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Krasnodębska P, Szkiełkowska A, Pollak A, Romaniszyn-Kania P, Bugdol MN, Bugdol MD, Mitas AW. Analysis of the relationship between emotion intensity and electrophysiology parameters during a voice examination of opera singers. Int J Occup Med Environ Health 2024; 37:84-97. [PMID: 38375631 PMCID: PMC10959272 DOI: 10.13075/ijomeh.1896.02272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/12/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Emotions and stress affect voice production. There are only a few reports in the literature on how changes in the autonomic nervous system affect voice production. The aim of this study was to examine emotions and measure stress reactions during a voice examination procedure, particularly changes in the muscles surrounding the larynx. MATERIAL AND METHODS The study material included 50 healthy volunteers (26 voice workers - opera singers, 24 control subjects), all without vocal complaints. All subjects had good voice quality in a perceptual assessment. The research procedure consisted of 4 parts: an ear, nose, and throat (ENT)‑phoniatric examination, surface electromyography, recording physiological indicators (heart rate and skin resistance) using a wearable wristband, and a psychological profile based on questionnaires. RESULTS The results of the study demonstrated that there was a relationship between positive and negative emotions and stress reactions related to the voice examination procedure, as well as to the tone of the vocal tract muscles. There were significant correlations between measures describing the intensity of experienced emotions and vocal tract muscle maximum amplitude of the cricothyroid (CT) and sternocleidomastoid (SCM) muscles during phonation and non-phonation tasks. Subjects experiencing eustress (favorable stress response) had increased amplitude of submandibular and CT at rest and phonation. Subjects with high levels of negative emotions, revealed positive correlations with SCMmax during the glissando. The perception of positive and negative emotions caused different responses not only in the vocal tract but also in the vegetative system. Correlations were found between emotions and physiological parameters, most markedly in heart rate variability. A higher incidence of extreme emotions was observed in the professional group. CONCLUSIONS The activity of the vocal tract muscles depends on the type and intensity of the emotions and stress reactions. The perception of positive and negative emotions causes different responses in the vegetative system and the vocal tract. Int J Occup Med Environ Health. 2024;37(1):84-97.
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Affiliation(s)
- Paulina Krasnodębska
- Institute of Physiology and Pathology of Hearing, Audiology and Phoniatrics Clinic, Kajetany, Poland
| | - Agata Szkiełkowska
- Institute of Physiology and Pathology of Hearing, Audiology and Phoniatrics Clinic, Kajetany, Poland
| | - Anita Pollak
- University of Silesia in Katowice, Institute of Psychology, Katowice, Poland
| | - Patrycja Romaniszyn-Kania
- Silesian University of Technology, Faculty of Biomedical Engineering, Department of Medical Informatics and Artificial Intelligence, Zabrze, Poland
| | - Monika N. Bugdol
- Silesian University of Technology, Faculty of Biomedical Engineering, Department of Medical Informatics and Artificial Intelligence, Zabrze, Poland
| | - Marcin D. Bugdol
- Silesian University of Technology, Faculty of Biomedical Engineering, Department of Medical Informatics and Artificial Intelligence, Zabrze, Poland
| | - Andrzej W. Mitas
- Silesian University of Technology, Faculty of Biomedical Engineering, Department of Medical Informatics and Artificial Intelligence, Zabrze, Poland
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Silva WJ, Lopes L, Galdino MKC, Almeida AA. Voice Acoustic Parameters as Predictors of Depression. J Voice 2024; 38:77-85. [PMID: 34353686 DOI: 10.1016/j.jvoice.2021.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze whether voice acoustic parameters are discriminant and predictive in patients with and without depression. METHODS Observational case-control study. The following instruments were administered to the participants: Self-Reporting Questionnaire (SRQ-20), Beck Depression Inventory-Second Edition (BDI-II), Voice Symptom Scale (VoiSS) and voice collection for subsequent extraction of the following acoustic parameters: mean, mode and standard deviation (SD) of the fundamental frequency (F0); jitter; shimmer; glottal to noise excitation ratio (GNE); cepstral peak prominence-smoothed (CPPS); and spectral tilt. A total of 144 individuals participated in the study: 54 patients diagnosed with depression (case group) and 90 without a diagnosis of depression (control group). RESULTS The means of the acoustic parameters showed differences between the groups: F0 (SD), jitter, and shimmer values were high, while values for GNE, CPPS and spectral tilt were lower in the case group than in the control group. There was a significant association between BDI-II and jitter, shimmer, CPPS, and spectral tilt and between CPPS and the class of antidepressants used. The multiple linear regression model showed that jitter and CPPS were predictors of depression, as measured by the BDI-II. CONCLUSION Acoustic parameters were able to discriminate between patients with and without depression and were associated with BDI-II scores. The class of antidepressants used was associated with CPPS, and the jitter and CPPS parameters were able to predict the presence of depression, as measured by the BDI-II clinical score.
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Affiliation(s)
- Wegina Jordana Silva
- Department of Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN), João Pessoa, Paraíba, Brazil.
| | - Leonardo Lopes
- Department of Speech Therapy, Federal University of Paraíba (UFPB), Graduate Program in Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN - PPgFon), Graduate Program in Decision and Health Models (PPgMDS), and Graduate Program in Linguistic (PROLING) of UFPB, João Pessoa, Paraíba, Brazil.
| | - Melyssa Kellyane Cavalcanti Galdino
- Department of Psychology, Federal University of Paraíba (UFPB), Graduate Program in Cognitive Neuroscience and Behavior (PPgNeC) of UFPB, João Pessoa, Paraíba, Brazil.
| | - Anna Alice Almeida
- Department of Speech Therapy, Federal University of Paraíba (UFPB), Graduate Program in Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN - PPgFon), Graduate Program in Decision and Health Models (PPgMDS), and Graduate Program in Cognitive Neuroscience and Behavior (PPgNeC) of UFPB, João Pessoa, Paraíba, Brazil.
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Venkatraman A, Fujiki RB, Sivasankar MP. A Review of Factors Associated with Voice Problems in the Fitness Instructor Population. J Voice 2023; 37:805.e13-805.e17. [PMID: 34154914 DOI: 10.1016/j.jvoice.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
There is a high prevalence of reported dysphonia symptomology in the fitness instructor population. This is concerning as these reported symptoms of dysphonia, aphonia, and vocal fatigue can significantly compromise quality of life. The purpose of this review is to explore key factors that may contribute to voice problems in the fitness instructor population. Voicing with concurrent phonation and exercise may be influenced by (1) the increased cardiovascular requirement during exercise, (2) the increased cognitive load associated with dual tasking, (3) the altered hydration state associated with prolonged exercise, and (4) the phonatory dose associated with continued voicing with loud background music. This manuscript will explore the literature on these key factors (ie, phonatory dose, dehydration, metabolic bioenergetics, cognitive load, and psychosocial stress) as they pertain to fitness instructors.
