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Kereković Mašić E, Varošanec-Škarić G, Bašić I, Stevanović S. Dysphonia Leading to a Delay in Psychosocial Development. Clin Pediatr (Phila) 2024; 63:840-843. [PMID: 37635397 DOI: 10.1177/00099228231193376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
| | - Gordana Varošanec-Škarić
- Department of Phonetics, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Iva Bašić
- Department of Phonetics, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
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Lechien JR, Maniaci A, Gengler IM, Barillari MR, Vaira LA, Mayo-Yanez M. Acute or persistent mechanisms of dysphonia in COVID-19 patients. Am J Otolaryngol 2024; 45:104223. [PMID: 38241760 DOI: 10.1016/j.amjoto.2024.104223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/24/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Jerome R Lechien
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Antonino Maniaci
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Isabelle M Gengler
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Maria Rosaria Barillari
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Naples, Italy
| | - Luigi A Vaira
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Italy; Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Italy
| | - Miguel Mayo-Yanez
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
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Davis J, Ward EC, Seabrook M, Gundara J, Whitfield BCS. Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery. Int J Lang Commun Disord 2024; 59:963-975. [PMID: 37921245 DOI: 10.1111/1460-6984.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. METHODS & PROCEDURES The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. RESULTS Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. CONCLUSION & IMPLICATIONS The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.
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Affiliation(s)
- Jennifer Davis
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Australian Catholic University, School of Allied Health, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Justin Gundara
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Department of Surgery, Redland Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Bernard C S Whitfield
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
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Ng CH, Rahman M, Damrose EJ. Patient With Dysphonia. JAMA Otolaryngol Head Neck Surg 2024; 150:349-350. [PMID: 38451545 DOI: 10.1001/jamaoto.2024.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
A male individual in his 60s presented with a hoarse and weak voice and a history of follicular lymphoma with multiple relapses treated with an allogeneic stem cell transplant complicated by graft-vs-host disease treated with sirolimus and steroids. What is your diagnosis?
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Affiliation(s)
- Christina H Ng
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Mobeen Rahman
- Department of Pathology, Stanford University, Stanford, California
| | - Edward J Damrose
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
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Caranti A, Spasiano R, Piantanida R, Catalano S, Campisi R, Bergmann M, Trimarchi M. Oncocytic papillary cystadenoma of the larynx: a case report. J Med Case Rep 2024; 18:172. [PMID: 38504337 PMCID: PMC10953284 DOI: 10.1186/s13256-024-04425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Cystadenoma of the salivary glands is a rare benign clinical condition affecting both major and minor salivary glands equally. It constitutes approximately 2% of total neoplasms and 4.2-4.7% of benign formations in minor salivary glands. Typically presenting as a slow-growing, painless neoplasm, it can be distinguished from Cystadenolymphoma (Whartin's Tumor) by the absence of lymphoid elements in histological examination. While mostly located in the oral cavity and oropharynx, it can also be found in sinonasal mucosa, and rare cases have been identified in the larynx. CASE PRESENTATION A 75-year-old Caucasian woman presented to the ear, nose, and throat department with complaints of dysphonia and headaches persisting for several months. Dysphonia had developed months after an unspecified vocal cord surgery elsewhere. Flexible laryngoscopy identified a left-sided cystic swelling affecting the supraglottic space, leading to respiratory obstruction and dysphonia. Head and neck computed tomography confirmed a 1.9 × 1.7 cm bilobed cystic mass originating from the left Morgagni ventricle. Microlaryngoscopy with CO2 laser excision and biopsy revealed a histopathological diagnosis of oncocytic papillary cystadenoma. Post-surgery, the patient fully recovered from dysphonia, with no significant complications noted. Long-term clinical surveillance was advised to detect potential recurrences promptly. CONCLUSION Ectopic minor salivary gland tumors, both benign and malignant, should be taken into consideration as potential differential diagnosis for any swelling arising within the upper digestive tract mucosa. Ears, nose, and throat clinical examination completed by videolaryngoscopy can easily point out the location of the mass. Imaging is mandatory for differential diagnosis and for surgical planning. Surgical excision can provide both diagnosis and definitive cure.
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Affiliation(s)
- Alberto Caranti
- ENT & Audiology Department, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Cona, FE, Italy.
- Gruppo Otorinolaringologico Della Romagna, Primus Medical Center of Forlì, Via Punta di Ferro 2/C, 47122, Forlì, FC, Italy.
| | - Roberto Spasiano
- ENT Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale EOC, Via Tesserete 46, 6900, Lugano, Tissin, Switzerland.
- USI - University of Italian Switzerland, Via Giuseppe Buffi 13, 6900, Lugano, Switzerland.
| | - Renato Piantanida
- ENT Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale EOC, Via Tesserete 46, 6900, Lugano, Tissin, Switzerland
| | - Salvatore Catalano
- ENT Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale EOC, Via Tesserete 46, 6900, Lugano, Tissin, Switzerland
| | - Ruggero Campisi
- ENT & Audiology Department, University Hospital of Ferrara, Via Aldo Moro 8, 44124, Cona, FE, Italy
- Gruppo Otorinolaringologico Della Romagna, Primus Medical Center of Forlì, Via Punta di Ferro 2/C, 47122, Forlì, FC, Italy
| | - Manuela Bergmann
- Institute of Pathology, Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland
| | - Matteo Trimarchi
- ENT Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale EOC, Via Tesserete 46, 6900, Lugano, Tissin, Switzerland
- USI - University of Italian Switzerland, Via Giuseppe Buffi 13, 6900, Lugano, Switzerland
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Schnell M, Slavin D. Intensive Voice Treatment following Botulinum Neurotoxin Injection for a Speaker with Abductor Laryngeal Dystonia: An Exploratory Case Study. Semin Speech Lang 2024; 45:137-151. [PMID: 38417816 PMCID: PMC10957285 DOI: 10.1055/s-0044-1779509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Abductor laryngeal dystonia (ABLD) is a rare neurological voice disorder which results in sporadic opening of the vocal folds during speech. Etiology is unknown, and to date there is no identified effective behavioral treatment for it. It is hypothesized that LSVT LOUD®, which was developed to treat dysphonia secondary to Parkinson's disease, may have application to speakers with ABLD to improve outcomes beyond that with botulinum neurotoxin (BoNT) treatment alone. The participant received one injection of BoNT in each vocal fold 2 to 3 months prior to initiating intensive voice therapy via teletherapy. Objective measures of vocal loudness (dB sound pressure level), maximum phonation time, and high/low pitch frequency (Hz) were recorded in all treatment sessions and follow-up sessions. Over the course of treatment, the participant showed steady gains in phonation time, volume, pitch range, and vocal quality with a substantial reduction in aphonic voice breaks by the end of the treatment program. Perceptual symptoms of ABLD were nearly undetectable by the participant and the clinicians up to 12 months posttreatment, with no additional BoNT injections. The results suggest that LSVT LOUD® following BoNT was effective, with long-lasting improvement in vocal function, for this speaker with ABLD.
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Affiliation(s)
- Mindy Schnell
- Department of Communication Sciences and Disorders, Long Island University, Post, Greenvale, New York
| | - Dianne Slavin
- Department of Communication Sciences and Disorders, Long Island University, Post, Greenvale, New York
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Hamdan AL, Alam E, Feghali PAR, Fadel C, Jabbour C, Ghanem A. Risk of fibromyalgia in patients with primary muscle tension dysphonia: a possible local manifestation of a musculoskeletal systemic disorder. J Laryngol Otol 2024; 138:341-344. [PMID: 37417245 DOI: 10.1017/s0022215123001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia. METHODS A retrospective review was conducted of patients with primary muscle tension dysphonia, diagnosed based on history of dysphonia with evidence of laryngeal muscle tension on examination. Fibromyalgia was assessed using the Fibromyalgia Rapid Screening Tool ('FiRST'). RESULTS Fifty patients were enrolled: 25 with primary muscle tension dysphonia (study group) and 25 matched controls. The mean age of the study group was 50.7 ± 15.2 years versus 49.5 ± 18.6 years for the controls, with a male to female ratio of 3:2 for both groups. Fifty-six per cent tested positive for fibromyalgia in the study group versus 4 per cent in the controls (p < 0.001). The mean Voice Handicap Index 10 score in the study group was significantly higher for those who screened positive for fibromyalgia compared to those who screened negative. There was a positive, strong point-biserial correlation between Fibromyalgia Rapid Screening Tool and Voice Handicap Index 10 scores (r = 0.39; p = 0.09). CONCLUSION These results suggest that fibromyalgia is a significant co-morbid condition in primary muscle tension dysphonia.
