Improve Voice Quality Research Articles

Disfonia como principal queixa num quadro de miastenia grave: diagnóstico e fonoterapia

Myasthenia gravis is an autoimmune disease, manifested by progressive muscular weakness and fatigue. There are frequent ocular and bulbar symptoms, among them, dysphonia. This article reports a case of dysphonia that contributed to the diagnosis of myasthenia gravis through a speech evaluation. The patient sought speech therapy with the ENT diagnosis of presbyphonia. The perceptual voice assessment and acoustic analysis pointed out respiration, glottal voice source and resonance affections. Considering that some of the data obtained from anamnesis and vocal assessments were not directly related to presbyphonia, the speech therapist discussed the case with the physician and they both concluded it was necessary to refer the patient to a neurological evaluation. The neurologist then raised the diagnostic hypotheses of myasthenia gravis and requested further examinations. The patient underwent speech therapy and drug treatment. A vocal reassessment, which occurred two months after the initial treatment, showed improvement in voice quality, with great impact on quality of life. This article shows the importance of detailed clinical speech evaluation and participation of a speech therapist in an interdisciplinary team.

Acoustic evaluation of short-term effects of repetitive transcranial magnetic stimulation on motor aspects of speech in Parkinson’s disease

Hypokinetic dysarthria in Parkinson's disease (PD) can be characterized by monotony of pitch and loudness, reduced stress, variable rate, imprecise consonants, and a breathy and harsh voice. Using acoustic analysis, we studied the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the primary orofacial sensorimotor area (SM1) and the left dorsolateral prefrontal cortex (DLPFC) on motor aspects of voiced speech in PD. Twelve non-depressed and non-demented men with PD (mean age 64.58 ± 8.04 years, mean PD duration 10.75 ± 7.48 years) and 21 healthy age-matched men (a control group, mean age 64 ± 8.55 years) participated in the speech study. The PD patients underwent two sessions of 10 Hz rTMS over the dominant hemisphere with 2,250 stimuli/day in a random order: (1) over the SM1; (2) over the left DLPFC in the "on" motor state. Speech examination comprised the perceptual rating of global speech performance and an acoustic analysis based upon a standardized speech task. The Mann-Whitney U test was used to compare acoustic speech variables between controls and PD patients. The Wilcoxon test was used to compare data prior to and after each stimulation in the PD group. rTMS applied over the left SM1 was associated with a significant increase in harmonic-to-noise ratio and net speech rate in the sentence tasks. With respect to the vowel task results, increased median values and range of Teager-Kaiser energy operator, increased vowel space area, and significant jitter decrease were observed after the left SM1 stimulation. rTMS over the left DLPFC did not induce any significant effects. The positive results of acoustic analysis were not reflected in a subjective rating of speech performance quality as assessed by a speech therapist. Our pilot results indicate that one session of rTMS applied over the SM1 may lead to measurable improvement in voice quality and intensity and an increase in speech rate and tongue movements. Nevertheless, these changes were not accompanied by changes in a perceptual evaluation of speech performance by a speech therapist. Future placebo-controlled studies in larger patient cohorts should verify if rTMS would be clinically useful for treating hypokinetic dysarthria in PD.

Effects of Omeprazole Over Voice Quality in Muscle Tension Dysphonia Patients With Laryngopharyngeal Reflux

BackroundLaryngopharyngeal reflux (LPR) is the backflow of stomach contents above upper esophageal sphincter, into the pharynx, larynx, and upper aerodigestive system.ObjectivesIn this study, effects of omeprazole over voice quality in muscle tension dysphonia with laryngopharyngeal reflux was ınvestigated.Patients and MethodsNine patients, 7 males and 2 females, aged between 27-43 (mean age:31) were included to this study. The diagnosis of muscle tension dysphonia with LPR was established by video laryngoscopy, rigid scope 70º. The laryngeal changes related with LPR were evaluated according to Reflux Finding Score. The patients received omeprazole 20 mg twice a day for a period of 6 months. None of the patients received voice therapy. Vocal hygiene guidelines were also explained to the patients. Objective and subjective voice parameters (Jitter, shimmer, NHR, Voice Handicap Index, and Auditive analysis; Roughness, breathiness, and hoarseness) were evaluated in this study.ResultsAfter treatment with omeprazol, all the parameters showed an improvement in voice quality, but only VHI (P = 0) and shimmer (P = 0,018) are statistically significant.ConclusionsFor FD patients with LPR condition, we highly recommend that LPR treatment should be part of the treatment plan.

Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy

To evaluate through a multidimensional protocol voice changes after voice therapy in patients with benign vocal fold lesions. 65 consecutive patients affected by benign vocal fold lesions were enrolled. Depending on videolaryngostroboscopy the patients were divided into 3 groups: 23 patients with Reinke's oedema, 22 patients with vocal fold cysts and 20 patients with gelatinous polyp. Each subject received 10 voice therapy sessions and was evaluated, before and after voice therapy, through a multidimensional protocol including videolaryngostroboscopy, perception, acoustics, aerodynamics and self-rating by the patient. Data were compared using Wilcoxon signed-rank test. Kruskal-Wallis test was used to analyse the mean variation difference between the three groups of patients. Mann-Whitney test was used for post hoc analysis. Only in 11 cases videolaryngostroboscopy revealed an improvement of the initial pathology. However a significant improvement was observed in perceptual, acoustic and self-assessment ratings in the 3 groups of patients. In particular the parameters of G, R and A of the GIRBAS scale, and the noise to harmonic ratio, Jitter and shimmer scores improved after rehabilitation. A significant improvement of all the parameters of Voice Handicap Index after rehabilitation treatment was found. No significant difference among the three groups of patients was visible, except for self-assessment ratings. Voice therapy may provide a significant improvement in perceptual, acoustic and self-assessed voice quality in patients with benign glottal lesions. Utilization of voice therapy may allow some patients to avoid surgical intervention.

Photoangiolytic Laser Treatment of Recurrent Respiratory Papillomatosis: A Scaled Assessment

To investigate the effectiveness of unsedated office-based photoangiolytic laser surgery (UOLS) for treating recurrent respiratory papillomatosis (RRP) using the Derkay severity scale, Voice Handicap Index-10 (VHI-10), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale. Although previous studies examined the effect of UOLS on voice quality, few studies evaluated the effect on disease regression or used accepted and validated scales as outcome measures. Retrospective case series. Charts were reviewed for patients who underwent UOLS for RRP (2007-2010). Twenty-one patients met the inclusion criteria. Nineteen patients underwent treatment with a 532-nm potassium titanyl phosphate laser and two with a 585-nm pulsed dye laser. The Derkay, VHI-10, and GRBAS scores of posttreatment findings were compared with those of the pretreatment findings. Twenty-one patients underwent 81 office procedures. Mean follow-up was 18 months. From baseline to latest follow-up, there was significant improvement in the mean Derkay score from 6.1 to 3.0 (P=0.001), VHI-10 score from 24.5 to 15.9 (P=0.04), and GRBAS score from 8.6 to 4.9 (P=0.004). UOLS results in patient benefit from disease regression, reduced voice handicap, and improved voice quality without the risks associated with direct laryngoscopy and general anesthesia. UOLS is an effective, safe, nonexperimental treatment modality for RRP that has shifted the therapeutic paradigm while decreasing patient morbidity.

Vocal cord reconstruction to treat aspiration caused by a post-intubation posterior glottic furrow

ObjectiveTo present the case of a premature child with a furrow in the posterior vocal cord as a result of prolonged intubation, with symptoms of aspiration and poor voice, treated with a novel method of vocal cord reconstruction. MethodsThe vocal cord was reconstructed endoscopically by freeing up the edge of cord remnant and suturing this to a flap of inter-arytenoid mucosa to create a new cord. ResultsThe resulting neo-cord was able to achieve full glottic closure with resolution of aspiration, and this was also accompanied by improvement in voice quality. ConclusionThe described vocal cord reconstruction method proved to be a useful treatment for aspiration and poor voice caused by a post-intubation vocal cord furrow.

Vocal Rehabilitation after Radiotherapy for Laryngeal Cancer—Pilot Study

Objective: Learning more about to what extent voice therapy with a speech-language pathologist is an effective method for improved vocal function for patients with laryngeal cancer. Results from self-evalutation forms as well as temporal and acoustical measures will be presented. The pilot participants are selected from a larger longitudinal study. Method: Twenty patients were randomized to vocal rehabilitation (VRG) or to a control group (CG). Text reading and sustained vowel production, S-SECEL (The Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer) and vocal fatigue were recorded pre- and post-voice therapy, 1 and 6 months after radiotherapy. Results: Maximum phonation time increased for CG and decreased for VRG, but was longer than for CG. Vocal fatigue, assessed on a VA-scale, as well as mean F0 decreased for both groups. Mean values of the total S-SECEL score increased for CG and decreased with 16.7% for VRG indicating a better vocal function. For CG shimmer increased with 0.03 dB and decreased for VRG with 0.13 dB, indicating an improved voice quality. Mean harmonic-to-noise ratio improved for VRG while it deteriorated for CG. Conclusion: Our results correspond with earlier studies on voice rehabilitation, showing an improved self-evaluated communication (S-SECEL) for VRG, which is also shown in the acoustic measures of voice quality. However, the expected result, with a more pronounced improvement for VRG in most dimensions is not supported.

