Dysphonic Patients Research Articles

Long term phonatory function following acoustic neuroma surgery: a cohort study

Background: Acoustic neuroma (AN) is a well-recognized cause of neurological morbidity, peripheral facial paralysis being one of the most prevalent. Phonatory dysfunction in the late post-operative term has not been properly addressed so far.Objective: The objective of this study is to describe the outcomes of phonatory function on the long-term follow-up of AN surgery and identify its prognostic factors.Material and methods: This cohort study included patients submitted to AN surgery from 1999 to 2014, with a mean follow up of 6.4 ± 4.5 years. To evaluate the phonatory function, we performed a combination of noninvasive acoustic and aerodynamic measurements including vocal intensity and stability, maximum declination rate of the glottal airflow (MDR) and transglottal pressure scale (TP).Results: 101 patients were studied. 25 (24.7%) presented a deficit in phonatory function. Women comprised 56% and the mean age was 42.4 ± 13.8 years (range19–80). 100% presented reduced expiratory airflow capacity with excessive manifestation of the laryngeal musculature (TP > 1,23s ;MDR/z/<MDR/s/). Dysphonic patients presented more neurofibromatosis II (NF II) (40% vs 12.7% p = .002), large tumors (3.8 ± 1.1 p = .002) and needed less surgeries (≥256.7% vs 74.6%, p = .0073) in univariate analysis. NFII and tumor size were predictive of dysphonia according to multivariate analysis (NFII-OR 5.57, p = .006; tumor size-each 1 cm, OR1.68, p = .062).Conclusion: The late postoperative prevalence of dysphonia corresponded to 24.7%. Dysphonia could be secondary to the hyperfunction of laryngeal musculature explained by the reduced expiratory airflow found in our patients. Tumor size and NF II were predictors for the occurrence of dysphonia in the present study.HighlightsThe comprise of phonation function can be a morbidity of AN surgeryNF II and tumor size were predictive of dysphonia on late postoperative periodData of hypofunction secondary to the phonatory hyperfunction were unanimous in the dysphonic patients.The early diagnosis and treatment of phonation function could avoid alterations of pneumophono-articulatory coordination and projection deficiency.

A panel of jitter/shimmer may identify functional dysphonia at risk of failure after speech therapy.

There are no reliable outcome predictors for functional dysphonia (FD) patients. To investigate if any clinical or phoniatric characteristics could identify FD patients at risk of negative outcome after speech therapy. We retrospectively reviewed the results of 78 FD patients treated with the proprioceptive elastic method. Before and one-month after therapy, patients underwent endoscopy, acoustic analysis with Multi-Dimensional Voice Program, and Voice Handicap Index-10 questionnaire (VHI-10). Negative outcome was the persistence of VHI-10≥13. 26 FD patients had negative outcome (i.e. VHI-10≥13) after speech therapy. At univariate analysis, clinical variables (i.e. sex, age, comorbidities, dysphonia duration, and professional voice use) were not associated with the outcome. Elevated Jitter% (Jitt; p=0.03), Shimmer% (Shim; statistical trend, p=0.06), and Noise to Harmonics Ratio (statistical trend, p=0.06) were found in patients with poor results. At multivariate analysis, higher Jitt was an independent negative prognostic factor (p=0.02), while a statically trend was identified for Shim (p=0.06). A panel of Jitt >1.5 and Shim >5.1 showed an acceptable discriminatory power (AUC [ROC]=0.76) according to Hosmer and Lemeshow scale. A panel of two acoustic analysis parameters could help in identifying FD patients at risk of speech therapy failure. Further studies in these patients are needed to evaluate the most efficient treatment protocol.

