Improvement In Vocal Quality Research Articles

Is There an Ideal Performance Time for the Latex Tube Exercise?

SOVTE has been widely used in voice clinic. Estimates of time to perform the technique with a flexible latex tube are still unknown. This study aimed to investigate the immediate effect of flexible latex tube immersed in water on amateur singers after 1, 3, 5 and 7 minutes, considering: (a) the singers' self-assessment regarding voice and vocal effort; (b) acoustic parameters; and (c) auditory-perceptual parameters of voice quality. Twenty nine amateur singers (14 women and 15 men) performed the exercise with latex tube (35 cm X 0.9 cm) in one 1-minute set and three 2-minute sets. Data collection was conducted before and immediately after each set using sustained emission of vowel [a]. Women and men were considered separately. Vocal self-assessment showed a statistically significant increase in negative sensations after 7 minutes of exercise for women. Auditory-perceptual analysis indicated voices were perceived more often as "equal" comparing pre exercise with first minute set and more often as "better" in the third and fifth minutes comparing with pre exercise only for women. The other parameters showed no significance. The exercise with flexible latex tube in amateur singers promoted improvement in vocal quality after 3 and 5 minutes for women. Also, the women presented significant negative sensations after 7 minutes. Immediate effect on the analyzed parameters was not observed in men.

Efeitos imediatos do inspirômetro de incentivo em mulheres vocalmente saudáveis

ABSTRACT Purpose To evaluate the immediate effect of the incentive spirometer on acoustic measures, aerodynamic measures and on the auditory-perceptual assessment of vocal quality in vocally healthy women. Methods This is an experimental intra-subject comparison study with the participation of 22 women without vocal complaints. Acoustic measures, aerodynamic measures and auditory-perceptual assessment of vocal quality were obtained before and immediately after using the incentive spirometer by the participants. The device was used in the orthostatic position and the participants performed three sets of ten repetitions with a one-minute interval between sets. Results After using the incentive spirometer, there was a significant reduction in jitter, shimmer and PPQ (period perturbation quotient) measurements and an increase in maximum expiratory volume, while the other acoustic and aerodynamic measurements were not significantly impacted. In addition, there was improvement in vocal quality in eight (36.4%) participants and 11 (50.0%) participants showed no changes in the auditory perceptual assessment of voice quality after using the incentive spirometer. Conclusion The use of the incentive spirometer is safe and, in its immediate effect, positively impacts the acoustic measures of short-term aperiodicity of frequency and intensity and increases the maximum expiratory volume in women with healthy voices.

Improved vocal quality and decreased vocal effort after botulinum toxin treatment for laryngeal dystonia

Objectives: Laryngeal dystonia (LD) is characterized by irregular and involuntary task-specific spasms of the intrinsic laryngeal muscles. There is no curative treatment for it, however, laryngeal botulinum neurotoxin injections (BoNT-I) are considered the standard of care therapy. This study aims to characterize the population of LD patients and to assess the results of laryngeal BoNT-I.Methods: A Retrospective cohort study was conducted. Medical records were reviewed for all the patients with LD diagnosis seen in the Voice Unit of the Red de Salud UCChristus between January 2013 and October 2021. Biodemographic, clinical and treatment data were collected. Additionally, a telephonic survey was completed by the patients that underwent laryngeal BoNT-I, including self-reported voice outcomes and Voice Handicap Index 10 (VHI-10).Results: Of the 34 patients with LD included in the study, 23 received a total of 93 laryngeal BoNT-I and 19 completed the telephone survey. The majority (97%) of the injections corresponded to patients with adductor LD and 3% to abductor LD. Patients received a median of 3 (1–17) injections, with a more frequent cricothyroid approach (94.4%), while the thyrohyoid approach accounted for 5.6% of cases. Most injections were bilateral (96.8%). A significant improvement in the vocal quality and effort was noted after the last injection and the overall BoNT-I treatment (P < 0.001). Similarly, the VHI-10 score improved from a median of 31 (7–40) to 2 (0–19) (P < 0.001) after the last injection. A post-treatment breathy voice was reported in 95% of patients, and dysphagia to liquids and solids in 68% and 21%, respectively.Conclusions: Laryngeal BoNT-I is an effective treatment for LD, achieving an improvement in self-reported vocal quality and VHI-10 scores, and a reduction of the self-reported vocal effort. Adverse effects are mild in the majority of cases, constituting a safe and effective therapy for these patients.

