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Karlsson T, Tuomi L, Finizia C. Do Effects of Voice Rehabilitation in Patients Irradiated for Laryngeal Cancer Remain 5 Years Postradiotherapy? J Voice 2024:S0892-1997(24)00074-2. [PMID: 38688777 DOI: 10.1016/j.jvoice.2024.03.002] [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: 01/17/2024] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Laryngeal cancer treated by radiotherapy results in many patients being left with an abnormal voice long-term. This prospective study aims to report efficacy of voice rehabilitation 5years postradiotherapy completion. METHODS Seventy-seven patients were randomized into an intervention group (n = 37) or a control group (n = 40). Voice rehabilitation was administered postradiotherapy. Patients were followed at baseline, 12- and 60-month postradiotherapy with voice recordings assessed using GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain). Patients filled in the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Head and Neck 35 (EORTC QLQ-HN35) and the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL). RESULTS There were no statistically significant differences between the intervention and control group in scores reported on EORTC QLQ-HN35, S-SECEL or in perceptual evaluation at study end-point. The intervention group reported an improvement in EORTC QLQ-HN35 Speech between baseline-60months postradiotherapy. No significant changes between 12-60months were observed. The control group demonstrated significant improvement in domains Pain, Senses, Speech, Social eating and Sexuality from baseline-60months postradiotherapy, of which only Speech showed a statistically significant change between 12-60months postradiotherapy (P = 0.02). Both groups reported improved S-SECEL scores from baseline-60months, with no significant dynamic between the 12- and 60-month follow-up. CONCLUSION Previously observed positive effects of voice rehabilitation on patient communicative skills and perceptual evaluation are no longer noticeable at 5-year post voice therapy completion. Nevertheless, patients receiving voice rehabilitation experience a greater improvement within the first year, which in the control group takes a corresponding 5years.
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Affiliation(s)
- Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lisa Tuomi
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Venkatraman A, Fujiki RB, Sivasankar MP. A Review of Factors Associated with Voice Problems in the Fitness Instructor Population. J Voice 2023; 37:805.e13-805.e17. [PMID: 34154914 DOI: 10.1016/j.jvoice.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
There is a high prevalence of reported dysphonia symptomology in the fitness instructor population. This is concerning as these reported symptoms of dysphonia, aphonia, and vocal fatigue can significantly compromise quality of life. The purpose of this review is to explore key factors that may contribute to voice problems in the fitness instructor population. Voicing with concurrent phonation and exercise may be influenced by (1) the increased cardiovascular requirement during exercise, (2) the increased cognitive load associated with dual tasking, (3) the altered hydration state associated with prolonged exercise, and (4) the phonatory dose associated with continued voicing with loud background music. This manuscript will explore the literature on these key factors (ie, phonatory dose, dehydration, metabolic bioenergetics, cognitive load, and psychosocial stress) as they pertain to fitness instructors.
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Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA.
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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3
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Semmler M, Lasar S, Kremer F, Reinwald L, Wittig F, Peters G, Schraut T, Wendler O, Seyferth S, Schützenberger A, Dürr S. Extent and Effect of Covering Laryngeal Structures with Synthetic Laryngeal Mucus via Two Different Administration Techniques. J Voice 2023:S0892-1997(23)00228-X. [PMID: 37648625 DOI: 10.1016/j.jvoice.2023.07.019] [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: 06/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The first goal of this study was to investigate the coverage of laryngeal structures using two potential administration techniques for synthetic mucus: inhalation and lozenge ingestion. As a second research question, the study investigated the potential effects of these techniques on standardized voice assessment parameters. METHODS Fluorescein was added to throat lozenges and to an inhalation solution to visualize the coverage of laryngeal structures through blue light imaging. The study included 70 vocally healthy subjects. Fifty subjects underwent administration via lozenge ingestion and 20 subjects performed the inhalation process. For the first research question, the recordings from the blue light imaging system were categorized to compare the extent of coverage on individual laryngeal structures objectively. Secondly, a standardized voice evaluation protocol was performed before and after each administration to determine any measurable effects of typical voice parameters. RESULTS The administration via inhalation demonstrated complete coverage of all laryngeal structures, including the vocal folds, ventricular folds, and arytenoid cartilages, as visualized by the fluorescent dye. In contrast, the application of the lozenge predominantly covered the pharynx and laryngeal surface toward the aryepiglottic fold, but not the inferior structures. All in all, the comparison before and after administration showed no clear effect, although a minor deterioration of the acoustic signal was noted in the shimmer and cepstral peak prominence after the inhalation. CONCLUSIONS Our findings indicate that the inhalation process is a more effective technique for covering deeper laryngeal structures such as the vocal folds and ventricular folds with synthetic mucus. This knowledge enables further in vivo studies on the role of laryngeal mucus in phonation in general, and how it can be substituted or supplemented for patients with reduced glandular activity as well as for heavy voice users.
