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Boominathan P, Mahalingam S, Arunachalam R, Venkatesh L. An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD). J Voice 2023; 37:969.e1-969.e21. [PMID: 34261583 DOI: 10.1016/j.jvoice.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. METHOD The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. RESULTS An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CONCLUSION CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.
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Affiliation(s)
- Prakash Boominathan
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.
| | - Shenbagavalli Mahalingam
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Ravikumar Arunachalam
- SRM Institute of Science & Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Diaz JA, Rangarathnam AB, Medina A, Khare VD, Fisher HR. Preliminary Perceptual Findings of Singing After Flow Phonation Voice Exercises for Singers in Training. J Voice 2023:S0892-1997(23)00256-4. [PMID: 37718141 DOI: 10.1016/j.jvoice.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Goals of voice therapy and vocal pedagogy share similar principles and therefore, therapy approaches designed to improve the disordered voice may be equally effective when used to enhance healthy voice and vice versa. The purpose of this study was to investigate the effects of flow phonation voice exercises on vocal characteristics of students in undergraduate vocal music training programs and examine their potential use in vocal pedagogy. METHODS A total of 10 cis females were recruited and were randomized into two groups: an experimental group (group 1, n = 6) receiving five sessions of flow phonation intervention across 5 weeks; and a control group (group 2, n = 4) that did not receive any direct intervention other than vocal hygiene education. Participants provided data pertaining to auditory perception, subjective respiratory measures, voice-related quality of life, and vocal fatigue before and after 5 weeks. Flow phonation exercises consisted of cup bubble blowing, gargling, and stretch and flow. Wilcoxon signed ranks test was administered to compare outcomes across time points and between groups. RESULTS Data indicate statistically significant changes in auditory perception of the singing voice, and voice-related quality of life for the group that received flow phonation exercises alone. No other measures showed statistical significance. DISCUSSION AND CONCLUSION Overall, this study indicates that the use of flow phonation voice exercises has the potential to improve voice instruction within the voice studio. While our target enrollments were not met to achieve optimal statistical power, our hypotheses were at least partially supported. In particular, positive intervention-related changes were observed in self-perceived voice handicap, and auditory perception of singing which were not observed in the control group.
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Affiliation(s)
- Jorge A Diaz
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL
| | | | - Angela Medina
- Department of Communication Sciences and Disorders, Florida International University, Miami, FL
| | | | - Hélène R Fisher
- Department of Speech-Language Pathology, Nova Southeastern University, Fort Lauderdale, FL
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Nallamuthu A, Boominathan P, Arunachalam R, Mariswamy P. Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems. J Voice 2023; 37:295.e11-295.e22. [PMID: 33483225 DOI: 10.1016/j.jvoice.2020.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol. METHOD VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice). RESULTS Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I0 (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048). CONCLUSION Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.
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Affiliation(s)
- Aishwarya Nallamuthu
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Prakash Boominathan
- Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Ravikumar Arunachalam
- Pro-Vice Chancellor (Medical & Health Sciences), SRM Medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu, India
| | - Pushpavathi Mariswamy
- All India Institute of Speech and Hearing, (Ministry of Health & Family Welfare, Govt. of India), Manasagangothri, Mysuru, India
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Andriollo DB, Frigo LF, Cielo CA. Effect of Pompage on Vocal and Respiratory Measurements from Female Teachers: A Randomized Clinical Trial. Folia Phoniatr Logop 2023; 75:295-305. [PMID: 36812904 DOI: 10.1159/000529832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Teachers stand out among occupational groups due to their contribution to modern societies, and their voice is the main form of interaction. OBJECTIVE The aim of the study was to verify the changes in vocal and respiratory measurements from teachers with vocal and musculoskeletal complaints and with normal larynx after applying a musculoskeletal manipulation protocol of myofascial release using pompage. METHODS Controlled and randomized clinical trial with 56 participants: 28 teachers in the study group and 28 teachers in the control group. Anamnesis, videolaryngoscopy, hearing screening, sound pressure and maximum phonation time measurements, and manovacuometry were performed. The musculoskeletal manipulation protocol of myofascial release using pompage consisted of a total of 24 sessions, 40 min for each session, three times a week, for 8 weeks. RESULTS There was a significant improvement in the maximum respiratory pressure in the study group after the intervention. The sound pressure level and the maximum phonation time did not change significantly. DISCUSSION AND CONCLUSION Musculoskeletal manipulation protocol of myofascial release using pompage had a direct effect on the respiratory measurements from female teachers, significantly increasing the maximum respiratory pressure but without affecting sound pressure level and the /a/ maximum phonation time.
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Affiliation(s)
- Débora Bonesso Andriollo
- Programa de Pós-graduação em Fonoaudiologia, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Brazil
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Vermeulen R, du Toit M, van Lierde K, van der Linde J. The Effect of Vocal Hygiene Education Programs on Voice Quality in Professional Voice Users: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4700-4713. [PMID: 36351245 DOI: 10.1044/2022_jslhr-22-00097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users. METHOD A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias. RESULTS Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment). CONCLUSIONS Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.
