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Hosokawa K, Iwahashi T, Iwahashi M, Iwaki S, Yoshida M, Kitayama I, Miyauchi A, Ogawa M, Inohara H. The Minimal Important Difference of Acoustic Voice Quality Index in the Treatment of Voice Disorders. Laryngoscope 2024; 134:2805-2811. [PMID: 38112338 DOI: 10.1002/lary.31230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES The acoustic voice quality index (AVQI) is a reliable tool that objectively assesses dysphonia levels using six acoustic parameters. Despite its high criterion-related concurrent validity, diagnostic accuracy, and minimal detectable change derived from test-retest reliability, the minimal important difference (MID) of the AVQI has not been tested before. This study aimed to estimate the MIDs of AVQI for improvement audibly perceived by clinicians and self-reported improvement by patients. METHODS A retrospective study was conducted on 110 patients who received treatment for voice disorders. Patients completed AVQI and Voice Handicap Index-10 (VHI-10) questionnaires before and after the therapy. The MIDs of the AVQI were estimated using the anchor of either auditory-perceptual judgment of total dysphonia levels by clinicians or the VHI-10 questionnaire by patients. A distribution-based approach was also used to complement the results. RESULTS First, using the auditory-perceptual anchor, a decrease of 0.95 in the AVQI was estimated as the MID for clinicians' perception, as a result of the receiver operating curve. Then, using the patient-reported anchor, an improvement of 1.36 in the AVQI was estimated as the MID for patients' voice-related disability. The distribution-based approach also ensured the anchor-based results of both the MIDs. CONCLUSIONS The AVQI is a reliable and valid tool for evaluating voice quality, and a 0.95 decrease in the AVQI represents a meaningful improvement for clinicians' perception, whereas a 1.36 decrease in the AVQI influences patients' self-reported disability. This study contributes to understanding the minimal change necessary for clinicians to make informed decisions and ensure patient satisfaction. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2805-2811, 2024.
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Affiliation(s)
- Kiyohito Hosokawa
- Department of Otorhinolaryngology and Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Otorhinolaryngology, Osaka Police Hospital, Osaka, Japan
| | | | | | - Shinobu Iwaki
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Misao Yoshida
- Department of Rehabilitation, Sakai Heisei Hospital, Osaka, Japan
| | - Itsuki Kitayama
- Department of Otorhinolaryngology and Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Makoto Ogawa
- Department of Otorhinolaryngology and Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology and Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Liou HH, Hsieh MHC, Hung DSY, Liu HL, Lee I, Lin YC, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty. J Voice 2022:S0892-1997(22)00343-5. [PMID: 36513561 DOI: 10.1016/j.jvoice.2022.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection. STUDY DESIGN Retrospective observational study. METHODS We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients' changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training. RESULTS Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease. CONCLUSIONS Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Hui-Ling Liu
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ishan Lee
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan.
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Baertsch HC, Bhatt NK, Giliberto JP, Dixon C, Merati AL, Sauder C. Quantification of Vocal Fold Atrophy in Age‐Related and Parkinson's Disease‐Related Vocal Atrophy. Laryngoscope 2022; 133:1462-1469. [PMID: 36111826 DOI: 10.1002/lary.30394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/07/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Vocal fold atrophy (VFA) is associated with aging and Parkinson's disease (PD). Clinical diagnosis of VFA depends on several visual-perceptual laryngostroboscopy findings that are inherently subjective. The purpose of this study was to use quantitative measurements to; (1) examine the relationships between VFA and dysphonia severity and (2) evaluate differences in VFA in patients with age-related VFA versus PD. METHODS Thirty-six patients >60 years of age with VFA were included in this retrospective cohort study. Demographic information, medical history, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), Voice Handicap Index-10 (VHI-10), and still images from the stroboscopic exam were obtained. Image J™ was used to measure VFA, including bowing index (BI), normalized glottal gap area, and normalized mucosal wave amplitude. Pearson's correlation was used to evaluate the relationship between VFA, CAPE-V, and VHI-10. t-Tests and multivariate linear regression were used to compare VFA measures by dysphonia severity (CAPE-V <30 vs. >30) and diagnosis (age-related vocal atrophy [ARVA] and PD). RESULTS BI was positively correlated with CAPE-V. Patients with CAPE-V >30 had a significantly larger BI compared to those with CAPE-V <30. Patients with PD had significantly larger BI than those with ARVA. Diagnosis of PD also predicted a larger BI after controlling for age and CAPE-V. CONCLUSION Quantitative measures supported an association between bowing severity and dysphonia severity in patients with PD and ARVA. A PD diagnosis significantly predicted more severe BI. These findings demonstrate the potential utility of BI. Quantitative VFA measures might also provide insight into the mechanisms of ARVA and dysphonia. LEVEL OF EVIDENCE 3 Laryngoscope, 133:1462-1469, 2023.
