1
|
Kemfack AM, Hernandez-Morato I, Moayedi Y, Pitman MJ. Transcriptome Analysis of Left Versus Right Intrinsic Laryngeal Muscles Associated with Innervation. Laryngoscope 2024. [PMID: 38721727 DOI: 10.1002/lary.31487] [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: 09/14/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function. STUDY DESIGN Laboratory experiment. METHODS RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing, 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions. RESULTS A total of 774 differentially expressed genes were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control. CONCLUSION Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
Collapse
Affiliation(s)
- Angela M Kemfack
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Ignacio Hernandez-Morato
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Yalda Moayedi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, U.S.A
- Pain Research Center, New York University College of Dentistry, New York University, New York, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| |
Collapse
|
2
|
Ramírez-Ruiz RD, Quintillá M, Sandoval M, León L, Costa JM, Quer M. Current opinion on laryngeal electromyography. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:148-154. [PMID: 37913988 DOI: 10.1016/j.otoeng.2023.07.001] [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: 12/06/2022] [Accepted: 07/03/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.
Collapse
Affiliation(s)
| | - Mariam Quintillá
- Department of Neurology, Hospital Moisès Broggi de Sant Joan Despí, Barcelona, Spain
| | - Marta Sandoval
- Department of Otolaryngology, Hospital Clínico, Barcelona, Spain
| | - Lucía León
- Department of Neurology, Hospital Moisès Broggi de Sant Joan Despí, Barcelona, Spain
| | | | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
3
|
Kapoor Nerurkar N, Goyal S. Utility of maximum phonation time in the diagnosis of spasmodic dysphonia (laryngeal dystonia). J Laryngol Otol 2024:1-5. [PMID: 38606430 DOI: 10.1017/s0022215124000574] [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: 04/13/2024]
Abstract
OBJECTIVES Maximum phonation time is a simple test used to assess glottic competency. Our objective was to evaluate any correlation between maximum phonation time and spasmodic dysphonia as adductor spasmodic dysphonia and abductor spasmodic dysphonia have an adductor and abductor overdrive, respectively. METHODS A 3-year data-review was performed for patients diagnosed with adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia. Maximum phonation time was noted on the first visit and compared with a control group. RESULTS Average maximum phonation time in adductor spasmodic dysphonia, abductor spasmodic dysphonia and control group was 25 seconds, 9 seconds and 16 seconds. A significant difference was found for adductor spasmodic dysphonia and abductor spasmodic dysphonia. A receiver operating characteristic curve analysis between adductor spasmodic dysphonia and control groups showed a positive predictive value of 81.3 per cent, negative predictive value of 83.9 per cent, sensitivity of 79.6 per cent and specificity of 85.2 per cent. Level of evidence = 4. CONCLUSION We recommend that maximum phonation time be added to the diagnostic armamentarium of spasmodic dysphonia. This correlation between maximum phonation time and spasmodic dysphonia has not been previously published.
Collapse
Affiliation(s)
- Nupur Kapoor Nerurkar
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, Mumbai400020, India
| | - Sakshi Goyal
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, Mumbai400020, India
| |
Collapse
|
4
|
Hage SR. Breathing control of vocalization. Science 2024; 383:1059-1060. [PMID: 38452093 DOI: 10.1126/science.ado2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
A crucial brainstem circuit for vocal-respiratory coordination of the larynx is revealed.
Collapse
Affiliation(s)
- Steffen R Hage
- Neurobiology of Social Communication, Department of Otolaryngology-Head and Neck Surgery, Hearing Research Centre, University of Tübingen, Medical Center, Tübingen, Germany
- Werner Reichardt Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| |
Collapse
|
5
|
Park J, Choi S, Takatoh J, Zhao S, Harrahill A, Han BX, Wang F. Brainstem control of vocalization and its coordination with respiration. Science 2024; 383:eadi8081. [PMID: 38452069 PMCID: PMC11223444 DOI: 10.1126/science.adi8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
Phonation critically depends on precise controls of laryngeal muscles in coordination with ongoing respiration. However, the neural mechanisms governing these processes remain unclear. We identified excitatory vocalization-specific laryngeal premotor neurons located in the retroambiguus nucleus (RAmVOC) in adult mice as being both necessary and sufficient for driving vocal cord closure and eliciting mouse ultrasonic vocalizations (USVs). The duration of RAmVOC activation can determine the lengths of both USV syllables and concurrent expiration periods, with the impact of RAmVOC activation depending on respiration phases. RAmVOC neurons receive inhibition from the preBötzinger complex, and inspiration needs override RAmVOC-mediated vocal cord closure. Ablating inhibitory synapses in RAmVOC neurons compromised this inspiration gating of laryngeal adduction, resulting in discoordination of vocalization with respiration. Our study reveals the circuits for vocal production and vocal-respiratory coordination.
