Managing dysphonia caused by misuse and overuse

Voice Therapy Efficacy in Pediatric Professional Voice Users With Vocal Fold Nodules: A Preliminary Study

INTRODUCTION

Vocal fold nodules are the most common diagnosis in children with dysphonia. It is also frequently seen in professional voice users who uses their voice as an occupational tool. It can be caused by excessive or hyperfunctional use of the voice leading to phonotrauma. Children who learn the Quran by heart and recite it use their voices excessively and it causes voice problems. Voice therapy can play an important role in regulating phonotraumatic behaviors and improving voice quality, thereby replacing surgical intervention in some cases or acting as a complementary therapy to improve eventual therapeutic outcomes.

OBJECTIVES

Our aim was to find the efficacy of group voice therapy compared to individual voice therapy in a group of pediatric professional voice users who go to the same religious school.

METHODS

To determine group therapy efficacy, 24 students between the age of nine and 14, were evaluated and 16 of them had vocal fold nodules. Therapy sessions started with 16 students whose ages ranged from nine to 14 with a mean of 11,3 ± 1,4 years old. They were divided into two groups: group and individual therapy groups. Treatment comprised both direct and indirect voice therapy and lasted 6 weeks. Three of the participants were dropped out due to absence. Pre- and post-therapy measures were collected from 13 participants using perceptual evaluation, videostroboscopy measures, and the pediatric voice handicap index to determine the efficacy of group voice therapy compared to individual voice therapy with a group of pediatric professional voice users with vocal fold nodules.

RESULTS

As a result of our study, eight of participants were found to have healthy vocal folds; the s/z ratio was significantly different between groups and within group therapy participants pre- and post-therapy. No significant difference was found in other parameters; except noise harmonic ratio (NHR). NHR was found significantly different between pre- and post-therapy when individual therapy and group therapy were compared. Although both treatments were shown to be beneficial in the management of vocal fold nodules, individual therapy was found to be somewhat more effective.

CONCLUSION

In pediatric voice therapy, group therapy is an effective option to reach out to more individuals with voice disorders. It can be beneficial for time management and cost effectiveness in voice therapy.

Study on Optimal Position and Covering Pressure of Wearable Neck Microphone for Continuous Voice Monitoring

Vocal cord disorder is one of the important health problems, especially in noisy industrial sites where excessive voice is required. A convenient and reliable communication method is required in a noisy environment to prevent the related disorders. However, the signal sensitivity of previous neck microphones is still insufficient to accurately convey the voice. In this study, we developed a skin-attachable neck microphone with a lightweight and flexible form factor. Also, we optimized the attachment position and covering pressure to maximize the signal sensitivity. As a result, we obtained the optimal position near the thyroid cartilage and confirmed that the signal sensitivity is the highest when the covering pressure is approximately 4 mmHg.Clinical Relevance- People can measure the voice status using a wearable neck microphone at the optimal position and covering pressure. It provides a solution to keep the vocal cords in good health even in a noisy environment.

Prevalence and Influencing Risk Factors of Voice Problems in Priests in Kerala

OBJECTIVE

Voice problems are commonly reported by professionals in occupations involving a large amount of voice loading. The aim of the present study was to investigate the prevalence of voice problems in Mar Thoma priests and identify possible risk factors responsible for voice problems.

STUDY DESIGN

This is a cross-sectional study.

METHOD

The study group consisted of 270 Mar Thoma priests with 1-35 years of professional experience. A self-reported questionnaire was used to collect the data.

RESULTS

Mar Thoma priests were found to have higher career (47.8%) and year prevalence (25.2%) of voice problems with 17.8% of them reporting frequent voice problems during their career. Asthma, allergy and frequent throat clearing behavior were found to have significant association with priests reporting frequent voice problems. Significantly higher number of priests with frequent voice problems missed their work.

CONCLUSION

The study results provide valuable preliminary information regarding the prevalence voice problems and associated risk factors in Mar Thoma priests. However, further investigations are required for in-depth understanding of the types of voice problems these priests experience and their impact on their quality of life.

Treatment Outcomes for Professional Voice Users

Professional voice users comprise 25% to 35% of the U.S. working population. Their voice problems may interfere with job performance and impact costs for both employers and employees. The purpose of this study was to examine treatment outcomes of two specific rehabilitation programs for a group of professional voice users. Eighteen professional voice users participated in this study; half had complaints of throat pain or vocal fatigue (Dysphonia Group), and half were found to have benign vocal fold lesions (Lesion Group). One group received 5 weeks of expiratory muscle strength training followed by six sessions of traditional voice therapy. Treatment order was reversed for the second group. The study was designed as a repeated measures study with independent variables of treatment order, laryngeal diagnosis (lesion vs non-lesion), gender, and time. Dependent variables included maximum expiratory pressure (MEP), Voice Handicap Index (VHI) score, Vocal Rating Scale (VRS) score, Voice Effort Scale score, phonetogram measures, subglottal pressures, and acoustic and perceptual measures. Results showed significant improvements in MEP, VHI scores, and VRS scores, subglottal pressure for loud intensity, phonetogram area, and dynamic range. No significant difference was found between laryngeal diagnosis groups. A significant difference was not observed for treatment order. It was concluded that the combined treatment was responsible for the improvements observed. The results indicate that a combined modality treatment may be successful in the remediation of vocal problems for professional voice users.

