Videolaryngostroboscopic Findings Research Articles

Long-term efficiency of vocal aptitude tests and voice training in student teachers

Teachers are subject to exceptionally high vocal stress throughout their lives and have an increased prevalence of voice disorders. The aim of this study was to evaluate the long-term efficiency of voice training in student teachers during their lifelong career as a teacher. In addition, we investigated the relationship between vocal aptitude tests and teachers' vocal health. In a multicentre case-control study, 202 teachers (median age: 48 years, 165 women, 37 men) were examined. The examination consisted of a standardised anamnesis, analysis of the voice, laryngostroboscopy and audiometry. Subjects were attributed to the case group if at least two of the following criteria were met: pathological videolaryngostroboscopic findings, pathological analysis of the voice, subjective vocal complaints. 65/202 teachers were categorised as cases. Comparing the groups, cases were older (p=0.001), worked more often in primary schools (p=0.008) and had more problems with reflux (p=0.002). 63.8% of the controls had completed a vocal aptitude test before starting their studies, compared to 47.6% of the cases (p=0.031). A multivariate analysis showed an OR of 1.6 for developing dysphonia if neither voice training nor a vocal aptitude test has taken place during the course of study. Many risk factors associated with dysphonia in teachers are often difficult or impossible to change. Vocal aptitude tests and voice training during the studies represent a primary prevention of occupational dysphonia in the teaching profession.

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.

Comparative Study of Videolaryngostroboscopic Findings and Voice Handicap Index Before and After Treatment in Patients Presenting with Hoarseness Due to Non Malignant Lesions.

Voice personifies an individual. Change in voice can be the only presentation for a benign malady like vocal nodule or acute laryngitis but can also indicate life threatening malignancy. Hence every voice change must be evaluated. The aim of this pioneering study was to assess patients with voice change due to non-malignant conditions, using Videolaryngostroboscopy (VLS) and Voice Handicap Index (VHI) pre and post1 month therapy. Diagnosis determined conservative therapy or Co2 laser phonosurgery according to accepted medical protocol. On VLS, glottic closure pattern and wave form was noted both before and after treatment. Patient completed VHI form before and after treatment. There is no previous study comparing pre and post treatment VHI and VLS in a extensive etiology of conservatively managed patients. In our study, 100 patients were enrolled in the age group between 10years to the eighties, with majority in their thirties. The male to female ratio was 1.9:1. The majority of patients belonged to level IV occupation. A wide gamut of diagnosis was noted, majority being vocal nodules, followed by polyps, cysts, vocal cord palsy etc. A statistically significant improvement was seen pre and post treatment VLS in glottic closure pattern, waves presence along with improvement in VHI. Thus, Voice Handicap Index and Videostroboscopy can be used to prognosticate the vocal cord lesions and measure the effectiveness of treatment in both surgically and conservatively managed patients.

Role of videolaryngostroboscopy in the diagnosis of dysphonic patient with normal fiberoptic laryngoscopy

Background: Dysphonia is altered voice quality, pitch, loudness, or vocal effort that impairs people’s quality of life. It is a very common complaint affecting nearly one-third of a population at some point in their life and could be caused by infection, tumor, trauma, vocal cord paralysis, etc . Indirect mirror or endoscopic laryngoscopy is used to assess the laryngeal condition in dysphonic patients seeking mainly for the cause, but frequently the findings were normal or unremarkable . Videolaryngoscopy (VLS) is very useful in dysphonic patients who have an otherwise normal indirect or flexible laryngoscopic examination. In addition to providing information regarding vocal fold vibrations, the image obtained through VLS can be magnified to make a more detailed assessment of the vocal cord anatomy than is possible with rigid of flexible laryngoscopy. Objective of study: To assess the videolaryngostroboscopic findings in dysphonic patients with normal fiber-optic laryngoscopy. Patient & Method: A cross-sectional study, Fifty patients were included in the study; They had complained of dysphonia, and the fiber-optic laryngoscopic examination was normal. Videostroboscopy were obtained for all patients to assess vocal fold vibration and seek any abnormal findings. Results: A total of 50 patients were enrolled in this study. Regarding the stroboscopic findings, 42% of the patients were normal, 15 (30%) had early soft singer’s nodules, 6 patients (12%) had intracordal lesions, 4 patients (8%)had vocal cord polypoidal changes, 2 patients (4%) had presbylaryngis, and the other 2 patients (4%) had sulcus vocalis. Conclusion: VLS is beneficial in detecting vocal cord lesions in patients with normal fiber-optic laryngoscopy. A high proportion (more than half) of dysphonic patients with normal fiber-optic laryngoscopy had abnormal findings. Keywords: Stroboscopy, Videolaryngoscopy, Fiberoptic laryngoscopy, Dysphonia.

