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Voloch L, Icht M, Ben-David BM, Carmel Neiderman NN, Levenberg G, Manor Y, Shpunt D, Oestreicher-Kedem Y. Seven Days of Voice Rest Post-phonosurgery Is Not Better than 3 days: A Prospective Randomized Short-term Outcome Study. Laryngoscope 2024. [PMID: 38837365 DOI: 10.1002/lary.31556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE The aim of the study is to compare the short-term effect of 7 versus 3 days of voice rest (VR) on objective vocal (acoustic) parameters following phonosurgery. METHODS A prospective randomized study conducted at a tertiary referral medical center. Patients with vocal fold nodules, polyps, or cysts and scheduled for phonosurgery were recruited from the Voice Clinic. They were randomized into groups of 7- or 3-day postoperative VR periods and their voices were recorded preoperatively and at 4-week postoperatively. A mixed linear model statistical analysis (MLMSA) was used to compare pre- and postoperative jitter, shimmer, harmonic-to-noise ratio, and maximum phonation time between the two groups. RESULTS Sixty-five patients were recruited, but only 34 fully complied with the study protocol, and their data were included in the final analysis (19 males, 20 females; mean age: 40.6 years; 17 patients in the 7-day VR group and 16 in the 3-day VR group). The groups were comparable in age, sex, and type of vocal lesion distribution. The preoperative MLMSA showed no significant group differences in the tested vocal parameters. Both groups exhibited significant (p < 0.05) and comparable improvement in all vocal parameters at postoperative week 4. CONCLUSIONS A VR duration of 7 days showed no greater benefit on the examined vocal parameters than the 3-day protocol 4-week postoperatively. Our results suggest that a 3-day VR regimen can be followed by patients who undergo phonosurgery without compromising the vocal results. Larger-scale and longer-duration studies are needed to confirm our findings. LEVEL OF EVIDENCE 2 Laryngoscope, 2024.
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Affiliation(s)
- Liat Voloch
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Boaz M Ben-David
- Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, Ontario, Canada
| | - Narin Nard Carmel Neiderman
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Guy Levenberg
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yael Manor
- Movement Disorders Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Faculty of Health Professions, Communication Sciences and Disorders Department, Ono Academic College, Kiryat Ono, Israel
| | - Dina Shpunt
- Movement Disorders Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Oestreicher-Kedem
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Echternach M, Köberlein M, Döllinger M, Kirsch J, Pilsl T. Does forced whisper have an impact on voice parameters? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08698-7. [PMID: 38709324 DOI: 10.1007/s00405-024-08698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES There has been the assumption that whispering may impact vocal function, leading to the widespread recommendation against its practice after phonosurgery. However, the extent to which whispering affects vocal function and vocal fold oscillation patterns remains unclear. METHODS 10 vocally healthy subjects (5 male, 5 female) were instructed to forcefully whisper a standardized text for 10 min at a sound level of 70 dB(A), measured at a microphone distance of 30 cm to the mouth. Prior to and following the whisper loading, the dysphonia severity index was assessed. Simultaneously, recordings of high speed videolaryngoscopy (HSV), electroglottography, and audio signals during sustained phonation on the vowel /i/ (250 Hz for females and 125 Hz for males) were analyzed after segmentation of the HSV material. RESULTS The pre-post analysis revealed only minor changes after the intervention. These changes included a rise in minimum intensity, an increase in the glottal area waveform-derived open quotient, and the glottal gap index. However, no statistically significant changes were observed in the harmonic-to-noise-ratio, the glottal- to-noise-excitation-ratio, and the electroglottographic open quotient. CONCLUSION Overall, the study suggests that there are only small effects on vocal function in consequence of a forced whisper loading.
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Affiliation(s)
- Matthias Echternach
- Division Phoniatrics and Pediatric Audiology, Department of Otolaryngology, Munich University Hospital and Faculty of Medicine, Munich University (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany.
| | - Marie Köberlein
- Division Phoniatrics and Pediatric Audiology, Department of Otolaryngology, Munich University Hospital and Faculty of Medicine, Munich University (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otolaryngology Head & Neck Surgery, University Hospital Erlangen, FAU Erlangen-Nuremberg, Erlangen, Germany
| | - Jonas Kirsch
- Division Phoniatrics and Pediatric Audiology, Department of Otolaryngology, Munich University Hospital and Faculty of Medicine, Munich University (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
| | - Theresa Pilsl
- Division Phoniatrics and Pediatric Audiology, Department of Otolaryngology, Munich University Hospital and Faculty of Medicine, Munich University (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
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Chi HW, Cho HC, Yang AY, Chen YC, Chen JW. Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:154-161. [PMID: 35218027 DOI: 10.1002/lary.30082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest. STUDY DESIGN Systematic review and meta-analysis. METHODS The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis. RESULTS Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group. CONCLUSIONS The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. LEVEL OF EVIDENCE 1 Laryngoscope, 133:154-161, 2023.
