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Buckley DP, Borders JC, Pisegna JM. Muscle Tension Dysphagia: An Expanded Investigation of Clinical Presentations and Swallowing Kinematics. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1802-1810. [PMID: 38573246 DOI: 10.1044/2024_ajslp-23-00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE This study retrospectively examined patient-reported symptoms, quality of life, and swallowing kinematics in individuals with presumed muscle tension dysphagia (MTDg). METHOD Twenty-six individuals met the inclusion criteria. Data were gathered from patient-reported outcome measures (PROs), symptomology, clinician reports of palpation, and hyolaryngeal and hyoid movements measured on a 20-ml thin liquid bolus during videofluoroscopic swallowing studies. RESULTS All PROs were outside of typical limits, except for the Voice Handicap Index-10. Mean hyoid excursion was 1.52 cm (SD = 0.46, range: 0.76-2.43), and hyolaryngeal excursion was 0.77 cm (SD = 0.44, range: -0.42-1.68). A minority of participants (4%-19%) demonstrated atypical hyoid and/or hyolaryngeal excursion compared to the available normative reference value sets. CONCLUSIONS Individuals demonstrated abnormalities in the clinical evaluation of the areas of palpation and reported perilaryngeal discomfort and symptoms of laryngeal hyperresponsiveness, with a negative impact on their quality of life across various PROs. Atypical hyoid and/or hyolaryngeal excursion during swallowing was rare when compared to available normative reference values. The clinical evaluation of MTDg may be enhanced by including components related to muscle tension and laryngeal hyperresponsiveness in order to differentiate MTDg from idiopathic functional dysphagia and lead the patient to the otolaryngology/speech-language pathology clinic for intervention and management.
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Affiliation(s)
- Daniel P Buckley
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology, Boston Medical Center, MA
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Jessica M Pisegna
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology, Boston Medical Center, MA
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2
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Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Smeltzer JCC, Mau T, Shembel AC. Optical Flow Analysis of Paralaryngeal Muscle Movement. Laryngoscope 2024; 134:1792-1801. [PMID: 37772838 PMCID: PMC10947946 DOI: 10.1002/lary.31063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES The paralaryngeal muscles are thought to be hyperfunctional with phonation in patients with primary muscle tension dysphonia (pMTD). However, objective, quantitative tools to assess paralaryngeal movement patterns lack. The objectives of this study were to (1) validate the use of optical flow to characterize paralaryngeal movement patterns with phonation, (2) characterize phonatory optical flow velocities and variability of the paralaryngeal muscles before and after a vocal load challenge, and (3) compare phonatory optical flow measures to standard laryngoscopic, acoustic, and self-perceptual assessments. METHODS Phonatory movement velocities and variability of the paralaryngeal muscles at vocal onsets and offsets were quantified from ultrasound videos and optical flow methods across 42 subjects with and without a diagnosis of pMTD, before and after a vocal load challenge. Severity of laryngoscopic mediolateral supraglottic compression, acoustic perturbation, and ratings of vocal effort and discomfort were also obtained at both time points. RESULTS There were no significant differences in optical flow measures of the paralaryngeal muscles with phonation between patients with pMTD and controls. Patients with pMTD had significantly more supraglottic compression, higher acoustic perturbations, and higher vocal effort and vocal tract discomfort ratings. Vocal load had a significant effect on vocal effort and discomfort but not on supraglottic compression, acoustics, or optical flow measures of the paralaryngeal muscles. CONCLUSION Optical flow methods can be used to study paralaryngeal muscle movement velocity and variability patterns during vocal productions, although the role of the paralaryngeal in pMTD diagnostics (e.g., vocal hyperfunction) remains suspect. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1792-1801, 2024.
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Affiliation(s)
- Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Adrianna C. Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Franzone R, Petrigna L, Signorelli D, Musumeci G. The Relationship between Posture and Muscle Tensive Dysphonia in Teachers: A Systematic Scoping Review. J Funct Morphol Kinesiol 2024; 9:60. [PMID: 38651418 PMCID: PMC11036206 DOI: 10.3390/jfmk9020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Teachers usually present work-related pain such as neck pain. Their posture could be the cause of these problems; indeed, it is often a sway-back posture. Furthermore, teachers can also experience problems with their voice such as dysphonia, specifically muscle tension dysphonia (MTD). This scoping review aims to find the correlation between teachers' posture and MTD. It also studies how a posture-based treatment can influence this disorder. Randomized controlled trials, controlled clinical trials, prospective cohort studies, and cross-sectional studies that considered the relationship between posture and MTD and that included teachers in their sample. The search led to an initial number of 396 articles; after the screening process, a final number of eight articles were included. A total of 303 patients were analyzed and all showed altered alignment of the head around the cervical spine with hypertonus of the cricothyroid, suprahyoid, and sternocleidomastoid muscles. Although MTD is a disorder with a multifactorial etiology, the articles revealed a correlation between posture and MTD related to a forward protraction of the cervical spine with a hypertonus of the laryngeal and hyoid musculature. This study also detected that an intervention in posture could reduce vocal disorders.
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Affiliation(s)
| | | | | | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (R.F.); (L.P.); (D.S.)
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Shembel AC, Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Comstock Smeltzer JC, Mau T. Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography. Laryngoscope 2023; 133:3482-3491. [PMID: 37334857 PMCID: PMC10728340 DOI: 10.1002/lary.30830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES It has been assumed that patients with primary muscle tension dysphonia (pMTD) have more extrinsic laryngeal muscle (ELM) tension, but tools to study this phenomenon lack. Shear wave elastography (SWE) is a potential method to address these shortcomings. The objectives of this study were to apply SWE to the ELMs, compare SWE measures to standard clinical metrics, and determine group differences in pMTD and typical voice users before and after vocal load. METHODS SWE measurements of the ELMs from ultrasound examinations of the anterior neck, supraglottic compression severities from laryngoscopic images, cepstral peak prominences (CPP) from voice recordings, and self-perceptual ratings of vocal effort and discomfort were obtained in voice users with (N = 30) and without (N = 35) pMTD, before and after a vocal load challenge. RESULTS ELM tension significantly increased from rest-to-voiced conditions in both groups. However, the groups were similar in their ELM stiffness levels at SWE at baseline, during vocalization, and post-vocal load. Levels of vocal effort and discomfort and supraglottic compression were significantly higher and CPP was significantly lower in the pMTD group. Vocal load had a significant effect on vocal effort and discomfort but not on laryngeal or acoustic patterns. CONCLUSION SWE can be used to quantify ELM tension with voicing. Although the pMTD group reported significantly higher levels of vocal effort and vocal tract discomfort and, on average, exhibited significantly more severe supraglottic compression and lower CPP values, there were no group differences in levels of ELM tension using SWE. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3482-3491, 2023.
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Affiliation(s)
- Adrianna C. Shembel
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Abur D, Hillman RE, Stepp CE. Auditory-Motor Function Pre- and Post-Therapy in Hyperfunctional Voice Disorders: A Case Series. J Voice 2023:S0892-1997(23)00264-3. [PMID: 37716889 DOI: 10.1016/j.jvoice.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE/HYPOTHESIS Behavioral voice therapy is the most common treatment for hyperfunctional voice disorders (HVDs) but has limited long-term effectiveness since the comprehensive mechanisms underlying HVDs remain unclear. Recent work has implicated disordered sensorimotor integration during speech in some speakers with HVDs and suggests that auditory processing is a key factor to consider in HVD assessment and therapy. The purpose of this case-series study was to assess whether current voice therapy approaches for HVDs resulted in improvements to auditory-motor function. STUDY DESIGN Longitudinal (pre-post) study. METHOD Pre and postvoice therapy for HVDs, 11 speakers underwent an assessment of auditory-motor function via auditory discrimination of vocal pitch, responses to unanticipated auditory perturbations, and responses to predictable auditory perturbations of vocal pitch. RESULTS At the post-therapy session, 10 out of 11 participants demonstrated voice therapy success (via self-reported voice problems and/or auditory-perceptual judgements of voice by a clinician) and eight of the 11 participants demonstrated improvements in at least one measure of auditory discrimination and/or auditory-motor control. Specifically, three speakers demonstrated improvements in auditory discrimination, five speakers demonstrated improved (within typical cutoffs) responses to predictable perturbations, and two speakers demonstrated improvements in both auditory discrimination and auditory-motor measures. CONCLUSIONS Together, these findings support that voice therapy in individuals with HVDs may impact auditory-motor control and highlight the potential benefit of systematically addressing auditory function in voice therapy and assessment for HVDs.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Computational Linguistics, Center for Language and Cognition Groningen, University of Groningen, Groningen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, the Netherlands.
