Duration of Clinical Response After In-Office Steroid Injection for Vocal Fold Scar

OBJECTIVE

To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar.

METHODS

Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints.

RESULTS

Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average.

CONCLUSION

Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2333-2339, 2023.

Voice quality severity and responsiveness to levodopa in Parkinson's disease

The effect of levodopa on perceptual and acoustic measures of voice quality was examined in fifty-one individuals with Parkinson's disease (IWPD). IWPDs produced prolonged vowels while on and off levodopa. Acoustic measures included jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence and the Acoustic Voice Quality Index. A perceptual measure of overall voice quality was obtained from 3 listeners. When the IWPDs were examined as a group, no significant difference was found between on and off levodopa conditions. In contrast, when IWPDs were split into two groups based on voice quality severity, a significant group-by-medication state interaction emerged. In addition, there was a significant correlation (r = .55) between the magnitude of levodopa-related improvement in perceived voice quality and voice quality severity. In contrast, levodopa-related improvement in voice quality was not correlated with duration of disease or levodopa use. Results do not support the hypothesis of reduced levodopa-responsiveness to voice symptoms as disease duration increases. Instead, the results suggest that the magnitude of the levodopa response may increase with increasing severity of the voice quality symptoms. These results suggest that the severity of speech and voice symptoms needs to be given greater consideration in future studies of levodopa effectiveness in IWPDs.

Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis

BACKGROUND

Corticosteroids are widely used to treat voice change after thyroidectomy. In this study, we evaluated the effect of a single dose of intravenous dexamethasone after thyroidectomy using a metaanalysis.

METHODS

Relevant studies were identified by searching the following databases: Medline, Embase, and Cochrane through February 2017. We followed PRISMA guidelines. The following search terms were used: "thyroidectomy," "voice," "steroid." Random-effects models were used to estimate standardized mean differences (SMDs) and 95% confidence intervals.

RESULTS

Our search yielded one retrospective cohort study involving 122 thyroidectomy patients and 3 randomized controlled studies involving 242 thyroidectomy patients. The pooled SMD for voice quality after thyroidectomy was -0.80 (P < .05). Subgroup analysis showed significant voice quality change 1 day after administration of dexamethasone.

CONCLUSIONS

Single-dose intravenous dexamethasone after thyroidectomy significantly improves subjective voice quality on day 1. The effect was not different significantly after day 1.

LEVEL OF EVIDENCE

Level 2a.

Polar-phase indices of perioral muscle reciprocity during syllable production in Parkinson's disease

PURPOSE

This research characterised perioral muscle reciprocity and amplitude ratio in lower lip during bilabial syllable production [pa] at three rates to understand the neuromotor dynamics and scaling of motor speech patterns in individuals with Parkinson's disease (PD).

METHOD

Electromyographic (EMG) signals of the orbicularis oris superior [OOS], orbicularis oris inferior [OOI] and depressor labii inferioris [DLI] were recorded during syllable production and expressed as polar-phase notations.

RESULT

PD participants exhibited the general features of reciprocity between OOS, OOI and DLI muscles as reflected in the EMG during syllable production. The control group showed significantly higher integrated EMG amplitude ratio in the DLI:OOS muscle pairs than PD participants. No speech rate effects were found in EMG muscle reciprocity and amplitude magnitude across all muscle pairs.

CONCLUSION

Similar patterns of muscle reciprocity in PD and controls suggest that corticomotoneuronal output to the facial nucleus and respective perioral muscles is relatively well-preserved in our cohort of mild idiopathic PD participants. Reduction of EMG amplitude ratio among PD participants is consistent with the putative reduction in the thalamocortical activation characteristic of this disease which limits motor cortex drive from generating appropriate commands which contributes to bradykinesia and hypokinesia of the orofacial mechanism.

Acoustic speech analysis of patients with decompensated heart failure: A pilot study

This pilot study used acoustic speech analysis to monitor patients with heart failure (HF), which is characterized by increased intracardiac filling pressures and peripheral edema. HF-related edema in the vocal folds and lungs is hypothesized to affect phonation and speech respiration. Acoustic measures of vocal perturbation and speech breathing characteristics were computed from sustained vowels and speech passages recorded daily from ten patients with HF undergoing inpatient diuretic treatment. After treatment, patients displayed a higher proportion of automatically identified creaky voice, increased fundamental frequency, and decreased cepstral peak prominence variation, suggesting that speech biomarkers can be early indicators of HF.

[The use of fenspiride for the combined treatment of exacerbation of chronic laryngitis]

The present study was carried out based at the Department of Otorhinolaryngology of I.P. Pavlov First State Medical University of Saint-Petersburg. The objective of this work was to elucidate the efficacy and safety of fenspiride therapy for the treatment of exacerbation of chronic laryngitis associated with an acute respiratory infection. The patients comprising the main group received fenspiride (Eurespal, 'Servier', France) at the standard dose in addition to the conventional therapy with the use of antibiotics, inhalation, and voice rest. The patients in the group of comparison were treated following the conventional protocol without fenspiride. The clinical symptoms evaluated based on the scoring system, the results of videolaryngoscopy, and computer-assisted analysis of the voice were compared before and after treatment in the patients of both groups. The results of the study have confirmed the high effectiveness and safety of fenspiride therapy of exacerbation of chronic laryngitis.

Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy

OBJECTIVES

Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease.

MATERIALS AND METHODS

Twenty-two disease-free survivors, treated with cisplatin-based CRT for inoperable HNC (1999-2004), were evaluated at 10-years post-treatment. A standard Dutch text was recorded. Perceptual analysis of voice, speech, and articulation was conducted by two expert listeners (SLPs). Also an experimental expert system based on automatic speech recognition was used. Patients' perception of voice and speech and related quality of life was assessed with the Voice Handicap Index (VHI) and Speech Handicap Index (SHI) questionnaires.

