Perceptual and acoustic characteristics of voice changes in reflux laryngitis patients

Normative Values of Client-Reported Outcome Measures and Self-Ratings of Six Voice Parameters via the VoiceEvalU8 App

OBJECTIVES

Ecological momentary assessments (EMA) and interventions (EMI) have the potential to assess and offer interventions repeatedly within the client's daily life through mobile app technology. Considering the development of the EMA VoiceEvalU8, the current work provided normative data by comparing traditional (i.e., paper and pencil) and electronic (i.e., VoiceEvalU8 app) administration modalities of client-reported outcome measures and client self-ratings of six voice parameters twice a day in their functional environment.

METHODS

In Experiment 1, 50 vocally healthy cisgender women and men completed the Voice Handicap Index (VHI)-30, VHI-10, and Vocal Fatigue Index (VFI) with paper and pencil and the VoiceEvalU8 app. The order of administration modality and perceptual scales was randomized for each participant. In Experiment 2, 104 vocally healthy cisgender women and men used the VoiceEvalU8 app across five days in the morning before talking all day and in the evening after talking all day to self-rate six voice parameters (i.e., overall quality, roughness, breathiness, strain, pitch, and loudness) on a scale from 0 - 100. Mann Whitney U tests were run for all measures. Means and standard deviations are reported for descriptive analysis and normative values.

RESULTS

In Experiment 1, results showed no significant differences between paper and pencil and VoiceEValU8 app administration for the VHI-30, VHI-10, and VFI for vocally healthy adults. Normative values in the current study were consistent with previous literature for the VHI-10 and VFI factor 1 and 2, but slightly higher for the VHI-30 and slightly lower for the VFI factor 3. In Experiment 2, results demonstrated significant differences for all six voice parameters between the morning and evening log sessions. Normative values demonstrated higher self-ratings in the morning as compared to the evening.

CONCLUSIONS

For vocally healthy adults, completing the VHI-30, VHI-10, and VFI via paper and pencil and the VoiceEvalU8 app yielded the same results. Client self-ratings of six voice parameters on a scale from 0 - 100 twice a day demonstrated that vocally healthy adults perceived voice to be worse in the morning before talking all day as compared to the evening after talking all day. The results from the current work are promising for EMA via the VoiceEvalU8 app and support the need for continued investigations with clients with voice differences, problems, and/or disorders.

Role of Voice Handicap Index in Evaluation of Patients with Moderate to Severe Bilateral Sensorineural Hearing Loss

Background

Our ability to hear and speak enables us to communicate with others, forming an integral part of our emotional and social well-being. Vocal problems in hearing-impaired patients have yet to be assessed in terms of subjective level of disability they cause. Present study aims to assess the different Voice Handicap Index (VHI) scores among patients with moderate to severe sensorineural hearing loss and compare them to those with normal hearing.

Materials and Methods

In this prospective case control study(n = 150), study group A (n = 100) consisted of subjects with bilateral moderate to profound hearing loss on Pure tone audiometry and control group B (n = 50) with normal hearing. Both groups were asked to fill out VHI form after a normal videostroboscopic assessment.

Results

Mean VHI score in group A was 57.5 ± 12.48 and 6.0 ± 3.24 in group B, difference being statistically significant. A strong positive correlation was found between severity of hearing loss and VHI total score. The difference between both groups was also statistically significant for each of the three subscales of VHI.

Conclusion

We infer that subjects with moderate and higher bilateral sensorineural hearing loss hearing have statistically significant higher VHI scores as compared to those with normal hearing. It was observed that perception of voice handicap increased with the severity of hearing loss. These findings emphasize the need for multilateral assessment and treatment of voice disorders in subjects with hearing loss.

To Compare and Evaluate Laryngeal Changes in Patients with Dysphonia in Laryngopharyngeal Reflux (LPR) before and after Treatment with Proton Pump Inhibitors (PPI) and Prokinetic Drugs