The Effect of Semi-Occluded Vocal Tract Exercise (SOVTE) and Traditional Vocal Warm-up (TVW) on the Vocal Quality of Untrained Female Singers in Malaysia: A Comparison

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

Experiences on voice assessment and voice intervention programs implemented remotely among college professors

This is a meta-analysis of two longitudinal studies and one cross-sectional study with the aim of analyzing the response rate and adherence to voice programs implemented remotely. In the cross-sectional study, we collected responses of around 150 college professors, for 2 weeks, by means of a Google form. Around 30% of participants reported voice symptoms. In the longitudinal studies, we recruited around 50 college professors, who were followed between 15 days and 5 weeks. In the first study, college professors met (in Zoom meetings) with a Speech-language pathologist every day to fill-in a short questionnaire and to record two voice samples. The main result was that sleep quality was associated with reductions in the maximum sound pressure level for vowel /i/. In the second study, college professors had meetings (in a Moodle platform), where they discuss about vocal hygiene practices, voice training exercises and adjustments of teaching-learning process to avoid voice misuse inside the classrooms. The main result was an improvement in vocal quality, reduction in vocal fatigue, and reduction of 2.5% in time dose. In conclusion, voice assessments and voice intervention programs conducted remotely showed good performance and positive effect on voice functioning among college professors.

Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence

BackgroundAnxiety disorders frequently have an onset during adolescence, which when left untreated could lead to a chronic course and outcome. This study aimed to examine the way in which a cognitive behaviour therapy-based programme (Super Skills for Life – adolescent version; SSL-A) could change the course of anxiety symptoms through adolescent's behavioural performance and cardiac function. MethodSixty-one adolescents at risk of developing an anxiety disorder (45.30% boys; M = 13.76 years, SD = 0.32) were randomly assigned to either an intervention (IG), placebo (PG), or a waitlist group (WG). Adolescents in the IG participated in SSL-A over an 8-week period. Adolescents in the PG participated in an 8-session school-work programme. Adolescents in the WG did not receive any intervention. Anxiety symptoms were assessed every six months, twice before the intervention, as well as at the post-intervention and six months after the intervention. Participants in the IG additionally underwent a stressful task to assess behavioural performance and cardiac adjustment. ResultsAdolescents in the IG significantly reported lower levels of social phobia and generalised anxiety symptoms at the follow-up assessment compared to the adolescents in the PG and the WG. They also showed a significant improvement in vocal quality and lower discomfort during a stressful task at post-intervention, and showed attenuated cardiac recovery indexes, in terms of sample entropy. LimitationsThe study has a small sample size. ConclusionSSL-A changed the natural course of anxiety symptoms, as shown by a significant reduction in social phobia and generalised anxiety symptoms, and a significant improvement in behaviour and physiological (cardiac) function during a stressful situation.

Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization.

Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialization laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many patients, however, fail to experience sufficient improvement in vocal quality postoperatively despite apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics may also have acoustic consequences. Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our knowledge there are no human observational studies examining this topic. We therefore aimed to correlate asymmetry in arytenoid height and patient-reported satisfaction in voice quality after thyroplasty. Retrospective cohort analysis. A retrospective review of prospectively collected data on consecutive patients who underwent medialization thyroplasty at a tertiary Sydney, Australia hospital was performed. Data collected included age, sex, onset of symptoms, as well as well as preoperative and 3-month postoperative maximum phonation time and Voice Handicap Index (VHI). Preoperative computed tomography scans were assessed for discrepancy of arytenoid vertical height discrepancy. Twenty-three patients (56.5% female) with mean age of 52.4 ± 14.9 years were included. Most patients underwent injection thyroplasty (78.3%, n = 5), whereas the remaining underwent an open approach. A statistically significant inverse correlation was found between increasing height discrepancy and VHI improvement (r = -0.6, P = .003.) Revision surgery was associated with increased height discrepancy. Findings of this study may affect future recommendations to address height discrepancy in surgery to treat unilateral vocal cord paralysis. 3 Laryngoscope, 130:418-422, 2020.

