Quantitative evaluation of phonetograms in the case of functional dysphonia.

PubMed

Airainer, R; Klingholz, F

1993-06-01

According to the laryngeal clinical findings, figures making up a scale were assigned to vocally trained and vocally untrained persons suffering from different types of functional dysphonia. The different types of dysphonia--from the manifested hypofunctional to the extreme hyperfunctional dysphonia--were classified by means of this scale. Besides, the subjects' phonetograms were measured and approximated by three ellipses, what rendered possible the definition of phonetogram parameters. The combining of selected phonetogram parameters to linear combinations served the purpose of a phonetographic evaluation. The linear combinations were to bring phonetographic and clinical evaluations into correspondence as accurately as possible. It was necessary to use different kinds of linear combinations for male and female singers and nonsingers. As a result of the reclassification of 71 and the new classification of 89 patients, it was possible to graduate the types of functional dysphonia by means of computer-aided phonetogram evaluation with a clinically acceptable error rate. This method proved to be an important supplement to the conventional diagnostics of functional dysphonia.

Voice Disorders: Etiology and Diagnosis.

PubMed

Martins, Regina Helena Garcia; do Amaral, Henrique Abrantes; Tavares, Elaine Lara Mendes; Martins, Maira Garcia; Gonçalves, Tatiana Maria; Dias, Norimar Hernandes

2016-11-01

Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients. We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses. Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated. In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[Description of dysphonia cases assisted in a mutua in 2013].

PubMed

Rodríguez Bayarri, M Jesús; Oliveres Verges, Joan; Linares Salas, Carlos; Martínez Llorente, Enrique; Puget Bosch, Dulce

2015-01-01

To describe a case series of patients with dysphonia evaluated in a national Spanish mutua. Computerized medical records of 2013 were reviewed and 129 patients with diagnoses compatible with dysphonia were identified. Eighty-six (67%) of the 129 cases were recognized as occupational diseases, three cases were considered as occupational injuries (two with a diagnosis of Reinke's edema) and the remaining 40 cases were considered to not be work-related. Most of the cases (90%) occurred in women between the ages of 30 and 49 years. Ninety-three percent of the cases diagnosed as occupational diseases underwent speech therapy and, of these, 72% were cured. The majority of the cases (61%) occurred in teachers. Average duration of sickness absence, among those patients who took it, was 113.5 days. All cases reported as occupational disease met the criteria set by the Spanish legislation (RD 1299/2006). Non-occupational diseases were referred to the national health service. Customized speech therapy was effective for most of the patients. The average duration of sick leave in our series was high. Copyright belongs to the Societat Catalana de Salut Laboral.

[Clinical-psychological components in the consideration of functional dysphonia--a review].

PubMed

Kiese-Himmel, C

2015-03-01

The etiopathogenesis of functional dysphonia is complex; it is not sufficient to look solely at vocal behavior aspects. The predisposing basis for functional dysphonia can lie in the constitution of an individual, his/her professional speaking and speech behavior and/or may be personality-based. (Prolonged) psychosocial stress, vocal overstressing, unfavorable speaking habits, infection of the upper respiratory tract, inflammatory processes in the larynx, emotional life events and COSO events are considered as possible triggers. The interaction of predisposed and causal factors is unknown. Stress, overall fatigue, anxiety, depression and/or certain personality traits (which complicate or hamper coping) are considered as perpetuating factors. In any case, overlaps between voice symptoms and reactive psychic as well as social problems have to be kept in mind (e. g. the burden of suffering, depressive processing, speaking anxiety, socially withdrawal). Because the association of multiple psychosocial factors with functional dysphonia is not distinct--such are always existent in organ medically unexplained symptoms--functional dysphonia has to be diagnostically differentiated. For the purpose of the article, a psycho-diagnostic path following the ICD-10 chapter V along general lines is presented. Until now, it is unknown which psychosocial factors discriminate a psychogenic dysphonia from muscle tension dysphonia. © Georg Thieme Verlag KG Stuttgart · New York.

Cross-system effects of dysphagia treatment on dysphonia: a case report

PubMed Central

LaGorio, Lisa A; Carnaby-Mann, Giselle D; Crary, Michael A

2008-01-01

Traditionally, treatment of dysphagia and dysphonia has followed a specificity approach whereby treatment plans have focused on each dysfunction individually. Recently however, a therapeutic cross-system effect has been proposed between these two dysfunctions. At least one study has demonstrated swallowing improvement in subjects who completed a dysphonia treatment program. However, we are unaware of any evidence demonstrating the converse effect. In this paper, we present a case-report of a 74 year old male who demonstrated improvement in selected vocal parameters after completion of a dysphagia therapy program. Dysphagia therapy resulted in improved laryngeal function in this subject. Results implicate improved vocal fold tension with increased glottal closure. Further investigation into the potential for this cross-system effect is warranted. PMID:18667069

Exploring the Clinical Utility of Relative Fundamental Frequency as an Objective Measure of Vocal Hyperfunction.

PubMed

Roy, Nelson; Fetrow, Rebecca A; Merrill, Ray M; Dromey, Christopher

2016-10-01

Vocal hyperfunction, related to abnormal laryngeal muscle activity, is considered the proximal cause of primary muscle tension dysphonia (pMTD). Relative fundamental frequency (RFF) has been proposed as an objective acoustic marker of vocal hyperfunction. This study examined (a) the ability of RFF to track changes in vocal hyperfunction after treatment for pMTD and (b) the influence of dysphonia severity, among other factors, on the feasibility of RFF computation. RFF calculations and dysphonia severity ratings were derived from pre- and posttreatment recordings from 111 women with pMTD and 20 healthy controls. Three vowel-voiceless consonant-vowel stimuli were analyzed. RFF onset slope consistently varied as a function of group (pMTD vs. controls) and time (pretherapy vs. posttherapy). Significant correlations between RFF onset cycle 1 and dysphonia severity were observed. However, in many samples, RFF could not be computed, and adjusted odds ratios revealed that these unanalyzable data were linked to dysphonia severity, phonetic (vowel-voiceless consonant-vowel) context, and group (pMTD vs. control). RFF onset appears to be sensitive to the presence and degree of suspected vocal hyperfunction before and after therapy. The large number of unanalyzable samples (related especially to dysphonia severity in the pMTD group) represents an important limitation.

Early Motor Unit Disease Masquerading as Psychogenic Breathy Dysphonia: A Clinical Case Presentation

ERIC Educational Resources Information Center

Aronson, Arnold E.

1971-01-01

Presented is a study of a 20-year-old girl with mild, breathy dysphonia, previously diagnosed as psychogenic. In actuality, her voice change was a sign of early myasthenia gravis. It is pointed out that voice changes can be a first and only sign of early neurologic disease. (Author/KW)

Phenotype- and Genotype-Specific Structural Alterations in Spasmodic Dysphonia

PubMed Central

Bianchi, Serena; Battistella, Giovanni; Huddleston, Hailey; Scharf, Rebecca; Fleysher, Lazar; Rumbach, Anna F.; Frucht, Steven J.; Blitzer, Andrew; Ozelius, Laurie J.; Simonyan, Kristina

2017-01-01

Background Spasmodic dysphonia is a focal dystonia characterized by involuntary spasms in the laryngeal muscles that occur selectively during speaking. Although hereditary trends have been reported in up to 16% of patients, the causative etiology of spasmodic dysphonia is unclear, and the influences of various phenotypes and genotypes on disorder pathophysiology are poorly understood. In this study, we examined structural alterations in cortical gray matter and white matter integrity in relationship to different phenotypes and putative genotypes of spasmodic dysphonia to elucidate the structural component of its complex pathophysiology. Methods Eighty-nine patients with spasmodic dysphonia underwent high-resolution magnetic resonance imaging and diffusion-weighted imaging to examine cortical thickness and white matter fractional anisotropy in adductor versus abductor forms (distinct phenotypes) and in sporadic versus familial cases (distinct genotypes). Results Phenotype-specific abnormalities were localized in the left sensorimotor cortex and angular gyrus and the white matter bundle of the right superior corona radiata. Genotype-specific alterations were found in the left superior temporal gyrus, supplementary motor area, and the arcuate portion of the left superior longitudinal fasciculus. Conclusions Our findings suggest that phenotypic differences in spasmodic dysphonia arise at the level of the primary and associative areas of motor control, whereas genotype-related pathophysiological mechanisms may be associated with dysfunction of regions regulating phonological and sensory processing. Identification of structural alterations specific to disorder phenotype and putative genotype provides an important step toward future delineation of imaging markers and potential targets for novel therapeutic interventions for spasmodic dysphonia. PMID:28186656

Persistant dysphonia following endotracheal intubation.

PubMed

Hamdan, Abdul-Latif; Sabra, Omar; Rameh, Charbel; El-Khatib, Mohamad

2007-02-01

Voice production is a complex process that involves more than one system, yet most causes of dysphonia are attributed to disturbances in the laryngeal structures and little attention is paid to extralaryngeal factors. Persistent dysphonia after general anesthesia is a challenge to both anesthesiologists and otolaryngologists. The etiology is often multivariable and necessitates a team approach for proper diagnosis. Laryngeal symptoms are subdivided into phonatory disturbances and airway related complaints. When they become persistent for more than 72 hours or are coupled with airway symptoms such as hemoptysis, stridor, dyspnea or aspiration, the anesthesiologist should suspect injury to the vocal folds or cricoarytenoid joints. Here-below, the laryngeal manifestations of endotracheal intubation and the pathophysiology of vocal fold scarring are discussed.

Phenotype- and genotype-specific structural alterations in spasmodic dysphonia.

PubMed

Bianchi, Serena; Battistella, Giovanni; Huddleston, Hailey; Scharf, Rebecca; Fleysher, Lazar; Rumbach, Anna F; Frucht, Steven J; Blitzer, Andrew; Ozelius, Laurie J; Simonyan, Kristina

2017-04-01

Spasmodic dysphonia is a focal dystonia characterized by involuntary spasms in the laryngeal muscles that occur selectively during speaking. Although hereditary trends have been reported in up to 16% of patients, the causative etiology of spasmodic dysphonia is unclear, and the influences of various phenotypes and genotypes on disorder pathophysiology are poorly understood. In this study, we examined structural alterations in cortical gray matter and white matter integrity in relationship to different phenotypes and putative genotypes of spasmodic dysphonia to elucidate the structural component of its complex pathophysiology. Eighty-nine patients with spasmodic dysphonia underwent high-resolution magnetic resonance imaging and diffusion-weighted imaging to examine cortical thickness and white matter fractional anisotropy in adductor versus abductor forms (distinct phenotypes) and in sporadic versus familial cases (distinct genotypes). Phenotype-specific abnormalities were localized in the left sensorimotor cortex and angular gyrus and the white matter bundle of the right superior corona radiata. Genotype-specific alterations were found in the left superior temporal gyrus, supplementary motor area, and the arcuate portion of the left superior longitudinal fasciculus. Our findings suggest that phenotypic differences in spasmodic dysphonia arise at the level of the primary and associative areas of motor control, whereas genotype-related pathophysiological mechanisms may be associated with dysfunction of regions regulating phonological and sensory processing. Identification of structural alterations specific to disorder phenotype and putative genotype provides an important step toward future delineation of imaging markers and potential targets for novel therapeutic interventions for spasmodic dysphonia. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Long-term Effect of Sodium Oxybate (Xyrem®) in Spasmodic Dysphonia with Vocal Tremor

PubMed Central

Simonyan, Kristina; Frucht, Steven J.

2013-01-01

Background Symptoms of spasmodic dysphonia (SD) are usually managed successfully with botulinum toxin injections. Vocal tremor (VT), which accompanies SD, has a poor response to this treatment. Case Report We report a case of a female with SD and VT who became symptom-free for 10 months after the intake of a single dose of sodium oxybate (Xyrem®). The long-term treatment effect correlated with attenuated brain activity in the key regions of dystonic brain network. Discussion Our case demonstrates that the novel treatment of sodium oxybate may hold promise for SD patients, especially those who have associated VT. PMID:24386608

Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia.

PubMed

Hussain, A; Shakeel, M

2010-08-01

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes. A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years. Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory). Four patients (two men and two women; mean age 65 years; age range 41-80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up. Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study.

PubMed

Ramos-Zúñiga, Rodrigo; Díaz-Guzmán, Laura Rocío; Velasquez, Shannen; Macías-Ornelas, Ana Magdalena; Rodríguez-Vázquez, Martín

2015-01-01

A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

Spasmodic Dysphonia: a Laryngeal Control Disorder Specific to Speech

PubMed Central

Ludlow, Christy L.

2016-01-01

Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief. PMID:21248101

Spasmodic dysphonia: a laryngeal control disorder specific to speech.

PubMed

Ludlow, Christy L

2011-01-19

Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief.

Non-functioning parathyroid cystic tumour: malignant or not? Report of a case

PubMed Central

COCORULLO, G.; SCERRINO, G.; MELFA, G.; RASPANTI, C.; ROTOLO, G.; MANNINO, V.; RICHIUSA, P.; CABIBI, D.; GIANNONE, A.G.; PORRELLO, C.; GULOTTA, G.

2017-01-01

Parathyroid carcinoma (PC) is a very rare endocrine tumour, usually characterized by symptoms such as a neck mass, dysphonia, severe hypercalcemia exceeding 140 mg/L and elevated serum parathyroid hormone levels, even more than 5 times the upper limit of normal. Non-functioning parathyroid cancer is extremely rare and, in this case, its pre-operative diagnosis is often difficult. A 54-year old female patient, referring dysphagia and dysphonia, underwent neck ultrasound and neck CT. A left thyroid nodule, probably cystic, was found. It presented caudal extent on anterior mediastinum causing compression of the left lateral wall of the trachea. The preoperative calcemia was into the normal range. The patient underwent left thyroid lobectomy. Histological exam showed a cystic lesion, immunohistochemically originating from parathyroid that oriented for carcinoma. The 18 months follow-up did not show a residual-recurrent disease. The parathyroid origin of a neck lesion could not be suspected before surgery when specific laboratory tests are not available and clinical effects of hyperparathyroidism syndrome are not present. Histological features are not always sufficient for the differential diagnosis between the parathyroid adenoma and carcinoma. The immunohistochemistry is an useful tool that can aid to reach the definite diagnosis. PMID:29280705

Non-functioning parathyroid cystic tumour: malignant or not? Report of a case.

PubMed

Cocorullo, G; Scerrino, G; Melfa, G; Raspanti, C; Rotolo, G; Mannino, V; Richiusa, P; Cabibi, D; Giannone, A G; Porrello, C; Gulotta, G

2017-01-01

Parathyroid carcinoma (PC) is a very rare endocrine tumour, usually characterized by symptoms such as a neck mass, dysphonia, severe hypercalcemia exceeding 140 mg/L and elevated serum parathyroid hormone levels, even more than 5 times the upper limit of normal. Non-functioning parathyroid cancer is extremely rare and, in this case, its pre-operative diagnosis is often difficult. A 54-year old female patient, referring dysphagia and dysphonia, underwent neck ultrasound and neck CT. A left thyroid nodule, probably cystic, was found. It presented caudal extent on anterior mediastinum causing compression of the left lateral wall of the trachea. The preoperative calcemia was into the normal range. The patient underwent left thyroid lobectomy. Histological exam showed a cystic lesion, immunohistochemically originating from parathyroid that oriented for carcinoma. The 18 months follow-up did not show a residual-recurrent disease. The parathyroid origin of a neck lesion could not be suspected before surgery when specific laboratory tests are not available and clinical effects of hyperparathyroidism syndrome are not present. Histological features are not always sufficient for the differential diagnosis between the parathyroid adenoma and carcinoma. The immunohistochemistry is an useful tool that can aid to reach the definite diagnosis.

Port-wine stains are more than skin-deep! Expanding the spectrum of extracutaneous manifestations of nevi flammei of the head and neck.

PubMed

Eivazi, Behfar; Roessler, Marion; Pfützner, Wolfgang; Teymoortash, Afshin; Werner, Jochen A; Happle, Rudolf

2012-01-01

It is well known that port-wine stains of the upper part of the face may herald abnormalities of the brain or eye in the form of Sturge-Weber syndrome. This study focuses on other extracutaneous anomalies in patients with nevi flammei of the head and neck, giving rise to functional complications. A retrospective study was performed on patients with port-wine stains involving the head and neck area. Records were reviewed for demographic parameters, extent of the lesion, clinical complications, diagnostic measures, previous treatments, ultimate therapeutic approach, and outcome. Nine patients, mean age 50.4 years, with port-wine stains and clinical symptoms due to extracutaneous involvement, were admitted and treated from 2006 to 2009. Major clinical features included macrocheilia in three cases, gingival bleeding in two, dysphonia with globus sensation, painful parotideal swelling with recurrent otitis, painful lingual swelling, recurrent epistaxis, and nasal obstruction in one case each. Cases with lower lip hypertrophy were treated by conventional surgical approaches. Recurrent epistaxis and nasal obstruction due to affected inferior turbinate were treated by Nd:YAG laser therapy, and globus sensation and dysphonia by speech therapy. Patients with gingival affection and recurrent otitis were treated by local ear care. Port-wine stains in the head and neck may develop extracutaneous manifestations causing severe problems. A multimodal and interdisciplinary approach is mandatory for an appropriate treatment.

Dysphonia and dysphagia after anterior cervical decompression.

PubMed

Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

2007-08-01

In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. 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. 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. 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.

The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment.

PubMed

Morzaria, S; Damrose, E J

2011-07-01

Botulinum toxin injection under electromyographic guidance is the 'gold standard' for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction. To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients. Stanford University Voice and Swallowing Center. Prospective case series (evidence level four). Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose-response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively. Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total). The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study

PubMed Central

2016-01-01

Objective To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI). Methods Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated. Results There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks. Conclusion The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI. PMID:27606266

Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study.

PubMed

Ko, Kyung Rok; Park, Hee Jung; Hyun, Jung Keun; Seo, In-Hyo; Kim, Tae Uk

2016-08-01

To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI). Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated. There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks. The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.

Hoarse voice in adults: an evidence-based approach to the 12 minute consultation.

PubMed

Syed, I; Daniels, E; Bleach, N R

2009-02-01

The hoarse voice is a common presentation in the adult ENT clinic. It is estimated that otolaryngology/voice clinics receive over 50 000 patients with dysphonia each year. Good vocal function is estimated to be required for around 1/3 of the labour force to fulfil their job requirements. The assessment and management of the patient with a hoarse voice is potentially a complex and protracted process as the aetiology is often multi-factorial. This article provides a guide for the clinician in the general ENT clinic to make a concise, thorough assessment of the hoarse patient and engage in an evidence based approach to investigation and management. Literature search performed on 4 October 2008 using EMBASE, MEDLINE, Cochrane databases using subject headings hoarse voice or dysphonia in combination with diagnosis, management, investigation, treatment, intervention and surgery. General vocal hygiene is beneficial for non organic dysphonia but the evidence base for individual components is poor. There is a good evidence base for the use of voice therapy as first line treatment of organic dysphonia such as vocal fold nodules and polyps. There is little evidence for surgical intervention as first line therapy for most common benign vocal fold lesions. Surgery is, however, the treatment of choice for hoarseness due to papillomatosis. Both CO(2) laser and microdissection are equally acceptable modalities for surgical resection of common benign vocal fold lesions. Laryngopharyngeal reflux is commonly cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor. Despite the widespread use of proton pump inhibitors for treating laryngopharyngeal reflux, there is high quality evidence to suggest that they are no more effective than placebo. A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood.

[Long term result of arytenoidectomy with CO₂ laser for dyspnoea in iatrogenic bilateral vocal fold paralysis patients].

PubMed

Cheng, Q H; Ge, P J; Sheng, X L; Jiang, J; Zhang, S Y; Chen, S H

2016-03-20

Objective: To investigate the optimal time of tracheotomy/arytenoidectomy and the improvement of dyspnoea, dysphonia and dysphagia after arytenoidectomy with CO₂ laser in iatrogenic bilateral vocal folds paralysis patients. Method: Thirty patients [29 females, 56 (49-60) years, one male, 49 years] with bilateral vocal cords paralysis resulted from neck surgery were retrospectively analyzed by case archived information and following-up questionnaire. The data included patients' dysponea time, degree and duration from tracheotomy/arytenoidectomy to neck surgery. Twenty sixty patients required unilateral partial/total arytenoidectomy. The results of treatment were evaluated by questionnaire including dyspnoea, dysphonia and dysphagia. Result: All patients whose bilateral vocal paralysis were resulted from thyroid gland surgery. Dysponea occurred immediately after thyroidectomy surgery in 14 cases (46.7%), and 2 years later after thyroidectomy in 13 cases (43.3%), 8 years later in 3 cases (10.0%). There was one (3.3%) patient without tracheotomy. The duration of tracheotomy/arytenoidectomy to neck surgery was significantly correlated with duration of tracheotomy/arytenoidectomy to dyspnoea appearance ( r =0.879, P <0.05), not correlated with duration of thyroid surgery to dyspnoea appearance. There is significantly negative correlation between degree of dyspnoea and duration of tracheotomy/arytenoidectomy to neck surgery ( r =0.452, P <0.05). Twenty six patients appeared dyspnoea and underwent CO₂ laser arytenoidectomy after thyoidectomy 0.5-23 years. Five patients did unilateral total arytenoidectomy and 21 patients did unilateral partial arytenoidectomy. After 12-96 months following up, dyspnoea improved in 24 patients, no improved in 2 patients. Dysphonia improved and remained in 17 patients, being worse mildly in 8 patients and obviously in one patient. Dysphagia improved and remained in 24 patients, being worse in 2 patients. There was no difference between total and partial arytenoidectomy in dyspnoea, dysphonia and dysphagia. Conclusion: The morbidity of dyspnoea was correlated with time after neck surgery. It was rarely necessary to take tracheotomy immediately in bilateral vocal fords paralysis patients after neck surgery. The severer degree of dyspnoea led to shorter duration between neck surgery and tracheotomy/arytenoidectomy. There was obvious improvement after arytenoidectomy in dyspnoea, no significant change in dysphonia and dysphagia. The effect of total arytenoidectomy on bilateral vocal paralysis was similar to partial arytenoidectomy. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

An Overview of Laryngeal Muscle Single Fiber Electromyography.

PubMed

Bertorini, Tulio E; Sharaf, Aboubakar G

2015-08-01

Needle electromyography is an important tool in the diagnosis of neuromuscular diseases and has also been applied successfully in the evaluation of the vocal cord paralysis. Laryngeal electromyography, initially described by Weddell, is used to determine the cause of vocal cord paralysis and to differentiate organic from nonorganic causes of speech disorders. This test allows the diagnosis of lower motor neuron and nerve paralysis as well as myopathies. Laryngeal electromyography also helps to determine the prognosis of paralysis caused by traumatic injury of the laryngeal nerves and is used for guidance during botulinum toxin injection in spasmodic dysphonias. Single fiber electromyography is used to diagnose abnormalities of neuromuscular transmission and is applied in the study the architecture of the motor unit in muscles. This article reviews the techniques of laryngeal muscles single fiber electromyography, provides limited informative data, and discusses its potential value in the evaluation of patients with dysphonia.

Persistent dysphonia in two performers affecting the singing and projected speaking voice: a report on a collaborative approach to management.

PubMed

Baker, Janet

2002-01-01

The projected speaking voice and the singing voice are highly sensitive to external and internal influences, and teachers of spoken voice and singing are in a unique position to identify subtle and more serious vocal difficulties in their students. Persistent anomalies may herald early onset of changes in vocal fold structure, neurophysiological control, or emotional stability. Two cases are presented to illustrate the benefits of a collaborative approach to diagnosis and management. The first, a 21-year-old male drama and singing student with an abnormally high speaking voice and falsetto singing voice was found to have a psychogenic dysphonia referred to as "puberphonia" or "mutational falsetto". The second, a 34-year-old female alto with strained phonation and perceived stutter of the vocal folds was diagnosed with "adductor spasmodic dysphonia" or "focal laryngeal dystonia" of neurological origin.

Reinke Edema: Watch For Vocal Fold Cysts.

PubMed

Tüzüner, Arzu; Demirci, Sule; Yavanoglu, Ahmet; Kurkcuoglu, Melih; Arslan, Necmi

2015-06-01

Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

Perspectives on voice treatment for unilateral vocal fold paralysis.

PubMed

Walton, Chloe; Carding, Paul; Flanagan, Kieran

2018-06-01

Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP.

[Acoustic characteristics of adductor spasmodic dysphonia].

PubMed

Yang, Yang; Wang, Li-Ping

2008-06-01

To explore the acoustic characteristics of adductor spasmodic dysphonia. The acoustic characteristics, including acoustic signal of recorded voice, three-dimensional sonogram patterns and subjective assessment of voice, between 10 patients (7 women, 3 men) with adductor spasmodic dysphonia and 10 healthy volunteers (5 women, 5 men), were compared. The main clinical manifestation of adductor spasmodic dysphonia included the disorders of sound quality, rhyme and fluency. It demonstrated the tension dysphonia when reading, acoustic jitter, momentary fluctuation of frequency and volume, voice squeezing, interruption, voice prolongation, and losing normal chime. Among 10 patients, there were 1 mild dysphonia (abnormal syllable number < 25%), 6 moderate dysphonia (abnormal syllable number 25%-49%), 1 severe dysphonia (abnormal syllable number 50%-74%) and 2 extremely severe dysphonia (abnormal syllable number > or = 75%). The average reading time in 10 patients was 49 s, with reading time extension and aphasia area interruption in acoustic signals, whereas the average reading time in health control group was 30 s, without voice interruption. The aphasia ratio averaged 42%. The respective symptom syllable in different patients demonstrated in the three-dimensional sonogram. There were voice onset time prolongation, irregular, interrupted and even absent vowel formants. The consonant of symptom syllables displayed absence or prolongation of friction murmur in the block-friction murmur occasionally. The acoustic characteristics of adductor spasmodic dysphonia is the disorders of sound quality, rhyme and fluency. The three-dimensional sonogram of the symptom syllables show distinctive changes of proportional vowels or consonant phonemes.

Brainstem pathology in spasmodic dysphonia

PubMed Central

Simonyan, Kristina; Ludlow, Christy L.; Vortmeyer, Alexander O.

2009-01-01

Spasmodic dysphonia (SD) is a primary focal dystonia of unknown pathophysiology, characterized by involuntary spasms in the laryngeal muscles during speech production. We examined two rare cases of postmortem brainstem tissue from SD patients compared to four controls. In SD patients, small clusters of inflammation were found in the reticular formation surrounding solitary tract, spinal trigeminal and ambigual nuclei, inferior olive and pyramids. Mild neuronal degeneration and depigmentation were observed in the substantia nigra and locus coeruleus. No abnormal protein accumulations and no demyelination or axonal degeneration were found. These neuropathological findings may provide insights into the pathophysiology of SD. PMID:19795469

Vocal therapy of hyperkinetic dysphonia.

PubMed

Mumović, Gordana; Veselinović, Mila; Arbutina, Tanja; Škrbić, Renata

2014-01-01

Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. The subjective acoustic analysis revealed a significant (p<0.01) reduction in all dysphonia parameters after vocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100) of adult patients and 29% (29/100) had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025) in all dysphonia parameters except SD FO and jitter %. In children, the acoustic parameters SD FO, jitter % and NNE (normal noise energy) were significantly improved (p=0.003-0.03). Pathological voice qualities were also improved in adults and children (p<0.05). Vocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affectinq diverse acoustic parameters.

Unusual Otolaryngologic Manifestations of Paracoccidioidomycosis: A Case Report and Review of Literature

PubMed Central

Lucinda, Lucas Resende; Polanski, José Fernando

2017-01-01

Paracoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis. It occurs more frequently in its chronic form, which particularly affects male adults from rural areas. These patients present with pulmonary involvement and systemic symptoms. Skin and mucosal lesions are rather typical and might suggest the diagnosis. The involvement of the upper airway mucosa is common and the patients usually complain of dysphagia and dysphonia. Nonetheless, in endemic areas, physicians should maintain a high level of suspicion even when faced with some atypical symptoms. We present the case of an adult diagnosed with nasopharyngeal paracoccidioidomycosis after presenting with an unusual otolaryngologic syndrome including unilateral soft palate paralysis with velopharyngeal insufficiency and hearing loss secondary to middle ear effusion. PMID:28500805

Unusual Otolaryngologic Manifestations of Paracoccidioidomycosis: A Case Report and Review of Literature.

PubMed

Lucinda, Lucas Resende; Polanski, José Fernando

2017-05-01

AbstractParacoccidioidomycosis is a systemic mycosis caused by Paracoccidioides brasiliensis . It occurs more frequently in its chronic form, which particularly affects male adults from rural areas. These patients present with pulmonary involvement and systemic symptoms. Skin and mucosal lesions are rather typical and might suggest the diagnosis. The involvement of the upper airway mucosa is common and the patients usually complain of dysphagia and dysphonia. Nonetheless, in endemic areas, physicians should maintain a high level of suspicion even when faced with some atypical symptoms. We present the case of an adult diagnosed with nasopharyngeal paracoccidioidomycosis after presenting with an unusual otolaryngologic syndrome including unilateral soft palate paralysis with velopharyngeal insufficiency and hearing loss secondary to middle ear effusion.

Autosomal-dominant GTPCH1-deficient DRD: clinical characteristics and long-term outcome of 34 patients.

PubMed

Trender-Gerhard, I; Sweeney, M G; Schwingenschuh, P; Mir, P; Edwards, M J; Gerhard, A; Polke, J M; Hanna, M G; Davis, M B; Wood, N W; Bhatia, K P

2009-08-01

An autosomal dominantly inherited defect in the GCH1 gene that encodes guanosine triphosphate cyclohydrolase 1 (GTPCH1) is the most common cause of dopa-responsive dystonia (DRD). A classic phenotype of young-onset lower-limb dystonia, diurnal fluctuations and excellent response to levodopa has been well recognised in association with GCH1 mutations, and rare atypical presentations have been reported. However, a number of clinical issues remain unresolved including phenotypic variability, long-term response to levodopa and associated non-motor symptoms, and there are limited data on long-term follow-up of genetically proven cases. A detailed clinical evaluation of 34 patients (19 women, 15 men), with confirmed mutations in the GCH1 gene, is presented. The classic phenotype was most frequent (n = 23), with female predominance (F:M = 16:7), and early onset (mean 4.5 years) with involvement of legs. However, a surprisingly large number of patients developed craniocervical dystonia, with spasmodic dysphonia being the predominant symptom in two subjects. A subset of patients, mainly men, presented with either a young-onset (mean 6.8 years) mild DRD variant not requiring treatment (n = 4), or with an adult-onset (mean 37 years) Parkinson disease-like phenotype (n = 4). Two siblings were severely affected with early hypotonia and delay in motor development, associated with compound heterozygous GCH1 gene mutations. The study also describes a number of supplementary features including restless-legs-like symptoms, influence of female sex hormones, predominance of tremor or parkinsonism in adult-onset cases, initial reverse reaction to levodopa, recurrent episodes of depressive disorder and specific levodopa-resistant symptoms (writer's cramp, dysphonia, truncal dystonia). Levodopa was used effectively and safely in 20 pregnancies, and did not cause any fetal abnormalities.

[Computer-assisted phonetography as a diagnostic aid in functional dysphonia].

PubMed

Airainer, R; Klingholz, F

1991-07-01

A total of 160 voice-trained and untrained subjects with functional dysphonia were given a "clinical rating" according to their clinical findings. This was a certain value on a scale that recorded the degree of functional voice disorder ranging from a marked hypofunction to an extreme hyperfunction. The phonetograms of these patients were approximated by ellipses, whereby the definition and quantitative recording of several phonetogram parameters were rendered possible. By means of a linear combination of phonetogram parameters, a "calculated assessment" was obtained for each patient that was expected to tally with the "clinical rating". This paper demonstrates that a graduation of the dysphonic clinical picture with regard to the presence of hypofunctional or hyperfunctional components is possible via computerised phonetogram evaluation. In this case, the "calculated assessments" for both male and female singers and non-singers must be computed using different linear combinations. The method can be introduced as a supplementary diagnostic procedure in the diagnosis of functional dysphonia.

Spasmodic Dysphonia: A Review. Part 1: Pathogenic Factors.

PubMed

Hintze, Justin M; Ludlow, Christy L; Bansberg, Stephen F; Adler, Charles H; Lott, David G

2017-10-01

Objective The purpose of this review is to describe the recent advances in identifying possible factors involved in the pathogenesis of spasmodic dysphonia. Spasmodic dysphonia is a task-specific focal laryngeal dystonia characterized by irregular and uncontrolled voice breaks. Pathogenesis of the disorder is poorly understood. Data Sources PubMed, Google Scholar, and Cochrane Library. Review Methods The data sources were searched using the following search terms: ( spasmodic dysphonia or laryngeal dystonia) and ( etiology, aetiology, diagnosis, pathogenesis, or pathophysiology). Conclusions Several potential etiological factors have been proposed by epidemiological, genetic, and neuropathological studies. Spasmodic dysphonia is a rare disorder primarily affecting females beginning in their 40s. Vocal tremor co-occurs in 30% to 60%. Large cohort studies identified risk factors such as a family history of neurological disorders including dystonia and tremor, recent viral illness, and heavy voice use. As none are rare events, a complex interactive process may contribute to pathogenesis in a small proportion of those at risk. Consequences to pathogenesis are neurological processes found in spasmodic dysphonia: loss of cortical inhibition, sensory processing disturbances, and neuroanatomical and physiological differences in the laryngeal motor control system. Implications for Practice Diagnosis of spasmodic dysphonia usually includes speech and laryngoscopic assessment. However, as diagnosis is sometimes problematic, measurement of neurophysiological abnormalities may contribute useful adjuncts for the diagnosis of spasmodic dysphonia in the future.

Causes and imaging manifestations of paralysis of the recurrent laryngeal nerve.

PubMed

Méndez Garrido, S; Ocete Pérez, R F

2016-01-01

The vocal cords play a key role in the functions of the larynx. Their motor innervation depends on the recurrent laryngeal nerve (a branch of the tenth cranial nerve), which follows a long trajectory comprising intracranial, cervical, and mediastinal segments. Vocal cord paralysis usually manifests as dysphonia, the main symptom calling for CT study, the first-line imaging test to investigate the cause of the lesion. Patients are asymptomatic in a third of cases, so the incidental detection of signs of vocal cord paralysis in a CT study done for other reasons should prompt a search for a potentially severe occult lesion. This article aims to familiarize readers with the anatomy of the motor innervation of the glottis, the radiological presentation and most common causes of vocal cord paralysis, and conditions that can simulate vocal cord paralysis. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

Sonographic detection of basal ganglia abnormalities in spasmodic dysphonia.

PubMed

Walter, U; Blitzer, A; Benecke, R; Grossmann, A; Dressler, D

2014-02-01

Abnormalities of the lenticular nucleus (LN) on transcranial sonography (TCS) are a characteristic finding in idiopathic segmental and generalized dystonia. Our intention was to study whether TCS detects basal ganglia abnormalities also in spasmodic dysphonia, an extremely focal form of dystonia. Transcranial sonography of basal ganglia, substantia nigra and ventricles was performed in 14 patients with spasmodic dysphonia (10 women, four men; disease duration 16.5 ± 6.1 years) and 14 age- and sex-matched healthy controls in an investigator-blinded setting. Lenticular nucleus hyperechogenicity was found in 12 spasmodic dysphonia patients but only in one healthy individual (Fisher's exact test, P < 0.001) whilst other TCS findings did not differ. The area of LN hyperechogenic lesions quantified on digitized image analysis correlated with spasmodic dysphonia severity (Spearman test, r = 0.82, P < 0.001). Our findings link the underlying pathology of spasmodic dysphonia to that of more widespread forms of dystonia. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Comparing health locus of control in patients with Spasmodic Dysphonia, Functional Dysphonia and Nonlaryngeal Dystonia.

PubMed

Haselden, Karen; Powell, Theresa; Drinnan, Mike; Carding, Paul

2009-11-01

Locus of Control (LoC) refers to an individuals' perception of whether they are in control of life events. Health Locus of Control refers to whether someone feels they have influence over their health. Health Locus of Control has not been studied in any depth in voice-disordered patients. The objective of this study was to examine Health Locus of Control in three patient groups: (1) Spasmodic Dysphonia, (2) Functional Dysphonia and (3) a nondysphonic group with Nonlaryngeal Dystonia. LoC was measured and compared in a total of 57 patients using the Multidimensional Health Locus of Control Scales (diagnostic specific) Form C. Internal, Chance, and Powerful others LoC were measured and comparisons were made using one-way analysis of variance. Contrary to expectations Internal LoC was found to be significantly higher in the Functional Dysphonia group when compared to the other two groups. There was no significant difference between the groups in Chance or Powerful others LoC. The two organic groups, Spasmodic Dysphonia and Nonlaryngeal Dystonia, were more alike in Internal Health Locus of Control than the Functional Dysphonia group. The diagnostic nature of the groups was reflected in their LoC scores rather than their voice loss. These results contribute to the debate about the etiology of Spasmodic Dysphonia and will be of interest to those involved in the psychology of voice and those managing voice-disordered patients.

[Laryngeal electromyography in diagnosis and treatment of voice disorders].

PubMed

García-López, Isabel; Santiago-Pérez, Susana; Peñarrocha-Teres, Julio; del Palacio, Antonio J; Gavilan, Javier

2012-01-01

Laryngeal electromyography, together with clinical evaluation, is a valuable tool in voice disorder management. It assesses the integrity of laryngeal nerves and muscles, contributing to the diagnosis of many diseases, especially laryngeal movement disorders. Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating voice disorders. A prospective study was designed to evaluate laryngeal movement disorders with laryngeal electromyography. Both the cricothyroid and thyroarytenoid muscles were tested routinely and, in some cases, the posterior cricoarytenoid muscle. The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist. We included 110 patients, with the most common symptom being dysphonia. Laryngeal electromyography was performed in 85% of cases. Primary diagnosis before electromyography was laryngeal immobility. Positive predictive value for diagnosis in cases of paralysis was 88%. Laryngeal electromyography is a useful adjunct, together with clinical evaluation, for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A possible association between dysphonia and sleep duration: A cross-sectional study based on the Korean National Health and nutrition examination surveys from 2010 to 2012

PubMed Central

Cho, Jung-Hae; Guilminault, Christian; Joo, Young-Hoon; Jin, Sang-Kyun; Han, Kyung-Do

2017-01-01

Background Sleep is important in terms of good general health and appropriate sleep duration has been linked to quality-of-life. Dysphonia may impair communication and social relationships, and is thus also closely related to quality-of-life. No large-scale, cross-sectional epidemiological study of a sample representative of the population of an entire country has yet assessed the possible existence of a relationship between sleep duration and dysphonia. Methods We investigated a possible association between subjective voice problems and self-reported sleep duration in South Korean subjects using 2010–2012 data from the Korean National Health and Nutrition Examination Survey (KNHANES). Cross-sectional data on 17,806 adults (7,578 males and 10,228 females) over the age of 19 years who completed the KNHANES were analyzed. All participants reported voice problems (if present) and their daily average sleep duration using a self-reporting questionnaire. Sleep duration was classified into five categories as follows: ≤5, 6, 7, 8, and ≥9 h/day. Results The overall prevalence of dysphonia was 6.8%; 5.7% in males and 7.7% in females. The prevalence for dysphonia by sleep duration exhibited a U-shape, with the lowest point being at sleep duration of 7-8h. After adjustment for covariates (age, sex, smoking status, alcohol consumption, regular exercise, low income, high-level education), a sleep duration of ≤5 h (OR = 1.454; 95% CI, 1.153–1.832) and a sleep duration of ≥9 h (OR = 1.365; 95% CI, 1.017–1.832) were significantly associated with dysphonia, compared to a sleep duration of 7 h. In terms of gender, males who slept for ≥9 h were at a 2-fold (OR = 2.028; 95% CI, 1.22–3.35) higher odds for dysphonia (p<0.05) compared to those who slept for 7 h. A sleep duration ≤5 h was associated with a 1.6-fold (OR = 1.574; 95% CI, 1.203–2.247) higher odds of dysphonia ≥3 weeks in duration (long-term dysphonia). Conclusions This is the first study to show that both short and long sleep duration were significantly associated with the development of dysphonia. The association between sleep duration and dysphonia was more marked in males than females. A sleep duration ≤5 h had a significant impact on the prevalence of long-term dysphonia. PMID:28783741

Acoustic and Perceptual Analyses of Adductor Spasmodic Dysphonia in Mandarin-speaking Chinese.

PubMed

Chen, Zhipeng; Li, Jingyuan; Ren, Qingyi; Ge, Pingjiang

2018-02-12

The objective of this study was to examine the perceptual structure and acoustic characteristics of speech of patients with adductor spasmodic dysphonia (ADSD) in Mandarin. Case-Control Study MATERIALS AND METHODS: For the estimation of dysphonia level, perceptual and acoustic analysis were used for patients with ADSD (N = 20) and the control group (N = 20) that are Mandarin-Chinese speakers. For both subgroups, a sustained vowel and connected speech samples were obtained. The difference of perceptual and acoustic parameters between the two subgroups was assessed and analyzed. For acoustic assessment, the percentage of phonatory breaks (PBs) of connected reading and the percentage of aperiodic segments and frequency shifts (FS) of vowel and reading in patients with ADSD were significantly worse than controls, the mean harmonics-to-noise ratio and the fundamental frequency standard deviation of vowel as well. For perceptual evaluation, the rating of speech and vowel in patients with ADSD are significantly higher than controls. The percentage of aberrant acoustic events (PB, frequency shift, and aperiodic segment) and the fundamental frequency standard deviation and mean harmonics-to-noise ratio were significantly correlated with the perceptual rating in the vowel and reading productions. The perceptual and acoustic parameters of connected vowel and reading in patients with ADSD are worse than those in normal controls, and could validly and reliably estimate dysphonia of ADSD in Mandarin-speaking Chinese. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

PubMed

Kaneko, Mami; Hitomi, Takefumi; Takekawa, Takashi; Tsuji, Takuya; Kishimoto, Yo; Hirano, Shigeru

2017-09-26

Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Toward the Development of an Objective Index of Dysphonia Severity: A Four-Factor Acoustic Model

ERIC Educational Resources Information Center

Awan, Shaheen N.; Roy, Nelson

2006-01-01

During assessment and management of individuals with voice disorders, clinicians routinely attempt to describe or quantify the severity of a patient's dysphonia. This investigation used acoustic measures derived from sustained vowel samples to predict dysphonia severity (as determined by auditory-perceptual ratings), for a diverse set of voice…

The Effect of Listener Experience and Anchors on Judgments of Dysphonia

ERIC Educational Resources Information Center

Eadie, Tanya L.; Kapsner-Smith, Mara

2011-01-01

Purpose: To determine the effect of auditory anchors on judgments of overall severity (OS) and vocal effort (VE) in dysphonic speech when judgments are made by experienced and inexperienced listeners, and when self-rated by individuals with dysphonia (speaker-listeners). Method: Twenty individuals with dysphonia and 4 normal controls provided…

Surgical Interventions for Pediatric Unilateral Vocal Cord Paralysis: A Systematic Review.

PubMed

Butskiy, Oleksandr; Mistry, Bhavik; Chadha, Neil K

2015-07-01

The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce. To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies. MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events. Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients. Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.

Influence of phonetic context on the dysphonic event: contribution of new methodologies for the analysis of pathological voice.

PubMed

Revis, J; Galant, C; Fredouille, C; Ghio, A; Giovanni, A

2012-01-01

Widely studied in terms of perception, acoustics or aerodynamics, dysphonia stays nevertheless a speech phenomenon, closely related to the phonetic composition of the message conveyed by the voice. In this paper, we present a series of three works with the aim to understand the implications of the phonetic manifestation of dysphonia. Our first study proposes a new approach to the perceptual analysis of dysphonia (the phonetic labeling), which principle is to listen and evaluate each phoneme in a sentence separately. This study confirms the hypothesis of Laver that the dysphonia is not a constant noise added to the speech signal, but a discontinuous phenomenon, occurring on certain phonemes, based on the phonetic context. However, the burden of executing the task has led us to look to the techniques of automatic speaker recognition (ASR) to automate the procedure. With the collaboration of the LIA, we have developed a system for automatic classification of dysphonia from the techniques of ASR. This is the subject of our second study. The first results obtained with this system suggest that the unvoiced consonants show predominant performance in the task of automatic classification of dysphonia. This result is surprising since it is often assumed that dysphonia occurs only on laryngeal vibration. We started looking for explanations of this phenomenon and we present our assumptions and experiences in the third work we present.

Cortical sensorimotor alterations classify clinical phenotype and putative genotype of spasmodic dysphonia.

PubMed

Battistella, G; Fuertinger, S; Fleysher, L; Ozelius, L J; Simonyan, K

2016-10-01

Spasmodic dysphonia (SD), or laryngeal dystonia, is a task-specific isolated focal dystonia of unknown causes and pathophysiology. Although functional and structural abnormalities have been described in this disorder, the influence of its different clinical phenotypes and genotypes remains scant, making it difficult to explain SD pathophysiology and to identify potential biomarkers. We used a combination of independent component analysis and linear discriminant analysis of resting-state functional magnetic resonance imaging data to investigate brain organization in different SD phenotypes (abductor versus adductor type) and putative genotypes (familial versus sporadic cases) and to characterize neural markers for genotype/phenotype categorization. We found abnormal functional connectivity within sensorimotor and frontoparietal networks in patients with SD compared with healthy individuals as well as phenotype- and genotype-distinct alterations of these networks, involving primary somatosensory, premotor and parietal cortices. The linear discriminant analysis achieved 71% accuracy classifying SD and healthy individuals using connectivity measures in the left inferior parietal and sensorimotor cortices. When categorizing between different forms of SD, the combination of measures from the left inferior parietal, premotor and right sensorimotor cortices achieved 81% discriminatory power between familial and sporadic SD cases, whereas the combination of measures from the right superior parietal, primary somatosensory and premotor cortices led to 71% accuracy in the classification of adductor and abductor SD forms. Our findings present the first effort to identify and categorize isolated focal dystonia based on its brain functional connectivity profile, which may have a potential impact on the future development of biomarkers for this rare disorder. © 2016 EAN.

Cortical sensorimotor alterations classify clinical phenotype and putative genotype of spasmodic dysphonia

PubMed Central

Battistella, Giovanni; Fuertinger, Stefan; Fleysher, Lazar; Ozelius, Laurie J.; Simonyan, Kristina

2017-01-01

Background Spasmodic dysphonia (SD), or laryngeal dystonia, is a task-specific isolated focal dystonia of unknown causes and pathophysiology. Although functional and structural abnormalities have been described in this disorder, the influence of its different clinical phenotypes and genotypes remains scant, making it difficult to explain SD pathophysiology and to identify potential biomarkers. Methods We used a combination of independent component analysis and linear discriminant analysis of resting-state functional MRI data to investigate brain organization in different SD phenotypes (abductor vs. adductor type) and putative genotypes (familial vs. sporadic cases) and to characterize neural markers for genotype/phenotype categorization. Results We found abnormal functional connectivity within sensorimotor and frontoparietal networks in SD patients compared to healthy individuals as well as phenotype- and genotype-distinct alterations of these networks, involving primary somatosensory, premotor and parietal cortices. The linear discriminant analysis achieved 71% accuracy classifying SD and healthy individuals using connectivity measures in the left inferior parietal and sensorimotor cortex. When categorizing between different forms of SD, the combination of measures from left inferior parietal, premotor and right sensorimotor cortices achieved 81% discriminatory power between familial and sporadic SD cases, whereas the combination of measures from the right superior parietal, primary somatosensory and premotor cortices led to 71% accuracy in the classification of adductor and abductor SD forms. Conclusions Our findings present the first effort to identify and categorize isolated focal dystonia based on its brain functional connectivity profile, which may have a potential impact on the future development of biomarkers for this rare disorder. PMID:27346568

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

PubMed Central

Nemr, Katia; Cota, Ariane; Tsuji, Domingos; Simões-Zenari, Marcia

2018-01-01

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses. PMID:29538494

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses.

PubMed

Nemr, Katia; Cota, Ariane; Tsuji, Domingos; Simões-Zenari, Marcia

2018-03-12

To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

The putative involvement of the transabdominal muscles in dysphonia: a preliminary study and thoughts.

PubMed

Rubin, J S; Macdonald, I; Blake, E

2011-03-01

Real-time ultrasound was used as an adjunct to assess patterns of periabdominal musculature in 14 individual with dysphonia and muscle tension dysphonia. Fourteen individuals with muscle tension dysphonia were evaluated with real-time ultrasound as a part of their initial evaluation and management. In 13 of 14 individuals, there was an imbalance found during phonation between the transversus abdominis muscles (TAs) and internal oblique muscles (IOs), whereby the IOs were found to be overactive and the TAs underactive. After physiotherapy, this pattern was reversed. The abdominal muscle pattern of overactivity of the internal oblique and underactivity of the TA during phonation was found to be present in the large majority of patients in this pilot sample who had presented with muscle tension dysphonia. The significance of this is unclear but deserves further review. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Parry-Romberg syndrome (progressive hemifacial atrophy) with spasmodic dysphonia--a rare association.

PubMed

Mugundhan, K; Selvakumar, C J; Gunasekaran, K; Thiruvarutchelvan, K; Sivakumar, S; Anguraj, M; Arun, S

2014-04-01

Parry-Romberg syndrome is a rare clinical entity characterised by progressive hemifacial atrophy with appearance of 'saber'. Various neurological and otorhinolaryngological disorders are associated with this syndrome. The association of Parry -Romberg syndrome with Spasmodic dysphonia has rarely been reported. A 37 year old female presented with progressive atrophy of tissues of left side of face for 10 years and change in voice for 1 year. On examination, wasting and atrophy of tissues including tongue was noted on left side of the face. ENT examination revealed adductor spasmodic dysphonia. We report the rare association of Parry -Romberg syndrome with spasmodic dysphonia.

Biofeedback in dysphonia - progress and challenges.

PubMed

Amorim, Geová Oliveira de; Balata, Patrícia Maria Mendes; Vieira, Laís Guimarães; Moura, Thaís; Silva, Hilton Justino da

There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Isolated laryngeal myasthenia gravis for 26 years.

PubMed

Renard, Dimitri; Hedayat, Amir; Gagnard, Corinne

2015-02-01

Laryngeal myasthenia gravis is a relatively rare variant of myasthenia gravis. A vast portion of patients with initial laryngeal myasthenia gravis develop involvement of ocular and/or extra-ocular muscles during the years after symptom onset although a minority of laryngeal myasthenia gravis patients continues to have isolated laryngeal muscle involvement for several years. We present a 58-year-old woman with recurrent episodic isolated dysphonia (associated with diffuse bilateral vocal cord paresis on laryngoscopy) since the age of 32. Dysphonia became permanent since 6 months. A diagnosis of laryngeal myasthenia gravis was made based on abnormal single-fiber electromyography and spectacular response to pyridostigmine treatment. Repetitive nerve stimulation was normal and anti-acetylcholine receptor and anti-muscle specific tyrosine kinase antibodies were absent. This case shows that laryngeal myasthenia gravis can be isolated during 26 years of follow-up. We propose that even when myasthenia gravis seems unlikely as underlying mechanism of isolated dysphonia (because of lack of antibodies, normal repetitive nerve stimulation, and absence of extra-laryngeal involvement after years of follow-up), single-fiber electromyography should be performed and myasthenia gravis treatment should be tried. Copyright © 2014 Elsevier B.V. All rights reserved.

Chiropractic Care for a Patient with Spasmodic Dysphonia Associated with Cervical Spine Trauma

PubMed Central

Waddell, Roger K.

2005-01-01

Abstract Objective To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. Clinical Features The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. Intervention and Outcome Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. Conclusion It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia. PMID:19674642

Co-Prevalence of Tremor with Spasmodic Dysphonia: A Case-Control Study

PubMed Central

White, Laura; Klein, Adam; Hapner, Edie; Delgaudio, John; Hanfelt, John; Jinnah, H. A.; Johns, Michael

2011-01-01

OBJECTIVES/HYPOTHESIS The aim of this study was to define the co-prevalence of tremor with spasmodic dysphonia (SD). STUDY DESIGN A single institution prospective, case-control study was performed from May 2010 to July 2010. METHODS Consecutive patients with SD (cases) and other voice disorders (controls) were enrolled prospectively. Each participant underwent a voice evaluation and an evaluation for tremor. RESULTS 146 voice disorder controls and 128 patients with SD were enrolled. 26% of patients with SD had vocal tremor, 21% had non-vocal tremor. Patients with SD were 2.8 times more likely to have co-prevalent tremor than the control group (OR = 2.81; 95% CI, 1.55 to 5.08) and only 35% of patients with SD had been seen by a neurologist for the evaluation of dystonia and tremor. CONCLUSIONS Tremor is highly prevalent in patients with SD. It is important for each patient diagnosed with SD to undergo an evaluation for tremor, this is especially important in patients diagnosed with vocal tremor. Level of evidence 3b. PMID:21792965

Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia.

PubMed

Conde, Mariana de Cásisa Macedo; Siqueira, Larissa Thaís Donalonso; Vendramini, José Eduardo; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Silverio, Kelly Cristina Alves

2018-05-01

This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Voice Disorder in Cystic Fibrosis Patients

PubMed Central

Lourenço, Bruna Mendes; Costa, Kauê Machado; da Silva Filho, Manoel

2014-01-01

Cystic fibrosis is a common autosomal recessive disorder with drastic respiratory symptoms, including shortness of breath and chronic cough. While most of cystic fibrosis treatment is dedicated to mitigating the effects of respiratory dysfunction, the potential effects of this disease on vocal parameters have not been systematically studied. We hypothesized that cystic fibrosis patients, given their characteristic respiratory disorders, would also present dysphonic symptoms. Given that voice disorders can severely impair quality of life, the identification of a potential cystic fibrosis-related dysphonia could be of great value for the clinical evaluation and treatment of this disease. We tested our hypothesis by measuring vocal parameters, using both objective physical measures and the GRBAS subjective evaluation method, in male and female cystic fibrosis patients undergoing conventional treatment and compared them to age and sex matched controls. We found that cystic fibrosis patients had a significantly lower vocal intensity and harmonic to noise ratio, as well as increased levels of jitter and shimmer. In addition, cystic fibrosis patients also showed higher scores of roughness, breathiness and asthenia, as well as a significantly altered general grade of dysphonia. When we segregated the results according to sex, we observed that, as a group, only female cystic fibrosis patients had significantly lower values of harmonic to noise ratio and an abnormal general grade of dysphonia in relation to matched controls, suggesting that cystic fibrosis exerts a more pronounced effect on vocal parameters of women in relation to men. Overall, the dysphonic characteristics of CF patients can be explained by dysfunctions in vocal fold movement and partial upper airway obstruction, potentially caused by the accumulation of mucus and chronic cough characteristic of CF symptomatology. Our results show that CF patients exhibit significant dysphonia and suggest they may potentially benefit from voice therapy as a parallel treatment strategy. PMID:24796691

Clinical practice: vocal nodules in dysphonic children.

PubMed

Martins, Regina Helena Garcia; Branco, Anete; Tavares, Elaine Lara Mendes; Gramuglia, Andrea Cristina Jóia

2013-09-01

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.

Tracing Spasmodic Dysphonia: The Source of Ludwig Traube's Priority.

PubMed

Lorch, Marjorie Perlman; Whurr, Renata

2016-08-01

Since the mid-20th century, one citation is given historical priority as the first description of spasmodic dysphonia (SD): Ludwig Traube's 1871 case of the "spastic form of nervous hoarseness." Our objective is to understand how this case serves as the foundation of understanding laryngeal movement disorders. The original German paper was located and translated. Bibliographical and bibliometric methods are used to determine the citation history of this original source over the past 140 years. Although secondary citations in contemporary publications typically credit Traube for establishing the clinical entity SD, his case does not conform to currently accepted diagnostic features. Citation patterns indicate the source of Traube's priority is publications by Arnold and Luchsinger, mid-20th-century ENT clinicians, particularly their influential 1965 textbook used to train US and UK clinicians on voice disorders for several generations. Sometimes secondary citations in medical literature lead to the inadvertent perpetuation of factual misrepresentation. The clinical picture of Traube's original case does not represent what clinicians would recognize as SD today. The rich 19th-century literature on voice disorders is a valuable resource for present day clinicians. © The Author(s) 2016.

Research Priorities in Spasmodic Dysphonia

PubMed Central

Ludlow, Christy L.; Adler, Charles H.; Berke, Gerald S.; Bielamowicz, Steven A.; Blitzer, Andrew; Bressman, Susan B.; Hallett, Mark; Jinnah, H. A.; Juergens, Uwe; Martin, Sandra B.; Perlmutter, Joel S.; Sapienza, Christine; Singleton, Andrew; Tanner, Caroline M.; Woodson, Gayle E.

2009-01-01

OBJECTIVE To identify research priorities for increasing understanding of the pathogenesis, diagnosis and improved treatment of spasmodic dysphonia. STUDY DESIGN AND SETTING A multidisciplinary working group was formed including both scientists and clinicians from multiple disciplines, otolaryngology, neurology, speech pathology, genetics and neuroscience, to review currently available information on spasmodic dysphonia and to identify research priorities. RESULTS Operational definitions for spasmodic dysphonia at different levels of certainty were recommended for diagnosis and recommendations made for a multi-center multidisciplinary validation study. CONCLUSIONS The highest priority is to characterize the disorder and identify risk factors that may contribute to its onset. Future research should compare and contrast spasmodic dysphonia with other forms of focal dystonia. Development of animal models is recommended to explore hypotheses related to pathogenesis. Improved understanding of the pathophysiology of SD should provide the basis for developing new treatment options and exploratory clinical trials. SIGNIFICANCE This document should foster future research to improve the care of patients with this chronic debilitating voice and speech disorder by otolaryngology, neurology, and speech pathology. PMID:18922334

Characteristics of mucosal glottic wave analyzed with HSDI-kymography, regional FFT, and red-color pattern after recurrent respiratory papillomatosis treated with laser surgery and intra-lesion bevacizumab injection

NASA Astrophysics Data System (ADS)

Cruz, Raul M.; Izdebski, Krzysztof; Yan, Yuling

2012-02-01

Recurrent Respiratory Papillomatosis (RRP) is a devastating disorder- especially in a performing professional voice user. The mainstay of treatment is based on immaculate serial removal of regrowing papillomas, usually with a laser. Repetitive laser excisions can cause significant scarring and webbing. The risks of post-operative sequela are exponentially increased with anterior location of papilloma clusters. The resultant dysphonia is not amenable to physiological voice therapy protocols. Additional or adjunctive treatments are eagerly sought by patients to avoid complications. Many of these treatments remain unproven. Recently, bevacizumab (Avastin) has been advocated as potentially useful. Consequently, we report a case treated with KTP lasering of papillomas with adjunctive intralesional bevacizumab injections. Current outcome of the case is analyzed with both traditional LVS and High Speed Digital Imaging (HSDI).

Mephedrone inhalation causes pneumomediastinum.

PubMed

Graham, Ruth; Bowen, Nia; Singh, Joy

2014-03-10

A 17-year-old male patient presented to A&E with swelling on the right side of his neck, extending to below the clavicle, associated with neck pain and dysphonia. On examination, subcutaneous supraclavicular and chest wall emphysema was noted. Clinical observations and bloods were normal. A chest X-ray and subsequent CT of the thorax showed evidence of pneumomediastinum and subcutaneous emphysema. The patient denied any history of trauma but admitted to inhalation of mephedrone 3 days previously. The patient was discussed with the regional cardiothoracic unit who advised conservative management. He was treated prophylactically with antibiotics and was initially kept nil by mouth, but diet was introduced 24 h later. He remained well, his dysphonia resolved and his subcutaneous emphysema improved. He was discharged after 3 days. He has not attended any formal follow-up but was well when contacted by phone.

Is Menstrual Dysphonia Associated With Greater Disability and Lower Quality of Life?

PubMed

Barillari, Maria Rosaria; Volpe, Umberto; Innaro, Nadia; Barillari, Umberto

2016-01-01

The aim of the present study had been to examine the relationships between menstrual dysphonia and measures of psychosocial distress, in a sample of female professional voice users. This is a prospective study of 52 consecutive professional voice users, aged 18-40 years, affected by transient dysphonia related to the menstrual cycle and recruited in the Division of Phoniatrics and Audiology of the Second University of Naples, from April 2011 to September 2014. The following evaluation protocol was used: videoendoscopy, the GIRBAS scale, the Voice Handicap Index, and the determination of sexual hormonal plasma levels both during the menstrual and the luteal phase of the cycle. Furthermore, we measured, in all patients, the levels of perceived disability and quality of life during and after the dysphonia episodes by means of the Manchester Short Assessment of Quality of Life and the Sheehan disability scale. Laryngoscopic evaluation revealed that only minor morphologic changes were present during the first days of the follicular phase, usually returning to normal morphology after the menstrual period was over. However, we found that dysphonia episodes of varying degree were present in most evaluated subjects; women with a moderate degree of dysphonia also had a lower quality of life and greater overall disability, during menses. Despite minimal morphologic signs of laryngeal pathology, menstrual dysphonia might represent a disease which is frequent among female professional voice users, which in turn is associated with a certain degree of disability and lower quality of life during premenstrual and menstrual phases. Copyright © 2016. Published by Elsevier Inc.

[Anaphylaxis caused by royal jelly].

PubMed

Roger, A; Rubira, N; Nogueiras, C; Guspi, R; Baltasar, M; Cadahia, A

1995-01-01

Royal jelly is the food on which are fed and which causes them to develop into queen bees. It is claimed to have rejuvenating virtues for human beings. This report describes a 15-year-old atopic woman who presented, 15 minutes after the intake of royal jelly, local angioedema, generalised urticaria, dysphonia and bronchospasm. She was given antihistaminics and corticoesteroids and responded well. The ingested product contains royal jelly, lactose and potassium sorbate. No anaphylactic reactions to lactose and sorbates have been described previously. Prick test to common food allergens hymenoptera venoms and pollens were negative. RAST to meletin was also negative. Blood eosinophils were 600 and total IgE 465. Non-commercial prepared specific IgE to royal jelly was positive (0.8 KU/l). Prick by prick was positive to 1/10 dilution, being negative in controls (undiluted). No oral provocation test was performed due to the risk of anaphylaxis. No reported cases of royal jelly allergy were founded in a review of the medical literature. Concluding, it is the first described case of IgE anaphylactic reaction due to royal jelly.