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA; MGH Institute of Health Professions, Boston, MA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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McKenna VS, Patel TH, Kendall CL, Howell RJ, Gustin RL. Voice Acoustics and Vocal Effort in Mask-Wearing Healthcare Professionals: A Comparison Pre- and Post-Workday. J Voice 2023; 37:802.e15-802.e23. [PMID: 34112547 DOI: 10.1016/j.jvoice.2021.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We evaluated voice acoustics and self-perceptual ratings in healthcare workers required to wear face masks throughout their workday. METHODS Eighteen subjects (11 cisgender female, 7 cisgender male; M = 33.72 years, SD = 8.30) completed self-perceptual ratings and acoustic recordings before and after a typical workday. Chosen measures were specific to vocal effort, dysphonia, and laryngeal tension. Mixed effects models were calculated to determine the impact of session, mask type, sex, and their interactions on the set of perceptual and acoustic measures. RESULTS The subjects self-reported a significant increase in vocal effort following the workday. These perceptual changes coincided with an increase in vocal intensity and harmonics-to-noise ratio, but decrease in relative fundamental frequency offset 10. As expected, men and women differed in measures related to fundamental frequency and vocal tract length. CONCLUSION Healthcare professionals wearing masks reported greater vocal symptoms post-workday compared to pre-workday. These symptoms coincided with acoustic changes previously related to vocal effort; however, the degree of change was considered mild. Further research is needed to determine whether vocal hygiene strategies may reduce vocal symptoms in mask-wearing workers.
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Affiliation(s)
- Victoria S McKenna
- Department of Communication Sciences and Disorders, University of Cincinnati; Department of Biomedical Engineering, University of Cincinnati.
| | - Tulsi H Patel
- Department of Communication Sciences and Disorders, University of Cincinnati
| | - Courtney L Kendall
- Department of Communication Sciences and Disorders, University of Cincinnati
| | - Rebecca J Howell
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati
| | - Renee L Gustin
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati
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7
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Serry MA, Alzamendi GA, Zañartu M, Peterson SD. Modeling the influence of the extrinsic musculature on phonation. Biomech Model Mechanobiol 2023; 22:1365-1378. [PMID: 37169957 PMCID: PMC10529543 DOI: 10.1007/s10237-023-01724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
Neck muscles play important roles in various physiological tasks, including swallowing, head stabilization, and phonation. The mechanisms by which neck muscles influence phonation are not well understood, with conflicting reports on the change in fundamental frequency for ostensibly the same neck muscle activation scenarios. In this work, we introduce a reduced-order muscle-controlled vocal fold model, comprising both intrinsic muscle control and extrinsic muscle effects. The model predicts that when the neck muscles pull the thyroid cartilage in the superior-anterior direction (with a sufficiently large anterior component), inferior direction, or inferior-anterior direction, tension in the vocal folds increases, leading to fundamental frequency rise during sustained phonation. On the other hand, pulling in the superior direction, superior-posterior direction, or inferior-posterior direction (with a sufficiently large posterior component) tends to decrease vocal fold tension and phonation fundamental frequency. Varying the pulling force location alters the posture and phonation biomechanics, depending on the force direction. These findings suggest potential roles of particular neck muscles in modulating phonation fundamental frequency, with implications for vocal hyperfunction.
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Affiliation(s)
- Mohamed A Serry
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Gabriel A Alzamendi
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Entre Ríos, 3100, Argentina
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D Peterson
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
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McGlashan J, Aaen M, White A, Sadolin C. A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol. Pilot Feasibility Stud 2023; 9:88. [PMID: 37226281 DOI: 10.1186/s40814-023-01317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT. METHODS/DESIGN In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I-III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions. CONCLUSION This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates. TRIAL REGISTRATION ClinicalTrials.gov website ( NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.
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Affiliation(s)
- Julian McGlashan
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK.
| | - Mathias Aaen
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Anna White
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Cathrine Sadolin
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
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Harris KJ, Jetté ME, Abaza M, Clary MS, Fink DS, Litts JK. Is Thyrohyoid Space Palpation a Reliable and Useful Clinical Tool Within Diagnostic Protocol for Voice Disorders? J Voice 2023:S0892-1997(23)00097-8. [PMID: 37076382 DOI: 10.1016/j.jvoice.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Palpation of the extrinsic laryngeal muscles is a common part of examination performed by otolaryngologists and speech-language pathologists on individuals presenting with voice complaints, thought to aid in diagnosis and treatment planning. While research has identified a significant relationship between thyrohyoid tension and hyperfunctional voice disorders, we are not aware of any studies exploring correlations between thyrohyoid posture during palpation and the full spectrum of voice disorders. This study aims to identify whether patterns in thyrohyoid posture at rest and during phonation can be related to stroboscopic findings and voice disorder diagnoses. METHODS A multidisciplinary team of three laryngologists and three speech-language pathologists participated in data collection during 47 new patient visits for voice complaints. Each patient underwent neck palpation and evaluation of thyrohyoid space at rest and during phonation by two independent raters. Clinicians then used stroboscopy to rate glottal closure and supraglottic activity as part of determining primary diagnosis. RESULTS Strong inter-rater agreement was found for ratings of thyrohyoid space posture both at rest (κ = 0.93) and during phonation (κ = 0.80). Findings revealed no significant correlations between patterns of thyrohyoid posture and laryngoscopic findings or primary diagnoses. CONCLUSIONS Findings suggest that the presented method of laryngeal palpation is a reliable measure for assessing thyrohyoid posture at rest and during phonation. Lack of significant correlation between palpation ratings and other collected measures suggests that this method of palpation is not a useful tool for predicting laryngoscopic findings or voice diagnoses. Laryngeal palpation may still be useful in predicting extrinsic laryngeal muscle tension and guiding treatment planning; however, further research exploring the validity of laryngeal palpation as a measure of extrinsic laryngeal muscle tension is needed, as well as studies that include patient-reported measures and repeated measurements of thyrohyoid posture over time to explore whether thyrohyoid posture is impacted by other factors.
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Affiliation(s)
- Kaila J Harris
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado; Massachusetts Eye and Ear Infirmary, Voice and Speech Laboratory, Boston, Massachusetts.
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Mona Abaza
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Daniel S Fink
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Juliana K Litts
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
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10
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Thomas CM, Rhodes D, Mehta M, Alexander J. Methods of Measuring Laryngeal Muscle Tension in Patients with Muscle Tension Dysphonia: A Scoping Review. J Voice 2023:S0892-1997(23)00106-6. [PMID: 37062641 DOI: 10.1016/j.jvoice.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND In clinical practice and research relating to Muscle Tension Dysphonia (MTD), several laryngeal muscle tension measurement methods are used to diagnose, to identify specific muscle strengths and deficits, and to measure therapeutic outcomes. The variety and reliability of available measurement methods presents challenges within diagnosis and treatment. The lack of methodical standardization presents a barrier to homogeneous practice in this area. There is a need for a comprehensive scoping review of laryngeal muscle tension measurement methods. STUDY DESIGN Scoping review. OBJECTIVES (1) To identify current methods of laryngeal muscle measurement which have been developed or tested with people with MTD; and (2) To identify the construct/s measured, reliability, validity, ability to detect change, efficiency and accessibility of identified methods. METHOD This scoping review was conducted using the Arksey and O'Malley framework. Studies were identified through searches of 4 major databases. The reviewer independently assessed titles, abstracts, and full-text articles. RESULTS Twenty seven papers published from 2000 to 2022 that satisfied the inclusion criteria were selected from 194 studies. The papers showed a variety of approaches with regards to the measurement of laryngeal activity and tension in subjects with MTD. Just over a quarter (25.9%) were reviews of the validity of assessment methods of MTD, including surface electromyography (sEMG), while 22.2% discussed surface electromyography as a measurement of muscle activity in subjects with MTD. 96.3% used a published methodological framework. CONCLUSIONS Assessment methods for Primary MTD are multifaceted, including patient history, laryngoscopic examination, and voice-related musculoskeletal features. Potential use of objective measurement methods, including sEMG, Real Time Elastosonography, Magnetic Resonance Imaging was noted. Due to variability in assessment methods and results, there is a need for greater objective practical methodological standardization to ensure accurate diagnosis, appropriate care, and chart patient progress.
