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Voice Problems (voice + problem)
Selected AbstractsAerodynamic Changes as a Result of Vocal Function Exercises in Elderly MenTHE LARYNGOSCOPE, Issue 10 2008Stephen Gorman PhD Abstract Objectives/Hypothesis: Voice therapy can improve the vocal quality of elderly patients with voice problems, but the changes in vocal aerodynamics associated with physiologic voice therapy are not well documented. The purpose of the present study was to determine the changes in vocal aerodynamics as a result of the management program known as Vocal Function Exercises (VFEs). Study Design: Pre- and post-treatment differences in VFE maximum phonation times (MPT) and measures of vocal aerodynamics were analyzed. Methods: There were 19 participants, aged 60 to 78 years, who performed VFEs twice a day for 12 weeks. Aerodynamic measures of glottal airflow and subglottic pressure were collected at comfortable, high, and low pitches both before the initiation of the exercise program and again at its conclusion. MPT data were collected weekly. Results: The participants showed continuous improvement in VFE MPT across the 12 weeks. Significant differences occurred from pre- to post-therapy on some measures of vocal aerodynamics relating to glottic closure. Conclusions: Decrease in glottic airflow was achieved, with a concomitant increase in subglottic pressure, but without an increase in acoustic power (comfortable and low pitch). Improvement in VFE MPT mirrored the improvement in vocal aerodynamics. [source] The Utility of Second-Look Operation After Laser Microresection of Glottic Carcinoma Involving the Anterior Commissure,THE LARYNGOSCOPE, Issue 8 2008Jong-Lyel Roh MD Abstract Objectives/Hypothesis: Transoral laser microsurgery for the treatment of glottic carcinoma with anterior commissure (A-com) involvement is associated with a high rate of recurrence. We prospectively evaluated the outcomes of laser microsurgery and the efficacy of second-look operation in these patients. Study Design: Prospective evaluation. Methods: Twenty-seven patients with glottic carcinomas involving the A-com underwent transoral laser microresection. Twenty-five patients underwent second-look operations 3 months after laser surgery. Results: After transoral laser microresection, all patients achieved microscopic clear resection margins. Local recurrence was found in 7 of 27 patients (25.9%). Regional recurrence was found in two patients. Patients with recurrences underwent laser re-resection or neck dissection; four received radiotherapy, two lost their larynxes, and three died of disease. At second-look operation, early local recurrence was found in two patients, and anterior glottic webs and granulomas causing dysphonia were treated in 8 and 11 patients, respectively. Conclusions: Laser microsurgery is an effective treatment modality in early glottic cancer with A-com involvement but is still associated with a high rate of recurrence. Second-look operation may help detect early local recurrence and treat postoperative airway or voice problems. [source] Hoarseness: Is It Really Laryngopharyngeal Reflux?,THE LARYNGOSCOPE, Issue 2 2008Seth M. Cohen MD Abstract Objective/Hypothesis: This study will test the hypothesis that proton pump inhibitor (PPI) use is prevalent among patients referred for hoarseness and will assess the ultimate diagnosis and factors associated with patients' voice outcomes. Study Design: Retrospective review of patients in a tertiary care voice clinic. Methods: Patients with a primary diagnosis of hoarseness, who were taking or had taken PPIs in the previous 2 months and referred to a tertiary care voice clinic, were identified. The dosage and length of PPI administration, patient report of gastroesophageal reflux (GER), presence of findings suggesting muscle tension dysphonia (MTD), patient demographics, diagnosis, chronicity of symptoms, interventions, follow-up, and outcome were determined. Results: Of 299 patients, 264 met the inclusion criteria. The mean age was 47.2 years, with a range of 18 to 89 years, with 26.7% male and 73.3% female. Among patients referred for voice problems, 148 (56.1%) had previously tried PPIs or were currently on PPI treatment; 44 (29.7%) stopped taking their PPI because of continued hoarseness, and 104 (70.3%) had persistent hoarseness and associated throat complaints