Self-perception of surface hydration effect on teachers’ voice quality: an intervention study

ABSTRACT Objective: to assess the effects of surface hydration on vocal quality according to teachers’ self-perception. Methods: an examiner-blinded pre-test and post-test intervention study carried out with a single group of 27 teachers. Sociodemographic characteristics and work questionnaire, Screening Index for Voice Disorder, Vocal Severity Rating Scale, Expected Effects Pre-intervention, Perceived Effects Post-intervention and Post-intervention Perception instruments, were applied. The intervention lasted 4 weeks and consisted of 5 minutes of nebulization with saline solution (sodium chloride 0.9%), after 10 minutes of mouth dehydration, prior to teaching. Results: screening Index for Voice Disorder scores demonstrated a statistically significant reduction (p=0.001). Frequency of voice disorders in the Vocal Severity Rating Scale was reduced without a statistical significance (p= 0.172). Expected Effects, Pre-intervention, and Perceived Effects, Post-intervention, showed improvement in vocal quality (40.7%), vocal comfort (40.7%) and vocal folds hydration (37%). Post-intervention perception form showed moderate improvement of the symptoms (59.3%), cleared voice (55.6%) and ease speaking (48.1%) as well as intense belief in the intervention (74.1%) and intense compliance to the intervention (74.1%). Conclusion: surface hydration with saline solution promoted self-perceived improvement in vocal quality.

Bilateral Posterior Cricoarytenoid Myoneurectomy for Abductor Spasmodic Dysphonia

To discuss the utility and outcomes of bilateral myoneurectomy for treatment of abductor spasmodic dysphonia. Bilateral myoneurectomy is a known treatment option for patients with adductor spasmodic dysphonia. Its use for treatment of abductor spasmodic dysphonia, however, has not been documented previously. In this case report, treatment and long-term outcomes of abductor spasmodic dysphonia with bilateral myoneurectomy are discussed. A 50-year-old male presented with abductor spasmodic dysphonia. His initial Voice Handicap Index-10 (VHI-10) score was 29, and he had breathy breaks during 60 series. He had no improvement in vocal quality after 6 botulinum toxin injections over 21 months. He underwent staged bilateral posterior cricoarytenoid partial myoneurectomy, with the left posterior cricoarytenoid myoneurectomy performed 33 months after presentation and right posterior cricoarytenoid myectomy 11 months later. Eight years postoperatively, his VHI-10 score was 12. During postoperative 60 series, the patient demonstrated few breathy breaks. Overall, the patient reports improved quality of life and satisfaction with his voice. This is the first report of a long-term follow-up data for bilateral, endoscopic, partial posterior cricoarytenoid muscle myoneurectomy to treat refractory abductor spasmodic dysphonia. Long-term VHI-10 results suggest improvement of symptoms, despite mild difficulty with 60 series. While botulinum toxin therapy is the mainstay of management for abductor spasmodic dysphonia, surgical treatment is a potential alternative at least for refractory cases.

Effectiveness of Vocal Therapy for the Elderly When Applying Conventional and Intensive Approaches: A Randomized Clinical Trial

The aim of this study was to verify the effects of the method Vocal Therapy for the Elderly and the differences in treatment efficacy when it was administered intensively or in the conventional way. Twenty-seven elderly individuals were randomized into two groups and referred for 16 sessions of vocal therapy. The Intensive Group (IG) had therapy four times a week, whereas the Conventional Group had it twice a week. The effects of the therapy were assessed by auditory-perceptual analysis, the Voice-Related Quality of Life protocol, and visual-perceptive analysis of laryngoscopy examinations. The first stage consisted of evaluating the vocal quality and self-assessment of 15 subjects before and after a time period equal to that which they would undergo in vocal therapy. The second stage consisted of comparing the assessments of all participants in the week preceding the beginning of treatment, in the week following the end of treatment, and 1 month after that. There was no difference between perceptual voice parameters and self-assessment when the subjects were not undergoing therapy. When comparing the periods immediately before and after therapy, there was improvement in vocal quality and Voice-Related Quality of Life. One month later, the benefits that had been revealed through the self-assessment protocol, and some of the improvements in vocal parameters were maintained. There was no difference between the IG and Conventional Group with the exception of vocal fold bowing, which decreased in the IG group. The Vocal Therapy for the Elderly program is effective for treating voice presbyphonia. An intensive approach may be superior with regard to vocal fold bowing.

