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Marchese MR, Longobardi Y, Libero R, Yesilli-Puzella G, D'Alatri L, Galli J. "Lombard Effect" and Voice Changes in Adductor Laryngeal Dystonia: A Pilot Study. Laryngoscope 2024; 134:3754-3760. [PMID: 38727193 DOI: 10.1002/lary.31491] [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: 08/18/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The aim was to describe the acoustic, auditory-perceptive, and subjective voice changes under the Lombard effect (LE) in adductor laryngeal dystonia (AdLD) patients. METHODS Subjective perception of vocal effort (OMNI Vocal Effort Scale OMNI-VES), Maximum Phonation Time (MPT), and the perceptual severity of dysphonia (GRBAS scale) were assessed in condition of stillness and under LE in 10 AdLD patients and in 10 patients with typical voice. Speakers were asked to produce the sustained vowel /a/ and to read a phonetically balanced text aloud. Using the PRAAT software, the following acoustic parameters were analyzed: Mean Pitch (Hz), Minimum and Maximum Intensity (dB), the Fraction of Locally Unvoiced Frames, the Number of Voice Breaks, the Degree of Voice Breaks (%), the Cepstral Peak Prominence-Smoothed (CPPS) (dB). RESULTS Under LE, the AdLD group showed a decrease of both G and S parameters of GRBAS and subjective effort, mean MPT increased significantly; in the controls there were no significant changes. In both groups under LE, pitch and intensity of the sustained vowel /a/ significantly increased consistently with LE. In the AdLD group the mean gain of OMNI-VES score and the mean gain of each parameter of the speech analysis were significantly greater than the controls' ones. CONCLUSION Auditory feedback deprivation obtained under LE improves subjective, perceptual-auditory, and acoustics parameters of AdLD patients. These findings encourage further research to provide new knowledge into the role of the auditory system in the pathogenesis of AdLD and to develop new therapeutic strategies. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3754-3760, 2024.
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Affiliation(s)
- Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Libero
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gamze Yesilli-Puzella
- School of Health Sciences, Speech and Language Therapy Department, Cappadocia University, Ürgüp/Nevşehir, Turkey
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
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Rumbach A, Aiken P, Novakovic D. Treatment Outcome Measures for Spasmodic Dysphonia: A Systematic Review. J Voice 2024; 38:540.e13-540.e43. [PMID: 35513935 DOI: 10.1016/j.jvoice.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This systematic review aims to identify instruments used to evaluate treatment outcomes for people with spasmodic dysphonia. METHODS Electronic database (PubMed, Cochrane Library, Embase, and CINAHL) searches and hand-searching identified studies that evaluated treatment approaches for spasmodic dysphonia which included pre and post outcome data. RESULTS A total of 4714 articles were retrieved from searching databases; 1165 were duplicates. Titles and abstracts of 3549 were screened, with 171 being selected for full-text review. During full-text review, 101 articles were deemed suitable for inclusion. An additional 24 articles were identified as suitable for inclusion through hand-searching of reference lists. Data was extracted from 125 studies, identifying 220 outcome measures. As per the World Health Organization's International Classification of Functioning (ICF), the majority measured body functions (n = 212, 96%). Outcomes that explored communication and participation in everyday life and attitudes towards communication (ie, activity and participation domains) were infrequent (n = 8; 4%). Quality of life, a paradigm outside of the scope of the ICF, was also captured by four outcome measures. No instruments evaluating communication partners' perspectives were identified. CONCLUSIONS Currently there is no unified approach to the measurement of outcomes in SD treatment research. Development and implementation of a core outcome set is recommended to facilitate improved understanding of the efficacy of current and new treatment options.
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Affiliation(s)
- Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Patrick Aiken
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Novakovic
- Dr Liang Voice Program - Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sanuki T. Spasmodic dysphonia: An overview of clinical features and treatment options. Auris Nasus Larynx 2023; 50:17-22. [PMID: 35697560 DOI: 10.1016/j.anl.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/06/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
Spasmodic dysphonia (SD) is considered a rare focal laryngeal dystonia characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndrome, it is typically a sporadic phenomenon, and the involvement of the laryngeal adductor muscles is more common than that of the abductor muscles. This research reviews the literature for the pathogenesis, clinical characteristics, treatment options, and current management methods of SD. Technological advances have enabled clinicians to better understand the connection between laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have helped better understand the underlying mechanisms of this neurolaryngology disorder. Currently, the standard of care for SD is the symptomatic management of botulinum toxin (BT) chemodenervation. This is supported by a large body of literature attesting to its efficacy in many different research studies, particularly in the uncomplicated adductor form of the disorder. Efforts towards surgical treatment predate the development of BT treatment by a decade, but the long-term efficacy has not been proven and, further research is expected. Symptom relief in patients with abductor SD and dystonia with tremors after surgical and BT treatments and those in patients remains suboptimal.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-Cho, Mizuho-Ku, Nagoya, Japan.
