Reverse phonation--physiologic and clinical aspects of this speech voice therapy modality. (49/189)

Reverse phonation is the voice production during inspiration, accomplished spontaneously in situations such as when a person sighs. AIM: to do a literature review, describing discoveries related to the use of the reverse phonation in the clinical practice, the anatomy and physiology of its production and its effects in vocal treatments; and moreover, indications and problems of the technique for speech disorders treatment and voice enhancement. RESULTS: there were reports of significant changes in vocal treatment during with the use of reverse phonation: ventricular distention, ventricular folds separation, increase in the fundamental frequency, mucous wave inverse movement; and it also facilitates the dynamic study of the larynx when associated with endoscopy, making it possible to have a better definition of lesion localization in vocal folds superficial lamina propria layers. CONCLUSION: There are few studies describing larynx behavior during reverse phonation and, for this technique to be used in a more precise and objective way, more studies are necessary in order to prove its effectiveness in practical matters.  (+info)

Preliminary considerations on the application of the voice handicap index to paediatric dysphonia. (50/189)

Dysphonia is a common paediatric condition. Adult voices are usually evaluated using a set of minimal basic measurements including: endoscopic examination, aerodynamics, perception, acoustics, and self-assessment by the patient. The Voice Handicap Index is the most widely used self-assessment tool, but its use in the paediatric setting has never been reported. Aim of this study was to report Voice Handicap Index ratings in a group of dysphonic children, multi-modally assessed before and after voice therapy. The study involved 28 children (16 female, 12 male, mean age 10.9 years (range 6-12)) presenting chronic hoarseness due to vocal fold nodules (18 cases), unilateral localised oedema (6 cases) or recurrent laryngeal paralysis (4 cases). All received voice therapy for 5-6 months, and underwent voice assessments based on video-endoscopy ratings (size of nodule/ oedema or glottic closure in the case of recurrent laryngeal paralysis), maximum phonation time, GIRBAS scale, spectrograms and a perturbation analysis. All patients also completed the Voice Handicap Index. Aerodynamic, acoustic, perceptual and self-assessment data, before and after voice therapy, were compared using Wilcoxon's test and Student's t test. Correlations between the Voice Handicap Index domains were measured by means of Pearson's correlation coefficient. Post-treatment measurements showed that the nodules/oedema had decreased in size in 18 children following therapy, and two subjects with recurrent laryngeal paralysis showed improved glottic closure. Mean maximum phonation time increased slightly, but the difference was not significant. There was a general reduction in perceptual severity, but this was only significant for parameters G, B and A. Spectrographic analysis showed no significant improvement and, although the mean perturbation analysis values improved, only the difference in jitter values was significant (p = 0.016). Voice Handicap Index was applicable in all cases, and showed a clear and significant improvement (p = 0.0006). The correlations between the three Voice Handicap Index factors were close; no correlation was found between the functional domain and the physical and emotional domains. The Voice Handicap Index is a useful tool in children with dysphonia, but an adapted version validated for paediatric patients is essential.  (+info)

Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study. (51/189)

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.  (+info)

Subjective voice assessment after thyroid surgery: a prospective study of 395 patients. (52/189)

BACKGROUND: Total thyroidectomy has become a routine surgical procedure. However, postoperative complications are not rare and can lead to voice disorders. AIM: To study voice quality after total thyroidectomy. SETTINGS AND DESIGN: Prospective study over a period of 5 years in 395 surgical patients undergoing total thyroidectomy. MATERIALS AND METHODS: The voice quality of patients was based on systematic preoperative and postoperative laryngeal and voice examination. Voice assessment was performed by means of a voice quality questionnaire and recovery time within 12 months postoperatively. Patients who had inferior laryngeal nerve palsy were excluded from the study. RESULTS: Preoperative subjective voice disorders were found in 21% of patients and 49% had voice impairment after surgery. The recovery time was less than 1 month for one-half of the patients with impaired voices and 85% of the patients had recovered their voice after 5 months. At the 1-year postoperative examination, the permanent impaired voice rate was 1.26%. CONCLUSION: Voice impairment is common after thyroidectomy but usually transient and less than 20% persist at 6 months. Patients must be informed about the risk of voice impairment after thyroid surgery. An objective voice assessment is desirable to monitor the presence and progress of voice disorders.  (+info)