Collapse
Affiliation(s)
- Jaehong Park
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Seonmi Choi
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jun Takatoh
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shengli Zhao
- Department of Neurobiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Andrew Harrahill
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Bao-Xia Han
- Department of Neurobiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Fan Wang
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| |
Collapse
|
6
|
Eugenia Castro M, Timmons Sund L, Zubiaur Gomar FM, Wilson ML, Hapner ER. Reliability of Phonemically Loaded Sentences in Spanish for Identifying Laryngeal Dystonia by Non-Spanish Speaking Speech-Language Pathologists. J Voice 2023:S0892-1997(23)00360-0. [PMID: 38036378 DOI: 10.1016/j.jvoice.2023.11.001] [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: 07/16/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Laryngeal dystonia (LD) is a focal dystonia affecting the intrinsic laryngeal muscles. Clinical diagnosis requires subjective evaluation by experienced clinicians and is primarily based on auditory-perceptual assessment. Several speech tasks are widely accepted to elicit diagnosis specific auditory-perceptual symptoms of glottal stops in adductor LD or breathy breaks in abductor LD in spoken English. With the growing Spanish speaking population in the US and lack of Spanish speech tasks to assist in identifying LD in Spanish speaking subjects, assessing the reliability of phonemically loaded sentences in Spanish for use by non-Spanish speaking providers is critical. The first aim of this study was to develop and assess the reliability of a set of Spanish language phonemically loaded sentences designed to elicit signs and symptoms of LD. The second aim was to determine the effectiveness of non-Spanish speaking speech-language pathologists (SLPs) in identifying LD in Spanish speaking subjects using these stimuli. METHODS Phonemically loaded sentences were developed for this study following current guidelines for assessment of LD. Voice samples were obtained from native Spanish speaking individuals. Participant-speakers included 20 people with LD and 20 people without LD who served as controls. All participant-speakers were assessed by a Spanish-speaking laryngologist. Audio samples were presented to non-Spanish speaking SLPs with expertise in working with people with LD who served as raters and classified the samples as either presence or absence of LD. Kappa and the intra-class correlation coefficient were calculated and mixed effects logistic regression was used for prediction. RESULTS The inter and intra-rater reliability indicated statistically significant agreement. Sensitivity, specificity, and predictive values for the diagnosis of LD by the raters were overall strong. CONCLUSIONS Findings demonstrate that non-Spanish speaking SLPs with expertise in the assessment and treatment of LD can reliably identify the presence of LD using Spanish language stimuli in Spanish-speaking individuals. This study supports the use of newly developed Spanish language phonemically loaded voiced and voiceless sentences by English speaking clinicians as an effective tool for identifying LD in Spanish speakers, perhaps mitigating diagnostic delays experienced by patients with LD.
Collapse
Affiliation(s)
- M Eugenia Castro
- USC Voice Center, Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California; Department of Communication Disorders, California State University Los Angeles, Los Angeles, California
| | - Lauren Timmons Sund
- USC Voice Center, Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Fermin M Zubiaur Gomar
- Escuela de Medicina, Universidad Panamericana, Clínica de la Voz, Ciudad de México, Mexico
| | - Melissa L Wilson
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California
| | - Edie R Hapner
- UAB Voice Center, Department of Otolaryngology, University of Alabama, Birmingham, Alabama.
| |
Collapse
|
7
|
Yousef AM, Deliyski DD, Zayernouri M, Zacharias SRC, Naghibolhosseini M. Deep Learning-Based Analysis of Glottal Attack and Offset Times in Adductor Laryngeal Dystonia. J Voice 2023:S0892-1997(23)00319-3. [PMID: 37977969 PMCID: PMC11093885 DOI: 10.1016/j.jvoice.2023.10.011] [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: 07/21/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Diagnosis of adductor laryngeal dystonia (AdLD) is challenging as it mimics voice features of other voice disorders. This could lead to misdiagnosis (or delayed diagnosis) and ineffective treatments of AdLD. This paper develops automated measurements of glottal attack time (GAT) and glottal offset time (GOT) from high-speed videoendoscopy (HSV) in connected speech as objective measures that can potentially facilitate the diagnosis of this disorder in the future. METHODS HSV data were recorded from vocally normal adults and patients with AdLD during the reading of the "Rainbow Passage" and six CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) sentences. A deep learning framework was designed and trained to segment the glottal area and detect the vocal fold edges in the HSV dataset. This automated framework allowed us to automatically measure and quantify the GATs and GOTs for the participants. Accordingly, a comparison was held between the obtained measurements among vocally normal speakers and those with AdLD. RESULTS The automated framework was successfully developed and able to accurately segment the glottal area/edges. The precise automated measurements of GAT and GOT revealed minor, nonsignificant differences compared to the results of manual analysis-showing a strong correlation between the measures by the automated and manual methods. The results showed significant differences in the GAT values between the vocally normal subjects and AdLD patients, with larger variability in both the GAT and GOT measures in the AdLD group. CONCLUSIONS The developed automated approach for GAT and GOT measurement can be valuable in clinical practice. These quantitative measurements can be used as meaningful biomarkers of the impaired vocal function in AdLD and help its differential diagnosis in the future.
Collapse
Affiliation(s)
- Ahmed M Yousef
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Dimitar D Deliyski
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Mohsen Zayernouri
- Departments of Mechanical Engineering & Statistics and Probability, Michigan State University, East Lansing, Michigan
| | - Stephanie R C Zacharias
- Head and Neck Regenerative Medicine Program, Mayo Clinic, Scottsdale, Arizona; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Maryam Naghibolhosseini
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan.
| |
Collapse
|
8
|
Park J, Choi S, Takatoh J, Zhao S, Harrahill A, Han BX, Wang F. Brainstem premotor mechanisms underlying vocal production and vocal-respiratory coordination. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.12.562111. [PMID: 37873071 PMCID: PMC10592834 DOI: 10.1101/2023.10.12.562111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Speech generation critically depends on precise controls of laryngeal muscles and coordination with ongoing respiratory activity. However, the neural mechanisms governing these processes remain unknown. Here, we mapped laryngeal premotor circuitry in adult mice and viral-genetically identified excitatory vocal premotor neurons located in the retroambiguus nucleus (RAm VOC ) as both necessary and sufficient for driving vocal-cord closure and eliciting mouse ultrasonic vocalizations (USVs). The duration of RAm VOC activation determines the lengths of USV syllables and post-inspiration phases. RAm VOC -neurons receive inhibitory inputs from the preBötzinger complex, and inspiration needs can override RAm VOC -mediated vocal-cord closure. Ablating inhibitory synapses in RAm VOC -neurons compromised this inspiration gating of laryngeal adduction, resulting in de-coupling of vocalization and respiration. Our study revealed the hitherto unknown circuits for vocal pattern generation and vocal-respiratory coupling. One-Sentence Summary Identification of RAm VOC neurons as the critical node for vocal pattern generation and vocal-respiratory coupling.