Nonsurgical versus Surgical Management of Vocal Cord Nodules

Objective: Vocal cord nodules are of the most common benign laryngeal pathologies that may cause dysphonia and hoarseness. This study aimed to assess the effectiveness of surgical versus nonsurgical interventions for vocal cord nodules. Method: In a cohort study, 60 patients with vocal cord nodules were enrolled in 2 groups. The study was carried out from 2010-2011 at Imam Reza Hospital of Tabriz. One group underwent surgical microscopic excision, and the other one was managed with medical and speech therapies. The results were evaluated 3 months later. Results: The mean age of patients was 37.35 ± 9.22 years with male to female ratio of 36/24. In each group, 27% of patients were smokers. Sixty percent of patients in the surgical group had job-related use of voice, compared to 72% in the nonsurgical group. In the surgical group, 63% of patients had bilateral nodules versus 76% in the nonsurgical group. In evaluating improvement of voice quality there was no statistically significant difference between the 2 groups regarding patient satisfaction and the surgeon’s evaluations ( P = .16 and P = .07, respectively). Conclusion: There was no definite difference between surgical and nonsurgical interventions of vocal cord nodules.

Intensive treatment of dysarthria secondary to stroke

This study investigated the impact of a well-defined behavioral dysarthria treatment on acoustic and perceptual measures of speech in four adults with dysarthria secondary to stroke. A single-subject A–B–A experimental design was used to measure the effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on the speech of individual participants. Dependent measures included vocal sound pressure level, phonatory stability, vowel space area, and listener ratings of speech, voice and intelligibility. Statistically significant improvements (p < 0.05) in vocal dB SPL and phonatory stability as well as larger vowel space area were present for all participants. Listener ratings suggested improved voice quality and more natural speech post-treatment. Speech intelligibility scores improved for one of four participants. These data suggest that people with dysarthria secondary to stroke can respond positively to intensive speech treatments such as LSVT. Further studies are needed to investigate speech treatments specific to stroke.

Eficacia del tratamiento vocal rehabilitador en los pacientes con disfonías funcionales hipercinéticas

ObjectiveTo evaluate the effectiveness of voice rehabilitation in patients with hyperkinetic functional dysphonia. Material and methodsWe carried out a prospective study of 65 patients diagnosed with hyperkinetic functional dysphonia and treated exclusively with systematized voivr rehabilitation. Clinical outcome was evaluated by perceptual measures, with application of the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale before and after the treatment. ResultsClinical improvement was found in 57 patients (87.7%). The disorder affected the five elements included in the GRBAS scale and, in most patients, severity was mild or moderate, with significant improvement in these five elements after the treatment. ConclusionWe believe that voice therapy is highly effective in improving voice quality in most patients with hyperkinetic functional dysphonia.

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

Frontolateral Laryngectomy with Imbrication Laryngoplasty for Stage I Glottic Carcinoma

Wpływ wibracyjnej terapii stymulującej na jakość głosu w postaci hiperfunkcjonalnej dysfonii zawodowej

Hyperfunctional dysphonia is the most frequent type of occupational functional dysphonia. Pharmacotherapy, physiotherapy and psychotherapy are used in the treatment of occupational dysphonia. Vibratory massages of the regions of the larynx relax the external muscles of neck, which have an indirect impact on the tension of the vocal folds. The aim of the study is to assess the impact of vibratory stimulation therapy on voice quality in patients with hyperfunctional occupational dysphonia treated pharmacologically. Forty patients with hyperfunctional occupational dysphonia treated phoniatrically in the Phoniatric Outpatient Clinic were included in the study. Patients were divided into two groups. Group I consisted of 20 patients treated pharmacologically. In group II, including 20 patients, apart from pharmacotherapy the vibratory stimulation therapy by the device of VR type (CyberBioMed LLC) was used. In the analysis of voice quality the evaluation of the vocal folds vibration using videolaryngostroboscopy and acoustic assessment of voice were conducted. The perceptual assessment of voice, the visualization of the vocal folds vibration in stroboscopic examination of the larynx and the acoustic assessment of voice enable the appropriate diagnostics of the clinical type and voice quality in hyperfunctional dysphonia. The tension of superficial and deep muscles of neck has the impact on the phonatory function of the larynx. Pharmacological treatment improves the voice quality in hyperfunctional occupational dysphonia. Pharmacological treatment combines with the relaxation of muscles of neck using the device of VR type significantly improve voice quality in hyperfunctional occupational dysphonia.