A Study of Local Administration of Autologous Mesenchymal Stromal Cells in Dysphonic Patients With Vocal Fold Scarring

A Study of Local Administration of Autologous Mesenchymal Stromal Cells in Dysphonic Patients With Vocal Fold Scarring

The Voice-Related Quality of Life (V-RQOL) Instrument: Cross-Cultural Translation and Test of Validity and Reliability of the Danish Version

To translate the voice-related quality of life (V-RQOL) questionnaire into Danish and to test the validity and reliability of this Danish version of the V-RQOL instrument. The translation process was done using forward and backward translation followed by pretesting interviews, performed on 21 participants. The final Danish version was then tested for validity and reliability on 80 cases with voice disorders and 21 controls without voice disorders. The Danish version proved to be valid and reliable. Validity was confirmed by convergent and discriminant validity, known-groups validity, clinical validity (Spearman correlation coefficient 0.64), confirmatory factor analysis, and Rasch analysis. The instrument showed no ceiling effects, but all items and the Social-Emotional domain showed substantial floor effects. The item-total correlations were all high (0.58-0.82) and none of the interitem correlations were low. Reliability was confirmed with regard to internal reliability (Cronbach's alpha 0.92) and test-retest reliability (interclass correlation coefficient 0.89). Our study shows that the Danish translation of the V-RQOL questionnaire is a valid and reliable instrument suitable for the assessment of the dysphonic patient. The high floor effects, however, indicate that minor differences in voice problems between patients may not be captured in the lower end of the scale with regard to the individual item and the Social-Emotional domain.

The Reflux Symptom Index and Symptom Overlap in Dysphonic Patients

The Reflux Symptom Index (RSI) is a validated quality-of-life instrument that quantifies symptoms associated with laryngopharyngeal reflux (LPR). Many dysphonic patients are managed empirically for reflux. In this study, we examine responses to the RSI in patients with dysphonia attributable to a variety of pathologies. Retrospective cohort study. This is an institutional review board-approved study. All patients presented to a tertiary care voice center January 2011 to June 2016 with the chief complaint of dysphonia. Patients were analyzed by 1) diagnosis and 2) treatment modality: surgery, medicine, or voice therapy (VT). Data collected included pre- and postintervention RSI and Voice Handicap Index, demographic, and clinical information. Statistical analysis was performed using SPSS. Five hundred forty-six dysphonic patients were included. One hundred forty required surgery, 155 were treated with VT alone, and 251 were medically managed (MM). Prior to therapy, 63.4% of surgery patients, 62.5% of VT patients, and 74.6% of MM patients had an abnormal RSI with a score greater than 13. The most common diagnosis for each group was vocal cord paresis/paralysis (surgery), vocal fold atrophy (VT), and LPR (MM). There was a statistically significant improvement in RSI after treatment for each group. In patients with dysphonia, pretreatment RSI scores were elevated for a variety of laryngeal pathologies. Scores often improved with directed treatment, regardless of etiology. This highlights the symptom overlap between reflux and nonreflux causes of dysphonia, and the importance of a comprehensive workup for patients with voice complaints. 4 Laryngoscope, 130:2631-2636, 2020.

Cross-Cultural Adaptation, Validation, and Cutoff Values of the Chilean Version of the Voice Symptom Scale: VoiSS

To evaluate psychometric properties of the Voice Symptom Scale (VoiSS) - Chilean Spanish version. Cross-sectional, nonrandomized, prospective study with controls. The validation of the Chilean Spanish VoiSS version met the criteria of the Scientific Advisory Committee of the Medical Outcomes Trust: Cultural and linguistic adaptation, by translation into Chilean Spanish and back-translation. Validity, employed external criteria (excellent, very good, fair, and poor). Reliability was made by test-retest and responsiveness to treatment, the initial voice and after vocal treatment of 12 dysphonic patients were analyzed, by GRBAS. The Chilean Spanish adapted VoiSS protocol, Escala de Síntomas Vocales (ESV-CL), was applied to 205 subjects, 89 with dysphonia and 116 of them vocally healthy. A cutoff value for the total score was determined by the efficiency characteristics. The ESV-CL demonstrates high validity, reliability, and responsiveness. A cutoff score of 35.5 was determined by using the high sensitivity (90%) and specificity (75%) found in subjects with dysphonia compared to vocally healthy subjects. The results of the Chilean version of VoiSS, renamed the ESV-CL, revealed it to be culturally equivalent to the original version, and to be a valid, reliable, and responsive instrument for voice symptoms in the Chilean population. Chilean speech-language pathologists can benefit from this adapted protocol in clinical research and voice management.