To evaluate and compare pre and post treatment results using the following parameters by (a) Dual probe pH monitoring. (b) Laryngeal mucosal changes as assessed by direct video laryngoscopy/stroboscopy using Belafsky scores. (c) Voice changes by using GRBAS and Dr Speech software for speech analysis. In our study we have evaluated and compared voice and laryngeal changes in patients with dysphonia and RSI > 10 (which is suggestive of LPR) before treatment and after 6 months of treatment with Tab. Pantoprazole and Tab. Mosapride. This prospective study was carried out on 50 patients attending the ENT OPD of a tertiary care referral centre over a period of 18 months i.e. from Nov 2008 to Apr 2010. The study showed that prolonged therapy (> 6 months) is required to treat LPR effectively and 24 h ambulatory dual probe pH metry and videolaryngoscopy to assess RFS are the most preferred diagnostic tools in LPR. Dr Speech software for voice analysis can give an objective assessment of voice changes in LPR before and after treatment. The treatment consisting of PPI and prokinetic drugs proved to be effective in laryngopharyngeal reflux disease as improvement was seen in all the parameters including reflux findings score, subjective and objective voice assessment. According to results of our study, 24 h ambulatory dual probe pH metry, Reflux Finding Score (RFS), subjective and objective acoustic parameters can be used as indicators of efficacy of treatment.

Vocal deviation in individuals with suggestive signs and symptoms of laryngopharyngeal reflux

PURPOSE

Verify and compare vocal deviation in quality, vocal symptoms and reflux symptom index in patients with clinical diagnosis of laryngopharyngeal reflux (LPR).

METHODS

100 individuals of both genders participated in this prospective study, aged between 18 and 60 years old, who presented signs of LPR in the nasofibrolaryngological exam. Participants answered the Reflux Symptom Index (RSI) questionnaire to determine the reflux index and the Voice Symptom Scale (VoiSS). Their voices were recorded for the auditory-perceptual assessment. Three speech therapists with voice experience were contacted and the most reliable one was maintained.

RESULTS

100 examined voices, 34 were classified as adapted and 66 as deviated. The predominant vocal quality type was rough and a slight degree of deviation. The average score on VoiSS and RSI of individuals with deviated voice is significantly higher than the adapted voice group on both protocols (p<0.01). The symptom reported with most frequency and intensity, in both analyses, was throat clearing. There were statistically significant differences once analyzed the vocal quality types by pairs: rough-adapted (p=0.0021) and tense-adapted (p=0.0075) on VoiSS, and rough-adapted (p=0.001) on RSI.

CONCLUSION

Individuals with deviated voice reported higher occurrence of LPR related vocal signals and symptoms measured by VoiSS and RSI. The numerous theories about the disease do not make possible a single conclusion on the subject. Further studies are needed in the area to assist the professional in the diagnosis and treatment of the RLF patient.

Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why?

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.

Dysphonia and reflux in children: A systematic review

OBJECTIVE

Aim of this review is to evaluate the relation between reflux (either laryngopharyngeal or gastroesophageal) and dysphonia in children.

DATA SOURCES

PubMed, Scopus, Embase.

REVIEW METHODS

A literature search was conducted over a period from January 1990 to March 2020. The following search words were used either individually or in combination: voice disorders, laryngopharyngeal reflux, and gastroesophageal reflux. The search was conducted over a period of a month: April 2020.

RESULTS

Five clinical research were selected based on our objectives and selection criteria. Four studies were of level III evidence. Altogether, a total of 606 patients were pooled with male predominance of 63%. In all studies, reflux was suggested to have strong relation with dysphonia. Majority of cases used 24-h pH monitoring to confirm reflux which yielded positive results in 69%. The top three most common endoscopic findings include: interarytenoid erythema and edema (32/38), vocal cord erythema and edema (160/231) and postglottic edema (141/337). Vocal cord nodules were found in 28% of our patients. Acoustic analysis and perceptual assessment of voice was performed in only 1 study. No complication from any procedure was mentioned in any of the studies. Outcome of treatment was mentioned in 1 study, whereby after 4.5 months of follow-up, 68% of children showed improvement in symptoms.

CONCLUSION

Current evidence shows that there is strong relation between reflux and dysphonia in children. Most common laryngoscopic findings suggestive of reflux includes interarytenoid erythema and edema, vocal cord erythema and edema and postglottic edema.

Voice Characteristics in Patients with Acromegaly during Treatment

BACKGROUND

Active acromegaly is characterized by Growth Hormone and Insulin-like Growth Factor (IGF)-1 excess. Voice complaints are common in active acromegaly and are suggested to be caused by effects of Growth Hormone or IGF-1 on vocal cords and the surrounding soft tissues. Prospective studies on the course of voice characteristics in acromegaly patients are scarce and results are conflicting. This study investigates objective changes in voice parameters, self-reported perception of voice and laryngostroboscopic features during the first 2.5 years of acromegaly treatment.