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Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA.
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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4
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Baker CP, Purdy SC, Rakena TO, Bonnini S. It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers. J Clin Med 2023; 12:5130. [PMID: 37568532 PMCID: PMC10420037 DOI: 10.3390/jcm12155130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers' perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/PSub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants' composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users.
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Affiliation(s)
- Calvin Peter Baker
- Speech Science, School of Psychology, University of Auckland, Auckland 1023, New Zealand;
- School of Music, University of Auckland, Auckland 1010, New Zealand;
| | - Suzanne C. Purdy
- Speech Science, School of Psychology, University of Auckland, Auckland 1023, New Zealand;
| | - Te Oti Rakena
- School of Music, University of Auckland, Auckland 1010, New Zealand;
| | - Stefano Bonnini
- Department of Economics & Management, University of Ferrara, 44121 Ferrara, Italy;
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McKenna VS, Roberts RM, Friedman AD, Shanley SN, Llico AF. Impact of naturalistic smartphone positioning on acoustic measures of voicea). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:323-333. [PMID: 37450331 DOI: 10.1121/10.0020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Smartphone technology has been used for at-home health monitoring, but there are few available applications (apps) for tracking acoustic measures of voice for those with chronic voice problems. Current apps limit the user by restricting the range of smartphone positions to those that are unnatural and non-interactive. Therefore, we aimed to understand how more natural smartphone positions impacted the accuracy of acoustic measures in comparison to clinically acquired and derived measures. Fifty-six adults (11 vocally healthy, 45 voice disordered, aged 18-80 years) completed voice recordings while holding their smartphones in four different positions (e.g., as if reading from the phone, up to the ear, etc.) while a head-mounted high-quality microphone attached to a handheld acoustic recorder simultaneously captured voice recordings. Comparisons revealed that mean fundamental frequency (Hz), maximum phonation time (s), and cepstral peak prominence (CPP; dB) were not impacted by phone position; however, CPP was significantly lower on smartphone recordings than handheld recordings. Spectral measures (low-to-high spectral ratio, harmonics-to-noise ratio) were impacted by the phone position and the recording device. These results indicate that more natural phone positions can be used to capture specific voice measures, but not all are directly comparable to clinically derived values.
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Affiliation(s)
- Victoria S McKenna
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio 45267, USA
| | - Rachel M Roberts
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio 45267, USA
| | - Aaron D Friedman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio 45267, USA
| | - Savannah N Shanley
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio 45267, USA
| | - Andres F Llico
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio 45221, USA
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Hari G, Naunheim M, Kallogjeri D, Huston M. Anxiety and Depression Diagnoses and the Cough Severity Index: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2023:1455613231180336. [PMID: 37317544 DOI: 10.1177/01455613231180336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Background: As mental health comorbidities can impact patient perception of symptoms, understanding a potential association of anxiety and depression with patients' perception of their cough may provide insight into preferred treatment plans. Methods: A retrospective cohort study of patients presenting with chronic cough was completed. Demographics, anxiety and depression diagnoses, and patient-reported outcome measures were collected. Patient-reported outcomes between the four groups of patients-anxiety only, depression only, anxiety and depression, and none of these conditions-were compared using Kruskal-Wallis and Mann-Whitney U tests that were used for post-hoc analysis. Results: Cough Severity Index scores were higher in those with both anxiety and depression as compared to neither, with a median score of 26 (range: 5-39) versus 19 (range: 1-38), respectively (P = .041). These results were persistent also after controlling for sex and smoking status in the robust regression analysis. Conclusions: Patients with prior diagnoses of anxiety and depression self-reported more severe symptoms for chronic cough. Adequately understanding the association of mental health with perceived cough severity may help for more individualized, successful treatment plans.
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Affiliation(s)
- Gopika Hari
- Department of Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Molly Huston
- Department of Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Ravi S, Lopez V, Carter KV, Sharpe SA, George D, Ebersole B, Machiorlatti M, Jamal N. Intersection of Mental Health and Dysphonia: A Scoping Review. J Voice 2023:S0892-1997(23)00130-3. [PMID: 37210321 DOI: 10.1016/j.jvoice.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Previous research has indicated that voice disorders frequently co-occur with mental health disorders, which may influence voice treatment seeking behavior and effectiveness. Our goal is to characterize the existing literature on the relationship between voice disorders and mental health and to investigate nuances related to mental health and voice disorder diagnosis. DATA SOURCES Ovid MEDLINE, ProQuest PsycINFO, and Web of Science. REVIEW METHODS Using the PRISMA protocol, a scoping review was performed. Databases searched included: Ovid MEDLINE, ProQuest PsycINFO, and Web of Science. Our inclusion criteria were all adults seen in an outpatient setting for voice and mental health disorders, excluding those with a prior history of head and neck surgery, cancers, radiation, or developmental anomalies, and certain mental health disorders. Results were screened by two independent screeners for inclusion. Data were then extracted and analyzed to present key findings and characteristics. RESULTS A total of 156 articles, with publication dates ranging from 1938 to 2021, were included in the analysis, with females and teachers being the most described population groups. The most frequently studied laryngeal disorders were dysphonia (n = 107, 68.6%), globus (n = 33, 21.2%), and dysphonia with globus (n = 16, 10.2%). The two most common mental health disorders found in the included studies were anxiety disorders (n = 123, 78.8%) and mood disorders (n = 111, 71.2%). The Voice Handicap Index was the most used tool to gather data on voice disorders (n = 36, 23.1%), while the Hospital Anxiety and Depression Scale was the most used tool to gather data on mental health disorders (n = 20, 12.8%). The populations studied within the included articles were predominately female and worked in educational occupations. Race and ethnicity was only reported for 10.2% of included articles (n = 16) and the most commonly studied race was White/Caucasian (n = 13, 8.3%). CONCLUSION Our scoping review of the current literature on mental health and voice disorders reveals an intersection between the conditions. The current literature represents change over time in terms of terminology that recognizes the patient's individualized experience of mental health and laryngeal conditions. However, there is still a great deal of homogeneity in the studied patient populations in terms of race and gender, with patterns and gaps that require further investigation.
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Affiliation(s)
- Saisree Ravi
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas.
| | - Vanessa Lopez
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Kathleen V Carter
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Stephanie A Sharpe
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Deepu George
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Barbara Ebersole
- Department of Head and Neck Surgery, Speech Pathology and Audiology Section, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Nausheen Jamal
- School of Medicine, The University of Texas Rio Grande Valley, Edinburg, Texas
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Mayne GV, Namazi M. Social Determinants of Health: Implications for Voice Disorders and Their Treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1050-1064. [PMID: 37059074 DOI: 10.1044/2023_ajslp-21-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations. CONCLUSIONS This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.