RESULTS

At a median follow-up of 11-years, perceptual evaluation showed abnormal scores in up to 64% of cases, depending on the outcome parameter analyzed. Automatic assessment of voice and speech parameters correlated moderate to strong with perceptual outcome scores. Patient-reported problems with voice (VHI>15) and speech (SHI>6) in daily life were present in 68% and 77% of patients, respectively. Patients treated with IMRT showed significantly less impairment compared to those treated with conventional radiotherapy.

CONCLUSION

More than 10-years after organ-preservation treatment, voice and speech problems are common in this patient cohort, as assessed with perceptual evaluation, automatic speech recognition, and with validated structured questionnaires. There were fewer complaints in patients treated with IMRT than with conventional radiotherapy.

Evaluation of speech impairment in early stages of Parkinson's disease: a prospective study with the role of pharmacotherapy

Despite the initial reports showing beneficial effects of dopaminergic treatment on speech in Parkinson's disease (PD), more recent studies based upon valid measurements have not approved any improvement of speech performance under pharmacotherapy. The aim of this study was to analyze the effect of treatment initiation on the progression of speech impairment in PD, using novel evaluation criteria. Nineteen de novo patients with PD were tested and retested within 2 years after the introduction of antiparkinsonian therapy. As controls, 19 age-matched individuals were recorded. Speech examination included sustained phonation, fast syllable repetition, reading text, and monolog. Quantitative acoustic analyses of the key aspects of speech based on Gaussian kernel distribution, statistical decision-making theory, and healthy speech observation were used to assess the improvement or deterioration of speech. A trend for speech performances to improve was demonstrated after treatment mainly in quality of voice, intensity variability, pitch variability, and articulation. The treatment-related improvement differed in various aspects of speech for individual PD patients. Improvements in vowel articulation and pitch variability correlated with treatment-related changes in bradykinesia and rigidity, whereas voice quality and loudness variability improved independently. Using a novel approach of acoustic analysis and advanced statistics, improvements in speech performance can be demonstrated in PD patients after the introduction of antiparkinsonian therapy. Moreover, changes in speech articulation and pitch variability appear to be related with dopaminergic responsiveness of bradykinesia and rigidity. Therefore, speech may be a valuable marker of disease progression and treatment efficacy in PD.

Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin

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.

Vibrato and tremor extent spectrum: algorithm and applications

This work investigated the measurement of vibrato and tremor extent values. Related works have not explored the possibility of measuring extent in the spectra of fundamental frequency (f(0)) low-frequency undulations. It is shown here that by canceling average (DC) values and baseline drifts of f(0) contours, as well as weighting the respective spectra by the time window DC value, extent measures can be promptly obtained in the frequency domain. The method is illustrated with measurements from synthetic and human data.

[Effectiveness of concomitant therapy with S-1, nedaplatin, and radiation for laryngeal cancer]

Laryngeal cancer occurs more frequently in head and neck cancers, so there are a number of reports regarding the treatment results,wherein the therapeutic strategy and results are stable to some extent. However, due to the spread of chemoradiotherapy, there are differences in the larynx preservation rates for T2 and T3 cases, depending on the facility. Our department has been administering chemoradiotherapy for advanced cancer based on the perspective of conserving the organ and the function. We herein report our examination of 20 laryngeal cancer cases receiving concomitant therapy with S-1, Nedaplatin, and radiation (hereinafter, referred to as SN therapy) in our department from April 2005 to December 2008. The resulting complete response (CR) rate for the SN therapy was 82.4%, excluding T4 cases. Due to their refusal of surgery, 2 of 3 cases in which the SN therapy had been administered for T4 cases receiving SN therapy showed CR, wherein the CR rate in all cases after the SN therapy was 80. 0%. The larynx preservation rate after the SN therapy was 94.1%.

Effect of intranasal estrogen on vocal quality

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Relationship of botulinum dosage to duration of side effects and normal voice in adductor spasmodic dysphonia

OBJECTIVE

Objective evaluation of botulinum toxin A (BTX-A) dosing by determination of the statistical relationship between injection amount and duration of side effects and normal voice in adductor spasmodic dysphonia (SD) patients. From this information, to provide a rational guide to determine the initial and follow-up BTX-A amounts for injection.

STUDY DESIGN AND SETTING

Private laryngology clinic. Statistical analysis was performed on data obtained from 101 patients with SD.

RESULTS

Significant and predictable positive correlations were found between duration of side effects and duration of normal voice after BTX-A injection in patients with SD. Dose of BTX-A injected also appeared to have a significant positive correlation with duration of side effects, but a negative correlation with duration of normal voice. A trend toward more severe side effects was seen with larger doses of BTX-A injections.

CONCLUSIONS AND SIGNIFICANCE

Increased understanding of the response of the human voice over time after BTX-A injection at various doses suggests new ideas to further increase clinical efficacy with the use of lower BTX-A doses.

Effects of antituberculosis treatment on self assessment, perceptual analysis and acoustic analysis of voice quality in laryngeal tuberculosis patients

OBJECTIVES

To evaluate the effects of antituberculosis treatment on the voice quality of laryngeal tuberculosis patients, measured by patient self-assessment, perceptual analysis and acoustic analysis.

MATERIALS AND METHODS

A total of 14 laryngeal tuberculosis patients were enrolled. Laryngeal tuberculosis was established either by biopsy and histopathological examination or by rapid regression of the laryngeal lesions after antituberculosis medication. Before and after treatment, all patients were evaluated perceptually (on a scale of zero to three), and 12 assessed their own voices using the voice handicap index-10 scale. Acoustic analysis was performed to allow objective evaluation.

RESULTS

Patients' ages ranged from 21 to 72 years (mean, 41). The male to female ratio was 12:2. Eight patients (57 per cent) had tuberculous involvement of the epiglottis, four (28 per cent) had involvement of the aryepiglottic fold and eight (57 per cent) had involvement of the false vocal folds. The glottis was the less commonly involved part of the larynx, including true vocal folds (28 per cent, n = 4) and posterior commissure (14 per cent, n = 2). Perceptual evaluation, on a scale of zero to three, gave the patients a median score of six; after commencement of treatment, the median score decreased to two. The mean voice handicap index-10 score decreased from 24 to 12 after treatment. An obvious improvement in acoustic analytical parameters was also found following treatment.

