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Cantaffa C, Donvito S, Manto AL, Serafini E, Caffagni R, Luppi MP, Tonelli R, Daniele M, Francesco M. Effect of Aging on Long-Term Functional Outcomes After Open Partial Laryngectomy. Otolaryngol Head Neck Surg 2024; 171:747-755. [PMID: 38946680 DOI: 10.1002/ohn.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Open partial horizontal laryngectomies (OPHLs) represent a comparable alternative to total laryngectomy and nonsurgical protocols in selected cases. While short-term functional outcomes of OPHLs have been widely investigated, few have focused on the effect of aging on residual laryngeal structures. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. METHODS Patients who underwent OPHLs after at least 1 year follow-up and optimal functional rehabilitation were included in the study. Swallowing function was assessed according to PAS (Penetration aspiration scale) and Pooling scores. Spectrogram analysis of voice was conducted according to Yanagihara classification and acoustic parameters were also recorded. Subjective questionnaire data about phonation and swallowing were also recorded. Data obtained were compared among patients according to age at time of surgery, evaluation and duration of follow-up. RESULTS Ninety-seven patients were enrolled with a mean age at surgery and evaluation of 63 and 70 years old, respectively. Median follow-up length was 5 years. OPHL type II was mostly performed. No significant correlation was observed between most of the analyzed variables and patient's age at the time of surgery and at the time of evaluation. Some acoustic parameters were negatively correlated with follow-up length, while Jitter, NHR (Noise-Harmonic Ratio), and Global grade and Roughness were significantly higher in patients >65 years old. CONCLUSION Patients who complete rehabilitation reach equally good results as their younger peers with stability over time. Finally, the effects of aging on residual larynx are of minor entity compared to the nonoperated patients. LEVEL OF EVIDENCE Level IV-retrospective cohort study.
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Affiliation(s)
- Carla Cantaffa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Sara Donvito
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfredo L Manto
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliera-Universitaria of Bologna, Bologna, Italy
| | - Rebecca Caffagni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Maria P Luppi
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences, University Hospital of Modena, Modena, Italy
| | - Marchioni Daniele
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Mattioli Francesco
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
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Yuen CWN, Ma EPM. Systematic Review: Singing-Based Interventions to Improve Physical Functions Related to Aging Voice in Older Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2139-2158. [PMID: 38875480 DOI: 10.1044/2024_jslhr-23-00641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
PURPOSE This systematic review aimed to evaluate the effects of singing as an intervention for aging voice. METHOD Quantitative studies of interventions for older adults with any medical condition that involves singing as training were reviewed, measured by respiration, phonation, and posture, which are the physical functions related to the aging voice. English and Chinese studies published until April 2024 were searched using 31 electronic databases, and seven studies were included. The included articles were assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations rubric. RESULTS Seven studies were included. These studies reported outcome measures that were related to respiratory functions only. For the intervention effect, statistically significant improvements were observed in five of the included studies, among which three studies had large effect sizes. The overall level of evidence of the included studies was not high, with three studies having moderate levels and the rest having lower levels. The intervention activities included trainings other than singing. These non-singing training items may have caused co-intervention bias in the study results. CONCLUSIONS This systematic review suggests that singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory-phonatory control. However, none of the included studies covers the other two of the physical functions related to aging voice (phonatory and postural functions). The overall level of evidence of the included studies was not high either. There is a need for more research evidence in singing-based intervention specifically for patient with aging voice.
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Affiliation(s)
- Crystal W-N Yuen
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
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Aboueisha MA, Sauder C, Jaleel Z, Fatahallah Y, Adcock K, Al-Awadi H, Jafari A, Bhatt NK. Endoscopic Distance and its Impact on Quantified Age-related Vocal Fold Atrophy Measures. Laryngoscope 2024. [PMID: 38877827 DOI: 10.1002/lary.31579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION The bowing index (BI) and normalized glottal gap area (NGGA) are used to quantify vocal fold morphology in ARVA; however, the influence of the distance between the flexible laryngoscope lens and the target area is not known. The goal is to test whether the endoscopic distance impacts vocal fold morphology measurements in patients with ARVA during flexible video laryngostroboscopy (VLS). METHOD Patients with ARVA who underwent VLS were included. Images were classified into near (close to the petiole of the epiglottis) and far (below nasopharynx, with tongue base and entire epiglottis visible) conditions. BI was calculated using a mobile application, and NGGA was measured using ImageJ. RESULTS This study included 23 patients; the mean age was 77 ± 7 years. Mean BI measured at the near distance was higher than far distances with a mean difference of 1.94 (95% CI: 0.92-2.96, p = 0.001). NGGA showed difference with changed distance -0.24 (95% CI: -0.48 to 0.01, p < 0.05).When stratifying patients into two groups based on median BI measurement, there was a statistically significant difference between near and far conditions, with increased BI in the near condition for patients above the median (p < 0.05), but no difference between the near and far condition for patients with BI below the median. CONCLUSION The BI and NGGA were impacted by the endoscopic distance during flexible VLS. BI was significantly higher in the near condition compared with the far condition. The difference in BI between the near and far conditions was more pronounced when the vocal fold bowing was greater. These findings call for heightened awareness of measurement discrepancies secondary to the endoscopic distance during flexible laryngostroboscopy. LEVEL OF EVIDENCE Level 2 Laryngoscope, 2024.