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Affiliation(s)
- Geneva V Mayne
- School of Communication Disorders and Deafness, Kean University, Union, NJ
| | - Mahchid Namazi
- School of Communication Disorders and Deafness, Kean University, Union, NJ
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9
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Barbosa I, Behlau M, Almeida LN, Ramos N, Lopes L, Almeida AA. Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory. J Voice 2023:S0892-1997(23)00028-0. [PMID: 36868955 DOI: 10.1016/j.jvoice.2023.01.027] [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: 10/26/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE this study aims to verify the stages of evidence of validity of the voice-adapted present perceived control scale (V-APPCS) in its translated and cross-culturally adapted version for the Brazilian Portuguese "Voice-Adapted Present Perceived Control Scale" and to estimate the psychometric measurements of the properties of its items based on the item response theory (IRT). METHODS the instrument underwent a process of translation and cross-cultural adaptation for the Brazilian Portuguese, the process was carried out by two qualified translators, native in the destination language, and fluent in the language and culture of origin. The first translated version of the protocol was forwarded to a back-translation, performed by a third bilingual Brazilian translator. The translations were analyzed and compared by a committee composed of five speech therapists who are specialists in voice and with proficiency in the English language. The empirical study used data from 168 individuals, 127 had voice problems and 41 vocally healthy ones. For the stages of validity evidence, the following analyses were performed: Cronbach's alpha, exploratory factor analysis, confirmatory factor analysis and IRT. RESULTS The stages of translation and cross-cultural adaptation allowed linguistic adjustments to be made so that the items were understandable and suitable for use in Brazil. The adequacy, structure, and application of the items were confirmed through the application of the final version of the scale in twenty individuals in a real context. The instrument in its Brazilian version presented good internal consistency, with bifactorial structure the exploratory factor analysis, besides presenting satisfactory values in the adjustment indexes of the model, confirming the structure of the confirmatory factor Analysis. The IT was applied to evaluate the parameters discrimination (a) and difficulty (b) of the items of the instrument; item 5 "I have control over my day-to-day reactions to the voice problem." Presented itself as a more discriminative item and item 8 "My reaction to the voice problem is not under my control." As an item of greater difficulty. CONCLUSION The V-APPCS, translated, cross-culturally adapted, and validated, is robust and adequate to represent the construct in the Brazilian versions.
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Affiliation(s)
- Iandra Barbosa
- Universidade Federal da Paraíba, UFPB and Universidade Federal do Rio Grande do Norte, UFRN, Brazil; Centro de Estudos da Voz- CEV, São Paulo, Brazil
| | - Mara Behlau
- Centro de Estudos da Voz- CEV, São Paulo, Brazil
| | | | - Noemi Ramos
- Universidade Federal da Paraíba, UFPB, João Pessoa, Paraíba
| | - Leonardo Lopes
- Centro de Estudos da Voz- CEV, São Paulo, Brazil; Universidade Federal da Paraíba, UFPB, João Pessoa, Paraíba
| | - Anna Alice Almeida
- Centro de Estudos da Voz- CEV, São Paulo, Brazil; Universidade Federal da Paraíba, UFPB, João Pessoa, Paraíba.
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Clunie GM, Belsi A, Roe JG, Sandhu G, McGregor A, Alexander CM. 'Is there something wrong with your voice?' A qualitative study of the voice concerns of people with laryngotracheal stenosis. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:376-389. [PMID: 36189991 DOI: 10.1111/1460-6984.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Acquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs) and a limited understanding of the impact of voice changes on adults with LTS. AIM To investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs. METHODS AND PROCEDURES A phenomenological, qualitative study design was used. Focus groups and semi-structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub-themes. OUTCOMES AND RESULTS A total of 24 participants (five focus groups and two interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub-themes directly related to voice included experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. CONCLUSIONS AND IMPLICATIONS In this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information provision throughout the course of their condition. The broader research literature relating to voice difficulties is explored with links made to people with LTS and recommendations made for future research into people living with LTS and dysphonia. WHAT THIS PAPER ADDS What is already known on this subject Adults with laryngotracheal stenosis (LTS) experience voice changes as a result of their condition, and the surgeries necessary as a treatment. These changes can lead to altered pitch, vocal fatigue, loss of pitch range and loss of volume control. Although there are known psychosocial implications both to living with a chronic condition and voice difficulties there has been no research exploring this in adults with LTS, and there is minimal clinical guidance for speech and language therapists (SLTs) working with these patients. What this paper adds to existing knowledge This research is the first study to explore the lived experience of adults with LTS who undergo reconstructive surgery, focusing on their voice concerns. This study demonstrates the multifactorial impacts of voice changes on all aspects of the lives of adults with LTS and the need for individualised information provision and clinical care to help support them. What are the potential or actual clinical implications of this work? Adults with LTS want expert SLTs to facilitate their care and support them throughout their LTS journey alongside other support networks. They want to be carefully prepared for reconstructive surgery and given clear information about symptoms and management of their voice difficulties. This has led to the reorganisation of the care pathway at our centre, and the introduction of a patient-led pretreatment session.
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Affiliation(s)
- Gemma M Clunie
- Department of Surgery & Cancer, Imperial College London, London, UK
- Caroline Therapies Department Guri, ENT Department, Imperial College Healthcare NHS Trust, London, UK
| | - Athina Belsi
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - JustinW G Roe
- Department of Surgery & Cancer, Imperial College London, London, UK
- Caroline Therapies Department Guri, ENT Department, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- Department of Surgery & Cancer, Imperial College London, London, UK
- Caroline Therapies Department Guri, ENT Department, Imperial College Healthcare NHS Trust, London, UK
| | - Alison McGregor
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Department of Surgery & Cancer, Imperial College London, London, UK
- Caroline Therapies Department Guri, ENT Department, Imperial College Healthcare NHS Trust, London, UK
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11
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Psychological Distress in a Sample of Adult Italian Patients Affected by Vocal Nodules and Muscle-Tension Dysphonia: Preliminary Results. J Voice 2023; 37:300.e21-300.e29. [PMID: 33388226 DOI: 10.1016/j.jvoice.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation. METHODS This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample. RESULTS In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress. CONCLUSION the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.
