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Hernández-Sandemetrio R, Oishi N, López-Sánchez I, García-López I, Zapater E. Validation of the 10-Item Unilateral Vocal Fold Paralysis-Handicap Index quality of life questionnaire. Clin Otolaryngol 2024; 49:185-190. [PMID: 37926511 DOI: 10.1111/coa.14120] [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: 08/02/2023] [Accepted: 10/14/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To validate and test the reliability of the 10-Item Unilateral Vocal Fold Paralysis-Voice Handicap Index (UVFP-HI-10) quality of life (QoL) questionnaire for patients with UVFP. DESIGN Prospective describe study based on perceptive surveys. PARTICIPANTS We recruited 61 patients with UVFP and 53 healthy individuals comprised the control group. MAIN OUTCOME MEASURES Both the patients and controls completed the UVFP-HI-10 questionnaire. A statistical analysis was performed to assess the internal consistency and validity of the survey. In addition, maximum phonation time (MPT) was used to objectively measure patient QoL. RESULTS Internal consistency was high (α = .914) and the correlation with MPT was significant (rs = -0.722). The estimated marginal mean in the discriminant validity study was around seven times higher in the UVFP group compared to the controls. The UVFP-HI-10 cut-off value was more than 0.9 and the sensitivity and specificity were more than 0.8. CONCLUSIONS The UVFP-HI-10 is a self-administered patient-reported outcome questionnaire with a high reliability and excellent criterion-based validity. This questionnaire can be used to evaluate specific clinical complaints (e.g., vocalisation, swallowing, and breathing) in terms of their impact on QoL in patients with UVFP. Thus, its use is appropriate as a basic assessment tool as part of a specific UVFP treatment protocol.
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Affiliation(s)
| | - Natsuki Oishi
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
| | - Isabel López-Sánchez
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
| | | | - Enrique Zapater
- ENT Department, University General Hospital of Valencia, Valencia School of Medicine, Valencia, Spain
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Heaton JT, Kobler JB, Otten DM, Tynan MA, Petrillo RH, Ottensmeyer MP, Slate AR, Hillman RE, Zeitels SM. Electrical Stimulation of Vocal Fold Adduction Triggered by Laryngeal Electromyography Using a Custom Implant. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4812-4827. [PMID: 37971489 DOI: 10.1044/2023_jslhr-23-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE Medialization procedures for unilateral vocal fold (VF) paralysis generally improve voice but do not fully replace dynamic VF adduction. Paralyzed VFs typically experience synkinetic reinnervation, which makes it feasible to elicit movement through electrical stimulation. We tested a novel laryngeal pacing implant capable of providing closed-loop (automatic) stimulation of a VF triggered by electromyography (EMG) potentials from the contralateral VF. METHOD A custom, battery-powered, microprocessor-based stimulator was tested in eight dogs with bipolar electrodes implanted for recording EMG from the left VF and stimulating adduction of the right VF. A cuff electrode on the left recurrent laryngeal nerve (RLN) stimulated unilateral VF adduction, modeling voluntary control in anesthetized animals. Closed-loop stimulation was tested in both acute and chronic experiments. Synkinetic reinnervation was created in two animals by right RLN transection and suture repair to model unilateral VF paralysis. RESULTS In all animals, left VF activation through RLN stimulation generated a robust EMG response that rapidly triggered stimulation of contralateral thyroarytenoid and lateral cricoarytenoid muscles, causing nearly simultaneous bilateral adduction. Optimal triggering of VF stimulation from elicited EMG was achieved using independent onset and offset thresholds. Real-time artifact blanking allowed closed-loop stimulation without self-perpetuating feedback, despite the proximity of recording and stimulation electrodes. CONCLUSIONS Using a custom implant system, we demonstrated real-time closed-loop stimulation of one VF triggered by the activation of the contralateral VF. This approach could potentially restore dynamic glottic closure for reflexive behaviors or phonation in cases of unilateral VF paralysis with synkinetic reinnervation. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24492133.