CONCLUSIONS

Antituberculosis treatment clearly improved the voice outcomes of laryngeal tuberculosis patients, according to self-assessment, perceptual analysis and acoustic analysis.

There is no dose-escalation response to dexamethasone (0.0625-1.0 mg/kg) in pediatric tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain, shortening time to first liquid intake, or the incidence of voice change

BACKGROUND

Tonsillectomy is associated with postoperative nausea and vomiting (PONV) if no prophylaxis is administered. Previous studies have shown that a single dose of dexamethasone decreases the incidence of PONV. The most effective dose of dexamethasone to affect clinical outcome is yet to be defined.

METHODS

One-hundred-twenty-five children were enrolled in a double-blind, prospective, randomized, dose-escalating study of dexamethasone: 0.0625, 0.125, 0.25, 0.5, or 1 mg/kg, maximum dose 24 mg. Nonparametric ANOVA was used to analyze the incidence of vomiting by treatment group for 0 to < or =5 h, >5 to 24 h. The Cox Proportional Likelihood Ratio Test was used to compare the time of first vomit and time to first pain medication across treatment groups.

RESULTS

There was no difference in the incidence of vomiting for the five escalating doses of dexamethasone in the time period. There were no differences in secondary outcomes (analgesic requirements, time to first liquid, and change in voice) across treatment groups.

CONCLUSION

We conclude that the lowest dose of dexamethasone (0.0625 mg/kg) was as effective as the highest dose of dexamethasone (1.0 mg/kg) for preventing PONV or reducing the incidence of other secondary outcomes following tonsillectomy or adenotonsillectomy. There is no justification for the use of high-dose dexamethasone for the prevention of PONV in this cohort of children.

Response of the female vocal quality and resonance in professional voice users taking oral contraceptive pills: a multiparameter approach

OBJECTIVE/HYPOTHESIS

The purpose of this study was to analyze the vocal quality and resonance (nasality and nasalance values) during the menstrual cycle in professional voice users using oral contraceptive pills (OCPs). Although professional voice users are more sensitive and aware of their vocal quality, no changes of voice and resonance characteristics were expected because OCPs create a stable hormonal balance throughout the menstrual cycle.

STUDY DESIGN

The authors conducted a comparative study of 24 healthy, young professional voice users using OCPs. One assessment was performed between the 10th and 17th day of pill intake, when hormonal levels reached a steady state. The second assessment was performed during the first 3 days of menses, when no pills were taken and hormonal levels were minimized.

METHODS

Subjective (perceptual evaluation of voice and nasality) and objective (aerodynamic, voice range, acoustic, Dysphonia Severity Index [DSI], nasometer) assessment techniques were used.

RESULTS

: The Mann-Whitney U test showed no significant difference between the perceptual evaluation of the voice and the nasality in the two assessments. The paired Student t test showed no significant difference regarding the maximum phonation time, the vocal performance, the acoustic parameters, and the DSI.

CONCLUSIONS

These findings indicate that OCPs do not have an impact on the objective and subjective voice and resonance parameters in young professional voice users. This information is specifically relevant to professional voice users who are more aware of vocal quality changes and ear, nose and throat specialists/voice therapists who treat professional voice users with voice problems/disorders. Further research regarding the impact of increased vocal load during the premenstrual or menstrual phase in professional voice users using OCPs should be considered.

Birth control pills and nonprofessional voice: acoustic analyses

PURPOSE

Two studies are presented here. Study 1 was aimed at evaluating whether the voice characteristics of women who use birth control pills that contain different progestins differ from the voice characteristics of a control group. Study 2 presents a meta-analysis that combined the results of Study 1 with those from 3 recent studies that compared voices of women who use and do not use birth control pills.

METHOD

In Study 1, voice samples from 30 women with no history of voice training, who use pills with different progestins (drospirenone, desogestrel, gestodene), and 10 women who do not use the pill were recorded at specific time points across the menstrual cycle and were analyzed acoustically. In Study 2, results from Study 1 were analyzed jointly with results from three recent studies, which used similar methodologies.

RESULTS

Results of Study 1 did not reveal acoustic differences in sustained phonation of vowels across the pill groups and controls. Results of the meta-analysis performed in Study 2 indicated that pill users exhibited lower jitter and shimmer values on sustained vowels, whereas no difference of fundamental frequency was observed among women who use the pill.

CONCLUSIONS

These results support findings from previous studies, which suggested that no adverse effect on voice was detected among nonprofessional speakers who use new-generation monophasic birth control pills, for the measures studied. Furthermore, results of the meta-analysis suggested that some acoustic properties of the voice, which are reflected in perturbation measures in sustained vowels, may be improved among women who use the pill.

The effects of a third generation combined oral contraceptive pill on the classical singing voice

The success of professional operatic singers depends upon the quality of their vocal mechanism. This is known to be sensitive to changes in the endocrine environment. Despite a widespread belief among singers that vocal quality changes according to the stage of the menstrual cycle, this has received little attention. In particular, the possibility that use of the contraceptive pill might stabilize vocal quality by "dampening" hormonal fluctuations has not previously been studied systematically. Here, we show that drospirenone containing oral contraceptive pill (Yasmin, Schering AG, West Sussex, UK) with antiandrogenic and antimineralocorticoid properties demonstrates a significant reduction in the irregularity of the pattern of vibration of the vocal folds during the performance of highly trained classical singers. This study constitutes the first double blind, randomized placebo controlled trial to assess the effects of the contraceptive pill on the patterns of vibration of the vocal folds during the performance of Western classical singing repertoire.

Histopathological changes of vocal folds induced by chronic pollutant exposure: an experimental study

Calcium carbonate (CaCO(3)) particles, the main component of chalk, are an important pollutant in the Brazilian school environment. However, there are few reports of the effect of this pollutant in the vocal folds and its influence in voice disorder in the literature.