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Affiliation(s)
- Hua-Wei Chi
- Department of Otolaryngology-Head and Neck Surgery, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Hsiao-Chien Cho
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - An-Yun Yang
- Master Program of Big Data in Biomedicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yong-Chen Chen
- College of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan.,Master Program of Big Data in Biomedicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,College of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Medical Research and Education, Cardinal Tien Hospital, New Taipei City, Taiwan
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Lima Neto JL, Fonseca ARBD, Tavares ELM, Gramuglia ACJ, Martins RHG. Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery. Int Arch Otorhinolaryngol 2022; 27:e77-e82. [PMID: 36714896 PMCID: PMC9879646 DOI: 10.1055/s-0042-1743463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/01/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.
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Affiliation(s)
- José Luiz Lima Neto
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Antônio Rodrigues Bueno da Fonseca
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Elaine Lara Mendes Tavares
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Andrea Cristina Joia Gramuglia
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil
| | - Regina Helena Garcia Martins
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatu, São Paulo, Brazil,Address for correspondence Regina Helena Garcia Martins, MD, PhD Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho, Unesp Botucatudistrito de Rubião Junior, s/n. CEP- 18618-970, São PauloBrasil
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Ding L, Lv T, Lou Z. The recurrent factors of idiopathic vocal process granulomas after cold steel excision. Am J Otolaryngol 2022; 43:103454. [PMID: 35413544 DOI: 10.1016/j.amjoto.2022.103454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/22/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify the factors predicting postoperative recurrence after cold steel excision for the market trader with idiopathic vocal process granulomas (VPGs). MATERIAL AND METHODS The market traders with idiopathic VPGs who do not respond to medical treatment were treated by cold steel excision. The factors considered likely to affect the recurrence were evaluated by univariate and multivariate logistic regression. RESULTS The total of 80 idiopathic VPGs underwent the cold steel excision. All postoperative 6 months, the complete remission rate was 37.5% (30 VPGs) and 50 recurrences developed (62.5%). The recurrence rate was not significantly associated with sex (P = 0.119), side (P = 0.468), VPG size (P = 0.726), LPR (P = 0.293), diabetes mellitus (P = 0.5611), cerebrovascular disease (P = 0.129), or chronic pulmonary disease (P = 0.190). Multivariate logistic regression showed that only vocalization frequency (P = 0.006) and smoking and alcohol consumption (P = 0.001) were independent predictors of recurrence. There was no significant correlation between age and recurrence (P = 0.59). However, recurrence was more common in those aged 51-60 years than those aged ≥61 years (P = 0.019). Of the recurrent 49 VPGs treated conservatively via behavioural modification and oral deanxit, the granulomas disappeared spontaneously in 38 (77.6%) within 6-10 months and in 11 (22.4%) within 2-3 years. CONCLUSIONS The market traders with VPG would be a high recurrence rate after cold steel excision, the frequency of voice use and smoking and alcohol consumption were significant independent predictors of recurrence. Antidepressant medications and behavioural modification could effectively improve the outcome of VPG.
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Björck G, Hertegård S, Ekelund J, Marsk E. Voice rest after vocal fold polyp surgery: A Swedish register study of 588 patients. Laryngoscope Investig Otolaryngol 2022; 7:486-493. [PMID: 35434318 PMCID: PMC9008164 DOI: 10.1002/lio2.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the impact of voice rest on patient‐reported voice outcome 4 months after vocal fold polyp surgery. Methods Preoperative information was collected about age, sex, and smoking habits and the voice handicap index‐10 (VHI‐10). Four months postoperatively, voice rest (total voice rest, spoke single words, and spoke normally), and pre and postoperative voice therapy were reported. This was correlated to voice satisfaction from a two‐category subjective evaluation “satisfied/ not satisfied” and to VHI‐10. Logistic regression models with relative risk for NOT being satisfied with voice after surgery were performed. Results Data from 588 patients were available. The group “spoke normally” showed the highest degree of patient satisfaction (92%). Younger patients (<59 years) were more satisfied than older (90% vs. 81.5%). High age and low VHI‐10 scores before surgery were statistically significant for negative voice outcome. Gender or voice rest type did not significantly affect outcome. The largest improvement in VHI‐scores was in the group who spoke normally and least in the group who spoke single words. Conclusion We found no significant difference in the two‐category subjective voice outcome depending on voice rest. VHI‐10 showed a statistically significant positive effect on self‐evaluated voice outcome, with the largest improvement in the group with no voice rest. However, the clinical relevance of the VHI changes is unclear. The present study does not show any advantage of total voice rest as compared to relative voice rest or speaking freely. High age and low preoperative VHI scores were significant risk factors for worse voice outcome. Level of evidence: 4
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Affiliation(s)
- Gunnar Björck
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | - Stellan Hertegård
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
| | | | - Elin Marsk
- Division of Ear, Nose and Throat, Department of Otorhinolaryngology, Phoniatric Section Karolinska University Hospital, CLINTEC, Karolinska Institutet Stockholm Sweden
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King RE, Novaleski CK, Rousseau B. Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:912-922. [PMID: 35179998 PMCID: PMC9150674 DOI: 10.1044/2021_ajslp-21-00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 11/14/2021] [Indexed: 06/01/2023]
Abstract
PURPOSE Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. METHOD Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. RESULTS Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. CONCLUSION VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19178459.