Collapse
|
9
|
Xu X, Saleh E, Lacke MR, Jiang JJ, Zhuang P. Vocal Vibration Opening Onset Position Abnormality in Patients With Adductor Spasmodic Dystonia by Using High-Speed Endoscopy. J Voice 2023:S0892-1997(23)00257-6. [PMID: 37730489 DOI: 10.1016/j.jvoice.2023.08.015] [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: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To analyze vocal fold vibration onset in patients with adductor laryngeal dystonia (ADLD) by analyzing vocal vibration opening onset position (VVOOP). STUDY DESIGN Case-control study SETTING: A voice center. METHODS Eleven patients with ADLD diagnosed in our voice center were enrolled in the ADLD group. Eleven healthy subjects matched by exact age and gender to the ADLD patients were selected as the control group. All subjects underwent laryngeal high-speed video endoscopy. VVOOP and its change were assessed by two otolaryngologists. The multiline video kymography was used to analyze the open quotient (OQ) and standard deviation of OQ. RESULTS VVOOP had more than one position in 54.6% (6/11) of the patients with ADLD, which was higher than the control group (P < 0.05). VVOOP appeared in the front of the vocal fold in 54.6% (6/11) of patients with ADLD and in the back of the vocal fold in 81.8% (9/11) of patients with ADLD. VVOOP can be abnormal in 90.9% (10/11) of patients with ADLD, and the rate of VVOOP abnormality was higher than that of the control group (P < 0.05). Of 11, 6 (54.6%) patients with ADLD had a variable VVOOP; the variability rate of VVOOP was higher than that in the control group (P < 0.05). OQ and OQ standard deviation in the ADLD group were significantly greater than in the control group (P < 0.05). CONCLUSIONS In patients with ADLD, vocal fold vibration was irregular, and VVOOP was abnormal and had a variable position and could reflect variability of the vocal vibration. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Xinlin Xu
- Department of Voice Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Key Laboratory of Voice of Xiamen City, Xiamen, Fujian, China
| | - Eyad Saleh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Margaret Rose Lacke
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Peiyun Zhuang
- Department of Voice Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Key Laboratory of Voice of Xiamen City, Xiamen, Fujian, China.
| |
Collapse
|
10
|
Lester-Smith RA, Miller CH, Cherney LR. Behavioral Therapy for Tremor or Dystonia Affecting Voice in Speakers with Hyperkinetic Dysarthria: A Systematic Review. J Voice 2023; 37:561-573. [PMID: 34112549 DOI: 10.1016/j.jvoice.2021.03.026] [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: 01/20/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hyperkinetic dysarthria is characterized by atypical involuntary movements within the speech mechanism that may affect the respiratory, laryngeal, pharyngeal-oral, or velopharyngeal-nasal subsystems and may alter speech production. Although articulatory impairments are commonly considered in hyperkinetic dysarthria, speakers with hyperkinetic dysarthria may also present with changes in voice quality, pitch, and loudness. In approximately 70% of speakers with hyperkinetic dysarthria, these voice alterations are associated with tremor or dystonia. The purpose of this systematic review was to investigate the association between behavioral therapy for tremor or dystonia affecting voice in speakers with hyperkinetic dysarthria and improvement in the functional, perceptual, acoustical, aerodynamic, or endoscopic characteristics of voice. METHOD MEDLINE (PubMed), Embase, PsycINFO, and ClinicalTrials.gov online databases were searched in August 2017, December 2018, and April 2020 for relevant studies. The searches provided 4,921 unique records, and six additional unique records were added from other sources. Twelve studies met the criteria for inclusion in the systematic review. Participants who received concurrent medical treatment were included in this review to ensure that the search was inclusive of all relevant studies and informative for typical clinical scenarios. RESULTS The most commonly administered treatment ingredient was relaxation training, which was investigated in three of the four studies on tremor and three of the eight studies on dystonia. Of these six studies, only one used an experimental design and administered relaxation training as the only behavioral approach. This single-case experiment reported a significant reduction in participant ratings of tremor severity and interference with activities of daily living, although the speaking subscale reportedly did not improve and oral medications were administered concurrently. In two group studies that tested potential behavioral therapy targets, production of a low pitch improved acoustical measures for participants with essential tremor and improved auditory-perceptual judgments for participants with laryngeal dystonia. Behavioral therapy improved functional, acoustical, and aerodynamic outcomes in participants with laryngeal dystonia who were also receiving botulinum toxin injections in a randomized cross-over study and a non-randomized controlled study. Because one study employed easy onset and breathing exercises, while the other employed loud voice exercises, the mechanism of action for improvement in voice associated with behavioral therapy requires further investigation. CONCLUSION This systematic review describes the current evidence for treatment of tremor and dystonia affecting voice in speakers with hyperkinetic dysarthria and highlights the need for future research on behavioral therapy for these disorders.
Collapse
Affiliation(s)
- Rosemary A Lester-Smith
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois.
| | - Corinne H Miller
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leora R Cherney
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois
| |
Collapse
|
11
|
Fujiki RB, Croegaert-Koch CK, Thibeault SL. Videostroboscopy Versus High-Speed Videoendoscopy: Factors Influencing Ratings of Laryngeal Oscillation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1496-1510. [PMID: 37040690 PMCID: PMC10457078 DOI: 10.1044/2023_jslhr-22-00649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The purpose of this study was to determine whether patient voice-related diagnosis, severity of dysphonia, and rater's experience influence the relationship between laryngeal oscillation ratings made from videostroboscopic and high-speed videoendoscopic (HSV) exams. METHOD Stroboscopy and HSV exams from 15 patients with adductor spasmodic dysphonia (ADSD) and 15 with benign vocal fold lesions were rated for laryngeal oscillation and closure by 10 licensed speech-language pathologists (SLPs). Raters were divided into low- (< 5 years) and high-experience (> 5 years) groups. Ratings of vocal fold amplitude, mucosal wave, periodicity, phase symmetry, nonvibrating portion of the vocal fold, and glottal closure were examined using an online form adapted from the Voice Vibratory Assessment of Laryngeal Imaging (VALI). RESULTS Stroboscopy and HSV ratings were more strongly positively correlated for patients with benign vocal fold lesions (r between .43 and .75) than for those with ADSD (r between .40 and .68). Differences between stroboscopy and HSV exams were significantly greater for ratings of amplitude, mucosal wave, and periodicity in patients with ADSD than for patients with benign vocal fold lesions. Raters with < 5 years of experience showed significantly greater differences between stroboscopy and HSV ratings of amplitude and nonvibrating portion of the vocal fold for patients with ADSD only. Significantly greater differences between ratings of periodicity and phase symmetry were observed in patients with more severe dysphonia. CONCLUSIONS Differences in laryngeal ratings made between HSV and stroboscopy exams may be influenced by patient diagnosis, severity of dysphonia, and rater experience. Future study is warranted to determine how the differences observed influence clinical diagnosis and outcomes.
