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Factors impacting therapy duration in children and adolescents with Paradoxical Vocal Fold Movement (PVFM). Int J Pediatr Otorhinolaryngol 2022; 158:111182. [PMID: 35594796 DOI: 10.1016/j.ijporl.2022.111182] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Paradoxical Vocal Fold Movement (PVFM) may cause airway restriction and resulting dyspnea in the pediatric population. Therapy with a speech-language pathologist (SLP) is the primary treatment for children and adolescents diagnosed with Paradoxical Vocal Fold Movement (PVFM). This study examined treatment duration and factors predicting number of therapy sessions required. METHODS Data were drawn from the University of Wisconsin-Madison Voice and Swallow Clinics Outcome Database. One hundred and twelve children and adolescents were included in this study. Participants were diagnosed with PVFM, followed for therapy with a SLP, and were subsequently discharged from therapy with successful outcomes. Extracted data included number of therapy sessions, PVFM symptoms, patient demographics, medical history, and comorbid diagnoses. Regression was used to determine factors predicting therapy duration. RESULTS Patients completed an average of 3.4 therapy sessions before discharge. Comorbid behavioral health diagnosis (β = 1.96, t = 3.83, p < .01) and a history of upper airway surgeries (β = 1.26, t = 2.615, p = .01) were significant predictors of the number of therapy sessions required before discharge; both factors significantly increased therapy duration. Age, symptom trigger-type, reflux symptoms, and dysphonia did not predict therapy duration. Overall, our regression model accounted for 42% of the variance in number of sessions required (r2 = 0.42). CONCLUSIONS On average, 3.4 sessions of therapy with an SLP resolved PVFM symptoms. Children with a behavioral health diagnosis required an average of 5.45 sessions and those with a history of upper airway surgery an average of 4.3 sessions. Future work should examine the relationship between behavioral health care and PVFM treatment, as well as how PVFM treatment efficiency can be maximized.
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Krishnan NV, Pujary K, Bhandarkar AM, Devadas U, Magazine R. Videostroboscopy and Voice Profile in Long-Term Combination Inhaler Users With Obstructive Lower Airway Disease. Otolaryngol Head Neck Surg 2021; 166:927-932. [PMID: 34311589 DOI: 10.1177/01945998211031449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Dysphonia is one of the most common side effects of long-term inhaler therapy containing corticosteroids in asthma or asthma-chronic obstructive pulmonary disease overlap (ACO) patients. This common, often reversible side effect is due to the structural changes in the vocal folds resulting from steroid deposition. This study determines the structural changes and voice profile of patients on long-term inhaler therapy by videostroboscopy and perceptual voice profile analysis. It also determines the duration, formulation, and drug delivery system producing the least side effects during therapy. STUDY DESIGN Prospective case-control study. SETTING Tertiary care hospital. METHODS In total, 196 patients diagnosed with moderate to severe asthma or ACO were divided into cases (patients on at least 6-month combination inhaler therapy) and controls (newly diagnosed patients not on inhaler therapy) and recruited in the study. They were assessed by videostroboscopy for structural changes and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and strain) perceptual scale for voice profile changes. RESULTS The prevalence of dysphonia was significantly higher in cases (62.2%) than controls (27.6%). Prevalence of laryngeal structural changes and voice profile changes were higher in cases. The prevalence of dysphonia and structural changes among cases was much lower when a spacer was used (P < .001). CONCLUSION This study adds evidence to the long-term side effects of combination inhaler therapy containing corticosteroids on the larynx as demonstrated by videostroboscopy and perceptual voice profile analysis. It also propagates the use of spacers in drug delivery to reduce the prevalence of side effects during long-term inhaler therapy.
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Affiliation(s)
- Neethu V Krishnan
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kailesh Pujary
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajay M Bhandarkar
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Usha Devadas
- Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rahul Magazine
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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3
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Abumossalam AM, Ahmed HA, Ibrahim OM, Algreisy TMS, Al-Shenqiti AM. Vocal cordopathy consequent to bronchial asthma inhalation therapy. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vocal cords signify an imperative lane for air flow in and out of the respiratory tract along with a phonetic role. So, the aim of this work is to assess the impact of habitual versus occasional utilization of inhalation therapy of patients with bronchial asthma on their vocal cords regarding visual endoscopic pathological changes in addition to phonetic dysfunction. This study was conducted on 112 diagnosed bronchial asthma patients (66 male and 46 females). They were classified into the following: group A (habitual user), 65 patients with severe persistent asthma with regular frequent intake of inhalation therapy, and group B (occasional user), 47 patients with intermittent asthma with alternating intake of inhalation therapy. They were submitted to clinical, vocal assessment plus laryngoscopic examination.
Results
The habitual users group demonstrated that laryngeal edema and hyperemia attained the higher percentage in the adult than children age group (60%, 40–67.3%, 50%) respectively together after 6 and 9 months of study followed by laryngeal nodules (5.4%, 0–9%, 10%). Occasional users presented the same findings comparable to the habitual group (27%, 10–32.4%, 20%). Cord paresis, cord dysfunction, and fungal plaques were in the second frequencies in both age groups with the same percentage (3.6%) at the end of the study; however, in occasional users, fungal plaques illustrated low percentage (2.7%, 5.4–0, 10%, respectively).
Conclusion
Inhalation therapy as a form of asthma medication correlated with major counter effects on vocal cords with well-recorded laryngeal hyperemia, edema, and vocal nodules in addition to fungal plaques moreover phonetic dysfunction.
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Spantideas N, Bougea A, Drosou E, Assimakopoulos D. The Role of Allergy in Phonation. J Voice 2018; 33:811.e19-811.e27. [PMID: 30145066 DOI: 10.1016/j.jvoice.2018.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Allergies are among the most common chronic conditions worldwide affecting 10%-30% of adult individuals and 40% of children. Phonation can be affected by different allergic conditions in various ways. The role of allergy in phonation has been under-researched and poorly understood and the respective literature is poor. Several studies have investigated the role of certain allergic diseases in phonation. In this review, we tried to include all allergic conditions that can affect voice production. METHODS We conducted a bibliography review looking for allergic conditions that can affect phonation. Allergic asthma, allergic laryngitis, allergic rhinitis and sinusitis, oral allergy syndrome, and angioedema were included in our search. RESULTS The literature on the impact of allergy in phonation remains poor and many key questions concerning basic information for epidemiology, pathophysiology, and larynx pathology in allergic patients with phonation problems still remain unanswered. CONCLUSIONS The role of allergy in voice production remains underinvestigated and many basic questions still remain open. Further research is needed to improve our understanding for these very common conditions.