Tempo ideal de vibração sonorizada de língua em crianças disfônicas

Objetivo: verificar o tempo ideal do exercício de vibração sonorizada de língua (EVSL) na voz de crianças disfônicas. Método: participaram vinte e sete crianças, entre 04 e 11 anos, com diagnóstico de nódulo ou cisto de pregas vocais. Dessas crianças, onze fizeram parte do grupo experimental (GE) e 16 do grupo controle (GC). A vogal sustentada /ε/ e a contagem de 1 a 10 foram registradas antes (m0) e após o primeiro (m1), terceiro (m3), quinto (m5) e o sétimo (m7) minuto de execução do EVSL. As gravações foram apresentadas a três fonoaudiólogas, que julgaram se houve modificação da qualidade vocal. Os parâmetros acústicos avaliados na vogal sustentada foram frequência fundamental, jitter, shimmer, glotal to noise excitation (GNE) e ruído. Resultados: na avaliação perceptivo-auditiva, não houve modificações significativas entre os momentos de execução do EVSL. Na análise acústica, observou-se que o parâmetro ruído diminuiu e o parâmetro GNE aumentou após três minutos de realização do exercício no GE, em comparação com o GC. Conclusão: não houve melhora em nenhum dos tempos na avaliação perceptivo-auditiva da voz de crianças disfônicas com o EVSL. A análise acústica indicou melhora da qualidade vocal aos três minutos de execução do exercício.

Our Experience of Medialization Thyroplasty with Freeze-Dried Cadaveric Human Fascia Lata in Unilateral True Vocal Cord Paralysis

Background: Use of autologous fascia, harvested from the thigh fascia lata, has been shown to be effective in the treatment of unilateral vocal fold paralysis (UVFP). However, advantages of this material have been less examined in the clinical setting. The present study aimed to assess the beneficial effects of medialization thyroplasty type I with cadaveric fascia lata on the vocal function of patients with UVFP. Methods: This prospective interventional case series was performed on 10 patients with UVFP, who were candidates for medialization thyroplasty. All the patients were assessed using video stereoscopy to determine the gap and closure of glottis. Voice analysis was also performed. The voice handicap index (VHI) was completed for all the patients. The level of satisfaction with voice quality was also assessed, using the visual analogue scale (VAS). Results: The mean VHI scores significantly decreased at 1, 3, and 6 months after surgery. The mean VAS scores (for voice quality) significantly increased within 1 month after surgery, whereas they gradually decreased at 5 months after surgery. The mean values of minimum and maximum pitch indices were comparable before and after surgery. The mean jitter score decreased at 1 month after surgery, while it remained constant at 6 months after surgery. The mean shimmer score gradually reduced within 3 months after surgery. On the other hand, the mean harmonic/noise ratio (HN/R) significantly increased at 6 months after surgery. The findings showed a significant decline in the frequency of anterior and posterior glottis gaps at all postoperative intervals. Conclusions: Short-term improvement of vocal quality and glottic efficiency, along with reduced glottis gap, is expected following medialization thyroplasty type I with cadaveric fascia lata.

Singer and Listener Perception of Vocal Warm-Up

This study investigated changes perceived by singers and listeners after the singers had vocally warmed up. The study used a repeated measures within-subject design to assess changes in vibrato quality from pre (nonwarmed-up voice) to post (warmed-up voice) test. Intraclass correlation coefficients were calculated to assess singers' self-ratings pre- and posttest and intra- and interlistener rater reliability. Twelve classically trained female singers recorded and self-rated their performance of an eight bar solo before and after 25 minutes of vocal warm-up exercises. Six experienced listeners assessed the vocal samples for pre- to posttest differences in tone quality and for each singer's warm-up condition. Perceptual judgements were also compared with pre- to posttest changes in vibrato. All singers perceived significant changes in tone quality, psychophysiological factors, proprioceptive feedback and technical command. Significant pre- to posttest differences in tone quality and correct appraisal of the singer's warm-up condition from most of the listeners were only observed for singers who moderated extremely fast or extremely slow vibrato after warming up. The findings reveal the divide between listeners' and singers' perceptions of the warmed-up voice and highlight the importance of enhanced vibrato quality to listener perception of an improvement in vocal quality.