MATERIAL AND METHOD

In this prospective study, acoustic voice analysis (and videolaryngostroboscopic examination were performed in 27 consecutive treatment-naive acromegaly patients at diagnosis (T₀), after 1 year (T₁) and after 2.5 years (T₂) of treatment. The voice handicap index (VHI-30) questionnaire was taken.

RESULTS

During acromegaly treatment, VHI scores decreased, and mucosal edema & hypertrophy diminished. No significant changes in objective voice parameters were detected. The within-subject change in serum IGF-1 levels (97.3 (40.6-208) to 22.4 (10.2-34.1) nmol/L (P < 0.001)) during follow-up correlated positively with the changes in VHI questionnaire scores (R 0.32-0.45; P = 0.002-0.03).

CONCLUSIONS

At diagnosis and during acromegaly treatment, mean VHI scores were in the normal range, although they decreased during follow-up. Mucosal edema and hypertrophy largely resolved during treatment. No significant changes in objective voice parameters were observed. Voice characteristics are in the normal range in patients with acromegaly, but may change during treatment. However, voice complaints are important to discuss, since they may influence quality of life.

Diagnostic Value of Acoustic and Aerodynamic Measurements in Vocal Fold Movement Disorders and their Correlation with Laryngeal Electromyography and Voice Handicap Index

OBJECTIVES

Investigate the relationships between the Voice Handicap Index, laryngeal electromyography, and objective acoustic voice testing in order to determine the utility of these measures in the management of vocal fold movement disorders.

METHODS

A retrospective review of patients who had completed a Voice Handicap Index-10 (VHI-10) questionnaire, laryngeal electromyography (LEMG), and objective acoustic measurements (including jitter, relative average perturbation, shimmer, noise-to-harmonic ratio, and standard deviation of fundamental frequency). All three tests had been completed within 30 days of the initial evaluation. All patients' results for acoustic measures were recorded as standard deviations from the norm. LEMG results were converted to grade of paresis (mild, moderate, severe) based on the muscle with the lowest recruitment. Spearman correlation coefficients were calculated to determine the relationship between these three parameters.

RESULTS

A total of 313 subjects were included in the analysis. VHI-10, LEMG (grade of paresis), and objective acoustic measures were, at best, weakly correlated. VHI-10 was better correlated than LEMG to each acoustic parameter including the average acoustic scores; however, the highest correlation observed only reached ρ = 0.349 (P < 0.001). The acoustic variables that correlated best with VHI-10 and LEMG were the standard deviation of the fundamental frequency (ρ = 0.349, P < 0.001) and shimmer (ρ = 0.207, P < 0.001), respectively.

CONCLUSION

This study demonstrates that these measures are, at best, weakly associated. VHI-10 correlated better than LEMG (grade of paresis) to each acoustic voice analysis parameter. However, the maximum correlation coefficient observed was 0.349. Therefore, VHI-10 scores and objective voice acoustic measurements are not useful for predicting the severity of vocal fold movement disorders. Moreover, a given severity of paresis can have different effects on voice handicap and acoustic output in different individuals.

Perceptual, Aerodynamic, and Acoustic Characteristics of Voice Changes in Patients with Laryngopharyngeal Reflux Disease

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.

Flexible voices: Identity perception from variable vocal signals

Human voices are extremely variable: The same person can sound very different depending on whether they are speaking, laughing, shouting or whispering. In order to successfully recognise someone from their voice, a listener needs to be able to generalize across these different vocal signals (‘telling people together’). However, in most studies of voice-identity processing to date, the substantial within-person variability has been eliminated through the use of highly controlled stimuli, thus focussing on how we tell people apart. We argue that this obscures our understanding of voice-identity processing by controlling away an essential feature of vocal stimuli that may include diagnostic information. In this paper, we propose that we need to extend the focus of voice-identity research to account for both “telling people together” as well as “telling people apart.” That is, we must account for whether, and to what extent, listeners can overcome within-person variability to obtain a stable percept of person identity from vocal cues. To do this, our theoretical and methodological frameworks need to be adjusted to explicitly include the study of within-person variability.