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Affiliation(s)
| | | | - Eirini Drosou
- Athens Speech Language and Swallowing Institute, Athens, Greece
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Voice Disorders and Voice Knowledge in Choir Singers. J Voice 2018; 34:157.e1-157.e8. [PMID: 30104126 DOI: 10.1016/j.jvoice.2018.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Singers have reported higher prevalence of vocally harmful behaviors, vocal symptoms, and voice disorders than nonsingers have. The purpose of this study was to investigate the prevalence of voice disorders among choir singers and to discover the risk factors associated with voice disorders. Another purpose was to explore the choir singers' knowledge about the anatomy and physiology of the voice, and voice ergonomics. METHODS Three hundred and fifteen adult choir singers, 65% women, and 35% men, completed a web-questionnaire. The questionnaire included demographic questions and questions about vocal symptoms, risk factors for voice disorders, and voice knowledge. RESULTS Twenty one percent of the participants experienced two or more frequently occurring vocal symptoms, which was defined as having a functional voice disorder. Choir singers with a vocally demanding profession were almost twice as likely to report several frequently occurring vocal symptoms. Health-related risk factors, such as inhalant allergy and asthma, had a significant relation with the number of vocal symptoms. The overall voice knowledge among the choir singers seemed limited. CONCLUSIONS The prevalence of voice disorders among choir singers seems to be similar to the prevalence rate among professional voice users. Choir singers with a vocally demanding profession are at a higher risk of developing a functional voice disorder. The results of this study raise the importance of educating choir singers about the voice, in order to prevent development of voice disorders.
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Malmström E, Hertegård S. Background Factors and Subjective Voice Symptoms in Patients with Acquired Vocal Fold Scarring and Sulcus Vocalis. Folia Phoniatr Logop 2018; 69:125-130. [PMID: 29346796 DOI: 10.1159/000484169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/11/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Vocal fold scarring (VFS) and sulcus vocalis (SV) often result in severe and chronic voice disorders. This study compares subjective voice complaints as rated with the Voice Handicap Index and etiological factors for patients with VFS and SV. PATIENTS AND METHODS Data were collected from the medical records at the Department of Otorhinolaryngology, Karolinska University Hospital, for 27 VFS patients and 27 SV patients. Descriptive background factors were compared between the groups and data were compared from the Swedish Voice Handicap Index (Sw-VHI) questionnaires. RESULTS Previous laryngeal surgery/trauma was significantly more common for the patients with VFS. The SV group had significantly more persistent dysphonia since childhood. It was significantly more common to have a non-Germanic language origin among the SV patients. VFS and SV rated high for the total median Sw-VHI scores. The VFS group's total Sw-VHI and the three domain scores were significantly higher compared to the SV group. The physical domain showed a significantly higher score when compared to the functional and emotional domains in the SV cohort and when compared to the emotional domain in the VFS cohort. CONCLUSION There are significant differences between the VFS group and SV group regarding etiological factors as well as the Sw-VHI. The degree and profile of VHI should be considered when selecting patients and evaluating the result of new treatments for this group of patients.
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Hamdan AL, Ziade G, Kasti M, Akl L, Bawab I, Kanj N. Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study. Indian J Otolaryngol Head Neck Surg 2016; 69:42-46. [PMID: 28239577 DOI: 10.1007/s12070-016-1035-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/05/2016] [Indexed: 11/25/2022] Open
Abstract
To investigate the prevalence of phonatory symptoms, perceptual, acoustic and aerodynamic findings in patients with asthma compared to a control group. This study is a cross-sectional study. A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and gender were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, vocal fatigue, phonatory effort, cough, dyspnea, and respiratory failure. Perceptual evaluation, acoustic analysis and aerodynamic measurements were also performed. Patient's self assessment using the Voice Handicap Index 10 was reported. The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the two groups (32.3 vs. 5.3%, p value 0.025) with a non-significant higher prevalence of vocal fatigue and phonatory effort. The overall grade of dysphonia was significantly higher in asthmatics compared to controls (p value 0.002). Patients with asthma had also significantly higher degree of asthenia and straining (p value of 0.04 and 0.008, respectively) with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for Shimmer, which was higher in the asthmatic group (p value of 0.037). There was also no significant difference in the Maximum phonation time between the two groups. Dysphonia is significantly more prevalent in patients with asthma compared to controls.
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Affiliation(s)
- Abdul Latif Hamdan
- Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Ziade
- Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maher Kasti
- Department of Otolaryngology, Head and Neck Surgery, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Leslie Akl
- Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Bawab
- Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadim Kanj
- Department of Internal Medicine, American University of Beirut, P.O. Box: 11-0236, Beirut, Lebanon
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Spantideas N, Drosou E, Bougea A, Assimakopoulos D. Inhaled Corticosteroids and Voice Problems. What Is New? J Voice 2016; 31:384.e1-384.e7. [PMID: 27742496 DOI: 10.1016/j.jvoice.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Voice problems are the most common and most annoying local side effect of inhaled corticosteroids (ICS), affecting not only patients' treatment compliance but also their quality of life. The literature is very poor regarding prevalence, mechanism, prevention, and management of voice problems attributed to ICS use and especially for the new ICS, ciclesonide. Prevalence of dysphonia seems to be less common with the use of ciclesonide and beclomethasone dipropionate. METHOD We conducted a bibliography review based on recently published data, including data from the recently introduced ICS, ciclesonide, which are lacking in previous reviews. RESULTS Very little improvement, based on limited number of new papers published during previous years without any direct comparison between available ICS, has been made in our understanding of ICS local side effects. CONCLUSION Our understanding concerning basic information of ICS effects on voice still remains poor, and further investigation is needed to have a better understanding on epidemiology, predisposing factors, mechanisms, prevention, and treatment of voice problems attributed to ICS.
