Cervical Spine Disability in Correlation with Subjective Voice Handicap in Patients With Voice Disorders: A Retrospective Analysis

[Patient-reported outcome measures for assessing health-related quality of life in patients with voice and swallowing disorders]

Standardized and validated patient surveys in the form of questionnaires are becoming increasingly important in otorhinolaryngology. Subjective symptoms and functional limitations but also health-related quality of life are assessed with so-called patient-reported outcome measures (PROMs). Besides patient history and objective findings, these questionnaires can be applied as another important source for ensuring the quality of patient-centered care. In German-speaking countries there are now several PROMs that specifically ask for the patient perspective on voice and swallowing disorders. For patients with voice disorders the following questionnaires based on the Voice Handicap Index (VHI), which are also used internationally, are mainly applied: VHI-30, VHI-12i, and VHI-9i. In the field of oropharyngeal dysphagia, the German versions of the Eating Assessment Tool-10 (EAT-10), des Sydney Swallow Questionnaire SSQ‑G, the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the MD Anderson Dysphagia Inventory (MDADI) are currently mostly used.

Effect of Pompage on Teachers Self-Assessment-Clinical Trial

OBJECTIVE

To verify the results of self-assessments of teachers with vocal and musculoskeletal complaints and with the normal larynx, after myofascial release using pompage.

METHODS

Double-blind, controlled, and randomized clinical trial including 28 teachers in the study group and 28 teachers in the control group, totaling 56 participants. Anamnesis, video laryngoscopy, hearing screening, clinical and photogrammetric postural assessment, pain threshold in cervical muscles, sound pressure and maximum phonation time measurements, and manovacuometry were performed. Protocols for vocal self-assessment, neck pain, anxiety and depression, and musculoskeletal pain were filled out. Pompage therapy consisted of a total of 24 sessions (8 weeks) of 40 minutes each, three times a week. Afterward, the groups were reassessed.

RESULTS

In the study group, there was a significant improvement in the results of the following instruments: Hospital Anxiety and Depression Scale, Vocal Tract Discomfort Scale, Voice Symptoms Scale, Vocal Activity and Participation Profile, Vocal Handicap Index, Voice-Related Quality of Life, and Nordic Musculoskeletal Questionnaire.

CONCLUSIONS

After myofascial release using pompage in teachers, there was an improvement in the self-assessed aspects regarding characteristics and quality of life related to the voice, social participation related to the voice, anxiety and depression, and musculoskeletal symptoms.

Respiratory and Sound Pressures, Maximum Phonation Time, Cervical Disability and Voice-Related Quality of Life of Teachers

INTRODUCTION

Many teachers report discomfort and a decrease in the quality of aerodynamic, respiratory, and cervical vocal aspects as well as of vocal self-assessment.

OBJECTIVE

Characterize and correlate measurements of Sound Pressure Levels, Maximum Phonation Time of /a/, Maximum Respiratory Pressures, Voice-Related Quality of Life and cervical pain in teachers with vocal and musculoskeletal complaints and no organic vocal fold lesions, and compare with normative values.

METHODS

Retrospective study with 56 teachers. Anamnesis, video laryngoscopy, hearing screening, measurements of sound pressure and maximum phonation time, and manovacuometry were performed. Self-assessment protocols for Voice-Related Quality of Life and Neck Disability Index were completed.

RESULTS

there was significant higher Sound Pressure Levels; significant lower Maximum Phonation Time of /a/, Maximum Expiratory Pressure, and total and physical scores of Voice-Related Quality of Life; most participants had mild cervical disability; there was a negative correlation between Maximum Expiratory Pressure and Neck Disability Index, between Maximum Inspiratory Pressure and Maximum Sound Pressure Level, and between Neck Disability Index and Voice-Related Quality of Life.

CONCLUSION

The results showed that there are damages and inadequacies in teachers' vocal production which affect their quality of life. Therefore, it is necessary to pay attention to the conditions of use of the voice by professionals, and to their health education.

Quality of life and phonatory and morphological outcomes in cognitively unimpaired adolescents with Pierre Robin sequence: a cross-sectional study of 72 patients

Background

Pierre Robin sequence (PRS) is a heterogeneous condition involving retro(micro)gnathia, glossoptosis and upper airway obstruction, very often with posterior cleft palate. Patients with PRS, either isolated or associated with Stickler syndrome have good intellectual prognosis. Nevertheless, the quality of life in adolescence and the phonatory and morphological outcomes are rarely analysed. We assessed the phonatory and morphological outcomes of 72 cognitively unimpaired adolescents with PRS, studied their oral (COHIP-SF19), vocal (VHI-9i) and generic quality of life (QoL; KIDSCREEN-52), and searched for determinants of these outcomes.

