Psychosocial risk factors which may differentiate between women with Functional Voice Disorder, Organic Voice Disorder and a Control group

This study aimed to explore psychosocial factors contributing to the development of functional voice disorders (FVD) and those differentiating between organic voice disorders (OVD) and a non-voice-disordered control group. A case-control study was undertaken of 194 women aged 18-80 years diagnosed with FVD (n = 73), OVD (n = 55), and controls (n = 66). FVD women were allocated into psychogenic voice disorder (PVD) (n = 37) and muscle tension voice disorder (MTVD) (n = 36) for sub-group analysis. Dependent variables included biographical and voice assessment data, the number and severity of life events and difficulties and conflict over speaking out (COSO) situations derived from the Life Events and Difficulties Schedule (LEDS), and psychological traits including emotional expressiveness scales. Four psychosocial components differentiated between the FVD and control group accounting for 84.9% of the variance: severe events, moderate events, severe COSO, and mild COSO difficulties. Severe events, severe and mild COSO difficulties differentiated between FVD and OVD groups, accounting for 80.5% of the variance. Moderate events differentiated between PVD and MTVD sub-groups, accounting for 58.9% of the variance. Psychological traits did not differentiate between groups. Stressful life events and COSO situations best differentiated FVD from OVD and control groups. More refined aetiological studies are needed to differentiate between PVD and MTVD.

Efficacy of intensive phonatory-respiratory treatment (LSVT) for presbyphonia: two case reports

OBJECTIVES

Research evidence has shown that neither traditional voice therapy nor surgery was efficacious in managing age-related dysphonia, specifically for more severe cases with pronounced fold atrophy or larger glottal gaps. The purpose of this study was to examine the efficacy of intensive respiratory-phonatory treatment (Lee Silverman voice treatment [LSVT]) for glottal incompetence associated with presbyphonia.

STUDY DESIGN

Nonrandomized prospective study.

METHODS

Two subjects with age-related vocal fold bowing received 4 weeks of the LSVT. Strobolaryngoscopic examination, phonatory function measurement, acoustical analyses, and perceptual judgments of voice were obtained at baseline and 2 weeks posttreatment. Additional acoustic measures of phonatory function, including vocal intensity, maximum phonation time, and pitch range, were also obtained during 16 treatment sessions.

RESULTS

Both subjects exhibited significant improvements in glottal closure, phonatory function, acoustic features, and perceptual ratings of voice after treatment. Significant changes of phonatory function measures were noticed relatively early and remained steady throughout the course of treatment.

CONCLUSIONS

These findings provide solid evidence that speakers with age-related vocal fold bowing and dysphonia may improve glottal competence and related vocal function with neither laryngeal trauma nor maladaptive laryngeal hyperfunction after the LSVT.

Evaluating the Autonomic Nervous System in Patients with Laryngopharyngeal Reflux

Objectives

The pathogenesis of laryngopharyngeal reflux (LPR) remains unclear. It is linked to but distinct from gastroesophageal reflux disease (GERD), which has been shown to be related to disturbed autonomic regulation. The aim of this study is to investigate whether autonomic dysfunction also plays a role in the pathogenesis of LPR.

Study Design

Case-control study.

Setting

Tertiary care center.

Subjects and Methods

Seventeen patients with LPR and 19 healthy controls, aged between 19 and 50 years, were enrolled in the study. The patients were diagnosed with LPR if they had a reflux symptom index (RSI) ≥13 and a reflux finding score (RFS) ≥7. Spectral analysis of heart rate variability (HRV) analysis was used to assess autonomic function. Anxiety and depression levels measured by the Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI-II) were also conducted.

Results

In HRV analysis, high frequency (HF) represents the parasympathetic activity of the autonomic nervous system, whereas low frequency (LF) represents the total autonomic activity. There were no significant differences in the LF power and HF power between the 2 groups. However, significantly lower HF% ( P = .003) and a higher LF/HF ratio ( P = .012) were found in patients with LPR, who demonstrated poor autonomic modulation and higher sympathetic activity. Anxiety was also frequently observed in the patient group.