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Affiliation(s)
- Abdul-Latif Hamdan
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Alam
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick A R Feghali
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Fadel
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher Jabbour
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Tohidast SA, Mansuri B, Memarian M, Ghobakhloo AH, Scherer RC. Voice Quality and Vocal Tract Discomfort Symptoms in Patients With COVID-19. J Voice 2024; 38:542.e29-542.e33. [PMID: 34776316 PMCID: PMC8511652 DOI: 10.1016/j.jvoice.2021.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Dysphonia and laryngeal problems are some of the manifestations of the COVID-19 pandemic due to respiratory disease as a primary effect of COVID-19. The aim of the present study was to investigate voice quality and vocal tract discomfort symptoms in patients with COVID-19. MATERIALS AND METHODS Forty-four COVID-19 patients with a mean age of 49.61 ± 16.48 years and 44 healthy subjects with a mean age of 48.52 ± 13.8 years participated in the study. The voice quality of the participants was evaluated using auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. The vocal tract discomfort symptoms of the participants were assessed using the Persian version of the VTD scale. RESULTS Patients with COVID-19 had higher scores in all items of the GRBAS, including grade, roughness, breathiness, asthenia, and strain, than healthy subjects, and these differences were statistically significant (P < 0.05). Among the GRBAS parameters, grade had the highest effect size and asthenia had the lowest effect size in both speech tasks. The COVID-19 patients had a greater frequency of vocal tract discomfort symptoms than healthy subjects in all items of the VTDp scale and these differences were statistically significant (P < 0.05) in the following items: burning, tight, dry, pain, sore, irritable, and lump in the throat. The most and the least effect size in frequency of the vocal tract discomfort symptoms were related to dry (d = 1.502) and tickling (d = 0.157), respectively. Also, COVID-19 patients had more significant severity in all items of the VTDp scale except tight and tickling. The most and the least effect size in severity of the vocal tract discomfort symptoms was related to dry (d = 1.416) and tickling (d = 0.152), respectively. CONCLUSION The present study suggests that COVID-19 patients have more deviations in voice quality than healthy subjects. Moreover, mild vocal tract discomfort is prevalent in patients with COVID-19, and patients have more frequent and severe physical discomforts of the vocal tract than healthy subjects.
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Affiliation(s)
- Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mohammad Memarian
- Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Ronald Callaway Scherer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
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Lechien JR, Carroll TL, Nowak G, Huet K, Harmegnies B, Lechien A, Horoi M, Dequanter D, Bon SDL, Saussez S, Hans S, Rodriguez A. Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality. J Voice 2024; 38:479-486. [PMID: 34702613 DOI: 10.1016/j.jvoice.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR). METHODS Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements. RESULTS From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients. CONCLUSION Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, ELSAN Hospital, Paris, France; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
| | - Thomas L Carroll
- Department of Otolaryngology, Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Géraldine Nowak
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Lechien
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihaela Horoi
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Kaneko M, Sugiyama Y, Fuse S, Mukudai S, Hirano S. Physiological Effects of Voice Therapy for Aged Vocal Fold Atrophy Revealed by EMG Study. J Voice 2024; 38:376-383. [PMID: 34649741 DOI: 10.1016/j.jvoice.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Age-related voice changes are characterized as breathy, weak and strained, and a deterioration in vocal function in the elderly has been putatively linked to a reduced intensity of speech. They contribute to undesirable voice changes known as presbyphonia. These changes are caused by histological alterations in the lamina propria of the vocal fold mucosa and atrophy of the thyroarytenoid muscle, as well as by decreased respiratory support. There are several clinical studies on presbylarynx dysphonia showing the effectiveness of voice therapy. However, physiological changes of the presbylarynx following voice therapy have not been verified. The purpose of this prospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating presbylarynx dysphonia, using vocal function assessments and thyroarytenoid muscular activity detection on laryngeal electromyography (LEMG). METHODS 10 patients who were diagnosed with aged vocal fold atrophy from ages 60 to 87 years (mean age: 72 years) underwent approximately 12 weeks of voice therapy, mainly using forward-focused voice and vocal resistance training. Stroboscopic examination, aerodynamic assessment, acoustic analysis, Voice Handicap Index (VHI)-10, and LEMG were performed pre- and post-voice therapy. Vocal fold vibratory amplitude (VFVA) was measured by image analysis from the stroboscopic examinations. Turns analysis during steady phonation on LEMG was also assessed. RESULTS Maximum phonation time, subglottic pressure, jitter, shimmer, VFVA, and VHI-10 significantly improved after voice therapy. The number of turns per second on LEMG also significantly increased. CONCLUSION Our data suggest that voice therapy may improve vocal function and thyroarytenoid muscle activity in patients with aged vocal fold atrophy.
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Affiliation(s)
- Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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Liu K, Mousset M, Schafer A, Rowlands N, Quinn N, Bourgeois T, Bergman M, Pattisapu P, Chiang T, Wiet G, Elmaraghy C. Surgical management of vocal cord nodules in children: Trends and outcomes. Am J Otolaryngol 2024; 45:104174. [PMID: 38101141 DOI: 10.1016/j.amjoto.2023.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Vocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy. METHODS Children with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant. RESULTS Three hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia. CONCLUSION For most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.
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Affiliation(s)
- Kevin Liu
- The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marike Mousset
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Arizona College of Osteopathic Medicine of Midwestern University, Glendale, AZ, USA
| | - Austin Schafer
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Neil Rowlands
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Natalie Quinn
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tran Bourgeois
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maxwell Bergman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Prasanth Pattisapu
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory Wiet
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
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12
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G/Tsion MT, Berhanu AB, Mitiku MW, Shumargaw AT, Kidane KH. Outcomes and predictors of complications of thyroidectomy in a scarce resource setting: Retrospective cross-sectional study. Am J Otolaryngol 2024; 45:104125. [PMID: 38039910 DOI: 10.1016/j.amjoto.2023.104125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Outcomes and predictors of complications of thyroidectomy are diverse and have been extensively studied, but data from our country and other African countries with high disease burdens are limited. OBJECTIVE To evaluate the outcomes and predictors of complications of thyroidectomy among operated patients. METHOD Single institution retrospective cross-sectional study was conducted by reviewing charts from 365 patients who had undergone thyroidectomy on an elective basis between March 2018-February 2022. All patients who were admitted and underwent thyroidectomy were included in this study. Bivariate and multivariate logistic regressions were used to identify risk factors. P-value <0.05 was considered statistically significant. RESULT Overall, post-thyroidectomy complications occurred in 17 % of the cases. The two most common complications were hypocalcemia and voice change; the latter being due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve with an incidence of 4.9 % and 2.5 % respectively. Thyroidectomy performed by surgical residents and having total thyroidectomy were significantly associated with overall complications of thyroidectomy. Total thyroidectomy was found to be a risk factor for postoperative hypocalcemia (AOR = 12.24 (95%CI: 4.53, 19.65); P = 0.02). Younger age of the patient (AOR =0.3(95%CI, 0.12,0.51)) and prolonged duration of presentation (AOR = 2.53(95%CI, 1.17,7.76)) were detected predictors of voice change due to injury of either external branch of superior laryngeal nerve or recurrent laryngeal nerve. CONCLUSION The rate of thyroidectomy complications is relatively similar to other studies. In this study demographic and clinical factors associated with increased risk of complications after thyroid surgery were identified. This information will be useful for educating patients about the risks of thyroid surgery.
