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Ren QW, Lei G, Zhao YL, Zhou L, Luo XL, Peng SL. Laryngopharyngeal Reflux and Benign Vocal Fold Lesions: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:309-319. [PMID: 37727944 DOI: 10.1002/ohn.529] [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: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE There is a link between laryngopharyngeal reflux (LPR) and the formation of benign vocal fold lesions (BVFLs). However, previous studies have mainly focused on LPR suggested by symptoms and signs, rather than objectively diagnosed LPR via pharyngeal pH monitoring. We, therefore, conducted a Meta-analysis to evaluate the association between pharyngeal pH monitoring diagnosed LPR and the odds of BVFLs. DATA SOURCES Relevant observational studies were identified by searching PubMed, Embase, Cochrane Library, and Web of Science. REVIEW METHODS We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. RESULTS Thirteen datasets from 9 studies were included. Among them, 493 were diagnosed with LPR and 344 had BVFLs. LPR was related to a higher odds of BVFLs (odds ratio: 3.26, 95% confidence interval: 1.84-5.76, P < .001) with moderate heterogeneity (P for Cochrane Q test = .006, I2 = 57%). Subgroup analyses showed that the association was similar in studies with only pharyngeal pH monitoring (Restech), with double-probe or 3-site pH monitoring, and with 24-hour multichannel intraluminal impedance-pH monitoring (P for subgroup difference = .15). In addition, subgroup analysis showed consistent results in studies from Asia and Europe (P for subgroup analysis = .12), and the association seemed to be consistent for vocal Reinke's edema, nodules, and polyps (P for subgroup difference = .09). CONCLUSION Pharyngeal pH monitoring diagnosed LPR is associated with the formation of BVFLs.
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Affiliation(s)
- Quan-Wei Ren
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Gang Lei
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yan-Li Zhao
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Li Zhou
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Li Luo
- Department of Otolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Shun-Lin Peng
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Robotti C, Schindler A, Lechien JR, Di Sabatino A, Capobianco S, Schindler A, Ottaviani F, Sims HS, Bertino G, Benazzo M, Mozzanica F. Prevalence of Laryngopharyngeal Reflux Symptoms, Dysphonia, and Vocal Tract Discomfort in Amateur Choir Singers. J Voice 2023; 37:932-944. [PMID: 34404581 DOI: 10.1016/j.jvoice.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Vocal tract discomfort (VTD), dysphonia, and laryngopharyngeal reflux (LPR) symptoms are complaints frequently reported by amateur singers. There are two aims of this study. The first is to evaluate the prevalence of these symptoms using validated questionnaires. The second is to correlate singing-related variables with the questionnaire responses. METHODS A total of 392 amateur choir singers (ACS) and 514 control subjects completed an online survey divided into four parts: (1) clinical and demographic characteristics, (2) training in singing and singing experience, (3) history of gastroesophageal reflux disease and LPR symptoms, (4) validated questionnaires. Specifically, the reflux symptom index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) were included to analyze the actual burden related to LPR symptoms, VTD, and dysphonia. RESULTS ACS demonstrated a healthier lifestyle and a lower prevalence of gastroesophageal reflux disease symptoms in comparison with control subjects. ACS scored significantly higher in VTDS and VoiSS than control subjects, while no differences in the RSI results were found. Significant correlations among the questionnaires' results were demonstrated. Occasional professional singing was the variable influencing VTDS and VoiSS results the most. CONCLUSION ACS do not evidently manifest a higher impairment connected to LPR (RSI score), while they do report higher levels of voice (VoiSS score) and vocal tract (VTDS score) impairments, in comparison with control subjects. The relevant correlations among the PRO measures suggest that LPR symptoms, VTD, and dysphonia are related to each other. Given the relevant repercussion on the severity of VTD and dysphonia, providers should specifically ask about occasional professional singing when treating amateur singers.
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Affiliation(s)
- Carlo Robotti
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonio Schindler
- Department of Biochemical and Clinical Science "L. Sacco", Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | - Jerome R Lechien
- Department of Otolaryngology - Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Capobianco
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT section, Pisa, Italy
| | - Antonio Schindler
- Department of Biochemical and Clinical Science "L. Sacco", Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | - Francesco Ottaviani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - H Steven Sims
- Chicago Institute for Voice Care, Department of Otolaryngology, University of Illinois Medical Center, Chicago, Illinois
| | - Giulia Bertino
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy.
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Bretl MM, Gerhard J, Rosow DE, Anis M, Landera MA, Libman D, Marchman J, Ragsdale F, Moore S, Ma R, Hoffman B, Ivey C, Johns MM, Menton SM, Lloyd AT. Vocal Fold Pathologies Among Undergraduate Singing Students In Three Different Genres. Laryngoscope 2023; 133:2317-2324. [PMID: 36567624 DOI: 10.1002/lary.30533] [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: 06/10/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points. METHODS This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres. RESULTS During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers. CONCLUSION No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre. LEVEL OF EVIDENCE 2 Laryngoscope, 133:2317-2324, 2023.
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Affiliation(s)
- Michelle M Bretl
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Julia Gerhard
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - David E Rosow
- Department of Otolaryngology, Miller School of Medicine, Department of Otolaryngology, Division of Laryngology and Voice, University of Miami, Miami, Florida, USA
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Mursalin Anis
- Department of Otolaryngology, Miller School of Medicine, Department of Otolaryngology, Division of Laryngology and Voice, University of Miami, Miami, Florida, USA
| | - Mario A Landera
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Dana Libman
- Department of Otolaryngology, Division of Audiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Judy Marchman
- School of Music, Hardin-Simmons University, Abilene, Texas, USA
| | - Frank Ragsdale
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Stephannie Moore
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Ruixuan Ma
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Bari Hoffman
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Chandra Ivey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael M Johns
- University of Southern California, Keck School of Medicine of USC, Department of Otolaryngology, Division of Laryngology, California, Los Angeles, USA
| | - Stacey M Menton
- Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam T Lloyd
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Zuim AF, Gerhard J, Lloyd AT, Rosow DE, Lundy DS. Independence of Vocal Load From Vocal Pathology Across Singing Genres. J Voice 2023; 37:294.e15-294.e20. [PMID: 33500198 DOI: 10.1016/j.jvoice.2020.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the extent to which vocal load is associated with previous diagnosis of a vocal pathology among four major genres of singers (primarily classical, primarily musical theatre (MT), classical and MT combined, and contemporary commercial music only). STUDY DESIGN Cross sectional survey. METHODS/DESIGN An anonymous online survey was sent out to about 1000 professional singers through convenience sampling to touring companies, opera companies, MT companies, agents, directors and musical directors. Social media and email were used to solicit participation in the study. We utilized means and standard deviations for continuous characteristics and frequencies and percentages for categorical characteristics and calculated P values to assess whether differences were statistically significant. RESULTS A total of 396 professional singers completed the survey, yielding a 40% response rate. Nonprofessional singers, incomplete surveys, and respondents <18 years old were excluded, resulting in a total of 238 responses. Among the 238 participants, 32% were performing in the classical style primarily, 33% in the MTstyle primarily, 15% in both classical and MT, and 20% in other contemporary styles only. Mean age was highest among CV + MT and lowest among primarily MT. Combined classical/MT singers were most likely to have a career outside of vocal performance and continue to work in that career followed by other contemporary styles, classical and MT (P = 0.02). Participants in the combined classical/MT group were most likely to have a reported history of vocal pathology followed by classical, other contemporary styles and MT (not statistically significant). However, participants in the contemporary styles were most likely to have a history of more than one type of vocal pathology. Mean vocal load was highest for the MT group. Other nonsinging factors proved significant such as allergy, hydration and acid reflux. Symptoms of allergies were found to be significant across singing genres. A possible reverse causality association was identified in regards to water intake. Participants with acid reflux were three times more likely to have ever reported vocal pathology. CONCLUSION Vocal load was not significantly associated with vocal pathology across singing genres; however other nonsinging factors such as allergy, reflux and water intake were significantly associated with vocal pathology.