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Affiliation(s)
- Rouxjeanne Vermeulen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Maria du Toit
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Kristiane van Lierde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
- Department of Speech, Language and Hearing Sciences, University of Ghent, Belgium
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Vahid M, Mansuri B, Farzadi F, Tohidast SA, Bagheri R, Scherer RC. Immediate Effects of Combining Kinesio Tape with Voice Therapy in Patients with Muscle Tension Dysphonia. J Voice 2022:S0892-1997(22)00278-8. [PMID: 36283906 DOI: 10.1016/j.jvoice.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The present study investigated the immediate effect of adding Kinesio taping along with voice therapy for the treatment of muscle tension dysphonia patients. MATERIALS AND METHODS Twenty patients with primary muscle tension dysphonia (MTD) (12 males and 8 females) with a mean age of 36.95 ± 9.58 years participated in the study. Participants were assigned to two groups: one group (6 males and 4 females) received only traditional voice therapy (VT) and the other group (6 males and 4 females) received Kinesio taping (KT) and voice therapy (VT). The VT group received laryngeal manual therapy (LMT) (for 15 minutes) and voice therapy techniques including humming, chewing, and yawn-sigh (for 15 minutes). The VT + KT group received both KT and the same VT as the first group. KT was applied to the sternocleidomastoid, infralaryngeal, and supralaryngeal muscles of the neck. Auditory-perceptual assessments using CAPE-V, acoustic voice analysis, and assessments of vocal tract discomfort and pain were used to evaluate the effects of a single treatment session. The Wilcoxon and Mann-Whitney U tests were used for data analysis. RESULTS The results of within-group comparison of the auditory-perceptual assessment (overall severity, roughness, breathiness, and strain) in both sustained vowels and connected speech tasks showed a significant reduction in all mentioned items in both groups (P < 0.05). Acoustic voice analysis showed significant improvement of HNR in the KT + VT group for both sustained vowels and connected speech tasks, and significant improvement of jitter in the VT group for sustained vowels (P < 0.05). Regarding vocal tract discomfort, the symptom of tightness in the KT + VT group, irritability and pain in the VT group, and the overall score of vocal tract discomfort in both groups, significantly decreased (P < 0.05). A significant decrease in pain severity in the front of the neck, throat, and larynx was reported by MTD patients in both groups (P < 0.05). Between-group comparisons indicated a significant difference only in the pain item of the VTD scale (P < 0.05) with greater pain decrease for the VT group. Comparison of the mean of differences showed that the VT group reduced irritability more than the KT + VT group (P < 0.05). CONCLUSION The present study showed that voice therapy with and without Kinesio taping can improve patients' voice quality (auditory-perceptual and acoustic voice analysis) and reduce vocal tract discomfort and pain in MTD patients after one therapy session. Moreover, MTD patients treated with KT + VT did not experience more significant improvements compared to those treated with VT alone. More studies in this area are recommended to better determine the effects of KT in MTD patients especially for long term effects of KT.
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Affiliation(s)
- Maedeh Vahid
- Department of Speech Therapy, School of Rehabilitation, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Faezeh Farzadi
- Otorhinolaryngology Research Center, Amir A'lam Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, 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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Sirpa P, Paula S, Terhi A, Niemitalo-Haapola E, Anneli Y, Leena R. A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies? J Voice 2022:S0892-1997(22)00191-6. [PMID: 35902298 DOI: 10.1016/j.jvoice.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). METHOD A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). RESULTS No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f0 increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f0 decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls' eight-week non-therapy period (P = 0.003). CONCLUSION The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.
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Affiliation(s)
- Pirilä Sirpa
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | - Saarentaus Paula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ansamaa Terhi
- Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland
| | - Elina Niemitalo-Haapola
- Faculty of Humanities/Logopedics, Child Language Research, University of Oulu, Oulu, Finland
| | - Yliherva Anneli
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Rantala Leena
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Liu J, Cao W, Sun DH, Wu L, Sun J, Xu B, Fu Y. Vocal nodules in children: Laryngoscopic morphological classification aids prognostic judgment. Front Pediatr 2022; 10:941483. [PMID: 36147819 PMCID: PMC9488521 DOI: 10.3389/fped.2022.941483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Vocal fold nodules (VFNs) are benign lesions, occurring at the junction of the anterior and middle thirds of bilateral vocal cords, for which pediatric prognosis and treatment remains controversial. There is a requirement for a correlation indicator to assess the prognosis by pediatric otolaryngologists. MATERIALS AND METHODS Patients with VFNs, who were admitted to the department of otolaryngology, were enrolled. The patient's gender, age, duration of dysphonia, laryngoscopy results and related diseases [allergic rhinitis, sinusitis, laryngopharyngeal reflux (LPR)] were collected and recovery from dysphonia followed up. Correlations between clinical factors and type of laryngoscopic morphology of VFNs were analyzed. RESULTS A total of 432 patients with dysphonia were identified, 208 agreed to undergo laryngoscopy and 194 were diagnosed with VFNs as a result. The modal age of patients with dysphonia was between 3 and 7 years with a male: female ratio of 2.1:1 (294:138) and 116 (26.85%; 116/432) had symptoms of allergic rhinitis. The boy to girl ratio among the 194 children with VFNs was about 2.6:1 (140:54) and modal age was consistent with dysphonia. Vocal nodules were the cause of most phonation disorders (93.27%; 194/208) and those with long duration of dysphonia presented more mature (p = 0.026) and discrete types (p = 0.022). Boys were more likely to have mature (p = 0.050) and discrete nodules (p = 0.008). Dysphonia recovery time was closely related to age (p = 0.000), duration of dysphonia (p = 0.000) and morphology of vocal nodules under laryngoscopy (p = 0.000). CONCLUSION Vocal nodules are the most frequent cause of phonation disorders in children. The morphological classification by endoscopy may help with clinical diagnosis and therapy choice. In the case of the older child with longer duration of dysphonia and the appearance of mature, large, discrete nodules by laryngoscopy, active treatment is recommended, such as drug therapy, voice therapy or surgical treatment.