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Affiliation(s)
- Mulugeta Taeme G/Tsion
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Abel Balcha Berhanu
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mengistu Worku Mitiku
- Department of Surgery, School of Medicine, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | | | - Kiflom Hadgu Kidane
- Department of Medicine, Menilik II Medical and Health Science College, Addis Ababa, Ethiopia
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Pimenta J, Macedo J, de Rezende Neto AL, de Moraes Marchiori LL. Sensation and Repercussion of the Use of Humid Heat in the Treatment of Dysphonia due to Laryngitis in Singers. J Voice 2024; 38:496-502. [PMID: 35078701 DOI: 10.1016/j.jvoice.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To verify the efficiency of thermotherapy perceptively and acoustically with hot vapor in the treatment of acute laryngitis. METHODS This is a pre and post test quasi-experimental study without a control group, approved by the ethics committee. Its sample counted with 65 singers - 37 females (56.9%) and 28 males (43.1%), mean age 33.7 years (±7.9) years, nonsmokers, with dysphonia due to acute laryngitis. They were submitted to videolaryngostroboscopy and perceptive-acoustic assessment of the voice before and 30 minutes after applying the inhalation of hot vapor. The appropriate statistical tests were used, adopting the significance level lower than 0.05. RESULTS In the acoustic assessment, there was a statistically significant improvement in jitter and shimmer for vowels A and E, P < 0.001. The F0 assessed separately per sex, as it presented a significant difference, P < 0.001. The women's F0 results before and after the heat were higher than the men's. In the analysis of the acoustic results based on harmonics-to-noise ratio and normalized noise energy, there was significant improvement after the heat. All the mean values increased after the heat. There was a statistically significant decrease in the parameters related to the perceptive-auditory assessment for G (grade of hoarseness), R (roughness), B (breathiness), and S (strain). Of the 47 singers that scored 2 for G, 28 (59.6%) reduced it to 1 after the heat, P < 0.001. All the 45 that scored 2 for R reduced it to 1, P = 0.011. Of the 8 who scored 2 for B, 6 (75%) reduced it to 1, P = 0.020. All the 28 singers that scored 1 for S reduced it to 0, P < 0.001. Only for A (asthenia), there was no significant improvement, P = 0.513. The results of the videolaryngostroboscopy revealed a statistically significant difference in all parameters analyzed, such as hyperemia, edema, muco-undulatory movement, and glottal coaptation. CONCLUSION The thermotherapy with using humid heat, provide symptomatic benefits in the treatment of dysphonia caused by laryngitis, demonstrating that the hyperthermoterapy is a potential auxiliary therapeutic resource for the treatment of acute dysphonia due to laryngitis since the intervention with the technique proposed increased the voice quality. It is suggested that this method be used in speech-language clinical practice and that new studies be conducted with stronger designs for its efficacy to be confirmed.
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Affiliation(s)
- Janaina Pimenta
- Postgraduation Program in University Veiga de Almeida, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Julya Macedo
- Postgraduation Program in Italian Institute of Rosario (IUNIR), Department Biomedical Sciences, Rosario, Santa Fe, Argentina
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虢 洪松, 刘 晓贺, 韦 红红, 李 长征. [Forensic identification of vocal cord paralysis and dysphonia caused by chest crush injury: A case report]. Fa Yi Xue Za Zhi 2024; 40:101-103. [PMID: 38500473 DOI: 10.12116/j.issn.1004-5619.2022.220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
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15
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Cvancara DJ, Baertsch HC, de Leon JA, Hollenbaugh ED, Giliberto JP, Zheng M, Bhatt NK. Quantitative Evaluation of Vocal Bowing Following Bilateral Thyroplasty in Age-Related Vocal Atrophy. Laryngoscope 2024; 134:835-841. [PMID: 37665069 DOI: 10.1002/lary.31026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Age-related vocal atrophy (ARVA) is associated with vocal fold bowing, persistent glottal gap during phonation, and dysphonia. Bilateral medialization thyroplasty is sometimes performed in patients with ARVA to improve vocal fold closure and voice. We set out to quantify stroboscopic changes in vocal fold bowing, glottal closure, and abduction angle following bilateral thyroplasty and determine how these changes affect voice quality among patients with ARVA. METHODS Fifteen individuals with ARVA who underwent bilateral medialization thyroplasty were included in this study. Two independent investigators calculated bowing index (BI), normalized glottal gap area (NGGA), and maximum abduction angle from laryngostroboscopic exams using ImageJ™. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and patient-reported measures were collected before and after thyroplasty. RESULTS Thyroplasty resulted in a 10-point improvement in overall CAPE-V (Mean dif -10; 95% CI -17, -3.3, p < 0.01) and VHI-10 (mean dif -3.8; 95% CI -9.8, 2.3, p = 0.19, n = 8). NGGA and BI significantly decreased following surgery (mean dif -78; 95% CI -155, -1.5, p = 0.05; and mean dif -2.1; 95% CI -2.4, -0.84, p < 0.01, respectively). BI correlated with CAPE-V scores (r = 0.66, 95% CI 0.22, 0.87, p < 0.01). When considering the normalized combined contributions of both NGGA and BI, there was a stronger correlation in CAPE-V scores (r = 0.87, 95% CI 0.50, 0.97, p < 0.01) compared with either measure alone. CONCLUSIONS Thyroplasty resulted in a decrease in vocal fold bowing, glottal gap area, and CAPE-V scores in patients with ARVA. Correction of vocal bowing and glottal gap, following bilateral thyroplasty, improved voice measures following surgery. Quantitative evaluation of vocal fold morphology may be valuable when assessing the severity and treatment-response in patients with ARVA following bilateral thyroplasty. Laryngoscope, 134:835-841, 2024.
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Affiliation(s)
- David J Cvancara
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hans C Baertsch
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julio A de Leon
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eric D Hollenbaugh
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - J P Giliberto
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Melissa Zheng
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Neel K Bhatt
- Division of Laryngology Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
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Gray AJ, Hoffman MR, Yang ZM, Vandiver B, Purvis J, Morgan JP, Hapner ER, Dominguez L, Tibbetts K, Simpson CB. Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block. Ann Otol Rhinol Laryngol 2024; 133:174-180. [PMID: 37608685 PMCID: PMC10771019 DOI: 10.1177/00034894231194384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. METHODS Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. RESULTS A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. CONCLUSION SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. LAY SUMMARY Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alan J. Gray
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Matthew R. Hoffman
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Zao M. Yang
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Beau Vandiver
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Joshua Purvis
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Jake P. Morgan
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Edie R. Hapner
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Laura Dominguez
- Department of Otolaryngology—Head and Neck Surgery, Cleveland Clinic Florida, Coral Springs, FL, USA
| | - Kathleen Tibbetts
- Department of Otolaryngology—Head and Neck Surgery, University of Texas-Southwestern, Dallas, TX, USA
| | - C. Blake Simpson
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
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Yaşar Ö, Tahir E, Erensoy I, Terzi M. Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls. Mult Scler Relat Disord 2024; 82:105378. [PMID: 38142514 DOI: 10.1016/j.msard.2023.105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Impairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. OBJECTIVES The study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. METHODS A total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). RESULTS Acoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0-28) and lower in the control group (median=0 range= 0-4). The mean VRQoL was lower in the MS group (median=95 range= 62.5-100) than in controls (median=100 range= 85-100) (p<0.001). CONCLUSION Our results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.
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Affiliation(s)
- Özlem Yaşar
- Ondokuz Mayıs University Faculty of Health Sciences, Department of Speech and Language Therapy, Samsun, Turkey.
| | - Emel Tahir
- Ondokuz Mayıs University School of Medicine, Department of Otolaryngology, Samsun, Turkey
| | - Ibrahim Erensoy
- Ondokuz Mayıs University Faculty of Health Sciences, Department of Speech and Language Therapy, Samsun, Turkey.
| | - Murat Terzi
- Ondokuz Mayıs University School of Medicine, Department of Neurology, Samsun, Turkey
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Momah T, Lijofi O. Squamous Cell Carcinoma of the Supraglottis Presenting as Hoarseness. West Afr J Med 2024; 41:97-99. [PMID: 38412544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Hoarseness is a well-known condition in primary care offices, with over 1% of primary care visits secondary to this ailment.1 The most common causes are acute laryngitis (40%), functional dysphonia (30%), benign and malignant tumors (2.2 to 30%), neurogenic factors such as vocal cord paralysis (8%), physiological aging (2%), and psychogenic factors (2.2%). Most of these cases are secondary to viral infections and do not require antibiotics on most occasions. These viral infections subside after 1 to 2 weeks, and in the case of persistent hoarseness (above 4 weeks) the American Academy of Otolaryngology recommends direct visualization with a laryngoscopy before treatment with proton pump inhibitors, antibiotics, or steroids. Our patient presented with prolonged hoarseness (greater than eight weeks) but had a quick turn around time interval between primary care visit and laryngoscopy evaluation (less than 2 weeks). This led to her diagnosis and treatment with chemo and radiation therapy within three months of diagnosis with Squamous Cell Carcinoma of the Supraglottis. The Primary care physician serves as the number one point of visitation by sufferers of hoarseness. It is important that they are knowledgeable and up to date with recommendations and guidelines for managing this condition, as unwarranted delay can affect overall outcome on the part of the patient. This is especially important in patients such as ours with high risk factors including Nicotine dependence, alcohol use, asbestos exposure, and HPV infection.
