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Migliorini E, van Dijk B, Philips B, Mylanus E, Huinck W. The relation between cochlear implant programming levels and speech perception performance in post-lingually deafened adults: a data-driven approach. Eur Arch Otorhinolaryngol 2024; 281:1163-1173. [PMID: 37665345 PMCID: PMC10858098 DOI: 10.1007/s00405-023-08195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Programming a cochlear implant (fitting) is an essential part of a user's post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high degree of variability in fitting practices, users' parameters, and probably outcomes. In this study a data-driven approach is used to retrospectively investigate the relation between cochlear implant fitting parameters and speech perception outcomes in post-lingually deafened adults. METHODS 298 data points corresponding to fitting parameters and speech audiometry test results for the same number of adult, post-lingually deafened, experienced CI users were analyzed. Correlation analysis was performed, after which parameters from the top-scoring and bottom-scoring tertiles were compared via the Mann-Whitney-Wilcoxon u test. RESULTS Weak correlations between dynamic range and speech audiometry outcomes were identified, having p values lower than (albeit close to) 0.05. A significant (p < 0.05) difference in electrical dynamic range (the difference between the minimum and maximum amount of current which may be delivered by each electrode) was found, with top-scoring subjects having on average a wider dynamic range. CONCLUSION The association between dynamic range and speech perception outcomes shown in this retrospective study highlights the need for deeper investigation into evidence-driven fitting. It might be a first step in the direction of evidence-based fitting, minimizing variability in outcomes for cochlear implant users and helping mitigate the issue of unexplained low performance.
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Affiliation(s)
- Enrico Migliorini
- Cochlear Technology Centre Belgium, Mechelen, Belgium.
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | | | | | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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Geerardyn A, Zhu M, Klabbers T, Huinck W, Mylanus E, Nadol JB, Verhaert N, Quesnel AM. Human Histology after Structure Preservation Cochlear Implantation via Round Window Insertion. Laryngoscope 2024; 134:945-953. [PMID: 37493203 DOI: 10.1002/lary.30900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Current surgical techniques aim to preserve intracochlear structures during cochlear implant (CI) insertion to maintain residual cochlear function. The optimal technique to minimize damage, however, is still under debate. The aim of this study is to histologically compare insertional trauma and intracochlear tissue formation in humans with a CI implanted via different insertion techniques. METHODS One recent temporal bone from a donor who underwent implantation of a full-length CI (576°) via round window (RW) insertion was compared with nine cases implanted via cochleostomy (CO) or extended round window (ERW) approach. Insertional trauma was assessed on H&E-stained histological sections. 3D reconstructions were generated and virtually re-sectioned to measure intracochlear volumes of fibrosis and neo-ossification. RESULTS The RW insertion case showed electrode translocation via the spiral ligament. 2/9 CO/ERW cases showed no insertional trauma. The total volume of the cochlea occupied by fibro-osseous tissue was 10.8% in the RW case compared with a mean of 30.6% (range 8.7%-44.8%, N = 9) in the CO/ERW cases. The difference in tissue formation in the basal 5 mm of scala tympani, however, was even more pronounced when the RW case (12.3%) was compared with the cases with a CO/ERW approach (mean of 93.8%, range 81% to 100%, N = 9). CONCLUSIONS Full-length CI insertions via the RW can be minimally traumatic at the cochlear base without inducing extensive fibro-osseous tissue formation locally. The current study further supports the hypothesis that drilling of the cochleostomy with damage to the endosteum incites a local tissue reaction. LEVEL OF EVIDENCE 4: Case-control study Laryngoscope, 134:945-953, 2024.