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Affiliation(s)
- Nikolaos Spantideas
- Athens Speech, Language and Swallowing Institute, 10 Lontou Street, Glyfada, Athens 16675, Greece.
| | - Eirini Drosou
- Athens Speech, Language and Swallowing Institute, 37 Oinois Street, Glyfada, Athens 16674, Greece
| | - Anastasia Bougea
- Athens Speech, Language and Swallowing Institute, 10 Lontou Street, Glyfada, Athens 16675, Greece
| | - Dimitrios Assimakopoulos
- ENT Department in University Hospital of Ioannina, Medical School of the University of Ioannina, 51 Napoleontos Zerva Street, Ioannina 45332, Greece
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9
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Turan M, Ekin S, Ucler R, Arısoy A, Bayram Y, Yalınkılıç A, Bozan N, Garca MF, Çankaya H. Effect of inhaled steroids on laryngeal microflora. Acta Otolaryngol 2016; 136:699-702. [PMID: 26901427 DOI: 10.3109/00016489.2016.1146409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Conclusions As is known, this study is the first study to evaluate the effect of inhaled steroids on laryngeal microflora. The data support that ICS usage causes changes in the larynx microflora. Purpose The aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of a control group. In addition, laryngeal microflora was compared to the smears obtained from the vallecula and pharynx. Materials and methods The study included 39 patients (mean age = 45.56 ± 12.76 years) who had been using a corticosteroid inhaler and control group consisting of 27 persons (mean age = 43.07 ± 13.23 years). Culture samples were obtained from the pharynx, larynx, and vallecula in the patient and control groups, and they were evaluated in the microbiology laboratory. Obtained culture results were named by the same microbiologist according to the basic microorganism classification method. Results Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS) and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared to the control group. Neisseria spp, basillus spp, and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared to the patient group.
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Affiliation(s)
- Mahfuz Turan
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Selami Ekin
- b Department of Chest Disease , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Rıfkı Ucler
- c Department of Endocrinology and Metabolism , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Ahmet Arısoy
- b Department of Chest Disease , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Yasemin Bayram
- d Department of Medical Microbiology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Abdulaziz Yalınkılıç
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Nazım Bozan
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Mehmet Fatih Garca
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
| | - Hakan Çankaya
- a Department of Otorhinolaryngology , Yuzuncu Yil University Faculty of Medicine , Van , Turkey
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10
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Abstract
Superficial fungal infection of the mucous membranes (thrush) isolated to the larynx is neither widely reported nor well recognized clinically. Therefore, it is often associated with ineffective treatment and delay in diagnosis, and sometimes associated with unneeded surgical intervention. Eight cases of thrush isolated to the larynx, with no oral or oropharyngeal manifestations, are presented. Four of these were isolated to the vocal folds alone. All patients were adults, and 4 were smokers. Hoarseness was always present. Pain was present inconsistently, and there was no dysphagia or odynophagia, in contrast to other forms of upper aerodigestive tract candidiasis. On average, diagnosis was not made until 6 months after the onset of symptoms. Possible causative factors included use of systemic steroids (3 cases), broad-spectrum antibiotics (1 case), or inhaled steroids (5 cases); diabetes (2 cases); and neutropenia (1 case). In 3 cases, all with thrush isolated to the vocal folds, inhaled steroids were the only causative factor identifiable — a feature reported only twice previously. Three patients underwent surgical procedures that might have been avoided had an accurate diagnosis been made. All patients responded readily to oral fluconazole and removal of predisposing factors where possible. The signs, symptoms, predisposing factors, and treatment are compared to those of 14 cases reported in the literature over 35 years.
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Affiliation(s)
- Lucian Sulica
- Department of Otolaryngology, Beth Israel Medical Center, New York, New York 10003, USA
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Lewandowski A, Gillespie AI. The Relationship Between Voice and Breathing in the Assessment and Treatment of Voice Disorders. ACTA ACUST UNITED AC 2016. [DOI: 10.1044/persp1.sig3.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coordination between the larynx and lower airways is essential for normal voice production. Dyscoordination may contribute to myriad voice problems. The current study provides an overview of respiratory and laryngeal physiology as it relates to normal and disordered voice production, as well as a review of phonatory aerodynamic assessment practices. Finally, the integration of voice and breathing in common voice therapy programs is explored.
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Affiliation(s)
- Ali Lewandowski
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center
Pittsburgh, PA
| | - Amanda I. Gillespie
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center
Pittsburgh, PA
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Abstract
PURPOSE OF REVIEW This article discusses the relationship between inhaled corticosteroids and dysphonia, with discussion of the therapeutic use of inhaled steroids in laryngeal disease and a review of negative laryngeal effects of this class of medication in patients with reactive airway disease. RECENT FINDINGS Although prescribed for their anti-inflammatory effects (predominantly for pulmonary disease and less often for laryngeal conditions), corticosteroid inhalers can cause laryngeal inflammation. This may relate to chemical irritation from the inhaler itself as well as fungal inflammation related to opportunistic candidiasis that may accompany inhaler use. Patients who suffer from dysphonia because of inhaler use may improve if switched to another inhaler. Studies suggest that ciclesonide metered-dose inhaler may have less oropharyngeal deposition and therefore be associated with reduced oropharyngeal candidiasis and dysphonia compared with other inhaled corticosteroids. SUMMARY Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints.
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Gillespie AI, Slivka W, Atwood CW, Verdolini Abbott K. The Effects of Hyper- and Hypocapnia on Phonatory Laryngeal Airway Resistance in Women. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:638-52. [PMID: 25764093 PMCID: PMC4610285 DOI: 10.1044/2015_jslhr-s-13-0270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 02/11/2015] [Indexed: 05/09/2023]
Abstract
PURPOSE The larynx has a dual role in the regulation of gas flow into and out of the lungs while also establishing resistance required for vocal fold vibration. This study assessed reciprocal relations between phonatory functions-specifically, phonatory laryngeal airway resistance (Rlaw)-and respiratory homeostasis during states of ventilatory gas perturbations. METHOD Twenty-four healthy women performed phonatory tasks while exposed to induced hypercapnia (high CO2), hypocapnia (low CO2), and normal breathing (eupnea). Effects of gas perturbations on Rlaw were investigated as were the reciprocal effects of Rlaw modulations on respiratory homeostasis. RESULTS Rlaw remained stable despite manipulations of inspired gas concentrations. In contrast, end-tidal CO2 levels increased significantly during all phonatory tasks. Thus, for the conditions tested, Rlaw did not adjust to accommodate ventilatory needs as predicted. Rather, stable Rlaw was spontaneously accomplished at the cost of those needs. CONCLUSIONS Findings provide support for a theory of regulation wherein Rlaw may be a control parameter in phonation. Results also provide insight into the influence of phonation on respiration. The work sets the foundation for future studies on laryngeal function during phonation in individuals with lower airway disease and other patient populations.