Collapse
|
12
|
Weismer G. Oromotor Nonverbal Performance and Speech Motor Control: Theory and Review of Empirical Evidence. Brain Sci 2023; 13:brainsci13050768. [PMID: 37239240 DOI: 10.3390/brainsci13050768] [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: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
This position paper offers a perspective on the long-standing debate concerning the role of oromotor, nonverbal gestures in understanding typical and disordered speech motor control secondary to neurological disease. Oromotor nonverbal tasks are employed routinely in clinical and research settings, but a coherent rationale for their use is needed. The use of oromotor nonverbal performance to diagnose disease or dysarthria type, versus specific aspects of speech production deficits that contribute to loss of speech intelligibility, is argued to be an important part of the debate. Framing these issues are two models of speech motor control, the Integrative Model (IM) and Task-Dependent Model (TDM), which yield contrasting predictions of the relationship between oromotor nonverbal performance and speech motor control. Theoretical and empirical literature on task specificity in limb, hand, and eye motor control is reviewed to demonstrate its relevance to speech motor control. The IM rejects task specificity in speech motor control, whereas the TDM is defined by it. The theoretical claim of the IM proponents that the TDM requires a special, dedicated neural mechanism for speech production is rejected. Based on theoretical and empirical information, the utility of oromotor nonverbal tasks as a window into speech motor control is questionable.
Collapse
Affiliation(s)
- Gary Weismer
- Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, WI 53706, USA
| |
Collapse
|
13
|
Dwyer CD, Gochman GE, Rosen CA, Young VN, Schneider SL. Comparison of Outcome Measures (Subjective, Objective, and Patient-Based) in Laryngeal Dystonia Treatment With Botulinum Toxin A Injection. J Voice 2023:S0892-1997(23)00122-4. [PMID: 37121839 DOI: 10.1016/j.jvoice.2023.03.019] [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: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Outcome assessment in laryngeal dystonia is hindered by lack of consensus on a core set of outcome measures to quantify treatment effect and disease severity on quality of life. Potential outcome measure domains include objective voice, clinician reported, and patient reported outcome measures (PROMs) for determining treatment success and longitudinal disease tracking. We aim to determine correlations between a selections of outcome measure tools following Botulinum toxin injection. METHODS A selection of instruments were administered to assess adductor laryngeal dystonia patient outcomes before and after Botulinum toxin injection. Voice samples recorded using a cellular telephone application were used for objective acoustic measures (CPPS, acoustic voice quality index) and speech language pathologist perceptual analysis (CAPE-V). Additionally, patients completed a PROMs battery consisting of the Voice Handicap Index-10, Communicative Participation Item Bank-10, OMNI-Vocal Effort Scale, 3 visual analog scale (VAS) questions. Changes in these outcome measures pre-post treatment were compared between each other and with a global rating of change questionnaire (GRCQ) using Spearman's rank correlation coefficients. RESULTS Twenty six patients (20 female, mean age 57.7 years) participated. Using an anchor based GRCQ, patients reported Botox efficacy was the only outcome measure found to have significant correlation (r = 0.54, P = 0.022); all other outcome measures did not meet statistically significant correlation. Amongst the selected outcome tools, several moderate-strong correlations were identified, largely for outcome measures within the same domain. Most notable were correlations between the patient reported OMNI-VES and VAS questions (r > 0.68, P < 0.05), clinician CAPE-V strain and overall severity (r = 0.900, P < 0.001), and acoustic voice quality index with sustained vowel CPPs (r = -0.797, P = 0.002). CONCLUSION Correlation between outcome measures instruments used for patients with adductor laryngeal dystonia requires further attention. Weak correlations with an anchor based GRCQ were found for this study's selected outcome instruments. A select number of correlations were found between outcome instruments within each of the individual outcome measure domains (patient perception, clinical perception, objective acoustics), but there was largely a lack of correlation found for instruments between these three separate domains.
Collapse
Affiliation(s)
- Christopher D Dwyer
- Division of Otolaryngology, Department of Surgery, Harvard University, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| |
Collapse
|
14
|
Calà F, Frassineti L, Manfredi C, Dejonckere P, Messina F, Barbieri S, Pignataro L, Cantarella G. Machine Learning Assessment of Spasmodic Dysphonia Based on Acoustical and Perceptual Parameters. Bioengineering (Basel) 2023; 10:bioengineering10040426. [PMID: 37106612 PMCID: PMC10135969 DOI: 10.3390/bioengineering10040426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Adductor spasmodic dysphonia is a type of adult-onset focal dystonia characterized by involuntary spasms of laryngeal muscles. This paper applied machine learning techniques for the severity assessment of spasmodic dysphonia. To this aim, 7 perceptual indices and 48 acoustical parameters were estimated from the Italian word /a’jwɔle/ emitted by 28 female patients, manually segmented from a standardized sentence and used as features in two classification experiments. Subjects were divided into three severity classes (mild, moderate, severe) on the basis of the G (grade) score of the GRB scale. The first aim was that of finding relationships between perceptual and objective measures with the Local Interpretable Model-Agnostic Explanations method. Then, the development of a diagnostic tool for adductor spasmodic dysphonia severity assessment was investigated. Reliable relationships between G; R (Roughness); B (Breathiness); Spasmodicity; and the acoustical parameters: voiced percentage, F2 median, and F1 median were found. After data scaling, Bayesian hyperparameter optimization, and leave-one-out cross-validation, a k-nearest neighbors model provided 89% accuracy in distinguishing patients among the three severity classes. The proposed methods highlighted the best acoustical parameters that could be used jointly with GRB indices to support the perceptual evaluation of spasmodic dysphonia and provide a tool to help severity assessment of spasmodic dysphonia.