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Ostermann TA, Fuchs M, Hinz A, Engel C, Berger T. Associations of Personality, Physical and Mental Health with Voice Range Profiles. J Voice 2023:S0892-1997(22)00377-0. [PMID: 36599716 DOI: 10.1016/j.jvoice.2022.11.025] [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: 05/09/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES There is evidence in the literature that voice characteristics are linked to mental and physical health. The aim of this explorative study was to determine associations between voice parameters measured by a voice range profile (VRP) and personality, mental and physical health. STUDY DESIGN Cross-sectional population-based study. METHODS As part of the LIFE-Adult-Study, 2639 individuals aged 18-80 years, randomly sampled from the general population, completed both speaking and singing voice tasks and answered questionnaires on depression, anxiety, life satisfaction, personality and quality of life. The voice parameters used were fundamental frequency, sound pressure level, their ranges and maximum phonation time. The associations were examined with the help of correlation and regression analyses. RESULTS Wider ranges between the lowest and highest frequency, between the lowest and highest sound pressure level and longer maximum phonation time were significantly correlated with extraversion and quality of life in both sexes, as well as openness and agreeableness in women. Smaller ranges and shorter maximum phonation time were significantly correlated with depression. Neuroticism in men was inversely correlated with the maximum phonation time. In the speaking VRP, the associations for sound pressure level were more pronounced than for the fundamental frequency. The same was true in reverse for the singing VRP. Few associations were found for anxiety, life satisfaction and conscientiousness. CONCLUSIONS Weak associations between voice parameters derived from the VRP and mental and physical health, as well as personality were seen in this exploratory study. The results indicate that the VRP measurements in a clinical context are not significantly affected by these parameters and thus are a robust measurement method for voice parameters.
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Affiliation(s)
- Thomas A Ostermann
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael Fuchs
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.
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Szkiełkowska A, Krasnodębska P, Mitas A, Bugdol M, Bugdol M, Romaniszyn-Kania P, Pollak A. Electrophysiological predictors of hyperfunctional dysphonia. Acta Otolaryngol 2023; 143:56-63. [PMID: 36595463 DOI: 10.1080/00016489.2022.2162961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relation between the autonomic nervous system (ANS) and muscles of the vocal tract is of particular importance when considering the pathomechanism of a functional voice disorder. AIMS The aim of this study was to record electrophysiological indicators from the ANS as well as the tone of the external laryngeal muscle and test whether together they could point to an enhanced risk of primary functional voice disorder. MATERIALS AND METHODS The study material consisted of 81 people, 27 of whom were professional opera singers. None reported any voice complaints. The research comprised ENT and phoniatric examination, superficial electromyography (SEMG), and recording of physiological indicators (pulse rate, skin resistance). RESULTS All subjects had a clear voice with no sign of vocal disability. Endoscopy revealed laryngeal hyperfunction in 26 people. SEMG revealed that the 26 had increased external laryngeal muscle tone during phonation, and this finding correlated with a change in certain electrophysiological indicators HRV, BVP, EDA. CONCLUSIONS We conclude that anomalies in electrophysiological parameters in individuals with subclinical symptoms of functional voice disorder may be at risk of developing fully symptomatic hyperfunctional dysphonia in the future. Vocal training, which differentiates singers and non-singers, is known to have an effect on subclinical hyperfunctional dysphonia. SIGNIFICANCE By measuring indicators of hyperfunctional dysphonia, it may be possible to take remedial action before symptomatic dysphonia develops.
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Affiliation(s)
- Agata Szkiełkowska
- Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Paulina Krasnodębska
- Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Andrzej Mitas
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Monika Bugdol
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Marcin Bugdol
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Patrycja Romaniszyn-Kania
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Anita Pollak
- University of Silesia, Institute of Psychology, Katowice, Poland
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González AD, de Almeida Lopes ACB, de Andrade SM, Gabani FL, da Silva Santos MC, Rodrigues R, Mesas AE. Schoolteachers with voice handicap are twice as likely to report depressive symptoms. Eur Arch Otorhinolaryngol 2022; 279:4043-4051. [PMID: 35441894 PMCID: PMC9249687 DOI: 10.1007/s00405-022-07376-w] [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: 01/17/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.
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Affiliation(s)
- Alberto Durán González
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil
| | - Ana Carolina Bertin de Almeida Lopes
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil
| | - Selma Maffei de Andrade
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil
| | - Flávia Lopes Gabani
- Department of Nursing, Health Sciences Center, State University of Londrina, Londrina, Brazil
| | - Mayara Cristina da Silva Santos
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil
| | - Renne Rodrigues
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Health Sciences Center, State University of Londrina, Av. Robert Koch, n° 60, Londrina, 86038-350, Brazil. .,Universidad de Castilla-La Mancha, Health and Social Research Centre, Cuenca, Spain.
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15
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Enin K, Parikh A, Kallogjeri D, Naunheim MR, Huston MN. Correlation Between a Diagnosis of Anxiety or Depression and Initial VHI-10 Scores in Benign Dysphonia. Otolaryngol Head Neck Surg 2022; 167:725-730. [PMID: 35104179 DOI: 10.1177/01945998221074994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anxiety and depression have demonstrated a positive correlation with vocal handicap among patients with benign causes of dysphonia. Our objective is to explore differences in initial Vocal Handicap Index-10 (VHI-10) scores between patients with a mental health history of anxiety or depression and those without. STUDY DESIGN Retrospective cohort study. SETTING Demographic data, diagnoses, and initial VHI-10 scores were collected for patients presenting with dysphonia to 2 tertiary laryngology clinics. METHODS A Kruskal-Wallis test and subsequent Mann-Whitney U test for pairwise comparisons were used to compare distribution of VHI-10 scores among patients with anxiety, depression, anxiety and depression, and no such conditions. Bonferroni correction was used to control for multiple comparisons. Robust regression was used for multivariable analysis. RESULTS A total of 620 cases of benign dysphonia were analyzed. Forty-two percent of the patient cohort had a preexisting diagnosis of anxiety (n = 121, 20%), depression (n = 64, 10%), or anxiety and depression (n = 74, 12%). VHI-10 scores were higher in patients with depression than in those without anxiety or depression (median difference, 4 [95% CI, 1-8]; P = .005) but did not differ significantly among the other groups. The effects of depression and anxiety status on initial VHI-10 scores among the causes of benign dysphonia varied. CONCLUSIONS Patients with a history of depression who presented with dysphonia had worse vocal handicap than those without anxiety/depression history. Future studies may clarify how optimization of anxiety and depression can affect patient-reported vocal handicap.
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Affiliation(s)
- Kwasi Enin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ayush Parikh
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Clayman GL, Roy R, Norman J. Human Amnion/Chorion Membrane May Reduce Transient Recurrent Laryngeal Nerve Injury During Thyroid Surgery. Cell Transplant 2022; 31:9636897211073136. [PMID: 35060401 PMCID: PMC8796105 DOI: 10.1177/09636897211073136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) damage is a significant and prevalent complication of thyroid surgery. Based on the beneficial role of a human amnion/chorion membrane (HACM) allograft in wound management and nerve regeneration, we investigated whether placement of a commercially available HACM allograft on dissected RLN could reduce the occurrence and/or duration of RLN injury during thyroidectomy. Among 67 patients undergoing thyroidectomy, 100 at-risk nerves (exposure of at least 3 cm of RLN) received intraoperative placement of HACM; 205 at-risk RLNs without HACM in 134 matched patients served as controls. Patient-reported vocal analysis, physician-assessed vocal analysis, and laryngoscopic assessment of vocal-fold dysfunction were performed before and after surgery. At 24 h after surgery, 17 patients in the control group (12.5%) had documented voice changes; these changes persisted for at least 3 weeks in seven patients (5%). Only one patient (1.5%) in the HACM group had vocal changes at 24 h after surgery, which resolved within 1 week (P < 0.01). Intraoperative placement of the HACM allograft over at-risk RLNs during thyroidectomy may reduce the incidence, severity, and/or duration of intraoperative RLN injury, which could address a significant complication of head and neck surgery. A larger prospectively designed clinical study is warranted to further investigate a possible benefit of the HACM allograft in thyroid surgery and to begin to understand the mechanisms through which a clinical benefit might be mediated.