METHODS

Thirty rats (Wistar), randomly divided into two groups, the control group and the experimental group, were submitted to air or to CaCO(3) inhalation, respectively, during 15, 30, and 90 days. Then, the larynx region was dissected and embedded in paraffin, and 5-mum sections were obtained for microscopic analysis.

RESULTS

No histopathological alteration was found on the vocal folds in the control group. In the experimental group, a moderate chronic inflammatory infiltrate, characterized by macrophage cells, was found in the vocal folds after 30 and 90 days of the CaCO(3) inhalation.

CONCLUSIONS

This study suggests that the inhalation of pollutant particles, such as CaCO(3), induces inflammatory alterations in the larynx; this can affect the vibration of the vocal folds, which influence vocal function.

The effect of acute xerostomia on vocal function

OBJECTIVE

To evaluate whether xerostomia can affect vocal function in an experimental model.

DESIGN

Randomized controlled study.

SETTING

Academic center.

SUBJECTS

Twenty healthy young men.

INTERVENTIONS

Glycopyrrolate was administered to induce acute xerostomia in 10 men, and saline was administered to 10 men who served as controls.

MAIN OUTCOME MEASURES

Whole salivary flow rate and dry mouth scale were time-serially measured, and subjective and objective vocal functions were checked before and after treatment. The salivary and vocal functions were compared between groups.

RESULTS

Significant salivary hypofunction and symptoms developed within 90 minutes after the administration of glycopyrrolate. Vocal effort and phonation threshold pressure significantly increased (P<.005) and voice range profiles decreased in the xerostomia group (P = .003) but not in the control group. Other voice parameters were comparable between groups (P>.05). High correlations were also found between salivary and vocal parameters.

CONCLUSION

Our findings suggest that vocal function can be affected by xerostomia.

Effect of nasal decongestion on voice spectrum of a nasal consonant-vowel

The nasal cavity and its related structures make significant contributions to human phonation, especially the resonance of voice spectra. The voice spectra of the nasal consonant-vowel (CV), [md:], in the subjects with nasal obstruction were obtained and were compared with the spectra of the same CV vocalized by the same subjects after topical nasal decongestion treatment with 1:1000 epinephrine solution. Results revealed that the intensity damping was more marked in the high-frequency area (>1600 Hz) after the nasal decongestion. Moreover, the intensities of the spectral valleys damped more than the spectral peaks, especially the spectral valley of 1000-2700 Hz. Therefore, a more complex spectral pattern was formed by the resultant uneven damping effect after nasal decongestion. The nasal cavity plays an important role in the formation of spectral peaks and valleys, and such engraved voice spectra may also characterize nasal voices like the nasal CV [md:] demonstrated in our study.

Early effects of smoking on the voice: a multidimensional study

BACKGROUND

The purpose of this study was to evaluate the effect of tobacco on the voice in a relatively early stage of the cigarette-smoking habit (<10 years).

MATERIAL/METHODS

A multi-parameter acoustic analysis tool, the Multi-Dimensional Voice Program (MDVP), was used to obtain a set of 27 parameters from sustained vowel phonations of 134 non-dysphonic young adults (aged 20-29) of both genders, including smokers and non-smokers.

RESULTS

Some voice parameters were significantly altered in young smokers when compared with young non-smokers, probably as a consequence of histological changes caused by tobacco. Main differences were observed in Frequency Perturbation parameters (jitter, sPPQ) for both genders, in Fundamental Frequency parameters (Fo, Fhi, Flo) mainly in women, and in tremor parameters (ATRI, FTRI) in men. The number of cigarettes smoked per day was related to the Fundamental Frequency values in women and FTRI in men. A discriminant analysis correctly classified 70-75% of the subjects in each gender group as smokers and non-smokers.

CONCLUSIONS

A combination of voice parameters seems to suggest a possible neurological effect of nicotine--or some other chemical component of tobacco--on the voice.

Therapeutic Potential of Growth Factors for Aging Voice

OBJECTIVES/HYPOTHESIS

It has been reported that in aged vocal folds, dense collagen deposition takes place and hyaluronic acid decreases in the lamina propria, which are thought to contribute to the vocal problems occurring with age (presbyphonia). To restore aged vocal folds to their younger state, it seems crucial to address these age-related lamina propria changes. Intervention that might increase hyaluronic acid and decrease collagen would appear to be a potentially useful approach. The present study examined the effects of growth factors on aged fibroblasts in terms of the production of hyaluronic acid and collagen type I.

STUDY DESIGN

In vitro study using animal model.

METHODS

Fibroblasts were harvested from young and aged rat vocal folds and cultured with or without hepatocyte growth factor and/or basic fibroblast growth factor at different concentrations. Subsequently, the production of hyaluronic acid and collagen type I was examined in the supernatant culture media using enzyme-linked immunosorbent assay.

RESULTS

Aged fibroblasts produced less hyaluronic acid than younger fibroblasts. When aged and young fibroblasts were cultured with basic fibroblast growth factor, hyaluronic acid production increased and collagen type I production decreased regardless of the concentration, whereas the effects of hepatocyte growth factor appeared to vary with concentration. The basic fibroblast growth factor also was associated with stimulation of growth of aged fibroblasts.

CONCLUSION

The present results suggest that growth factors, especially basic fibroblast growth factor, may have therapeutic potential in restoration of aged vocal fold.

Voice changes after androgen therapy for hypogonadotrophic hypogonadism

OBJECTIVES/HYPOTHESIS

Males with isolated hypogonadotropic hypogonadism (IHH) fail to undergo normal sexual development, including the lack of masculinization of the larynx. The objective of this study was to measure the mean vocal fundamental frequency (MF0) in IHH patients and determine the impact of androgen treatment. An additional aim was to compare the MF0 between IHH patients and controls.

STUDY DESIGN

Prospective observational study.

METHODS

Twenty-four patients with IHH were identified along with 30 normal males and females. Voice recordings were obtained on all subjects. Androgen therapy was administered to the IHH patients. The MF0 and serum sex hormone levels were measured before treatment and at intervals during therapy. These results were compared with the pretreatment data within the IHH group. Voice parameters were also compared between the pre- and posttreatment IHH patients and the normal males and females.