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Affiliation(s)
- Tobe Momah
- Department of Family Medicine, University of Mississippi Medical Center (UMMC) Jackson, MS Clinical Science Building, 2500 North State Street, Jackson (Fourth Floor), MS 39216 USA. Emails include , 1-6019846800 (Office Phone)
| | - Olusegun Lijofi
- Department of Family and Pain Medicine , University of Mississippi Medical Center (UMMC) Jana, Taylor, School of Medicine, UMMC, USA
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Issa PP, Hossam E, Cheng JH, Magazine BM, Hussein M, Luo X, Abdelhady A, Staav J, LaForteza A, Albuck AL, Shama M, Toraih E, Kandil E. Completion thyroidectomy: A safe option for high-volume surgeons. Head Neck 2024; 46:57-63. [PMID: 37872858 DOI: 10.1002/hed.27551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/10/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The risk of complication in patients undergoing completion thyroidectomy (cT) is mixed. Several studies report increased risk in comparison to total thyroidectomy (TT) and still others reporting a comparatively decreased risk. We compared the rates of complication in patients at our institution undergoing thyroid lobectomy (TL), (TT), and cT by a single high-volume surgeon. METHODS We performed a single-institution retrospective cohort study. Patients undergoing TL, TT, or cT by a high-volume surgeon were included. Rates of complication were collected and compared between the three cohorts. RESULTS A total of 310 patients were included. The overall rate of complication was 4.2%. The complication rates in the TL, TT, and cT cohorts were 1%, 7.1%, and 4.5%, respectively (p = 0.10). Transient hypocalcemia was slightly more common in the TT cohort (6.1%) as opposed to the TL (0%) or cT (0.9%) cohort (p = 0.01). The cohorts also had similar rates of recurrent laryngeal nerve signal loss leading to transient dysphonia (TL: 0% vs. TT: 1% vs. cT: 3.6%, p = 0.10). CONCLUSIONS While rates of complication tended to predictably decrease as approaches became less extensive, there were no significant differences in complication rates among the three surgical approaches when performed by a high-volume surgeon. Considering the low rates of complication overall, patient counseling and preference should be emphasized to provide appropriate and tailored treatment plans.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eslam Hossam
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jack H Cheng
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brandon M Magazine
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Xinyi Luo
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ali Abdelhady
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jonathan Staav
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Alexandra LaForteza
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron L Albuck
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Circiu MP, Lechien JR, Gravel G, Hans S. An Unusual Cause of Laryngeal Dyspnea. J Voice 2024; 38:247.e27-247.e29. [PMID: 34384661 DOI: 10.1016/j.jvoice.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Medialization laryngoplasty with autologous fat (MLA) is indicated in some patients with glottic insufficiency. The approach is usually safe but long-term complications are poorly described. CASE REPORT We present the history of a patient who developed progressive dyspnea and dysphonia two decades after bilateral MLA, which were due to the development of laryngea lipoma into the site of fat injection. DISCUSSION The potential relationship between MLA and the development of laryngeal lipoma was discussed. The lipoma may be a long-term survival of too much fat tissue, which was reorganized into a well-limited lipoma over the long-term. Another hypothesis consisted of the injection of fat tissue, including fatty stem cells, and the development of a lipoma over the year through the neovascularization process. CONCLUSION We reported the first case of lipoma developed into the laryngeal site of fat injection. Future studies are needed to explore the long-term evolution of injected fat tissue in the context of MLA.
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Affiliation(s)
- Marta P Circiu
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Guillaume Gravel
- Department of Radiology, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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21
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Gartling GJ, van Mersbergen M, Crow K, Lewandowski A, Smith LJ, Gartner-Schmidt JL. The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders. J Voice 2024; 38:244.e15-244.e27. [PMID: 34615615 DOI: 10.1016/j.jvoice.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder. DESIGN Retrospective between-subject, non-experimental design. METHODS Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions. RESULTS There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures. DISCUSSION This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.
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Affiliation(s)
- Gary J Gartling
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Miriam van Mersbergen
- School of Communication Sciences and Disorders, The University of Memphis, Memphis, Tennessee
| | - Karen Crow
- Louisville Center for Voice Care, Louisville, Kentucky
| | - Ali Lewandowski
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Libby J Smith
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie L Gartner-Schmidt
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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22
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Heffernan A, Hu A. Spasmodic Dysphonia Patients' Perception of Pain with Botulinum Toxin Injections. Laryngoscope 2024; 134:240-246. [PMID: 37409790 DOI: 10.1002/lary.30864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate spasmodic dysphonia patients' perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher pain scores relative to other included patients. METHODS Prospective cohort study. Adult patients with adductor spasmodic dysphonia that presented to a tertiary laryngology practice for BTX injections were recruited from March to July 2022. Patients completed the visual analog scale (VAS) pre-procedure to quantify predicted pain. Ten minutes post-procedure they completed VAS and the short form McGill Pain Questionnaire (SF-MPQ). Factors that may affect pain were extracted from charts. Descriptive statistics, univariate, and multivariate analyses were conducted (alpha = 0.05). RESULTS One hundred and nineteen patients were included (63 ± 14 yo, 26% Male). SF-MPQ reported mild pain (4.12 ± 4.05 out of 45) with a pain intensity of none to mild (0.70 ± 0.89 out of 5). Bilateral injections yielded significantly higher SF-MPQ scores (5.19 ± 4.66) than unilateral injections (3.30 ± 3.30) (p = 0.012). There was a significant VAS reduction from pre 28.9 ± 24.6 mm (out of 10 mm) to post 24.5 ± 22.3 (p < 0.001). On multiple regression analyses, receiving a bilateral injection significantly (p < 0.05) contributed to a model that predicted higher pre-VAS (p = 0.013). Bilateral injections (p < 0.05) and higher VHI-10 (p < 0.05) contributed to a model that predicted higher total SF-MPQ (p = 0.001) and affective SF-MPQ (p = 0.001) scores. Not being a professional voice user (PVU) significantly (p < 0.05) contributed to a model that predicted higher post-VAS (p = 0.008) scores. CONCLUSIONS BTX injections were well tolerated with low pain scores. Factors associated with higher relative predicted or experienced pain included bilateral versus unilateral injection, PVU status, and higher VHI-10. LEVEL OF EVIDENCE 4 Laryngoscope, 134:240-246, 2024.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Hu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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23
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Storr M. [What to do with cough, dysphonia, hoarseness and scratching throat?]. MMW Fortschr Med 2024; 166:52-53. [PMID: 38261208 DOI: 10.1007/s15006-023-3503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Martin Storr
- Zentrum für Endoskopie, Internistenzentrum, Oßwaldstr. 1, 82319, Starnberg, Deutschland.
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24
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Beka E, Gimm O. Voice Changes Without Laryngeal Nerve Alterations After Thyroidectomy: The Need For Prospective Trials - A Review Study. J Voice 2024; 38:231-238. [PMID: 34404582 DOI: 10.1016/j.jvoice.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat. SUMMARY The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves. CONCLUSIONS While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment.
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Affiliation(s)
- Ervin Beka
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden.
| | - Oliver Gimm
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden
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25
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Meisner JW, Izadi S, Kamran A, Shieh HF, Smithers CJ, Bennett J, Demehri FR, Mohammed S, Lawlor C, Choi SS, Zendejas B. Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery. Laryngoscope 2023; 133:3564-3570. [PMID: 36892035 DOI: 10.1002/lary.30646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/04/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients. OBJECTIVE Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms. METHODS A single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms. RESULTS We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI. CONCLUSION Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3564-3570, 2023.
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Affiliation(s)
- Jay W Meisner
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - C Jason Smithers
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - John Bennett
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Claire Lawlor
- Department of Ear, Nose and Throat Surgery, Children's National, Washington, District of Columbia, U.S.A
| | - Sukgi S Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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26
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Toya Y, Hiroshiba S. Durability of Titanium Implants Following Type II Thyroplasty for Adductor Type Spasmodic Dysphonia. Laryngoscope 2023; 133:3028-3033. [PMID: 37070643 DOI: 10.1002/lary.30707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To determine the durability of current titanium implants (TI) used in voice improvement surgery for adductor spasmodic dysphonia (ADSD), which is type II thyroplasty (T2T), and identify the effects of their fractures on vocal functions. METHODS A total of 36 ADSD patients who underwent T2T had the following exams: The CT scans of the larynx were performed 1 year after the surgery to assess the fractures of TI. The improvement in the mean voice handicap index 10 (VHI-10) scores and the success rate between nonfractured (NFR) and fractured (FR) groups were compared. RESULTS It was indicated that TI was broken in 21 cases (58.3%). In one case (2.7%), a fracture on the part of the bridge that connects both sides of the plates was observed, and fractures at holes placed on the plates in the other 35 cases (55.6%). The mean VHI-10 score improved from 27.2 ± 8.1 to 11.4 ± 7.9 in the NFR group and from 26.3 ± 4.9 to 9.7 ± 7.9 in the FR group. The success rates were 66.6% in the NFR group and 71.5% in the FR group. No statistical difference was observed in the improvement in the mean VHI-10 scores, and the success rate between the two groups. However, two cases resulted in failure in the FR group, whereas no worsened case was observed in the NFR group. CONCLUSION The current TI used in T2T has low durability and could result in the worsening of vocal symptoms after the surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3028-3033, 2023.