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Affiliation(s)
- Gary L. Clayman
- Hospital for Endocrine Surgery, Tampa, FL, USA
- Clayman Thyroid Center, Tampa, FL, USA
| | - Rashmi Roy
- Hospital for Endocrine Surgery, Tampa, FL, USA
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Hoffmeister JD, Kelm-Nelson CA, Ciucci MR. Quantification of brainstem norepinephrine relative to vocal impairment and anxiety in the Pink1-/- rat model of Parkinson disease. Behav Brain Res 2021; 414:113514. [PMID: 34358571 PMCID: PMC8393386 DOI: 10.1016/j.bbr.2021.113514] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/31/2022]
Abstract
Vocal communication impairment and anxiety are co-occurring and interacting signs of Parkinson Disease (PD) that are common, poorly understood, and under-treated. Both vocal communication and anxiety are influenced by the noradrenergic system. In light of this shared neural substrate and considering that noradrenergic dysfunction is a defining characteristic of PD, tandem investigation of vocal impairment and anxiety in PD relative to noradrenergic mechanisms is likely to yield insights into the underlying disease-specific causes of these impairments. In order to address this gap in knowledge, we assessed vocal impairment and anxiety behavior relative to brainstem noradrenergic markers in a genetic rat model of early-onset PD (Pink1-/-) and wild type controls (WT). We hypothesized that 1) brainstem noradrenergic markers would be disrupted in Pink1-/-, and 2) brainstem noradrenergic markers would be associated with vocal acoustic changes and anxiety level. Rats underwent testing of ultrasonic vocalization and anxiety (elevated plus maze) at 4, 8, and 12 months of age. At 12 months, brainstem norepinephrine markers were quantified with immunohistochemistry. Results demonstrated that vocal impairment and anxiety were increased in Pink1-/- rats, and increased anxiety was associated with greater vocal deficit in this model of PD. Further, brainstem noradrenergic markers including TH and α1 adrenoreceptor immunoreactivity in the locus coeruleus, and β1 adrenoreceptor immunoreactivity in vagal nuclei differed by genotype, and were associated with vocalization and anxiety behavior. These findings demonstrate statistically significant relationships among vocal impairment, anxiety, and brainstem norepinephrine in the Pink1-/- rat model of PD.
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Affiliation(s)
- Jesse D Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Cynthia A Kelm-Nelson
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA.
| | - Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, 53792-7375, USA; Neuroscience Training Program, University of Wisconsin-Madison, 9531 WIMR II, 1111 Highland Avenue, Madison, WI, 53705, USA.
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Nguyen-Feng VN, Frazier PA, Roy N, Cohen S, Misono S. Perceived Control, Voice Handicap, and Barriers to Voice Therapy. J Voice 2021; 35:326.e13-326.e19. [PMID: 31604609 PMCID: PMC7138698 DOI: 10.1016/j.jvoice.2019.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.
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Affiliation(s)
| | - Patricia A Frazier
- Department of Psychology, College of Liberal Arts, University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Stephanie Misono
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
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Bonetti A, Bonetti L, Čipčić O. Self-Assessment of Vocal Fatigue in Muscle Tension Dysphonia and Vocal Nodules: A Preliminary Analysis of the Discriminatory Potential of the Croatian Adaptation of the Vocal Fatigue Index (VFI-C). J Voice 2021; 35:325.e1-325.e15. [DOI: 10.1016/j.jvoice.2019.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
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20
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Voice Symptoms, Perceived Voice Control, and Common Mental Disorders in Elementary School Teachers. J Voice 2021; 35:158.e1-158.e7. [DOI: 10.1016/j.jvoice.2019.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022]
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21
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Nguyen-Feng VN, Asplund A, Frazier PA, Misono S. Association Between Communicative Participation and Psychosocial Factors in Patients With Voice Disorders. JAMA Otolaryngol Head Neck Surg 2020; 147:2774498. [PMID: 33355630 PMCID: PMC7758827 DOI: 10.1001/jamaoto.2020.4956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Communicative participation can be conceptualized as taking part in life situations in which people are socially engaged. Communicative participation is an important aspect in the lives of patients with voice disorders, although it has not been formally assessed among a broad sample of patients with voice disorders. The associations between communicative participation and associated concepts (vocal impairment, psychosocial distress, and voice-specific perceived control) are unknown yet important for integrated treatment approaches. OBJECTIVE The primary objective was to examine the associations between communicative participation and vocal impairment, psychosocial distress, and voice-specific perceived control. The secondary objective was to examine whether perceived control moderates the association of distress with communicative participation and vocal impairment, the latter of which would replicate previous research. The hypotheses were that communicative participation would be associated with lower vocal impairment, lower distress, and higher perceived control and that higher perceived control would moderate the association between communicative participation and both vocal impairment and psychosocial distress. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from June 2014 to May 2017 among a consecutive sample of adult patients with voice disorders at an academic voice clinic affiliated with the University of Minnesota. Of the 744 patients approached to participate in the survey study, 590 patients agreed. Data analysis was performed from January to June 2020. MAIN OUTCOMES AND MEASURES Communicative participation (measured by the 10-item general short form of the Communicative Participation Item Bank), vocal impairment (measured by the 10-item version of the Voice Handicap Index), psychosocial distress (measured by the 18-item version of the Brief Symptom Inventory), and voice-specific perceived control (measured by the 8-item present control subscale of the Perceived Control Over Stressful Events Scale). RESULTS The sample comprised 590 patients (mean [SD] age, 51.9 [17.1] years; 390 women [66.1%]) with voice disorders. Communicative participation was associated with lower vocal impairment (r = -0.73; 95% CI, -0.77 to -0.69), lower overall psychosocial distress (r = -0.22; 95% CI, -0.30 to -0.14), and higher voice-specific perceived control (r = 0.30; 95% CI, 0.23-0.37). Moderation analyses indicated that communicative participation was negatively associated with distress at all levels of perceived control and, replicating previous findings, greater vocal impairment was associated with higher psychosocial distress only in patients with lower perceived control. CONCLUSIONS AND RELEVANCE In this study, communicative participation was associated with, but distinct from, vocal impairment and was also associated with psychosocial distress and voice-specific perceived control. The study's results suggest that communicative participation is an important addition to voice research and clinical care.