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Affiliation(s)
- Ana Flavia Zuim
- New York University Steinhardt School of Culture, Education, and Human Development, Department of Music and Performing Arts Professions, New York, New York.
| | | | - Adam T Lloyd
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | - David E Rosow
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | - Donna S Lundy
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
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Nacci A, Capobianco S, Mazzoni L, Fattori B, Barillari MR, Genovese E, Berrettini S, Bastiani L. Development of a New Self-Assessment Tool for Laryngopharyngeal Reflux Screening in Singers (SVHI-12-LPR). Folia Phoniatr Logop 2023; 75:284-294. [PMID: 36822157 DOI: 10.1159/000529800] [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: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION The present study aimed to develop a new tool for the evaluation of singers with self-reported symptoms suggestive of laryngopharyngeal reflux (LPR) (the SVHI-12-LPR), by correlating RSI with SVHI in a population sample of 163 subjects (both professional and amateur singers), evaluated also by videolaryngostroboscopy. This study was a cross-sectional, double-observational study. METHODS RSI and SVHI were administered to 159 singers (amateurs, singing students, and professional singers). All subjects underwent videolaryngostroboscopy to objectively identify four subgroups: normal subjects (41.5%), subjects with organic lesions occupying the glottic space (17.6%), subjects with functional dysphonia (18.2%), and subjects presenting solely signs suggestive of LPR (22.6%). Using the validated RSI threshold, 33.9% of participants presented an RSI total score >13, suggestive of LPR. RESULTS Subjects with a suspected diagnosis of LPR at videolaryngostroboscopy presented a mean RSI significantly higher than other subgroups (p < 0.001). Moreover, the SVHI-36 score did not statistically differ between pathological subgroups. A significant positive relationship was observed between RSI and SVHI total score (Spearman's rank correlation coefficient [ρ] = 0.474, p < 0.001). 12 SVHI items (items 1, 2, 4, 5, 6, 7, 12, 20, 24, 25, 26, 30) showed a significant association with RSI pathology classification. Statistical analysis demonstrated for the 12 selected items (SVHI-12-LPR) acceptable specificity (0.691) and sensibility (0.833) for the suspected diagnosis of LPR with a cut-off of 15. CONCLUSIONS From the SVHI-36, 12 items were extracted that correlated with the specific impact that LPR has on the singer's voice (SVHI-12-LPR), as evaluated by RSI and videolaryngostroboscopy. Such questionnaire represents a new tool that could be applied to singers with symptoms suggestive of LPR to select which patients would benefit from a further phoniatric and videolaryngostroboscopic evaluation.
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Affiliation(s)
- Andrea Nacci
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Silvia Capobianco
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Laura Mazzoni
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Fattori
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy
| | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
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Kazi AA, Yu C, Vahidi NA, Donnell C, Moore JE. Longitudinal Assessment of Singing Students. J Voice 2023; 37:145.e19-145.e21. [PMID: 33413983 DOI: 10.1016/j.jvoice.2020.12.026] [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: 05/31/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Singers have unique vocal demands, and if the voice is impaired there can be a negative impact on their quality of life. While a variety of options exist to assess vocal health, the utilization of cepstral peak prominence (CPP) has increased due to his reliability in some situations. However, it has not been utilized commonly in the singing population. This study sought to assess vocal health in singing students using noninvasive measures such as singing voice handicap index (SVHI) and consensus auditory perceptual evaluation of voice (CAPE-V) as well as CPP to provide preliminary information on this measure. METHODS A prospective longitudinal study of singing students independent of year of training enrolled in a 2-credit voice lesson at an undergraduate School of Music was conducted. Non-invasive measures were used to evaluate the voice. All participants recorded the same spoken sentence at four equally spaced intervals throughout the semester using a ZOOM H4n Pro (two cardioid input microphone, Hauppauge, New Year). Participants completed SVHI at the time of each recording, and CAPE-V conducted by two speech language pathologists trained in voice. CPP was determined using running speech samples. RESULTS A total of 23 singers completed the study (11 male, 12 female). There was a significant difference in SVHI at the first recording compared to the final recording (10.6 ± 4.6 vs 9.3 ± 5.9, P= 0.008). Similarly, there was a significant difference in CPP at the first recording compared to the final recording (9 ± 3 vs 9.4 ± 1.1, P < 0.001). However, no significant difference was seen with CAPE-V. CONCLUSION Our results are similar to previous studies. There was no evidence in decline in objective and subjective vocal quality utilizing the measure included in our study.
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Affiliation(s)
- Aasif A Kazi
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Cheryl Yu
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Nima A Vahidi
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Cynthia Donnell
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jaime E Moore
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Music, Virginia Commonwealth University School of the Arts, Richmond, Virginia.
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Ahmadi N, Abbott KV, Rajati F, Khoddami SM, Torabinezhad F, Ebrahimi Takamjani I, Vasaghi-Gharamaleki B. Effects of Laryngeal Manual Therapy on Primary Muscle Tension Dysphonia (MTD-1): Implications for MTD-1 Type. J Voice 2022:S0892-1997(22)00106-0. [PMID: 35963763 DOI: 10.1016/j.jvoice.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study investigated effects of laryngeal manual therapy on different types of primary muscle tension dysphonia (MTD-1). STUDY DESIGN Interventional pre-test post-test design. METHODS Thirty-two traditional Iranian singers (mean age of 36.75 ± 9.34 years.) diagnosed with MTD-1, 8 female and 24 male, and recruited by convenience sampling completed the study. MTD-1 was classified as Morrison and Rammage's types 1-5, based on standardized criteria (1993). Pre-post-treatment measures were based on visual ratings of the larynx, acoustic analyses, auditory-perceptual assessments of voice (Auditory-Perceptual Rating Instrument for Operatic Singing Voice: EAI Scale Form), and the Persian Singing Voice Handicap Index (P-SVHI), reported before and after 10 sessions of laryngeal manual therapy (LMT). RESULTS The most notable finding was that the number of cases with MTD-1 types 1 and 2 actually increased after treatment, while the number of cases with MTD-1 types 3, 4 and 5 decreased. The data suggested that MTD-1 types 3, 4, and 5 tended to convert to types 1 and 2 with LMT. Acoustic analyses showed a significant decrease in F0 (males only; P = 0.011), a sharp decrease in HNR from 23.26 dB to 14.74 dB (P = 0.000), and an increase in shimmer from 4.18% to 6.90 % while no appreciable change was found in jitter (P = 0.57). Mean P-SVHI score decreased significantly from 52.03 to 41.16 (P = 0.002) and EAI score increased from 4.41 to 6.31 (P = 0.000) after treatment. CONCLUSIONS The primary finding was that the distribution of MTD-1 type changed after treatment in many cases, converting from one to another type. Acoustic as well as glottal closure measures for several participants revealed closure insufficiency after treatment, unveiled as hyperfunction was unloaded with LMT. For those participants, complementary treatments aimed at reinforcement of laryngeal closure functions would be appropriate.