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Affiliation(s)
- Claire M Thomas
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK.
| | - David Rhodes
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Melanie Mehta
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Jill Alexander
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
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11
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Kleiner C, Häsner P, Birkholz P. Intrinsic velocity differences between larynx raising and larynx lowering. PLoS One 2023; 18:e0281877. [PMID: 36795744 PMCID: PMC9934366 DOI: 10.1371/journal.pone.0281877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
In this study, 23 subjects produced cyclic transitions between rounded vowels and unrounded vowels as in /o-i-o-i-o-…/ at two specific speaking rates. Rounded vowels are typically produced with a lower larynx position than unrounded vowels. This contrast in vertical larynx position was further amplified by producing the unrounded vowels with a higher pitch than the rounded vowels. The vertical larynx movements of each subject were measured by means of object tracking in laryngeal ultrasound videos. The results indicate that larynx lowering was on average 26% faster than larynx raising, and that this velocity difference was more pronounced in woman than in men. Possible reasons for this are discussed with a focus on specific biomechanical properties. The results can help to interpret vertical larynx movements with regard to underlying neural control and aerodynamic conditions, and to improve movement models for articulatory speech synthesis.
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Affiliation(s)
- Christian Kleiner
- Institute of Acoustics and Speech Communication, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
- * E-mail:
| | - Patrick Häsner
- Institute of Acoustics and Speech Communication, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
| | - Peter Birkholz
- Institute of Acoustics and Speech Communication, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
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12
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Park Y, Anand S, Gifford SM, Shrivastav R, Eddins DA. Development and Validation of a Single-Variable Comparison Stimulus for Matching Strained Voice Quality Using a Psychoacoustic Framework. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:16-29. [PMID: 36516473 PMCID: PMC10023177 DOI: 10.1044/2022_jslhr-22-00280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Acoustic and perceptual quantification of vocal strain has been a vexing problem for years. To increase measurement rigor, a suitable single-variable matching stimulus for strain was developed and validated, based on the matching stimulus used previously for breathy and rough voice qualities. METHOD A set of 21 comparison stimuli for a single-variable matching task (SVMT) was synthesized based on a speech-shaped sawtooth waveform mixed with speech-shaped noise. Variable bandpass filter gain in mid-to-high frequencies achieved a wide range of computed sharpness (in constant sharpness steps) and served as the independent variable for the SVMT. Ten natural /ɑ/ stimuli with a wide range of the primary voice quality of strain and a minimum of breathiness or roughness were selected and assessed using the SVMT. Natural voice samples and synthetic comparison stimuli were also assessed using a perceptual magnitude estimation (ME) task. RESULTS ME data validated the correspondence of the set of comparison stimuli to varying perceived strain. Perceived strain magnitudes of the comparison stimuli increased significantly and linearly with computed sharpness (r 2 = .99). A linear regression revealed that strain matching values were significantly predicted by computed sharpness (r 2 = .96) and perceived strain magnitudes (r 2 = .95) of the natural voice stimuli. CONCLUSION The perception of vocal strain is strongly associated with computed sharpness and is captured accurately and precisely using an SVMT, in which the independent variable is the bandpass filter gain (in steps of equal sharpness) applied to the comparison stimuli.
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Affiliation(s)
- Yeonggwang Park
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Supraja Anand
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Sophia M. Gifford
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Rahul Shrivastav
- Office of the Provost & Executive Vice President, Indiana University, Bloomington
| | - David A. Eddins
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
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13
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Tulunoğlu S, Cangi ME, Yılmaz G, Polat BN. The Immediate and Long-Term Effects of Tube and Mask+Tube Phonation in Water Exercises and Their Duration as Measured by Electroglottographic and Nasometric Parameters. J Voice 2022:S0892-1997(22)00212-0. [PMID: 35973876 DOI: 10.1016/j.jvoice.2022.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated the immediate effects and their persistence (at 15 minutes) of various durations of semi-occluded vocal tract exercise (SOVTE) (standard tube into water and modified mask+tube into water exercises) as measured by electroglottographic (EGG) and nasometric parameters. METHODS The study included 30 women aged 19 through 28 years with healthy voices, and it comprised five randomly implemented procedures (Ps): P1-tube phonation into water for 5 minutes; P2-tube phonation into water for 10 minutes; P3-tube+ventilation mask phonation into water for 5 minutes; P4-tube+ventilation mask phonation into water for 10 minutes; P5-phonation with ventilation mask for 5 minutes. Fifteen-minute voice rest breaks were provided between each procedure. Nasometric and electroglottographic measurements were taken before, during, immediately after and at 5, 10, and 15 minutes after the exercises, and the recorded measurements were analyzed. RESULTS The immediate effects of P3 and P4 on voice quality showed better performance than the other procedures. Among all the procedures, P1 had the smallest effect on voice quality in terms of nasometric and EGG parameters and the least degree of effect permanence. In all the fluctuating SOVTE procedures except P1, the nasalance scores decreased (P1, P2, P3, and P4: fluctuating SOVTE; P5: steady SOVTE). CONCLUSION The tube phonation exercises modified by the addition of a ventilation mask were highly advantageous in terms of EGG parameters. In addition to this, regardless of the mode of application of the retention time, it was observed that the positive effect (ie, lower vertical laryngeal position) of the exercises applied for 10 minutes was higher than the exercises applied for 5 minutes.
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Affiliation(s)
- Serenay Tulunoğlu
- İstanbul Kent University, Speech and Language Therapy Department, İstanbul, Turkey
| | - M Emrah Cangi
- University Of Health Sciences, Speech and Language Therapy Department, İstanbul, Turkey.
| | - Göksu Yılmaz
- Üsküdar University, Speech and Language Therapy Department, İstanbul, Turkey
| | - Beyza Nur Polat
- Üsküdar University, Speech and Language Therapy Department, İstanbul, Turkey
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14
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Nusseck M, Immerz A, Richter B, Traser L. Vocal Behavior of Teachers Reading with Raised Voice in a Noisy Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158929. [PMID: 35897294 PMCID: PMC9331438 DOI: 10.3390/ijerph19158929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023]
Abstract
(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results.