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Affiliation(s)
- Jia Liu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Department of Endoscopy Center, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Cao
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Dan-Hua Sun
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Wu
- Department of Endoscopy Center, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Sun
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Fu
- Department of ENT and Head and Neck Surgery, National Clinical Research Center for Child Health, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3015-3031. [PMID: 34269598 DOI: 10.1044/2021_jslhr-21-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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Zenari MS, Cota ADR, Rodrigues DDA, Nemr K. Do Professionals Who Use the Voice in a Journalistic Context Benefit from Humming as a Semi-occluded Vocal Tract Exercise? J Voice 2021:S0892-1997(21)00100-4. [PMID: 33895007 DOI: 10.1016/j.jvoice.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many vocal enhancement and rehabilitation programs for voice professionals define vocal exercises without analyzing their effects on that specific population in which they will be applied, in the established dose and often without considering the presence and absence of vocal alteration. Journalists have sought the voice clinic due to new professional vocal demands and a vocal program is being elaborated. OBJECTIVE To determine the immediate effect of humming in professionals with and without voice disorders who work under high vocal demand in a journalistic context. METHOD Thirty-six individuals who completed the Dysphonia Risk Screening Protocol and underwent voice recording participated in the study. Three speech therapists defined the presence and/or absence of vocal changes by consensus. Subsequently, five repetitions of humming were proposed; the exercises lasted five seconds each and were separated by five seconds of complete silence, and recordings were made before and after the exercise (vowel and phrase). For the pre and post comparison between the groups with and without vocal changes, acoustic measurements and spectrogram, including the classification of the signal type, were performed. RESULTS The sample had a similar distribution of men and women and a mean age of 39.9 years. Most of the professionals were journalists or reporters. The risk of dysphonia was high for half of the sample, and the presence of vocal changes, predominantly mild ones, was identified in 56%. After the exercise, a decrease in noise at low frequencies and an improvement in the series of harmonics and the signal type were observed in both groups; a decrease in irregularity was observed only in the participants without vocal changes. CONCLUSION The proposed humming exercise had an immediate positive effect on the voice of professionals working in a journalistic context, and the changes were particularly evident in aspects of the voice that were initially altered.
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Affiliation(s)
- Marcia Simoes Zenari
- Department of Speech Therapy, Physiotherapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, Brazil.
| | - Ariane Dos Reis Cota
- Department of Speech Therapy, Physiotherapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, Brazil
| | - Danilo de Albuquerque Rodrigues
- Department of Speech Therapy, Physiotherapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, Brazil
| | - Katia Nemr
- Department of Speech Therapy, Physiotherapy and Occupational Therapy, University of São Paulo Medical School, São Paulo, Brazil
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Christmann MK, Scapini F, Lima JPDM, Gonçalves BFDT, Bastilha GR, Cielo CA. Aerodynamic Vocal Measurements in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy. J Voice 2021; 35:259-270. [DOI: 10.1016/j.jvoice.2019.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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Helou LB, Gartner-Schmidt JL, Hapner ER, Schneider SL, Van Stan JH. Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System. Semin Speech Lang 2021; 42:5-18. [PMID: 33596600 PMCID: PMC7935442 DOI: 10.1055/s-0040-1722756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meta-therapy refers to the clinical dialogue via which direct and indirect voice treatments are introduced and discussed, and which helps build a useful conceptual framework for voice therapy. Meta-therapy was idiosyncratically defined in previous work. However, the current colloquial narrative of meta-therapy is not standardized or specific enough to be reliably taught, rigorously studied, or clinically delivered with high fidelity. Therefore, this article uses a standard framework (the Rehabilitation Treatment Specification System or RTSS) to further articulate and operationalize meta-therapy in vocal rehabilitation. Meta-therapy's conceptual framework generally aligns with the RTSS's treatment theory and associated concepts; e.g., the treatment component and its underlying ingredients, mechanisms of action, and target. Because the treatment theories in meta-therapy most frequently involve mechanisms of action related to information processing, they primarily map onto the RTSS's Representations treatment components. The treatment targets in meta-therapy are often focused on changes in the patient's cognitions, knowledge, beliefs, attitudes, intentions, and/or awareness regarding voice-related modifications. The ingredients in meta-therapy are frequently clinician actions conveying information with the goal of appropriately shaping the patient's mental representations, and are delivered with verbal cues, stories, analogies, etc. This manuscript provides specific examples of how meta-therapy is applied in clinical voice practice. Considerations for future investigation of meta-therapy are proposed.
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Affiliation(s)
- Leah B. Helou
- Department of Communication Science & Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jacqueline L. Gartner-Schmidt
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edie R. Hapner
- Department of Otolaryngology, UAB Voice Center, University of Alabama, Birmingham, Birmingham, Alabama
| | - Sarah L. Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco
| | - Jarrad H. Van Stan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
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Christmann MK, Scapini F, Lima JPDM, Gonçalves BFDT, Bastilha GR, Cielo CA. Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy. J Voice 2020; 36:736.e1-736.e15. [PMID: 33032885 DOI: 10.1016/j.jvoice.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions. OBJECTIVES Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique. METHODS Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other). RESULTS The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group. CONCLUSION Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.
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Affiliation(s)
- Mara Keli Christmann
- Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil; Associação Educacional Luterana Bom Jesus (IELUSC), Joinville, SC, Brazil; Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Fabricio Scapini
- Departamento de Clínica Médica, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Tafiadis D, Helidoni ME, Chronopoulos SK, Kosma EI, Alexandropoulou A, Velegrakis S, Konitsiotis S, Ziavra N. ROC Analysis Cut-off Points of Hellenic Voice Handicap Index for Neurogenic Voice Disorders Patients: an Exploratory Study. J Voice 2020; 36:875.e25-875.e33. [PMID: 33012628 DOI: 10.1016/j.jvoice.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The inclusion of subjective methods for evaluating Voice Disorders is proven an essential factor for diagnosis as these methods include self-reported questionnaires (eg, Voice Handicap Index-VHI) for everyday clinical practice. In turn, by obtaining cut-off scores of self-perceived questionnaires intended for assessment procedures of different voice disorders (eg, patients with neurological problems), the clinicians might be helped toward finding their patients' needs leading to better monitoring, and treatment suggestions. Consequently, the purpose of this study was to estimate the cut-off scores for the Greek VHI relevant to patients with neurogenic voice disorders. METHODS Ninety subjects participated in this research. Sixty-six of them served as the control group while the remaining 24 patients exhibited Neurogenic Voice Disorders (eg, spasmodic dysphonia or vocal fold paralysis). They filled in the VHI and the Voice Evaluation Template. All participants were examined with the use of video laryngeal endoscopy and stroboscopy. RESULTS The analysis revealed higher medians in all domains (of the VHI) for the patients compared to the control group. The cut-off points were estimated at the values of 24.50 (Total Score-AUC 0.932, P = 0.000), 9.00 (Functional Domain-AUC 0.917, P = 0.000), 10.00 (Physical Domain-AUC 0.948, P = 0.000), and 9.00 (Emotional Domain-AUC 0.830, P = 0.000). CONCLUSION The estimated cut-off scores are in agreement with previous studies. These scores could probably used to enhance therapeutic monitoring of patients who suffer from neurogenic voice disorders. This study underlines the importance of considering different cutoff points for individuals with voice disorders due to diverse neurogenic etiologies.