Airway involvement and obstruction from granulomas in African-American patients with sarcoidosis. (53/189)

Sarcoidosis is a global disorder whose breadth of organ involvement can often be underappreciated. Head and neck manifestations include involvement of the skin, salivary glands, sinonasal cavity, and larynx. Of cases of upper airway sarcoidosis, laryngeal sarcoidosis and airway compromise portend a greater risk of fatal outcomes. People representing all racial groups have been diagnosed with sarcoidosis. Although many studies have evaluated incidence and manifestations of sarcoidosis in multiple ethnicities, few studies have explored racial predilection for laryngeal involvement. However, assertions that disease severity and poor outcome may be tied to the African diaspora as well as related socio-economic and cultural realities have been recognized. We present our case series of six African-American patients diagnosed with sarcoidosis and presented with complaints of voice change and increased shortness of breath. Four of them required expeditious, surgical management of the airway. Two had limited supraglottic involvement and have avoided tracheotomy with aggressive and timely pharmacotherapeutic intervention and close clinical surveillance. Early recognition of laryngeal manifestations of sarcoidosis and airway compromise is essential to provide patients with conservative management without the need for aggressive surgical intervention.  (+info)

Is dysphonia permanent or temporary after anterior cervical approach? (54/189)

The rate, causes and prognosis of dysphonia after anterior cervical approach (ACA) were investigated in our clinical series. During a 10-year interval, 235 consecutive patients with cervical disc disease underwent surgical treatment using anterior approach. Retrospective chart reviews showed recurrent laryngeal nerve (RLN) injury in 3 (1.27%) patients. All three patients were men and only one patient had multilevel surgery. These patients had RLN injury after virgin surgery. Laryngoscopic examination demonstrated unilateral vocal cord paralysis in all patients who had postoperative dysphonia. No permanent dysphonia was observed in our series and patients recovered after a mean of 2 months (range 1-3 months) duration. Dysphonia after ACA was a rare complication in our clinical series. Pressure on RLN or retraction may result in temporary dysphonia.  (+info)

Morphological aspect of voice disturbances of aged persons coexisting hypopharynx cancer. (55/189)

The voice quality in prebysphonia is conditioned by morphological changes in the vocal folds mucosa. The studies including light microscopy and transmission electron microscopy (TEM) revealed changes within the basal membrane epithelium and the stroma of the vocal folds mucosa. Age-related changes in thickness of the epithelium and direction of the basal membrane, increased number of collagenous fibres (C) and fibroblasts and chronic inflammatory process in the stroma were found. Vacuolated and keratinised epithelial cells, enlarged extracellular spaces and numerous blood vessels confirm the edematous form of prebysphonia. Thinned epithelium with signs of hyalinization, inflammatory infiltrations in the stroma with numerous collagenous fibres and small number of blood vessels indicate atrophy of the vocal folds mucosa. Edematous and atrophic changes in the vocal folds mucosa are most frequently reported form of prebysphonia.  (+info)

Voice quality after endoscopic laser surgery and radiotherapy for early glottic cancer: objective measurements emphasizing the Voice Handicap Index. (56/189)

We analyzed the functional outcome and self-evaluation of the voice of patients with T1 glottic carcinoma treated with endoscopic laser surgery and radiotherapy. We performed an objective voice evaluation, as well as a physical, emotional and functional well being assessment of 19 patients treated with laser surgery and 18 patients treated with radiotherapy. Voice quality is affected both by surgery and radiotherapy. Voice parameters only show differences in the maximum phonation time between both treatments. Results in the Voice Handicap Index show that radiotherapy has less effect on patient voice quality perception. There is a reduced impact on the patient's perception of voice quality after radiotherapy, despite there being no significant differences in vocal quality between radiotherapy and laser cordectomy.  (+info)