Aspectos do sistema estomatognático pré e pós-adenotonsilectomia

To verify the speech therapy aspects of the stomatognathic system, including phonoarticulatory structures (lips, tongue, and soft palate) and swallowing, respiratory, speech, and phonation (vocal quality and resonance) functions, before and after undergoing adenotonsillectomy. The study included 22 children, 17 males and 5 females, aged between 5 and 10 years, suffering from hypertrophy of palatine and adenoid tonsils, with surgical indication for adenotonsillectomy and with no previous speech therapy. The speech-language pathology evaluation was performed before surgery and during the period between 1 and 6 months after adenotonsillectomy. It consisted of an evaluation of structures (lips, tongue, and soft palate) and of swallowing (liquid), respiration (mode), speech, and phonation (voice quality and resonance) functions. To evaluate vocal quality and resonance, 15 participants with the postoperative evaluation carried out in a period from 1 to 2 months were considered. There were differences regarding nasal respiratory mode, lips closed at rest posture, changed tongue tonus, adequate mobility of the soft palate, changed tongue posture during liquid swallowing, and absence of interposition compensatory mechanism of lips in swallowing. Reduction in the frequency of distortion processes was also found. With regard to speech, little improvement in vocal quality and resonance was seen. Following adenotonsillectomy, some structures and functions can spontaneously readapt or improve. However, most children needed to be referred to speech therapy for readapting stomatognathic structures and the assessed functions.

Análise acústica e perceptivo-auditiva da voz em pacientes parkinsonianos pré e pós-terapia fonoaudiológica

The objective of this study was to evaluate the voice of the individual with Parkinson’s Disease, pre and post-exercises of phonatory efforts, and re-evaluate them at 1 and 6 months post-treatment. Ten parkinsonians of both sexes, who were submitted to perceptual auditory and acoustic analysis of their voices, participated in this study. The speech material collected was sustained vowel and chained speech. The perceptual auditory analysis showed that all individuals with Parkinson presented alteration in the vocal quality and most of them obtained reduction of the deviation degree remaining constant up to the one month re-evaluation. In the acoustic analysis we have verified that maximum phonation times were below expectation, but only women reached values considered normal in post-treatment evaluations. Fundamental frequency values (f0) on male appeared to be similar in comparison to aged population and it increased in both sexes post-treatment. As for the variability of fundamental frequency (f0), there was a significant increase on values in post-treatment evaluation. Vocal intensity increased in the post-treatment and remained stable during the one to six month post-treatment re-evaluations. In general, there was improvement in vocal quality, vocal intensity and speech intelligibility, showing the effectiveness of the adopted technique.

Voz e fala de Parkinsonianos durante situações de amplificação, atraso e mascaramento

individuals with Parkinson's disease present voice and speech alterations, especially regarding loudness and speech rate. to determine the immediate effect of modified auditory feedback: amplification, delay and masking in the voice and speech of individuals with Parkinson's disease, according to gender. twenty-six subjects with Parkinson's disease (15 men and 11 women) with ages ranging between 40 and 86 years (mean age of 69 years) participated in the study. The speech material consisted of the counting from twenty to zero, four times, in four different listening conditions: habitual, amplified, delayed and masked. The following parameters were selected for the auditory-perceptual analysis: vocal quality, loudness, pitch, overall strain level, speech rate and articulation. The assessment was carried out by five Speech-Language Pathologists specialists in voice. The following parameters were selected for the acoustic analysis: fundamental frequency, intensity and maximum phonation time. regarding the auditory-perceptual analysis, an improvement in vocal quality, increase in loudness and overall strain level was observed in the masking situation. On the other hand, a decrease in vocal quality, a decrease in loudness and overall strain level, a decrease in speech rate and in articulation precision was observed in the amplification and delay situations. In the acoustic analysis, an increase in the fundamental frequency and vocal intensity was observed in the masking situation and an increase of the maximum phonation time was observed in the delay situation. the masking situation presents better immediate effect in the voice and speech of individuals with Parkinson's disease while the amplification and delay situations do not produce satisfactory immediate modifications.

Distonia focal laríngea: investigações no corpo que remetem à mente

There seems to be a consensus in the literature on the symptomatic description of laryngeal focal dystonia (LFD). Its etiology, however, presents controversies since the literature points to psychological and neurological aspects. As a result of this controversy, presented not only in the literature but also in the clinical practice, the present research privileged this pathology among others that also have vocal symptoms because it seems to be, per excellence, a pathology where both voice/psychic can be treated. To report a case study of a patient diagnosed with LFD, emphasizing the mutual effects between voice and psychic. This is a clinical qualitative research, based on a case study (follow-up) of a male patient, 54 years old, who was diagnosed with LFD. All therapeutic sessions were systematically registered and were later analyzed based on the existing speech-language, medical and psychoanalytical literature. The analysis of the results indicate that the combination of different therapeutic procedures--attentive to the fact that interventions on the body tend to produce physical and psychological effects--along with dealing with the psychological contents, resulted in therapeutic progresses and improvement of vocal quality. The vocal symptom not only reflects a sick body, but also an individual who suffers and evokes a symptom that needs to be heard. In this way, the clinical method investigates not only the organic symptom, but also the reason why it manifests itself in the voice.

