Functional impact of nodules: a case-comparison study

Investigating the Effects of Warm-up Exercises on Acoustic Characteristics of Voice in Female Gym Coaches

INTRODUCTION

A plethora of vocal enhancement and rehabilitation programs for voice professionals define vocal exercises irrespective of analyzing their effects on the specific population on which they are applied, in the established dose and often without considering the presence and absence of vocal alteration. So, in this study we investigated the impact of warm-up exercises (WUE) on the acoustic features of the gym coaches.

OBJECTIVE

To determine the effectiveness of WUE on the acoustic characteristics of the voice in gym coaches.

STUDY DESIGN

This was a Quasi-experimental control group design study.

METHOD

The study was carried out through participation of forty-five female gym coaches with a mean age of 31.4 years (range: 19-44 years) in Mashhad gym salon. Participants were recruited into two conditions. In the first condition, participants did not receive the exercises for a week and were acoustically evaluated at the beginning and end of the week. In the second condition, participants received the exercises once a day for a week and were acoustically evaluated at the beginning and end of the week. Voice samples were included: at least 3 vowels / a / for at least five seconds. The voice samples analyzed by the Praat software recorder (Version 6.0.23) were collected to detect the acoustic characteristics of voice including fundamental frequency (f0) (Hz), jitter (%), shimmer (dB) and noise to harmonic ratio (NHR) (dB). Finally, the data obtained from these two condition were compared.

RESULTS

After WUE, a significant increased f0, decreased jitter, decreased shimmer and decreased NHR were measured. (p-value < 0.005).

CONCLUSION

The WUE had an immediate positive effect on acoustic characteristics of voice)f0, jitter, shimmer and NHR(in the short term and this study suggests that the WUE is an effective technique for enhancing the overall voice quality of gym coaches.

The Effect of An Indirect Voice Therapy Approach on the Voice of Children With Vocal Fold Nodules: A Prospective Cohort Study

PURPOSE

To investigate the effect of a combination indirect voice therapy approach on the management of vocal nodules in the pediatric population.

METHODS

A prospective cohort study with thirty children (24 males and 6 females; mean age 8.8 ± 2.2) with a diagnosis of vocal fold nodule (VFN) was conducted. All participants were included in an 8-week voice therapy program consisting of vocal hygiene education and parental rule-setting. Videolaryngoscopic examination, auditory-perceptual evaluation, and acoustic voice analysis were performed immediately before and after the intervention.

RESULTS

The comparison of videolaryngoscopic findings before and after the therapy revealed that the size of the nodules decreased significantly (P < 0.001). Findings from the laryngeal examination showed that the vast majority of children 73.3% (n = 22) had no VFN anymore after the intervention. The auditory-perceptual evaluation showed that overall severity of dysphonia decreased significantly [from 50 (40-70) to 38 (30-45), P < 0.001]. Jitter local (P = 0.031) and Jitter local abs (P = 0.043) parameters statistically differed after the therapy. There were not any statistically significant differences for mean F0, shimmer local (%), shimmer local (dB), and mean HNR.

CONCLUSIONS

The voice therapy method in this study has a clear benefit on the voice of children with VFN and can be used in clinical practice. Specifically, clinicians should consider the parents as a core component of voice therapies and pay attention to vocal hygiene education for optimal management of VFN related childhood dysphonia.

Prevalence of Perceived Dysphonia and Its Correlation With the Prevalence of Clinically Diagnosed Laryngeal Disorders: The Korea National Health and Nutrition Examination Surveys 2010-2012

OBJECTIVE

This study investigated the prevalence of perceived dysphonia and its correlation with the prevalence of clinically diagnosed laryngeal disorders.

METHODS

Subjects were 8713 non-institutionalized civilian adults over the age of 19 (3810 men and 4912 women) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. A Poisson regression was used to examine the association between perceived dysphonia and laryngeal disorders.

RESULTS

Adjusting for covariates (age, sex, education level, income, occupation, alcohol drinking, and self-reported health status), those with perceived voice problems were 4.8 times (OR=4.75, 95% CI, 3.77-5.99) more likely to have laryngeal disorders than those without voice problems. In particular, the vocal fold pathology correlated with perceived dysphonia was: vocal fold nodules (OR=5.32, 95% CI, 3.43-8.26), vocal polyps (OR=3.73, 95% CI, 1.57-8.86), vocal cysts (OR=11.97, 95% CI, 1.97-72.72), Reinke's edema (OR=9.27, 95% CI, 4.77-18.00), laryngeal paralysis (OR=3.58, 95% CI, 1.56-8.26), laryngeal granulomas (OR=4.31, 95% CI, 1.01-18.80), epiglottic cyst (OR=2.94, 95% CI, 1.21-7.13), and laryngitis (OR=4.07, 95% CI, 2.91-5.69).

CONCLUSION

People with self-perceived dysphonia had a high risk of laryngeal disorders.