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Affiliation(s)
- Amanda I. Gillespie
- University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, PA
- University of Pittsburgh, PA
| | | | | | - Katherine Verdolini Abbott
- University of Pittsburgh, Center for the Neural Basis of Cognition, PA
- McGowan Institute for Regenerative Medicine, Carnegie Mellon University, Pittsburgh, PA
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14
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Tuzuner A, Demirci S, Bilgin G, Cagli A, Aydogan F, Ozcan KM, Samim EE. Voice Assessment After Treatment of Subacute and Chronic Cough With Inhaled Steroids. J Voice 2015; 29:484-9. [PMID: 25704467 DOI: 10.1016/j.jvoice.2014.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Furthermore, the efficacy of inhaled steroids on cough was investigated, as well. MATERIAL AND METHODS This study included 46 patients (27 females and 19 males) with a persistent cough lasting at least 3 weeks and treated with inhaled steroids. All patients were examined by a pulmonologist and lung auscultation where a posteroanterior chest X-ray and spirometry were performed. The patients were also examined by an otolaryngologist. Anterior rhinoscopy, flexible fiberoptic nasopharyngoscopy, and laryngostroboscopy were performed. Also, the patients' acoustic voice analyses were performed and recorded using a multidimensional voice program. Cough symptom index (CSI) scores were used to evaluate the response to treatment. Patients with an underlying disease that was unresponsive to inhaled steroids were excluded from study. The 46 patients were administered inhaled budesonide 400 mcg twice a day, for 1 month, and their acoustic voice analyses were performed again at the end of the treatment. In addition, CSI scores were determined after stopping medication. RESULTS When pretreatment and posttreatment acoustic voice analysis parameters (Fo, Jita, Jitt, Shim, APQ, vAm, and NHR) were compared, statistically significant differences were detected for vAm (P = 0.001) and F0 (P0.003). After treatment with inhaled steroids, the CSI score reduced from 3 to 1 (median), and the difference was statistically significant. CONCLUSIONS Inhaled budesonide treatment in the proper dose seems to be an effective treatment for persistent cough, in the selected patient group. In addition, short-term budesonide application did not cause any negative effects on the voice parameters in these patients. These findings may be related to the steroid formulation used, the application method, and the duration of treatment. Further studies are needed on a larger group of patients with different formulations of inhaled steroids to clarify aforementioned issues.
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Affiliation(s)
- Arzu Tuzuner
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Sule Demirci
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Gulden Bilgin
- Department of Pulmonology, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ali Cagli
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Islahiye State Hospital, Gaziantep, Turkey
| | - Filiz Aydogan
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kursat Murat Ozcan
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Numune Training and Research Hospital, Ankara, Turkey
| | - Etem Erdal Samim
- Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey
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15
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Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope 2014; 125:746-50. [PMID: 25220824 DOI: 10.1002/lary.24931] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 08/12/2014] [Accepted: 08/25/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the prevalence of pediatric voice and swallowing problems in the United States. METHODS The 2012 National Health Interview Survey pediatric voice and language module was analyzed, identifying children reporting a voice or swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for voice or swallowing problems, diagnoses given, and severity of voice or swallowing problem were analyzed. RESULTS An estimated 839 ± 89 thousand children (1.4% ± 0.1%) reported a voice problem. Overall, 53.5% ± 1.9% were given a diagnosis for the voice problem and 22.8% ± 4.6% received voice services. Laryngitis (16.6% ± 5.5%) and allergies (10.4% ± 4.0%) were the most common diagnoses. A total of 16.4% graded the voice problem as a "big" or "very big" problem. An estimated 569 ± 63 thousand children (0.9% ± 0.1%) reported a swallowing problem. A total of 12.7% ± 3.8% received swallowing services and 13.4% ± 1.6% were given a diagnosis for their swallowing problem. Neurological problems were the most common diagnoses (11.1% ± 4.5%). A total of 17.9% graded the swallowing problem as a "big" or "very big" problem. CONCLUSION These data provide the first insight into the prevalence of childhood voice and swallowing problems, which affect approximately 1% of children annually. A relative minority seek care for their problem, despite the disease impact.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Voice changes in patients with chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sahrawat R, Robb MP, Kirk R, Beckert L. Effects of inhaled corticosteroids on voice production in healthy adults. LOGOP PHONIATR VOCO 2013; 39:108-16. [PMID: 23570418 DOI: 10.3109/14015439.2013.777110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The isolated effects of inhaled corticosteroids (ICS) on voice production were examined in 30 healthy adults with no known pre-existing airway disease. All participants followed a daily ICS treatment regime of 500 μg in the morning and evening over a 6-day period. Sustained vowels and connected speech samples were audio recorded before, during, and after the ICS regime. Each participant's audio recorded samples were acoustically analysed. Results revealed that ICS has a short-term detrimental effect on various acoustic properties of voice. These effects were more evident in connected speech compared to isolated vowel productions. All acoustic parameters returned to normalcy after discontinuing the ICS. The study provides insight as to the influence of ICS on healthy voice production.
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Affiliation(s)
- Ramesh Sahrawat
- University of Canterbury, Health Sciences Centre , Private Bag 4800, Christchurch, 8140 New Zealand
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Galván CA, Guarderas JC. Practical considerations for dysphonia caused by inhaled corticosteroids. Mayo Clin Proc 2012; 87:901-4. [PMID: 22958993 PMCID: PMC3496982 DOI: 10.1016/j.mayocp.2012.06.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 10/27/2022]
Abstract
Inhaled corticosteroid (ICS) therapy has become standard in the treatment of asthma. A common local adverse effect of ICS therapy is dysphonia, which has been reported to affect 5% to 58% of patients. Although causes of dysphonia associated with ICS therapy have been underinvestigated, it may result from deposition of an active ICS in the oropharynx during administration, which then causes myopathy or a mucosal effect in the laryngopharynx. Use of ICS should be considered during any evaluation of dysphonia. We recommend using the lowest effective dosage of ICS, administering medication with a spacer, gargling, rinsing the mouth and washing the face after inhalation, and washing the spacer. If dysphonia develops despite these interventions, ICS use should be suspended until symptoms resolve, provided that asthma control is not compromised.