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Affiliation(s)
- Dionysios Tafiadis
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece; Department of Speech & Language Therapy, Faculty of Health Sciences, European University, Nicosia, Cyprus.
| | - Meropi E Helidoni
- Department of Otolaryngology, University of Crete, Crete, Iraklion, Greece
| | - Spyridon K Chronopoulos
- Electronics-Telecommunications and Applications Laboratory, Physics Department, University of Ioannina, Ioannina, Greece
| | - Evangelia I Kosma
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Anna Alexandropoulou
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece
| | | | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Nafsika Ziavra
- Department of Speech & Language Therapy, University of Ioannina, Ioannina, Greece
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Pomaville F, Tekerlek K, Radford A. The Effectiveness of Vocal Hygiene Education for Decreasing At-Risk Vocal Behaviors in Vocal Performers. J Voice 2020; 34:709-719. [DOI: 10.1016/j.jvoice.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
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Lopes LW, da Silva ACF, da Silva IM, de Paiva MAA, Silva SIDN, Almeida LNA, Ribeiro VV. Evidence of Internal Consistency in the Spectrographic Analysis Protocol. J Voice 2020; 36:445-456. [PMID: 32782177 DOI: 10.1016/j.jvoice.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To verify the validity in the internal consistency in the spectrographic analysis protocol (SAP). MATERIAL AND METHODS Thirty-nine students of the Speech-Language Pathology graduate program and 38 speech-language pathologists, specialized in voice, participated in the study. The participants made visual inspections of 10 spectrograms and marked the items of the SAP. For analysis of the internal consistency in the SAP, the exploratory factor analysis (EFA) and confirmatory factor analysis were performed. RESULTS Most items showed corrected item-total correlation above 0.3, indicating that the items have a good relationship with each other and with the SAP as a whole. Six items presented values below the average, suggesting the exclusion of these from the construct. However, three of these were maintained because they were judged as important parameters in clinical practice, requiring the training of judges when using the SAP to properly understand the items. The EFA regrouped the previous domains of the SAP into three factors. All items presented a factor load above 0.4, suggesting the retention of all, except for the items previously indicated, for exclusion. The confirmatory factor analysis corroborated with the EFA and its indexes. CONCLUSION The SAP has good internal consistency. All items have a good degree of relationship with each other and contribute positively to the protocol as a whole. The final version of the SAP, at this stage, has 15 items (from the 25 items of the initial SAP version), distributed among three domains.
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Affiliation(s)
- Leonardo Wanderley Lopes
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil.
| | - Allan Carlos França da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Itacely Marinho da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Maxsuel Alves Avelino de Paiva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Saulo Iordan do Nascimento Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Larissa Nadjara Alves Almeida
- Program of Decision and Health Models, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal de Sergipe - UFS, Lagarto, Sergipe, Brazil
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Transcutaneous Electrical Nerve Stimulation Combined With Voice Therapy in Women With Muscle Tension Dysphonia. J Voice 2020; 34:490.e11-490.e21. [DOI: 10.1016/j.jvoice.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022]
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Bastilha GR, Pagliarin KC, Moraes DADO, Cielo CA. Spectrographic Vocal Assessment Protocol (SVAP): Reliability and Criterion Validity. J Voice 2020; 35:931.e1-931.e14. [PMID: 32209278 DOI: 10.1016/j.jvoice.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To present evidence of the reliability and validity in the Spectrographic Vocal Assessment Protocol. METHODS The sample consisted of 50 female participants, aged 25-62 years old, 24 with a otorhinolaryngological diagnosis of the normal larynx or posterior glottal gap, and 26 diagnosed with vocal fold disturbances. The emission of the vowel /a:/ was analyzed by the Real Time Spectrogram software. The spectrographs were analyzed with a protocol by two speech therapist judges. For reliability analysis, inter- and intrajudge analysis were performed using the Kendall coefficient. For criterion validity, the t test for matched samples with Bonferroni correction was used to compare the average performance of the protocol between the two groups of subjects. RESULTS Protocol reliability: for broadband items, the agreement between judges ranged from moderate (0.462) to almost perfect (0.888), and it is significant for all items, and an intrajudge agreement was almost perfect and significant (0.865-1.000) for all items. For narrowband items, the agreement between judges ranged from moderate (0.469) to almost perfect (0.922), and it is significant for all items except for the presence of "subharmonics in high frequencies" where agreement was moderate (0.504), but not significant, and the intrajudge agreement was almost perfect (0.874-1.000) and significant for all items. Criterion validity: for most broadband and narrowband items, the groups with normal or altered diagnosis differed statistically. CONCLUSION The Spectrographic Vocal Assessment Protocol presented adequate evidence in reliability and validity.