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Marks KL, Feaster TF, Baker S, Díaz-Cádiz ME, Doyle PC, Stepp CE. Spectral Aggregate of the High-Passed Fundamental Frequency and Its Relationship to the Primary Acoustic Features of Adductor Laryngeal Dystonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4085-4095. [PMID: 36198059 PMCID: PMC9940896 DOI: 10.1044/2022_jslhr-22-00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/26/2022] [Accepted: 07/15/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Currently, no clinically feasible objective measures exist that are specific to the signs of adductor laryngeal dystonia (LD), deterring effective diagnosis and treatment. This project sought to establish concurrent validity of a new automated acoustic outcome measure, designed to be specific to adductor laryngeal dystonia (AdLD): the spectral aggregate of the high-passed fundamental frequency contour (SAHf o). METHOD Twenty speakers with AdLD read voiced phoneme-loaded (more symptomatic) and voiceless phoneme-loaded (less symptomatic) sentences. LD discontinuities (defined as phonatory breaks, frequency shifts, and creak), the acoustic ramifications of laryngeal spasms, were manually identified. The frequency content of the f o contour was examined as a function of time, and content above 1000 Hz was summed to automatically calculate SAHf o. Multiple linear regression analysis was applied to SAHf o based on LD discontinuities and sentence type (voiced or voiceless phoneme-loaded). RESULTS The regression model accounted for 41.1% of the variance in SAHf o. Both the LD discontinuities and sentence type were statistically related to SAHf o. CONCLUSION Results of this study provide evidence of concurrent validity. SAHf o is an automatic outcome measure specific to acoustic signs of AdLD that may be useful to track treatment progress.
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Hyodo M, Asano K, Nagao A, Hirose K, Nakahira M, Yanagida S, Nishizawa N. Botulinum Toxin Therapy: A Series of Clinical Studies on Patients with Spasmodic Dysphonia in Japan. Toxins (Basel) 2021; 13:toxins13120840. [PMID: 34941678 PMCID: PMC8709071 DOI: 10.3390/toxins13120840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Spasmodic dysphonia (SD) is a rare voice disorder caused by involuntary and intermittent spasms of the laryngeal muscles. Both diagnosis and treatment have been controversial. Therefore, a series of clinical studies has recently been conducted in Japan. A nationwide epidemiological survey revealed that adductor SD predominated (90–95% of all cases; 3.5–7.0/100,000), principally among young women in their 20s and 30s. To facilitate early diagnosis, we created diagnostic criteria for SD and a severity grading system. The diagnostic criteria include the principal and accompanying symptoms, clinical findings during phonation, the treatment response, and the differential diagnoses. The severity grade is determined using a combination of subjective and objective assessments. Botulinum toxin (BT) injection is the treatment of choice; however, there have been few high-quality clinical studies and BT has been used off-label. We conducted a placebo-controlled, randomized, double-blinded clinical trial of BT therapy; this was effective and safe. BT treatment is now funded by the Japanese medical insurance scheme. Studies thus far have facilitated early diagnosis and appropriate therapy; they have fostered patient awareness of SD.
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Affiliation(s)
- Masamitsu Hyodo
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
- Correspondence: ; Tel.: +81-88-880-2393
| | - Kento Asano
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku 783-8505, Japan;
- Department of Medical Innovation, Osaka University Hospital, Suita 565-0871, Japan
| | - Asuka Nagao
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
| | - Kahori Hirose
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
| | - Maya Nakahira
- Rehabilitation Department, Kochi Medical School Hospital, Nankoku 783-8505, Japan;
| | - Saori Yanagida
- Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan; (S.Y.); (N.N.)
| | - Noriko Nishizawa
- Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan; (S.Y.); (N.N.)
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Engelhoven AER, Zraick RI, Bursac Z, Tulunay-Ugur O, Hadden K. The Effects of Self-Esteem, Coping, and Voice-Related Quality of Life on Communicative Participation Before and After BOTOX® Treatment for Spasmodic Dysphonia. J Voice 2020; 36:146.e5-146.e16. [PMID: 32451253 DOI: 10.1016/j.jvoice.2020.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/07/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to (1) investigate the percent change in communicative participation in individuals with spasmodic dysphonia (SD) pre- and post-BOTOX® treatment; and (2) to investigate if percent change in communicative participation is predicted by change in self-esteem, coping, and/or Voice-Related Quality of Life (V-RQOL) pre- and post-BOTOX® treatment. STUDY DESIGN/METHODS A cross-sectional study of 49 patients was conducted across three clinics, with each participant completing the Rosenberg Self-Esteem Scale, the Voice Disability Coping Questionnaire (VDCQ), the V-RQOL instrument, and the Communication Participation Item Bank (CPIB) before BOTOX® treatment and 10-14 days following BOTOX® treatment. DATA ANALYSIS For Research Question 1, a paired t test was applied to test the equality of means for CPIB and to test the pre-post changes among other composite measurements before and after the BOTOX® treatment. For Research Question 2, a multivariable linear regression model was applied with percent change in CPIB as a main outcome, and change in Rosenberg Self-Esteem Scale, VDCQ, and the V-RQOL as independent variables (or covariates) in order to test the associations. RESULTS The results indicated that pre- and post-BOTOX® measures of communicative participation are not statistically significantly different among the participants with SD. There was a strong positive correlation between change in coping and voice-related QOL. CONCLUSIONS A better understanding of the relationship between communicative participation and voice-related QOL is warranted. Item analysis of the V-RQOL and the VDCQ may illustrate coping strategies and functional impairments and provide further information regarding highly variable communicative participation among individuals with SD.