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Affiliation(s)
| | - Alexa Asplund
- Department of Psychology, University of Minnesota Duluth, Duluth
| | | | - Stephanie Misono
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Twin Cities, Minneapolis
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22
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Berger T, Meuret S, Engel C, Vogel M, Kiess W, Fuchs M, Poulain T. [Detection of relevant changes in the speaking voice of women measured by the speaking voice profile]. Laryngorhinootologie 2020; 101:127-137. [PMID: 33327005 DOI: 10.1055/a-1327-4275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A healthy voice serves us as a basis for communication and an indispensable tool in a modern society with a growing number of vocal-intensive professions. There are indications that the average frequency of the speaking voice of women has decreased in recent years and is approaching that of men in the sense of sociophony. An epidemiological prospective cohort study will investigate the influences of age, personality traits and socio-demographic factors on the speaking voice of women. MATERIAL AND METHODS Within the framework of a standardized examination procedure, the speaking voice of 2478 voice-healthy female participants between 5 and 83 years of age was registered in 4 different intensity levels (softest voice, conversational voice, classroom voice and shouting voice). Subsequently, the collected values for frequency and loudness of the different intensity levels were examined for correlation with age and results from questionnaires on personality (FFFK and BFI-10), on (mental) health (Patient-Health-Questionnaire - PHQ) and on socio-economic status (SES). RESULTS Significant age-related influences on the speaking voice could be demonstrated for all voice intensities. For the personality traits investigated, significant positive correlations between the volume of the calling and speaking voice and extraversion were found. For the frequency of the softest voice and speaking voice, significant correlations were found for the personality traits of extraversion and tolerance. While no significant associations were found between the voice parameters of the speaking voice and the PHQ, it was found that the SES has a significant influence on both frequency and intensity. CONCLUSION In addition to age-related changes, relevant influences of personality traits and the SES on speaking voice parameters in women were confirmed, which should be considered in clinical care of dysphonia.
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Affiliation(s)
- Thomas Berger
- Klinik für Hals-Nasen-Ohrenheilkunde/Plastische Operationen, Universitätsklinikum Leipzig - AöR
| | - Sylvia Meuret
- Sektion Phoniatrie und Audiologie, Klinik für Hals-Nasen-Ohrenheilkunde/Plastische Operationen, Universitätsklinikum Leipzig - AöR
| | - Christoph Engel
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig
| | - Mandy Vogel
- Medizinische Fakultät, LIFE Forschungszentrum, Universität Leipzig
| | - Wieland Kiess
- Medizinische Fakultät, LIFE Forschungszentrum, Universität Leipzig.,Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Leipzig - AöR
| | - Michael Fuchs
- Sektion Phoniatrie und Audiologie, Klinik für Hals-Nasen-Ohrenheilkunde/Plastische Operationen, Universitätsklinikum Leipzig - AöR
| | - Tanja Poulain
- Medizinische Fakultät, LIFE Forschungszentrum, Universität Leipzig
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Barbosa IKL, Behlau M, Lopes LW, Almeida LNA, Nascimento JAD, Almeida AA. Voice and Self-Regulation: Integrating Review of the Literature. J Voice 2020; 36:499-506. [PMID: 32753295 DOI: 10.1016/j.jvoice.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To verify the relationship between self-regulation and voice behavior according to national and international literature. METHODS A literature survey was performed using the PubMed, LILACS, and SciELO databases. The search terms used were the following: self-regulation, self-control, combined with voice, voice disorders, and dysphonia, in Portuguese, English, and Spanish. Articles that addressed self-regulation and voice behavior or voice disorders published in English, Spanish, or Portuguese were included, without restriction of date. The variables preselected for the data organization were authors, database, country, impact factor, journal, type of study, sample size, sample characteristics, methods for data collection, group comparison, objective, and outcome. RESULTS A total of 10,176 articles were identified in the databases, of which 10 were selected based on title, read in full, and kept for data analysis. The studies were found predominantly in American journals and were published between 2013 and 2019. The United States published most articles, and the predominant methodological aspect was observational and cross-sectional. CONCLUSION Despite the small number of articles, the studies analyzed can show self-regulation as an important factor in vocal behavior and call attention to its performance in voice disorders.
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Affiliation(s)
- Iandra Kaline Lima Barbosa
- Speech-Language Pathology Program at the Universidade Federal da Paraíba (UFPB) and Universidade Federal do Rio Grande do Norte, João Pessoa, Paraiba, Brazil
| | - Mara Behlau
- Universidade Federal de São Paulo - UNIFESP, Centro de Estudos da Voz, São Paulo - SP
| | - Leonardo Wanderley Lopes
- Speech-Language Pathology Program at the Universidade Federal da Paraíba (UFPB) and Universidade Federal do Rio Grande do Norte, João Pessoa, Paraiba, Brazil; Graduate Program in Decision and Health Models, UFPB, João Pessoa, Paraiba, Brazil; Department of Speech-Language Pathology, UFPB, João Pessoa, Paraiba, Brazil
| | | | | | - Anna Alice Almeida
- Speech-Language Pathology Program at the Universidade Federal da Paraíba (UFPB) and Universidade Federal do Rio Grande do Norte, João Pessoa, Paraiba, Brazil; Graduate Program in Decision and Health Models, UFPB, João Pessoa, Paraiba, Brazil; Department of Speech-Language Pathology, UFPB, João Pessoa, Paraiba, Brazil.
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Anxiety and depression in patients with vocal fold nodules, edema and polyps. Eur Arch Otorhinolaryngol 2020; 277:2493-2500. [PMID: 32355993 DOI: 10.1007/s00405-020-06001-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the prevalence and severity of depression and anxiety among patients with vocal fold (VF) nodules, polyps and edema. At the same time the aim was to analyse association between severity of distress and the level of vocal handicap as well as to identify other factors related to severity of depression and anxiety in these patients. METHODS To all participants were given five questionnaires: (1) questionnaire on socio-demographic and some other characteristics of patient; (2) Beck's Depression Inventory (BDI); (3) State-Trait Anxiety Inventory (STAI) 1 (State Anxiety); (4) STAI 2 (Trait Anxiety); and (5) Voice Handicap Index (VHI)-10. RESULTS A total of 205 patients were included in this study. Mild-to-severe depression, according to BDI was present in 79 (38.6%) patients. Mild-to-severe state anxiety and trait anxiety were present in 199 (97.1%) and 200 (97.6%) patients, respectively. Only 10 patients had VHI-10 score ≤ 11. Multivariate analyses showed that there were no significant differences in the level of depression and anxiety between patients with VF nodules, polyps and edema. The VHI-10 score was significantly higher in patients with VF edema in comparison with VF nodule patients (p = 0.001), as well as in comparison with VF polyp patients (p = 0.001). CONCLUSION The present study identified a high prevalence of psychological and vocal distress among patients with vocal disorders. Severity of depression and anxiety did not differ between patients with VF nodules, polyps and edema, and it was not related to the level of vocal handicap.