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Affiliation(s)
- Gabriele Rodrigues Bastilha
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brasil.
| | - Karina Carlesso Pagliarin
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brasil
| | | | - Carla Aparecida Cielo
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brasil
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Bastilha GR, Pagliarin KC, Cielo CA. Development and Evidence of Content Validity of the Spectrographic Vocal Assessment Protocol (SVAP). J Voice 2020; 35:512-520. [PMID: 31955913 DOI: 10.1016/j.jvoice.2019.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and seek evidence of content validity of a spectrographic vocal assessment protocol. METHODS Methodological study for development and validation of an assessment instrument. A broad literature search was conducted to develop and substantiate a spectrographic vocal assessment protocol. The protocol items were sent to five expert judges, speech therapists, nonauthors of the research, doctors, and clinicians, with experience in the field of voice and spectrographic acoustic analysis, who individually analyzed the protocol items. For data analysis, the Gwet analysis and the Content Validity Ratio formula were used. RESULTS The Spectrographic Vocal Assessment Protocol was developed, subdivided into Broadband and Narrowband. Twenty-four protocol items had Content Validity Ratio 1.0 and 25 items had 0.6. Gwet analysis indicated substantial agreement (0.656) for broadband and almost perfect (0.848) for narrowband items. CONCLUSION Evidence of satisfactory content validity was obtained in the development of the protocol.
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Affiliation(s)
- Gabriele Rodrigues Bastilha
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil.
| | - Karina Carlesso Pagliarin
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
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Lopes LW, Silva IMD, Sousa ESDS, Silva ACFD, Paiva MAAD, Diniz EGR, Silva POC. Classificação espectrográfica do sinal vocal: relação com o diagnóstico laríngeo e a análise perceptivo-auditiva. AUDIOLOGY - COMMUNICATION RESEARCH 2020. [DOI: 10.1590/2317-6431-2019-2194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Verificar se existe associação entre a presença de alteração laríngea, a análise perceptivo-auditiva da qualidade vocal e a classificação espectrográfica do sinal vocal em indivíduos com distúrbio de voz. Métodos Participaram 478 pacientes com distúrbios de voz. Foi realizada gravação da vogal /Ɛ/ sustentada e o exame médico para estabelecimento de diagnóstico laríngeo. Os espectrogramas da vogal foram utilizados para classificação dos sinais em Tipo I, II, III e IV. Resultados Vozes de indivíduos sem alteração laríngea foram classificadas, predominantemente, como Tipo I e Tipo II, enquanto sinais de indivíduos com alteração laríngea foram classificados nos Tipos III e IV. Vozes desviadas foram classificadas, predominantemente, como Tipo II, enquanto os sinais de pacientes com desvio vocal foram categorizados, predominantemente, como Tipos II e III. Apenas os sinais de indivíduos com desvio vocal foram classificados como Tipo IV. Sinais Tipo III e IV apresentaram valores mais elevados no grau geral do desvio e nos graus de rugosidade e soprosidade, em relação aos sinais Tipo I e Tipo II. Os sinais Tipo IV apresentaram maior grau geral e graus de rugosidade e soprosidade, em comparação aos sinais Tipo III. Apenas os sinais Tipo IV apresentaram valores mais elevados no grau de tensão, em relação aos sinais Tipo I, II e III. Conclusão Há associação entre a presença de alteração laríngea, a análise perceptivo-auditiva e a classificação espectrográfica do sinal vocal em indivíduos com distúrbio de voz.
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Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4062-4079. [PMID: 31619107 PMCID: PMC7203518 DOI: 10.1044/2019_jslhr-s-19-0136] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 05/22/2023]
Abstract
Purpose Conversation training therapy (CTT) is the 1st voice therapy approach to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus. The purpose of this investigation was to determine the efficacy of CTT compared to standard-of-care voice therapy approaches for the treatment of patients with voice disorders. Method A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions compared to age, gender, and diagnosis historical matched control (HMC) patients was used. The primary outcome was change in Voice Handicap Index-10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data were collected before treatment (baseline), at the start of each therapy session, 1 week after the final therapy session (short-term follow-up), and 3 months after the final therapy session (long-term follow-up). Results For the CTT group, statistically significant improvements were observed for VHI-10. Though statistically significant improvements were observed for the VHI-10 for the HMC group, the CTT group saw significantly greater improvement in VHI-10. Furthermore, equivalent gains were observed following only 2 sessions of CTT compared to 4-8 sessions of traditional therapy. Significant improvements in the CTT group were observed for cepstral peak prominence in a vowel, fundamental frequency, Cepstral Spectral Index of Dysphonia in a vowel and connected speech, vocal intensity, average airflow in speech in a reading passage, number of breaths and duration of reading passage, and auditory-perceptual measurement of overall voice severity. Conclusions Results support the hypothesis that training voice techniques in the context of spontaneous conversational speech improves patient perception of voice handicap and acoustic, aerodynamic, and auditory-perceptual voice outcomes both immediately following treatment and at long-term follow-up. CTT participants also demonstrated significantly larger decreases in VHI-10 compared to HMC participants who received standard-of-care, nonconversational, hierarchical-based voice therapy.
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Affiliation(s)
| | - Jonathan Yabes
- Department of Biostatistics, University of Pittsburgh, PA
| | - Clark A. Rosen
- Department of Otolaryngology, University of California, San Francisco
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de Souza AJ, Gonçalves DDS, Bastilha GR, Christmann MK, Scapini F, Cielo CA. Acoustic Measurements of the Glottic Source of Female Teachers With Dysphonia. J Voice 2019; 34:838-846. [PMID: 31174883 DOI: 10.1016/j.jvoice.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/15/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To verify the acoustic measurements of glottic source of dysphonic teachers of a medium-sized municipality of interior of the state. METHODS Retrospective, cross-sectional, and quantitative study, with a composite sample of 34 dysphonic teachers, of which 21 teachers without laryngeal affections and 13 with laryngeal affections, mean age 39.1 years old and 39.5 years old, respectively. Glottic source acoustic analysis was performed with the Multi-Dimensional Voice Program Advanced. The data were analyzed statistically to verify the significance of each acoustic measure between the groups (with laryngeal affection, without laryngeal affection, and total) and in relation to the normality proposed by the software. RESULTS In the three conditions (groups with and without affection and total) the means were statistically below normality in the measurements of maximum and minimum fundamental frequency. In the group without affection, frequency, and noise measurements presented above normality. In both groups, measurements of frequency, noise, and subharmonic segments were above normal, and number of voice breaks below normal. CONCLUSION Acoustic parameters outside the normal pattern showed an aperiodic vocal production, with presence of noise and instability in the vocal signal, in dysphonic teachers with or without alteration at the laryngeal level.