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Affiliation(s)
- Mohamed A Aboueisha
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, U.S.A
| | - Zaroug Jaleel
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Yasmine Fatahallah
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Kelson Adcock
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Hamzah Al-Awadi
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Aria Jafari
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Neel K Bhatt
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
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Sund LT, Cameron B, Johns MM, Gao WZ, O'Dell K, Hapner ER. Laryngologists' Reported Decision-Making in Presbyphonia Treatment. J Voice 2024; 38:723-730. [PMID: 34819238 DOI: 10.1016/j.jvoice.2021.10.008] [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: 09/11/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Decision-making regarding behavioral versus procedural intervention in the treatment of presbyphonia has not been well defined. The study objective was to survey laryngologists' reported practice patterns and decision-making in presbyphonia. METHODS All laryngology faculty in U.S. academic medical centers with residency programs were recruited to complete an anonymous 29-item survey regarding decision-making in presbyphonia treatment. The survey included 5 sections: demographics, first-line treatment distribution, factors that drive decision-making toward procedural intervention, treatment progression if first-line treatment is insufficient, durable treatment. RESULTS Of 153 laryngologists surveyed, 89 responded (58%). Voice therapy (VT) was the most often reported first-line treatment, with 57% of respondents indicating the majority of their patients receive VT initially. Most respondents (83%) indicated they occasionally use procedural intervention as first-line treatment. Factors driving first-line procedural intervention were severe glottal insufficiency (87%), high occupational/social voice demands (76%), voice not stimulable for change (73%), difficulty attending VT (70%), severe dysphonia (65%), and dysphagia (61%). The majority of respondents indicated the following do not affect their decision to pursue procedural intervention: patient age (88%); medical comorbidities (63%); patient's desire for a "quick fix" (55%); patient-reported outcome measures (51%). Most respondents (81%) use trial injection augmentation before durable treatment. Of durable treatments, bilateral thyroplasty was preferred (71%), followed by CaHA (15%) and lipoinjection (11%). CONCLUSIONS This study is the first to our knowledge to examine factors that influence decision-making in presbyphonia treatment. While VT remains the most frequent first-line treatment, study results better inform decision-making regarding first-line procedural intervention.
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Affiliation(s)
- Lauren Timmons Sund
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - Brian Cameron
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas - Houston, Cameron, Houston, Texas
| | - Michael M Johns
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Karla O'Dell
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Edie R Hapner
- UAB Voice Center, Department of Otolaryngology, University of Alabama at Birmingham, Hapner, Birmingham, Alabama.
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Almutawa D, Lagos-Villaseca A, Albathi M, Martignetti L, Masuda M, Zhu N, Li-Jessen NYK, Kost KM. Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic. J Voice 2024:S0892-1997(23)00410-1. [PMID: 38216385 DOI: 10.1016/j.jvoice.2023.12.018] [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: 07/29/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Voice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors. STUDY DESIGN Retrospective cohort study. METHODS Medical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018-March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI), and treatment modalities. RESULTS A total of 267 patients were included, with a mean [standard deviation (SD)] age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P < 0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P = 0.04) and laryngopharyngeal reflux diagnosis (P = 0.01), displaying a significantly longer MPT (P < 0.001) and lower G-B-S scores (P < 0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups. CONCLUSIONS The predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.
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Affiliation(s)
- Deema Almutawa
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Monirah Albathi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Lisa Martignetti
- School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Maia Masuda
- School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Nanqing Zhu
- Precision Analytics, Montréal, Quebec, Canada
| | - Nicole Y K Li-Jessen
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; The Centre for Research on Brain, Language and Music, McGill University, Montréal, Quebec, Canada; Department of Biomedical Engineering, McGill University, Montréal, Quebec, Canada; Research Institute of McGill University Health Center, Montréal, Quebec, Canada
| | - Karen M Kost
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
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Zagzoog FH, Bukhari M, Almohizea MI, Almothahbi AS. Efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:13-21. [PMID: 37709923 DOI: 10.1007/s00405-023-08226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions. METHODS MEDLINE, Cochrane Central, Web of Science, and Scopus databases were searched in April 2023 for relevant clinical trials. Inclusion criteria were clinical trials evaluating the efficacy of PRP in benign vocal fold lesions. We conducted a comparative double-arm analysis using the pooled mean difference (MD) and 95% confidence interval (CI). Outcomes of interest included the vocal handicap index (VHI), the Jitter and Shimmer percentages, and the noise-to-harmonic ratio (NHR). RESULTS Six studies matched the inclusion criteria. The pooled analysis shows that PRP was associated with significantly lower VHI scores compared with the control (MD = - 5.06, p < 0.01). Regarding the Jitter percentage, the PRP group was not superior to the control group at 2 and 4 weeks. However, the results revealed that PRP significantly reduced the Jitter percentage at 3 months (MD = - 0.61, p = 0.0008). The overall analysis favored the PRP arm significantly (p < 0.001). As for the Shimmer percentage, the combined effect estimate favored the PRP group (MD = - 1.22, p = 0.002). Subgroup analysis according to the time did not reveal any significant differences between studies at 2 weeks, 4 weeks, and 3 months. The analysis of the NHR outcome revealed a significant difference between both groups (MD = -1.09, p = 0.01). However, at 4 weeks, the treatment group had a significantly lower NHR % compared to the control group (MD = - 0.61, p = 0.02). There was no significant difference at 3 months (MD = - 2.14, p = 0.14). CONCLUSIONS Platelet-rich plasma is effective in reducing VHI scores, Jitter and Shimmer percentages, and NHR values. This effect is more evident after follow-up, especially 3 months.
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Affiliation(s)
- Faisal H Zagzoog
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Manal Bukhari
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Almohizea
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Saeed Almothahbi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Chang FC, Doan TN, Wang LH, To TL, Ho WC, Chou LW. Prevalence of Presbyphonia in Older Adults With Dysphonia: A Systematic Review and Meta-Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3064-3076. [PMID: 37816221 DOI: 10.1044/2023_ajslp-23-00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
PURPOSE This study aims to investigate the prevalence of presbyphonia among older adults who report voice complaints. METHOD We conducted a systematic search of five medical databases to identify studies that reported on presbyphonia as the cause of voice disorders in older adults. The pooled prevalence was calculated using random-effects models and presented as percentages with 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using I2 statistics. Subgroup analyses were performed to identify the sources of heterogeneity. RESULTS Out of 764 abstracts from five libraries, 11 studies were included in this systematic review. The pooled prevalence of presbyphonia among older adults with voice disorders is 17.78% (95% CI [12.69, 23.51]). We conducted a subgroup analysis on studies that used laryngeal visualization to confirm the diagnosis for all patients and found that the prevalence of presbyphonia was lower in studies with unrestrictive inclusion criteria (12.84%, 95% CI [8.38, 18.08]) compared to studies with restricted inclusion criteria (22.59%, 95% CI [14.49, 31.88]). CONCLUSIONS This study suggests that voice disorders in older adults have multiple causes, not predominantly presbyphonia. Overestimation of presbyphonia prevalence occurs if certain diagnoses are excluded at recruitment. This study emphasizes the importance of recognizing the diverse underlying etiologies of dysphonia in older adults; therefore, comprehensive examination and accurate diagnosis are crucial. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24263029.