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27
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Feijen J, Verguts M, Van Gool K, Maryn Y, Bernaerts A, De Foer B, van Dinther JJS. Two Cases of Atraumatic Laryngeal Fractures. J Voice 2023; 37:973.e11-973.e14. [PMID: 34294489 DOI: 10.1016/j.jvoice.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing. CASE REPORT A 37-year-old male presented to the outpatient ENT clinic with severe dysphonia and odynophagia. He reported feeling a crack in the throat after swallowing with a flexed head. The patient's physical examination showed diffuse swelling and tenderness over the thyroid cartilage without subcutaneous emphysema. Flexible nasolaryngoscopy showed a large right true vocal fold hematoma with normal vocal fold movement. Computed tomography (CT) showed a fracture of the thyroid. Treatment consisted of corticosteroids and pantoprazole. Two years later he presented again at the emergency department with extreme odynophagia after suffering a knee punch on the larynx. CT showed a new fracture line, slightly off midline to the left in the thyroid cartilage. A 42-year-old male presented at the emergency department with odynophagia, dysphonia, and fever after feeling a crack in the throat during forceful swallowing in an extended neck position. Physical examination demonstrated a painful thyroid cartilage with subcutaneous emphysema. Flexible nasolaryngoscopy was normal but CT scan showed a slightly displaced fracture line of the median thyroid cartilage. Complaints gradually disappeared with conservative treatment with corticosteroids and antibiotics. CONCLUSION Congenital anomalies by abnormal mineralization and ossification could lead to focal weakness of the thyroid cartilage and thus predispose to non-traumatic fractures. The double triad of odynophagia, dysphagia, and dysphonia after sneezing, coughing or swallowing should raise the physician's attention to the possibility of thyroid cartilage fracture, especially after feeling or hearing a crack. Further investigation is obligatory with high-resolution CT of the neck and examination by an ENT specialist.
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Affiliation(s)
- Jef Feijen
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium.
| | - Monique Verguts
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium; Departement of ENT, AZ Diest, Diest, Belgium
| | | | - Youri Maryn
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium
| | - Anja Bernaerts
- Department of radiology, Sint-Augustin's GZA, Antwerp, Belgium
| | - Bert De Foer
- Department of radiology, Sint-Augustin's GZA, Antwerp, Belgium
| | - Joost J S van Dinther
- European Institute for ORL-HNS, Department of ENT-HNS, Sint-Augustine's, GZA Hospital, Antwerp, Belgium
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28
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White AC, Awad R, Carding P. Pre and Post-operative Voice Therapy Intervention for Benign Vocal Fold Lesions: A Systematic Review. J Voice 2023; 37:857-874. [PMID: 34272141 DOI: 10.1016/j.jvoice.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 01/16/2023]
Abstract
Benign vocal fold lesions cause dysphonia by preventing vocal fold closure, causing irregular vibration and increasing compensatory muscle tension. Voice therapy delivered in addition to phonosurgery may improve voice and quality of life outcomes but the evidence base is lacking and what constitutes voice therapy for this population is not defined. The purpose of this systematic review is to critically evaluate the evidence for pre and post-operative voice therapy to inform the development of an evidence based intervention. STUDY DESIGN Systematic Review. METHODS Electronic databases were searched using key terms including dysphonia, phonosurgery, voice therapy and outcomes. Eligible articles were extracted and reviewed by the authors for risk of bias and for information regarding the content, timing and intensity of any pre and post-operative voice therapy intervention. RESULTS Of the 432 articles identified, 35 met the inclusion criteria and were included in the review. 5 were RCTs, 2 were individual cohort studies, 1 was a case control study and 26 were case series. There was considerable heterogeneity in participant characteristics. Information was frequently lacking regarding the content timing and intensity of the reported voice therapy intervention, and where present, interventions were highly variable. CONCLUSION Reporting in relevant literature is limited in all aspects of content, timing and intensity of intervention. Further intervention development work is required to develop a robust voice therapy treatment intervention for this population, before effectiveness work can commence.
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Affiliation(s)
- Anna C White
- Division of Rehabilitation, Wellbeing and Ageing, University of Nottingham, Nottingham NG7 2UH; Nottingham University Hospitals NHS Trust, Nottingham, NG72UH.
| | - Rehab Awad
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham Hospital, Lewisham High Street, London, SE13 6LH; Kasr Alaini Hospital, Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt
| | - Paul Carding
- Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research, Jack Straws Lane, Oxford, OX3 0FL, England
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29
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Leis-Cofiño C, Arriero-Sánchez P, González-Herranz R, Arenas-Brítez Ó, Hernández-García E, Plaza G. Persistent Dysphonia in Hospitalized COVID-19 Patients. J Voice 2023; 37:971.e17-971.e23. [PMID: 34384660 PMCID: PMC8302831 DOI: 10.1016/j.jvoice.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The main objective of this study is to estimate the prevalence of persistent dysphonia in hospitalised COVID-19 patients. METHODS Data were collected from those COVID-19 patients who, during the months of March to April 2020, were hospitalised in ward or intensive care unit at the University Hospital of Fuenlabrada. Patients with dysphonia prior to SARS-CoV-2 were excluded. Informed consent was obtained orally by a telephone call, as well as clinical and epidemiological data. Patients who reported persistent dysphonia were assessed using the Voice Handicap Index 10, the maximum phonation time, the s/z ratio and a fibrolaryngoscope examination. Patients who reported persistent dysphagia were assessed with the Eating Assessment Tool 10. RESULTS A total of 79 patients were included in the study (48 men and 31 women). 10 ICU patients (25%) and 4 ward patients (10,3%) had dysphonia at least 3 months after hospital discharge, but no association was found between ICU admission and the presence of persistent dysphonia (P = 0.139). Persistent dysphonia in patients admitted to the ICU is associated with persistent dysphagia (P = 0.002), also the age of patients with persistent dysphonia is significantly higher than the age of non-dysphonic patients (P = 0.046). The most frequent exploratory finding was vocal cord paresis/paralysis (60.4%). CONCLUSION This is one of the first studies to show that persistence of dysphonia may be a consequence of COVID-19, so further studies are needed to assess the evolution and prognosis of these patients and the possible association of dysphonia with the severity of the disease.
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Affiliation(s)
- Carlos Leis-Cofiño
- Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain.
| | - Paula Arriero-Sánchez
- Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
| | - Ramón González-Herranz
- Hospital Universitario de Fuenlabrada, Department of Otorhinolaryngology, Fuenlabrada, Madrid, Spain
| | - Óscar Arenas-Brítez
- Hospital Universitario de Fuenlabrada, Department of Otorhinolaryngology, Fuenlabrada, Madrid, Spain
| | | | - Guillermo Plaza
- Hospital Universitario de Fuenlabrada, Department of Otorhinolaryngology, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
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30
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Rodriguez A, Maniaci A, Vaira LA, Saussez S, Lechien JR. Xerostomia, sticky saliva and dysphonia. Eur Arch Otorhinolaryngol 2023; 280:5147-5148. [PMID: 37542563 DOI: 10.1007/s00405-023-08171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Alexandra Rodriguez
- Department of Otolaryngoly-Head Neck Surgery, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sven Saussez
- Department of Laryngology and Broncho-Esophagology, EpiCURA Hospital, Anatomy Department of University of Mons, Mons, Belgium
| | - Jerome R Lechien
- Department of Otolaryngoly-Head Neck Surgery, CHU Saint-Pierre, Free University of Brussels, Brussels, Belgium.
- Department of Laryngology and Broncho-Esophagology, EpiCURA Hospital, Anatomy Department of University of Mons, Mons, Belgium.
- Department of Otolaryngoly-Head Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France.