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Affiliation(s)
- Nassim Ahmadi
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Katherine Verdolini Abbott
- Departments of Communication Sciences and Disorders and Linguistics, and Department of Linguistics and Cognitive Science, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Fatemeh Rajati
- Research Center Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Torabinezhad
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Behnoosh Vasaghi-Gharamaleki
- Rehabilitation Research Center, Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Mohd Mossadeq N, Mohd Khairuddin KA, Zakaria MN. Cross-cultural Adaptation of the Consensus Auditory-perceptual Evaluation of Voice (CAPE-V) Into Malay: A Validity Study. J Voice 2022:S0892-1997(22)00151-5. [PMID: 35760635 DOI: 10.1016/j.jvoice.2022.05.018] [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: 04/13/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
Auditory-perceptual rating of voice is one component of voice evaluation, and the CAPE-V is one of the tools for this purpose. Because of its advantages, the CAPE-V has been adapted into several languages. Accordingly, the adaptation of the CAPE-V into Malay is essential for its utility among the Malaysian population, which this study aimed to accomplish. This study involved translating the CAPE-V into Malay, termed the Malay CAPE-V, followed by establishing its validity. The translation processes (ie, forward translation and backward translation) involved four different translators ie, three speech-language therapists (SLTs), and one linguist with at least 14 years of experience. Most items were similarly translated, except for a few, which were subsequently accepted as similar, following consensus among the translators. In the examination of content validity, two raters (ie, SLTs) with at least 12 years of clinical experience reviewed and scored the tested items. Given that the scale-level content validity index average value (S-CVI/Ave) was above the acceptable level, all items were retained. The examination of construct validity and concurrent validity involved ratings of voice samples recorded from 38 participants, comprising 19 individuals with normal and disordered voices, respectively. The ratings were performed by three raters (ie, SLTs) with at least 12 years of clinical experience. For the construct validity, the Mann-Whitney U test indicated significantly higher scores of the vocal parameters of the Malay CAPE-V for the disordered voice group than for the normal voice group. Meanwhile, for the concurrent validity, the Spearman correlation indicated that all relationships between the scores of the vocal parameters of the Malay CAPE-V and GRBAS Scale were significant, with most of them achieving a very strong positive correlation. The results demonstrated that the Malay CAPE-V is a valid tool for an auditory-perceptual rating of voice among the Malaysian population.
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Affiliation(s)
- Nurhayati Mohd Mossadeq
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Khairy Anuar Mohd Khairuddin
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Mohd Normani Zakaria
- Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Thommen J, Gogos B, Héritier F, Unteregger F, Lieb J, Storck C. Endoscopic and Computed Tomography Evaluation of Posterior Glottic Closure During Phonation. Laryngoscope 2021; 132:124-129. [PMID: 34165798 DOI: 10.1002/lary.29707] [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: 05/05/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high-resolution computed tomography (HRCT) and three-dimensional (3D) reconstruction findings. STUDY DESIGN Prospective study. METHODS Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air-column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants. RESULTS The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P = .33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P = .036). CONCLUSIONS The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Jan Thommen
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, University Hospital Basel, Basel, Switzerland
| | - Bettina Gogos
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, University Hospital Basel, Basel, Switzerland
| | - Florent Héritier
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, University Hospital Basel, Basel, Switzerland
| | - Fabian Unteregger
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, University Hospital Basel, Basel, Switzerland
| | - Johanna Lieb
- Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Claudio Storck
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, University Hospital Basel, Basel, Switzerland
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10
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Beaud M, Amy de la Bretèque B, Pillot-Loiseau C, Henrich Bernardoni N. Clinical characteristics of singers attending a phoniatric outpatient clinic. LOGOP PHONIATR VOCO 2021; 47:209-218. [PMID: 34110262 DOI: 10.1080/14015439.2021.1924853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Studies suggest that singers are over-represented in voice clinics and present a high risk of developing voice disorders. This retrospective study aims to describe the characteristics of 78 singers consulting a phoniatrician.Methods: In their medical files, data related to age, gender, occupational status, singing training, musical style, voice complaint, diagnosis, voice-quality grading (GRBAS) and treatment were gathered.Results: The patients were mostly female singers (87%). Non-professional singers (semi-professional included) represented 64%, professional singers 25% and students of singing 11%. The majority of singers were choristers (27%) and 22% were classical-style/oratorio-style singers. Two-thirds of the population had intensive vocal activity in speech or singing. Vocal endurance, somatosensory signs and difficulties with high pitches were the most frequent symptoms. Among the patients, 79% presented with singing-voice disorders with 85% of these having vocal fold lesions. Generally, their speaking voices were preserved. Vocal-folds nodules were the most prevalent pathology (37%) followed by sulcus (26%) and voice therapy was the main treatment.Conclusions: This study emphasizes the fact that singers have specific voice complaints related to their voice usage. The high occurrence of sulcus and other congenital-lesion suspicions, unusual in the general population consulting an ENT phoniatrician, seems to be rather specific for singers in agreement with the literature.
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Affiliation(s)
- Marion Beaud
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | | | - Claire Pillot-Loiseau
- Phonetics and Phonology Lab, CNRS UMR 7018, Paris 3 Sorbonne Nouvelle University, Paris, France
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11
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Boles RW, Gao WZ, Johns MM, Daniero JJ, Grant NN, Rubin AD, Bhatt NK, Hapner ER, O'Dell K. Flexible Versus Rigid Laryngoscopy: A Prospective, Blinded Comparison of Image Quality. J Voice 2021; 37:440-443. [PMID: 33775470 DOI: 10.1016/j.jvoice.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability. STUDY DESIGN Prospective cohort study; blinded comparison. METHODS Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ2. Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement. RESULTS RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P<0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01). CONCLUSIONS There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant.
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Affiliation(s)
- Roger W Boles
- Keck School of Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nazaneen N Grant
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical School, Washington, District of Columbia
| | - Adam D Rubin
- Lakeshore Ears, Nose, Throat Center, St. Clair Shores, Michighan
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Edie R Hapner
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
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12
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Rotsides J, Chen S, Winchester A, Amin MR, Johnson AM. Laryngeal Pathologies Associated with the Genre of Singing and Professional Singing Status in a Treatment-Seeking Population. Laryngoscope 2020; 131:2076-2080. [PMID: 33270237 DOI: 10.1002/lary.29303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Singers have high vocal demands and are at increased risk of developing voice disorders. Different singing genres place different technical demands on the voice. However, differences in laryngeal pathology based on genre have not been well-researched. The purpose of this study was to determine the prevalence of laryngeal pathology in different genres of professional and amateur singers who present with a voice complaint. STUDY DESIGN Retrospective review. METHODS Retrospective review of patients seen at a tertiary laryngology practice. Self-identified singers who reported their primary singing genre and categorized their singing as a full-time job, part-time job, or amateur involvement were included. Type and prevalence of pathology were calculated based on genre and professional status. RESULTS Of the 302 self-identified singers, 54% (n = 164) had laryngeal pathology. Among those with pathology, the most common finding was fibrotic lesion (38.4%, 63/164). Genres in which a majority of singers had pathology were other (69.2%, 9/13), choral (64.7%, 11/17), pop (63.2%, 12/19), musical theater (61.4%, 43/70), country (100%, 4/4), and Latin (100%, 2/2). The highest prevalence of pathology was seen in part-time professional singers (62.2%, 41/66) and full-time professionals (60.8%, 62/102), compared to amateurs (45.1%, 60/133). CONCLUSIONS Laryngeal pathology is prevalent in singers presenting with a voice complaint. Regardless of genre or professional status, fibrotic lesions were the most common pathological finding. This study provides preliminary data on the prevalence of different laryngeal pathologies found in singers by genre and degree of professional involvement. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2076-2080, 2021.
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Affiliation(s)
- Janine Rotsides
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Sophia Chen
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Arianna Winchester
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Milan R Amin
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Aaron M Johnson
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
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13
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Mohd Khairuddin KA, Ahmad K, Mohd Ibrahim H, Yan Y. Description of the Features and Vibratory Behaviors of the Nyquist Plot Analyzed From Laryngeal High-Speed Videoendoscopy Images. J Voice 2020; 36:582.e11-582.e22. [PMID: 32861565 DOI: 10.1016/j.jvoice.2020.07.036] [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: 05/19/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022]
Abstract
Facilitative playback-based subjective measures offer a more reliable evaluation of the vocal fold vibration than those derived from direct inspection of video playback. One of the measures is a Nyquist plot, which presents the analyzed cycle-to-cycle vibratory information in a graphical form. While the potential is evident, the information of the features of the Nyquist plot, which the evaluation is based on, is still incomplete. The current identified features and their vibratory behaviors may be inadequate to guarantee accurate interpretation of the findings. The present study aims to address this issue by examining the features of the Nyquist plot and their vibratory behaviors. A total of 56 young normophonic speakers, that is, 20 males and 36 females were recruited as the participants. Each of them underwent laryngeal high-speed videoendoscopy to record the images of the vocal fold vibration, which were then analyzed to generate the Nyquist plots. The features were identified by inspecting the properties of the plot points forming the Nyquist plots. For each identified feature, its vibratory behaviors were examined. The results revealed four features: rim contour depicting the longitudinal phase difference; left edge shape signifying the glottal configuration, phase closure, and closed phase duration; rim width and rim pattern visualizing the regularity of glottal areas and the regularity of the intracycle variations, respectively. The findings present a more complete reference of the features and their vibratory behaviors that is pertinent for the Nyquist plot interpretation.