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Affiliation(s)
- Fei-Chun Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
| | - Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Vietnam
| | - Liang-Hui Wang
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
- Department of Speech Language Pathology and Auditory, Hungkuang University, Taichung, Taiwan
| | - Thi-Lien To
- Faculty of Nursing, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
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Oliveira Santos A, Godoy J, Silverio K, Brasolotto A. Vocal Changes of Men and Women from Different Age Decades: An Analysis from 30 Years of Age. J Voice 2023; 37:840-850. [PMID: 34284927 DOI: 10.1016/j.jvoice.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify the modifications in auditory-perceptual and acoustic parameters of the fundamental frequency, short-term perturbation, noise, and cepstral measures of voice in young and elderly were distributed over the age of decades. METHODS The study was conducted on 265 subjects (140 females and 125 males), aged 30 to 79 years, without a history of vocal complaints or dysphonia, distributed in five age groups for females and males (30-39 years until 70-79 years). Three speech therapists voice specialists performed the perceptual-auditory analysis using a 100-mm visual analog scale, based on the overall dysphonia grade (overall grade), roughness, and breathiness from the sustained vowel /a/. The smoothed cepstral peak prominence (CPPS), average fundamental frequency (F0), standard deviation of the fundamental frequency (std-F0), jitter percentage (%), shimmer percentage (%), noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI) were extracted for the acoustic analysis RESULTS: In the case of the auditory-perceptual characteristics, the comparison between aged groups showed that, in men, the vocal quality did not show significant differences in the overall grade, roughness, and breathiness. However, women in the 3rd decade of life presented higher breathiness than those in the 5th, 6th, and 7th decades. Men had a higher overall grade and roughness than women. In the case of the acoustic data, the cepstral measure showed that in the 3rd decade, men presented higher CPPS than females. The noise measures, in the comparison by age groups, only VTI and SPI were different for women: VTI was higher in the 7th decade than in the 4th, whereas SPI was higher in the 4th decade than in older women. In the male population, the SPI in the 4th decade was also higher than that in the older population CONCLUSION: The analysis by age groups of life allowed the identification of breathiness as a sensitive parameter in the different stages of adult life in women. The CPPS analysis showed that the 7th age decade is the period of the appearance of vocal changes for females, characterized by higher CPPS. The results related to traditional short-term perturbation and noise measurements showed that changes in F0, jitter, shimmer, and NHR were not found. Among the other noise measurements, VTI and SPI demonstrated some changes in different decades of life.
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Affiliation(s)
- Aline Oliveira Santos
- Department of Speech Hearing and Language Disorders, University of São Paulo, São Paulo.
| | - Juliana Godoy
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal
| | - Kelly Silverio
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
| | - Alcione Brasolotto
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
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Presbyphonia as an Individual Process of Voice Change. J Voice 2023; 37:303.e1-303.e14. [PMID: 33495034 DOI: 10.1016/j.jvoice.2020.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to determine the individual variability of the severity of dysphonia in the population of older women and men using the initial perceptual voice assessment (GRBAS) and objective diagnosis of the clinical form of Presbyphonia with laryngeal visualization technique (High-Speed Digital Imaging [HSDI]) and acoustic voice analysis (Diagnoscope Specjalista). METHODS The study included 302 elderly women and men. Application of perceptual GRBAS scale allowed to extract 230 subjects with voice disorders (Group I). Remaining 72 elderly subjects without the symptoms of dysphonia consisted Group II. Group III included 50 subjects with euphonic voice. In the assessment of dysphonia, visualization technique (HSDI) as well as acoustic method (Diagnoscope Specjalista). The observation of real vibration of vocal folds using HSDI technique and HS camera allowed to examine symmetricity (Shaw-Deliyski scale), periodicity and amplitude of vibration, Mucosal Wave (MW) morphology, Glottal Closure Type, and value of Open Quotient (OQ). Acoustic analysis allowed to assess value of Fundamental Frequency (F0), Maximum Phonation Time (MPT) as well as Jitter, Shimmer, Noise-to-Harmonics Ratio (NHR) parameters. Narrowband Spectrography was performed. RESULTS HSDI technique allowed to register in elderly women with voice disorders a mild asymmetry and aperiodicity of vibrations, MW reduction, amplitude increase and glottal insufficiency in the posterior segment of glottis which indicated edematous changes in the larynx. In 90% of men in this group, moderate asymmetry and aperiodicity were observed as well as amplitude decrease, significant limitation of MW and glottal insufficiency in the middle segment of the glottis which indicated atrophic changes in the larynx. In remaining 10% of men, amplitude of vibration was increased which indicated the existence of hypofunctional dysphonia. Objective confirmation of glottal insufficiency in women with edematous changes was high value of OQ in posterior segment of the glottis registered with HSDI technique. In men with larynx atrophy, the value of OQ was the highest in the middle segment of the glottis. Glottal insufficiency, especially in the middle segment, coexisted with the increase of NHR parameter observed in acoustic examination and with numerous nonharmonic components in the scope of high frequencies revealed in narrowband spectrography, especially in men with larynx atrophy. What is more, in men, the increase of F0 and reduction of MPT was registered. In women with edematous changes of the larynx, acoustic analysis revealed decrease of F0 value, increase of Jitter, Shimmer, NHR as well as reduction of MPT. Narrowband sopectrography revealed not only harmonic components but also nonharmonics in the range of low, medium, and high frequencies. CONCLUSIONS The course of Presbyphonia varies individually in the elderly. In many subjects, the process of aging does not influence the quality of voice. Crucial importance in the diagnosis of Presbyphonia is assigned to High-Speed Digital Imaging technique which confirms the existence of edematous changes in the larynx in women as well as atrophy and hypofunctional dysphonia in men. The acoustic examination of voice confirmed the individual variability of the severity of Presbyphonia in the elderly depending on the clinical form of dysphonia determined by the gender of the diagnosed person.