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Jordan VA, Lunos S, Sieger G, Horvath KJ, Cohen S, Misono S. Association of voice and mental health diagnoses with differences in voice-related care utilization. Laryngoscope 2019; 130:1496-1502. [PMID: 31508825 DOI: 10.1002/lary.28277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/25/2019] [Accepted: 08/19/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare healthcare utilization in voice patients with versus without mental health (MH) diagnoses STUDY DESIGN: Retrospective study using electronic medical records from large regional healthcare system. METHODS We examined data on sociodemographic characteristics, comorbidities, voice-related diagnoses, and patterns of healthcare utilization (including medication use, tests and procedures, and outpatient visits). The study period spanned January 2005 through June 2017. RESULTS A total of 24,672 patients had at least one voice-related diagnosis. Of these, 11,483 (47%) also had at least one MH diagnosis compared to 14% in the overall repository (P < 0.0001). The most common voice-related diagnoses were nonspecific dysphonia (80%), acute laryngitis (30%), and vocal fold paresis/paralysis (7%). The 11,483 patients with both voice-related and MH diagnoses were more likely to have acute laryngitis and/or nonspecific dysphonia; less likely to have laryngeal cancer and/or paresis/paralysis; and more likely to have seen a primary care provider, to have received medications, and to have undergone radiology studies. In contrast, the 13,189 patients with only voice-related diagnoses had more overall voice-related visits, were more likely to have seen an otolaryngologist, and were more likely to have undergone a voice evaluation with a speech language pathologist. CONCLUSION Voice patients with MH diagnoses were less likely to see otolaryngology and more likely to have radiology studies than voice patients without MH diagnoses. Further study is warranted to characterize temporal sequences of care in this group of patients and determine whether these differences are attributable to referral patterns from primary care. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1496-1502, 2020.
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Affiliation(s)
- Victoria A Jordan
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Gretchen Sieger
- Best Practices Integrated Informatics Core, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Keith J Horvath
- Department of Psychology at San Diego State University, San Diego, Minnesota, CA
| | - Seth Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Stephanie Misono
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Farzal Z, Overton LJ, Farquhar DR, Stephenson ED, Shah RN, Buckmire RA. Sex‐based outcomes in type I thyroplasty for nonparalytic glottic incompetence. Laryngoscope 2019; 129:2543-2548. [DOI: 10.1002/lary.27770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Zainab Farzal
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Lewis J. Overton
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Douglas R. Farquhar
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Elizabeth D. Stephenson
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Rupali N. Shah
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
| | - Robert A. Buckmire
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina U.S.A
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Lee JM, Roy N, Dietrich M. Personality, Psychological Factors, and Behavioral Tendencies in Children With Vocal Nodules: A Systematic Review. J Voice 2018; 33:945.e1-945.e18. [PMID: 30529034 DOI: 10.1016/j.jvoice.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies. METHODS Four electronic databases-PubMed, Scopus, ScienceDirect, EBSCO Host-as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist. RESULTS Four studies were rated as "good quality" and four were "fair". The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed. CONCLUSIONS Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah
| | - Maria Dietrich
- Department of Communication Science and Disorders, University of Missouri, Columbia, Missouri
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Dysphonia, Perceived Control, and Psychosocial Distress: A Qualitative Study. J Voice 2018; 33:682-690. [PMID: 29759920 DOI: 10.1016/j.jvoice.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this qualitative study was to examine relationships between psychological factors, particularly perceived control, and voice symptoms in adults seeking treatment for a voice problem. METHODS Semistructured interviews of adult patients with a clinical diagnosis of muscle tension dysphonia were conducted and transcribed. Follow-up interviews were conducted as needed for further information or clarification. A multidisciplinary team analyzed interview content using inductive techniques. Common themes and subthemes were identified. A conceptual model was developed describing the association between voice symptoms, psychological factors, precipitants of ongoing voice symptoms, and perceived control. RESULTS Thematic saturation was reached after 23 interviews. No participants reported a direct psychological cause for their voice problem, although half described significant life events preceding voice problem onset (eg, miscarriage and other health events, interpersonal conflicts, and family members' illnesses, injuries, and deaths). Participants described psychological influences on voice symptoms that led to rapid exacerbation of their voice symptoms. Participants described the helpfulness of speech therapy and sometimes also challenges of applying techniques in daily life. They also discussed personal coping strategies that included behavioral (eg, avoiding triggers and seeking social support) and psychological (eg, mind-body awareness and emotion regulation) components. Voice-related perceived control was associated with adaptive emotional and behavioral responses, which appeared to facilitate symptom improvement. CONCLUSIONS In this qualitative pilot study, participant narratives suggested that psychological factors and emotions influence voice symptoms, facilitating development of a preliminary conceptual model of how adaptive and maladaptive responses develop and how they influence vocal function.
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Holmqvist-Jämsén S, Johansson A, Santtila P, Westberg L, von der Pahlen B, Simberg S. Investigating the Role of Salivary Cortisol on Vocal Symptoms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2781-2791. [PMID: 28915296 DOI: 10.1044/2017_jslhr-s-16-0058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE We investigated whether participants who reported more often occurring vocal symptoms showed higher salivary cortisol levels and if such possible associations were different for men and women. METHOD The participants (N = 170; men n = 49, women n = 121) consisted of a population-based sample of Finnish twins born between 1961 and 1989. The participants submitted saliva samples for hormone analysis and completed a web questionnaire including questions regarding the occurrence of 6 vocal symptoms during the past 12 months. The data were analyzed using the generalized estimated equations method. RESULTS A composite variable of the vocal symptoms showed a significant positive association with salivary cortisol levels (p < .001). Three of the 6 vocal symptoms were significantly associated with the level of cortisol when analyzed separately (p values less than .05). The results showed no gender difference regarding the effect of salivary cortisol on vocal symptoms. CONCLUSIONS There was a positive association between the occurrence of vocal symptoms and salivary cortisol levels. Participants with higher cortisol levels reported more often occurring vocal symptoms. This could have a connection to the influence of stress on vocal symptoms because stress is a known risk factor of vocal symptoms and salivary cortisol can be seen as a biomarker for stress.