Spontaneous Regression of Recurrent Respiratory Papillomatosis with HPV Vaccination: A Case Study

Recurrent respiratory papillomatosis (RRP) is characterized by recurrent laryngeal papillomas and treated with repeated surgical excision. The human papillomavirus (HPV) vaccine prevents infection with strains of HPV unrelated to RRP, and has recently been shown to increase the interval between surgeries when used as an adjuvant. The objective of this study was to report one case from our institution in which HPV vaccination was found to induce spontaneous regression of disease, absent of surgical intervention or use of other adjuvants. Retrospective case study. Records of one patient with RRP receiving partial HPV vaccination was reviewed with attention to videolaryngostroboscopic findings, Derkay score, need for surgical intervention, and voice quality. Spontaneous regression of disease after vaccination was seen in this patient, as evidenced by reduced tumor burden and decreased voice handicap index. The patient was a 30-year old female, who had improved disease burden and voice quality after one dose and total resolution of disease following the second dose. Vaccine administration was the sole therapeutic mechanism. These findings suggest that HPV vaccination can treat RRP without surgical intervention. Further studies are needed to investigate the underlying mechanism of disease regression and which patients may benefit most. We believe that HPV vaccination for all patients with RRP, even over the age of 45 years, may decrease treatment costs for individuals and the healthcare system overall.

Effects of Rheumatoid Arthritis on the Larynx.

Introduction:The aim of the present study was to compare the videolaryngostroboscopic findings between patients with rheumatoid arthritis and vocally healthy controls. Materials and Methods:This case-control descriptive study was performed on 113 people, including 50 patients with rheumatoid arthritis and 63 controls. The participants were subjected to videolaryngostroboscopic examinations in order to evaluate fundamental frequency, different structural vocal lesions, patterns of glottal closure, subglottal changes, supraglottis appearance, and movement patterns of the arytenoid cartilage. The obtained results were compared between the two research groups. Data analysis was performed in the Statistical Package for the Social Sciences, version 24.0. A p-value less than 0.05 was considered statistically significant.Results:The results revealed a statistically significant difference between the two groups in terms of the complete pattern (P=0.00) and strained state of glottal closure (P=0.00), pattern of subglottal changes (χ2=25.98, df=2; P<0.001), and movement patterns of the arytenoid (χ2=21.16, df=1; P<0.001). Additionally, based on the obtained frequencies, the two groups showed significant differences regarding the normal state of the larynx (P=0.00), hypertrophy of vocal fold (P=0.007), epithelial change (P=0.007), and Reinke's edema (P=0.001). However, the videolaryngostroboscopic examination results revealed no significant difference between the two groups in terms of polyp (P=0.20), nodule (P=0.57), sulcus vocalis (P=0.08), cyst (P=0.45), and atrophy of vocal folds (P=0.45). Conclusion:It seems that rheumatoid arthritis affects the patterns of arytenoids movement, some kinds of glottal closure patterns, and subglottal changes. As the results indicated, the occurrence of some laryngeal structural changes was higher in patients with rheumatoid arthritis than in individuals without this disorder.