The management of vocal fold nodules in children: a national survey of speech-language pathologists

The purpose of this study was to determine the management options and voice therapy techniques currently being used by practicing speech-language pathologists (SLPs) to treat vocal fold nodules (VFNs) in children. The sources used by SLPs to inform and guide their clinical decisions when managing VFNs in children were also explored. Sixty-two SLPs completed a 23-item web-based survey. Data was analysed using frequency counts, content analyses, and supplementary analyses. SLPs reported using a range of management options and voice therapy techniques to treat VFNs in children. Voice therapy was reportedly the most frequently used management option across all respondents, with the majority of SLPs using a combination of indirect and direct voice therapy techniques. When selecting voice therapy techniques, the majority of SLPs reported that they did not use the limited external evidence available to guide their clinical decisions. Additionally, the majority of SLPs reported that they frequently relied on lower levels of evidence or non-evidence-based sources to guide clinical practice both in the presence and absence of higher quality evidence. Further research needs to investigate strategies to remove the barriers that impede SLPs use of external evidence when managing VFNs in children.

Voice Activity and Participation Profile (VAPP) in assessing the effects of voice disorders on patients' quality of life: validity and reliability of the Finnish version of VAPP

The Voice Activity and Participation Profile (VAPP) is a self-assessment questionnaire describing the limitation of activities and participation of individuals with dysphonia. In this study, the validity and reliability of the Finnish translation of the VAPP was evaluated using 43 outpatients with various functional and organic voice disorders. A control group was formed consisting of 43 subjects matched according to age, gender, and profession, with normal voices. The VAPP was sensitive for voice disorders and items in the questionnaire had high internal consistency. The VAPP had a strong correlation with the Voice Handicap Index. The results showed that the questionnaire is a valid and reliable instrument to measure voice-related quality of life. It also showed that limitations in activity and participation levels should be examined separately.

Comparisons between therapists' and patients' views of dysphonia: a survey study

Speech and language therapists (SLTs) recognise the need to involve patients in the design and implementation of services. The present study describes the results of a questionnaire survey undertaken among SLTs working with patients with voice disorders to determine whether patients' and therapists' views on issues around dysphonia were in harmony. The SLTs' views of patients' disabilities and handicaps associated with dysphonia are reported and compared with those of an earlier survey of patient-reported difficulties (Scott et al. Clin Otolaryngol 1997; 22: 37-40). A close, but incomplete, match of therapists' and patients' views of dysphonia is reported and discussed.

Fat augmentation following microsurgical removal of the vocal nodules

OBJECTIVES

Autogenous fat augmentation has been used as a treatment for glottic insufficiency. However, no information is available on the effectiveness of fat injection in patients with vocal nodules or recurrent vocal nodules after surgery.

STUDY DESIGN

The retrospective study reviews the efficiency of fat injection after surgery in patients with vocal nodules (n = 18) and recurrent vocal nodules (n = 5).

METHODS

The perceptual acoustic, phonatory function, and video laryngostroboscopic data were evaluated before and after surgery in 23 patients.

RESULTS

Mean follow-up time was 7.5 months. Nineteen patients had excellent results. Two patients had improvement, and no change was observed in two patients. Phonatory function showed significant improvement in shimmer, harmonic-to-noiseratio (P <.05), maximum phonation time, grade, roughness, and breathiness (P <.001). Video laryngostroboscopic rating showed significant improvement in linearity of the vocal fold edge, amplitude of vocal fold vibration, and excursion of the mucosal wave (P <.001). Less improvement was observed in recurrent vocal nodules than in nonrecurrent vocal nodules.

CONCLUSIONS

Fat injection is an effective autogenous implant and may be considered as an option in management of patients with vocal nodules after surgery. Recurrence of nodules is a problem, but the procedure may be repeated.

Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study

Although persistent hoarseness has been recognized in patients who have sustained burn and/or smoke inhalation injuries, there is little documentation to support this observation. Furthermore, there is no quantification of either the pervasiveness of the problem or the severity of the dysphonia resulting. It was the intent of this study to examine the laryngeal condition and voice production of a group of patients who were long-term survivors of burns and inhalation injuries. Only 10 patients (8 male and 2 female) of a larger cohort were willing to return for this examination. They were ambulatory and did not require respiratory assistance, and it had been 16 to 25 years since their initial traumas. Videostrobolaryngoscopic examinations were performed and analyzed, measures of various acoustic and aerodynamic parameters were made, and severity of dysphonia was judged. Seven of the 10 subjects were rated by experienced listeners as having some degree of dysphonia. All subjects had some abnormality of the laryngeal mucosa. Stroboscopic examination was found to be helpful in identifying laryngeal abnormalities in at least half of the subjects. Early attention to these problems, many of which are treatable surgically or behaviorally or both could lead to an improved voice for the patient and for this reason an improved quality of life.

Voice activity and participation profile: assessing the impact of voice disorders on daily activities

Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders.

Voice therapy methods in dysphonia

Voice therapy, the behavioral approach to the treatment of disorders of voice, can take many forms. The intent of this article is to provide informative, useful, and usable information about a selected number of therapy techniques and methods. Some methods are all-inclusive and stand alone in the belief that they are adequate and appropriate for treatment of certain conditions or many conditions. The article presents a description, the rationale, key points in manner of use, concerns, and expectations for the methods and techniques described.