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van der Woerd B, O'Dell K, Castellanos CX, Bhatt N, Benssousan Y, Reddy NK, Blood T, Chhetri DK, Johns MM. Safety of Platelet-Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy. Laryngoscope 2023; 133:647-653. [PMID: 35822344 DOI: 10.1002/lary.30288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. METHODS Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires. RESULTS Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. CONCLUSION This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. LEVEL OF EVIDENCE 4 Laryngoscope, 133:647-653, 2023.
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Affiliation(s)
- Benjamin van der Woerd
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Karla O'Dell
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Carlos X Castellanos
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Neel Bhatt
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Yael Benssousan
- USF Health Voice Center, Department of Otolaryngology - Head & Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Neha K Reddy
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Timothy Blood
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Dinesh K Chhetri
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Michael M Johns
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Bhatt NK, Gao WZ, Timmons Sund L, Castro ME, O'Dell K, Johns MM. Platelet-Rich Plasma for Vocal Fold Scar: A Preliminary Report of Concept. J Voice 2023; 37:302.e17-302.e20. [PMID: 33446439 DOI: 10.1016/j.jvoice.2020.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Vocal fold atrophy and scar can lead to loss of normal superficial lamina propria, negatively affecting the vibratory function of the vocal fold. These changes can lead to dysphonia, vocal fatigue, decreased volume, and altered pitch. Treatment options for these conditions are limited. Platelet-rich plasma (PRP) consists of platelets, growth factors, and cytokines derived from the patient's own blood and is believed to activate tissue regeneration. The purpose of this study was to review the technical aspects of collecting PRP and injecting it into the vocal fold injection - based on our initial experience with this procedure. CASE A patient with vocal fold scar was identified and enrolled in an ongoing prospective clinical trial study of a series of 4 monthly subepithelial vocal fold PRP injections, which was temporarily halted due to the COVID-19 pandemic. Patient underwent a single injection of autologous PRP into the left vocal fold. There were no adverse events during the study period. Subjective improvement in voice was noted at 1 month after injection with subsequent return to baseline over the next 4 months. Videostroboscopy performed on postinjection day 1 and day 7 and demonstrated no concerning exam changes. Compared to the preinjection baseline, the patient-reported voice-handicap index-10 (VHI-10) and voice catastrophization index were similar at 4 months following injection (20 to 20 and 4 to 3, respectively). Independent perceptual analysis of voice showed improvement at 4 months postinjection, compared to baseline consensus auditory-perceptual evaluation of voice 60 to 44. CONCLUSIONS This preliminary report was part of a prospective trial investigating the use of PRP to treat vocal fold atrophy and scar. This work highlights the technical considerations for injecting PRP into the vocal fold. Planned prospective enrollment in this study will help to validate the safety and efficacy of PRP injections.
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Affiliation(s)
- Neel K Bhatt
- University of Washington Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - William Z Gao
- Department of Otolaryngology - Head and Neck Surgery, Georgetown University Medical Center, Washington DC
| | - Lauren Timmons Sund
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - M Eugenia Castro
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Michael M Johns
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California.
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Alves CS, Santos M, Castro A, Lino J, Freitas SV, Almeida e Sousa C, da Silva ÁM. Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists. Eur Arch Otorhinolaryngol 2023; 280:461-467. [PMID: 36094563 PMCID: PMC9466320 DOI: 10.1007/s00405-022-07641-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/25/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. METHODS Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. RESULTS The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. CONCLUSIONS This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.
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Affiliation(s)
- Clara Serdoura Alves
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Mariline Santos
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Afonso Castro
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - João Lino
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Susana Vaz Freitas
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal ,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal ,LIAAD, Laboratório de Inteligência Artificial e Apoio à Decisão, INESCTEC, Porto, Portugal
| | - Cecília Almeida e Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Álvaro Moreira da Silva
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
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Chang SW, Lim GC, Kang JW. Subjective voice change was associated with appendicular skeletal muscle mass in elderly men, but not in women: A cross-sectional study. Clin Otolaryngol 2023; 48:58-64. [PMID: 36320144 DOI: 10.1111/coa.14002] [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: 05/25/2022] [Revised: 08/23/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the relationship between subjective voice changes and appendicular skeletal muscle in the elderly in Korea. DESIGN Retrospective cross-sectional study. SETTING Population-based survey data were collected by the Korean National Health and Nutrition Examination Survey between January 2009 and December 2011. PARTICIPANTS A total of 2611 participants (1081 men and 1530 women) aged 65 to 80 years were enrolled in the Korean National Health and Nutrition Examination Survey from 2009 to 2011. A 70-degree laryngeal endoscopy was performed to check for abnormalities in the larynx, while dual-energy x-ray absorptiometry was utilised to measure appendicular skeletal muscle mass. The correlation between subjective voice change and appendicular skeletal muscle index (ASMI) was analysed using a linear-by-linear association test and logistic regression analysis. RESULTS When comparing ASMI according to the presence or absence of subjective voice change, elderly men showed significantly lower ASMI values when subjective voice change was present (p = .021). However, in women, the ASMI was not significantly lower in the presence of subjective voice changes (p = .365). We confirmed that subjective voice change was significantly lower in the highest quintile of ASMI compared to lowest quintile of ASMI in the men using logistic regression analysis (B 0.281, 95% confident interval 0.082-0.964, p < .044). CONCLUSIONS This study has shown that in Korean men aged >65 years, subjective voice abnormality significantly increased as skeletal muscle mass decreased. Further longitudinal studies are needed to determine whether a correlation exists between objective voice test results and ASMI.