Assessment of pre and postoperative voice quality in cases of vocal fold polyp

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Benign vocal fold lesions comprise of a wide range of conditions resulting from vocal misuse or abuse (vocal nodules, polyps, cysts etc.), acute and chronic inflammatory changes, congenital vocal fold anomalies, vocal fold trauma and benign tumours. It results in significant impairment of vocal communication with major psychosocial impact.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The&lt;strong&gt; &lt;/strong&gt;prospective&lt;strong&gt; &lt;/strong&gt;study was conducted in Department of Otolaryngology, Vivekananda Institute of Medical Sciences, Kolkata from January 2016 to January 2018. All forty patients diagnosed with vocal fold polyp underwent phonomicrosurgery using micro-flap technique followed by voice therapy. Detailed pre-operative and post-operative (3 weeks, 6 weeks, 12 weeks follow up) voice assessment including fibre optic laryngoscopy and laryngovideo-stroboscopic findings were recorded. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Voice quality of the 40 patients with vocal fold polyps who underwent cold steel phonomicrosurgery had a statistically significant improvement at each follow up visit (3 weeks, 6 weeks and 12 weeks) as assessed by the subjective variables of voice handicap index score, visual analogue scale score and grade, roughness, breathiness, asthenia, strain score and objective variables of jitter, shimmer, harmonic-to-noise ratio, maximum phonation time and fibreoptic laryngoscopy and videolaryngostroboscopic findings. Fundamental frequency in females had statistically improved results but in males, though there was an improvement, the values were not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Cold steel microlaryngeal surgery using micro-flap technique offers excellent results in patients with vocal fold polyps. Perceptual, aerodynamic, acoustic, self-analysis and videolaryngostroboscopic parameters together allow multidimensional assessment of voice characteristics.&lt;/p&gt;

Clinical and Acoustical Voice Quality Evolutions Throughout Empirical Treatment for Laryngopharyngeal Reflux Disease According to Gender: A Preliminary Study

Objective: To compare symptoms, signs, and acoustical voice quality changes throughout the 6-month course of empirical treatment between laryngopharyngeal reflux (LPR) males and females. Materials and Methods: Forty clinically diagnosed LPR females and 40 males with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations during 3 or 6 months according to their evolution. RSI, RFS, and acoustic parameters were assessed at baseline and 3 and 6 months posttreatment. A correlation analysis between videolaryngostroboscopic findings and acoustic measurements was performed. Results: RSI, RFS, and many acoustic measurements (i.e., percent jitter, percent shimmer, phonatory fundamental frequency range, fundamental frequency variation, and peak-to-peak amplitude variation) significantly improved from baseline to 3 months posttreatment in male group. In female group, RSI and RFS total score significantly improved along the 3 first months of treatment. However, some clinical outcomes (i.e., RSI total score, hoarseness, cough, and globus) continued to improve from 3 to 6 months of treatment. We did not identify significant improvement of acoustic measurements in female group. The correlation study did not reveal significant correlation between videolaryngostroboscopic findings and acoustic measurements. Conclusion: This preliminary study suggests the occurrence of gender-related differences in the LPR therapeutic response. Further studies need to clarify whether females require a longer course of therapy than males.

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

This study aimed to describe the videolaryngostroboscopic (VLS) findings in a cohort of patients with isolated paresis of laryngeal adduction and identify predictive variables that may be related to voice recovery. Chart review and VLS analysis of dysphonic patients diagnosed with isolated paresis of laryngeal adduction by laryngeal electromyography (LEMG). Demographic, clinical, VLS, and LEMG findings were analyzed according to the outcome of dysphonia. There were 17 patients, 12 males (70.6%), mean age of 46.6 years, with median dysphonia duration of 4 months (range, 1-60 months) included in the study. In all patients, gross movement of both vocal folds were normal. Laryngoscopy showed limited adduction of the ipsilateral ventricular fold, contralateral interarytenoid region deviation, and vocal fold atrophy in 100%, 94.1%, and 76.5% of patients, respectively. VLS findings included: impairment of glottic closure (94.1%), phase asymmetry (94.1%), and reduced mucosal wave on the affected side (76.5%). Predictors of good voice outcome were sudden onset (P = .012), duration of dysphonia on presentation shorter than 5 months (P = .005), and absence of polyphasic potentials on LEMG (P = .041). Findings on VLS as described suggest isolated paresis of laryngeal adduction and should warrant indication of LEMG for definite diagnosis. Voice improvement may be related to clinical and LEMG findings. 4 Laryngoscope, 129:919-925, 2019.

Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis

The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.

Effect of voice therapy on vocal fold polyp treatment.

To investigate the role of voice therapy (VT) and factors that may affect the response to VT in the treatment of vocal fold polyps, especially as a complementto phonosurgery. Retrospective review of patients with vocal fold polyp undergoing surgery and/or VT in a tertiary medical center. The demographic data, phoniatric history, videolaryngostroboscopic findings, polyp characteristics, VHI-10 and GRB scores, and voice analysis data were recorded before and after the treatment. The patients were grouped as those who had undergone endolaryngeal microsurgery only (Group S), those who had first received VT then undergone surgery due to inadequate VT outcome (Group VTpS), and those who had only undergone VT with a follow-up plan (Group VT). Data were reviewed from 211 (108M, 103F) patients with a mean age of41.3 ± 11years. The improvement in all voice-related variables observed in the S and VTpS groups was significantly greater compared to the VT group despite the degree of improvement achieved in this group. At the end of the treatment period, improvements in G-R-B, VHI-10 and stroboscopy scores were significantly greater in the VTpS group than in the S and VT groups. Voice therapy can improve voice quality to some extent during the treatment of vocal fold polyps. However, VT alone is unsatisfactory compared to surgery alone. Pre-surgical VT can enhance the ultimate success of treatment. A young age, small polyps, and short duration of dysphonia may increase the possibility of benefiting from VT.

Does CPAP treatment affect the voice?

The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

Importance of laryngologic examination in chronic cough

This study aims to investigate the distribution of etiologic factors related to otorhinolaryngology in chronic cough patients with normal lung examination and spirometric findings, and also highlight the importance of videolaryngostroboscopic (VLS) examination with these patients. Seventy-six patients (31 males, 45 females; mean age 48.0±15.5 years; range 18 to 83 year) who applied to pulmonology outpatient clinic with cough complaint for more than two months were included in the study. After being evaluated by a pulmonologist, patients were referred to otolaryngology outpatient clinic. To detect the underlying cause of cough, patients' detailed histories, and flexible fiberoptic endoscopy and VLS findings were reviewed. Reflux symptom index (RSI) was used for the diagnosis of gastroesophageal reflux. In RSI ≥13 group, posterior commissure edema was detected in 12 patients (42.9%), and posterior commissure hyperemia was detected in four patients (14.3%). These findings were statistically significantly higher than RSI <13 group (p=0.006 and p=0.016, respectively). No significant difference was present between the group of patients with allergic rhinitis and the group of patients without allergic rhinitis in terms of VLS findings. Mucopurulent secretion rate in posterior commissure in patients with acute sinusitis findings was statistically higher than patients without acute sinusitis findings (p<0.001). Chronic cough is a common symptom of many different diseases. Therefore, a multidisciplinary approach is important for diagnosis. Videolaryngostroboscopy is a valuable examination tool in the differential diagnosis of gastroesophageal reflux and acute sinusitis.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

IntroductionPsychogenic dysphonia is a functional disorder with variable clinical manifestations. ObjectiveTo assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series. MethodsThe study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings. Results28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n=17), teacher (n=4), salesclerk (n=4), nurse (n=1), retired (n=1), and psychologist (n=1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms. ConclusionsIn this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.

Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

Vocal fold hyperplastic lesions: an evaluation of surgical outcome with videolaryngostroboscopy.

Vocal fold hyperplastic lesions are premalignant lesions that can be treated effectively by removal of the lesions surgically. The aim of this study was to discuss the success of surgery in patients with vocal fold hyperplastic lesions in terms of preserving vibratory function by comparing the preoperative and postoperative videolaryngostroboscopy findings. The medical charts and videolaryngostroboscopic recordings of patients diagnosed with hyperplastic lesions on the vocal folds were reviewed retrospectively. Twenty seven patients with unilateral lesions who underwent type1 subepithelial cordectomy were enrolled in the study. The videolaryngostroboscopic recordings were evaluated by three raters who were not the operating surgeon and who were blinded to the histology of patients. To evaluate the videolaryngostroboscopic findings, a form, which is a modification of criteria described by Hirano and Bless, was used. Preoperative and 6th month postoperative videolaryngostroboscopic recordings were compared with each other and with recordings of the control group, which included 50 healthy volunteers. All videolaryngostroboscopic findings, except false cord vibration, were significantly improved after surgery. The principle of vocal fold surgery in patients with benign lesions is to preserve the vibratory tissue. This principle also applies to patients with hyperplastic lesions that are premalignant. The hydrodissection technique may be beneficial for this purpose.