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Affiliation(s)
- Hans C. Baertsch
- Keck School of Medicine University of Southern California Los Angeles California U.S.A
| | - Neel K. Bhatt
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - John P. Giliberto
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - Connor Dixon
- Elson S Floyd College of Medicine Washington State University Spokane Washington U.S.A
| | - Albert L. Merati
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
| | - Cara Sauder
- Division of Laryngology, Department Otolaryngology Head and Neck Surgery University of Washington Seattle Washington U.S.A
- Speech and Hearing Sciences University of Washington Seattle Washington U.S.A
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Subjective voice analysis in patients with muscular tension dysphonia: comparison between clinician and patient evaluation. The Journal of Laryngology & Otology 2021; 135:458-463. [PMID: 33906703 DOI: 10.1017/s0022215121001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study evaluated the correlation between patient and clinician subjective voice analysis in a group of patients suffering from muscular tension dysphonia. This disease does not usually present with organic lesions, and voice analysis is crucial to evaluate it. METHODS A retrospective study with 75 patients was performed. Correlation between grade, roughness, breathiness, asthenia and strain scale and voice handicap index-10 was analysed. Any possible influence of the type of muscular tension dysphonia on these two scales was studied. RESULTS There are only a few studies that correlate voice handicap index-10 and the grade, roughness, breathiness, asthenia and strain scale; however, none of them are specific for patients suffering from muscular tension dysphonia. A moderate correlation (r = 0.56) was found. No influence of muscular tension dysphonia type on voice handicap index-10 score was found, but muscular tension dysphonia type 4 had worse grade, roughness, breathiness, asthenia and strain scale scores than other muscular tension dysphonia types. This could be explained if muscular tension dysphonia type 4 is considered to be the most severe form of this disease. CONCLUSION The use of assessment scales based on the opinion of both the clinician and patient must be considered as complementary clinical tools in order to perform a complete assessment of dysphonia.
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Naunheim ML, Yung KC, Schneider SL, Henderson-Sabes J, Kothare H, Hinkley LB, Mizuiri D, Klein DJ, Houde JF, Nagarajan SS, Cheung SW. Cortical networks for speech motor control in unilateral vocal fold paralysis. Laryngoscope 2019; 129:2125-2130. [PMID: 30570142 DOI: 10.1002/lary.27730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/09/2018] [Accepted: 11/07/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate brain networks for motor control of voice production in patients with treated unilateral vocal fold paralysis (UVFP). STUDY DESIGN Cross-sectional comparison. METHODS Nine UVFP patients treated by type I thyroplasty, and 11 control subjects were compared using magnetoencephalographic imaging to measure beta band (12-30 Hz) neural oscillations during voice production with perturbation of pitch feedback. Differences in beta band power relative to baseline were analyzed to identify cortical areas with abnormal activity within the 400 ms perturbation period and 125 ms beyond, for a total of 525 ms. RESULTS Whole-brain task-induced beta band activation patterns were qualitatively similar in both treated UVFP patients and healthy controls. Central vocal motor control plasticity in UVFP was expressed within constitutive components of central human communication networks identified in healthy controls. Treated UVFP patients exhibited statistically significant enhancement (P < 0.05) in beta band activity following pitch perturbation onset in left auditory cortex to 525 ms, left premotor cortex to 225 ms, and left and right frontal cortex to 525 ms. CONCLUSION This study further corroborates that a peripheral motor impairment of the larynx can affect central cortical networks engaged in auditory feedback processing, vocal motor control, and judgment of voice-as-self. Future research to dissect functional relationships among constitutive cortical networks could reveal neurophysiological bases of central contributions to voice production impairment in UVFP. Those novel insights would motivate innovative treatments to improve voice production and reduce misalignment of voice-quality judgment between clinicians and patients. LEVEL OF EVIDENCE 3b Laryngoscope, 129:2125-2130, 2019.