Conclusion

The study suggests that autonomic dysfunction seems to be involved in the pathogenesis of LPR. The potential beneficial effect of autonomic nervous system modulation as a therapeutic modality for LPR merits further investigation.

The impact of laryngeal disorders on work-related dysfunction

OBJECTIVES/HYPOTHESIS

To determine the short-term disability (STD) and lost work productivity related to laryngeal disorders.

STUDY DESIGN

A retrospective analysis of a national database of work absence and STD claims was performed.

METHODS

Patients with 12 months of follow-up who had an STD claim specifically linked to a dysphonia diagnosis based on ICD-9 codes were identified during the period of January 1, 2004, to December 31, 2008. Patient age, sex, and diagnosis and the total number of work days absent were determined. Using the mean national hourly wage, productivity losses in terms of lost wages were calculated.

RESULTS

Of the 18,466 unique patients with an STD claim, 386 (2.1%) had an STD claim due to a laryngeal disorder. The mean age was 45.9 years (standard deviation, 9.6) with 53.2% male. The mean number of work days absent was 39.2 days (95% confidence interval: 31.9-46.5). Total STD payments in 2008 dollars were $647,269.30 with a mean per person in 12 months of $3,406.68. Total and mean lost wages in 12 months were $843,198.72 and $4,437.89, respectively. Patients with laryngeal cancer had the most days absent and highest total STD payment.

CONCLUSIONS

Laryngeal disorders lead to work-related disability with STD and productivity losses and represent a significant societal burden. Managing work limitations from laryngeal disorders is an important public health goal.

Direct health care costs of laryngeal diseases and disorders

OBJECTIVES/HYPOTHESIS

To estimate the annual direct costs associated with the diagnosis and management of laryngeal disorders.

STUDY DESIGN

Retrospective analysis of data from a large, nationally representative, administrative US claims database.

METHODS

Patients with a laryngeal disorder based on International Classification of Diseases,Ninth Revision-Clinical Modification codes from January 1, 2004 to December 31, 2008 and who were continuously enrolled for 12 months were included. Data regarding age, gender, geographic location, and type of physician providing the diagnosis were collected. Medical encounter, medication, and procedure costs were determined. Total and mean costs per person for 12 months were determined.

RESULTS

Of almost 55 million individuals in the database, 309,300 patients with 12 months follow-up, mean age of 47.3 years (standard deviation: 21.3), and 63.5% female were identified. Acute and chronic laryngitis, nonspecific causes of dysphonia, and benign vocal fold lesions were the most common etiologies. The total annual direct costs ranged between $178,524,552 to $294,827,671, with mean costs per person between $577.18 and $953.21. Pharmacy claims accounted for 20.1% to 33.3%, procedure claims 50.4% to 69.9%, and medical encounter claims 16.3% to 8.6% of overall direct costs. Antireflux medication accounted for roughly 10% and antibiotics 6% of annual direct costs.

CONCLUSIONS

This study establishes the economic impact of the assessment and management of patients with laryngeal disorders and permits cost comparisons with other diseases.

Modulation of inflammatory and profibrotic signaling in a rabbit model of acute phonotrauma using triamcinolone

OBJECTIVE

To investigate the hypothesis that prophylactic triamcinolone modulates acute vocal fold inflammatory and profibrotic signaling during acute phonotrauma.

STUDY DESIGN

In vivo rabbit phonation model.

SETTING

Academic medical center.

SUBJECTS AND METHODS

Forty New Zealand white breeder rabbits were randomly assigned to 1 of 4 groups: control (no intervention), no treatment (30 minutes of raised intensity phonation), sham treatment (bilateral intralaryngeal triamcinolone acetonide injection at 0 µg/25 µL followed by 30 minutes of raised intensity phonation), or steroid treatment (bilateral intralaryngeal triamcinolone acetonide injection at 400 µg/25 µL followed by 30 minutes of raised intensity phonation). Quantitative polymerase chain reaction (qPCR) was used to investigate gene expression levels of cyclooxygenase-2 (COX-2), interleukin (IL)-1β, and transforming growth factor (TGF)-β1.

