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Angadi V, Dressler E, Kudrimoti M, Valentino J, Aouad R, Gal T, Stemple J. Efficacy of Voice Therapy in Improving Vocal Function in Adults Irradiated for Laryngeal Cancers: A Pilot Study. J Voice 2019; 34:962.e9-962.e18. [PMID: 31235195 DOI: 10.1016/j.jvoice.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation therapy (XRT) for laryngeal cancers causes acute and chronic vocal dysfunction. Although these deleterious effects of XRT are well-established, there is a dearth of research with respect to effective voice rehabilitation following XRT for laryngeal cancers. OBJECTIVE To obtain preliminary data on the efficacy of voice rehabilitation, using vocal function exercises (VFEs) in improving vocal function in adults irradiated for laryngeal cancer. The comparison treatment group (VH) received vocal hygiene counseling. STUDY DESIGN Randomized clinical trial. METHODS Participants were randomized to the VFE + VH or VH group. Both interventions lasted 6 weeks. The primary outcome measure was improvement in VHI scores. Secondary outcome measures included auditory-perceptual assessments, acoustic and aerodynamic measures, and laryngeal imaging. RESULTS Ten participants were recruited for the study. The VFE + VH (n = 6) group demonstrated a statistically significant improvement in the primary outcome measure (P = 0.03), as well as select parameters of all secondary outcome measures. The VH (n = 4) group did not demonstrate a statistically significant improvement in primary or secondary outcome measures. CONCLUSIONS This study offers preliminary data for the utility of VFEs in the irradiated laryngeal cancer population. However, findings in the VFE + VH group lack generalizability, secondary to sample heterogeneity, and limited sample size.
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Affiliation(s)
- Vrushali Angadi
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky.
| | - Emily Dressler
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Chandler Medical Center, Lexington, Kentucky
| | - Joseph Valentino
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Rony Aouad
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Thomas Gal
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Stemple
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky
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Effectiveness of Voice Therapy Associated With Electromyographic Biofeedback in Women With Behavioral Dysphonia: Randomized Placebo-Controlled Double-Blind Clinical Trial. J Voice 2019; 33:381.e11-381.e22. [DOI: 10.1016/j.jvoice.2017.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/12/2017] [Indexed: 11/18/2022]
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Bane M, Brown M, Angadi V, Croake DJ, Andreatta RD, Stemple JC. Vocal function exercises for normal voice: With and without semi-occlusion. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:175-181. [PMID: 29614887 PMCID: PMC6207476 DOI: 10.1080/17549507.2017.1416176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying degrees of vocal tract (VT) occlusion used during Vocal Function Exercises (VFEs) on attainment of maximum phonation time (MPT) goals in normal voice. Greater VT occlusion was expected to result in increased MPT. The overarching goal was to determine whether the semi-occluded vocal tract (SOVT) posture used during VFEs could be modified while preserving efficacy. METHOD Twenty-six females ages 18-30 participated in this pre-post longitudinal group study. Participants were randomly assigned to three experimental groups and completed a six-week VFE protocol. The first group performed exercises using the prescribed SOVT posture; the second group used the vowel /o/; group three used the vowel /a/. The primary outcome measure was MPT as performed on the exercise tasks using the assigned vocal tract posture. RESULT MPT significantly improved in the prescribed SOVT group, but did not significantly improve in the modified /o/ and /a/ groups. CONCLUSION The SOVT posture used during VFEs is modifiable to a small extent without significantly undermining efficacy. Changes in MPT are less robust with reduced VT occlusion. Research in a clinical population is warranted.
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Affiliation(s)
- Maria Bane
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Megan Brown
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Daniel J Croake
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Richard D Andreatta
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
| | - Joseph C Stemple
- a Department of Rehabilitation Sciences, University of Kentucky , Lexington , KY , USA
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Ribeiro VV, de Oliveira AG, da Silva Vitor J, Siqueira LTD, Moreira PAM, Brasolotto AG, Silverio KCA. The Effect of a Voice Therapy Program Based on the Taxonomy of Vocal Therapy in Women with Behavioral Dysphonia. J Voice 2019; 33:256.e1-256.e16. [DOI: 10.1016/j.jvoice.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/24/2022]
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Watts CR, Hamilton A, Toles L, Childs L, Mau T. Intervention Outcomes of Two Treatments for Muscle Tension Dysphonia: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:272-282. [PMID: 30950698 DOI: 10.1044/2018_jslhr-s-18-0118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to test the hypothesis that stretch-and-flow voice therapy (SnF) is noninferior to resonant voice therapy (RVT) for speakers with muscle tension dysphonia. Method Participants with primary muscle tension dysphonia were randomly assigned to 1 of 2 treatment groups. Participants received 6 sessions of either SnF or RVT for 6 weeks (1 session per week). Pretreatment and posttreatment audio recordings of sustained vowels and connected speech were acquired. Response to treatment was assessed using the voice handicap index (VHI) as the primary outcome measure. Secondary outcome measures included the acoustic voice quality index, the smoothed cepstral peak prominence, and scales from the Consensus Auditory-Perceptual Evaluation of Voice instrument. Data were analyzed for 21 participants who completed the study (12 in the SnF group, 9 in the RVT group). Results Direction of change for the primary outcome measure and all 3 secondary outcome measures at posttreatment was in the direction of improvement for both SnF and RVT. Confidence intervals for VHI measures did not cross the null effect line on forest plots, suggesting significant effects for both treatments on the primary outcome measure. The effect sizes for pretreatment to posttreatment changes in VHI were large for both treatment groups. Similar results were found for the secondary acoustic outcome measures. There were statistically significant pretreatment to posttreatment changes in the primary and secondary outcome measures for patients receiving both treatments, indicating significant improvement in response to both RVT and SnF. There were no statistically significant differences in pretreatment to posttreatment changes in the primary outcome measure or any secondary outcome measure between the two groups. The within-group pretreatment to posttreatment changes in Consensus Auditory-Perceptual Evaluation of Voice scales did not reach statistical significance for either RVT or SnF. Conclusions Both SnF and RVT produced positive treatment response in speakers with muscle tension dysphonia, with no statistically significant difference in the outcome measures between the two treatments. This suggests that SnF is noninferior to RVT and that both are effective options for treating vocal hyperfunction. Results from this study also support previous findings documenting the sensitivity of multidimensional acoustic measurements to treatment response.
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Affiliation(s)
- Christopher R Watts
- Department of Communication Sciences & Disorders, Texas Christian University, Fort Worth
| | - Amy Hamilton
- Clinical Center for Voice Care, Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Laura Toles
- MGH Institute of Health Professions, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Lesley Childs
- Clinical Center for Voice Care, Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas
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Bane M, Angadi V, Dressler E, Andreatta R, Stemple J. Vocal function exercises for normal voice: The effects of varying dosage. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:37-45. [PMID: 28925286 PMCID: PMC6207485 DOI: 10.1080/17549507.2017.1373858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity. METHOD Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture. RESULT No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups. CONCLUSION High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.