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Affiliation(s)
- Renee E. King
- Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Carolyn K. Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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King RE, Dailey SH, Thibeault SL. Role of Voice Therapy in Adherence to Voice Rest After Office-Based Vocal Fold Procedures. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2542-2553. [PMID: 34520225 PMCID: PMC9132023 DOI: 10.1044/2021_ajslp-21-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Purpose Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest. Method Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1-3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure. Results Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up. Conclusions Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up. Supplemental Material https://doi.org/10.23641/asha.16589864.
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Affiliation(s)
- Renee E. King
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | - Seth H. Dailey
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
| | - Susan L. Thibeault
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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Hortobagyi D, Grossmann T, Tschernitz M, Grill M, Kirsch A, Gerstenberger C, Gugatschka M. In vitro mechanical vibration down-regulates pro-inflammatory and pro-fibrotic signaling in human vocal fold fibroblasts. PLoS One 2020; 15:e0241901. [PMID: 33211714 PMCID: PMC7676657 DOI: 10.1371/journal.pone.0241901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/22/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Voice rest following phonotrauma or phonosurgery has a considerable clinical impact, but clinical recommendations are inconsistent due to inconclusive data. As biopsies of the vocal folds (VF) for molecular biology studies in humans are unethical, we established a new in vitro model to explore the effects of vibration on human vocal fold fibroblasts (hVFF) in an inflammatory and normal state, which is based on previously published models. METHODS By using a phonomimetic bioreactor we were able to apply predefined vibrational stress patterns on hVFF cultured under inflammatory or normal conditions. Inflammatory and pro-fibrotic stimuli were induced by interleukin (IL)1β and transforming growth factor (TGF)β1, respectively. Mechanical stimulation was applied four hours daily, over a period of 72 hours. Outcome measurements comprised assessment of extracellular matrix (ECM)-related components, angiogenic factors, and inflammatory and fibrogenic markers on gene expression and protein levels. RESULTS Under inflammatory conditions, the inflammatory cytokine IL11, as well as the myofibroblast marker alpha smooth muscle actin (α-SMA) were significantly reduced when additional vibration was applied. The desirable anti-fibrotic ECM component hyaluronic acid was increased following cytokine treatment, but was not diminished following vibration. CONCLUSION Our experiments revealed the effect of vibrational stress on hVFF in an inflammatory state. Elevated levels of certain pro-inflammatory/pro-fibrotic factors could be mitigated by additional vibrational excitation in an in vitro setting. These findings corroborate clinical studies which recommend early voice activation following an acute event.
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Affiliation(s)
- David Hortobagyi
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Tanja Grossmann
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | | | - Magdalena Grill
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Andrijana Kirsch
- Division of Phoniatrics, Medical University of Graz, Graz, Austria
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Wang Y, Yang J, Liang F, Liu J, Liang M, Zhang X, Chen W, Zheng Y. Acoustic and Aerodynamic Analyses of the Voice of Prelingually Deaf Young Men After Cochlear Implantation. J Voice 2020; 35:838-842. [PMID: 32430161 DOI: 10.1016/j.jvoice.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to characterize the acoustic and aerodynamics of the voice of young men with prelingual deafness after cochlear implantation (CI) to provide a theoretical basis for their rehabilitation after CI. METHODS The CI group included 17 young men with prelingual deafness who implanted cochlear at 18-24 years old. The control group included 17 normally hearing young men at the same age. The 10-item Voice Handicap Index, acoustic parameters, and aerodynamic parameters were evaluated. RESULTS For the acoustic parameters, the F0, SDF0, and Jitter of the CI group were higher than those of the Control group, and these differences were statistically significant. Additionally, The difference in mean shimmer and mean NHR values between the CI group and the Control group was not statistically significant For the aerodynamic parameters, the subglottal pressure and aerodynamic power of the CI group were significantly higher than those of the Control group, whereas the MPT was significantly shorter. DISCUSSION Due to excessive stress on the laryngeal muscle and limited pneumo-phono-articulatory coordination, the young men in the CI group had a thin voice and poor voice control and muscle coordination, and they exhibited excessive laryngeal resistance. We propose that after CI, in addition to regular hearing and speech rehabilitation, voice training is also extremely important for prelingually deaf young men.
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Affiliation(s)
- Yajing Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jinshan Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Faya Liang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jiahao Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Maojin Liang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xueyuan Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenjun Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yiqing Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
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