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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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Meenan K, Catanoso L, Aoyama J, Stephan SR, Chauvin R, Sataloff RT. The Utility of Pulmonary Function Testing in Patients Presenting With Dysphonia. J Voice 2018; 33:567-574. [PMID: 29753445 DOI: 10.1016/j.jvoice.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aimed to evaluate the utility of pulmonary function testing (PFT), particularly forced expiratory flow (FEF) 25-75%, in patients presenting with dysphonia. STUDY DESIGN A retrospective chart review was carried out. METHODS Records of 199 patients who presented with dysphonia were reviewed to determine whether in-office PFTs, which we perform routinely, lead to new pulmonary diagnoses or the need for additional pulmonary medications, after assessment by a pulmonologist. Of particular interest was evaluating if FEF25-75% of predicted values less than 80% can be used as a marker for occult pulmonary disease in patients presenting with dysphonia. RESULTS Of the 199 patient charts reviewed, 129 were female and 70 were male. The age of patients ranged from 18 to 88 years, with a mean of 46.8 years. The body mass index ranged from 17.5 to 53.4 kg/m2. One hundred five (52.8%) patients had FEF25-75% values less than 80% of predicted (poor midflow values). Of these patients, 76 (72.4%) were referred to a pulmonologist, 22 of 76 (28.9%) completed the referral, and 17 of 22 (77.3%) received a new pulmonary diagnosis or change in medications. Of the 155 patients without a history of pulmonary disease, 76 had poor midflow values, 57 (75%) of these patients were referred, and 12 of 57 (21%) completed the referral. Eight (67%) of these 12 patients were diagnosed with a previously unrecognized pulmonary disorder. Of the 44 patients with a prior history of pulmonary disease, 29 (65.9%) had poor midflow values. Nineteen (65.5%) of these patients were referred, and 9 (47%) received a new pulmonary diagnosis or a change in their medications. There were 51 classically trained singers and 148 nonclassically trained singers or nonsingers. There was no significant difference in average midflow values between the two groups (80.96 ± 24.7 and 80.73 ± 28.4, respectively) or in the percentage of classically trained singers with poor midflow values compared with nonsingers (53.5% vs. 49%, respectively). CONCLUSION This study suggests that patients with dysphonia may have unrecognized underlying pulmonary disease, and PFT should be considered as part of the routine initial voice evaluation for patients presenting with dysphonia.
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Affiliation(s)
- Kirsten Meenan
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lisa Catanoso
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Julien Aoyama
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Ridley Chauvin
- Drexel University College of Medicine, Philadelphia, Pennsylvania
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Abstract
IgE-mediated allergy plays a well-established role in both nasal and pulmonary diseases due to the common epithelium and shared mediator responses of the upper and lower airways. This "unified airway" concept has also been described in other sites within the head and neck that contain similar respiratory mucosa: the middle ear and the larynx. This review will highlight the data suggesting a role for IgE-mediated allergic disease in chronic laryngopharyngeal and middle ear disease and the role for allergy testing to aid in diagnosis and treatment of these disorders.
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Strom MA, Silverberg JI. Asthma, hay fever, and food allergy are associated with caregiver-reported speech disorders in US children. Pediatr Allergy Immunol 2016; 27:604-11. [PMID: 27091599 PMCID: PMC5216174 DOI: 10.1111/pai.12580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children with asthma, hay fever, and food allergy may have several factors that increase their risk of speech disorder, including allergic inflammation, ADD/ADHD, and sleep disturbance. However, few studies have examined a relationship between asthma, allergic disease, and speech disorder. We sought to determine whether asthma, hay fever, and food allergy are associated with speech disorder in children and whether disease severity, sleep disturbance, or ADD/ADHD modified such associations. METHODS We analyzed cross-sectional data on 337,285 children aged 2-17 years from 19 US population-based studies, including the 1997-2013 National Health Interview Survey and the 2003/4 and 2007/8 National Survey of Children's Health. RESULTS In multivariate models, controlling for age, demographic factors, healthcare utilization, and history of eczema, lifetime history of asthma (odds ratio [95% confidence interval]: 1.18 [1.04-1.34], p = 0.01), and one-year history of hay fever (1.44 [1.28-1.62], p < 0.0001) and food allergy (1.35 [1.13-1.62], p = 0.001) were associated with increased odds of speech disorder. Children with current (1.37 [1.15-1.59] p = 0.0003) but not past (p = 0.06) asthma had increased risk of speech disorder. In one study that assessed caregiver-reported asthma severity, mild (1.58 [1.20-2.08], p = 0.001) and moderate (2.99 [1.54-3.41], p < 0.0001) asthma were associated with increased odds of speech disorder; however, severe asthma was associated with the highest odds of speech disorder (5.70 [2.36-13.78], p = 0.0001). CONCLUSION Childhood asthma, hay fever, and food allergy are associated with increased risk of speech disorder. Future prospective studies are needed to characterize the associations.