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Affiliation(s)
- Arieli Jaques de Souza
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Daniela da Silva Gonçalves
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Gabriele Rodrigues Bastilha
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil.
| | - Mara Keli Christmann
- Department of Speech-Language Pathology and Audiology, Universidade do Vale do Itajaí (UNIVALI) - Itajaí SC e Associação Educacional Luterana Bom Jesus - IELUSC - Joinville Santa Catarina, Brazil
| | - Fabrício Scapini
- Department of Medicine, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Santa Maria/UFSM, Santa Maria, Rio Grande do Sul, Brazil
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França FP, Almeida AAD, Lopes LW. Configuração acústico-articulatória das vogais de mulheres com nódulos vocais e vocalmente saudáveis. Codas 2019; 31:e20180241. [DOI: 10.1590/2317-1782/20192018241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/04/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Analisar a configuração acústico-articulatória das vogais em mulheres com nódulos vocais e vocalmente saudáveis. Método Participaram do estudo 12 mulheres com nódulos vocais (GE) e 12 vocalmente saudáveis (GC). Todas as mulheres gravaram frases-veículo com as vogais /a/, /i/ e /u/ em posição tônica, sucedidas e precedidas da oclusiva /p/: “Digo papa baixinho”, “Digo pipa baixinho” e “Digo pupa baixinho”. Posteriormente, foram extraídos os três primeiros formantes (F1, F2 e F3) dessas vogais. Resultados Observou-se diferença nas medidas de F1 para as vogais /a/ e /u/ e F2 para a vogal /a/ entre os dois grupos estudados. Mulheres com nódulos vocais apresentam menor valor dessas medidas em relação às mulheres vocalmente saudáveis. Pacientes com nódulos vocais apresentaram menor intervalo nos valores de F1 e F2 entre as vogais /a/, /i/ e /u/ em relação às mulheres vocalmente saudáveis. Conclusão Mulheres com nódulos vocais apresentam menores valores de F1 e F2, e menor amplitude de movimentação dos articuladores na produção vocálica em relação às mulheres vocalmente saudáveis.
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Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H. Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. J Voice 2018; 32:609-620. [DOI: 10.1016/j.jvoice.2017.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/11/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Hosoya M, Kobayashi R, Ishii T, Senarita M, Kuroda H, Misawa H, Tanaka F, Takiguchi T, Tashiro M, Masuda S, Hashimoto S, Goto F, Minami S, Yamamoto N, Nagai R, Sayama A, Wakabayashi T, Toshikuni K, Ueha R, Fujimaki Y, Takazawa M, Sekimoto S, Itoh K, Nito T, Kada A, Tsunoda K. Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial. Laryngoscope 2018; 128:2593-2599. [PMID: 30079962 PMCID: PMC6585860 DOI: 10.1002/lary.27415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
Objectives/Hypothesis Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost‐effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost‐effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene. Study Design Multicenter randomized controlled trial. Methods Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO‐style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules. Results After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test). Conclusions Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial. Level of Evidence 1b Laryngoscope, 2593–2599, 2018
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Rika Kobayashi
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Toyota Ishii
- Department of Otolaryngology, National Hospital Organization, Sagamihara Hospital Organization, Sagamihara, Japan
| | - Masamitsu Senarita
- Department of Otolaryngology, National Hospital Organization, Mito Medical Center, Mito, Japan
| | - Hiroyuki Kuroda
- Department of Otolaryngology, National Hospital Organization, Kobe Medical Center, Kobe, Japan
| | - Hayato Misawa
- Department of Otolaryngology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Fujinobu Tanaka
- Department of Otolaryngology, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Tetsuya Takiguchi
- Department of Otolaryngology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Masatsugu Tashiro
- Department of Otolaryngology, National Hospital Organization, Tochigi Medical Center, Tochigi, Japan
| | - Sawako Masuda
- Department of Otolaryngology, Mie National Hospital, Tsu, Japan
| | - Sho Hashimoto
- Department of Otolaryngology, National Hospital Organization, Sendai Medical Center, Sendai, Japan
| | - Fumiyuki Goto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Nobuko Yamamoto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Ryoto Nagai
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Akiko Sayama
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Keitaro Toshikuni
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Mihiro Takazawa
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Sotaro Sekimoto
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Kenji Itoh
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Koichi Tsunoda
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
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Voice-Specialized Speech-Language Pathologist's Criteria for Discharge from Voice Therapy. J Voice 2018; 32:332-339. [DOI: 10.1016/j.jvoice.2017.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
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Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis C(CW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg 2018; 158:S1-S42. [DOI: 10.1177/0194599817751030] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Libby J. Smith
- University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Abstract
ABSTRACT Objective: to verify the content evidence of a spectrographic analysis protocol. Methods: a methodological study in which five speech therapists who assessed the clarity and the relevance of the protocol were selected. The Content Validity Index (CVI) was used to investigate the level of agreement among judges regarding overall aspects, items and domains of the protocol. Results: most judges considered the overall aspects of the protocol as comprehensive. As for clarity, 17 items showed an excellent content validity (CVI ≥ 0.78), three showed a good content validity (0.60 ≤ CVI ≤ 0.77) and two items were judged as poor (CVI ≤ 0.59). As for relevance, 19 items obtained an excellent content validity (CVI ≥ 0.78) and three had a good content validity (0.60 ≤ CVI ≤ 0.77). The judges suggested adding items related to vocal signal normality in all domains. After the analysis, 18 items required no reformulation, five items were added, three were reformulated and one was excluded. Conclusion: the proposed protocol was regarded as a comprehensive one. The items presented a good to excellent content validity as for clarity and relevance. After this validation step, the protocol ended up presenting 25 items distributed into five domains.