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Affiliation(s)
| | - Ada Johansson
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
- Department of Psychology and Speech-Language Pathology, Faculty of Social Sciences, University of Turku, Turku, Finland
| | - Pekka Santtila
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Lars Westberg
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Susanna Simberg
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
- Department of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Norway
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Functional Voice Disorders: The Importance of the Psychologist in Clinical Voice Assessment. J Voice 2017; 31:507.e13-507.e22. [DOI: 10.1016/j.jvoice.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022]
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Frazier P, Merians A, Misono S. Perceived control and voice handicap in patients with voice disorders. Health Psychol 2017; 36:1105-1108. [PMID: 28557498 DOI: 10.1037/hea0000520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of the study was to replicate and extend previous research on the relation between perceived present control and voice handicap and to further examine the psychometric properties of a present control scale adapted for patients with voice disorders (Misono, Meredith, Peterson, & Frazier, 2016). METHOD Sample 1 consisted of 1,129 patients recruited from a voice disorder clinic who completed measures of perceived present control, distress, and voice handicap in the clinic. Sample 2 consisted of 62 patients from the same clinic who completed measures of present control, distress, voice handicap, and general control beliefs online at baseline and measures of present control and voice handicap again 3 weeks later (n = 59). RESULTS With regard to the psychometric properties of the voice-adapted present control scale, alpha coefficients were above .80 and the 3-week test-reliability coefficient was .69. There was mixed support for the hypothesized 1-factor structure of the scale. In Sample 1, present control was more strongly associated with lower voice handicap than was distress and accounted for significant variance in voice handicap controlling for distress. In Sample 2, present control at baseline predicted later voice handicap, controlling for general control beliefs and distress. CONCLUSIONS Present control appears to be a promising target for adjunctive interventions for patients with voice disorders. An evidence-based online present control intervention (Hintz, Frazier, & Meredith, 2015) is being adapted for this patient population. (PsycINFO Database Record
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Martins RHG, do Amaral HA, Tavares ELM, Martins MG, Gonçalves TM, Dias NH. Voice Disorders: Etiology and Diagnosis. J Voice 2016; 30:761.e1-761.e9. [DOI: 10.1016/j.jvoice.2015.09.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/29/2015] [Indexed: 11/16/2022]
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Marmor S, Horvath KJ, Lim KO, Misono S. Voice problems and depression among adults in the United States. Laryngoscope 2015; 126:1859-64. [PMID: 26691195 DOI: 10.1002/lary.25819] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/27/2015] [Accepted: 11/13/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Prior studies have observed a high prevalence of psychosocial distress, including depression, in patients with voice problems. However, these studies have largely been performed in care-seeking patients identified in tertiary care voice clinics. The objective of this study was to examine the association between depression and voice problems in the U.S. STUDY DESIGN Cross-sectional analysis of National Health Interview Survey (NHIS) data. METHODS We identified adult cases reporting a voice problem in the preceding 12 months in the 2012 NHIS. Self-reported demographics and data regarding healthcare visits for voice problems, diagnoses given, severity of the voice problem, and depression symptoms were analyzed. RESULTS The total weighted sample size was 52,816,364. The presence of depressive symptoms was associated with a nearly two-fold increase (odds ratio = 1.89, 95% confidence interval = 1.21-2.96) in the likelihood of reporting a voice problem in the past year. Patients who reported feeling depressed were less likely to receive care for the voice problem and less likely to report that treatment had helped than those who did not feel depressed. CONCLUSION These findings indicate that the co-occurrence of voice problems and depressive symptoms is observed in the general population, not only in care-seeking patients, and that depressive symptoms may influence reported likelihood of receiving voice treatment and effectiveness. This suggests that voice care providers should take mental health symptoms into account when treating patients, and also indicates a need for further investigation. LEVEL OF EVIDENCE NA. Laryngoscope, 126:1859-1864, 2016.
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Affiliation(s)
- Schelomo Marmor
- Department of Otolaryngology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Surgery, School of Medicine, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Keith J Horvath
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Kelvin O Lim
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Stephanie Misono
- Department of Otolaryngology, School of Medicine, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Salturk Z, Kumral TL, Aydoğdu I, Arslanoğlu A, Berkiten G, Yildirim G, Uyar Y. Psychological effects of dysphonia in voice professionals. Laryngoscope 2015; 125:1908-10. [PMID: 25892054 DOI: 10.1002/lary.25319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the psychological effects of dysphonia in voice professionals compared to non-voice professionals and in both genders. STUDY DESIGN Cross-sectional analysis. METHODS Forty-eight 48 voice professionals and 52 non-voice professionals with dysphonia were included in this study. All participants underwent a complete ear, nose, and throat examination and an evaluation for pathologies that might affect vocal quality. Participants were asked to complete the Turkish versions of the Voice Handicap Index-30 (VHI-30), Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). HADS scores were evaluated as HADS-A (anxiety) and HADS-D (depression). Dysphonia status was evaluated by grade, roughness, breathiness, asthenia, and strain (GRBAS) scale perceptually. The results were compared statistically. RESULTS Significant differences between the two groups were evident when the VHI-30 and PSS data were compared (P = .00001 and P = .00001, respectively). However, neither HADS score (HADS-A and HADS-D) differed between groups. An analysis of the scores in terms of sex revealed that females had significantly higher PSS scores (P = .006). The GRBAS scale revealed no difference between groups (P = .819, .931, .803, .655, and .803, respectively). No between-sex differences in the VHI-30 or HADS scores were evident CONCLUSIONS We found that voice professionals and females experienced more stress and were more dissatisfied with their voices. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ziya Salturk
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | | | - Imran Aydoğdu
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Arslanoğlu
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Güler Berkiten
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Güven Yildirim
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Uyar
- ENT Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
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New Perspective on Psychosocial Distress in Patients with Dysphonia: The Moderating Role of Perceived Control. J Voice 2015; 30:172-6. [PMID: 25795347 PMCID: PMC4573772 DOI: 10.1016/j.jvoice.2015.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
Abstract
Objectives Although an association between psychosocial distress (depression, anxiety, somatization, and perceived stress) and voice disorders has been observed, little is known about the relationship between distress and patient-reported voice handicap. Further, the psychological mechanisms underlying this relationship are poorly understood. Perceived control plays an important role in distress associated with other medical disorders. The objectives of this study were to 1) characterize the relationship between distress and patient-reported voice handicap and 2) examine the role of perceived control in this relationship. Study Design Cross-sectional study in tertiary care academic voice clinic. Methods Distress, perceived stress, voice handicap, and perceived control were measured using established assessment scales. Association was measured with Pearson’s correlation coefficient; moderation was assessed using multiple hierarchical regression. Results 533 patients enrolled. 34% met criteria for clinically significant distress (i.e., depression, anxiety, and/or somatization). A weak association (r=0.13, p=0.003) was observed between severity of psychosocial distress and vocal handicap. Present perceived control was inversely associated with distress (r=−0.41, p<0.0001), stress (r=−0.30, p<0.0001), and voice handicap (r=−0.30, p<0.0001). The relationship between voice handicap and psychosocial distress was moderated by perceived control (b for interaction term −0.15, p<0.001); greater vocal handicap was associated with greater distress in patients with low perceived control. Conclusions Severity of distress and vocal handicap were positively related, and the relation between them was moderated by perceived control. Vocal handicap was more related to distress among those with low perceived control; targeting this potential mechanism may facilitate new approaches for improved care.
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