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Affiliation(s)
- Khairy Anuar Mohd Khairuddin
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Speech Pathology Program, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
| | - Kartini Ahmad
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hasherah Mohd Ibrahim
- Speech Sciences Program, Centre for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yuling Yan
- Department of Bioengineering, School of Engineering, Santa Clara University, California, USA
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14
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Lee DR, Weinrich B, Zacharias S, LeBorgne W, Beckmeyer J, Eanes C, Tabangin ME, de Alarcon A. Endoscopic Findings in Male Prepubertal Choir Singers. Laryngoscope 2020; 131:592-597. [PMID: 32589783 DOI: 10.1002/lary.28786] [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: 01/28/2020] [Revised: 04/26/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The male singing voice through puberty undergoes many changes that present challenges for the singer and choral director. The purpose of this study was to discuss the endoscopic findings seen in prepubescent choir singers. STUDY DESIGN Single-institution prospective study. METHODS Subjects were recruited from the Cincinnati Boychoir and were described as Cooksey stage unchanged or mid-voice I, as described by the Boychoir artistic director. Vocal history was obtained via questionnaire at the initial visit. Subjects with known laryngeal pathologies were excluded. Endoscopic laryngeal examinations were performed using videoendoscopy. During examination, each subject sang four discrete frequencies. Findings of the endoscopic exam were judged by a board-certified pediatric otolaryngologist specializing in pediatric voice. RESULTS We evaluated 28 subjects prior to vocal maturation. Their age range was 8 to 13 years old (mean = 10.2 ± 1.2 years). The singing voice category of all 28 subjects was described as soprano vocal range by the Boychoir artistic director. The subjects had a mean of 1.7 ± 1.1 years in the Boychoir (0-5 years). None reported history of vocal issues or voice problems in the past; seven (25%) subjects had vocal fold lesions seen at one or more frequencies; 24 (85%) subjects had a posterior gap seen at one or more frequencies. Two subjects (7%) had a posterior gap at one frequency, C3 and G3, respectively. Five subjects (18%) had a posterior gap at two frequencies, seven subjects (25%) at three frequencies, and 10 subjects (36%) in all four frequencies. CONCLUSIONS Our study aimed to describe the laryngeal examination of dedicated Boychoir singers prior to undergoing pubertal development and vocal maturation. In elite pediatric singers we found that vocal nodules are common (25%) and are not correlated with vocal symptoms. These findings may suggest that asymptomatic lesions may be more prevalent than previously thought. In these individuals, posterior glottic gap is common and can be considered a normal glottal configuration. LEVEL OF EVIDENCE 4 Laryngoscope, 131:592-597, 2021.
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Affiliation(s)
- David R Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Barbara Weinrich
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Speech Pathology and Audiology, Miami University, Oxford, Ohio, U.S.A
| | - Stephanie Zacharias
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Division of Pediatric Otolaryngology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Wendy LeBorgne
- Professional Voice Center of Greater Cincinnati, Cincinnati, Ohio, U.S.A
| | - Janet Beckmeyer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Christopher Eanes
- Cincinnati Boychoir, Cincinnati, Ohio, U.S.A.,Cathedral Choral Society, Washington National Cathedral, Washington, District of Columbia, U.S.A
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Alessandro de Alarcon
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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15
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Nacci A, Bastiani L, Barillari MR, Martinelli M, Lechien JR, Simoni F, Berrettini S, Fattori B. Reflux Symptom Index (RSI) and Singing Voice Handicap Index (SVHI) in Singing Students: A Pilot Study. J Voice 2020; 36:288.e25-288.e34. [PMID: 32553500 DOI: 10.1016/j.jvoice.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To correlate, RSI with SVHI, in a group of singing students, by means of a specific anamnestic questionnaire which analyzes the physical, social, emotional, and economic impacts of voice problems on their lives. This study is a cross-sectional single-center observational study. METHODS Forty-two modern singing students (26F/16M; average age: 24.9 ± 5.7; range: 16-46 years old) were recruited. A self-assessment of the singing-voice (SVHI) and of reflux symptom (RSI) was performed. RESULTS Using the validated RSI threshold, 31% of participants were classified as RSI greater than 13 as an indication of suspected LPR. Classifying the SVHI score as proposed in the recent literature (cutoff of 20.35) our sample was a voice disorders prevalence of 71.4%. There was no significant positive or negative relationship between RSI and SVHI total score (rho = 0.238, P = 0.13). Instead, by considering the relationship between the individual items of the two questionnaires, it is highlighted that the item 1 of SVHI was significantly correlated with most of the RSI items (P = 0.0001-0.006). In the same vein, the item 5 of SVHI was correlated to hoarseness and coughing (P = 0.005-0.006). The item 20 of SVHI was significantly correlated with hoarseness, excess mucus in the throat or postnasal drip and with the pharyngeal Globus sensation (P = 0.001-0.005). By aggregating the SVHI item response as a positive response (2-4) versus a negative response (0 or 1) between "RSI pathology classification," a significant association was observed for SVHI item 1 (P < 0.021), item 5 (P < 0.006), item 20 (P < 0.042), item 24 (P < 0.044) item 25 (P < 0.047). These associations were confirmed by univariate binary logistic. Multivariate binary logistic regression confirms that SVHI Item 1, Item 5 were more associated with RSI positive. Based on results, we propose a questionnaire that combines the most relevant SVHI items correlated to LPRD (SVHI-10-LPRD questionnaire). Cronbach's alpha coefficient for the 10 items selected was 0.87; item-total correlation coefficients for each item were in the range of 0.461 to 0.670. CONCLUSIONS This pilot study shows that, in case of significant RSI for LPR, it is possible to observe a significant association with some symptoms described in SVHI. These results underline that the association of the RSI and SVHI questionnaires administered to singers and singing students, can represent a simple screening to reveal possible alterations of the singing voice correlate to LPR. Moreover, we propose a Singing Voice Handicap Index correlated to LPR (SVHI-10-LPRD). It will be necessary to increase the sample of subjects in the study to confirm these preliminary data.