Impact of an Upper Respiratory Tract Infection on Botulinum Toxin Efficacy in Spasmodic Dysphonia Patients.

To determine whether the presence of a concomitant upper respiratory tract infection (URI) impacts upon Botulinum toxin (BoNT) efficacy in spasmodic dysphonia (SD) patients. Case series and literature review. All SD patients with a concurrent URI, presenting for BoNT therapy at a clinical research center from November 2016 to December 2017 were included. A total of 12 patients were identified. Patients were followed for at least two BoNT treatment cycles (approximately 6 months). The primary outcome measure was efficacy of the initial BoNT injection and the secondary outcome measure was the efficacy of the subsequent BoNT injection. All subjects had adductor type SD (ADSD). There were 10 females and two males with a median age of 55 years (±19.5). All patients were well established on a consistent BoNT treatment regime, with an average administered dose of 1.0 unit (range 0.2-1.80 units). Bilateral injections were administered to 10 patients. Regarding the primary outcome measure, five failed to have any response to BoNT (41.7%), four had a partial response (33.3%), and three had a positive response to treatment (25.0%). When patients had their follow-up injection in the absence of URI symptoms, 11 patients had a positive response to treatment (91.7%). While the interplay between illness and BoNT efficacy is yet to be elucidated, we report that some patients are affected. We recommend that SD patients presenting for BoNT administration with a concomitant URI, should be counseled that their treatment might have decreased effect. 4 Laryngoscope, 130:1746-1749, 2020.

Imitating dysphonic voice: a suitable technique to create speech stimuli for spoken language processing tasks?

Purpose: The aim of this study was to assess the suitability of imitated dysphonic voice samples for their application in listening tasks investigating the impact of speakers’ voice quality on spoken language processing. Methods: A female voice expert recorded speech samples (sustained vowels and connected speech) in her normal voice and while imitating a dysphonic voice. Voice characteristics, authenticity, and consistency of the two voice qualities were evaluated by means of acoustic measurements (Acoustic Voice Quality Index [AVQI], jitter, shimmer, harmonics-to-noise ratio [HNR]) and perceptual evaluation (GRBAS scale, consistency, and authenticity rated by five speech-language pathologists). Results: Based on acoustic and perceptual assessments, the degree of voice impairment for the imitated dysphonic voice was found to be moderate to severe. Roughness and asthenia were the predominant perceptual features. The perceptual rating indicated a high consistency and acceptable authenticity of the imitated dysphonic voice. Conclusions: Results suggest that an imitation of dysphonic voice quality may resemble the voice characteristics typically found in dysphonic patients. Implications: The voice samples validated here shall be applied in future listening tasks and may promote our understanding of how dysphonic speech is processed.

Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?

Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?

The health utility of mild and severe dysphonia.

The impact of disease states can be measured using health state utilities, which are values that reflect economic preferences for health outcomes. Utilities for dysphonia have not been studied using direct methods. The objective of this project was to establish the baseline health utilities of mild and severe dysphonia from a societal perspective. Direct utility elicitation survey. Four health states (monocular blindness, binocular blindness, mild dysphonia, and severe dysphonia) were evaluated by a convenience sample of adults recruited from the general public with three computer-aided estimation techniques (visual analog scale [VAS], standard gamble [SG], and time trade-off [TTO]). Standardized descriptions and voice recordings from multiple dysphonic patients were employed. Perfect health was defined as a utility of 1, with death 0. Analysis of variance with post hoc pairwise comparison was used to calculate significant differences between health states. Three hundred participants were surveyed, and 225 (75.0%) responses met quality thresholds. Severe dysphonia (VAS = 48.3, SG = 0.810, TTO = 0.798) was valued significantly worse than monocular blindness (VAS = 56.2, SG = 0.834, TTO = 0.839) on the VAS (P < .001) and equivalent on SG and TTO; it was preferred over binocular blindness (VAS = 25.7, SG = 0.631, TTO = 0.622; P < .001) with all methods. Mild dysphonia evaluated favorably with all methods to the other health states (VAS = 78.5, SG = 0.902, TTO = 0.908; P < .001). Voice disorders may have a measurable impact on utility, with severe dysphonia valued equivalently to monocular blindness. Mild dysphonia has a utility decrement from perfect health. These estimates are critical for quality-of-life assessment and could be used to assess cost-effectiveness of treatments for voice disorders. NA Laryngoscope, 130:1256-1262, 2020.