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Affiliation(s)
- Maria Bane
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Vrushali Angadi
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Emily Dressler
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Richard Andreatta
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
| | - Joseph Stemple
- a Rehabilitation Sciences Doctoral Programme , University of Kentucky , Lexington , KY , USA
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Brooks M, McLaughlin E, Shields N. Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:89-100. [PMID: 29090601 DOI: 10.1080/17549507.2017.1387285] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/08/2017] [Accepted: 09/23/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the effects of expiratory muscle strength training on communication and swallowing outcomes in adults with acquired motor based communication and/or swallowing difficulties of any aetiology. METHOD A systematic review was conducted. Six databases (CINAHL, MEDLINE, EMBASE, SPEECHBYTE, AMED and PUBMED) were searched from inception until end of May 2016. Randomised and non-randomised controlled studies and pre-test/post-test studies published in English that investigated the effects of expiratory muscle strength training were included. Study quality was assessed using the PEDro scale. Data were analysed descriptively and effect sizes and associated 95% confidence intervals were calculated. RESULT Seven articles reporting data from five studies were included. Preliminary data suggests expiratory muscle strength training improved airway safety during swallowing in people with dysphagia and increased the strength of the expiratory muscles in all patient groups. There was little evidence to suggest changes in communication outcomes after expiratory muscle strength training. CONCLUSION Speech-language pathologists might consider using expiratory muscle strength training to improve airway safety in adults with swallowing disorders.
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Affiliation(s)
- Marinda Brooks
- a Department of Allied Health , Northern Health , Epping , Australia
| | - Emma McLaughlin
- b School of Allied Health , La Trobe University , Melbourne , Australia , and
- c Department of Allied Health , Castlemaine Health , Castlemaine , Australia
| | - Nora Shields
- a Department of Allied Health , Northern Health , Epping , Australia
- b School of Allied Health , La Trobe University , Melbourne , Australia , and
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Sundram ER, Norsa'adah B, Mohamad H, Moy FM, Husain NRN, Shafei MN. The Effectiveness of a Voice Care Program Among Primary School Teachers in Northeastern Malaysia. Oman Med J 2019; 34:49-55. [PMID: 30671184 PMCID: PMC6330182 DOI: 10.5001/omj.2019.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives We sought to determine the effectiveness of a voice care program among primary school teachers in a northeastern district in Malaysia. Methods We conducted a randomized community trial in eight primary schools in a northeastern district in Malaysia. The self-administered and validated Malay-Voice Handicap Index-10 (M-VHI-10) questionnaire was used to assess overall voice handicap scores pre-intervention and eight weeks post-intervention. Teachers with a score of five or more (n = 86) were randomized into intervention (n = 41) and control groups (n = 45). The intervention group received portable voice amplifiers and vocal hygiene instruction, which was delivered by lectures and a booklet. The control group was not prescribed any intervention. Results The sociodemographic, lifestyle, and occupational characteristics of the teachers (except maximum number of students per class) were similar between both groups. The baseline M-VHI-10 scores between both groups were also comparable. After the intervention phase, there was a significant effect observed in the total M-VHI-10 scores (p = 0.021, F-stat (df): 5.33 (1,79)) between both groups after controlling for the maximum number of students per class. Conclusions Our results support the use of voice amplification in adjunct with vocal hygiene instruction as a prevention and treatment modality to reduce voice handicap among teachers. Our study demonstrated encouraging evidence on the low-cost voice care program as well as the success of group and workplace-based approaches in the school setting.
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Affiliation(s)
- Esther Rishma Sundram
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Bachok Norsa'adah
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Hazama Mohamad
- Department of Otorhinolaryngology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Foong Ming Moy
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Nazri Shafei
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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Effects of Vocal Function Exercises: A Systematic Review. J Voice 2019; 33:124.e13-124.e34. [DOI: 10.1016/j.jvoice.2017.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/08/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022]
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Van Stan JH, Dijkers MP, Whyte J, Hart T, Turkstra LS, Zanca JM, Chen C. The Rehabilitation Treatment Specification System: Implications for Improvements in Research Design, Reporting, Replication, and Synthesis. Arch Phys Med Rehabil 2019; 100:146-155. [PMID: 30267666 PMCID: PMC6452635 DOI: 10.1016/j.apmr.2018.09.112] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/30/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022]
Abstract
Despite significant advances in measuring the outcomes of rehabilitation interventions, little progress has been made in specifying the therapeutic ingredients and processes that cause measured changes in patient functioning. The general approach to better clarifying the process of treatment has been to develop reporting checklists and guidelines that increase the amount of detail reported. However, without a framework instructing researchers in how to describe their treatment protocols in a manner useful to or even interpretable by others, requests for more detail will fail to improve our understanding of the therapeutic process. In this article, we describe how the Rehabilitation Treatment Specification System (RTSS) provides a theoretical framework that can improve research intervention reporting and enable testing and refinement of a protocol's underlying treatment theories. The RTSS framework provides guidance for researchers to explicitly state their hypothesized active ingredients and targets of treatment as well as for how the individual ingredients in their doses directly affect the treatment targets. We explain how theory-based treatment specification has advantages over checklist approaches for intervention design, reporting, replication, and synthesis of evidence in rehabilitation research. A complex rehabilitation intervention is used as a concrete example of the differences between an RTSS-based specification and the Template for Intervention Description and Replication checklist. The RTSS's potential to advance the rehabilitation field can be empirically tested through efforts to use the framework with existing and newly developed treatment protocols.
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Affiliation(s)
- Jarrad H Van Stan
- Harvard Medical School, Boston, MA; Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA; Massachusetts General Hospital Institute of Health Professions, Charlestown, MA.