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Affiliation(s)
- Amy E R Engelhoven
- University of Central Florida, School of Communication Sciences and Disorders, Orlando, Florida.
| | - Richard I Zraick
- University of Central Florida, School of Communication Sciences and Disorders, Orlando, Florida
| | - Zoran Bursac
- Robert Stempel College of Public Health, Florida International University, Miami, Florida
| | - Ozlem Tulunay-Ugur
- University of Arkansas for Medical Sciences, Department of Otolaryngology, Little Rock, Arkansas
| | - Kristie Hadden
- University of Arkansas for Medical Sciences, Center for Health Literacy, Little Rock, Arkansas
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Rumbach A, Aiken P, Novakovic D. RETRACTED: Outcome Measurement in the Treatment of Spasmodic Dysphonia: A Systematic Review of the Literature. J Voice 2019; 33:810.e13-810.e39. [DOI: 10.1016/j.jvoice.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Faham M, Torabinezhad F, Murry T, Dabirmoghaddam P, Abolghasemi J, Kamali M, Asgari M. Quality of Life and Voice Changes After a Single Injection in Patients With ADSD Over Time. J Voice 2019; 33:721-727. [DOI: 10.1016/j.jvoice.2018.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/30/2018] [Indexed: 10/14/2022]
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Faham M, Ahmadi A, Silverman E, Harouni GG, Dabirmoghaddam P. Quality of Life After Botulinum Toxin Injection in Patients With Adductor Spasmodic Dysphonia; a Systematic Review and Meta-analysis. J Voice 2019; 35:271-283. [PMID: 31477348 DOI: 10.1016/j.jvoice.2019.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Adductor spasmodic dysphonia is an extremely disabling voice disorder that negatively impacts a patient's quality of life (QOL). We performed a systematic review to determine if Botulinum Toxin (BT) injections improved voice related QOL in patients with this disorder. METHODS PubMed, EMBASE, Web of Science, Cochrane Library, ProQuest, and Scopus from 2000, to and including November 1st, 2018, were searched. We identified randomized controlled trials, controlled trials, and observational studies of the effects of BT injections on the QOL in patients with adductor spasmodic dysphonia. The two authors, separately and individually chose the studies based on inclusion criteria, assessed study quality, and relevant extracted data. RESULTS Nine studies used the Voice Handicap Index (VHI). The results showed significant changes pre- to post-BT injection (SMD = -0.357; 95% CI: -0.579, -0.136; z = 3.16; P = 0.002; I-squared = 0.000%). Five studies used the Voice-Related QOL; their results also showed a significant improvement pre- to postinjection (SMD = -2.99; 95% CI: -3.27, -1.32; z = 4.61; P < 0.001; I-squared = 87%). Three other studies used other, shortened versions of the VHI, VHI-10. They also showed significant results (SMD = -0.145; 95% CI: -0.349, 0.06; z = 1.38; P = 0.17; I-squared = 0.000). CONCLUSION BT injections positively affect patients' QOL. However, patients' QOL scores may never be normalized, in line with perceptual voice quality and acoustic parameters.
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Affiliation(s)
- Maryam Faham
- Department of Speech and Language Pathology, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Akram Ahmadi
- Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, IR Iran
| | - Erin Silverman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
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DeVore EK, Shrime MG, Wittenberg E, Franco RA, Song PC, Naunheim MR. The health utility of mild and severe dysphonia. Laryngoscope 2019; 130:1256-1262. [DOI: 10.1002/lary.28216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Elliana K. DeVore
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Mark G. Shrime
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
- Center for Global Surgery EvaluationMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Eve Wittenberg
- Center for Health Decision ScienceHarvard T. H. Chan School of Public Health Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Phillip C. Song
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Matthew R. Naunheim
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
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Girach A, Vinagre Aragon A, Zis P. Quality of life in idiopathic dystonia: a systematic review. J Neurol 2018; 266:2897-2906. [PMID: 30460447 PMCID: PMC6851210 DOI: 10.1007/s00415-018-9119-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/03/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Dystonia is characterised by sustained muscular contractions frequently producing repetitive, twisting and patterned movements. The primary aim of this systematic review was to establish how quality of life (QoL) is affected in idiopathic focal, multifocal and segmental dystonia. This review aimed to evaluate variations in QoL between different subtypes of dystonia, identify the determinants of QoL and assess the effects of different treatments on QoL. METHODOLOGY A systematic computer-based literature search was conducted using the PubMed database to search for papers on QoL in idiopathic focal, segmental, multifocal and generalized dystonia. We identified 75 studies meeting our inclusion criteria. Information was extracted regarding prevalence, demographics and response to treatment where indicated. RESULTS This review revealed QoL to be a significant yet often overlooked issue in idiopathic dystonia. Data consistently showed that dystonia has a negative effect on QoL in patients compared to healthy controls, when measured using disease-specific and generic QoL measures. The majority of studies (n = 25) involved patients with cervical dystonia, followed by benign-essential blepharospasm (n = 10). Along with the beneficial effect to the dystonia symptoms, treatment using Botulinum Toxin and Deep Brain Stimulation is also effective in improving overall QoL across the majority of subtypes. CONCLUSION The findings demonstrate that patients' QoL should routinely be assessed and monitored, as this may affect subsequent management. Further research will allow for more robust management of factors contributing to impaired QoL, aside from the physical defects found in dystonia.
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Affiliation(s)
- Ayesha Girach
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.
| | - Ana Vinagre Aragon
- Academic Department of Neurosciences, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,Medical School, University of Cyprus, Nicosia, Cyprus
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O'Connell Ferster AP, Sataloff RT, Shewokis PA, Hu A. Socioeconomic Variables of Patients with Spasmodic Dysphonia: A Preliminary Study. J Voice 2018; 32:479-483. [DOI: 10.1016/j.jvoice.2017.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
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Wermke K, Haschemi AA, Hesse V, Robb MP. Inspiratory Phonation in Baby Voice. J Voice 2018; 32:185-191. [DOI: 10.1016/j.jvoice.2017.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022]
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Jahanshahi M. Neuropsychological and Neuropsychiatric Features of Idiopathic and DYT1 Dystonia and the Impact of Medical and Surgical treatment. Arch Clin Neuropsychol 2017; 32:888-905. [DOI: 10.1093/arclin/acx095] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 11/14/2022] Open
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Paniello RC, Edgar JD, Perlmutter JS. Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial. Ann Otol Rhinol Laryngol 2017. [DOI: 10.1177/000348940911801102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.