Posterior Cordectomy. Our Experience

ObjectiveSeveral surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral cord palsy. We performed a retrospective study of our experience in posterior cordectomy with a laser CO2, analysing the improvement of dyspnoea and voice quality after surgery. MethodsThis was a retrospective study of 13 cases (9 female, 4 male). The age range was 25–79 years. Iatrogenic post-thyroidectomy (4 cases) was the most common aetiology of bilateral laryngeal palsy in our study.We assessed the subjective improvement of respiratory function and voice quality after laser surgery using the Spanish adaptation of the Voice Handicap Index (VHI). ResultsDyspnoea improved in all patients. Two cases had a worsening of dyspnoea in the immediate postoperative period and one case was successfully solved with a new surgical intervention.After surgery, most of patients suffered from mild or middle dysphonia. ConclusionsThe posterior cordectomy is an easy, safe, and effective treatment for dyspnoea secondary to bilateral laryngeal palsy, maintaining acceptable voice quality.

Solitary fibrous tumor of the larynx

Solitary fibrous tumors of the larynx are extremely rare. To date only occasional cases have been reported in the literature. We present this case report as an additional case to existing literature. This report presents a patient with progressive dysphonia for two years. Examination revealed a bulging mass in the left paraglottic space. A CT scan was performed which demonstrated a well delineated, submucosal mass. The mass was firm and non-mobile and due to this fact obtaining material for biopsy was technically impossible. A surgical excision of the mass via a cervical approach was performed. The mass was completely removed and there was an immediate improvement in the patient's voice quality. Histological examination and immunohistochemical studies revealed a solitary fibrous tumor. This is a rare presentation of a solitary fibrous tumor in the larynx. Management options are discussed and the literature on this uncommon entity is reviewed.

Treatment of laryngeal hyperfunction with flow phonation: A pilot study

Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.

A Case of Surgical Removal of Hyaluronic Acid Injected in Reinke's Space

Injection laryngoplasty is a simple and noninvasive method for treating unilateral vocal cord paralysis. Lately hyaluronic acid is widely used as injection material, because it is spontaneously resolved after few months and can be injected superficially compared to other materials. However, if hyaluronic acid is injected in the superficial layer of lamina propria (Reinke’s space), it can cause inflammation or granuloma, interrupt the vibration of the vocal cord and worsen the quality of voice. We here present a case of granuloma that occurred as a complication of injection laryngoplasty, where simple surgical method was employed to improve voice quality.� Korean J Otorhinolaryngol-Head Neck Surg 2012;55:782-6 Key WordsZZGranuloma ㆍHyaluronic acid ㆍInjection laryngoplasty.

Insertion of a second nasal pack as a prognostic indicator of emergency theatre requirement in epistaxis patients