| | - Marcel P Dijkers
- Wayne State University, Detroit, MI; Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA
| | - Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA
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Santana ER, Araújo TMD, Masson MLV. Self-perception of surface hydration effect on teachers’ voice quality: an intervention study. REVISTA CEFAC 2018. [DOI: 10.1590/1982-021620182068418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Frisancho K, Salfate L, Lizana K, Guzman M, Leiva F, Quezada C. Immediate Effects of the Semi-Occluded Ventilation Mask on Subjects Diagnosed With Functional Dysphonia and Subjects With Normal Voices. J Voice 2018; 34:398-409. [PMID: 30424914 DOI: 10.1016/j.jvoice.2018.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to assess the immediate effects of the semi-occluded ventilation mask (SOVM) in subjects with functional dysphonia and subjects with normal voice. METHODS Sixty-four participants were included in this study (48 women and 16 men). Thirty-one of them were diagnosed with functional dysphonia and 33 with normal voice. All subjects were randomly assigned to one of two conditions: an experimental condition using the SOVM (n = 33) and a control condition with participants not using the SOVM (n = 31). Thus, within both conditions, participants could be either dysphonic or normal-voiced. This produced a total of four different groups: (1) subjects with normal voice with SOVM (n = 17), (2) subjects with normal voice without SOVM (n = 16), (3) dysphonic subjects with SOVM (n = 16), and (4) dysphonic subjects without SOVM (n = 15). All participants underwent aerodynamic, electroglottographic (EGG), and acoustic assessments, and were also asked to assess their own voice, before and after voice exercises. RESULTS Significant differences were found for aerodynamic, EGG, and acoustic variables when comparing SOVM conditions (dysphonic and normal) against control. Cepstral peak prominence and EGG contact quotient showed an increase among dysphonic participants with SOVM. L1-L0 showed an increase for all participants in SOVM condition (dysphonic and normal). Self-perceived resonant voice quality showed an increase for both groups in SOVM condition. Glottal airflow showed a decrease for the dysphonic participants in SOVM condition. Phonation threshold pressure and subglottic pressure showed a decrease for both groups in SOVM condition. CONCLUSION The present study suggests that immediate positive effect could be produced by connected speech phonatory tasks using the SOVM in both dysphonic subjects and subjects with normal voice, the change being greater among the former. SOVM seems to promote an easy voice production and a more efficient phonation.
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Affiliation(s)
- Kharina Frisancho
- Department of EDUCATION, Universidad Nacional de San Agustin, Arequipa, Perú
| | - Lukas Salfate
- Hospital Salvador, Department of otolaryngology, Santiago, Chile
| | - Karla Lizana
- Department of Communication Sciences and Disorders, Universidad de Los Lagos, Osorno, Chile
| | - Marco Guzman
- Universidad de los Andes, CHILE; Department of Otolaryngology, Voice Center, Las Condes Clinic, Santiago, Chile.
| | - Fernando Leiva
- Department of Communication Sciences and Disorders, Universidad Pedro de Valdivia, Santiago, Chile
| | - Camilo Quezada
- Department of Communication Sciences and Disorders, Universidad de Chile, Santiago, Chile
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Guzman M, Acuña G, Pacheco F, Peralta F, Romero C, Vergara C, Quezada C. The Impact of Double Source of Vibration Semioccluded Voice Exercises on Objective and Subjective Outcomes in Subjects with Voice Complaints. J Voice 2018; 32:770.e1-770.e9. [DOI: 10.1016/j.jvoice.2017.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
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Amin MR, Achlatis S, Gherson S, Fang Y, Wang B, Born H, Branski RC, Johnson AM. The Role of Oral Steroids in the Treatment of Phonotraumatic Vocal Fold Lesions in Women. Otolaryngol Head Neck Surg 2018; 160:512-518. [PMID: 30322353 DOI: 10.1177/0194599818804776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES (1) To determine the short-term effectiveness of oral steroids in women with benign vocal fold lesions and (2) to determine the effectiveness of adjuvant oral steroids in women undergoing voice therapy for benign vocal fold lesions. STUDY DESIGN Randomized, double-blind, placebo-controlled clinical trial. SETTING Tertiary voice care center. SUBJECTS AND METHODS Thirty-six patients undergoing voice therapy for the treatment of phonotraumatic vocal fold lesions randomly received either a 4-day course of oral steroids or a placebo prior to initiating voice therapy. Voice Handicap Index-10 (VHI-10) scores, video and audioperceptual analyses, acoustic and aerodynamic analyses at baseline, and patient perception of improvement after a short course of steroids or a placebo and at the conclusion of voice therapy were collected. RESULTS Thirty patients completed the study, of whom 27 (only female) were analyzed. The primary outcome measure, VHI-10, did not improve after the 4-day course of steroids or placebo. Secondary measures similarly showed no improvement with steroids relative to placebo. Voice therapy demonstrated a positive effect on both VHI-10 and patient-perceived improvement of voice in all subjects. CONCLUSION A short course of oral steroids did not benefit women with phonotraumatic vocal fold lesions. In addition, steroids had little beneficial effect when used adjunctively with voice therapy in this patient cohort.
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Affiliation(s)
- Milan R Amin
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Stratos Achlatis
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Shirley Gherson
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA.,2 Rusk Institute of Rehabilitation, New York University School of Medicine, New York, New York, USA
| | - Yixin Fang
- 3 Department of Mathematical Sciences, New Jersey Institute of Technology, Newark, New Jersey, USA.,4 Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York, USA
| | - Binhuan Wang
- 4 Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York, USA
| | - Hayley Born
- 5 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Ryan C Branski
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - Aaron M Johnson
- 1 NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
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Barcelos CB, Silveira PAL, Guedes RLV, Gonçalves AN, Slobodticov LDS, Angelis ECD. Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer. Braz J Otorhinolaryngol 2018; 84:620-629. [PMID: 28882539 PMCID: PMC9452225 DOI: 10.1016/j.bjorl.2017.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach. Objective To evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure. Methods Prospective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1–3 months), medium-term (4–6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index. Results Multiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p < 0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p = 0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased Jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation. Conclusion Vocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy success.