Is Computerized Dynamic Posturography Analysis in Dysphonic Patients Different after Vocal Rehabilitation Treatment? A Longitudinal Study

Is Computerized Dynamic Posturography Analysis in Dysphonic Patients Different after Vocal Rehabilitation Treatment? A Longitudinal Study

Injection laryngoplasty as adjunct treatment method for muscle tension dysphonia: Preliminary findings.

ObjectivesThis study examined the effectiveness of injection laryngoplasty (IL) in muscle tension dysphonia (MTD) patients who did not fully respond to voice therapy. It was hypothesized that IL would improve voice quality and voice‐related quality of life measures in MTD.MethodsA retrospective review was conducted on 37 patients with a primary diagnosis of MTD who underwent IL following a suboptimal response to voice therapy (mean age = 43.0 years; standard deviation [SD] = 13.4; range = 23 to 71). Outcome measures included laryngoscopic signs of supraglottic constriction, Voice Handicap Index‐10 (VHI‐10) scores, maximal phonation time, vowel fundamental frequency (F0), standard deviation of F0 (F0SD), harmonics‐to‐noise ratio (HNR), and smoothed cepstral peak prominence. These were compared between baseline and within 3 months following the IL procedure.ResultsThere was significant decrease in supraglottic constriction. Mean (SD) of VHI‐10 scores decreased from 25.4 (5.7) at baseline to 15.3 (9.3) following IL. This improvement in VHI‐10 was observed in patients with and without baseline glottal insufficiency (GI). Mean (SD) of HNR (decibels) increased from 21.1 (5.4) at baseline to 22.8 (4.3) after IL. Only patients with GI demonstrated a significant improvement in HNR from baseline to post‐IL. No statistically significant differences in other acoustic measures were observed.ConclusionsIL resulted in positive changes in voice‐related quality of life in MTD patients with and without GI. Acoustically, only those with GI demonstrated an increase in HNR following IL. Further studies are needed to examine the effects of IL in MTD.Level of Evidence4 Laryngoscope, 130:980–985, 2020

Assessment of Patient Outcomes After Adjuvant Vocal Fold Steroid Injection for Fibrosis After Microlaryngeal Surgery