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Affiliation(s)
- Randal C. Paniello
- Departments of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Julia D. Edgar
- Departments of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Joel S. Perlmutter
- Departments of Neurology, Departments of Radiology, Departments of Neurobiology, Departments of Occupational Therapy, and Departments of Physical Therapy, Washington University School of Medicine, St Louis, Missouri
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Bradley JP, Barrow EM, Hapner ER, Klein AM, Johns MM. Botulinum Toxin-A Dosing Trends for Adductor Spasmodic Dysphonia at a Single Institution Over 10 Years. J Voice 2017; 31:363-365. [DOI: 10.1016/j.jvoice.2016.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/17/2016] [Accepted: 09/19/2016] [Indexed: 11/25/2022]
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Adaptation and Validation of the Voice-Related Quality of Life Measure Into Polish. J Voice 2016; 30:773.e7-773.e12. [DOI: 10.1016/j.jvoice.2015.11.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/18/2015] [Indexed: 11/21/2022]
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Johns MM, Garrett CG, Hwang J, Ossoff RH, Courey MS. Quality-of-Life Outcomes following Laryngeal Endoscopic Surgery for Nonneoplastic Vocal Fold Lesions. Ann Otol Rhinol Laryngol 2016; 113:597-601. [PMID: 15330137 DOI: 10.1177/000348940411300801] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preservation of the vocal fold cover during laryngeal surgery should optimize vocal outcomes for patients with benign glottal lesions. The aim of this study was to evaluate changes in the quality of life, perceptual voice evaluation, and acoustic and aerodynamic measures of patients before and after endoscopic laryngeal microsurgery for true vocal fold cysts, polyps, and scarring. Preoperative and postoperative Voice Handicap Index (VHI) scores, Short Form 36 scores, and perceptual, acoustic, and aerodynamic voice measures were obtained prospectively from 42 patients who underwent phonomicrosurgery from February 2000 through May 2003. The mean (+/-SD) preoperative VHI was 49.6 +/- 21. The mean postoperative VHI score at a minimum of 3 months after surgery decreased to 26.8 +/- 21 (p < .001). When divided by lesion type, VHI scores improved significantly after surgery for vocal fold polyps and cysts. Although patients with vocal fold scarring demonstrated improvement in VHI scores after surgery, statistical significance was not achieved. For the entire group, the Short Form 36 scores were not significantly different from US norms either before or after operation. The acoustic data showed statistically significant decreases in jitter (2.05% to 1.26%), shimmer (7.06% to 4.03%), and noise-to-harmonics ratio (0.18 to 0.13) after surgery (p < .05) in female patients. The upper pitch limit increased after surgery in women (495.3 Hz to 654.9 Hz, p < .001). These results indicate that the voice-related quality of life and some acoustic parameters improve significantly for patients who have undergone laryngeal microsurgery for vocal fold cysts and polyps. Vocal fold scarring remains a difficult clinical problem with less favorable outcomes following surgical treatment in this patient set.
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Affiliation(s)
- Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37212-3102, USA
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Eadie TL, Nicolici C, Baylor C, Almand K, Waugh P, Maronian N. Effect of Experience on Judgments of Adductor Spasmodic Dysphonia. Ann Otol Rhinol Laryngol 2016; 116:695-701. [DOI: 10.1177/000348940711600912] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We performed a prospective, exploratory study 1) to determine differences in judgments of overall severity (OS) and vocal effort (VE) in adductor spasmodic dysphonia (ADSD) when judgments are made by experienced listeners, naive listeners, and speakers with ADSD; 2) to determine differences in judgments of listener comfort (LC) in ADSD when judgments are made by experienced and naive listeners; and 3) to determine relationships between auditory-perceptual ratings of voice and speakers' voice handicap. Methods: Twenty speakers with ADSD provided speech recordings. They judged their own speech samples for OS and VE and completed the Voice Handicap Index (VHI). Twenty naive and 8 experienced listeners evaluated speech samples for OS, VE, and LC using rating scales. Results: No differences were found for judgments of OS, VE, or LC across the groups. However, the strategies used by the speakers seemed to differ from those used by the other listeners in making OS and VE judgments. The speakers' self-judged VE correlated moderately with voice handicap; experienced and naive listeners' judgments were only weakly related to VHI scores. Conclusions: Speakers with ADSD and listeners appear to use auditory-perceptual dimensions differently. Voice handicap is best predicted by patient-perceived VE, and not by clinician or naive listeners' judgments.
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Moore J, Greenberg C, Thibeault SL. Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population. J Voice 2016; 31:41-47. [PMID: 26952321 DOI: 10.1016/j.jvoice.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI). STUDY DESIGN Prospective, survey study. METHODS Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. The VHI was sent to patients 6 months post clinic visit to determine change in voice handicap from baseline. General health was screened using the 12-item Short Form Health Survey, using physical component summary and mental component summary scores. Predictor variables included treatment (medical and/or behavioral); dysphonia sub-diagnosis; grade, roughness, breathiness, asthenia, and strain rating; age; sex; socioeconomic factors; smoking history; and comorbidity score. RESULTS Two hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned 6-month surveys. The VHI was significantly correlated with mental component summary scores. Patients with a higher grade in baseline grade, roughness, breathiness, asthenia, and strain score were more likely to receive voice intervention (P = 0.04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher educational level in both univariate (P < 0.01, P = 0.04) and multivariate analyses (P < 0.01, P = 0.02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI score. CONCLUSIONS Our results suggest that it is important to consider baseline self-perceived voice impact measures and educational level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted.