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Ouyoung L(M, Villegas BC, Liu C, Talmor G, Sinha UK. Effects of Resonance Voice Therapy on Hormone-Related Vocal Disorders in Professional Singers: A Pilot Study. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018; 11:1179550618786934. [PMID: 30093799 PMCID: PMC6081754 DOI: 10.1177/1179550618786934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Menstruation-related hormonal alteration can be detrimental to the professional singing voice of women. Resonance Voice Therapy (RVT) has been proven to improve vocal production. However, no research to date has been conducted examining the subjective, acoustic, and stroboscopic effects of RVT on professional female singers having premenstrual or postmenopausal voice disorders. AIM The aim of this study is to compare the vocal effects of RVT with a control cervical-thoracic intervention in healthy female singers during the premenstrual phase as well as in postmenopausal singers and to evaluate which intervention will allow singers to improve vocal performance regardless of changes in hormonal status. DESIGN A randomized study was designed for this research. The research subjects were 20 professional female singers from the Southern California area, USA, with 10 premenstrual subjects in one group and 10 postmenopausal subjects in the other group. Among each group, 5 subjects were randomly selected to receive RVT and the remaining subjects received cervical-thoracic-focused exercises. The therapies consisted of 1 month of daily 15-minute sessions. For premenstrual subjects, voice data were collected at days 25 to 27 of the premenstrual phase during a scheduled initial voice evaluation. Follow-up data were collected during the same phase of the menstrual cycle (days 25-27) after 1 month of exercises. For postmenopausal subjects, voice data were collected at an initial voice evaluation with follow-up after 1 month of the assigned voice treatment. Outcomes were assessed with the singer's voice handicap index (VHI), laryngeal videostroboscopic examination, maximum phonation time (MPT), relative average perturbation (RAP), and pitch range before and following completion of therapies. Alleviation or deterioration percentages were used for statistical analysis. Student t test was used for statistical comparison between therapies. RESULTS The RVT decreased singer's VHI for both premenstrual and postmenopausal subjects by an average of 67%, compared with 7.8% for the cervical-thoracic therapy. The RVT also effectively decreased RAP by an average of 57% when combining the premenstrual and postmenopausal groups. The RVT increased MPT and pitch range among both premenstrual and postmenopausal subjects. The stroboscopic examination did not detect any significant differences between the 2 interventions. CONCLUSIONS The RVT is effective for professional female singers with hormone-related premenstrual and postmenopausal vocal changes. The RVT is suggested as one of the therapeutic approaches for vocal abnormalities in such a population. A larger cohort may be needed for future research. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Laishyang (Melody) Ouyoung
- Keck Medical Center of USC and USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Brenda Capobres Villegas
- Keck Medical Center of USC and USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Changxing Liu
- Keck Medical Center of USC and USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Guy Talmor
- Keck Medical Center of USC and USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Uttam K Sinha
- Keck Medical Center of USC and USC Tina and Rick Caruso Department of Otolaryngology – Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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Atará-Paraquive ÁP, Ángel-Gordillo LF. Amplificación vocal en el ámbito ocupacional educativo: una revisión de la literatura. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.58517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La amplificación vocal se ha utilizado como una herramienta para prevenir desórdenes de voz en profesores.Objetivos. Conocer los cambios reportados sobre el comportamiento vocal cuando los profesores utilizan sistemas de amplificación vocal y hacer una comparación entre el antes y el después de su uso.Materiales y métodos. Se realizó una revisión de artículos en cuatro bases de datos y se seleccionaron 11 bajo criterios de inclusión y exclusión: 3 presentaron un nivel de evidencia IIb, mientras que 8, IV. Se analizó la información de los artículos para recolectar datos sobre los efectos en el comportamiento vocal a nivel perceptivo y acústico frente al uso de amplificación vocal.Resultados. Los participantes tuvieron una reducción en la intensidad y en la frecuencia fundamental con mayores efectos en la población sin desorden de voz. Hubo una disminución significativa de la dosis de distancia a diferencia de la dosis de ciclo. En los cuestionarios se infirió un descenso en síntomas, reducción de la carga vocal y mejora en la comunicación.Conclusión. Los amplificadores de voz sirven para prevenir trastornos de la voz. Investigaciones futuras deberán manejar un rigor investigativo en los niveles de evidencia y un diseño de estudio que permita obtener resultados consistentes en diferentes usuarios de la voz.
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Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis C(CW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg 2018; 158:S1-S42. [DOI: 10.1177/0194599817751030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Libby J. Smith
- University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Masson MLV, de Araújo TM. Protective Strategies Against Dysphonia in Teachers: Preliminary Results Comparing Voice Amplification and 0.9% NaCl Nebulization. J Voice 2018; 32:257.e1-257.e10. [DOI: 10.1016/j.jvoice.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022]
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Assad JP, Gama ACC, Santos JN, de Castro Magalhães M. The Effects of Amplification on Vocal Dose in Teachers with Dysphonia. J Voice 2017; 33:73-79. [PMID: 29122417 DOI: 10.1016/j.jvoice.2017.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/29/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine if voice amplification influenced vocal dose in female teachers with dysphonia. MATERIAL AND METHODS This was an experimental study with comparative intrasubjects in which 15 individuals were compared in two different moments: condition 1 (C1) without voice amplification and condition 2 (C2) with voice amplification. All of them were female, kindergarten and elementary school teachers who presented organic or functional dysphonia. The search was carried out at the school where the teachers work. The professional voice use was considered the teachers' activity for a continuous period of two classes (average recording time of 96 minutes, with no difference in time between C1 and C2). To measure the dose we used the vocal dosimeter composed of a microphone, an accelerometer fixed to the neck, and a portable unit that stores the vocal data. The phonation data (intensity, fundamental frequency, phonation percentage, cycle dose, and distance dose) were analyzed by the equipment software (VoxLog). RESULTS The use of vocal amplification in teachers promotes a reduction of the fundamental frequency (295.6-267.7 Hz), the voice intensity (96.2-93.3 dB sound pressure level), the cycle doses (489.4-345.2 thousand cycles per second), and distance doses (3,800-2,300 m). CONCLUSION The vocal amplification allows the teacher to maintain the same phonation time (phonation percentage) but decreases the number of vocal fold oscillations (cycle dose) and the total distance traveled by the vocal fold tissue during phonation (distance dose), reducing the exposure of the vocal folds to voice trauma.
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Affiliation(s)
- Joana Perpetuo Assad
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Côrtes Gama
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Juliana Nunes Santos
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Physical Therapy, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Minas Gerais, Brazil
| | - Max de Castro Magalhães
- Department of Structural Engineering, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Meerschman I, Van Lierde K, Peeters K, Meersman E, Claeys S, D'haeseleer E. Short-Term Effect of Two Semi-Occluded Vocal Tract Training Programs on the Vocal Quality of Future Occupational Voice Users: "Resonant Voice Training Using Nasal Consonants" Versus "Straw Phonation". JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2519-2536. [PMID: 28837727 DOI: 10.1044/2017_jslhr-s-17-0017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the short-term effect of 2 semi-occluded vocal tract training programs, "resonant voice training using nasal consonants" versus "straw phonation," on the vocal quality of vocally healthy future occupational voice users. METHOD A multigroup pretest-posttest randomized control group design was used. Thirty healthy speech-language pathology students with a mean age of 19 years (range: 17-22 years) were randomly assigned into a resonant voice training group (practicing resonant exercises across 6 weeks, n = 10), a straw phonation group (practicing straw phonation across 6 weeks, n = 10), or a control group (receiving no voice training, n = 10). A voice assessment protocol consisting of both subjective (questionnaire, participant's self-report, auditory-perceptual evaluation) and objective (maximum performance task, aerodynamic assessment, voice range profile, acoustic analysis, acoustic voice quality index, dysphonia severity index) measurements and determinations was used to evaluate the participants' voice pre- and posttraining. Groups were compared over time using linear mixed models and generalized linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. RESULTS No significant time × group interactions were found for any of the outcome measures, indicating no differences in evolution over time among the 3 groups. Within-group effects of time showed a significant improvement in dysphonia severity index in the resonant voice training group, and a significant improvement in the intensity range in the straw phonation group. CONCLUSIONS Results suggest that the semi-occluded vocal tract training programs using resonant voice training and straw phonation may have a positive impact on the vocal quality and vocal capacities of future occupational voice users. The resonant voice training caused an improved dysphonia severity index, and the straw phonation training caused an expansion of the intensity range in this population.