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Affiliation(s)
- James T Heaton
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - James B Kobler
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - David M Otten
- Laboratory for Electromagnetic and Electronic Systems, Massachusetts Institute of Technology, Cambridge
| | - Monica A Tynan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Robert H Petrillo
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | | | - Andrea R Slate
- Center for Comparative Medicine, Massachusetts General Hospital, Boston
| | - Robert E Hillman
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Steven M Zeitels
- Department of Surgery, Harvard Medical School, Boston, MA
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
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Kissel I, D'haeseleer E, Meerschman I, Wackenier E, Van Lierde K. Clinical Experiences of Speech-Language Pathologists in the Rehabilitation of Unilateral Vocal Fold Paralysis. J Voice 2023:S0892-1997(23)00134-0. [PMID: 37156684 DOI: 10.1016/j.jvoice.2023.04.010] [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: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Unilateral vocal fold paralysis (UVFP) is a neurological voice disorder that is often first treated by a speech-language pathologist (SLP). In literature, little consensus is found regarding voice therapy onset, duration, frequency, and content. The aim of the current study is to investigate the clinical practice of SLPs for treatment of UVFP regarding diagnostics and treatment characteristics. Additionally, the study examined the personal experiences of SLPs regarding UVFP care. METHOD An online survey was completed by 37 respondents, all SLPs with experience in treating UVFP. Demographic characteristics, experiences with voice assessments and treatment modalities were examined. Lastly, experiences and opinions of SLPs on evidence-based practice and their own clinical practice were surveyed. RESULTS Almost all respondents used a multidimensional voice assessment with findings from laryngovideostroboscopy to assess UVFP. Laryngeal electromyography is not yet integrated in regular clinical practices. The most commonly used vocal techniques were resonant voice exercises, laryngeal manipulation, semioccluded vocal tract exercises (SOVTEs), vocal hygiene, and Vocal Function Exercises, with SOVTEs most often considered effective. A total of 75% of the respondents feel confident treating UVFP, and 87.6% believe it is important to stay updated on evidence-based practice. Variation in therapy timing and dosage was observed, and 48.4% of SLPs usually started early voice therapy within 4 weeks after UVFP onset. CONCLUSION Flemish SLPs generally feel confident treating UVFP patients and show interest in improving evidence-based practice. Initiatives to train clinicians further in UVFP care and encouraging SLPs to provide practice-based evidence will enhance the knowledge base for evidence-based practice in UFVP.
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Affiliation(s)
- Imke Kissel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Musical Department, Royal Conservatory Brussels, Bruxelles, Belgium
| | - Iris Meerschman
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Eline Wackenier
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Mari G, Marchese MR, Longobardi Y, Proietti I, Marenda ME, Di Cesare T, D'Alatri L. Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time. J Voice 2022:S0892-1997(22)00108-4. [PMID: 35641380 DOI: 10.1016/j.jvoice.2022.04.005] [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: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). METHODS Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. RESULTS Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. CONCLUSIONS With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.
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Affiliation(s)
- Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
| | - Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Ilaria Proietti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Tiziana Di Cesare
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
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Kurz A, Volk GF, Arnold D, Schneider-Stickler B, Mayr W, Guntinas-Lichius O. Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis. Front Neurol 2022; 13:869900. [PMID: 35444611 PMCID: PMC9013944 DOI: 10.3389/fneur.2022.869900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.