Collapse
|
15
|
Naghibolhosseini M, Zacharias SRC, Zenas S, Levesque F, Deliyski DD. Laryngeal Imaging Study of Glottal Attack/Offset Time in Adductor Spasmodic Dysphonia during Connected Speech. APPLIED SCIENCES (BASEL, SWITZERLAND) 2023; 13:2979. [PMID: 37034315 PMCID: PMC10077958 DOI: 10.3390/app13052979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Adductor spasmodic dysphonia (AdSD) disrupts laryngeal muscle control during speech and, therefore, affects the onset and offset of phonation. In this study, the goal is to use laryngeal high-speed videoendoscopy (HSV) to measure the glottal attack time (GAT) and glottal offset time (GOT) during connected speech for normophonic (vocally normal) and AdSD voices. A monochrome HSV system was used to record readings of six CAPE-V sentences and part of the "Rainbow Passage" from the participants. Three raters visually analyzed the HSV data using a playback software to measure the GAT and GOT. The results show that the GAT was greater in the AdSD group than in the normophonic group; however, the clinical significance of the amount of this difference needs to be studied further. More variability was observed in both GATs and GOTs of the disorder group. Additionally, the GAT and GOT time series were found to be nonstationary for the AdSD group while they were stationary for the normophonic voices. This study shows that the GAT and GOT measures can be potentially used as objective markers to characterize AdSD. The findings will potentially help in the development of standardized measures for voice evaluation and the accurate diagnosis of AdSD.
Collapse
Affiliation(s)
- Maryam Naghibolhosseini
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
| | - Stephanie R. C. Zacharias
- Head and Neck Regenerative Medicine Program, Mayo Clinic, Scottsdale, AZ 85259, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Sarah Zenas
- Lyman Briggs College, Michigan State University, East Lansing, MI 48825, USA
| | - Farrah Levesque
- Warrington College of Business, University of Florida, Gainesville, FL 32611, USA
| | - Dimitar D. Deliyski
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI 48824, USA
| |
Collapse
|
16
|
Vanderaa V, Vinney LA. Laryngeal Sensory Symptoms in Spasmodic Dysphonia. J Voice 2023; 37:302.e1-302.e12. [PMID: 33485747 DOI: 10.1016/j.jvoice.2020.12.047] [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: 09/08/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this research was to determine whether an association between laryngeal hypersensitivity (LH) and spasmodic dysphonia (SD) exists using the LH Questionnaire (LHQ). This study also explored the prevalence of self-reported upper respiratory infection (URI) at the time of SD onset across SD phenotypes. METHODS Individuals with and without SD were recruited to complete an online survey measure. All respondents provided demographic information and completed the LHQ. Participants with SD were also asked to provide information about their diagnosed SD subtype and pattern of onset, including whether onset was associated with a URI. The percentage of respondents with and without SD who were classified with LH was determined based on the LHQ. Scores on the LHQ were also compared between the non-SD and the SD groups, as well as between SD phenotypes (adductor SD, abductor SD, and mixed)). RESULTS AND CONCLUSIONS Significant associations were found between ADSD and LH, mixed SD and LH, and URI at time of SD onset and increased severity of LH symptoms. These findings suggest that laryngeal sensory symptoms may potentially contribute to or result from motor spasms in SD and/or have implications for its pathophysiology.
Collapse
Affiliation(s)
| | - Lisa A Vinney
- Department of Communication Sciences and Disorders, Illinois State University, Normal, Illinois.
| |
Collapse
|
17
|
Yeung W, Richards AL, Novakovic D. Botulinum Neurotoxin Therapy in the Clinical Management of Laryngeal Dystonia. Toxins (Basel) 2022; 14:toxins14120844. [PMID: 36548741 PMCID: PMC9784062 DOI: 10.3390/toxins14120844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a chronic, task-specific, focal movement disorder affecting the larynx. It interferes primarily with the essential functions of phonation and speech. LD affects patients' ability to communicate effectively and significantly diminishes their quality of life. Botulinum neurotoxin was first used as a therapeutic agent in the treatment of LD four decades ago and remains the standard of care for the treatment of LD. This article provides an overview of the clinical application of botulinum neurotoxin in the management of LD, focusing on the classification for this disorder, its pathophysiology, clinical assessment and diagnosis, the role of laryngeal electromyography and a summary of therapeutic injection techniques, including a comprehensive description of various procedural approaches, recommendations for injection sites and dosage considerations.
Collapse
Affiliation(s)
- Winnie Yeung
- Voice Research Laboratory, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Otolaryngology, The Canterbury Hospital, Campsie, NSW 2194, Australia
- Correspondence:
| | - Amanda L. Richards
- Department of Otolaryngology, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Daniel Novakovic
- Voice Research Laboratory, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Otolaryngology, The Canterbury Hospital, Campsie, NSW 2194, Australia
| |
Collapse
|
18
|
Spasmodische Dysphonie vom Adduktortyp. Laryngorhinootologie 2022; 101:704-705. [PMID: 36041446 DOI: 10.1055/a-1293-1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
19
|
Patel RR, Zauber SE, Yadav AP, Witt TC, Halum S, Gupta K. Globus Pallidus Interna and Ventral Intermediate Nucleus of the Thalamus Deep Brain Stimulation for Adductor Laryngeal Dystonia: a Case Report of Blinded Analyses of Objective Voice Outcomes in 2 Patients. Neurosurgery 2022; 90:457-463. [PMID: 35138294 DOI: 10.1227/neu.0000000000001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adductor laryngeal dystonia (ADLD) is a substantially debilitating focal progressive neurological voice disorder. Current standard of care is symptomatic treatment with repeated injections of botulinum toxin into specific intrinsic laryngeal muscles with extremely variable and temporary benefits. We report the use of bilateral deep brain stimulation (DBS) of globus pallidus (GPi) for long-term improvement of ADLD voice symptoms. OBJECTIVE To investigate the effects of bilateral DBS of the GPi and ventral intermediate nucleus (VIM) of the thalamus on vocal function in 2 patients with ADLD associated with voice and hand tremor. METHODS Blinded objective and quantitative analyses of voice were conducted before and after treatment in 2 female patients (70 and 69 years). Paired t-tests were conducted to compare voice measurements pre-GPi and post-GPi and VIM-DBS. A 2-way analysis of variance was conducted to determine the interaction between target (GPi/VIM) and time (pre/post) for each voice measure. RESULTS Although the follow-up period differed between patients, the GPi-DBS implanted patient had notable improvement in vowel voicing (%), extent of tremor intensity (%), and overall speech intelligibility (%), compared with preoperative status. GPi-DBS also resulted in significant improvement in cepstral peak prominence (dB). VIM-DBS resulted in a significantly greater change in the tremor rate (Hz). CONCLUSION Changes in phonatory function provide preliminary support for the use of bilateral GPi-DBS for treatment of ADLD and bilateral VIM-DBS for vocal tremor predominant ADLD. Future studies with larger sample sizes and standardized follow-up periods are needed to better assess the role of DBS for ADLD.