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31
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Sadasivan C, Kubinec C, Ao P, Captan V. Acute-onset dysphonia secondary to a ruptured mycotic aortic arch aneurysm: a rare case of Ortner syndrome. Intern Med J 2023; 53:1929-1930. [PMID: 37859539 DOI: 10.1111/imj.16240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Chandu Sadasivan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Chelsea Kubinec
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Ao
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vasile Captan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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32
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Lin YH, Wang CT. Salvage Treatments for Poor Voice Outcomes Following Autologous Fat Injection Laryngoplasty. Ann Otol Rhinol Laryngol 2023; 132:1200-1205. [PMID: 36510646 DOI: 10.1177/00034894221140777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL. METHODS Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs). RESULTS Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P < .05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P > .05). CONCLUSIONS This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- School of Medicine, Chung Shan Medical University, Taichung
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
- Department of Electrical Engineering, Yuan Ze University, Taoyuan
- Department of Special Education, University of Taipei, Taipei
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Hseu AF, Spencer GP, Jo S, Kawai K, Nuss RC. Pediatric Dysphonia: When to Refer. Clin Pediatr (Phila) 2023; 62:1261-1268. [PMID: 36856137 DOI: 10.1177/00099228231157957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Grant P Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Hamdan AL, Hosri J, Feghali PAR, Abi Zeid Daou C, Ghanem A. Office-based Blue Laser Therapy of Vocal Fold Polyps: A Cohort of 18 Patients: Blue Laser Therapy of Vocal Fold Polyps. Laryngoscope 2023; 133:2712-2718. [PMID: 36752582 DOI: 10.1002/lary.30602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate the effect of office-based blue laser therapy of vocal fold polyps on voice. METHODS The medical records and video recordings of patients who underwent office-based laser therapy in a tertiary referral center between February 2020 and May 2020, and May 2021 and October 2022 was conducted. Only patients with vocal fold polyps who had undergone office-based blue laser therapy were included. The voice was evaluated before and after surgery using the Voice Handicap Index-10 (VHI-10), GRB perceptual evaluation, acoustic analysis, and maximum phonation time. RESULTS A total of 18 patients were included. The mean age of the study group was 52.5 ± 11.94 years. The male-to-female ratio was 2:1. Ten patients of the total group (53.6%) had hemorrhagic polyps and the most common site was the mid-third of the vocal fold. All patients who presented for follow-up (n = 15) had partial or complete regression of the lesion (4 and 11, respectively). There was a significant decrease in the mean score of VHI-10 (17.6 ± 9.97 vs. 4.27 ± 5.76, p < 0.001) and in the means of grade of dysphonia (2.0 ± 0.73 to 0.5 ± 0.63, p < 0.001), roughness (1.88 ± 0.81 to 0.44 ± 0.51, p < 0.001) and breathiness (0.81 ± 0.75 to 0.13 ± 0.34 p < 0.001). There was also a marked decrease in the perturbation parameters (jitter and shimmer) and a significant increase in the MPT from 10.66 ± 4.22 s to 14.26 ± 6.26 s (p = 0.028). CONCLUSION Office-based blue laser therapy is an effective treatment modality in patients with vocal fold polyps. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2712-2718, 2023.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Jad Hosri
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Patrick Abou Raji Feghali
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
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Palmer AD, Graville DJ, Bolognone RK, Gorecki J, Groth S, March J, Schindler JS. Longitudinal Voice Outcomes and Neoglottic Function After Supracricoid Partial Laryngectomy: The Development of a New Scale. Ann Otol Rhinol Laryngol 2023; 132:1206-1215. [PMID: 36541624 DOI: 10.1177/00034894221141518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Supracricoid partial laryngectomy (SCPL) is an oncologically sound alternative to total laryngectomy that results in long-term alterations in vocal function. Little is known about long-term improvements in dysphonia and the mechanism of vocal recovery is unclear due to the lack of a standardized rating tool: The Pattern, Degree, and Vibration (PDV) Scale. METHODS Data from 24 individuals were compared over 3 post-operative timepoints after SCPL: 3 to 11, 12 to 35, and over 35 months. Voice outcomes were assessed using the Voice Handicap Index (VHI) and the GRBAS scale. Laryngeal exams were deidentified and rated using a novel rating scheme developed using literature review and consensus panel discussions. RESULTS There were significant improvements in VHI scores, Grade, and Strain over time. There was an increase in the Degree of Closure and a decline in Mucosal Vibration across timepoints. Pattern of Movement (P) was associated with dysphonia Grade. Better Degree of Closure (D) was associated with lower VHI scores and better Grade and Roughness. Mucosal Vibration (V) was associated with reduced Breathiness and Strain but variable Roughness. Age, T-stage, radiation treatment, surgery type, and time to feeding-tube removal were also associated with voicing characteristics. CONCLUSIONS There is evidence of improvement in several voice parameters over time after the first post-operative year. Various subcomponents of the new PDV rating scale were associated with voice outcomes. Its utility for research and clinical practice merits further investigation.
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Affiliation(s)
- Andrew D Palmer
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Donna J Graville
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Rachel K Bolognone
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Joseph Gorecki
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Suzanne Groth
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer March
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Joshua S Schindler
- NW Clinic for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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Lin CW, Wang YH, Li YE, Chiang TY, Chiu LW, Lin HC, Chang CT. COVID-related dysphonia and persistent long-COVID voice sequelae: A systematic review and meta-analysis. Am J Otolaryngol 2023; 44:103950. [PMID: 37354724 PMCID: PMC10250057 DOI: 10.1016/j.amjoto.2023.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Dysphonia is a common symptom due to the coronavirus disease of the 2019 (COVID-19) infection. Nonetheless, it is often underestimated for its impact on human's health. We conducted this first study to investigate the global prevalence of COVID-related dysphonia as well as related clinical factors during acute COVID-19 infection, and after a mid- to long-term follow-up following the recovery. METHODS Five electronic databases including PubMed, Embase, ScienceDirect, the Cochrane Library, and Web of Science were systematically searched for relevant articles until Dec, 2022, and the reference of the enrolled studies were also reviewed. Dysphonia prevalence during and after COVID-19 infection, and voice-related clinical factors were analyzed; the random-effects model was adopted for meta-analysis. The one-study-removal method was used for sensitivity analysis. Publication bias was determined with funnel plots and Egger's tests. RESULTS Twenty-one articles comprising 13,948 patients were identified. The weighted prevalence of COVID-related dysphonia during infection was 25.1 % (95 % CI: 14.9 to 39.0 %), and male was significantly associated with lower dysphonia prevalence (coefficients: -0.116, 95 % CI: -0.196 to -0.036; P = .004) during this period. Besides, after recovery, the weighted prevalence of COVID-related dysphonia declined to 17.1 % (95 % CI: 11.0 to 25.8 %). 20.1 % (95 % CI: 8.6 to 40.2 %) of the total patients experienced long-COVID dysphonia. CONCLUSIONS A quarter of the COVID-19 patients, especially female, suffered from voice impairment during infection, and approximately 70 % of these dysphonic patients kept experiencing long-lasting voice sequelae, which should be noticed by global physicians.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Han Wang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-En Li
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Business Management, Institute of Healthcare Management and Institute of Biomedical Science, National Sun Yat-sen University, Kaohsiung, Taiwan; Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Chun-Tuan Chang
- Department of Business Management, Institute of Healthcare Management and Institute of Biomedical Science, National Sun Yat-sen University, Kaohsiung, Taiwan
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Pasqualini MP, Bressan M, Lubianca JPN, Silva TL, Foinquinos GVG, Lubianca Neto JF. Unusual cause of progressing dysphonia and stridor in a child. Braz J Otorhinolaryngol 2023; 89:101308. [PMID: 37634405 PMCID: PMC10472233 DOI: 10.1016/j.bjorl.2023.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Marina Paese Pasqualini
- Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Mariele Bressan
- Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | | | | | | | - José Faibes Lubianca Neto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Cirúrgica e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil.
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Leydon C, Mital K, DoCarmo J, Gaffney A, Ullucci P. The Impact of Vocal Task on Voice Acoustics, Effort and Discomfort Following Submandibular Neuromuscular Electrical Stimulation in Healthy Adults. J Voice 2023; 37:700-706. [PMID: 34116890 DOI: 10.1016/j.jvoice.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) offers a potential adjuvant to traditional voice therapy for individuals with dysphonia. The type of vocal task to implement in conjunction with electrical stimulation to achieve maximal therapeutic benefit is unknown. The purpose of this study was to elucidate the impact of tasks on voice outcomes. METHODS Nineteen vocally-healthy adult females, between 23 and 27 years of age (Ave: 23.8, SD: 1.13), participated in the study. 15 participants completed all three 30-minute sessions, and four completed at least one session. NMES was paired with three different voice conditions: high-pitched hum, low-pitched hum, and comfortable-pitched hum. Acoustic (average fundamental frequency and loudness; perturbation (jitter, shimmer, noise to harmonic ratio); Cepstral Spectral Index of Dysphonia; pitch range), perceived phonatory effort, and discomfort (delayed onset muscle soreness) measures were compared across conditions. RESULTS Eight participants experienced discomfort following NMES. Three participants withdrew from the study due to discomfort, and one withdrew due to an unrelated oral surgery. NMES paired with high-pitch humming resulted in increased average fundamental frequency during sustained phonation and reading tasks, and increased Cepstral Spectral Index of Dysphonia during sustained phonation. Low-pitch humming resulted in a decreased noise to harmonic ratio. No statistically significant changes in perceived phonatory effort were noted. CONCLUSION Almost half of the participants reported temporary discomfort. Task-specific differences in some outcomes were noted indicating that the nature of voice task performed with NMES must be considered when examining the impact of NMES on voice. Vocal tasks can impact discomfort and acoustic vocal outcomes of NMES.