RESULTS

The MF0 in untreated IHH patients was 229 +/- 41 Hz. This was intermediate between the normal male (150 +/- 22 Hz, P < .001) and normal female patients (256 +/- 29 Hz, P < .01). After treatment, the MF0 in the IHH group decreased to 173 +/- 30 Hz (P < .0001); indeed, their posttreatment MF0 approached that of normal males (P < .08). Serum hormone levels responded to the injected testosterone, but these levels did not directly correlate with MF0.

CONCLUSIONS

MF0 in IHH patients is intermediate between normal male and female levels. After treatment with testosterone, these values approach the range of normal males. This prospective study details the impact of androgens on the larynx and vocal function in patients with IHH.

The impact of hormonal fluctuations on female vocal folds

PURPOSE OF REVIEW

Sex hormone fluctuations were shown to affect female vocal folds and laryngeal function. Laryngeal changes are evident throughout the span of life, starting at puberty with the arousal of the hormonal system, fluctuating systematically during the reproductive years with the menstrual cycle, and then changing again with the decline of hormonal activity at menopause. This paper reviews recent developments in this field.

RECENT FINDINGS

Early studies that explored this relation were based merely on subjective impressions of voice quality, recent studies have used more objective tools for examining this relation, including histologic observations, stroboscope, electroglottography (EGG), and computerized acoustic analyses. In these studies, the larynx was shown to be a hormonal target organ and, as such, sex hormones affect its morphology, histology, and function, similar to their effect on the genitals and other organs.

SUMMARY

Examining the relation between sex hormones and the larynx could assist in understanding the mechanisms of voice production, and it could provide the clinician with supplemental diagnostic information on different medical conditions.

Longitudinal Effects of Botox Injections on Voice-Related Quality of Life (V-RQOL) for Patients With Adductory Spasmodic Dysphonia

OBJECTIVE

To investigate the longitudinal effects of botulinum toxin type A (Botox) injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia.

DESIGN

Prospective study.

SETTING

Academic tertiary care referral center.

PARTICIPANTS

Forty-two patients who presented to our institution with dysphonia and were diagnosed as having adductory spasmodic dysphonia during a 38-month period.

INTERVENTION

Patients received Botox injections into both thyroarytenoid muscles via the cricothyroid membrane. The typical starting dose was 1.0 U per vocal fold. If necessary, the dosage was adjusted in subsequent injections to reduce adverse effects or to enhance duration of benefit.

MAIN OUTCOME MEASURES

Patients filled out questionnaires, including the V-RQOL Measure and a self-assessed overall voice rating, before each injection. Postinjection questionnaires were completed 6 to 8 weeks after each treatment. Mean pretreatment and posttreatment scores were calculated for each treatment.

RESULTS

The number of treatments per patient ranged from 1 to 7. Statistically significant improvements in mean total and domain V-RQOL scores were calculated for every injection (P<.01) (no postinjection questionnaires were available for the seventh injections). The magnitude of the effect remained constant for later injections. Eighty-two percent of the population recorded at least 1 category of improvement in overall self-assessed voice rating with each injection.

CONCLUSIONS

Botox has a significant beneficial effect on V-RQOL for at least 6 injection cycles. This study demonstrates the efficacy of Botox for treating patients with adductory spasmodic dysphonia and further illustrates the usefulness and validity of the V-RQOL Measure in evaluating patients with dysphonia.

An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP)

Clinicians frequently offer advice to performers and voice-disordered patients aimed ostensibly to manipulate the water content and/or viscosity of the mucus blanket covering the vocal folds. To evaluate the relative effects of three potential laryngeal lubricants on phonatory function (ie, water, Mannitol--an osmotic agent, and Entertainer's Secret Throat Relief (Kli Corp., Carmel, IN)--a glycerin-based product), phonation threshold pressure (PTP) was measured in 18 healthy, vocally normal female participants twice before (baseline) and then four times after 2 ml of each substance were nebulized. PTP is the minimum subglottal pressure required to initiate vocal fold oscillation, and the lowering of PTP is assumed to correspond to physiologically more efficient phonation and reduced phonatory effort. Over a 3-week period, participants were tested on three separate occasions (at 1-week intervals). On each occasion, a different nebulized treatment was administered. PTP for both comfortable and high fundamental frequency productions was measured using an oral pressure-flow system (Perci-Sars, MicroTronics Corp., Chapel Hill, NC). Analysis of the results revealed that Mannitol, an agent that encourages osmotic water flux to the luminal airway surface, lowered PTP immediately after its administration (ie, p = 0.071, for high-pitched productions only). However, the duration of its PTP lowering effect was less than 20 minutes. The other two substances did not demonstrate any significant postadministration effect on PTP.

Steroid injection for Reinke's edema using fiberoptic laryngeal surgery

OBJECTIVE

Since 1990, we have performed steroid injections into the vocal fold under topical anesthesia using fiberoptic laryngeal surgery (FLS) in an outpatient clinic. The aim of this study was to retrospectively assess the usefulness of this treatment method in 44 patients with mild Reinke's edema.

MATERIAL AND METHODS

Using fiberoptic monitoring of the larynx, a curved injection needle was inserted via the oral cavity and triamcinolone acetonide was injected into Reinke's space of the bilateral vocal fold.

RESULTS

Remission or improvement was observed in almost all patients in terms of both patients' self-rating of hoarseness and endoscopic vocal fold findings The maximum phonation time was a mean of 9.0 s before operation and 11.4 safter operation, and this increase was significant (p < 0.01). Voice pitch also improved, from 168 to 181 Hz, in female patients, and this increase was also significant (p < 0.05).

CONCLUSION

Steroid injection is considered to be useful for treating mild Reinke's edema.

Do oral contraceptives improve vocal quality? Limited trial on low-dose formulations

OBJECTIVE

To evaluate the effect of low-dose monophasic oral contraceptives on female vocal quality.

