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Stager SV, Bielamowicz SA. Evidence of Long-Term Voice Therapy Effectiveness in Patients With Presbylarynges. J Voice 2024:S0892-1997(24)00010-9. [PMID: 38320901 DOI: 10.1016/j.jvoice.2024.01.009] [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: 11/01/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Evidence for long-term effectiveness of voice therapy (>2 years from previous clinic visit) is lacking from patients over 60 years who initially presented with voice complaints and subsequently demonstrated videostroboscopic signs of aging leading to voice therapy recommendations. Over the telephone, a certified speech-language pathologist enquired from those compliant and non-compliant, whether their voices were better, stable, or worse since their previous clinic visit, and asked them to rate Voice-Related Quality of Life, voice satisfaction, and Glottal Function Index to compare with their previous clinic visit ratings. Further questions focused on current voice satisfaction, and for those who were compliant, therapeutic experiences including home exercises. Twenty-four participated (16 complied; eight non-compliant), with a mean of 3.7 ± 1.2 years since the previous clinic visit. For those compliant, 0% reported better voices, 69% stable, and 31% worse. Most compliant participants (56%) attended between two and five therapy sessions. The most frequently reported therapy techniques were repeating nasal sounds/words; straw phonation; fewer words/breath group; and increasing pitch range. Eighty-one percent of compliant participants were given home exercises. They stopped regular practice a few months post-therapy but continued using them as rescue techniques. For those non-compliant, 88% reported better voices, 0% stable, and 12% worse. Most non-compliant participants (43%) reported lack of time as their reason for non-compliance. Most compliant participants reported stable voices, supporting voice therapy's role in maintaining voice function over time in the context of progressive aging. However, non-compliant participants were not associated with poorer voice quality over time.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, 2300 M Street N.W., Room 418, Washington, DC 20037.
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, 2300 M Street N.W., Room 400, Washington, DC 20037
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Eckel HNC, Nolte A, Otte MS, Shabli S, Lang-Roth R, Klußmann JP, Hansen KK. 3D-exoscopic microlaryngoscopy in phonosurgery for glottic insufficiency. Eur Arch Otorhinolaryngol 2024; 281:855-861. [PMID: 38105362 PMCID: PMC10796486 DOI: 10.1007/s00405-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. METHODS 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. RESULTS Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. CONCLUSION Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.
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Affiliation(s)
- Hans N C Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Antonia Nolte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Martin S Otte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Jens P Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Kevin K Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
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Chang FC, Doan TN, Wang LH, To TL, Ho WC, Chou LW. Prevalence of Presbyphonia in Older Adults With Dysphonia: A Systematic Review and Meta-Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3064-3076. [PMID: 37816221 DOI: 10.1044/2023_ajslp-23-00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
PURPOSE This study aims to investigate the prevalence of presbyphonia among older adults who report voice complaints. METHOD We conducted a systematic search of five medical databases to identify studies that reported on presbyphonia as the cause of voice disorders in older adults. The pooled prevalence was calculated using random-effects models and presented as percentages with 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using I2 statistics. Subgroup analyses were performed to identify the sources of heterogeneity. RESULTS Out of 764 abstracts from five libraries, 11 studies were included in this systematic review. The pooled prevalence of presbyphonia among older adults with voice disorders is 17.78% (95% CI [12.69, 23.51]). We conducted a subgroup analysis on studies that used laryngeal visualization to confirm the diagnosis for all patients and found that the prevalence of presbyphonia was lower in studies with unrestrictive inclusion criteria (12.84%, 95% CI [8.38, 18.08]) compared to studies with restricted inclusion criteria (22.59%, 95% CI [14.49, 31.88]). CONCLUSIONS This study suggests that voice disorders in older adults have multiple causes, not predominantly presbyphonia. Overestimation of presbyphonia prevalence occurs if certain diagnoses are excluded at recruitment. This study emphasizes the importance of recognizing the diverse underlying etiologies of dysphonia in older adults; therefore, comprehensive examination and accurate diagnosis are crucial. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24263029.