Results

Two-thirds of our adolescents retained low or moderate phonation difficulties, but risk factors were not identified. For 14%, morphological results were considered disharmonious, with no link to neonatal retrognathia severity. Only one vs two-stage surgery seemed to affect final aesthetic results. The oral QoL of these adolescents was comparable to that of control patients and was significantly better than that of children with other craniofacial malformations (COHIP-SF19 = 17.5, 15.4 and 25.7, respectively). The oral QoL of the adolescents with non-isolated PRS was significantly worse (COHIP-SF19 = 24.2) than that of control patients and close to that of children with other craniofacial malformations. The vocal QoL of the adolescents (mean [SD] VHI-9i = 7.5 [5.4]) was better than that of patients with other voice pathologies and better when phonation was good. The generic QoL of the adolescents was satisfactory but slightly lower than that of controls, especially in dimensions concerning physical well-being, relationships and autonomy. QoL results were lower for adolescents with non-isolated than isolated PRS. Only non-isolated PRS and low oral QoL affected generic QoL.

Conclusion

Morphological or phonatory impairments remain non-rare in adolescents with PRS but do not seem to be directly responsible for altered QoL. These adolescents, especially those with non-isolated PRS, show self-confidence and social-relation fragility. We must focus on long-term functional and psychological results for PRS patients and improve therapy protocols and follow-up, notably those affecting the oral aspects of the disease.

Validation and Classification of the 9-Item Voice Handicap Index (VHI-9i)

The international nine-item Voice Handicap Index (VHI-9i) is a clinically established short-scale version of the original VHI, quantifying the patients’ self-assessed vocal handicap. However, the current vocal impairment classification is based on percentiles. The main goals of this study were to establish test–retest reliability and a sound statistical basis for VHI-9i severity levels. Between 2009 and 2021, 17,660 consecutive cases were documented. A total of 416 test–retest pairs and 3661 unique cases with complete multidimensional voice diagnostics were statistically analyzed. Classification candidates were the overall self-assessed vocal impairment (VHIs) on a four-point Likert scale, the dysphonia severity index (DSI), the vocal extent measure (VEM), and the auditory–perceptual evaluation (GRB scale). The test–retest correlation of VHI-9i total scores was very high (r = 0.919, p < 0.01). Reliability was excellent regardless of gender or professional voice use, with negligible dependency on age. The VHIs correlated best with the VHI-9i, whereas statistical calculations proved that DSI, VEM, and GRB are unsuitable classification criteria. Based on ROC analysis, we suggest modifying the former VHI-9i severity categories as follows: 0 (healthy): 0 ≤ 7; 1 (mild): 8 ≤ 16; 2 (moderate): 17 ≤ 26; and 3 (severe): 27 ≤ 36.

Assessment of the Minimum Clinically Important Difference in Symptoms and Functions of Patients With Acute Schizophrenia: A Post hoc Analysis of an Open-Label, Single-Arm Multicenter Study

The purpose of this study was to evaluate the application of the minimum clinically important difference (MCID) concept to clinical results in Chinese patients with acutely exacerbated schizophrenia. The original study was an 8-week, open-label, single-arm, multicenter study of flexible doses of paliperidone-extended release (pali-ER) in Chinese patients with acutely exacerbated schizophrenia. This is a post hoc analysis to determine the MCID value of PANSS, PSP and evaluate the responsiveness of each outcome measurements in the acute phase of schizophrenia. The responsiveness of the four measurements (PANSS, PANSS reduction rate, PSP, CGI-S) was analyzed. Four hundred ninety nine patients completed the 8-week follow-up and were finally used for this post hoc analysis. The MCID calculated by different approaches varied from 14.02 to 31.50 for PANSS, 15.14 to 42.79% for PANSS reduction rate, and 7.62 to 13.13% for PSP. In addition, the improvement of the CGI-S owned the highest responsiveness of the four outcome measurements. The threshold value of MCID for schizophrenia patients was determined by choice of the assessment method to an extent. In addition, the CGI-S score appeared to be the most valid and responsive measure of effectiveness for the acute phase of schizophrenia when take the treatment satisfaction of patients as anchor.

[Pretesting of the German Vocal Fatigue Index (VFI-D)-transcultural translation and cross validation]

BACKGROUND

In clinical routine, vocal fatigue is a common symptom in patients with dysphonia.

OBJECTIVE

The aim of this study was to conduct a transcultural translation of the Vocal Fatigue Index (VFI), a standardized subjective questionnaire. Furthermore, pretesting and prevalidation were performed in 20 subjects, with comparison to the Voice Handicap Index (VHI‑9i) and the Vocal Tract Discomfort Scale (VTD).

MATERIALS AND METHODS

The translation, content review, and pretest of the German Vocal Fatigue Index (VFI-D) was divided into four sections: 1. transcultural translation, 2. expert voting on comprehensibility, 3. test of comprehensibility through cognitive interviews in 15 participants, 4. pretest of the VFI‑D with cross validation compared to VHI‑9i and VTD in 20 subjects. This process corresponds to current standards for transcultural translation and adaptation of questionnaires.

RESULTS

According to expert voting and cognitive testing, the VFI‑D is correct and comprehensible (intercoder reliability κ = 0.66). The factor analysis revealed three distinguishable parts: VFI‑D part 1 correlates strongly with VHI‑9i and VTD, VFI‑D part 2 with VTD only (rho ≈ 0.800 each), and VFI‑D part 3 correlates only weakly with VHI‑9i and VTD (rho ≈ 0.585). Thus, convergence and divergence validity are proven.

CONCLUSION

The first German version of the VFI‑D might be a base for further research on symptoms, causes, and treatment options in vocal fatigue. Particularly patients in voice-intensive professions may benefit.