RESULTS

Results revealed a significant main effect for COX-2 (P = .002). Post hoc testing revealed that rabbits receiving no treatment (15.10) had higher COX-2 gene expression than control (5.90; P < .001). There were no significant differences in COX-2 expression between treatment groups. Results revealed a significant main effect for IL-1β (P < .001). Post hoc testing revealed that rabbits receiving no treatment (14.70) had higher IL-1β gene expression than control (6.30) (P = .001). There were no significant differences in IL-1β gene expression between treatment groups. There were no significant differences in TGF-β1 gene expression (P = .525) between treatment and control groups.

CONCLUSION

Given conflicting evidence, further studies are necessary to investigate vocal fold steroid injections prior to and following the induction of phonotrauma. Prophylactic administration of triamcinolone immediately prior to acute phonotrauma resulted in no significant changes in COX-2, IL-1β, and TGF-β1 gene transcript levels.

Coprevalence of anxiety and depression with spasmodic dysphonia: a case-control study

INTRODUCTION

There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD.

MATERIALS AND METHODS

A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis.

RESULTS

One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR]=0.985, 95% confidence interval [CI]=0.59-1.63; and OR=1.314; 95% CI=0.75-2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups.

CONCLUSION

Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate.

The role of psychological distress in laryngopharyngeal reflux patients: a prospective questionnaire study

OBJECTIVES

To determine the role of psychological distress in laryngopharyngeal reflux patients and evaluate the correlation between symptoms, laryngeal signs, pH monitoring results and psychological profile.

DESIGN

Prospective study.

SETTING

Hanyang University Hospital, a university teaching hospital and tertiary referral center.

PARTICIPANTS

One hundred and six patients who were diagnosed with laryngopharyngeal reflux by 24-h ambulatory double probe pH monitoring and 119 healthy controls visiting our health promotion center from January 2006 to June 2007.

MAIN OUTCOME MEASURES

The psychological profile of laryngopharyngeal reflux patients measured by the Symptom Checklist-90-Revised questionnaire were evaluated and compared with those of healthy controls. The correlation between reflux symptom index, reflux finding score, parameters of pH monitoring and the Symptom Checklist-90-Revised profiles were also evaluated.

RESULTS

On the Symptom Checklist-90-Revised questionnaire, the total mean T-scores of the nine symptom dimensions and three global indices of the laryngopharyngeal reflux patients were all below 50. The Global Severity Index, which indicates overall psychological distress, was normal in all of the patients. On comparison with the control group, no statistically significant difference was noted in the psychological profile except on the Somatisation scale where laryngopharyngeal reflux patients showed significantly higher scores. Reflux symptom index showed significant positive correlation with the number of reflux episodes, percentage of time which pH fell below 4 in total positions, and DeMeester score of the upper probe. The nine symptom dimensions and three global indices of Symptom Checklist-90-Revised questionnaire did not show any correlation with reflux symptom index, reflux finding score and the parameters of the 24-h ambulatory double probe pH monitoring.

CONCLUSIONS

Laryngopharyngeal reflux patients did not demonstrate any significant level of psychological distress and their symptom severity showed significant positive correlation with reflux severity.

A senescence accelerated mouse model to study aging in the larynx

Objective: Age-related changes in the larynx lead to significant voice impairment and reduced quality of life. There is a need for aged animal models that have practical generation times to study the fundamental changes and new therapeutics for the aging voice. The senescence accelerated prone mouse strain (SAMP) animals experience rapid aging without any experimental manipulation. The main objective of this study was to demonstrate the use of senescence accelerated mice to study aging in the larynx.

Study Design: Murine model.

Setting: Department of Animal Resources, Emory University.