METHODS

Acoustic voice parameters of six women who use oral contraceptives and six women who do not were evaluated repeatedly during the menstrual cycle. Frequency and amplitude variations were measured using a computerized voice analysis program. Repeated-measures analysis of variance was performed to test differences between groups for each acoustic voice parameter.

RESULTS

Vocal stability among the women who use oral contraceptives was significantly better than among those who did not use oral contraceptives (P <.05). Specifically, amplitude and frequency variations between successive vocal cycles were smaller in women using oral contraceptives in comparison with the control group (.24 dB versus.37 dB and.86% versus 1.27% for amplitude and frequency variations, respectively).

CONCLUSION

Contrary to the reports of adverse effects that high-dose pills have on voice, low-dose oral contraceptives show a favorable influence on voice in young women.

Harmonics-to-noise ratio: an index of vocal aging

Distinguishing between vocal changes that occur with normal aging and those that are associated with disease is an important goal of research in voice. Several acoustic measures have been used in an attempt to illuminate the integrity of the vocal mechanism, including harmonics-to-noise ratio (HNR), jitter, and fundamental frequency (F0). HNR is a measure that quantifies the amount of additive noise in the voice signal; jitter reflects the periodicity of vocal fold vibration. In this study, measures of HNR, jitter and F0 were used to compare vocal function in three groups of normally speaking women: young adults, middle-aged adults, and elderly adults. Significant differences in HNR emerged between the elderly women and the other two groups. F0 differences were also apparent between the elderly group and the two younger groups; there were no significant differences in jitter between the three groups. HNRwas found to be a more sensitive index of vocal function than jitter. The significant lowering of HNR evident in t he elderly speakers may be attributable in part to medications taken by the majority of these elderly subjects.

The effect of oral contraceptives on voice: preliminary observations

Most studies investigating the effect of sex hormones on the larynx and vocal folds focused on the voice quality of women either around menopause or during the menstrual cycle. To our knowledge, however, there have been no studies that investigated the effect of oral contraceptives on the female voice. In the present study five women who ingest oral contraceptives (pill group) and five women who do not (natural group) were recorded producing the vowels /i/ and /a/ repeatedly over a period of 40 days. Acoustic analyses were performed on these recordings including F0, amplitude, jitter, shimmer, and harmonic-to-noise ratio (HNR). Results indicated that jitter and shimmer values of the pill group were significantly lower than those of the natural group. No group differences were found for F0, amplitude, or HNR. In addition, the pill group demonstrated significantly smaller variance for all variables tested. The results suggest that oral contraceptives might increase voice stability associated with smaller hormonal changes. Thus the present study provides preliminary evidence of the effect of oral contraceptives on the female voice.

Effect of chronic electrical stimulation of laryngeal muscle on voice

Conventional surgical therapies for bilateral laryngeal paralysis sacrifice voice to enlarge the airway. Electrical pacing of the posterior cricoarytenoid (PCA) muscle to restore glottal opening and allow ventilation offers a new treatment approach. The purpose of this investigation was to determine whether long-term stimulation of the PCA muscle altered perceptual, acoustic, and aerodynamic parameters of voice. Two patients underwent implantation of a Medtronic Itrel II laryngeal pacemaker. Voice evaluation was performed before surgery and at monthly postoperative sessions with the pacemaker off. Months of PCA stimulation did not change perceptual descriptors of voice quality. Measures of fundamental frequency and intensity, upper and lower limits of the dynamic frequency and intensity range, and phonatory flow rates were largely unaltered. The results indicated that there was no effect of laryngeal pacing on voice.

Harmful substances on the opera stage: possible negative effects on singers' respiratory tracts

Objective, quantitative information is lacking in the medical community about actual working conditions for professional singers onstage, and moreover, about which conditions are safe. Physicians, speech-language pathologists, and speech scientists focusing on laryngology should have relevant information about the opera as workplace and the medical sequelae of unhealthy environments. We describe five toxic substances to which singers presenting to our clinics were exposed while working professionally on the opera stage: (1) aromatic diisocyanates, (2) penicillium frequentans in cork granulate, (3) formaldehyde in cork granulate, (4) cobalt and aluminum (pigment components), and (5) quartz sand capable of entering the alveolae. Biological considerations and clinical data for some subjects suggest a direct causal link between the exposures and the patients' complaints and findings. Our observations suggest that whenever singers complain about deleterious conditions such as dry and hot onstage climate or suspicion of the presence of harmful substances, the specific conditions existing in the theater in question should be investigated. Harmful substances are not only poorly tolerated by singers, but also they should be preventable.

Effects of levodopa on laryngeal muscle activity for voice onset and offset in Parkinson disease

The laryngeal pathophysiology underlying the speech disorder in idiopathic Parkinson disease (IPD) was addressed in this electromyographic study of laryngeal muscle activity. This muscle activity was examined during voice onset and offset gestures in 6 persons in the early stages of IPD who were not receiving medication. The purpose was to determine (a) if impaired voice onset and offset control for speech and vocal fold bowing were related to abnormalities in laryngeal muscle activity in the nonmedicated state and (b) if these attributes change with levodopa. Blinded listeners rated the IPD participants' voice onset and offset control before and after levodopa was administered. In the nonmedicated state, the IPD participants' vocal fold bowing was examined on nasoendoscopy, and laryngeal muscle activity levels were compared with normal research volunteers. The IPD participants were then administered a therapeutic dose of levodopa, and changes in laryngeal muscle activity for voice onset and offset gestures were measured during the same session. Significant differences were found between IPD participants in the nonmedicated state: those with higher levels of muscle activation had vocal fold bowing and greater impairment in voice onset and offset control for speech. Similarly, following levodopa administration, those with thyroarytenoid muscle activity reductions had greater improvements in voice onset and offset control for speech. In this study, voice onset and offset control difficulties and vocal fold bowing were associated with increased levels of laryngeal muscle activity in the absence of medication.