Analysis of possible factors of vocal interference during the teaching activity

PubMed Central

Silva, Bárbara Gabriela; Chammas, Tiago Visacre; Zenari, Marcia Simões; Moreira, Renata Rodrigues; Samelli, Alessandra Giannella; Nemr, Kátia

2017-01-01

ABSTRACT OBJECTIVE To measure the risk of dysphonia in teachers, as well as investigate whether the perceptual-auditory and acoustic aspects of the voice of teachers in situations of silence and noise, the signal-to-noise ratio, and the noise levels in the classroom are associated with the presence of dysphonia. METHODS This is an observational cross-sectional research with 23 primary and secondary school teachers from a private school in the municipality of São Paulo, Brazil, divided into the groups without dysphonia and with dysphonia. We performed the following procedures: general Dysphonia Risk Screening Protocol (General-DRSP) and complementary to speaking voice - teacher (Specific-DRSP), voice recording during class and in an individual situation in a silent room, and measurement of the signal-to-noise ratio and noise levels of classrooms. RESULTS We have found differences between groups regarding physical activity (General-DRSP) and particularities of the profession (Specific-DRSP), as well as in all aspects of the perceptual-auditory vocal analysis. We have found signs of voice wear in the group without dysphonia. Regarding the vocal resources in the situations of noise and silence, we have identified a difference for the production of abrupt vocal attack and the tendency of a more precise speech in the situation of noise. Both the signal-to-noise ratio and the room noise levels during class were high in both groups. CONCLUSIONS Teachers in both groups are at high risk for developing dysphonia and have negative vocal signals to a greater or lesser extent. Signal-to-noise ratio was inadequate in most classrooms, considering the standards for both children with normal hearing and with hearing loss, as well as equivalent noise levels. PMID:29236878

Abnormal striatal dopaminergic neurotransmission during rest and task production in spasmodic dysphonia.

PubMed

Simonyan, Kristina; Berman, Brian D; Herscovitch, Peter; Hallett, Mark

2013-09-11

Spasmodic dysphonia is a primary focal dystonia characterized by involuntary spasms in the laryngeal muscles during speech production. The pathophysiology of spasmodic dysphonia is thought to involve structural and functional abnormalities in the basal ganglia-thalamo-cortical circuitry; however, neurochemical correlates underpinning these abnormalities as well as their relations to spasmodic dysphonia symptoms remain unknown. We used positron emission tomography with the radioligand [(11)C]raclopride (RAC) to study striatal dopaminergic neurotransmission at the resting state and during production of symptomatic sentences and asymptomatic finger tapping in spasmodic dysphonia patients. We found that patients, compared to healthy controls, had bilaterally decreased RAC binding potential (BP) to striatal dopamine D2/D3 receptors on average by 29.2%, which was associated with decreased RAC displacement (RAC ΔBP) in the left striatum during symptomatic speaking (group average difference 10.2%), but increased RAC ΔBP in the bilateral striatum during asymptomatic tapping (group average difference 10.1%). Patients with more severe voice symptoms and subclinically longer reaction time to initiate the tapping sequence had greater RAC ΔBP measures, while longer duration of spasmodic dysphonia was associated with a decrease in task-induced RAC ΔBP. Decreased dopaminergic transmission during symptomatic speech production may represent a disorder-specific pathophysiological trait involved in symptom generation, whereas increased dopaminergic function during unaffected task performance may be explained by a compensatory adaptation of the nigrostriatal dopaminergic system possibly due to decreased striatal D2/D3 receptor availability. These changes can be linked to the clinical and subclinical features of spasmodic dysphonia and may represent the neurochemical basis of basal ganglia alterations in this disorder.

Brain structural changes in spasmodic dysphonia: A multimodal magnetic resonance imaging study.

PubMed

Kostic, Vladimir S; Agosta, Federica; Sarro, Lidia; Tomić, Aleksandra; Kresojević, Nikola; Galantucci, Sebastiano; Svetel, Marina; Valsasina, Paola; Filippi, Massimo

2016-04-01

The pathophysiology of spasmodic dysphonia is poorly understood. This study evaluated patterns of cortical morphology, basal ganglia, and white matter microstructural alterations in patients with spasmodic dysphonia relative to healthy controls. T1-weighted and diffusion tensor magnetic resonance imaging (MRI) scans were obtained from 13 spasmodic dysphonia patients and 30 controls. Tract-based spatial statistics was applied to compare diffusion tensor MRI indices (i.e., mean, radial and axial diffusivities, and fractional anisotropy) between groups on a voxel-by-voxel basis. Cortical measures were analyzed using surface-based morphometry. Basal ganglia were segmented on T1-weighted images, and volumes and diffusion tensor MRI metrics of nuclei were measured. Relative to controls, patients with spasmodic dysphonia showed increased cortical surface area of the primary somatosensory cortex bilaterally in a region consistent with the buccal sensory representation, as well as right primary motor cortex, left superior temporal, supramarginal and superior frontal gyri. A decreased cortical area was found in the rolandic operculum bilaterally, left superior/inferior parietal and lingual gyri, as well as in the right angular gyrus. Compared to controls, spasmodic dysphonia patients showed increased diffusivities and decreased fractional anisotropy of the corpus callosum and major white matter tracts, in the right hemisphere. Altered diffusion tensor MRI measures were found in the right caudate and putamen nuclei with no volumetric changes. Multi-level alterations in voice-controlling networks, that included regions devoted not only to sensorimotor integration, motor preparation and motor execution, but also processing of auditory and visual information during speech, might have a role in the pathophysiology of spasmodic dysphonia. Copyright © 2016 Elsevier Ltd. All rights reserved.

Abnormal Striatal Dopaminergic Neurotransmission during Rest and Task Production in Spasmodic Dysphonia

PubMed Central

Berman, Brian D.; Herscovitch, Peter; Hallett, Mark

2013-01-01

Spasmodic dysphonia is a primary focal dystonia characterized by involuntary spasms in the laryngeal muscles during speech production. The pathophysiology of spasmodic dysphonia is thought to involve structural and functional abnormalities in the basal ganglia–thalamo-cortical circuitry; however, neurochemical correlates underpinning these abnormalities as well as their relations to spasmodic dysphonia symptoms remain unknown. We used positron emission tomography with the radioligand [11C]raclopride (RAC) to study striatal dopaminergic neurotransmission at the resting state and during production of symptomatic sentences and asymptomatic finger tapping in spasmodic dysphonia patients. We found that patients, compared to healthy controls, had bilaterally decreased RAC binding potential (BP) to striatal dopamine D2/D3 receptors on average by 29.2%, which was associated with decreased RAC displacement (RAC ΔBP) in the left striatum during symptomatic speaking (group average difference 10.2%), but increased RAC ΔBP in the bilateral striatum during asymptomatic tapping (group average difference 10.1%). Patients with more severe voice symptoms and subclinically longer reaction time to initiate the tapping sequence had greater RAC ΔBP measures, while longer duration of spasmodic dysphonia was associated with a decrease in task-induced RAC ΔBP. Decreased dopaminergic transmission during symptomatic speech production may represent a disorder-specific pathophysiological trait involved in symptom generation, whereas increased dopaminergic function during unaffected task performance may be explained by a compensatory adaptation of the nigrostriatal dopaminergic system possibly due to decreased striatal D2/D3 receptor availability. These changes can be linked to the clinical and subclinical features of spasmodic dysphonia and may represent the neurochemical basis of basal ganglia alterations in this disorder. PMID:24027271

Analysis of possible factors of vocal interference during the teaching activity.

PubMed

Silva, Bárbara Gabriela; Chammas, Tiago Visacre; Zenari, Marcia Simões; Moreira, Renata Rodrigues; Samelli, Alessandra Giannella; Nemr, Kátia

2017-12-11

To measure the risk of dysphonia in teachers, as well as investigate whether the perceptual-auditory and acoustic aspects of the voice of teachers in situations of silence and noise, the signal-to-noise ratio, and the noise levels in the classroom are associated with the presence of dysphonia. This is an observational cross-sectional research with 23 primary and secondary school teachers from a private school in the municipality of São Paulo, Brazil, divided into the groups without dysphonia and with dysphonia. We performed the following procedures: general Dysphonia Risk Screening Protocol (General-DRSP) and complementary to speaking voice - teacher (Specific-DRSP), voice recording during class and in an individual situation in a silent room, and measurement of the signal-to-noise ratio and noise levels of classrooms. We have found differences between groups regarding physical activity (General-DRSP) and particularities of the profession (Specific-DRSP), as well as in all aspects of the perceptual-auditory vocal analysis. We have found signs of voice wear in the group without dysphonia. Regarding the vocal resources in the situations of noise and silence, we have identified a difference for the production of abrupt vocal attack and the tendency of a more precise speech in the situation of noise. Both the signal-to-noise ratio and the room noise levels during class were high in both groups. Teachers in both groups are at high risk for developing dysphonia and have negative vocal signals to a greater or lesser extent. Signal-to-noise ratio was inadequate in most classrooms, considering the standards for both children with normal hearing and with hearing loss, as well as equivalent noise levels.

Parkinson's disease detection based on dysphonia measurements

NASA Astrophysics Data System (ADS)

Lahmiri, Salim

2017-04-01

Assessing dysphonic symptoms is a noninvasive and effective approach to detect Parkinson's disease (PD) in patients. The main purpose of this study is to investigate the effect of different dysphonia measurements on PD detection by support vector machine (SVM). Seven categories of dysphonia measurements are considered. Experimental results from ten-fold cross-validation technique demonstrate that vocal fundamental frequency statistics yield the highest accuracy of 88 % ± 0.04. When all dysphonia measurements are employed, the SVM classifier achieves 94 % ± 0.03 accuracy. A refinement of the original patterns space by removing dysphonia measurements with similar variation across healthy and PD subjects allows achieving 97.03 % ± 0.03 accuracy. The latter performance is larger than what is reported in the literature on the same dataset with ten-fold cross-validation technique. Finally, it was found that measures of ratio of noise to tonal components in the voice are the most suitable dysphonic symptoms to detect PD subjects as they achieve 99.64 % ± 0.01 specificity. This finding is highly promising for understanding PD symptoms.

Is the perception of dysphonia severity language-dependent? A comparison of French and Italian voice assessments.

PubMed

Ghio, Alain; Cantarella, Giovanna; Weisz, Frédérique; Robert, Danièle; Woisard, Virginie; Fussi, Franco; Giovanni, Antoine; Baracca, Giovanna

2015-04-01

In this cross-language study, six Italian and six French voice experts evaluated perceptually the speech of 27 Italian and 40 French patients with dysphonia to determine if there were differences based on native language. French and Italian voice specialists agreed substantially in their evaluations of the overall grade of dysphonia and moderately concerning roughness and breathiness. No statistically significant effects were found related to the language of the speakers with the exception of breathiness, a finding that was interpreted as being due to different voice pathologies in the patient groups. It was concluded that the perception of the overall grade of dysphonia and breathiness is not language-dependent, whereas the significant difference in the perception of roughness may be related to a perception/adaption process.

Microvascular lesions of the true vocal fold.

PubMed

Postma, G N; Courey, M S; Ossoff, R H

1998-06-01

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.

Exploring the Clinical Utility of Relative Fundamental Frequency as an Objective Measure of Vocal Hyperfunction

ERIC Educational Resources Information Center

Roy, Nelson; Fetrow, Rebecca A.; Merrill, Ray M.; Dromey, Christopher

2016-01-01

Purpose: Vocal hyperfunction, related to abnormal laryngeal muscle activity, is considered the proximal cause of primary muscle tension dysphonia (pMTD). Relative fundamental frequency (RFF) has been proposed as an objective acoustic marker of vocal hyperfunction. This study examined (a) the ability of RFF to track changes in vocal hyperfunction…

Case-control study of risk factors for spasmodic dysphonia: A comparison with other voice disorders.

PubMed

Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Sauder, Cara; Houtz, Daniel R; Smith, Marshall E

2012-05-01

This epidemiology study examined risk factors uniquely associated with spasmodic dysphonia (SD). Case-control. A questionnaire was administered to 150 patients with SD (with and without coexisting vocal tremor) and 136 patients with other structural, neurological, and functional voice disorders (excluding SD and vocal tremor). Questions included personal and family medical histories, environmental exposures, trauma, illnesses, voice use habits, and the Short Form 36. Several factors were uniquely associated with SD (α = .05), including: 1) a personal history of cervical dystonia, sinus and throat illnesses, mumps, rubella, dust exposure, and frequent volunteer voice use, 2) a family history of voice disorders, 3) an immediate family history of vocal tremor and meningitis, and 4) an extended family history of head and neck tremor, ocular disease, and meningitis. Vocal tremor coexisted with SD in 29% of cases. Measles and mumps vaccines were protective for SD. SD is likely multifactorial and associated with several endogenous and exogenous factors. Certain viral exposures, voice use patterns, and familial neurological conditions may contribute to the onset of SD later in life. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Efficacy and safety of acute injection laryngoplasty for vocal cord paralysis following thoracic surgery.

PubMed

Graboyes, Evan M; Bradley, Joseph P; Meyers, Bryan F; Nussenbaum, Brian

2011-11-01

The primary objective of this study was to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures. Retrospective consecutive case series in an academic institution. Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006, to March 31, 2010, for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (N = 20). All patients were injected with Radiesse Voice Gel using microlaryngoscopy technique. The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operative-related complication of intraoperative bile reflux that caused a pneumonitis. Ninety percent of patients were recommended for strict nothing by mouth prior to injection. Of these, 94% were allowed an oral diet following injection, and 67% tolerated a regular diet. None of the patients required subsequent procedures for aspiration or dysphagia, and 25% required further intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection. Acute treatment of thoracic surgery-related unilateral vocal cord paralysis with injection laryngoplasty appears safe and effective at preventing postoperative aspiration pneumonia and improves swallowing function to allow resumption of an oral diet. A single injection is often the only required treatment. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Cortical Silent Period Reveals Differences Between Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia.

PubMed

Samargia, Sharyl; Schmidt, Rebekah; Kimberley, Teresa Jacobson

2016-03-01

The pathophysiology of adductor spasmodic dysphonia (AdSD), like other focal dystonias, is largely unknown. The purposes of this study were to determine (a) cortical excitability differences between AdSD, muscle tension dysphonia (MTD), and healthy controls; (b) distribution of potential differences in cranial or skeletal muscle; and (c) if cortical excitability measures assist in the differential diagnosis of AdSD and MTD. Ten participants with adductor spasmodic dysphonia, 8 with muscle tension dysphonia, and 10 healthy controls received single and paired pulse transcranial magnetic stimulation (TMS) to the primary motor cortex contralateral to tested muscles, first dorsal interosseus (FDI), and masseter. We tested the hypothesis that cortical excitability measures in AdSD would be significantly different from those in MTD and healthy controls. In addition, we hypothesized that there would be a correlation between cortical excitability measures and clinical voice severity in AdSD. Cortical silent period duration in masseter and FDI was significantly shorter in AdSD than MTD and healthy controls. Other measures failed to demonstrate differences. There are differences in cortical excitability between AdSD, MTD, and healthy controls. These differences in the cortical measure of both the FDI and masseter muscles in AdSD suggest widespread dysfunction of the GABAB mechanism may be a pathophysiologic feature of AdSD, similar to other forms of focal dystonia. Further exploration of the use of TMS to assist in the differential diagnosis of AdSD and MTD is warranted. © The Author(s) 2015.

Cortical silent period reveals differences between adductor spasmodic dysphonia and muscle tension dysphonia

PubMed Central

Samargia, Sharyl; Schmidt, Rebekah; Kimberley, Teresa Jacobson

2015-01-01

Background The pathophysiology of adductor spasmodic dysphonia (AdSD), like other focal dystonias, is largely unknown. Objective The purposes of this study were to determine 1) cortical excitability differences between AdSD, muscle tension dysphonia (MTD) and healthy controls 2) distribution of potential differences in cranial or skeletal muscle, and 3) if cortical excitability measures assist in the differential diagnosis of AdSD and MTD. Methods 10 participants with adductor spasmodic dysphonia, 8 with muscle tension dysphonia and 10 healthy controls received single and paired pulse transcranial magnetic stimulation (TMS) to the primary motor cortex contralateral to tested muscles, first dorsal interosseus (FDI) and masseter. We tested the hypothesis that cortical excitability measures in AdSD would be significantly different than in MTD and healthy. In addition, we hypothesized there would be a correlation between cortical excitability measures and clinical voice severity in AdSD. Results Cortical silent period (CSP) duration in masseter and FDI was significantly shorter in AdSD than MTD and healthy controls. Other measures failed to demonstrate differences. Conclusion There are differences in cortical excitability between AdSD, MTD and healthy controls. These differences in the cortical measure of both the FDI and masseter muscles in AdSD suggest widespread dysfunction of the GABAB mechanism may be a pathophysiologic feature of AdSD, similar to other forms of focal dystonia. Further exploration of the use of TMS to assist in the differential diagnosis of AdSD and MTD is warranted. PMID:26089309

Current and emerging concepts in muscle tension dysphonia: a 30-month review.

PubMed

Altman, Kenneth W; Atkinson, Cory; Lazarus, Cathy

2005-06-01

The modern theory of hoarseness is that there are multifactorial etiologies contributing to the voice problem. The hypothesis of this study is that muscle tension dysphonia is multifactorial with various contributing etiologies. This project is a retrospective chart review of all patients seen in the Voice Speech and Language Service and Swallowing Center at our institution with a diagnosis of muscle tension (functional hypertensive) dysphonia over a 30-month period. A literature search and review is also performed regarding current and emerging concepts of muscle tension dysphonia. One hundred fifty subjects were identified (60% female, 40% male, with a mean age of 42.3 years). Significant factors in patient history believed to contribute to abnormal voice production were gastroesophageal reflux in 49%, high stress levels in 18%, excessive amounts of voice use in 63%, and excessive loudness demands on voice use in 23%. Otolaryngologic evaluation was performed in 82% of patients, in whom lesions, significant vocal fold edema, or paralysis/paresis was identified in 52.3%. Speech pathology assessment revealed poor breath support, inappropriately low pitch, and visible cervical neck tension in the majority of patients. Inappropriate intensity was observed in 23.3% of patients. This set of multiple contributing factors is discussed in the context of current and emerging understanding of muscle tension dysphonia. Results confirm multifactorial etiologies contributing to hoarseness in the patients identified with muscle tension dysphonia. An interdisciplinary approach to treating all contributing factors portends the best prognosis.

The role of laryngoscopy in the diagnosis of spasmodic dysphonia.

PubMed

Daraei, Pedram; Villari, Craig R; Rubin, Adam D; Hillel, Alexander T; Hapner, Edie R; Klein, Adam M; Johns, Michael M

2014-03-01

Spasmodic dysphonia (SD) can be difficult to diagnose, and patients often see multiple physicians for many years before diagnosis. Improving the speed of diagnosis for individuals with SD may decrease the time to treatment and improve patient quality of life more quickly. To assess whether the diagnosis of SD can be accurately predicted through auditory cues alone without the assistance of visual cues offered by laryngoscopic examination. Single-masked, case-control study at a specialized referral center that included patients who underwent laryngoscopic examination as part of a multidisciplinary workup for dysphonia. Twenty-two patients were selected in total: 10 with SD, 5 with vocal tremor, and 7 controls without SD or vocal tremor. The laryngoscopic examination was recorded, deidentified, and edited to make 3 media clips for each patient: video alone, audio alone, and combined video and audio. These clips were randomized and presented to 3 fellowship-trained laryngologist raters (A.D.R., A.T.H., and A.M.K.), who established the most probable diagnosis for each clip. Intrarater and interrater reliability were evaluated using repeat clips incorporated in the presentations. We measured diagnostic accuracy for video-only, audio-only, and combined multimedia clips. These measures were established before data collection. Data analysis was accomplished with analysis of variance and Tukey honestly significant differences. Of patients with SD, diagnostic accuracy was 10%, 73%, and 73% for video-only, audio-only, and combined, respectively (P < .001, df = 2). Of patients with vocal tremor, diagnostic accuracy was 93%, 73%, and 100% for video-only, audio-only, and combined, respectively (P = .05, df = 2). Of the controls, diagnostic accuracy was 81%, 19%, and 62% for video-only, audio-only, and combined, respectively (P < .001, df = 2). The diagnosis of SD during examination is based primarily on auditory cues. Viewing combined audio and video clips afforded no change in diagnostic accuracy compared with audio alone. Laryngoscopy serves an important role in the diagnosis of SD by excluding other pathologic causes and identifying vocal tremor.

Occupational vocal cord dysfunction due to exposure to wood dust and xerographic toner.

PubMed

Muñoz, Xavier; Roger, Alex; De la Rosa, David; Morell, Ferran; Cruz, Maria J

2007-04-01

Vocal cord dysfunction is a poorly understood entity that is often misdiagnosed as asthma. Both irritant and non-irritant vocal cord dysfunction have been described. This report presents two cases of irritant vocal cord dysfunction secondary to specific environmental exposure, the first to iroko and western red cedar wood (a carpenter) and the second to xerographic printing toner (a secretary). Several tests were performed, including chest radiographs, measurements of total serum immunoglobulin E, skin prick tests with common pneumoallergens (as well as iroko and western red cedar in the first case), pulmonary function studies, methacholine challenge testing, specific inhalation challenge performed with suspected agents in a single-blinded fashion, and peak expiratory flow testing and fiberoptic rhinolaryngoscopy (in case 1). During the specific inhalation challenge, the patients showed dysphonia, chest tightness, inspiratory stridor, and flattening of the inspiratory limb of the maximum flow-volume loop in spirometry, with no significant decreases in the level of forced expiratory volume in 1 second; fiberoptic rhinolaryngoscopy confirmed the diagnosis of vocal cord dysfunction in case 1. It is important to know that agents that can cause occupational asthma can also cause vocal cord dysfunction. The mechanisms by which these agents produce vocal cord dysfunction are unknown. The differences in the clinical presentation of the patients described relative to the reported cases suggest that more than one pathophysiological mechanism may be implicated in the genesis of this entity.

Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire study.

PubMed

Kaptein, A A; Hughes, B M; Scharloo, M; Hondebrink, N; Langeveld, T P M

2010-02-01

To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. Prospective controlled cohort study. A tertiary care facility. Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. Psychosocial functioning, illness perceptions, and treatment perceptions. Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life.

Chemodenervation of the Larynx

PubMed Central

Kaye, Rachel; Blitzer, Andrew

2017-01-01

Botulinum neurotoxin (BoNT) has existed for thousands of years; however, it was not medically utilized until investigations into its therapeutic use began in sincerity during the late 1970s and 1980s. This, coupled with the reclassification of spasmodic dysphonia as a focal dystonia, led to the use of chemodenervation for this disorder, which has since become a refined technique. Indeed, due to its safety and efficacy, BoNT has been investigated in multiple neurolaryngology disorders, including spasmodic dysphonia, vocal tremor, and muscle tension dysphonia. BoNT has been shown to be a useful and safe adjunct in the treatment for these disorders and may reduce or eliminate oral pharmacotherapy and/or prevent the need for a surgical intervention. We present the historical background, development, proposed mechanisms of action, uses, and techniques for administering BoNT for laryngeal disorders, with a particular focus on spasmodic dysphonia. PMID:29099066

A comparison of the VHI, VHI-10, and V-RQOL for measuring the effect of botox therapy in adductor spasmodic dysphonia.

PubMed

Morzaria, Sanjay; Damrose, Edward J

2012-05-01

Although disease-specific quality-of-life (QOL) instruments are an invaluable outcome measure in spasmodic dysphonia, there is no consensus on which QOL instrument should be used. To determine the responsiveness of the Voice Handicap Index (VHI), Voice Handicap Index-10 (VHI-10), and Voice-Related Quality of Life (V-RQOL) to the treatment effect of botulinum toxin (Botox) in adductor spasmodic dysphonia (ADSD). Stanford University Voice and Swallowing Center. Prospective case series (level of evidence=4). Consecutive ADSD patients with a stable Botox dose-response relationship were recruited prospectively. VHI, VHI-10, and V-RQOL scores were obtained pretreatment and during the middle third of the posttreatment injection cycle. Thrity-seven patients completed the follow-up. The average total Botox dose was 0.88 units. The average follow-up time after injection was 7.84 weeks. The pretreatment QOL scores reflected the burden of the disease. All the three instruments were highly correlated in subscale and total scores. After treatment, all three instruments showed significant improvement. The VHI, VHI-10, and V-RQOL all reflected the morbidity associated with ADSD and were significantly responsive to the effect of Botox therapy. The choice of instrument should be based on physician preference. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Non-functioning parathyroid adenoma: a rare differential diagnosis for vocal-cord paralysis

PubMed Central

Kamali, D; Sharpe, A; Nagarajan, S; Elsaify, W

2016-01-01

Introduction Adenomas of the parathyroid gland typically present with symptoms of hyperparathyroidism, manifested by fatigue, bone pain, abdominal pain, weakness, dyspepsia, nephrolithiasis and skeletal bone disease. Here, we describe, for the first time, a case of a non-functioning benign tumour of the parathyroid gland presenting as vocal-cord paralysis. Case History A 49-year-old male presented with a 10-week history of dysphonia and the feeling of having ‘something stuck in my throat’. History-taking elicited no other associated symptoms. Flexible nasal endoscopy demonstrated paralysis of the left vocal cord. Computed tomography of the neck revealed a cystic lesion, 18mm in diameter adjacent to the oesophagus. After more rigorous tests, a neck exploration, left hemithyroidectomy, excision of the left paratracheal mass and level-VI neck dissection was undertaken, without incident to the patient or surgical team. Histology was consistent with a parathyroid adenoma. Conclusions This case emphasises the importance of including adenomatous disease of the parathyroid gland in the differential diagnosis despite normal parathyroid status as a cause of vocal cord palsy. PMID:27055408

Spasmodic dysphonia: onset, course, socioemotional effects, and treatment response.

PubMed

Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Sauder, Cara; Houtz, Daniel R; Smith, Marshall E

2011-07-01

This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD). A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD. Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor. The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.

The prevalence of childhood dysphonia: a cross-sectional study.

PubMed

Carding, Paul N; Roulstone, Sue; Northstone, Kate

2006-12-01

There is only very limited information on the prevalence of voice disorders, particularly for the pediatric population. This study examined the prevalence of dysphonia in a large cohort of children (n = 7389) at 8 years of age. Data were collected within a large prospective epidemiological study and included a formal assessment by one of five research speech and language therapists as well as a parental report of their child's voice. Common risk factors that were also analyzed included sex, sibling numbers, asthma, regular conductive hearing loss, and frequent upper respiratory infection. The research clinicians identified a dysphonia prevalence of 6% compared with a parental report of 11%. Both measures suggested a significant risk of dysphonia for children with older siblings. Other measures were not in agreement between clinician and parental reports. The clinician judgments also suggested significant risk factors for sex (male) but not for any common respiratory or otolaryngological conditions that were analyzed. Parental report suggested significant risk factors with respect to asthma and tonsillectomy. These results are discussed in detail.

Short-Term Effect of Two Semi-Occluded Vocal Tract Training Programs on the Vocal Quality of Future Occupational Voice Users: "Resonant Voice Training Using Nasal Consonants" Versus "Straw Phonation".

PubMed

Meerschman, Iris; Van Lierde, Kristiane; Peeters, Karen; Meersman, Eline; Claeys, Sofie; D'haeseleer, Evelien

2017-09-18

The purpose of this study was to determine the short-term effect of 2 semi-occluded vocal tract training programs, "resonant voice training using nasal consonants" versus "straw phonation," on the vocal quality of vocally healthy future occupational voice users. A multigroup pretest-posttest randomized control group design was used. Thirty healthy speech-language pathology students with a mean age of 19 years (range: 17-22 years) were randomly assigned into a resonant voice training group (practicing resonant exercises across 6 weeks, n = 10), a straw phonation group (practicing straw phonation across 6 weeks, n = 10), or a control group (receiving no voice training, n = 10). A voice assessment protocol consisting of both subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, aerodynamic assessment, voice range profile, acoustic analysis, acoustic voice quality index, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and posttraining. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. No significant time × group interactions were found for any of the outcome measures, indicating no differences in evolution over time among the 3 groups. Within-group effects of time showed a significant improvement in dysphonia severity index in the resonant voice training group, and a significant improvement in the intensity range in the straw phonation group. Results suggest that the semi-occluded vocal tract training programs using resonant voice training and straw phonation may have a positive impact on the vocal quality and vocal capacities of future occupational voice users. The resonant voice training caused an improved dysphonia severity index, and the straw phonation training caused an expansion of the intensity range in this population.

Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use.

PubMed

Singh, Vikas; Cohen, Seth M; Rousseau, Bernard; Noordzij, J Pieter; Garrett, C Gaelyn; Ossoff, Robert H

2010-06-01

Owing to their vasodilatory effects, the phosphodiesterase-5 inhibitors have become widely used for the treatment of erectile dysfunction. Among the reported adverse events of these agents are epistaxis, variceal bleeding, intracranial hemorrhage, and hemorrhoidal bleeding. We report a case of vocal fold hemorrhage that occurred after vardenafil use in a 31-year-old man who was a professional singer.

Thyrotoxicosis presenting as acute bulbar palsy.

PubMed

Mathew, Betsy; Devasia, Anup J; Ayyar, Vaggesh; Thyagaraj, Vijayasree; Francis, Geetha Ann

2011-06-01

Myopathy chiefly affecting the proximal muscles of the limbs is frequently seen in hyperthyroidism. But isolated acute bulbar palsy without skeletal muscle involvement is rare in thyrotoxicosis. We report the case of a 52 year old man who presented with severe dysphagia, dysphonia and bouts of aspiration. Laboratory testing revealed an underlying Graves' thyrotoxicosis. His symptoms recovered dramatically within 6 weeks with treatment of hyperthyroidism. This case is reported to emphasize that thyrotoxicosis should be considered in the differential diagnosis of dysphagia of obscure etiology.

Speech Intelligibility in Severe Adductor Spasmodic Dysphonia

ERIC Educational Resources Information Center

Bender, Brenda K.; Cannito, Michael P.; Murry, Thomas; Woodson, Gayle E.

2004-01-01

This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched…

Disfluency in Spasmodic Dysphonia: A Multivariate Analysis.

ERIC Educational Resources Information Center

Cannito, Michael P.; Burch, Annette Renee; Watts, Christopher; Rappold, Patrick W.; Hood, Stephen B.; Sherrard, Kyla

1997-01-01

This study examined visual analog scaling judgments of disfluency by normal listeners in response to oral reading by 20 adults with spasmodic dysphonia (SD) and nondysphonic controls. Findings suggest that although dysfluency is not a defining feature of SD, it does contribute significantly to the overall clinical impression of severity of the…

Articulatory Changes Following Treatment of Muscle Tension Dysphonia: Preliminary Acoustic Evidence

ERIC Educational Resources Information Center

Dromey, Christopher; Nissen, Shawn L.; Roy, Nelson; Merrill, Ray M.

2008-01-01

Purpose: Primary muscle tension dysphonia (MTD), a voice disturbance that occurs in the absence of structural or neurological pathology, may respond to manual circumlaryngeal techniques, which ostensibly alter the posture of the larynx and/or the configuration of the vocal folds without directly targeting supralaryngeal articulatory structures.…

Intensified Voice Therapy: A New Model for the Rehabilitation of Patients Suffering from Functional Dysphonias

ERIC Educational Resources Information Center

Fischer, Michael J.; Gutenbrunner, Christoph; Ptok, Martin

2009-01-01

The objective of this study was to evaluate a new intervention for chronic dysphonias, consisting of a 2-week outpatient treatment period using intensified voice therapy combined with elements of physical medicine, including physiotherapy (orthotherapy, detonisation and training of the trunk muscles, respiratory therapy and others), manual therapy…

Functional Dysphonia during Mental Imagery: Testing the Trait Theory of Voice Disorders

ERIC Educational Resources Information Center

van Mersbergen, Miriam; Patrick, Christopher; Glaze, Leslie

2008-01-01

Purpose: Previous research has proposed that persons with functional dysphonia (FD) present with temperamental traits that predispose them to their voice disorder. We investigated this theory in a controlled experiment and compared them with social anxiety (SA) and healthy control (HC) groups. Method: Twelve participants with FD, 19 participants…

Dysphonia Detected by Pattern Recognition of Spectral Composition.

ERIC Educational Resources Information Center

Leinonen, Lea; And Others

1992-01-01

This study analyzed production of a long vowel sound within Finnish words by normal or dysphonic voices, using the Self-Organizing Map, the artificial neural network algorithm of T. Kohonen which produces two-dimensional representations of speech. The method was found to be both sensitive and specific in the detection of dysphonia. (Author/JDD)

Aerodynamic Profiles of Women with Muscle Tension Dysphonia/Aphonia

ERIC Educational Resources Information Center

Gillespie, Amanda I.; Gartner-Schmidt, Jackie; Rubinstein, Elaine N.; Abbott, Katherine Verdolini

2013-01-01

Purpose: In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-P[subscript sub]) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine…

Acoustic Variations in Adductor Spasmodic Dysphonia as a Function of Speech Task.

ERIC Educational Resources Information Center

Sapienza, Christine M.; Walton, Suzanne; Murry, Thomas

1999-01-01

Acoustic phonatory events were identified in 14 women diagnosed with adductor spasmodic dysphonia (ADSD), a focal laryngeal dystonia that disturbs phonatory function, and compared with those of 14 age-matched women with no vocal dysfunction. Findings indicated ADSD subjects produced more aberrant acoustic events than controls during tasks of…

Theoretical Analyses of the Functional Regions of the Heavy Chain of Botulinum Neurotoxin

DTIC Science & Technology

1994-01-01

SE. Schulz GM. liallctt M. Effects of hb)tulinum toxin injections on speech in adductor spasmodic dysphonia . Neurology 1988,38:1220-1225. 3. Jankovic...hemifacial spasm. Mov Disord 1987:4:237-254. 5. Brin MF. Blitzer A, Fahn S, Gould W. Lovelace RE. Adductor laryngeal dystonia (spastic dysphonia ): treatment

Articulatory Changes in Muscle Tension Dysphonia: Evidence of Vowel Space Expansion Following Manual Circumlaryngeal Therapy

ERIC Educational Resources Information Center

Roy, Nelson; Nissen, Shawn L.; Dromey, Christopher; Sapir, Shimon

2009-01-01

In a preliminary study, we documented significant changes in formant transitions associated with successful manual circumlaryngeal treatment (MCT) of muscle tension dysphonia (MTD), suggesting improvement in speech articulation. The present study explores further the effects of MTD on vowel articulation by means of additional vowel acoustic…

Exploring Genetic and Environmental Effects in Dysphonia: A Twin Study

ERIC Educational Resources Information Center

Simberg, Susanna; Santtila, Pekka; Soveri, Anna; Varjonen, Markus; Sala, Eeva; Sandnabba, N. Kenneth

2009-01-01

Purpose: To explore the existence of genetic effects as well as the interaction between potential genetic effects and a voice-demanding occupation on dysphonia. Method: One thousand seven hundred and twenty-eight Finnish twins (555 male; 1,173 female) born between 1961 and 1989 completed a questionnaire concerning vocal symptoms and occupation.…

Effectiveness of voice therapy in functional dysphonia: where are we now?

PubMed

Bos-Clark, Marianne; Carding, Paul

2011-06-01

To review the recent literature since the 2009 Cochrane review regarding the effectiveness of voice therapy for patients with functional dysphonia. A range of articles report on the effects of voice therapy treatment for functional dysphonia, with a wide range of interventions described. Only one study is a randomized controlled trial. A number of excellent review articles have extended the knowledge base. In primary research, methodological issues persist: studies are small, and not adequately controlled. Studies show improved standards of outcome measurement and of description of the content of voice therapy. There is a continued need for larger, methodologically sound clinical effectiveness studies. Future studies need to be replicable and generalizable in order to inform and elucidate clinical practice.

Anaphylaxis induced by ingestion of a pollen compound.

PubMed

Chivato, T; Juan, F; Montoro, A; Laguna, R

1996-01-01

We report on the case of a 32-year-old atopic patient who showed a severe anaphylactic reaction due to the ingestion of a pollen compound prepared in an herbalist's. A few minutes after ingestion, generalized pruritus, difuse erythema, facial edema, cough, hoarseness and dysphonia appeared, and the emergency administration of subcutaneous epinephrine and intravenous methylprednisolone was necessary. Skin tests with a battery of inhalants and food allergens were performed. The patient only showed sensitization to Artemisia vulgaris, Taraxacum officinalis and Salix alba. Specific IgE levels were evaluated by FEIA-CAP giving a seric level of CAP class 3 to Artemisia vulgaris and class 2 to Taraxacum officinalis and Salix alba. Samples of the pollen compound were shown in the microscopical analysis to be 93% pollens and 6% fungi. In the qualitative study Taraxacum officinalis (15%), Artemisia vulgaris (5%) and Salix alba (15%) were the main elements identified. In summary, this case study describes a food-induced systemic reaction due to a pollen compound in an atopic patient with a history of allergic rhinitis. Pollinic patients must be informed on the risks that the consumption of these compounds might cause.

Unilateral Vocal Fold Paralysis: A Systematic Review of Speech-Language Pathology Management.

PubMed

Walton, Chloe; Conway, Erin; Blackshaw, Helen; Carding, Paul

2017-07-01

Dysphonia due to unilateral vocal fold paralysis (UVFP) can be characterized by hoarseness and weakness, resulting in a significant impact on patients' activity and participation. Voice therapy provided by a speech-language pathologist is designed to maximize vocal function and improve quality of life. The purpose of this paper is to systematically review literature surrounding the effectiveness of speech-language pathology intervention for the management of UVFP in adults. This is a systematic review. Electronic databases were searched using a range of key terms including dysphonia, vocal fold paralysis, and speech-language pathology. Eligible articles were extracted and reviewed by the authors for risk of bias, methodology, treatment efficacy, and clinical outcomes. Of the 3311 articles identified, 12 met the inclusion criteria: seven case series and five comparative studies. All 12 studies subjectively reported positive effects following the implementation of voice therapy for UVFP; however, the heterogeneity of participant characteristics, voice therapy, and voice outcome resulted in a low level of evidence. There is presently a lack of methodological rigor and clinical efficacy in the speech-language pathology management of dysphonia arising from UVFP in adults. Reasons for this reduced efficacy can be attributed to the following: (1) no standardized speech-language pathology intervention; (2) no consistency of assessment battery; (3) the variable etiology and clinical presentation of UVFP; and (4) inconsistent timing, frequency, and intensity of treatment. Further research is required to develop the evidence for the management of UVFP incorporating controlled treatment protocols and more rigorous clinical methodology. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Nonlinear dynamic-based analysis of severe dysphonia in patients with vocal fold scar and sulcus vocalis

PubMed Central

Choi, Seong Hee; Zhang, Yu; Jiang, Jack J.; Bless, Diane M.; Welham, Nathan V.

2011-01-01

Objective The primary goal of this study was to evaluate a nonlinear dynamic approach to the acoustic analysis of dysphonia associated with vocal fold scar and sulcus vocalis. Study Design Case-control study. Methods Acoustic voice samples from scar/sulcus patients and age/sex-matched controls were analyzed using correlation dimension (D2) and phase plots, time-domain based perturbation indices (jitter, shimmer, signal-to-noise ratio [SNR]), and an auditory-perceptual rating scheme. Signal typing was performed to identify samples with bifurcations and aperiodicity. Results Type 2 and 3 acoustic signals were highly represented in the scar/sulcus patient group. When data were analyzed irrespective of signal type, all perceptual and acoustic indices successfully distinguished scar/sulcus patients from controls. Removal of type 2 and 3 signals eliminated the previously identified differences between experimental groups for all acoustic indices except D2. The strongest perceptual-acoustic correlation in our dataset was observed for SNR; the weakest correlation was observed for D2. Conclusions These findings suggest that D2 is inferior to time-domain based perturbation measures for the analysis of dysphonia associated with scar/sulcus; however, time-domain based algorithms are inherently susceptible to inflation under highly aperiodic (i.e., type 2 and 3) signal conditions. Auditory-perceptual analysis, unhindered by signal aperiodicity, is therefore a robust strategy for distinguishing scar/sulcus patient voices from normal voices. Future acoustic analysis research in this area should consider alternative (e.g., frequency- and quefrency-domain based) measures alongside additional nonlinear approaches. PMID:22516315

Risk and protective factors for spasmodic dysphonia: a case-control investigation.

PubMed

Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Kimber, Kamille; Sauder, Cara; Houtz, Daniel R; Doman, Darrin; Smith, Marshall E

2011-01-01

Spasmodic dysphonia (SD) is a chronic, incurable, and often disabling voice disorder of unknown pathogenesis. The purpose of this study was to identify possible endogenous and exogenous risk and protective factors uniquely associated with SD. Prospective, exploratory, case-control investigation. One hundred fifty patients with SD and 150 medical controls (MCs) were interviewed regarding their personal and family histories, environmental exposures, illnesses, injuries, voice use patterns, and general health using a previously vetted and validated epidemiologic questionnaire. Odds ratios and multiple logistic regression analyses (α<0.15) identified several factors that significantly increased the likelihood of having SD. These factors included (1) a personal history of mumps, blepharospasm, tremor, intense occupational and avocational voice use, and a family history of voice disorders; (2) an immediate family history of meningitis, tremor, tics, cancer, and compulsive behaviors; and (3) an extended family history of tremor and cancer. SD is likely multifactorial in etiology, involving both genetic and environmental factors. Viral infections/exposures, along with intense voice use, may trigger the onset of SD in genetically predisposed individuals. Future studies should examine the interaction among genetic and environmental factors to determine the pathogenesis of SD. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Dysphonia in adults with developmental stuttering: A descriptive study.

PubMed

Botha, Anél; Ras, Elizbé; Abdoola, Shabnam; Van der Linde, Jeannie

2017-06-26

Persons with stuttering (PWS) often present with other co-occurring conditions. The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) proposes that it is important to understand the full burden of a health condition. A few studies have explored voice problems among PWS, and the characteristics of voices of PWS are relatively unknown. The importance of conducting future research has been emphasised. This study aimed to describe the vocal characteristics of PWS. Acoustic and perceptual data were collected during a comprehensive voice assessment. The severity of stuttering was also determined. Correlations between the stuttering severity instrument (SSI) and the acoustic measurements were evaluated to determine the significance. Twenty participants were tested for this study. Only two participants (10%) obtained a positive Dysphonia Severity Index (DSI) score of 1.6 or higher, indicating that no dysphonia was present, while 90% of participants (n = 18) scored lower than 1.6, indicating that those participants presented with dysphonia. Some participants presented with weakness (asthenia) of voice (35%), while 65% presented with a slightly strained voice quality. Moderately positive correlations between breathiness and SSI (r = 0.40, p = 0.08) have been reported. In addition, participants with high SSI scores also scored a poor DSI of below 1.6, as observed by a moderate positive correlation between SSI and DSI (r = 0.41). The majority of PWS presented with dysphonia, evident in the perceptual or acoustic parameters of their voices. These results can be used for further investigation to create awareness and to establish intervention strategies for voice disorders among PWS.

Is the sagittal postural alignment different in normal and dysphonic adult speakers?

PubMed

Franco, Débora; Martins, Fernando; Andrea, Mário; Fragoso, Isabel; Carrão, Luís; Teles, Júlia

2014-07-01

Clinical research in the field of voice disorders, in particular functional dysphonia, has suggested abnormal laryngeal posture due to muscle adaptive changes, although specific evidence regarding body posture has been lacking. The aim of our study was to verify if there were significant differences in sagittal spine alignment between normal (41 subjects) and dysphonic speakers (33 subjects). Cross-sectional study. Seventy-four adults, 35 males and 39 females, were submitted to sagittal plane photographs so that spine alignment could be analyzed through the Digimizer-MedCalc Software Ltd program. Perceptual and acoustic evaluation and nasoendoscopy were used for dysphonic judgments: normal and dysphonic speakers. For thoracic length curvature (TL) and for the kyphosis index (KI), a significant effect of dysphonia was observed with mean TL and KI significantly higher for the dysphonic speakers than for the normal speakers. Concerning the TL variable, a significant effect of sex was found, in which the mean of the TL was higher for males than females. The interaction between dysphonia and sex did not have a significant effect on TL and KI variables. For the lumbar length curvature variable, a significant main effect of sex was demonstrated; there was no significant main effect of dysphonia or significant sex×dysphonia interaction. Findings indicated significant differences in some sagittal spine posture measures between normal and dysphonic speakers. Postural measures can add useful information to voice assessment protocols and should be taken into account when considering particular treatment strategies. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

The Consequences of Spasmodic Dysphonia on Communication-Related Quality of Life: A Qualitative Study of the Insider's Experiences

ERIC Educational Resources Information Center

Baylor, C.R.; Yorkston, K.M.; Eadie, T.L.

2005-01-01

The purpose of this study was to explore the biopsychosocial consequences of spasmodic dysphonia (SD) as experienced by people with SD. Qualitative research methods were used to investigate the insider's perspective of living with SD. Six adults with SD participated in face-to-face phenomenological interviews. The results are summarized in a model…

[Signs and symptoms of autonomic dysfunction in dysphonic individuals].

PubMed

Park, Kelly; Behlau, Mara

2011-01-01

To verify the occurrence of signs and symptoms of autonomic nervous system dysfunction in individuals with behavioral dysphonia, and to compare it with the results obtained by individuals without vocal complaints. Participants were 128 adult individuals with ages between 14 and 74 years, divided into two groups: behavioral dysphonia (61 subjects) and without vocal complaints (67 subjects). It was administered the Protocol of Autonomic Dysfunction, containing 46 questions: 22 related to the autonomic nervous system and had no direct relationship with voice, 16 related to both autonomic nervous system and voice, six non-relevant questions, and two reliability questions. There was a higher occurrence of reported neurovegetative signs in the group with behavioral dysphonia, in questions related to voice, such as frequent throat clearing, frequent swallowing need, fatigability when speaking, and sore throat. In questions not directly related to voice, dysphonic individuals presented greater occurrence of three out of 22 symptoms: gas, tinnitus and aerophagia. Both groups presented similar results in questions non-relevant to the autonomic nervous system. Reliability questions needed reformulation. Individuals with behavioral dysphonia present higher occurrence of neurovegetative signs and symptoms, particularly those with direct relationship with voice, indicating greater lability of the autonomic nervous system in these subjects.

Spasmodic dysphonia: let's look at that again.

PubMed

Murry, Thomas

2014-11-01

G. Paul Moore influenced the study of spasmodic dysphonia (SD) with his 1960 publication that examined the neurological, medical, and vocal fold behavior in a group of patients with adductor spasmodic dysphonia (ADSD). This review of advances in the diagnosis and treatment of SD follows a time line of research that can be traced in part to the early work of Moore et al. This article reviews the research in ADSD over the past 50 plus years. The capstone events that brought SD to its present day level of management by laryngologists and speech-language pathologists are highlighted. A look to the future to understand more of the disorder is offered for this debilitating disorder. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Alterations in CNS Activity Induced by Botulinum Toxin Treatment in Spasmodic Dysphonia: An H[subscript 2][superscript 15]O PET Study

ERIC Educational Resources Information Center

Ali, S. Omar; Thomassen, Michael; Schulz, Geralyn M.; Hosey, Lara A.; Varga, Mary; Ludlow, Christy L.; Braun, Allen R.

2006-01-01

Speech-related changes in regional cerebral blood flow (rCBF) were measured using H[subscript 2][superscript 15]O positron-emission tomography in 9 adults with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (BTX) injection and 10 age- and gender-matched volunteers without neurological disorders. Scans were acquired at rest…

Assessing the effectiveness of botulinum toxin injections for adductor spasmodic dysphonia: clinician and patient perception.

PubMed

Braden, Maia N; Johns, Michael M; Klein, Adam M; Delgaudio, John M; Gilman, Marina; Hapner, Edie R

2010-03-01

To determine the effectiveness of Botox treatment for adductor spasmodic dysphonia (ADSD), the clinician and patient judge changes in voice symptoms and the effect on quality of life. Currently, there is no standard protocol for determining the effectiveness of Botox injections in treating ADSD. Therefore, clinicians use a variety of perceptual scales and patient-based self-assessments to determine patients' impressions of severity and changes after treatments. The purpose of this study was to assess clinician-patient agreement of the effects of Botox on voice quality and quality of life in ADSD. Retrospective chart review of 199 randomly selected patients since 2004. Results indicated a weak correlation between the patient's assessment of voice impairment (EIS) and patient's quality of life impairment (Voice-Related Quality of Life [V-RQOL]) in the mild-moderate dysphonia severity group and the moderate-to-severe dysphonia group. There was a weak correlation between the patient's assessment of voice impairment EIS and the clinician's perceptual judgment of voice impairment (Consensus Auditory Perceptual Evaluation of Voice [CAPE-V]) only in the moderate to severe dysphonia group. There was a weak correlation between the patient's quality of life impairment (V-RQOL) and the clinician's perceptual judgment of voice impairment (CAPE-V) only in the severe to profound dysphonia group. The poor relationship among commonly used outcome measures leads us to question how best to assess the effectiveness of Botox in ADSD. Clinicians are required to document treatment outcomes, making it important to use scales that are valid, reliable, and sensitive to change. Future research directions include examining relationships between measures both before and after Botox injections, examining the specific factors that determine quality of life changes, and further research on specific parameters of the CAPE-V as well as comparing perceptual and quality of life scales with acoustic and aerodynamic measures in this population would be beneficial in the move toward more effective ways of measuring change. Copyright (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Interarytenoid muscle botox injection for treatment of adductor spasmodic dysphonia with vocal tremor.

PubMed

Kendall, Katherine A; Leonard, Rebecca J

2011-01-01

Up to one-third of patients presenting with adductor spasmodic dysphonia will have an associated vocal tremor. These patients may not respond fully to treatment using thyroarytenoid (TA) muscle botulinum toxin (Botox) injection. Treatment failures are attributed to the involvement of multiple muscle groups in the tremor. This study evaluates the results of combined interarytenoid (IA) and TA muscle Botox injection in a group of 27 patients with adductor spasmodic dysphonia and vocal tremor and in four patients with severe vocal tremor alone. Patient-satisfaction data were reviewed retrospectively. Pre- and postinjection acoustic data were collected prospectively. Acoustic measures of fundamental frequency and cycle-by-cycle variability in frequency (jitter) and intensity (shimmer) were obtained from 15 patients' sustained vowel productions. Measures were collected after TA muscle injection, alone, and after combined TA and IA (TA+IA) muscle injections. In addition, two experienced voice clinicians blindly assessed tremor severity from recordings made for each patient in the two conditions. Patients were also queried regarding their satisfaction with the results of the injections and whether they desired to continue receiving TA+IA treatment. Significant improvement in all acoustic measures except for % jitter was observed after the TA+IA muscle injections. Listeners identified voice samples after TA+IA muscle injections as demonstrating less tremor in 73% of the paired comparisons. Sixty-seven percent of the patients with spasmodic dysphonia and vocal tremor wished to continue to receive IA muscle injections. Only one patient with severe vocal tremor wished to continue with injections. The addition of an IA muscle Botox injection to the treatment of patients with a combination adductor spasmodic dysphonia and vocal tremor may improve voice outcomes. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Gender differences in onabotulinum toxin A dosing for adductor spasmodic dysphonia.

PubMed

Lerner, Michael Z; Lerner, Benjamin A; Patel, Amit A; Blitzer, Andrew

2017-05-01

The objective of this study was to determine the influence of gender on onabotulinum toxin A dosing for the treatment of adductor spasmodic dysphonia symptoms. Retrospective review. A chart review of the senior author's database of botulinum toxin injections was performed. Patients diagnosed with adductor spasmodic dysphonia who received onabotulinum toxin A (BoNTA) injections to the thyroarytenoid muscle for at least 5 years were included for study. Patients who received alternate formulations of botulinum toxin (Myobloc, Dysport, or Xeomin) and patients with alternate diagnoses, such as abductor spasmodic dysphonia, tremor, and oromandibular dystonia, were excluded. The average BoNTA dose was calculated for each patient and statistical analysis was performed comparing the male and female groups. A total of 201 patients (52 males and 149 females) met inclusion criteria. The average follow-up times for the male and female groups were 10.2 ± 3.6 and 11.1 ± 4 years, respectively. The average BoNTA doses for the male and female groups were 0.6 ± 0.42 U and 1.3 ± 1.1 U, respectively. Statistical analysis was performed using an independent samples two-tailed t test yielding a P value of .0000000002. A large effect size was noted with Cohen's d = 0.85. The data from this retrospective chart review reveal a statistically and clinically significant correlation between female gender and higher average BoNTA dose for symptom control in adductor spasmodic dysphonia. Explanations for this observation are speculative and include a possible inverse relationship between optimal BoNTA dose and vocal fold mass and possibly greater neutralizing antibody formation among female patients. 4. Laryngoscope, 127:1131-1134, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

A case of bilateral vocal fold mucosal bridges, bilateral trans-vocal fold type III sulci vocales, and an intracordal polyp.

PubMed

Tan, Melin; Pitman, Michael J

2011-07-01

We present a patient with a novel finding of bilateral mucosal bridges, bilateral type III trans-vocal fold sulci vocales, and a vocal fold polyp. Although sulci and mucosal bridges occur in the vocal folds, it is rare to find multiples of these lesions in a single patient, and it is even more uncommon when they occur in conjunction with a vocal fold polyp. To our knowledge, this is the first description of a vocal fold polyp in combination with multiple vocal fold bridges and multiple type III sulci vocales in a single patient. To describe and visually present the diagnosis and treatment of a patient with an intracordal polyp, bilateral mucosal bridges, as well as bilateral type III trans-vocal fold sulci vocales. Presentation of a set of high definition intraoperative photos displaying the extent of the vocal fold lesions and the resection of the intracordal polyp. This patient presented with only 6 months of significant dysphonia. It was felt that the recent change in voice was because of the polyp and not the bridges or sulci vocales. Considering the patient's presentation and the possible morbidity of resection of mucosal bridges and sulci, only the polyp was excised. Postoperatively, the patient's voice returned to his acceptable mild baseline dysphonia, and the benefit has persisted 6 months postoperatively. The combination of bilateral mucosal bridges, bilateral type III sulcus vocalis, and an intracordal polyp in one patient is rare if not novel. Treatment of the polyp alone returned the patient's voice to his lifelong baseline of mild dysphonia. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Botulinum Toxin Dosing Trends in Spasmodic Dysphonia Over a 20-year Period.

PubMed

Namin, Arya W; Christopher, Kara M; Eisenbeis, John F

2017-01-01

The study aims to (1) identify the botulinum toxin (BTX) dosing trend in a cohort of patients who received at least 20 injections for the treatment of adductor spasmodic dysphonia (ADSD), (2) describe two distinct BTX dosing trends in treating ADSD (a "classic" dosing trend that initially decreases before stabilizing, and a "fluctuating" dosing trend), and (3) determine if patients with the "classic" dosing trend differed in age or in dosing intervals from those with the "fluctuating" dosing trend. This is a retrospective case series. Of 149 patients who received a total of 2484 BTX injections for the treatment of spasmodic dysphonia in 1993-2013, 49 patients received at least 20 injections. The BTX dose and the interval between doses were recorded. The mean dose of injections 1-20 was determined. The age at initial injection, initial dose, and interval in days between treatments were compared for the "fluctuating" and "classic" groups. The cohort exhibits a significant decrease in dose during the first 10-15 injections. The "fluctuating" group had a significantly shorter interval between injections (mean interval = 97.09 days, SD = 29.41; mean interval = 136.90 days, SD = 43.76, P = 0.002). The mean age at initial dose was not significantly different between the "classic" and "fluctuating" groups. The average BTX dose of patients with ADSD who receive long-term injections significantly decreases during the initial 10-15 injections before stabilizing. Patients who exhibit the "fluctuating" dosing pattern have a significantly shorter interval between injections than those with the "classic" dosing pattern. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The Impact of a Teaching or Singing Career on the Female Vocal Quality at the Mean Age of 67 Years: A Pilot Study.

PubMed

D'haeseleer, Evelien; Claeys, Sofie; Bettens, Kim; Leemans, Laura; Van Calster, Ann-Sophie; Van Damme, Nina; Thijs, Zoë; Daelman, Julie; Leyns, Clara; Van Lierde, Kristiane

2017-07-01

The purpose of this study was to measure the objective and subjective vocal quality in women aged between 60 and 75 years. Secondly, the impact of a teaching or singing career on the vocal quality was investigated by comparing the vocal quality of retired women with different careers. This is a case-control study. Seventy-three retired women between 60 and 75 years (mean age: 67 years, standard deviation: 4.49) participated in the study and were divided into three groups: women with a teaching career (n = 21), choir singers with a singing career (n = 12), and women with a non-vocal career (n = 40). All subjects underwent the same assessment protocol consisting of objective (aerodynamic, maximum performance, vocal range, acoustic measurements, and the Dysphonia Severity Index) and subjective (the Voice Handicap Index, auditory-perceptual evaluations by three listeners) voice measurements. In all three groups, objective and perceptual voice analysis showed a mild dysphonia. No differences in the Dysphonia Severity Index were found between the three groups. The voices of choir singers with a singing career were perceived significantly less rough than voices of the women with a non-vocal career. Additionally, the lowest frequency of the frequency range was significantly lower in the retired teachers and choir singers than in the controls. The results of this study prudently suggest that a singing or a teaching career compared with a non-vocal career has a positive impact on the vocal frequency range, and that singing has a positive impact on the perceptual vocal quality of the older female voice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Correlation of otologic complaints in soldiers with speech disorders after traumatic brain injury.

PubMed

Dion, Gregory R; Miller, Courtney L; O'Connor, Peter D; Howard, N Scott

2014-01-01

To determine the prevalence of otologic complaints in subjects with dysphonia and traumatic brain injury (TBI) in a sample population of the US Army. Cross-sectional study. A total of 292 subjects were identified with a new diagnosis of voice disorder during a 3.5-year period at three large military medical centers. Of them, 70 subjects were also identified with TBI and had no history of dysphonia before this time period. In those with voice disorders and TBI, documentation of hearing complaints, hearing loss, tinnitus, or vertigo was recorded. Time to visit an otolaryngologist and audiologist were also recorded. A total of 70 soldiers were identified with a diagnosis of a voice disorder and TBI. Of these soldiers, 83% had at least one otologic complaint and 50% had more than one. Approximately 60%, 39%, and 44% of the subjects reported tinnitus, hearing loss, or vertigo, respectively. A total of 62% of the subjects with otologic complaints, TBI, and dysphonia were seen by an otolaryngologist. Time until an otolaryngologist evaluated these soldiers varied widely, with an average of 17 months and standard deviation of 12.5 months. Otologic manifestations are common in soldiers with dysphonia and TBI. Careful consideration of communication impairment from otologic dysfunction in those with speech disorders after TBI is warranted. Published by Mosby, Inc.

Abnormal activation of the primary somatosensory cortex in spasmodic dysphonia: an fMRI study.

PubMed

Simonyan, Kristina; Ludlow, Christy L

2010-11-01

Spasmodic dysphonia (SD) is a task-specific focal dystonia of unknown pathophysiology, characterized by involuntary spasms in the laryngeal muscles during speaking. Our aim was to identify symptom-specific functional brain activation abnormalities in adductor spasmodic dysphonia (ADSD) and abductor spasmodic dysphonia (ABSD). Both SD groups showed increased activation extent in the primary sensorimotor cortex, insula, and superior temporal gyrus during symptomatic and asymptomatic tasks and decreased activation extent in the basal ganglia, thalamus, and cerebellum during asymptomatic tasks. Increased activation intensity in SD patients was found only in the primary somatosensory cortex during symptomatic voice production, which showed a tendency for correlation with ADSD symptoms. Both SD groups had lower correlation of activation intensities between the primary motor and sensory cortices and additional correlations between the basal ganglia, thalamus, and cerebellum during symptomatic and asymptomatic tasks. Compared with ADSD patients, ABSD patients had larger activation extent in the primary sensorimotor cortex and ventral thalamus during symptomatic task and in the inferior temporal cortex and cerebellum during symptomatic and asymptomatic voice production. The primary somatosensory cortex shows consistent abnormalities in activation extent, intensity, correlation with other brain regions, and symptom severity in SD patients and, therefore, may be involved in the pathophysiology of SD.

Acoustic correlate of vocal effort in spasmodic dysphonia.

PubMed

Eadie, Tanya L; Stepp, Cara E

2013-03-01

This study characterized the relationship between relative fundamental frequency (RFF) and listeners' perceptions of vocal effort and overall spasmodic dysphonia severity in the voices of 19 individuals with adductor spasmodic dysphonia. Twenty inexperienced listeners evaluated the vocal effort and overall severity of voices using visual analog scales. The squared correlation coefficients (R2) between average vocal effort and overall severity and RFF measures were calculated as a function of the number of acoustic instances used for the RFF estimate (from 1 to 9, of a total of 9 voiced-voiceless-voiced instances). Increases in the number of acoustic instances used for the RFF average led to increases in the variance predicted by the RFF at the first cycle of voicing onset (onset RFF) in the perceptual measures; the use of 6 or more instances resulted in a stable estimate. The variance predicted by the onset RFF for vocal effort (R2 range, 0.06 to 0.43) was higher than that for overall severity (R2 range, 0.06 to 0.35). The offset RFF was not related to the perceptual measures, irrespective of the sample size. This study indicates that onset RFF measures are related to perceived vocal effort in patients with adductor spasmodic dysphonia. These results have implications for measuring outcomes in this population.

Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin.

PubMed

Dejonckere, P H; Neumann, K J; Moerman, M B J; Martens, J P; Giordano, A; Manfredi, C

2012-04-01

Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.

Voice Onset Time for the Word-Initial Voiceless Consonant /t/ in Japanese Spasmodic Dysphonia-A Comparison With Normal Controls.

PubMed

Yanagida, Saori; Nishizawa, Noriko; Mizoguchi, Kenji; Hatakeyama, Hiromitsu; Fukuda, Satoshi

2015-07-01

Voice onset time (VOT) for word-initial voiceless consonants in adductor spasmodic dysphonia (ADSD) and abductor spasmodic dysphonia (ABSD) patients were measured to determine (1) which acoustic measures differed from the controls and (2) whether acoustic measures were related to the pause or silence between the test word and the preceding word. Forty-eight patients with ADSD and nine patients with ABSD, as well as 20 matched normal controls read a story in which the word "taiyo" (the sun) was repeated three times, each differentiated by the position of the word in the sentence. The target of measurement was the VOT for the word-initial voiceless consonant /t/. When the target syllable appeared in a sentence following a comma, or at the beginning of a sentence following a period, the ABSD patients' VOTs were significantly longer than those of the ADSD patients and controls. Abnormal prolongation of the VOTs was related to the pause or silence between the test word and the preceding word. VOTs in spasmodic dysphonia (SD) may vary according to the SD subtype or speaking conditions. VOT measurement was suggested to be a useful method for quantifying voice symptoms in SD. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Abnormal Activation of the Primary Somatosensory Cortex in Spasmodic Dysphonia: An fMRI Study

PubMed Central

Ludlow, Christy L.

2010-01-01

Spasmodic dysphonia (SD) is a task-specific focal dystonia of unknown pathophysiology, characterized by involuntary spasms in the laryngeal muscles during speaking. Our aim was to identify symptom-specific functional brain activation abnormalities in adductor spasmodic dysphonia (ADSD) and abductor spasmodic dysphonia (ABSD). Both SD groups showed increased activation extent in the primary sensorimotor cortex, insula, and superior temporal gyrus during symptomatic and asymptomatic tasks and decreased activation extent in the basal ganglia, thalamus, and cerebellum during asymptomatic tasks. Increased activation intensity in SD patients was found only in the primary somatosensory cortex during symptomatic voice production, which showed a tendency for correlation with ADSD symptoms. Both SD groups had lower correlation of activation intensities between the primary motor and sensory cortices and additional correlations between the basal ganglia, thalamus, and cerebellum during symptomatic and asymptomatic tasks. Compared with ADSD patients, ABSD patients had larger activation extent in the primary sensorimotor cortex and ventral thalamus during symptomatic task and in the inferior temporal cortex and cerebellum during symptomatic and asymptomatic voice production. The primary somatosensory cortex shows consistent abnormalities in activation extent, intensity, correlation with other brain regions, and symptom severity in SD patients and, therefore, may be involved in the pathophysiology of SD. PMID:20194686

Relationships between CSID and vocal fold vibratory function

NASA Astrophysics Data System (ADS)

Cooke, Melissa L.

High correlations have been reported between the acoustic-based Cepstral/Spectral Index of Dysphonia (CSID) and perceptual judgments of dysphonia. This study explores whether CSID provides additional insight and explains more of the variance in HSV-based properties of vocal fold vibratory function than has been reported for other acoustic measures. Using the Analysis of Dysphonia in Speech and Voice (ADSV) program, CSID and its component variables were correlated with HSV-based measures of glottal cycle aperiodicity and glottal area for 20 subjects who underwent phonomicrosurgery. Results indicate CSID is only marginally correlated with glottal cycle aperiodicity in pre- and post-surgical conditions and does not correlate as highly as the cepstral peak prominence alone. Additionally, results reveal higher correlations when examining within-subject change from pre-surgical to post-surgical assessments rather than correlating measures across subjects. Future directions are discussed that aim at improving our understanding of the relationships between acoustic parameters and underlying phonatory function.

Voice related quality of life in pediatric patients with a history of prematurity.

PubMed

Walz, Patrick C; Hubbell, Michael P; Elmaraghy, Charles A

2014-07-01

To determine incidence of dysphonia in patients with history of prematurity and evaluate the correlation between dysphonia and risk factors unique to premature infants. The aim of this study is to determine parent-perceived vocal quality in patients with history of prematurity and whether duration of intubation, number of intubations, and incidence of patent ductus arteriosus repair were correlated with these perceptions. Cohort study of premature patients presenting to outpatient clinics from January 2010 to January 2013 in tertiary care center. Patients gestational age ≤37 weeks at birth without history of tracheostomy or known vocal fold pathology were eligible. A volunteer sample was obtained from patients presenting in Otolaryngology clinics from January 2010 to January 2013 whose parents agreed to complete surveys. Outcomes were assessed via parental completion of pediatric voice outcomes score (pVOS) and pediatric voice-related quality of life (pVRQOL) instruments. The primary outcome assessed was the incidence of dysphonia in infants with a history of prematurity without known vocal pathology. Additionally, patient factors associated with dysphonia were evaluated. The hypothesis tested was formulated prior to data collection. Sixty-nine participants were included. Mean age at follow-up was 28 (3-197) months. Mean gestational age was 29 (23-37) weeks. Mean intubation duration was 3 (0-22) weeks and median number of intubations was 1 (range 0-5). Voice outcome scores varied widely with pVRQOL scores demonstrating a mean of 89.2±18.1 (25-100) and pVOS with a mean of 11.4±2.2 (0-13). Univariate analysis utilized Spearman correlation coefficients for continuous variables and Wilcoxon Two-sample test for categorical groups. Significance was set at p<0.05. All significant univariate associations were placed in a multivariate model. Duration of intubation ≥4 weeks was the only factor which correlated with dysphonia on multivariate analysis (p=0.0028, OR=6.4, 95% CI=1.9-21.6). The data suggest that prolonged intubation is associated with poorer long term parent-perceived voice quality in premature patients. Further study is required to correlate parent perceptions with objective vocal quality data and physical findings of vocal pathology. These data may increase the clinician's suspicion for and evaluation of dysphonia in this population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Articulatory changes in muscle tension dysphonia: evidence of vowel space expansion following manual circumlaryngeal therapy.

PubMed

Roy, Nelson; Nissen, Shawn L; Dromey, Christopher; Sapir, Shimon

2009-01-01

In a preliminary study, we documented significant changes in formant transitions associated with successful manual circumlaryngeal treatment (MCT) of muscle tension dysphonia (MTD), suggesting improvement in speech articulation. The present study explores further the effects of MTD on vowel articulation by means of additional vowel acoustic measures. Pre- and post-treatment audio recordings of 111 women with MTD were analyzed acoustically using two measures: vowel space area (VSA) and vowel articulation index (VAI), constructed using the first (F1) and second (F2) formants of 4 point vowels/ a, i, ae, u/, extracted from eight words within a standard reading passage. Pairwise t-tests revealed significant increases in both VSA and VAI, confirming that successful treatment of MTD is associated with vowel space expansion. Although MTD is considered a voice disorder, its treatment with MCT appears to positively affect vocal tract dynamics. While the precise mechanism underlying vowel space expansion remains unknown, improvements may be related to lowering of the larynx, expanding oropharyngeal space, and improving articulatory movements. The reader will be able to: (1) describe possible articulatory changes associated with successful treatment of muscle tension dysphonia; (2) describe two acoustic methods to assess vowel centralization and decentralization, and; (3) understand the basis for viewing muscle tension dysphonia as a disorder not solely confined to the larynx.

Dysphonia risk screening protocol

PubMed Central

Nemr, Katia; Simões-Zenari, Marcia; da Trindade Duarte, João Marcos; Lobrigate, Karen Elena; Bagatini, Flavia Alves

2016-01-01

OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors). CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics. PMID:27074171

Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia?

PubMed

Reetz, Stephanie; Bohlender, Joerg E; Brockmann-Bauser, Meike

2018-01-29

The validity and sensitivity to change of instrumental acoustic measurements in patients with functional dysphonia have been controversially discussed. This work examines combined voice therapy effects on standard acoustic measurements, and if these agree with perceptual and subjective voice outcomes. Retrospective study. Thirty-nine patients (26 women, 13 men) aged 20-70 years (mean: 46.3, standard deviation 12.8) with functional dysphonia were investigated before and after combined voice therapy. Instrumental parameters included mean and range of speaking fundamental frequency (f o ) and intensity (SPL (dBA)); maximum SPL and mean f o of calling voice; minimum, maximum, range of singing voice f o and SPL, jitter (%), and the Dysphonia Severity Index. Voice Handicap Index-9 international was used for subjective and Grading-Roughness-Breathiness-Asthenia-Strain scale for perceptual assessment. Differences were investigated by Wilcoxon signed ranks test and coherences by Spearman rank correlation coefficient. After treatment, the speaking voice f o range (7-8.13 semitones) and SPL range (12.9-14.85 dB(A)) were significantly larger (P < 0.05). Both parameters were highly correlated (P < 0.001). Subjective symptoms were significantly reduced from a mean Voice Handicap Index-9 international of 15.6-8.6, and all perceptual Grading-Roughness-Breathiness-Asthenia-Strain scale parameters were significantly improved (G: 1.05-0.51) after therapy (P < 0.05). These findings were not associated with any acoustic parameter (P > 0.05). Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger f o and SPL speaking voice range after treatment indicate an altered voice technique. These instrumental measures may be clinical indicators of therapy success and transfer effects. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Factors Associated With Patient-perceived Hoarseness in Spasmodic Dysphonia Patients.

PubMed

Hu, Amanda; Hillel, Al; Meyer, Tanya

2016-11-01

The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines on Hoarseness distinguishes between hoarseness, which is a symptom perceived by the patient, and dysphonia, which is a diagnosis made by the clinician. Our objective was to determine factors that are associated with patient-perceived hoarseness in spasmodic dysphonia (SD) patients. Retrospective study. Adductor SD patients who presented for botulinum toxin injections from September 2011 to June 2012 were recruited. The main outcome variable, Voice Handicap Index-10 (VHI-10), was used to quantify patient-perceived hoarseness. Clinical data, Hospital Anxiety and Depression Scale (HADS), and VHI-10 were collected. Clinician-perceived dysphonia was measured by a speech-language pathologist with Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). Statistical analysis included univariate analyses and multiple linear regression. One hundred thirty-nine SD patients had VHI-10 score of 26.0 ± 7.2 (mean ± standard deviation), disease duration of 10.5 + 7.0 years, CAPE-V overall score of 43.2 ± 21.8, HADS anxiety score of 6.7 ± 3.8, and HADS depression score of 3.6 ± 2.8. In univariate analyses, there were positive correlations (P < 0.05) between VHI-10 and female gender, CAPE-V overall, older age, HADS anxiety, and depression. There was no correlation with professional voice use and disease duration. In multiple linear regression (R 2  = 0.178, P < 0.001), age, HADS anxiety, female gender, and CAPE-V were significant. Older age, higher anxiety levels, female gender, and clinician-perceived dysphonia are associated with higher levels of patient-perceived hoarseness in SD patients. Hoarseness is a very personal symptom. Multiple factors determine its self-perception. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Analysis of laryngeal amyloidosis using high speed digital phonoscopy and acoustics (Conference Presentation)

NASA Astrophysics Data System (ADS)

Blanco, Matthew; Cruz, Raul M.; Izdebski, Krzysztof; Yan, Yuling

2017-02-01

Amyloidosis is an unknown pathogenic process in which abnormally folded proteins are deposited in the extracellular space as macroscopic aggregates. Laryngeal deposits of these proteins are extremely rare, but primarily cause dysphonia in patients. High Speed Digital Phonoscopy (HSDP) was used to capture the kinematics of vocal folds in a patient with laryngeal amyloidosis. Acoustic data was also recorded and both HSDP and acoustics were processed using custom Vocalizer® software to help elucidate the physiological impact of amyloids in the larynx, especially in regards to effects on the voice.

Management of Posterior Glottic Stenosis using the Combined Glottic Reconstruction Procedure.

PubMed

Nouraei, S A R; Dorman, E B; Vokes, D E

2018-05-29

Laryngotracheal stenosis secondary to Bilateral Vocal Fold Mobility Impairment (BVFMI) is a challenging condition to treat. The glottic aperture accounts for 25% of the respiratory resistance 1 and BVFMI prevents its breath-by-breath regulation, causing severe airway compromise. Moreover, since the larynx is also the organ of phonation and its reflexive closure during swallowing is the principal airway protective mechanism, improving airway may worsen dysphonia, dysphagia, and aspiration. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Back-and-Forth Methodology for Objective Voice Quality Assessment: From/to Expert Knowledge to/from Automatic Classification of Dysphonia

NASA Astrophysics Data System (ADS)

Fredouille, Corinne; Pouchoulin, Gilles; Ghio, Alain; Revis, Joana; Bonastre, Jean-François; Giovanni, Antoine

2009-12-01

This paper addresses voice disorder assessment. It proposes an original back-and-forth methodology involving an automatic classification system as well as knowledge of the human experts (machine learning experts, phoneticians, and pathologists). The goal of this methodology is to bring a better understanding of acoustic phenomena related to dysphonia. The automatic system was validated on a dysphonic corpus (80 female voices), rated according to the GRBAS perceptual scale by an expert jury. Firstly, focused on the frequency domain, the classification system showed the interest of 0-3000 Hz frequency band for the classification task based on the GRBAS scale. Later, an automatic phonemic analysis underlined the significance of consonants and more surprisingly of unvoiced consonants for the same classification task. Submitted to the human experts, these observations led to a manual analysis of unvoiced plosives, which highlighted a lengthening of VOT according to the dysphonia severity validated by a preliminary statistical analysis.

Treatment for spasmodic dysphonia: limitations of current approaches

PubMed Central

Ludlow, Christy L.

2009-01-01

Purpose of review Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years. Recent findings When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. However, recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection. Summary Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms. PMID:19337127

Medications and Adverse Voice Effects.

PubMed

Nemr, Kátia; Di Carlos Silva, Ariana; Rodrigues, Danilo de Albuquerque; Zenari, Marcia Simões

2017-08-16

To identify the medications used by patients with dysphonia, describe the voice symptoms reported on initial speech-language pathology (SLP) examination, evaluate the possible direct and indirect effects of medications on voice production, and determine the association between direct and indirect adverse voice effects and self-reported voice symptoms, hydration and smoking habits, comorbidities, vocal assessment, and type and degree of dysphonia. This is a retrospective cross-sectional study. Fifty-five patients were evaluated and the vocal signs and symptoms indicated in the Dysphonia Risk Protocol were considered, as well as data on hydration, smoking and medication use. We analyzed the associations between type of side effect and self-reported vocal signs/symptoms, hydration, smoking, comorbidities, type of dysphonia, and auditory-perceptual and acoustic parameters. Sixty percent were women, the mean age was 51.8 years, 29 symptoms were reported on the screening, and 73 active ingredients were identified with 8.2% directly and 91.8% indirectly affecting vocal function. There were associations between the use of drugs with direct adverse voice effects, self-reported symptoms, general degree of vocal deviation, and pitch deviation. The symptoms of dry throat and shortness of breath were associated with the direct vocal side effect of the medicine, as well as the general degree of vocal deviation and the greater pitch deviation. Shortness of breath when speaking was also associated with the greatest degree of vocal deviation. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[The lombard reflex as a test of vocal function (author's transl)].

PubMed

Schultz-Coulon, H J; Fues, C P

1976-06-01

Any impairment of audio-phonatory control by background noise is followed by an increase in both the intensity and pitch of the speaking voice (Lombard reflex, 1911), thus increasing vocal strain. As a consequence, it might be anticipated that persons reacting to noise with marked changes in voice might be more liable to develop dysphonia. 22 singers, 34 normal controls, and 22 patients with hyperfunctional dysphonia where studied. In all patients, both ears were gradually masked with white noise. The change of the mean intensity level and of the mean pitch level of the speaking voice were then measured objectively with a special fundamental frequency analyzer (Fedders and Schultz-Coulon, 1975). Results show that the increase of intensity is comparable in all subjects, whereas the elevation of the mean pitch level differs significantly: trained voices (singers) react with the least pitch increment whereas dysphonic patients react with the most. The following conclusions were made from the present investigation: 1. Extreme increments in pitch level can be considered to be a more significant etiological factor of dysphonia than intensity increments; 2. Vocal therapy and voice training may have a favorable effect on the Lombard reflex (probably by improvement of the kinesthetic control mechanism) so that the speaking voice in a noisy environment is raised less with less vocal strain. The study also indicates that measurement of pitch changes during binaural masking can provide important information for the diagnosis, therapy and prophylaxis of dysphonia.

Perceptual analyses of spasmodic dysphonia before and after treatment.

PubMed

Cannito, Michael P; Woodson, Gayle E; Murry, Thomas; Bender, Brenda

2004-12-01

To evaluate expert listeners' perceptions of voice and fluency in persons with adductor spasmodic dysphonia (ADSD) before and after treatment with botulinum toxin type A (Botox), as a function of initial severity of the disorder (while controlling for patients' age at injection). Simple before-and-after trial with blinded randomized listener judgments. Ambulatory care clinic at a single medical center. Forty-two consecutive patients with ADSD who underwent examination, with a 3- to 6-week follow-up, after initial botulinum toxin type A injection. There were also 42 age- and sex-matched healthy control subjects. Injections of botulinum toxin type A into the thyroarytenoid muscle(s). Computer-implemented visual analog scaling judgments of voice quality and speech fluency made by expert listeners under psychoacoustically controlled conditions. Response to botulinum toxin type A varied markedly as a function of pretreatment severity of ADSD. More severe initial symptoms exhibited greater magnitudes of improvement. Patients with mild dysphonia did not exhibit pretreatment to posttreatment change. Following treatment, voice and fluency remained significantly (P<.05) poorer in ADSD than in healthy speakers. Older patients exhibited less improvement than younger patients when the effect of initial severity was statistically controlled. Voice quality and fluency improved for most patients following treatment, but older patients and those with milder dysphonia exhibited the least optimal responses to the procedure. Patients who were profoundly impaired demonstrated the greatest amount of improvement. Computer-implemented visual analog scaling provided a reliable clinical tool for determining treatment-related changes in those with ADSD.

Speech therapy after thyroidectomy

PubMed Central

Wu, Che-Wei

2017-01-01

Common complaints of patients who have received thyroidectomy include dysphonia (voice dysfunction) and dysphagia (difficulty swallowing). One cause of these surgical outcomes is recurrent laryngeal nerve paralysis. Many studies have discussed the effectiveness of speech therapy (e.g., voice therapy and dysphagia therapy) for improving dysphonia and dysphagia, but not specifically in patients who have received thyroidectomy. Therefore, the aim of this paper was to discuss issues regarding speech therapy such as voice therapy and dysphagia for patients after thyroidectomy. Another aim was to review the literature on speech therapy for patients with recurrent laryngeal nerve paralysis after thyroidectomy. Databases used for the literature review in this study included, PubMed, MEDLINE, Academic Search Primer, ERIC, CINAHL Plus, and EBSCO. The articles retrieved by database searches were classified and screened for relevance by using EndNote. Of the 936 articles retrieved, 18 discussed “voice assessment and thyroidectomy”, 3 discussed “voice therapy and thyroidectomy”, and 11 discussed “surgical interventions for voice restoration after thyroidectomy”. Only 3 studies discussed topics related to “swallowing function assessment/treatment and thyroidectomy”. Although many studies have investigated voice changes and assessment methods in thyroidectomy patients, few recent studies have investigated speech therapy after thyroidectomy. Additionally, some studies have addressed dysphagia after thyroidectomy, but few have discussed assessment and treatment of dysphagia after thyroidectomy. PMID:29142841

Involuntary movements in the elderly. Parkinson's disease and other causes.

PubMed

Miller, J Q

1986-03-01

Dyskinesia is usually lifelong and progressive; therefore, physicians generally see the disorder in elderly patients. Medical treatment must be carefully selected on the basis of the cause of the dyskinesia. Parkinsonian dyskinesia is well controlled by drug therapy. However, patients can become less responsive to a drug after years of use and may experience unwelcome side effects. Cerebellar tremor is extremely disabling because it worsens with activity, but no satisfactory therapy is available. Senile, essential, and familial tremors are also intensified by action, but they can often be suppressed with a mild tranquilizer or a beta blocker. Drug treatment of blepharospasm and spastic dysphonia has been disappointing: Facial or laryngeal surgery is sometimes required. Tardive dyskinesia is caused by neuroleptic drugs, so the only therapy for the disorder is withdrawal of the offending drug.

Hereditary whispering dysphonia.

PubMed Central

Parker, N

1985-01-01

An Australian family group is described where at least twenty members have inherited torsion dystonia and two siblings with an affected mother have similar clinical manifestations, but have also the biochemical and pathological changes found in Wilson's disease. Whispering dysphonia was the commonest presenting symptom, and a diagnosis of hysteria was invariably made if the family history was not known. This group emphasises the enormously varied ways in which torsion dystonia may be manifested in one family, and raises the possibility of a disturbance in copper transport in diseases of the basal ganglia other than Wilson's disease. Images PMID:3156966

A Clinical Comparison of Anterior Cervical Plates Versus Stand-Alone Intervertebral Fusion Devices for Single-Level Anterior Cervical Discectomy and Fusion Procedures.

PubMed

Panchal, Ripul R; Kim, Kee D; Eastlack, Robert; Lopez, John; Clavenna, Andrew; Brooks, Daina M; Joshua, Gita

2017-03-01

To compare radiologic and clinical outcomes, including rates of dysphagia and dysphonia, using a no-profile stand-alone intervertebral spacer with integrated screw fixation versus an anterior cervical plate and spacer construct for single-level anterior cervical discectomy and fusion (ACDF) procedures. This multicenter, randomized, prospective study included 54 patients with degenerative disc disease requiring ACDF at a single level at C3-C7. Twenty-six patients underwent single-level ACDF with stand-alone spacers, and 28 with plate fixation and spacers. Analyses were based on comparison of perioperative outcomes, radiologic and clinical metrics, and incidence of dysphagia and/or dysphonia. Mean patient age was 48.8 ± 10.1years (53.7% female). No significant differences were observed between groups in operative time (101.8 ± 34.4 minutes, 114.4 ± 31.5 minutes), estimated blood loss (44.8 ± 76.5 mL, 82.5 ± 195.1 mL), or length of hospital stay (1.2 ± 0.6 days, 1.3 ± 0.6 days). Mean visual analog scale pain scores and Neck Disability Index scores improved significantly from preoperative to last follow-up (10.8 ± 2.6 months) in both groups (P < 0.05). Mean Voice Handicap Index and Eating Assessment Tool scores improved significantly from discharge to last follow-up in both groups (P < 0.05). From discharge to 6 months, the stand-alone spacers group consistently demonstrated greater improvement in Voice Handicap Index. Preoperative intervertebral disc and neuroforaminal heights increased significantly across treatment groups (P < 0.01), and no cases required surgical revision at index or adjacent levels. Anterior cervical discectomy and fusion with stand-alone spacers resulted in similar clinical and radiologic outcomes as compared with plate and spacers and may help minimize postoperative dysphonia. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluating the cost-effectiveness of laryngeal examination after elective total thyroidectomy.

PubMed

Lang, Brian Hung-Hin; Wong, Carlos K H; Tsang, Raymond K Y; Wong, Kai Pun; Wong, Birgitta Y H

2014-10-01

Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective. Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty. RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely. In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost.

Vocal characteristics of congenital anterior glottic webs in children: A case report.

PubMed

Shah, Jay; White, Katherine; Dohar, Joseph

2015-06-01

This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Vocal Parameters and Self-Perception in Individuals With Adductor Spasmodic Dysphonia.

PubMed

Rojas, Gleidy Vannesa E; Ricz, Hilton; Tumas, Vitor; Rodrigues, Guilherme R; Toscano, Patrícia; Aguiar-Ricz, Lílian

2017-05-01

The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. This is a prospective cohort study. Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time. Copyright © 2017. Published by Elsevier Inc.

Auditory-Perceptual and Acoustic Methods in Measuring Dysphonia Severity of Korean Speech.

PubMed

Maryn, Youri; Kim, Hyung-Tae; Kim, Jaeock

2016-09-01

The purpose of this study was to explore the criterion-related concurrent validity of two standardized auditory-perceptual rating protocols and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in Korean speech. Sixty native Korean subjects with various voice disorders were asked to sustain the vowel [a:] and to read aloud the Korean text "Walk." A 3-second midvowel portion of the sustained vowel and two sentences (with 25 syllables) were edited, concatenated, and analyzed according to methods described elsewhere. From 56 participants, both continuous speech and sustained vowel recordings had sufficiently high signal-to-noise ratios (35.5 dB and 37 dB on average, respectively) and were therefore subjected to further dysphonia severity analysis with (1) "G" or Grade from the GRBAS protocol, (2) "OS" or Overall Severity from the Consensus Auditory-Perceptual Evaluation of Voice protocol, and (3) AVQI. First, high correlations were found between G and OS (rS = 0.955 for sustained vowels; rS = 0.965 for continuous speech). Second, the AVQI showed a strong correlation with G (rS = 0.911) as well as OS (rP = 0.924). These findings are in agreement with similar studies dealing with continuous speech in other languages. The present study highlights the criterion-related concurrent validity of these methods in Korean speech. Furthermore, it supports the cross-linguistic robustness of the AVQI as a valid and objective marker of overall dysphonia severity. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Application of the acoustic voice quality index for objective measurement of dysphonia severity.

PubMed

Núñez-Batalla, Faustino; Díaz-Fresno, Estefanía; Álvarez-Fernández, Andrea; Muñoz Cordero, Gabriela; Llorente Pendás, José Luis

Over the past several decades, many acoustic parameters have been studied as sensitive to and to measure dysphonia. However, current acoustic measures might not be sensitive measures of perceived voice quality. A meta-analysis which evaluated the relationship between perceived overall voice quality and several acoustic-phonetic correlates, identified measures that do not rely on the extraction of the fundamental period, such the measures derived from the cepstrum, and that can be used in sustained vowel as well as continuous speech samples. A specific and recently developed method to quantify the severity of overall dysphonia is the acoustic voice quality index (AVQI) that is a multivariate construct that combines multiple acoustic markers to yield a single number that correlates reasonably with overall vocal quality. This research is based on one pool of voice recordings collected in two sets of subjects: 60 vocally normal and 58 voice disordered participants. A sustained vowel and a sample of connected speech were recorded and analyzed to obtain the six parameters included in the AVQI using the program Praat. Statistical analysis was completed using SPSS for Windows, version 12.0. Correlation between perception of overall voice quality and AVQI: A significant difference exists (t(95) = 9.5; p<.000) between normal and dysphonic voices. The findings of this study demonstrate the clinical feasibility of the AVQI as a measure of dysphonia severity. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Treatment efficacy of electromyography versus fiberscopy-guided botulinum toxin injection in adductor spasmodic dysphonia patients: a prospective comparative study.

PubMed

Kim, Jae Wook; Park, Jae Hong; Park, Ki Nam; Lee, Seung Won

2014-01-01

This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group). Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P > 0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

Multidimensional assessment of strongly irregular voices such as in substitution voicing and spasmodic dysphonia: a compilation of own research.

PubMed

Moerman, Mieke; Martens, Jean-Pierre; Dejonckere, Philippe

2015-04-01

This article is a compilation of own research performed during the European COoperation in Science and Technology (COST) action 2103: 'Advance Voice Function Assessment', an initiative of voice and speech processing teams consisting of physicists, engineers, and clinicians. This manuscript concerns analyzing largely irregular voicing types, namely substitution voicing (SV) and adductor spasmodic dysphonia (AdSD). A specific perceptual rating scale (IINFVo) was developed, and the Auditory Model Based Pitch Extractor (AMPEX), a piece of software that automatically analyses running speech and generates pitch values in background noise, was applied. The IINFVo perceptual rating scale has been shown to be useful in evaluating SV. The analysis of strongly irregular voices stimulated a modification of the European Laryngological Society's assessment protocol which was originally designed for the common types of (less severe) dysphonia. Acoustic analysis with AMPEX demonstrates that the most informative features are, for SV, the voicing-related acoustic features and, for AdSD, the perturbation measures. Poor correlations between self-assessment and acoustic and perceptual dimensions in the assessment of highly irregular voices argue for a multidimensional approach.

Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

PubMed Central

Kim, Jae Wook; Park, Jae Hong; Park, Ki Nam; Lee, Seung Won

2014-01-01

Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group). Methods. Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection. Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P > 0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable. PMID:25383369

Review of differential diagnosis and management of spasmodic dysphonia.

PubMed

Whurr, Renata; Lorch, Marjorie

2016-06-01

The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

[Social consequence of a dysphonic voice, design and validation of a questionnaire and first results].

PubMed

Revis, J; Robieux, C; Ghio, A; Giovanni, A

2013-01-01

In our society, based on communication, dysphonia becomes a handicap that could be responsible of work discrimination. Actually, several commercial services are provided by phone only, and voice quality is mandatory for the employees. This work aim was to determine the social picture relayed by dysphonia. Our hypothesis was that dysphonia sounds pejorative compared to normal voice. 40 voice samples (30 dysphonic and 10 normal) were presented randomly to a perceptual jury of 20 naïve listener. The task was for each of them to fill a questionnaire, designed specifically to describe the speaker's look and personality. 20 items were evaluated, divided into 4 categories: health, temperament, appearance, and way of life. The results showed significant differences between normal subjects and dysphonic patients. For instance, the pathological voices were depicted as more tired, introverted, sloppy than normal voices, and less trustable. No significant differences were found according to the severity of voice disorders. This work is presently continued. It allowed to validate our questionnaire and has offers great perspectives on patient's management and voice therapy.

Coprevalence of Anxiety and Depression With Spasmodic Dysphonia: A Case-Control Study

PubMed Central

White, Laura J.; Hapner, Edie R.; Klein, Adam M.; Delgaudio, John M.; Hanfelt, John J.; Jinnah, H. A.; Johns, Michael M.

2012-01-01

Summary Introduction There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD. Materials and Methods A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. Results One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR] = 0.985, 95% confidence interval [CI] = 0.59–1.63; and OR = 1.314; 95% CI 0.75–2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups. Conclusion Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate. PMID:22209056

Long-term Evaluation of Type 2 Thyroplasty with Titanium Bridges for Adductor Spasmodic Dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji

2017-07-01

Objectives Standard treatments of adductor spasmodic dysphonia (AdSD) provide temporary relief of symptoms. Type 2 thyroplasty offers a long-term solution; however, long-term voice outcome data are lacking. The objective of this study was to assess the long-term voice outcomes of type 2 thyroplasty with titanium bridges through use of a validated voice questionnaire. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Forty-seven consecutively enrolled patients with AdSD underwent type 2 thyroplasty with titanium bridges between August 2006 and November 2014. Questionnaires were completed during regularly scheduled follow-ups and, in some cases, were sent to patients who missed follow-up appointments. In 2015, questionnaires were mailed to all 47 patients and included a Voice Handicap Index-10 evaluation, as well as questions on postoperative vocal symptoms, surgical site, and status of the implanted titanium bridges. Results Of 47 patients with AdSD, 31 (66%) completed the questionnaires. The average follow-up interval was 41.3 months. No patient reported experiencing an adverse event around the surgical site, and almost all were satisfied with their voices postoperatively. The mean postoperative (>3 years) Voice Handicap Index-10 score improved significantly, from 26.3 to 9.4 (n = 17, P = .0009). Conclusions Type 2 thyroplasty for AdSD significantly improved patient quality of life and voice symptoms and continued to do so long after the surgery. The results of this study suggest that type 2 thyroplasty provides relief from vocal symptoms in patients with AdSD for >3 years.

Coprevalence of anxiety and depression with spasmodic dysphonia: a case-control study.

PubMed

White, Laura J; Hapner, Edie R; Klein, Adam M; Delgaudio, John M; Hanfelt, John J; Jinnah, H A; Johns, Michael M

2012-09-01

There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD. A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR]=0.985, 95% confidence interval [CI]=0.59-1.63; and OR=1.314; 95% CI=0.75-2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups. Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

PubMed

Russell, Jonathon O; Yan, Kenneth; Burkey, Brian; Scharpf, Joseph

2016-12-01

Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations. Case series with chart review. Tertiary care hospital. We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available. Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01). Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

The effect of unilateral thalamic deep brain stimulation on the vocal dysfunction in a patient with spasmodic dysphonia: interrogating cerebellar and pallidal neural circuits.

PubMed

Poologaindran, Anujan; Ivanishvili, Zurab; Morrison, Murray D; Rammage, Linda A; Sandhu, Mini K; Polyhronopoulos, Nancy E; Honey, Christopher R

2018-02-01

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.

Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

PubMed

Esposito, Marcello; Dubbioso, R; Apisa, P; Allocca, R; Santoro, L; Cesari, U

2015-09-01

Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time.

Adductor spasmodic dysphonia: Relationships between acoustic indices and perceptual judgments

NASA Astrophysics Data System (ADS)

Cannito, Michael P.; Sapienza, Christine M.; Woodson, Gayle; Murry, Thomas

2003-04-01

This study investigated relationships between acoustical indices of spasmodic dysphonia and perceptual scaling judgments of voice attributes made by expert listeners. Audio-recordings of The Rainbow Passage were obtained from thirty one speakers with spasmodic dysphonia before and after a BOTOX injection of the vocal folds. Six temporal acoustic measures were obtained across 15 words excerpted from each reading sample, including both frequency of occurrence and percent time for (1) aperiodic phonation, (2) phonation breaks, and (3) fundamental frequency shifts. Visual analog scaling judgments were also obtained from six voice experts using an interactive computer interface to quantify four voice attributes (i.e., overall quality, roughness, brokenness, breathiness) in a carefully psychoacoustically controlled environment, using the same reading passages as stimuli. Number and percent aperiodicity and phonation breaks correlated significanly with perceived overall voice quality, roughness, and brokenness before and after the BOTOX injection. Breathiness was correlated with aperidocity only prior to injection, while roughness also correlated with frequency shifts following injection. Factor analysis reduced perceived attributes to two principal components: glottal squeezing and breathiness. The acoustic measures demonstrated a strong regression relationship with perceived glottal squeezing, but no regression relationship with breathiness was observed. Implications for an analysis of pathologic voices will be discussed.

Outcomes assessment following treatment of spasmodic dysphonia with botulinum toxin.

PubMed

Courey, M S; Garrett, C G; Billante, C R; Stone, R E; Portell, M D; Smith, T L; Netterville, J L

2000-09-01

Spasmodic dysphonia (SD), a disabling focal dystonia involving the laryngeal musculature, is most commonly treated by the intramuscular injection of botulinum toxin (BTX). Although the treatment is well tolerated and generally produces clinical voice improvement, it has never been statistically shown to alter the patient's perception of voice quality or general health. Declining resources for medical care mandate that treatment outcomes be documented. A prospective analysis of the effects of BTX on the patient's perception of voice and general health was undertaken. The Voice Handicap Index (VHI) and Short Form 36 (SF-36) surveys were administered to patients before treatment and 1 month after. Pretreatment and posttreatment scores were analyzed with a Student's t-test. On the VHI, improvements in the patients' perception of their functional, physical, and emotional voice handicap reached statistical significance (p < or = .0005). On the SF-36, patients had statistically significant improvements in mental health (p < or = .03) and social functioning (p < or = .04). Treatment of SD with BTX significantly lessened the patients' perception of dysphonia. In addition, it improved their social functioning and their perception of their mental health. These outcome measures justify the continued treatment of SD with BTX.

Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection.

PubMed

Cannito, Michael P; Kahane, Joel C; Chorna, Lesya

2008-01-01

Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.

Treatment of spasmodic dysphonia with a neuromodulating electrical implant.

PubMed

Pitman, Michael J

2014-11-01

To investigate the feasibility of an implantable electrical stimulation device to treat spasmodic dysphonia (SD) by neuromodulation of the muscle spindle gamma loop. Prospective case series. Five subjects underwent daily stimulation of the left thyroarytenoid muscle (TA) below the level of α-motor neuron activation (AMNA) for 5 consecutive days. Professional and patient voice evaluations were performed. Transcartilagenous placement of an implantable stimulation device lead was investigated in anesthetized porcine and cadaveric human models. Three of 5 subjects improved in all categories of evaluation. One subject improved in three of four categories. These four subjects described significant carryover of effect after treatment. The fifth subject evidenced improvement until contracting an upper respiratory infection on day 3. Transcartilagenous electrode placement into the porcine TA with muscle stimulation was successful. The electrode lead was passed from the cadaveric larynx to the mastoid tip in the subplatysma layer with an absence of tension. The symptoms of SD improve after electrical stimulation of the TA at levels below AMNA. This is likely through neuromodulation of the muscle spindle gamma loop. Implantation of an electrode into the TA with a postauricular implanted stimulator is feasible with modifications of an already existing device. With further investigation, such a device has the potential to deliver an alternative treatment for SD. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.

PubMed

Zur, Karen B; Carroll, Linda M

2015-12-01

To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation. Retrospective case-series chart review. Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time. Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis. This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Extramedullary plasmacytoma of the larynx

PubMed Central

Pinto, José Antônio; Sônego, Thiago Branco; Artico, Marina Spadari; Leal, Carolina de Farias Aires; Bellotto, Silvana

2012-01-01

Summary Introduction: The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx. Objective: To describe a case of extramedullary plasmocytoma of the larynx, with literature review. Case Report: Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma. Conclusion: Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a “follow up” appropriate. PMID:25991967

Spasmodic Dysphonia

MedlinePlus

... motor control Boston University College of Health & Rehabilitation Sciences: Sargent College ... U.S. Department of Health and Human Services National Institutes of Health USA.gov—Government ...

The Impact of Dysphonic Voices on Healthy Listeners: Listener Reaction Times, Speech Intelligibility, and Listener Comprehension.

PubMed

Evitts, Paul M; Starmer, Heather; Teets, Kristine; Montgomery, Christen; Calhoun, Lauren; Schulze, Allison; MacKenzie, Jenna; Adams, Lauren

2016-11-01

There is currently minimal information on the impact of dysphonia secondary to phonotrauma on listeners. Considering the high incidence of voice disorders with professional voice users, it is important to understand the impact of a dysphonic voice on their audiences. Ninety-one healthy listeners (39 men, 52 women; mean age = 23.62 years) were presented with speech stimuli from 5 healthy speakers and 5 speakers diagnosed with dysphonia secondary to phonotrauma. Dependent variables included processing speed (reaction time [RT] ratio), speech intelligibility, and listener comprehension. Voice quality ratings were also obtained for all speakers by 3 expert listeners. Statistical results showed significant differences between RT ratio and number of speech intelligibility errors between healthy and dysphonic voices. There was not a significant difference in listener comprehension errors. Multiple regression analyses showed that voice quality ratings from the Consensus Assessment Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were able to predict RT ratio and speech intelligibility but not listener comprehension. Results of the study suggest that although listeners require more time to process and have more intelligibility errors when presented with speech stimuli from speakers with dysphonia secondary to phonotrauma, listener comprehension may not be affected.

Pharyngeal Dystonia Mimicking Spasmodic Dysphonia.

PubMed

Shi, Lucy L; Simpson, C Blake; Hapner, Edie R; Jinnah, Hyder A; Johns, Michael M

2018-03-01

The aim of this study was to describe the presentation of pharyngeal dystonia (PD), which can occur as a focal or segmental dystonia with a primarily pharyngeal involvement for the discussion of treatment methods for controlling consequent symptoms. PD is specific to speech-related tasks. A retrospective medical record review of four patients with PD was performed. All patients were initially misdiagnosed with adductor spasmodic dysphonia and failed standard treatment with botulinum toxin type A (BTX). On laryngoscopy, the patients were discovered to have segmental or focal dystonia primarily affecting the pharyngeal musculature contributing to their vocal manifestations. A novel treatment regimen was designed, which involved directing BTX injections into the muscles involved in spasmodic valving at the oropharyngeal level. After titrating to an optimal dose, all patients showed improvement in their voice and speech with only mild dysphagia. These patients have maintained favorable results with repeat injections at 6- to 12-week intervals. PD, or dystonia with predominant pharyngeal involvement, is a rare entity with vocal manifestations that are not well described. It can be easily mistaken for spasmodic dysphonia. PD is specific to speech-related tasks. A novel method of BTX injections into the involved muscles results in a significant improvement in voice without significant dysphagia. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

PubMed Central

Upile, Tahwinder; Elmiyeh, Behrad; Jerjes, Waseem; Prasad, Vyas; Kafas, Panagiotis; Abiola, Jesuloba; Youl, Bryan; Epstein, Ruth; Hopper, Colin; Sudhoff, Holger; Rubin, John

2009-01-01

Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia. PMID:19852852

Vocal aging and adductor spasmodic dysphonia: Response to botulinum toxin injection

PubMed Central

Cannito, Michael P; Kahane, Joel C; Chorna, Lesya

2008-01-01

Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age. PMID:18488884

The treatment of muscle tension dysphonia: a comparison of two treatment techniques by means of an objective multiparameter approach.

PubMed

Van Lierde, Kristiane M; De Bodt, Marc; Dhaeseleer, Evelien; Wuyts, Floris; Claeys, Sofie

2010-05-01

The purpose of the present study is to measure the effectiveness of two treatment techniques--vocalization with abdominal breath support and manual circumlaryngeal therapy (MCT)--in patients with muscle tension dysphonia (MTD). The vocal quality before and after the two treatment techniques was measured by means of the dysphonia severity index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following set of voice measurements: maximum phonation time (MPT), highest frequency, lowest intensity, and jitter. The repeated-measures analysis of variance (ANOVA) revealed a significant difference between the objective overall vocal quality before and after MCT. No significant differences were measured between the objective overall vocal quality before and after vocalization with abdominal breath support. This study showed evidence that MCT is an effective treatment technique for patients with elevated laryngeal position, increased laryngeal muscle tension, and MTD. The precise way in which MCT has an effect on vocal quality has not been addressed in this experiment, but merits study. Further research into this topic could focus on electromyography (EMG) recordings in relation to vocal improvements with larger sample of subjects. (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

A psychosocial intervention for the management of functional dysphonia: complex intervention development and pilot randomised trial.

PubMed

Deary, Vincent; McColl, Elaine; Carding, Paul; Miller, Tracy; Wilson, Janet

2018-01-01

Medically unexplained loss or alteration of voice-functional dysphonia-is the commonest presentation to speech and language therapists (SLTs). Besides the impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aims of this research were the systematic development of a complex intervention to improve the treatment of functional dysphonia, and the trialling of this intervention for feasibility and acceptability to SLTs and patients in a randomised pilot study. A theoretical model of medically unexplained symptoms (MUS) was elaborated through literature review and synthesis. This was initially applied as an assessment format in a series of patient interviews. Data from this stage and a small consecutive cohort study were used to design and refine a brief cognitive behavioural therapy (CBT) training intervention for a SLT. This was then implemented in an external pilot patient randomised trial where one SLT delivered standard voice therapy or voice therapy plus CBT to 74 patients. The primary outcomes were of the acceptability of the intervention to patients and the SLT, and the feasibility of changing the SLT's clinical practice through a brief training. This was measured through monitoring treatment flow and through structured analysis of the content of intervention for treatment fidelity and inter-treatment contamination. As measured by treatment flow, the intervention was as acceptable as standard voice therapy to patients. Analysis of treatment content showed that the SLT was able to conduct a complex CBT formulation and deliver novel treatment strategies for fatigue, sleep, anxiety and depression in the majority of patients. On pre-post measures of voice and quality of life, patients in both treatment arms improved. These interventions were acceptable to patients. Emotional and psychosocial issues presented routinely in the study patient group and CBT techniques were used, deliberately and inadvertently, in both treatment arms. This CBT "contamination" of the voice therapy only arm reflects the chief limitation of the study: one therapist delivered both treatments. Registered with the ISRCTN under the title: Training a Speech and Language Therapist in Cognitive Behavioural Therapy to treat Functional Dysphonia - A Randomised Controlled Trial .Trial Identifier: ISRCTN20582523 Registered 19/05/2010; retrospectively registered. http://www.isrctn.com/ISRCTN20582523.

Botulinum toxin injection - larynx

MedlinePlus

Injection laryngoplasty; Botox - larynx: spasmodic dysphonia-BTX; Essential voice tremor (EVT)-btx; Glottic insufficiency; Percutaneous electromyography - guided botulinum toxin treatment; Percutaneous indirect laryngoscopy - guided botulinum toxin treatment; ...

The Comparison of Thyroarytenoid Muscle Myectomy and Type II Thyroplasty for Spasmodic Dysphonia.

PubMed

Nomoto, Masaki; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Konomi, Ujimoto; Motohashi, Rei; Sakurai, Eriko; Toyomura, Fumimasa; Ueda, Yuri; Inoue, Shun; Tsukahara, Kiyoaki; Suzuki, Mamoru

2015-07-01

Surgical treatments for adductor spasmodic dysphonia include bilateral thyroarytenoid muscle myectomy (TAM) and type II thyroplasty (TPII), both of which are commonly performed. The present study aimed to compare the effects of TAM and TPII. Retrospective study. Subjects were 30 and 35 patients who underwent TAM and TPII, between March 2008 and November 2012. Voice quality was evaluated based on "voice handicap index 10 (VHI10)" and auditory impressions before and 6 months after surgery using five parameters: "strangulation," "interruption," "tremor," "grade," and "breathiness." Comparison of the two procedures revealed significant improvements in VHI10, strangulation, interruption, and tremor, and a significant decline in breathiness after surgery. In particular, VHI10 was improved by more than six points in 90% of patients with TAM, and 96% with TPII. No significant difference was observed between the severities of two procedures preoperatively. Comparison of each postoperative score between the two procedures revealed that TAM significantly improved strangulation, interruption, and tremor, and significantly worsened breathiness, with no significant difference in VHI10. Scatter plots (x: preoperative scores; y: postoperative scores) and regression lines of evaluation items demonstrated that TAM is more effective than TPII in severe cases. Compared with TPII, TAM tends to improve strangulation, interruption, and tremor; however, it tends to worsen breathiness postoperatively. Postoperative VHI10 scores did not differ significantly between the two procedures. Given favorable improvement rates, both surgical procedures were considered effective. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes.

PubMed

Simpson, C Blake; Lee, Christopher T; Hatcher, Jeanne L; Michalek, Joel

2016-01-01

Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection. Retrospective case series. Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire. A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%. Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

[Sarcomatoid carcinoma of larynx. A histological challenge?

PubMed

Osorio-Velásquez, Alejandra; Chiesa-Estomba, Carlos M; Betances-Reinoso, Frank A; San Miguel-Fraile, M Pilar; Ortiz-Rey, José A

Sarcomatoid carcinoma can occur in any part of the body; in the head and neck it occurs most frequently in the major salivary glands, with only about 1% of cases found in the larynx. As it has both epithelial and mesenchymal components, there are many theories concerning its origin and it can prove a diagnostic challenge. A 76 year old male smoker presented with dysphonia. Vocal cord injury was found on examination but no lymphadenopathy or metastases were present. Laryngeal microsurgery was performed with complete excision of the lesion. Histopathology showed it to be a carcinosarcoma which showed intense and diffuse positivity for vimentin and focal positivity for AE1-AE3, CK5 and p63. The patient underwent radiotherapy as complementary treatment. Sarcomatoid carcinoma usually presents with obstructive symptoms such as dysphonia. Prognosis depends on the stage and the presence or not of metastases. Both epithelial markers EMA, cytokeratin (AE1-AE3), epithelial membrane antigen, Ki 67 and mesenchymal markers such as vimentin, desmin, S-100 may be positive in these tumours. Recommended treatment for T2-T1 stages is an excisional biopsy which can be followed by adjuvant radiotherapy; radiotherapy alone has also been successful. T3-T4 stages can be treated with local excision, partial laryngectomy or total laryngectomy with subsequent ganglion emptying and concomitant radio and chemotherapy. Copyright © 2016 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.

Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment.

PubMed

Geneid, Ahmed; Lindestad, Per-Åke; Granqvist, Svante; Möller, Riitta; Södersten, Maria

2016-01-01

To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD. © 2016 S. Karger AG, Basel.

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

PubMed

Ramos, Lorena de Almeida; Gama, Ana Cristina Côrtes

2017-05-01

This study aimed to verify the effects of execution time on auditory-perceptual and acoustic responses in children with dysphonia completing straw phonation exercises. A randomized, prospective, comparative intra-subject study design was used. Twenty-seven children, ranging from 5 to 10 years of age, diagnosed with vocal cord nodules or cysts, were enrolled in the study. All subjects included in the Experimental Group were also included in the Control Group which involved complete voice rest. Sustained vowels (/a/e/ε/e/) counting from 1 to 10 were recorded before the exercises (m0) and then again after the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of straw phonation exercises. The recordings were randomized and presented to five speech therapists, who evaluated vocal quality based on the Grade Roughness Breathiness Asthenia/Strain Instability scale. For acoustic analysis, fundamental frequency, jitter, shimmer, glottal to noise excitation ratio, and noise parameters were analyzed. Reduced roughness, breathiness, and noise measurements as well as increased glottal to noise excitation ratio were observed in the Experimental Group after 3 minutes of exercise. Reduced grade of dysphonia and breathiness were noted after 5 minutes. The ideal duration of straw phonation in children with dysphonia is from 3 to 5 minutes. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Spasmodic Dysphonia in Multiple Sclerosis Treatment With Botulin Toxin A: A Pilot Study.

PubMed

Di Stadio, Arianna; Bernitsas, Evanthia; Restivo, Domenico Antonio; Alfonsi, Enrico; Marchese-Ragona, Rosario

2018-04-09

This study aims to evaluate the effect of botulin toxin A in patients with multiple sclerosis (MS) affected by spasmodic dysphonia (SD) and to show the safety and effectiveness of this treatment in long-term observation. This is a pilot study on three relapsing-remitting MS patients with SD and their response to botulin toxin A. None of the patients reported dysphagia or other adverse events. Significant improvement was observed in terms of both voice quality and laryngostroboscopy results. The treatment effect was durable for 6-8 months. Botulin toxin A is a safe treatment that can be successfully used to treat SD in patients with MS. Larger studies are necessary to confirm our results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Endoscopic laser thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia: a pilot study on long-term outcome on voice quality.

PubMed

Tsuji, Domingos Hiroshi; Takahashi, Marystella Tomoe; Imamura, Rui; Hachiya, Adriana; Sennes, Luiz Ubirajara

2012-09-01

Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. Prospective study. Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study.

PubMed

Misono, Stephanie; Haut, Caroline; Meredith, Liza; Frazier, Patricia A; Stockness, Ali; Michael, Deirdre D; Butcher, Lisa; Harwood, Eileen M

2018-05-11

The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation?

PubMed

Sipp, J Andrew; Kerschner, Joseph E; Braune, Nicole; Hartnick, Christopher J

2007-08-01

To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI). Retrospective medical chart review. Two tertiary academic centers. All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006. Injection laryngoplasty, ansa cervicalis-recurrent laryngeal nerve anastomosis, or thyroplasty. Age, sex, intervention, etiology, time from onset of UVFI to surgery, subjective success in improving voice, subjective duration of improvement, and complications. Twenty-seven procedures were performed in 15 patients (mean age, 10.6 years). Nineteen injection laryngoplasties, 3 thyroplasties (1 bilateral), 2 ansa cervicalis-recurrent laryngeal nerve reinnervation procedures, 1 adduction arytenoidopexy, and 1 cricothyroid joint subluxation were performed. Causes of UVFI included thoracic surgery in 6 cases (40%), prolonged intubation in 4 (26%), central nervous system neoplasm in 3 (20%), unknown etiology in 1 (7%), and anoxic brain injury in 1 (7%). The mean duration from onset of symptoms to treatment was 47 months. There was 1 surgical complication (postoperative aspiration pneumonia following thyroplasty while the patient was under local anesthesia). Parents reported a satisfactory outcome in all cases. Injection laryngoplasty, thyroplasty, and nerve reinnervation can be performed in pediatric patients with good outcomes and an acceptable safety profile. This article describes the experiences of 2 institutions with phonosurgery for UVFI in children and provides insight into the advantages and disadvantages of each procedure. Prospective studies, with validated quality-of-life measurements, are needed to greater clarify the role of different types of phonosurgery in children with UVFI.

Quantitative evaluation of the voice range profile in patients with voice disorder.

PubMed

Ikeda, Y; Masuda, T; Manako, H; Yamashita, H; Yamamoto, T; Komiyama, S

1999-01-01

In 1953, Calvet first displayed the fundamental frequency (pitch) and sound pressure level (intensity) of a voice on a two-dimensional plane and created a voice range profile. This profile has been used to evaluate clinically various vocal disorders, although such evaluations to date have been subjective without quantitative assessment. In the present study, a quantitative system was developed to evaluate the voice range profile utilizing a personal computer. The area of the voice range profile was defined as the voice volume. This volume was analyzed in 137 males and 175 females who were treated for various dysphonias at Kyushu University between 1984 and 1990. Ten normal subjects served as controls. The voice volume in cases with voice disorders significantly decreased irrespective of the disease and sex. Furthermore, cases having better improvement after treatment showed a tendency for the voice volume to increase. These findings illustrated the voice volume as a useful clinical test for evaluating voice control in cases with vocal disorders.

Clinical course of acute laryngeal trauma and associated effects on phonation.

PubMed

Brosch, S; Johannsen, H S

1999-01-01

We report the clinical course of blunt laryngeal trauma in three young patients. All three patients underwent several phoniatric examinations as well as indirect microlaryngoscopy and microstroboscopy. The follow-up period ranged from three to eight months. In the first case, there was isolated haemorrhage of the left vocal fold; in the second, dislocation of the arytenoid cartilage with formation of an adhesion in the area of the anterior commissure; and, in the third, non-dislocated fracture of the thyroid cartilage with development of haematoma in the right hemilarynx and transient vocal fold paralysis. One patient required surgical treatment; however, repositioning of the arytenoid cartilage, attempted seven weeks following the injury, proved unsuccessful. In conclusion, all three patients showed significant limitation of vocal fold vibration many months after trauma which was unrelated to the extent of resulting tissue damage. In all three cases, patients developed secondary posttraumatic functional dysphonia requiring treatment.

Spasmodic dysphonia

MedlinePlus

Medicine that treats spasm of the vocal cord muscles may be tried. They appear to work in up to one half of people, at best. Some of these medicines have bothersome side effects. Botulinum toxin (Botox) treatments may ...

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery.

PubMed

Isshiki, N

2000-06-01

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias. Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx. Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery.

PubMed

Isshiki, N

1998-06-01

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias . Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx . Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.

The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

PubMed

Patel, Alpen B; Bansberg, Stephen F; Adler, Charles H; Lott, David G; Crujido, Lisa

2015-11-01

Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies. Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded. Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%). Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias. © The Author(s) 2015.

Vocal outcome after endoscopic thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia.

PubMed

Gandhi, Sachin; Remacle, Marc; Mishra, Prasun; Desai, Vrushali

2014-12-01

Spasmodic dysphonia (SD) remains one of the most difficult of laryngeal pathologies to treat. With limited role for speech therapy, various surgical modalities have been tried with various success rates. The objective of the study is to report the results of vocal outcome after thyroarytenoid myoneurectomy in patients of adductor spasmodic dysphonia (ASD). 15 patients of ASD were selected. GRBAS, and voice handicap index (VHI) were used for perceptual evaluation of voice. Thyroarytenoid myoneurectomy was performed by vaporizing the muscular layer of the vocal fold with CO2 laser, at an intensity of 6 W with 1.2 mm diameter in scanner mode. Voice analysis was repeated at 12, 24 and 48 months follow-up. Preoperative GRBAS scores and VHI score of all the patients were poor. At 12 months 12/15 (80 %) patients having strain score of 0. There was marked improvement in VHI scores at 6 months. 10/15 (67 %) patients have been followed up for 24 months. 5/10 (50 %) patients have strain (S) value of 0. VHI scoring of 5/10 (50 %) patients was <30. Two of the four patients completed 48 months follow-up had a strain (S) value of 0, one patient has strain value of 1 and one patient had strain value of 2. 2/4 patients had VHI score of <30; one patient had that of 40. Trans-oral CO2 laser thyroarytenoid myoneurectomy shows significant long-term improvement in voice quality in terms of reduced speech brakes, effort and strain in voice.

Voice disorder in systemic lupus erythematosus

PubMed Central

de Macedo, Milena S. F. C.; da Silva Filho, Manoel

2017-01-01

Systemic lupus erythematosus (SLE) is a chronic disease characterized by progressive tissue damage. In recent decades, novel treatments have greatly extended the life span of SLE patients. This creates a high demand for identifying the overarching symptoms associated with SLE and developing therapies that improve their life quality under chronic care. We hypothesized that SLE patients would present dysphonic symptoms. Given that voice disorders can reduce life quality, identifying a potential SLE-related dysphonia could be relevant for the appraisal and management of this disease. We measured objective vocal parameters and perceived vocal quality with the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale in SLE patients and compared them to matched healthy controls. SLE patients also filled a questionnaire reporting perceived vocal deficits. SLE patients had significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer. All subjective parameters of the GRBAS scale were significantly abnormal in SLE patients. Additionally, the vast majority of SLE patients (29/36) reported at least one perceived vocal deficit, with the most prevalent deficits being vocal fatigue (19/36) and hoarseness (17/36). Self-reported voice deficits were highly correlated with altered GRBAS scores. Additionally, tissue damage scores in different organ systems correlated with dysphonic symptoms, suggesting that some features of SLE-related dysphonia are due to tissue damage. Our results show that a large fraction of SLE patients suffers from perceivable dysphonia and may benefit from voice therapy in order to improve quality of life. PMID:28414781

Speech–Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function

PubMed Central

Barkmeier-Kraemer, Julie M.; Clark, Heather M.

2017-01-01

Background Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition. Speech–language pathologists (SLPs) play an important role in the evaluation and management of dysarthria and dysphagia. This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations. Methods A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar. Search terms included 1) hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington’s Disease, myoclonus; and evaluation/treatment terms: 2) Speech–Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis. Results The standard SLP clinical speech and swallowing evaluation of chorea/Huntington’s disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1) case history; 2) examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (i.e., cranial nerve assessment); 3) evaluation of speech characteristics; and 4) patient self-report of the impact of their disorder on activities of daily living. SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility. Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation. Discussion SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and deglutition associated with hyperkinetic disorders. PMID:28983422

A report on alterations to the speaking and singing voices of four women following hormonal therapy with virilizing agents.

PubMed

Baker, J

1999-12-01

Four women aged between 27 and 58 years sought otolaryngological examination due to significant alterations to their voices, the primary concerns being hoarseness in vocal quality, lowering of habitual pitch, difficulty projecting their speaking voices, and loss of control over their singing voices. Otolaryngological examination with a mirror or flexible laryngoscope revealed no apparent abnormality of vocal fold structure or function, and the women were referred for speech pathology with diagnoses of functional dysphonia. Objective acoustic measures using the Kay Visipitch indicated significant lowering of the mean fundamental frequency for each woman, and perceptual analysis of the patients' voices during quiet speaking, projected voice use, and comprehensive singing activities revealed a constellation of features typically noted in the pubescent male. The original diagnoses of a functional dysphonia were queried, prompting further exploration of each woman's medical history, revealing in each case onset of vocal symptoms shortly after commencing treatment for conditions with medications containing virilizing agents (eg, Danocrine (danazol), Deca-Durabolin (nandrolene decanoate), and testosterone). Although some of the vocal symptoms decreased in severity with the influences from 6 months voice therapy and after withdrawal from the drugs, a number of symptoms remained permanent, suggesting each subject had suffered significant alterations in vocal physiology, including muscle tissue changes, muscle coordination dysfunction, and propioceptive dysfunction. This retrospective study is presented in order to illustrate that it was both the projected speaking voice and the singing voice that proved so highly sensitive to the virilization effects. The implications for future prospective research studies and responsible clinical practice are discussed.

Neural correlates of dystonic tremor: a multimodal study of voice tremor in spasmodic dysphonia.

PubMed

Kirke, Diana N; Battistella, Giovanni; Kumar, Veena; Rubien-Thomas, Estee; Choy, Melissa; Rumbach, Anna; Simonyan, Kristina

2017-02-01

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). We found that, compared to controls, SD patients with and without DTv showed similarly increased activation in the sensorimotor cortex, inferior frontal (IFG) and superior temporal gyri, putamen and ventral thalamus, as well as deficient activation in the inferior parietal cortex and middle frontal gyrus (MFG). Common structural alterations were observed in the IFG and putamen, which were further coupled with functional abnormalities in both patient groups. Abnormal activation in left putamen was correlated with SD onset; SD/DTv onset was associated with right putaminal volumetric changes. DTv severity established a significant relationship with abnormal volume of the left IFG. Direct patient group comparisons showed that SD/DTv patients had additional abnormalities in MFG and cerebellar function and white matter integrity in the posterior limb of the internal capsule. Our findings suggest that dystonia and dystonic tremor, at least in the case of SD and SD/DTv, are heterogeneous disorders at different ends of the same pathophysiological spectrum, with each disorder carrying a characteristic neural signature, which may potentially help development of differential markers for these two conditions.

Brain Activity in Patients With Adductor Spasmodic Dysphonia Detected by Functional Magnetic Resonance Imaging.