Vocal assessment in patients submited to CO2 laser cordectomy

SummaryAimTo evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy.Method15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group.ResultsMost of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to video-laryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. Conclusions: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life. Avaliação da voz em pacientes submetidos à cordectomia com laser de CO2.

Fat Augmentation following Microsurgical Removal of the Vocal Nodules: Long-Term Results

While the effectiveness of autogenous fat augmentation after microsurgical removal (FAMSR) of the vocal nodules (VN) has been previously shown in patient treatment programs, relatively little information is available regarding the long-term effectiveness of such a procedure. This paper examines, in retrospect, the long-term effectiveness of FAMSR in patients with VN (n = 41) using pre- and post-FAMSR perceptual acoustic and phonatory function data and videolaryngostroboscopic findings for 33 patients. The mean follow-up time was 18 months. Thirty-three (80.4%) patients displayed excellent results; 4 (9.8%) experienced improvement, and 4 (9.8%) postprocedure failure. Patient phonatory functions showed significant improvements in shimmer, harmonic-to-noise ratio, phonation time (p < 0.05), grade, roughness and breathiness (p < 0.001). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude, and mucosal wave excursion (p < 0.001). Improvements observed through long-term follow-up tended to be less dramatic in patients with recurrent VN than those with nonrecurrent VN. FAMSR is an easy, safe, and fast procedure which should be considered as an option in treating VN patients who either require surgery or do not have the time or perseverance to complete a lengthy program of speech therapy.

Voice analysis and videolaryngostroboscopy in patients with Parkinson's disease.

Parkinson's disease (PD) is clinically characterized by a resting tremor, bradykinesia, cogwheel phenomenon, rigidity, disorder of postural reflexes and especially changes in voice and speech. We studied 30 PD patients who were treated with dopamine and 20 normal subjects as the control group. The parameters of vocal fold edges, glottal closure, vertical levels of cords, amplitude of vibration, mucosal wave, vibratory behavior, phase symmetry, ventricular folds and movements, periodicity, arytenoids and thick mucous were evaluated by videolaryngostroboscopy. The Unified Parkinson's Disease Rating Scale was applied to the patient group. The voices of the patients were evaluated by the Dr.Speech-4 and Spectra-PRO computer programs. Maximum phonation time, fundamental frequency, amplitude and the harmonic-to-noise ratio were recorded and compared with those of the control group. The abnormal videolaryngostroboscopic findings were more frequent in the PD group (70% versus 45%; P<0.05). Voice analysis showed significant differences in the parameters such as maximum phonation time, maximum fundamental frequency, the frequency range and the harmonic-to-noise ratio. We thought that these methods and parameters yielded sufficient information for diagnosis and follow-up of vocal function in patients with PD.

The turbulent noise ratio: an estimation of noise power of the breathy voice using PARCOR analysis.

The degree of turbulent noise in the breathy voice of 25 patients with incomplete glottal closure was determined by PARCOR (PARtial autoCORrelation) analysis. From 10,000 acoustic data points, 44 PARCOR coefficients were calculated to form the residue wave which is representative of the glottal source. The power difference between the residue wave and the original acoustic wave was calculated in order to define a new measurement of acoustic power termed the turbulent noise ratio (TNR). The 25 patients were studied before and after Isshiki thyroplasty type I (IttI). The TNR became smaller in 24 of these patients following IttI, and corresponded closely with acoustic (Fukazawa's Br-Index), aerodynamic (Isshiki's AC/DC ratio), mean airflow rate during phonation, and videolaryngostroboscopic findings. Data affirm that the TNR accurately reflects the degree of turbulent noise at the glottal source.