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Affiliation(s)
- Iris Meerschman
- Department of Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Speech, Language and Hearing Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Karen Peeters
- Department of Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Eline Meersman
- Department of Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - Evelien D'haeseleer
- Department of Speech, Language and Hearing Sciences, Ghent University, Belgium
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Van Stan JH, Park SW, Jarvis M, Mehta DD, Hillman RE, Sternad D. Measuring vocal motor skill with a virtual voice-controlled slingshot. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 142:1199. [PMID: 28964079 PMCID: PMC5648563 DOI: 10.1121/1.5000233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 05/30/2023]
Abstract
Successful voice training (e.g., singing lessons) and vocal rehabilitation (e.g., therapy for a voice disorder) involve learning complex, vocal behaviors. However, there are no metrics describing how humans learn new vocal skills or predicting how long the improved behavior will persist post-therapy. To develop measures capable of describing and predicting vocal motor learning, a theory-based paradigm from limb motor control inspired the development of a virtual task where subjects throw projectiles at a target via modifications in vocal pitch and loudness. Ten subjects with healthy voices practiced this complex vocal task for five days. The many-to-one mapping between the execution variables pitch and loudness and resulting target error was evaluated using an analysis that quantified distributional properties of variability: Tolerance, noise, covariation costs (TNC costs). Lag-1 autocorrelation (AC1) and detrended-fluctuation-analysis scaling index (SCI) analyzed temporal aspects of variability. Vocal data replicated limb-based findings: TNC costs were positively correlated with error; AC1 and SCI were modulated in relation to the task's solution manifold. The data suggests that vocal and limb motor learning are similar in how the learner navigates the solution space. Future work calls for investigating the game's potential to improve voice disorder diagnosis and treatment.
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Affiliation(s)
- Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Se-Woong Park
- Department of Biology, Northeastern University, Boston, Massachusetts 02115, USA
| | | | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Dagmar Sternad
- Departments of Biology, Electrical and Computer Engineering, and Physics, Northeastern University, Boston, Massachusetts 02115, USA
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Smith AG, Sandage MJ, Pascoe DD, Plexico LW, Lima IR, Cao G. Elementary School Teachers' Vocal Dose: Muscle Bioenergetics and Training Implications. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1831-1842. [PMID: 28614843 DOI: 10.1044/2016_jslhr-s-16-0193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/29/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers. METHOD Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data-collected via an ambulatory phonation monitor-for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher. RESULTS Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall. CONCLUSIONS Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation.
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Relations Between Self-Regulation Behavior and Vocal Symptoms. J Voice 2017; 31:455-461. [DOI: 10.1016/j.jvoice.2016.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/21/2016] [Accepted: 10/19/2016] [Indexed: 11/24/2022]
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Souza RCD, Masson MLV, Araújo TMD. Efeitos do exercício do trato vocal semiocluído em canudo comercial na voz do professor. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719315516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: verificar os efeitos do exercício de fonação em canudo comercial na voz de professores. Métodos: estudo de intervenção, com grupo único de professores, cego ao avaliador. Os participantes foram solicitados a executar o exercício de fonação em canudo imerso a uma garrafa com água no início do turno de trabalho, por quatro semanas consecutivas. Utilizou-se o parâmetro “grau global de severidade” do protocolo Consenso da avaliação perceptivoauditiva da voz (CAPE-V) para a avaliação perceptivoauditiva, o protocolo de autoavaliação índice de triagem de distúrbios de voz (ITDV) e os efeitos vocais autorreferidos na comparação entre os momentos pré e pós-intervenção. Resultados: a média de idade dos professores foi de 45,28 (± 8,48) anos, variando entre 30 e 58 anos, sendo composta, na sua maioria, pelo sexo feminino (79,3%). A frequência de alteração vocal autorreferida foi 58,6%. Houve decréscimo na média dos escores do CAPE-V e do ITDV na comparação antes e após a intervenção com significância estatística (p<0,05). Na pós-intervenção os efeitos autorreferidos ocorridos mais frequentes foram “melhora na voz”, “menor cansaço” (ambos com 37,9%). Conclusão: o exercício com canudo comercial promoveu melhora na voz dos professores e efeitos benéficos autorreferidos e pode ser utilizado como medida protetora.
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Guzman M, Jara R, Olavarria C, Caceres P, Escuti G, Medina F, Medina L, Madrid S, Muñoz D, Laukkanen AM. Efficacy of Water Resistance Therapy in Subjects Diagnosed With Behavioral Dysphonia: A Randomized Controlled Trial. J Voice 2017; 31:385.e1-385.e10. [DOI: 10.1016/j.jvoice.2016.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Yiu EML, Lo MCM, Barrett EA. A systematic review of resonant voice therapy. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:17-29. [PMID: 27705008 DOI: 10.1080/17549507.2016.1226953] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using resonant voice therapy in treating dysphonia. METHOD Refereed journal papers from 1974 to 2014 were retrieved and reviewed by two independent reviewers using the keywords "Humming, Resonance, Resonant Voice, Semi-occluded or closed tube phonation" using available database systems. Quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULT Thirteen papers met the search criteria. Nine papers were selected by the two reviewers. Two of the papers were randomised-controlled studies and the other seven were observational studies. At least four types of resonant voice therapies were described. They included the Lessac-Madsen Resonant Voice Therapy, Y-Buzz, Resonance Therapy and Humming. The overall level of quality of evidence was graded as "moderate". CONCLUSION There were limited studies that investigated the effectiveness of resonant voice therapy. Most studies were small-scale uncontrolled observational studies with the inclusion of only small samples or specific populations. There is clearly a need for more large-scale randomised controlled studies with a wider range of populations to provide further evidence on the effectiveness of resonant voice training for different populations.