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Affiliation(s)
- Jaime Moore
- Department of Surgery and Communication Sciences and Disorders, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275
| | - Caprice Greenberg
- Department of Surgery and School of Medicine and Public Health, 7375 Clinical Science Center, K6/148, University of Wisconsin-Madison, 600 Highland Ave., Madison, Wisconsin 53792
| | - Susan L Thibeault
- Department of Surgery, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275..
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Vanryckeghem M, Hoffman Ruddy B, Lehman J. Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia. J Voice 2015. [PMID: 26209041 DOI: 10.1016/j.jvoice.2015.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE/HYPOTHESIS This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice. METHODS Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individual's speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors. RESULTS Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests. CONCLUSIONS The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data.
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Affiliation(s)
- Martine Vanryckeghem
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida.
| | - Bari Hoffman Ruddy
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida; The Ear Nose Throat and Plastic Surgery Associates, Orlando, Florida
| | - Jeffrey Lehman
- The Ear Nose Throat and Plastic Surgery Associates, Orlando, Florida
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Yanagida S, Nishizawa N, Mizoguchi K, Hatakeyama H, Fukuda S. Voice Onset Time for the Word-Initial Voiceless Consonant /t/ in Japanese Spasmodic Dysphonia—A Comparison With Normal Controls. J Voice 2015; 29:450-4. [DOI: 10.1016/j.jvoice.2014.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022]
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Cross-Cultural Adaptation and Validation of the Voice-Related Quality of Life Into Persian. J Voice 2014; 28:842.e1-9. [DOI: 10.1016/j.jvoice.2014.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/18/2014] [Indexed: 11/21/2022]
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Yeung JC, Fung K, Davis E, Rai SK, Day AMB, Dzioba A, Bornbaum C, Doyle PC. Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia. Laryngoscope 2014; 125:661-6. [DOI: 10.1002/lary.24953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/13/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Jeffrey C. Yeung
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ottawa Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery; Schulich School of Medicine and Dentistry; Western University; London Ontario Canada
| | - Eric Davis
- School of Communication Sciences and Disorders; Western University; London Ontario Canada
| | - Sunita K. Rai
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Adam M. B. Day
- School of Communication Sciences and Disorders; Western University; London Ontario Canada
| | - Agnieszka Dzioba
- School of Communication Sciences and Disorders; Western University; London Ontario Canada
| | - Catherine Bornbaum
- School of Communication Sciences and Disorders; Western University; London Ontario Canada
| | - Philip C. Doyle
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ottawa Ontario Canada
- School of Communication Sciences and Disorders; Western University; London Ontario Canada
- Health and Rehabilitation Sciences; Western University; London Ontario Canada
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Kupfer RA, Hogikyan EM, Hogikyan ND. Establishment of a Normative Database for the Voice-Related Quality of Life (V-RQOL) Measure. J Voice 2014; 28:449-51. [DOI: 10.1016/j.jvoice.2013.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 11/07/2013] [Indexed: 11/29/2022]
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Bornbaum CC, Day AMB, Doyle PC. Examining the construct validity of the V-RQOL in speakers who use alaryngeal voice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:196-202. [PMID: 24686439 DOI: 10.1044/2013_ajslp-13-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy. METHOD A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure. RESULTS Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social-emotional), which is consistent with the identified domains in the current V-RQOL. However, the current data indicate that some of the questions proposed by the original authors of the V-RQOL (Questions 7 and 9) do not align with their proposed domains in this postlaryngectomy sample. CONCLUSION The results indicate that some V-RQOL questions do not align with their proposed domains. Consequently, an alternative scoring algorithm may be warranted for alaryngeal populations, and the authors make suggestions for this change that are simple and efficient. Based on the findings of the present factor analysis, use of this modified scoring procedure may serve to increase the sensitivity of the V-RQOL for those who are laryngectomized and use alaryngeal methods of voice and speech. Consequently, the value and application of the V-RQOL may be expanded in the clinical setting.
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Correlation of self-assessment with expert rating and acoustic analysis for spasmodic dysphonia treatment with botulinum neurotoxin A. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.baga.2013.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Meyer TK, Hu A, Hillel AD. Voice disorders in the workplace: Productivity in spasmodic dysphonia and the impact of botulinum toxin. Laryngoscope 2013; 123 Suppl 6:S1-14. [DOI: 10.1002/lary.24292] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Tanya K. Meyer
- Department of Otolaryngology; University of Washington; Seattle Washington
| | - Amanda Hu
- Department of Otolaryngology; Drexel University; Philadelphia Pennsylvania U.S.A
| | - Allen D. Hillel
- Department of Otolaryngology; University of Washington; Seattle Washington
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Paoliello K, Oliveira G, Behlau M. Singing voice handicap mapped by different self-assessment instruments. Codas 2013; 25:463-8. [DOI: 10.1590/s2317-17822013005000008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 10/18/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To map voice handicap of popular singers with a general voice and two singing voice self-assessment questionnaires. METHODS: Fifty singers, 25 male and 25 female, 23 with vocal complaint and 27 without vocal complaint answered randomly the questionnaires. For the comparison of data, the following statistical tests were performed: Mann-Whitney, Friedman, Wilcoxon, Spearman and Correlation. RESULTS: Data showed that the VHI yielded a smaller handicap when compared to the other two questionnaires (VHI x S-VHI - p=0.001; VHI x MSVH - p=0.004). The S-VHI and MSVH produced similar results (p=0.723). Singers with vocal complaint had a VHI total score of 17.5. The other two instruments showed more deviated scores (S-VHI - 24.9; MSVH - 25.2). There was no relationship between gender and singing style with the handicap perceived. A weak negative correlation between the perceived handicap and the time of singing experience was found (-37.7 to -13.10%), that is, the smaller the time of singing experience, the greater the handicap is. CONCLUSION: The questionnaires developed for the assessment of singing voice, S-VHI and MSVH, showed to be more specific and correspondent to each other for the evaluation of vocal handicap in singers. Findings showed that the more the time of singer's singing experience, the smaller the handicap is. Gender and singing styles did not influence the perception of the handicap.
