Voice reactions to histamine inhalation in asthma

Laryngeal Mucosal Reaction during Bronchial Histamine Challenge Test Visualized by Videolaryngostroboscopy

OBJECTIVES/HYPOTHESIS

To examine the changes in the larynx, as well as self-reported voice and throat symptoms, among patients undergoing a histamine challenge test. Thus, to understand the possible clinical effects of histamine on the larynx.

STUDY DESIGN

Controlled, open prospective study.

METHODS

Thirty adult patients with prolonged cough and suspicion of bronchial asthma underwent a histamine challenge test. Videolaryngostroboscopy was performed immediately before and after the challenge. Voice and throat symptoms immediately before and after the challenge test were assessed using a visual analog scale.

RESULTS

Videolaryngostroboscopy after exposure showed significant increases in edema (P < 0.001) as well as redness (P < 0.001) of the vocal folds after the exposure. Self-reported voice complaints increased significantly for 8 of 11 symptoms. A moderate positive correlation was found between the increase in edema of the vocal folds and reported heartburn/regurgitation symptoms (r = 0.42, P < 0.05). Atopy, asthma, nasal symptoms, or bronchial hyperreactivity during the histamine challenge test were not associated with laryngeal reactions.

CONCLUSIONS

According to the results, the laryngeal mucosal reaction during a histamine challenge test can be objectively visualized. Videolaryngostroboscopy findings, together with an increase in self-reported voice and throat symptoms, show that histamine has potential effects on vocal folds. The mucosal reaction seems to be pronounced among patients with reflux symptoms, probably reflecting the permeability features of the vocal folds.

Evidence for primary laryngeal inhalant allergy: a randomized, double-blinded crossover study

BACKGROUND

Despite anecdotal reports, no controlled studies to date link allergen exposure with a change in vocal function or dysphonia. The aim of this study was to determine whether allergen exposure in susceptible individuals impairs vocal function.

METHODS

The study was a prospective, double-blind, placebo-controlled study in which subjects serve as their own controls. The participants were 5 inhalant allergic adults with suspected dysphonia from allergies, without evidence of reactive lower airways based on methacholine challenge. All subjects were exposed to 2 experimental conditions in which they were challenged with (1) orally inhaled diluent placebo on 1 day, and (2) orally inhaled allergen on another day. Conditions were randomly ordered across subjects and separated by at least 48 hours. Phonatory threshold pressure (PTP) at the 80th percentile pitch was measured prior to diluent and allergen challenge, and 15 and 60 minutes postchallenge to assess potential change in vocal function after challenge testing.

RESULTS

A repeated measures ANOVA revealed a significant main effect for treatment (allergen vs placebo, p = 0.013) with greater PTP required post-allergen challenge compared to placebo and an effect size of 0.821.

CONCLUSION

A primary causal relationship between allergen exposure and impaired vocal function, as assessed by PTP, was observed in adults with documented allergy independent of asthma or nasal exposure. The current design establishes a safe model for laryngeal inhalant allergen challenge.

Vocal acoustic characteristics in pre-school aged children

Evaluation is the first step for any treatment. Therefore, normal parameters are the bases for proper evaluation.

Aim

Verify measures and vocal acoustic characteristics of 23 pre-school aged children of both genders, aged four to six years and eight months.

Methods

The sampling process comprised a questionnaire -that was sent to parents, auditory screening and vocal-perception auditory assessment, based on the R.A.S.A.T. scale. Acoustic analysis was carried out through the Multi Dimensional Voice Program.

Study

Prospective and cross-sectional.

Results

The noise-harmonic ratio (NHR) and frequency variation (vf0) of the total sample was higher than what was found for five and six-year-olds. As age increased, NHR values decreased. As the total mean of amplitude perturbation quotient (APQ) increased, vf0, variation of amplitude (vAm) soft phonation index (SPI) and NHR also increased; the same occurred between mean total NHR and vf0. As the total means of pitch perturbation quotient (PPQ) and voice turbulence index (VTI) increased, SPI mean value decreased.

Conclusions

The results of the acoustic parameters at the age of four years seem to show an immaturity of the structures and lack of neuro-muscular control at that age and the maturation process onset happens near five and six years old.

Peak flow and voice pathology

Lung function influences voice quality. The aim of this study was to determine if there was a link between subjective voice pathology and peak flow in patients newly presenting with voice problems. A prospective, multigroup study design was designed, with three groups: New voice pathology patients presenting to voice clinics or speech therapists; General patients from ear, nose, and throat clinics with no voice or hearing abnormality; and Asthmatics presenting to general practitioner surgeries or asthma groups for review of asthma treatment. Fifty general ENT patients, 50 voice pathology patients, and 26 asthmatics were included. Peak flow and Voice Handicap Index (VHI) were measured in all subjects. Analysis of the correlation between VHI and percentage of expected peak flow showed a small correlation between the two for voice pathology patients (r=-0.304, P=0.016). No significant correlation was found for the other two groups. These results do not justify the routine measurement of peak flow in all voice clinic patients, but suggest that peak flow measurement and optimization may have a place in those with the most severely impaired VHI.

Acute asphyxia caused by Gerhardt's syndrome associated with asthma

Vocal cord dysfunction (VCD) has been frequently discussed as confounding the diagnosis of asthma, and it is recommended to examine vocal cord function in cases of difficult asthma. However, there is also strong evidence that asthma may be associated with VCD, sometimes masquerading as exercise-induced asthma. Gerhardt's syndrome frequently induces severe acute respiratory distress requiring ventilatory support, and this condition might be mistaken for a severe acute asthma attack. Here, a case of bilateral paralysis of the vocal cords, which was associated with asthma, is described.

Acoustic analysis in the diagnosis of voice disorders in children

The main aim of this study was to describe the changes in acoustic analysis in diagnosing voice disorders in children. The secondary goal was the attempt at differentiation of organic and functional disorders by means of acoustic analysis. The study included 112 children in treated due to laryngeal papilloma, gastro-esophageal reflux, atopic disease and noduli vocales. The following values have been determined: basic frequency F(o), jitter, shimmer, F(o) tremor and the harmonics to noise ratio (HNR). The study results confirmed that the HNR value was the most sensitive indicator of changes in the voice organ.