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Affiliation(s)
- Andrea Nacci
- ENT Audiology Phoniatric Unit, University of Pisa, Pisa, Italy; Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
| | - Luca Bastiani
- CNR Institute of Clinical Physiology, Epidemiology Section, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France; Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University, Naples, Italy
| | - Massimo Martinelli
- CNR Institute of Information Science and Technologies, Signals & Images Lab, Pisa, Italy
| | - Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, University of Paris Saclay, Paris, France
| | - Federica Simoni
- ENT Audiology Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Stefano Berrettini
- ENT Audiology Phoniatric Unit, University of Pisa, Pisa, Italy; Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Bruno Fattori
- ENT Audiology Phoniatric Unit, University of Pisa, Pisa, Italy
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16
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Devadas U, Kumar PC, Maruthy S. Prevalence of and Risk Factors for Self-Reported Voice Problems Among Carnatic Singers. J Voice 2020; 34:303.e1-303.e15. [DOI: 10.1016/j.jvoice.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
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17
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Zuim AF, Lloyd AT, Gerhard J, Rosow D, Lundy D. Associations of Education and Training with Perceived Singing Voice Function Among Professional Singers. J Voice 2019; 35:500.e17-500.e24. [PMID: 31679926 DOI: 10.1016/j.jvoice.2019.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The educational backgrounds of professional singers vary greatly and span from no formal training to advanced degrees in music or theater. Consequently, professional singers have a wide range of knowledge regarding basic voice care. The objective of this study was to examine associations between singers' educational backgrounds, specifically their knowledge of vocal pedagogy and awareness of vocal health, and their perceptions of their current vocal function associated with singing. STUDY DESIGN Cross sectional survey. METHODS An online survey was distributed nationwide to over 1,000 self-identifying as a professional singer working full time as a performer. The survey included 54 questions about their background education, performance history, years of professional experience, affiliation to a professional union, general health and wellness, and the Evaluation of the Ability to Sing Easily (EASE), a 20-item scale to assess singers' perceptions of the current status of their vocal function. RESULTS A total of 396 amateur and professional singers completed the survey yielding a 40% response rate. Of 396 surveys received, 154 were excluded because the respondent was not a professional singer and/or the survey was incomplete and four were excluded because the respondent was <19 years old (396-158 = 238). Of 238, 199 completed the EASE (included in this analysis sample). The respondents identified their primary singing genre(s) as follows: 29% classical, 22% musical theatre, 45% both classical and musical theatre, and 5% other contemporary styles. Overall mean (SD, range) Rasch converted EASE score was 19.9 units (9.0, 0-50). Mean EASE score was 19.6 for primary classical, 22.7 for primary musical theatre, 18.4 for both classical and musical theatre, and 23.3 for other contemporary styles (P = 0.03). Participants who were older, had more years of singing training, had a college degree or higher in music, studied classical singing in an academic or private setting, and those who received education in vocal health had significantly lower (better) EASE scores (P-values <0.05). CONCLUSIONS Professional singers' perception of their current vocal function differed according to their singing genre, age, extent and type of vocal training and vocal health education. Singing teachers, speech-language pathologists, and physicians could use these results to tailor voice education messages to professional singers. This knowledge could help voice care professionals to educate and treat this elite group of voice users to avoid long-term sequelae from suboptimal voice care.
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Affiliation(s)
- Ana Flavia Zuim
- New York University, Steinhardt School, Department of Music and Performing Arts Professions, New York City, New York.
| | - Adam T Lloyd
- University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | | | - David Rosow
- University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | - Donna Lundy
- University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida
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18
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Lloyd AT, Gerhard J, Baker P, Lundy DS, Diaz J, Bretl MM, Landera MA, Anis M, Marchman J, Rosow DE. Prevalence of Vocal Fold Pathologies Among First‐Year Singing Students Across Genres. Laryngoscope 2019; 130:1996-2002. [DOI: 10.1002/lary.28354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Adam T. Lloyd
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Julia Gerhard
- Division of Speech–Language Pathology Florida Hospital Winter Park Florida U.S.A
| | - Paul Baker
- University of Miami, School of Medicine Miami Florida U.S.A
| | - Donna S. Lundy
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Jennylee Diaz
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Michelle M. Bretl
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Mario A. Landera
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Mursalin Anis
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Judy Marchman
- Division of Vocal Performance Frost School of Music, University of Miami Miami Florida U.S.A
| | - David E. Rosow
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
- Division of Vocal Performance Frost School of Music, University of Miami Miami Florida U.S.A
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19
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Korn GP, Azevedo RR, Monteiro JC, Pinheiro DS, Park SW, Biase NGD. Difficulty producing high-pitched sounds in singing: correlations with laryngostroboscopy and electromyographic findings. Braz J Otorhinolaryngol 2019; 86:669-675. [PMID: 31164276 PMCID: PMC9422624 DOI: 10.1016/j.bjorl.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/22/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Difficulties or limitations in producing high-pitched sounds while singing may be due to the vocal technique used or organic factor. The observation of such difficulty or limitation by singing teachers is one of the main reasons affected individuals are referred to otolaryngologists. OBJECTIVE To evaluate the laryngostroboscopic and electromyographic changes in the cricothyroid muscles of singers with difficulties or limitations producing high-pitched sounds. METHODS This is a cross-sectional study. Ten singers with difficulty producing high-pitched sounds underwent voice, laryngostroboscopic, and electromyographic evaluations. RESULTS None of the evaluated singers presented signs of impairment of the superior laryngeal nerve on laryngostroboscopy. The electromyographic findings for the cricothyroid muscle were normal for all singers. Six singers presented vocal fold lesions, seven had signs suggestive of laryngopharyngeal reflux, and two presented vascular changes. CONCLUSION No signs suggestive of superior laryngeal nerve paresis or paralysis were observed on laryngostroboscopy and electromyography of the cricothyroid muscle in singers with difficulties or limitations producing high-pitched sounds. The presence of vocal fold lesions should be investigated in this population.
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Affiliation(s)
- Gustavo Polacow Korn
- Universidade Federal São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Renata Rangel Azevedo
- Universidade Federal São Paulo, Departamento de Fonoaudiologia, São Paulo, SP, Brazil
| | - Juliana Ceglio Monteiro
- Universidade Federal São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | | | - Sung Woo Park
- Universidade Federal São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Noemi Grigoletto de Biase
- Universidade Federal São Paulo, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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20
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Lechien JR, Saussez S, Nacci A, Barillari MR, Rodriguez A, Le Bon SD, Crevier-Buchman L, Harmegnies B, Finck C, Akst LM. Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review. Laryngoscope 2019; 129:E329-E341. [PMID: 30892725 DOI: 10.1002/lary.27932] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate the role of laryngopharyngeal reflux (LPR) in the development of benign lesions of the vocal folds (BLVF). METHODS PubMed, Cochrane Library, and Scopus were searched by three independent investigators for articles published between January 1990 and November 2018 providing substantial information about the role of LPR in the development of nodules, polyps, cysts, Reinke's edema, and sulcus vocalis. Inclusion, exclusion, diagnostic criteria and clinical outcome evaluation of included studies were analyzed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. RESULTS Of the 155 relevant publications, 42 studies were included. Thirty-five were clinical studies and seven were experimental research studying the impact of reflux on vocal fold tissue. Only seven clinical studies utilized objective LPR diagnoses (pH monitoring), suggesting an association between LPR and the development of nodules, polyps, and Reinke's edema. These studies were characterized by a substantial heterogeneity due to discrepancies in inclusion/exclusion criteria, diagnostic methods, and clinical outcome evaluation. The few basic science studies on this topic support that LPR creates an environment that may predispose to BLVF through changes in defense mechanisms of the vocal folds, cell-to-cell dehiscence, inflammatory reaction of the vocal folds, and reaction to phonotrauma. CONCLUSIONS Caustic mucosal injury from LPR could cause increased susceptibility of the vocal fold mucosa to injury and subsequent formation of nodules, polyps, or Reinke's edema. However, the heterogeneity and the low number of high-quality studies limit the ability to draw definitive conclusions. Future clinical and experimental studies are needed to better identify the role of reflux in development of BLVF. Laryngoscope, 129:E329-E341, 2019.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Université de Lille, Lille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Nacci
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Luigi Vanvitelli, Naples, Italy
| | - Alexandra Rodriguez
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, Paris, France
| | - Bernard Harmegnies
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Camille Finck
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Liège, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of the Young Otorhinolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Nacci A, Baracca G, Romeo SO, Cavaliere MD, Barillari MR, Berrettini S, Ursino F, Fattori B. Endoscopic and Phoniatric Evaluation in Singing Students. J Voice 2019; 33:135-142. [DOI: 10.1016/j.jvoice.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
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Kwok M, Eslick GD. The Impact of Vocal and Laryngeal Pathologies Among Professional Singers: A Meta-analysis. J Voice 2019. [DOI: 10.1016/j.jvoice.2017.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Vocal Tract Discomfort and Dysphonia in Patients Undergoing Empiric Therapeutic Trial with Proton Pump Inhibitor for Suspected Laryngopharyngeal Reflux. J Voice 2018; 34:280-288. [PMID: 30563730 DOI: 10.1016/j.jvoice.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION the aim of this study was to evaluate the correlation among dysphonic and vocal tract discomfort symptoms in patients who underwent empiric therapeutic trial with proton pump inhibitor (PPI) for a suspected laryngopharyngeal reflux (LPR). MATERIALS AND METHODS A total of 34 patients with suspected LPR were enrolled in this study. All of them were evaluated using the reflux finding score, the reflux symptom Index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) before and after the PPI treatment. RESULTS A significant difference was found between pretreatment and posttreatment reflux finding score, RSI, VTDS, and VoiSS scores. Significant correlations among RSI, VTDS, and VoiSS before the PPI treatment were found. CONCLUSION PPI treatment determined a significant improvement of symptoms related to dysphonia and vocal tract discomfort in patients with suspected LPR, in addition, significant correlations among the RSI, VTDS, and VoiSS scores were demonstrated thus suggesting that LPR might influence the response of questionnaires not specifically developed in order to assess the complains in LPR patient.