Microlaryngeal surgery (MLS) is one of the most common procedures in laryngology; however, in cases of postoperative fibrosis, few remedial options are available. To investigate the outcomes of vocal fold steroid injection (VFSI) as an adjuvant treatment for fibrosis after MLS. Case series of 228 consecutive patients who underwent MLS for benign vocal lesions between January 2014 and December 2016 at a tertiary medical center. Adjuvant VFSI was performed in 25 patients (11%) with postoperative fibrosis, defined as severely decreased or absent mucosal wave on videolaryngostroboscopy (VLS) lasting for longer than 1 month postoperatively. Data were analyzed from July 1, 2018 to April 30, 2019. All adjuvant VFSIs were performed in the office under local anesthesia and were repeated monthly if the status of the mucosal wave did not return to normal or mildly decreased on the follow-up VLS. The outcome parameters, namely, the 10-item Voice Handicap Index (VHI-10), smoothed cepstral peak prominence (CPP) of recorded voice samples, and mucosal wave status on VLS, were measured before and after MLS and after adjuvant VFSI. In this case series of 228 patients (72 men and 156 women; mean [SD] age, 42.8 [12.3] years), 25 had a decreased or absent mucosal wave after MLS, indicating postoperative fibrosis. Of these patients, 22 presented with deep-seated lesions that were removed using a microflap approach. After 1 course of adjuvant VFSI in 17 patients and 2 serial monthly injections in 8 patients, VFSI was associated with improved VHI-10 scores (mean, 24.4 points preoperatively, 22.1 points postoperatively, and 12.9 points after VFSI) that were comparable to the scores of the other 203 patients without vocal fold fibrosis after MLS (mean, 24.8 points preoperatively, 11.7 points postoperatively). Adjuvant VFSI was also associated with improved CPP (mean, 4.04 preoperatively, 4.23 postoperatively, and 5.11 after VFSI) that was comparable to the CPP of the other patients without postoperative fibrosis (mean, 4.33 preoperatively and 5.15 postoperatively). Overall, 19 (76%) of 25 patients with vocal fold fibrosis after MLS had normal (n = 11) or mildly decreased (n = 8) mucosal wave after adjuvant VFSI. Adjuvant VFSI appeared to be associated with improvements in mucosal wave, voice quality, and subjective perception of dysphonia in patients with fibrosis after MLS, with outcomes comparable to those of the other patients without fibrosis. Adjuvant VFSI may be considered a rescue technique, reducing the rate of fibrosis after MLS from 11% to 3%.

Evaluation of Postural Changes Using Dynamic Posturography after Speech Rehabilitation in Patients with Voice Disorders: A Longitudinal Study

Background: The association between voice and body posture is consensual across the scientific literature and seems to be established both ways. Any changes in normal posture can influence the mechanisms of vocal production; on the other hand, vocal rehabilitation can influence posture. Objectives: This study aimed to evaluate the postural pattern in subjects with organic voice disorders before and after speech rehabilitation, using computerised dynamic posturography (CDP). Methods: In this prospective cohort study, 21 patients affected by dysphonia caused by benign vocal fold lesions, never treated with speech therapy/vocal training, were submitted to a posturographic analysis using CDP before and after vocal rehabilitation/therapy. Each patient underwent an accurate voice and ear, nose, and throat (ENT) anamnesis, a general ENT examination, a rigid and flexible laryngoscopy, a videolaryngostroboscopy, an acoustic voice analysis including aerodynamic evaluation, and a perceptual evaluation of voice using the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and the Voice Handicap Index (VHI) questionnaire, before and after vocal therapy. Fifteen healthy age- and sex-matched volunteers were also submitted to a posturographic analysis on the day of recruitment and 4 weeks later. Results: All patients showed an improvement in voice quality after vocal training. The VHI decreased in all subjects, and the GRBAS scale showed a decrease in all parameters in each vowel (/a/, /i/, /e/) and in spontaneous speech (p < 0.001 for all). Posturographic results showed an improvement in equilibrium score, in conditions 2–6 and composite score. Strategic analysis results showed an improvement in conditions 1–6. Conclusions: The posturographic analysis showed a significant difference in the visual, vestibular, and proprioceptive component of posture after voice therapy. These results showed that dysphonic patients changed their postural patterns after an effective voice treatment, with an improvement in postural performance. It seems like modifications of breathing pattern and voice production techniques led to objective and measurable postural changes.