PubMed

Kiyuna, Asanori; Kise, Norimoto; Hiratsuka, Munehisa; Kondo, Shunsuke; Uehara, Takayuki; Maeda, Hiroyuki; Ganaha, Akira; Suzuki, Mikio

2017-05-01

Spasmodic dysphonia (SD) is considered a focal dystonia. However, the detailed pathophysiology of SD remains unclear, despite the detection of abnormal activity in several brain regions. The aim of this study was to clarify the pathophysiological background of SD. This is a case-control study. Both task-related brain activity measured by functional magnetic resonance imaging by reading the five-digit numbers and resting-state functional connectivity (FC) measured by 150 T2-weighted echo planar images acquired without any task were investigated in 12 patients with adductor SD and in 16 healthy controls. The patients with SD showed significantly higher task-related brain activation in the left middle temporal gyrus, left thalamus, bilateral primary motor area, bilateral premotor area, bilateral cerebellum, bilateral somatosensory area, right insula, and right putamen compared with the controls. Region of interest voxel FC analysis revealed many FC changes within the cerebellum-basal ganglia-thalamus-cortex loop in the patients with SD. Of the significant connectivity changes between the patients with SD and the controls, the FC between the left thalamus and the left caudate nucleus was significantly correlated with clinical parameters in SD. The higher task-related brain activity in the insula and cerebellum was consistent with previous neuroimaging studies, suggesting that these areas are one of the unique characteristics of phonation-induced brain activity in SD. Based on FC analysis and their significant correlations with clinical parameters, the basal ganglia network plays an important role in the pathogenesis of SD. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Neural correlates of dystonic tremor: A multimodal study of voice tremor in spasmodic dysphonia

PubMed Central

Kirke, Diana N.; Battistella, Giovanni; Kumar, Veena; Rubien-Thomas, Estee; Choy, Melissa; Rumbach, Anna; Simonyan, Kristina

2016-01-01

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous, as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). We found that, compared to controls, SD patients with and without DTv showed similarly increased activation in the sensorimotor cortex, inferior frontal (IFG) and superior temporal gyri, putamen and ventral thalamus, as well as deficient activation in the inferior parietal cortex and middle frontal gyrus (MFG). Common structural alterations were observed in the IFG and putamen, which were further coupled with functional abnormalities in both patient groups. Abnormal activation in left putamen was correlated with SD onset; SD/DTv onset was associated with right putaminal volumetric changes. DTv severity established a significant relationship with abnormal volume of the left IFG. Direct patient group comparisons showed that SD/DTv patients had additional abnormalities in MFG and cerebellar function and white matter integrity in the posterior limb of the internal capsule. Our findings suggest that dystonia and dystonic tremor, at least in the case of SD and SD/DTv, are heterogeneous disorders at different ends of the same pathophysiological spectrum, with each disorder carrying a characteristic neural signature, which may potentially help development of differential markers for these two conditions. PMID:26843004

Effects of type II thyroplasty on adductor spasmodic dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro

2010-04-01

Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD. Case series. University hospital. Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/. Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery. Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

Use of Botulinum Neurotoxin for the Treatment of Movement Disorders

MedlinePlus

... spasmodic dysphonia, or ABSD). Does BoNT control motor tics? Tics associated with Tourette syndrome are relatively brief, intermittent movements (also known as motor tics) or sounds (also known as vocal or phonic ...

Extramedullary plasmacytoma of the larynx.

PubMed

Pinto, José Antônio; Sônego, Thiago Branco; Artico, Marina Spadari; Leal, Carolina de Farias Aires; Bellotto, Silvana

2012-07-01

 The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx.  To describe a case of extramedullary plasmocytoma of the larynx, with literature review.  Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma.  Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a "follow up" appropriate.

Retropharyngeal course of the internal carotid artery.

PubMed

Ballivet de Regloix, Stanislas; Maurin, O

2017-12-01

A 77-year-old male patient presented with dysphonia. Endoscopic examination demonstrated a distortion of the posterior pharyngeal wall, which was pulsatile. The axial CT showed left internal carotid artery in a retropharyngeal location. An anomalous course of the carotid artery in the retropharyngeal space is an unusual finding that poses a risk of vascular injury during pharyngeal surgery and intubation. Such an anomaly may be congenital (incomplete descent of the third aortic arch) and may be more pronounced in older patients secondary to atherosclerosis and hypertension as occurred in our case noted here. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

75 FR 76020 - Prospective Grant of Exclusive License: Devices for Treating Dysphagia and Dysphonia

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... patents and patent applications intended for licensure disclose or cover a system, device and method for... device allows the patient coordinate muscular movement with a button press to permit volitional...

Videostrobolaryngoscopy of mucus layer during vocal fold vibration in patients with laryngeal tension-fatigue syndrome.

PubMed

Hsiao, Tzu-Yu; Liu, Chia-Ming; Lin, Kai-Nan

2002-06-01

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Botulinum Toxin in Secondarily Nonresponsive Patients with Spasmodic Dysphonia.

PubMed

Mor, Niv; Tang, Christopher; Blitzer, Andrew

2016-09-01

Chemodenervation with botulinum toxin (BoNT) has been effective and well tolerated for all types of dystonia for >30 years. We reviewed outcomes of our patients treated with BoNT serotype A (BoNT-A) for spasmodic dysphonia (SD) who became secondarily nonresponsive. We found that 8 of 1400 patients became nonresponsive to BoNT-A (0.57%), which is lower than the secondary nonresponse rate in other dystonias. After a cessation period, 4 of our patients resumed BoNT-A injections, and recurrence of immunoresistance was not seen in any of them. When compared with patients with other dystonias, patients with SD receive extremely low doses of BoNT. Small antigen challenge may explain the lower rate of immunoresistance and long-lasting efficacy after BoNT-A is restarted among secondary nonresponsive patients with SD. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

PubMed

DeConde, Adam S; Long, Jennifer L; Armin, Bob B; Berke, Gerald S

2012-09-01

Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy. The patient's symptomatic vocal fold adduction resolved completely on division of the ansa-RLN neurorraphy confirming successful selective functional reinnervation of vocal fold adductors by the ansa cervicalis. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Differences in botulinum toxin dosing between patients with adductor spasmodic dysphonia and essential voice tremor.

PubMed

Orbelo, Diana M; Duffy, Joseph R; Hughes Borst, Becky J; Ekbom, Dale; Maragos, Nicolas E

2014-01-01

To explore possible dose differences in average botulinum toxin (BTX) given to patients with adductor spasmodic dysphonia (ADSD) compared with patients with essential voice tremor (EVT). A retrospective study compared the average BTX dose injected in equal doses to the thyroarytenoid (TA) muscles of 51 patients with ADSD with 52 patients with EVT. Those with ADSD received significantly higher total doses (6.80 ± 2.79 units) compared with those with EVT (5.02 ± 1.65 units). Dose at time of first injection, age at time of first injection, gender, year of first injection, and average time between injections were included in multivariate analysis but did not interact with total average dose findings. Patients with ADSD may need relatively higher doses of BTX injections to bilateral TA muscles compared with patients with EVT. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Reliability and validity of the Chinese pediatric voice handicap index.

PubMed

Liu, Kena; Liu, Shaofeng; Zhou, Zhou; Ren, Qinyi; Zhong, Jie; Luo, Renzhong; Qin, Huabiao; Zhang, Siyi; Ge, Pingjiang

2018-02-01

To evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI). The original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient. The internal consistency of total score and three subscales scores of Chinese pVHI were 0.788-0.944. The test-retest reliability was 0.631-0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694-0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01). The Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia. Copyright © 2017. Published by Elsevier B.V.

A Computerized Tomography Study of Vocal Tract Setting in Hyperfunctional Dysphonia and in Belting.

PubMed

Saldias, Marcelo; Guzman, Marco; Miranda, Gonzalo; Laukkanen, Anne-Maria

2018-04-03

Vocal tract setting in hyperfunctional patients is characterized by a high larynx and narrowing of the epilaryngeal and pharyngeal region. Similar observations have been made for various singing styles, eg, belting. The voice quality in belting has been described to be loud, speech like, and high pitched. It is also often described as sounding "pressed" or "tense". The above mentioned has led to the hypothesis that belting may be strenuous to the vocal folds. However, singers and teachers of belting do not regard belting as particularly strenuous. This study investigates possible similarities and differences between hyperfunctional voice production and belting. This study concerns vocal tract setting. Four male patients with hyperfunctional dysphonia and one male contemporary commercial music singer were registered with computerized tomography while phonating on [a:] in their habitual speaking pitch. Additionally, the singer used the pitch G4 in belting. The scannings were studied in sagittal and transversal dimensions by measuring lengths, widths, and areas. Various similarities were found between belting and hyperfunction: high vertical larynx position, small hypopharyngeal width, and epilaryngeal outlet. On the other hand, belting differed from dysphonia (in addition to higher pitch) by a wider lip and jaw opening, and larger volumes of the oral cavity. Belting takes advantage of "megaphone shape" of the vocal tract. Future studies should focus on modeling and simulation to address sound energy transfer. Also, they should consider aerodynamic variables and vocal fold vibration to evaluate the "price of decibels" in these phonation types. Copyright © 2018. Published by Elsevier Inc.

Laryngeal manual therapy palpatory evaluation scale: A preliminary study to examine its usefulness in diagnosis of occupational dysphonia.

PubMed

Woźnicka, Ewelina; Niebudek-Bogusz, Ewa; Morawska, Joanna; Wiktorowicz, Justyna; Śliwińska-Kowalska, Mariola

2017-03-24

The aim of this study has been to assess the larynx and soft tissue around the vocal tract in a group of people with healthy voice, and in a group of patients with occupational dysphonia using the new laryngeal manual therapy palpatory evaluation scale (LMTPE). The examinations were performed in a study (dysphonic) group of professional voice users who had developed voice disorders (N = 51) and in the control group of normophonic subjects (N = 50). All the participants underwent perceptual voice assessment and examination by means of the LMTPE scale. Additionally, phoniatric examination including VHI (Voice Handicap Index) questionnaire, GRBAS (the Grade of hoarseness, Roughness, Breathiness, Asthenic, Strained) perceptual evaluation, maximum phonation time (MPT) measurement and videostroboscopy was performed in the study group. The comparison of the LMTPE total score showed that the results of the study group were significantly poorer than those of controls (p < 0.001). In the study group, correlations were found between the LMTPE results and the VHI scores (p < 0.05), perceptual evaluation by the GRBAS (p < 0.05) and the objective parameter MPT (p < 0.05). The study has proven that the LMTPE scale is characterized by the high score of Cronbach's α ratio estimating the reliability of the test. The results have confirmed that the LMTPE scale seems to be a valuable tool, useful in diagnostics of occupational dysphonia, particularly of hyperfunction origin. Med Pr 2017;68(2):179-188. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Communication-related affective, behavioral, and cognitive reactions in speakers with spasmodic dysphonia.

PubMed

Watts, Christopher R; Vanryckeghem, Martine

2017-12-01

To investigate the self-perceived affective, behavioral, and cognitive reactions associated with communication of speakers with spasmodic dysphonia as a function of employment status. Prospective cross-sectional investigation. 148 Participants with spasmodic dysphonia (SD) completed an adapted version of the Behavior Assessment Battery (BAB-Voice), a multidimensional assessment of self-perceived reactions to communication. The BAB-Voice consisted of four subtests: the Speech Situation Checklist for A) Emotional Reaction (SSC-ER) and B) Speech Disruption (SSC-SD), C) the Behavior Checklist (BCL), and D) the Communication Attitude Test for Adults (BigCAT). Participants were assigned to groups based on employment status (working versus retired). Descriptive comparison of the BAB-Voice in speakers with SD to previously published non-dysphonic speaker data revealed substantially higher scores associated with SD across all four subtests. Multivariate Analysis of Variance (MANOVA) revealed no significantly different BAB-Voice subtest scores as a function of SD group status (working vs. retired). BAB-Voice scores revealed that speakers with SD experienced substantial impact of their voice disorder on communication attitude, coping behaviors, and affective reactions in speaking situations as reflected in their high BAB scores. These impacts do not appear to be influenced by work status, as speakers with SD who were employed or retired experienced similar levels of affective and behavioral reactions in various speaking situations and cognitive responses. These findings are consistent with previously published pilot data. The specificity of items assessed by means of the BAB-Voice may inform the clinician of valid patient-centered treatment goals which target the impairment extended beyond the physiological dimension. 2b.

Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia.

PubMed

Vanryckeghem, Martine; Hoffman Ruddy, Bari; Lehman, Jeffrey

2016-01-01

This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice. Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individual's speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors. Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests. The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data. Published by Elsevier Inc.

Objective Dysphonia Quantification in Vocal Fold Paralysis: Comparing Nonlinear with Classical Measures

PubMed Central

Little, Max A.; Costello, Declan A. E.; Harries, Meredydd L.

2010-01-01

Summary Clinical acoustic voice-recording analysis is usually performed using classical perturbation measures, including jitter, shimmer, and noise-to-harmonic ratios (NHRs). However, restrictive mathematical limitations of these measures prevent analysis for severely dysphonic voices. Previous studies of alternative nonlinear random measures addressed wide varieties of vocal pathologies. Here, we analyze a single vocal pathology cohort, testing the performance of these alternative measures alongside classical measures. We present voice analysis pre- and postoperatively in 17 patients with unilateral vocal fold paralysis (UVFP). The patients underwent standard medialization thyroplasty surgery, and the voices were analyzed using jitter, shimmer, NHR, nonlinear recurrence period density entropy (RPDE), detrended fluctuation analysis (DFA), and correlation dimension. In addition, we similarly analyzed 11 healthy controls. Systematizing the preanalysis editing of the recordings, we found that the novel measures were more stable and, hence, reliable than the classical measures on healthy controls. RPDE and jitter are sensitive to improvements pre- to postoperation. Shimmer, NHR, and DFA showed no significant change (P > 0.05). All measures detect statistically significant and clinically important differences between controls and patients, both treated and untreated (P < 0.001, area under curve [AUC] > 0.7). Pre- to postoperation grade, roughness, breathiness, asthenia, and strain (GRBAS) ratings show statistically significant and clinically important improvement in overall dysphonia grade (G) (AUC = 0.946, P < 0.001). Recalculating AUCs from other study data, we compare these results in terms of clinical importance. We conclude that, when preanalysis editing is systematized, nonlinear random measures may be useful for monitoring UVFP-treatment effectiveness, and there may be applications to other forms of dysphonia. PMID:19900790

Reliability and validity of the Korean version of Pediatric Voice Handicap Index: in school age children.

PubMed

Park, Sung Shin; Kwon, Tack-Kyun; Choi, Seong Hee; Lee, Won Yong; Hong, Young Hye; Jeong, Nyun Gi; Sung, Myung-Whun; Kim, Kwang Hyun

2013-01-01

The aim of this study was to assess the reliability and validity of the Pediatric Voice Handicap Index (pVHI) for cross-cultural adaptation of the Korean version with school age children. The questionnaire was translated into Korean and was completed by 101 Korean parents who have children with or without disordered voice. The Korean version-pVHI scores were obtained with 60 parents of normal children and 41 parents who have children with voice problems. Content validity was verified by five experienced speech-language pathologists with clinical specialization in voice disorders. Internal consistency was calculated through Cronbach's α coefficient and test-retest reliability of the Korean version-pVHI score was determined using Pearson product-moment correlation coefficients. Mann-Whitney U test was used to compare GRBAS with the Korean version-pVHI scores between normal and dysphonia group. The relationship between the parent-reported the Korean version-pVHI total scores and perceptual ratings of voice quality from experts was investigated using Spearman correlation coefficients. The results showed that the Korean version-pVHI provided a high internal consistency (α=0.92) and test-retest reliability of its subscales: total (T) 0.97, functional (F) 0.90, physical (P) 0.95, emotional (E) 0.92. The Korean version-pVHI mean scores in normal group were 1.28 (T), 0.62 (F), 0.35 (P) and 0.32 (E), respectively whereas those of the Korean version-pVHI in children group with dysphonia were 23.13 (T), 8.90 (F), 9.54 (P) and 4.93 (E). Significant differences in the Korean version-pVHI (T, F, P, E) and perceptual evaluation (grade, rough, breathy) between normal and dysphonia group were revealed (P<0.05). Moreover, relatively moderate-to-high correlation between the Korean version-pVHI parameters (T) and perceptual measures (G) was exhibited in children with dysphonia. The subjective Korean version-pVHI can be applicable and useful supplementary tool for evaluating parents' perception of their children's voice dysfunction, identifying multifactors on daily life affecting their children's voice and measuring treatment efficacy before and after therapeutic intervention. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Liquid-type Botulinum Toxin Type A in Adductor Spasmodic Dysphonia: A Prospective Pilot Study.

PubMed

Cha, Wonjae; Jang, Jeon Yeob; Wang, Soo-Geun; Kang, Ji-Heon; Jo, Min-Gyu

2017-05-01

Botulinum toxin (BTX) has been widely used to treat adductor spasmodic dysphonia (ADSD). Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. Herein, we present a prospective pilot study to investigate the efficacy and safety of liquid-type BTX-A in the treatment of ADSD. Twenty-six consecutive liquid-type BTX-A injections were performed in 12 patients with ADSD. We included as a control group 34 consecutive patients with ADSD who had previously undergone 52 vocal fold injection procedures with freeze-dried-type BTX-A. All patients in both groups had improvement of symptoms related to ADSD and period of normal voice. Most patients experienced breathiness, and the onset time, the peak response time, and the duration of breathiness were similar in both groups. The duration of effect (days) was 96.96 ± 18.91 and 77.38 ± 18.97 in the freeze-dried-type and the liquid-type groups, and the duration of benefit (days) was 80.02 ± 18.24 and 62.69 ± 19.73 in the freeze-dried-type and the liquid-type groups. To compare the efficacy between the freeze-dried-type and the liquid-type BTX-A, the sessions of the unilateral vocal fold injection were included and were categorized as group A (1 ~ 2 units BTX-A) and group B (2 ~ 3 units BTX-A), according to the dose per vocal fold. There was no significant difference of effect time between freeze-dried-type and liquid-type BTX-A groups. No adverse events related to BTX or vocal fold injection were reported. Liquid-type BTX-A is safe and effective for the treatment of spasmodic dysphonia. With the advantages of simple preparation, storage, and reuse and animal protein-free constituents, liquid-type BTX-A may be a good option in the treatment of spasmodic dysphonia. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Parents' Evaluations of Their Children's Dysphonia: The Mamas and the Papas.

PubMed

Amir, Ofer; Wolf, Michael; Mick, Liron; Levi, Omer; Primov-Fever, Adi

2015-07-01

This study aimed to evaluate the validity and reliability of a Hebrew translation of the Pediatric Voice Handicap Index (pVHI). It also examined differences between mothers and fathers in evaluating their child's dysphonia. Observational design. The pVHI was first translated and adapted to Hebrew. The translated version was, then, administered to a group of 141 parents of children aged younger than 14 years. Fifty-eight parents had a dysphonic child, and 83 had a nondysphonic child. Based on the parents' responses to the pVHI, statistical analyses were performed, evaluating validity and reliability, as well as group differences. Following, a subset of the participants, in which only cases where the responses of both parents were available, was examined for evaluating differences between the responses of mothers (n = 46) and fathers (n = 46). Statistical analyses revealed high reliability of the Hebrew version of the pVHI (Cronbach alpha = .97). Parents of the dysphonic children rated their children significantly higher than parents of the nondysphonic group (P < 0.001). Mothers of the dysphonic children rated their children significantly higher than the fathers, on all subscales of the questionnaire (≥0.001 P < 0.047). In contrast, no significant differences were found between mothers and fathers of the nondysphonic children (P > 0.05). The Hebrew version of the pVHI is a reliable tool for quantifying parents' perception of their child's voice handicap. Mothers of dysphonic children evaluate their children's voice handicap more severely than fathers, whereas both parents of nondysphonic children perform this evaluation similarly. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Considerations for initial dosing of botulinum toxin in treatment of adductor spasmodic dysphonia.

PubMed

Rosow, David E; Parikh, Punam; Vivero, Richard J; Casiano, Roy R; Lundy, Donna S

2013-06-01

To assess the effect on voice improvement and duration of breathiness based on initial dose of onabotulinum toxin A (BTX-A) in the management of adductor spasmodic dysphonia (SD) and to compare voice outcomes for initial bilaterally injected doses of 1.25 units (group A) vs 2.5 units (group B) of BTX-A. Case series with chart review of patients with adductor SD treated at a tertiary care facility from 1990 to 2011. Academic subspecialty laryngology practice. Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between groups A and B using the Student t test and χ(2) analysis. Of 478 patients identified, 305 (223 in group A, 82 in group B) patients met inclusion criteria. The average age was 56.2 years in group A and 57.4 years in group B (P = .5). The female to male ratio was 2.91 for group A vs 3.56 for group B (P = .61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients vs 94% of group B (P = .75). The average duration of voice improvement was 99.7 days for group A and 108.3 days for group B (P = .54). The average duration of breathiness was 10.88 days for group A vs 15.42 days for group B (P = .02). Patients injected with 1.25 units bilaterally had a statistically significant shorter duration of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial BTX-A dose be used with subsequent titration to achieve improved voice outcomes.

Hoarseness.

PubMed

Sulica, Lucian

2011-06-01

Hoarseness is the colloquial expression for dysphonia ; these terms are often used interchangeably in medicine to refer to altered voice quality. Hoarseness may be both a symptom and a sign of dysfunction of the phonatory apparatus. It is never a diagnosis, despite having a corresponding International Classification of Diseases code and sometimes serving as such for purposes of administrative convenience. The same anatomical and physiological features that make the vocal folds uniquely suited for the high-speed vibration necessary for sound production render them exquisitely sensitive to a wide range of abnormalities. The breadth of pathologic conditions that can cause hoarseness makes a unified overview a challenge; hoarseness is simply not a homogeneous category after the initial laryngoscopy. Moreover, the available literature predominantly focuses on specific diagnoses rather than on hoarseness as a whole, so scant published data exist to support an evidence-based approach. Nevertheless, certain unifying principles exist.

Assessment of vocal cord nodules: a case study in speech processing by using Hilbert-Huang Transform

NASA Astrophysics Data System (ADS)

Civera, M.; Filosi, C. M.; Pugno, N. M.; Silvestrini, M.; Surace, C.; Worden, K.

2017-05-01

Vocal cord nodules represent a pathological condition for which the growth of unnatural masses on vocal folds affects the patients. Among other effects, changes in the vocal cords’ overall mass and stiffness alter their vibratory behaviour, thus changing the vocal emission generated by them. This causes dysphonia, i.e. abnormalities in the patients’ voice, which can be analysed and inspected via audio signals. However, the evaluation of voice condition through speech processing is not a trivial task, as standard methods based on the Fourier Transform, fail to fit the non-stationary nature of vocal signals. In this study, four audio tracks, provided by a volunteer patient, whose vocal fold nodules have been surgically removed, were analysed using a relatively new technique: the Hilbert-Huang Transform (HHT) via Empirical Mode Decomposition (EMD); specifically, by using the CEEMDAN (Complete Ensemble EMD with Adaptive Noise) algorithm. This method has been applied here to speech signals, which were recorded before removal surgery and during convalescence, to investigate specific trends. Possibilities offered by the HHT are exposed, but also some limitations of decomposing the signals into so-called intrinsic mode functions (IMFs) are highlighted. The results of these preliminary studies are intended to be a basis for the development of new viable alternatives to the softwares currently used for the analysis and evaluation of pathological voice.

Vernet syndrome resulting from varicella zoster virus infection-a very rare clinical presentation of a common viral infection.

PubMed

Ferreira, João; Franco, Ana; Teodoro, Tiago; Coelho, Miguel; Albuquerque, Luísa

2018-03-12

Vernet syndrome is a unilateral palsy of glossopharyngeal, vagus, and accessory nerves. Varicella zoster virus (VZV) infection has rarely been described as a possible cause. A 76-year-old man presented with 1-week-long symptoms of dysphonia, dysphagia, and weakness of the right shoulder elevation, accompanied by a mild right temporal parietal headache with radiation to the ipsilateral ear. Physical examination showed signs compatible with a right XI, X, and XI cranial nerves involvement and also several vesicular lesions in the right ear's concha. He had a personal history of poliomyelitis and chickenpox. Laringoscopy demonstrated right vocal cord palsy. Brain MRI showed thickening and enhancement of right lower cranial nerves and an enhancing nodular lesion in the ipsilateral jugular foramen, in T1 weighted images with gadolinium. Cerebrospinal fluid (CSF) analysis disclosed a mild lymphocytic pleocytosis and absence of VZV-DNA by PCR analysis. Serum VZV IgM and IgG antibodies were positive. The patient had a noticeable clinical improvement after initiation of acyclovir and prednisolone therapy. The presentation of a VZV infection with isolated IX, X, and XI cranial nerves palsy is extremely rare. In our case, the diagnosis of Vernet syndrome as a result of VZV infection was made essentially from clinical findings and supported by analytical and imaging data.

Bamboo Nodes of Vocal Folds: A Description of 10 Cases and Review of the Literature.

PubMed

Todic, Jelena; Schweizer, Valérie; Leuchter, Igor

2018-05-30

Bamboo nodes are vocal fold lesions, mostly associated with autoimmune diseases. This is a retrospective clinical study including 10 patients with bamboo nodes. Data were collected regarding associated autoimmune disorder and type of treatment. A systematic review of the literature was conducted. All patients were women, with hoarseness as the most frequent symptom. There was in most cases an associated autoimmune disease: 3 patients with systemic lupus erythematosus; 3 with rheumatoid arthritis; 1 with Sjögren syndrome; 1 with Hashimoto disease; and 1 with mixed connective tissue disease. Four patients were treated with speech therapy, 3 with oral steroids, 1 with speech therapy and oral steroids combined, 1 with oral steroids and laryngeal steroid injections, and 1 had oral steroids, surgery, and speech therapy. Speech therapy was the first-line treatment. Bamboo nodes should be looked for in every patient with a diagnosis of autoimmune disease complaining of dysphonia. © 2018 S. Karger AG, Basel.

The Role of Occupational Voice Demand and Patient-Rated Impairment in Predicting Voice Therapy Adherence.

PubMed

Ebersole, Barbara; Soni, Resha S; Moran, Kathleen; Lango, Miriam; Devarajan, Karthik; Jamal, Nausheen

2018-05-01

Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence. A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk. Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P < 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P < 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of >40 is a significant cutoff point for predicting therapy nonadherence (P < 0.011 and P < 0.004, respectively). Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of >40 is a significant cutoff point for predicting nonadherence risk. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Validation of the Acoustic Voice Quality Index in the Lithuanian Language.

PubMed

Uloza, Virgilijus; Petrauskas, Tadas; Padervinskis, Evaldas; Ulozaitė, Nora; Barsties, Ben; Maryn, Youri

2017-03-01

The aim of the present study was to validate the Acoustic Voice Quality Index in Lithuanian language (AVQI-LT) and investigate the feasibility and robustness of its diagnostic accuracy, differentiating normal and dysphonic voice. A total of 184 native Lithuanian subjects with normal voices (n = 46) and with various voice disorders (n = 138) were asked to read aloud the Lithuanian text and to sustain the vowel /a/. A sentence with 13 syllables and a 3-second midvowel portion of the sustained vowel were edited. Both speech tasks were concatenated, and perceptually rated for dysphonia severity by five voice clinicians. They rated the Grade (G) from the Grade Roughness Breathiness Asthenia Strain (GRBAS) protocol and the overall severity from the Consensus Auditory-perceptual Evaluation of Voice protocol with a visual analog scale (VAS). The average scores (G mean and VAS mean ) were taken as the perceptual dysphonia severity level for every voice sample. All concatenated voice samples were acoustically analyzed to receive an AVQI-LT score. Both auditory-perceptual judgment procedures showed sufficient strength of agreement between five raters. The results achieved significant and marked concurrent validity between both auditory-perceptual judgment procedures and AVQI-LT. The diagnostic accuracy of AVQI-LT showed for both auditory-perceptual judgment procedures comparable results with two different AVQI-LT thresholds. The AVQI-LT threshold of 2.97 for the G mean rating obtained reasonable sensitivity = 0.838 and excellent specificity = 0.937. For the VAS rating, an AVQI-LT threshold of 3.48 was determined with sensitivity = 0.840 and specificity = 0.922. The AVQI-LT is considered a valid and reliable tool for assessing the dysphonia severity level in Lithuanian-speaking population. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Adaptation and validation of Spanish version of the pediatric Voice Handicap Index (P-VHI).

PubMed

Sanz, Lorena; Bau, Patricia; Arribas, Ignacio; Rivera, Teresa

2015-09-01

The voice in childhood is a communication tool and a form of emotional expression. It is estimated that 6 to 23% of children may have voice disorders. There is a test, the Pediatric Voice Handicap Index (P-VHI), validated in English to assess the specific impact on quality of life of children with speech pathology. Spanish is the second most widely used language in the world in terms of number of speakers, with over 500 million native speakers, so it is necessary to have tools that allow us to evaluate the effects of dysphonia in Spanish-speaking children. The aim of our study is the validation of the Spanish version of the P-VHI. We performed a cross-sectional study including patients between 4 and 15 years of age. The English P-VHI validated version was translated into Spanish and this translation was reviewed and modified by three specialists in Otorhinolaryngology. There were two study groups, children who had dysphonia (n=44) and a control group of children without alterations in voice (n=44). The questionnaire was always answered by parents. Significant differences were found between the group of children with dysphonia and the control group in the overall P-VHI score and the different subscales (p<0.001). Optimal internal consistency with a good Cronbach's alpha (α=0.81) was found, with high test-retest reliability (Wilcoxon z: -0847, p>0.05). The Spanish version of the P-VHI is a validated tool that has good internal consistency. It is a reliable test that evaluates the Voice Handicap Index in the pediatric population, with easy application for daily clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Adherence to Voice Therapy Recommendations Is Associated With Preserved Employment Fitness Among Teachers With Work-Related Dysphonia.

PubMed

Rinsky-Halivni, Lilah; Klebanov, Miriam; Lerman, Yehuda; Paltiel, Ora

2017-05-01

Referral to voice therapy and recommendations for voice rest and microphone use are common interventions in occupational medicine aimed at preserving the working capability of teachers with occupation-related voice problems. Research on the impact of such interventions in terms of employment is lacking. This study examined changes in fitness (ie, ability) to work of dysphonic teachers referred to an occupational clinic and evaluated employment outcomes following voice therapy, voice rest, and microphone use. A historical prospective study was carried out. Of 365 classroom teachers who were first referred to a regional occupational medicine clinic due to dysphonia between January 2007 and December 2012, 156 were sampled and 153 were followed-up for an average of 5 years (range 2-8). Data were collected from medical records and from interviews conducted in 2014 aimed at assessing employment status. Logistic regression models were used to assess associations between interventions and employment outcomes. Survival analyses were performed to evaluate the association between participating in voice therapy and length of retained employment fitness. Thirty-four (22.2%) teachers suffered declines in working capabilities due to dysphonia. Voice therapy was demonstrated as being a protective factor against such declines (odds ratio = 0.05 [0.01-0.27]). Adherence to recommendation of voice therapy was <50%. Most of the decline in working fitness among nonadherent teachers occurred within 20 months after referral. Unlike voice therapy, voice rest and microphone use were not associated with retention of working capabilities. Voice therapy, especially when instituted early, is a strong predictor for retaining fitness for employment among dysphonic teachers. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effect of adenoid hypertrophy on the voice and laryngeal mucosa in children.

PubMed

Gomaa, Mohammed A; Mohammed, Haitham M; Abdalla, Adel A; Nasr, Dalia M

2013-12-01

The adenoids, or pharyngeal tonsils, are lymphatic tissue localized at the mucous layer of the roof and posterior wall of nasopharynx. Dysphonia defined as perceptual audible change of a patient's habitual voice as self judged or judged by his or her listeners. The diagnosis of dysphonia relies on clinical judgment based on phoniatric symptoms, auditory perceptual assessment of voice (APA) and full laryngeal examination. Our study was conducted to evaluate the effect of adenoid hypertrophy on voice and laryngeal mucosa. The study sample composed of sixty children, forty of them had adenoid hypertrophy (patient's group) and twenty healthy children (control group). Patient's group composed of 17 boys (42.5%) and 23 girls (57.5%), while control group consists of 8 males (40%) and 12 females (60%). All patients and control group subjected to history taking, clinical examination, lateral soft tissue X-ray on the nasopharynx, APA based on the modified GRBAS scale and full laryngeal examination. The data are collected and analyzed statistically by using software SPSS. Our results showed that there is a significant association between adenoid hypertrophy and, degree of dysphonia, leaky voice, pitch of voice and laryngeal lesion. Adenoid hypertrophy did not associate with loudness of voice, as well as character (irregular, breathy and strained). Laryngeal lesions were detected in thirteen children from patient group (32.5%): nodules (n = 6), thickening (n = 5), congestion (n = 2), while one child only out of 20 children of the control group had congestion (5.0%). Our results showed the importance of the assessment of voice and laryngeal examination in patients with adenoid hypertrophy, also treating the minimal mucosal lesions that results from adenoid hypertrophy should be taken in consideration. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Differentiating between adductor and abductor spasmodic dysphonia using airflow interruption

PubMed Central

Hoffman, Matthew R.; Jiang, Jack J.; Rieves, Adam L.; McElveen, Kelsey A.B.; Ford, Charles N.

2009-01-01

Objective To measure the laryngeal resistance (RL), subglottal pressure (Ps), and mean flow rate (MFR) of adductor (ADSD) and abductor (ABSD) spasmodic dysphonia patients using the airflow interrupter. Methods The RL of six ABSD and seven ADSD patients was measured using the airflow interrupter, a noninvasive device designed to measure MFR and Ps via mechanical balloon valve interruption. Subjects performed ten trials at each of two intensity levels, with each trial consisting of a sustained /a/ during which phonation was interrupted for 500 ms. Laryngeal resistance was calculated as subglottal pressure divided by airflow. Results Mean RL for the ADSD and ABSD subtypes at 65 dB were 24.78 cmH2O/l/s and 14.51 cmH2O/l/s, respectively (p = 0.04). Mean RL at 70 dB were 40.02 cmH2O/l/s and 15.84 cmH2O/l/s (p = 0.014). Ps for the ADSD and ABSD subtypes at 65 dB were 10.23 cmH2O and 8.32 cmH2O, respectively (p = 0.582). At the 70 dB level, Ps were 12.39 cmH2O and 11.78 cmH2O (p = 0.886). MFR for the ADSD and ABSD subtypes at 65 dB were 435 ml/s and 746 ml/s (p = 0.205). Mean MFR at 70 dB were 518 ml/s and 848 ml/s (p = 0.198). Conclusion Noninvasive measurements of RL may be useful for differentiating between ADSD and ABSD. This simple objective test which produces a quantitative output could be used to evaluate laryngeal function in patients with spasmodic dysphonia. PMID:19554636

Communication‐related affective, behavioral, and cognitive reactions in speakers with spasmodic dysphonia

PubMed Central

Vanryckeghem, Martine

2017-01-01

Objectives To investigate the self‐perceived affective, behavioral, and cognitive reactions associated with communication of speakers with spasmodic dysphonia as a function of employment status. Study Design Prospective cross‐sectional investigation Methods 148 Participants with spasmodic dysphonia (SD) completed an adapted version of the Behavior Assessment Battery (BAB‐Voice), a multidimensional assessment of self‐perceived reactions to communication. The BAB‐Voice consisted of four subtests: the Speech Situation Checklist for A) Emotional Reaction (SSC‐ER) and B) Speech Disruption (SSC‐SD), C) the Behavior Checklist (BCL), and D) the Communication Attitude Test for Adults (BigCAT). Participants were assigned to groups based on employment status (working versus retired). Results Descriptive comparison of the BAB‐Voice in speakers with SD to previously published non‐dysphonic speaker data revealed substantially higher scores associated with SD across all four subtests. Multivariate Analysis of Variance (MANOVA) revealed no significantly different BAB‐Voice subtest scores as a function of SD group status (working vs. retired). Conclusions BAB‐Voice scores revealed that speakers with SD experienced substantial impact of their voice disorder on communication attitude, coping behaviors, and affective reactions in speaking situations as reflected in their high BAB scores. These impacts do not appear to be influenced by work status, as speakers with SD who were employed or retired experienced similar levels of affective and behavioral reactions in various speaking situations and cognitive responses. These findings are consistent with previously published pilot data. The specificity of items assessed by means of the BAB‐Voice may inform the clinician of valid patient‐centered treatment goals which target the impairment extended beyond the physiological dimension. Level of Evidence 2b PMID:29299525

Cepstral analysis of normal and pathological voice in Spanish adults. Smoothed cepstral peak prominence in sustained vowels versus connected speech.

PubMed

Delgado-Hernández, Jonathan; León-Gómez, Nieves M; Izquierdo-Arteaga, Laura M; Llanos-Fumero, Yanira

In recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia. Forty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale. Significantly lower values were found in the dysphonic voices, both for/a/(t [38] = 4.85, P<.000) and for phrases (t [38] = 5,75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (r s = -0.73) and moderate correlation with that calculated from the sustained vowel (r s = -0,56). The results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Emotional Considerations in Spasmodic Dysphonia: Psychometric Quantification.

ERIC Educational Resources Information Center

Cannito, Michael P.

1991-01-01

This study examined emotional characteristics of 18 female spasmodic dysphonic subjects in comparison to matched normal controls across psychometric measures of depression, anxiety, and somatic complaints. Statistically significant differences were noted between groups for all measures and over half of the dysphonic subjects exhibited clinically…

Voice care knowledge among clinicians and people with healthy voices or dysphonia.

PubMed

Fletcher, Helen M; Drinnan, Michael J; Carding, Paul N

2007-01-01

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.

Pathogenic variants in TUBB4A are not found in primary dystonia

PubMed Central

Vemula, Satya R.; Xiao, Jianfeng; Bastian, Robert W.; Momčilović, Dragana; Blitzer, Andrew

2014-01-01

Objective: To determine the contribution of TUBB4A, recently associated with DYT4 dystonia in a pedigree with “whispering dysphonia” from Norfolk, United Kingdom, to the etiopathogenesis of primary dystonia. Methods: High-resolution melting and Sanger sequencing were used to inspect the entire coding region of TUBB4A in 575 subjects with primary laryngeal, segmental, or generalized dystonia. Results: No pathogenic variants, including the exon 1 variant (c.4C>G) identified in the DYT4 whispering dysphonia kindred, were found in this study. Conclusion: The c.4C>G DYT4 mutation appears to be private, and clinical testing for TUBB4A mutations is not justified in spasmodic dysphonia or other forms of primary dystonia. Moreover, given its allelic association with leukoencephalopathy hypomyelination with atrophy of basal ganglia and cerebellum and protean clinical manifestations (chorea, ataxia, dysarthria, intellectual disability, dysmorphic facial features, and psychiatric disorders), DYT4 should not be categorized as a primary dystonia. PMID:24598712

Botulinum Toxin-A Dosing Trends for Adductor Spasmodic Dysphonia at a Single Institution Over 10 Years.

PubMed

Bradley, Joseph P; Barrow, Emily M; Hapner, Edie R; Klein, Adam M; Johns, Michael M

2017-05-01

This study aimed to identify the changes in dosing of botulinum toxin-A for adductor spasmodic dysphonia (ADSD) over a prolonged period. This is a retrospective chart review. One hundred thirteen subjects treated for ADSD from 2003 to 2013 were identified from a clinical database. Subject age, gender, and total injection dose amount were all recorded for all subjects who had at least 10 injections. Fifty-four subjects met criteria for inclusion. There were no age or gender differences in the starting dose for subjects. Dosing decreased significantly compared with the second dose (5.05 ± 1.623 Units), by the sixth dose (4.26 ± 1.698 Units), and continued through the 10th dose (4.08 ± 2.019 Units) (P < 0.005 for all). Botulinum toxin-A dosing for ADSD decreases consistently over subsequent injections after the initial two dose titrations. Copyright © 2017. Published by Elsevier Inc.

Laryngeal dystonia gravidarum: sudden onset of adductor spasmodic dysphonia in pregnancy.

PubMed

Ankola, Ashish; Sulica, Lucian; Murry, Thomas

2013-12-01

The purpose of this study was to identify the presence or absence of known factors related to onset of adductor spasmodic dysphonia (ADSD) in a population with sudden onset during or after pregnancy. Retrospective review. A review of 350 patient records identified five patients with sudden onset of ADSD related to pregnancy. An age-matched group with sudden onset of ADSD not related to pregnancy served as controls. All subjects completed a 20-question survey of risk factors relevant to ADSD. The average age of onset in both groups was 31 years. Three had onset of ADSD in the postpartum period, the other two during pregnancy. Significantly increased avocational voice use was found in the pregnant group compared to the control group. There was a significant difference in the two groups regarding cumulative risk factors traditionally associated with ADSD. Sudden onset of ADSD can occur in pregnancy in women with clinical profiles that differ from traditional ADSD patients. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

A Qualitative Study of Interference with Communicative Participation across Communication Disorders in Adults

ERIC Educational Resources Information Center

Baylor, Carolyn; Burns, Michael; Eadie, Tanya; Britton, Deanna; Yorkston, Kathryn

2011-01-01

Purpose: To explore the similarities and differences in self-reported restrictions in communicative participation across different communication disorders in community-dwelling adults. Method: Interviews were conducted with 44 adults representing 7 different medical conditions: spasmodic dysphonia, multiple sclerosis, stroke, stuttering,…

Consensus-Based Attributes for Identifying Patients With Spasmodic Dysphonia and Other Voice Disorders.

PubMed

Ludlow, Christy L; Domangue, Rickie; Sharma, Dinesh; Jinnah, H A; Perlmutter, Joel S; Berke, Gerald; Sapienza, Christine; Smith, Marshall E; Blumin, Joel H; Kalata, Carrie E; Blindauer, Karen; Johns, Michael; Hapner, Edie; Harmon, Archie; Paniello, Randal; Adler, Charles H; Crujido, Lisa; Lott, David G; Bansberg, Stephen F; Barone, Nicholas; Drulia, Teresa; Stebbins, Glenn

2018-06-21

A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders. To determine the agreement among experts not using standard guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert consensus attributes for classifying patients for research. From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study). Subsequently, a 4-stage Delphi method study used reiterative stages of review by an expert panel and 46 community experts to develop consensus on attributes to be used for classifying patients with the 4 disorders (second study). The study used a convenience sample of 178 patients clinically diagnosed with ADSD, ABSD, VT MTD, vocal fold paresis/paralysis, psychogenic voice disorders, or hypophonia secondary to Parkinson disease. Participants were aged 18 years or older, without laryngeal structural disease or surgery for ADSD and underwent speech and nasolaryngoscopy video recordings following a standard protocol. Speech and nasolaryngoscopy video recordings following a standard protocol. Specialists at 4 sites classified 178 patients into 11 categories. Four international experts independently classified 75 patients using the same categories without guidelines after viewing speech and nasolaryngoscopy video recordings. Each member from the 4 sites also classified 50 patients from other sites after viewing video clips of voice/laryngeal tasks. Interrater κ less than 0.40 indicated poor classification agreement among rater pairs and across recruiting sites. Consequently, a Delphi panel of 13 experts identified and ranked speech and laryngeal movement attributes for classifying ADSD, ABSD, VT, and MTD, which were reviewed by 46 community specialists. Based on the median attribute rankings, a final attribute list was created for each disorder. When classifying patients without guidelines, raters differed in their classification distributions (likelihood ratio, χ2 = 107.66), had poor interrater agreement, and poor agreement with site categories. For 11 categories, the highest agreement was 34%, with no κ values greater than 0.26. In external rater pairs, the highest κ was 0.23 and the highest agreement was 38.5%. Using 6 categories, the highest percent agreement was 73.3% and the highest κ was 0.40. The Delphi method yielded 18 attributes for classifying disorders from speech and nasolaryngoscopic examinations. Specialists without guidelines had poor agreement when classifying patients for research, leading to a Delphi-based development of the Spasmodic Dysphonia Attributes Inventory for classifying patients with ADSD, ABSD, VT, and MTD for research.

[Hyperthyroidism in children. Experience in internal medicine in Mali].

PubMed

Sidibé, A T; Dembélé, M; Diarra, A S; Bocoum, A I; Mousseni, E; Ag Aboubacrine, S; Traoré, H A; Ag Rhaly, A

2007-06-01

Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

[The effect of smoking and forced use of the voice to development of the vocal polyps].

PubMed

Gnjatic, M; Stankovic, P; Djukić, V

2009-01-01

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 pathophysiological 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 aswell as other benign changes.

Vocal Function in Introverts and Extraverts during a Psychological Stress Reactivity Protocol

ERIC Educational Resources Information Center

Dietrich, Maria; Verdolini Abbott, Katherine

2012-01-01

Purpose: To examine the proposal that introversion predictably influences extralaryngeal and vocal behavior in vocally healthy individuals compared with individuals with extraversion and whether differences are of a nature that may support a risk hypothesis for primary muscle tension dysphonia. Method: Fifty-four vocally healthy female adults…

Longitudinal Phonatory Characteristics after Botulinum Toxin Type A Injection.

ERIC Educational Resources Information Center

Fisher, Kimberly V.; And Others

1996-01-01

A study investigated the long-term effects of a Botulinum Toxin Type A injection on the glottal competency of a man with adductor spasmodic dysphonia. Results suggest that change in degree of glottal adduction over time can be observed even when vocal instability is present within each recording session. (CR)

An atypical sarcoidosis involvement in FDG PET/CT

PubMed Central

Robin, Philippe; Benigni, Paolo; Feger, Benoit; Salaun, Pierre-Yves; Abgral, Ronan

2016-01-01

Abstract Rationale: Sarcoidosis is an idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis which involve various organs. Laryngeal involvement is extremely rare, with a prevalence of about 0.5 to 1%. Diagnoses: Here we present a case of laryngeal involvement of sarcoidosis demonstrated on 18F-Fluorodesoxyglucose Positron-Emission Tomography/Computed Tomography (FDG PET/CT). Patient concerns: A 63 year-old man suffering from dysphonia was referred to our department for characterization of laryngeal lesion suspicious for cancer with non-informative biopsy, the sample was not sufficient for diagnosis. Interventions: FDG PET/CT showed a pathological uptake on the right vocal cord, but also highlighted a bilateral uptake in intrathoracic hilar lymphadenopathy areas, typically found in several inflammatory diseases. Outcomes: New laryngeal targeted biopsies revealed non-caseating epithelioid granulomas suggesting sarcoidosis involvement. After 6 months of systemic steroid treatment, FDG PET/CT showed a significant decrease of the laryngeal uptake. Lessons: This case shows the usefulness of FDG PET/CT to accurately assess inflammatory activity in rare extra-pulmonary sarcoidosis involvement. Moreover, this case emphasizes that FDG PET/CT is an interesting tool for assessing therapeutic efficacy of inflammatory diseases such as sarcoidosis. PMID:28033265

PubMed

Schützenberger, Anne; Hammer, Georg Philipp

2018-06-01

Sanuki T et al. Long-term Evaluation of Type 2 Thyroplasty with Titanium Bridges for Adductor Spasmodic Dysphonia. Otolaryngol Head Neck Surg 2017; 157: 80–84 JAPANISCHE ÄRZTE FüR HALS-, NASEN- UND OHRENHEILKUNDE SOWIE KOPF- UND HALSCHIRURGIE BERICHTETEN üBER STIMMLICHE LANGZEITERGEBNISSE NACH DURCHFüHRUNG EINER THYROPLASTIK TYP 2 ZUR BEHANDLUNG DER SPASMODISCHEN DYSPHONIE VOM ADDUKTOR TYP.

Comparing Voice-Therapy and Vocal-Hygiene Treatments in Dysphonia Using a Limited Multidimensional Evaluation Protocol

ERIC Educational Resources Information Center

Rodriguez-Parra, Maria J.; Adrian, Jose A.; Casado, Juan C.

2011-01-01

Purpose: This study evaluates the effectiveness of two different programs of voice-treatment on a heterogeneous group of dysphonic speakers and the stability of therapeutic progress for longterm follow-up post-treatment period, using a limited multidimensional protocol of evaluation. Method: Forty-two participants with voice disorders were…

Reliability and Applicability of Aerodynamic Measures in Dysphonia Assessment

ERIC Educational Resources Information Center

Yiu, Edwin M.-L.; Yuen, Yuet-Ming; Whitehill, Tara; Winkworth, Alison

2004-01-01

Aerodynamic measures are frequently used to analyse and document pathological voices. Some normative data are available for speakers from the English-speaking population. However, no data are available yet for Chinese speakers despite the fact that they are one of the largest populations in the world. The high variability of aerodynamic measures…

Difference in Voice Problems and Noise Reports Between Teachers of Public and Private Schools in Upper Egypt.

PubMed

Abo-Hasseba, Ahmed; Waaramaa, Teija; Alku, Paavo; Geneid, Ahmed

2017-07-01

This study aimed to assess teachers' voice symptoms and noise in schools in Upper Egypt and to study possible differences between teachers in public and private schools. A cross-sectional analysis via questionnaire was carried out. Four schools were chosen randomly to represent primary and preparatory schools as well as public and private ones. In these schools, a total of 140 teachers participated in the study. They answered a questionnaire on vocal and throat symptoms and their effects on working and social activities, as well as levels and effects of experienced noise. Of all teachers, 47.9% reported moderate or severe dysphonia within the last 6 months, and 21.4% reported daily dysphonia. All teachers reported frequent feelings of being in noise, with 82.2% feeling it sometimes or always during the working day, resulting in a need to raise their voice. Teachers in public schools experienced more noise from nearby classes. The working conditions and vocal health of teachers in Upper Egypt, especially in public schools, are alarming. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study

PubMed Central

Gündel, H; Busch, R; Ceballos‐Baumann, A; Seifert, E

2007-01-01

Objectives To study the prevalence of psychiatric comorbidity assessed by a structured clinical interview in patients with spasmodic dysphonia (SD) compared with patients suffering from vocal fold paralysis (VFP). Methods In 48 patients with SD and 27 patients with VFP, overall psychiatric comorbidity was studied prospectively using the Structured Clinical Interview for DSM‐IV Axis I disorders. Physical disability and psychometric variables were assessed with standardised self‐rating questionnaires. Results 41.7% of SD subjects and 19.5% of the control group met DSM‐IV clinical criteria for current psychiatric comorbidity (p<0.05). Significant predictors of psychiatric comorbidity in SD were severity of voice impairment and subjective assessment of “satisfaction with health”. As a limitation, the severity of voice impairment in patients with SD was nearly twice as high, and their illness had lasted nearly twice as long. Conclusions We found a high prevalence of psychiatric comorbidity in patients with SD. The significant correlation between current psychiatric comorbidity and the extent of voice pathology may point to an especially strong interaction between somatic and psychiatric complaints in SD. PMID:17615166

An unusual presentation of an infected vallecular cyst presenting as supraglottitis

PubMed Central

Pattni, Vijay; Porter, Graham; Omakobia, Eugene

2013-01-01

A 50-year-old gentleman presented to the emergency department with a 24 h history of stridor, dysphonia, dysphagia and vomiting. On examination, the patient had fever and tachycardic. There was no palpable cervical lymphadenopathy. Flexible nasendoscopy and lateral neck x-ray revealed soft tissue swelling around the epiglottis. The swelling subsided with conservative management of intravenous antibiotics and steroids, only to later reveal a vallecular cyst, which was confirmed on microlaryngoscopy. The cyst was subsequently deroofed and sent for biopsy. Histological examination revealed an infected, benign vallecular cyst consisting of a squamous epithelium with underlying lymphoid tissue. In adults, vallecular cysts are usually asymptomatic, but can become infected and initiate acute supraglottitis, potentially leading to life-threatening airway obstruction. The case described here, although rare, highlights how early definitive diagnosis and management of vallecular cysts can lead to significantly improved patient outcomes. PMID:23608863

Posterior pharyngeal candidiasis in the absence of clinically overt oral involvement: a cross-sectional study.

PubMed

Glavey, Siobhan V; Keane, Niamh; Power, Maria; O'Regan, Anthony W

2013-12-01

Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy. We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy. Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage. This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.

Correlation Between Acoustic Measurements and Self-Reported Voice Disorders Among Female Teachers.

PubMed

Lin, Feng-Chuan; Chen, Sheng Hwa; Chen, Su-Chiu; Wang, Chi-Te; Kuo, Yu-Ching

2016-07-01

Many studies focused on teachers' voice problems and most of them were conducted using questionnaires, whereas little research has investigated the relationship between self-reported voice disorders and objective quantification of voice. This study intends to explore the relationship of acoustic measurements according to self-reported symptoms and its predictive value of future dysphonia. This is a case-control study. Voice samples of 80 female teachers were analyzed, including 40 self-reported voice disorders (VD) and 40 self-reported normal voice (NVD) subjects. The acoustic measurements included jitter, shimmer, and noise-to-harmonics ratio (NHR). Levene's t test and logistic regression were used to analyze the differences between VD and NVD and the relationship between self-reported voice conditions and the acoustic measurements. To examine whether acoustic measurements can be used to predict further voice disorders, we applied a receiver operating characteristic (ROC) curve to determine the cutoff values and the associated sensitivity and specificity. The results showed that jitter, shimmer, and the NHR of VD were significantly higher than those of NVD. Among the parameters, the NHR and shimmer demonstrated the highest correlation with self-reported voice disorders. By using the NHR ≥0.138 and shimmer ≥0.470 dB as the cutoff values, the ROC curve displayed 72.5% of sensitivity and 75% of specificity, and the overall positive predictive value for subsequent dysphonia achieved 60%. This study demonstrated a significant correlation between acoustic measurements and self-reported dysphonic symptoms. NHR and ShdB are two acoustic parameters that are more able to reflect vocal abnormalities and, probably, to predict subsequent subjective voice disorder. Future research recruiting more subjects in other occupations and genders shall validate the preliminary results revealed in this study. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Contemporary management of voice and swallowing disorders in patients with advanced lung cancer.

PubMed

Brady, Grainne C; Carding, Paul N; Bhosle, Jaishree; Roe, Justin W G

2015-06-01

Advanced lung cancer can cause changes to swallowing and communication function. Direct tumour invasion, dyspnoea and deconditioning can all impact on swallowing function and communication. Cancer treatment, if administered, may cause or compound symptoms. In this study, the nature of swallowing and communication difficulties in patients with advanced lung cancer will be discussed, and management options including medical management, speech and language therapy (SLT) intervention, and surgical interventions will be considered. Advanced lung cancer can result in voice and swallowing difficulties, which can increase symptom burden and significantly impact on quality of life (QOL). There is a growing evidence base to support the use of injection laryngoplasty under local anaesthetic to offer immediate improvement in voice, swallowing and overall QOL. There is limited literature on the nature and extent of voice and swallowing impairment in patients with lung cancer. Well designed studies with robust and sensitive multidimensional dysphagia and dysphonia assessments are required. Outcome studies examining interventions with clearly defined treatment goals are required. These studies should include both functional and patient-reported outcome measures to develop the evidence base and to ensure that interventions are both timely and appropriate.

Developing the Communicative Participation Item Bank: Rasch Analysis Results from a Spasmodic Dysphonia Sample

ERIC Educational Resources Information Center

Baylor, Carolyn R.; Yorkston, Kathryn M.; Eadie, Tanya L.; Miller, Robert M.; Amtmann, Dagmar

2009-01-01

Purpose: The purpose of this study was to conduct the initial psychometric analyses of the Communicative Participation Item Bank--a new self-report instrument designed to measure the extent to which communication disorders interfere with communicative participation. This item bank is intended for community-dwelling adults across a range of…

The Effect of Background Noise on Intelligibility of Dysphonic Speech

ERIC Educational Resources Information Center

Ishikawa, Keiko; Boyce, Suzanne; Kelchner, Lisa; Powell, Maria Golla; Schieve, Heidi; de Alarcon, Alessandro; Khosla, Sid

2017-01-01

Purpose: The aim of this study is to determine the effect of background noise on the intelligibility of dysphonic speech and to examine the relationship between intelligibility in noise and an acoustic measure of dysphonia--cepstral peak prominence (CPP). Method: A study of speech perception was conducted using speech samples from 6 adult speakers…

Use of Spectral/Cepstral Analyses for Differentiating Normal from Hypofunctional Voices in Sustained Vowel and Continuous Speech Contexts

ERIC Educational Resources Information Center

Watts, Christopher R.; Awan, Shaheen N.

2011-01-01

Purpose: In this study, the authors evaluated the diagnostic value of spectral/cepstral measures to differentiate dysphonic from nondysphonic voices using sustained vowels and continuous speech samples. Methodology: Thirty-two age- and gender-matched individuals (16 participants with dysphonia and 16 controls) were recorded reading a standard…

Behavioral and Environmental Analysis of Self-Reported Dysphonic and Non-Dysphonic High School Music Teachers

ERIC Educational Resources Information Center

Brown, Emily Pence

2016-01-01

Vocal fatigue and dysphonia are considered to be common hazards associated with occupational voice users. Teachers, due to the consistent communication demands of the profession, represent the highest percentage of clinical voice disorder patients (Verdolini & Ramig, 2001). Voice related injuries in teachers could result in lost wages due to…

Genetic and Environmental Effects on Vocal Symptoms and Their Intercorrelations

ERIC Educational Resources Information Center

Nybacka, Ida; Simberg, Susanna; Santtila, Pekka; Sala, Eeva; Sandnabba, N. Kenneth

2012-01-01

Purpose: Recently, Simberg et al. (2009) found genetic effects on a composite variable consisting of 6 vocal symptom items measuring dysphonia. The purpose of the present study was to determine genetic and environmental effects on the individual vocal symptoms in a population-based sample of Finnish twins. Method: The sample comprised 1,728 twins…

Behavioral and Environmental Analysis of Self-Reported Dysphonic and Nondysphonic High School Music Teachers

ERIC Educational Resources Information Center

Brown, Emily Pence

2017-01-01

Dysphonia is considered to be a common hazard associated with occupational voice users. Teachers represent the highest percentage of clinical voice disorder patients. Voice injuries in teachers could result in lost wages due to missed work, additional costs for medications, therapy, and surgeries, and teacher attrition. The purpose of this study…

Primary thyroid tuberculosis: a rare etiology of hypothyroidism and anterior cervical mass mimicking carcinoma.

PubMed

Silva, Bradley Paulino da; Amorim, Erico Gurgel; Pavin, Elizabeth João; Martins, Antonio Santos; Matos, Patrícia Sabino de; Zantut-Wittmann, Denise Engelbrecht

2009-06-01

The involvement of the thyroid by tuberculosis (TB) is rare. Hypothyroidism caused by tissue destruction is an extremely rare report. Our aim was to report a patient with primary thyroid TB emphasizing the importance of diagnosis, despite the rarity of the occurrence. Women, 62 years old, showing extensive cervical mass since four months, referring lack of appetite, weight loss, dysphagia and dysphonia. Laboratorial investigation revealed primary hypothyroidism. Cervical ultrasound: expansive lesion in left thyroid lobe, involving adjacent muscle. Computed tomography scan: 13 cm diameter cervical mass with central necrosis. Fine needle biopsy: hemorrhagic material. total thyroidectomy, left radical neck dissection and protective tracheotomy. The pathological examination showed chronic granulomatous inflammatory process with areas of caseous necrosis and lymph node involvement. The thyroid baciloscopy was positive. Pulmonary disease was absent. The patient was treated with antituberculosis drugs. Thyroid TB is not frequent, and should be considered as differential diagnosis of hypothyroidism and anterior cervical mass.

Wong-Type Dermatomyositis Showing Porokeratosis-Like Changes (Columnar Dyskeratosis): A Case Report and Review of the Literature

PubMed Central

Umanoff, Nicole; Fisher, Ari; Carlson, J. Andrew

2015-01-01

Background Wong-type dermatomyositis (DM) exhibits simultaneous pityriasis rubra pilaris (PRP) features. Case Report A 50-year-old woman presented with a heliotrope rash, Gottron's papules, and a poikilodermic, erythematous rash in shawl distribution without evidence of muscle weakness. Despite topical corticosteroids, the eruption progressed 9 months later to include generalized hyperkeratotic follicular papules, islands of sparing, and atrophic macules with a collarette of scale suggestive of porokeratosis. Mild dysphonia was the only sign of muscle weakness. Serology showed positive ANA. Histopathology revealed interface dermatitis with dermal mucin and melanophages, irregular psoriasiform hyperplasia, alternating mounds of para- and orthokeratosis, and tiers of dyskeratotic cells (columnar dyskeratosis). Systemic corticosteroid therapy was not tolerated; acitretin diminished the hyperkeratosis. While hyperpigmentation persisted, no progression of cutaneous or muscular symptoms has occurred after 22 months of follow-up and cessation of the therapy. Overall, her course did not differ from the natural history documented in the literature review of Wong-type DM. The most similar case also exhibited pseudocornoid lamella changes. Conclusion Wong-type DM is a clinicopathologic DM-PRP hybrid that can also exhibit porokeratosis-like features best described as columnar dyskeratosis. Recognizing these types of lesions in DM is warranted in order to make an accurate assessment of their prognostic significance. PMID:27047930

Outcomes Measurement in Voice Disorders: Application of an Acoustic Index of Dysphonia Severity

ERIC Educational Resources Information Center

Awan, Shaheen N.; Roy, Nelson

2009-01-01

Purpose: The purpose of this experiment was to assess the ability of an acoustic model composed of both time-based and spectral-based measures to track change following voice disorder treatment and to serve as a possible treatment outcomes measure. Method: A weighted, four-factor acoustic algorithm consisting of shimmer, pitch sigma, the ratio of…

Voice quality change in future professional voice users after 9 months of voice training.

PubMed

Timmermans, Bernadette; De Bodt, Marc; Wuyts, Floris; Van de Heyning, Paul

2004-01-01

Sixty-eight students of a school for audiovisual communication participated in this study. A part of them, 49 students, received voice training for 9 months (the trained group); 19 subjects received no specific voice training (the untrained group). A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, Maximum Phonation Time (MPT), jitter, lowest intensity (IL), highest frequency (FoH), Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after training to evaluate training outcome. The voice training is made up of technical workshops in small groups (five to eight subjects) and vocal coaching in the ateliers. In the technical workshops, basic skills are trained (posture, breathing technique, articulation and diction), and in the ateliers, the speech and language pathologist assists the subjects in the practice of their voice work. This study revealed a significant amelioration over time for the objective measurements [Dysphonia Severity Index: from 2.3 to 4.5 ( P<0.001)] and the self-evaluation [Voice Handicap Index, from 23 to 18.4 ( P=0.016)] for the trained group only. This outcome favors the systematic introduction of voice training during the schooling of professional voice users.