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Affiliation(s)
- Alexander Geerardyn
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Tim Klabbers
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Joseph B Nadol
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Nicolas Verhaert
- ExpORL, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alicia M Quesnel
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Otopathology Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Philpott N, Philips B, Tromp K, Kramer S, Mylanus E, Huinck W. Phoneme Training for Adult Cochlear Implant Users: A Review of the Literature and Study Protocol. J Speech Lang Hear Res 2023; 66:5071-5086. [PMID: 37889216 DOI: 10.1044/2023_jslhr-23-00335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE This study describes a protocol for a novel individualized phoneme training program for adult cochlear implant (CI) users, based on individual phoneme confusion errors. The protocol is underpinned by a literature review on phoneme training and a focus group with adult CI users. METHOD After a literature search, five studies were included for review and evaluation of quality and level of evidence. A focus group with experienced adult CI users (n = 7) was then conducted to gain insights into their experiences of auditory training post-implantation and recommendations for future training programs. The knowledge gained from the literature review and focus group was used as the foundation for a novel, individualized phoneme training program for adult CI users, for which the protocol is described in this study. RESULTS A review of the literature shows that phoneme training in adult CI users has variable outcomes for on-task and off-task measures. Overall, the concept of individualized training relates to adaptive difficulty within training tasks and not to tailoring training content to participants' individual needs, as indicated by clinical outcomes. The focus group revealed that participants want to be able to track their training progress, have training content tailored to their individual needs, and expressed a preference for shorter training sessions. CONCLUSIONS Using learnings from a literature review and focus group, this study describes a protocol for a novel, individualized phoneme training program for adult CI users. Study findings from this phoneme training program will be disseminated when available. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24392863.
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Affiliation(s)
- Nikki Philpott
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
- Cochlear Ltd., Mechelen, Belgium
| | | | | | - Sophia Kramer
- Department of Otolaryngology-Head and Neck Surgery, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
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Philpott N, Philips B, Donders R, Mylanus E, Huinck W. Variability in clinicians' prediction accuracy for outcomes of adult cochlear implant users. Int J Audiol 2023:1-9. [PMID: 37782308 DOI: 10.1080/14992027.2023.2256973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The variability in outcomes among adult cochlear implant (CI) users poses challenges for clinicians in accurately predicting the benefits of the implant for individual candidates. This study aimed to investigate the accuracy and confidence of clinicians in predicting speech perception outcomes for adult CI users one-year post-implantation. DESIGN Participants were presented with comprehensive information on pre-implantation, one-month post-implantation, and six-month post-implantation data for 10 case studies. The cases encompassed a range of one-year post-implantation phoneme scores, from low performers (27%) to high performers (92%). Participants were tasked with predicting the speech perception outcomes for these cases one year after implantation. STUDY SAMPLE Forty-one clinicians completed the full outcome prediction survey. RESULTS Our findings revealed a significant over-prediction of low performance by clinicians. Interestingly, clinicians tended to predict average performance (73-76% phoneme score) even when provided with information suggesting lower-than-average performance. Most clinicians expressed confidence in their predictions, irrespective of their accuracy. CONCLUSIONS Identifying signs of low performance, particularly in the early post-implantation period, can enable clinicians to implement early interventions. Further research into accurate outcome prediction is essential for managing expectations, providing counselling, increasing CI adoption, and optimising clinical care for both high and low performers.
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Affiliation(s)
- Nikki Philpott
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Cochlear Ltd, Mechelen, Belgium
| | | | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Beckers L, Tromp N, Philips B, Mylanus E, Huinck W. Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes-A scoping review. Front Neurosci 2023; 17:1046669. [PMID: 36816114 PMCID: PMC9932917 DOI: 10.3389/fnins.2023.1046669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological and audiological factors. Studies investigating this, use varying methods and observe varying outcomes, and their relevance has yet to be evaluated in a review. Gathering and structuring this evidence in this scoping review provides a clear overview of where this research line currently stands, with the aim of guiding future research. Objective To understand to which extent different neurocognitive factors influence speech perception in adult CI users with a postlingual onset of hearing loss, by systematically reviewing the literature. Methods A systematic scoping review was performed according to the PRISMA guidelines. Studies investigating the influence of one or more neurocognitive factors on speech perception post-implantation were included. Word and sentence perception in quiet and noise were included as speech perception outcome metrics and six key neurocognitive domains, as defined by the DSM-5, were covered during the literature search (Protocol in open science registries: 10.17605/OSF.IO/Z3G7W of searches in June 2020, April 2022). Results From 5,668 retrieved articles, 54 articles were included and grouped into three categories using different measures to relate to speech perception outcomes: (1) Nineteen studies investigating brain activation, (2) Thirty-one investigating performance on cognitive tests, and (3) Eighteen investigating linguistic skills. Conclusion The use of cognitive functions, recruiting the frontal cortex, the use of visual cues, recruiting the occipital cortex, and the temporal cortex still available for language processing, are beneficial for adult CI users. Cognitive assessments indicate that performance on non-verbal intelligence tasks positively correlated with speech perception outcomes. Performance on auditory or visual working memory, learning, memory and vocabulary tasks were unrelated to speech perception outcomes and performance on the Stroop task not to word perception in quiet. However, there are still many uncertainties regarding the explanation of inconsistent results between papers and more comprehensive studies are needed e.g., including different assessment times, or combining neuroimaging and behavioral measures. Systematic review registration https://doi.org/10.17605/OSF.IO/Z3G7W.