Collapse
Affiliation(s)
- Rita R Patel
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine/Indiana University Bloomington, Indianapolis, Indiana, USA
| | - S Elizabeth Zauber
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amol P Yadav
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas C Witt
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stacey Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine/Indiana University Bloomington, Indianapolis, Indiana, USA
| | - Kunal Gupta
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
20
|
Rapoport SK, Kirke DN. How can we make better decisions about dystonic voice management? Curr Opin Otolaryngol Head Neck Surg 2021; 29:445-450. [PMID: 34670256 DOI: 10.1097/moo.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The optimal diagnosis and management of dystonic voice disorders are rooted in the nuanced understanding of their phenomenology. Distinguishing between subtypes of vocal dystonia is challenging, not only because the audible and physical presentations of these dystonia's can seem similar, but also because there is a lack of scientific consensus regarding the diagnostic criteria for these conditions. To help improve the clinician's acumen we focus on outlining the classification of the top three neurological voice disorders, notably: spasmodic dysphonia, (2) spasmodic dysphonia with tremor, and essential tremor of the voice. We also provide an algorithmic approach based on current evidence-based literature to guide practitioners through the clinical diagnosis and management of each possible etiology. RECENT FINDINGS Much remains unknown about the subtypes of vocal dystonia, and this gap in our knowledge likely limits our ability to advance clinical management. Still, continued experience evaluating and treating these patients yields refined clinical evaluations and decision making. SUMMARY Improvements in our clinical decision-making can be made by acknowledging that our limited understanding of vocal dystonia may hinder what therapeutic interventions we can offer, yet our ability to accurately diagnose the dystonia is central to providing optimal patient management.
Collapse
Affiliation(s)
- Sarah K Rapoport
- Department of Otolaryngology Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Diana N Kirke
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
21
|
Kang MS, Lee SJ, Choi HS, Lim JY. Factors influencing long-term treatment response to botulinum toxin injection for spasmodic dysphonia. Clin Otolaryngol 2020; 46:436-444. [PMID: 33260261 DOI: 10.1111/coa.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/09/2019] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the outcomes of long-term botulinum toxin type A (BoNTA) treatment for adductor spasmodic dysphonia (AdSD) and to determine the factors predictive of treatment response by investigating dose stability and average intervals. DESIGN Retrospective cohort study. SETTING Academic tertiary medical centre. EXPOSURES A total of 470 patients with adductor spasmodic dysphonia, who received electromyography-guided BoNTA injections over 12 years, were retrospectively enrolled in this study. MAIN OUTCOMES AND MEASURES The patients' demographic data, baseline voice dynamics and treatment profiles (dose, frequency and intervals) were evaluated. Factors correlating with the dose adjustment ratio (number of increasing dosing/total number of BoNTA toxin injections) and changes in intervals between injections were statistically analysed. RESULTS A total of 122 patients, who received ≥ 4 injections and whose average treatment interval was < 240 days, were finally evaluated. Of them, 115 (94.3%) were female and seven (5.7%) were male, and the mean age at initial treatment was 34.89 ± 13.07 and 41.14 ± 12.71 years, respectively. On average, patients received 18.00 ± 13.33 injections (1.67 ± 0.60 U/injection) to alternating unilateral vocal folds. The treatment period was 65.07 ± 43.28 months and the mean interval between injections was 4.16 ± 1.28 months. The mean dose adjustment ratio among patients who received ≥ 4 injections was 0.15 ± 0.13, and dose changes occurred 4.36 times/patient. The patients' age and gender significantly affected the treatment response, where younger or female patients showed greater dosing variability and shorter intervals between injections. However, the baseline voice dynamics (voice handicap index, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximum phonation time and degree of voice breaks) did not predict the dose adjustment ratio or interval changes. In addition, patients with fluctuating doses showed lower age and higher VHI subscale scores, and patients with short-treatment interval (< 100 days) showed higher SDF0. CONCLUSIONS Almost all patients received stable low doses of BoNTA over time, irrespective of the baseline results. Patients' age, gender and VHI scores were correlated with poor treatment responses, such as frequent dose changes and shorter intervals between injections.
Collapse
Affiliation(s)
- Min Seok Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jin Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong-Shik Choi
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Watson NA, Miller BJ, Siddiqui Z, Karagama Y, Gibbins N. The Therapeutic Use of Botulinum Toxin Injections for Conditions Affecting the Head and Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00305-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Hyperactive sensorimotor cortex during voice perception in spasmodic dysphonia. Sci Rep 2020; 10:17298. [PMID: 33057071 PMCID: PMC7566443 DOI: 10.1038/s41598-020-73450-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Spasmodic dysphonia (SD) is characterized by an involuntary laryngeal muscle spasm during vocalization. Previous studies measured brain activation during voice production and suggested that SD arises from abnormal sensorimotor integration involving the sensorimotor cortex. However, it remains unclear whether this abnormal sensorimotor activation merely reflects neural activation produced by abnormal vocalization. To identify the specific neural correlates of SD, we used a sound discrimination task without overt vocalization to compare neural activation between 11 patients with SD and healthy participants. Participants underwent functional MRI during a two-alternative judgment task for auditory stimuli, which could be modal or falsetto voice. Since vocalization in falsetto is intact in SD, we predicted that neural activation during speech perception would differ between the two groups only for modal voice and not for falsetto voice. Group-by-stimulus interaction was observed in the left sensorimotor cortex and thalamus, suggesting that voice perception activates different neural systems between the two groups. Moreover, the sensorimotor signals positively correlated with disease severity of SD, and classified the two groups with 73% accuracy in linear discriminant analysis. Thus, the sensorimotor cortex and thalamus play a central role in SD pathophysiology and sensorimotor signals can be a new biomarker for SD diagnosis.