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Affiliation(s)
- Marion Semmler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Sarina Lasar
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Franziska Kremer
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Laura Reinwald
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Fiori Wittig
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Gregor Peters
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Tobias Schraut
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Olaf Wendler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stefan Seyferth
- Department of Chemistry and Pharmacy, Chair of Pharmaceutics, Friedrich-Alexander-University Erlangen-Nürnberg, Cauerstr. 4, 91058 Erlangen, Germany.
| | - Anne Schützenberger
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stephan Dürr
- University Hospital Regensburg, Department of Otorhinolaryngology, Division of Phoniatrics and Pediatric Audiology, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
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Slovarp LJ, Reynolds JE, Tolbert S, Campbell S, Welby S, Morkrid P. Cough desensitization treatment for patients with refractory chronic cough: results of a second pilot randomized control trial. BMC Pulm Med 2023; 23:148. [PMID: 37118696 PMCID: PMC10141869 DOI: 10.1186/s12890-023-02423-6] [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: 12/08/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE The purpose of this study was to collect pilot efficacy data on a novel treatment for refractory chronic cough (RCC), which we call cough desensitization treatment (CDT). DESIGN AND METHODS In this parallel cohort, sham-controlled, randomized controlled trial, 21 adults with RCC were randomly assigned to 12 sessions of either CDT (progressive doses of aerosolized capsaicin while behaviorally suppressing cough; n = 11) or a sham treatment (repeated exposure to aerosolized saline; n = 9). The Leicester Cough Questionnaire (LCQ) was the primary outcome measure. Perceived cough severity with a visual analogue scale and cough challenge testing (for measuring cough-reflex sensitivity) were secondary outcome measures. Data were analyzed with mixed effects linear regression and follow-up contrasts. RESULTS Results on all measures favored CDT. Excluding one sham participant, whose baseline LCQ scores were deemed unreliable, mean change in LCQ at 3-weeks post treatment was 6.35 and 2.17 in the CDT and sham groups, respectively. There was moderate to strong evidence of a greater improvement in the CDT group in total LCQ score (p = .058) and LCQ Psychological domain (p = .026) and Physical domain (p = .045) scores. Strong evidence was found for a greater reduction in urge-to-cough during CCT in the CDT group (p = .037) and marginal for a reduction in the capsaicin cough-reflex sensitivity (p = .094). There was weak evidence of a greater reduction in cough severity in the CDT group (p = .103). DISCUSSION Although the study is limited due to the small sample size, the data provide additional evidence supporting further research on CDT. CDT resulted in a greater change in the primary efficacy measure (LCQ) than both pharmaceutical and behavioral treatments currently found in the literature. TRIAL REGISTRATION This trial (NCT05226299) was registered on Clinicaltrials.gov on 07/02/2022.
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Affiliation(s)
- Laurie J Slovarp
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA.
| | - Jane E Reynolds
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Sophia Tolbert
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Sarah Campbell
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Shannon Welby
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
| | - Paige Morkrid
- University of Montana, School of Speech, Language, Hearing, & Occupational Sciences, Missoula, MT, USA
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3015-3031. [PMID: 34269598 DOI: 10.1044/2021_jslhr-21-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:691-706. [PMID: 33561361 DOI: 10.1044/2020_jslhr-20-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
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Grinstein-Koren O, Herzog N, Amir O. Hyposalivation Affecting Womens' Voice. J Voice 2021; 37:469.e19-469.e27. [PMID: 33518475 DOI: 10.1016/j.jvoice.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Balanced hydration is crucial for optimal physiological function, whereas hypohydration may cause adverse effects. Like many other organs, the larynx is negatively affected by hypohydration, potentially affecting voice production. Therefore, the purpose of this study was to examine voice properties in women diagnosed with dry-mouth. METHODS Twenty-four women diagnosed with hyposalivation and 24 age-matched controls were recruited. All participants underwent three sialometry tests for quantifying oral-dryness. These tests were conducted in three conditions: after 2-hour fasting, after gustatory salivary stimulation and after drinking water. After each sialometry, participants were recorded while producing the vowels /a/ and /i/, and during a standardized reading task. A basic set of acoustic measures was extracted from these recordings. Self-evaluation of voice was performed using the VHI-10 questionnaire; and listeners' perception of the voice was performed by five professional judges who rated the recordings perceptually, using the GRBAS scale. RESULTS Significant group differences were found in fundamental frequency and jitter, but not in shimmer and noise-to-harmonic ratio (corrected P < 0.05). The participants in the hyposalivation group exhibited higher scores on the VHI-10 questionnaire compared to the control group (P = 0.002), and the judges perceptually rated their voices higher on the Grade and Roughness scales (0.03 ≤ P ≤ 0.04). In contrast with the significant group differences, no significant differences were found between the three study conditions. CONCLUSIONS Women suffering from oral-dryness were shown to exhibit degradation in voice quality, evident in both acoustic, perceptual and self-evaluation measures. However, in this paradigm, short-term superficial hydration was not shown to elicit a significant improvement in voice properties. These findings highlight the importance of consistent oral-hydration for voice, especially among people suffering from hyposalivation.