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Affiliation(s)
- Suk Won Chang
- Department of Otorhinolaryngology, Jeju National University Hospital, Jeju, Republic of Korea
| | - Gil-Chai Lim
- Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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do Nascimento NC, Bailey TW, Santos AP, Duan C, Mohallem R, Franco J, Aryal UK, Xie J, Cox A, Sivasankar MP. Proteomic analysis reveals that aging rabbit vocal folds are more vulnerable to changes caused by systemic dehydration. BMC Genomics 2022; 23:762. [PMID: 36411412 PMCID: PMC9677652 DOI: 10.1186/s12864-022-08975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Older adults are more prone to develop systemic dehydration. Systemic dehydration has implications for vocal fold biology by affecting gene and protein expression. The objective of this study was to quantify vocal fold protein changes between two age groups and hydration status, and to investigate the interaction of age and hydration status on protein expression, which has not been investigated in the context of vocal folds before. Comparative proteomics was used to analyze the vocal fold proteome of 6.5-month-old and > 3-year-old rabbits subjected to water ad libitum or water volume restriction protocol. RESULTS Young and older adult rabbits (n = 22) were either euhydrated (water ad libitum) or dehydrated by water volume restriction. Dehydration was confirmed by body weight loss of - 5.4% and - 4.6% in young and older groups, respectively, and a 1.7-fold increase of kidney renin gene expression in the young rabbits. LC-MS/MS identified 2286 proteins in the rabbit vocal folds of young and older adult rabbits combined. Of these, 177, 169, and 81 proteins were significantly (p ≤ 0.05) affected by age, hydration status, or the interaction of both factors, respectively. Analysis of the interaction effect revealed 32 proteins with opposite change patterns after dehydration between older and young rabbit vocal folds, while 31 proteins were differentially regulated only in the older adult rabbits and ten only in the young rabbits in response to systemic dehydration. The magnitude of changes for either up or downregulated proteins was higher in the older rabbits. These proteins are predominantly related to structural components of the extracellular matrix and muscle layer, suggesting a disturbance in the viscoelastic properties of aging vocal fold tissue, especially when subjected to systemic dehydration. CONCLUSIONS Water restriction is a laboratory protocol to assess systemic dehydration-related changes in the vocal fold tissue that is translatable to human subjects. Our findings showed a higher number of proteins differentially regulated with a greater magnitude of change in the vocal folds of older adult rabbits in the presence of systemic dehydration compared to younger rabbits. The association of these proteins with vocal fold structure and biomechanical properties suggests that older human subjects may be more vulnerable to the effects of systemic dehydration on vocal function. The clinical implications of these protein changes warrant more investigation, but age should be taken into consideration when evaluating vocal treatment recommendations that interfere with body fluid balance.
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Affiliation(s)
- Naila C. do Nascimento
- grid.169077.e0000 0004 1937 2197Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Taylor W. Bailey
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Andrea P. Santos
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Chenwei Duan
- grid.169077.e0000 0004 1937 2197Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Rodrigo Mohallem
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA ,grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Jackeline Franco
- grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Uma K. Aryal
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA ,grid.169077.e0000 0004 1937 2197Purdue Proteomics Facility, Bindley Bioscience Center, Discovery Park, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Jun Xie
- grid.169077.e0000 0004 1937 2197Department of Statistics, Purdue University, West Lafayette, Indiana, 47907 USA
| | - Abigail Cox
- grid.169077.e0000 0004 1937 2197Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, 47907 USA
| | - M. Preeti Sivasankar
- grid.169077.e0000 0004 1937 2197Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, 47907 USA
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Sugito R, Yamauchi A, Sato T, Goto T, Ueha R, Nito T, Yamasoba T. Sex-and Age-Based Etiological Analysis of 2901 Patients With Dysphonia in a Japanese Tertiary Medical Institute. J Voice 2022:S0892-1997(22)00236-3. [PMID: 36085095 DOI: 10.1016/j.jvoice.2022.08.003] [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: 05/26/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Societal aging is a grave concern in Japan, and its impact on voice clinics has not been investigated. This study aimed to clarify recent demographic features of geriatric dysphonia at a tertiary medical institute in Japan. STUDY DESIGN Retrospective study. METHODS The medical records of 2901 patients newly referred to the Voice Outpatient Clinic of the University of Tokyo Hospital between 2003 and 2020 were analyzed for age, sex, and etiology. RESULTS The mean ± standard deviation age of all patients was 53.2 ± 20.7 (median, 58; range, 0-95) years. The aging rate (ratio of patients aged ≥65 years) increased continuously during the study period, and the recent aging rate was the highest in the world (43%). However, its rate of increase has slowed over the past 10 years. The etiologies of dysphonia associated with the largest number of older patients were vocal fold immobility (32%), vocal fold atrophy (23%), and benign vocal fold lesions (11%). The highest aging rate was detected in patients with laryngeal cancer/leukoplakia, vocal tremor, vocal fold atrophy, sulcus vocalis, and vocal fold immobility. CONCLUSIONS Societal aging substantially increased the aging rate of patients with dysphonia in a Japanese voice clinic. The incidence of vocal fold immobility and atrophy is expected to continue to increase, whereas that of benign vocal fold lesions is expected to decrease.
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Affiliation(s)
- Ryosuke Sugito
- Department of Otolaryngology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Kawagoe-shi, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Song JS, Campbell R, Lin RJ, Jeffery CC. Laryngoscopic Findings of Age-related Vocal Fold Atrophy are Reliable but not Specific. Clin Otolaryngol 2022; 47:516-520. [PMID: 35397140 DOI: 10.1111/coa.13936] [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: 10/31/2021] [Revised: 01/18/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists. DESIGN Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymized laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy, and specify which laryngoscopy features were present to make the diagnosis. SETTING Tertiary care laryngology practice. PARTICIPANTS Two fellowship-trained laryngologists and three trainee otolaryngologists. MAIN OUTCOME MEASURES Accuracy of age categorization was determined and Kappa analysis was performed to assess inter-rater agreement. RESULTS The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds, and prominent vocal processes were all identified with high agreement (>80.0%). CONCLUSION Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.