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Affiliation(s)
- Annabella Kurz
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Haddad R, Ismail S, Khalaf MG, Matar N. Lipoinjection for Unilateral Vocal Fold Paralysis Treatment: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:1630-1640. [PMID: 34894158 DOI: 10.1002/lary.29965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Lipoinjection is one of the available treatments for unilateral vocal fold paralysis. OBJECTIVE To evaluate lipoinjection predictability, and analyze the differences in safety and efficacy of the different techniques. STUDY DESIGN Systematic review and meta-analysis. METHODS AND RESULTS A systematic review on Medline, Cochrane, and Scopus databases included 49 articles analyzing the data of 1,166 patients, concerning technical details and voice parameters changes. Lipoinjection used a mean volume of 1.3 mL, 95% confidence interval (CI) (0.92, 1.69)-average overcorrection of 30%. Meta-analysis of pre- and postoperative voice parameters' means showed a significant improvement at 6 months of mean phonation time (preoperative: 5.12, 95% CI [4.48, 5.76]-6 months: 10.46, 95% CI [9.18, 11.75]), Jitter (preoperative: 2.71, 95% CI [2.08, 3.33])-6 months: 1.37, 95% CI [1.05, 1.70]), Shimmer (preoperative: 4.55, 95% CI [3.04, 6.07]-6 months: 2.57, 95% CI [1.69, 3.45]), grade (preoperative: 2.15, 95% CI [1.73, 2.57]-6 months: 0.12, 95% CI [0.97, 1.43]), breathiness (preoperative: 2.012, 95% CI [1.48, 2.55]-6 months: 0.99, 95% CI [0.58, 1.40]), and asthenia (preoperative: 1.90, 95% CI [1.33, 2.47]-6 months: 0.75, 95% CI [0.17, 1.33]) of GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain), and Voice Handicap Index-30 (preoperative: 72.06, 95% CI [54.35, 89.76]-6 months: 26.24, 95% CI [19.58, 32.90]). Subgroup analysis by harvesting technique concluded in no statistically significant difference between them. Few complications were reported. Reintervention was only required for 86 patients. CONCLUSION Lipoinjection seems a safe therapeutic option for unilateral vocal fold paralysis, with available data showing an efficacy lasting 6 months to 1 year. Laryngoscope, 2021.
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Affiliation(s)
- Ralph Haddad
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Salim Ismail
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michel G Khalaf
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Nayla Matar
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Gray R, Misono S. Patient-Centered Care in Vocal Fold Paralysis: What Really Matters? CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wenke R, Coman L, Walton C, Madill C, Theodoros D, Bishop C, Stabler P, Lawrie M, O'Neill J, Gray H, Cardell EA. Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group. J Voice 2021; 37:466.e17-466.e34. [PMID: 33741236 DOI: 10.1016/j.jvoice.2021.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the noninferiority of intensive voice therapy and compare its effects with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction, and attendance in people with muscle tension dysphonia (MTD). The study further aimed to explore clinician's perceptions of barriers and enablers to implementation of intensive therapy. STUDY DESIGN Noninferiority randomised controlled trial with nested focus group. METHODS Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks). Participants were assessed by a blinded assessor twice before treatment, once post treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction) and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech Language Pathologists also participated in a focus group to explore barriers and enablers to implementing intensive therapy, with questions and analyses guided by the Theoretical Domains Framework. RESULTS While noninferiority for the primary outcome measure VHI was not confirmed, secondary outcome measures revealed comparable within group clinically important improvements for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures for both groups. A trend of more improvements being maintained in the intensive group was identified. Comparably high satisfaction and attendance was also found between groups. Clinicians reported more enablers than barriers to providing intensive therapy which included beliefs that it led to greater progression and consolidation of patient learning, was supported by the local context and was associated with positive emotions. Barriers related to difficulties with booking and scheduling and the belief that intensive therapy was not for all patients. CONCLUSIONS While the current study was likely underpowered to establish non-inferiority of intensive therapy, secondary outcomes suggested that intensive therapy may produce comparable benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy and may be a viable therapy option for individuals with MTD. When implementing intensive therapy, clinicians should consider patient's preferences and availability, as well as systems which allow for flexible booking and therapy provision for patients. Clear recommendations for future research including the use of a larger sample and telehealth are also provided.