Perfil dos profissionais da voz com queixas vocais atendidos em um centro terciário de saúde

As laringopatias relacionadas ao trabalho acarretam conseqüências para os profissionais da voz. OBJETIVO: Analisar o perfil destes profissionais atendidos em um hospital terciário. FORMA DE ESTUDO: Estudo de coorte histórica longitudinal. MATERIAL E MÉTODOS: Análise retrospectiva de prontuários. Os diagnósticos foram fornecidos através de videoestrobolaringoscopia. RESULTADOS: Foram atendidos 163 pacientes (119 do sexo feminino, 44 do sexo masculino), idade média de 36,5 anos. Em relação aos grupos profissionais, encontramos profissionais da voz falada (vendedores, professores, telemarketing, recepcionistas, atores e profissionais de saúde) e da voz cantada. Os diagnósticos foram: alteração estrutural mínima (33%), nódulos (22%), edema de Reinke (10%) e pólipos (6%). Foi observada correlação com tabagismo (p=0,002), sexo (p=0,004) e idade (p<0,001), com tendência para associação do tabagismo com edema de Reinke e leucoplasia; sexo feminino com AEM, nódulos e edema de Reinke; pacientes acima de 40 anos com edema de Reinke, e dos mais jovens com nódulos, cordite e AEM. O tempo de queixa foi superior a 6 meses em 74% dos casos. CONCLUSÃO: Este perfil inclui profissionais da voz falada e cantada. Houve predomínio das AEMs, seguida por nódulos, edema de Reinke e pólipos.

Profile of Voice Professionals Seen in a Tertiary Health Center

Summary

Work-related laryngopathy may have negative consequences for voice professionals.

Aim

To analyze the profile of voice professionals seen in a tertiary level hospital.

Study design

a longitudinal historical cohort.

Methods

A retrospective analysis of patient files. Diagnosis was reached using videostroboscopy.

Results

163 patients (119 females and 44 males) were seen. The mean age was 36.5 years. Professionals included spoken voice users (salesman, teachers, telemarketers, receptionists, health professionals) and singers. The most frequent diagnoses were: minor structural changes (33%), nodules (22%), Reinke's edema (10%), and polyps (6%). A correlation was observed between smoking, age and gender; there was an association between smoking and Reinke's edema, leucoplasia and tabagism, females and Reinke's edema, nodules and minor structural changes, and also between patients aged over 40 years and Reinke's edema, and patients under 40 with nodules, laryngitis, and minor structural changes. Symptoms lasted more than 6 months in 74% of patients.

Conclusion

The profile of voice professionals seen in a tertiary hospital included spoken voice patients and singers. In our study minor structural changes predominated, followed by nodules, Reinke edema and polyps.

Voice Care Knowledge Among Clinicians and People With Healthy Voices or Dysphonia

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.

Current and Emerging Concepts in Muscle Tension Dysphonia: A 30-Month Review

The modern theory of hoarseness is that there are multifactorial etiologies contributing to the voice problem. The hypothesis of this study is that muscle tension dysphonia is multifactorial with various contributing etiologies.

METHODS

This project is a retrospective chart review of all patients seen in the Voice Speech and Language Service and Swallowing Center at our institution with a diagnosis of muscle tension (functional hypertensive) dysphonia over a 30-month period. A literature search and review is also performed regarding current and emerging concepts of muscle tension dysphonia.

RESULTS

One hundred fifty subjects were identified (60% female, 40% male, with a mean age of 42.3 years). Significant factors in patient history believed to contribute to abnormal voice production were gastroesophageal reflux in 49%, high stress levels in 18%, excessive amounts of voice use in 63%, and excessive loudness demands on voice use in 23%. Otolaryngologic evaluation was performed in 82% of patients, in whom lesions, significant vocal fold edema, or paralysis/paresis was identified in 52.3%. Speech pathology assessment revealed poor breath support, inappropriately low pitch, and visible cervical neck tension in the majority of patients. Inappropriate intensity was observed in 23.3% of patients. This set of multiple contributing factors is discussed in the context of current and emerging understanding of muscle tension dysphonia.

CONCLUSIONS

Results confirm multifactorial etiologies contributing to hoarseness in the patients identified with muscle tension dysphonia. An interdisciplinary approach to treating all contributing factors portends the best prognosis.

VoiSS: a patient-derived Voice Symptom Scale

OBJECTIVE

Many voice-rating tools are either physician-derived, disease-specific measures or they merely combine general quality-of-life domains with vocal symptoms. The aim of this series of studies was to devise and validate a patient-derived inventory of voice symptoms for use as a sensitive assessment tool of (i) baseline pathology and (ii) response to change in adult dysphonia clinics.

METHOD

Three stages in the development of the instrument are described. First, an initial exploratory, open-ended questionnaire study was used to compile a prototype list of voice complaints [Clin Otolaryngol 22 (1997) 37]. Second, the prototype list was administered to 168 subjects with dysphonia and underwent principal components analysis. Qualitatively, it was also assessed at this stage for its ability to capture voice-related impairment, disability and handicap. Third, a modified 44-item scale was administered to 180 new subjects.

RESULTS

The symptoms were highly endorsed. Principal components analysis with oblique rotation yielded a Voice Symptom Scale (VoiSS); 43 of the items comprise a 'general voice pathology' scale. More specifically, five oblique components provided assessments of: 'communication problems,' 'throat infections,' 'psychosocial distress,' 'voice sound and variability' and 'phlegm.'

CONCLUSION

The VoiSS is simple for patients to complete and easy to score. It is sensitive enough to reflect the wide range of communication, physical symptoms and emotional responses implicit in adult dysphonia.