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15
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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16
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Kolnes LJ. Stressed and Distressed: Potential Underpinnings of Exercise-Related Inspiratory Distress in Adolescent Sport Performers. Phys Ther 2022; 102:6398921. [PMID: 34662404 DOI: 10.1093/ptj/pzab242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/23/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Abstract
UNLABELLED Many adolescent sport performers present with exercise-related respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO). The pathogenic underpinnings of EILO are not fully resolved, and existing behavioral management includes therapies targeting laryngeal physiology whereas surgical interventions target laryngeal anatomical anomalies. Recent findings from research and clinical practice indicate that psychological stress and thoracic breathing co-occur with laryngeal tightness in adolescent sport performers with EILO. This Perspective article theorizes on this potential coexistence. It discusses possible underpinnings of respiratory symptoms (including EILO) and thoracic breathing in adolescent sport performers by considering the effects of various stressors to which adolescent sport performers are exposed, and the impact these may have on the breathing, including in terms of laryngeal narrowing. The effect of stress on the breathing is examined in light of the reciprocal communication between the brain and the body and the relationship between psychological stress and stress responses in the respiratory system mediated by the autonomic nervous system. To inform decision-making and clinical awareness in this area, it may be worth expanding the focus from targeting mainly laryngeal structures to also include constrictions of the airways and the effects of thoracic breathing on the larynx during exercise. The importance of considering respiratory distress from a multidimensional perspective, and of incorporating the complexity of sport performers' psychological and physical experiences in the management of their health and well-being, is emphasized. IMPACT This Perspective adds to the understanding of respiratory distress in populations other than adults, which is important and necessary. LAY SUMMARY Adolescent sport performers are exposed to a number of stressors that may affect breathing and laryngeal narrowing, which in turn may have implications for the management of their overall health and well-being.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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17
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Abur D, Perkell JS, Stepp CE. Impact of Vocal Effort on Respiratory and Articulatory Kinematics. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:5-21. [PMID: 34843405 PMCID: PMC9150749 DOI: 10.1044/2021_jslhr-21-00323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The goal of this study was to examine the effects of increases in vocal effort, without changing speech intensity, on respiratory and articulatory kinematics in young adults with typical voices. METHOD A total of 10 participants completed a reading task under three speaking conditions: baseline, mild vocal effort, and maximum vocal effort. Respiratory inductance plethysmography bands around the chest and abdomen were used to estimate lung volumes during speech, and sensor coils for electromagnetic articulography were used to transduce articulatory movements, resulting in the following outcome measures: lung volume at speech initiation (LVSI) and at speech termination (LVST), articulatory kinematic vowel space (AKVS) of two points on the tongue dorsum (body and blade), and lip aperture. RESULTS With increases in vocal effort, and no statistical changes in speech intensity, speakers showed: (a) no statistically significant differences in LVST, (b) statistically significant increases in LVSI, (c) no statistically significant differences in AKVS measures, and (d) statistically significant reductions in lip aperture. CONCLUSIONS Speakers with typical voices exhibited larger lung volumes at speech initiation during increases in vocal effort, paired with reduced lip displacements. To our knowledge, this is the first study to demonstrate evidence that articulatory kinematics are impacted by modulations in vocal effort. However, the mechanisms underlying vocal effort may differ between speakers with and without voice disorders. Thus, future work should examine the relationship between articulatory kinematics, respiratory kinematics, and laryngeal-level changes during vocal effort in speakers with and without voice disorders. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17065457.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Joseph S. Perkell
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge
| | - Cara E. Stepp
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, MA
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18
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Dabirmoghaddam P, Aghajanzadeh M, Erfanian R, Aghazadeh K, Sohrabpour S, Firouzifar M, Maroufizadeh S, Nikravesh M. Comparative Study of Increased Supraglottic Activity in Normal Individuals and those with Muscle Tension Dysphonia (MTD). J Voice 2021; 35:554-558. [DOI: 10.1016/j.jvoice.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
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19
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Dabirmoghaddam P, Rahmaty B, Erfanian R, Taherkhani S, Hosseinifar S, Satariyan A. Voice Component Relationships with High Reflux Symptom Index Scores in Muscle Tension Dysphonia. Laryngoscope 2020; 131:E1573-E1579. [PMID: 33135806 DOI: 10.1002/lary.29220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To analyze the Reflux Symptom Index (RSI) and the Voice-Related Quality of Life (V-RQOL) scores based on the perceptual and analytical parameters in primary MTD patients with no reflux. STUDY DESIGN Cross-sectional study. METHODS One hundred and eighteen participants, that is, sixty patients with normal voices and fifty-eight patients with primary MTD were recruited in this study. The diagnosis of primary MTD was made by perceptual voice analysis, neck palpation, video-laryngoscopic examination, and exclusion of other etiologies. Acoustic analysis and the GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were evaluated for all participants. The V-RQOL and RSI questionnaires were then given to all participants. RESULTS This study included 118 participants of 29 males (48.3%) and 31 females (51.7%) in the normal group. MTD group also included 27 males (46.6%) and 31 (53.4%) female patients. Mean (SD) RSI and V-RQOL scores were 12.35 (3.84) and 11.09 (2.20) for the normal group, and 22.87 (6.97) and 22.89 (7.94) for the MTD group (P = .000). In the MTD group, V-RQOL had a positive correlation with jitter for /i/ and /u/, Noise to Harmonic Ratio (NHR) for /i/, /a/, and /u/, and Grade, Roughness, and Strain of GRBAS scale (P < .05). In addition, RSI had a positive correlation with Strain in the MTD group (P < .05). CONCLUSION MTD patients in the absence of laryngopharyngeal reflux findings may have high RSI scores. Hence, patients with high RSI scores and disproportionate acoustic and perceptual analysis would require a thorough evaluation of MTD. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1573-E1579, 2021.
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Affiliation(s)
- Payman Dabirmoghaddam
- Associate Professor of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Resident of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Assistant Professor of Otorhinolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Safa Taherkhani
- Department of Biomedical Engineering (Center of Excellence), Amirkabir University of Technology, Tehran, Iran
| | - Shamim Hosseinifar
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Adnan Satariyan
- College of Arts, Law, and Education, University of Tasmania (UTAS), Launceston, Tasmania, Australia
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20
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Venkatraman A, Fujiki RB, Craig BA, Sivasankar MP, Malandraki GA. Determining the Underlying Relationship Between Swallowing and Maximum Vocal Pitch Elevation: A Preliminary Study of Their Hyoid Biomechanics in Healthy Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3408-3418. [PMID: 32966145 PMCID: PMC8582751 DOI: 10.1044/2020_jslhr-20-00125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/21/2020] [Accepted: 07/20/2020] [Indexed: 05/04/2023]
Abstract
Purpose Deficiencies in swallowing (aspiration) and in maximum vocal pitch elevation have been shown to correlate in dysphagia. However, the underlying mechanisms that may explain this relationship are not known. In this study, we compare hyoid kinematics between swallowing and maximum vocal pitch elevation in healthy adults. Method Ten young (M = 21 ± 1.33 years) and eight older (M = 72.85 ± 5.59 years) healthy adults completed trials of maximum vocal pitch elevation (vowels /a/ and /i/) and swallowing (thin liquid and pudding) under videofluoroscopy. Superior and anterior hyoid excursions were obtained using kinematic analysis. Two-way analyses of variance and Spearman rho correlations were used to examine differences and relationships between swallowing and maximum pitch elevation biomechanics. Results Superior hyoid excursion was significantly greater for liquid swallows compared to pitch elevation tasks (/a/ and /i/; p = .002; Cohen's d = 1.28; p = .0179, Cohen's d = 1.03, respectively) and for pudding swallows compared to pitch tasks (p = .000, Cohen's d = 1.64; p = .001, Cohen's d = 1.38, respectively). Anterior hyoid excursion was not significantly different between the two functions, but was overall reduced in the older group (p = .0231, Cohen's d = .90). Furthermore, there was a moderate positive correlation between the degree of superior excursion during liquid swallows and maximum pitch elevation for both vowels (r s = .601, p = .001; r s = .524, p = .003) in young adults, and between the degree of anterior excursion during liquid swallows and pitch elevation for both vowels (r s = .688, p = .001; r s = .530, p = .008) in older adults. Conclusions Swallowing and maximum pitch elevation require similar anterior, but not superior, hyoid excursion in healthy adults. Differential correlations between the two tasks for each age group may be associated with age-related muscle changes. We provide evidence of partially shared biomechanics between swallowing and maximum pitch elevation.
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Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Bruce A. Craig
- Department of Statistics, Purdue University, West Lafayette, IN
| | - M. Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Georgia A. Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
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21
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Azizi Ata N, Khoddami SM, Babaei-Ghazani A, Izadi F, Maroufizadeh S. Strain Elastosonography Measurement in Patients with Primary Muscle Tension Dysphonia Compared with Healthy Speakers: A Pilot Study. J Voice 2020; 36:290.e7-290.e15. [PMID: 33069507 DOI: 10.1016/j.jvoice.2020.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate real-time elastosonography (RTE) to measure strain of the (para)laryngeal muscles in patients with primary muscle tension dysphonia (MTD) and healthy speakers. STUDY DESIGN This is a cross-sectional study. METHODS Ten patients with primary MTD (37.8 ± 10.53 years) and 10 healthy speakers (36.9 ± 9.8 years) participated. Participants were diagnosed as MTD patient or healthy via voice history, voice self-assessment, perceptual voice evaluation, laryngeal palpation, and videostroboscopy. Then, RTE was performed to extract strain index (SI) and strain ratio (SR) for all participants. The RTE was utilized for the suprahyoid, thyrohyoid, and the cricothyroid muscles, both in right and left sides during rest, /a/, and /i/ prolongations. To study the effect of group, task, and interactive effect on the SI and SR, two-way repeated-measures analysis of variance was performed. RESULTS The effect of group on the SI was significant for the right cricothyroid (P ˂ 0.001). Significant effect of group on the SR obtained for the right suprahyoid, left thyrohyoid, and right cricothyroid (P < 0.05). Moreover, the only muscle whose SR was significantly affected by task was the left suprahyoid (P < 0.05). Compared to healthy speakers, the interactive effect was significantly lower in SI for the left cricothyroid, and higher in SR for both the right suprahyoid and left cricothyroid in patients (P < 0.05). CONCLUSIONS The RTE can discriminate patients with primary MTD from healthy subjects in some laryngeal muscles, especially suprahyoid and cricothyroid. It may be regarded as a clinical instrument in the assessment of MTD in future. Further studies with bigger sample size are recommended.