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Affiliation(s)
- Rachel Wenke
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; Allied Health Research, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia.
| | - Leah Coman
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Chloe Walton
- Speech Pathology, Logan & Beaudesert Health Service, Metro South Health, Meadowbrook, Queensland, Australia
| | - Catherine Madill
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Lidcombe, New South Wales, Australia
| | - Deborah Theodoros
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Carol Bishop
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Penny Stabler
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Melissa Lawrie
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia; School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - John O'Neill
- Ear, Nose and Throat Department, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Heidi Gray
- Speech Pathology Services, Gold Coast Hospital & Health Service, Southport, Queensland, Australia
| | - Elizabeth A Cardell
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Englert M, Barsties V Latoszek B, Maryn Y, Behlau M. Validation of the acoustic breathiness index to the Brazilian Portuguese language. LOGOP PHONIATR VOCO 2021; 47:56-62. [PMID: 33404289 DOI: 10.1080/14015439.2020.1864467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the concurrent validity and the diagnostic accuracy of the Acoustic Breathiness Index (ABI) in Brazilian Portuguese. METHODS The counting numbers 1-20 and the vowel /a/ of 150 subjects were recorded (37 vocally healthy and 113 with dysphonia). The analyzed samples were the counting number 1-11 and 3 s of the sustained vowel. Nine voice specialists performed the perceptual judgment of the degree of breathiness. The Spearman Correlation and the receiver operating characteristic (ROC) curve were used to assess ABI's concurrent validity and diagnosis accuracy. RESULTS Results from five listeners were chosen for the study analyses due to moderate and substantial intra-rater reliability (Cohen's Kappa values = 0.520-0.772) and moderate inter-rater reliability (Fleiss Kappa = 0.353). The ABI presented a high concurrent validity (r = 0.746); 55.6% of the breathiness vocal deviation can be explained by the acoustic analysis (r2 = 0.556). The ROC curve presented good diagnostic accuracy (85.2%). At a threshold of 2.94, the sensitivity was 75.3% and the specificity was 93.4%. CONCLUSION The ABI is a valid tool for screening and patient's follow-up regarding breathy vocal qualities in the Brazilian Portuguese language.
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Affiliation(s)
- Marina Englert
- Unifesp - "Universidade Federal de São Paulo" and CEV - "Centro de Estudos da Voz", São Paulo, Brazil
| | - Ben Barsties V Latoszek
- Speech-Language Pathology, SRH University of Applied Health Sciences, Düsseldorf, Germany.,Department of Phoniatrics and Pediatric Audiology, University Hospital Münster, Westphalian Wilhelm University, Münster, Germany
| | - Youri Maryn
- ENT Department, Sint-Augustinus GZA, Wilrijk, Belgium
| | - Mara Behlau
- Unifesp - "Universidade Federal de São Paulo" and CEV - "Centro de Estudos da Voz", São Paulo, Brazil
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Clunie GM, Roe JWG, Alexander C, Sandhu G, McGregor A. Voice and Swallowing Outcomes Following Airway Reconstruction in Adults: A Systematic Review. Laryngoscope 2021; 131:146-157. [PMID: 31943240 PMCID: PMC7754401 DOI: 10.1002/lary.28494] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery. STUDY DESIGN Systematic review. METHODS Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. RESULTS A total of 143 abstracts were reviewed, with 67 articles selected for full-text review. Twenty studies met the inclusion criteria. Data extraction was completed with the Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous, and there was limited information provided about rationale or reliability. CONCLUSIONS The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there are no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement. Laryngoscope, 131:146-157, 2021.