Collapse
|
24
|
Lee SJ, Kang MS, Choi HS, Lim JY. Alternating Unilateral Versus Bilateral Injections of Botulinum Toxin for the Treatment of Adductor Spasmodic Dysphonia. Otolaryngol Head Neck Surg 2020; 164:815-820. [PMID: 32957836 DOI: 10.1177/0194599820957608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to compare the long-term efficacy, durability, and dose and interval stability between alternating unilateral and bilateral injections of botulinum neurotoxin type A for the treatment of adductor spasmodic dysphonia. STUDY DESIGN Retrospective cohort study. SETTING Academic tertiary medical center. METHODS A total of 137 patients (105 alternating unilateral and 32 bilateral injections) who were administered ≥5 injections of botulinum neurotoxin type A were included in this study. The mean dosage change, dose adjustment ratio (number of dose increases/total number of injections), and stability of treatment responses were compared between the alternating unilateral and bilateral injection groups. RESULTS Long-term changes in the mean dosages for alternating unilateral (mean ± SD, -0.010 ± 0.048 IU) and bilateral (-0.042 ± 0.142 IU) injections did not differ between groups (P = .225), suggesting that both methods follow a decreasing dosing trend over time. The dose adjustment ratio also did not differ between groups (P = .077), although a longer average treatment interval (P < .001) and duration of hoarse voice (P = .045) were found in the bilateral injection group. The proportion of stable patients who did not increase injection dose and had regular follow-up did not differ between the groups. CONCLUSION Both alternating unilateral and bilateral injection methods showed a long-term decreasing dosing trend, with comparable levels of efficacy, durability, and stability for treating adductor spasmodic dysphonia. Our findings indicate that alternating unilateral injections can be routinely performed with fewer side effects, albeit at shorter treatment intervals, than bilateral injections.
Collapse
Affiliation(s)
- Seung Jin Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Min Seok Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | | | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
25
|
Yiu Y, Baylor CR, Bamer AM, Shelly S, Klein AM, Garrett CG, Pitman MJ. Validation of the Communicative Participation Item Bank as an Outcome Measure for Spasmodic Dysphonia. Laryngoscope 2020; 131:859-864. [PMID: 32710809 DOI: 10.1002/lary.28897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/11/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Current patient-reported outcome measures do not adequately capture the impact of spasmodic dysphonia (SD) on communication in daily life situations. The aim of this study was to validate the Communicative Participation Item Bank (CPIB), which specifically measures a disease's impact on daily conversational situations, as an outcome measure for SD. STUDY DESIGN Multi-institutional prospective cohort study. METHODS A prospective study was conducted with administration of the 46-question CPIB and the Voice Handicap Index-10 (VHI-10) to 190 participants with SD before (time 1) and 6 weeks after (time 2) botulinum toxin injection. Differential item function (DIF) analyses were performed to examine potential item bias. Paired t-tests were used to assess change in each of the CPIB and VHI-10 scores after treatment. Pearson correlations were calculated between the CPIB and VHI-10. RESULTS DIF analyses revealed no clinically meaningful difference between the item parameters generated for this SD sample and the original CPIB calibration sample. There were statistically significant changes between the pre-treatment and post-treatment time points for both the CPIB and VHI-10. Correlations between the CPIB and VHI were moderate-high. CONCLUSIONS The CPIB item bank, General Short Form, and scoring parameters can be used with people with SD for valid and reliable measurement of the impact of communication disorders on communication in everyday life. The CPIB is sensitive to changes with intervention, proving useful for clinical and research purposes to assess the efficacy and effectiveness of interventions. LEVEL OF EVIDENCE Level 2, prospective observational research with an experimental design (ie, cohort study). Laryngoscope, 131:859-864, 2021.
Collapse
Affiliation(s)
- Yin Yiu
- Texas Voice Center, Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Sandeep Shelly
- Emory Voice Center, Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Adam M Klein
- Emory Voice Center, Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology - Head & Neck Surgery, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, U.S.A
| |
Collapse
|
26
|
Schuering JHC, van Hof KS, Heijnen BJ, van Benthem PPG, Sjögren EV, Langeveld APM. Proposal for a Core Outcome Set of Measurement Instruments to Assess Quality of Voice in Adductor Spasmodic Dysphonia Based on a Literature Review. J Voice 2020; 35:933.e7-933.e21. [PMID: 32234360 DOI: 10.1016/j.jvoice.2020.02.010] [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: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Uniform evaluation of treatment effect on the quality of voice in adductor spasmodic dysphonia (AdSD) is challenging due to the broad variety of available outcome measurement instruments (OMIs). The European Laryngological Society categorized five types of measurement domains for voice quality evaluations: patient-reported outcome measures, perceptual analyses, acoustic analyses, visual analyses, and aerodynamic measurements. The aim of this study was to propose a core outcome set (COS) for these domains, enabling systematic assessments of treatment effects on the quality of voice in patients with AdSD. METHODS The PubMed, Embase, and Cochrane databases were searched for eligible studies published before July 2019. The results were systematically analyzed following the protocol of the COnsensus-based Standards for the selection of health Measurement INstruments/Core Outcome Measures in Effectiveness Trials initiative. The proposed COS is based on the prevalence of OMIs, quality of the included studies, criteria for good measurement properties, and correlations to other OMI domains. RESULTS A total of 76 articles were included, with nearly all studies and OMIs found to be of moderate or low quality. The 19 studies that reported on the correlation of OMIs demonstrated conflicting results. Appraising the best available evidence, our proposed COS consisted of patient-reported outcome measures (voice handicap index), perceptual measurements (grade, roughness, breathiness, strain, and voice breaks) and acoustic measurements (voice breaks, voice onset time, aperiodicity, and multiparameter algorithms). CONCLUSION A review of OMIs evaluating treatment effects in AdSD was conducted. Based on this review, a uniform COS was proposed. However, evidence for the selected instruments was limited. Further exploration into the validity and reliability of OMIs for AdSD is recommended.