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The Voice-Related Quality of Life (V-RQOL) Measure—A Study on Validity and Reliability of the Norwegian Version. J Voice 2013; 27:258.e29-258.e33. [DOI: 10.1016/j.jvoice.2012.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022]
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Abstract
Recently research offers new insights into the pathogenesis, pathophysiology, and socioemotional implications of spasmodic dysphonia (SD). Among these advances are epidemiologic studies clarifying (1) SD onset and course, (2) SD risk factors, and (3) the relationships among SD course, treatment, and psychosocial impact. In this paper, I will provide a summary of recent epidemiologic and socioemotional research advances involving the onset, course, risk factors, and psychosocial impact of SD.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University Provo, Utah
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32
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Silverman EP, Garvan C, Shrivastav R, Sapienza CM. Combined Modality Treatment of Adductor Spasmodic Dysphonia. J Voice 2012; 26:77-86. [DOI: 10.1016/j.jvoice.2010.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/27/2010] [Indexed: 11/16/2022]
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Dejonckere PH, Neumann KJ, Moerman MBJ, Martens JP, Giordano A, Manfredi C. Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin. Eur Arch Otorhinolaryngol 2011; 269:1195-203. [PMID: 22210475 PMCID: PMC3311985 DOI: 10.1007/s00405-011-1890-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/12/2011] [Indexed: 11/27/2022]
Abstract
Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.
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Affiliation(s)
- P H Dejonckere
- University Medical Centre, ORL Phoniatrics, Utrecht University, Utrecht, The Netherlands.
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Baylor C, Burns M, Eadie T, Britton D, Yorkston K. A qualitative study of interference with communicative participation across communication disorders in adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 20:269-87. [PMID: 21813820 PMCID: PMC3296484 DOI: 10.1044/1058-0360(2011/10-0084)] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE To explore the similarities and differences in self-reported restrictions in communicative participation across different communication disorders in community-dwelling adults. METHOD Interviews were conducted with 44 adults representing 7 different medical conditions: spasmodic dysphonia, multiple sclerosis, stroke, stuttering, Parkinson's disease, amyotrophic lateral sclerosis, and laryngectomy. This article represents a secondary analysis of qualitative data collected in cognitive interviews during development of the Communicative Participation Item Bank. The data were analyzed to identify themes in participants' experiences related to communicative participation. RESULTS Participants described many situations in which they experienced interference in communicative participation. Two themes emerged from the data. The first theme was Interference is both "functional" and "emotional," in which participants defined interference as limitations in accomplishing tasks and emotional consequences. The second theme was "It depends"-sources of interference, in which participants described many variables that contribute to interference in participation. Participants had limited control of some variables such as symptoms and environmental contexts, but personal decisions and priorities also influenced participation. CONCLUSIONS Despite different impairments and activity limitations, participants described similar communicative participation restrictions. These similarities may have theoretical and clinical implications in terms of how we assess, treat, and study the participation restrictions associated with communication disorders.
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Affiliation(s)
- Carolyn Baylor
- Dept. of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195, Phone: 206-221-3563,
| | - Michael Burns
- Dept. of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195, Phone: 559-930-9455,
| | - Tanya Eadie
- Dept. of Speech and Hearing Sciences, University of Washington, 1417 NE 42 St., Seattle, WA 98105, Phone: 206-616-2753,
| | - Deanna Britton
- Dept. of Rehabilitation Medicine, Box 356154, University of Washington, Seattle, WA 98195, Phone: 206-598-3337,
| | - Kathryn Yorkston
- Dept. of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195, Phone: 206-543-3345,
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Tanner K, Roy N, Merrill RM, Sauder C, Houtz DR, Smith ME. Spasmodic dysphonia: onset, course, socioemotional effects, and treatment response. Ann Otol Rhinol Laryngol 2011; 120:465-73. [PMID: 21859056 DOI: 10.1177/000348941112000708] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD). METHODS A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD. RESULTS Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor. CONCLUSIONS The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Sciences and Disorders, the Division of Otolaryngology-Head and Neck Surgery, and the Voice Disorders Center, The University of Utah, Salt Lake City, UT 84108, USA
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Abstract
OBJECTIVES The objective of this study was to elucidate the normative values for the Voice Handicap Index-10 (VHI-10) questionnaire. METHODS VHI questionnaires were completed by 190 subjects without voice complaints. The results were then analyzed for mean, standard error of the mean (SEM), and standard deviation (SD) for both the original VHI and VHI-10 subset questionnaires. Outliers were defined as being more than three standard deviations above the mean. RESULTS Analysis of 156 VHI questionnaires revealed a mean of 6.86 (SEM=0.79, SD=9.88) for the normative values. One hundred fifty-eight VHI-10 questionnaires were analyzed to show a mean of 2.83 (SEM=0.31, SD=3.93) for the normative values. CONCLUSIONS This study offers normative data for the VHI-10 that has been missing in the literature. A VHI-10 score >11 should be considered abnormal.