Results of a Voice-Related Survey of Physical Education Student Teachers

The current study investigated physical education (PE) student teachers' understanding of the vocal demands of their future profession, interest in participating in a voice-training program, and the current impact of the voice on quality-of-life by the Voice Handicap Index (VHI, Jacobson et al., 1997). Seventy-four PE student teachers completed a voice-related survey and the VHI. Forty-three percent of participants indicated that teaching will negatively affect the voice and 29% of participants reported that they may develop a voice problem because of teaching; however, only 17% of participants indicated that a voice training program was needed to learn healthy and effective voice use for teaching. Based on the results, participants knew that teaching may negatively impact the voice, but they were not convinced that a voice training program was necessary. In addition, the student teachers' voices were not negatively impacting quality- of-life, as determined by the VHI.

Factors associated with voice disorders among the elderly: a systematic review

Introduction

During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective.

Objective

The present study is a literature review to identify factors associated with voice disorders among the elderly described in population-based studies.

Methods

A systematic review of electronic databases was carried out. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The research was conducted independently by two researchers.

Results

Although two articles met the eligibility criteria, none fulfilled all the criteria for the evaluation of methodological quality. According to the two studies selected for this review, factors associated with voice disorders among the elderly included both physical and psychosocial aspects. However, the methodological discrepancies between the studies, particularly in relation to sample selection and the instruments used indicate great variability and compromise the reliability of the results.

Conclusion

Further prevalence studies and investigations of factors associated with voice disorders in the elderly from an epidemiological perspective, and which involve different cultures, should be carried out.

Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Objective

To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps’ tissues.

Study Design

Cross-sectional study.

Setting

Nanfang Hospital of Southern Medical University.

Subjects and Methods

The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed.

Results

The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%).

Conclusion

Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study

BACKGROUND

Laryngopharyngeal reflux is a prevalent, not well-understood disease affecting a high proportion of patients who seek laryngology consultation. The objective of this prospective case series is to explore the subjective and objective voice modifications in Laryngopharyngeal reflux (LPR), especially the usefulness of acoustic parameters as treatment outcomes, and to better understand the pathophysiological mechanisms underlying the development of voice disorder.

METHODS

Forty-one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily for three months. RSI, RFS, Voice Handicap Index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) were assessed at baseline and after three months post-therapy. Acoustic parameters were measured by selecting the most stable interval of the vowel /a/. A study of correlations between acoustic measurements and laryngoscopic signs was conducted in patients with roughness. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS).

RESULTS

Significant improvement in RSI, RFS, VHI, jitter, percent jitter, relative average perturbation (RAP), shimmer, percent shimmer, and amplitude perturbation quotient (APQ) was found at 3 months of treatment (p < .05). A correlation analysis revealed significant correlations between the grade of dysphonia, breathiness, asthenia, instability and jitter, percent jitter, RAP, shimmer, percent shimmer and APQ. In dividing our cohort into two groups of patients according to the presence of roughness, shimmer, percent shimmer and APQ significantly improved in patients with roughness, but no positive correlation was found between acoustic parameters and laryngoscopic signs.

CONCLUSION

Acoustic parameters can help to better understand voice disorders in LPR and can be used as treatment outcomes in patients with roughness.

Emirati Teachers' Perceptions of Voice Handicap

OBJECTIVES

The purpose of the study was to explore Emirati teachers' perceptions of voice handicap and to analyze their acoustic characteristics to determine whether acoustic measures of teachers' voice would verify their perceptions of voice handicap.

METHODS

Sixty-six Emirati school teachers (33 men and 33 women), with different years of teaching experience and age, and 100 control participants (50 men and 50 women) underwent vocal assessment that included the Voice Handicap Index (VHI-Arab) and acoustic measures (F0, jitter%, shimmer%, signal to noise ratio [SNR]).

RESULTS

Significant differences between the teachers' group scores and the control group scores on the following subscales of VHI-Arab: physical (P = 0.006), emotional (P = 0.004), and total score of the test (P = 0.002). No significant differences were found among teachers in the three VHI subscales, and the total score regarding gender (functional P = 0.307; physical P = 0.341; emotional P = 0.126; and total P = 0.184), age (functional P = 0.972; physical P = 0.525; emotional P = 0.772; and total P = 0.848), and years of teaching experience (functional P = 0.319; physical P = 0.619; emotional P = 0.926; and total P = 0.638). The significant differences between the teacher's group and the control group in three acoustic measures: F0 (P = 0.000), shimmer% (P = 0.000), and SNR (P = 0.000) were further investigated. Significant differences were found among female and male teachers in F0 (P = 0.00) and SNR (P = 0.007). As for teachers' age, significant differences were found in SNR (P = 0.028). Teachers' years of experience did not show significant differences in any of the acoustic measures.