Inferring speaker attributes in adductor spasmodic dysphonia: ratings from unfamiliar listeners.

PubMed

Isetti, Derek; Xuereb, Linnea; Eadie, Tanya L

2014-05-01

To determine whether unfamiliar listeners' perceptions of speakers with adductor spasmodic dysphonia (ADSD) differ from control speakers on the parameters of relative age, confidence, tearfulness, and vocal effort and are related to speaker-rated vocal effort or voice-specific quality of life. Twenty speakers with ADSD (including 6 speakers with ADSD plus tremor) and 20 age- and sex-matched controls provided speech recordings, completed a voice-specific quality-of-life instrument (Voice Handicap Index; Jacobson et al., 1997), and rated their own vocal effort. Twenty listeners evaluated speech samples for relative age, confidence, tearfulness, and vocal effort using rating scales. Listeners judged speakers with ADSD as sounding significantly older, less confident, more tearful, and more effortful than control speakers (p < .01). Increased vocal effort was strongly associated with decreased speaker confidence (rs = .88-.89) and sounding more tearful (rs = .83-.85). Self-rated speaker effort was moderately related (rs = .45-.52) to listener impressions. Listeners' perceptions of confidence and tearfulness were also moderately associated with higher Voice Handicap Index scores (rs = .65-.70). Unfamiliar listeners judge speakers with ADSD more negatively than control speakers, with judgments extending beyond typical clinical measures. The results have implications for counseling and understanding the psychosocial effects of ADSD.

Everyday listeners' impressions of speech produced by individuals with adductor spasmodic dysphonia.

PubMed

Nagle, Kathleen F; Eadie, Tanya L; Yorkston, Kathryn M

2015-01-01

Individuals with adductor spasmodic dysphonia (ADSD) have reported that unfamiliar communication partners appear to judge them as sneaky, nervous or not intelligent, apparently based on the quality of their speech; however, there is minimal research into the actual everyday perspective of listening to ADSD speech. The purpose of this study was to investigate the impressions of listeners hearing ADSD speech for the first time using a mixed-methods design. Everyday listeners were interviewed following sessions in which they made ratings of ADSD speech. A semi-structured interview approach was used and data were analyzed using thematic content analysis. Three major themes emerged: (1) everyday listeners make judgments about speakers with ADSD; (2) ADSD speech does not sound normal to everyday listeners; and (3) rating overall severity is difficult for everyday listeners. Participants described ADSD speech similarly to existing literature; however, some listeners inaccurately extrapolated speaker attributes based solely on speech samples. Listeners may draw erroneous conclusions about individuals with ADSD and these biases may affect the communicative success of these individuals. Results have implications for counseling individuals with ADSD, as well as the need for education and awareness about ADSD. Copyright © 2015 Elsevier Inc. All rights reserved.

[Stimuli phrases of adductor spasmodic dysphonia phonatory break in mandarin Chinese].

PubMed

Ge, Pingjiang; Ren, Qingyi; Chen, Zhipeng; Cheng, Qiuhui; Sheng, Xiaoli; Wang, Ling; Chen, Shaohua; Zhang, Siyi

2015-12-01

To investigate the characteristics of adductor spasmodic dysphonia phonatory break in mandarin Chinese and select the stimuli phrases. Thirty-eight patients with adductor spasmodic dysphonia were involved in this study. Standard phrase " fù mŭ xīn" and a speech corpus in mandarin Chinese with 229 syllables covering all vowel and constant of mandarin Chinese were selected. Every patient read the phrases above twice in normal speed and comfortable voice. Two auditory perpetual speech pathologists marked phonatory break syllables respectively. The frequency of phonatory break syllables and their located phrases were calculated, rated and described. The phrases including the most phonatory break syllables were selected as stimuli phrases, the phonatory break frequency of which was also higher than that of standard phrase "fù mŭ xīn". Phonatory break happened in the reading of all patients. The average number of phonatory break syllables was 14 (3-33). Phonatroy break occurred when saying 177 (77.3%) syllables in the speech corpus. The syllables "guŏ, rén, zāng, diàn, chē, gè, guăn, a, bā, ne, de" broke in 23.1%-41.0% patients. These syllables belonged to the phrases "pĭng guŏ, huŏ chē, shì de, nĭ shì gè hăo rén, wŏ mén shì yŏu zŏng shì bă qĭn shì nong dé hĕn zāng, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a,wŏ yīng gāi zài xìn lĭ xiĕ yī xiē shén mē ne?". Thirty-seven patients (97.3%) had phonatory break in above mentioned words. Ratios of these words phonatory break also were more than "fù mŭ xīn". Adductor spasmodic dysphonic patients exhibited different degrees of phonatory break in mandarine Chinese. The phrases" shì de, pĭng guŏ, huŏ chē, nĭ shì gè hăo rén, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a" were recommended as stimuli phrases for adductor spasmodic dysphonia evaluation.

Vocal Fold Bowing in Elderly Male Monozygotic Twins: A Case Study

PubMed Central

Tanner, Kristine; Sauder, Cara; Thibeault, Susan L.; Dromey, Christopher; Smith, Marshall E.

2009-01-01

Objectives This study examined case histories, diagnostic features, and treatment response in two 79-year-old male monozygotic (identical) twins with vocal fold bowing, exploring both genetic and environmental factors. Study Design Case study. Methods DNA concordance was examined via cheek swab. Case histories, videostroboscopy, auditory- and visual-perceptual assessment, electromyography, acoustic measures, and Voice Handicap ratings were undertaken. Both twins underwent surgical intervention and subsequent voice therapy. Results Monozygosity was confirmed for DNA polymorphisms, with 10 of 10 concordance for STR DNA markers. For both twins, auditory and visual-perceptual assessments indicated severe bowing, hoarseness and breathiness, although Twin 1 was judged to be extremely severe. Differences in RMS amplitudes were observed for TA and LCA muscles, with smaller relative amplitudes observed for the Twin 1 versus Twin 2. No consistent voice improvement was observed following surgical intervention(s), despite improved mid-membranous vocal fold closure. Marked reductions in Voice Handicap Index total scores were observed following behavioral voice therapy, coinciding with increased mid-membranous and posterior laryngeal (interarytenoid) glottal closure. No substantive differences in acoustic measures were observed. Conclusions Vocal fold bowing was more severe for Twin 1 versus Twin 2 despite identical heritability factors. Overall voice improvement with treatment was greater for Twin 2 than Twin 1. Environmental factors might partially account for the differences observed between the twins, including variability in their responsiveness to behavioral voice therapy. Voice therapy was useful in improving mid-membranous and posterior laryngeal closure, although dysphonia remained severe in both cases. PMID:19664899

Factors Associated With Infectious Laryngitis: A Retrospective Review of 15 Cases.

PubMed

Thomas, Carissa M; Jetté, Marie E; Clary, Matthew S

2017-05-01

To identify the culturable microbes associated with infectious laryngitis and outline effective treatment strategies. This is a retrospective chart review of adult patients with persistent dysphonia plus evidence of laryngeal inflammation who underwent biopsy for culture at a tertiary care medical center. Demographic factors, symptoms as reported on validated patient assessment tools, past medical history, social history, culture results, and treatment duration and response were reviewed. Fifteen patients with infectious laryngitis were included in this study. Culture results demonstrated Methicillin-sensitive Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Serratia marcescens, and "normal respiratory flora." In most patients, multiple courses of prolonged antibiotics were needed to treat MSSA or MRSA. Infections associated with other microbes resolved with a single course of antibiotics. In this population, infectious laryngitis is defined as colonization with bacteria not found in the previously characterized laryngeal microbiome of benign vocal fold lesions. In suspected cases of infectious laryngitis, culture is recommended, by biopsy if needed. For MSSA- and MRSA-associated laryngitis, an extended course of antibiotics may be necessary for symptom improvement and resolution of laryngeal inflammation. However, the optimal treatment regimen has yet to be defined and will require larger, prospective studies.

Voice disorders in the workplace: productivity in spasmodic dysphonia and the impact of botulinum toxin.

PubMed

Meyer, Tanya K; Hu, Amanda; Hillel, Allen D

2013-11-01

The impact of the disordered voice on standard work productivity measures and employment trends is difficult to quantify; this is in large part due to the heterogeneity of the disease processes. Spasmodic dysphonia (SD), a chronic voice disorder, may be a useful model to study this impact. Self-reported work measures (worked missed, work impairment, overall work productivity, and activity impairment) were studied among patients receiving botulinum toxin (BTX) treatments for SD. It was hypothesized that there would be a substantial difference in work-related measures between the best and worst voicing periods. In addition, job types, employment shifts, and vocal requirements during the course of vocal disability from SD were investigated for each individual, and the impact of SD on these patterns was studied. A total of 145 patients with SD, either adductor or abductor, who were established in routine therapeutic BTX injections agreed to participate in a self-administered questionnaire study. Seventy-two participants were currently working and provided highly detailed information on work-related measures. Their answers characterized the effect of SD on their employment status, productivity at work, activity impairment outside of work, employment retention or change, and whether the individual perceived that BTX therapy affected these measures. Patients were asked to complete the Work Productivity and Activity Impairment (WPAI) instrument to determine these measures for their best and worst voicing weeks over the duration since their previous BTX injection. Voice-specific quality of life instruments (Voice Handicap Index-10) and perceptual assessments (Consensus Auditory Perceptual Evaluation of Voice) were elicited to provide correlations of work measures with patient-perceived voice handicap and clinician-perceived voice quality. Cross-sectional analysis using self-administered questionnaire. A total of 108 patients reported ever working during their diagnosis and treatment of SD, and 72 patients were currently working and had undergone BTX therapy for at least 1 year at the time of the analysis. Currently employed patients reported a mean 4.4% decrease in work missed (absenteeism), a 28.1% decrease in work impairment (presenteeism), a 29.4% decrease in work productivity, and a 21.4% decrease in activity impairment (P <.001) in their best, as compared to their worst voicing period over their last BTX injection cycle. Presenteeism accounted for the major component of the percent work productivity impairment calculation. There was neither apparent shift in job categories nor any change in the vocal demands of their employment over the course of their disease. Among patients that have worked during their diagnosis of SD, greater than 98% report that BTX injections helped them at work. Patients with SD reported that their vocal dysfunction caused a significant negative effect on work productivity and increase in activity impairment. There was a significant improvement in their voice-related work parameters from their worst to best voicing periods over their last BTX injection cycle. Patients undergoing long-term BTX treatment report a positive effect of this treatment in their workplace. Spasmodic dysphonia is a meaningful model in which to study the effects of voice disorders on work productivity and employment patterns. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

[Laryngeal disease. Endoscopic characterization of 1493 procedures based on age].

PubMed

Che-Morales, José Luis; Figueroa-Hurtado, Esperanza; Cortes-Télles, Arturo

2018-01-01

Based on international epidemiology, some laryngeal diseases could be more frequent at certain ages. The objective was to describe endoscopic findings in patients through distinct decades of age in a laryngoscopy facility. retrospective and descriptive study; clinical and endoscopic records were collected from 1493 procedures performed between 2009 and 2015, and organized in five groups of age for analysis. Differences among them were analyzed by chi squared and ANOVA. 70% of patients reported dysphonia as a main symptom; 24% of subjects were referred with cancer diagnosis and just 7% of them, showed findings related to malignancy; on the other hand, cancer suspicion increased in direct proportion with age (p < 0.0001); inespecific inflammation and other benign endoscopic manifestations (e.g. vocal fold paralysis, subglotic stenosis and nodules) represented 80% of the whole findings; 14% of the procedures were reported as normal. Glottic and supraglottic structures were the two regions affected by malignancy; this finding was directly related to advanced age, particularly in patients of 70 years of age or older. Finally, subglottic stenosis was observed in patients younger than 50 years of age (p < 0.0001). Causes of laryngeal diseases are different in individuals according to their age. Carcinoma was more prevalent in adults of 70 years of age or older. Benign causes were secondary to inflammatory and functional conditions.

Using Trial Vocal Fold Injection to Select Vocal Fold Scar Patients Who May Benefit From More Durable Augmentation.

PubMed

Carroll, Thomas L; Dezube, Aaron; Bauman, Laura A; Mallur, Pavan S

2018-02-01

Clinical indications for vocal fold injection augmentation (VFI) are expanding. Prior studies demonstrate the benefit of trial VFI for select causes of glottic insufficiency. No studies have examined trial VFI for glottic insufficiency resulting from true vocal fold (TVF) scar. Retrospective chart review of patients who underwent trial VFI for a dominant pathology of TVF scar causing dysphonia. Patients who subsequently underwent durable augmentation were identified. The primary study outcome was the difference in Voice Handicap Index-10 (VHI-10) score from pretrial VFI to post-durable augmentation. Twenty-eight patients underwent trial VFI for TVF scar, 22 of whom reported a positive response. Fifteen of 22 subjects who underwent durable augmentation had viable data for analysis. Mean VHI-10 improved from 26.9 to 18.6 ( P < .05), for a delta VHI-10 of 8.3, or 30.9% improvement. Twelve of the 15 (80%) showed a clinically significant improvement (delta VHI-10 >5). A trial VFI is a potentially useful, low-risk procedure that appears to help the patient and clinician identify when global augmentation might improve the voice when vocal fold scar is present. Patients who reported successful trial VFI often demonstrated significant improvement in their VHI-10 after subsequent durable augmentation.

Improving access to psychological therapies in voice disorders: a cognitive behavioural therapy model.

PubMed

Miller, Tracy; Deary, Vincent; Patterson, Jo

2014-06-01

The improving access to psychological therapies initiative has highlighted the importance of managing mental health problems effectively, and research has shown excellent outcomes from cognitive behavioural therapy (CBT) interventions. Patients presenting with functional dysphonia will often also describe psychological distress including anxiety, depression and reduced general well-being, and it is felt that effective voice therapy needs to include the management of psychological well-being. The evidence for the use of CBT enhanced voice therapy is limited to date. Recent research has only started to identify the benefits of this approach and questions regarding how to achieve and maintain competence are essential. Voice therapy outcomes are positive and patients receiving CBT with voice therapy have shown more improvement in their general well-being and distress. CBT is a very well evidenced therapy and recommended by The National Institute for Health and Care Excellence (NICE) as the treatment of choice for mental health difficulties and medically unexplained symptoms. Allied health professionals are increasingly being trained to use CBT skills in the management of a number of symptoms/illnesses, and this should be considered for the management of functional dysphonia. However, there is a need for more research and detailed consideration of how therapists should be trained and supervised and how cost-effective this approach may be.

Bedside screen for oral cavity structure, salivary flow, and vocal production over the 14days following endotracheal extubation.

PubMed

Chen, Cheryl Chia-Hui; Wu, Kuo-Hsiang; Ku, Shih-Chi; Chan, Ding-Cheng; Lee, Jang-Jaer; Wang, Tyng-Guey; Hsiao, Tzu-Yu

2018-06-01

To describe the sequelae of oral endotracheal intubation by evaluating prevalence rates of structural injury, hyposalivation, and impaired vocal production over 14days following extubation. Consecutive adults (≥20years, N=114) with prolonged (≥48h) endotracheal intubation were enrolled from medical intensive care units at a university hospital. Participants were assessed by trained nurses at 2, 7, and 14days after extubation, using a standardized bedside screening protocol. Within 48-hour postextubation, structural injuries were common, with 51% having restricted mouth opening. Unstimulated salivary flow was reduced in 43%. For vocal production, 51% had inadequate breathing support for phonation, dysphonia was common (94% had hoarseness and 36% showed reduced efficiency of vocal fold closure), and >40% had impaired articulatory precision. By 14days postextubation, recovery was noted in most conditions, but reduced efficiency of vocal fold closure persisted. Restricted mouth opening (39%) and reduced salivary flow (34%) remained highly prevalent. After extubation, restricted mouth opening, reduced salivary flow, and dysphonia were common and prolonged in recovery. Reduced efficiency of vocal cord closure persisted at 14days postextubation. The extent and duration of these sequelae remind clinicians to screen for them up to 2weeks after extubation. Copyright © 2017 Elsevier Inc. All rights reserved.

Morell Mackenzie's Contribution to the Description of Spasmodic Dysphonia.

PubMed

Lorch, Marjorie Perlman; Whurr, Renata

2016-12-01

Since the middle of the 20th century, most discussions of spasmodic dysphonia (SD) reference a paper by Ludwig Traube published in1871 as the first historical citation, crediting him with priority for this clinical syndrome. However, our recent research has determined that the original observation by Traube was published in 1864 and does not in fact describe what is currently recognized as SD. It appears that many clinics throughout Europe and North America were investigating and publishing observations on a range of voice disorders. The wider context of work on laryngeal disorders in the 1860s-1870s is considered. One of Traube's contemporaries, Morell Mackenzie, made significant contributions to the understanding of laryngeal movement disorder and its consequences for the voice. These will be examined to gain a clearer focus on the characterization of this disorder. The clinical descriptions published by Morrell Mackenzie in the 1860s provide details that conform quite closely to our current-day understanding of SD. The citation of Traube's "hysterical" patient links to mid 20th-century views of the functional nature of SD and the utility of psychiatric treatment. The description presented by Mackenzie is consistent with current views of SD as a movement disorder. © The Author(s) 2016.

Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education

PubMed Central

Creighton, Francis X.; Hapner, Edie; Klein, Adam; Rosen, Ami; Jinnah, Hyder A.; Johns, Michael M.

2016-01-01

Summary Purpose Spasmodic dysphonia (SD) is a rare but often debilitating disease. Due to lack of awareness among practitioners and lack of well-defined diagnostic criteria, it can be difficult for patients with SD to receive a diagnosis and subsequent treatment. There is currently no literature documenting the efficacy of the medical community in recognizing and diagnosing this disorder. We aimed to quantify the patients’ experiences with obtaining a diagnosis of SD. Methods One hundred seven consecutive patients with SD completed questionnaires about their experiences with SD. Patients were recruited either during outpatient laryngology visits or during participation in a National Institutes of Health funded study investigating SD. Results It took patients an average of 4.43 years (53.21 months) to be diagnosed with SD after first going to a physician with vocal symptoms. Patients had to see an average of 3.95 physicians to receive a diagnosis of SD. Patients (31.4%) had been prescribed medications other than botulinum toxin to treat their symptoms. Patients (30%) attempted alternative therapies for treatment of SD, such as chiropractor or dietary modification. Conclusions Despite advances in diagnostic modalities in medicine, the diagnosis of SD still remains elusive. Objective criteria for the diagnosis of SD and increased clinician education are warranted to address this diagnostic delay. PMID:25873547

Abnormal Structure–Function Relationship in Spasmodic Dysphonia

PubMed Central

Ludlow, Christy L.

2012-01-01

Spasmodic dysphonia (SD) is a primary focal dystonia characterized by involuntary spasms in the laryngeal muscles during speech production. Although recent studies have found abnormal brain function and white matter organization in SD, the extent of gray matter alterations, their structure–function relationships, and correlations with symptoms remain unknown. We compared gray matter volume (GMV) and cortical thickness (CT) in 40 SD patients and 40 controls using voxel-based morphometry and cortical distance estimates. These measures were examined for relationships with blood oxygen level–dependent signal change during symptomatic syllable production in 15 of the same patients. SD patients had increased GMV, CT, and brain activation in key structures of the speech control system, including the laryngeal sensorimotor cortex, inferior frontal gyrus (IFG), superior/middle temporal and supramarginal gyri, and in a structure commonly abnormal in other primary dystonias, the cerebellum. Among these regions, GMV, CT and activation of the IFG and cerebellum showed positive relationships with SD severity, while CT of the IFG correlated with SD duration. The left anterior insula was the only region with decreased CT, which also correlated with SD symptom severity. These findings provide evidence for coupling between structural and functional abnormalities at different levels within the speech production system in SD. PMID:21666131

Developing the Communicative Participation Item Bank: Rasch Analysis Results From a Spasmodic Dysphonia Sample

PubMed Central

Baylor, Carolyn R.; Yorkston, Kathryn M.; Eadie, Tanya L.; Miller, Robert M.; Amtmann, Dagmar

2011-01-01

Purpose The purpose of this study was to conduct the initial psychometric analyses of the Communicative Participation Item Bank—a new self-report instrument designed to measure the extent to which communication disorders interfere with communicative participation. This item bank is intended for community-dwelling adults across a range of communication disorders. Method A set of 141 candidate items was administered to 208 adults with spasmodic dysphonia. Participants rated the extent to which their condition interfered with participation in various speaking communication situations. Questionnaires were administered online or in a paper version per participant preference. Participants also completed the Voice Handicap Index (B. H. Jacobson et al., 1997) and a demographic questionnaire. Rasch analyses were conducted using Winsteps software (J. M. Linacre, 1991). Results The results show that items functioned better when the 5-category response format was recoded to a 4-category format. After removing 8 items that did not fit the Rasch model, the remaining 133 items demonstrated strong evidence of sufficient unidimensionality, with the model accounting for 89.3% of variance. Item location values ranged from −2.73 to 2.20 logits. Conclusions Preliminary Rasch analyses of the Communicative Participation Item Bank show strong psychometric properties. Further testing in populations with other communication disorders is needed. PMID:19717652

Lateral Cricoarytenoid Release: Development of a Novel Surgical Treatment Option for Adductor Spasmodic Dysphonia in a Canine Laryngeal Model.

PubMed

Park, Andrea M; Paniello, Randal C

2016-09-01

To investigate the efficacy of a novel adductor muscle-releasing technique designed to decrease the force of vocal fold adduction, as a potential surgical therapy for patients with adductor spasmodic dysphonia (ADSD). Experimental animal study. A canine laryngeal model was used to assess the acute and sustained efficacy of a lateral cricoarytenoid (LCA) muscle release. A total of 34 canine hemilaryngeal preparations were divided among 7 experimental groups. The LCA muscle was separated from its cricoid cartilage origin via an open, anterior, submucosal approach. The laryngeal adductory pressures (LAP) were assessed pre- and post-muscle release via direct recurrent laryngeal nerve stimulation. Measurements were repeated at 1.5, 3, or 6 months postoperatively. Another study evaluated release of the thyroarytenoid (TA) muscle from its thyroid cartilage origin. Releasing the LCA muscle demonstrated a significant decrease in LAP acutely and was maintained at all 3 time points with the aid of a barrier (P < .05). Without the barrier, the LCA muscle reattached to the cricoid. Acute release of the TA muscle did not significantly decrease the LAP. The proposed LCA release procedure may provide patients with a permanent treatment option for ADSD. However, longer-term studies and human trials are needed. © The Author(s) 2016.

Perioperative complications and safety of type II thyroplasty (TPII) for adductor spasmodic dysphonia.

PubMed

Mizoguchi, Kenji; Hatakeyama, Hiromitsu; Yanagida, Saori; Nishizawa, Noriko; Oridate, Nobuhiko; Fukuda, Satoshi; Homma, Akihiro

2017-05-01

Type II thyroplasty (TPII) is one of the surgical options offered in the management of adductor spasmodic dysphonia (AdSD); however, there have been no detailed reports of its safety and associated complications during the perioperative period. Our aim was to assess the complications and safety of TPII. TPII was performed for consecutive 15 patients with AdSD from April 2012 through May 2014. We examined retrospectively the perioperative complications, the degree of surgical invasion, and recovery process from surgery. All patients underwent successful surgery under only local anesthesia. Vocal fold erythema was observed in 14 patients and vocal fold edema in 10 patients; however, all of them showed complete resolution within 1 month. No patient experienced severe complications such as acute airway distress or hemorrhage. Fourteen patients were able to have oral from the 1st postoperative morning, with the remaining patient able to have oral intake from the 2nd postoperative day. In addition, no patient experienced aspiration postoperatively. In conclusion, only minor complications were observed in association with TPII in this study. No dysphagia was observed postoperatively, which is an advantage over other treatments. The results of our study suggest that TPII is a safe surgical treatment for AdSD.

Aerodynamic profiles of women with muscle tension dysphonia/aphonia.

PubMed

Gillespie, Amanda I; Gartner-Schmidt, Jackie; Rubinstein, Elaine N; Abbott, Katherine Verdolini

2013-04-01

In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-Psub) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine whether results suggest new understanding of pathogenesis in MTD/A. Retrospective review of aerodynamic data collected from 90 women at the time of primary MTD/A diagnosis. Aerodynamic profiles were significantly different for women with MTD/A as compared with healthy speakers. Five distinct profiles were identified: (a) normal flow, normal est-Psub; (b) high flow, high est-Psub; (c) low flow, normal est-Psub; (d) normal flow, high est-Psub; and (e) high flow, normal est-Psub. This study is the first to identify distinct subgroups of aerodynamic profiles in women with MTD/A and to quantitatively identify a clinical phenomenon sometimes described in association with it-"breath holding"-that is shown by low airflow with normal est-Psub. Results were consistent with clinical claims that diverse respiratory and laryngeal functions may underlie phonatory patterns associated with MTD/A. One potential mechanism, based in psychobiological theory, is introduced to explain some of the variability in aerodynamic profiles of women with MTD/A.

Value of Laryngeal Electromyography in Spasmodic Dysphonia Diagnosis and Therapy.

PubMed

Yang, Qingwen; Xu, Wen; Li, Yun; Cheng, Liyu

2015-07-01

To investigate the role of laryngeal electromyography (LEMG) in the diagnosis and treatment of spasmodic dysphonia (SD). The clinical manifestations, characteristics of motor unit potentials (MUPs), recruitment potentials, and laryngeal nerve evoked potentials (EPs) in LEMG, as well as the changes after botulinum toxin (BTX) treatment, were analyzed in 39 patients with adductor SD. The main clinical manifestations were a strained voice and phonation interruptions; in addition, the patients displayed hyper-adducted vocal folds during phonation. LEMG revealed significantly increased amplitudes of the thyroarytenoid muscle MUPs. The recruitment potentials were in a dense bunch, discharging full interference patterns with significantly increased amplitudes; the mean and maximum amplitude of recruitment potentials were 3090 μV and 5000 μV, respectively. The amplitude of EPs of thyroarytenoid muscle increased significantly; the mean and maximum amplitudes were 10.3 mV and 26.3 mV, respectively. After BTX was injected, the LEMG revealed denervation changes, and the EPs weakened or disappeared in the injected muscle. SD could be diagnosed, and the therapeutic efficacy of SD treatments could be evaluated based on clinical characteristics combined with LEMG characteristics. The increased amplitudes of the recruitment potentials and EPs of the thyroarytenoid muscle were the characteristic indexes. After BTX was injected, denervated potential characteristics appeared in the muscles. © The Author(s) 2015.

Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients.

PubMed

do Valle, A C; Aprigliano Filho, F; Moreira, J S; Wanke, B

1995-01-01

Systematic examination of the upper respiratory and digestive tracts (URDT) was performed in a group of 80 paracoccidioidomycosis (PCM) patients submitted to post-treatment follow-up ranging from 8 months to 17 years. Mucosae of the URDT had been involved prior to specific treatment in 74 patients, distributed as follows: oropharynx, 50 (41 alone, 7 in association with the larynx, and 2 with the nasal mucosa); larynx, 30 (23 alone and 7 in association); and nasal mucosa, 3 (1 alone and 2 in association). Inactive lesions were observed in all the 50 patients with lesions of the oropharynx, 3 of whom with deforming scars (1 with retraction of the tongue and 2 with narrowing of the oral orifice). One case presented a destructive lesion, with perfuration of the palate. Of the other 46 cases, examination showed nacreous white striated scars which were nearly imperceptible in some cases and in others displayed partial retraction of anatomical structures without any alteration of their features. Patients presented a high rate of missing teeth. In 3 patients with involvement of the nasal mucosa, none of whom presented active PCM lesions, 2 still had nasal voices. In 30 patients with lesions of the larynx, 1 suffered a relapse of PCM and 2 developed epidermoid carcinoma. Of the other 27 cases, none of whom had active PCM lesions, 15 presented dysphonia, 3 were tracheotomized, and 9 were asymptomatic.

Fine needle aspiration of secondary synovial sarcoma of the thyroid gland.

PubMed

Murro, Diana; Slade, Jamie Macagba; Syed, Sahr; Gattuso, Paolo

2015-11-01

Synovial sarcomas (SS) of the head and neck region are extremely rare and arise in only 5% of cases. We present a case of secondary SS of the thyroid originally diagnosed as medullary carcinoma on fine needle aspiration (FNA). A 41-year-old man presented with several weeks of dysphonia and a left thyroid mass. FNA of the thyroid nodule showed a cellular smear composed of loosely cohesive oval to spindle-shaped cells with irregular nuclear borders, finely granular chromatin, and inconspicuous nucleoli. The patient was diagnosed with medullary carcinoma and underwent a total thyroidectomy. Intro-operatively, the mass was found to arise from the tracheoesophageal groove with spread to the left thyroid. Microscopic examination of the thyroid tumor revealed a dense spindle cell proliferation with abundant mitoses, scant cords and nests of epithelial cells and foci of necrosis. The spindle cells were positive for bcl2 and vimentin and the epithelial cells were positive for cytokeratin 8/18 and epithelial membrane antigen (EMA). Both spindle and epithelial cells were negative for thyroglobulin, calcitonin, synaptophysin and chromogranin. Fluorescence in situ hybridization (FISH) demonstrated translocation (X;18)(p11;q11), confirming the diagnosis of SS. The patient underwent a total laryngopharyngoesophagectomy with subsequent adjuvant therapy and is currently disease free. Only 6 cases of histologically confirmed primary SS of the thyroid have been reported. To the best of our knowledge, this is the first case of FISH-confirmed secondary SS of the thyroid and also the first case of SS arising from the tracheoesophageal groove. © 2015 Wiley Periodicals, Inc.

Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.

PubMed

Hogikyan, N D; Wodchis, W P; Terrell, J E; Bradford, C R; Esclamado, R M

2000-09-01

Unilateral vocal fold paralysis is a common clinical problem which frequently causes severe dysphonia. Various treatment options exist for this condition, with the type I thyroplasty being one of the more commonly performed surgical procedures for vocal rehabilitation. The Voice-Related Quality of Life (V-RQOL) Measure is a validated outcomes instrument for voice disorders. This study measured the V-RQOL of patients with unilateral vocal fold paralysis who had undergone a type I thyroplasty and compared these scores to those of patients with untreated and uncompensated unilateral vocal fold paralysis and to normals. Treated patients had significantly higher domain and overall V-RQOL scores than untreated patients, but also scored lower than normals. These differences were true across gender and age. Patients who were more distant from surgery had lower V-RQOL scores than those who had more recently been treated. It is concluded that type I thyroplasty leads to a significantly higher V-RQOL for patients with unilateral vocal fold paralysis. This study also demonstrates further the utility of patient-oriented measures of treatment outcome.

Early diagnosis and treatment in a child with foodborne botulism.

PubMed

Proverbio, Maria Renata; Lamba, Marta; Rossi, Alessandro; Siani, Paolo

2016-06-01

Foodborne botulism is a neuroparalytic disease caused by ingestion of food contaminated with botulinum toxins. Despite rare the mortality rate is high if untreated. Diagnosis of botulism is still a challenge for clinician, due to the variability of clinical manifestations and disease course. We report on a child with type B botulin intoxication who was early diagnosed and treated underlining that clinical suspicion is crucial to start prompt treatment. An 11-year-old boy presented with bilateral ptosis and mydriasis, dry mouth, difficulty in swallowing, dysphonia, urine retention and constipation. Clear sensorium and no fever were observed. Immediately the suspicion of botulism was risen and botulinum antitoxin was administered. 3 days later serum and rectal samples tested positive for Clostridium botulinum. The patient completely recovered when discharged from hospital. Foodborne botulism is still possible in developed countries. The confirmation test of botulism requires some days. To avoid long delays between intoxication and diagnosis prompt clinical suspicion is thus crucial. The outcome depends on rapid implementation of appropriate management with intensive respiratory care and antitoxin administration. Copyright © 2015 Elsevier Ltd. All rights reserved.

Long-term follow-up and outcome in patients with recurrent respiratory laryngeal papillomatosis.

PubMed

Rasmussen, Eva Rye; Schnack, Didde T; Jørkov, Andreas Schjellerup; Raja, Anna Axelsson; Olsen, Caroline Holkmann; Homøe, Preben

2017-12-01

Recurrent respiratory papillomatosis is characterized by wart-like lesions of the upper airway and is most frequently caused by human papillomavirus (HPV). The disease has significant impact on quality of life due to potential airway obstruction, dysphonia and the need for serial surgeries. The main objective of this study was to describe patient characteristics and long-term follow-up data in a Danish cohort with the disease. The study was a longitudinal retrospective cohort-study using data from electronic medical records and a pathology database. A total of 61 adult and four juvenile patients were identified. The male-to-female ratio was 2.4. In the adult population, the mean age at onset was 45 years. The median number of surgeries was four (interquartile range: 2.8). The mean follow-up time was 8.7 years (range: 7 days-30 years). Three cases of malignant transformation were observed. In the juvenile population, the mean age of onset was 8.5 years (range: 3-12 years). The mean follow-up time was 11.5 years (range: 2-23 years), and the number of surgeries per year at risk was one/year. CO2-laser and microdebrider were the surgical techniques usually employed. 43% of histopathologic analyses could detect HPV infection (subtype 6 or 11). More males than females suffer from respiratory papillomatosis; age of onset was either in childhood or in mid-life. Use of CO2-laser or microdebrider was the preferred surgical approach in this cohort. none. not relevant. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Speech reconstruction using a deep partially supervised neural network.

PubMed

McLoughlin, Ian; Li, Jingjie; Song, Yan; Sharifzadeh, Hamid R

2017-08-01

Statistical speech reconstruction for larynx-related dysphonia has achieved good performance using Gaussian mixture models and, more recently, restricted Boltzmann machine arrays; however, deep neural network (DNN)-based systems have been hampered by the limited amount of training data available from individual voice-loss patients. The authors propose a novel DNN structure that allows a partially supervised training approach on spectral features from smaller data sets, yielding very good results compared with the current state-of-the-art.

Voice activity and participation profile: assessing the impact of voice disorders on daily activities.

PubMed

Ma, E P; Yiu, E M

2001-06-01

Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders.

A Randomized Controlled Trial of Two Semi-Occluded Vocal Tract Voice Therapy Protocols

PubMed Central

Hunter, Eric J.; Kirkham, Kimberly; Cox, Karin; Titze, Ingo R.

2015-01-01

Purpose Although 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. Method Twenty 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. Results Voice 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. Conclusions VFE 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. PMID:25675335

A comparison of trained and untrained vocalists on the Dysphonia Severity Index.

PubMed

Awan, Shaheen N; Ensslen, Anysia J

2010-11-01

The purposes of this study were (1) to compare trained and untrained singers on the Dysphonia Severity Index (DSI) and its component measures, and (2) to contribute to normative DSI data for trained singers. This study included 36 untrained participants (15 males and 21 females) and 30 participants (15 males and 15 females) with singing experience between the ages of 18 and 30 years. Measures of maximum phonation time (MPT), highest phonational frequency, lowest intensity, and jitter were obtained for each subject and incorporated into the previously published multivariate DSI formula. Results indicated that vocally trained subjects have significantly higher DSI scores than untrained subjects (mean DSI: 6.48 vs 4.00, respectively), with significant differences observed between trained and untrained groups for three of the four components of the DSI (F(0) high; I low; jitter). The findings of this study are consistent with previous reports that indicate significant increases in the DSI with vocal training, and with various studies that have observed increased vocal capability in trained singers versus their untrained counterparts. The results of this study indicate that alternative normative expectations for the DSI may need to be taken into account when using the DSI with patients who have participated in directed vocal training, such as choral participation and voice/singing lessons. Copyright © 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Signs and symptoms of temporomandibular disorders in women and men.

PubMed

Ferreira, Claudia Lúcia Pimenta; Silva, Marco Antônio Moreira Rodrigues da; Felício, Cláudia Maria de

2016-01-01

Women are more likely to present temporomandibular disorders (TMD); however, studies comparing genders in Brazilian samples are rare. To analyze the proportion of men and women, as well as the association between gender and age, problem duration, and TMD symptoms in patients admitted to an university clinic for treatment. Interview and assessment data of protocols from 1,000 patients diagnosed with TMD were collected and analyzed and then divided into two groups, male (n = 177) and female (n = 823). The exploratory analysis was based on contingency tables and χ2 test was carried out. Subsequently, the logistic regression model was used and the odds ratios (OR) concerning the evaluated comparisons were calculated. Females were more prevalent in the sample, and mean ages and TMD duration were similar between the groups, with higher occurrence in young adults (19 to 40 years old). The OR values showed an association between the female gender and the signs/symptoms of pain in the temporomandibular joint, pain in the facial muscles, neck and shoulders, headache, fatigue in the muscles of mastication, otologic symptoms, and dysphonia. Women had two times higher chances of presenting these symptoms than men. In the sample of Brazilian patients with TMD, the number of women who presented a higher prevalence of painful symptoms was greater, followed by otologic symptoms and complaints of dysphonia. The prevalence of joint noise was similar in both studied groups.

Patient perceptions of factors leading to spasmodic dysphonia: a combined clinical experience of 350 patients.

PubMed

Childs, Lesley; Rickert, Scott; Murry, Thomas; Blitzer, Andrew; Sulica, Lucian

2011-10-01

Spasmodic dysphonia (SD) is an idiopathic voice disorder that is characterized by either a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. It has been suggested that environmental factors play a role in triggering the onset. Clinical observation suggests that some patients associate onset with specific events or factors while others do not. The purpose of this study was to examine a large database of SD patients to determine if specific triggers are associated with the onset of SD. Retrospective chart review. A total of 350 charts of patients with SD were identified and were categorized as either "sudden onset" or "gradual onset." One hundred sixty-nine recalled their circumstances surrounding onset. Forty-five percent of these patients described the onset as sudden. Patient perceptions of inciting events in the sudden onset group were identified 77% of the time and 2% of the time in the gradual onset group. The most common factors identified were stress (42%), upper respiratory infection (33%), and pregnancy and parturition (10%). Thirty-five percent of SD patients perceive their disorder to have a sudden onset with identified inciting events. This prevalence raises questions regarding possible behavioral and environmental factors surrounding the onset of this disorder. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Brain activity related to phonation in young patients with adductor spasmodic dysphonia.

PubMed

Kiyuna, Asanori; Maeda, Hiroyuki; Higa, Asano; Shingaki, Kouta; Uehara, Takayuki; Suzuki, Mikio

2014-06-01

This study investigated the brain activities during phonation of young patients with adductor spasmodic dysphonia (ADSD) of relatively short disease duration (<10 years). Six subjects with ADSD of short duration (mean age: 24. 3 years; mean disease duration: 41 months) and six healthy controls (mean age: 30.8 years) underwent functional magnetic resonance imaging (fMRI) using a sparse sampling method to identify brain activity during vowel phonation (/i:/). Intragroup and intergroup analyses were performed using statistical parametric mapping software. Areas of activation in the ADSD and control groups were similar to those reported previously for vowel phonation. All of the activated areas were observed bilaterally and symmetrically. Intergroup analysis revealed higher brain activities in the SD group in the auditory-related areas (Brodmann's areas [BA] 40, 41), motor speech areas (BA44, 45), bilateral insula (BA13), bilateral cerebellum, and middle frontal gyrus (BA46). Areas with lower activation were in the left primary sensory area (BA1-3) and bilateral subcortical nucleus (putamen and globus pallidus). The auditory cortical responses observed may reflect that young ADSD patients control their voice by use of the motor speech area, insula, inferior parietal cortex, and cerebellum. Neural activity in the primary sensory area and basal ganglia may affect the voice symptoms of young ADSD patients with short disease duration. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education.

PubMed

Creighton, Francis X; Hapner, Edie; Klein, Adam; Rosen, Ami; Jinnah, Hyder A; Johns, Michael M

2015-09-01

Spasmodic dysphonia (SD) is a rare but often debilitating disease. Due to lack of awareness among practitioners and lack of well-defined diagnostic criteria, it can be difficult for patients with SD to receive a diagnosis and subsequent treatment. There is currently no literature documenting the efficacy of the medical community in recognizing and diagnosing this disorder. We aimed to quantify the patients' experiences with obtaining a diagnosis of SD. One hundred seven consecutive patients with SD completed questionnaires about their experiences with SD. Patients were recruited either during outpatient laryngology visits or during participation in a National Institutes of Health funded study investigating SD. It took patients an average of 4.43 years (53.21 months) to be diagnosed with SD after first going to a physician with vocal symptoms. Patients had to see an average of 3.95 physicians to receive a diagnosis of SD. Patients (31.4%) had been prescribed medications other than botulinum toxin to treat their symptoms. Patients (30%) attempted alternative therapies for treatment of SD, such as chiropractor or dietary modification. Despite advances in diagnostic modalities in medicine, the diagnosis of SD still remains elusive. Objective criteria for the diagnosis of SD and increased clinician education are warranted to address this diagnostic delay. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Type II thyroplasty changes cortical activation in patients with spasmodic dysphonia.

PubMed

Tateya, Ichiro; Omori, Koichi; Kojima, Hisayoshi; Naito, Yasushi; Hirano, Shigeru; Yamashita, Masaru; Ito, Juichi

2015-04-01

Spasmodic dysphonia (SD) is a complex neurological communication disorder characterized by a choked, strain-strangled vocal quality with voice stoppages in phonation. Its symptoms are exacerbated by situations where communication failures are anticipated, and reduced when talking with animals or small children. Symptoms are also reduced following selected forms of treatment. It is reasonable to assume that surgical alteration reducing symptoms would also alter brain activity, though demonstration of such a phenomenon has not been documented. The objective of this study is to reveal brain activity of SD patients before and after surgical treatment. We performed lateralization thyroplasties on three adductor SD patients and compared pre- and post-operative positron emission tomography recordings made during vocalization. Pre-operatively, cordal supplementary motor area (SMA), bilateral auditory association areas, and thalamus were activated while reading aloud. Such activity was not observed in normal subjects. Type II thyroplasty was performed according to Isshiki's method and the strained voice was significantly reduced or eliminated in all three patients. Post-operative PET showed normal brain activation pattern with a significant decrease in cordal SMA, bilateral auditory association areas and thalamus, and a significant increase in rostral SMA compared with pre-operative recordings. This is the first report showing that treatment to a peripheral organ, which reverses voice symptoms, also reverses dysfunctional patterns of the central nervous system in patients with SD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Shortened cortical silent period in adductor spasmodic dysphonia: evidence for widespread cortical excitability.

PubMed

Samargia, Sharyl; Schmidt, Rebekah; Kimberley, Teresa Jacobson

2014-02-07

The purpose of this study was to compare cortical inhibition in the hand region of the primary motor cortex between subjects with focal hand dystonia (FHD), adductor spasmodic dysphonia (AdSD), and healthy controls. Data from 28 subjects were analyzed (FHD n=11, 53.25 ± 8.74 y; AdSD: n=8, 56.38 ± 7.5 y; and healthy controls: n=941.67 ± 10.85 y). All subjects received single pulse TMS to the left motor cortex to measure cortical silent period (CSP) in the right first dorsal interosseus (FDI) muscle. Duration of the CSP was measured and compared across groups. A one-way ANCOVA with age as a covariate revealed a significant group effect (p<0.001). Post hoc analysis revealed significantly longer CSP duration in the healthy group vs. AdSD group (p<0.001) and FHD group (p<0.001). These results suggest impaired intracortical inhibition is a neurophysiologic characteristic of FHD and AdSD. In addition, the shortened CSP in AdSD provides evidence to support a widespread decrease in cortical inhibition in areas of the motor cortex that represent an asymptomatic region of the body. These findings may inform future investigations of differential diagnosis as well as alternative treatments for focal dystonias. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Central voice production and pathophysiology of spasmodic dysphonia.

PubMed

Mor, Niv; Simonyan, Kristina; Blitzer, Andrew

2018-01-01

Our ability to speak is complex, and the role of the central nervous system in controlling speech production is often overlooked in the field of otolaryngology. In this brief review, we present an integrated overview of speech production with a focus on the role of central nervous system. The role of central control of voice production is then further discussed in relation to the potential pathophysiology of spasmodic dysphonia (SD). Peer-review articles on central laryngeal control and SD were identified from PUBMED search. Selected articles were augmented with designated relevant publications. Publications that discussed central and peripheral nervous system control of voice production and the central pathophysiology of laryngeal dystonia were chosen. Our ability to speak is regulated by specialized complex mechanisms coordinated by high-level cortical signaling, brainstem reflexes, peripheral nerves, muscles, and mucosal actions. Recent studies suggest that SD results from a primary central disturbance associated with dysfunction at our highest levels of central voice control. The efficacy of botulinum toxin in treating SD may not be limited solely to its local effect on laryngeal muscles and also may modulate the disorder at the level of the central nervous system. Future therapeutic options that target the central nervous system may help modulate the underlying disorder in SD and allow clinicians to better understand the principal pathophysiology. NA.Laryngoscope, 128:177-183, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Muscle tension dysphonia in Vietnamese female teachers.

PubMed

Nguyen, Duong Duy; Kenny, Dianna T; Tran, Ninh Duy; Livesey, Jonathan R

2009-03-01

There has been no published research on muscle tension dysphonia (MTD) in speakers who use a tonal language. Using a sample of 47 Northern Vietnamese female primary school teachers with MTD, we aimed to discover whether professional voice users of tonal languages presented with the same symptoms of MTD as speakers of nontonal languages and whether they presented with additional symptoms as a result of speaking a tonal language. The vocal characteristics were assessed by use of a questionnaire and expert perceptual evaluation. Laryngeal features were assessed by photolaryngoscopy. The results showed that MTD was associated with a larger number of vocal symptoms than previously reported. However, the participants did not have the same vocal symptoms reported in English speakers, for example, hard glottal attack, pitch breaks, unusual speech rate, and glottal fry. Factor analysis of the vocal symptoms revealed three factors: "vocal fatigue/hyperfunction," "physical discomfort," and "voice quality," all of which demonstrated high reliability. The major laryngeal characteristic was a glottal gap. The glottal shapes observed included: 44.7% had an incomplete closure, 29.8% a posterior gap, 12.8% an hourglass-shaped gap, 8.5% a spindle-shaped gap, and 4.3% had complete glottal closure. The findings implied a potential contribution of linguistic-specific factors and teaching-related factors to the presentation of this voice disorder in this group of teachers.

Effect of geographical and ethnic variation on Dysphonia Severity Index: a study of Indian population.

PubMed

Jayakumar, T; Savithri, S R

2012-01-01

Dysphonia Severity Index (DSI) is a widely used multiparametric approach to objectively quantify the voice quality. Few research groups have investigated the test-retest, interobserver variability, and influence of age and gender. They have also verified the application of DSI in various voice rehabilitation conditions. However, all these studies have been conducted on European population. There is a possibility of variation in the basic parameters of DSI across geographical and ethnic groups. Hence, the present study evaluated DSI in Indian population. One hundred twenty voluntary participants (60 males, 60 females) who had G(0) on the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale participated in the study (age range of 18-25 years, M=21.8, standard deviation=2.7). Maximum phonation time (MPT), frequency intensity, and jitter measurements were made using CSL 4500 (Kay Elemetrics, Pine Brook, NJ). Results showed noticeable difference between Indian and European population on MPT, Highest frequency (F(0)-High), and DSI values. Significant gender difference was also observed on MPT and F(0)-High. Test-retest reliability showed >95% for all the parameters. The MPT decrement lead to a reduction in the overall DSI value in both the genders. These results of the study caution voice professionals to reinvestigate and establish their own norms for their geographical and ethnic groups. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Management of unilateral true vocal cord paralysis in children.

PubMed

Setlur, Jennifer; Hartnick, Christopher J

2012-12-01

Historically, information gained from the treatment of unilateral true vocal cord paralysis (UVCP) in adults was the same used to treat children. Today, there is a growing body of literature aimed specifically at the treatment of this condition in children. It is an area of growing interest as UVCP can significantly impact a child's quality of life. Children with UVCP may present with stridor, dysphonia, aspiration, feeding difficulties, or a combination of these symptoms. Diagnosis relies on laryngoscopy, but other adjuncts such as ultrasound and laryngeal electromyography may also be helpful in making the diagnosis and forming a treatment plan. In many instances, there is effective compensation by the contralateral vocal fold, making surgical intervention unnecessary. Children who cannot compensate for a unilateral defect may suffer from significant dysphonia that can affect their quality of life because their ability to be understood may be diminished. In these patients, treatment in the form of medialization or reinnervation of the affected recurrent laryngeal nerve may be warranted. UVCP is a well recognized problem in pediatric patients with disordered voice and feeding problems. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment. Improved diagnostics and a growing understanding of prognosis can help guide therapy decisions along with the goals and desires of the patient and his or her family.

Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness.

PubMed

Guzman, Marco; Rubin, Adam; Cox, Paul; Landini, Fernando; Jackson-Menaldi, Cristina

2014-03-01

In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Aspecific membranous laryngitis after infectious mononucleosis.

PubMed

Di Girolamo, S; Anselmi, M; Piccini, A; De Lauretis, A; Passàli, D

1996-01-01

Aspecific membranous laryngitis is an unusual but very serious complication of viral infections. Here, we report the uncommon finding of infectious mononucleosis characterized by aspecific membranous laryngitis with fever, dysphonia and severe dyspnea in a 12-year-old girl. Endoscopy showed mucopus and sloughed epithelium forming a pseudomembrane covering almost all the supraglottal region and a supraglottal swelling including the epiglottis and arytenoids. The importance of suspecting diphtheria, epiglottitis, viral or bacterial croup and laringo-tracheo-bronchitis and including them in the differential diagnosis is emphasized.

Histologic and rheologic characterization of vocal fold scarring.

PubMed

Thibeault, Susan L; Gray, Steven D; Bless, Diane M; Chan, Roger W; Ford, Charles N

2002-03-01

Scarring of the vocal fold causes considerable dysphonia and presents significant treatment challenges. A rabbit model was developed to investigate the histologic ultrastructure and rheologic properties of the scarred vocal fold lamina propria. Eleven rabbit larynges were scarred by means of forcep biopsy. Sixty days postoperatively, the rabbits were sacrificed and their vocal folds were harvested. Histological analysis of the scarred and normal lamina propria was completed for collagen, procollagen, elastin, and hyaluronic acid. Linear viscoelastic shear properties of the tissues were also measured, including elastic shear modulus and dynamic viscosity. Compared to normal vocal fold lamina propria, scarred tissues demonstrated significantly less collagen, an increase in procollagen, and a decrease in elastin. Rheologically, both elastic shear modulus and dynamic viscosity were significantly higher for the scarred tissues. Increased stiffness and viscosity do not appear to result from an increase in collagen, but rather appear to be related to the presence of new, disorganized collagen scaffolding. Results are interpreted in terms of the possible role of interstitial proteins in the etiology of increased stiffness and viscosity, which requires further investigation. This animal model should allow for systematic future investigations of vocal fold scarring and its treatment.

War, politics, and voice: the vocal fold paralysis of George Orwell.

PubMed

Sulica, Lucian

2007-02-01

In 1936, like many individuals who felt the menace of fascism, George Orwell traveled to Spain to lend his support to the cause of the Republic, battling a right-wing coup. Spain, during its Civil War, was an eye-opening experience for him, yielding insights that allowed, and even compelled him to write Animal Farm and 1984. Spain was also a close brush with death. In May of 1937, in a trench on a windswept ridge near Huesca, Orwell was shot through the neck by a sniper, leaving him with a paralyzed vocal fold. A thorough review of firsthand accounts of Orwell's injury and subsequent care was made. These are presented in the context of current knowledge of ballistics, penetrating neck trauma, and vocal fold paralysis. Orwell survived largely because of the nature of his wounding with a high-velocity jacketed military round. His recovery followed a course in many ways typical for patients with vocal fold paralysis. His writings leave us a unique and extraordinary account of the experience of being shot, of the medical care of the day, of the handicap of paralytic dysphonia, and of survival and heroism under extraordinary circumstances.

[Observation of the dysphonia severity index in evaluating curative effect of vocal cord polyp surgery].

PubMed

Zhou, Zhou; Ge, Pingjiang; Liu, Qian; Liu, Ming; Zhang, Wei

2015-08-01

To investigate the applicability of the eysphonia severity index (DSI) in evaluating effects of surgery between before and after groups of vocal polyp patients. Analyses of measurement data pre and pro-surgery of 70 vocal polyp patients and 35 no voice disorders volunteers (control group). The voice quality was measured subjectively with the voice handicap index (VHI), the GRBAS and fiber electronic laryngoscopy. Measures of maximum phonation time (MPT), shimmer and jitter were obtained for each subject by using DiVAS 2.30 (XION, Germany). The DiVAS 2.30 had spotanenously calculate the scores of DSI. Using SPSS 17.0 to find the differences of DSI scores among the three groups by one-way ANOVA variance analysis. And finding out of the correlation with DSI scores and VHI scores, GRBAS, MPT, jitter and shimmer. DSI improved significantly after surgery in the vocal polyps group (mean difference DSI -2.92 and 1.87, respectively) and also in the control group (mean difference DSI -2.92 and 2.30, respectively). However, no significant difference between the control group and the after surgery group. By using Pearson correlation analysis, this study observed a strong correlation between the DSI scores and the VHI scores, the values of GRBAS, shimmer (P < 0.01). DSI is an effective and high accuracy multi-parameter system for evaluation of vocal cord polyp patients as an independent assessment of dysphonia. DSI also can be used in evaluation of the effects of the vocal polyps surgery.

Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients.

PubMed

van Esch, Babette F; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2017-02-01

Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

Long-term voice handicap index after type II thyroplasty using titanium bridges for adductor spasmodic dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Kodama, Narihiro; Minoda, Ryosei; Kumai, Yoshihiko

2014-06-01

To determine the long-term functional outcomes of type II thyroplasty using titanium bridges for adductor spasmodic dysphonia (AdSD) by perceptual analysis using the Voice Handicap Index-10 (VHI-10) and by acoustic analysis. Fifteen patients with AdSD underwent type II thyroplasty using titanium brides between August 2006 and February 2011. VHI-10 scores, a patient-based survey that quantifies a patient's perception of his or her vocal handicap, were determined before and at least 2 years after surgery. Concurrent with the VHI-10 evaluation, acoustic parameters were assessed, including jitter, shimmer, harmonic-to-noise ratio (HNR), standard deviation of F0 (SDF0), and degree of voice breaks (DVB). The average follow-up interval was 30.1 months. No patient had strangulation of the voice, and all were satisfied with the voice postoperatively. In the perceptual analysis, the mean VHI-10 score improved significantly, from 26.7 to 4.1 two years after surgery. All patients had significantly improved each score of three different aspects of VHI-10, representing improved functional, physical, and emotional well-being. All acoustic parameters improved significantly 2 years after surgery. The treatment of AdSD with type II thyroplasty significantly improved the voice-related quality of life and acoustic parameters 2 years after surgery. The results of the study suggest that type II thyroplasty using titanium bridges provides long-term relief of vocal symptoms in patients with AdSD. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Voice tuning with new instruments for type II thyroplasty in the treatment of adductor spasmodic dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Toya, Yutaka; Kumai, Yoshihiko

2016-10-01

Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type II thyroplasty differs from previous treatments in that this surgery does not involve any surgical intervention into the laryngeal muscle, nerve or vocal folds. Type II thyroplasty intervenes in the thyroid cartilage, which is unrelated to the lesion. This procedure, conducted with the aim of achieving lateralization of the vocal folds, requires utmost surgical caution due to the extreme delicacy of the surgical site, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages at a correct position. During surgery, the correct separation of the incised cartilage edges with voice monitoring is the most important factor determining surgical success and patient satisfaction. We designed new surgical instruments: a thyroid cartilage elevator for undermining the thyroid cartilage, and spacer devices to gauge width while performing voice monitoring. These devices were designed to prevent surgical complications, and to aid in selecting the optimal size of titanium bridges while temporally maintaining a separation during voice monitoring. We designed new surgical instruments, including a thyroid cartilage elevator and spacer devices. Precise surgical procedures and performing voice tuning during surgery with the optimal separation width of the thyroid cartilage are key points for surgical success. We introduce the technique of voice tuning using these surgical tools in order to achieve a better outcome with minimal surgical complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An open-label study of sodium oxybate (Xyrem®) in spasmodic dysphonia

PubMed Central

Rumbach, Anna F.; Blitzer, Andrew; Frucht, Steven J.; Simonyan, Kristina

2016-01-01

Objective Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed. Study Design and Methods We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem®), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration. Results Sodium oxybate significantly improved voice symptoms (p = 0.001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (p = 0.03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug’s effects were observed approximately 30–40 min after its intake and lasted about 3.5–4 hours. Conclusion Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol and as such sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients. PMID:27808415

Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing.

PubMed

Sielska-Badurek, Ewelina; Osuch-Wójcikiewicz, Ewa; Sobol, Maria; Kazanecka, Ewa; Rzepakowska, Anna; Niemczyk, Kazimierz

2017-07-01

The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice. This is a prospective, randomized study. Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index. After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P < 0.001), perceptual voice assessment (P < 0.001), phonetograms (P = 0.002), and singing range obtained from acoustic analysis of glissando (P < 0.001). In the control group, no statistically significant differences were found between the first and the second assessments. Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Dysphagia risk assessment in acute left-hemispheric middle cerebral artery stroke.

PubMed

Somasundaram, Sriramya; Henke, Christian; Neumann-Haefelin, Tobias; Isenmann, Stefan; Hattingen, Elke; Lorenz, Matthias W; Singer, Oliver C

2014-01-01

Bedside evaluation of dysphagia may be challenging in left middle cerebral artery (MCA) stroke due to frequently existing aphasia. Here we analyse the predictive value of common bedside screening tests and of two items of cortical dysfunction, aphasia and buccofacial apraxia (BFA), for the detection of dysphagia. We prospectively examined 67 consecutive patients with clinical and imaging evidence of acute (<72 h) left MCA stroke. Dysphonia, dysarthria, abnormal volitional cough and abnormal gag reflex were assessed followed by a standardized 50-ml water-swallowing test determining the symptoms cough and voice change after swallow. Aphasia and BFA were assessed according to defined criteria. Fibre-optic endoscopic evaluation of swallowing (FEES) was performed for validation of dysphagia. 41 (61%) patients had FEES-proven dysphagia. Abnormal gag reflex, abnormal volitional cough, cough after swallow, aphasia and BFA were significantly more frequent in dysphagic as compared to non-dysphagic patients, while dysphonia, dysarthria and voice change after swallow were not. Aphasia and BFA had the highest sensitivity (97 and 78%, respectively) and high negative predictive values (89 and 68%, respectively) for dysphagia. Multivariate regression analysis did not identify an independent predictor of dysphagia. In left MCA stroke, the sensitivity and specificity of common bedside dysphagia screening methods are low. In contrast, aphasia and BFA have a high sensitivity and high negative predictive power, presumably due to the neuro-anatomical overlap between cortical regions involved in swallowing, speech production, imitation and voluntary movement control. © 2014 S. Karger AG, Basel.

Glottoplasty for male-to-female transsexualism: voice results.

PubMed

Remacle, Marc; Matar, Nayla; Morsomme, Dominique; Veduyckt, Ingrid; Lawson, Georges

2011-01-01

The aim of this study was to evaluate the objective voice results of Wendler's glottoplasty in male-to-female transsexuals. We retrospectively reviewed our patients treated with Wendler's technique with minor modifications. Glottoplasty consisted in CO(2)-laser epithelial ablation of the anterior commissure and the two vocal folds in anterior third, suturing of the two vocal folds with two stitches of 3.0 resorbable thread, and application of fibrin sealant to strengthen the suture. Voice assessment was based mainly on fundamental frequency (F(0)), frequency range, jitter, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP) grade of dysphonia (G), and voice handicap index (VHI). These measures were taken before surgery and on the last follow-up visit. Our series included 15 patients with a mean age of 36 years. The mean follow-up period was 7.2 months. We did not observe any early complications related to the technique. The comparison between the preoperative and the postoperative measurements, using Wilcoxon signed rank test, showed a significant improvement of median F(0) from 139 to 191 Hz (P=0.006) with an increase in the grade of dysphonia (G(pre)=0.2, G(post)=1, P=0.013) and ESGP (ESGP(pre)=8.1 ± 3.2, ESGP(post)=12.0 ± 3.8, P=0.002). Other measurements, including VHI, did not show any significant differences pre- and postoperatively. Wendler's glottoplasty can contribute to feminize the voice. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy.

PubMed

Guglielmi, Rinaldo; Pacella, Claudio Maurizio; Bianchini, Antonio; Bizzarri, Giancarlo; Rinaldi, Roberta; Graziano, Filomena Maria; Petrucci, Lucilla; Toscano, Vincenzo; Palma, Enzo; Poggi, Maurizio; Papini, Enrico

2004-02-01

To establish the role of percutaneous ethanol injection (PEI) treatment in benign thyroid lesions by evaluating: (1) the long-term efficacy and side effects of the treatment, (2) the factors predictive of efficacy of PEI, and (3) the cost effectiveness of the procedure. Fifty-eight recurrent cystic nodules, 95 autonomously functioning nodules (AFTN), and 17 hyperfunctioning nodules causing thyrotoxicosis (toxic nodules) were treated by PEI from 1990 to 1996 in our center. Ultrasound (US) and color flow doppler (CFD) examinations were carried out before and after each treatment. In patients with AFTN, serum thyrotropin (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb) levels were tested before and after PEI. All patients were independently reexamined by two external reviewers after a minimum follow-up of 5 years (median, 6.9 years). The median number of treatments was 2.0 (range, 1.0-4.0) for cystic nodules, 4 (range, 2.0-6.0) for AFTN, and 5 (range, 3.0-7.0) for toxic nodules. At the 5-year evaluation cystic nodules showed a volume reduction greater than 75% versus baseline in 86.2% of cases and an improvement of local symptoms in 91.4% of cases. AFTN presented serum TSH within normal limits in 60.0% of patients. Toxic nodules showed a detectable serum TSH and normal FT3 and FT4 values in 35.3% of cases. Two cases of transient dysphonia were observed. In cystic lesions no significant correlation was found between the baseline and the final volume (r2 = 0.17) and no significant predictor of treatment efficacy was found. However, unilocularity was associated with a lower number of treatments than multilocularity (median, 2.0 vs. 3.0). Independent predictors of clinical efficacy in both AFTN and toxic nodules were a baseline volume less than 5.0 mL and a fluid component greater than 30% (odds ratio [OR] = 6.1 and 3.3, respectively). Most recurrent cystic lesions of the thyroid can be cured by PEI, which should become the first line of treatment. The majority of AFTN and toxic nodules with volume less than 5.0 mL presented a marked volume decrease and normal serum TSH levels when treated by PEI, which seems a valid alternative to clinical follow-up alone in patients refusing 131I. PEI is not indicated in large or toxic nodules, for which 131I is the treatment of choice.

Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?

PubMed

Martins, Regina Helena Garcia; Tavares, Elaine Lara Mendes; Pessin, Adriana Bueno Benito

2017-05-01

Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice. The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers. A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms. Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group. Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Outcome Measurement in the Treatment of Spasmodic Dysphonia: A Systematic Review of the Literature.

PubMed

Rumbach, Anna; Aiken, Patrick; Novakovic, Daniel

2018-04-11

The aim of this review was to systematically identify all available studies reporting outcomes measures to assess treatment outcomes for people with spasmodic dysphonia (SD). Full-text journal articles were identified through searches of PubMed, Embase, CINAHL, and Cochrane databases and hand searching of journals. A total of 4,714 articles were retrieved from searching databases; 1,165 were duplicates. Titles and abstracts of 3,549 were screened, with 171 being selected for full-text review. During full-text review, 101 articles were deemed suitable for inclusion. An additional 24 articles were identified as suitable for inclusion through a hand search of reference lists. Data were extracted from 125 studies. A total of 220 outcome measures were identified. Considered in reference to the World Health Organization International Classification of Functioning, Disability and Health (ICF), the majority of outcomes were measured at a Body Function level (n = 212, 96%). Outcomes that explored communication and participation in everyday life and attitudes toward communication (ie, activity and participation domains) were infrequent (n = 8; 4%). Quality of life, a construct not measured within the ICF, was also captured by four outcome measures. No instruments evaluating communication partners' perspectives or burden/disability were identified. The outcome measures used in SD treatment studies are many and varied. The outcome measures identified predominately measure constructs within the Body Functions component of the ICF. In order to facilitate data synthesis across trials, the development of a core outcome set is recommended. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Cultural adaptation of the short Self-Regulation Questionnaire: suggestions for the speech area.

PubMed

Almeida, Anna Alice; Behlau, Mara

2017-08-14

To present the translated and linguistic and culturally adapted version of the Short self-regulation Questionnaire (SSRQ) for the Brazilian Portuguese and to check its applicability to patients with dysphonia. The SSRQ is a tool used to evaluate the ability to self-regulate behavior; it has 31 items and generates three scores: total index of individual self-regulation capacity and partial scores for goal setting and impulse control. Each item should be scored by means of a Likert-type 5-point scale; the total score ranges from 29 to 145 points. The original instrument was translated and culturally adapted to Brazilian Portuguese by two English-speaking speech therapists who combined their translations and made linguistic adjustments to compose a single final version. This version was back-translated by a third speech therapist with experience in validation studies and without knowledge of the original instrument. The translation and the back-translation were compared with each other and with the original English version by five speech therapists that reached a consensus on additional changes. In this way, the final version was produced. This was called "Questionário Reduzido de Autorregulação" (QRAR). The QRAR was applied to 45 randomly chosen subjects with and without dysphonia in a teaching clinic. No item had to be eliminated, since the respondents did not find it difficult to indicate their answers. The "Questionário Reduzido de Autorregulação" (QRAR) has been successfully translated and culturally and linguistically adapted to Brazilian and Portuguese and can be applied to individuals with voice problems.

Prevalence of Voice Disorders in Iranian Primary School Students.

PubMed

Mohammadzadeh, Ali; Sandoughdar, Nazila

2017-03-01

The voice is the sound produced by vibration of our vocal cords and has an important role in verbal communication. A child's voice disorder may significantly impair his or her ability to be heard and understood. The purpose of this study was to determine the prevalence of voice disorders in primary school students. In this descriptive-analytical study, a total of 501 fourth through fifth grade primary school students (boys = 51.6%, girls = 48.4%) with the age range of 10-12 years were selected from nine public school systems in Tehran that were assessed in October 2013 through March 2014. Presence of a voice disorder characterized by hoarseness was identified by a dual approach including investigator screening and parent identification. We used the grade of overall dysphonia, roughness, breathiness, asthenia, and strain scale for perceptual evaluation of voice. All children were assessed with video laryngoscopy examination by an otorhinolaryngologist. The recordings were made during spontaneous speech, counting numbers, sustained utterance of the (/a/) vowel, reading a standard passage in Farsi, and the ratio of /s/ and /z/. Statistical analysis was done via chi-square test and t test. Results indicated that the prevalence of voice disorders in primary school students is 53.2%. The results indicated significant differences between gender and subjects with lesions (P = 0.00000), gender and vocal disorders (P = 0.04), and s/z ratio and type of lesion (P = 0.0002). Phonotrauma seems to play an important role in child dysphonia, with nodules as main diagnosis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A Measure of the Auditory-perceptual Quality of Strain from Electroglottographic Analysis of Continuous Dysphonic Speech: Application to Adductor Spasmodic Dysphonia.

PubMed

Somanath, Keerthan; Mau, Ted

2016-11-01

(1) To develop an automated algorithm to analyze electroglottographic (EGG) signal in continuous dysphonic speech, and (2) to identify EGG waveform parameters that correlate with the auditory-perceptual quality of strain in the speech of patients with adductor spasmodic dysphonia (ADSD). Software development with application in a prospective controlled study. EGG was recorded from 12 normal speakers and 12 subjects with ADSD reading excerpts from the Rainbow Passage. Data were processed by a new algorithm developed with the specific goal of analyzing continuous dysphonic speech. The contact quotient, pulse width, a new parameter peak skew, and various contact closing slope quotient and contact opening slope quotient measures were extracted. EGG parameters were compared between normal and ADSD speech. Within the ADSD group, intra-subject comparison was also made between perceptually strained syllables and unstrained syllables. The opening slope quotient SO7525 distinguished strained syllables from unstrained syllables in continuous speech within individual subjects with ADSD. The standard deviations, but not the means, of contact quotient, EGGW50, peak skew, and SO7525 were different between normal and ADSD speakers. The strain-stress pattern in continuous speech can be visualized as color gradients based on the variation of EGG parameter values. EGG parameters may provide a within-subject measure of vocal strain and serve as a marker for treatment response. The addition of EGG to multidimensional assessment may lead to improved characterization of the voice disturbance in ADSD. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

An open-label study of sodium oxybate in Spasmodic dysphonia.

PubMed

Rumbach, Anna F; Blitzer, Andrew; Frucht, Steven J; Simonyan, Kristina

2017-06-01

Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed. Open-label study. We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration. Sodium oxybate significantly improved voice symptoms (P = .001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (P = .03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug's effects were observed approximately 30 to 40 minutes after its intake and lasted about 3.5 to 4 hours. Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol, and as such, sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients. 4 Laryngoscope, 127:1402-1407, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Workplace productivity and voice disorders: a cognitive interviewing study on presenteeism in individuals with spasmodic dysphonia.

PubMed

Isetti, Derek; Meyer, Tanya

2014-11-01

The objective of this study was to obtain initial reactions and suggested modifications to two existing presenteeism scales: the Stanford Presenteeism Scale 6 (SPS-6) and the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP) among a cohort of employed individuals with a focal laryngeal dystonia, spasmodic dysphonia (SD). The study design is a qualitative study. Nine speakers with SD underwent cognitive interviews, during which they were asked to evaluate the relevance of statements and clarity of wording on the SPS-6, the WPAI-SHP, and an additional set of voice-related statements designed by the researchers. Participants were asked to complete the scales, rank order statements in terms of perceived importance, and suggest additional statements of relevance. Although all participants noted that their SD did have an effect on their jobs, there were suggestions for modifying both the WPAI-SHP and the SPS-6. Participants regarded specific voice-related statements that were generated by the researchers to be of greater importance than the majority of the statements on the SPS-6. Minor changes in the wording of the instructions on the WPAI-SHP were recommended. Presenteeism is an important construct to measure in individuals with a chronic voice disorder such as SD. However, existing presenteeism scales might best be administered in conjunction with additional statements that are more voice related so that clinicians can be made aware of specific difficulties encountered in the workplace. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A measure of the auditory-perceptual quality of strain from electroglottographic analysis of continuous dysphonic speech: Application to adductor spasmodic dysphonia

PubMed Central

Somanath, Keerthan; Mau, Ted

2016-01-01

Objectives (1) To develop an automated algorithm to analyze electroglottographic (EGG) signal in continuous, dysphonic speech, and (2) to identify EGG waveform parameters that correlate with the auditory-perceptual quality of strain in the speech of patients with adductor spasmodic dysphonia (ADSD). Study Design Software development with application in a prospective controlled study. Methods EGG was recorded from 12 normal speakers and 12 subjects with ADSD reading excerpts from the Rainbow Passage. Data were processed by a new algorithm developed with the specific goal of analyzing continuous dysphonic speech. The contact quotient (CQ), pulse width (EGGW), a new parameter peak skew, and various contact closing slope quotient (SC) and contact opening slope quotient (SO) measures were extracted. EGG parameters were compared between normal and ADSD speech. Within the ADSD group, intra-subject comparison was also made between perceptually strained syllables and unstrained syllables. Results The opening slope quotient SO7525 distinguished strained syllables from unstrained syllables in continuous speech within individual ADSD subjects. The standard deviations, but not the means, of CQ, EGGW50, peak skew, and SO7525 were different between normal and ADSD speakers. The strain-stress pattern in continuous speech can be visualized as color gradients based on the variation of EGG parameter values. Conclusions EGG parameters may provide a within-subject measure of vocal strain and serve as a marker for treatment response. The addition of EGG to multi-dimensional assessment may lead to improved characterization of the voice disturbance in ADSD. PMID:26739857

Onabotulinum toxin A dosage trends over time for adductor spasmodic dysphonia: A 15-year experience.

PubMed

Tang, Christopher G; Novakovic, Daniel; Mor, Niv; Blitzer, Andrew

2016-03-01

Although onabotulinum neurotoxin A (BoNTA) has been used for over three decades for the treatment of adductor spasmodic dysphonia, no study has been performed to look at the trend of BoNTA dosages across time. The goal of this study is to evaluate the dosage trends to determine if the dosage necessary for voice improvement in patients increases over time. Charts were reviewed for patients with 15 years or more of experience. Linear regression analysis was performed to determine correlation coefficients and trends. Fifty-five patients receiving BoNTA injections by the senior author (a.b.) for over 15 years were evaluated. Thirty-nine patients (82% female) met inclusion criteria. Patients received injections over an average of 18.6 years ± 1.36 years, with the longest follow-up of 21.5 years. Of 39 patients, 16 (41%) had a negative correlation coefficient (Pearson's r) suggesting a decrease over time, whereas 23 (59%) had a positive correlation coefficient suggesting an increase over time. The mean correlation coefficient was 0.139 ± 0.534 and P < 0.05 in 19 patients and P > 0.05 in 20 patients. R(2) for all patients were less than 0.75. Onabotulinum neurotoxin A injection dosage trends vary depending on the individual over time. Overall, the dose range appears to be stable in the majority of patients, suggesting that tolerance does not play a significant part in dose variation over time. 4. Laryngoscope, 126:678-681, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Factors influencing botulinum toxin dose instability in spasmodic dysphonia patients.

PubMed

Rosow, David E; Pechman, Amanda; Saint-Victor, Sandra; Lo, Kaming; Lundy, Donna S; Casiano, Roy R

2015-05-01

Many patients with spasmodic dysphonia (SD) see consistent effects from botulinum toxin (BTX) injections of the same dose, whereas others require dosage changes over time. We sought to determine whether demographics (age and gender) or environmental factors (smoking) affect the long-term stability of BTX dosing in these patients. Retrospective review. Charts of all patients undergoing BTX injection for adductor SD were reviewed. Dosage change, defined as whether there was any difference in total dosage used between two beneficial injections, was used as a measure of dosing stability. Beneficial injections were indicated by a voice rating score of at least three of four and any non-zero duration of improved voice. Logistic regression analysis was performed to determine whether age, gender, smoking status, or duration of treatment correlated with odds of having a dosage change. A total of 211 patients were ultimately included. Age, gender, and smoking status were all found to have no correlative effect on dosing stability. The only factor that was predictive of dose stability was the number of previous beneficial injections, as every additional injection led to decreased odds of a change in dosage for the next injection (odds ratio=0.964; 95% confidence interval=0.947-0.981). Dosage of BTX injections for long-term treatment of SD has a significant propensity to remain stable over time. Factors such as age, gender, and smoking status do not appear to influence the dosage stability. These findings should allow for better patient counseling regarding expectations for their long-term treatment. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Impact of muscle tension dysphonia on tonal pitch target implementation in vietnamese female teachers.

PubMed

Nguyen, Duong Duy; Kenny, Dianna T

2009-11-01

Muscle tension dysphonia (MTD) is a voice disorder with deteriorated vocal quality, particularly pitch problems. Because pitch is mainly controlled by the laryngeal muscles, and because MTD is characterized by increased laryngeal muscle tension, we hypothesized that it may result in problems in pitch target implementation in tonal languages. We examined tonal samples of 42 Vietnamese female primary school teachers diagnosed with MTD and compared them with 30 vocally healthy female teachers who spoke the same dialect. Tonal data were analyzed using Computerized Speech Lab (CSL-4300B) for Windows. From tonal sampling bases, fundamental frequency (F0) was measured at target points specified by contour examination. Parameters representing pitch movement including time, size, and speed of movement were measured for the falling tone and rising tone. We found that F0 at target points in MTD group was lowered in most tones, especially tones with extensive F0 variation. In MTD group, target F0 of the broken tone in isolation was 37.5 Hz lower (P<0.01) and target F0 of rising tone in isolation was 46 Hz lower (P<0.01) than in control group. In MTD group, speed of pitch fall of the falling tone in isolation was faster than control group by 2.2 semitones/second (st/s) (P<0.05) and speed of pitch rise in the rising tone in isolation was slower than control group by 7.2 st/s (P<0.01). These results demonstrate that MTD is associated with problems in tonal pitch variation.

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery.

PubMed

Hsiung, Ming-Wang

2004-03-01

Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery. Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery. Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia. Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.

Day surgery for vocal fold lesions using a double-bent 60-mm Cathelin needle.

PubMed

Toyomura, Fumimasa; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Tsukahara, Kiyoaki; Motohashi, Ray; Sakurai, Eriko; Nomoto, Masaki; Suzuki, Mamoru

2014-11-01

Day surgery for vocal cord lesions overcomes the disadvantages of laryngomicrosurgery under general anesthesia. We present our experience with treatment of vocal fold lesions using a long double-bend Cathelin needle that can access all parts of the vocal cords. A 23G, 60-mm-long Cathelin needle was bent twice by 45(o) at a distance of 1 and 2 cm from the tip, and was attached to a syringe. Under topical anesthesia and nasal endoscopy of the laryngopharynx, the needle was inserted percutaneously perpendicular to the skin, the direction of insertion being altered when the bends in the needle reached the skin surface. This allows the tip of the needle to access all parts of the glottis, allowing the performance of procedures such as biopsies, excision of lesions, and injection into the vocal folds. Between January 2011 and December 2013, we used this technique to perform vocal fold procedures in 566 patients presenting for treatment of spasmodic dysphonia (412 cases, 73 %) and other vocal fold lesions. Only minor complications, such as hematoma (3 patients, 0.5 %) and slight bleeding from the puncture site in the epiglottic vallecula (all patients, 100 %), which ceased spontaneously within 10 min, were seen. Erroneous puncture occurred in three patients (0.5 %) and the puncture had to be repeated in 38 patients (6.7 %). The procedure was completed successfully in all cases (100 %). Surgery for vocal fold lesions under topical anesthesia using our double-bend Cathelin needle technique is simple, safe, and useful.

Laryngeal muscle activity in unilateral vocal fold paralysis patients using electromyography and coronal reconstructed images.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Nishimoto, Kohei; Minoda, Ryosei

2014-04-01

To assess laryngeal muscle activity in unilateral vocal fold paralysis (UVFP) patients using laryngeal electromyography (LEMG) and coronal images. Case series with chart review. University hospital. Twenty-one patients diagnosed with UVFP of at least 6 months in duration with paralytic dysphonia, underwent LEMG, phonatory function tests, and coronal imaging. A 4-point scale was used to grade motor unit (MU) recruitment: absent = 4+, greatly decreased = 3+, moderately decreased = 2+, and mildly decreased = 1+. Maximum phonation time (MPT) and mean flow rate (MFR) were employed. Coronal images were assessed for differences in thickness and vertical position of the vocal folds during phonation and inhalation. MU recruitment in thyroarytenoid/lateral cricoarytenoid (TA/LCA) muscle complex results were 1+ for 4 patients, 2+ for 5, 3+ for 6, and 4+ for 6. MPT was positively correlated with MU recruitment. Thinning of the affected fold was evident during phonation in 19 of the 21 subjects. The affected fold was at an equal level with the healthy fold in all 9 subjects with MU recruitment of 1+ and 2+. Eleven of 12 subjects with MU recruitments of 3+ and 4+ showed the affected fold at a higher level than the healthy fold. There was a significant difference between MU recruitment and the vertical position of the affected fold. Synkinetic reinnervation may occur in some cases with UVFP. MU recruitments of TA/LCA muscle complex in UVFP patients may be related to phonatory function and the vertical position of the affected fold.

How to help teachers' voices.

PubMed

Saatweber, Margarete

2008-01-01

It has been shown that teachers are at high risk of developing occupational dysphonia, and it has been widely accepted that the vocal characteristics of a speaker play an important role in determining the reactions of listeners. The functions of breathing, breathing movement, breathing tonus, voice vibrations and articulation tonus are transmitted to the listener. So we may conclude that listening to the teacher's voice at school influences children's behavior and the perception of spoken language. This paper presents the concept of Schlaffhorst-Andersen including exercises to help teachers improve their voice, breathing, movement and their posture. Copyright 2008 S. Karger AG, Basel.

Magnetic Tissue Engineering for Voice Rehabilitation - First Steps in a Promising Field.

PubMed

Dürr, Stephan; Bohr, Christopher; Pöttler, Marina; Lyer, Stefan; Friedrich, Ralf Philipp; Tietze, Rainer; Döllinger, Michael; Alexiou, Christoph; Janko, Christina

2016-06-01

The voice is one of the most important instruments of communication between humans. It is the product of intact and well-working vocal folds. A defect of these structures causes dysphonia, associated with a clear reduction of quality of life. Tissue engineering of the vocal folds utilizing magnetic cell levitation after nanoparticle loading might be a technique to overcome this challenging problem. Vocal fold fibroblasts (VFFs) were isolated from rabbit larynges and cultured. For magnetization, cells were incubated with superparamagnetic iron oxide nanoparticles (SPION) and the loading efficiency was determined by Prussian blue staining. Biocompatibility was analyzed in flow cytometry by staining with annexin V-fluorescein isothiocyanate propidium iodide, 1,1',3,3,3',3'-hexamethylindodicarbo-cyanine iodide [DiIC1(5)] and propidium idodide-Triton X-100 to monitor phosphatidylserine exposure, plasma membrane integrity, mitochondrial membrane potential and DNA degradation. Isolated VFFs can be successfully loaded with SPION, and optimal iron loading associated with minimized cytotoxicity represents a balancing act in magnetic tissue engineering. Our data are a firm basis for the next steps of investigations. Magnetic tissue engineering using magnetic nanoparticle-loaded cells which form three-dimensional structures in a magnetic field will be a promising approach in the future. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence, signs, and symptoms at presentation

PubMed Central

Adham, Marlinda; Kurniawan, Antonius N.; Muhtadi, Arina Ika; Roezin, Averdi; Hermani, Bambang; Gondhowiardjo, Soehartati; Tan, I Bing; Middeldorp, Jaap M.

2012-01-01

Among all head and neck (H&N) cancers, nasopharyngeal carcinoma (NPC) represents a distinct entity regarding epidemiology, clinical presentation, biological markers, carcinogenic risk factors, and prognostic factors. NPC is endemic in certain regions of the world, especially in Southeast Asia, and has a poor prognosis. In Indonesia, the recorded mean prevalence is 6.2/100 000, with 13 000 yearly new NPC cases, but otherwise little is documented on NPC in Indonesia. Here, we report on a group of 1121 NPC patients diagnosed and treated at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia between 1996 and 2005. We studied NPC incidence among all H&N cancer cases (n=6000) observed in that period, focusing on age and gender distribution, the ethnic background of patients, and the disease etiology. We also analyzed most prevalent signs and symptoms and staging of NPC patients at first presentation. In this study population, NPC was the most frequent H&N cancer (28.4%), with a male-to-female ratio of 2.4, and was endemic in the Javanese population. Interestingly, NPC appeared to affect patients at a relatively young age (20% juvenile cases) without a bimodal age distribution. Mostly, NPC initiated in the fossa of Rosenmuller and spreaded intracranially or locally as a mass in the head. Occasionally, NPC developed at the submucosal level spreading outside the anatomic limits of the nasopharynx. At presentation, NPC associated with hearing problems, serous otitis media, tinnitus, nasal obstruction, anosmia, bleeding, difficulty in swallowing and dysphonia, and even eye symptoms with diplopia and pain. The initial diagnosis is difficult to make because early signs and symptoms of NPC are not specific to the disease. Early-age Epstein-Barr virus (EBV) infection combined with frequent exposure to environmental carcinogenic co-factors is suggested to cause NPC development. Undifferentiated NPC is the most frequent histological type and is closely associated with EBV. Expression of the EBV-encoded latent membrane protein 1(LMP1) Oncogene in biopsy material was compared between NPC patients of < 30 years old and those of ≥ 30 years old, matched for sex and tumor stage. Higher LMP1 expression in patients of <30 years old was observed, which was related to more locoregional progressivity. Increased medical awareness of prevailing early stage signs and symptoms coupled to use of EBV-related diagnostic tumor markers may lead to down-staging and timely treatment to improve survival of patients with this aggressive disease. PMID:22313595

Comparison of Pitch Strength With Perceptual and Other Acoustic Metric Outcome Measures Following Medialization Laryngoplasty.

PubMed

Rubin, Adam D; Jackson-Menaldi, Cristina; Kopf, Lisa M; Marks, Katherine; Skeffington, Jean; Skowronski, Mark D; Shrivastav, Rahul; Hunter, Eric J

2018-05-14

The diagnoses of voice disorders, as well as treatment outcomes, are often tracked using visual (eg, stroboscopic images), auditory (eg, perceptual ratings), objective (eg, from acoustic or aerodynamic signals), and patient report (eg, Voice Handicap Index and Voice-Related Quality of Life) measures. However, many of these measures are known to have low to moderate sensitivity and specificity for detecting changes in vocal characteristics, including vocal quality. The objective of this study was to compare changes in estimated pitch strength (PS) with other conventionally used acoustic measures based on the cepstral peak prominence (smoothed cepstral peak prominence, cepstral spectral index of dysphonia, and acoustic voice quality index), and clinical judgments of voice quality (GRBAS [grade, roughness, breathiness, asthenia, strain] scale) following laryngeal framework surgery. This study involved post hoc analysis of recordings from 22 patients pretreatment and post treatment (thyroplasty and behavioral therapy). Sustained vowels and connected speech were analyzed using objective measures (PS, smoothed cepstral peak prominence, cepstral spectral index of dysphonia, and acoustic voice quality index), and these results were compared with mean auditory-perceptual ratings by expert clinicians using the GRBAS scale. All four acoustic measures changed significantly in the direction that usually indicates improved voice quality following treatment (P < 0.005). Grade and breathiness correlated the strongest with the acoustic measures (|r| ~0.7) with strain being the least correlated. Acoustic analysis on running speech highly correlates with judged ratings. PS is a robust, easily obtained acoustic measure of voice quality that could be useful in the clinical environment to follow treatment of voice disorders. Copyright © 2018. Published by Elsevier Inc.

The clinical spectrum of laryngeal dystonia includes dystonic cough: observations of a large series.

PubMed

Payne, Susannah; Tisch, Stephen; Cole, Ian; Brake, Helen; Rough, Judy; Darveniza, Paul

2014-05-01

Laryngeal dystonia is a movement disorder of the muscles within the larynx, which most commonly manifests as spasmodic dysphonia (SD). Rarer reported manifestations include dystonic respiratory stridor and dyscoordinate breathing. Laryngeal dystonia has been treated successfully with botulinum neurotoxin (BTX) injections since 1984. We reviewed prospectively collected data in a consecutive series of 193 patients with laryngeal dystonia who were seen at St. Vincent's Hospital between 1991 and 2011. Patient data were analyzed in Excel, R, and Prism. Laryngeal dystonia manifested as SD (92.7%), stridor (11.9%), dystonic cough (6.2%), dyscoordinate breathing (4.1%), paroxysmal hiccups (1.6%), and paroxysmal sneezing (1.6%). There were more women (68.4%) than men (31.6%), and the average age at onset was 47 years. A positive family history of dystonia was present in 16.1% of patients. A higher incidence of extra-laryngeal dystonia (ie, torticollis and blepharospasm) and concurrent manifestations of laryngeal dystonia were present in patients with dystonic cough, dyscoordinate breathing, paroxysmal sneezing, and hiccups than in other patients (P = 0.003 and P < 0.0001, respectively). The average starting dose of BTX decreased from 2.3 to 0.5 units between 1991 and 2011. The median treatment rating was excellent across all subgroups. Patients with adductor SD, stridor, extra-laryngeal dystonia and male patients had relatively better treatment outcomes. Technical failures were rare (1.1%). Dysphonia secondary to vocal cord paresis followed 38.7% of treatments. Laryngeal dystonia manifests predominantly as SD, but other manifestations include stridor, dyscoordinate breathing, paroxysmal cough, hiccups, and sneezing. BTX injections are very effective across all subgroups. Severe adverse events are rare. © 2014 International Parkinson and Movement Disorder Society.

Predicting Voice Disorder Status From Smoothed Measures of Cepstral Peak Prominence Using Praat and Analysis of Dysphonia in Speech and Voice (ADSV).

PubMed

Sauder, Cara; Bretl, Michelle; Eadie, Tanya

2017-09-01

The purposes of this study were to (1) determine and compare the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from connected speech samples using two software systems: Analysis of Dysphonia in Speech and Voice (ADSV) and Praat; and (2) to determine the relationship between measures of CPPS generated from these programs. This is a retrospective cross-sectional study. Measures of CPPS were obtained from connected speech recordings of 100 subjects with voice disorders and 70 nondysphonic subjects without vocal complaints using commercially available ADSV and freely downloadable Praat software programs. Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate and compare the diagnostic accuracy of CPPS measures. Relationships between CPPS measures from the programs were determined. Results showed acceptable overall accuracy rates (75% accuracy, ADSV; 82% accuracy, Praat) and area under the ROC curves (area under the curve [AUC] = 0.81, ADSV; AUC = 0.91, Praat) for predicting voice disorder status, with slight differences in sensitivity and specificity. CPPS measures derived from Praat were uniquely predictive of disorder status above and beyond CPPS measures from ADSV (χ 2 (1) = 40.71, P < 0.001). CPPS measures from both programs were significantly and highly correlated (r = 0.88, P < 0.001). A single acoustic measure of CPPS was highly predictive of voice disorder status using either program. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Perceptual structure of adductor spasmodic dysphonia and its acoustic correlates.

PubMed

Cannito, Michael P; Doiuchi, Maki; Murry, Thomas; Woodson, Gayle E

2012-11-01

To examine the perceptual structure of voice attributes in adductor spasmodic dysphonia (ADSD) before and after botulinum toxin treatment and identify acoustic correlates of underlying perceptual factors. Reliability of perceptual judgments is considered in detail. Pre- and posttreatment trial with comparison to healthy controls, using single-blind randomized listener judgments of voice qualities, as well as retrospective comparison with acoustic measurements. Oral readings were recorded from 42 ADSD speakers before and after treatment as well as from their age- and sex-matched controls. Experienced judges listened to speech samples and rated attributes of overall voice quality, breathiness, roughness, and brokenness, using computer-implemented visual analog scaling. Data were adjusted for regression to the mean and submitted to principal components factor analysis. Acoustic waveforms, extracted from the reading samples, were analyzed and measurements correlated with perceptual factor scores. Four reliable perceptual variables of ADSD voice were effectively reduced to two underlying factors that corresponded to hyperadduction, most strongly associated with roughness, and hypoadduction, most strongly associated with breathiness. After treatment, the hyperadduction factor improved, whereas the hypoadduction factor worsened. Statistically significant (P<0.01) correlations were observed between perceived roughness and four acoustic measures, whereas breathiness correlated with aperiodicity and cepstral peak prominence (CPPs). This study supported a two-factor model of ADSD, suggesting perceptual characterization by both hyperadduction and hypoadduction before and after treatment. Responses of the factors to treatment were consistent with previous research. Correlations among perceptual and acoustic variables suggested that multiple acoustic features contributed to the overall impression of roughness. Although CPPs appears to be a partial correlate of perceived breathiness, a physical basis of this percept remained less clear. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia.

PubMed

Yeung, Jeffrey C; Fung, Kevin; Davis, Eric; Rai, Sunita K; Day, Adam M B; Dzioba, Agnieszka; Bornbaum, Catherine; Doyle, Philip C

2015-03-01

Adductor spasmodic dysphonia (AdSD) is a voice disorder characterized by variable symptom severity and voice disability. Those with the disorder experience a wide spectrum of symptom severity over time, resulting in varied degrees of perceived voice disability. This study investigated the longitudinal variability of AdSD, with a focus on auditory-perceptual judgments of a dimension termed laryngeal overpressure (LO) and patient self-assessments of voice-related quality of life (V-RQOL). Longitudinal, correlational study. Ten adults with AdSD were followed over three time periods. At each, both voice samples and self-ratings of V-RQOL were gathered prior to their scheduled Botox injection. Voice recordings subsequently were perceptually evaluated by eight listeners for LO using a visual analog scale. LO ratings for all-voiced and Rainbow Passage sentence stimuli were found to be highly correlated. However, only the LO ratings obtained from judgments of AV stimuli were found to correlate moderately with self-ratings of voice disability for both the physical functioning and social-emotional subscores, as well as the total V-RQOL score. Based on perceptual judgments, LO appears to provide a reliable means of quantifying the severity of voice abnormalities in AdSD. Variability in self-ratings of the V-RQOL suggest that perceived disability related to AdSD should be actively monitored. Further, auditory-perceptual judgments may provide an accurate index of the potential impact of the disorder on the speaker. Similarly, LO was supported as a simple clinical measure that serves as a reliable index of voice change over time. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Clinical experience with patients with spasmodic dysphonia and primary Meige syndrome.

PubMed

Pedrero-Escalas, María Fernanda; García-López, Isabel; Santiago-Pérez, Susana; Vivancos, Francisco; Gavilán, Javier

2018-04-28

Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS. A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner. Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire. In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD. Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.

Validation of a telephone screening tool for spasmodic dysphonia and vocal fold tremor.

PubMed

Johnson, David M; Hapner, Edie R; Klein, Adam M; Pethan, Madeleine; Johns, Michael M

2014-11-01

The objective of this study was to ascertain whether clinicians can reliably distinguish between spasmodic dysphonia (SD)/vocal tremor and other voice disorders by telephone, despite this modality's limited frequency response. Randomized, single-blinded, and prospective study. Voice-disordered patients with (n = 22) and without (n = 17) SD and/or vocal tremor recorded standardized utterances via landline telephone. A laryngologist and two speech-language pathologists blinded to the diagnoses rated each recording as "yes" or "no" to "SD or tremor present?," and if "yes" categorized into adductor, abductor, tremor only, or adductor with tremor subtypes. Twenty-one recordings were presented twice at random so intrarater reliability could be assessed. All ratings were compared with gold standard diagnosis by a second laryngologist who performed a full examination, including videostroboscopy, on each patient. For the comparison "SD or tremor" yes versus no, sensitivity, specificity, positive predictive value, and negative predictive value are 90%, 95%, 96%, and 89%, respectively. Interrater reliability (Cohen kappa) compared with the gold standard ranged from 0.70 to 0.93 (substantial to almost perfect agreement). Cronbach alpha among three raters was 0.90 for this comparison. Intrarater reliability (number matched/number inspected) was very high, ranging from 0.97 to 1.0. Comparing gold standard and telephone rating of SD/tremor subtypes, kappa ranged from 0.48 to 0.60 (moderate agreement). Cronbach alpha among three raters was 0.88 for this comparison. Intrarater reliability ranged from 0.84 to 0.97. SD and tremor can be reliably distinguished from other voice disorders over the telephone. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Abnormal motor cortex excitability during linguistic tasks in adductor-type spasmodic dysphonia.

PubMed

Suppa, A; Marsili, L; Giovannelli, F; Di Stasio, F; Rocchi, L; Upadhyay, N; Ruoppolo, G; Cincotta, M; Berardelli, A

2015-08-01

In healthy subjects (HS), transcranial magnetic stimulation (TMS) applied during 'linguistic' tasks discloses excitability changes in the dominant hemisphere primary motor cortex (M1). We investigated 'linguistic' task-related cortical excitability modulation in patients with adductor-type spasmodic dysphonia (ASD), a speech-related focal dystonia. We studied 10 ASD patients and 10 HS. Speech examination included voice cepstral analysis. We investigated the dominant/non-dominant M1 excitability at baseline, during 'linguistic' (reading aloud/silent reading/producing simple phonation) and 'non-linguistic' tasks (looking at non-letter strings/producing oral movements). Motor evoked potentials (MEPs) were recorded from the contralateral hand muscles. We measured the cortical silent period (CSP) length and tested MEPs in HS and patients performing the 'linguistic' tasks with different voice intensities. We also examined MEPs in HS and ASD during hand-related 'action-verb' observation. Patients were studied under and not-under botulinum neurotoxin-type A (BoNT-A). In HS, TMS over the dominant M1 elicited larger MEPs during 'reading aloud' than during the other 'linguistic'/'non-linguistic' tasks. Conversely, in ASD, TMS over the dominant M1 elicited increased-amplitude MEPs during 'reading aloud' and 'syllabic phonation' tasks. CSP length was shorter in ASD than in HS and remained unchanged in both groups performing 'linguistic'/'non-linguistic' tasks. In HS and ASD, 'linguistic' task-related excitability changes were present regardless of the different voice intensities. During hand-related 'action-verb' observation, MEPs decreased in HS, whereas in ASD they increased. In ASD, BoNT-A improved speech, as demonstrated by cepstral analysis and restored the TMS abnormalities. ASD reflects dominant hemisphere excitability changes related to 'linguistic' tasks; BoNT-A returns these excitability changes to normal. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Influence of consonant voicing characteristics on sentence production in abductor versus adductor spasmodic dysphonia.

PubMed

Cannito, Michael P; Chorna, Lesya B; Kahane, Joel C; Dworkin, James P

2014-05-01

This study evaluated the hypotheses that sentence production by speakers with adductor (AD) and abductor (AB) spasmodic dysphonia (SD) may be differentially influenced by consonant voicing and manner features, in comparison with healthy, matched, nondysphonic controls. This was a prospective, single blind study, using a between-groups, repeated measures design for the independent variables of perceived voice quality and sentence duration. Sixteen subjects with ADSD and 10 subjects with ABSD, as well as 26 matched healthy controls produced four short, simple sentences that were systematically loaded with voiced or voiceless consonants of either obstruant or continuant manner categories. Experienced voice clinicians, who were "blind" as to speakers' group affixations, used visual analog scaling to judge the overall voice quality of each sentence. Acoustic sentence durations were also measured. Speakers with ABSD or ADSD demonstrated significantly poorer than normal voice quality on all sentences. Speakers with ABSD exhibited longer than normal duration for voiceless consonant sentences. Speakers with ADSD had poorer voice quality for voiced than for voiceless consonant sentences. Speakers with ABSD had longer durations for voiceless than for voiced consonant sentences. The two subtypes of SD exhibit differential performance on the basis of consonant voicing in short, simple sentences; however, each subgroup manifested voicing-related differences on a different variable (voice quality vs sentence duration). Findings suggest different underlying pathophysiological mechanisms for ABSD and ADSD. Findings also support inclusion of short, simple sentences containing voiced or voiceless consonants as part of the diagnostic protocol for SD, with measurement of sentence duration in addition to judments of voice quality severity. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Minithyrotomy with radiofrequency-induced thermotherapy for the treatment of adductor spasmodic dysphonia.

PubMed

Desai, Shaun C; Park, Andrea M; Chernock, Rebecca D; Paniello, Randal C

2016-10-01

A simple, safe and effective surgical alternative for treating adductor spasmodic dysphonia (ADSD) would appeal to many patients. This study evaluates a new option, using radiofrequency-induced thermotherapy (RFITT) of the thyroarytenoid muscle (TA) via the minithyrotomy approach to reduce the force of adduction. Fifteen dogs were used. In part 1, the optimal RFITT power settings, exposure time, probe location, and number of passes were determined. Part 2 compared laryngeal adductor pressures (LAPs) at baseline; immediately postintervention; and at 1, 3, or 6 months postintervention. Interventions included RFITT via the transcervical minithyrotomy approach (n = 15), transoral RFITT (n = 3), botulinum toxin (Botox) injection (n = 3), or no-intervention controls (n = 3). Postintervention induced phonation and histologic analyses were performed as well. In the minithyrotomy RFITT group, the mean LAP was 30.3% of baseline immediately posttreatment. At 1, 3, and 6 months postoperatively, the mean LAPs were 24.9%, 44.8%, and 43.5%, respectively. Transoral RFITT reduced LAP to 56.6% of baseline immediately posttreatment, but returned to normal in the 1 and 3 month animals. The Botox injections dropped the LAP to 57% of baseline at 1 month, but returned to normal at 3 months. Mucosal waves, based on induced phonation stroboscopy, were present at the terminal date in all animals. Thirteen of 15 transcervical RFITT preparations (87%) showed no injury to the lamina propria, whereas 80% showed evidence of TA muscle atrophy and fibrosis. Minithyrotomy RFITT is a feasible technique that shows encouraging long-term results for the potential treatment of patients with ADSD. N/A. Laryngoscope, 126:2325-2329, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Clinical voice analysis of Carnatic singers.

PubMed

Arunachalam, Ravikumar; Boominathan, Prakash; Mahalingam, Shenbagavalli

2014-01-01

Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice. Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings. Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective. Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center.

PubMed

de la Fuente, Jaime; Garrett, C Gaelyn; Ossoff, Robert; Vinson, Kim; Francis, David O; Gelbard, Alexander

2017-11-01

To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.

Effects of exposure to sulfur mustard on speech aerodynamics.

PubMed

Heydari, Fatemeh; Ghanei, Mostafa

2011-01-01

Sulfur mustard is an alkylating agent with highly cytotoxic properties even at low exposure. It was used widely against both military and civilian population by Iraqi forces in the Iraq-Iran war (1983-1988). Although various aspects of mustard gas effects on patients with chemical injury have been relatively well characterized, its effects on speech are still evolving. We evaluated aerodynamics of speech in male patients following sulfur mustard inhalation. In a case-control study patients with chemical injuries (n=19) along with age and sex-matched healthy control group (n=20) were selected. Aerodynamic analyses were performed by using the Glasgow Airflow Measurement System (known as ST1 dysphonia). Results indicated that except mean flow rate, there were statistically significant differences in vital capacity, phonation time, phonation volume, vocal velocity index, total expired volume and phonation quotient of patients between experimental and control groups (P<0.05). This study demonstrated mustard gas can impair different parameters of speech aerodynamics. As a result of this activity, the reader will be able to describe: (1) the evaluation of air flow in relation to speech system dysfunction and efficiency; (2) the effect of sulfur mustard known as mustard gas on respiratory physiology. Copyright © 2011 Elsevier Inc. All rights reserved.

Functional speech disorders: clinical manifestations, diagnosis, and management.

PubMed

Duffy, J R

2016-01-01

Acquired psychogenic or functional speech disorders are a subtype of functional neurologic disorders. They can mimic organic speech disorders and, although any aspect of speech production can be affected, they manifest most often as dysphonia, stuttering, or prosodic abnormalities. This chapter reviews the prevalence of functional speech disorders, the spectrum of their primary clinical characteristics, and the clues that help distinguish them from organic neurologic diseases affecting the sensorimotor networks involved in speech production. Diagnosis of a speech disorder as functional can be supported by sometimes rapidly achieved positive outcomes of symptomatic speech therapy. The general principles of such therapy are reviewed. © 2016 Elsevier B.V. All rights reserved.

[Quality of life in dysphonia].

PubMed

Rosanowski, F; Grässel, E; Hoppe, U; Köllner, V

2009-09-01

Quality of life is multidimensional and comprises physical, emotional, and social aspects. It has always been the implicit focus of medical work. However, since the 1980s it has been possible to measure it explicitly. Quality of life is impaired in dysphonic patients; this finding is supported by specific studies on self-reported physical, emotional, and social well-being. For practical application of these data, it is recommended to measure all three domains. From a therapeutic point of view, verbal intervention following the PLISSIT model (permission, limited information, special suggestions, intensive therapy) has been proven to enhance patient satisfaction. Therefore, this clinical procedure is recommended for routine application in dysphonic patients.

Electrophysiology of Cranial Nerve Testing: Cranial Nerves IX and X.

PubMed

Martinez, Alberto R M; Martins, Melina P; Moreira, Ana Lucila; Martins, Carlos R; Kimaid, Paulo A T; França, Marcondes C

2018-01-01

The cranial nerves IX and X emerge from medulla oblongata and have motor, sensory, and parasympathetic functions. Some of these are amenable to neurophysiological assessment. It is often hard to separate the individual contribution of each nerve; in fact, some of the techniques are indeed a composite functional measure of both nerves. The main methods are the evaluation of the swallowing function (combined IX and X), laryngeal electromyogram (predominant motor vagal function), and heart rate variability (predominant parasympathetic vagal function). This review describes, therefore, the techniques that best evaluate the major symptoms presented in IX and X cranial nerve disturbance: dysphagia, dysphonia, and autonomic parasympathetic dysfunction.

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female - a case report and literature review.

PubMed

Bardakhchyan, Samvel; Kager, Leo; Danielyan, Samvel; Avagyan, Armen; Karamyan, Nerses; Vardevanyan, Hovhannes; Mkhitaryan, Sergey; Papyan, Ruzanna; Zohrabyan, Davit; Safaryan, Liana; Sargsyan, Lilit; Harutyunyan, Lilit; Hakobyan, Lusine; Iskanyan, Samvel; Tamamyan, Gevorg

2017-03-29

Giant cell tumor of bone (GCT) is a rare primary bone tumor, which can metastasize and undergo malignant transformation. The standard treatment of GCT is surgery. In patients with unresectable or metastatic disease, additional therapeutic options are available. These include blocking of the receptor activator of NF-kappa B ligand (RANKL) signaling pathway, which plays a role in the pathogenesis of GCT of bone, via the anti-RANKL monoclonal antibody denosumab. Herein we report on a female teenager who presented in a very poor clinical condition (cachexia, diplopia, strabismus, dysphonia with palsy of cranial nerves V, VI, VIII, IX, X, XI and XII) due to progressive disease, after incomplete resection and adjuvant radiotherapy, of a GCT which affected the cervical spine (C1 and C2) as well as the skull base; and who had an impressive clinical response to denosumab therapy. To the best of our knowledge, this is the youngest patient ever reported with a skull base tumor treated with denosumab. In situations when surgery can be postponed and local aggressiveness of the tumor does not urge for acute surgical intervention, upfront use of denosumab in order to reduce the tumor size might be considered. Principally, the goal of denosumab therapy is to reduce tumor size as much as possible, with the ultimate goal to make local surgery (or as in our case re-surgery) amenable. However, improvement in quality of life, as demonstrated in our patient, is also an important aspect of such targeted therapies.

The relation of vocal fold lesions and voice quality to voice handicap and psychosomatic well-being.

PubMed

Smits, R; Marres, H; de Jong, Felix

2012-07-01

Voice disorders have a multifactorial genesis and may be present in various ways. They can cause a significant communication handicap and impaired quality of life. To assess the effect of vocal fold lesions and voice quality on voice handicap and psychosomatic well-being. Female patients, aged 18-65 years, who were referred to the outpatient clinic with voice problems were subsequently assessed. Laryngostroboscopic examination and acoustic voice analysis were carried out, and the patients were asked to fill in the Voice Handicap Index (VHI) and Symptom Check List-90 questionnaires. Eighty-two patients were included. In 43 patients (52.4%), a vocal fold lesion was observed. The VHI and psychosomatic well-being did not differ significantly between patients with and without a vocal fold lesion. The patients with a vocal fold lesion showed lower scores on the Dysphonia Severity Index (DSI) compared with those without a vocal fold lesion. However, the DSI was not correlated with voice handicap and psychosomatic well-being, except for the VHI physical subscale. Objective measurement does not necessarily correlate with the subjective appraisal of the patient's voice handicap and psychosomatic well-being. Furthermore, the criterion of the presence of a vocal fold lesion as the base of indemnity that is applied by health insurance institutions should be questioned. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Dosage dependent effect of high-resistance straw exercise in dysphonic and non-dysphonic women.

PubMed

Paes, Sabrina Mazzer; Behlau, Mara

2017-03-09

to study the dosage dependent effect of high-resistance straw exercise in women with behavioral dysphonia and in vocally healthy women. 25 dysphonic women (DG), with average age of 35 years (SD = 10.5) and 30 vocally healthy women (VHG), with average age of 31.6 years (SD = 10.3). The participants produced a continuous sound into a thin high-resistance straw for seven minutes, being interrupted after the first, third, fifth and seventh minute. At each interval, speech samples were recorded (sustained vowel and counting up to 20) and subsequently acoustically analyzed. Each participant reported the effort necessary to perform exercise and to speak, indicating their ratings on visual analog scales (VAS). with regard to the DG, the exercise caused positive vocal changes, especially between the third and fifth minute: less phonatory effort, increase in MPT, and reduction of F0 variability; these voice parameters deteriorated after five minutes. This fact associated with the increased effort to perform the exercise indicates a possible overload of the phonatory system. As to the VHG, MPT improved after one minute of exercise, while the other parameters did not change over time, probably due to the fact that the voices were not deviant; seven minutes did not seem to impose an overload in this population. positive vocal changes were observed with the high-resistance straw exercise; however, there are dosage restrictions, especially for dysphonic women.

Bilateral vocal fold immobility: a 13 year review of etiologies, management and the utility of the Empey index.

PubMed

Brake, Maria K; Anderson, Jennifer

2015-06-26

Bilateral vocal fold immobility (BVFI) is a rare diagnosis causing dyspnea, dysphonia and dysphagia. Management depends on respiratory performance, airway patency, vocal ability, and quality-of-life priorities. The authors review the presentation, management and outcome in patients diagnosed with BVFI. The utility and efficacy of the Empey index (EI) and the Expiratory Disproportion Index (EDI) are evaluated as an objective monitoring tools for BVFI patients. A 13-year retrospective review was performed of BVFI patients at St. Michael's Hospital, University of Toronto, a tertiary referral centre for laryngology. Forty-eight patients were included; 46 presented with airway obstruction symptoms. Tracheotomy was required for airway management in 40% of patients throughout the course of their treatment, which was reduced to 19% at the end of the study period. Twenty-one patients underwent endoscopic arytenoidectomy/cordotomy. Non-operative management included continuous positive airway pressure devices. Pulmonary function testing was carried out in 29 patients. Only a portion of the BVFI patients met the defined upper airway obstruction criteria (45% EI and 52% EDI). Seven patients had complete pre- and post-operative PFTs for comparison and all seven had ratios that significantly improved post-operatively which correlated clinically. The EI and EDI have limited use in evaluating patients with who have variable upper airway obstruction, but may be helpful in monitoring within subject airway function changes.

Incidence and predisposing factors of common upper respiratory tract infections in vocal students during their professional training.

PubMed

Zimmer-Nowicka, Joanna; Januszewska-Stańczyk, Henryka

2011-07-01

Upper respiratory tract infections (URTI) are among the major causes of dysphonia. There are only scarce data available on the incidence and predisposing factors of URTI in young singers, in particular, during a period of intense voice training. The data were obtained from medical records and a 43-item questionnaire distributed among 94 students of the vocal faculty (66 females and 28 males-age: 23.5±3.7 years) at all levels of their studies. The questions were divided into several categories, that is, personal, anthropometric, demographic, history of vocal education, and both general and singer-specific health risk factors. The rate of URTI showed a steady decrease during vocal studies. The strongest factor predisposing to infections in the multivariate regression model was nonadherence to vocal hygiene. There was also a weak protective effect of a regular holiday rest and negative effect of allergy. The prevalence of several recognized risk factors of URTI was exceptionally high in the group of vocal students, for example, passive smoking (42.5%), poor dental status (39.4%), frequent gastric complaints (44.7%), and allergy (50%). Despite the persistence of many risk factors throughout the vocal studies, the frequency of URTI significantly decreases most likely because of vocal hygiene education and growing professional experience. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Intraoperative nerve monitoring in laryngotracheal surgery.

PubMed

Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Reflux and Voice Disorders: Have We Established Causality?

PubMed Central

Schneider, G. Todd; Vaezi, Michael F.; Francis, David O.

2017-01-01

A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford-Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change). PMID:28163985

[Botulism, a clinical diagnosis].

PubMed

Delbos, Valérie; Abgueguen, Pierre; Fanello, Serge; Brenet, Olivier; Alquier, Philippe; Granry, Jean-Claude; Pichard, Eric

2005-03-26

Foodborne botulism results from the effect of a neurotoxin produced by a sporulated anaerobic bacillus called Clostridium botulinum. The mode of contamination occurs through the consumption of foodstuff, already contaminated by the neurotoxin. Following an incubation period that varies from 2 hours to 8 days, the symptoms start with intestinal problems. Then paralysis of the cranial nerve pairs sets in, classically manifested by diplopia, dysphagia, dysphonia, areactive mydriasis and ptosis. The onset of motor disorders occurs in descending order with possible involvement of the respiratory muscles, hence requiring reanimation measures and sometimes mechanical ventilation. The diagnosis of botulism is clinical. Identification of the botulinum toxin in the blood or faeces of the patients or in the contaminating food stuff confirms the diagnosis.

The Vocal Tract Discomfort Scale: Validity and Reliability of the Persian Version in the Assessment of Patients With Muscle Tension Dysphonia.

PubMed

Torabi, Hadi; Khoddami, Seyyedeh Maryam; Ansari, Noureddin Nakhostin; Dabirmoghaddam, Payman

2016-11-01

To cross-culturally adapt of Persian Vocal Tract Discomfort (VTDp) scale and evaluate its validity and reliability in the assessment of patients with muscle tension dysphonia (MTD). A cross-sectional and prospective cohort design was used to psychometrically test the VTDp. The VTD scale was cross-culturally adapted into Persian language following standard forward-backward translations. The VTDp scale was administrated to 100 patients with MTD (54 men and 46 women; mean age: 38.05 ± 10.02 years) and 50 healthy volunteers (26 men and 24 women; mean age: 36.50 ± 12.27 years). Forty-five patients with MTD completed the VTDp 7 days later for test-retest reliability. Patients also completed the Persian Voice Handicap Index (VHIp) to assess construct validity. The results of discriminative validity demonstrated that the VTDp was able to discriminate between patients with MTD and healthy participants. The internal consistency was confirmed with Cronbach α .77 and 0.73 for VTDp frequency and severity subscales, respectively. The test-retest reliability was excellent with an intraclass correlation coefficient (ICC agreement ) of 0.93 for the frequency subscale and 0.91 for the severity subscale. Construct validity of the VTDp was shown with significant correlations between the VTDp frequency and severity subscales and the VHIp total scores (0.36 and 0.37, respectively). The standard error of measurement and smallest detectable change values for VTDp frequency (2.11 and 5.85, respectively) and severity (2.25 and 6.23, respectively) were acceptable. The Bland-Altman analysis for assessing the agreement between test and retest measurements showed no systematic bias. The VTDp is a valid and reliable self-administered scale to measure patient's vocal tract sensations in Persian-speaking population. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Validity and Reliability of Surface Electromyography in the Assessment of Primary Muscle Tension Dysphonia.

PubMed

Khoddami, Seyyedeh Maryam; Talebian, Saeed; Izadi, Farzad; Ansari, Noureddin Nakhostin

2017-05-01

The study aims to evaluate the reliability and the discriminative validity of surface electromyography (sEMG) in the assessment of patients with primary muscle tension dysphonia (MTD). The study design is cross-sectional. Fifteen patients with primary MTD (mean age: 34.07 ± 10.99 years) and 15 healthy volunteers (mean age: 34.53 ± 10.63 years) were included. All participants underwent evaluation of sEMG to record the electrical activity of the thyrohyoid and cricothyroid muscles. The outcome measures were the root mean square (RMS), activity peak, duration, and time to the peak activity, which were obtained during /a/ and /i/ prolongation for test-retest reliability. The test-retest reliability was good to excellent for the RMS and peak activity measures (intraclass correlation coefficient [agreement] [ICC agreement ] = 0.49-0.98). The reliability for the activity duration was poor to excellent (ICC agreement  = 0.19-0.9). Poor test-retest reliability was found for the time to peak measure (ICC agreement  = 0.15-0.37). The standard error of measurement for all sEMG measures was between 0.41 and 2.05. The smallest detectable change (SDC) was calculated between 1.13 and 5.66. The highest SDC values were obtained for the peak and the lowest SDCs were documented for the duration (5.66 and 1.13, respectively). All sEMG measures were not able to discriminate between the MTD patients and healthy subjects (P > 0.05). The sEMG is a reliable tool to measure the RMS, the peak activity, and the activity duration in primary MTD. However, it is not able to discriminate the patients with primary MTD from healthy subjects. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Disease-specific self-efficacy in spasmodic dysphonia patients.

PubMed

Hu, Amanda; Isetti, Derek; Hillel, Allen D; Waugh, Patricia; Comstock, Bryan; Meyer, Tanya K

2013-03-01

Self-efficacy (SE) is an optimistic self-belief that one can perform a novel task. This concept involves empowerment, self-esteem, and adaptation to a stressful situation. SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease-specific SE-SD scale. Prospective study. Academic hospital. Disease-specific SE-SD items were developed with laryngologists, speech pathologists, and SD patients. These items, General SE Scale, Voice Handicap Index-10 (VHI-10), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Hospital Anxiety and Depression Scale (HADS), were administered to SD patients who presented for botulinum toxin injections. One hundred forty-five SD patients (mean age 59.5 ± 13.6 years) had a general SE score (Cronbach's α = 0.894) of 33.4 ± 5.2 out of 40. This was negatively correlated with HADS-A (r = -0.42, P < 0.001) and HADS-D (r = -0.42, P < .001), but not correlated with VHI-10 (r = -0.098, P = .243) and CAPE-V (r = -0.047, P = .57). Factor analysis selected 8 items from the general SE scale and 5 disease-specific SE-SD items to generate a 13-item disease-specific SE-SD scale (Cronbach's α = 0.907). Disease-specific SE-SD score was 42.1 ± 6.9 out of 52 and was negatively correlated with VHI-10 (r = -0.19, P = .005), HADS-A (r = -0.43, P < .001), and HADS-D (r = -0.57, P < .001), but not correlated with CAPE-V (r = -0.024, P = .60). SD patients established on botulinum toxin injections have high degrees of general and disease-specific SE. Patients with higher SE-SD demonstrate lower vocal handicap and lower levels of anxiety and depression. A 13-item disease-specific SE-SD scale has been developed.

Clinical and biological features of adult toxocariasis.

PubMed

Cojocariu, Ingrid Elena; Bahnea, Roxana; Luca, Cătălina; Leca, Daniela; Luca, Mariana

2012-01-01

To determine the main clinical signs and symptoms of adult toxocariasis and the relationship between anti-Toxocara canis antibody levels, symptoms, and the other biological parameters. Prospective study conducted in the interval 2008 - 2011 in a series of 457 adult patients from Moldova, Romania. The ELISA method was used to detect the presence of IgG antibodies against T. canis. Fasting blood samples were collected from all patients who then underwent the following tests by standard methods: hemoglobin, hematocrit, eosinophils, lymphocytes, white blood cell count, SGOT, SGPT. An IgG titer of 1/100 was most commonly found in case of allergies, physical asthenia, sensation of constriction in the anterior cervical area, right hypochondriac pain, paresthesies, nervousness (anxiety) and lipotimic states; a 1/50 titer was most often associated with hive reactions, dysphonia, lower limb edema, and pale/yellow axy skin. In patients with laterocervical adenopathy the most frequent determinations were 1/100 (34.0%), followed by 1/50 (22.6%). The statistically significant clinical signs and symptoms may represent a starting point in making a diagnosis of toxocariasis. Of the non-specific laboratory findings we mention: hyperleukocytosis , hypereosinophilia and low hen)atocit, elevated transaminases level having a high sensitivity and specificity. The diagnosis of certainty is made by determining IgG for T. canis or the presence of larvae in the biopsy tissues. Key-

Long-term follow-up after surgery in localized laryngeal amyloidosis.

PubMed

Hazenberg, Aldert J C; Hazenberg, Bouke P C; Dikkers, Frederik G

2016-09-01

To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21-77 years) and median follow-up 6.4 years (2.4-17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4-6 years, progression slows down thereafter. Late progression, however, remains possible.

Hypopharyngeal applications of a new flexible robotic system in otolaryngology.

PubMed

Chao, Janet Ren; Goodman, Joseph; Fuson, Andrew; Romero, Nahir J; Joshi, Arjun

2017-09-27

This case report describes the use a new flexible robotic system in otolaryngology, the FlexRobot ® for cricopharyngeal myotomy in cadaver dissections, and for the treatment of a patient with esophageal stenosis and secondary dysphagia and dysphonia. The Flexrobot ® facilitates access to the hypopharynx with increased proximity to the surgical field and improved optics, allowing more exact dilatation and injection in our patient. It also would allow surgeons to reach deep inside the cavity of the hypopharynx into anatomical regions that are typically inaccessible without an open approach, as shown in our cadaveric procedure, where full exposure of the posterior aspect of the cricopharyngeus and isolation of the muscle belly were achieved. While esophageal dysmotility can be treated through botulinum toxin injection and esophageal dilation as demonstrated in our patient, for longer term results, operative cricopharyngeal myotomy is superior. Surgical complications include infection, hematoma, mucosal damage, fistula, and recurrent laryngeal nerve paralysis. While endoscopic procedures avoid the risk of recurrent laryngeal nerve or great vessel injury and lower the risk of perforation and fistula, they create the potential for mediastinitis as a consequence of opening the pharyngoesophageal muscosa and violating the buccopharyngeal fascia. Based on the cadaveric procedure, we believe that the robotic approach would reduce the risk of mediastinitis as a result of better visualization of the buccopharyngeal fascia and the robot's precise instrument control.

Self-expanding stent made of polyester mesh with silicon coating (Polyflex) in the treatment of inoperable tracheal stenoses.

PubMed

Terra, Ricardo Mingarini; Minamoto, Helio; Tedde, Miguel Lia; Almeida, José Luiz Jesus de; Jatene, Fabio Biscegli

2007-01-01

To evaluate the Polyflex stent in terms of its efficacy, ease of implantation, and complications in patients with tracheobronchial affections. This was a prospective study, in which sixteen patients with inoperable tracheal stenosis secondary to orotracheal intubation (n = 12), neoplasia (n = 3), or Wegener's granulomatosis (n = 1) were monitored. Of these patients, eleven were women, and five were men. The mean age was 42.8 years (range, 21-72 years). Patients were submitted to implantation of a total of 21 Polyflex stents. All procedures were carried out in the operating room under general anesthesia, and the stents were implanted via suspension laryngoscopy using the stent applicator. Stents were implanted and symptoms were resolved in all cases. The stents remained in place for a mean period of 7.45 months, ranging from 2 to 18 months. The complications observed in the immediate postoperative period were dysphonia (in two patients, 12.5%) and odynophagia (in two patients, 12.5%). Late complications were cough (in ten patients, 62.5%), migration (in seven patients, 43.75%), granuloma formation (in two patients, 12.5%), and pneumonia (in one patient, 6.25%). The Polyflex stent is easily implanted, easily removed, well tolerated by patients and effective in resolving symptoms. However, its use is associated with a high rate of migration, especially in patients with post-orotracheal intubation stenosis.

Laryngeal Reflexes: Physiology, Technique and Clinical Use

PubMed Central

Ludlow, Christy L.

2015-01-01

This review examines the current level of knowledge and techniques available for the study of laryngeal reflexes. Overall, the larynx is under constant control of several systems (including respiration, swallowing and cough) as well as sensory-motor reflex responses involving glossopharyngeal, pharyngeal, laryngeal and tracheobronchial sensory receptors. Techniques for the clinical assessment of these reflexes are emerging and need to be examined for sensitivity and specificity in identifying laryngeal sensory disorders. Quantitative assessment methods for the diagnosis of sensory reductions as well as sensory hypersensitivity may account for laryngeal disorders such as chronic cough, paradoxical vocal fold disorder and muscular tension dysphonia. The development of accurate assessment techniques could improve our understanding of the mechanisms involved in these disorders. PMID:26241237

Interstitial protein alterations in rabbit vocal fold with scar.

