Twenty-four musical theater students (16 women and eight men, with a mean age of 21 years) were randomly assigned into a study group and a control group. The study group received a vocal warm-up session with the innovative water resistance ventilation mask (tube attached to the mask “outside” the mouth), whereas the control group received the traditional water resistance approach (tube “inside” the mouth). Both sessions lasted 30 min and were similar with respect to vocal demand tasks. A multidimensional voice assessment including objective and subjective outcomes was performed pre- and posttraining by an assessor blinded to group allocation. Results The Dysphonia Severity Index significantly and similarly increased (improved) in both the study and control groups, whereas the Acoustic Voice Quality Index solely decreased (improved) in the control group. The intensity range significantly decreased (worsened) and the semitone range significantly increased (improved) in the study group, whereas no differences in voice range profile were found in the control group. Auditory-perceptually, a more strenuous speaking voice was noticed after the use of the traditional water resistance approach. The subjects perceived both SOVTEs as comfortable vocal warm-up exercises that decrease the amount of effort during speaking and singing, with a slight preference for the water resistance ventilation mask. Conclusions Both the innovative water resistance ventilation mask and the traditional water resistance exercise seem effective vocal warm-up exercises for musical theater students. The additional articulatory freedom of the mask might increase the phonatory comfort and the practical implementation of SOVTEs in the daily vocal warm-up of (future) elite vocal performers. The hypothesis of a higher transfer to continuous speech or singing in the mask condition has not been supported by the current study. Larger scale investigation and longer term follow-up studies are needed to confirm these preliminary results. Supplemental Material https://doi.org/10.23641/asha.11991549

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Guimarães, Michelle Ferreira, Letícia Osório Cézar de Oliveira, and Elma Heitmann Mares Azevedo. "Vocal activity profile and dysphonia coping strategies in subjects with laryngeal cancer treated with radiotherapy." Revista CEFAC 20, no. 3 (May 2018): 374–81. http://dx.doi.org/10.1590/1982-021620182031218.

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ABSTRACT Purpose: to verify the vocal activity participation and the dysphonia coping strategies of subjects with laryngeal cancer treated with radiotherapy. Methods: a cross-sectional trial involving 17 individuals with laryngeal cancer treated only by radiotherapy with vocal complaints after radiotherapy management. A sociodemographic questionnaire, the Brazilian versions of Voice Activity and Participation Profile and Voice Disability Coping Questionnaire protocols were applied. Results: there was a prevalence of male participants (n=16) and the mean age was 62 years. All were former smokers and 15 were former drinkers. Voice Activity and Participation Profile in mean scores was: overall,141.2, self-perception of vocal problem, 6.2, effect at work, 19.1, effects on daily communication, 60.5, effects on media, 20.1, and effects on their emotional, 36.7. In Voice Disability Coping Questionnaire mean scores were: overall,71.7, focusing on problem, 33, and focusing on emotion, 38.9. Conclusion: the participants had high Voice Activity and Participation Profile scores as compared to the literature scores considered for dysphonic individuals in general, and activity with effects on daily communication was the most affected. Voice Disability Coping Questionnaire demonstrates that these patients adopt dysphonia coping strategies with greater focus on emotion.

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Ruas, A. C. Nunes, V. Cavalcanti Rolla, M. H. de Araújo-Melo, J. Soares Moreira, and C. M. Valete-Rosalino. "Vocal quality of patients treated for laryngeal tuberculosis, before and after speech therapy." Journal of Laryngology & Otology 124, no. 11 (September 16, 2010): 1153–57. http://dx.doi.org/10.1017/s0022215110001106.

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AbstractObjectives:To evaluate dysphonia in patients treated for laryngeal tuberculosis, and to assess the effect of speech therapy on patients' vocal quality.Materials and methods:Seven of 23 patients with a confirmed diagnosis of laryngeal tuberculosis, treated at the Evandro Chagas Institute of Clinical Research, Oswaldo Cruz Foundation, underwent speech therapy for six months. These seven patients were evaluated by videolaryngoscopy and vocal acoustic analysis, before, during and after a course of speech therapy.Results:The 23 patients with laryngeal tuberculosis comprised five women and 18 men, with ages ranging from 25 to 83 years (mean 41.3 years). Dysphonia was present in 91.3 per cent of these laryngeal tuberculosis patients, being present as the first symptom in 82.6 per cent. In laryngeal tuberculosis patients with dysphonia, laryngeal tuberculosis treatment resulted in dysphonia resolution in only 15.8 per cent. After speech therapy, dysphonia patients had better vocal quality, as demonstrated by statistical analysis of jitter, shimmer, fundamental frequency variability, maximum phonation time, and the ratio between maximum phonation time for voiceless and voiced fricative sounds.Conclusions:Following treatment of laryngeal tuberculosis, the incidence of dysphonia was very high. Speech therapy improved patients' vocal quality.