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Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers. J Voice 2018; 34:380-386. [PMID: 30470594 DOI: 10.1016/j.jvoice.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders. AIM This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers. METHODS This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions. RESULTS A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders. CONCLUSION Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.
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Brunings JW, Vanbelle S, Akkermans A, Heemskerk NMM, Kremer B, Stokroos RJ, Baijens LWJ. Observer Agreement for Measurements in Videolaryngostroboscopy. J Voice 2017; 32:756-762. [PMID: 29122415 DOI: 10.1016/j.jvoice.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/25/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study evaluated the levels of intraobserver and interobserver agreement for measurements of visuoperceptual variables in videolaryngostroboscopic examinations and compared the observers' behavior during independent versus consensus panel rating. STUDY DESIGN This is a retrospective study. SETTING This study was conducted in a single-center tertiary care facility. PARTICIPANTS Sixty-four patients with dysphonia of heterogeneous etiology were included. EXPOSURE All subjects underwent a standardized videolaryngostroboscopic examination. MAIN OUTCOME AND MEASURES Two experienced and trained observers scored exactly the same examinations, first independently and then on a consensus panel. Specific visuoperceptual variables and the clinical diagnosis (as recommended by the Committee on Phoniatrics and the Phonosurgery Committee of the European Laryngological Society and advised by the American Speech-Language-Hearing Association) were scored. Descriptive and kappa statistics were used. RESULTS In general, intraobserver agreement was better than agreement between observers for measurements of several variables. The intrapanel observer agreement levels were slightly higher than the intraobserver agreement levels on the independent rating task. When rating on the consensus panel, the observers deviated considerably from the scores they had previously given on the independent rating task. CONCLUSION AND RELEVANCE Observer agreement in videolaryngostroboscopic assessment has important implications not only for the diagnosis and treatment of dysphonic patients but also for the interpretation of the results of scientific studies using videolaryngostroboscopic outcome parameters. The identification of factors that can influence the levels of observer agreement can provide a better understanding of the rating process and its limitations. The results of this study suggest that future research could achieve better agreement levels by rating the visuoperceptual variables in a panel setting.
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Affiliation(s)
- Jan Wouter Brunings
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; MHeNs-School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Sophie Vanbelle
- Department of Methodology and Statistics, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Akkermans
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nienke M M Heemskerk
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; MHeNs-School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Carroll TL, Werner A, Nahikian K, Dezube A, Roth DF. Rethinking the laryngopharyngeal reflux treatment algorithm: Evaluating an alternate empiric dosing regimen and considering up-front, pH-impedance, and manometry testing to minimize cost in treating suspect laryngopharyngeal reflux disease. Laryngoscope 2017; 127 Suppl 6:S1-S13. [PMID: 28842999 DOI: 10.1002/lary.26806] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Empiric proton pump inhibitor (PPI) trials for laryngopharyngeal reflux (LPR) are common. A majority of the patients respond to acid suppression. This work intends to evaluate once-daily, 40 mg omeprazole and once-nightly, 300 mg ranitidine (QD/QHS) dosing as an alternative regimen, and use this study's cohort to evaluate empiric regimens prescribed for LPR as compared to up-front testing with pH impedance multichannel intraluminal impedance (MII) with dual pH probes and high-resolution manometry (HRM) for potential cost minimization. STUDY DESIGN Retrospective cohort review and cost minimization study. METHODS A chart review identified patients diagnosed with LPR. All subjects were treated sequentially and outcomes recorded. Initial QD/QHS dosing increased after 3 months to BID if no improvement and ultimately prescribed MII and HRM if they failed BID dosing. Decision tree diagrams were constructed to determine costs of two empiric regimens and up-front MII and HRM. RESULTS Ninety-seven subjects met the criteria. Responders and nonresponders to empiric therapy were identified. Seventy-two subjects (74%) responded. Forty-eight (67% of responders and 49% of all) improved with QD/QHS dosing. Forty-nine (51%) subjects escalated to BID dosing. Twenty-four subjects (33% of responders and 25% of all) improved on BID therapy. Twenty-five subjects (26%) did not respond to acid suppression. Average weighted cost was $1,897.00 per patient for up-front testing, $3,033.00 for initial BID, and $3,366.00 for initial QD/QHS. CONCLUSIONS An alternate QD/QHS regimen improved the majority who presented with presumed LPR. Cost estimates demonstrate that the QD/QHS regimen was more expensive than the initial BID high-dose PPI for 6 months. Overall per-patient cost appears less with up-front MII and HRM. LEVEL OF EVIDENCE 4. Laryngoscope, 127:S1-S13, 2017.
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Affiliation(s)
- Thomas L Carroll
- Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | | | - Aaron Dezube
- Tufts Medical School, Boston, Massachusetts, U.S.A
| | - Douglas F Roth
- Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, U.S.A
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Abstract
OBJECTIVE Workplace hazards in the performing arts cause injuries, disabilities, and deaths every year. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute to efforts to reduce them. This article reviews current health issues in the performing arts and highlights opportunities for occupational health contributions. METHODS Recognized experts in performing arts medicine were consulted and articles illustrating performing arts health issues were reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles. RESULTS Resources discussing hazards and health issues in theater, dance, voice, and instrumental musicians were located and reviewed. CONCLUSIONS Treatment providers have a history of involvement with segments of the performing arts. The occupational health approach to workplace health issues can effectively complement these efforts. Sources of further information on performing arts health concerns are available.
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28
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Neto L, Meyer D. A Joyful Noise: The Vocal Health of Worship Leaders and Contemporary Christian Singers. J Voice 2017; 31:250.e17-250.e21. [DOI: 10.1016/j.jvoice.2016.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/16/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
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29
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Voice and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schneider GT, Vaezi MF, Francis DO. Reflux and Voice Disorders: Have We Established Causality? CURRENT OTORHINOLARYNGOLOGY REPORTS 2016; 4:157-167. [PMID: 28163985 DOI: 10.1007/s40136-016-0121-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A trend of attributing abnormal voice changes to reflux has gained momentum among medical professionals over the last few decades. Evidence supporting the connection between reflux and voice and the use of anti-reflux medication in patients with dysphonia is conflicting and deserves careful examination. In the current health care environment, it is important that medical decisions be based on science rather than anecdote and practice patterns. The goal of this review is to investigate the evidence linking reflux and voice changes. Specifically, this association will be examined in the context of the Bradford-Hill criteria to determine what evidence exists for a causal relationship between this exposure (reflux) and outcome (voice change).
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Affiliation(s)
- G Todd Schneider
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Surgical Quality and Outcomes Research, Center for Population Sciences, and Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
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31
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Myint C, Moore JE, Hu A, Jaworek AJ, Sataloff RT. A Comparison of Initial and Subsequent Follow-Up Strobovideolaryngoscopic Examinations in Singers. J Voice 2016. [DOI: 10.1016/j.jvoice.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mesallam TA, Malki KH, Farahat M, Bukhari M, Alharethy S. Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Folia Phoniatr Logop 2014; 65:280-7. [PMID: 24861352 DOI: 10.1159/000362835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring. PATIENTS AND METHODS Eighty-two patients with voice-related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI-10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS. RESULTS Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found between the Ryan composite measurements and both severity ratings (VHI-10, RSI). CONCLUSION LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients' self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.