PubMed

Thibeault, Susan L; Bless, Diane M; Gray, Steven D

2003-09-01

Fibrous and interstitial proteins compose the extracellular matrix of the vocal fold lamina propria and account for its biomechanic properties. Vocal fold scarring is characterized by altered biomechanical properties, which create dysphonia. Although alterations of the fibrous proteins have been confirmed in the rabbit vocal fold scar, interstitial proteins, which are known to be important in wound repair, have not been investigated to date. Using a rabbit model, interstitial proteins decorin, fibromodulin, and fibronectin were examined immunohistologically, two months postinduction of vocal fold scar by means of forcep biopsy. Significantly decreased decorin and fibromodulin with significantly increased fibronectin characterized scarred vocal fold tissue. The implications of altered interstitial proteins levels and their affect on the fibrous proteins will be discussed in relation to increased vocal fold stiffness and viscosity, which characterizes vocal fold scar.

Influence of Smartphones and Software on Acoustic Voice Measures

PubMed Central

GRILLO, ELIZABETH U.; BROSIOUS, JENNA N.; SORRELL, STACI L.; ANAND, SUPRAJA

2016-01-01

This study assessed the within-subject variability of voice measures captured using different recording devices (i.e., smartphones and head mounted microphone) and software programs (i.e., Analysis of Dysphonia in Speech and Voice (ADSV), Multi-dimensional Voice Program (MDVP), and Praat). Correlations between the software programs that calculated the voice measures were also analyzed. Results demonstrated no significant within-subject variability across devices and software and that some of the measures were highly correlated across software programs. The study suggests that certain smartphones may be appropriate to record daily voice measures representing the effects of vocal loading within individuals. In addition, even though different algorithms are used to compute voice measures across software programs, some of the programs and measures share a similar relationship. PMID:28775797

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

PubMed

Abrão, Aline Lauria Pires; Santana, Caroline Menezes; Bezerra, Ana Cristina Barreto; Amorim, Rivadávio Fernandes Batista de; Silva, Mariana Branco da; Mota, Licia Maria Henrique da; Falcão, Denise Pinheiro

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases.

PubMed

Abrão, Aline Lauria Pires; Santana, Caroline Menezes; Bezerra, Ana Cristina Barreto; Amorim, Rivadávio Fernandes Batista de; Silva, Mariana Branco da; Mota, Licia Maria Henrique da; Falcão, Denise Pinheiro

2016-02-11

Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.

PubMed

Watts, Christopher R; Diviney, Shelby S; Hamilton, Amy; Toles, Laura; Childs, Lesley; Mau, Ted

2015-03-01

To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders. Prospective case series. Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included. Participants received stretch-and-flow voice therapy structured once weekly for 6 weeks. Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]). All measures were obtained at baseline before treatment and within 2 weeks posttreatment. The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant (P < 0.05) improvement through therapy. Effect sizes reflecting the magnitude of change were large for s/z ratio and VHI (d = 1.25 and 1.96 respectively), and moderate for maximum phonation time and sentence CPP (d = 0.79 and 0.74, respectively). This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. The treatment effect was large or moderate for multiple outcome measures. The data provide justification for larger, controlled clinical trials on the application of stretch-and-flow voice therapy in the treatment of hyperfunctional voice disorders. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Occupational voice demands and their impact on the call-centre industry.

PubMed

Hazlett, D E; Duffy, O M; Moorhead, S A

2009-04-20

Within the last decade there has been a growth in the call-centre industry in the UK, with a growing awareness of the voice as an important tool for successful communication. Occupational voice problems such as occupational dysphonia, in a business which relies on healthy, effective voice as the primary professional communication tool, may threaten working ability and occupational health and safety of workers. While previous studies of telephone call-agents have reported a range of voice symptoms and functional vocal health problems, there have been no studies investigating the use and impact of vocal performance in the communication industry within the UK. This study aims to address a significant gap in the evidence-base of occupational health and safety research. The objectives of the study are: 1. to investigate the work context and vocal communication demands for call-agents; 2. to evaluate call-agents' vocal health, awareness and performance; and 3. to identify key risks and training needs for employees and employers within call-centres. This is an occupational epidemiological study, which plans to recruit call-centres throughout the UK and Ireland. Data collection will consist of three components: 1. interviews with managers from each participating call-centre to assess their communication and training needs; 2. an online biopsychosocial questionnaire will be administered to investigate the work environment and vocal demands of call-agents; and 3. voice acoustic measurements of a random sample of participants using the Multi-dimensional Voice Program (MDVP). Qualitative content analysis from the interviews will identify underlying themes and issues. A multivariate analysis approach will be adopted using Structural Equation Modelling (SEM), to develop voice measurement models in determining the construct validity of potential factors contributing to occupational dysphonia. Quantitative data will be analysed using SPSS version 15. Ethical approval is granted for this study from the School of Communication, University of Ulster. The results from this study will provide the missing element of voice-based evidence, by appraising the interactional dimensions of vocal health and communicative performance. This information will be used to inform training for call-agents and to contribute to health policies within the workplace, in order to enhance vocal health.

Computerized Tomography Measures During and After Artificial Lengthening of the Vocal Tract in Subjects With Voice Disorders.

PubMed

Guzman, Marco; Miranda, Gonzalo; Olavarria, Christian; Madrid, Sofia; Muñoz, Daniel; Leiva, Miguel; Lopez, Lorena; Bortnem, Cori

2017-01-01

The present study aimed to observe the effect of two types of tubes on vocal tract bidimensional and tridimensional images. Ten participants with hyperfunctional dysphonia were included. Computerized tomography was performed during production of sustained [a:], followed by sustained phonation into a drinking straw, and then repetition of sustained [a:]. A similar procedure was performed with a stirring straw after 15 minutes of vocal rest. Anatomic distances and area measures were obtained from computerized tomography midsagittal and transversal images. Vocal tract total volume was also calculated. During tube phonation, increases were measured in the vertical length of the vocal tract, oropharyngeal area, hypopharyngeal area, outlet of the epilaryngeal tube, and inlet to the lower pharynx. Also, the larynx was lower, and more closure was noted between the velum and the nasal passage. Tube phonation causes an increased total vocal tract volume, mostly because of the increased cross-sectional areas in the pharyngeal region. This change is more prominent when the tube offers more airflow resistance (stirring straw) compared with less airflow resistance (drinking straw). Based on our data and previous studies, it seems that vocal tract changes are not dependent on the voice condition (vocally trained, untrained, or disordered voices), but on the exercise itself and the type of instructions given to subjects. Tube phonation is a good option to reach therapeutic goals (eg, wide pharynx and low larynx) without giving biomechanical instructions, but only asking patients to feel easy voice and vibratory sensations. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

“Finding a Voice”: Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis

PubMed Central

Vachha, B.A.; Ginat, D.T.; Mallur, P.; Cunnane, M.; Moonis, G.

2017-01-01

SUMMARY Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis. PMID:27173367

PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it?

PubMed

Andrianopoulos, M V; Gallivan, G J; Gallivan, K H

2000-12-01

Paroxysmal vocal cord movement/motion (PVCM), paroxysmal vocal cord dysfunction (PVCD), episodic paroxysmal laryngospasm (EPL), and irritable larynx syndrome (ILS) are terms used to describe laryngeal dysfunction masquerading as asthma, upper airway obstruction, or functional and organic voice disorders. The differential diagnosis of PVCM, PVCD, EPL, and ILS is critical to successful medical and behavioral management of the patient. During the past 10 years, 27 subjects, ages 15-79 years, were identified to have paroxysms of inspiratory stridor, acute respiratory distress, associated aphonia and dysphonia, resulting in misdiagnosis and unnecessary emergency treatments, including endotracheal intubation, cardiopulmonary resuscitation, massive pharmacotherapy, or tracheostomy. A multifactorial management program is proposed utilizing principles of motor learning, neurolinguistic programming model, respiratory and phonatory synchronization, relaxation techniques, concurrent monitoring of behavioral adjustments, and formal psychological counseling.

Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

NASA Astrophysics Data System (ADS)

Zhang, Yu; Jiang, Jack J.

2008-09-01

Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low-frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases.

Assessment of recurrent laryngeal nerve function during thyroid surgery

PubMed Central

Douglas, J; Smith, B; Dougherty, T; Ayshford, C

2014-01-01

Introduction There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. Methods Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. Results Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. Conclusions Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures. PMID:24780671

Plastic laryngeal foreign bodies in children: a diagnostic challenge.

PubMed

Bloom, David C; Christenson, Tom E; Manning, Scott C; Eksteen, Eduard C; Perkins, Jonathan A; Inglis, Andrew F; Stool, Sylvan E

2005-05-01

To review Children's Hospital and Regional Medical Center experience with pediatric airway foreign bodies, and examine the incidence and treatment of laryngeal foreign bodies. To determine if plastic laryngeal foreign bodies present differently than other laryngeal foreign bodies. A retrospective review of all cases of children (1874 patients) undergoing direct laryngoscopy and/or bronchoscopy from 1st January 1997 to 9th September 2003 at a tertiary care children's hospital. Patients with endoscopically documented laryngeal foreign bodies were identified and the medical record reviewed in more detail. Patient age, gender, foreign body location, foreign body type, duration of foreign body presence, radiographic findings, endoscopic findings and treatment complications were recorded. One hundred and five aspirated foreign bodies were identified. The nine laryngeal foreign bodies included five clear plastic radiolucent items, two radiolucent food items, and two sharp radioopaque pins. Time to diagnosis and treatment was on average 11.6 days with 17.6 days for thin/plastic foreign bodies and 1.6 days for metal/food foreign bodies. Laryngeal foreign bodies represent a small portion of all pediatric airway foreign bodies. Difficulty in identifying laryngeal foreign bodies, especially thin, plastic radiolucent foreign bodies can delay treatment. Thin plastic foreign bodies can present without radiographic findings, can be difficult to image during endoscopy and can be particularly difficult to diagnose. A history of choking and vocal changes is associated with laryngeal foreign bodies. Laryngeal foreign bodies should be in the differential diagnosis of all children presenting with atypical upper respiratory complaints especially if a history suggestive of witnessed aspiration and dysphonia can be obtained.

Vocal fold pseudocyst: results of 46 cases undergoing a uniform treatment algorithm.

PubMed

Estes, Christine; Sulica, Lucian

2014-05-01

To describe treatment results and identify predictors of the need for surgical intervention in patients with vocal fold pseudocyst. Retrospective cohort study with longitudinal followup via survey. Clinical records were reviewed for demographic information, VHI-10 score, and degree of severity of dysphonia. Videostroboscopic examinations were evaluated for presence of vocal fold pseudocyst, along with additional clinical variables, including laterality, reactive lesion, paresis, varix, and hemorrhage. Follow-up surveys were sent to all participants to evaluate current VHI-10 score and degree of vocal limitation. Results were analyzed to determine predictors of surgery and recurrence of pathology. Forty-six patients (41F:5M) with pseudocyst (40 unilateral: 6 bilateral) were reviewed. Twenty-three (50%) had reactive lesions, nineteen (41%) had paresis by clinical criteria, 10 (22%) had varices, and 6 (13%) had hemorrhage on examination. All underwent initial behavioral management (2-12 sessions of voice therapy; mean of 8 sessions). Seventeen (37%) eventually required surgical intervention. No demographic or clinical variables proved predictive of surgical intervention. Follow-up surveys were completed by 63% of patients, and 79% agreed with the statement that they were not professionally limited by their voices. This experience supports behavioral management as an initial intervention in patients with pseudocyst, sufficient by itself to restore vocal function in approximately two out of three patients. Neither initial severity nor any of the studied clinical findings predicted the need for surgery. The large majority of patients with pseudocyst are able to be treated effectively without impact in their professional function. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

The Effect of Parkinson Disease Tremor Phenotype on Cepstral Peak Prominence and Transglottal Airflow in Vowels and Speech.

PubMed

Burk, Brittany R; Watts, Christopher R

2018-02-19

The physiological manifestations of Parkinson disease are heterogeneous, as evidenced by disease subtypes. Dysphonia has been well documented as an early and progressively significant impairment associated with the disease. The purpose of this study was to investigate how acoustic and aerodynamic measures of vocal function were affected by Parkinson tremor subtype (phenotype) in an effort to better understand the heterogeneity of voice impairment severity in Parkinson disease. This is a prospective case-control study. Thirty-two speakers with Parkinson disease assigned to tremor and nontremor phenotypes and 10 healthy controls were recruited. Sustained vowels and connected speech were recorded from each speaker. Acoustic measures of cepstral peak prominence (CPP) and aerodynamic measures of transglottal airflow (TAF) were calculated from the recorded acoustic and aerodynamic waveforms. Speakers with a nontremor dominant phenotype exhibited significantly (P < 0.05) lower CPP and higher TAF in vowels compared with the tremor dominant phenotype and control speakers, who were not different from each other. No significant group differences were observed for CPP or TAF in connected speech. When producing vowels, participants with nontremor dominant phenotype exhibited reduced phonation periodicity and elevated TAF compared with tremor dominant and control participants. This finding is consistent with differential limb-motor and cognitive impairments between tremor and nontremor phenotypes reported in the extant literature. Results suggest that sustained vowel production may be sensitive to phonatory control as a function of Parkinson tremor phenotype in mild to moderate stages of the disease. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Assessment of recurrent laryngeal nerve function during thyroid surgery.

PubMed

Smith, J; Douglas, J; Smith, B; Dougherty, T; Ayshford, C

2014-03-01

There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.

Collaboration and conquest: MTD as viewed by voice teacher (singing voice specialist) and speech-language pathologist.

PubMed

Goffi-Fynn, Jeanne C; Carroll, Linda M

2013-05-01

This study was designed as a qualitative case study to demonstrate the process of diagnosis and treatment between a voice team to manage a singer diagnosed with muscular tension dysphonia (MTD). Traditionally, literature suggests that MTD is challenging to treat and little in the literature directly addresses singers with MTD. Data collected included initial medical screening with laryngologist, referral to speech-language pathologist (SLP) specializing in voice disorders among singers, and adjunctive voice training with voice teacher trained in vocology (singing voice specialist or SVS). Initial target goals with SLP included reducing extrinsic laryngeal tension, using a relaxed laryngeal posture, and effective abdominal-diaphragmatic support for all phonation events. Balance of respiratory forces, laryngeal coordination, and use of optimum filtering of the source signal through resonance and articulatory awareness was emphasized. Further work with SVS included three main goals including a lowered breathing pattern to aid in decreasing subglottic air pressure, vertical laryngeal position to lower to allow for a relaxed laryngeal position, and a top-down singing approach to encourage an easier, more balanced registration, and better resonance. Initial results also emphasize the retraining of subject toward a sensory rather than auditory mode of monitoring. Other areas of consideration include singers' training and vocal use, the psychological effects of MTD, the personalities potentially associated with it, and its relationship with stress. Finally, the results emphasize that a positive rapport with the subject and collaboration between all professionals involved in a singer's care are essential for recovery. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Reflections: The Value of Patient Support Groups.

PubMed

Hu, Amanda

2017-04-01

A patient support group is defined as "a group of people with common experiences and concerns who provide emotional and moral support for one another." Support groups fulfill many functions: educating patients/family, sharing the illness experience, providing strength to its members, raising public awareness, and fundraising. Some research has shown an improvement in quality of life of patients with head and neck cancer who have participated in support groups. A wide variety of support groups are available for otolaryngology patients, ranging from head and neck oncology to tinnitus and spasmodic dysphonia. Some support groups are face-to-face, while others use social media and the Internet. Surprisingly, engagement in patient support groups is low-about 10%. Some barriers to accessing support groups are awareness, time constraints, and confrontation of negative aspects of the disease. As otolaryngologists, we can help our patients access support groups so that they can benefit from these resources.

Successful conservative management of Ludwig's angina in advanced pregnancy.

PubMed

Soltero, Roxana; Mercado-Alvarado, Joanna

2009-01-01

A 20 year-old female in her 32nd week of gestation presented to the Emergency Department with dysphonia and dysphagia associated to a recent recurrence of a periapical abscess. Her oral examination showed trismus, elevated tongue and neck swelling. A clinical diagnosis of Ludwig's angina was reached, and empirical antibiotic coverage was started. The decompression and drainage placement was performed successfully under local anesthesia without airway compromise. At the moment, no clear guidelines exist for the acute treatment of Ludwig's angina. Establishment of a secure airway has long been considered the gold standard, yet new literature suggests a more conservative management. Ascertaining an early diagnosis at the Emergency Department, and involvement of Anesthesia, Obstetrics, and, Ear, Nose and Throat specialist services is vital for materno-fetal wellbeing. Careful evaluation of the airway status in addition to prompt antimicrobial therapy with surgical decompression may represent a plausible alternative in pregnant patients.

Airway complications in the head injured.

PubMed

Woo, P; Kelly, G; Kirshner, P

1989-07-01

Fifty head-injured patients who had tracheostomy were followed during rehabilitation by video fiberoptic laryngoscopy examination. Complications of aspiration (23/50), airway stenosis (13/50), and phonation dysfunction (16/24) were followed. Spontaneous resolution of aspiration may require a prolonged course. A majority of patients (37/50) had improvement and could be decannulated. Prognostic factors correlated to eventual decannulation included age, level on the Glasgow Coma Outcome Scale, and type of head injury. Those with poor neurologic improvement and glottic incompetence (13/50) are poor candidates for decannulation. Significant airway stenosis can involve both laryngeal and tracheal sites. Neurologic dysfunction may complicate the decannulation process after airway anatomy has been restored by surgery. Dysphonia resulting from intubation, peripheral laryngeal and nerve injury, or central laryngeal movement dysfunction are common. Preventive maintenance with ongoing evaluation can avoid airway crises such as aspiration pneumonia, hemoptysis, and innominate artery.

[Neuromuscular electric stimulation therapy in otorhinolaryngology].

PubMed

Miller, S; Kühn, D; Jungheim, M; Schwemmle, C; Ptok, M

2014-02-01

Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.

Automated analysis of connected speech reveals early biomarkers of Parkinson's disease in patients with rapid eye movement sleep behaviour disorder.

PubMed

Hlavnička, Jan; Čmejla, Roman; Tykalová, Tereza; Šonka, Karel; Růžička, Evžen; Rusz, Jan

2017-02-02

For generations, the evaluation of speech abnormalities in neurodegenerative disorders such as Parkinson's disease (PD) has been limited to perceptual tests or user-controlled laboratory analysis based upon rather small samples of human vocalizations. Our study introduces a fully automated method that yields significant features related to respiratory deficits, dysphonia, imprecise articulation and dysrhythmia from acoustic microphone data of natural connected speech for predicting early and distinctive patterns of neurodegeneration. We compared speech recordings of 50 subjects with rapid eye movement sleep behaviour disorder (RBD), 30 newly diagnosed, untreated PD patients and 50 healthy controls, and showed that subliminal parkinsonian speech deficits can be reliably captured even in RBD patients, which are at high risk of developing PD or other synucleinopathies. Thus, automated vocal analysis should soon be able to contribute to screening and diagnostic procedures for prodromal parkinsonian neurodegeneration in natural environments.

[Extensive treatment of teacher's voice disorders in health spa].

PubMed

Niebudek-Bogusz, Ewa; Marszałek, Sławomir; Woźnicka, Ewelina; Minkiewicz, Zofia; Hima, Joanna; Sliwińska-Kowalska, Mariola

2010-01-01

Treatment in a health spa with proper infrastructure and professional medical care can provide optimal conditions for intensive voice rehabilitation, especially for people with occupational voice disorders. The most numerous group of people with voice disorders are teachers. In Poland, they have an opportunity to take care of, or regain, their health during a one-year paid leave. The authors describe a multi-specialist model of extensive treatment of voice disorders in a health spa, including holistic and interdisciplinary procedures in occupational dysphonia. Apart from balneotherapy, the spa treatment includes vocal training exercises, relaxation exercises, elements of physiotherapy with the larynx manual therapy and psychological workshops. The voice rehabilitation organized already for two groups of teachers has been received with great satisfaction by this occupational group. The implementation of a model program of extensive treatment of voice disorders in a health spa should become one of the steps aimed at preventing occupational voice diseases.

Nebulized isotonic saline improves voice production in Sjögren's syndrome.

PubMed

Tanner, Kristine; Nissen, Shawn L; Merrill, Ray M; Miner, Alison; Channell, Ron W; Miller, Karla L; Elstad, Mark; Kendall, Katherine A; Roy, Nelson

2015-10-01

This study examined the effects of a topical vocal fold hydration treatment on voice production over time. Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. 2b. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Frequency of Acute Hepatitis Following Acute Paraphenylene Diamine Intoxication.

PubMed

Ishtiaq, Rizwan; Shafiq, Sadaf; Imran, Ali; Masroor Ali, Qazi; Khan, Raheel; Tariq, Hassan; Ishtiaq, Daniyal

2017-04-21

Paraphenylene diamine (PPD) ingestion is manifesting as one of the more common ways of committing suicide in Southern Punjab, Pakistan, especially Bahawalpur. PPD is an ingredient of a compound commonly known "Kala Pathar" which means "Black Stone" in Urdu. It is readily available in the market at low cost and is used to dye hair and fur. Its intoxication inhibits cellular oxidation and affects the muscles causing rhabdomyolysis. This leads to myoglobinuria followed by renal failure and edema of face and throat resulting in respiratory difficulty. Very little is known about the impact of PPD intoxication on liver tissue. The purpose of the study was to find out the frequency of acute hepatitis following PPD intoxication. We reviewed the medical records of 109 patients with PPD intoxication admitted to Medical Unit-2, Bahawalpur Victoria Hospital from January 1, 2015, to June 30, 2015, in a descriptive, cross-sectional study. We noted the frequency of acute hepatitis and other complications, and we recorded the demographic features, clinical features, and outcomes of these patients. Our study included 32 men (29%) and 77 women (71%). The mean age was 22 ± 3.4 years, and most patients were young women aged 15 to 24 years. Suicidal ingestion was the leading cause of admission for 101 patients (93%). The most common clinical presentation was cervicofacial edema (95%), throat pain (88%), dysphonia (95%), cola-colored urine (100%), and oliguria (95%). Rhabdomyolysis (86%), acute hepatitis (51%), and acute renal failure (63%) were the most common clinical conditions following poisoning. Overall mortality was noted in 39 patients (36%) while all other patients achieved complete clinical recovery (64%). In patients with mortality, 20 of 39 (51%) developed acute hepatitis. Most patients (95%) in our study underwent tracheostomy. The frequency of acute hepatitis in PPD intoxication is high in this population, especially in young women. Measures need to be instituted regarding the management of acute hepatitis in PPD intoxication to improve patient outcomes. Workups in patients with PPD poisoning should include regular monitoring of aspartate aminotransferase and alanine aminotransferase to observe any damages to the liver so that acute hepatitis can be managed in a timely fashion.

Causes of death of patients with lung cancer.

PubMed

Nichols, Larry; Saunders, Rachel; Knollmann, Friedrich D

2012-12-01

The causes of death for patients with lung cancer are inadequately described. To categorize the immediate and contributing causes of death for patients with lung cancer. The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives.

[A study on vowel duration and word length of adductor spasmodic dysphonia].

PubMed

Chen, Zhipeng; Ge, Pingjiang

2016-03-01

To understand the vowel duration and statement reading of the adductor spasmodic dysphonia (ADSD) patients compared with their normal controls, and provide ideas for clinical diagnosis and treatment. Twenty-nine ADSD patients were included in the research, with 31 normal controls. All subjects filled in form voice handicap index (VHI) by themselves. Maximum phonetic time (MPT) and maximum loudness phonetic time(MLPT) were tested on /a/ sound for all patients. Also, all the patients were required to read aloud a standard mandarin assay named , duration were measured with Praat5. 0 software after sounds were collected. A one-way t-test was performed to compare spasmodic group with control group on VHI, MPT, MLPT and duration for reading standard sentences. Pearson/Spearman correlation was tested. Result: The VHI of the 29 ADSD patients is 89±12, and their normal controls 15±16, indicating that the VHI in ADSD group is significantly higher than in the control group(P<0. 01). The MPT of the ADSD group is(16. 9±9. 8 s), and the control group is (25. 3±10.0)s, indicating that MPT in the ADSD group is significantly shorter than the control group(P<0. 01). The MLPT of the ADSD group is (15.7±7. 6)s, and the control group is (26. 5±11. 4)s, indicating that MLPT in the ADSD group is significantly shorter than the control group (P<0. 01). The duration of standard sentence reading of the ADSD group is (55.0±14. 2)s, and the control group is (37. 8±4. 8)s, indicating that the duration of standard sentence reading in the ADSD group is significantly longer than the control group (P<0. 01). Correlation analysis showed that MPT and MLPT are related within the ADSD group(r=0. 697,P< 0.01), other indexes being tested have no significant correlations. The voice disorder condition of the ADSD patients is significantly worse than normal people. Their pronunciations on continuous vowels are not lasting compared with normal people. In the meantime, their ability to read sentences is worse than normal people, needing longer time to complete the reading task. There is a significant correlation between MLPT and MPT, which can be used as an alternative to MPT.

The role of histology in forensic autopsies: is histological examination always necessary to determine a cause of death?

PubMed

Fronczek, Judith; Hollingbury, Frances; Biggs, Michael; Rutty, Guy

2014-03-01

In England and Wales there is a conflict between the law and advice from regulatory bodies in relation to the sampling of human tissue for histological examination following medico-legal post-mortem examinations. Considering the results of previous publications, we performed a specific study to investigate the role of histology in determining the cause of death in cases at a forensic unit. A retrospective study of 500 adult forensic cases was performed. Cases were categorized by the role the histological examination played in determining a cause of death and its contributory factors. Furthermore, cause of death, manner of death, organ systems involved, and discrepancies were assessed. Of the 500 cases, histology was undertaken in 287 cases (58 %). Microscopic examination provided the cause of death in 2 % of cases where histology had been undertaken, and it added to the cause of death in 8 %. In 61 % of cases microscopy confirmed the macroscopic findings, and in 30 % it did not influence the medical cause of death. Histological examination of all organs in all forensic cases for the purpose of providing a medical cause of death is not supported. Practice guidance should be adjusted to reflect that, while histological examination is essential in certain circumstances, the decision to retain material for histology should be made on a case by case basis at the pathologist's discretion.

Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery.

PubMed

Puccinelli, Cassandra; Modzeski, Mara C; Orbelo, Diana; Ekbom, Dale C

Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility. Retrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery. Pulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days (x¯=114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days (x¯=29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days (x¯=367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility. Many cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Surgery or Rehabilitation: A Randomized Clinical Trial Comparing the Treatment of Vocal Fold Polyps via Phonosurgery and Traditional Voice Therapy with "Voice Therapy Expulsion" Training.

PubMed

Barillari, Maria Rosaria; Volpe, Umberto; Mirra, Giuseppina; Giugliano, Francesco; Barillari, Umberto

2017-05-01

Phonomicrosurgery is generally considered to be the treatment of choice for removing vocal fold polyps. However, specific techniques of voice therapy may represent, in selected cases and under certain conditions, a noninvasive therapeutic option for the treatment of such laryngeal lesions. The aim of the present study is to longitudinally assess, in terms of clinical outcomes and quality of life, two groups of patients with cordal polyps, treated either with standard surgery plus standard voice therapy or with a specific training of voice therapy alone, which we have called "Voice Therapy Expulsion." This study is a randomized controlled trial. A total of 150 patients with vocal fold polyps were randomly assigned to either standard surgery or "voice therapy expulsion" protocol. The trial was carried out at the Division of Phoniatrics and Audiology of the Second University of Naples and at the Division of Communication Disorders of Local Health Unit (3 Naples South) from January 2010 to December 2013. A thorough phoniatric evaluation, including laryngostroboscopy, acoustic voice analysis, global grade of dysphonia, instability, roughness, breathiness, asthenia, and strain scale, Voice Handicap Index, and Voice-Related Quality of Life, was performed by using standardized tools, at baseline, at the end of the treatment, and up to 1 year after treatment. We found no significant differences between the two experimental groups in terms of clinical outcomes and personal satisfaction. However, "Voice Therapy Expulsion" was associated with higher scores for quality of life at endpoint evaluation. Besides phonosurgery, this specific "Voice Therapy Expulsion" technique should be considered as a valid, noninvasive, and well-tolerated therapeutic option for the treatment of selected patients with vocal fold polyps. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Epidemiological, clinical and genetic aspects of adult onset isolated focal dystonia in Ireland.

PubMed

Williams, L; McGovern, E; Kimmich, O; Molloy, A; Beiser, I; Butler, J S; Molloy, F; Logan, P; Healy, D G; Lynch, T; Walsh, R; Cassidy, L; Moriarty, P; Moore, H; McSwiney, T; Walsh, C; O'Riordan, S; Hutchinson, M

2017-01-01

Adult onset idiopathic isolated focal dystonia presents with a number of phenotypes. Reported prevalence rates vary considerably; well-characterized cohorts are important to our understanding of this disorder. To perform a nationwide epidemiological study of adult onset idiopathic isolated focal dystonia in the Republic of Ireland. Patients with adult onset idiopathic isolated focal dystonia were recruited from multiple sources. Diagnosis was based on assessment by a neurologist with an expertise in movement disorders. When consent was obtained, a number of clinical features including family history were assessed. On the prevalence date there were 592 individuals in Ireland with adult onset idiopathic isolated focal dystonia, a point prevalence of 17.8 per 100 000 (95% confidence interval 16.4-19.2). Phenotype numbers were cervical dystonia 410 (69.2%), blepharospasm 102 (17.2%), focal hand dystonia 39 (6.6%), spasmodic dysphonia 18 (3.0%), musician's dystonia 17 (2.9%) and oromandibular dystonia six (1.0%). Sixty-two (16.5%) of 375 consenting index cases had a relative with clinically confirmed adult onset idiopathic isolated focal dystonia (18 multiplex and 24 duplex families). Marked variations in the proportions of patients with tremor, segmental spread, sensory tricks, pain and psychiatric symptoms by phenotype were documented. The prevalence of adult onset idiopathic isolated focal dystonia in Ireland is higher than that recorded in many similar service-based epidemiological studies but is still likely to be an underestimate. The low proportion of individuals with blepharospasm may reflect reduced environmental exposure to sunlight in Ireland. This study will serve as a resource for international comparative studies of environmental and genetic factors in the pathogenesis of the disorder. © 2016 EAN.

Relationship between patient-perceived vocal handicap and clinician-rated level of vocal dysfunction.

PubMed

Childs, Lesley F; Bielinski, Clifford; Toles, Laura; Hamilton, Amy; Deane, Janis; Mau, Ted

2015-01-01

The relationship between patient-reported vocal handicap and clinician-rated measures of vocal dysfunction is not understood. This study aimed to determine if a correlation exists between the Voice Handicap Index-10 (VHI-10) and the Voice Functional Communication Measure rating in the National Outcomes Measurement System (NOMS). Retrospective case series. Four hundred and nine voice evaluations over 12 months at a tertiary voice center were reviewed. The VHI-10 and NOMS scores, diagnoses, and potential comorbid factors were collected and analyzed. For the study population as a whole, there was a moderate negative correlation between the NOMS rating and the VHI-10 (Pearson r = -0.57). However, for a given NOMS level, there could be considerable spread in the VHI-10. In addition, as the NOMS decreased stepwise below level 4, there was a corresponding increase in the VHI-10. However, a similar trend in VHI-10 was not observed for NOMS above level 4, indicating the NOMS versus VHI-10 correlation was not linear. Among diagnostic groups, the strongest correlation was found for subjects with functional dysphonia. The NOMS versus VHI-10 correlation was not affected by gender or the coexistence of a psychiatric diagnosis. A simple relationship between VHI-10 and NOMS rating does not exist. Patients with mild vocal dysfunction have a less direct relationship between their NOMS ratings and the VHI-10. These findings provide insight into the interpretation of patient-perceived and clinician-rated measures of vocal function and may allow for better management of expectations and patient counseling in the treatment of voice disorders. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection.

PubMed

Larijani, Bagher; Pajouhi, Mohammad; Ghanaati, Hossein; Bastanhagh, Mohammad-Hassan; Abbasvandi, Fereshteh; Firooznia, Kazem; Shirzad, Mahmood; Amini, Mohammad-Reza; Sarai, Maryam; Abbasvandi, Nasreen; Baradar-Jalili, Reza

2002-12-06

BACKGROUND: Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. METHODS: 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (<0.24 &mgr;IU/ml) and normal thyroid hormone levels. Ethanol injections were performed once every 1-4 weeks. Ethanol injections were stopped when serum T3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. RESULTS: Average pre-treatment nodule volume [18.2 PlusMinus; 12.7 ml] decreased to 5.7 PlusMinus; 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 PlusMinus; 0.02 &mgr;IU/ml to 0.65 PlusMinus; 0.8 &mgr;IU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T4 and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. CONCLUSION: Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.

Effect of Increased Body Mass Index on Complication Rates during Laryngotracheal Surgery Utilizing Jet Ventilation.

PubMed

Barry, Rachel A; Fink, Daniel S; Pourciau, Dusty Cole; Hayley, Kasey; Lanius, Rachael; Hayley, Schuylor; Sims, Eddy; McWhorter, Andrew J

2017-09-01

Objective Jet ventilation has been used for >30 years as an anesthetic modality for laryngotracheal surgery. Concerns exist over increased risk with elevated body mass index (BMI). We reviewed our experience using jet ventilation for laryngotracheal stenosis to assess for complication rates with substratification by BMI. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A total of 126 procedures with jet ventilation were identified from October 2006 to December 2014. Complications were recorded, including intubation, unplanned admission, readmission, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy. Lowest intraoperative oxygen saturation and maximum end-tidal CO 2 (ETCO 2 ) levels were recorded. Results Among 126 patients, 43, 77, and 6 had BMIs of <25, 25-35, and 36-45, respectively. In the BMI <25 group, there was 1 unplanned intubation. Mean maximum ETCO 2 was 36.51 with no hypoxemia observed. In the BMI 25-35 group, 2 patients required intubation, and 1 sustained minor oral trauma. The mean maximum ETCO 2 was 38.85, with 4 patients having oxygen saturation <90%. In the BMI 36-45 group, 2 patients required intubation. The mean maximum ETCO 2 was 41 with no hypoxemia observed. BMI and length of stenosis were statistically significant variables associated with incidence of intraoperative intubation. Conclusion Increased BMI was associated with an increase in highest ETCO 2 intraoperatively. However, this was not associated with an increase in major complications. Jet ventilation was performed without significant adverse events in this sample, and it is a viable option if used with an experienced team in the management of laryngotracheal stenosis.

E6 and E7 oncogene expression by human papilloma virus (HPV) and the aggressive behavior of recurrent laryngeal papillomatosis (RLP).

PubMed

Shehata, Bahig M; Otto, Kristen J; Sobol, Steven E; Stockwell, Christina A; Foulks, Cora; Lancaster, Wayne; Gregoire, Lucie; Hill, Charles E

2008-01-01

Recurrent laryngeal papillomatosis (RLP), a chronic disease associated with human papilloma virus (HPV), requires serial surgical procedures for debulking, resulting in debilitating long-term dysphonia, laryngeal scarring, and rarely malignant degeneration. Human papilloma virus 11 tumors have been widely accepted as more aggressive than HPV 6 tumors; however, the clinical course has been difficult to predict at disease onset, and the biologic mediators of proliferation have not been well characterized. A retrospective case review of 43 patients (4 months to 10 years at diagnosis) was performed on children treated for recurrent laryngeal papillomatosis. Patient charts were reviewed for demographic information, age at RLP diagnosis, approximate frequency of surgical intervention, and absolute number of surgical procedures performed. Human papilloma virus subtyping was performed. Expression analysis of the HPV-encoded E6 and E7 oncogenes was performed by reverse-transcriptase polymerase chain reaction. Fourteen patients had subtype 11 (33%) and 29 patients had subtype 6 (67%). As expected, HPV 11 patients showed a more aggressive clinical course than HPV 6 patients. However, 38% of patients with subtype 6 (11 patients) followed a clinical course that mirrored the more severe subtype 11 patients. These patients expressed the disease at a younger age (P < 0.0002) and showed higher levels of E6 and E7 oncogenes compared to the patients with the more indolent course. Although HPV subtype and early onset of RLP are well characterized prognostic factors, our study documents the significance of E6 and E7 oncogene expression as potential biologic mediators of proliferation and thereby clinical behavior.

Reliability and Validity of the Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).

PubMed

Özcebe, Esra; Aydinli, Fatma Esen; Tiğrak, Tuğçe Karahan; İncebay, Önal; Yilmaz, Taner

2018-01-11

The main purpose of this study was to culturally adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to Turkish and to evaluate its internal consistency, validity, and reliability. The Turkish version of CAPE-V was developed, and with the use of a prospective case-control design, the voice recordings of 130 participants were collected according to CAPE-V protocol. Auditory-perceptual evaluation was conducted according to CAPE-V and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale by two ear, nose, and throat specialists and two speech and language therapists. The different types of voice disorders, classified as organic and functional disorders, were compared in terms of their CAPE-V scores. The overall severity parameter had the highest intrarater and inter-reliability values for all the participants. For all four raters, the differences in the six CAPE-V parameters between the study and the control groups were found to be statistically significant. Among the correlations for the comparable parameters of the CAPE-V and the GRBAS scales, the highest correlation was found between the overall severity-grade parameters. There was no difference found between the organic and functional voice disorders in terms of the CAPE-V scores. The Turkish version of CAPE-V has been proven to be a reliable and valid instrument to use in the auditory-perceptual evaluation of voice. For the future application of this study, it would be important to investigate whether cepstral measures correlate with the auditory-perceptual judgments of dysphonia severity collected by a Turkish version of the CAPE-V. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Tinea corporis caused by Trichophyton equinum in a rider and review of the literature.

PubMed

Veraldi, Stefano; Genovese, Giovanni; Peano, Andrea

2018-02-01

Trichophyton equinum is a zoophilic dermatophyte usually causing ringworm in horses. Cases of skin infections in humans are very rare. CASE REPORT : ​We describe a case of tinea corporis caused by T. equinum on a buttock of a rider who often rode bareback with short trousers. Although T. equinum was considered in the past as a strict zoophilic dermatophyte, our case report confirms that it can cause dermatophytoses also in humans. A review of epidemiological and clinical features of human infections caused by T. equinum is presented.

Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

PubMed

Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

2014-02-01

Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P < 0.001), advanced comorbidity (OR = 2.3 [2.0-2.6], P < 0.001), revision surgery (OR = 2.7 [2.3-3.1], P < 0.001), disc prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P < 0.001). Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P < 0.001), tracheostomy (OR = 2.3 [1.6-3.3], P < 0.001), gastrostomy (OR = 30.9 [25.3-37.8], P < 0.001), and speech therapy/dysphagia training (OR = 32.0 [15.4-66.4], P < 0.001). Aspiration pneumonia was significantly associated with in-hospital mortality (OR = 15.9 [11.0-23.1], P < 0.001). Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology intervention appears underutilized in this population.

Psychic trauma as cause of death.

PubMed

Terranova, C; Snenghi, R; Thiene, G; Ferrara, S D

2011-01-01

of study Psychic trauma is described as the action of 'an emotionally overwhelming factor' capable of causing neurovegetative alterations leading to transitory or persisting bodily changes. The medico-legal concept of psychic trauma and its definition as a cause in penal cases is debated. The authors present three cases of death after psychic trauma, and discuss the definition of cause within the penal ambit of identified 'emotionally overwhelming factors'. The methodological approach to ascertainment and criterion-based assessment in each case involved the following phases: (1) examination of circumstantial evidence, clinical records and documentation; (2) autopsy; (3) ascertainment of cause of death; and (4) ascertainment of psychic trauma, and its coexisting relationship with the cause of death. The results and assessment of each of the three cases are discussed from the viewpoint of the causal connotation of psychic trauma. In the cases presented, psychic trauma caused death, as deduced from assessment of the type of externally caused emotional insult, the subjects' personal characteristics and the circumstances of the event causing death. In cases of death due to psychic trauma, careful methodological ascertainment is essential, with the double aim of defining 'emotionally overwhelming factors' as a significant cause of death from the penal point of view, and of identifying the responsibility of third parties involved in the death event and associated dynamics of homicide.

[Corneal ulcer caused by Serratia marcescens: case report].

PubMed

Aprelev, A E; Iakovleva, N A; Valyshev, A V

2013-01-01

A case of corneal ulcer caused by Serratia marcescens is reported in a patient with history of corneal microtrauma. Biological features (pathogenicity factors, antibiotic resistance) of isolated culture were characterized. Keratitis cases caused by this agent were analyzed.

Common diagnoses and treatments in professional voice users.

PubMed

Franco, Ramon A; Andrus, Jennifer G

2007-10-01

Common problems among all patients seen by the laryngologist are also common among professional voice users. These include laryngopharyngeal reflux, muscle tension dysphonia, fibrovascular vocal fold lesions (eg, nodules and polyps), cysts, vocal fold scarring, changes in vocal fold mobility, and age-related changes. Microvascular lesions and their associated sequelae of vocal fold hemorrhage and laryngitis due to voice overuse are more common among professional voice users. Much more common among professional voice users is the negative impact that voice problems have on their ability to work, on their overall sense of well-being, and sometimes on their very sense of self. This article reviews the diagnosis and treatment options for these and other problems among professional voice users, describing the relevant roles of medical treatment, voice therapy, and surgery. The common scenario of multiple concomitant entities contributing to a symptom complex is underscored. Emphasis is placed on gaining insight into the "whole" patient so that individualized management plans can be developed. Videos of select diagnoses accompany this content online.

Treatment of vocal fold scarring: rheological and histological measures of homologous collagen matrix.

PubMed

Kriesel, Kevin J; Thiebault, Susan L; Chan, Roger W; Suzuki, Tatsutoshi; VanGroll, Patrick J; Bless, Diane M; Ford, Charles N

2002-10-01

The current treatment options for dysphonia secondary to vocal fold scarring are limited. Few studies address changes in the lamina propria, which is critical to vocal fold biomechanical properties and voice production. Using rheological and histological measures of homologous collagen matrix (HCM)-injected vocal folds, we assessed HCM's potential for providing bulk and restoring biomechanical performance. Twenty rabbits underwent bilateral vocal fold scarring. After 10 weeks of scar maturation, the rabbits had unilateral injections of HCM or saline solution. Ten weeks after the injections, histological studies revealed well-defined collagen globules distributed throughout the lamina propria and underlying muscular tissue. Significantly more procollagen was observed in the HCM-treated group. No significant differences in elastic shear modulus or dynamic viscosity were found between the treatment groups. This study demonstrates that HCM is an inert, relatively stable injectate that may serve well for medialization but does not appear to improve the dynamic properties of the lamina propria.

[Analysis of characteristics of acute poisoning caused by various poisons in Guangxi, China].

PubMed

Hu, De-hong; Zhang, Zhen-ming; Liu, Qing-hua; Jiang, Dong-fang

2013-11-01

To investigate the characteristics of acute poisonings caused by various poisons in Guangxi, China. A retrospective investigation was performed in 5859 cases of acute poisonings who were admitted to 63 hospitals in 11 cities, as well as 531 types of poisons involved. The poisons were categorized into 6 groups; each group of cases was stratified by the rural or urban settings, frequency of poisoning, and cause of poisoning to analyze the numbers of cases and constituent ratios. Most types of poisons (68.74%) belonged to drugs (217 types) and pesticides (148 types). Most cases of poisonings (61.63%) were caused by pesticides (n = 2547) and chemicals (n = 1064). Pesticides, poisons of plant origins, and poisons of animal origins were responsible for most of the cases in rural settings; 88.46%, 79.10%, and 66.74% of the cases of these poison categories happened in rural settings. Chemicals, drugs, and other poisons were responsible for most of the cases in urban settings; 70.20%, 61.74%, and 63.73% of the cases of these poison categories happened in urban settings. The numbers of cases in 5-year-poisoning groups were the highest in all categories of poisons, accounting for 85.24%, 88.57%, 55.16%, 70.79%, 68.36%, and 66.44%of cases of respective categories. Most cases of poisonings by chemicals, poisons of animal origin, and other poisons were accident-related (86.24%, 72.66%, and 46.71%of the poison categories). Most cases of poisonings by pesticides and drugs were suicide-related (59.39% and 33.52% of the poison categories). Most cases by poisons of plant origin were caused by accidental ingestion (70.36% of the poison category). Most of the acute poisonings in Guangxi area are caused by pesticides and chemicals; the most common causes of poisoning are accidents, accidental ingestion, and suicide. There are significant differences in the causes of acute poisonings between the urban and rural settings.

[Forensic Analysis of 20 Dead Cases Related to Heroin Abuse].

PubMed

Huang, W Q; Li, L H; Li, Z; Hong, S J

2016-08-01

To perform retrospective analysis on 20 dead cases related to heroin abuse, and to provide references for the forensic assessment of correlative cases. Among 20 dead cases related to heroin abuse, general situation, using method of drug, cause of death and result of forensic examination were analyzed by statistical analysis for summarizing the cause of death and pathologic changes. The dead were mostly young adults, with more male than female. The results of histopathological examinations showed non-specific pathological changes. There were four leading causes of death, including acute poisoning of heroin abuse or leakage （13 cases, 65%）, concurrent diseases caused by heroin abuse （3 cases, 15%）, inspiratory asphyxia caused by taking heroin （2 cases, 10%）, and heroin withdrawal syndrome （2 cases, 10%）. The forensic identification on dead related to heroin abuse must base on the comprehensive autopsy, and combine with the qualitative and quantitative analysis of heroin and its metabolites in death and the case information, as well as the scene investigation. Copyright© by the Editorial Department of Journal of Forensic Medicine

Postoperative epidural haematomas associated with hydrocephalus caused by intraoperative overdrainage of cerebrospinal fluid: two case reports with a literature review of 19 cases

PubMed Central

Niimura, Manabu; Takai, Keisuke; Taniguchi, Makoto

2015-01-01

We report two cases with postoperative epidural haematomas (EDHs) associated with hydrocephalus and discuss the cause of haematoma development on the basis of a literature review. A 13-year-old boy presented with obstructive hydrocephalus caused by a sellar mass lesion. Multifocal EDHs occurred after partial resection of the lesion via a transcallosal approach following ventricular drainage. In the second case, a 26-year-old man who had a history of ventriculoperitoneal shunting for congenital hydrocephalus presented with hydrocephalus caused by ventricular catheter obstruction. An EDH occurred after replacement of the ventricular catheter with a new burr hole opening. On the basis of a review of 19 cases including our two cases, the authors concluded that postoperative EDH development associated with hydrocephalus was mostly caused by intraoperative overdrainage of cerebrospinal fluid, resulting in rapid shrinkage of the brain with dilation of the epidural space, a situation that may have caused dural venous bleeding. PMID:25666241

President's Address

PubMed Central

Kidd, Frank

1928-01-01

Twenty-four cases of purpura of the urinary tract are discussed and analysed. Purpura of the kidney may be a cause of painless hæmaturia. In some cases nephrectomy may be necessary to check the bleeding. Purpura of the bladder is a cause of painful hæmaturia. In such cases the diagnosis can be made with the cytoscope. A number of the cases appear to be caused by a streptococcal infection of throat, teeth or bowel. The exhibition of horse serum by the mouth usually has an immediate effect in checking the bleeding tendency Splenectomy should be considered in severe chronic recurrent cases. Purpura is a symptom and not a disease. It can attack the kidney or bladder in any type of case. The attacks may be simple, recurrent or fulminating. In many cases no cause can be discovered, in others it is associated with acute rheumatism. In a number of cases a proximate cause can be discovered, in the nature of a bacterial infection, a chemical poison, a thrombocytopenia, splenomegaly, or the deprivation of some vitamin. ImagesFig. 1Fig. 2Fig. 3 PMID:19986473

Thunderclap headache caused by minimally invasive medical procedures: description of 2 cases.

PubMed

Devetag Chalaupka, Flavio; Caneve, Giorgio; Mauri, Michela; Zaiotti, Giuseppe

2007-02-01

We report 2 very unusual cases of thunderclap headache complicating minimally invasive medical procedures. In the first case headache developed as the consequence of a pneumocephalus caused by an inadvertent intrathecal puncture during oxygen-ozone therapy for lumbar disk herniation. The second case involved intracranial hypotension, caused by the persistence of the needle, used for epidural anesthesia, and then penetrated in the subarachnoid space.

Case to Cause: Back to the Future

ERIC Educational Resources Information Center

Abramovitz, Mimi; Sherraden, Margaret S.

2016-01-01

This article reopens the historic debate about the roles of micro and macro practice in social work and encourages the profession to find ways to achieve a better balance between case and cause in education, practice, and research. To this end, it traces the history of the case versus cause debate including conceptual frameworks for rebalancing…

Commotio Cordis Caused by Violence in China

PubMed Central

Mu, Jiao; Chen, Zhenglian; Chen, Xinshan; Lin, Wei; Dong, Hongmei

2015-01-01

Abstract Commotio cordis (CC) is a recognized rare cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. CC diagnosis is still a challenge for forensic pathologists. A retrospective study of 9794 autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC, China) from 1955 to 2014. A total of 39 cases (0.4%) were determined to be caused by CC. A male preponderance (male to female of 37:2) was found in the victims, whose age ranged from 13 to 47 years, including more than 85% individuals in their 10s and 20s. Most victims (27 cases, 69.2%) came from village. The highest rate of victims was found for middle school and college students (15 cases, 38.5%), followed by prisoners (11 cases, 28.2%), farmers (9 cases, 23.1%), workers (3 cases, 7.7%), and office staff (1 case, 2.6%). Chest blows were produced by fists (28 cases, 71.8%), feet (6 cases, 15.4%), knee (2 case, 5.1%), head (1 case, 2.6%), or objects (2 cases, 5.1%). Witness statements indicated that most victims collapsed after being impacted in the precordium. The autopsy findings were unremarkable except bruises, contusions, or subcutaneous hemorrhage in the anterior chest (13 cases), bleeding of intercostal muscles (5 cases), and disperse focal petechiae of the epicardium (11 cases). All CC cases in this study were caused by violent attacks and related to criminal processes. Correct diagnosis of CC due to violence has important implications in the judicial system. PMID:26705218

[Analysis of death causes among infants in Guangzhou from 2010 to 2013].

PubMed

Shen, Jichuan; Wang, Ming; Dong, Hang; Zhou, Qin

2014-06-01

To analyze the main death causes among infants in Guangzhou in 2010-2013 and to provide an objective and scientific basis for risk communication of public health emergencies in the future. Descriptive epidemiological method was used to analyze the death causes among infants reported in Guangzhou from the National Death Registration Reporting Information System. The death causes among infants were classified by the 10th international classification of diseases (ICD-10). The constitution and rank order of death causes among infants were analyzed according to the underlying causes of deaths. A total of 4 880 cases of infant deaths were reported in Guangzhou from 2010 to 2013 and infant deaths in floating population were 1.8 (3 135/1 745) times of registered population. The deaths of male infants were 1.73 (3 094/1 786) times of female infants. The neonatal group accounted for 52.32% (2 553/4 880) of total infant deaths and early neonatal group accounted for 64.86% (1 656/2 553) of total neonatal deaths. The top five causes of infant deaths followed by perinatal diseases, congenital malformations, respiratory diseases (mainly pneumonia), accidental deaths and communicable diseases. The mortality ratios were respectively 44.12% (2 153 cases) , 24.73% (1 207 cases), 6.86% (335 cases), 3.48% (170 cases), 3.01% (147 cases) , and no vaccine-related death case was reported. The primary cause of infant deaths in Guangzhou 2010-2013 was perinatal diseases.

First case of pneumonia caused by Cupriavidus pauculus in an infant in the Gulf Cooperation Council.

PubMed

Yahya, Raghda; Alyousef, Wafaa; Omara, Abdelwahab; Alamoudi, Suha; Alshami, Alanoud; Abdalhamid, Baha

2017-02-28

Cupriavidus pauculus is an emerging organism causing infections in immunocompromised and immunocompetent patients. We report a C.pauculus pneumonia case susceptible to cefepime in an infant with end-stage renal failure. To our knowledge, this is the first case report of C. pauculus causing respiratory infections in the Gulf Cooperation Council.

Transarterial embolization for the treatment of massive bleeding in gynecologic and obstetric emergencies: a single center experience.

PubMed

Hongsakul, Keerati; Songjamrat, Apiradee; Rookkapan, Sorracha

2014-08-01

Delayed treatment of the massive bleeding in gynecologic and obstetric conditions can cause high morbidity and mortality. The aim of this study is to assess the angiographic findings and outcomes of transarterial embolization in cases of massive hemorrhage from underlying gynecological and obstetrical conditions. This is a retrospective study of 18 consecutive patients who underwent transarterial embolization of uterine and/or hypogastric arteries due to massive bleeding from gynecological and obstetrical causes from January 2006 to December 2011. The underlying causes of bleeding, angiographic findings, technical success rates, clinical success rates, and complications were evaluated. Massive gynecological and obstetrical bleeding occurred in 12 cases and 6 cases, respectively. Gestational trophoblastic disease was the most common cause of gynecological bleeding. The most common cause of obstetrical hemorrhage was primary post-partum hemorrhage. Tumor stain was the most frequent angiographic finding (11 cases) in the gynecological bleeding group. The most common angiographic findings in obstetrical patients were extravasation (2 cases) and pseudoaneurysm (2 cases). Technical and final clinical success rates were found in all 18 cases and 16 cases. Collateral arterial supply, severe metritis, and unidentified cervical laceration were causes of uncontrolled bleeding. Only minor complications occurred, which included pelvic pain and groin hematoma. Percutaneous transarterial embolization is a highly effective and safe treatment to control massive bleeding in gynecologic and obstetric emergencies.

Epidemiological characteristics of cases of death from tuberculosis and vulnerable territories1

PubMed Central

Yamamura, Mellina; Santos-Neto, Marcelino; dos Santos, Rebeca Augusto Neman; Garcia, Maria Concebida da Cunha; Nogueira, Jordana de Almeida; Arcêncio, Ricardo Alexandre

2015-01-01

Objective: to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirão Preto, Brazil. Method: an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate. Results: of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality. Conclusion: the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies. PMID:26487142

A World Health Organization field trial assessing a proposed ICD-11 framework for classifying patient safety events.

PubMed

Forster, Alan J; Bernard, Burnand; Drösler, Saskia E; Gurevich, Yana; Harrison, James; Januel, Jean-Marie; Romano, Patrick S; Southern, Danielle A; Sundararajan, Vijaya; Quan, Hude; Vanderloo, Saskia E; Pincus, Harold A; Ghali, William A

2017-08-01

To assess the utility of the proposed World Health Organization (WHO)'s International Classification of Disease (ICD) framework for classifying patient safety events. Independent classification of 45 clinical vignettes using a web-based platform. The WHO's multi-disciplinary Quality and Safety Topic Advisory Group. The framework consists of three concepts: harm, cause and mode. We defined a concept as 'classifiable' if more than half of the raters could assign an ICD-11 code for the case. We evaluated reasons why cases were nonclassifiable using a qualitative approach. Harm was classifiable in 31 of 45 cases (69%). Of these, only 20 could be classified according to cause and mode. Classifiable cases were those in which a clear cause and effect relationship existed (e.g. medication administration error). Nonclassifiable cases were those without clear causal attribution (e.g. pressure ulcer). Of the 14 cases in which harm was not evident (31%), only 5 could be classified according to cause and mode and represented potential adverse events. Overall, nine cases (20%) were nonclassifiable using the three-part patient safety framework and contained significant ambiguity in the relationship between healthcare outcome and putative cause. The proposed framework enabled classification of the majority of patient safety events. Cases in which potentially harmful events did not cause harm were not classifiable; additional code categories within the ICD-11 are one proposal to address this concern. Cases with ambiguity in cause and effect relationship between healthcare processes and outcomes remain difficult to classify. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Impact of SurePath® liquid-based preparation in cytological analysis of peritoneal washing in practice of gynecologic oncology

PubMed Central

Tyagi, Ruchita; Gupta, Nalini; Bhagat, Priyanka; Gainder, Shalini; Rai, Bhavna; Dhaliwal, L K; Rajwanshi, Arvind

2017-01-01

Context: Peritoneal washing is performed for staging of gynecologic tumors to detect subclinical intraperitoneal metastases. Aim: The aim of the present study was to assess the impact of SurePath™ liquid-based cytology (LBC) in peritoneal washing in various gynecological malignancies. Settings and Design: An audit of peritoneal-fluid/washing (January 2012 to July 2013) was performed with corresponding gynecologic specimens. All peritoneal washings were processed using both conventional and LBC technique. Suspicious cases on cytology were reported along with gynecologic specimens. Results: There were a total of 393 peritoneal fluids. Eighty-three (21.1%) were positive for malignancy, and the corresponding histology was available in 352 (89.6%) cases. Sixty-nine positive samples had ovarian malignancies and 5 had uterine causes. There were 9 cases of peritoneal washings in which no histopathology was available. The most common cause of positive peritoneal cytology was ovarian serous carcinoma in 55/84 (65.5%) cases. Other causes included mucinous cystadenocarcinoma, dysgerminoma, squamous cell carcinoma in teratoma, yolk sac tumor, and granulosa cell tumor. Uterine causes included 2/45 (4.4%) cases of endometrioid adenocarcinoma, ¼ (25%) cases of clear cell carcinoma, ½ (50%) cases of carcinosarcoma, and ¼ (25%) cervix carcinoma. On review of positive cases (n = 83), 10 cases were identified, which had nil (n = 4) to low cellularity (<3 tumor clusters/smear; n = 6) on conventional smears, and were confirmed malignant on LBC. Conclusions: The most common ovarian malignancy causing positive peritoneal cytology is papillary serous carcinoma. Endometrioid adenocarcinoma rarely leads to positive peritoneal cytology. LBC technique leads to concentration of tumor cells causing reduction in false negative cases, especially in hemorrhagic and low-cellular cases. PMID:28469317

Air-borne contact dermatitis caused exclusively by xanthium strumarium.

PubMed

Pasricha, J S; Verma, K K; D'Souza, P

1995-01-01

Most cases having air-borne contact dermatitis (ABCD) in India are considered to be caused by Parthenium hysterophorus. In some cases however, other plants have also been noticed to give positive patch test reactions. We are reporting two cases presenting as ABCD who showed positive patch tests with Xanthium strumarium while the patch tests with Parthenium hysterophorus were negative. It is therefore necessary to realise that every case of ABCD is not caused by Parthenium, and patch testing with Parthenium alone can lead to serious mistakes.

A rare cause of Cushing's syndrome: an ACTH-secreting phaeochromocytoma

PubMed Central

Folkestad, Lars; Andersen, Marianne Skovsager; Nielsen, Anne Lerberg; Glintborg, Dorte

2014-01-01

Excess glucocorticoid levels cause Cushing's syndrome (CS) and may be due to pituitary, adrenal or ectopic tumours. Adrenocorticotropic hormone (ACTH) levels are useful in identifying adrenal tumours. In rare cases, ACTH-producing phaeochromocytomas are the cause of CS. We present two cases of ACTH-secreting phaeochromocytoma as the underlying cause of CS. In both cases, female patients presented with the classical clinical signs of CS and an adrenal mass. High ACTH levels raised the suspicion of an ACTH-secreting phaeochromocytoma. The diagnosis was confirmed by urinary catecholamine levels and positive fluorine-18-L-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET) CT (Case 1) and fluorodeoxyglucose PET-CT (Case 2). Both patients were treated with an α-blocker prior to surgical intervention. The two cases underline the importance of thorough diagnostic workup in patients with CS. An ACTH-secreting phaeochromocytoma should be checked for in patients with an adrenal mass and elevated ACTH levels. PMID:25297883

Cannabis, possible cardiac deaths and the coroner in Ireland.

PubMed

Tormey, W P

2012-12-01

The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2 h after smoking. To examine the possible role of cannabis in cardiac deaths. CASES AND RESULTS: From 3,193 coroners' cases over 2 years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9-tetrahydrocannabinol-carboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured. To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners' cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.

Strangulation and Its Role in Multiple Causes of Death.

PubMed

Hlavaty, Leigh; Sung, LokMan

2017-12-01

Forensic pathologists have a duty to determine the cause and manner of death and are bound by international guidelines in the completion of the death certificate. Sometimes, there are complex circumstances surrounding a death that cannot be captured in the structure of the death certificate and its requirement of listing only 1 cause of death per line. Cases may have multiple causes of death with comorbid medical conditions or inflicted injuries that equally contribute to the ultimate demise. Compared with other forms of homicide, autopsy evidence of strangulation will often be found with other life-threatening traumatic injuries. The Wayne County Medical Examiner's Office conducted a retrospective study of strangulation cases that came into the office from mid-2007 to the end of 2016. The purpose of the study was to examine patterns of injuries in strangulation cases and identify those with additional traumatic injuries of commensurate extent that required incorporation into the cause of death. A total of 43 strangulation cases were found, of which there were equal numbers of ligature and manual strangulations (19 each) and 5 cases in which the method was not specified, and decedents were divided: 63% female and 37% male. Fourteen of these cases were recognized to have multiple causes of death, where blunt force trauma was the most common additional cause, and the sex distribution weighed heavily toward the female (approximately 79%).

[Recurrent bleeding following the renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage: causes and countermeasure].

PubMed

Ren, Y M; Wu, X M; Wen, Y; Lai, Q; Chen, W Z; Qian, Y X; Liang, R G

2017-01-03

Objective: To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage. Methods: A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied. Results: The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm ( n =12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula( n =2), recanalization of the embolized arteries ( n =2). Conclusion: The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.

Wheelbarrow tire explosion causing trauma to the forearm and hand: a case report

PubMed Central

2009-01-01

Introduction Tire explosion injuries are rare, but they may result in a severe injury pattern. Case reports and statistics from injuries caused by exploded truck tires during servicing are established, but trauma from exploded small tires seems to be unknown. Case presentation A 47-year-old german man inflated a wheelbarrow tire. The tire exploded during inflation and caused an open, multiple forearm and hand injury. Conclusion Even small tires can cause severe injury patterns in the case of an explosion. High inflating pressures and low safety distances are the main factors responsible for this occurrence. Broad safety information and suitable filling devices are indispensable for preventing these occurrences. PMID:19946543

Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-03-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-01-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mitecontaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan. © 2014 Japanese Society of Allergology.