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Affiliation(s)
- Mark A Strom
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA
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5
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Vocal allergy: recent advances in understanding the role of allergy in dysphonia. Curr Opin Otolaryngol Head Neck Surg 2010; 18:176-81. [DOI: 10.1097/moo.0b013e32833952af] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Abstract
Over the past 10 years, there has been increasing recognition of the interaction between the upper and lower airways in patients with a variety of infectious and inflammatory illnesses, including allergic rhinitis, rhinosinusitis, and asthma. Epidemiologic and mechanistic links have been proposed to demonstrate these relationships and to offer possible etiologic explanations to account for these observations. Among patients with upper respiratory illnesses, cough can be seen as a common symptom, both from the direct influences of upper airway inflammation, which incite reflex changes and bronchospasm, and from the exacerbation of associated pulmonary processes, such as asthma. Despite this increasing awareness of interaction between the upper and lower airways, the influence of both upstream and downstream respiratory inflammatory processes on laryngeal pathophysiology has not been extensively studied. Research suggests, however, that both direct stimulatory effects on the larynx and secondary effects of mucus production and mucus trafficking can create a range of laryngeal symptoms, including cough. This review discusses the interaction of the upper and lower airway in respiratory disease, and focuses on the effect of these respiratory processes on laryngeal inflammation, function, and symptoms.
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7
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Oh JE, Choi YM, Kim SJ, Joo CU. Acoustic variations associated with congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.2.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Eun Oh
- Department of Pediatrics, Chonbuk National University Medical school, Jeonju, Korea
| | - Yoon Mi Choi
- Institute of Cardiovascular Research, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical school, Jeonju, Korea
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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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Millqvist E, Bende M, Brynnel M, Johansson I, Kappel S, Ohlsson AC. Voice change in seasonal allergic rhinitis. J Voice 2007; 22:512-5. [PMID: 17512169 DOI: 10.1016/j.jvoice.2006.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 12/12/2006] [Indexed: 11/19/2022]
Abstract
Voice problems are seldom reported in pollen allergy, although the allergic reaction involves the entire airways. The objective of this study was to investigate voice dysfunction during the pollen season in patients with allergic rhinitis. Thirty patients with verified birch pollen allergy and 30 controls were investigated twice, during the pollen season and outside the pollen season. Both times they scored respiratory and voice symptoms, the latter with the validated questionnaire Voice Handicap Index (VHI), and performed standardized voice recordings. These recordings were analyzed in a controlled manner by a professional voice therapist. During the allergy season, patients reported more respiratory and voice symptoms compared with controls. Those with blinded scored voice dysfunction scored their voice quality during springtime as 31 mm (95% confidence interval [CI] 20-42 mm), compared with 13 mm (95% CI 6-21 mm for participants without voice dysfunction (P<0.01). Furthermore, the group with experienced voice dysfunction scored significantly higher on the VHI in the functional and physical domains and in the total VHI score. Although voice problems during the pollen season are rarely discussed, in allergic rhinitis the larynx may also be involved. These findings support that some patients experience voice change, an experience which can be objectively confirmed.
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Affiliation(s)
- Eva Millqvist
- Department of Otorhinolaryngology and Allergy Centre, Central Hospital, Skövde, Sweden
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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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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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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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