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Affiliation(s)
- Fei-Chun Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
| | - Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Vietnam
| | - Liang-Hui Wang
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
- Department of Speech Language Pathology and Auditory, Hungkuang University, Taichung, Taiwan
| | - Thi-Lien To
- Faculty of Nursing, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
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Oliveira Santos A, Godoy J, Silverio K, Brasolotto A. Vocal Changes of Men and Women from Different Age Decades: An Analysis from 30 Years of Age. J Voice 2023; 37:840-850. [PMID: 34284927 DOI: 10.1016/j.jvoice.2021.06.003] [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: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify the modifications in auditory-perceptual and acoustic parameters of the fundamental frequency, short-term perturbation, noise, and cepstral measures of voice in young and elderly were distributed over the age of decades. METHODS The study was conducted on 265 subjects (140 females and 125 males), aged 30 to 79 years, without a history of vocal complaints or dysphonia, distributed in five age groups for females and males (30-39 years until 70-79 years). Three speech therapists voice specialists performed the perceptual-auditory analysis using a 100-mm visual analog scale, based on the overall dysphonia grade (overall grade), roughness, and breathiness from the sustained vowel /a/. The smoothed cepstral peak prominence (CPPS), average fundamental frequency (F0), standard deviation of the fundamental frequency (std-F0), jitter percentage (%), shimmer percentage (%), noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI) were extracted for the acoustic analysis RESULTS: In the case of the auditory-perceptual characteristics, the comparison between aged groups showed that, in men, the vocal quality did not show significant differences in the overall grade, roughness, and breathiness. However, women in the 3rd decade of life presented higher breathiness than those in the 5th, 6th, and 7th decades. Men had a higher overall grade and roughness than women. In the case of the acoustic data, the cepstral measure showed that in the 3rd decade, men presented higher CPPS than females. The noise measures, in the comparison by age groups, only VTI and SPI were different for women: VTI was higher in the 7th decade than in the 4th, whereas SPI was higher in the 4th decade than in older women. In the male population, the SPI in the 4th decade was also higher than that in the older population CONCLUSION: The analysis by age groups of life allowed the identification of breathiness as a sensitive parameter in the different stages of adult life in women. The CPPS analysis showed that the 7th age decade is the period of the appearance of vocal changes for females, characterized by higher CPPS. The results related to traditional short-term perturbation and noise measurements showed that changes in F0, jitter, shimmer, and NHR were not found. Among the other noise measurements, VTI and SPI demonstrated some changes in different decades of life.
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Affiliation(s)
- Aline Oliveira Santos
- Department of Speech Hearing and Language Disorders, University of São Paulo, São Paulo.
| | - Juliana Godoy
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal
| | - Kelly Silverio
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
| | - Alcione Brasolotto
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
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Tsai MJ, Wang CT, Fu S, Lin FC. Effect of intensive water resistance phonation therapy for people with presbyphonia: A pilot study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-9. [PMID: 37908078 DOI: 10.1080/17549507.2023.2261660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose: The aim of this pilot study was to explore the efficacy of an intensive 3 week water resistance phonation (WRP) therapy program for people with presbyphonia.Method: Participants included 13 people with presbyphonia who received intensive WRP therapy. All participants completed eight sessions of therapy over 3 weeks. Auditory perceptual ratings, and acoustic and aerodynamic assessments were performed before and after treatment. Participants also completed the voice-related quality of life questionnaire before and after the treatment.Result: After 3 weeks of intensive voice therapy, significant improvements were demonstrated in acoustic, aerodynamic, and auditory perceptual parameters, as well as patient perceptions of voice-related quality of life. Acoustically, it was found there were significant decreases in shimmer (p = 0.019), noise-to-harmonic ratio (p = 0.016), and smoothed cepstral peak prominence (p = 0.001). Perceptually, the clients with presbyphonia showed significant reductions in the ratings of the overall grade, roughness, asthenia, and strain. Moreover, there was a significant increase in the total score of the Mandarin version of the Voice-Related Quality of Life measure post-therapy.Conclusion: The investigation provides preliminary evidence that people with presbyphonia can improve their vocal function and voice-related quality of life through intensive WRP therapy within a short period of time.