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Affiliation(s)
- Jin Soo Song
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Health Sciences, University of Alberta, Edmonton, AB, CANADA
| | - Ross Campbell
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, CANADA
| | - R Jun Lin
- Department of Otolaryngology-Head and Neck Surgery, Laryngology, St. Michael's Hospital, University of Toronto, ON, CANADA
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Health Sciences, University of Alberta, Edmonton, AB, CANADA.,Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, CANADA
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Leão RLDS, Gomes ADOC, Queiroz MRG, Lucena JA. Terapia vocal com abordagem respiratória em idosos: revisão integrativa da literatura. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222427721s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: caracterizar a terapia vocal com abordagem respiratória em idosos disfônicos. Métodos: a busca foi realizada nas bases PubMed, BVS, Scopus, Web of Science e Embase. Foram incluídos estudos originais, nos idiomas inglês, espanhol e português, que tratassem sobre terapia vocal associada à abordagem respiratória na população idosa. Foram analisadas as variáveis gênero, faixa etária, etiologia associada, frequência e duração da sessão, dosagem de exercícios, intervenção e benefícios. Resultados: foram encontrados 1.425 artigos, porém, apenas nove foram incluídos na revisão. Na terapia vocal para idosos, destacaram-se as estratégias do Exercício de Função Vocal e o Método Lee Silverman®, além de outras, como o ParkinSong e o uso do tubo submerso em água. Tais abordagens modificam a função da musculatura laríngea, o impulso e o suporte respiratório, bem como o treino para aumento da intensidade vocal. Os principais resultados terapêuticos foram: melhora nos parâmetros perceptivo-auditivos, acústicos, aerodinâmicos, tempo máximo de fonação, nível de esforço fonatório e qualidade vocal. Conclusão: a terapia vocal com abordagem respiratória caracterizou-se pelo uso de estratégias direcionadas tanto à população idosa de forma geral, quanto a populações com disfonia neurológica, cujos resultados mostraram melhoria no controle de intensidade, frequência, ressonância e coordenação pneumofônica.
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Leão RLDS, Gomes ADOC, Queiroz MRG, Lucena JA. Voice therapy with a respiratory approach in older people: an integrative literature review. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222427721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to characterize voice therapy with a respiratory approach in dysphonic older people. Methods: a search made in PubMed, VHL, Scopus, Web of Science, and EMBASE. Original studies in English, Spanish, and Portuguese, addressing voice therapy in combination with a respiratory approach in the older population, were included. The analysis encompassed sex, age, associated etiology, session frequency and duration, exercise dosage, intervention, and benefits. Results: altogether, 1,425 articles were found, of which only nine were included in the review. In voice therapy for older people, the following strategies stood out: Vocal Function Exercises, Lee Silverman Voice Treatment®, ParkinSong, and tubes immersed in water. These approaches change the laryngeal muscle function and respiratory impulse and support and increase vocal intensity. The main therapeutic findings included improved auditory-perceptual, acoustic, and aerodynamic parameters, maximum phonation time, phonatory effort level, and voice quality. Conclusion: voice therapy with a respiratory approach characteristically used strategies aimed at both the general older population and those with neurological dysphonia. Their results showed improvement in frequency, resonance, intensity control, and breathing/phonation coordination.
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Pilmane M, Sumerags D, Jain N, Jain S, Sumeraga G. Singer’s Nodules: Investigating the Etiopathogenetic Markers Progressing Their Pathogenesis and Clinical Manifestations. BIOLOGY 2021; 10:biology10121268. [PMID: 34943184 PMCID: PMC8698952 DOI: 10.3390/biology10121268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary Vocal nodules, together with vocal polyps, are the most common benign vocal cord structures that are thought to be caused by extensive vocal abuse (shouting, talking loudly for prolonged periods) and are routinely treated surgically. However, surgical excision of these nodules, does not exclude the possibility of recurrence of these nodules, especially if lifestyle changes are not adapted to prevent phonetic trauma. Furthermore, the etiopathogenetic pathways governing the formation and maintenance of these nodules are not known. Herein, we investigated the etiopathogenetic markers for proliferation, apoptosis, growth, ischemia (tissue hypoxia), inflammation and innervation to elucidate the causative pathways. We found a profound and significant intensification of apoptosis in tissue epithelium, which strongly correlated with proliferative, ischemic, and inflammatory changes, highlighting the underlying complex interactions between various mechanisms on a cellular and tissue level, which occur during the morpho-pathogenesis of vocal nodules. Abstract Vocal nodules (or Singer’s nodules) are benign vocal cord structures which are commonly encountered by clinicians. Though phonetic trauma/abuse is thought to be the main cause of the development of vocal nodules, the exact etiopathogenesis remains unknown. Hence, we compared the immunohistochemical markers for proliferation (Ki-67), apoptosis (TUNEL), growth (EGFR), ischemia (VEGF), inflammation (IL-1α and 10), and immunoreactive innervation (PGP 9.5), in vocal nodule tissue samples obtained from 10 females (17–56 years) and vocal cord tissue from seven controls. A statistically significant increase in Ki-67, TUNEL, EGFR, VEGF and IL-1α expression was noted (p < 0.05) between nodule tissue and control tissue in both epithelial and subepithelial layers. However, the difference was non-significant for both IL-10 and PGP 9.5 (p > 0.05). All markers demonstrated moderate to strong positive correlations, except for IL-10. These findings suggest increased cellular growth and proliferation in vocal nodules coupled with a persistent presence of inflammatory and ischemic environment. Furthermore, global prevalence of apoptotic cells and decreased anti-inflammatory cytokines highlight the presence of underlying complex mechanisms in the etiopathogenesis of vocal nodules, with age having a negligible impact on the marker levels. Our results could potentially further our knowledge in understanding the effects of different treatment modalities available at the cellular level.