CONCLUSIONS

Teachers have a higher perception of voice handicap. However, they were able to produce better voice quality than control participants were, as expressed in better SNRs. This might have been caused either by manipulation of vocal properties or abusive overloading the vocal system to produce a procedurally acceptable voice quality.

Vocal fold epithelial barrier in health and injury: a research review

PURPOSE

Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults, including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of current knowledge of the vocal fold epithelial barrier.

METHOD

A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced.

RESULTS/CONCLUSIONS

Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation.

Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring

BACKGROUND AND OBJECTIVES

There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring.

PATIENTS AND METHODS

Eighty-two patients with voice-related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI-10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS.

RESULTS

Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found between the Ryan composite measurements and both severity ratings (VHI-10, RSI).

CONCLUSION

LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients' self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.

LPR: how different diagnostic tools shape the outcomes of treatment

OBJECTIVE

To seek a deeper and more comprehensive understanding of two major diagnostic methods for laryngopharyngeal reflux by exploring whether and how differences exist before and after treatment between patients diagnosed by either Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) or 24-hour pH monitoring.

MATERIALS AND METHODS

Two groups of patients who confirmed laryngopharyngeal reflux disease (LPRD) by either a combination of RSI and RFS (Questionnaire group, 35 patients) or 24-hour multichannel intraluminal impedance (MII) pH monitoring (pH Group, 23 patients) were recruited. All patients were prescribed esomeprazole 20 mg twice a day for 1 month. RSI, RFS, and acoustic parameters before and after treatment were compared between the two groups. Intrinsic correlations involving multiple parameters were investigated as well.

RESULTS

Except for excess throat mucus (P = 0.019) and subglottic edema (P = 0.042), most RSI and RFS items before treatment were not significantly different between the Questionnaire and pH Groups, and nearly all such items in both groups exhibited distinct remission after therapy (P < 0.05). Absolute value of remission in RSI after treatment was more prominent in pH Group than in the Questionnaire group (P = 0.007). Jitter (P = 0.252), shimmer (P = 0.815), and harmonics-to-noise ratio (P = 0.117) descended to normal value after treatment. Moderate to high levels of correlation were found between the patient's original status and the absolute value of remission in most items of RSI and RFS as well as voice parameters.

CONCLUSION

The 24-hour MII pH monitoring and a combination of RSI and RFS are quite competitive with each other in selecting LPRD patients. Although treatment worked out on nearly all the symptoms, laryngeal images and voice parameters, 24-hour MII pH seems to be more promising in a greater symptom relief. The extent of relief that can take place in most of the measurements is considerably determined by their initial status.

Jordanian teachers' perceptions of voice handicap

This study aimed to investigate if Jordanian school teachers perceive their voice as handicapped using the Voice Handicap Index (VHI)-Arab. The effect of teachers' age, gender, years of teaching, class taught, and education level on VHI was examined. A total of 289 teachers and a control group of 100 participants took part in the study. The teachers' group differed significantly from the control group in the physical, emotional, and functional subscales and the total score of the VHI-Arab. There was no significant difference among teachers in any of the three VHI subscales or total regarding gender, age, years of teaching experience, education level, and classes taught. Jordanian teachers have a strong perception of voice handicap. Thus, preventive and treatment vocal programs are strongly advised.

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring

PURPOSE

To investigate laryngeal and voice disorders in patients with gastroesophageal symptoms and their correlation with pH-monitoring.

METHODS

A prospective study was carried out in patients attended at the Voice Disorder Outpatient Clinics of Botucatu Medical School in a five-year period and had vocal and gastroesophagic symptoms. Patients underwent videolaryngoscopy, auditory-perceptual vocal analyses, computerized acoustic vocal analysis and dual probe pH-monitoring for 24 hours.

RESULTS

Fifty-seven patients were included (aged between 21 and 65 years; 45 women and 12 men), 18 had normal (31.6%) and 39 had abnormal pH-monitoring results (68.4%). Videolaryngoscopy recorded several laryngeal lesions for both patients with normal and abnormal pH-monitoring, but mostly for the latter group, highlighting posterior pachyderma. Auditory-perceptual vocal assessments identified vocal changes of several intensities for both groups but especially for patients with abnormal pH-monitoring results. All acoustic parameters, except f0, were abnormal for both groups, compared to the control population.