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Affiliation(s)
- Edwin M-L Yiu
- a Voice Research Laboratory, Division of Speech & Hearing Sciences , The University of Hong Kong , Pokfulam, Hong Kong
| | - Marco C M Lo
- a Voice Research Laboratory, Division of Speech & Hearing Sciences , The University of Hong Kong , Pokfulam, Hong Kong
| | - Elizabeth A Barrett
- a Voice Research Laboratory, Division of Speech & Hearing Sciences , The University of Hong Kong , Pokfulam, Hong Kong
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Misono S, Marmor S, Roy N, Mau T, Cohen SM. Factors Influencing Likelihood of Voice Therapy Attendance. Otolaryngol Head Neck Surg 2016; 156:518-524. [PMID: 27879417 DOI: 10.1177/0194599816679941] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To identify factors associated with the likelihood of attending voice therapy among patients referred for it in the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure. Study Design Prospectively enrolled cross-sectional study. Setting CHEER network of community and academic sites. Methods Data were collected on patient-reported demographics, voice-related diagnoses, voice-related handicap (Voice Handicap Index-10), likelihood of attending voice therapy (VT), and opinions on factors influencing likelihood of attending VT. The relationships between patient characteristics/opinions and likelihood of attending VT were investigated. Results A total of 170 patients with various voice-related diagnoses reported receiving a recommendation for VT. Of those, 85% indicated that they were likely to attend it, regardless of voice-related handicap severity. The most common factors influencing likelihood of VT attendance were insurance/copay, relief that it was not cancer, and travel. Those who were not likely to attend VT identified, as important factors, unclear potential improvement, not understanding the purpose of therapy, and concern that it would be too hard. In multivariate analysis, factors associated with greater likelihood of attending VT included shorter travel distance, age (40-59 years), and being seen in an academic practice. Conclusions Most patients reported plans to attend VT as recommended. Patients who intended to attend VT reported different considerations in their decision making from those who did not plan to attend. These findings may inform patient counseling and efforts to increase access to voice care.
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Affiliation(s)
- Stephanie Misono
- 1 Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- 1 Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,2 Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nelson Roy
- 3 Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA
| | - Ted Mau
- 4 Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Seth M Cohen
- 5 Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Tsai YC, Huang S, Che WC, Huang YC, Liou TH, Kuo YC. The Effects of Expiratory Muscle Strength Training on Voice and Associated Factors in Medical Professionals With Voice Disorders. J Voice 2016; 30:759.e21-759.e27. [DOI: 10.1016/j.jvoice.2015.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/22/2015] [Indexed: 12/16/2022]
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80
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Gartner-Schmidt J, Gherson S, Hapner ER, Muckala J, Roth D, Schneider S, Gillespie AI. The Development of Conversation Training Therapy: A Concept Paper. J Voice 2016; 30:563-73. [DOI: 10.1016/j.jvoice.2015.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
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de Campos Moreira T, Gadenz CD, Capobianco DM, Figueiró LR, Ferigolo M, Vissoci JRN, Barros HMT, Cassol M, Pietrobon R. Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis. J Voice 2016; 31:259.e29-259.e40. [PMID: 27545074 DOI: 10.1016/j.jvoice.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation. STUDY DESIGN This study used systematic review and meta-analysis (CRD42013003807). METHODS We included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles. RESULTS A total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix. CONCLUSIONS Dropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.
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82
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Cohen SM, Dupont WD, Courey MS. Quality-of-Life Impact of Non-Neoplastic Voice Disorders: A Meta-Analysis. Ann Otol Rhinol Laryngol 2016; 115:128-34. [PMID: 16514796 DOI: 10.1177/000348940611500209] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We undertook to explore the relationship between non-neoplastic voice disorders and patients' quality of life. Methods: A PubMed search (1966 to 2003) for the terms Voice Handicap Index (VHI), Short Form-36 (SF-36), voice disorders, voice quality, treatment outcome, voice outcome, quality of life, and questionnaires was performed. Raw data were obtained whenever possible. Studies were analyzed by meta-analysis techniques. Results: Of 54 VHI studies identified, 11 were excluded, and of 21 SF-36 studies, 7 were excluded for incomplete data, non-English language, measuring malignant disease, or duplicate publication. Patients with neurologic and inflammatory or traumatic laryngeal disease had worse VHI scores than controls, and those with neurologic laryngeal disease had the most severe impairment (p <.001, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Those with neurologic laryngeal disease had worse SF-36 subdomain scores than did controls in 6 of 8 subdomains (p <.03, Kruskal-Wallis analysis of variance; p <.05, Dunn's method of multiple comparisons). Both patients with neurologic disease and patients with inflammatory or traumatic laryngeal disorders had changes in SF-36 subdomains similar to those of patients with other chronic disease states. Conclusions: Non-neoplastic voice disorders adversely impact patients' voice-related and general quality of life, and neurologic voice disorders have the greatest impact.
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Affiliation(s)
- Seth M Cohen
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Andreetta MD, Adams SG, Dykstra AD, Jog M. Evaluation of Speech Amplification Devices in Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:29-45. [PMID: 26847491 DOI: 10.1044/2015_ajslp-15-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/31/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of selected speech amplification devices in individuals with hypophonia and idiopathic Parkinson's disease (PD). METHOD This study compared the effectiveness of seven devices (ADDvox, BoomVox, ChatterVox, Oticon Amigo, SoniVox, Spokeman, and Voicette) to unamplified speech for 11 participants with PD during conversation in 65-dB SPL multitalker noise, using experience ratings collected from participant questionnaires and speech performance measures (i.e., speech-to-noise ratio [SNR], speech intensity, and intelligibility) obtained from audio recordings. RESULTS Compared with unamplified speech, device use increased SNR by 1.07-4.73 dB SPL and speech intensity by 1.1-5.1 dB SPL, and it significantly increased transcribed intelligibility from 13.8% to 58.9%. In addition, the type of device used significantly affected speech performance measures (e.g., BoomVox was significantly higher than most of the other devices for SNR, speech intensity, and intelligibility). However, experience ratings did not always correspond to performance measures. CONCLUSIONS This study found preliminary evidence of improved speech performance with device use for individuals with PD. A tentative hierarchy is suggested for device recommendations. Future research is needed to determine which measures will predict long-term device acceptance in PD.
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Ouyoung LM, Swanson MS, Villegas BC, Damodar D, Kokot N, Sinha UK. ABCLOVE: Voice therapy outcomes for patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1810-3. [DOI: 10.1002/hed.24322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/03/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Laishyang Melody Ouyoung
- Department of Speech Pathology; Keck Medical Center of University of Southern California; Los Angeles California
| | - Mark S. Swanson
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Brenda Capobres Villegas
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Dhanur Damodar
- Keck School of Medicine - University of Southern California; Los Angeles California
| | - Niels Kokot
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Uttam K. Sinha
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
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85
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Moy FM, Hoe VCW, Hairi NN, Chu AHY, Bulgiba A, Koh D. Determinants and Effects of Voice Disorders among Secondary School Teachers in Peninsular Malaysia Using a Validated Malay Version of VHI-10. PLoS One 2015; 10:e0141963. [PMID: 26540291 PMCID: PMC4634998 DOI: 10.1371/journal.pone.0141963] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 10/15/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia. METHODS This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance. RESULTS In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06). CONCLUSIONS The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.