The Effect of Voice Therapy Applying Self-Regulation Concepts on Dysphonia Patients

The Effect of Voice Therapy Applying Self-Regulation Concepts on Dysphonia Patients

Application of High-Frequency Transcutaneous Electrical Nerve Stimulation in Muscle Tension Dysphonia Patients With the Pain Complaint: The Immediate Effect

The aim of the present study was to investigate the immediate effect of the application of high-frequency Transcutaneous electrical nerve stimulation (TENS) in muscle tension dysphonia (MTD) patients with the pain complaint. Thirty patients with MTD, 10 men and 20 women with a mean age of 36.40 ± 5.76 years, participated in the study. The patients were randomized into two groups: (1) Treatment group (TENS) (10 women and 5 men) and (2) Sham TENS group (10 women and 5 men). The treatment group (TENS) received a unique 20-minute session of high-frequency TENS. The sham TENS group was treated in the same condition as the treatment group and received a unique 20-minute session of high-frequency TENS, but no stimulation was given. Auditory-perceptual assessments, acoustic voice analysis, vocal tract discomfort (VTD), and musculoskeletal pain were used to compare the patients pre- and post-treatment. There was a significant improvement in the asthenia parameter of auditory-perceptual assessment in the TENS group. This improvement in asthenia was significant when comparing the TENS group with the sham TENS group. These differences in the asthenia were not significant after using Holm-Bonferroni correction. A comparison of the VTD before and after the TENS application showed there was a significant reduction in the severity of the symptoms (burning, tight, dry, pain, tickling, sore, irritable, and lump in the throat). When comparing the TENS group with the sham TENS group, improvements in burn, tight, dry, pain, and irritable items of VTD were observed. However, after applying the Holm-Bonferroni correction, only reductions in dry and pain items remain significantly different between the groups. After the TENS application, the pain intensity was significantly reduced in the anterior and posterior neck, larynx, submandibular, masseter, temporal region, and upper back. After applying the Holm-Bonferroni correction, pain intensity reduction was significant in the anterior neck and larynx. When comparing the TENS group with the sham TENS group, pain intensity was reduced significantly in the larynx of the TENS group. This difference between the two groups was not significant after using Holm-Bonferroni correction. The pain and VTD assessments in the present study were performed using valid and reliable self-reported scales (NMSQ-E and VTD). High-frequency TENS can be used in the voice treatment program of patients with MTD. MTD patients with pain complaint reported that their vocal tract discomfort and pain were decreased following the high-frequency TENS. Notably, these positive effects were obtained after a single session of high-frequency TENS application.

Top-down alteration of functional connectivity within the sensorimotor network in focal dystonia.

To determine the directionality of regional interactions and influences of one region on another within the functionally abnormal sensorimotor network in isolated focal dystonia. A total of 40 patients with spasmodic dysphonia with and without dystonic tremor of voice and 35 healthy controls participated in the study. Independent component analysis (ICA) of resting-state fMRI was used to identify 4 abnormally coupled brain regions within the functional sensorimotor network in all patients compared to controls. Follow-up spectral dynamic causal modeling (DCM) estimated regional effective connectivity between patients and controls and between patients with spasmodic dysphonia with and without dystonic tremor of voice to expand the understanding of symptomatologic variability associated with this disorder. ICA found abnormally reduced functional connectivity of the left inferior parietal cortex, putamen, and bilateral premotor cortex in all patients compared to controls, pointing to a largely overlapping pathophysiology of focal dystonia and dystonic tremor. DCM determined that the disruption of the sensorimotor network was both top-down, involving hyperexcitable parieto-putaminal influence, and interhemispheric, involving right-to-left hyperexcitable premotor coupling in all patients compared to controls. These regional alterations were associated with their abnormal self-inhibitory function when comparing patients with spasmodic dysphonia patients with and without dystonic tremor of voice. Abnormal hyperexcitability of premotor-parietal-putaminal circuitry may be explained by altered information transfer between these regions due to underlying deficient connectivity. Identification of brain regions involved in processing of sensorimotor information in preparation for movement execution suggests that complex network disruption is staged well before the dystonic behavior is produced by the primary motor cortex.

Geriatric Dysphonia: Characteristics of Diagnoses in Age-Based Cohorts in a Tertiary Voice Clinic.