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Affiliation(s)
- Loes Beckers
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Loes Beckers,
| | - Nikki Tromp
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Snels C, Roland JT, Treaba C, Jethanamest D, Huinck W, Friedmann DR, Dhooge I, Mylanus E. Force and pressure measurements in temporal bones. Am J Otolaryngol 2021; 42:102859. [PMID: 33440250 DOI: 10.1016/j.amjoto.2020.102859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Some cochlear implant (CI) patients lose their residual hearing during surgery. Two factors that might play a role in residual hearing loss are the change in intracochlear hydraulic pressure and force on the cochlear wall during electrode insertion. The aim of this study is to investigate whether a difference in peak hydraulic pressure and peak force on the cochlear wall exists during a CI electrode insertion with different insertion techniques. MATERIALS AND METHODS Twenty fresh frozen temporal bones were used. Hydraulic pressure and force on the cochlear wall were recorded during straight electrode insertions with 1) slow versus fast insertion speed, 2) manual versus automatic insertion method and 3) round window approach (RWA) versus extended RWA (ERWA). RESULTS When inserting with a slow compared to a fast insertion speed, the peak hydraulic pressure is 239% (95% CI: 130-399%) higher with a RWA and 58% (95% CI: 6-137%) higher with an ERWA. However, the peak force on the cochlear wall is a factor 29% less (95% CI: 13-43%) with a slow insertion speed. No effect was found of opening and insertion method. CONCLUSIONS As contradictory findings were found for hydraulic pressure and force on the cochlear wall on insertion speed, it remains unclear which insertion speed (slow versus fast) is less traumatic to inner ear structure.
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Heutink F, Koch V, Verbist B, van der Woude WJ, Mylanus E, Huinck W, Sechopoulos I, Caballo M. Multi-Scale deep learning framework for cochlea localization, segmentation and analysis on clinical ultra-high-resolution CT images. Comput Methods Programs Biomed 2020; 191:105387. [PMID: 32109685 DOI: 10.1016/j.cmpb.2020.105387] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Performing patient-specific, pre-operative cochlea CT-based measurements could be helpful to positively affect the outcome of cochlear surgery in terms of intracochlear trauma and loss of residual hearing. Therefore, we propose a method to automatically segment and measure the human cochlea in clinical ultra-high-resolution (UHR) CT images, and investigate differences in cochlea size for personalized implant planning. METHODS 123 temporal bone CT scans were acquired with two UHR-CT scanners, and used to develop and validate a deep learning-based system for automated cochlea segmentation and measurement. The segmentation algorithm is composed of two major steps (detection and pixel-wise classification) in cascade, and aims at combining the results of a multi-scale computer-aided detection scheme with a U-Net-like architecture for pixelwise classification. The segmentation results were used as an input to the measurement algorithm, which provides automatic cochlear measurements (volume, basal diameter, and cochlear duct length (CDL)) through the combined use of convolutional neural networks and thinning algorithms. Automatic segmentation was validated against manual annotation, by the means of Dice similarity, Boundary-F1 (BF) score, and maximum and average Hausdorff distances, while measurement errors were calculated between the automatic results and the corresponding manually obtained ground truth on a per-patient basis. Finally, the developed system was used to investigate the differences in cochlea size within our patient cohort, to relate the measurement errors to the actual variation in cochlear size across different patients. RESULTS Automatic segmentation resulted in a Dice of 0.90 ± 0.03, BF score of 0.95 ± 0.03, and maximum and average Hausdorff distance of 3.05 ± 0.39 and 0.32 ± 0.07 against manual annotation. Automatic cochlear measurements resulted in errors of 8.4% (volume), 5.5% (CDL), 7.8% (basal diameter). The cochlea size varied broadly, ranging between 0.10 and 0.28 ml (volume), 1.3 and 2.5 mm (basal diameter), and 27.7 and 40.1 mm (CDL). CONCLUSIONS The proposed algorithm could successfully segment and analyze the cochlea on UHR-CT images, resulting in accurate measurements of cochlear anatomy. Given the wide variation in cochlear size found in our patient cohort, it may find application as a pre-operative tool in cochlear implant surgery, potentially helping elaborate personalized treatment strategies based on patient-specific, image-based anatomical measurements.