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Affiliation(s)
- Foong Ming Moy
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Victor Chee Wai Hoe
- Centre for Occupational and Environmental Health-UM, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Hin Yee Chu
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Koh
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei, Brunei Darussalam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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86
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Medical Costs and Productivity Costs Related to Voice Symptoms in Colombian Teachers. J Voice 2015; 29:776.e15-22. [DOI: 10.1016/j.jvoice.2015.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/21/2015] [Indexed: 11/21/2022]
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87
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Teixeira LC, Behlau M. Comparison Between Vocal Function Exercises and Voice Amplification. J Voice 2015; 29:718-26. [DOI: 10.1016/j.jvoice.2014.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
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88
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Schaser AJ, Ciucci MR, Connor NP. Cross-activation and detraining effects of tongue exercise in aged rats. Behav Brain Res 2015; 297:285-96. [PMID: 26477376 DOI: 10.1016/j.bbr.2015.10.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 02/05/2023]
Abstract
Voice and swallowing deficits can occur with aging. Tongue exercise paired with a swallow may be used to treat swallowing disorders, but may also benefit vocal function due to cross-system activation effects. It is unknown how exercise-based neuroplasticity contributes to behavior and maintenance following treatment. Eighty rats were used to examine behavioral parameters and changes in neurotrophins after tongue exercise paired with a swallow. Tongue forces and ultrasonic vocalizations were recorded before and after training/detraining in young and old rats. Tissue was analyzed for neurotrophin content. Results showed tongue exercise paired with a swallow was associated with increased tongue forces at all ages. Gains diminished after detraining in old rats. Age-related changes in vocalizations, neurotrophin 4 (NT4), and brain derived neurotrophic factor (BDNF) were found. Minimal cross-system activation effects were observed. Neuroplastic benefits were demonstrated with exercise in old rats through behavioral improvements and up-regulation of BDNF in the hypoglossal nucleus. Tongue exercise paired with a swallow should be developed, studied, and optimized in human clinical research to treat swallowing and voice disorders in elderly people.
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Affiliation(s)
- Allison J Schaser
- Department of Communication Sciences and Disorders, Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 53706, United States.
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 53706, United States
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, 53706, United States
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89
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Pereira LPDP, Masson MLV, Carvalho FM. Vocal warm-up and breathing training for teachers: randomized clinical trial. Rev Saude Publica 2015; 49:67. [PMID: 26465664 PMCID: PMC4587821 DOI: 10.1590/s0034-8910.2015049005716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of two speech therapy interventions, vocal warm-up and breathing training, focusing on teachers' voice quality.METHODS A single-blind, randomized, parallel clinical trial was conducted. The research included 31 20 to 60-year old teachers from a public school in Salvador, BA, Northeasatern Brazil, with minimum workloads of 20 hours a week, who have or have not reported having vocal alterations. The exclusion criteria were the following: being a smoker, excessive alcohol consumption, receiving additional speech therapy assistance while taking part in the study, being affected by upper respiratory tract infections, professional use of the voice in another activity, neurological disorders, and history of cardiopulmonary pathologies. The subjects were distributed through simple randomization in groups vocal warm-up (n = 14) and breathing training (n = 17). The teachers' voice quality was subjectively evaluated through the Voice Handicap Index (Índice de Desvantagem Vocal, in the Brazilian version) and computerized voice analysis (average fundamental frequency, jitter, shimmer, noise, and glottal-to-noise excitation ratio) by speech therapists.RESULTS Before the interventions, the groups were similar regarding sociodemographic characteristics, teaching activities, and vocal quality. The variations before and after the intervention in self-assessment and acoustic voice indicators have not significantly differed between the groups. In the comparison between groups before and after the six-week interventions, significant reductions in the Voice Handicap Index of subjects in both groups were observed, as wells as reduced average fundamental frequencies in the vocal warm-up group and increased shimmer in the breathing training group. Subjects from the vocal warm-up group reported speaking more easily and having their voices more improved in a general way as compared to the breathing training group.CONCLUSIONS Both interventions were similar regarding their effects on the teachers' voice quality. However, each contribution has individually contributed to improve the teachers' voice quality, especially the vocal warm-up.TRIAL RECORD NCT02102399, "Vocal Warm-up and Respiratory Muscle Training in Teachers".
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90
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Kletzien H, Russell JA, Connor NP. The effects of treadmill running on aging laryngeal muscle structure. Laryngoscope 2015; 126:672-7. [PMID: 26256100 DOI: 10.1002/lary.25520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/06/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms that are consistent with a fast-to-slow transformation in muscle fiber type. STUDY DESIGN Randomized parallel group controlled trial. METHODS Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks. RESULTS Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast-contracting MHCIIL isoform. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx isoforms. CONCLUSION Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-to-slow transition that is characteristic of exercise manipulations in other skeletal muscles. LEVEL OF EVIDENCE NA. Laryngoscope, 126:672-677, 2016.
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Affiliation(s)
- Heidi Kletzien
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - John A Russell
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A
| | - Nadine P Connor
- Department of Surgery, Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, U.S.A.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison, Wisconsin, U.S.A
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91
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Kapsner-Smith MR, Hunter EJ, Kirkham K, Cox K, Titze IR. A Randomized Controlled Trial of Two Semi-Occluded Vocal Tract Voice Therapy Protocols. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:535-49. [PMID: 25675335 PMCID: PMC4610291 DOI: 10.1044/2015_jslhr-s-13-0231] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/28/2014] [Indexed: 05/13/2023]
Abstract
PURPOSE Although there is a long history of use of semi-occluded vocal tract gestures in voice therapy, including phonation through thin tubes or straws, the efficacy of phonation through tubes has not been established. This study compares results from a therapy program on the basis of phonation through a flow-resistant tube (FRT) with Vocal Function Exercises (VFE), an established set of exercises that utilize oral semi-occlusions. METHOD Twenty subjects (16 women, 4 men) with dysphonia and/or vocal fatigue were randomly assigned to 1 of 4 treatment conditions: (a) immediate FRT therapy, (b) immediate VFE therapy, (c) delayed FRT therapy, or (d) delayed VFE therapy. Subjects receiving delayed therapy served as a no-treatment control group. RESULTS Voice Handicap Index (Jacobson et al., 1997) scores showed significant improvement for both treatment groups relative to the no-treatment group. Comparison of the effect sizes suggests FRT therapy is noninferior to VFE in terms of reduction in Voice Handicap Index scores. Significant reductions in Roughness on the Consensus Auditory-Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were found for the FRT subjects, with no other significant voice quality findings. CONCLUSIONS VFE and FRT therapy may improve voice quality of life in some individuals with dysphonia. FRT therapy was noninferior to VFE in improving voice quality of life in this study.