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Affiliation(s)
- César A Galván
- Clinical Immunology and Allergic Diseases Division, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.
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Plexico LW, Sandage MJ, Faver KY. Assessment of phonation threshold pressure: a critical review and clinical implications. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 20:348-66. [PMID: 21856967 DOI: 10.1044/1058-0360(2011/10-0066)] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To describe the origins of the task elicitation procedure for determining phonation threshold pressure and, through a literature review and online survey, describe published procedural, environmental, and participant variable departures from the original methodology. METHOD Literature search terms included phonation threshold pressure, subglottal pressure and phonation, pressure measurement and phonation, lung pressure and phonation, and vocal fold oscillation onset. Inclusion criteria were limited to indirect assessment of phonation threshold pressure, English language publications between 1980 and 2009, and peer-reviewed journals. Studies including animals, computer or physical models, alaryngeal speakers, laryngeal airway resistance, or any airflow interruption technique were excluded. Twenty-four articles matched the inclusionary criteria. An online survey to query task elicitation procedures was then developed from the literature review. RESULTS The scientific rationale for inclusion of phonation threshold pressure data was consistent across published studies; however, variations in procedural methodology for task elicitation were identified, as were environmental and participant inconsistencies that might affect phonation threshold pressure values. Findings of the online survey mirrored the inconsistencies identified in the literature review. CONCLUSIONS The methodological differences for task elicitation identified in this comprehensive review of the literature and the online survey, while bringing into question the reliability of phonation threshold pressure measurement, illuminate scientific questions yet to be answered to further refine and potentially standardize phonation threshold pressure as a more reliable research and clinical measurement.
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Erickson E, Sivasankar M. Evidence for adverse phonatory change following an inhaled combination treatment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:75-83. [PMID: 19696437 DOI: 10.1044/1092-4388(2009/09-0024)] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Voice problems are reported as a frequent side effect of inhaled combination (IC) treatments. The purpose of this experimental study was to investigate whether IC treatments are detrimental to phonation. We hypothesized that IC treatment would significantly increase phonation threshold pressure (PTP) and perceived phonatory effort (PPE), whereas sham treatment would not. METHOD Fourteen healthy adults participated in a repeated-measures design in which they received IC and sham treatments in counterbalanced order. PTP and PPE were measured prior to treatments, immediately following treatments, and at 1 and 2 hr following treatments. RESULTS IC treatment increased PTP, but sham treatment did not. The increase in PTP was maintained for a 2 hr period following administration. PPE ratings were not significantly correlated with PTP. CONCLUSIONS IC treatments can have acute, adverse effects on phonation. Detrimental phonatory effects were elicited in participants with no self-reported voice problems. IC treatments are being increasingly prescribed across the lifespan. The current data increase our understanding of the nature of phonatory deterioration associated with IC treatment and lay the groundwork for increased research effort to develop IC treatments that effectively control respiratory disease while minimizing an adverse effect on phonation.
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A short-term investigation of dysphonia in asthmatic patients using inhaled budesonide. J Voice 2010; 25:88-93. [PMID: 20080023 DOI: 10.1016/j.jvoice.2009.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 07/08/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dysphonia is one of the most common side effects of patients who use corticosteroid inhalers. The aim of this study was to investigate, prospectively, the occurrence of dysphonia in patients who used corticosteroid inhalers. METHODS Outpatients aged 18 years or older initially treated with inhaled corticosteroids were recruited. All patients were prescribed budesonide/formoterol. Questionnaires, perceptual studies, and acoustic analysis were performed five times during the study: at study entry and after 1, 4, 8, and 12 weeks. Videostroboscopy was performed at study entry and at 12 weeks. The data collected were analyzed by repeated-measures analysis of variance tests and Wilcoxon's signed rank test (P<0.01). RESULTS Sixty-two patients were enrolled and 29 patients (M:F=19:10) completed the study. Seven patients reported that they had problems with their voice; however, there were no statistically significant changes in the perceptual studies or the acoustic analysis. The videostroboscopy showed that "injection" and "increase of mucus" significantly increased by week 12. Vocal fold bowing was not noted in any of the patients. CONCLUSIONS The results of this study showed no significant voice changes in patients using corticosteroid inhalers over a period of 3 months. However, minor mucosal changes were found on videostroboscopy.
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Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM. Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngol Head Neck Surg 2009; 141:S1-S31. [DOI: 10.1016/j.otohns.2009.06.744] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 12/27/2022]
Abstract
Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Reliability of perceptions of voice quality: evidence from a problem asthma clinic population. The Journal of Laryngology & Otology 2009; 123:755-63. [PMID: 19250586 DOI: 10.1017/s0022215109004605] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off. MATERIALS AND METHODS Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories. RESULTS AND ANALYSIS Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender. DISCUSSION These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.
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Sivasankar M, Blazer-Yost B. Effects of long-acting beta adrenergic agonists on vocal fold ion transport. Laryngoscope 2009; 119:602-7. [DOI: 10.1002/lary.20091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Vocal Characteristics in Children With Attention Deficit Hyperactivity Disorder. J Voice 2009; 23:190-4. [DOI: 10.1016/j.jvoice.2007.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 09/10/2007] [Indexed: 11/20/2022]
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Bhalla RK, Watson G, Taylor W, Jones AS, Roland NJ. Prospective, randomized cross-over trial to assess the ability of a dry-powder inhaler to reverse the local side effects of pressurized metered-dose inhalers. J Asthma 2008; 45:814-9. [PMID: 18972301 DOI: 10.1080/02770900802311485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether a corticosteroid dry-powder inhaler could reverse the pharyngeal and laryngeal side effects produced by a corticosteroid pressurised metered-dose inhaler. DESIGN Prospective, randomized, controlled, cross-over, evaluator-blinded study. SETTING University Hospital Aintree, Liverpool, United Kingdom. PATIENTS Thirty-seven adults recruited over a 12-month period from Ear, Nose and Throat clinics at our University hospital. Patients were randomized into three groups using a computer-generated random number list and sealed opaque envelopes. MAIN OUTCOME MEASURES Scores were achieved on respiratory symptom and vocal performance questionnaires. Acoustic analysis was performed followed by a standardized biopsy of the posterior pharyngeal wall. Histological markers of inflammation were correlated with pharyngitis. The data were tested for normality using the Kalmogorov-Smirnov test. The Kruskal-Wallis analysis of variance was used to investigate differences between medians and ranges. The data were further investigated for correlations using the Spearman test. Discriminant analysis was used to examine the effect of the three groups on each variable. RESULTS Discomfort scores (median and range) were significantly lower after dry-powder inhaler use than with either a spacer or water gargle (p < 0.01). These worsened after restoring pressurized metered-dose inhaler therapy. The reduction in pharyngitis in each of the three groups was not significant. Vocal performance scores improved with dry-powder inhaler use. Jitter, shimmer, and closed-phase quotient scores improved with dry-powder inhaler use (p < 0.01). Shimmer scores deteriorated once the pressurized metered-dose inhaler was restored (p < 0.01). There was no significant difference between the groups in most observed parameters of inflammation (p > 0.01). CONCLUSION A dry-powder inhaler may alleviate the local side effects produced by a pressurized metered-dose inhaler. Laryngeal dysfunction appears to be particularly responsive to the absence of propellant. More observational and randomized controlled trials are necessary to examine existing inhalers and specifically, how and why they cause local side effects.