Effects of testosterone replacement on a male professional singer

Testosterone has been known to play an important role in the development of the postpubertal male voice for many centuries. In fact, the prevention of pubertal development of the voice by castrating young male singers was a well-known practice, especially in Italy beginning in the sixteenth century. The "castrati" were well known for their clear, high-pitched voices. Because of the resulting small larynx and vocal folds, castrati apparently produced a distinctive resonance as well as the high pitch, which cannot be matched even by the counter tenors of today. Busy voice labs occasionally see males with sex hormone deficiencies secondary to chromosomal or gonadal problems. This is a presentation of an unusual patient who was a trained tenor singer and was found to have hypogonadism on a premarital health examination. Administration of replacement testosterone resulted in significant vocal register and voice quality changes.

Inhaled beclomethasone dipropionate improves acoustic measures of voice in patients with asthma

BACKGROUND

Inhaled corticosteroids have the potential to produce upper-airway side effects such as hoarseness. As new compounds and delivery devices are developed and compared, it is difficult to quantify their adverse upper-airway effects.

OBJECTIVE

We undertook the following study to test the ability of an acoustic analysis technique to quantify changes in vocal function in steroid-naive patients with asthma who receive inhaled beclomethasone dipropionate (BDP), 1,000 microg/d for 4 months.

METHODS

Patients self-administered one of four regimens of inhaled BDP. Group 1 patients received one 250-microg puff qid via metered-dose inhaler (MDI); group 2 patients received one 250-microg puff qid via MDI with a holding chamber; group 3 patients received two 250-microg puffs bid via MDI; and group 4 patients received two 250-microg puffs bid via MDI with a holding chamber. A smaller cohort of nonsmoking asthmatic patients was managed without steroid intervention for 4 months. At baseline and again at 8 weeks and 16 weeks after the initiation of BDP treatment, patients underwent spirometry and methacholine challenge. At baseline and again at 2, 4, 8, 12, and 16 weeks, patients underwent voice recording for analysis of voice parameters. The recorded vowels were low-pass filtered (10 KHz), digitized (22 KHz), and analyzed by software to obtain two acoustic measures: (1) jitter, the cycle-to-cycle variation in the time period of the voice signal; and (2) shimmer, the cycle-to-cycle variation in voice signal amplitude.

RESULTS

We recruited 77 patients for randomization to inhaled steroid therapy and 10 patients who continued to receive only occasional inhaled bronchodilator therapy. In all active treatment groups, FEV(1), FVC, and provocative concentration of methacholine causing a 20% fall in FEV(1) improved significantly after BDP treatment. Mean jitter scores, a measurement of variation in voice pitch, were not significantly influenced by BDP treatment. However, mean shimmer scores, a reflection of perturbation in vocal amplitude, fell significantly (p < 0.05) in the active treatment groups. These reductions in shimmer scores were not significantly different in the active treatment groups. Shimmer scores in the bronchodilator-treated group were unchanged during the 16 weeks of follow-up.

CONCLUSIONS

Our data show that a simple and noninvasive acoustic analysis of voice is sensitive to subclinical changes associated with inhaled corticosteroid therapy. We have shown that 1,000 microg/d of inhaled BDP actually improves specific acoustic measures of voice in patients with inadequately controlled asthma. These improvements were uninfluenced by dosing schedule and whether a spacing chamber was used.

Evaluation of voice quality in adductor spasmodic dysphonia before and after botulinum toxin treatment

In this prospective study, the efficacy of botulinum toxin (Botox) injections in patients with adductor spasmodic dysphonia (AdSD) was assessed by 3 different modalities: perceptual and acoustic analyses and subjective self-assessment. This was done by comparing AdSD patients' pretreatment and posttreatment values and comparing these values with those of normal control speakers. In contrast to most other studies, the posttreatment status was defined as the optimal voice quality as judged by the patient. The aim of the study was to assess to what extent Botox injections actually improve voice quality and function. The AdSD subjects rated a significantly improved voice quality and function after Botox treatment. However, the results were never within normal limits. Perceptually, the characteristic and severely impaired AdSD voice improved, but another "type" of pathological voice was detected after Botox treatment. Acoustic analyses demonstrated a significant improvement, as well. Nevertheless, the "optimally" treated AdSD voice still remained significantly deviant as compared to normal voice production. Currently, Botox injection is the therapy of first choice for AdSD. Although significant improvement could be measured in our study perceptually, acoustically, and subjectively, the optimal voice that was achieved never fully matched normal voice quality or function.

[Diagnosis and therapy of laryngitis gastrica]

We treated 64 patients with the diagnosis of laryngitis gastrica with Antra (Omeprazol) in doses of 10, 20, and 40 mg. To determine the success of the therapy, pH monitoring of the esophagus and hypopharynx, the voice status and measurement of vocal penetrating capacity were used. The results prove that a 20-mg dose of Antra is suitable for the therapy of laryngitis gastrica with a high rate of success. Problems which arose during the investigation, consequent changes of the original concept of the project as well as new aspects and questions which resulted from this are discussed with respect to further investigation.

[Phoniatric studies in myasthenia gravis patients]

The authors have for the first time evaluated the basic parameters of the voice using computed voice analysis in patients with myasthenia gravis (MG). The aim of the study was to introduce an objective method suitable for the assessment of dysphonic symptoms, which predominate in bulbar, oculobulbar and generalized MG. Voice profile studies included the evaluation of the singing voice range, voice dynamics, maximum phonation time, and mean fundamental frequency and intensity during speech. The characteristic of the stroboscopic picture was also determined. Investigations were carried out before and after the intake of Mestinon, a reversible cholinesterase inhibitor, and healthy subjects were used as a control group. In MG, the voice range and dynamics are badly impaired, maximum phonation time is shortened, the mean fundamental frequency during speech is increased, while the intensity is decreased. Mestinon resulted in an improvement in all these parameters, however, they were still impaired in comparison to the control subjects. Most changes were found to be statistically significant. The authors emphasize the role of the otolaryngologist and objective phoniatric methods in the evaluation of MG and other myasthenia-like neurological diseases. The use of these methods for the assessment of phoniatric symptoms in neurological diseases is highly recommended.