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Dolan, Sean, Claire McArthur, and Malcolm A. Buchanan. "Isolated vocal cord palsy secondary to a paraoesophageal hiatus hernia: a rare variant of Ortner’s syndrome." BMJ Case Reports 15, no. 11 (November 2022): e252022. http://dx.doi.org/10.1136/bcr-2022-252022.

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Dysphonia is a common presenting symptom to the outpatient ear, nose and throat team and the need to have a systematic approach to its investigation and management is imperative. Red flag features combined with clinical examination including flexible nasoendoscopy will help to identify laryngeal causes of dysphonia. Vocal cord palsy can have both laryngeal and extralaryngeal aetiologies including Ortner’s syndrome. We present a case where a woman in her 70s was referred with persistent hoarseness, found to have an isolated vocal cord palsy with CT scan revealing a very large hiatus hernia producing mass effect at the aortopulmonary window with no other pathology identified. To our knowledge, this is the second case in the literature of a hiatus hernia causing a vocal cord palsy. This case underpins the need for prompt assessment by flexible laryngoscopy, and consideration of extralaryngeal causes of vocal cord palsy during a dysphonia assessment.

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Tervonen, Hanna, Mika Niemelä, Eija-Riitta Lauri, Leif Bäck, Anja Juvas, Pirjo Räsänen, Risto P. Roine, et al. "Dysphonia and dysphagia after anterior cervical decompression." Journal of Neurosurgery: Spine 7, no. 2 (August 2007): 124–30. http://dx.doi.org/10.3171/spi-07/08/124.

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Object. In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. Methods. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology—Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Results. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Conclusions. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.

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LeJeune, Francis E. "Vocal Ligametry." Annals of Otology, Rhinology & Laryngology 96, no. 5 (September 1987): 597–600. http://dx.doi.org/10.1177/000348948709600523.

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In 1983, a report was made concerning experience with a technique of vocal ligament tightening in certain cases of dysphonia due to the ligament's stretching or lengthening. Since that time, efforts to measure the relative slackness or loss of tension of the vocal ligament have been partially successful. This report addresses the topics of consent forms; review of the local board of human procedures; and technical problems of instrument design, fabrication, and calibration. A large data base will be needed before true usefulness can be derived from these efforts. The author hopes to stimulate other workers in the field of phonosurgery to parallel these efforts and explore a field that is still relatively uncharted.

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Wolfe, Virginia I., and David L. Ratusnik. "Acoustic and Perceptual Measurements of Roughness Influencing Judgments of Pitch." Journal of Speech and Hearing Disorders 53, no. 1 (February 1988): 15–22. http://dx.doi.org/10.1044/jshd.5301.15.

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Listeners matched the pitch of 36 clear to severely dysphonic vowels to the frequency of pure tones produced by a signal generator. Mean difference scores on pitch match correlated –.56 with jitter, –.51 with jitter ratio, –.57 with spectrographic noise classifications, and –.64 with vocal roughness. Moderately to severely dysphonic vowels received significantly lower pitch match values than clear to mildly dysphonic vowels. Findings suggest that the effect of vocal roughness on pitch should be considered by the clinician who makes use of perceptual judgments.

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Behlau, Mara, Paulo Pontes, Vanessa Pedrosa Vieira, Rosiane Yamasaki, and Glaucya Madazio. "Presentation of the Comprehensive Vocal Rehabilitation Program for the treatment of behavioral dysphonia." CoDAS 25, no. 5 (October 2013): 492–96. http://dx.doi.org/10.1590/s2317-17822013000500015.

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Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient' s learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.

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Shean Ter, Wei, and Kwan Yie Wong. "The Effect of Semi-Occluded Vocal Tract Exercise (SOVTE) and Traditional Vocal Warm-up (TVW) on the Vocal Quality of Untrained Female Singers in Malaysia: A Comparison." Pertanika Journal of Social Sciences and Humanities 30, no. 2 (June 15, 2022): 557–77. http://dx.doi.org/10.47836/pjssh.30.2.08.