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Affiliation(s)
- Mara R. Kapsner-Smith
- National Center for Voice and Speech, University of Utah, Salt Lake City
- University of Washington, Seattle
| | - Eric J. Hunter
- National Center for Voice and Speech, University of Utah, Salt Lake City
- Michigan State University, East Lansing
| | - Kimberly Kirkham
- National Center for Voice and Speech, University of Utah, Salt Lake City
| | - Karin Cox
- National Center for Voice and Speech, University of Utah, Salt Lake City
| | - Ingo R. Titze
- National Center for Voice and Speech, University of Utah, Salt Lake City
- University of Iowa, Iowa City
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92
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Van Stan JH, Mehta DD, Zeitels SM, Burns JA, Barbu AM, Hillman RE. Average Ambulatory Measures of Sound Pressure Level, Fundamental Frequency, and Vocal Dose Do Not Differ Between Adult Females With Phonotraumatic Lesions and Matched Control Subjects. Ann Otol Rhinol Laryngol 2015; 124:864-74. [PMID: 26024911 DOI: 10.1177/0003489415589363] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls. METHODS Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor. RESULTS Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes. CONCLUSIONS Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.
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Affiliation(s)
- Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - James A Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anca M Barbu
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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93
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Van Stan JH, Roy N, Awan S, Stemple J, Hillman RE. A taxonomy of voice therapy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:101-25. [PMID: 25763678 PMCID: PMC6195037 DOI: 10.1044/2015_ajslp-14-0030] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/30/2014] [Accepted: 02/10/2015] [Indexed: 05/23/2023]
Abstract
PURPOSE Voice therapy practice and research, as in most types of rehabilitation, is currently limited by the lack of a taxonomy describing what occurs during a therapy session (with enough precision) to determine which techniques/components contribute most to treatment outcomes. To address this limitation, a classification system of voice therapy is proposed that integrates descriptions of therapeutic approaches from the clinical literature into a framework that includes relevant theoretical constructs. METHOD Literature searches identified existing rehabilitation taxonomies/therapy classification schemes to frame an initial taxonomic structure. An additional literature search and review of clinical documentation provided a comprehensive list of therapy tasks. The taxonomy's structure underwent several iterations to maximize accuracy, intuitive function, and theoretical underpinnings while minimizing redundancy. The taxonomy was then used to classify established voice therapy programs. RESULTS The taxonomy divided voice therapy into direct and indirect interventions delivered using extrinsic and/or intrinsic methods, and Venn diagrams depicted their overlapping nature. A dictionary was developed of the taxonomy's terms, and 7 established voice therapy programs were successfully classified. CONCLUSION The proposed taxonomy represents an important initial step toward a standardized voice therapy classification system expected to facilitate outcomes research and communication among clinical stakeholders.
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Affiliation(s)
- Jarrad H. Van Stan
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
| | | | | | | | - Robert E. Hillman
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
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94
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van Leer E, Connor NP. Predicting and influencing voice therapy adherence using social-cognitive factors and mobile video. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:164-76. [PMID: 25611762 PMCID: PMC4610279 DOI: 10.1044/2015_ajslp-12-0123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 03/17/2013] [Accepted: 10/23/2014] [Indexed: 05/13/2023]
Abstract
PURPOSE Patient adherence to voice therapy is an established challenge. The purpose of this study was (a) to examine whether adherence to treatment could be predicted from three social-cognitive factors measured at treatment onset: self-efficacy, goal commitment, and the therapeutic alliance, and (b) to test whether the provision of clinician, self-, and peer model mobile treatment videos on MP4 players would influence the same triad of social cognitive factors and the adherence behavior of patients. METHOD Forty adults with adducted hyperfunction with and without benign lesions were prospectively randomized to either 4 sessions of voice therapy enhanced by MP4 support or without MP4 support. Adherence between sessions was assessed through self-report. Social cognitive factors and voice outcomes were assessed at the beginning and end of therapy. Utility of MP4 support was assessed via interviews. RESULTS Self-efficacy and the therapeutic alliance predicted a significant amount of adherence variance. MP4 support significantly increased generalization, self-efficacy for generalization, and the therapeutic alliance. An interaction effect demonstrated that MP4 support was particularly effective for patients who started therapy with poor self-efficacy for generalization. CONCLUSION Adherence may be predicted and influenced via social-cognitive means. Mobile technology can extend therapy to extraclinical settings.
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Tanner K, Nissen SL, Merrill RM, Miner A, Channell RW, Miller KL, Elstad M, Kendall KA, Roy N. Nebulized isotonic saline improves voice production in Sjögren's syndrome. Laryngoscope 2015; 125:2333-40. [PMID: 25781583 DOI: 10.1002/lary.25239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/12/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Shawn L Nissen
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ray M Merrill
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Alison Miner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ron W Channell
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Karla L Miller
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Mark Elstad
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Salt Lake City, Utah, U.S.A.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, U.S.A
| | - Katherine A Kendall
- Division of Otolaryngology, Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, U.S.A
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Watts CR, Diviney SS, Hamilton A, Toles L, Childs L, Mau T. The Effect of Stretch-and-Flow Voice Therapy on Measures of Vocal Function and Handicap. J Voice 2015; 29:191-9. [DOI: 10.1016/j.jvoice.2014.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 11/27/2022]
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97
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Ziegler A, Dastolfo C, Hersan R, Rosen CA, Gartner-Schmidt J. Perceptions of Voice Therapy From Patients Diagnosed With Primary Muscle Tension Dysphonia and Benign Mid-Membranous Vocal Fold Lesions. J Voice 2014; 28:742-52. [DOI: 10.1016/j.jvoice.2014.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
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99
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Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders. J Voice 2014; 28:440-8. [DOI: 10.1016/j.jvoice.2013.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/30/2013] [Indexed: 11/24/2022]
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100
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Abstract
PURPOSE This study investigated whether resonant voice training would enhance facial bone vibration during resonant voice production. METHODS Twelve normal healthy participants undertook four sessions of resonant voice training, each lasted for 30 minutes. Piezoelectric accelerometer was used to measure the vibratory level on the face (nasal bridge and upper lip) and the perilaryngeal area during the production of nasal consonant /m/ and vowels /a/, /i/, and /u/ before and after the resonant voice training. The extents of vibration of these four sounds among these three sites were compared. RESULTS Significant increase in facial bone vibration following resonant voice training was found. The nasal bridge showed a significantly larger magnitude of increase when compared with that at the upper lip. Different sounds were also found to facilitate different magnitude of facial bone vibration. Greater magnitude of facial bone vibration was found with the phonation of /m/, /i/, and /u/ when compared with the phonation of /a/. CONCLUSION Resonant voice training facilitated an increase in facial bone vibration, more so at the nasal bridge area than around the upper lip. This is hypothesized to contribute to the improved resonant voice production. Sounds that involve relatively restricted oropharyngeal cavities facilitated a greater extent of facial bone vibration during resonant voice production.
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