Electroglottographic tracking of phonatory response to Botox

Botox injection into the thyroarytenoid muscle is thought to alter the glottal competence and laryngeal adduction of patients with adductor spasmodic dysphonia (ADSD). Hypofunctional responses to treatment have been rated subjectively and inferred from postinjection breathy voice, aphonia, midline glottal gap, or subclinical aspiration. Clinical experience suggests that temporary hypofunction varies in duration and severity among patients. This study used electroglottographic measures to examine changes over time in glottal competence during the relatively stable phonation produced by 5 patients with ADSD. Hierarchical linear modeling was used to test 3 hypotheses: (a) that reduced laryngeal adduction would occur during the first 3 weeks postinjection, followed by a reversal; (b) that patients' hypofunctional response curves would differ one from another; and (c) that changes in adduction, if present, would be related to changes in severity ratings of ADSD symptoms. For 3 participants, significant hypoadduction occurred after injection and reversed toward preinjection level over an 8-week period. Two participants demonstrated a flat or increasing vocal fold contact response curve during the early postinjection period. Observations were consistent with the previously reported differences and possibly complex relation between the resolution of breathy hypofunction and ultimate return of ADSD symptoms.

Effect of caffeine on the vocal folds: a pilot study

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing 'Happy Birthday', substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intra-subject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.

Effects of botulinum toxin on vocal tract steadiness in patients with spasmodic dysphonia

Since laryngeal botulinum toxin (BTX) injections have become the treatment of choice for spasmodic dysphonia, the purpose of this study was to examine its effects on the stability of the upper vocal tract as compared to the effects on glottic stability. Two different acoustic methods were used to analyze voice samples from 16 patients with adductor-type spasmodic dysphonias before and after BTX therapy and from a normal control group. Independent acoustic analyses were used to determine laryngeal and upper vocal tract stability. The results showed significantly higher values for the standard deviation of fundamental frequency (SDF0), reflecting laryngeal instability, for the patient group than for the control group and an impressive improvement for the patients after BTX therapy. Further, the equally high values of SDF0 for the initial second and a second from the midsegment of phonation were differentially reduced by BTX therapy, resulting in a normal pattern of laryngeal stability during sustained phonation. The variability of the first and second formants, reflecting upper vocal tract instability, showed higher values for the patients compared with the control group, but this difference was not statistically significant. The present findings showed that BTX injections to the thyroarytenoid muscle had no discernible effect on stability of the upper vocal tract.

The effect of postmenopause and postmenopausal HRT on measured voice values and vocal symptoms

OBJECTIVES

To study the effect of postmenopause and postmenopausal hormone replacement therapy (HRT) on the measured fundamental frequency (F0) and sound pressure level (SPL) of sustained phonation and speaking voice samples and on subjective vocal/laryngeal symptoms.

METHODS

Forty-three postmenopausal women (mean age 51.6) were divided into three groups: a group with no HRT, an estrogen group (daily oral dose of 2 mg of estradiol valerate), and an estrogen-progestin group (daily oral dose of 2 mg of 17-B-estradiol and 1 mg of northisterone acetate). Voice measurements were made before and after 1 year of treatment. Subjective symptoms were registered using a questionnaire.

RESULTS

The mean F0 and SPL decreased significantly in the group with no HRT in spontaneous speech and reading samples as did SPL in the normal phonation sample. In both groups with HRT, the mean F0 decreased significantly only in the spontaneous speech sample and the decrease was smaller than in the group with no HRT. The mean SPL decrease in the estrogen group was significant in the normal phonation sample while in the estrogen-progestin group it was significant in both the normal phonation and the reading sample. The number of subjective symptoms was smallest in the estrogen group.

CONCLUSIONS

The changes in the measured voice values and the subjective symptoms experienced suggest that at least the early postmenopausal years are associated with vocal changes and that HRT counteracts this phenomenon. This seems to be more pronounced with estrogen than with a combination of estrogen and progestin.

Voice reactions to histamine inhalation in asthma

Susceptibility to voice reactions during a histamine provocation test was studied in 21 asthmatics and 21 healthy subjects. Speech samples were recorded before, and 5 and 15 min after histamine inhalation, and the samples were rated by six speech pathologists. Deterioration of voice quality occurred in 2/12 asthmatic men and in 3/9 asthmatic women within 5 min after histamine inhalation; no change was observed between 5 and 15 min. Voice reactions were not related to the degree of bronchial obstruction: the subjects with the most pronounced decrease in peak expiratory flow (PEF) (60-61% in three subjects) did not develop voice reactions, and PEF did not decrease in one subject with voice reactions. No voice reactions were observed in the healthy subjects.

Change in speaking fundamental frequency in hormone-treated patients with Turner's syndrome--a longitudinal study of four cases

Change in speaking fundamental frequency for four hormone-treated girls with Turner's syndrome was registered using two computerized analysis methods for a period of four years. The girls were treated with human growth hormone, oxandrolone and ethinyl estradiol. The overall pattern for three of the girls was a distinct decline in speaking fundamental frequency during the first year, while for the fourth patient the pattern of change was more complicated. For all four girls, the final pitch level was within the normal range for adult women. It is important that voice effects are taken into account in the hormonal treatment of Turner's syndrome and that patients are informed of the changes to be expected.

Virilization of the voice in post-menopausal women due to the anabolic steroid nandrolone decanoate (Decadurabolin). The effects of medication for one year

In a prospective study the effects on the voice of nandrolone decanoate super-imposed on cyclical hormonal replacement therapy (HRT) given to post-menopausal women suffering from a severe form osteoporosis were compared with the effects of HRT alone. Comparing the experimental group with the control group, after one year of medication in the experimental group a higher percentage of patients had: a lower fundamental frequency during speech, a loss of high frequencies and an increase in voice instability and creakiness. The lowering of the frequencies and the increase of instability can be explained by histological changes in the vocal cords and by problems in the adaptation to these histological changes.