CONCLUSION

Acoustic and perceptual vocal changes and laryngeal lesions were recorded for both patients with normal pH-monitoring results and patients with abnormal pH-monitoring results, evidencing the importance of clinical history and videolaryngoscopic findings for diagnosing acid laryngitis.

Effects of omeprazole over voice quality in muscle tension dysphonia patients with laryngopharyngeal reflux

Backround

Laryngopharyngeal reflux (LPR) is the backflow of stomach contents above upper esophageal sphincter, into the pharynx, larynx, and upper aerodigestive system.

Objectives

In this study, effects of omeprazole over voice quality in muscle tension dysphonia with laryngopharyngeal reflux was ınvestigated.

Patients and Methods

Nine patients, 7 males and 2 females, aged between 27-43 (mean age:31) were included to this study. The diagnosis of muscle tension dysphonia with LPR was established by video laryngoscopy, rigid scope 70º. The laryngeal changes related with LPR were evaluated according to Reflux Finding Score. The patients received omeprazole 20 mg twice a day for a period of 6 months. None of the patients received voice therapy. Vocal hygiene guidelines were also explained to the patients. Objective and subjective voice parameters (Jitter, shimmer, NHR, Voice Handicap Index, and Auditive analysis; Roughness, breathiness, and hoarseness) were evaluated in this study.

Results

After treatment with omeprazol, all the parameters showed an improvement in voice quality, but only VHI (P = 0) and shimmer (P = 0,018) are statistically significant.

Conclusions

For FD patients with LPR condition, we highly recommend that LPR treatment should be part of the treatment plan.

The effects of cigarette smoking on the female voice

To investigate voice changes as they develop over time due to cigarette smoking, women who never smoked (NS), women who smoked less than 10 years (S1), and women who smoked 10 or more years (S2) were compared. Acoustic (fundamental frequency, jitter, shimmer, signal-to-noise ratio), electroglottographic (open, closing, and speed quotients), aerodynamic (subglottal pressure, airflow, laryngeal airway resistance), and perceptual measures were obtained. Fundamental frequency and open quotient significantly decreased and speed quotient significantly increased in S1 and S2; jitter and shimmer significantly increased in S2 only. NS were perceived as non-smokers more reliably than S1 and S2 as smokers. Fundamental frequency, open quotient, and speed quotient were the most sensitive indicators of smoking effects on the female voice.

Combination of voice therapy and antireflux therapy rapidly recovers voice-related symptoms in laryngopharyngeal reflux patients

OBJECTIVE

Patients with laryngopharyngeal reflux frequently experience voice-related symptoms. This study was designed to investigate the effectiveness of combined voice and medical therapy in comparison with medical therapy alone in the improvement of voice-related symptoms and parameters in patients with laryngopharyngeal reflux.

STUDY DESIGN

Concurrent nonrandomized comparative trial.

SETTING

Otolaryngology department at a university hospital.

SUBJECTS AND METHODS

In this prospective study, 100 patients diagnosed with laryngopharyngeal reflux with voice symptoms were divided into 2 groups: 50 patients were treated with medication alone, and 50 were treated with medication plus voice therapy. The following data were recorded before treatment and at 1, 2, and 3 months posttreatment: reflux symptom index (RSI), reflux finding score (RFS), voice handicap index (VHI), perceptual analysis, and acoustic analysis. The numbers of patients showing clinically significant reductions in these parameters were compared between groups using the following cutoff values: change in RSI ≥5, change in RFS ≥3, change in VHI ≥15, and change in grade, roughness, breathiness, asthenia, and strain scale (GRBAS) ≥1.

RESULTS

Significantly more patients in the study group showed a clinically significant change in RSI, VHI, and GRBAS score at the 1-, 2-, and 3-month follow-up evaluations. No clinically significant change in RFS was achieved in either group at 1 or 2 months, but a significantly greater change was achieved in the study group at 3 months.

CONCLUSIONS

Voice therapy may help to restore reversible mucosal change secondary to acidic reflux, inducing rapid resolution of symptoms and shortening of the treatment period.

Normative values for the Voice Handicap Index-10

OBJECTIVES

The objective of this study was to elucidate the normative values for the Voice Handicap Index-10 (VHI-10) questionnaire.