Subjects and Methods: Larynges from five senescence accelerated prone mice, five normal aging senescence resistant mice, and five C57BL/6 mice were harvested and processed for paraffin sections. Histomorphometry was performed for assessment of collagen and hyaluronic acid distribution. In addition, frozen laryngeal tissue was harvested for transcriptional and translational assessment of collagen-1, using real-time polymerase chain reaction with specific primers and Western blots. Myofibroblast assessment was performed by immunostaining for the presence of α-smooth muscle actin.

Results: The deposition of collagen increased at six months of age in the SAMP vocal fold, and the level of collagen-1 mRNA increased with age. The myofibroblast protein α-smooth muscle actin was also found at a higher concentration in the SAMP vocal tissue. In contrast, the levels of hyaluronic acid in the vocal folds of SAMP mice decreased with age when compared to age-matched C57BL/6 mice.

Conclusion: SAMP mice show accelerated, age-related changes in the vocal fold that were evident at as early as six months of age. The use of senescence accelerated mice offers promise as a model to study age-related laryngeal changes.

Coprevalence and impact of dysphonia and hearing loss in the elderly

OBJECTIVES/HYPOTHESIS

To determine the coprevalence of voice problems and hearing loss in the elderly, to assess whether hearing loss is a risk factor for dysphonia, and to evaluate the quality-of-life impact of dysphonia and hearing loss among the elderly.

STUDY DESIGN

Cross-sectional study of independent living residents in two retirement communities.

METHODS

Main outcome measures include prevalence of dysphonia and hearing loss, Voice Related Quality of Life (VRQOL), Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), and the Center for Epidemiologic Studies Depression (CES-D) scale. Relationships between continuous variables were analyzed with Spearman correlation, between categorical variables with chi-square, and between categorical and continuous variable with analysis of variance (ANOVA) on ranks.

RESULTS

A total of 248 residents responded with a mean age of 82.4 years. Of those, 19.8% had dysphonia, 50.0% had hearing loss, and 10.5% had both. Respondents with hearing loss were more likely to have dysphonia than those without hearing loss (odds ratio = 2.31, 95% confidence interval, 1.19-4.47). Worse VRQOL scores were associated with more impairment on the HHIE-S (Spearman correlation = -0.36, P < .001). Respondents with both dysphonia and hearing loss had greater depression scores than those with neither symptom (median CES-D score 13 vs. 8, P = .03, ANOVA on ranks, Dunn's method, P < .05).

CONCLUSIONS

Voice problems and hearing loss are common in the elderly, adversely impact quality of life, and require simultaneous management.

Primary care approach to dysphonia

Objective: To understand how primary care physicians manage patients with dysphonia and the barriers they face when evaluating patients for voice problems.

Study Design: Cross-sectional survey.

Setting: Primary care community.

Subjects and Methods: A total of 933 internal and family medicine physicians were randomly selected from a database of physicians in a referral basin of a tertiary care medical center and mailed a questionnaire. Questions concerned physician comfort level in recognizing an abnormal voice, their view of the quality of life impact of dysphonia, frequency of evaluating patients for voice problems, barriers to the evaluation of voice problems, reasons for referral, and common treatments prior to referral.

Results: A total of 271 physicians responded, for a response rate of 29.0 percent. Of those who responded, 36.5 percent routinely evaluate their patients for voice problems. Reasons for not evaluating patients for voice problems were patients not complaining about hoarseness, more pressing issues, not feeling comfortable assessing patients for voice problems, and time constraints. Chronic voice changes and not being able to understand patients' speech were the most common reasons for referral. Reflux and allergy treatment were common treatment modalities prior to referral. A total of 67.5 percent of respondents were interested in learning more about voice problems.

Conclusion: Primary care physicians face limitations with respect to evaluating patients for voice problems. Otolaryngologists must continue outreach efforts and collaboration with primary care colleagues in order to enhance the screening for voice problems.

Risk and protective factors for spasmodic dysphonia: a case-control investigation

OBJECTIVES

Spasmodic dysphonia (SD) is a chronic, incurable, and often disabling voice disorder of unknown pathogenesis. The purpose of this study was to identify possible endogenous and exogenous risk and protective factors uniquely associated with SD.

STUDY DESIGN

Prospective, exploratory, case-control investigation.