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Affiliation(s)
- Neda Azizi Ata
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran; Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada
| | - Farzad Izadi
- Department of Ear, Nose, Throat, Head and Neck Research Center, Hazrat-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saman Maroufizadeh
- Ph D in Biostatistics, School of Nursing and Midwifery, Gilan University of Medical Sciences, Rasht, Iran
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22
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Kridgen S, Hillman RE, Stadelman-Cohen T, Zeitels S, Burns JA, Hron T, Krusemark C, Muise J, Van Stan JH. Patient-Reported Factors Associated with the Onset of Hyperfunctional Voice Disorders. Ann Otol Rhinol Laryngol 2020; 130:389-394. [PMID: 32909443 DOI: 10.1177/0003489420956379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Prevention, diagnosis, and treatment of hyperfunctional voice disorders would be improved by better understanding their etiological contributing factors. Therefore, this study estimated the prevalence of etiological factors using self-reported data about disorder onset from a large cohort of patients with Phonotraumatic Vocal Hyperfunction (PVH) and Non-Phonotraumatic Vocal Hyperfunction (NPVH). METHODS Retrospective chart review extracted the self-reported rate (gradual, sudden) and events associated (voice use, anxiety/stress, upper respiratory infection [URI]) with disorder onset from 1,577 patients with PVH and 979 patients with NPVH. RESULTS Both patient groups reported a gradual onset more than a sudden onset. Voice use was the most frequently reported event for PVH and the NPVH group self-reported all three events at equal frequency. The largest PVH subgroups were associated with voice use while the NPVH subgroups were associated with only voice use, only URI, or only anxiety/stress. CONCLUSION The results support the general clinical view that PVH is most strongly related to the gradual accumulated effects of phonotrauma, while NPVH has a more heterogeneous etiology. The identified PVH and NPVH subgroups may have clinical relevance and future work could investigate differences in treatment and outcomes among these subgroups.
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Affiliation(s)
- Samantha Kridgen
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Tara Stadelman-Cohen
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Steven Zeitels
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - James A Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Tiffiny Hron
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Carol Krusemark
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Jason Muise
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA
| | - Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.,MGH Institute of Health Professions, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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23
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Lopes LW, França FP, Evangelista DDS, Alves JDN, Vieira VJD, de Lima-Silva MFB, Pernambuco LDA. Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders? J Voice 2020; 36:583.e17-583.e29. [PMID: 32917459 DOI: 10.1016/j.jvoice.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022]
Abstract
AIM To analyze the accuracy of traditional acoustic measurements (F0, perturbation, and noise) and formant measurements in discriminating between women with and without voice disorders, and with different laryngeal disorders. STUDY DESIGN A descriptive, cross-sectional, and retrospective. METHOD Two hundred and sixty women participated. All participants recorded the spoken vowel /Ɛ/ and underwent laryngeal visual examination. Acoustic measures of the mean and standard deviation of the fundamental frequency (F0), jitter, shimmer, glottal-to-noise excitation ratio, and the values of the first three formants (F1, F2, and F3) were obtained. RESULTS Individual acoustic measurements did not demonstrate adequate (<70%) performance when discriminating between women with and without voice disorders. The combination of the standard deviation of the F0, shimmer, glottal-to-noise excitation ratio, F1, F2, and F3 showed acceptable (>70%) performance in classifying women with and without voice disorders. Individual measures of jitter as well as F1 and F3 demonstrated acceptable (>70%) performance when distinguishing women with different laryngeal diagnoses, including without voice disorders (healthy larynges), Reinke's edema, unilateral vocal fold paralysis, and sulcus vocalis. The combination of acoustic measurements showed excellent (>80%) performance when discriminating women without voice disorder from those with Reinke's edema (mean of F0, F1, and F3) and with sulcus vocalis (mean of F0, F1, and F2). CONCLUSIONS Individual formant and traditional acoustic measurements do not demonstrate adequate performance when discriminating between women with and without voice disorders. However, the combination of traditional and formant measurements improves the discrimination between the presence and absence of voice disorders and differentiates several laryngeal diagnoses.
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Affiliation(s)
- Leonardo Wanderley Lopes
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil.
| | - Fernanda Pereira França
- Ph.D Candidate of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Deyverson da Silva Evangelista
- Ph.D Candidate of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Jônatas do Nascimento Alves
- Master degree of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Vinícius Jefferson Dias Vieira
- Post doctorate researcher in the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Maria Fabiana Bonfim de Lima-Silva
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Leandro de Araújo Pernambuco
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
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Fernández S, Garaycochea O, Martinez-Arellano A, Alcalde J. Does More Compression Mean More Pressure? A New Classification for Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2177-2184. [PMID: 32615843 DOI: 10.1044/2020_jslhr-20-00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective The aims of this study were to test the hypothesis that greater supraglottic compression (anteroposterior or lateral) correlates with higher subglottic pressure (SGP) and to develop a classification of muscle tension dysphonia (MTD), based on the degree of supraglottic compression during speech. Method A prospective, cross-sectional study was conducted in a series of 37 consecutive patients diagnosed with MTD with an altered aerodynamic profile characterized by high SGP (more than 90 mmH2O). Supraglottic anteroposterior and lateral compression were categorized in three grades and assessed during the laryngoscopic examination. All patients completed the Spanish Voice Handicap Index (VHI) questionnaire and completed an acoustic and aerodynamic voice assessment. The relationship between compression grade and VHI with SGP was analyzed. Results More than 90% of patients demonstrated some degree of anteroposterior compression, and 67% had some degree of lateral compression. The mean (SD) SGP was 111.03 (16.7) mmH2O, and the mean VHI was 27.86 (12.5). The degree of SGP was statistically different in the different grades of anteroposterior compression, and also anteroposterior compression correlated with an SGP (p < .05). The degree of lateral compression was not correlated with SGP. Neither the degree of anteroposterior or lateral compression nor the value of SGP was found to correlate with VHI. Conclusions Because grade of anteroposterior compression correlates with SGP, these grades can be used for diagnosis and follow-up of MTD patients. To this end and on this basis, we propose a new classification for MTD. Unlike the established classification, our proposed one makes it possible to combine different laryngoscopic features, improving the description of the larynx during phonation.
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Affiliation(s)
- Secundino Fernández
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
| | - Octavio Garaycochea
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
| | | | - Juan Alcalde
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Navarra Clinic, Pamplona, Spain
- Faculty of Medicine, University of Navarra, Pamplona, Spain
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Lowell SY, Colton RH, Kelley RT, Auld M, Schmitz H. Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings. J Voice 2020; 36:361-382. [PMID: 32682682 DOI: 10.1016/j.jvoice.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion. METHOD A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods. Following four baseline probes (1-4), two phases of treatment were implemented over 6 weeks. Respiratory lung volume-based training (RLVT) and subsequent performance was probed at sessions 5 to 7 and laryngeal-based training was added to the RLVT and probed at sessions 8 to 10. Visual biofeedback was used during RLVT to assist the motor learning process. Respiratory outcome measures of lung volume initiation, termination and excursion were objectively measured using respiratory plethysmography (InductoTrace), and cepstral and spectral-based acoustic measures were also determined at each time point. RESULTS All participants showed improvement in one or more respiratory measures as well as reduced acoustic dysphonia severity following phase 1 of RLVT alone. Two participants achieved further marked improvement in acoustic voice measures after laryngeal-based training was added in phase 2 of treatment, but this was generally also accompanied by further improvement or stabilization of respiratory measures. CONCLUSION Results from this preliminary study support the feasibility of RLVT for improving speech breathing behavior, and suggest that RLVT alone can improve objectively measured dysphonia severity.