METHODS

VHI questionnaires were completed by 190 subjects without voice complaints. The results were then analyzed for mean, standard error of the mean (SEM), and standard deviation (SD) for both the original VHI and VHI-10 subset questionnaires. Outliers were defined as being more than three standard deviations above the mean.

RESULTS

Analysis of 156 VHI questionnaires revealed a mean of 6.86 (SEM=0.79, SD=9.88) for the normative values. One hundred fifty-eight VHI-10 questionnaires were analyzed to show a mean of 2.83 (SEM=0.31, SD=3.93) for the normative values.

CONCLUSIONS

This study offers normative data for the VHI-10 that has been missing in the literature. A VHI-10 score >11 should be considered abnormal.

Disfonia organofuncional e queixas de distúrbios alérgicos e/ou digestivos

OBJETIVO: verificar a ocorrência de queixas de distúrbios alérgicos e/ou digestivos em pacientes com disfonia organofuncional, atendidos no Setor de Voz de uma clínica-escola de Fonoaudiologia. MÉTODOS: este estudo caracteriza-se como estudo de série, retrospectivo e transversal. Realizou-se uma análise de 113 prontuários de pacientes com disfonia organofuncional que apresentavam queixas de distúrbios alérgicos e/ou digestivos, na faixa etária de cinco a 76 anos, sendo 41 do sexo masculino e 72 do feminino. O procedimento estatístico utilizado foi o Teste de Hipótese para Duas Proporções. RESULTADOS: houve significante frequência de queixas de distúrbios alérgicos e digestivos associados nos pacientes dos disfonia organofuncional; entre as queixas de distúrbios alérgicos, de distúrbios digestivos, e de ambas associadas, as queixas de distúrbios alérgicos foram significantemente mais frequentes nos pacientes com disfonia organofuncional. CONCLUSÃO: existe uma relação entre as queixas de distúrbios alérgicos e/ou digestivos e a disfonia, uma vez que esses são co-fatores para o estabelecimento da disfonia e da lesão laríngea. A alta freqüência de queixas de distúrbios alérgicos nos indivíduos com disfonia organofuncional, no presente estudo, pode ter relação com o clima do sul do Brasil.

Reliability of perceptions of voice quality: evidence from a problem asthma clinic population

INTRODUCTION

Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off.

MATERIALS AND METHODS

Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories.

RESULTS AND ANALYSIS

Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender.

DISCUSSION

These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.

Change of acoustic parameters before and after treatment in laryngopharyngeal reflux patients

OBJECTIVES

To evaluate the usefulness of acoustic parameters as an indicator of laryngopharyngeal reflux (LPR) treatment efficacy.

STUDY DESIGN

A prospective case series analysis.

MATERIALS AND METHODS

From January to September 2005, we prospectively analyzed 40 patients who were diagnosed with laryngopharyngeal reflux by 24-hour ambulatory double-probe pH monitoring. Laryngopharyngeal reflux patients were treated medically and voice analysis was conducted three times: before treatment, 1 to 2 months after treatment, and 3 to 4 months after treatment. Jitter, shimmer, and harmonic-to-noise ratio (HNR) were analyzed as the acoustic parameters. Pre- and posttreatment reflux symptom index and reflux finding score were documented.

RESULTS

Jitter, shimmer, and HNR had improved significantly at 1 to 2 months after treatment and were maintained at 3 to 4 months after treatment. Jitter was significantly correlated with reflux symptom index.

CONCLUSION

Acoustic parameters can be used as indicators of treatment efficacy for laryngopharyngeal reflux disease.

[Comparison of the results obtained through manual and automatic phonetogram]

INTRODUCTION

The phonetogram (F) is the graphic representation of a person phonatory potential. The F carried out with a sonometer and a frequency analyser is what is called "manual phonetogram" (MPh), and the one obtained by means of a computer is called the "automatic phonetogram" (APh).

MATERIAL AND METHODS

We have carried out in 12 lyrical singers a standard MPh and an APh with the program Dr. Speech Science 3.0.

RESULTS

It was showed a significant difference with a p < 0.0005 in 14 of the 15 measures compared, and a p < 0.05 for the other one, being in general the results of the automatic test different from those of the manual in excess, with a correlation between the results obtained through both methods.

CONCLUSIONS

The APh obtained with the program Dr. Speech Science 3.0 is a faster and easier way to obtain the phonetogram than the one used to obtain the MPh, showing however big differences in excess compared with the ones of the MPh in all the usual phonetometric parameters.