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Affiliation(s)
- Molly L Naunheim
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Katherine C Yung
- San Francisco Voice & Swallowing, University of California, San Francisco, California, U.S.A
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Jennifer Henderson-Sabes
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Hardik Kothare
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - David J Klein
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - John F Houde
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Srikantan S Nagarajan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
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Naunheim ML, Yung KC, Schneider SL, Henderson‐Sabes J, Kothare H, Mizuiri D, Klein DJ, Houde JF, Nagarajan SS, Cheung SW. Vocal motor control and central auditory impairments in unilateral vocal fold paralysis. Laryngoscope 2018; 129:2112-2117. [DOI: 10.1002/lary.27680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 09/08/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Molly L. Naunheim
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
| | - Katherine C. Yung
- San Francisco Voice & SwallowingUniversity of California San Francisco California U.S.A
| | - Sarah L. Schneider
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
| | - Jennifer Henderson‐Sabes
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
| | - Hardik Kothare
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California U.S.A
| | - Danielle Mizuiri
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California U.S.A
| | - David J. Klein
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
| | - John F. Houde
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
| | - Srikantan S. Nagarajan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
- Department of Radiology and Biomedical ImagingUniversity of California San Francisco California U.S.A
| | - Steven W. Cheung
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco California U.S.A
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Ebersole B, Soni RS, Moran K, Lango M, Devarajan K, Jamal N. The Influence of Occupation on Self-perceived Vocal Problems in Patients With Voice Complaints. J Voice 2018; 32:673-680. [DOI: 10.1016/j.jvoice.2017.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
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Cross-cultural Adaptation and Validation of the Greek Voice Handicap Index-10 (GVHI-10) With Additional Receiver Operating Characteristic Analysis. J Voice 2018; 34:304.e1-304.e8. [PMID: 30301578 DOI: 10.1016/j.jvoice.2018.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE(S) The use of subjective evaluation tools are proven useful and of high clinical value in the case of voice disordered population. For that type of evaluation, self-assessment questionnaires about the severity of the voice like Voice Handicap Index-30 (VHI-30) have been developed. The VHI-30 is the most studied tool which includes psychometrically robustness while guiding physician's therapeutic decision making. Additionally, a valid abbreviated version of VHI-30 was developed for the first time in the Greek Language which is named as Greek Voice Handicap Index-10 (GVHI-10). Consequently, the aim of our study was to validate the proposed version of the VHI-10. METHODS Ninety nondysphonic individuals and 90 dysphonic patients were classified by Otolaryngologists and Speech Language Pathologists. The study's subjects were evaluated with endoscopy and stroboscopy. Also, they were administrated the GVHI-30 and the translated version of the Voice Evaluation Template (VEF). The GVHI-10 was extracted by the Greek version of VHI-30. RESULTS The group with voice disorders exhibited higher statistical significance in all GVHI-10 scores compared to those of the control group. The GVHI-10 showed a high internal consistency (Cronbach's a = 0.915 and split-half reliability coefficient equal to 0.86), good sensitivity compared to Greek VHI-30 (r = 0.764, P = 0.000) and intraclass correlation. A total cut-off point equal to 6.50 (AUC: 0.964; P < 0.001) was also calculated. CONCLUSIONS The proposed version of GVHI-10 distinguished the perceived levels of voice between dysphonic and nondysphonic groups and between different voice disordered populations. The GVHI-10 is shown to be clinically valid and sensitive exhibiting high reliability.
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Measurement properties of self-report questionnaires on health-related quality of life and functional health status in dysphonia: a systematic review using the COSMIN taxonomy. Qual Life Res 2018; 28:283-296. [DOI: 10.1007/s11136-018-2001-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/14/2022]
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10
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Carroll TL, Lee SE, Lindsay R, Locandro D, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology, Part 6: Patient-Reported Outcomes in Clinical Practice. Otolaryngol Head Neck Surg 2017; 158:8-15. [DOI: 10.1177/0194599817731759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one’s practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the “Evidence-Based Medicine in Otolaryngology” series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios.
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Affiliation(s)
- Thomas L. Carroll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stella E. Lee
- Division of Sinonasal Disorders and Allergy, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robin Lindsay
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Drew Locandro
- Northwest ENT and Allergy Center, Marietta, Georgia, USA
| | - Gregory W. Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J. Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Purpose (1) To explore the role of native voice and effects of voice loss on self-concept and identity, and survey the state of assistive voice technology; (2) to establish the moral case for developing personalized voice technology. Methods This narrative review examines published literature on the human significance of voice, the impact of voice loss on self-concept and identity, and the strengths and limitations of current voice technology. Based on the impact of voice loss on self and identity, and voice technology limitations, the moral case for personalized voice technology is developed. Results Given the richness of information conveyed by voice, loss of voice constrains expression of the self, but the full impact is poorly understood. Augmentative and alternative communication (AAC) devices facilitate communication but, despite advances in this field, voice output cannot yet express the unique nuances of individual voice. The ethical principles of autonomy, beneficence and equality of opportunity establish the moral responsibility to invest in accessible, cost-effective, personalized voice technology. Conclusions Although further research is needed to elucidate the full effects of voice loss on self-concept, identity and social functioning, current understanding of the profoundly negative impact of voice loss establishes the moral case for developing personalized voice technology. Implications for Rehabilitation Rehabilitation of voice-disordered patients should facilitate self-expression, interpersonal connectedness and social/occupational participation. Proactive questioning about the psychological and social experiences of patients with voice loss is a valuable entry point for rehabilitation planning. Personalized voice technology would enhance sense of self, communicative participation and autonomy and promote shared healthcare decision-making. Further research is needed to identify the best strategies to preserve and strengthen identity and sense of self.
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Affiliation(s)
- Esther Nathanson
- a The Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine , Maywood , IL , USA
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Ouyoung LM, Swanson MS, Villegas BC, Damodar D, Kokot N, Sinha UK. ABCLOVE: Voice therapy outcomes for patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1810-3. [DOI: 10.1002/hed.24322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/03/2015] [Accepted: 09/20/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Laishyang Melody Ouyoung
- Department of Speech Pathology; Keck Medical Center of University of Southern California; Los Angeles California
| | - Mark S. Swanson
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Brenda Capobres Villegas
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Dhanur Damodar
- Keck School of Medicine - University of Southern California; Los Angeles California
| | - Niels Kokot
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Uttam K. Sinha
- Department of Otolaryngology - Head and Neck Surgery; University of Southern California; Los Angeles California
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