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Behlau M, Alves dos Santos LDM, Oliveira G. Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Brazilian Portuguese. J Voice 2011; 25:354-9. [DOI: 10.1016/j.jvoice.2009.09.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 09/23/2009] [Indexed: 10/19/2022]
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The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment. The Journal of Laryngology & Otology 2011; 125:714-8. [DOI: 10.1017/s0022215111000739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Botulinum toxin injection under electromyographic guidance is the ‘gold standard’ for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction.Objective:To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients.Setting:Stanford University Voice and Swallowing Center.Design:Prospective case series (evidence level four).Methods:Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose–response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively.Results:Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total).Conclusion:The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.
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Novakovic D, Waters HH, D'Elia JB, Blitzer A. Botulinum toxin treatment of adductor spasmodic dysphonia: longitudinal functional outcomes. Laryngoscope 2011; 121:606-12. [PMID: 21298641 DOI: 10.1002/lary.21395] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Laryngeal botulinum toxin (BoNT) injection is a well-established symptomatic treatment for adductor spasmodic dysphonia (AdSD). Injections may be followed by a period of muscle weakness characterized by breathiness, voice weakness, and dysphagia for liquids. A recent study described some detriment and limited functional improvement with "good voice" for only one-third of the period between successive injections. Our objective was to examine the longitudinal effect of BoNT treatment for AdSD upon functional outcomes and quality of life when using a patient-specific dosing regimen. STUDY DESIGN Prospective cohort study. METHODS Patients presenting for BoNT treatment of AdSD were asked to complete evaluation of voice function after each injection using the percentage of normal function (PNF) scale (daily for two weeks, then weekly). Other parameters measured included voice handicap index (VHI), duration of effect, and complications. RESULTS A total of 133 patients treated continuously between January 2006 and January 2009 with an individuated regime (dose, pattern, and schedule) were included. Of 1,457 treatments, 50.9% experienced some breathiness. Mean VHI improvement was 9.6%. Mean PNF improvement was 30.3%. There was correlation between the two scales. Dysphagia to liquids was reported after 14.2% of treatments. We describe two distinct types of functional outcome curve. A total of 28.5% of treatments were followed by initial functional decline. Mean time below baseline function was 5.7%. Mean proportion of time in plateau phase was 42.5%. CONCLUSIONS It is important to consider longitudinal functional outcomes in BoNT treatment of AdSD. An individuated dosing regimen helps minimize side effects and maximize functional and quality-of-life outcomes.
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Affiliation(s)
- Daniel Novakovic
- New York Center for Voice and Swallowing Disorders, New York, New York, USA.
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Abstract
Dystonia is defined as involuntary sustained muscle contractions producing twisting or squeezing movements and abnormal postures. The movements can be stereotyped and repetitive and they may vary in speed from rapid to slow; sustained contractions can result in fixed postures. Dystonic disorders are classified into primary and secondary forms. Several types of adult-onset primary dystonia have been identified but all share the characteristic that dystonia (including tremor) is the sole neurologic feature. The forms most commonly seen in neurological practice include cranial dystonia (blepharospasm, oromandibular and lingual dystonia and spasmodic dysphonia), cervical dystonia (also known as spasmodic torticollis) and writer's cramp. These are the disorders that benefit most from botulinum toxin injections. A general characteristic of dystonia is that the movements or postures may occur in relation to specific voluntary actions by the involved muscle groups (such as in writer's cramp). Dystonic contractions may occur in one body segment with movement of another (overflow dystonia). With progression, dystonia often becomes present at rest. Dystonic movements typically worsen with anxiety, heightened emotions, and fatigue, decrease with relaxation, and disappear during sleep. There may be diurnal fluctuations in the dystonia, which manifest as little or no involuntary movement in the morning followed by severe disabling dystonia in the afternoon and evening. Morning improvement (or honeymoon) is seen with several types of dystonia. Patients often discover maneuvers that reduce the dystonia and which involve sensory stimuli such as touching the chin lightly in cervical dystonia. These maneuvers are known as sensory tricks, or gestes antagonistes. This chapter focuses on adult-onset focal dystonias including cranial dystonia, cervical dystonia, and writer's cramp. The chapter begins with a review of the epidemiology of focal dystonias, followed by discussions of each major type of focal dystonia, covering clinical phenomenology, differential genetics, and diagnosis. The chapter concludes with discussions of the pathophysiology, the few pathological cases published of adult-onset focal dystonia and management options, and a a brief look at the future.
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Affiliation(s)
- Marian L Evatt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Paniello RC, Edgar JD, Perlmutter JS. Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial. Ann Otol Rhinol Laryngol 2010. [DOI: 10.1177/000348941011901102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods: Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results: Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions: These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.
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Sheppert AD, Spirou GA, Berrebi AS, Garnett JD. Three-dimensional reconstruction of immunolabeled neuromuscular junctions in the human thyroarytenoid muscle. Laryngoscope 2010; 113:1973-6. [PMID: 14603058 DOI: 10.1097/00005537-200311000-00022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to reveal the location of the neuromuscular junctions in a three-dimensional reconstruction of the human thyroarytenoid muscle within the true vocal fold. STUDY DESIGN Immunohistochemical analysis of serially sectioned human true vocal folds was performed, followed by reconstruction in three dimensions using computer imaging software. METHODS Six fresh human larynges from autopsy were harvested, fixed in formalin, and embedded in paraffin. Eight vocal cords were studied from these six larynges. Five-micron serial sections were collected throughout the entire vocal cord in an axial plane at 500-microm intervals. Immunohistochemical analysis was performed with anti-synaptophysin antibody. A computer-controlled imaging and reconstruction system was used to create a three-dimensional reconstruction from the serial sections and to represent the location of the clustered band of neuromuscular junctions within each true vocal fold. The vocal cord was divided into equal thirds from anterior to posterior for statistical analysis. RESULTS The most neuromuscular junctions (74%) were located in the middle third, and the least (7%) were found in the anterior third. The difference in anterior-to-posterior distribution was statistically significant in all eight specimens by chi2 analysis (P <.001). CONCLUSION The distribution of neuromuscular junctions is not random within the human thyroarytenoid muscle. Because neuromuscular junctions are most highly concentrated in a band within the mid belly of the muscle, botulinum toxin type A (Botox) injection in patients with spasmodic dysphonia should be targeted to this region.