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Vocal warm-up has garnered much research attention these recent years. This study compared the short-term effects of straw phonation (SP) with a traditional vocal warm-up (TVW) on the vocal quality of untrained female singers. It also determined the effect of exercise type on the vocal economy and skill acquisition. Vocal quality was measured using voice range profile (VRP), multi-parametric index, acoustic, and aerodynamic parameters. Eighty participants were randomly recruited and divided into two equal groups to perform vocal warm-ups at a frequency of two 10-minute sessions per day for three weeks. Voice data were collected using Praat and Vocalgrama software, while the statistical results were analysed using Statistical Product and Service Solution (SPSS). As a result, some parameters, i.e., fundamental frequency maximum (F0-max), maximum intensity (max Int) and area of VRP, fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), and dysphonia severity index (DSI), projected significant changes after three weeks of warming up exercise in TVW group. In the SP group, the participants experienced significant changes in max Int and area of VRP only. Both groups did not exert significant changes to min Int, which indirectly measures phonation threshold pressure (PTP), signifying no improvement for the vocal economy. Participants from the TVW group benefitted the most from vocal warm-ups due to notable improvement in vocal quality, technical singing skills (i.e., skill acquisition), and vocal efficiency. Meanwhile, the SP group only benefitted in terms of enhanced vocal efficiency. Acoustic parameters, aerodynamic, dysphonia severity index, semi-occluded vocal tract exercise, traditional vocal warm-up, vocal quality, voice range profile

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Lundy, Donna S., Carlos Silva, Roy R. Casiano, F. Ling Lu, and Jun Wu Xue. "Cause of Hoarseness in Elderly Patients." Otolaryngology–Head and Neck Surgery 118, no. 4 (April 1998): 481–85. http://dx.doi.org/10.1177/019459989811800409.

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Hoarseness is a common symptom in older individuals and may reflect a wide variety of pathologic, medical, physiologic, and/or functional causes. Although vocal fold atrophy is one of the more common reported findings in the elderly, inconclusive information is known about the differential diagnosis and cause of dysphonia in older individuals. The purpose of this investigation was to review the cause of hoarseness in all patients older than 65 years and to determine any correlation with advancing age and other demographic factors. Additionally, we wanted to determine the effect vocal pathology has on objective voice measures with advancing age. The two most common causes of hoarseness found in 393 patients older than 65 years were vocal fold bowing and unilateral vocal fold paralysis, followed by benign vocal fold lesions, voice tremor, and spasmodic dysphonia. Although objective measures of vocal function were abnormal compared with reported normative data, they did not increase in severity with advancing age. Apparently, the compounding effect of age on underlying vocal pathology does not increase the severity of the vocal disturbance, at least as represented by objective voice measures. The high incidence of medical illnesses seen in this population also needs to be kept in mind because it may further affect the underlying voice disturbance. It might be interesting to compare data on the patients' perceptions of their vocal disturbance for each disorder as a function of age. It would also be helpful to know whether patients responded to treatment differentially based on age.

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Lam, So Yi, Chung-Shien Lee, Sandhya Sharma, and Kit Cheng. "Bevacizumab-induced dysphonia: A case report with brief review of literature." Journal of Oncology Pharmacy Practice 26, no. 4 (November 26, 2019): 1032–36. http://dx.doi.org/10.1177/1078155219889388.

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Introduction Anti-angiogenic treatment in adjunct with chemotherapy is widely used for the treatment of various cancers. These agents inhibit vascular endothelial growth factor (VEGF) signaling thereby inhibiting tumor proliferation and invasion. Dysphonia, or voice changes, has been documented, but is an underreported side effect of anti-angiogenic agents. We report a case of intermittent dysphonia in a patient with metastatic, platinum-refractory ovarian cancer treated with bevacizumab. Case report A 48-year-old female with high grade mixed type ovarian adenocarcinoma and concurrent left sided breast cancer was transitioned to palliative therapy with gemcitabine-bevacizumab for her ovarian cancer. At a follow-up visit after three cycles of the new therapy, the patient complained of intermittent changes in her voice, describing periods of hoarseness or softness in her voice after the chemotherapy—sometimes to the point that her voice was inaudible. Management and outcome: A new pelvic thrombus was discovered upon assessment of the patient’s disease. Bevacizumab was held and she was referred to ear, nose, and throat evaluation for dysphonia. Laryngoscopic examination showed normal vocal cord, with normal movements and no lesion or necrosis. During subsequent follow-up, the patient reported improvement in her voice with no additional dysphonia. Discussion Vocal adverse effects of anti-VEGF agents have been documented in landmark trials and case reports; however, clinicians are often unaware of this rare side effect. Although VEGF-induced dysphonia may be rare and may not impede the patient’s quality of life in some cases, it is critical to acknowledge and not underestimate this adverse effect.