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Affiliation(s)
- Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
| | - Raymond H Colton
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Richard T Kelley
- Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York
| | - Madeline Auld
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Hanna Schmitz
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
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Groll MD, McKenna VS, Hablani S, Stepp CE. Formant-Estimated Vocal Tract Length and Extrinsic Laryngeal Muscle Activation During Modulation of Vocal Effort in Healthy Speakers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1395-1403. [PMID: 32379521 PMCID: PMC7842116 DOI: 10.1044/2020_jslhr-19-00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/16/2019] [Accepted: 01/28/2020] [Indexed: 05/31/2023]
Abstract
Purpose The goal of this study was to explore the relationships among vocal effort, extrinsic laryngeal muscle activity, and vocal tract length (VTL) within healthy speakers. We hypothesized that increased vocal effort would result in increased suprahyoid muscle activation and decreased VTL, as previously observed in individuals with vocal hyperfunction. Method Twenty-eight healthy speakers of American English produced vowel-consonant-vowel utterances under varying levels of vocal effort. VTL was estimated from the vowel formants. Three surface electromyography sensors measured the activation of the suprahyoid and infrahyoid muscle groups. A general linear model was used to investigate the effects of vocal effort level and surface electromyography on VTL. Two additional general linear models were used to investigate the effects of vocal effort on suprahyoid and infrahyoid muscle activities. Results Neither vocal effort nor extrinsic muscle activity showed significant effects on VTL; however, the degree of extrinsic muscle activity of both suprahyoid and infrahyoid muscle groups increased with increases in vocal effort. Conclusion Increasing vocal effort resulted in increased activation of both suprahyoid and infrahyoid musculature in healthy adults, with no change to VTL.
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Affiliation(s)
- Matti D. Groll
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, & Hearing Sciences, Boston University, MA
| | - Victoria S. McKenna
- Department of Speech, Language, & Hearing Sciences, Purdue University, West Lafayette, IN
| | - Surbhi Hablani
- Department of Speech, Language, & Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, & Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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A Novel Laryngeal Palpatory Scale (LPS) in Patients with Muscle Tension Dysphonia. J Voice 2020; 34:488.e9-488.e27. [DOI: 10.1016/j.jvoice.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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McKenna VS, Hylkema JA, Tardif MC, Stepp CE. Voice Onset Time in Individuals With Hyperfunctional Voice Disorders: Evidence for Disordered Vocal Motor Control. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:405-420. [PMID: 32013664 PMCID: PMC7210440 DOI: 10.1044/2019_jslhr-19-00135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Purpose This study examined vocal hyperfunction (VH) using voice onset time (VOT). We hypothesized that speakers with VH would produce shorter VOTs, indicating increased laryngeal tension, and more variable VOTs, indicating disordered vocal motor control. Method We enrolled 32 adult women with VH (aged 20-74 years) and 32 age- and sex-matched controls. All were speakers of American English. Participants produced vowel-consonant-vowel combinations that varied by vowel (ɑ/u) and plosive (p/b, t/d, k/g). VOT-measured at the release of the plosive to the initiation of voicing-was averaged over three repetitions of each vowel-consonant-vowel combination. The coefficient of variation (CoV), a measure of VOT variability, was also computed for each combination. Results The mean VOTs were not significantly different between the two groups; however, the CoVs were significantly greater in speakers with VH compared to controls. Voiceless CoV values were moderately correlated with clinical ratings of dysphonia (r = .58) in speakers with VH. Conclusion Speakers with VH exhibited greater variability in phonemic voicing targets compared to vocally healthy speakers, supporting the hypothesis for disordered vocal motor control in VH. We suggest future work incorporate VOT measures when assessing auditory discrimination and auditory-motor integration deficits in VH.
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Affiliation(s)
- Victoria S. McKenna
- Department of Speech, Language, & Hearing Sciences, Purdue University, West Lafayette IN
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | | | - Monique C. Tardif
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, MA
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Hosbach-Cannon CJ, Lowell SY, Colton RH, Kelley RT, Bao X. Assessment of Tongue Position and Laryngeal Height in Two Professional Voice Populations. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:109-124. [PMID: 31944876 DOI: 10.1044/2019_jslhr-19-00164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To advance our current knowledge of singer physiology by using ultrasonography in combination with acoustic measures to compare physiological differences between musical theater (MT) and opera (OP) singers under controlled phonation conditions. Primary objectives addressed in this study were (a) to determine if differences in hyolaryngeal and vocal fold contact dynamics occur between two professional voice populations (MT and OP) during singing tasks and (b) to determine if differences occur between MT and OP singers in oral configuration and associated acoustic resonance during singing tasks. Method Twenty-one singers (10 MT and 11 OP) were included. All participants were currently enrolled in a music program. Experimental procedures consisted of sustained phonation on the vowels /i/ and /ɑ/ during both a low-pitch task and a high-pitch task. Measures of hyolaryngeal elevation, tongue height, and tongue advancement were assessed using ultrasonography. Vocal fold contact dynamics were measured using electroglottography. Simultaneous acoustic recordings were obtained during all ultrasonography procedures for analysis of the first two formant frequencies. Results Significant oral configuration differences, reflected by measures of tongue height and tongue advancement, were seen between groups. Measures of acoustic resonance also showed significant differences between groups during specific tasks. Both singer groups significantly raised their hyoid position when singing high-pitched vowels, but hyoid elevation was not statistically different between groups. Likewise, vocal fold contact dynamics did not significantly differentiate the two singer groups. Conclusions These findings suggest that, under controlled phonation conditions, MT singers alter their oral configuration and achieve differing resultant formants as compared with OP singers. Because singers are at a high risk of developing a voice disorder, understanding how these two groups of singers adjust their vocal tract configuration during their specific singing genre may help to identify risky vocal behavior and provide a basis for prevention of voice disorders.
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Affiliation(s)
| | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Raymond H Colton
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Richard T Kelley
- Department of Otolaryngology, Upstate Medical University, Syracuse, NY
| | - Xue Bao
- Department of Speech-Language Pathology, MGH-IHP, Boston, MA
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An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study. J Voice 2019; 35:330.e1-330.e7. [PMID: 31668907 DOI: 10.1016/j.jvoice.2019.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices. METHOD(S) Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale. RESULTS Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method. DISCUSSION These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.
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Lopes LW, de Oliveira Florencio V, Silva POC, da Nóbrega e Ugulino AC, Almeida AA. Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Evaluation of Patients With Voice Disorders. J Voice 2019; 33:381.e23-381.e32. [DOI: 10.1016/j.jvoice.2017.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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McKenna VS, Diaz-Cadiz ME, Shembel AC, Enos NM, Stepp CE. The Relationship Between Physiological Mechanisms and the Self-Perception of Vocal Effort. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:815-834. [PMID: 30969902 PMCID: PMC6802880 DOI: 10.1044/2018_jslhr-s-18-0205] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 11/30/2018] [Indexed: 05/09/2023]
Abstract
Purpose This study aimed to examine the relationship between a large set of hypothesized physiological measures of vocal effort and self-ratings of vocal effort. Method Twenty-six healthy adults modulated speech rate and vocal effort during repetitions of the utterance /ifi/, followed by self-perceptual ratings of vocal effort on a visual analog scale. Physiological measures included (a) intrinsic laryngeal tension via kinematic stiffness ratios determined from high-speed laryngoscopy, (b) extrinsic suprahyoid and infrahyoid laryngeal tension via normalized percent activations and durations derived from surface electromyography, (c) supraglottal compression via expert visual-perceptual ratings, and (d) subglottal pressure via magnitude of neck surface vibrations from an accelerometer signal. Results Individual statistical models revealed that all of the physiological predictors, except for kinematic stiffness ratios, were significantly predictive of self-ratings of vocal effort. However, a combined regression model analysis yielded only 3 significant predictors: subglottal pressure, mediolateral supraglottal compression, and the normalized percent activation of the suprahyoid muscles (adjusted R 2 = .60). Conclusions Vocal effort manifests as increases in specific laryngeal physiological measures. Further work is needed to examine these measures in combination with other contributing factors, as well as in speakers with dysphonia.