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Affiliation(s)
- Osnat Grinstein-Koren
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, School of Dental Medicine, Tel-Aviv University, Israel; Oral Medicine Clinic, Maccabi Healthcare Services, Hasharon District, Israel
| | - Nitzan Herzog
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ofer Amir
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Vermeulen R, van der Linde J, Abdoola S, van Lierde K, Graham MA. The Effect of Superficial Hydration, With or Without Systemic Hydration, on Voice Quality in Future Female Professional Singers. J Voice 2020; 35:728-738. [PMID: 32046884 DOI: 10.1016/j.jvoice.2020.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the effect of superficial hydration, with or without systemic hydration, on voice quality in future female professional singers by assessing acoustic and perceptual parameters of voice production as well as symptoms of vocal fatigue. STUDY DESIGN This is an experimental design study. METHODS A study was performed on a sample of 24 female voice majors to ascertain the effect of superficial hydration, with or without systemic hydration, on acoustic parameters and perception of vocal fatigue. The study replicated a prior study by van Wyk et al (2016) with some modifications; we looked at the effect of both systemic and superficial hydration independently and together on voice quality and vocal fatigue. Acoustic measurements including GRBASI, jitter, shimmer, F0 MPT, frequency min and max, intensity min and max, and dysphonia severity index were measured along with perceived vocal fatigue using the Vocal Fatigue Index. RESULTS A statistically significant increase in MPT values were obtained when comparing pre- and post-test results of the hypo hydrated (P = 0.015) and superficial hydration condition (P = 0.004). A significant increase in frequency min (Hz) within the hypo hydrated condition was also observed (P = 0.019). A significant increase was observed in the intensity min (dB) (P = 0.010) and F0 min (Hz) (P = 0.002) within the combined hydration condition. Also, when superficial hydration was applied, mean shimmer % (P = 0.016), MPT (sec) (P = 0.003) and dysphonia severity index (P = 0.020) scores increased significantly in a between-group, post-test comparison. A significant reduction in mean intensity max (dB) (P = 0.049) and intensity min (dB) (P = 0.018) was also observed. CONCLUSIONS This study demonstrates that the use of superficial hydration results in positive outcomes of perceptual parameters of voice quality and symptoms of vocal fatigue in future female professional singers. However, mixed results were observed regarding the acoustic parameters of voice. The superficial hydration data is compelling enough to warrant implementing in a vocal hygiene protocol for singers.
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Affiliation(s)
- Rouxjeanne Vermeulen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield(,) Pretoria, South Africa.
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield(,) Pretoria, South Africa
| | - Shabnam Abdoola
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield(,) Pretoria, South Africa
| | - Kristiane van Lierde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Hatfield(,) Pretoria, South Africa; Department of Speech, Language and Hearing Sciences, University of Ghent(,) Ghent, Belguim
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Groenkloof, Pretoria, South Africa
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Gupta S, Ferrada MA, Hasni SA. Pulmonary Manifestations of Primary Sjögren's Syndrome: Underlying Immunological Mechanisms, Clinical Presentation, and Management. Front Immunol 2019; 10:1327. [PMID: 31249572 PMCID: PMC6583234 DOI: 10.3389/fimmu.2019.01327] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary involvement in primary Sjögren's syndrome (pSS) is an understudied entity with important clinical implications. Its prevalence has been reported in up to 20% of pSS patients. Pulmonary manifestations of pSS are diverse with involvement of airway and/or lung parenchyma. Histopathology of lung lesions suggests a predominance of submucosal mononuclear cell infiltration consisting predominantly of CD4+ T cells. Current understanding of the pathophysiology of lung disease in pSS suggests a similar process driving the pulmonary process as those in the salivary glands, with epithelial cells playing a critical role in the initiation, maintenance, and symptomatology of the disease. Clinical manifestations of lung involvement in pSS are as varied as the underlying pathology and can be vague and non-specific, thus delaying diagnosis. Management options depend on the underlying pathology but are generally limited due to lack of systematic randomized controlled trials. This review helps summarize our current understanding of lung involvement in pSS.