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Desjardins M, Halstead L, Cooke M, Bonilha HS. A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies. J Voice 2017; 31:392.e13-392.e32. [DOI: 10.1016/j.jvoice.2016.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 12/31/2022]
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Rinsky-Halivni L, Klebanov M, Lerman Y, Paltiel O. Adherence to Voice Therapy Recommendations Is Associated With Preserved Employment Fitness Among Teachers With Work-Related Dysphonia. J Voice 2017; 31:386.e19-386.e26. [DOI: 10.1016/j.jvoice.2016.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/17/2022]
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Treatment for Vocal Polyps: Lips and Tongue Trill. J Voice 2017; 31:252.e27-252.e36. [DOI: 10.1016/j.jvoice.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 11/22/2022]
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Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support. Eur Arch Otorhinolaryngol 2016; 274:2049-2058. [DOI: 10.1007/s00405-016-4420-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/02/2016] [Indexed: 11/26/2022]
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Carding P, Bos-Clark M, Fu S, Gillivan-Murphy P, Jones S, Walton C. Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders. Clin Otolaryngol 2016; 42:201-217. [DOI: 10.1111/coa.12765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P. Carding
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
| | - M. Bos-Clark
- Royal Devon and Exeter NHS Trust and University of ST Mark and St John; Plymouth UK
| | - S. Fu
- Department of Audiology and Speech Pathology; MacKay Medical College; New Taipei City Taiwan
| | | | - S.M. Jones
- University Hospital of South Manchester; Manchester UK
| | - C. Walton
- Speech Pathology; Australian National Catholic University; Brisbane Qld Australia
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Gartner-Schmidt J, Gherson S, Hapner ER, Muckala J, Roth D, Schneider S, Gillespie AI. The Development of Conversation Training Therapy: A Concept Paper. J Voice 2016; 30:563-73. [DOI: 10.1016/j.jvoice.2015.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
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Meerschman I, D'haeseleer E, De Cock E, Neyens H, Claeys S, Van Lierde K. Effectiveness of Chewing Technique on the Phonation of Female Speech-Language Pathology Students: A Pilot Study. J Voice 2016; 30:574-8. [DOI: 10.1016/j.jvoice.2015.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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de Campos Moreira T, Gadenz CD, Capobianco DM, Figueiró LR, Ferigolo M, Vissoci JRN, Barros HMT, Cassol M, Pietrobon R. Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis. J Voice 2016; 31:259.e29-259.e40. [PMID: 27545074 DOI: 10.1016/j.jvoice.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation. STUDY DESIGN This study used systematic review and meta-analysis (CRD42013003807). METHODS We included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles. RESULTS A total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix. CONCLUSIONS Dropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.
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Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016; 7:CD006937. [PMID: 27428115 PMCID: PMC6457859 DOI: 10.1002/14651858.cd006937.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with motor impairments often have the motor speech disorder dysarthria, a condition which effects the tone, strength and co-ordination of any or all of the muscles used for speech. Resulting speech difficulties can range from mild, with slightly slurred articulation and breathy voice, to profound, with an inability to produce any recognisable words. Children with dysarthria are often prescribed communication aids to supplement their natural forms of communication. However, there is variation in practice regarding the provision of therapy focusing on voice and speech production. Descriptive studies have suggested that therapy may improve speech, but its effectiveness has not been evaluated. OBJECTIVES To assess whether any speech and language therapy intervention aimed at improving the speech of children with dysarthria is more effective in increasing children's speech intelligibility or communicative participation than no intervention at all , and to compare the efficacy of individual types of speech language therapy in improving the speech intelligibility or communicative participation of children with dysarthria. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015 , Issue 7 ), MEDLINE, EMBASE, CINAHL , LLBA, ERIC, PsychInfo, Web of Science, Scopus, UK National Research Register and Dissertation Abstracts up to July 2015, handsearched relevant journals published between 1980 and July 2015, and searched proceedings of relevant conferences between 1996 to 2015. We placed no restrictions on the language or setting of the studies. A previous version of this review considered studies published up to April 2009. In this update we searched for studies published from April 2009 to July 2015. SELECTION CRITERIA We considered randomised controlled trials and studies using quasi-experimental designs in which children were allocated to groups using non-random methods. DATA COLLECTION AND ANALYSIS One author (LP) conducted searches of all databases, journals and conference reports. All searches included a reliability check in which a second review author independently checked a random sample comprising 15% of all identified reports. We planned that two review authors would independently assess the quality and extract data from eligible studies. MAIN RESULTS No randomised controlled trials or group studies were identified. AUTHORS' CONCLUSIONS This review found no evidence from randomised trials of the effectiveness of speech and language therapy interventions to improve the speech of children with early acquired dysarthria. Rigorous, fully powered randomised controlled trials are needed to investigate if the positive changes in children's speech observed in phase I and phase II studies are generalisable to the population of children with early acquired dysarthria served by speech and language therapy services. Research should examine change in children's speech production and intelligibility. It must also investigate children's participation in social and educational activities, and their quality of life, as well as the cost and acceptability of interventions.