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Affiliation(s)
- Ciara Leydon
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut.
| | - Kaitlyn Mital
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; The Spine and Health Center of Closter, Cloister, NJ
| | - Julie DoCarmo
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; Yale New Haven Hospital, Milford, CT
| | - Annelise Gaffney
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; AMN Healthcare/ClubStaffing, Kauai, HI
| | - Paul Ullucci
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; College of Health & Wellness, Johnson & Wales University, Providence, RI
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Kosztyła-Hojna B, Rogowski M, Duchnowska E, Zdrojkowski M, Łobaczuk-Sitnik A. Multidimentional assessment of voice quality in patients with laryngopharyngeal reflux disease. Otolaryngol Pol 2023; 78:20-30. [PMID: 38332705 DOI: 10.5604/01.3001.0053.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
<b><br>Introduction:</b> Gastroesophageal Reflux Disease (GERD) is a common disorder in world population. As a result of the regurgitation of acid content from the stomach to laryngopharynx and larynx, secondary damage of laryngeal mucosa occur, which is highly sensitive to hydrochloric acid, and morphological changes are observed. Symptomatology of laryngopharyngeal reflux is varied which makes differential diagnosis difficult.</br> <b><br>Aim:</b> The aim of the study was the assessment of voice quality, morphological changes in larynx as well as etiology of Laryngopharyngeal Reflux Disease.</br> <b><br>Material and method:</b> The severity of dysphonia was classified using perceptual and acoustic methods as well as RSI. Morphological control was performed using HSDI technique and RFS. Etiological factors were examined basing on barofunction of upper esophageal sphincter and 24-hour pH-metry of air exhaled expressed in Ryan score.</br> <b><br>Results:</b> In the majority of patients with Laryngopharyngeal Reflux, dysphonia was recognized, intensified especially in women (G3R2B0A0S3), which was confirmed in Yanagihara classification (type III) and parameters of acoustic analysis. Voice disorders were the most frequently the result of edema and congestion of interarytenoid area, aytenoids and vocal folds. Those symptoms were caused by the decrease of upper esophageal sphincter tension and acidity of exhaled air which was confirmed in 24-hour pHmetry.</br> <b><br>Conclusions:</b> It is important to educate physicians and patients about the possibilty of negative impact of reflux disease on the occurrence of voice quality disorders. Current diagnostic methods for dysphonia guarantee accurate recognition and therapeutic success improving the prognoses of patients with Laryngopharyngeal Reflux.</br>.
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Affiliation(s)
- Bożena Kosztyła-Hojna
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Marek Rogowski
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Emilia Duchnowska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Maciej Zdrojkowski
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Anna Łobaczuk-Sitnik
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
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Ferrari EP, Simões-Zenari M, Master S, Nemr K. Risk of dysphonia and voice quality in performing arts students. Codas 2023; 35:e20220036. [PMID: 37610967 PMCID: PMC10446748 DOI: 10.1590/2317-1782/20232022036pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. METHODS Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade. RESULTS Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations. CONCLUSION Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.
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Affiliation(s)
| | - Marcia Simões-Zenari
- Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil.
| | - Suely Master
- Instituto de Artes, Universidade Estadual Paulista de Júlio Mesquita Filho - UNESP - São Paulo (SP), Brasil.
| | - Katia Nemr
- Faculdade de Medicina, Universidade de São Paulo - USP - São Paulo (SP), Brasil.
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de Lima HVSL, Lopes LW, da Silva HJ, Vieira ACDC, da Cruz TVS, Gomes ADOC, de Lira ZS. Performance of the phonatory deviation diagram in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. Codas 2023; 35:e20210224. [PMID: 37466502 PMCID: PMC10446749 DOI: 10.1590/2317-1782/20232021224pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/04/2022] [Indexed: 07/20/2023] Open
Abstract
PURPOSE To assess the performance of the phonatory deviation diagram and its measurements in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. METHODS Retrospective and documentary study. A sample of 30 subjects was used, 50% male, with a mean age of 62.13 ± 9.05 years. The results of the phonatory deviation diagram were analyzed, in the moments before and after vocal exercise with the pushing technique associated with plosive sounds, considering the area, density, shape and location of the diagram in the quadrants. For comparison purposes, the acoustic parameters of jitter, shimmer, glottal to noise excitation ratio and results of the auditory-perceptual analysis, carried out in previous research, were also considered, in the pre- and post-technical moments. RESULTS Despite the fact that there was no difference in the distribution of samples in the diagram, after performing the vocal technique, a change in the displacement of the diagram towards the area of normality was identified in the visual qualitative analysis, and there was an association between the general degree of vocal deviation in the analysis auditory perception and the area of the diagram. There was an improvement in the shimmer values after the vocal technique. CONCLUSION The displacement of the phonatory deviation diagram towards the area of normality corroborated the results in relation to the general degree of dysphonia, evaluated by the auditory-perceptual analysis and the shimmer results, after the vocal technique. Thus, the diagram shows good performance in monitoring voice quality of individuals with Parkinson's.
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Affiliation(s)
- Hellen Vasconcelos Silva Leal de Lima
- Programa de Pós-Graduação em Saúde da Comunicação Humana, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
| | - Leonardo Wanderley Lopes
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.
| | - Hilton Justino da Silva
- Programa de Pós-Graduação em Saúde da Comunicação Humana, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
| | - Ana Cláudia de Carvalho Vieira
- Departamento de Fonoaudiologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
| | - Thalita Vitória Silva da Cruz
- Departamento de Fonoaudiologia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
| | - Adriana de Oliveira Camargo Gomes
- Programa de Pós-Graduação em Saúde da Comunicação Humana, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
| | - Zulina Souza de Lira
- Programa de Pós-Graduação em Saúde da Comunicação Humana, Centro de Ciências da Saúde, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil.
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Vaira LA, Saussez S, Maniaci A, Boscolo-Rizzo P, Hans S, Lechien JR. Post-thyroidectomy dysphonia and swallowing symptoms: The role of cricopharyngeal sphincter. Am J Otolaryngol 2023; 44:103910. [PMID: 37178537 DOI: 10.1016/j.amjoto.2023.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/25/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Luigi A Vaira
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Italy; Biomedical Science PhD School, Biomedical Science Department, University of Sassari, Italy
| | - Sven Saussez
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Antonino Maniaci
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Catania 95123, Italy
| | - Paolo Boscolo-Rizzo
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Stephane Hans
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jerome R Lechien
- Research Committee of Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (World Ear, Nose, and Throat Federation), Paris, France; Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
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Kim GJ, Bang J, Shin HI, Kim SY, Bae JS, Kim K, Kim JS, Hwang YS, Shim MR, Sun DI. Persistent subjective voice symptoms for two years after thyroidectomy. Am J Otolaryngol 2023; 44:103820. [PMID: 36893530 DOI: 10.1016/j.amjoto.2023.103820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Voice change after thyroidectomy is an important issue in thyroid surgery. However, little is known about long-term voice outcomes after thyroidectomy. This study investigates the long-term voice outcomes of thyroidectomy up to two years after surgery. Also, we analyzed the pattern of recovery through acoustic tests over time. METHODS We reviewed data from 168 patients who underwent thyroidectomy between January 2020 and August 2020 at a single institution. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) score and acoustic voice analysis results were examined preoperatively and postoperative one, three, and six months, and one and two years after surgery. We divided patients into two groups based on the TVSQ score (≥15 or <15) at two years postoperatively. We investigated the difference of acoustic characteristics between the two groups and analyzed correlations between acoustic parameters and various clinical and surgical factors. RESULTS Voice parameters tended to recover, but some parameters and TVSQ scores exhibited deterioration two years after surgery. In the subgroups, among the many clinicopathologic factors examined, voice abuse history including professional voice users (p = 0.014), greater extent of thyroidectomy and neck dissection (p = 0.019, p = 0.029), and high pitch voice (F0; p = 0.005, SFF; p = 0.016) were associated with high TVSQ score at two years. CONCLUSIONS Patients frequently experience voice discomfort after thyroidectomy. After surgery, voice abuse history including professional voice users, greater extent of surgery, and higher pitch voice are associated with worse voice quality and increased risk of persistent voice symptoms over the long-term.
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Affiliation(s)
- Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Jooin Bang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Hyun-Il Shin
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Shin Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Mi-Ran Shim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Republic of Korea.
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Maffei MF, Green JR, Murton O, Yunusova Y, Rowe HP, Wehbe F, Diana K, Nicholson K, Berry JD, Connaghan KP. Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis. J Speech Lang Hear Res 2023; 66:872-887. [PMID: 36802910 PMCID: PMC10205101 DOI: 10.1044/2022_jslhr-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.