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Ji, Mingjun, Boquan Liu, Jack Jiang, Matthew R. Hoffman, Jinwei Lan, and Jin Fang. "Effect of Controlled Muscle Activation in a Unilateral Vocal Fold Polyp Setting on Vocal Fold Vibration." Applied Sciences 12, no. 23 (December 6, 2022): 12486. http://dx.doi.org/10.3390/app122312486.

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Unilateral vocal fold polyps can lead to incomplete glottal closure and irregular vocal fold vibration. Depending on polyp size and resulting dysphonia severity, voice therapy or surgery may be recommended. As part of voice therapy, patients may learn how to optimize intrinsic and extrinsic laryngeal muscle use to mitigate benign lesion effects, increase vocal efficiency, and improve voice quality. In this study, we used a low-dimensional mass model with a simulated unilateral vocal fold polyp and varied intra-laryngeal muscle activity to simulate vocal fold vibration across varied conditions. Differing muscle activation has different effects on frequency, periodicity, and intensity. Accordingly, learning how to optimize muscle activity in a unilateral polyp setting may help patients achieve the best possible periodic and most efficiently produced voice in the context of abnormal vocal fold morphology.

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Makiyama, Kiyoshi, Akinori Kida, and Masayuki Sawashima. "Evaluation of Expiratory Effort on Dysphonic Patients on Increasing Vocal Intensity." Otolaryngology–Head and Neck Surgery 118, no. 5 (May 1998): 723–27. http://dx.doi.org/10.1177/019459989811800531.

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It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinke's edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinke's edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer. (Otolaryngol Head Neck Surg 1998;118:723–7.)

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Hamdan, A.-L., A. Sibai, L. Mahfoud, D. Oubari, J. Ashkar, and N. Fuleihan. "Short term effect of hubble-bubble smoking on voice." Journal of Laryngology & Otology 125, no. 5 (January 31, 2011): 486–91. http://dx.doi.org/10.1017/s0022215110003051.

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AbstractObjective:To investigate the short term effect of hubble-bubble smoking on voice.Study design:Prospective study.Material:Eighteen non-dysphonic subjects (seven men and 11 women) with a history of hubble-bubble smoking and no history of cigarette smoking underwent acoustic analysis and laryngeal video-stroboscopic examination before and 30 minutes after hubble-bubble smoking.Results:On laryngeal video-stroboscopy, none of the subjects had vocal fold erythema either before or after smoking. Five patients had mild vocal fold oedema both before and after smoking. After smoking, there was a slight increase in the number of subjects with thick mucus between the vocal folds (six, vs four before smoking) and with vocal fold vessel dilation (two, vs one before smoking). Acoustic analysis indicated a drop in habitual pitch, fundamental frequency and voice turbulence index after smoking, and an increase in noise-to-harmonics ratio.Conclusion:Even 30 minutes of hubble-bubble smoking can cause a drop in vocal pitch and an increase in laryngeal secretions and vocal fold vasodilation.

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Meerschman, Iris, Sofie Claeys, Kim Bettens, Laura Bruneel, Evelien D'haeseleer, and Kristiane Van Lierde. "Massed Versus Spaced Practice in Vocology: Effect of a Short-Term Intensive Voice Therapy Versus a Long-Term Traditional Voice Therapy." Journal of Speech, Language, and Hearing Research 62, no. 3 (March 25, 2019): 611–30. http://dx.doi.org/10.1044/2018_jslhr-s-18-0013.