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Affiliation(s)
| | | | - Adrianna C. Shembel
- Department of Otolaryngology–Head and Neck Surgery, New York University Langone Medical Center and Voice Center, New York
| | - Nicole M. Enos
- Department of Biomedical Engineering, Boston University, MA
- Department of Electrical and Computer Engineering, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, MA
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Detection of Muscle Tension Dysphonia Using Eulerian Video Magnification: A Pilot Study. J Voice 2019; 34:622-628. [PMID: 30917886 DOI: 10.1016/j.jvoice.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/14/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether Eulerian Video Magnification software is useful in diagnosis of muscle tension dysphonia (MTD). STUDY DESIGN Prospective. METHODS Adult patients scheduled in a tertiary care laryngology practice for evaluation of dysphonia were recruited between November 2016 and March 2017. Demographic and clinical data were extracted from patient charts. Diagnosis of MTD was confirmed with videostroboscopic and physical exam and by a speech-language pathologist. Eighteen MTD patients were video recorded while at rest and with phonation. Five patients without MTD also were analyzed as controls. Videos were analyzed using Eulerian Video Magnification software (Massachusetts Institute of Technology) to assess change in blood flow at the forehead, infrahyoid muscles, and sternocleidomastoid muscles, while using the values of the background wall as a control value. RESULTS Patients with MTD demonstrated little change in perfusion to the infrahyoid muscles of the neck while phonating (+1% ± 55%). Control subjects demonstrated an increase in perfusion to the infrahyoid muscles while phonating (+102% ± 164%), with this change being significant when comparing the two groups (P = 0.04, t = 2.189, df = 21). A change in perfusion of 0% or less to infrahyoid muscles was 75% sensitive and 70% specific for diagnosis of MTD. No differences in perfusion were found between other regions assessed. Patient age and gender did not correlate with any change in perfusion between rest and phonation. CONCLUSION Our data suggest that Eulerian Video Magnification can be used in the diagnosis of MTD by focusing on the difference in perfusion to the infrahyoid muscles between rest and phonation.
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McGarey PO, Barone NA, Freeman M, Daniero JJ. Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem. OTO Open 2018; 2:2473974X18795671. [PMID: 31535069 PMCID: PMC6737875 DOI: 10.1177/2473974x18795671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/20/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD). Study Design Retrospective chart review performed over a 14-month period from October 2014 to December 2015. Setting Voice and swallowing center of a tertiary academic medical center. Subjects and Methods Thirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures. Results Among patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia (P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia (P = .002). Conclusions Patients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.
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Affiliation(s)
- Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nicholas A Barone
- Curry School of Education, Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Pettit NJ, Auvenshine RC. Change of hyoid bone position in patients treated for and resolved of myofascial pain. Cranio 2018; 38:74-90. [DOI: 10.1080/08869634.2018.1493178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nathan J. Pettit
- MedCenter TMJ, PC, Houston, TX, USA
- TMD/Orofacial Pain Clinic, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Ronald C. Auvenshine
- MedCenter TMJ, PC, Houston, TX, USA
- TMD/Orofacial Pain Clinic, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- University of Texas Health Science Center, School of Dentistry, Houston, TX, USA
- Louisiana State University, School of Dentistry, New Orleans, LA, USA
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Kolnes LJ, Stensrud T. Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications. Physiother Theory Pract 2018; 35:1170-1181. [PMID: 29757061 DOI: 10.1080/09593985.2018.1474306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures. Informed by knowledge from physical therapy, as well as the fields of voice rehabilitation and vocal pedagogy, this theoretical article presents a novel way of understanding and managing EILO by exploring bodily mechanisms and structures that may disturb laryngeal function during strenuous exercise. Firstly, the status quo of the EILO diagnosis, its aetiology and treatment options are reviewed. Secondly, considerations associated with laryngeal structures and mechanisms, and their potential influence on laryngeal movement and sensitivity are examined. Thirdly, the manner in which postural de-alignment and breathing pattern may interfere with laryngeal functioning will be discussed. Finally, interventions for voice disorders and singing and the relevance of these for EILO are evaluated. It is argued that clients with EILO should undergo a thorough physical examination to identify constrictions in the body as a whole - such as postural de-alignments and a dysfunctional breathing pattern - as these are hypothesized as playing a critical role in laryngeal tightness during exercise. Physical therapists possess particular skills and competence with regard to examining breathing patterns and postural de-alignments, and should be included in the treatment process of EILO.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of health, Norwegian Institute of Sports Medicine, Oslo, Norway
| | - Trine Stensrud
- Department of Sports medicine, The Norwegian School of Sport Sciences, Oslo, Norway
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DePietro JD, Rubin S, Stein DJ, Golan H, Noordzij JP. Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia. Dysphagia 2018; 33:468-473. [PMID: 29372358 DOI: 10.1007/s00455-018-9875-x] [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] [Received: 01/09/2017] [Accepted: 01/05/2018] [Indexed: 11/29/2022]
Abstract
The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.
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Affiliation(s)
- Joseph D DePietro
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Samuel Rubin
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Daniel J Stein
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Hadas Golan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - J Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA.
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Hosseini PS, Karimi MT, Moayedfar S, Golabbakhsh M, Abnavi F. Effects of Minerva Orthosis on Larynx Height in Young, Healthy Volunteers. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2017; 10:1179550617746961. [PMID: 29276420 PMCID: PMC5734566 DOI: 10.1177/1179550617746961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022]
Abstract
Background: During speech, larynx is higher in the neck for high-pitched sounds and lower for low-pitched sounds. Patients with different problems in cervical and cervicothoracic spine use cervical orthosis to limit cervical motion. This study aimed to evaluate the effects of Minerva orthosis on larynx height in young, healthy volunteers. Subjects and methods: This study included 18 subjects. Acoustic measurement of frequency variability has been assessed in 3 brace conditions: (1) without brace, (2) with brace, and (3) 30 minutes after wearing the brace. Results: Several statistically significant differences were found in the comparison between Minerva and 30 minutes after Minerva. Conclusion: When planning cervical orthosis treatment, it is important to consider the reduction in larynx height that may result from bracing for those who are already at risk of developing dysphagia and dysphonia.
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Affiliation(s)
- Pegah Saddat Hosseini
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Taghi Karimi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Moayedfar
- Department of Speech therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Golabbakhsh
- Department of Biomedical Engineering, School of Medicine, McGill University, Montréal, Canada
| | - Fatemeh Abnavi
- Department of Speech therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Kryshtopava M, Van Lierde K, Defrancq C, De Moor M, Thijs Z, D'Haeseleer E, Meerschman I, Vandemaele P, Vingerhoets G, Claeys S. Brain activity during phonation in healthy female singers with supraglottic compression: an fMRI pilot study. LOGOP PHONIATR VOCO 2017; 44:95-104. [PMID: 29219633 DOI: 10.1080/14015439.2017.1408853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This pilot study evaluated the usability of functional magnetic resonance imaging (fMRI) to detect brain activation during phonation in healthy female singers with supraglottic compression. Four healthy female classical singers (mean age: 26 years) participated in the study. All subjects had normal vocal folds and vocal characteristics and showed supraglottic compression. The fMRI experiment was carried out using a block design paradigm. Brain activation during phonation and exhalation was analyzed using Brain Voyager software (Brain Innovation B.V., Maastricht, The Netherlands). An fMRI data analysis showed a significant effect of phonation control in the bilateral pre/postcentral gyrus, and in the frontal, cingulate, superior and middle temporal gyrus, as well as in the parietal lobe, insula, lingual gyrus, cerebellum, thalamus and brainstem. These activation areas are consistent with previous reports using other fMRI protocols. In addition, a significant effect of phonation compared to exhalation control was found in the bilateral superior temporal gyrus, and the pre/postcentral gyrus. This fMRI pilot study allowed to detect a normal pattern of brain activity during phonation in healthy female singers with supraglottic compression using the proposed protocol. However, the pilot study detected problems with the experimental material/procedures that would necessitate refining the fMRI protocol. The phonation tasks were not capable to show brain activation difference between high-pitched and comfortable phonation. Further fMRI studies manipulating vocal parameters during phonation of the vowels /a/ and /i/ may elicit more distinctive hemodynamic response (HDR) activity patterns relative to voice modulation.