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Affiliation(s)
- Lindsay Pennington
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Naomi K Parker
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Helen Kelly
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Nick Miller
- Newcastle UniversityInstitute of Health and SocietySir James Spence Institute ‐ Royal Victoria InfirmaryQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Pedrosa V, Pontes A, Pontes P, Behlau M, Peccin SM. The Effectiveness of the Comprehensive Voice Rehabilitation Program Compared With the Vocal Function Exercises Method in Behavioral Dysphonia: A Randomized Clinical Trial. J Voice 2016; 30:377.e11-9. [DOI: 10.1016/j.jvoice.2015.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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Wendler Glottoplasty and Voice-Therapy in Male-to-Female Transsexuals: Results in Pre and Post-Surgery Assessment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Glotoplastia de Wendler y tratamiento logopédico en la feminización de la voz en transexuales: resultados de la valoración pre- vs. poscirugía. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:83-92. [DOI: 10.1016/j.otorri.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/02/2015] [Accepted: 02/06/2015] [Indexed: 11/19/2022]
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Vasconcelos DD, Gomes AODC, Araújo CMTD. Efetividade da fonoterapia no tratamento do pólipo em pregas vocais. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517614215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: O objetivo dessa revisão de literatura foi verificar a efetividade da fonoterapia no tratamento do pólipo em pregas vocais, a partir de levantamento bibliográfico. Foi realizada pesquisa bibliográfica na plataforma PublicMedline e nas bases de dados Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature e Web of Science, seguindo etapas de seleção e análise crítica dos artigos. Foram incluídos artigos originais que utilizaram a fonoterapia como tratamento para o pólipo vocal, sem restrições de data de publicação ou língua. Foram excluídos artigos que abordassem exclusivamente outros tratamentos para pólipo vocal e os que utilizaram a fonoterapia somente após a cirurgia laríngea. Foram encontrados inicialmente 905 artigos. Após as etapas de seleção, restaram nove artigos na composição final da amostra. Foram então analisados na íntegra, cadastrados por meio de protocolo previamente elaborado que contemplou autor, ano, local, tipo de estudo, amostra, classificação do pólipo, tipo de intervenção e principais resultados. Os artigos analisados apresentaram fragilidade metodológica e ausência de padronização quanto aos protocolos e procedimentos fonoaudiológicos utilizados. Foram constituídos em sua maioria por série de casos retrospectiva. A amostra dos estudos variou em relação à quantidade de participantes, tipo de lesão e tipo de pólipo. A fonoterapia para o tratamento do pólipo em pregas vocais demonstrou efetividade entre 38% e 100% nos estudos analisados, com melhores resultados em lesões pequenas e recentes.
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De Bodt M, Patteeuw T, Versele A. Temporal Variables in Voice Therapy. J Voice 2015; 29:611-7. [DOI: 10.1016/j.jvoice.2014.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/02/2014] [Indexed: 11/30/2022]
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Santos ACMD, Borrego MCDM, Behlau M. Effect of direct and indirect voice training in Speech-Language Pathology and Audiology students. Codas 2015; 27:384-91. [DOI: 10.1590/2317-1782/20152014232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To verify the effect of two approaches of vocal training in Speech Language Pathology and Audiology students, a direct and an indirect approach.METHODS: Participants were 25 female Speech Language Pathology and Audiology students divided into two groups: direct training with vocal exercises, DTG (n=13); and indirect training with vocal orientations, ITG (n=12). The training sessions were conducted by the same speech language pathologist in six weekly sessions of 30 minutes. Both groups underwent multidimensional voice assessment, pre- and post-training: vocal self-assessment; Vocal Symptoms Scale (VSS); auditory perceptual analysis of sustained vowel and connected speech; acoustic analysis of voice through the Vocal Range Profile (VRP) and Speech Range Profile (SRP); and Group Climate Questionnaire, only at the end of training.RESULTS: The DTG showed changes in auditory perceptual analysis of vowel, which was less diverted after training; and expansion of the voice range in the VRP and SRP, which proves best vocal performance. However, the ITG showed no changes in any of the parameters evaluated. In Group Climate, the ITG obtained the highest conflict score in comparison to the DTG, probably because the indirect approach did not favor exchange in the group and did not allow a better quality interaction.CONCLUSION: The direct approach provided greater benefits to students than the indirect approach, with significant change in voice quality, and can serve as inspiration to Speech Language Pathology and Audiology courses to prevent dysphonia.
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Fu S, Theodoros DG, Ward EC. Intensive Versus Traditional Voice Therapy for Vocal Nodules: Perceptual, Physiological, Acoustic and Aerodynamic Changes. J Voice 2015; 29:260.e31-44. [DOI: 10.1016/j.jvoice.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/05/2014] [Indexed: 11/16/2022]
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Ziegler A, Dastolfo C, Hersan R, Rosen CA, Gartner-Schmidt J. Perceptions of Voice Therapy From Patients Diagnosed With Primary Muscle Tension Dysphonia and Benign Mid-Membranous Vocal Fold Lesions. J Voice 2014; 28:742-52. [DOI: 10.1016/j.jvoice.2014.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
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The effect of retinyl palmitate on healing of benign vocal fold lesions. Eur Arch Otorhinolaryngol 2012; 270:239-42. [PMID: 22923168 DOI: 10.1007/s00405-012-2163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/13/2012] [Indexed: 10/28/2022]
Abstract
The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.
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Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 2, 2001 and previously updated in 2007 and 2009.Vocal cord nodules are bilateral, benign, callous-like growths of the mid-portion of the membranous vocal folds. They are of variable size and are characterised histologically by thickening of the epithelium with a variable degree of inflammation in the underlying superficial lamina propria. They characteristically produce hoarseness, discomfort and an unstable voice when speaking or singing. OBJECTIVES To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 9 April 2012. SELECTION CRITERIA Randomised and quasi-randomised trials comparing any surgical intervention for vocal cord nodules with non-surgical treatment or no treatment. DATA COLLECTION AND ANALYSIS No suitable trials were identified. MAIN RESULTS No studies fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS There is a need for high-quality randomised controlled trials to evaluate the effectiveness of surgical and non-surgical treatment of vocal cord nodules.
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Affiliation(s)
- Mette Pedersen
- The Medical CenterENTØstergade 18, 3CopenhagenDenmark1100
| | - Julian McGlashan
- Queen's Medical CentreDepartment of OtolaryngologyUniversity HospitalNottinghamUKNG7 2UH
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