Voice Hygiene Research Articles

Dysphonia in the Elderly: A Comparison of Benign Etiologies of Hoarseness in Two Different Cultures

Objective: The objective of this study was to review the benign causes of hoarseness in the elderly above 60 years of age and to compare them between the two different cultures of Switzerland and Turkey. Material and Method: 140 patients were enrolled in the study, 69 (37 males, 32 females; mean age 66 years) from Berne, Switzerland, and 71 (41 males, 30 females; mean age 63 years) from Izmir, Turkey. Results and Conclusions: In the Berne study group, the most common benign causes of hoarseness registered in the elderly above 60 years of age were vocal cord paralysis (n = 31; 45%) and functional dysphonia (n = 24; 35%). These were followed by benign vocal cord lesions such as Reinke edema, contact granuloma or laryngeal papilloma (n = 4; 6%) and presbyphonia (n = 4; 6%). Laryngopharyngeal reflux was found in 8 patients (12%), 7 of them with functional dysphonia. In the Izmir study group, the most common benign causes of hoarseness detected in the elderly were vocal cord lesions (n = 28; 39%) and vocal cord paralysis (n = 25; 35%). These were followed by functional dysphonia (n = 10; 14%) and presbyphonia (n = 8; 11%). Seven patients (10%) in the Izmir study group were suffering from laryngopharyngeal reflux; this was combined with benign vocal cord lesions or functional dysphonia. The high percentage of patients with vocal cord paralysis is presumed to be due to the consultation having taken place at a tertiary-care center. However, there is a notable difference in the etiologies of vocal cord paralysis between the two compared groups: the paralysis in the Berne group was caused by diagnostic or therapeutic procedures relating to bronchopulmonary malignancies, whereas it was caused by the disease itself in the Izmir group. Organic manifestations of vocal misuse and poor voice hygiene were more frequent in the Izmir group. It may be supposed that the patients in the Swiss group were more careful with their voices and/or consulted their ENT specialists on functional voice disorders before organic lesions developed.

Efficacy of the Accent Method of Voice Therapy

There is an increasing need for studies of efficacy of behavior readjustment therapy procedures in human communicative disorders. Legal, social, scientific and professional considerations point up the need for more careful documentation of the effects of treatment techniques used by phoniatricians and speech-language pathologists. This study is conducted in order to evaluate the efficacy of the accent method of voice therapy (AM). The AM is one of the holistic approaches for behavior readjustment voice therapy. It tackles collectively and simultaneously the various parameters of voice such as pitch, loudness and timbre. The results of intervention utilizing the AM in this clinical trial are assessed in a relatively controlled setup. Patients with voice problems resulting from various etiologic vocal pathologies are distributed randomly into two groups. Group 1 (G1) is given the full aspect of the AM, that is, voice hygiene advice plus the accent exercises to correct the faulty vocal technique (habit). Group 2 (G2) receives only voice hygiene advice. The AM is administered in individual sessions 20 min each, twice a week, while the voice hygiene advice counseling is given once a week. The assessment of the vocal pathology is done following a diagnostic protocol utilizing subjective as well as quasi-objective measures of evaluation. The initial assessment presents the baseline (pretest) data for both groups. The follow-up evaluations are done at mid intervention (mid-test), that is, 10 sessions for G1 and 5 sessions for G2, and at the termination of intervention/therapy (post-test). The difference in improvement between G1 and G2 at the end of the observation was generally significant in favor of G1. There were significant improvements in G1 in certain items specific for the various etiologic categories. The improvement from pretest to mid-test to post-test values followed a linear tendency. The significance of the results is discussed and the conclusions are outlined and criticized.