Collapse
Affiliation(s)
- Juliëtta H C Schuering
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Kira S van Hof
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas J Heijnen
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
27
|
French G, Bosch JD, Randall DR. Retrospective review of dosing trends in botulinum toxin injections for the treatment of adductor spasmodic dysphonia in a long-term cohort. J Otolaryngol Head Neck Surg 2020; 49:4. [PMID: 31937363 PMCID: PMC6961226 DOI: 10.1186/s40463-020-0401-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Botulinum toxin A (BT) is the gold standard treatment for adductor spasmodic dysphonia (AdSD) with established use for greater than thirty years. The spasmodic dysphonia (SD) literature would benefit from additional long-term cohort data, especially in the Canadian population. The goals of this study were to evaluate whether BT dosage required to achieve acceptable voice shifts over time and to elucidate differences in the subgroups of patients receiving unilateral vocal fold (UVF) injections. Methods Patient records were retrospectively reviewed at the regional tertiary Voice Clinic for AdSD patients from 1996 to 2017 to identify AdSD patients treated with serial BT injections. Descriptive statistics, paired t-tests for time between treatments and ANOVA tests were used to evaluate trends in subgroup age. Results One-hundred and twenty-six patients (61% female, mean age = 53 ± 15.5 years) met inclusion criteria and received laryngeal EMG-guided BT injections for up to twenty-two years and as many as 79 treatments. The mean total BT dosage for our population was 1.54 ± 0.35 Units per side. The majority of subjects had decreasing doses over time with a small subgroup having slowly increasing doses. Comparing treatment dosages between unilateral and bilateral injection groups, injection dosage per vocal fold was 1.65 ± 0.62 with time between injections was significantly shorter for the unilateral injection group (mean = 105 days, SD ± 19.8 days, p = 0.005) compared to the bilateral injection subgroup (137 ± 35.7 days, p < 0.005). The mean age of the unilateral injection population as younger at 42.4 ± 11.8 years (p = 0.004). Conclusion The majority of patients in this study had decreasing BT injection dosages over time, with a smaller proportion having slowly increasing doses, thought to be likely relating to disease severity. The unilateral vocal fold injections were well tolerated despite needing more frequent injections, and found to be more prevalent in the younger age group.
Collapse
Affiliation(s)
- Gabrielle French
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, T2W 3K2, Canada
| | - J Douglas Bosch
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, T2W 3K2, Canada
| | - Derrick R Randall
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, T2W 3K2, Canada.
| |
Collapse
|
28
|
Othman S, Daggumati S, Patel R, Ross J, Sataloff RT. Laboratory Evaluation of Spasmodic Dysphonia. J Voice 2019; 34:934-939. [PMID: 31288958 DOI: 10.1016/j.jvoice.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the utility of comprehensive laboratory evaluation in patients with spasmodic dysphonia (SD). STUDY DESIGN Retrospective chart review. METHODS A review of the medical records of 40 patients diagnosed with spasmodic dysphonia from 2009-2018 was preformed to evaluate abnormal test results that were significant when compared with abnormal results of the general population and for any other clinically relevant pathology. RESULTS Erythrocyte sedimentation rate, ceruloplasmin levels, and anti-AChR were found to be elevated at levels considered statistically significant (p <0.05). Furthermore, we found levels of cholesterol, thyroid-stimulating hormone (TSH), T3, fasting blood glucose, creatine kinase, immunoglobulin, antinuclear antibody (ANA), and alpha-fetoprotein (AFP) levels to be abnormal at a greater rate in our population, but these were not statistically significant. Workup revealed several underlying conditions including thyroid neoplasms, hypothyroidism, and laryngopharyngeal reflux. Additionally, brain MRI revealed age-related ischemic pathology in an elevated number of patients, but with no obvious clinical sequalae. CONCLUSION There is an association between serological values and spasmodic dysphonia that can aid in diagnosing pathology, as well as establishing a directed workup. Additionally, our study shows the utility of comprehensive evaluation in identifying undetected disease.
Collapse
Affiliation(s)
- Sammy Othman
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Rohan Patel
- Department of Otolaryngology - Head & Neck Surgery, The State University of New York Upstate Medical University, Syracuse, New York
| | - Justin Ross
- Department of Otolaryngology - Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head & Neck Surgery, Senior Associate Dean, Drexel University College of Medicine, Philadelphia, Pennsylvania.
| |
Collapse
|
29
|
Spasmodic Dysphonia in Multiple Sclerosis Treatment With Botulin Toxin A: A Pilot Study. J Voice 2019; 33:550-553. [DOI: 10.1016/j.jvoice.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022]
|
30
|
Abstract
The primary movement disorders affecting the voice are laryngeal dystonia (including spasmodic dysphonia), essential voice tremor, and Parkinson disease. Diagnosis of these conditions is clinical and based on a detailed history, voice evaluation, and physical and laryngoscopic examination. Laryngeal dystonia and essential voice tremor are hyperfunctional disorders and are treated most commonly with botulinum toxin injections. Parkinson disease is a hypofunctional disorder that may affect the voice and most commonly is treated with Lee Silverman Voice Treatment.
Collapse
|
31
|
Albanese A, Di Giovanni M, Lalli S. Dystonia: diagnosis and management. Eur J Neurol 2018; 26:5-17. [DOI: 10.1111/ene.13762] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Affiliation(s)
- A. Albanese
- Unità Operativa di Neurologia IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
- Istituto di Neurologia Università Cattolica del Sacro Cuore Milano Italy
| | - M. Di Giovanni
- Unità Operativa di Neurologia IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
| | - S. Lalli
- Unità Operativa di Neurologia IRCCS Istituto Clinico Humanitas Rozzano Milano Italy
- Istituto di Neurologia Università Cattolica del Sacro Cuore Milano Italy
| |
Collapse
|