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Kishimoto Y, Hiwatashi N, Kawai Y, Fujimura S, Sogami T, Hayashi Y, Omori K. A retrospective analysis of revision framework surgeries for unilateral vocal fold paralysis. Braz J Otorhinolaryngol 2020; 88:767-772. [PMID: 33419650 PMCID: PMC9483942 DOI: 10.1016/j.bjorl.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Revision framework surgeries might be required for unilateral vocal fold paralyses. However, outcomes and indications of revision surgeries have not been adequately documented. For a better understanding of indications for the procedure and to help in achieving better vocal outcomes, we performed a retrospective chart review of patients who underwent revision framework surgeries for unilateral vocal fold paralysis. OBJECTIVES This study aimed to present clinical features of patients who underwent revision framework surgeries for the treatment of unilateral vocal fold paralysis. METHODS Of the 149 framework surgeries performed between October 2004 and October 2019, 21 revision framework surgeries were performed in 19 patients. Self-assessments by patients using the voice handicap index-10 questionnaire, and objective aerodynamic and acoustic assessments performed pre- and post-operatively were analyzed using the Wilcoxon's signed-rank test for paired comparisons. RESULTS Undercorrection was indicated as reasons for revision surgeries in all cases. The revision techniques included type I thyroplasty, type IV thyroplasty, and arytenoid adduction, and revision surgeries were completed without any severe complication in all cases. Pre- and post-operative voice handicap index-10 scores were obtained in 12 cases, and other parameters were evaluated in 18 cases. Significant improvements were observed in voice handicap index-10 scores, maximum phonation time, mean flow rate, Current/Direct Current ratio, and pitch perturbation quotient. CONCLUSION Undercorrection was observed in all patients who underwent revision framework surgeries for unilateral vocal fold paralysis, and the initial assessment and planning are thought to be important in order to avoid revision surgeries. Revision surgeries were performed safely in all cases, and significantly improved vocal outcomes were observed, even after multiple procedures. Revision surgery should be considered for patients with unsatisfactory vocal functions after primary framework surgeries for unilateral vocal fold paralysis.
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Affiliation(s)
- Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Nao Hiwatashi
- Department of Otolaryngology, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tohru Sogami
- Department of Otolaryngology, Soseikai General Hospital, Kyoto, Japan
| | - Yasuyuki Hayashi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Pathology-Related Influences on the VEM: Three Years' Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5309508. [PMID: 33506007 PMCID: PMC7814951 DOI: 10.1155/2020/5309508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023]
Abstract
The vocal extent measure (VEM) represents a new diagnostic tool to express vocal capacity by quantifying the dynamic performance and frequency range of voice range profiles (VRPs). For VEM calculation, the VRP area is multiplied by the quotient of the theoretical perimeter of a circle with equal VRP area and the actual VRP perimeter. Since different diseases affect voice function to varying degrees, pathology-related influences on the VEM should be investigated more detailed in this retrospective study, three years after VEM implementation. Data was obtained in a standardized voice assessment comprising videolaryngostroboscopy, voice handicap index (VHI-9i), and acoustic-aerodynamic analysis with automatic calculation of VEM and dysphonia severity index (DSI). The complete dataset comprised 1030 subjects, from which 994 adults (376 male, 618 female; 18-86 years) were analyzed more detailed. The VEM differed significantly between pathology subgroups (p < 0.001) and correlated with the corresponding DSI values. Regarding VHI-9i, the VEM reflected the subjective impairment better than the DSI. We conclude that the VEM proved to be a comprehensible and easy-to-use interval-scaled parameter for objective VRP evaluation in all pathology subgroups. As expected, exclusive consideration of the measured pathology-related influences on the VEM does not allow conclusions regarding the specific underlying diagnosis.
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Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients. The Journal of Laryngology & Otology 2020; 134:1085-1093. [PMID: 33308327 DOI: 10.1017/s0022215120002558] [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
OBJECTIVE To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. METHODS This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. RESULTS Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. CONCLUSION Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.
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Orbelo DM, Ekbom DC, Van Houten HK, Bayan SL, Balakrishnan K. Speech Pathology Utilization and Stroboscopy Before and After Adult Medialization Laryngoplasty. J Voice 2020; 36:423-433. [PMID: 32690345 DOI: 10.1016/j.jvoice.2020.06.024] [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: 04/07/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. METHODS Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. RESULTS 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. CONCLUSION Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.