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Affiliation(s)
- Andrew D Sheppert
- Department of Otolaryngology, West Virginia University, Morgantown 26505, USA
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Saleem AF, Natour YS. Standardization of the Arabic version of the Voice Handicap Index: an investigation of validity and reliability. LOGOP PHONIATR VOCO 2010; 35:183-8. [PMID: 20804442 DOI: 10.3109/14015439.2010.490851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Validity and reliability of the Arabic version of the VHI (VHI-Arab) were investigated. Possible effects of participant-inherent factors (i.e. age, sex) on participant (77 females, 35 males) responses were also investigated. Results showed high internal consistency (Cronbach's alpha r > 0.857 for all scores). Test-retest reliability was found to be strong (r > 0.87 for all scores). Validity results indicated significant moderate correlations between total VHI score and responses to severity (r = 0.521, P = 0.015) and satisfaction (r = 20.556, P = 0.009) questions. VHI-Arab was found to be unaffected by age (P > 0.10 for all scores) or sex (P > 0.05). This study produced a valid and reliable instrument for measuring participation restriction in Arabic-speaking individuals with voice disorders.
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Affiliation(s)
- Ahmad F Saleem
- Department of Audiology & Speech Pathology, Amman University, Amman, Jordan.
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Kaptein AA, Hughes BM, Scharloo M, Hondebrink N, Langeveld TPM. Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire study. Clin Otolaryngol 2010; 35:31-8. [PMID: 20447160 DOI: 10.1111/j.1749-4486.2009.02070.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. DESIGN Prospective controlled cohort study. SETTING A tertiary care facility. PARTICIPANTS Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. MAIN OUTCOME MEASURES Psychosocial functioning, illness perceptions, and treatment perceptions. RESULTS Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. CONCLUSIONS Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life.
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Affiliation(s)
- A A Kaptein
- Department of Medical Psychology, Leiden University Medical Centre (LUMC), 2300 RC Leiden, The Netherlands.
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Braden MN, Johns MM, Klein AM, Delgaudio JM, Gilman M, Hapner ER. Assessing the Effectiveness of Botulinum Toxin Injections for Adductor Spasmodic Dysphonia: Clinician and Patient Perception. J Voice 2010; 24:242-9. [DOI: 10.1016/j.jvoice.2008.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 08/18/2008] [Indexed: 11/30/2022]
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Haselden K, Powell T, Drinnan M, Carding P. Comparing Health Locus of Control in Patients with Spasmodic Dysphonia, Functional Dysphonia and Nonlaryngeal Dystonia. J Voice 2009; 23:699-706. [DOI: 10.1016/j.jvoice.2008.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 03/31/2008] [Indexed: 10/21/2022]
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Vasconcelos S, Bırkent H, Sardesaı MG, Meratı AL, Hıllel AD. Influence of age and gender on dose and effectiveness of botulinum toxin for laryngeal dystonia. Laryngoscope 2009; 119:2004-7. [DOI: 10.1002/lary.20564] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vocal fold surgery of benign inflammatory lesions of Reinke’s space: an outcome study in 47 subjects. Eur Arch Otorhinolaryngol 2009; 266:1753-7. [DOI: 10.1007/s00405-009-0991-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 04/29/2009] [Indexed: 10/20/2022]
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Thomas L, Jones T, Tandon S, Carding P, Lowe D, Rogers S. Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain. Clin Otolaryngol 2009; 34:34-42. [DOI: 10.1111/j.1749-4486.2008.01830.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gasparini G, Behlau M. Quality of Life: Validation of the Brazilian Version of the Voice-Related Quality of Life (V-RQOL) Measure. J Voice 2009; 23:76-81. [PMID: 17628396 DOI: 10.1016/j.jvoice.2007.04.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/19/2007] [Indexed: 11/28/2022]
Abstract
The purpose of this prospective study was to perform the Brazilian Voice-Related Quality of Life (V-RQOL) version and to check its psychometric measurement properties and the relationship between vocal self-assessment and the instrument's scores. The translation and validation were performed following the guidelines of the Scientific Advisory Committee of Medical Outcomes Trust. The instrument was administered to 234 patients, 114 with vocal complaints, and 120 without vocal complaints. The instrument was submitted to validation, reliability, reproducibility, and responsiveness evaluation. Results showed that internal consistency was demonstrated with high coefficient values (P<0.001) and a statistically acceptable level of reliability (functioning 0.700; social-emotional 0.070; and total 0.108). Pre- and posttreatment results showed a significant responsiveness (Functioning 0.026; Social-Emotional 0.006; and Total 0.008). The study concluded that the Brazilian version of the V-RQOL is valid, reliable, and responsive to change and it can play an important role in the dysphonic patient's voice evaluation.
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Affiliation(s)
- Gisele Gasparini
- Human Communication Disorders Department, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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