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Affiliation(s)
- Sarthak Gupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sarfaraz A Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
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Tanner K, Anderson C, Smith ME. Nebulizer Use in Adults With Subglottic Stenosis: A Survey Study. Ann Otol Rhinol Laryngol 2019; 128:345-351. [DOI: 10.1177/0003489418823797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: People with subglottic stenosis (SGS) may experience laryngeal symptoms that pose significant challenges to management. This study surveyed the use and effects of nebulized treatments on laryngeal symptoms in a large cohort of adults with SGS. Methods: A survey of nebulized treatment practices was distributed to an online international community of over 2000 members; 316 individuals (298 female, 1 male, 17 declined to specify; age 25+ years) completed the survey. Results: Nearly half (144) of participants had tried a nebulizer in the past. Among those, half currently used nebulized treatments; the majority used these treatments regularly and for greater than 1 year. The most frequently reported treatments included isotonic saline (0.9% Na+Cl–) or hypertonic saline (3% Na+Cl–). Symptoms improved by these treatments included thick mucus (69%), cough (57%), throat dryness (31%), stridor (28%), and voice (15%). The most frequently reported limitations to nebulizer use included time, noise, and portability. Conclusion: Among those individuals with SGS who have tried nebulized treatments, nearly half experienced relief from secondary laryngeal symptoms. Additional efficacy research is needed, particularly with respect to treatment type and dosage. The results are encouraging given the adverse impact these laryngeal symptoms can have on activities of daily living and quality of life.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT, USA
- Division of Otolaryngology—Head & Neck Surgery, The University of Utah, Salt Lake City, UT, USA
| | | | - Marshall E. Smith
- Division of Otolaryngology—Head & Neck Surgery, The University of Utah, Salt Lake City, UT, USA
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Roy N, Merrill RM, Pierce J, Sundar KM. Voice Disorders in Obstructive Sleep Apnea: Prevalence, Risk Factors, and the Role of CPAP. Ann Otol Rhinol Laryngol 2018; 128:249-262. [PMID: 30577715 DOI: 10.1177/0003489418819541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is characterized by frequent interruptions in breathing related to upper airway collapse during sleep and may adversely affect phonatory function. This study aimed to: (1) establish the prevalence, risks, and quality of life burden of voice disorders in OSA and (2) explore the relation between voice disorders and positive airway pressure (PAP) therapy. STUDY DESIGN Cross-sectional, descriptive epidemiology study. METHODS Analyses were based on 94 individuals with OSA (53 men, 41 women; mean age = 54.7 ± 12.8 years) who completed a telephone interview. RESULTS Twenty-eight percent of participants reported having a current voice disorder. Of those with a current voice disorder, 83% had experienced symptoms for at least a year, and 58% had symptoms for at least 4 years. The prevalence of a current voice disorder was greater in women than men (44% vs 15%, P = .0020) but did not vary significantly across different age groups, body mass index (BMI), apnea/hypopnea index (AHI) severity, or medical history. After adjusting for sex, consistent use of PAP therapy (with humidification) was associated with (1) lower occurrence of voice disorders in women (Mantel-Haenszel [MH] χ2P = .0195), (2) reduced snoring severity accompanied by fewer voice disorders in men (MH χ2P = .0101), and (3) fewer reports of acid reflux as a possible trigger for voice problems (MH χ2P = .0226). Patients with OSA who also had a current voice disorder experienced lower overall quality of life compared to those without. CONCLUSIONS Chronic, longstanding voice disorders are common in women with OSA and produce significant adverse effects on quality of life. Nightly PAP use (with humidification) was associated with fewer voice symptoms and reduced severity of snoring and acid reflux as possible contributors. Further research is necessary to better understand the origin of these voice disorders in OSA and their potential response to treatment.