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Affiliation(s)
- Diana M Orbelo
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Dale C Ekbom
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MNinnesota; OptumLabs, Cambridge, Massachusetts
| | - Semirra L Bayan
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karthik Balakrishnan
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, Palo Alto, California
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Adamian N, Naunheim MR, Jowett N. An Open-Source Computer Vision Tool for Automated Vocal Fold Tracking From Videoendoscopy. Laryngoscope 2020; 131:E219-E225. [PMID: 32356903 DOI: 10.1002/lary.28669] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Contemporary clinical assessment of vocal fold adduction and abduction is qualitative and subjective. Herein is described a novel computer vision tool for automated quantitative tracking of vocal fold motion from videolaryngoscopy. The potential of this software as a diagnostic aid in unilateral vocal fold paralysis is demonstrated. STUDY DESIGN Case-control. METHODS A deep-learning algorithm was trained for vocal fold localization from videoendoscopy for automated frame-wise estimation of glottic opening angles. Algorithm accuracy was compared against manual expert markings. Maximum glottic opening angles between adults with normal movements (N = 20) and those with unilateral vocal fold paralysis (N = 20) were characterized. RESULTS Algorithm angle estimations demonstrated a correlation coefficient of 0.97 (P < .001) and mean absolute difference of 3.72° (standard deviation [SD], 3.49°) in comparison to manual expert markings. In comparison to those with normal movements, patients with unilateral vocal fold paralysis demonstrated significantly lower maximal glottic opening angles (mean 68.75° ± 11.82° vs. 49.44° ± 10.42°; difference, 19.31°; 95% confidence interval [CI] [12.17°-26.44°]; P < .001). Maximum opening angle less than 58.65° predicted unilateral vocal fold paralysis with a sensitivity of 0.85 and specificity of 0.85, with an area under the receiver operating characteristic curve of 0.888 (95% CI [0.784-0.991]; P < .001). CONCLUSION A user-friendly software tool for automated quantification of vocal fold movements from previously recorded videolaryngoscopy examinations is presented, termed automated glottic action tracking by artificial intelligence (AGATI). This tool may prove useful for diagnosis and outcomes tracking of vocal fold movement disorders. LEVEL OF EVIDENCE IV Laryngoscope, 131:E219-E225, 2021.
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Affiliation(s)
- Nat Adamian
- Surgical Photonics & Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew R Naunheim
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nate Jowett
- Surgical Photonics & Engineering Laboratory, Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
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Fernandes-Taylor S, Damico Smith C, Arroyo N, Bonnet K, Schlundt D, Wichmann M, Feurer I, Francis DO. Study protocol to develop a patient-reported outcome measuring disability associated with unilateral vocal fold paralysis: a mixed-methods approach with the CoPE collaborative. BMJ Open 2019; 9:e030151. [PMID: 31666263 PMCID: PMC6830693 DOI: 10.1136/bmjopen-2019-030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patient-reported outcome (PRO) measures are increasingly developed with multisite, representative patient populations so that they can serve as a primary endpoint in clinical trials and longitudinal studies. Creating multisite infrastructure during PRO measure development can facilitate future comparative effectiveness trials. We describe our protocol to simultaneously develop a PRO measure and create a collaborative of tertiary care centres to address the needs of patients with unilateral vocal fold paralysis (UVFP). We describe the stakeholder engagement, information technology and regulatory foundations for PRO measure development and how the process enables plans for multisite trials comparing treatments for this largely iatrogenic condition. METHODS AND ANALYSIS The study has three phases: systematic review, measure development and measure validation. Systematic reviews and qualitative interviews (n=75) will inform the development of a conceptual framework. Qualitative interviews with patients with UVFP will characterise the lived experience of the condition. Candidate PRO measure items will be derived verbatim from patient interviews and refined using cognitive interviews and expert input. The PRO measure will be administered to a large, multisite cohort of adult patients with UVFP via the CoPE (vocal Cord Paralysis Experience) Collaborative. We will establish CoPE to facilitate measure development and to create preliminary infrastructure for future trials, including online data capture, stakeholder engagement, and the identification of barriers and facilitators to participation. Classical test theory psychometrics and grounded theory characterise our approach, and validation includes assessment of latent structure, reliability and validity. ETHICS AND DISSEMINATION Our study is approved by the University of Wisconsin Health Sciences Institutional Review Board. Findings from this project will be published in open-access journals and presented at international conferences. Subsequent use of the PRO measure will include comparative effectiveness trials of treatments for UVFP at CoPE Collaborative sites.
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Affiliation(s)
| | - Cara Damico Smith
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Margarete Wichmann
- University of Wisconsin Survey Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Irene Feurer
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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