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Affiliation(s)
- Mara Pilmane
- Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
- Correspondence: (M.P.); (N.J.); Tel.: +371-6732086 (M.P. & N.J.)
| | - Dins Sumerags
- Cesu Klinika Hospital, Slimnicas Street 9, LV-4101 Cesis, Latvia;
| | - Nityanand Jain
- Department of Morphology, Institute of Anatomy and Anthropology, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
- Correspondence: (M.P.); (N.J.); Tel.: +371-6732086 (M.P. & N.J.)
| | - Shivani Jain
- Department of Oral and Maxillofacial Surgery, Genesis Institute of Dental Sciences & Research, Ferozepur 152002, Punjab, India;
| | - Gunta Sumeraga
- Department of Otorhinolaryngology, Riga Stradiņš University, Dzirciema Street 16, LV-1002 Riga, Latvia;
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Moura WER, Gadenz CD, Lemos IDO, Bós ÂJG, Cassol M. Analysis of the singing voice handicap index for elderly choristers. Codas 2021; 34:e20200302. [PMID: 34705924 PMCID: PMC9886114 DOI: 10.1590/2317-1782/20212020302] [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: 10/27/2020] [Accepted: 04/07/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyze the singing voice handicap index in elderly choristers and verify its relationship with the profile, habits and health conditions of the participants. METHODS 110 individuals aged 60 years or older, participating in amateur choirs, were included. Choir singers were interviewed in order to verify data such as age, time in choir singing, vocal classification, and the presence of habits and health conditions adverse to voice production. Subsequently, they answered the questionnaire "Singing Voice Handicap Index (SVHI)", which assesses the individual's self-perception in relation to experiences in the use of the singing voice. RESULTS The SVHI score had a median of 25, with a minimum score of 0 and a maximum score of 86. The most scored items were related to physical aspects in the use of singing voice: "I am unable to use my 'high voice'" (Q10) and "My throat is dry when I sing"(Q13). It was found that older adults over 75 years of age had a greater voice handicap when compared to younger ones (p=0.020). Choir singers classified as contralto also had a higher SVHI score (p=0.023), as well as individuals who reported drinking little water (p=0.007). CONCLUSION The choristers in this study presented a singing voice handicap index compatible with healthy singing voices. When verifying the relationship of the SVHI score with the characteristics of the participants and with respect to habits and health conditions, it was found that the elderly choir singers over 75 years old, the contralto choir singers, and those who claimed to drink little water had higher scores for the singing voice handicap.
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Affiliation(s)
| | - Camila Dalbosco Gadenz
- Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde – UFCSPA - Porto Alegre (RS), Brasil.
| | - Isadora de Oliveira Lemos
- Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde – UFCSPA - Porto Alegre (RS), Brasil.
| | - Ângelo José Gonçalves Bós
- Departamento de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul – PUCRS - Porto Alegre (RS), Brasil.
| | - Mauriceia Cassol
- Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde – UFCSPA - Porto Alegre (RS), Brasil.
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Jacks A, Kavookjian H, Kraft S. Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age. Otolaryngol Head Neck Surg 2020; 165:142-148. [PMID: 33290166 DOI: 10.1177/0194599820978435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care voice center between January 2011 and June 2016. METHODS A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. RESULTS The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia (P = .006) and vocal cord atrophy (P < .001) but were less likely to have laryngopharyngeal reflux (P = .001), benign vocal cord lesions (P < .001), or muscle tension dysphonia (P < .001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery (P = .001) and voice therapy (P = .034), as did the <65 cohort (surgery, P < .001; voice therapy, P = .015). Adult surgical patients <65 reported greater improvements than patients ≥65 (P = .021). CONCLUSIONS There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy.
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Affiliation(s)
- Amy Jacks
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hannah Kavookjian
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shannon Kraft
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
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22
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Stager SV, Sparks AD, Bielamowicz SA, Edgar JD. The Role of Choral Singing in Speaking Voice Preservation of Aging Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2099-2114. [PMID: 32569498 DOI: 10.1044/2020_jslhr-19-00347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory-perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15-20 months apart. Vocal function measures and auditory-perceptual ratings of estimated age and the presence of voice disorders were compared across singing status and visit. Changes in the presence and degree of laryngeal signs of aging between visits were compared across singing status. Results Using an alpha of .2, deemed acceptable for pilot studies, vocal function measures supported choral singing as an intervention to preserve the speaking voice as less noise energy between 2 and 3 kHz (p = .01) and lower phonation threshold pressures (PTPs) were present (p = .09) for singers compared to nonsinging controls. Greater flows at comfortable pitch (p = .04) and high pitch (p = .06) as well as lower cepstral peak prominence smoothed (CPPS) for the vowel /a/ (p < .01) were found at Visit 2 for both groups, but singers demonstrated lower flows at Visit 2 than nonsinging controls at comfortable pitch (p = .06). Auditory-perceptual ratings did not support preservation of speaking voice, although a larger percentage of listeners rated nonsinging controls as voice disordered at Visit 2. Endoscopic ratings supported preservation, as singers were more likely than nonsinging controls to be rated as having laryngeal signs of aging absent at both visits (p = .02). Conclusion The findings from this pilot study provide evidence that regular singing in senior chorales may assist in preserving older adults' speaking voices.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, The George Washington University School of Medicine, Washington, DC
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Julia D Edgar
- Department of Communication Disorders, Truman State University, Kirksville, MO
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Kosztyła-Hojna B, Duchnowska E, Zdrojkowski M, Łobaczuk-Sitnik A, Biszewska J. Application of High Speed Digital Imaging (HSDI) technique and voice acoustic analysis in the diagnosis of the clinical form of Presbyphonia in women. Otolaryngol Pol 2020; 74:24-30. [PMID: 34550094 DOI: 10.5604/01.3001.0014.1580] [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: 11/13/2022]
Abstract
<b>Introduction:</b> The aging process of voice begins after the age of 60 and has an individually variable course. Voice quality disorders at this age are called senile voice (Presbyphonia or Vox Senium). Voice pathology is particularly severe in women. The aim of the study was to diagnose the clinical form of Presbyphonia in elderly women using High Speed Digital Imaging (HSDI) and acoustic voice analysis. <br><b>Material and methods:</b> Study included 50 elderly women (average age 69) with dysphonia (Group I). Control group (Group II) included 30 women (average age 71) without voice quality disorders. Visualization assessment has been conducted with High Speed Digital Imaging (HSDI) with High Speed camera (HS). Acoustic evaluation of voice included analysis isolated vowel "a" and continuous linguistic text with Diagnoscope Specialista software. Maximum Phonation Time (MPT) has been determined. <br><b>Results:</b> In Group I, 78% of women revealed vocal folds vibrations asymmetry, vibration amplitude increase, Mucousal Wave (MW) limitation and Type D glottal insufficiency (GTs). Acoustic voice analysis proved decrease in F0, increase in Jitter, Shimmer, NHR. In 22% of women, next to vibrations asymmetry, vibration amplitude reduction and MW limitation, Type E glottal insufficiency (GTs) have been found. Acoustic voice analysis revealed slight decrease in F0 and the presence of numerous non-harmonic components in the glottis region. <br><b>Conclusions:</b> Vocal folds visualization with HSDI showed edema, less often atrophy in elderly women. Both forms of dysphonia were caused abnormal values of F0, Jitter, Shimmer, NHR in the acoustic voice evaluation and significant reduction of MPT.