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Affiliation(s)
- Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, USA
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT, USA
| | - Jenny Pierce
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, USA
| | - Krishna M Sundar
- Division of Pulmonary, Critical Care and Sleep Medicine, The University of Utah, Salt Lake City, UT, USA
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Millgård M, Tuomi L. Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation. J Voice 2018; 34:486.e13-486.e22. [PMID: 32389236 DOI: 10.1016/j.jvoice.2018.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The study aimed to investigate the short-term and long-term effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer as measured by both the acoustic measure smoothed cepstral peak prominence (CPPS) and perceptual measures. A secondary aim was to investigate the relationship between acoustic and perceptual measures. METHODS In total, 37 patients received voice rehabilitation post-radiotherapy and 37 patients constituted the irradiated control group. Outcome measures were mean CPPS for connected speech and ratings with the auditory-perceptual Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Outcome measures were analyzed 1 (baseline), 6, 12, and 24 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points. Additional recordings were acquired from vocally healthy participants for comparison. RESULTS CPPS values of the voice rehabilitation group and vocally healthy group were not significantly different at 24 months post-radiotherapy. Ten out of 19 patients who received voice rehabilitation yielded a CPPS value above the threshold for normal voice 24 months post-radiotherapy, compared to 11 out of 26 in the irradiated control group. No statistically significant correlations were found between CPPS and perceptual parameters of GRBAS. CONCLUSION Voice rehabilitation for irradiated laryngeal cancer patients may have positive effects on voice quality up to 24 months post-radiotherapy. The relationship between CPPS and GRBAS as well as the applicability of CPPS for evaluation over several points of measurement needs to be studied further.
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Affiliation(s)
- Moa Millgård
- Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden.
| | - Lisa Tuomi
- Sahlgrenska University Hospital, Department of Otorhinolaryngology, Gothenburg, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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13
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Liu X, Li X, Li X, Li Z, Zhao D, Liu S, Zhang M, Zhang F, Zhu P, Chen J, Wei W, Lin B, Zhou Y, Chen J, Pang Y, Zhang L, Sun X, Yu Z, Jia Y, Wang J, Sun W, Chiu F, Pang L, Wang G. The efficacy and safety of total glucosides of peony in the treatment of primary Sjögren's syndrome: a multi-center, randomized, double-blinded, placebo-controlled clinical trial. Clin Rheumatol 2018; 38:657-664. [PMID: 30280368 DOI: 10.1007/s10067-018-4315-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022]
Abstract
To evaluate the efficacy and safety of total glucosides of peony (TGP) in adults with primary Sjögren's syndrome (pSS). A multi-center, randomized, double-blinded, placebo-controlled study was conducted between March 2012 and July 2014 at ten Chinese hospitals. In total, 320 pSS patients-classified according to the 2002 American-European Consensus Group Criteria-were randomized (2:1 ratio) to receive TGP(600 mg, tid) in the TGP group or placebo for 24 weeks in the placebo group. Study personnel, investigators, and patients were blinded to the treatment grouping. The primary endpoint was the improvement of EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) at week 24. The secondary endpoints were dry eyes/mouth/skin/nose/throat/vagina visual analogue scale (VAS), pain and discomfort VAS, fatigue VAS, mental discomfort VAS, patient global assessment (PGA), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer's test, basal/stimulated salivary flow-rate values, and erythrocyte sedimentation rate (ESR). All adverse events were recorded during the trial period. ESSPRI improved more in the TGP than the placebo group (p < 0.001). Dry eyes/throat/vagina VAS, fatigue VAS, mental discomfort VAS, PGA, Schirmer's test, and ESR also improved more in the TGP group than in the placebo group (all p < 0.05). Stimulated salivary flow-rate values increased in the TGP group at week 12 but not at week 24. Adverse events in TGP group were 10.9%. TGP can alleviate some dryness symptoms as well as disease activity in pSS patients over 24 weeks. TGP was well tolerated by study subjects. TGP seems to be an effective and safe treatment for pSS.