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Affiliation(s)
- Tamer A Mesallam
- Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Donahue EN, LeBorgne WD, Brehm SB, Weinrich BD. Reported Vocal Habits of First-Year Undergraduate Musical Theater Majors in a Preprofessional Training Program: A 10-Year Retrospective Study. J Voice 2014; 28:316-23. [DOI: 10.1016/j.jvoice.2013.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/27/2013] [Indexed: 11/25/2022]
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Guss J, Sadoughi B, Benson B, Sulica L. Dysphonia in Performers: Toward a Clinical Definition of Laryngology of the Performing Voice. J Voice 2014; 28:349-55. [DOI: 10.1016/j.jvoice.2013.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/08/2013] [Indexed: 10/25/2022]
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Hočevar-Boltežar I, Šereg-Bahar M, Kravos A, Mumović G, Mitrović S. Is an occupation with vocal load a risk factor for laryngopharyngeal reflux: a prospective, multicentre, multivariate comparative study. Clin Otolaryngol 2013; 37:362-8. [PMID: 22943594 DOI: 10.1111/coa.12006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To compare the prevalence of laryngopharyngeal reflux in choristers, teachers and control subjects without vocal load at work and to determine the risk factors for laryngopharyngeal reflux. DESIGN A prospective, multicentre, multivariate comparative study. PARTICIPANTS One hundred and nineteen singers from four professional choirs, seventy teachers from four schools and 111 control subjects with an occupation without vocal load. MAIN OUTCOME MEASURES All participants completed a questionnaire about their dietary habits, height and weight, presence of stress, smoking and allergies, including the nine-item Reflux Symptom Index. The groups of choristers, teachers and the controls were compared with each other with regard to their sex, age, dietary habits, body-mass index, Reflux Symptom Index score and other factors affecting voice quality. The subjects from all three groups with suspected laryngopharyngeal reflux were compared with the subjects without it. The relationship between the Reflux Symptom Index score and the possible risk factors for reflux was estimated. RESULTS The results showed significantly higher Reflux Symptom Index scores in the choristers than in the teachers and the controls (mean scores, 7.86 versus 6.33, P = 0.044; 7.86 versus 4.80, P = 0.000, respectively), but the number of subjects with suspected laryngopharyngeal reflux (Reflux Symptom Index score >13) did not differ significantly between the groups. The choristers were significantly more often treated for laryngopharyngeal reflux than the teachers and the controls (41%, 17% and 28%, respectively). The occupation chorister and frequently experiencing stress were the only factors that influenced the total Reflux Symptom Index score. CONCLUSIONS Laryngopharyngeal reflux affects the choristers more often than the teachers or the control subjects without vocal load at work. These results suggest that singing as the main professional activity can notably contribute to the development of the reflux. Vocal load without singing is probably not an important aetiological factor for laryngopharyngeal reflux. The extraoesophageal symptoms affecting voice require treatment for laryngopharyngeal reflux and proper dietary habits especially in the group with high voice quality demands.
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Affiliation(s)
- I Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Phyland DJ, Thibeault SL, Benninger MS, Vallance N, Greenwood KM, Smith JA. Perspectives on the Impact on Vocal Function of Heavy Vocal Load Among Working Professional Music Theater Performers. J Voice 2013; 27:390.e31-9. [DOI: 10.1016/j.jvoice.2012.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/06/2012] [Indexed: 11/27/2022]
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Powell J, Cocks HC. Mucosal changes in laryngopharyngeal reflux--prevalence, sensitivity, specificity and assessment. Laryngoscope 2012. [PMID: 23208751 DOI: 10.1002/lary.23693] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES/HYPOTHESIS A literature review regarding the use of laryngopharyngeal mucosal signs in diagnosing laryngopharyngeal reflux (LPR). STUDY DESIGN Literature review. METHODS A search of MEDLINE in February 2012 using the terms laryngopharyngeal reflux, laryngitis, mucosa, appearances, and signs (English language only). RESULTS One or more laryngopharyngeal mucosal signs associated with LPR were identified in 64% to 93% of healthy volunteers (3% >5 signs) and in 17% to 85% of gastroesophageal reflux disease sufferers (Reflux Finding Score [RFS] >7 in 24%). Reinke's edema, pseudosulcus, ventricular obliteration, vocal cord nodules, and granulomas have in some, but not all studies, been shown to be more prevalent in those with pH-proven pharyngeal reflux. Pseudosulcus, interarytenoid thickening, and Reinke's edema were more prevalent in those symptomatic of LPR than those not. The use of multiple mucosal signs may improve detection of reflux sufferers from asymptomatic controls. The RFS has a sensitivity and specificity of 87.8% and 37.5%, respectively, for picking up pH-proven pharyngeal reflux individuals. Inter- and intrarater reliability for identifying signs is fair to good in most studies. CONCLUSIONS The limited evidence for each mucosal finding should be considered in making the diagnosis of LPR. Further quality research in to mucosal findings in LPR is needed.
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Affiliation(s)
- Jason Powell
- Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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38
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Prevalence of Abnormal Laryngeal Findings in Healthy Singing Teachers. J Voice 2012; 26:577-83. [DOI: 10.1016/j.jvoice.2012.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 01/17/2012] [Indexed: 11/23/2022]
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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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Voice and Dysphagia. Dysphagia 2011. [DOI: 10.1007/174_2011_341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marchese M, Spada C, Costamagna G. Stress-related esophagopharyngeal reflux during warm-up exercises in a singer. Gastroenterology 2008; 134:2192-3; author reply 2193-4. [PMID: 18486620 DOI: 10.1053/j.gastro.2008.02.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 02/08/2008] [Indexed: 12/02/2022]
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Kelchner LN, Horne J, Lee L, Klaben B, Stemple JC, Adam S, Kereiakes T, Levin L. Reliability of Speech-Language Pathologist and Otolaryngologist Ratings of Laryngeal Signs of Reflux in an Asymptomatic Population Using the Reflux Finding Score. J Voice 2007; 21:92-100. [PMID: 16546351 DOI: 10.1016/j.jvoice.2005.09.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 09/14/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine inter- and intrajudge agreement in rating signs of laryngopharyngeal reflux (LPR) under "ideal" conditions: Experienced coworkers in a practice devoted to voice-disordered patients, raters trained in the items on a standardized scale, raters from both speech-language pathology (SLP) and otolaryngology, and raters of asymptomatic participants. STUDY DESIGN Prospective study using a scale to rate videolaryngoscopic examinations. METHODS Two SLPs and two otolaryngologists used the Reflux Finding Scale (RFS) to independently rate videotapes of endoscopic examinations for 30 participants asymptomatic of reflux. RESULTS Thirteen (43%) were assigned a total score >7, indicative of LPR, by at least one rater. Intraclass correlation coefficients showed a significant lack of agreement in total scores provided by the otolaryngologists and by all raters combined. One otolaryngologist and the two SLPs demonstrated good interrater agreement in total scores. McNamar's statistic and Poisson regression modeling showed differences in rater agreement for many individual items. Repeated ratings of four participants showed no significant differences, indicating good intrarater reliability. CONCLUSIONS Level of rater agreement regarding the presence and the severity of physical findings attributed to LPR within and between otolaryngologists and SLPs differed. Given the role each profession plays in the diagnosis and treatment of LPR and related voice disturbances, higher levels of interprofessional agreement are desired. Results support the need for greater consensus among professionals regarding the discreet features of physical findings associated with LPR, a fuller understanding of normal variants, and greater emphasis on interrater reliability when rating physical findings.
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Affiliation(s)
- Lisa N Kelchner
- Department of Communication Sciences & Disorders, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Venables KM, Allender S. Occupational health needs of universities: a review with an emphasis on the United Kingdom. Occup Environ Med 2006; 63:159-67. [PMID: 16497856 PMCID: PMC2078136 DOI: 10.1136/oem.2005.022145] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This study describes the needs of universities in relation to planning the provision of occupational health services, by detailing their occupational hazards and risks and other relevant factors. The paper presents the results of (1) an enquiry into publicly available data relevant to occupational health in the university sector in the United Kingdom, (2) a literature review on occupational health provision in universities, and (3) selected results from a survey of university occupational health services in the UK. Although the enquiry and survey, but not the literature review, were restricted to the UK, the authors consider that the results are relevant to other countries because of the broad similarities of the university sector between countries. These three approaches showed that the university sector is large, with a notably wide range of occupational hazards, and other significant factors which must be considered in planning occupational health provision for individual universities or for the sector as a whole.