An aging population has increased focus on geriatric otolaryngology. Those ≥65 years old are not a uniform population, however, and recent gerontology literature recognizes important physiologic differences between the young-old (ages 65-74 years), middle-old (75-84), and old-old (≥85). This study evaluates differences within these groups among dysphonia patients ≥65 years relative to diagnosis and voice-related quality of life (V-RQOL). Chart review of all new patients ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017 identified chief complaint, diagnosis, and self-reported voice handicap. Etiology of dysphonia diagnoses were classified. Diagnostic categories and V-RQOL were evaluated as functions of patient age and gender. Of 839 new patients ≥65 years, 463 (55.2%) reported chief complaint of dysphonia, with the most common etiologies being vocal fold immobility (28.3%) and atrophy (21.6%). Younger cohorts were more likely to present with benign vocal fold lesion and vocal fold immobility, while older cohorts were more likely to present with atrophy ( P = .016). The odds of having a diagnosis of vocal fold atrophy increased 7% with each year of life (odds ratio = 1.07; 95% CI, 1.03-1.11). V-RQOL scores were similar across gender and age categorization. Dysphonia patients ≥65 years are not a uniform group, and important differences exist in terms of diagnosis as a function of age. Knowledge of these differences may inform further investigations in the growing field of geriatric otolaryngology.

The Impact of Socioeconomic Status on Voice Outcomes in Patients With Spasmodic Dysphonia Treated With Botulinum Toxin Injections.

To determine the impact of socioeconomic status (SES) on voice outcomes for spasmodic dysphonia (SD) patients treated with botulinum toxin injections. This was a prospective cross-sectional study in a tertiary care, academic voice clinic in Canada. Adult SD patients returning to the voice clinic for their botulinum toxin injections were recruited from October 2017 to April 2018. Patients completed a questionnaire on demographic data, the Hollingshead Four-Factor Index for socioeconomic status (validated instrument based on education, occupation, gender, and marital status), and the Voice-Handicap Index 10 (VHI-10) (validated instrument on self-reported vocal handicap). Primary outcome was the association between VHI-10 and Hollingshead Index. Secondary variables were median household income by postal code, duration of disease, gender, age, and professional voice user. Descriptive statistics and multiple linear regression were conducted. One hundred and one patients (age = 62.8 ± 13.7 years, 20.8% male) were recruited with VHI-10 of 22.1 ± 8.1 (out of 40) and Hollingshead Index of 46.3 ± 11.7 (range, 8-66). Median household income was $75 875 ± $16 393, which was above the Canadian average of $70 336. About 91.1% were Caucasian, 54.4% had university degree, 86.1% spoke English, and 43.5% were employed. In multiple linear regression, there was mild to moderate negative correlation (r = -.292, P = .004) between VHI-10 and Hollingshead Index when controlling for disease duration, age, gender, and professional voice use. SD patients treated with botulinum toxin were mostly affluent, Caucasian, well educated, and English speakers. Lower self-perceived vocal handicap was associated with higher socioeconomic status.

Vocal Tract Discomfort and Dysphonia in Patients Undergoing Empiric Therapeutic Trial with Proton Pump Inhibitor for Suspected Laryngopharyngeal Reflux

Introductionthe aim of this study was to evaluate the correlation among dysphonic and vocal tract discomfort symptoms in patients who underwent empiric therapeutic trial with proton pump inhibitor (PPI) for a suspected laryngopharyngeal reflux (LPR). Materials and methodsA total of 34 patients with suspected LPR were enrolled in this study. All of them were evaluated using the reflux finding score, the reflux symptom Index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) before and after the PPI treatment. ResultsA significant difference was found between pretreatment and posttreatment reflux finding score, RSI, VTDS, and VoiSS scores. Significant correlations among RSI, VTDS, and VoiSS before the PPI treatment were found. ConclusionPPI treatment determined a significant improvement of symptoms related to dysphonia and vocal tract discomfort in patients with suspected LPR, in addition, significant correlations among the RSI, VTDS, and VoiSS scores were demonstrated thus suggesting that LPR might influence the response of questionnaires not specifically developed in order to assess the complains in LPR patient.