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Affiliation(s)
- Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
| | - Olivia Murton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kathleen Diana
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - James D. Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Kim JM, Yoo SD, Park EJ. Nutritional Biomarkers as Predictors of Dysphonia Severity in Patients with Ischemic Stroke. Nutrients 2023; 15:nu15030652. [PMID: 36771359 PMCID: PMC9919533 DOI: 10.3390/nu15030652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Dysphonia and malnutrition are major problems in patients who have suffered an ischemic stroke. Tools to assess dysphonia severity include the dysphonia severity index (DSI) and maximum phonation time (MPT). This study aimed to investigate whether the nutritional biomarkers transferrin, albumin, and prealbumin could be predictors of dysphonia severity. A retrospective analysis was conducted between January 2018 and October 2022. A total of 180 patients who had suffered an ischemic stroke were included. Serum transferrin, albumin, and prealbumin levels were significantly correlated with DSI and MPT levels. In a multiple regression analysis, prealbumin and transferrin were significant predictors of DSI, whereas only prealbumin was a significant predictor of MPT. Serum transferrin, albumin, and prealbumin levels in patients who have suffered an ischemic stroke may correlate with dysphonia severity as assessed using DSI and MPT. These results may provide objective evidence that nutritional biomarkers affect dysphonia severity.
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Affiliation(s)
- Ji Min Kim
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
- Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
- Correspondence: ; Tel.: +82-2-440-7246
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Basar G, Kaleoglu Aslan O, Surmeli M. Relationship between dysphonia and anxiety in fibromyalgia syndrome. Eur Arch Otorhinolaryngol 2023; 280:285-288. [PMID: 35943596 DOI: 10.1007/s00405-022-07555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our aim in conducting this study is to determine the relationship dysphonia and anxiety in patients with fibromyalgia syndrome (FS). METHODS Between April 2021 and June 2021, 25 FS diagnosed patients (22 females, 3 males; mean age: 45.36 ± 7.68 years; range 27-65 years), and, for the control group, 25 healthy volunteers (20 females, 5 males; mean age: 42.60 ± 9.98 years; range 29-62 years) with similar demographic features were included in the study. Visual Analog Scale (VAS), Beck Anxiety Questionary (BAQ), and voice analyses were evaluated for all the participants. Acoustic parameters (AP), such as F0 (Hz), jitter (%), shimmer (%), and Maximum Phonation Time (MPT), were measured for dysphonia. The correlation between MPT and BAQ was evaluated. RESULTS The demographic characteristics of the groups did not differ statistically significantly (p > 0.05). VAS and BAQ scores were statistically significantly higher in the FS group than healthy individuals. In the assessment of sound, there was no significant difference between F0 and jitteriness between the two groups. While shimmer scores were significantly higher in the FS group, MPT scores were statistically significantly higher in healthy individuals. CONCLUSIONS In our study, we observed that FS patients had statistically significantly higher BAQ, VAS scores compared to the control group. The shimmer of voice was increased and MPT values were decreased statistically significantly in FS patients. This says that there may be weakness in the laryngeal muscles affecting the vocal cord and thus voice quality. In addition to this, increased anxiety in FS patients may be associated with dysphonia. There is need for more controlled studies with increased number of patients to investigate the dysphonia in FS patients.
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Affiliation(s)
- Gokhan Basar
- Physical Medicine and Rehabilitation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Kaleoglu Aslan
- Physical Medicine and Rehabilitation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Surmeli
- Department of Otolaryngology, Head and Neck Surgery Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
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Kryshtopava MA, Alenskaya TL, Azaronak MK, Petrova LG. [Voice disorders associated with novel coronavirus infection]. Vestn Otorinolaringol 2023; 88:30-37. [PMID: 38153890 DOI: 10.17116/otorino20238806130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients. MATERIAL AND METHODS A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month. RESULTS Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment. CONCLUSION In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.
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Affiliation(s)
- M A Kryshtopava
- Vitebsk State Order of Friendship of Peoples Medical University, Vitebsk, Republic of Belarus
| | - T L Alenskaya
- Vitebsk State Order of Friendship of Peoples Medical University, Vitebsk, Republic of Belarus
| | - M K Azaronak
- Vitebsk State Order of Friendship of Peoples Medical University, Vitebsk, Republic of Belarus
| | - L G Petrova
- Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus
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Park EJ, Yoo SD. Vitamin D level in relation to phonetic function among subacute stroke patients. Medicine (Baltimore) 2022; 101:e31769. [PMID: 36550807 PMCID: PMC9771342 DOI: 10.1097/md.0000000000031769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are many stroke patients with decreased phonation ability. Vitamin D is associated with weakness in muscle power and a decreased function of activity and is often accompanied by a deficiency of serum vitamin D in stroke patients. This study was conducted to evaluate the correlation between serum vitamin D level and phonetic function in subacute stroke patients. Among subacute stroke patients, patients with dysphonia were retrospectively recruited. Phonation function was assessed by acoustic analysis using the dysphonia severity index (DSI) and maximum phonation time for 4 corner vowels/a/,/i/,/u/, and/ae/. As a statistical method, the relationships of vitamin D levels with the maximum phonation time and DSI were evaluated using Pearson's correlation analysis and linear regression analysis. A total of 32 stroke patients with dysphonia were assessed. A positive correlation was found between vitamin D levels and the DSI of /a/, /u/, /i/, and/ae/. The DSI of/u/ was significantly lower in the group with vitamin D deficiency. Vitamin D level was associated with phonation function and its deficiency may be a factor in predicting phonation severity in stroke patients.
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Affiliation(s)
- Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Physical Medicine and Rehabilitation, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Medicine, AgeTech-Service Convergence Major, Yongin, Korea
- * Correspondence: Seung Don Yoo, Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gandong-gu, Seoul 05278, Korea (e-mail: )
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Cordani C, Battel I, Del Furia MJ, Lazzarini SG, Negrini S, Arienti C. Dysphagia, dysphonia and olfactory disease: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:875-879. [PMID: 36534007 PMCID: PMC10153549 DOI: 10.23736/s1973-9087.22.07811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Currently, no evidence exists on specific treatments for post COVID-19 condition (PCC). However, rehabilitation interventions that proved effective for similar symptoms in other health conditions could be applied to people with PCC. With this overview of systematic reviews with mapping, we aimed to describe the Cochrane evidence on rehabilitation interventions proposed for dysphagia, dysphonia and olfactory dysfunction in different health conditions that can be relevant for PCC. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "dysphagia," "swallowing disorder," "dysphonia," "voice disorder," "olfactory dysfunction," "smell changes" and "rehabilitation" in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 170 CSRs published between 2016 and 2021 and 1 was included. It provided data on dysphagia in acute and subacute stroke. Interventions included were acupuncture, neuromuscular electrical stimulation, transcranial magnetic stimulation and behavioral interventions, and swallowing therapy, with very low- to moderate-quality evidence. We did not find any CSR on dysphonia and olfactory disease. CONCLUSIONS These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Irene Battel
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy -
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Miles A, Brodsky MB. Current opinion of presentation of dysphagia and dysphonia in patients with coronavirus disease 2019. Curr Opin Otolaryngol Head Neck Surg 2022; 30:393-399. [PMID: 36004777 PMCID: PMC9612417 DOI: 10.1097/moo.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Dysphagia and dysphonia are common presentations of both acute and long coronavirus disease 2019 (COVID-19). The majority of peer-reviewed publications in 2020 and early 2021 were expert guidance and consensus statements to support dysphagia management in multidisciplinary teams while protecting clinicians and patients from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This review discusses dysphagia and dysphonia primary data published in 2021-2022, focusing on patient presentations, pathophysiology, and evidence for interventions. RECENT FINDINGS Clinicians and researchers amassed knowledge of the cross-system presentation of dysphagia and dysphonia in patients with COVID-19, from severe disease requiring ICU stays to those with mild-to-moderate disease presenting to outpatient clinics. Pre-COVID-19 health status, hospitalization experience, presence of neurological symptoms, and impact of the virus to the upper aerodigestive and respiratory system need consideration in patient management. Long-term dysphagia and dysphonia manifested from COVID-19 require otolaryngologist and speech-language pathologist input. SUMMARY Changes in immunity through population vaccination and variations in COVID-19 from SARS-CoV-2 mutations means prevalence data are challenging to interpret. However, there is no doubt of the presence of long-term dysphagia and dysphonia in our clinics. Long-term dysphagia and dysphonia are complex and a multidisciplinary team with a tailored approach for each patient is required.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Martin B. Brodsky
- Department of Physical Medicine and Rehabilitation; Department of Medicine, Division of Pulmonary and Critical Care Medicine; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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