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Affiliation(s)
- R K Bhalla
- Department of Otolaryngology, Head & Neck Surgery, University Hospital Aintree, Liverpool, UK.
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Perceived vocal morbidity in a problem asthma clinic. The Journal of Laryngology & Otology 2008; 123:96-102. [PMID: 18644167 DOI: 10.1017/s002221510800323x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer. METHODS Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade-roughness-breathiness-asthenicity-strain system (GRBAS). Laryngoscopy was also performed. RESULTS The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0-21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 microg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy. CONCLUSIONS Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.
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Bhalla RK, Watson G, Taylor W, Jones AS, Roland NJ. Acoustic analysis in asthmatics and the influence of inhaled corticosteroid therapy. J Voice 2008; 23:505-11. [PMID: 18346871 DOI: 10.1016/j.jvoice.2007.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022]
Abstract
The impact of sustained inhaled corticosteroid (ICS) therapy on the larynx and pharynx was assessed using a prospective, cross-sectional, and investigator-blinded study conducted at the University Hospital Aintree, Liverpool, UK. Forty-six adults recruited from two local general practices and from general ENT clinics at our University hospital were investigated for the study. Patients were allocated to three groups according to ICS use. Laryngeal effects were measured by correlating the results of a vocal performance questionnaire, a respiratory symptom questionnaire, and measurements obtained by computerized speech analysis. Sustained vowels and connected speech were analyzed in normal and asthmatic subjects. Acoustic analysis was correlated with cellular markers of inflammation after biopsy. Regular ICS users had significantly more pharyngeal inflammation and throat discomfort (P<0.0001). Vocal performance was also worse in this group (P<0.0001). They were more likely to have hoarseness, weakness of voice, aphonia, sore throat, throat irritation, and cough (P<0.0001). All these variables were directly related to one another (P<0.0001). Multiple linear regression analysis showed that jitter was a good objective measure of hoarseness (P<0.05). Regular ICS users were significantly more likely to have abnormal jitter, shimmer, and closed-phase quotient scores (P<0.0001). There was no difference between the groups in the observed parameters of inflammation (P>0.01). A higher pharyngitis score did not correlate with any of the histological markers of inflammation (P>0.01). Local side effects are more common in asthmatics that use ICS regularly. Measures of laryngeal function are significantly worse in regular ICS users. However, histological markers and oropharyngeal redness are not reliable measures of inflammation.
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Affiliation(s)
- R K Bhalla
- Department of Otolaryngology, University Hospital Aintree, Liverpool, United Kingdom.
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Bijwerkingen van inhalatiecorticosteroïden: consequenties voor de eerste lijn. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf03087607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Simberg S, Sala E, Tuomainen J, Rönnemaa AM. Vocal symptoms and allergy--a pilot study. J Voice 2007; 23:136-9. [PMID: 17624725 DOI: 10.1016/j.jvoice.2007.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
Allergic rhinitis and asthma are common among university students. Inhalant allergies have been considered to be a risk factor contributing to voice disorders. The purpose of this pilot study was to determine if students with confirmed respiratory allergies have frequently occurring vocal symptoms. A questionnaire concerning the prevalence of vocal symptoms was distributed to 49 students attending a 3-year allergen immunotherapy program and to 54 students without known allergy. The results indicated that subjects with allergy report significantly more vocal symptoms than subjects without allergy. Allergy should be considered as an underlying factor for vocal symptoms, especially for persons who work in or study for vocally demanding occupations.
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Gallivan GJ, Gallivan KH, Gallivan HK. Inhaled Corticosteroids: Hazardous Effects on Voice—An Update. J Voice 2007; 21:101-11. [PMID: 16442776 DOI: 10.1016/j.jvoice.2005.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2005] [Indexed: 10/25/2022]
Abstract
Inhaled corticosteroids (ICS) have become the prevalent treatment in asthmatics. Hazards to voice are under-recognized. A total of 38 patients with voice complaints associated with the use of ICS were assessed by 79 strobovideolaryngoscopy (SVL) examinations, 24 single and 14 multiple SVL. Hoarseness and dysphonia were the primary reasons for referral. The ICS initially used most frequently was Advair Diskus (fluticasone propionate and salmeterol-inhalation powder-[IP]) in 22 patients, followed by Flovent (fluticasone propionate inhalation aerosol-pressurized metered-dose inhaler-[PMDI]) in 11. Duration of ICS usage varied from 2 weeks to 4-5 years. Higher dosage and frequency of use exacerbated problems. Hazards to voice previously unrecognized by real-time indirect mirror or fiberoptic laryngoscopy were identified by meticulous attention to SVL abnormalities. There was essentially no difference in occurrence of abnormalities whether analyzed from the perspective of the initial 38 or all 79 examinations. These included abnormal mucosal wave symmetry/periodicity (76-63%), phase closure (74-63%), glottic closure (63-59%), mucosal wave amplitude/magnitude (50-35%), supraglottic hyperactivity (39-25%), mucosal quality (34-34%), and glottic plane (10-5%). Candidiasis of the larynx was infrequently observed. Fluticasone ICS were a cause of steroid inhaler laryngitis, and the best treatment was their avoidance or cessation. Further prospective studies ideally might include SVL documented as a pretherapy baseline and then repeated in each ICS patient who developed hoarseness/dysphonia.