The Accent Method: Behavior readjustment voice therapy

The place of voice therapy in the management of voice disorders is highlighted, with a summary of the available categories of behavior readjustment voice therapy methods. Most voice therapy programs aim at 2 major targets, voice hygiene advice and correction of the faulty vocal technique. The Accent Method (AM) tackles these two targets in a holistic manner, regarding both the vocal function as well as the communicative behavior. The AM rests on 3 main principles; 1) Optimal abdomino-diaphragmatic breath support, 2) Rhythmic play of accentuated relaxed vowels with progressive carry over to connected speech, 3) Dynamic rhythmic body and arm movements. The technical aspects can be divided into the following groups of exercises: Respiratory, phonatory, and articulatory, given in a hierarchy of escalating difficulty. Facilitatory pedagological recommendations are presented, with guidelines for termination of the therapy and the clinical indications of the AM. Efficacy studies are discussed. Finally an endeavor to explain the rationale and mode of action of the AM is made.

DO AEROBIC INSTRUCTORS EXPERIENCE VOICE PROBLEMS? 1208

The purpose of this study was to evaluate risk factors and the prevalence of voice problems in aerobic instructors. Fifty-four aerobic instructors, mean age 34.1 yrs, completed a voice loss questionnaire. The questionnaire included items related to yrs teaching experience, teaching environment, voice projection, music volume, history of illness, allergies, voice loss, hoarseness, smoking habits, and knowledge of voice hygiene. Results of the questionnaire showed that 44% of the instructors experienced complete or partial voice loss during and/or after instructing. The group experiencing voice loss had a greater number of yrs teaching experience 7.8 vs. 4.9 yrs (p< 0.05). A chi-squared analysis comparing the groups indicated the following symptoms related to voice loss: hoarseness (p = 0.00), sore throat(p = 0.00), and shouting to cue the class (p = 0.00). There was no significant difference between groups for acoustics (p = 0.10), size of facility (p = 0.08), music volume (p = 0.65), microphone usage (p = 0.45), and substitution for other instructors (p = 0.09). It was concluded that aerobic instructors experience a high incidence of voice loss and vocal related problems.

Voice therapy for dysphonia — still more art than science?

ABSTRACT It is estimated that between 16,000–55,000 patients undergo voice therapy for dysphonia in speech and language therapy clinics annually in the UK. Although well‐founded in tradition, the remedial techniques have not been subject to scientific scrutiny. No evaluation of voice therapy efficacy can be possible until established practice has been defined. The aim of this study was, therefore, to assess prevailing treatment strategies for common causes of dysphonia. A questionnaire outlining five typical dysphonia case histories — vocal cord nodules, chronic laryngitis, glottic chink, functional dysphonia and Reinke's oedema — was circulated to 237 UK speech and language therapy managers for completion by the area voice specialist. Respondents were asked to select from 10 offered therapeutic strategies, and to indicate counselling and group therapy approaches. A working definition of consensus was agreed at the outset: &gt;75% = acceptance; &lt;25% = rejection. One hundred and sixty‐three completed responses (69%) were obtained from therapists with a median of 12 years' experience. Most use two to six treatment sessions (up to 30% favoured more than six sessions). Group therapy was rejected as sole management for each condition, but accepted in combination with individual therapy by 60% for vocal nodules. A minority approved its use in combination for Reinke's oedema, chronic laryngitis and glottic chink. Counselling was accepted for all conditions (76–89%). Non‐directive counselling was almost always the most popular option (used significantly more in glottic chink and Reinke's oedema than in chronic laryngitis p&lt;0.0002 and functional dysophonia, p=0.02). A choice of 50 treatment strategies (10 for each of five conditions) was offered. Twelve (24%) were accepted by consensus and nine (18%) were rejected. The remaining 29 strategies fell into a grey area being nether accepted nor rejected. The survey had a high response rate by experienced therapists and is a valid representation of UK practice. Therapists are agreed on the duration of treatment, the inadvisability of group therapy as a sole strategy and of the importance of counselling. The principal conclusion of the study is, however, that the level of agreement in voice treatment strategies is low. Those items which were more general, such as voice hygiene, lifestyle application, relaxation and breath support, being the most widely agreed upon. Of the more ‘voice specific’ measures only one achieved consensus at the 75% level, i.e. reduction of hard glottic attack in vocal nodules. The variation in clinical practice among speech and language therapists reflects the lack of scientific basis for treatment selection. The results do, however, highlight the more commonly used strategies which should be given priority in the design of studies on the efficacy of voice therapy for dysphonia.