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Affiliation(s)
- Xia Liu
- Department of Rheumatology, China-Japan Friendship Hospital, No.2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Xiangpei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Zhijun Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Dongbao Zhao
- Department of Rheumatology and Immunology, Changhai Hospital, Shanghai, China
| | - Shengyun Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fengxiao Zhang
- Department of Rheumatology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ping Zhu
- Department of Clinical Immunology, Xi-Jing Hospital, Xi'an, Shaanxi, China
| | - Jinwei Chen
- Division of Rheumatoid Immunology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bing Lin
- Department of Rheumatology, China-Japan Friendship Hospital, No.2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Yingbo Zhou
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Jing Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Yafei Pang
- Department of Rheumatology and Immunology, Changhai Hospital, Shanghai, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxuan Sun
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhibo Yu
- Department of Rheumatology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yun Jia
- Department of Clinical Immunology, Xi-Jing Hospital, Xi'an, Shaanxi, China
| | - Jia Wang
- Division of Rheumatoid Immunology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wenwen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, China
| | - Frank Chiu
- Boon Pharmaceutical Research Ltd., 45 Topanga, Irvine, CA, 92602, USA
| | - Liping Pang
- Boon Pharmaceutical Research Ltd., 45 Topanga, Irvine, CA, 92602, USA
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, No.2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
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Sandage MJ, Rahn KA, Smith AG. Vocal Ergonomics in the Workplace: Heating, Ventilation, and Air-Conditioning Method Influences on Vocal Comfort and Function. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:355-363. [PMID: 28124067 DOI: 10.1044/2016_jslhr-s-16-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/20/2016] [Indexed: 05/26/2023]
Abstract
PURPOSE The purpose of this study was to examine the influence of the heating, ventilation, and air-conditioning method on voice function following a voicing task using ecologically valid offices, one with radiant HVAC and one with forced air. METHOD A total of 12 consented participants (6 women, 6 men) narrated a video in each of 4 environmental conditions in a within-between repeated-measures design. Acoustic data were collected with an ambulatory phonation monitor and perceived phonatory effort was determined following the voicing task. Data were analyzed using a within-between repeated-measures analysis of variance with significance set at α < .05. RESULTS Perceived phonatory effort did not differ between environments; however, a significant difference in vocal amplitude between 2 trials was identified for the male participants and physiologically significant differences in vocal amplitude were identified for male and female participants. CONCLUSIONS The findings suggest that perceived phonatory effort may not be a sensitive measure of vocal function differences following a voicing task in ecologically valid office spaces despite significant acoustic findings. Future research should address longer exposure to environmental differences combined with a longer voicing task within ecologically valid work spaces as well as the recruitment of participants who have particular vulnerability to environmental perturbations.
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Laryngeal Desiccation Challenge and Nebulized Isotonic Saline in Healthy Male Singers and Nonsingers: Effects on Acoustic, Aerodynamic, and Self-Perceived Effort and Dryness Measures. J Voice 2016; 30:670-676. [DOI: 10.1016/j.jvoice.2015.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/25/2015] [Indexed: 12/16/2022]
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Saltürk Z, Özdemir E, Kumral TL, Karabacakoğlu Z, Kumral E, Yildiz HE, Mersinlioğlu G, Atar Y, Berkiten G, Yildirim G, Uyar Y. Subjective and objective voice evaluation in Sjögren's syndrome. LOGOP PHONIATR VOCO 2015; 42:9-11. [PMID: 26634781 DOI: 10.3109/14015439.2015.1116606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective The aim of this study is to assess the subjective and objective aspects of voice in Sjögren's syndrome. Methods The study enrolled 10 women with Sjögren's syndrome and 12 healthy women. Maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were determined during acoustic voice analysis. The Stroboscopy Evaluation Rating Form was used for the laryngostroboscopic evaluation. A subjective evaluation was performed using the Turkish version of Voice Handicap Index-10. Results The mean age of the Sjögren's syndrome and control groups was 46 ± 13.89 and 41.27 ± 6.99 years, respectively, and did not differ (P = 0.131). In the laryngostroboscopic evaluation, the smoothness and straightness of vocal folds, regularity, and glottal closure differed significantly. In the acoustic and aerodynamic analyses, none of the parameters differed statistically, while the Sjögren's syndrome group had significantly higher Voice Handicap Index-10 scores than the controls. Conclusion Sjögren's syndrome affects the voice and voice quality.
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Affiliation(s)
- Ziya Saltürk
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Erdi Özdemir
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Tolgar Lütfi Kumral
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Zeynep Karabacakoğlu
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Esra Kumral
- b Haydarpaşa Numune Training and Research Hospital Ophthalmology Clinic , İstanbul , Turkey
| | - Hatice Elvin Yildiz
- b Haydarpaşa Numune Training and Research Hospital Ophthalmology Clinic , İstanbul , Turkey
| | - Gökhan Mersinlioğlu
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Yavuz Atar
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Güler Berkiten
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Güven Yildirim
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
| | - Yavuz Uyar
- a Okmeydanı Training and Research Hospital Ear Nose and Throat Clinic , İstanbul , Turkey
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