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Affiliation(s)
- Floris Heutink
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Valentin Koch
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Berit Verbist
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Willem Jan van der Woude
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Emmanuel Mylanus
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology and Donders Institute for Brain, Cognition and Behavior, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Dutch Expert Center for Screening (LRCB), Wijchenseweg 101, 6538 SW, Nijmegen, the Netherlands
| | - Marco Caballo
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
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Abstract
OBJECTIVE The validity of a simple and not time-consuming self-assessment (SA) Scale was tested to establish progress after or during stuttering therapy. PATIENTS AND METHOD The scores on the SA scale were related to (1) objective measures (percentage of stuttered syllables, and syllables per minute) and (2) (self-)evaluation tests (self-evaluation questionnaires and perceptual evaluations or judgments of disfluency, naturalness and comfort by naïve listeners). Data were collected from two groups of stutterers at four measurement times: pretherapy, posttherapy, 12 months after therapy and 24 months after therapy. The first group attended the Comprehensive Stuttering Program: an integrated program based on fluency shaping techniques, and the second group participated in a Dutch group therapy: the Doetinchem Method that focuses on emotions and cognitions related to stuttering. RESULTS Results showed similar score patterns on the SA scale, the self-evaluation questionnaires, the objective measures over time, and significant correlations between the SA scale and syllables per minute, percentage of stuttered syllables, Struggle subscale of the Perceptions of Stuttering Inventory and judged fluency on the T1-T2 difference scores. CONCLUSION We concluded that the validity of the SA measure was proved and therefore encourage the use of such an instrument when (stuttering) treatment efficacy is studied.
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Affiliation(s)
- Wendy Huinck
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Kooijman PGC, de Jong FICRS, Thomas G, Huinck W, Donders R, Graamans K, Schutte HK. Risk Factors for Voice Problems in Teachers. Folia Phoniatr Logop 2006; 58:159-74. [PMID: 16636564 DOI: 10.1159/000091730] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In order to identify factors that are associated with voice problems and voice-related absenteeism in teachers, 1,878 questionnaires were analysed. The questionnaires inquired about personal data, voice complaints, voice-related absenteeism from work and conditions that may lead to voice complaints and absenteeism. Different factors play a role in the development and consolidation of voice problems. Physical and psycho-emotional factors appear to be the most important risk factors. Remarkably, voice load and environment seem to be less important as risk factors in the development and consolidation of voice complaints. Teachers who experienced voice problems during their training reported more voice problems during their career. The results of this study stress the importance of a multifactorial approach in the diagnosis and treatment of voice problems, whereby physical and psycho-emotional aspects should be considered as sensitive to the risk of developing voice problems. Moreover, this study shows the crucial importance of adequate voice training during the teacher training programme.
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Affiliation(s)
- P G C Kooijman
- Department of ORL, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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Kooijman PGC, de Jong FICRS, Oudes MJ, Huinck W, van Acht H, Graamans K. Muscular Tension and Body Posture in Relation to Voice Handicap and Voice Quality in Teachers with Persistent Voice Complaints. Folia Phoniatr Logop 2005; 57:134-47. [PMID: 15914997 DOI: 10.1159/000084134] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.
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Affiliation(s)
- P G C Kooijman
- Department of ORL, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
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