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Affiliation(s)
- Ming-Jhen Tsai
- Department of Otorhinolaryngology - Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electric Engineering, Yuan-Ze University, Taoyuan, Taiwan
| | - Sherry Fu
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
- Lower School, Taipei American School, Taipei, Taiwan
| | - Feng-Chuan Lin
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Presbyphonia as an Individual Process of Voice Change. J Voice 2023; 37:303.e1-303.e14. [PMID: 33495034 DOI: 10.1016/j.jvoice.2020.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to determine the individual variability of the severity of dysphonia in the population of older women and men using the initial perceptual voice assessment (GRBAS) and objective diagnosis of the clinical form of Presbyphonia with laryngeal visualization technique (High-Speed Digital Imaging [HSDI]) and acoustic voice analysis (Diagnoscope Specjalista). METHODS The study included 302 elderly women and men. Application of perceptual GRBAS scale allowed to extract 230 subjects with voice disorders (Group I). Remaining 72 elderly subjects without the symptoms of dysphonia consisted Group II. Group III included 50 subjects with euphonic voice. In the assessment of dysphonia, visualization technique (HSDI) as well as acoustic method (Diagnoscope Specjalista). The observation of real vibration of vocal folds using HSDI technique and HS camera allowed to examine symmetricity (Shaw-Deliyski scale), periodicity and amplitude of vibration, Mucosal Wave (MW) morphology, Glottal Closure Type, and value of Open Quotient (OQ). Acoustic analysis allowed to assess value of Fundamental Frequency (F0), Maximum Phonation Time (MPT) as well as Jitter, Shimmer, Noise-to-Harmonics Ratio (NHR) parameters. Narrowband Spectrography was performed. RESULTS HSDI technique allowed to register in elderly women with voice disorders a mild asymmetry and aperiodicity of vibrations, MW reduction, amplitude increase and glottal insufficiency in the posterior segment of glottis which indicated edematous changes in the larynx. In 90% of men in this group, moderate asymmetry and aperiodicity were observed as well as amplitude decrease, significant limitation of MW and glottal insufficiency in the middle segment of the glottis which indicated atrophic changes in the larynx. In remaining 10% of men, amplitude of vibration was increased which indicated the existence of hypofunctional dysphonia. Objective confirmation of glottal insufficiency in women with edematous changes was high value of OQ in posterior segment of the glottis registered with HSDI technique. In men with larynx atrophy, the value of OQ was the highest in the middle segment of the glottis. Glottal insufficiency, especially in the middle segment, coexisted with the increase of NHR parameter observed in acoustic examination and with numerous nonharmonic components in the scope of high frequencies revealed in narrowband spectrography, especially in men with larynx atrophy. What is more, in men, the increase of F0 and reduction of MPT was registered. In women with edematous changes of the larynx, acoustic analysis revealed decrease of F0 value, increase of Jitter, Shimmer, NHR as well as reduction of MPT. Narrowband sopectrography revealed not only harmonic components but also nonharmonics in the range of low, medium, and high frequencies. CONCLUSIONS The course of Presbyphonia varies individually in the elderly. In many subjects, the process of aging does not influence the quality of voice. Crucial importance in the diagnosis of Presbyphonia is assigned to High-Speed Digital Imaging technique which confirms the existence of edematous changes in the larynx in women as well as atrophy and hypofunctional dysphonia in men. The acoustic examination of voice confirmed the individual variability of the severity of Presbyphonia in the elderly depending on the clinical form of dysphonia determined by the gender of the diagnosed person.
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Ng WC, Lokanathan Y, Baki MM, Fauzi MB, Zainuddin AA, Azman M. Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel. Biomedicines 2022; 10:biomedicines10123082. [PMID: 36551838 PMCID: PMC9775346 DOI: 10.3390/biomedicines10123082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton's Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration.