METHODS

One hundred fifty patients with SD and 150 medical controls (MCs) were interviewed regarding their personal and family histories, environmental exposures, illnesses, injuries, voice use patterns, and general health using a previously vetted and validated epidemiologic questionnaire.

RESULTS

Odds ratios and multiple logistic regression analyses (α<0.15) identified several factors that significantly increased the likelihood of having SD. These factors included (1) a personal history of mumps, blepharospasm, tremor, intense occupational and avocational voice use, and a family history of voice disorders; (2) an immediate family history of meningitis, tremor, tics, cancer, and compulsive behaviors; and (3) an extended family history of tremor and cancer.

CONCLUSIONS

SD is likely multifactorial in etiology, involving both genetic and environmental factors. Viral infections/exposures, along with intense voice use, may trigger the onset of SD in genetically predisposed individuals. Future studies should examine the interaction among genetic and environmental factors to determine the pathogenesis of SD.

Voice disorders and mental health in teachers: a cross-sectional nationwide study

BACKGROUND

Teachers, as professional voice users, are at particular risk of voice disorders. Among contributing factors, stress and psychological tension could play a role but epidemiological data on this problem are scarce. The aim of this study was to evaluate prevalence and cofactors of voice disorders among teachers in the French National Education system, with particular attention paid to the association between voice complaint and psychological status.

METHODS

The source data come from an epidemiological postal survey on physical and mental health conducted in a sample of 20,099 adults (in activity or retired) selected at random from the health plan records of the national education system. Overall response rate was 53%. Of the 10,288 respondents, 3,940 were teachers in activity currently giving classes to students. In the sample of those with complete data (n = 3,646), variables associated with voice disorders were investigated using logistic regression models. Studied variables referred to demographic characteristics, socio-professional environment, psychological distress, mental health disorders (DSM-IV), and sick leave.

RESULTS

One in two female teachers reported voice disorders (50.0%) compared to one in four males (26.0%). Those who reported voice disorders presented higher level of psychological distress. Sex- and age-adjusted odds ratios [95% confidence interval] were respectively 1.8 [1.5-2.2] for major depressive episode, 1.7 [1.3-2.2] for general anxiety disorder, and 1.6 [1.2-2.2] for phobia. A significant association between voice disorders and sick leave was also demonstrated (1.5 [1.3-1.7]).

CONCLUSION

Voice disorders were frequent among French teachers. Associations with psychiatric disorders suggest that a situation may exist which is more complex than simple mechanical failure. Further longitudinal research is needed to clarify the comorbidity between voice and psychological disorders.

Clinical Practice Guideline: Hoarseness (Dysphonia)

Objective:

This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

Purpose:

The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers.

Results

The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures.

Disclaimer:

This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). 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 may not provide the only appropriate approach to diagnosing and managing this problem.

Development of a modified diagnostic classification system for voice disorders with inter-rater reliability study

Diversity in nomenclature and on-going dilemmas over the conceptual bases for the classification of voice disorders make it virtually impossible for the collation and accurate comparison of evidence-based data across different clinical settings. This has significant implications for treatment outcome studies. The first aim of this study was to develop a modified diagnostic classification system for voice disorders with clearly defined operational guidelines by which we might reliably distinguish voice disorders from one another. The second aim was to establish the face validity and reliability of the system as an effective diagnostic tool for the allocation of patients to different diagnostic groups for clinical and research purposes. After the Diagnostic Classification System for Voice Disorders (DCSVD) had been developed, it was used in an inter-rater reliability study for the independent assessment of 53 new consecutive patients referred to the Voice Analysis Clinics of three tertiary hospitals. There were three raters present for the assessment and diagnostic allocation of each patient. The high levels of inter-rater reliability suggest this may be a robust classification system that has good face validity and even at this early stage, strong construct validity.