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PurposeThe aim of this study was to compare the effect of a short-term intensive voice therapy (IVT) with a long-term traditional voice therapy (TVT) on the vocal quality, vocal capacities, psychosocial impact, vocal tract discomfort, laryngological anatomy/physiology, and session attendance of patients with dysphonia. An additional comparison was made between an individual IVT (IVT-I) and a group IVT (IVT-G).MethodA longitudinal, prospective controlled trial was used. Forty-six adults diagnosed with dysphonia were assigned to 1 of the 3 treatment groups. The IVT groups practiced with a frequency of 1 hr 20 min a day and a duration of 2 weeks. The TVT group practiced with a frequency of two 30-min sessions a week and a duration of 6 months. Both therapy programs were content-identical and guided by the same voice therapist. A multidimensional voice assessment consisting of both objective (maximum performance task, aerodynamic measurements, voice range profile, acoustic analysis, multiparametric voice quality indices) and subjective (subject's self-report, auditory-perceptual evaluation, flexible videolaryngostroboscopy) outcomes was used to evaluate the participants' voice.ResultsIVT made an equal progress in only 2 weeks and 12 hr of therapy compared with TVT that needed 6 months and 24 hr of therapy. IVT-I and IVT-G showed comparable results. Session attendance was clearly higher in IVT compared with TVT. Long-term follow-up results (1 year) were positive for the 3 groups, except for the self-reported psychosocial impact that increased in the IVT-I group.ConclusionsShort-term IVT is at least equally effective in treating patients with dysphonia as long-term TVT. Group treatment seemed as effective as individual treatment. Attendance and cost-effectiveness are important advantages of IVT. A potential drawback might be an insufficient psychosocial progress. The golden mean between intensive and traditional treatment might therefore be an achievable, effective, and efficient solution for everyday clinical practice.Supplemental Materialhttps://doi.org/10.23641/asha.7761872

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Kapsner-Smith, Mara R., Eric J. Hunter, Kimberly Kirkham, Karin Cox, and Ingo R. Titze. "A Randomized Controlled Trial of Two Semi-Occluded Vocal Tract Voice Therapy Protocols." Journal of Speech, Language, and Hearing Research 58, no. 3 (June 2015): 535–49. http://dx.doi.org/10.1044/2015_jslhr-s-13-0231.

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PurposeAlthough there is a long history of use of semi-occluded vocal tract gestures in voice therapy, including phonation through thin tubes or straws, the efficacy of phonation through tubes has not been established. This study compares results from a therapy program on the basis of phonation through a flow-resistant tube (FRT) with Vocal Function Exercises (VFE), an established set of exercises that utilize oral semi-occlusions.MethodTwenty subjects (16 women, 4 men) with dysphonia and/or vocal fatigue were randomly assigned to 1 of 4 treatment conditions: (a) immediate FRT therapy, (b) immediate VFE therapy, (c) delayed FRT therapy, or (d) delayed VFE therapy. Subjects receiving delayed therapy served as a no-treatment control group.ResultsVoice Handicap Index (Jacobson et al., 1997) scores showed significant improvement for both treatment groups relative to the no-treatment group. Comparison of the effect sizes suggests FRT therapy is noninferior to VFE in terms of reduction in Voice Handicap Index scores. Significant reductions in Roughness on the Consensus Auditory-Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were found for the FRT subjects, with no other significant voice quality findings.ConclusionsVFE and FRT therapy may improve voice quality of life in some individuals with dysphonia. FRT therapy was noninferior to VFE in improving voice quality of life in this study.

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Makiyama, Kiyoshi, Nahoko Shimazaki, Akinori Kida, and Masayuki Sawashima. "95: Evaluation of Expiratory Effort by Dysphonic Patients upon Increasing Vocal Intensity." Otolaryngology–Head and Neck Surgery 115, no. 2 (August 1996): P189. http://dx.doi.org/10.1016/s0194-5998(96)80957-0.

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MAKIYAMA, KIYOSHI, AKINORI KIDA, and MASAYUKI SAWASHIMA. "Evaluation of expiratory effort on dysphonic patients on increasing vocal intensity☆☆☆★." Otolaryngology - Head and Neck Surgery 118, no. 5 (May 1998): 723–27. http://dx.doi.org/10.1016/s0194-5998(98)70252-9.

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Santos, Andréia Cristina Muznlinger dos, Maria Cristina de Menezes Borrego, and Mara Behlau. "Effect of direct and indirect voice training in Speech-Language Pathology and Audiology students." CoDAS 27, no. 4 (August 2015): 384–91. http://dx.doi.org/10.1590/2317-1782/20152014232.