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Affiliation(s)
- Gregory J Gallivan
- Department of Clinical Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
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Zraick RI, Gentry MA, Smith-Olinde L, Gregg BA. The Effect of Speaking Context on Elicitation of Habitual Pitch. J Voice 2006; 20:545-54. [PMID: 16274957 DOI: 10.1016/j.jvoice.2005.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to investigate if there was an effect of speaking context on the elicitation of habitual pitch [speaking fundamental frequency (SFF)]. Six simulated speaking contexts were created (speaking during a voice evaluation, speaking in public, speaking to a peer, speaking to a superior, speaking to a subordinate, and speaking to a parent or spouse), and the SFF for 30 adult women with normal voice was compared across these contexts. A one-way analysis of variance (ANOVA) revealed a statistically significant (P < 0.001) effect of simulated speaking context on SFF, with post hoc analyses indicating a statistically significant difference in SFF while "speaking to a superior" (P < 0.001) and "speaking to a subordinate" (P < 0.001). Possible reasons for an effect of speaking context are discussed. Also, the implications of the use of varied speaking contexts when eliciting SFF are discussed, as is the possibility of an effect of speaking context on the elicitation of other clinically useful voice parameters.
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Affiliation(s)
- Richard I Zraick
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Abstract
The widespread use of inhaled corticosteroids (ICS) for the treatment of persistent asthma, although highly effective, may be associated with both systemic and local side effects. Systemic side effects of ICS have been extensively studied. In contrast, relatively few studies have been performed to specifically evaluate local side effects of ICS. These local side effects--including oropharyngeal candidiasis, dysphonia, pharyngitis, and cough--are generally viewed as minor complications of therapy. However, they can be clinically significant, affect patient quality of life, hinder compliance with therapy, and mask symptoms of more serious disease. Local side effects result from deposition of an active ICS in the oropharynx during administration of the drug. Numerous factors can influence the proportion of an inhaled dose that is deposited in the oropharyngeal cavity, including the ICS formulation, type of delivery system, and patient compliance with administration instructions. Therefore, the incidence of local side effects can vary widely. The goal in developing a new ICS is to include key pharmacologic characteristics that reduce oropharyngeal exposure to active drug while maintaining efficacy comparable with currently available ICS.
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Affiliation(s)
- R Buhl
- Mainz University Hospital, Mainz, Germany
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Vertigan AE, Gibson PG, Theodoros DG, Winkworth AL, Borgas T, Reid C. Involuntary Glottal Closure during Inspiration in Muscle Tension Dysphonia. Laryngoscope 2006; 116:643-9. [PMID: 16585873 DOI: 10.1097/01.mlg.0000201906.41316.fc] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/HYPOTHESIS The purpose of this study was to examine respiratory function in a group of patients with muscle tension dysphonia (MTD) DESIGN: Cross-sectional analytical study. METHODS Participants included 15 people with a diagnosis of MTD referred to speech pathology for management of their voice disorder, fiberoptic evidence of glottal or supraglottic constriction during phonation with or without posterior chink, or bowing combined and deviation in perceptual voice quality. A second group of 15 participants with no history of voice disorder served as healthy controls. Baseline pulmonary function test measures included forced expiratory volume in the first second (FEV1), FVC, FEF25 to 75, FIF50, FEV1/FVC, ratio and FEF50/FIF50 ratio. Hypertonic saline challenge test measures included FEV1 and FIF50 after provocation, dose response slope, and provocation dose. RESULTS Compared with healthy controls, participants with MTD demonstrated a higher prevalence of glottal constriction during inspiration after provocation with nebulized hypertonic saline as demonstrated by a reduction in FIF50 after the hypertonic saline challenge. There was no significant difference between the MTD and healthy control groups in baseline pulmonary function testing. Participants with MTD demonstrated a higher prevalence than healthy controls of abnormal glottic closure during inspiration similar to paradoxical vocal fold movement (PVFM). This suggests that they either had previously undiagnosed coexisting PVFM or that the condition of MTD could be expanded to include descriptions of aberrant glottic function during respiration. This study enhances the understanding of PVFM and MTD by combining research advances made in the fields of otolaryngology and respiratory medicine.
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Affiliation(s)
- Anne E Vertigan
- Division of Speech Pathology, University of Queensland, Brisbane, Queensland, Australia.
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Dogan M, Eryuksel E, Kocak I, Celikel T, Sehitoglu MA. Subjective and objective evaluation of voice quality in patients with asthma. J Voice 2006; 21:224-30. [PMID: 16504474 DOI: 10.1016/j.jvoice.2005.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 11/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the voice quality in patients with mild-to-moderate asthma by subjective and objective methods. STUDY DESIGN Comparative, controlled, cross-sectional study. METHODS Patients with mild-to-moderate asthma (n=40) and age- and sex-matched healthy controls (n=40) were included. Acoustic analyses were performed by the Multi-Dimensional Voice Program (MDVP; Kay Elemetrics Corporation, Lincoln Park, NJ) and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). In addition, the duration of illness, maximum phonation time, "s/z" values, and vital capacity were evaluated. Voice Handicap Index (VHI) and GRB scales were used for subjective evaluations. RESULTS Maximum phonation time values were significantly shorter both in male and female asthma patients compared with controls (P<0.0001). Also, average shimmer values in MDVP were higher for both sexes in the patient group compared with controls (P=0.002 and P=0.04, respectively). There was a significant difference between female patients and sex-matched controls with regard to mean noise-to-harmonic ratio values (P=0.006). Female patients with asthma had higher average jitter values compared with sex-matched controls (P<0.0001). A significant difference was noted between asthma and control groups with regard to GRB scale (P<0.0001, P<0.001, and P<0.0001, respectively). The VHI score was above the normal limit in 16 (40%), and VLS findings were abnormal in 39 (97.5%) asthmatics. CONCLUSION In asthmatic patients, maximum phonation time, frequency, and amplitude perturbation parameters were impaired, but the vital capacity and the duration of illness did not correlate with these findings.
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Affiliation(s)
- Muzeyyen Dogan
- Marmara University School of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Istanbul, Turkey.