The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice

The study's objectives were to investigate (1) the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, (2) the distribution of these variables by diagnosis, and (3) the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) in a cohort of new patients presenting to a voice clinic. Data are presented on 160 patients with muscle tension dysphonia (MTD), benign vocal fold lesions, paradoxical vocal fold movement disorder (PVFMD), or glottal insufficiency. Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, 25.0%, 36.9%, and 31.2% of patients showed elevated stress, anxiety, and depression scores, respectively, compared to norms. Patients with PVFMD had the most frequent occurrence-and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety. More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large. Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals.

Voice Therapy Improves Quality of Life in Age-Related Dysphonia: A Case-Control Study

The objective of the study is to determine the efficacy of voice therapy in the treatment of age-related dysphonia. The study was conducted using a retrospective case-control chart review. The medical records of 54 patients older than 60 years diagnosed with age-related dysphonia without complicating diagnoses were reviewed. Patients who chose to undergo voice therapy were grouped as cases. Patients who chose not to undergo voice therapy were grouped as controls. The voice-related quality of life (VRQOL) measure was used to measure outcomes before and after treatment in cases and at a minimum 2-month follow-up in controls. Of the 54 patients, 19 (10 female, 9 male; mean age 73 years) chose to undergo voice therapy and filled in >1 VRQOL questionnaire. Six patients (3 female, 3 male; mean age 66 years) chose not to undergo voice therapy and filled in >1 VRQOL questionnaire. The 19 cases experienced a mean improvement in VRQOL score of 19.21 (2-tailed matched pairs t test P=0.00038) after a mean of 4.1 voice therapy sessions and 5.1 months. The six controls experienced a mean change in VRQOL score of 0.42 (2-tailed matched pairs t test P=0.96) after a mean of 3.3 months. Voice therapy leads to statistically significant improvement in the VRQOL life in elderly patients with age-related dysphonia. It is an efficacious noninvasive therapy for this disease.

The role of psychogenic and psychosocial factors in the development of functional voice disorders

The primary objective of this discussion paper is to review the available evidence for the role of psychogenic and psychosocial factors in the development of functional voice disorders (FVD). Current theoretical models linking these factors to the aetiology of FVD and to vocal hyperfunction are then considered. Since there is a paucity of solid empirical evidence to date, general patterns of evidence derived from single case reports and case series are examined first, followed by those empirical studies using more sophisticated methodologies. The discussion is structured around a framework that includes the following psychosocial areas of enquiry: demographic profiles of individuals with FVD; stressful incidents preceding onset; personality traits; coping styles and psychiatric disorder. Current evidence and associated theoretical models suggest that cognitive, affective, neurophysiological and behavioural aspects culminate in the development of these complex voice disorders. The implications of these findings are discussed with respect to clinical practice and clinical training, with suggestions for future scientific research.

Prevalence of perceived dysphonia in a geriatric population

OBJECTIVES

To characterize geriatric dysphonia, including its prevalence, quality-of-life impairment, and association with overall health status.

DESIGN

A validated survey-based study of geriatric dysphonia.

SETTING

An independent living facility for geriatric individuals.

PARTICIPANTS

The entire population of residents at the facility was offered the survey. The inclusion criterion was aged 65 and older.

MEASUREMENTS

Two survey-based measures were used to characterize dysphonia: a direct question asking whether participants had problems with their voice and a voice-related quality-of-life (V-RQOL) measure. In addition, participants were administered the 12-item Medical Outcomes Study Short Form survey, U.S. version 2.0, a concise survey designed to evaluate overall health status.

RESULTS

The prevalence of dysphonia was 20%. More than 50% of patients with voice problems incurred significant quality-of-life impairment resulting from their dysphonia as measured using V-RQOL scores. The mean total V-RQOL score+/-standard deviation was 89+/-20. Finally, general health measures did not reflect V-RQOL.

CONCLUSION

There is a high prevalence of voice problems in older people, with a large proportion having significantly impaired quality of life related to their dysphonia. General health measures do not reflect V-RQOL, and many individuals may wrongly attribute dysphonia to age-related change alone. Administration of validated instruments for assessing dysphonia is encouraged, because direct questions regarding voice difficulties may not be sensitive to the severity of vocal impairment.