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PURPOSE: To verify the effect of two approaches of vocal training in Speech Language Pathology and Audiology students, a direct and an indirect approach.METHODS: Participants were 25 female Speech Language Pathology and Audiology students divided into two groups: direct training with vocal exercises, DTG (n=13); and indirect training with vocal orientations, ITG (n=12). The training sessions were conducted by the same speech language pathologist in six weekly sessions of 30 minutes. Both groups underwent multidimensional voice assessment, pre- and post-training: vocal self-assessment; Vocal Symptoms Scale (VSS); auditory perceptual analysis of sustained vowel and connected speech; acoustic analysis of voice through the Vocal Range Profile (VRP) and Speech Range Profile (SRP); and Group Climate Questionnaire, only at the end of training.RESULTS: The DTG showed changes in auditory perceptual analysis of vowel, which was less diverted after training; and expansion of the voice range in the VRP and SRP, which proves best vocal performance. However, the ITG showed no changes in any of the parameters evaluated. In Group Climate, the ITG obtained the highest conflict score in comparison to the DTG, probably because the indirect approach did not favor exchange in the group and did not allow a better quality interaction.CONCLUSION: The direct approach provided greater benefits to students than the indirect approach, with significant change in voice quality, and can serve as inspiration to Speech Language Pathology and Audiology courses to prevent dysphonia.

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Poologaindran, Anujan, Zurab Ivanishvili, Murray D. Morrison, Linda A. Rammage, Mini K. Sandhu, Nancy E. Polyhronopoulos, and Christopher R. Honey. "The effect of unilateral thalamic deep brain stimulation on the vocal dysfunction in a patient with spasmodic dysphonia: interrogating cerebellar and pallidal neural circuits." Journal of Neurosurgery 128, no. 2 (February 2018): 575–82. http://dx.doi.org/10.3171/2016.10.jns161025.

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Spasmodic dysphonia (SD) is a neurological disorder of the voice where a patient's ability to speak is compromised due to involuntary contractions of the intrinsic laryngeal muscles. Since the 1980s, SD has been treated with botulinum toxin A (BTX) injections into the throat. This therapy is limited by the delayed-onset of benefits, wearing-off effects, and repeated injections required every 3 months. In a patient with essential tremor (ET) and coincident SD, the authors set out to quantify the effects of thalamic deep brain stimulation (DBS) on vocal function while investigating the underlying motor thalamic circuitry.A 79-year-old right-handed woman with ET and coincident adductor SD was referred to our neurosurgical team. While primarily treating her limb tremor, the authors studied the effects of unilateral, thalamic DBS on vocal function using the Unified Spasmodic Dysphonia Rating Scale (USDRS) and voice-related quality of life (VRQOL). Since dystonia is increasingly being considered a multinodal network disorder, an anterior trajectory into the left thalamus was deliberately chosen such that the proximal contacts of the electrode were in the ventral oralis anterior (Voa) nucleus (pallidal outflow) and the distal contacts were in the ventral intermediate (Vim) nucleus (cerebellar outflow). In addition to assessing on/off unilateral thalamic Vim stimulation on voice, the authors experimentally assessed low-voltage unilateral Vim, Voa, or multitarget stimulation in a prospective, randomized, doubled-blinded manner. The evaluators were experienced at rating SD and were familiar with the vocal tremor of ET. A Wilcoxon signed-rank test was used to study the pre- and posttreatment effect of DBS on voice.Unilateral left thalamic Vim stimulation (DBS on) significantly improved SD vocal dysfunction compared with no stimulation (DBS off), as measured by the USDRS (p < 0.01) and VRQOL (p < 0.01). In the experimental interrogation, both low-voltage Vim (p < 0.01) and multitarget Vim + Voa (p < 0.01) stimulation were significantly superior to low-voltage Voa stimulation.For the first time, the effects of high-frequency stimulation of different neural circuits in SD have been quantified. Unexpectedly, focused Voa (pallidal outflow) stimulation was inferior to Vim (cerebellar outflow) stimulation despite the classification of SD as a dystonia. While only a single case, scattered reports exist on the positive effects of thalamic DBS on dysphonia. A Phase 1 pilot trial (DEBUSSY; clinical trial no. NCT02558634, clinicaltrials.gov) is underway at the authors' center to evaluate the safety and preliminary efficacy of DBS in SD. The authors hope that this current report stimulates neurosurgeons to investigate this new indication for DBS.

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Gnjatic, M., P. Stankovic, and V. Djukic. "The effect of smoking and forced use of the voice to development of the vocal polyps." Acta chirurgica Iugoslavica 56, no. 2 (2009): 27–32. http://dx.doi.org/10.2298/aci0902027g.