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Affiliation(s)
- Wan-Chiew Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence:
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Motohashi R, Tokashiki R, Konomi U, Sakurai E, Saito Y, Shoji Y, Osanai A, Tsukahara K. Effectiveness of Breath-holding Pulling Exercise in Patients with Vocal Fold Atrophy. J Voice 2022:S0892-1997(22)00199-0. [PMID: 35987739 DOI: 10.1016/j.jvoice.2022.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In recent years, the incidence of vocal fold atrophy has increased among the elderly. Vocal function exercises (VFE) are performed in patients with age-related vocal fold atrophy; however, treatment could be challenging if the patient is unable to go to the hospital or in hospitals that do not have a speech pathologist. Breath-holding pulling exercises are simple and can be performed anywhere for the management of such patients. This study aimed to examine the effectiveness of breath-holding pulling exercises in patients with vocal fold atrophy. STUDY DESIGN Retrospective study METHODS: With the hands folded in front of the chest, the patients were instructed to take a deep breath, pull their hands to the left and right, and then hold their breath for 5 seconds. The physician instructed the patients to do this 10 times each morning, afternoon, and evening. Speech function, acoustic analysis, pitch range, and Voice Handicap Index-10 (VHI-10) were evaluated and compared before and 4-8 weeks after treatment. RESULTS Maximum phonation time (MPT), the primary endpoint, significantly improved after treatment from 14.2 ± 6.6 to 20.3 ± 9.3 seconds. Among the secondary endpoints, mean flow rate (207.5 ± 104.4 to 165.1 ± 66.5 mL/s), pitch range (22.9 ± 8.3 to 26.2 ± 8.1 semitones), VHI-10 (18.1 ± 7.2 to 12.5 ± 6.3 points) jitter (2.5±1.6 to 1.7±1.2%), and shimmer (5.9±3.5 to 4.8±3.3%) showed significant improvement. CONCLUSION Breath-holding pulling exercises were found to be effective in patients with vocal fold atrophy. These can be performed in hospitals with no speech pathologists, in patients who are unable to go to the hospital, and in patients who are hospitalized or unable to speak loudly. Moreover, as with conventional VFE, the training method achieves a high level of patient satisfaction.
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Affiliation(s)
- Ray Motohashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Ryoji Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan
| | - Ujimoto Konomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Eriko Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Saito
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Shoji
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ayaka Osanai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Song JS, Campbell R, Lin RJ, Jeffery CC. Laryngoscopic Findings of Age-related Vocal Fold Atrophy are Reliable but not Specific. Clin Otolaryngol 2022; 47:516-520. [PMID: 35397140 DOI: 10.1111/coa.13936] [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: 10/31/2021] [Revised: 01/18/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists. DESIGN Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymized laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy, and specify which laryngoscopy features were present to make the diagnosis. SETTING Tertiary care laryngology practice. PARTICIPANTS Two fellowship-trained laryngologists and three trainee otolaryngologists. MAIN OUTCOME MEASURES Accuracy of age categorization was determined and Kappa analysis was performed to assess inter-rater agreement. RESULTS The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds, and prominent vocal processes were all identified with high agreement (>80.0%). CONCLUSION Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.
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Affiliation(s)
- Jin Soo Song
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Health Sciences, University of Alberta, Edmonton, AB, CANADA
| | - Ross Campbell
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, CANADA
| | - R Jun Lin
- Department of Otolaryngology-Head and Neck Surgery, Laryngology, St. Michael's Hospital, University of Toronto, ON, CANADA
| | - Caroline C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Health Sciences, University of Alberta, Edmonton, AB, CANADA.,Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, CANADA
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González-Herranz R, Navarro-Mediano A, Hernández-García E, Plaza G. Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia. Otolaryngol Head Neck Surg 2021; 167:118-124. [PMID: 34546813 DOI: 10.1177/01945998211045292] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. STUDY DESIGN Retrospective cohort study. SETTING Academic secondary medical center. METHODS This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index-10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. RESULTS At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds (P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. CONCLUSIONS AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.
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Affiliation(s)
- Ramón González-Herranz
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | | | - Estefanía Hernández-García
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
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