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Affiliation(s)
- Maryna Kryshtopava
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Kristiane Van Lierde
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Charlotte Defrancq
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Michiel De Moor
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Zoë Thijs
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Evelien D'Haeseleer
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Iris Meerschman
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Pieter Vandemaele
- c Department of Radiology and Nuclear Medicine , University Hospital Ghent , Ghent , Belgium
| | - Guy Vingerhoets
- d Department of Experimental Psychology , Faculty of Psychology and Educational Sciences, Ghent University , Ghent , Belgium.,e Ghent Institute for functional and Metabolic Imaging (GIfMI) , University Hospital Ghent , Ghent , Belgium
| | - Sofie Claeys
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
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Kryshtopava M, Van Lierde K, Meerschman I, D'Haeseleer E, Vandemaele P, Vingerhoets G, Claeys S. Brain Activity During Phonation in Women With Muscle Tension Dysphonia: An fMRI Study. J Voice 2017; 31:675-690. [DOI: 10.1016/j.jvoice.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022]
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Faralli M, Lapenna R, Pagliari J, Longari F, D’Ascanio L, Ricci G. The effect of speech rehabilitation therapy for muscle tension dysphonia on global postural strategy. HEARING, BALANCE AND COMMUNICATION 2017. [DOI: 10.1080/21695717.2017.1379677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mario Faralli
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology – Head and Neck Surgery, University of Perugia, Perugia, Italy
| | - Ruggero Lapenna
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology – Head and Neck Surgery, University of Perugia, Perugia, Italy
| | - Jenny Pagliari
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology – Head and Neck Surgery, University of Perugia, Perugia, Italy
| | - Fabrizio Longari
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology – Head and Neck Surgery, University of Perugia, Perugia, Italy
| | - Luca D’Ascanio
- Department of Otolaryngology – Head and Neck Surgery, “Carlo Poma” Civil Hospital, Mantova, Italy
| | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology – Head and Neck Surgery, University of Perugia, Perugia, Italy
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Franco D, Fragoso I, Andrea M, Teles J, Martins F. Somatotype and Body Composition of Normal and Dysphonic Adult Speakers. J Voice 2017; 31:132.e9-132.e21. [DOI: 10.1016/j.jvoice.2015.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
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Functional Magnetic Resonance Imaging Study of Brain Activity Associated With Pitch Adaptation During Phonation in Healthy Women Without Voice Disorders. J Voice 2017; 31:118.e21-118.e28. [DOI: 10.1016/j.jvoice.2016.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022]
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Macari AT, Ziade G, Turfe Z, Chidiac A, Alam E, Hamdan AL. Correlation Between the Position of the Hyoid Bone on Lateral Cephalographs and Formant Frequencies. J Voice 2015; 30:757.e21-757.e26. [PMID: 26604010 DOI: 10.1016/j.jvoice.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/27/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study is to examine the F1, F2, F3, and F4 during sustained vowels /ɑ/, /i/, /o/, /u/. STUDY DESIGN Prospective cross-sectional study. METHODS Fifty-two consecutive patients aged between 9 years and 38 years were invited to participate in this study. Linear measurements included linear vertical distance from the hyoid bone to the sella turcica (H-S); linear vertical distance from the hyoid bone to the posterior nasal spine (H-PNS); linear measure from the hyoid bone to the most anterior point of the cervical vertebra C3 (H-C3); and linear vertical distance from the hyoid bone to the mandibular plane (H-MP). RESULTS The results showed a moderate and statistically significant correlation between the average fundamental frequency for the vowel /ɑ/ and H-C3, H-S, and H-PNS and another moderate negative correlation between F3 and F4, and the vertical position of the hyoid bone H-C3 and H-S. For the vowel /i/, there was a moderate negative correlation between F1, F3, and F4 and H-S and also a moderate negative correlation between F3 and F4 and H-C3. For the vowel /o/, there was a moderate negative correlation between F4 and H-S and H-PNS. For the vowel /u/, only F4 correlated significantly with H-S. CONCLUSION There is a moderate correlation between the high formants, mostly F4, and the cephalo-caudal position of the hyoid bone.
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Affiliation(s)
- Anthony T Macari
- Department of Otolaryngology-Head & Neck Surgery, Orthodontics and Dentofacial Orthopedics Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Ziade
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zaahir Turfe
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | | | - Elie Alam
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul-Latif Hamdan
- Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Smith NR, Rivera LA, Dietrich M, Shyu CR, Page MP, DeSouza GN. Detection of Simulated Vocal Dysfunctions Using Complex sEMG Patterns. IEEE J Biomed Health Inform 2015; 20:787-801. [PMID: 26469789 DOI: 10.1109/jbhi.2015.2490087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptoms of voice disorder may range from slight hoarseness to complete loss of voice; from modest vocal effort to uncomfortable neck pain. But even minor symptoms may still impact personal and especially professional lives. While early detection and diagnosis can ameliorate that effect, to date, we are still largely missing reliable and valid data to help us better screen for voice disorders. In our previous study, we started to address this gap in research by introducing an ambulatory voice monitoring system using surface electromyography (sEMG) and a robust algorithm (HiGUSSS) for pattern recognition of vocal gestures. Here, we expand on that work by further analyzing a larger set of simulated vocal dysfunctions. Our goal is to demonstrate that such a system has the potential to recognize and detect real vocal dysfunctions from multiple individuals with high accuracy under both intra and intersubject conditions. The proposed system relies on four sEMG channels to simultaneously process various patterns of sEMG activation in the search for maladaptive laryngeal activity that may lead to voice disorders. In the results presented here, our pattern recognition algorithm detected from two to ten different classes of sEMG patterns of muscle activation with an accuracy as high as 99%, depending on the subject and the testing conditions.
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Khoddami SM, Ansari NN, Jalaie S. Review on Laryngeal Palpation Methods in Muscle Tension Dysphonia: Validity and Reliability Issues. J Voice 2015; 29:459-68. [PMID: 25795346 DOI: 10.1016/j.jvoice.2014.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal palpation is a common clinical method for the assessment of neck and laryngeal muscles in muscle tension dysphonia (MTD). OBJECTIVE To review the available laryngeal palpation methods used in patients with MTD for the assessment, diagnosis, or document of treatment outcomes. STUDY DESIGN (METHOD) A systematic review of the literature concerning palpatory methods in MTD was conducted using the databases MEDLINE (PubMed), ScienceDirect, Scopus, Web of science, Web of knowledge and Cochrane Library between July and October 2013. Relevant studies were identified by one reviewer based on screened titles/abstracts and full texts. Manual searching was also used to track the source literature. RESULTS There were five main as well as miscellaneous palpation methods that were different according to target anatomical structures, judgment or grading system, and using tasks. There were only a few scales available, and the majority of the palpatory methods were qualitative. Most of the palpatory methods evaluate the tension at both static and dynamic tasks. There was little information about the validity and reliability of the available methods. CONCLUSION The literature on the scientific evidence of muscle tension indicators perceived by laryngeal palpation in MTD is scarce. Future studies should be conducted to investigate the validity and reliability of palpation methods.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Watts CR. The Effect of CAPE-V Sentences on Cepstral/Spectral Acoustic Measures in Dysphonic Speakers. Folia Phoniatr Logop 2015; 67:15-20. [DOI: 10.1159/000371656] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Spencer ML. Muscle Tension Dysphonia: A Rationale for Symptomatic Subtypes, Expedited Treatment, and Increased Therapy Compliance. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/vvd25.1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article will briefly identify the variable nature of muscle tension dysphonia (MTD). Causes such as psychogenicity and maladaptive “vocal posture” will be described and questioned. Special Interest Group (SIG) 3 members may benefit from identification of the strengths and weaknesses of an ongoing movement towards a symptomatically generic “MTD.” More specific subtyping of MTD into 9 categories will be proposed, as well as description of associated therapy methods. Increased patient awareness that some subtypes may be self-correctable could simplify intervention, increase compliance, and improve clinician and researcher effectiveness.
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