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Dysphonia is often caused by polyps which are benign changes of pseudotumors With their presence they are hampering with glotis oclusion Laryngomicroscopy of general and endotracheal anaesthesia has been preformed on all of the patients. Microsurgical technique has been used to remove the polyps. Bioptic material was analyzed in pathohystlogoical laboratory of clinic of pathology in Banjaluka. All of the results were presented through tables and graphic representations. Frequency of polyps through age and sex groups, along with the examination of ethyological factors in emergence of polyps of vocal cords. Results are in accordance with the results of other authors who were involved in similar problematics. Through analysis of our data we percieve that the abuse of voice is part of ethiological factors that lead not only to emergence of vocal fold lesions but as well as other benign changes.

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Samlan, Robin A., Melda Kunduk, Takeshi Ikuma, Mindy Black, and Christianne Lane. "Vocal Fold Vibration in Older Adults With and Without Age-Related Dysphonia." American Journal of Speech-Language Pathology 27, no. 3 (August 6, 2018): 1039–50. http://dx.doi.org/10.1044/2018_ajslp-17-0061.

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Purpose The purpose of this study was to identify the extent to which 7 measures of glottal area timing and regularity differ between older adults with and without age-related dysphonia (ARD). Method Laryngeal high-speed videoendoscopy was completed at 4,000 frames per second for 42 adults aged 70 years and older (ARD: 9 female, 5 male; control group: 15 female, 13 male). Relative glottal gap, open quotient, speed index, maximum area declination rate, harmonics-to-noise ratio, harmonic richness factor, and standard deviation of fundamental frequency were measured from a 0.5-s segment of the glottal area waveform. Eta squared (η 2 ) was computed to estimate group effect. Results Small effect sizes (η 2 = .18–.35) were present for relative glottal gap, open quotient, maximum area declination rate, harmonic richness factor, and standard deviation of fundamental frequency. Speed index and glottal harmonics-to-noise ratio did not explain group membership (η 2 = .001 and .05, respectively). Conclusion These findings provide evidence that vocal fold vibration in ARD is different than in normal aging, whereas the overlap in values for every measure is consistent with the concept that normal aging and ARD exist as a continuum of health and disease.

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Pratap, R., P. Mehta, B. Blagnys, and P. Q. Montgomery. "Early results for treatment of unilateral vocal fold palsy with injection medialisation under local anaesthetic." Journal of Laryngology & Otology 123, no. 8 (August 2009): 873–76. http://dx.doi.org/10.1017/s0022215109004629.

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AbstractBackground:The diagnosis and treatment of unilateral vocal fold palsy is a common part of otolaryngology practice. In those patients in whom resolution of symptoms is slow, the resulting dysphonia can have a dramatic effect on the patient's quality of voice and life. We have previously described the procedure of direct phonoplasty under local anaesthesia using the transnasal laryngoesophagoscope.Objective:To examine the subjective and objective data for the first five patients to undergo this procedure, in the form of laryngographic speech analysis, perceptual assessment and therapy outcome measures.Results:Analysis showed a statistically significant improvement in voice quality, in all the above assessment categories, following local anaesthetic direct phonoplasty using the transnasal laryngoesophagoscope.Conclusion:Collagen injection via transnasal flexible laryngoesophagoscopy is a particularly useful technique for treating vocal fold medialisation, especially in palliative care patients and those with shortened life expectancy.

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Simonyan, Kristina, and Steven J. Frucht. "Long-term Effect of Sodium Oxybate (Xyrem®) in Spasmodic Dysphonia with Vocal Tremor." Tremor and Other Hyperkinetic Movements 3 (December 9, 2013): 03. http://dx.doi.org/10.5334/tohm.156.

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Rainey, Cheryl L., David L. Zealear, Mark Courey, and R. E. (Ed) Stone. "Voice Response to Injection of Succinylcholine in the Thyroarytenoid Muscle of Normal Subjects." American Journal of Speech-Language Pathology 5, no. 2 (May 1996): 43–52. http://dx.doi.org/10.1044/1058-0360.0502.43.

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Botulinum toxin (Botox) is commonly used in the treatment of spasmodic dysphonia. Succinylcholine is a neuromuscular blocking agent that mimics the biological activity of Botox yet takes effect within minutes. Four subjects with normal voice underwent bilateral vocal fold injection of succinylcholine to determine whether the drug would alter voice in a way comparable to previously reported analyses of voice response with Botox. Acoustic analyses confirmed that succinylcholine induced an increase in fundamental frequency, jitter, and shimmer, and a decrease in harmonic-to-noise ratio. Glottal flow rates were elevated after drug injection. Succinylcholine induced perceptual changes in pitch and quality. These findings suggest that succinylcholine alters vocal parameters that are also influenced by Botox. This drug may prove useful as a screening agent in patients for whom the benefit of Botox is questionable, or as an agent injected coincidentally with Botox to predict an optimal voice result and avoid the side effects associated with treatment.