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Affiliation(s)
- Bożena Kosztyła-Hojna
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Emilia Duchnowska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Maciej Zdrojkowski
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Anna Łobaczuk-Sitnik
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Jolanta Biszewska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
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Gugatschka M, Feiner M, Mayr W, Groselj-Strele A, Eberhard K, Gerstenberger C. Functional Electrical Stimulation for Presbyphonia: A Prospective Randomized Trial. Laryngoscope 2020; 130:E662-E666. [PMID: 31910302 PMCID: PMC7687219 DOI: 10.1002/lary.28489] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/01/2019] [Accepted: 12/12/2019] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this prospective study was to examine the effects of transcutaneous functional electrical stimulation (FES) in a group of elderly women with presbyphonia. Study Design Prospective randomized study. Methods Fourteen participants were enrolled prospectively and attributed randomly to two different treatment groups, where one group (n = 7) received 8 weeks of training (5 days a week), whereas the other group (n = 7) received 4 weeks of ineffective stimulation, followed by 4 weeks of effective training. Stimulation protocols were established during baseline examination and confirmed with endoscopy to ensure a glottal reaction. Numerous acoustical, vocal, patient‐centered, and respiratory parameters were obtained at several time points. Results Neither 4 weeks nor 8 weeks of functional electrical transcutaneous stimulation led to changes of vocal, acoustical, or respiratory parameters, apart from patient‐centered items (Voice Handicap Index 12, Voice‐Related Quality of Life), which improved over time. However, there were no differences between the two arms for both items. Conclusions Transcutaneous FES over 4 weeks and 8 weeks did not lead to significantly improved objective voice and acoustical parameters, which could be caused by the fact that the muscles of interest cannot be targeted specifically enough. However, we found a significant improvement of subjective voice perception and voice‐related quality of life in both groups. We explain this finding with an observer‐expectancy effect secondary to the very time‐consuming and elaborate study procedures. Level of Evidence 1b Laryngoscope, 130:E662–E666, 2020
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Affiliation(s)
| | - Marlies Feiner
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | | | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
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The Plasma Bioavailability of Coenzyme Q 10 Absorbed from the Gut and the Oral Mucosa. J Funct Biomater 2018; 9:jfb9040073. [PMID: 30558322 PMCID: PMC6306788 DOI: 10.3390/jfb9040073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022] Open
Abstract
Coenzyme Q10 (CoQ10) has a central role in the generation of cellular bioenergy and its regulation. The hydrophobicity exhibited by the CoQ10 molecule leads to reports of poor absorption profiles, therefore, the optimization of formulations and modes of delivery is an ever-evolving therapeutic goal. The aim of this study was to investigate different CoQ10 formulations. The article summarizes the findings from an Australian comparative study involving adults administered CoQ10 through different oral delivery platforms. A total of 11 participants (six males and five females) voluntarily participated in a comparative clinical study of three different CoQ10 formulations across a six-week period, completing 198 person-hours of cumulative contribution equivalent to n = 33 participation. All of the eligible participants (n = 11) administered the three formulations blinded from who the commercial supplier of the formulation was and from what the chemical form of the CoQ10 was that was being administered. The dosing between the CoQ10 preparations were dispensed sequentially and were administered following three-week washouts. Three commercial preparations were tested, which included the following: formulations with capsules each containing ubiquinol and ubiquinone (150 mg/capsule), and a liposome ubiquinone formulation (40 mg/mL at 2 actuations of the pump). A significant inter-subject variation in the plasma level of CoQ10 at baseline that was observed to increase with an increase in age. This trend persisted in the post administration of the different formulations. Furthermore, it was observed that the intestinal absorption and bioavailability of CoQ10 varied significantly in the plasma between subjects, irrespective of whether the ubiquinol or ubiquinone forms were administered. The administration of CoQ10 as a liposome for preparation showed the poorest response in bioavailability. Although the ubiquinol capsule form of CoQ10 was observed to have increased in the plasma versus the ubiquinone capsules and the ubiquinol liposome at the two-hour interval, the inter-subject variation was such that the difference was not significant (p > 0.05). All of the CoQ10 formulations showed no further increases in their plasma levels over the remaining study period (i.e., four hours). This study further concluded that the intestinal absorption of CoQ10 is highly variable and is independent of the molecular form administered. Furthermore, it also concludes that liposomes are not an effective vehicle for the oral administration of CoQ10, and as such, did not improve the oral mucosal/sublingual absorption and bioavailability of the molecule. Of interest was the observation that with the increasing subject age, there was an observed increase in the baseline plasma CoQ10 levels in the participants prior to dosing. It was posited that the increase in the baseline plasma levels of CoQ10 with an increase in age could be due to the loss of skeletal muscle mass, a result that still needs to be verified.
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