Oral Mite Anaphylaxis Caused by Mite-Contaminated Okonomiyaki/Pancake-Mix in Japan: 8 Case Reports and a Review of 28 Reported Cases.

PubMed

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2013-12-25

Background: Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. Methods: In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Results: Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Conclusions: Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Changes of the speaking and singing voice after thyroid or parathyroid surgery.

PubMed

Musholt, Thomas J; Musholt, Petra B; Garm, Jens; Napiontek, Ulrike; Keilmann, Annerose

2006-12-01

While permanent dysphonia is a rare complication of thyroid or parathyroid surgery, postoperative changes of the speaking and/or singing voice often remain unrecognized. In a prospective 4-arm study, vocal fold videolaryngostroboscopy and functional assessment of pre- and postoperative vocal performance was used to evaluate voice disturbances in 120 patients undergoing extended cervical surgery and in 19 patients with limited interventions for thyroid and/or parathyroid pathology. Impairments, especially of the singing voice, were predominantly observed after extended endocrine neck surgery. In women, the highest pitch of the singing voice (HPS) dropped from 651 Hz to 563 Hz (E5 to Csharp5, P < .001). In men, the HPS decreased to a lesser extent (423 Hz to 374 Hz, (Gsharp4 to Fsharp4, P = .009). Covariant analysis of influencing factors revealed the preoperative maximum frequency range and the HPS as predictors of the postoperative voice outcome. While alterations of the speaking voice after thyroid and parathyroid surgery usually remain subclinical, transient changes of the singing voice will matter to voice professionals.

Quantitative Analysis of Vocal Fold Vibration in Vocal Fold Paralysis With the Use of High-speed Digital Imaging.

PubMed

Yamauchi, Akihito; Yokonishi, Hisayuki; Imagawa, Hiroshi; Sakakibara, Ken-Ichi; Nito, Takaharu; Tayama, Niro

2016-11-01

The goal of this work was to objectively elucidate the vibratory characteristics of vocal fold paralysis (VFP) using high-speed digital imaging (HSDI). HSDI was performed in 29 vocally healthy subjects (12 women and 17 men) and in 107 patients with VFP (40 women and 67 men). Then, the HSDI data were evaluated by visual-perceptual rating, single-line kymography, multiline kymography, laryngotopography, and glottal area waveform analysis. Patients with VFP compared with vocally healthy subjects revealed more frequent incomplete glottal closure, greater asymmetry in amplitude, mucosal wave, frequency, and phase, as well as larger open quotient, smaller speed index, larger maximal and minimal glottal area, and smaller glottal area difference. Paralyzed vocal folds in VFP revealed reduced mucosal wave than nonparalyzed vocal folds in VFP or in intact vocal folds in vocally healthy subjects. HSDI was effective in documenting the characteristics of vocal fold vibrations in patients with VFP and in exploring the vibratory disturbance for estimating the severity of dysphonia. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers.

PubMed

McIvor, R Andrew; Devlin, Hollie M; Kaplan, Alan

2018-01-01

Valved holding chambers (VHCs) have been used with pressurized metered-dose inhalers since the early 1980s. They have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce side effects such as throat irritation, dysphonia, and oral candidiasis that are common with use of pressurized metered-dose inhalers (pMDIs) alone. VHCs act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a two-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. The design of VHC devices can have an impact on performance. Features such as antistatic properties, effective face-to-facemask seal feedback whistles indicating correct inhalation speed, and inhalation indicators all help improve function and performance, and have been demonstrated to improve asthma control, reduce the rate of exacerbations, and improve quality of life. Not all VHCs are the same, and they are not interchangeable. Each pairing of a pMDI device plus VHC should be considered as a unique delivery system.

Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers

PubMed Central

Devlin, Hollie M.

2018-01-01

Valved holding chambers (VHCs) have been used with pressurized metered-dose inhalers since the early 1980s. They have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce side effects such as throat irritation, dysphonia, and oral candidiasis that are common with use of pressurized metered-dose inhalers (pMDIs) alone. VHCs act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a two-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. The design of VHC devices can have an impact on performance. Features such as antistatic properties, effective face-to-facemask seal feedback whistles indicating correct inhalation speed, and inhalation indicators all help improve function and performance, and have been demonstrated to improve asthma control, reduce the rate of exacerbations, and improve quality of life. Not all VHCs are the same, and they are not interchangeable. Each pairing of a pMDI device plus VHC should be considered as a unique delivery system. PMID:29849831

Work-associated irritable larynx syndrome.

PubMed

Anderson, Jennifer A

2015-04-01

The purpose of this study is to review the relevant literature concerning work-associated irritable larynx syndrome (WILS), a hyperkinetic laryngeal disorder associated with occupational irritant exposure. Clinical symptoms are variable and include dysphonia, cough, dyspnoea and globus pharyngeus. WILS is a clinical diagnosis and can be difficult to differentiate from asthma. Treatment options for WILS include medical and behavioural therapy. Laryngeal-centred upper airway symptoms secondary to airborne irritants have been documented in the literature under a variety of diagnostic labels, including WILS, vocal cord dysfunction (VCD), laryngeal hypersensitivity and laryngeal neuropathy and many others. The underlying pathophysiology is as yet poorly understood; however, the clinical scenario suggests a multifactorial nature to the disorder. More recent literature indicates that central neuronal plasticity, inflammatory processes and psychological factors are all likely contributors. Possible mechanisms for WILS include central neuronal network plasticity after noxious exposure and/or viral infection, inflammation (i.e. reflux disease) and intrinsic patient factors such a psychological state. Treatment is individualized and frequently includes one or more of the following: environmental changes in the workplace, GERD therapy, behavioural/speech therapy, psychotherapy counselling and neural modifiers.

Cystic Echinococcoses in Mongolia: Molecular Identification, Serology and Risk Factors

PubMed Central

Ito, Akira; Dorjsuren, Temuulen; Davaasuren, Anu; Yanagida, Tetsuya; Sako, Yasuhito; Nakaya, Kazuhiro; Nakao, Minoru; Bat-Ochir, Oyun-Erdene; Ayushkhuu, Tsendjav; Gonchigsengee, Nyamkhuu; Li, Tiaoying; Agvaandaram, Gurbadam; Davaajav, Abmed; Boldbaatar, Chinchuluun; Chuluunbaatar, Gantigmaa

2014-01-01

Background Cystic echinococcosis (CE) is a globally distributed cestode zoonosis that causes hepatic cysts. Although Echinococcus granulosus sensu stricto (s.s.) is the major causative agent of CE worldwide, recent molecular epidemiological studies have revealed that E. canadensis is common in countries where camels are present. One such country is Mongolia. Methodology/Principal Findings Forty-three human hepatic CE cases that were confirmed histopathologically at the National Center of Pathology (NCP) in Ulaanbaatar (UB) were identified by analysis of mitochondrial cox 1 gene as being caused by either E. canadensis (n = 31, 72.1%) or E. granulosus s.s. (n = 12, 27.9%). The majority of the E. canadensis cases were strain G6/7 (29/31, 93.5%). Twenty three haplotypes were identified. Sixteen of 39 CE cases with data on age, sex and province of residence were citizens of UB (41.0%), with 13 of the 16 cases from UB caused by E. canadensis (G6/7) (81.3%). Among these 13 cases, nine were children (69.2%). All pediatric cases (n  =  18) were due to E. canadensis with 17 of the 18 cases (94.4%) due to strain G6/7. Serum samples were available for 31 of the 43 CE cases, with 22 (71.0%) samples positive by ELISA to recombinant Antigen B8/1 (rAgB). Nine of 10 CE cases caused by E. granulosus s.s. (90.0%) and 13 of 20 CE cases by E. canadensis (G6/7) (65.0%) were seropositive. The one CE case caused by E. canadensis (G10) was seronegative. CE cases caused by E. granulosus s.s. showed higher absorbance values (median value 1.131) than those caused by E. canadensis (G6/7) (median value 0.106) (p  =  0.0137). Conclusion/Significance The main species/strains in the study population were E. canadenis and E. granulossus s.s. with E. canadensis the predominant species identified in children. The reason why E. canadensis appears to be so common in children is unknown. PMID:24945801

Body-packing as cause of unexpected sudden death.

PubMed

Heinemann, A; Miyaishi, S; Iwersen, S; Schmoldt, A; Püschel, K

1998-03-02

Four fatalities related to smuggling of drugs by body-packing were investigated. The victims were examined at the Institute of Forensic Medicine of Hamburg University between 1983 and 1995, two of them due to "sudden" unknown cause of death. All victims were male. Two of them were found already dead in a backyard and in a hotel, two other were emergency cases and died at a hospital. Smuggled substances included cocaine (two cases), heroin and amphetamine/caffeine. In all cases, the cause of death was intoxication caused by torn packages which were detected at autopsy. The maximum weight of the packet's contents was 630 g divided in 90 packages. Only one victim was apparently an intravenous drug-abuser. Hair analysis was performed in three cases and revealed in one case a difference between a concealed and a habitually consumed drug. Toxicological analysis revealed that the substances were quite pure and provided evidence that rather long survival was possible following intoxication in three cases, in two cases supported by hospital treatment in the final stage. The procedural regimen in cases of suspected body-packing is discussed.

Actinomyces naeslundii: An Uncommon Cause of Endocarditis

PubMed Central

Cortes, Christopher D.; Urban, Carl; Turett, Glenn

2015-01-01

Actinomyces rarely causes endocarditis with 25 well-described cases reported in the literature in the past 75 years. We present a case of prosthetic valve endocarditis (PVE) caused by Actinomyces naeslundii. To our knowledge, this is the first report in the literature of endocarditis due to this organism and the second report of PVE caused by Actinomyces. PMID:26697243

Oral Campylobacter Species Involved in Extraoral Abscess: a Report of Three Cases

PubMed Central

Han, Xiang Y.; Tarrand, Jeffrey J.; Rice, David C.

2005-01-01

Oral Campylobacter species are rarely reported to cause extraoral infections. Here we present three cases of extraoral abscess caused by an oral Campylobacter sp. and a Streptococcus sp. The Campylobacter species were all isolated anaerobically and identified by sequencing analysis of the 16S rRNA gene. The cases included a breast abscess caused by Campylobacter rectus and a non-group A beta-hemolytic streptococcus in a patient with lymphoma, a liver abscess caused by Campylobacter curvus and an alpha-hemolytic streptococcus in a patient with complicated ovarian cancer, and a postobstructive bronchial abscess caused by C. curvus and group C beta-hemolytic Streptococcus constellatus in a patient with lung cancer. The abscesses were drained or resected, and the patients were treated with antibiotics with full resolution of the lesions. The C. curvus cases are likely the first reported infections by this organism, and the C. rectus case represents the second such reported extraoral infection. PMID:15872299

Simultaneous presence of two hematological malignancies: chronic lymphocytic leukemia and myelofibrosis in a patient.

PubMed

Palta, Anshu; Garg, Shailja; Chauhan, Sandeep; Varma, Neelam

2011-03-01

Coexistence of chronic lymphocytic leukemia (CLL) with myelofibrosis is a rare association with only isolated case reports in the literature. We report an unusual case of CLL in which the cause of anemia was coexistent myelofibrosis. In a case of CLL presenting with refractory anemia, besides common causes like autoimmune hemolytic anemia and marrow infiltration, other causes like myelofibrosis should be searched for.

Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review.

PubMed

Bednar, Drew A; Almansoori, Khaled

2015-10-01

Study Design Case report and review of the literature. Objective To present a unique case of L5 radiculopathy caused by a sacral stress fracture without neurologic compression. Methods We present our case and its clinical evolution and review the available literature on similar pathologies. Results Relief of the unusual mechanical loading causing sacral stress fracture led to rapid resolution of radiculopathy. Conclusion L5 radiculopathy can be caused by a sacral stress fracture and can be relieved by simple mechanical treatment of the fracture.

Cases of death caused by gas or warning firearms.

PubMed

Rothschild, M A; Maxeiner, H; Schneider, V

1994-01-01

Five cases of lethal injuries caused by gas or warning firearms are discussed. In one suicide case a modified weapon (elongated barrel) and steel bullets were used to fire a shot into the head, the bullets lodged in the skull and lethal bleeding resulted. In the other cases conventional gas weapons without evidence of alteration were used for contact shots; injuries were caused by the effect of propelling powder gases. Two of these cases were suicides (temporal contact shot and back of the neck contact shot), one was an accident (inguinal contact shot with lethal bleeding), and one was an attack by another person with a contact shot against the neck with bilateral tears of the hypopharynx. After successful surgery, a delayed death occurred 12 days later caused by bleeding into the airways from the ruptured external carotid artery.

[Cervical necrotizing fasciitis caused by Klebsiella pneumoniae: three cases report and review of literature].

PubMed

Cong, Tiechuan; Liu, Yuhe; Gao, Weihua; Li, Tiancheng; Wang, Quangui; Xiao, Shuifang; Qin, Yong

2013-10-01

To analyze the clinical manifestations of three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae and to analyze the published articles concerning the relationship between invasive klebsiella syndrome and necrotizing fasciitis in Chinese Mainland. We have retrospectively analyzed three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae treated in our department between 2003 and 2012. We also reviewed the Chinese-language scientific literature included in the WanFang data by searching with the following key words: necrotizing fasciitis, klebsiella pneumoniae and liver abscess. These patients recovered uneventfully without obvious complications or disseminated infection foci. Sporadic cases of invasive klebsiella syndrome were reported without necrotizing fasciitis involvement in Chinese Mainland. Cervical necrotizing fasciitis caused by klebsiella pneumoniae may give rise to disseminated infection but there has been no such case report in Chinese Mainland.

Ocular morbidity patterns among children in schools for the blind in Chennai.

PubMed

Prakash, M Vs; Sivakumar, S; Dayal, Ashutosh; Chitra, A; Subramaniam, Sudharshini

2017-08-01

To identify the morbidity patterns causing blindness in children attending schools for the blind in Chennai and comparing our data with similar studies done previously. A cross-sectional prevalence study was carried out in two schools for the blind in Chennai. Blind schools were visited by a team of ophthalmologists and optometrists. Students with best-corrected visual acuity (BCVA) worse than 3/60 in the better eye were included and relevant history was noted. Every student underwent anterior segment evaluation and detailed fundus examination. Morbidity of the better eye was taken as cause of blindness. Health records maintained by the school were referred to wherever available. The anatomical causes of blindness include optic nerve disorders in 75 (24.8%) cases, retinal disorders in 55 (18.2%), corneal disorders in 47 (15.6%), lens-related disorders in 39 (12.9%), congenital anomalies in 11 (3.6%), and congenital glaucoma in 20 (6.6%) cases. The whole globe was involved in six cases (1.99%). Among conditions causing blindness, optic atrophy seen in 73 (24.17%) cases was the most common, followed by retinal dystrophy in 44 (14.56%), corneal scarring in 35 (11.59%), cataract in 22 (7.28%), and congenital glaucoma in 20 (6.6%) cases. It was found that avoidable causes of blindness were seen in 31% of cases and incurable causes in 45%. Optic nerve atrophy and retinal dystrophy are the emerging causes of blindness, underlining the need for genetic counseling and low vision rehabilitation centers, along with a targeted approach for avoidable causes of blindness.

Ocular morbidity patterns among children in schools for the blind in Chennai

PubMed Central

Prakash, MVS; Sivakumar, S; Dayal, Ashutosh; Chitra, A; Subramaniam, Sudharshini

2017-01-01

Purpose: To identify the morbidity patterns causing blindness in children attending schools for the blind in Chennai and comparing our data with similar studies done previously. Methods: A cross-sectional prevalence study was carried out in two schools for the blind in Chennai. Blind schools were visited by a team of ophthalmologists and optometrists. Students with best-corrected visual acuity (BCVA) worse than 3/60 in the better eye were included and relevant history was noted. Every student underwent anterior segment evaluation and detailed fundus examination. Morbidity of the better eye was taken as cause of blindness. Health records maintained by the school were referred to wherever available. Results: The anatomical causes of blindness include optic nerve disorders in 75 (24.8%) cases, retinal disorders in 55 (18.2%), corneal disorders in 47 (15.6%), lens-related disorders in 39 (12.9%), congenital anomalies in 11 (3.6%), and congenital glaucoma in 20 (6.6%) cases. The whole globe was involved in six cases (1.99%). Among conditions causing blindness, optic atrophy seen in 73 (24.17%) cases was the most common, followed by retinal dystrophy in 44 (14.56%), corneal scarring in 35 (11.59%), cataract in 22 (7.28%), and congenital glaucoma in 20 (6.6%) cases. Conclusion: It was found that avoidable causes of blindness were seen in 31% of cases and incurable causes in 45%. Optic nerve atrophy and retinal dystrophy are the emerging causes of blindness, underlining the need for genetic counseling and low vision rehabilitation centers, along with a targeted approach for avoidable causes of blindness. PMID:28820161

Tuberculosis Caused by Mycobacterium africanum, United States, 2004-2013.

PubMed

Sharma, Aditya; Bloss, Emily; Heilig, Charles M; Click, Eleanor S

2016-03-01

Mycobacterium africanum is endemic to West Africa and causes tuberculosis (TB). We reviewed reported cases of TB in the United States during 2004-2013 that had lineage assigned by genotype (spoligotype and mycobacterial interspersed repetitive unit variable number tandem repeats). M. africanum caused 315 (0.4%) of 73,290 TB cases with lineage assigned by genotype. TB caused by M. africanum was associated more with persons from West Africa (adjusted odds ratio [aOR] 253.8, 95% CI 59.9-1,076.1) and US-born black persons (aOR 5.7, 95% CI 1.2-25.9) than with US-born white persons. TB caused by M. africanum did not show differences in clinical characteristics when compared with TB caused by M. tuberculosis. Clustered cases defined as >2 cases in a county with identical 24-locus mycobacterial interspersed repetitive unit genotypes, were less likely for M. africanum (aOR 0.1, 95% CI 0.1-0.4), which suggests that M. africanum is not commonly transmitted in the United States.

The value of case reports in human teratology.

PubMed

Goldberg, J D; Golbus, M S

1986-03-01

Birth defects caused by human teratogens are an important and potentially preventable cause of perinatal morbidity and mortality. Case reports provide an initial suggestion that a specific agent may be a human teratogen and provide the basis for further study. This review discusses the importance of case reports in human teratology and provides guidance in evaluating new case reports.

Aeromonas as a Cause of Purulent Folliculitis: A Case Report and Review of the Literature

PubMed Central

Olszewski, Aleksandra E.; Karandikar, Manjiree V.

2017-01-01

Abstract Aeromonas species are rarely an identified cause of folliculitis. Here, we describe the case of a patient who had purulent folliculitis of the breast caused by an Aeromonas species and review 4 other cases presented in the literature, highlighting the commonalities observed. Aeromonas infection should be considered in patients who present with purulent folliculitis, particularly those with exposure to nonchlorinated pools or baths. PMID:27988495

Infective endocarditis causing mitral valve stenosis - a rare but deadly complication: a case report.

PubMed

Hart, Michael A; Shroff, Gautam R

2017-02-17

Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred. We report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness. The discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.

Brown tumours of the tibia and second metacarpal bone in a woman with severe vitamin D deficiency.

PubMed

Al-Sharafi, Butheinah A; Al-Imad, Shafiq A; Shamshair, Amani M; Al-Faqeeh, Derhim H

2015-08-03

Brown tumours caused by vitamin D deficiency are rare. Most cases are caused by primary hyperparathyroidism, and are rarely caused by secondary hyperparathyroidism in cases of renal failure. We present a case of Brown tumours of the tibia and second metacarpal bone in a 50-year-old woman who had a low dietary intake of vitamin D and had worn a veil for most of her adult life. The Brown tumours were caused by vitamin D deficiency and secondary hyperparathyroidism. The patient improved on treatment with vitamin D3 and calcium supplements. This is a rare case and the first, to our knowledge, with a Brown tumour of the tibia caused by vitamin D deficiency due to decreased dietary intake and decreased exposure to sunlight. The course of treatment and investigations of the patient are described. 2015 BMJ Publishing Group Ltd.

Neonatal Bartter syndrome and unilateral ectopic renal cyst as new renal causes of hydrops fetalis: two case reports and review of the literature.

PubMed

Çetinkaya, Merih; Durmaz, Oguzhan; Büyükkale, Gökhan; Ozbek, Sibel; Acar, Deniz; Kilicaslan, Isin; Kavuncuoglu, Sultan

2013-07-01

Non-immune hydrops fetalis (NIHF) is a challenging entity as it represents the end stage of several different disorders. Renal and genitourinary causes of NIHF are rare and include congenital renal malformations, tumors and ureter-urethra disorders. Herein, two NIHF cases with different renal causes were presented. The first case that had antenatal NIHF was diagnosed neonatal Bartter syndrome. The second case of NIHF with antenatal large cyst in the surrenal gland area required surgery and ectopic renal cyst was diagnosed. To our best of knowledge, these are the first reports of NIHF associated with neonatal Bartter syndrome and ectopic renal cyst in neonates. Although it may be coincidental, these cases suggest that both neonatal Bartter syndrome and unilateral ectopic renal cyst may cause NIHF development in neonates by several different mechanisms. Therefore, these two rare entities should be suspected in cases of NIHF with similar findings.

A rare cause of Cushing's syndrome: an ACTH-secreting phaeochromocytoma.

PubMed

Folkestad, Lars; Andersen, Marianne Skovsager; Nielsen, Anne Lerberg; Glintborg, Dorte

2014-10-08

Excess glucocorticoid levels cause Cushing's syndrome (CS) and may be due to pituitary, adrenal or ectopic tumours. Adrenocorticotropic hormone (ACTH) levels are useful in identifying adrenal tumours. In rare cases, ACTH-producing phaeochromocytomas are the cause of CS. We present two cases of ACTH-secreting phaeochromocytoma as the underlying cause of CS. In both cases, female patients presented with the classical clinical signs of CS and an adrenal mass. High ACTH levels raised the suspicion of an ACTH-secreting phaeochromocytoma. The diagnosis was confirmed by urinary catecholamine levels and positive fluorine-18-L-dihydroxyphenylalanine (18F-DOPA) positron emission tomography (PET) CT (Case 1) and fluorodeoxyglucose PET-CT (Case 2). Both patients were treated with an α-blocker prior to surgical intervention. The two cases underline the importance of thorough diagnostic workup in patients with CS. An ACTH-secreting phaeochromocytoma should be checked for in patients with an adrenal mass and elevated ACTH levels. 2014 BMJ Publishing Group Ltd.

An unusual osteomyelitis caused by Moraxella osloensis: A case report.

PubMed

Alkhatib, Nidal J; Younis, Manaf H; Alobaidi, Ahmad S; Shaath, Nebal M

2017-01-01

Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Three cases of the malignant esophageal stenosis successfully treated with the Niti-S™ esophageal stent].

PubMed

Isohata, Noriyuki; Naritaka, Yoshihiko; Asaka, Shinichi; Shimakawa, Takeshi; Miyaki, Akira; Yamaguchi, Kentaro; Murayama, Minoru; Katsube, Takao; Ogawa, Kenji

2011-11-01

We herein report three cases of the malignant esophageal stenosis successfully treated with the Niti-S™ esophageal stent. CASE 1: The hilar lung cancer and its mediastinal lymph node metastasis pressed the esophagus extramurally and caused the marked stenosis. CASE 2: A metastatic lymph node along the left laryngeal nerve caused the stenosis of the trachea. A primary esophageal lesion located at the middle thoracic esophagus also caused the marked stenosis. At first, tracheal stent was placed because of dyspnea, and two weeks later, we placed an esophageal stent. Case 3: Esophageal cancer at lower thoracic esophagus after definitive radiation therapy caused the marked stenosis. Because of the stenosis of esophago-gastric junction( EGJ), we used an esophageal stent with a long cover in order to prevent a reflux into the esophagus. This new Niti-STM esophageal stent was easy to place at the stenosis without difficulty using a conventional device. The symptom was improved immediately for each case. We hope this new device will be used widely.

An unusual cause of small bowel obstruction in children: lentil soup bezoar

PubMed Central

Plataras, Christos; Sardianos, Nektarios; Vlatakis, Stephanos; Nikas, Konstantinos

2014-01-01

Bezoars are an unusual cause of acute intestinal obstruction in children. Most cases are trichobezoars in adolescent girls who swallow their hair. Lactobezoars are another unusual but occasionally reported cause of intestinal obstruction in neonates. Phytobezoars and food bolus bezoars are the least common types of intestinal obstruction that have been reported in children. Of the few paediatric cases that have been described, the majority involve persimmons. Moreover, all of these cases involve the ingestion of raw fibres or fruit that have not been cooked. We report a case of a girl who presented with acute ileal obstruction because of lentil soup bezoar. Given the wide use of this otherwise nutritional foodstuff, we highlight the danger from its inappropriate preparation to the health of children. This is the first reported case of intestinal obstruction caused by lentils in children and we hope to raise concern among paediatricians regarding this matter. PMID:24692381

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

PubMed Central

2014-01-01

Background There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. Methods Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes. Results Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes. Conclusions There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes. PMID:25123846

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rearden, Bradley T; Marshall, William BJ J

In the course of criticality code validation, outlier cases are frequently encountered. Historically, the causes of these unexpected results could be diagnosed only through comparison with other similar cases or through the known presence of a unique component of the critical experiment. The sensitivity and uncertainty (S/U) analysis tools available in the SCALE 6.1 code system provide a much broader range of options to examine underlying causes of outlier cases. This paper presents some case studies performed as a part of the recent validation of the KENO codes in SCALE 6.1 using S/U tools to examine potential causes of biases.

Travel-associated infections caused by unusual serogroups of Legionella pneumophila identified using Legionella BIOCHIP slides in Turkey and Iraq.

PubMed

Kocazeybek, Bekir S; Yuksel, Pelin; Keskin, Dilek; Sheikh, Suhail; Habip, Zafer; Yavuzer, Serap Sahin; Caliskan, Reyhan; Altun, Yagız Meric; Kuskucu, Mert; Cengiz, Mahir; Dinc, Harika Oyku; Karakullukcu, Asiye; Ergin, Sevgi; Saribas, Suat; Yilmaz, Nail; Tokman, Hrisi Bahar

2016-01-01

Although Legionella pneumophila serogroup 1 is the common disease causing serogroup, rare serogroups can also may cause legionellosis. A 54-year-old male patient (index case) reported that he had been on a religious trip (for visiting, tomb of Ali, which is important for Shias) to Iraq with a large group (50 shia pilgrims from Kars city of Turkey) two weeks prior to admission. Due to civil war, the hotel where the patient stayed in Iraq lacked proper hygiene. A large number of people in the travel group were experiencing the same symptoms. Other five cases were 2 males (ages; 50, 45) and 3 females including the wife of the index case (ages; 50, 28, 27). The detection of L. pneumophila IgG and IgM was performed by anti-L. pneumophila Indirect Immunofluorescent IgM, IgG kit. Legionella 1 biochip/verification BIOCHIP slides were used for serogrouping in Euroimmun AG, Leubeck, Germany. In index case, L. pneumophila IgM was positive with a titer of 1/32 titer. IgG was negative with a 1/100 titer. Another case (28 year old female), had clinical symptoms identical to the index case. L. pneumophila IgM and IgG were positive with titers of 1/64 and 1/100, respectively. These two cases were diagnosed with Legionnaires' disease caused by L. pneumophila serogroup 12 (index case) and female (28-year-old) by serogroup 11. The other 4 cases were diagnosed with possible Pontiac fever caused by L. pneumophila serogroups 14 (wife of the index case), 4, and 6 whereas the serogroup of L. pneumophila detected in 27 years old female case could not be identified. A major limitation of this work is the absence of genotyping and the serogroup difference between index case and his wife who shared the same hotel. We suggest that this serogroup difference may be caused by (for men and women) sitting separately in Islamic rules. On the other hand, the movement of people in the context of mutual visits between countries or neighboring countries for tourism-related (i.e., for religious events or visits to holy sites) or immigration-related reasons, may cause some epidemic diseases. This study reemphasized that not only L. pneumophila serogroup 1, but other rare serogroups might cause also legionellosis which may increase in frequency and cause regional epidemics. We propose that increased financial resources for improving the hygiene conditions and performing routine legionella surveillance studies in touristic hotels would be useful measures for legionellosis prevention and control. Copyright © 2016 Elsevier Ltd. All rights reserved.

Postorgasm illness syndrome--a spectrum of illnesses.

PubMed

Ashby, Jane; Goldmeier, David

2010-05-01

We describe two men with marked symptoms following orgasm. In each case, the symptoms were consistent with those found in postorgasm illness syndrome (POIS). Further elucidation of the cause of the patients' symptoms. Both cases were investigated for causes of POIS with biochemical, hormonal, neurological, autonomic, cardiological, and psychological workup. Extensive investigation did not reveal a major organic cause for these patients' symptoms. Detailed history revealed likely differing etiologies in each case. In one case, the symptom picture suggested cytokine release, and, in fact, the patient subjectively improved by 80% on taking nonsteroidal anti-inflammatory drugs just prior to and for a day or two after orgasm. The other case appeared to have an ethnic/cultural etiology that was associated with the "Dhat" syndrome. The apparent differing etiologies/clinical associations of these cases highlight the need for careful history, examination, and investigations in patients presenting with POIS. We recommend that each case needs individual consideration and investigation, and treatment needs to be tailored to the likely cause. It seems likely that POIS represents a spectrum of syndromes of differing etiologies. Further research into the neurobiochemical sequelae of orgasm will be useful in understanding the pathological processes in these cases.

Descending necrotizing Mediastinitis caused by Kocuria rosea: a case report

PubMed Central

2013-01-01

Background Kocuria species are gram-positive, non-pathogenic commensals. However, in immunocompromised patients such as transplant recipients, cancer patients, or patients with chronic medical conditions, they can cause opportunistic infections. Case presentation We report the first case of descending necrotizing mediastinitis in a 58-year-old, relatively healthy woman caused by Kocuria rosea. Conclusion Descending necrotizing mediastinitis due to Kocuria rosea can be successfully treated with prompt surgical drainage combined with antimicrobial therapy. PMID:24112281

Peritonitis due to Curvularia inaequalis in an elderly patient undergoing peritoneal dialysis and a review of six cases of peritonitis associated with other Curvularia spp.

PubMed

Pimentel, Jason D; Mahadevan, Kumar; Woodgyer, Alan; Sigler, Lynne; Gibas, Connie; Harris, Owen C; Lupino, Michael; Athan, Eugene

2005-08-01

Fungal peritonitis due to Curvularia species in patients undergoing peritoneal dialysis is a very rare problem. We report a case of peritonitis caused by Curvularia inaequalis. This is the first report in the English literature of this species causing human infection. We also review the six previously reported cases of continuous ambulatory peritoneal dialysis peritonitis caused by other Curvularia species.

[Etiological analysis of 264 cases with chronic kidney disease stage 2 to 5 in children].

PubMed

Miao, Qianfan; Shen, Qian; Xu, Hong; Sun, Li; Tang, Xiaoshan; Fang, Xiaoyan; Liu, Haimei; Zhai, Yihui; Bi, Yunli; Wang, Xiang; Chen, Hong

2015-09-01

To study and summarize the etiology of children patients with chronic kidney disease (CKD) stage 2 to 5 seen in Children's Hospital of Fudan University from Jan. 2004 to Dec. 2013. By complying with the NKF-K/DOQI guidelines, we collected data of 264 cases of children patients with CKD stage 2-5 from Jan. 2004 to Dec. 2013 in the medical record system of Children's Hospital of Fudan University. And we retrospectively analyzed their age and CKD stage at first diagnosis, primary diseases, complications, etc. In the collected 264 cases, 52 cases (19.7%) were diagnosed at stage 2, 67 (25.4%) at stage 3, 52 (19.7%) at stage 4 and 93 (35.2%) at stage 5. For disease causes, 116 cases (43.9%) had congenital anomalies of the kidney and urinary tract (CAKUT), 61 cases (23.1%) had glomerular disease, 15 (5.7%) had hereditary kidney disease, 14 (5.3%) had other diseases and in 58 cases (22.0%) the causes of disease were unknown. In the group with age between 0 and 3.0 and 3.1 and 6.0 years, 57.1% (24 cases) and 60.0% (30 cases) had primary disease with CAKUT. In the group with age older than 10 years, 49.2% (30 cases) had primary disease with glomerular disease and 32.0% (32 cases) with unknown causes. The major cause of CKD stage 2-5 in children in our hospital during the last ten years was CAKUT (43.9%), followed by glomerular disease (23.1%). The primary diseases of CKD were significantly different between the 2 age groups. CAKUT was more common in infants and preschool children while for adolescents, glomerular disease was the major cause.

Foodborne Salmonella-caused outbreaks in Catalonia (Spain), 1990 to 2003.

PubMed

Domínguez, Angela; Torner, Nuria; Ruiz, Laura; Martínez, Ana; Bartolomé, Rosa; Sulleiro, Elena; Teixidó, Angel; Plasencia, Antoni

2007-01-01

In most developed countries, nontyphoid Salmonella is an important cause of sporadic cases and outbreaks of foodborne gastroenteritis. The aim of this study was to investigate the trend of foodborne Salmonella-caused outbreaks and number of cases, hospitalizations, and deaths and compare them with those caused by other infectious agents. The study was carried out in Catalonia, a region in northeastern Spain with a population of 6.5 million inhabitants, in 2002. All information on reported outbreaks of foodborne disease from 1990 to 2003 was reviewed. For each outbreak, the following variables were collected: year; setting (household, restaurant, school, hospital, nursing home, and others); number of cases, hospitalizations, and deaths; causal agent; and food vehicle involved. Of 1652 reported outbreaks, 1078 had a known causal agent. Among them, 871 (80.8%) were caused by Salmonella, with 14,695 cases, 1534 hospitalizations, and 4 deaths. The rate of hospitalization was higher in outbreaks due to Salmonella than in those caused by other infectious agents (rate ratio, 2.54; 95% confidence interval, 2.20 to 2.94). Forty-eight percent of Salmonella-caused outbreaks were eggborne, compared with 5.3% of those caused by other infectious agents (rate ratio, 1.40; 95% confidence interval, 1.33 to 1.48). The annual number of cases in household outbreaks of eggborne Salmonella rose over time (R2 = 0.82), but the number of outbreaks produced in other settings did not. Eggborne outbreaks caused by Salmonella in households are a major cause of disease, and increased preventive efforts are necessary, especially consumer education and awareness of the risk of eating food containing raw or slightly cooked eggs.

[Analysis of the causes of 117 infants with persistent hoarseness].

PubMed

Li, Li; Yang, Teng-fei; Xu, Zheng-min

2011-04-01

To explore the causes of persistent hoarseness in infants. One hundred and seventeen infants with persistent hoarseness treated in the department of otorhinolaryngology in Children's Hospital of Fudan University between June 2008 and July 2010 were retrospectively analyzed (all patients received antibiotic therapy for 2 weeks and the symptoms were not relieved after that). The patients were divided into three groups according to the age at first visit: 22 newborns, < 6 months old in 60 cases, < 12 months old in 35 cases. All patients had video laryngoscope examinations. Some of them received CT scan, cardiac ultrasonography and pathological examination in additional. The diagnosis was established by clinical history and imaging modalities, and the causes were analyzed subsequently. Among the 117 patients, 45 cases were vocal hypertrophy and hyperplasia (37.81%), 39 cases were vocal cord paralyses (32.78%), 7 cases were laryngeal hemangiomas (5.89%), 4 cases were laryngeal webs and cyst (3.36%), 2 cases were vocal cord polyps (1.68%), 2 cases were glottic incompetence (1.68%), 1 case was laryngeal papillomas(0.84%), 1 case was vocal code granulomas (0.84%), 1 case was glottis restricted by neck lymphangioma (0.84%); 4 cases were undetermined and 13 cases were no abnormalities. The percentage of patients with congenital heart diseases (19 cases) in vocal cord paralysis was 48.72%. The proportion of vocal cord paralysis in younger group was higher than that in elder one, their percentage were 50.00%, 36.67% and 17.14% respectively (χ(2) = 7.18, P < 0.05). A variety of causes can lead to persistent hoarseness in infants. The majority of them are vocal hypertrophy and hyperplasia, followed by vocal cord paralyze. Vocal cord paralysis is more common in younger infants than in elder ones, and the main causes are post-cardiac surgery and congenital heart disease.

Prosthetic joint infection caused by Pasteurella multocida: a case series and review of literature.

PubMed

Honnorat, Estelle; Seng, Piseth; Savini, Hélène; Pinelli, Pierre-Olivier; Simon, Fabrice; Stein, Andreas

2016-08-20

Pasteurella multocida is a well-recognized zoonotic agent following dog or cat bites or scratches. Nevertheless, prosthetic joint infection caused by P. multocida are rarely reported. We report here a series of six cases of prosthetic joint infection caused by P. multocida managed at a referral centre for the treatment of bone and joint infection in southern France. We also reviewed the 26 cases reported in literature. The mean age of our cases was 74 years [±8.2, range 63-85]. In majority of our cases (5 cases) were associated with knee prostheses and one case with a hip prosthesis. Most of cases occurred after cat or dog scratches or licks or contact. Diagnoses of prosthetic joint infection caused by P. multocida were made by positive cultures of surgical biopsies or needle aspiration. Mean time delay between prosthetic joint implantation and infection onset was 7.6 years (±5.12 years, range 2-17). Local inflammation, which occurred in all six cases, was the most frequent clinical symptom, followed by pain in five cases, fever and swollen joints in four cases, and a fistula with purulent discharge inside the wound in two cases. The mean time of antibiotic therapy was 8 months. Surgical treatment with prosthesis removal was performed in three cases. Six of our cases were in remission without apparent relapse at 3 years after end of treatment. Prosthetic joint infections caused by P. multocida usually occur after animal scratches or bites, but can occasionally occur after a short animal lick. These infections are usually resulting from a contiguous infection and localized in the knee. An early antibiotic therapy after surgical debridement could avoid prosthetic withdrawal, notably in elderly patients. Patients with prosthetic joints should be warned that animals are potential sources of serious infection and urgent medical advice should be sought if they are bitten or scratched.

Binasal hemianopia.

PubMed

Salinas-Garcia, R F; Smith, J L

1978-09-01

The visual fields of 100 patients referred for neuro-ophthalmologic examination were reviewed; eight cases had binasal visual field defects. Most clinicians have suspected an intracranial cause for such field defects since the classic report of Cushing and Walker in 1912. However, in this study, the cause for the binasal hemianopia was found to be ischemic optic neuropathy in two patients, and one case each of optic nerve drusen, glaucoma, congenital optic nerve pits, and retinitis pigmentosa sine pigmento. Thus 75% of the cases had an intraocular cause for the binasal hemianopia. Two patients had congenital hydrocephalus, and an intracranial basis was thus noted in 25% of these cases. The neurosurgeon should realize that the patient with binasal field defects is much more likely to have an ocular cause than an intracranial one for his problem.

Evaluation of workforce perceptions as a means to identify and mitigate the causes of musculoskeletal disorders.

DOT National Transportation Integrated Search

2010-01-01

An analysis of workers compensation data showed that five job classifications accounted for over 93% of all cases. This analysis also showed that 48% of the cases resulted in sprains and strains, and 70% of those cases were caused by over-exertion...

Comparison of the Victorian Audit of Surgical Mortality with coronial cause of death.

PubMed

Hansen, Dylan; Retegan, Claudia; Woodford, Noel; Vinluan, Jessele; Beiles, Charles B

2016-06-01

The Victorian Audit of Surgical Mortality (VASM) is designed to improve the level of patient care by educating surgeons of areas for improvement in patient management during a surgical admission. Coronial data obtained via the National Coronial Information System were used as an independent method to validate the cause of death as determined by the treating surgeon. The audit prospectively collected 4905 cases that underwent peer assessment and 842 (17%) received an in-depth second-line assessment of which 200 (24%) also underwent a coronial review. Using the coronial assessment as the reference standard, retrospective comparison of coronial diagnoses compared with the audit case outcomes was conducted to determine the overall accuracy of the stated cause of death. The degree of agreement was also analysed based on whether the patient received a full autopsy (internal examination) or an external examination only. The time taken to obtain the coronial and audit case closure was also analysed. Overall, 195 of the 200 cases had a cause of death identified by the coroner. In 82%, the cause of death reported to VASM by the treating surgeon matched the cause of death determined by the coroner. Concordance was not affected by the extent of post-mortem performed. Time taken to finalize cases was slightly shorter for the coronial process, but unclosed coronial findings resulted in the exclusion of 103 cases. The causes of death data in VASM are accurate when compared with the coronial data independent of whether the coronial investigation included a complete autopsy. © 2015 Royal Australasian College of Surgeons.

Septicemia caused by Vibrio parahemolyticus: a case report.

PubMed

Hsu, G J; Young, T; Peng, M Y; Chang, F Y; Chou, M Y

1993-11-01

Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.

[A text-book case of tropical facial elephantiasis].

PubMed

Dilu, N-J; Sokolo, R

2007-02-01

Tropical facial elephantiasis is a nosological entity which can arise from various underlying causes: von Recklinghausen neurofibromatosis, lymphatic and cutaneodermal filarioses, deep mycosis. We report an exceptional case of tropical facial elephantiasis caused by onchocercosis and entomophtoromycosis (rhinophycomycosis). The patient's facial morphology was noted "hippopotamus-face" or "dog-face". Onchocercosis and entomophtoromycosis are two diseases known to cause facial elephantiasis. We have not however been able to find any case report in the literature of co-morbidity nor any information on factors predictive of concomitant occurrence.

[Histopathological analysis of organs submitted by legal medicine experts in Baojii City: 358 forensic identification cases].

PubMed

Dong, Du-xuan; Shi, Ping-xia; Li, Yun-li; Tian, San-hu; Yang, Jia; Gao, Gang; Zheng, Yun; Jia, Le; Ju, Hong-ya; Sun, Lu-ying; Chen, Ni; Wang, Xiao-bao

2014-08-01

To analyze pathological characteristics of organs recovered during forensic autopsy submitted by legal medicine experts. From Baoji city, 358 cases of forensic autopsy specimens from a series of routine exams were collected. And histopathological diagnoses were reviewed. Majority of the 358 cases were young men. The major causes of death were trauma, sudden death and poisoning. The cause of death was determined with histology in 250 cases. No typical histological changes were noted in 101 cases. The tissue autolysis and decomposition were present in 7 cases. The major pathological diagnosis was cardiovascular disease, followed by diseases in respiratory, nervous, and digestive systems. Forensic autopsy with its professional characteristics, is different from regular autopsy. When diagnosing cause of death by histopathological examination, pathologists should collaborate with legal medicine experts to know the details of the cases, circumstances surrounding the death, and specific forensic pathological characteristics.

Pediatric ocular trauma caused by recreational drones: two case reports.

PubMed

Spitzer, Nicole; Singh, Jasleen K

2018-03-14

Drones are increasingly being used by children and adults recreationally and commercially. The propeller blades when spinning at high speeds may cause serious harm to the eye and orbital structures. We report 2 cases of injuries to the eye and orbital structures caused by drones. Copyright © 2018. Published by Elsevier Inc.

Debendox does not cause the Poland anomaly.

PubMed Central

David, T J

1982-01-01

The suggestion that Debendox may cause the Poland anomaly is refuted by a study of the antenatal drug exposure in 46 cases of the Poland anomaly and 32 cases of isolated absence of the pectoralis major. Debendox had been prescribed in one case of the Poland anomaly and in one case of isolated pectoralis absence, but in neither was the compound given during organogenesis. In none of the 78 cases could Debendox be causally implicated. PMID:7092316

Acute Sinusitis

MedlinePlus

... headache. Acute sinusitis is mostly caused by the common cold. Unless a bacterial infection develops, most cases resolve ... Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, ...

Neurological and developmental findings in children with cataracts.

PubMed

Pike, M G; Jan, J E; Wong, P K

1989-06-01

Ninety-seven children who were born between 1954 and 1986 and presented to the Visually Impaired Program of British Columbia's Children's Hospital, Vancouver, Canada, with a primary ophthalmologic diagnosis of cataracts, were assessed neurologically, ophthalmologically, audiologically, and developmentally. Causal factors included prenatal infection (35 cases), hereditary cataracts (22 cases), various syndromes and metabolic disorders (9 cases), trauma (1 case), and unknown (30 cases). Ninety children were diagnosed to have congenital cataracts while 7 acquired them. Findings indicated that prenatal infection continues to be a cause of infantile cataracts, despite rubella immunization; that prematurity is not, as has been stated in the past, a cause of infantile cataract; and that careful neurological, audiological, and developmental examination is vital in the assessment of likely causes of this condition.

[Survival analysis of 487 patients with kidney transplantation].

PubMed

Ianhez, L E; de Paula, F J; Campagnari, J C; Nahas, W C; Saldanha, L B; Arap, S; Sabbaga, E

1992-01-01

The causes of graft loss were analysed in a group of 487 kidney transplants, of which 252 (51.46%) concerned related donors, 139 (28.5%) cadaver donors and 96 (19.7%) non-related donors. A total of 74 kidneys were lost in the first 3 months after transplantation (15.19%). In 34 cases the loss was due to immunological factors (45.9%) in 21 cases (28.3%) to the death of the patients and in 19 cases (25.7%) to the technical causes. From 34 losses by immunological problems, 32 were rejections with humoral character (acute vascular rejection in 11 cases, late humoral rejection in 11 cases, immediate humoral rejection in 9 cases, ABO incompatibility in one case) and recurrence of original disease in one case. Acute cellular rejection was observed in only one patient. None of the patients died from immunological loss of the graft. The most frequent cause of death were sepsis (13 out of 21 patients) and the most common focus of infection was pulmonary (5 patients). It occurred most frequently with cadaveric donor, (10.07%). Death related to cardiovascular causes occurred in four patients, digestive in two and in consequence of arterial bleeding in two. Among the 23 losses by technical factors renal artery thrombosis was the most frequent (11 cases); renal rupture occurred in three cases, renal vein thrombosis in two rupture of arterial anastomosis in one and inviable kidney in another one. The technical loss was most frequent with cadaver donors (8.63%), followed by non-related donors (4.16%) and related donors (2.77%). Four patients died from causes directly related to technical factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Sudden infant death syndrome caused by poliomyelitis.

PubMed

Dunne, J W; Harper, C G; Hilton, J M

1984-07-01

Most seemingly well infants who die suddenly and unexpectedly have no adequate cause of death found on thorough postmortem examination. Respiratory and enteric viruses are often present, especially in the upper respiratory tract, but the infective process seems, of itself, insufficient to cause death. In the remainder of the cases, a variety of lesions will be discovered, including viral myocarditis, bronchiolitis, and sepsis. We report a case of sudden and unexpected death in a 5-week-old male infant due to acute anterior poliomyelitis. This case illustrates the importance of a thorough postmortem examination, including histologic studies of the brain stem and spinal cord in cases of sudden infant death syndrome.

Homicidal commotio cordis caused by domestic violence: A report of two cases.

PubMed

Mu, Jiao; Zhang, Ji; Liu, Liang; Dong, Hongmei

2016-04-01

Commotio cordis is a rare and fatal mechano-electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two cases of sudden death due to homicidal commotio cordis caused violence from an intimate partner. The two decedents were both young women. They suffered from physical abuse by their intimate partner and collapsed immediately after being punched in the precordium. Electrocardiograms were recorded at the hospital and showed ventricular fibrillation in one case. An autopsy was performed in each case, and no structural cardiac damage, evident lesions of other internal organs or underlying diseases were found. Combined with the negative toxicological analysis, it was concluded that the cause of death was commotio cordis due to a blunt force to the anterior chest. To the best of the authors' knowledge, there is no published report on commotio cordis caused by physical abuse from an intimate partner. The accurate diagnosis of the cause of death is emphasised, as it is important for judicial fairness. © The Author(s) 2015.

Distinct mortality profile in systemic sclerosis: a death certificate study in Rio de Janeiro, Brazil (2006-2015) using a multiple causes of death analysis.

PubMed

de Rezende, Rodrigo Poubel Vieira; Gismondi, Ronaldo Altenburg; Maleh, Haim Cesar; de Miranda Coelho, Elisa Mendes; Vieira, Carol Sartori; Rosa, Maria Luiza Garcia; Mocarzel, Luis Otavio

2017-12-16

The objective of this study was to assess the mortality profile related to SSc in the state of Rio de Janeiro, Brazil. We retrospectively examined all registered deaths in the region (2006-2015 period) in which the diagnosis of SSc was mentioned on any line of the death certificates (underlying cause of death [UCD], n = 223; non-UCD, n = 151). Besides the analysis of gender, age, and the causes of death, we also compared the mortality from UCDs between individuals whose death causes included SSc (cases) and those whose death causes did not include SSc (deceased controls). For the latter comparison, we used the mortality odds ratio to approximate the cause-specific standardized mortality ratio. We identified 1495 death causes among the 374 SSc cases. The mean age at death of the SSc cases (85% women) was significantly lower than that of the controls (n = 1,294,117) (58.7 vs. 65.5 years, respectively). The main death causes were circulatory system diseases, infections, and respiratory diseases (36%, 34%, and 21% of SSc cases, respectively). Compared to the deceased controls, there were proportionally more deaths among the SSc cases from pulmonary arterial hypertension, lung fibrosis, septicemia, gastrointestinal hemorrhage, other systemic connective tissue diseases, and heart failure (for death age < 50 years). We confirmed the high burden of cardiovascular, respiratory, and infectious causes in this predominantly non-Caucasian sample of SSc patients. Of interest, the percentage of infection-related deaths in our report was about three times higher than that in SSc studies with predominantly Caucasian populations.

Endometrioid endometrial carcinoma indirectly caused by pituitary prolactinoma: a case report.

PubMed

Nishino, Kimihiro; Niwa, Yuri; Mizutani, Teruyuki; Shimizu, Ken; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu

2013-01-01

We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.

[An analysis of the causes of refractory pharyngeal paraesthesia in 600 cases].

PubMed

Wang, Xingwei

2006-02-01

To investigate the causes of refractory pharyngeal paraesthesia. Besides routine examination of otolaryngology, 600 patients were tested by fiberoptic laryngoscopy, fiberoptic gastroesophagoscopy, nasal sinuses CT, styloid process X-ray as well as neck and thyroid gland B ultrasonography. Then, they were treated according to respective causes. Among 600 cases of refractory pharyngeal paraesthesia, 229 (38.2%) cases were diagnosed as gastroesophagitis, 113 (18.8%) nasal sinusitis, 57 (9.5%) climacteric syndromes, 40 (6.7%) chronic tonsillitis, 22 (3.7%) carcinophobia, 13 (2.2%) subacute thyroiditis or thyrophymas, 9 (1.5%) elongation of styloid process and 117 (19.5%) other causes. All patients were treated according to respective causes and total cure rate was 84.2% after 6 months. There are many causes of pharyngeal paraesthesia. We should pay attention to its relationship with gastroesophagitis and nasal sinusitis etc, especially, gastroesophageal reflux disease.

Endometrioid Endometrial Carcinoma Indirectly Caused by Pituitary Prolactinoma: A Case Report

PubMed Central

Nishino, Kimihiro; Niwa, Yuri; Mizutani, Teruyuki; Shimizu, Ken; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu

2013-01-01

We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential. PMID:23467393

Foodborne Botulism in the United States, 1990–2000

PubMed Central

Tucker, Nicole; Sulka, Alana; McLaughlin, Joseph; Maslanka, Susan

2004-01-01

Foodborne botulism, a potentially lethal neuroparalytic disease, is caused by ingesting preformed Clostridium botulinum neurotoxin. We reviewed surveillance data and reports from 1990 to 2000. Of 263 cases from 160 foodborne botulism events (episode of one or more related cases) in the United States, 103 (39%) cases and 58 events occurred in Alaska. Patients' median age was 48 years; 154 (59%) were female; the case-fatality rate was 4%. The median number of cases per event was 1 (range 1–17). Toxin type A caused 51% of all cases; toxin type E caused 90% of Alaska cases. A particular food was implicated in 126 (79%) events. In the lower 49 states, a noncommercial food item was implicated in 70 (91%) events, most commonly home-canned vegetables (44%). Two restaurant-associated outbreaks affected 25 persons. All Alaska cases were attributable to traditional Alaska Native foods. Botulism prevention efforts should be focused on those who preserve food at home, Alaska Natives, and restaurant workers. PMID:15498163

Drug induced liver injury with analysis of alternative causes as confounding variables.

PubMed

Teschke, Rolf; Danan, Gaby

2018-04-01

Drug-induced liver injury (DILI) is rare compared to the worldwide frequent acute or chronic liver diseases. Therefore, patients included in series of suspected DILI are at high risk of not having DILI, whereby alternative causes may confound the DILI diagnosis. The aim of this review is to evaluate published case series of DILI for alternative causes. Relevant studies were identified using a computerized search of the Medline database for publications from 1993 through 30 October 2017. We used the following terms: drug hepatotoxicity, drug induced liver injury, hepatotoxic drugs combined with diagnosis, causality assessment and alternative causes. Alternative causes as variables confounding the DILI diagnosis emerged in 22 published DILI case series, ranging from 4 to 47%. Among 13 335 cases of suspected DILI, alternative causes were found to be more likely in 4555 patients (34.2%), suggesting that the suspected DILI was probably not DILI. Biliary diseases such as biliary obstruction, cholangitis, choledocholithiasis, primary biliary cholangitis and primary sclerosing cholangitis were among the most missed diagnoses. Alternative causes included hepatitis B, C and E, cytomegalovirus, Epstein-Barr virus, ischemic hepatitis, cardiac hepatopathy, autoimmune hepatitis, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and alcoholic liver disease. In more than one-third of published global DILI case series, alternative causes as published in these reports confounded the DILI diagnosis. In the future, published DILI case series should include only patients with secured DILI diagnosis, preferentially established by prospective use of scored items provided by robust diagnostic algorithms such as the updated Roussel Uclaf causality assessment method. © 2018 The British Pharmacological Society.

Deaths among women of reproductive age: a forensic autopsy study.

PubMed

Padubidri, Jagadish Rao; Menezes, Ritesh G; Pant, Sadip; Shetty, Soumya B

2013-08-01

Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Unnatural deaths formed 93.6% of the cohort. The top three causes of death included burns, poisoning and hanging forming 69.5% of the cases. The manner of death was suicide in 45.4% cases, accident in 43.6% cases and homicide in 4.6% cases. The circumstances of death were related to alleged medical negligence in 2.4% cases. Death in 4% cases was natural mannered with a disease being the cause of death. Three-fourths of the victims were married. Married women formed 63.1% of the suicidal victims. Homicidal deaths were not reported among unmarried women. The preponderant method of suicide was by poisoning at 42.3% (63 cases), followed by hanging (34.9%), burns (11.4%) and drowning (9.4%). These four methods comprised 98% of the total suicidal deaths in this study cohort. Accidental deaths were predominantly caused by burns (62.2%) and road traffic accident (23.1%). Two-thirds of the homicidal deaths were due to assault caused by blunt-force trauma, ligature strangulation and sharp-force trauma. One-third of the homicidal victims died due to burns. With a clear understanding of the cause and manner of death, it may be possible to predict, and hopefully prevent, future cases of unnatural deaths in women of reproductive age who form a very important group of society. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Molecular epidemiology of human cutaneous leishmaniasis in Jericho and its vicinity in Palestine from 1994 to 2015.

PubMed

Al-Jawabreh, A; Dumaidi, K; Ereqat, S; Al-Jawabreh, H; Nasereddin, A; Azmi, K; Barghuthy, F; Sawalha, S; Salah, I; Abdeen, Z

2017-06-01

Cutaneous leishmaniases (CL) are vector-borne parasitic diseases endemic in many countries of the Middle East including Palestine. Between 1994 and 2015, 2160 clinically suspected human cases of CL from the Jericho District were examined. Stained skin tissue smears and aspirates were checked by microscopy and cultured for promastigotes, respectively. For leishmanial species identification, amplification products from a PCR-ITS1 followed by RFLP analysis using Hae III. Data were analyzed using Epi Info free-software. The overall infection rate was 41.4% (895/2160), 56.3% (504/895) of the cases were male, 43.7% (391/895) female, 60.5% (514/849) children under age 14, 41.3% (259/627) of the cases were caused by Leishmaniamajor and 57.3% (359/627) by Leishmaniatropica. The case numbers peaked in 1995, 2001, 2004, and 2012. Statistically-significant clusters of cases caused by L. major were restricted to the Jericho District; those caused by L. tropica were from the districts of Jericho, Bethlehem, Nablus and Tubas. CL is seasonal and trails the sand fly season. Distribution of cases was parabolic with fewest in July. The monthly total number of cases of CL and just those caused by L. major correlated significantly with temperature, rainfall, relative humidity, evaporation, wind speed and sunshine (P<0.05, r 2 =0.7-0.9 and P<0.05, r 2 =0.5-0.8, respectively). Cases caused by L. tropica, significantly, had a single lesion compared to cases caused by L. major (P=0.0001), which, significantly, had multiple lesions (P=0.0001). This and previous studies showed that CL is present in all Palestinian districts. The surveillance of CL has increased public awareness and molecular biological methodology for leishmanial species identification is an essential addition to classical diagnosis. The overall results are discussed, correlated to climatic and environmental changes and large-scale human activities. Copyright © 2016 Elsevier B.V. All rights reserved.

Typhoid ulcer causing life-threatening bleeding from Dieulafoy's lesion of the ileum in a seven-year-old child: a case report

PubMed Central

2010-01-01

Introduction We describe a case of rare complication of typhoid fever in a seven-year-old child and review the literature with regard to other rare causes of bleeding per rectum. Dieulafoy's lesion is an uncommon but important cause of recurrent gastrointestinal bleeding. Dieulafoy's lesion located extragastrically is rare. We report a case of typhoid ulcer with Dieulafoy's lesion of the ileum causing severe life-threatening bleeding and discuss the management of this extremely uncommon entity. Case presentation As a complication of typhoid fever, a seven-year-old Kurdish girl from Northern Iraq developed massive fresh bleeding per rectum. During colonoscopy and laparotomy, she was discovered to have multiple bleeding ulcers within the Dieulafoy's lesion in the terminal ileum and ileocecal region. Conclusion Although there is no practical way of predicting the occurrence of such rare complications, we emphasize in this case report the wide array of pathologies that can result from typhoid fever. PMID:20525295

The Causes of Churn in the Telecommunication Industry: A Single, Exploratory Case Study on Kenyan Carriers

ERIC Educational Resources Information Center

Halim, Joseph

2015-01-01

This single explorative case study investigated the causes of churn in the telecommunication industry in Kenya, narrowed down to include only the capital city of Nairobi. The question of this dissertation was split into three sub-questions. The first sub-question investigated the behavioral patterns of customers causing churn. The second…

Acute esophageal necrosis caused by alcohol abuse

PubMed Central

Endo, Tetsu; Sakamoto, Juichi; Sato, Ken; Takimoto, Miyako; Shimaya, Koji; Mikami, Tatsuya; Munakata, Akihiro; Shimoyama, Tadashi; Fukuda, Shinsaku

2005-01-01

Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture. PMID:16222758

Unexplained Deaths and Critical Illnesses of Suspected Infectious Cause, Taiwan, 2000–2005

PubMed Central

Wei, Kuo-Chen; Jiang, Donald Dah-Shyong; Chiu, Chan-Hsian; Chang, Shan-Chwen

2008-01-01

We report 5 years’ surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection. A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%). PMID:18826839

Post-mortem CT: Hounsfield unit profiles obtained in the lungs with respect to the cause of death assessment.

PubMed

Schober, Daniel; Schwendener, Nicole; Zech, Wolf-Dieter; Jackowski, Christian

2017-01-01

Segmentation of the lungs using post-mortem computed tomography (PMCT) data was so far not feasible due to post-mortem changes such as internal livores. Recently, an Osirix plug-in has been developed allowing automatically segmenting lungs also in PMCT data. The aim of this study was to investigate if the Hounsfield unit (HU) profiles obtained in PMCT data of the segmented lung tissue present with specific behaviour in relation to the cause of death. In 105 PMCT data sets of forensic cases, the entire lung volumes were segmented using the Mia Lite plug-in on Osirix. HU profiles of the lungs were generated and correlated to cause of death groups as assessed after forensic autopsy (cardiac death, fatal haemorrhage, craniocerebral injury, intoxication, drowning, hypothermia, hanging and suffocation). Especially cardiac death cases, intoxication cases, fatal haemorrhage cases and hypothermia cases showed very specific HU profiles. In drowning, the profiles showed two different behaviours representing wet and dry drowning. HU profiles rather varied in craniocerebral injury cases, hanging cases as well as in suffocation cases. HU profiles of the lungs segmented from PMCT data may support the cause of death diagnosis as they represent specific morphological changes in the lungs such as oedema, congestion or blood loss. Especially in cardiac death, intoxication, fatal haemorrhage, hypothermia and drowning cases, HU profiles may be very supportive for the forensic pathologist.

[Investigation of the causes of infant sudden unexpected death in children younger than one year in Bariloche city and surrounding areas].

PubMed

Gil, Leonardo; Herbón, Fabiana; Little, Andrés; López, Mónica; Martínez, Lucía; Cancilliere, María del Carmen

2008-12-01

In the beginning of 2002 there were an unusually high number of sudden unexpected infant deaths. A prospective study was started to determine the cause of unexpected deaths in infants younger than 1 year. Investigate the possible causes of sudden and unexpected death in infants of Bariloche and surrounding areas, using a protocol created for that purpose. All infants under 1 year of age who died unexpectedly between May 2002 and April 2007 were studied. A complete physical examination, a thorough interrogation to the parents and an autopsy were performed. According to the findings a definitive diagnosis was made on each case. During the study period 10 infants younger than 1 year died. One case was excluded because the autopsy could not be done. The mean age was 74 days, 6 were males. All died while sleeping and no sign of disease were noticed in any case. In 6 cases, the autopsy findings explained the death. In the 3 others no cause for the death was found. The implementation of this protocol allowed to find out the cause of death in 6 cases, that could not have been achieved without the autopsy.