s / International Journal of Surgery 10 (2012) S1–S52 S36 ABSTRACTS Conclusions: In our study, thyroplasty as a method for vocal cord medialisation led to improved voice quality post-operatively and to good patient satisfaction. 0363: INSERTION OF A SECOND NASAL PACK AS A PROGNOSTIC INDICATOR OF EMERGENCY THEATRE REQUIREMENT IN EPISTAXIS PATIENTS Edward Ridyard , Vinay Varadarajan , Indu Mitra . University of Manchester, Manchester, UK; North West Higher Surgical Training Scheme, North West, UK; Manchester Royal Infirmary, Manchester, UK Aim: To quantify the significance of second nasal pack insertion in epistaxis patients, as a measure of requirement for theatre. Method: A one year retrospective analysis of 100 patient notes was undertaken. After application of exclusion criteria (patients treated as outpatients, inappropriate documentation and patients transferred from peripheral hospitals) a total of n1⁄434 patients were included. Of the many variables measured, specific credence was given to requirement of second packing and requirement for definitive management in theatre. Results: Of all patients, 88.5% required packing. A further 25% (7/28) of this group had a second pack for cessation of recalcitrant haemorrhage. Of the second pack group, 85.7% (6/7) ultimately required definitive management in theatre. One sample t-test showed a statistically significant correlation between patients with a second nasal pack and requirement for theatre (p 0.05). Conclusion: Rhinoplasty is a common operation in both England and Wales. The current economic constraint combined with differences in funding and corporate ethos between the two sister NHS organisations has led to a statistical reduction in numbers undergoing rhinoplasty in England but not in Wales. 0427: PATIENTS' PREFERENCES FOR HOW PRE-OPERATIVE PATIENT INFORMATION SHOULD BE DELIVERED Jonathan Bird, Venkat Reddy, Warren Bennett, Stuart Burrows. Royal Devon and Exeter Hospital, Exeter, Devon, UK Aim: To establish patients' preferences for preoperative patient information and their thoughts on the role of the internet. Method: Adult patients undergoing elective ENT surgery were invited to take part in this survey day of surgery. Participants completed a questionnaire recording patient demographics, operation type, quality of the information leaflet they had received, access to the internet and whether they would be satisfied accessing pre-operative information online. Results: Respondents consisted of 52 males and 48 females. 16% were satisfied to receive the information online only, 24% wanted a hard copy only and 60% wanted both. Younger patients aremore likely towant online information in stark contrast to elderly patients who preferred a hard copy. Patients aged 50-80 years would be most satisfied with paper and internet information as they were able to pass on the web link to friends and family who wanted to know more. 37% of people were using the internet to further research information on their condition/operation. However, these people wanted information on reliable online sources to use. Conclusions: ENT surgeons should be alert to the appetite for online information and identify links that are reliable to share with patients. 0510: ENHANCING COMMUNICATION BETWEEN DOCTORS USING DIGITAL PHOTOGRAPHY. A PILOT STUDY AND SYSTEMATIC REVIEW Hemanshoo Thakkar, Vikram Dhar, Tony Jacob. Lewisham Hospital NHS

The Efficacy of Treatment for Vocal Fold Bowing with Pulsed Dye Laser

ABSTRACT Bowing of the vocal folds can result from aging, atrophy or idiopathic causes, such as an injudicious vocal cord surgery. Bowing results in dysphonia due to inadequate approximation of the vocal folds. A number of treatments have been proposed for this condition. Intracordal injection of biological materials including liquid silicon and Teflon and various types of thyroplasty have been utilized. However, full voice recovery has never been fully achieved. We present a case involving a 64-year-old Asian man with dysphonia for 30 years. The patient's vocal fold bowing was examined on laryngoscopy. The disease was effectively treated with pulsed dye laser (PDL) followed by speech therapy. Observation of the patient over 1 year did not show any signs of recurrence. Our analysis revealed voice quality improvement. How to cite this article Koo YC, Chung HJ, Suh MJ, Choi HS. The Efficacy of Treatment for Vocal Fold Bowing with Pulsed Dye Laser. Int J Phonosurg Laryngol 2012;2(1):46-48.

Bamboo nodes associated with mixed connective tissue disease as a cause of hoarseness

Vocal fold lesions related to autoimmune diseases are rheumatoid nodules and, to a lesser extent, bamboo nodes. Mostly transverse, they are located in the middle third of the vocal cord and exhibit a yellowish appearance. The characteristic shape of these lesions led to their name. These vocal fold deposits may interfere with the normal vibratory cycle during phonation and thus may be an unusual cause of hoarseness. We present a 43-year-old woman with known mixed connective tissue disease and a dysphonia. Laryngostroboscopy showed bamboo nodes as described above. We applied several laryngeal injections of cortisone as described previously in the literature. Since this treatment did not lead to a sufficient voice improvement, we attempted to surgically remove the deposits. After the surgery, the voice improved considerably. In all patients with rheumatic diseases who suffer from a rough, breathy, or unstable voice, a laryngostroboscopic examination should be done. If, however, a bamboo node lesion of the vocal folds is found by the laryngologists, an associated autoimmune disorder must be assumed, and adequate diagnostic procedures have to be initiated. Local laryngeal injections (1–3 times) with steroids should be the first line of therapy. In unsuccessful cases, subsequent surgery can be a useful treatment of bamboo nodes to stabilize and improve voice quality.

Endoscopic Laser Thyroarytenoid Myoneurectomy in Patients with Adductor Spasmodic Dysphonia: A Pilot Study on Long-Term Outcome on Voice Quality

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.