Clinical analysis of microdebrider removal of recurrent respiratory papilloma: A report of 33 cases

OBJECTIVE To investigate the advantages of applying microdebrider removal of juvenile-onset recurrent respiratory papillary epithelioma (JO-RRP), using an endoscopy-assisted prop-up laryngoscope. METHODS The degree of severity of the neoplasms was divided into 3 scores (i.e. 1 point for a slight degree, 2 points for a moderate and 3 points for a severe degree). The involvement of 22 respiratory and digestive sub-areas was evaluated and the total accumulative scoring and the scores for the lesions in the vocal area were calculated and sub-grouped. All the papillary epitheliomas were excised using a laryngeal micro-debrider or the micro laryngeal forceps under endoscopy-assisted suspension laryngoscopy. The differences between applications of the two modes of treatment for the cases of the groups with same scoring were compared as follows: the operation time, interval of operation, recent vocal quality after operation, postoperative scarring and incision of the trachea, as well as the distribution of tumors in a re-operation. RESULTS The 142 operative procedures were performed in 33 pediatric patients, with application of a laryngeal microdebrider in 14 cases and excision in 19. Compared to the excision group (EG), the laryngeal microdebrider group (MDG) displayed many superior features, such as a short operation time, long interval between operations, obvious improvement in vocal quality soon after operation, and a low frequency of subsequent tumors. There was a significant difference between these modes of the operation. A postoperative incision of the trachea was required in 2 cases of EG, whereas no post-operation was needed in the MDG. CONCLUSION There are many advantages in using laryngeal micro-debrider removal of JO-RRP. The procedure is simple and convenient, having a distinct operating field, precise incision, minor wounds, fewer complications and better vocal quality soon after operation, as well as quicker rehabilitation and longer intervals between operations, etc.

Vocal quality of life improves with treatment of laryngopharyngeal reflux

Objectives: To determine if vocal quality of life improves with treatment of laryngopharyngeal reflux disease (LPRD). Methods: A prospective case series study was performed on patients with a diagnosis of laryngopharyngeal reflux disease at a tertiary center of laryngology from 6/01 to 12/03. Pre- and posttreatment reflux symptoms, physical examination scores, and vocal quality of life scores were assessed using validated and standardized instruments (Voice Handicap Inventory-10 [VHI-10], Reflux Symptom Index [RSI], and Laryngopharyngeal Reflux Disease Index [LRDI]). Results: A significant improvement in posttreatment vocal quality of life as measured by the VHI-10 was noted (mean score, 8.3) as compared to pretreatment (mean score 13.48, P < 0.001). This improvement correlated significantly with improvement in the RSI (posttreatment 12.56 vs pretreatment 18.10, P < 0.001, Pearson correlation coefficient 0.359). Physical examination score as measured by the LRDI improved with treatment but the degree of improvement did not correlate with improvement in the VHI-10 or the RSI. Conclusions: Treatment of LPRD significantly improves vocal quality of life. Laryngeal reflux symptoms improve with treatment and this improvement correlates with improvement in vocal quality of life.

Precise vocal cord medialization using an adjustable laryngeal implant: A preliminary study

Treatment of symptomatic unilateral vocal cord paralysis is most frequently surgical. Medialization of the vocal cord using Teflon injection has proved effective; however, studies have shown this technique to produce stiffness of the vocal fold with loss of the "mucosal wave" and concomitantly poor vocal function. As well, overcorrection may occur and is not reversible. Isshiki type 1 medialization thyroplasty has been shown to produce a substantial improvement in vocal quality, as well as preserve the mucosal wave. A number of problems encountered during the performance of Isshiki type 1 thyroplasty has led us to modify the original technique. We have developed a new implant that allows for precise, easily adjustable control of vocal cord medialization. To evaluate the degree of vocal cord medialization afforded by this implant, larynges of fresh male and female cadavers were used as an experimental model. In both larynges, vocal cord medialization was shown to occur in a predictable fashion for the anterior, middle, and posterior segments, as well as in the functionally important inter-arytenoid region. We believe the use of this implant in medialization thyroplasty will allow precise, atraumatic medialization of the paralyzed vocal cord. This greater control over positioning and ease of adjustment should contribute to enhanced vocal quality.