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Affiliation(s)
- K M Venables
- Department of Public Health, University of Oxford, Headington, Oxford OX3 7LF, UK.
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45
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Abstract
PURPOSE OF REVIEW In this article, we illustrate the evolution of studies that contribute to a better understanding of vocal care for professional voice users and singers in particular. RECENT FINDINGS Research on vocal hygiene is specific, focusing on concrete solutions. It has commonly been believed that hydration and vocal rest are beneficial; recent research proves this supposition. An exhaustive medical diagnosis and careful therapy is stressed to detect and treat any micro-organic lesions caused by reflux, infection, allergy and environmental circumstances, which can harm a singer's voice. The use of medication is reviewed and side effects are evaluated. SUMMARY Vocal coaches, speech therapists and otolaryngologists need to focus more specifically on the management of vocal care. Accurate medical diagnosis and specific guidelines for singers must be provided as higher voice demands imply more profound and structured voice care. In the past, vocal hygiene had a negative connotation; a more positive and supporting approach to voice care, with more attention to the singer, is recommended.
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Schneider B, Bigenzahn W. Influence of glottal closure configuration on vocal efficacy in young normal-speaking women. J Voice 2003; 17:468-80. [PMID: 14740929 DOI: 10.1067/s0892-1997(03)00065-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posterior closure insufficiency of the glottis is often mentioned in connection with permanent voice disorders. Recently published studies have revealed that an incomplete closure of the glottis can be found also in normal-speaking voices, especially in women. However, the effect of glottal closure configuration on vocal efficacy is not sufficiently clarified. The purpose of this study was to determine the effect of glottal closure configuration on singing and speaking voice characteristics. Overall, 520 young female normal-speaking subjects were examined by videostroboscopy for different phonation conditions in the combination of soft, loud, low, and/or high phonation and by voice range profile measurements. According to the videostroboscopic analysis, the subjects were subdivided into four groups: complete closure of the vocal folds already in soft phonation (group 1), closure of the vocal fold with increasing intensity (group 2), persistent closure insufficiencies despite increasing intensity (group 3), and hourglass-shaped closure in subjects with vocal nodules (group 4). Subjects in which the glottal closure could not be evaluated sufficiently were subclassified into group 5 (missing values). Selected criteria of the singing and speaking voice were evaluated and statistically processed according to the mentioned subclassification. Group 1 reached significantly the highest sound pressure levels (SPLmax) for the singing voice as well as for the shouting voice. Group 3 showed a limited capacity to increase the intensity of the singing and speaking voice. The results gathered in this study objectify the relationship of insufficient glottal closure and reduced vocal capabilities. As long as no conclusive data on long-term consequences of insufficient glottal closure are available, a prophylactic improvement of the laryngeal situation especially in female professional voice users by voice therapy should be recommended.
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Affiliation(s)
- Berit Schneider
- Department of Otorhinolaryngology, University Hospital of Vienna, School of Medicine, Wien, Austria.
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47
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Abstract
Anecdotally, in some persons it has been observed by the Senior Author (K.K.) that asymmetries of the mucosal wave exist when examined videostroboscopically. In the vast majority of these people, no pathology is ever discovered. Mucosal wave asymmetries could cause concern for the otolaryngologist, who may consider them to be a forewarning of subclinical pathology and subject the patient to unnecessary, expensive, and anxiety-provoking investigations or interventions. The purpose of this study was to establish the prevalence of mucosal wave asymmetries in an asymptomatic population lacking laryngeal pathology. Acoustic spectral analysis is also utilized to determine if the presence of subharmonics might be associated. A hospital-based, cross-sectional study design was used. The subjects had no known vocal or medical pathologies, and were nonsmoking. The study group was composed of 30 males aged 35-50 years and 30 women between 22-55 years. Each of the males underwent acoustic spectral analysis; and all subjects completed a medical questionnaire, subjective talkativeness rating, and videostroboscopic laryngeal examination. 10.5% of the subjects (exact 95% CI = 4.0-21.5%) exhibited mucosal wave variations at stroboscopy, characterized as periodic lateral phase asymmetries found consistently in both the modal and upper registers. There was no association with the chosen acoustic spectral parameters, talkativeness scales, or questionnaire-based variables. Mucosal wave asymmetries may be a variance of normal, and are likely to be far more common in the general population than previously believed. The prevalence detected here is expected to be important in the clinical laryngology practice, where these asymmetries may be frequently encountered and influencing management decisions. There has been little normative data published for variations of the mucosal wave specifically for epidemiological purposes. Clinically, in the absence of such data, otolaryngologists may over interpret videostroboscopic findings, leading to unnecessary investigations or interventions.
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Affiliation(s)
- C Michael Haben
- Department of Otolaryngology, McGill University Health Center, Laboratoire de la voix, Hôpital General de Montreal, Universite McGill, Montreal, Quebec, Canada
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Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE. The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice 2002; 16:564-79. [PMID: 12512644 DOI: 10.1016/s0892-1997(02)00132-7] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Routine laryngeal examination of patients with otolaryngologic complaints often reveals findings thought to result from gastroesophageal reflux. The direct association between these mucosal findings and uncontrolled reflux is not well established. To begin exploring the specificity of tissue signs, 105 normal, healthy, adult volunteers were examined by routine video fiber-optic endoscopy for the presence of findings attributed to reflux disease. Medical conditions, lifestyle factors, and ENT complaints were surveyed to reveal potential airway irritants, while the study design attempted to eliminate silent reflux. The majority of subjects (86%) had findings associated with reflux and certain signs reached a prevalence of 70%. Prevalence was not affected by ENT complaint, smoking, alcohol, or asthma. Intraexaminer and interexaminer agreement information is provided. The traditional attribution of hypopharynx irritation signs to reflux is challenged; the need for improved diagnostic specificity is highlighted.
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Affiliation(s)
- Douglas M Hicks
- The Voice Center, Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
Professional voice users often present to otolaryngologists and laryngologists with specific voice complaints. The contributions of pathologic lesions to the patients' vocal complaints are not always clear on examination, and often, premorbid examinations of the larynx are not available for review. This study examines the incidence of laryngeal pathology among singing teachers. At a national convention of singing teachers, volunteers were recruited for a "free strobovideolaryngoscopic examination." All volunteers completed a detailed questionnaire of their vocal and medical history and underwent strobovideolaryngoscopic examination. Strobovideolaryngoscopic examinations were completed in 20 volunteers, 7 of whom had voice complaints and 13 of whom perceived their voices to be normal. Vocal fold masses were common among the asymptomatic singing teachers. Evidence of reflux laryngitis was a common finding among both symptomatic and asymptomatic singing teachers. Asymmetries in vocal fold hypomobility were more common among those with voice complaints than was the presence of vocal fold masses in the population studied.
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Affiliation(s)
- Yolanda D Heman-Ackah
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois-Chicago, 60612, USA.
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50
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Abstract
BACKGROUND Vocal cord nodules are bilateral swellings 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 inflammatory action in the underlying superficial lamina propria. They characteristically produce hoarseness. Treatment of vocal cord nodules aims to eliminate or reduce this hoarseness. OBJECTIVES To assess the effectiveness of surgery versus non-surgical interventions for vocal cord nodules. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (CCTR) and Medline (1966-2000), Embase (1974-2000), Biological Abstracts (1970-2000), Biological Abstracts RRM (Reports, Reviews and Meetings) on CD-ROM (1989-2000) and review articles. 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. REVIEWER'S 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)
- M Pedersen
- Department of Otolaryngology - Head and Neck Surgery, The Medical Center, Østergade 18,3, DK-1100 Copenhagen, Denmark.
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