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ÇEÇEN, Ayse, and Begüm KORUNUR ENGIZ. "Objective and subjective voice evaluation in Covid 19 patients and prognostic factors affecting the voice." Journal of Experimental and Clinical Medicine 39, no. 3 (August 30, 2022): 664–69. http://dx.doi.org/10.52142/omujecm.39.3.14.

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Coronavirus disease 2019 (COVID-19), a respiratory and systemic zoonosis form caused by a virus belonging to the Coronaviridae family. Although several studies have shown the otolaryngology symptoms are affected in COVID-19 patients, the number of studies regarding the COVID-19 effects on voice is limited. Our study aims to evaluate the effect of COVID-19 on voice objectively - subjectively and compare it with the control group. 50 hospitalized patients with laboratory-confirmed COVID-19 and 50 healthy individuals were included in the study as study and control group, respectively. All subjects were trained to vocalize a continuous/a/ vocal pattern at speech sound intensity for Maximum Phonation Time. Voice samples were recorded using a Sony (ICD-PX470) audio recorder and analyzed by the Praat program. Dysphonia grades were ranked on 4-point scales (grade: 0=none; 1= mild; 2= moderate; 3=severe). It is seen from the results that, there were significant differences between the male and female participants in acoustic parameters of fundamental frequency (F0) (p<0.001), shimmer and mean harmonic to noise ratio (HNR) (p=0.011). There was also a significant difference in F0 values of infected and healthy participants (p=0.008). However, there was no significant interaction between gender and health status in any acoustic parameters (p>0.05). The degree of thoracic computed tomography (CT) involvement had no significant effect on parameters (p>0.05), while there was a weak positive relationship between the duration of hospitalization and F0 (rs=0.397, p=0.004). Dysphonia was positively associated with health status (rs=0. 682, p<0.001), and female infected participants reported more frequent dysphonia than males. In our study, we examined the effect of COVID-19 on voice both objectively and subjectively and evaluated the relationship between CT involvement and duration of hospitalization, which made our study more reliable. Future studies with larger and more specific patient groups to investigate the relationship between COVID-19 and dysphonia will shed a light on the subject.

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Kaneko, Mami, Yoichiro Sugiyama, Shigeyuki Mukudai, and Shigeru Hirano. "Effect of Voice Therapy Using Semioccluded Vocal Tract Exercises in Singers and Nonsingers With Dysphonia." Journal of Voice 34, no. 6 (November 2020): 963.e1–963.e9. http://dx.doi.org/10.1016/j.jvoice.2019.06.014.

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Murgia, Silvia, Taylor Mekus, and Pasquale Bottalico. "Intelligibility of dysphonic speech in primary schools." Journal of the Acoustical Society of America 151, no. 4 (April 2022): A169. http://dx.doi.org/10.1121/10.0011002.

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School children need clear auditory signals and low background noise to learn. When classroom acoustics are poor, teachers often compensate by raising their voices, usually with limited effect against background noise, and, long-term, this makes vocal overuse the primary cause (60%) of the high prevalence of voice problems in teachers. Speech intelligibility tests were performed in primary schools with normal hearing students using words produced by an actor with normal voice quality and simulating a dysphonic voice. The speech was played by a Head and Torso Simulator. Artificial classroom noise and classrooms with different reverberation times were used to obtain a range of Speech Transmission Index from 0.2 to 0.7 (from bad to good). Results showed a statistically significant decrease in intelligibility when the speaker was dysphonic with a maximum of 15% intelligibility loss. This study extends an important pairing of problems related to student learning: classroom acoustics and teachers with voice disorders. It provides important insights into the enormous variability in speech intelligibility in classrooms by characterizing students’ intelligibility when students receive degraded auditory input. The degraded auditory input results from the intersection of classroom acoustics and poor teacher voice quality

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Ramos, Lorena de Almeida, and Ana Cristina Côrtes Gama. "Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children." Journal of Voice 31, no. 3 (May 2017): 329–35. http://dx.doi.org/10.1016/j.jvoice.2016.05.011.

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