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Carding PN, Roulstone S, Northstone K. The prevalence of childhood dysphonia: a cross-sectional study. J Voice 2005; 20:623-30. [PMID: 16360302 DOI: 10.1016/j.jvoice.2005.07.004] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2005] [Indexed: 11/24/2022]
Abstract
There is only very limited information on the prevalence of voice disorders, particularly for the pediatric population. This study examined the prevalence of dysphonia in a large cohort of children (n = 7389) at 8 years of age. Data were collected within a large prospective epidemiological study and included a formal assessment by one of five research speech and language therapists as well as a parental report of their child's voice. Common risk factors that were also analyzed included sex, sibling numbers, asthma, regular conductive hearing loss, and frequent upper respiratory infection. The research clinicians identified a dysphonia prevalence of 6% compared with a parental report of 11%. Both measures suggested a significant risk of dysphonia for children with older siblings. Other measures were not in agreement between clinician and parental reports. The clinician judgments also suggested significant risk factors for sex (male) but not for any common respiratory or otolaryngological conditions that were analyzed. Parental report suggested significant risk factors with respect to asthma and tonsillectomy. These results are discussed in detail.
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Affiliation(s)
- Paul N Carding
- Otolaryngology, The Medical School, Newcastle University, Newcastle, UK.
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Zraick RI, Birdwell KY, Smith-Olinde L. The Effect of Speaking Sample Duration on Determination of Habitual Pitch. J Voice 2005; 19:197-201. [PMID: 15907434 DOI: 10.1016/j.jvoice.2004.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2004] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate if there was an effect of duration of speaking on determination of habitual pitch. Five speaking periods commonly used to elicit habitual pitch in clinical voice evaluations were compared (1, 5, 15, 30, and 60 seconds). Thirty female speakers with normal voices participated. Results of a within-subject univariate F-test revealed a statistically significant (p < 0.001) difference in habitual pitch among the speaking periods. Habitual pitch for the 1-second and 60-second speaking periods were found to be statistically significantly (p < 0.05) different than all remaining speaking periods, and the habitual pitch for the 30-second speaking period was found to be statistically significantly (p < 0.05) different than 60-second speaking period. Implications for the use of various speaking durations when determining habitual pitch are discussed, as is the possibility of a speaking duration effect on determination of other pitch-related voice parameters.
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Affiliation(s)
- Richard I Zraick
- University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
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Ihre E, Zetterström O, Ihre E, Hammarberg B. Voice problems as side effects of inhaled corticosteroids in asthma patients--a prevalence study. J Voice 2005; 18:403-14. [PMID: 15331115 DOI: 10.1016/j.jvoice.2003.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2003] [Indexed: 11/30/2022]
Abstract
Voice disturbances in asthma patients may be caused by inhaled corticosteroids. In order to study the prevalence of such voice disturbances, a questionnaire was delivered to asthma patients at three asthma and allergy departments in Stockholm. The questionnaire consisted of 25 questions concerning the asthma disease symptoms, medication, voice function, and voice disturbances. A total of 350 questionnaires were delivered. Response frequency was 80%. There was a significant positive correlation between inhalation of cortison and voice disturbances. Most of the patients complained about hoarseness, followed by throat clearing, a lump in the throat, loss of voice, and less frequently, throat pain. There were no significantly differences between men and women. Elderly had more voice problems than young persons. Patients with voice-demanding professions had more problems than patients who used their voice to a lesser extent during the working day. There was a significant positive correlation between high cortison doses and voice problems as well as between voice problems and acid regurgitation.
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Affiliation(s)
- Eva Ihre
- Department of Logopedics and Phoniatrics, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
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Abstract
Glucocorticosteroid injections into the shoulder are commonly used in the treatment of rotator cuff tendinitis. These injections rarely result in any serious complications and are generally considered a safe therapeutic intervention. Despite the extensive application of this treatment, there have been no reports of dysphonia occurring after corticosteroid injection into the subacromial space. We report the case of a 66-yr-old man with dysphonia after undergoing subacromial glucocorticosteroid injection for treatment of rotator cuff tendinitis.
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Affiliation(s)
- Faisel M Zaman
- Penn Spine Center, Department of Rehabilitation Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Zraick RI, Marshall W, Smith-Olinde L, Montague JC. The effect of task on determination of habitual loudness. J Voice 2005; 18:176-82. [PMID: 15193650 DOI: 10.1016/j.jvoice.2003.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2003] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to investigate if there is an effect of task on determination of habitual loudness. Four tasks commonly used to elicit habitual loudness were compared (automatic speech, elicited speech, spontaneous speech, and reading aloud). Participants were adult female speakers (N=30) with normal voice. A one-way analysis of variance (ANOVA) revealed a statistically significant (p < 0.05) effect of task, with post-hoc analyses indicating that there was a statistically significant difference in habitual loudness elicited via automatic versus spontaneous speech (p < 0.05), and automatic speech versus reading aloud (p < 0.001). The issue of how habitual loudness is defined is considered. Implications of the use of one task for determination of habitual loudness are discussed, as is the possibility of a task effect on determination of other clinically useful vocal parameters.
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Affiliation(s)
- Richard I Zraick
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Abstract
The author believes that allergy plays an important role in the field of laryngology. Not every patient has significant allergic problems, but the allergic factor in laryngeal problems should not be underestimated. The insights and technology for research have never been better. Many cause-and-effect relationships have been suggested and often provide the working basis for current therapeutics. Many current models of operation need to be verified, explored further, and modified through research. It is hoped that new technologies will achieve a higher degree of sensitivity without sacrificing specificity. Better specificity is particularly needed in allergy testing and in testing thyroid and pulmonary function. The author hopes that the contemporary laryngologist/otolaryngologist will use this overview to formulate a complete and orderly approach to laryngeal problems. Because of the complexity of laryngeal problems, referral to other specialists may be necessary. The laryngologist, however, should be able to orchestrate the appropriate use of technologies and health care specialists to address these problems.
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Affiliation(s)
- Stephen J Chadwick
- Division of Otolaryngology, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653, USA.
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A screening assessment of voice, resonance, and articulation: a guide for the otolaryngologist. Curr Opin Otolaryngol Head Neck Surg 2001. [DOI: 10.1097/00020840-200112000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:263-78. [PMID: 11505947 DOI: 10.1002/pds.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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