despite continued PPI treatment. Among patients who quit taking their PPI because of continued voice complaints, 79.5% did not have traditional GER symptoms of heartburn or regurgitation. The most common treatment after referral was voice therapy, with an overall voice therapy response rate of 62.7%. Conclusions: PPI use is prevalent among patients referred because of persistent hoarseness. Whether patients have GER or MTD may influence patients' voice outcomes in response to PPI treatment. [source] Injection of Embryonic Stem Cells Into Scarred Rabbit Vocal Folds Enhances Healing and Improves Viscoelasticity: Short-Term Results,THE LARYNGOSCOPE, Issue 11 2007Jessica Cedervall MSc Abstract Objectives: Scarring caused by trauma, postcancer treatment, or inflammation in the vocal folds is associated with stiffness of the lamina propria and results in severe voice problems. Currently there is no effective treatment. Human embryonic stem cells (hESC) have been recognized as providing a potential resource for cell transplantations, but in the undifferentiated state, they are generally not considered for therapeutic use due to risk of inadvertent development. This study assesses the functional potential of hESC to prevent or diminish scarring and improve viscoelasticity following grafting into scarred rabbit vocal folds. Study Design: hESC were injected into 22 scarred vocal folds of New Zealand rabbits. After 1 month, the vocal folds were dissected and analyzed for persistence of hESC by fluorescence in situ hybridization using a human specific probe, and for differentiation by evaluation in hematoxylin-eosin-stained tissues. Parallel-plate rheometry was used to evaluate the functional effects, i.e., viscoelastic properties, after treatment with hESC. Results: The results revealed significantly improved viscoelasticity in the hESC-treated vs. non-treated vocal folds. An average of 5.1% engraftment of human cells was found 1 month after hESC injection. In the hESC-injected folds, development compatible with cartilage, muscle and epithelia in close proximity or inter-mixed with the appropriate native rabbit tissue was detected in combination with less scarring and improved viscoelasticity. Conclusions: The histology and location of the surviving hESC-derived cells strongly indicate that the functional improvement was caused by the injected cells, which were regenerating scarred tissue. The findings point toward a strong impact from the host microenvironment, resulting in a regional specific in vivo hESC differentiation and regeneration of three types of tissue in scarred vocal folds of adult rabbits. [source] Epidemiology of Voice Disorders in the Elderly: Preliminary FindingsTHE LARYNGOSCOPE, Issue 4 2007Nelson Roy PhD Abstract Objectives: Epidemiologic studies of the prevalence and risk factors of voice disorders in the elderly, nontreatment seeking population are nonexistent. The purpose of this preliminary investigation was to 1) estimate the prevalence of voice disorders, 2) identify variables associated with increased risk of voice disorders, and 3) measure the socioemotional impact of voice disorders on the elderly who live independently. Study Design: Prospective, cross-sectional survey. Methods: One hundred seventeen seniors (39 males and 78 females; mean age, 76.1 yr; SD, 8.5 yr; range, 65,94 yr), residing in Utah and Kentucky, were interviewed using a questionnaire that addressed three areas related to voice disorders: prevalence, potential risk factors, and socioemotional consequences/effects. Results: The lifetime prevalence of a voice disorder was 47%, with 29.1% of participants reporting a current voice disorder. The majority of respondents (60%) reported chronic voice problems persisting for at least 4 weeks. Seniors who had experienced esophageal reflux, severe neck/back injury, and chronic pain were at increased risk. Voice-related effort and discomfort, combined with increased anxiety and frustration and the need to repeat oneself, were specific areas that adversely affected quality of life. Conclusions: This preliminary epidemiologic study confirmed that voice disorders are common among the elderly, and further research is needed to identify additional risk factors contributing to voice disorder vulnerability. [source] The efficacy of voice therapy in patients after treatment for early glottic carcinomaCANCER, Issue 1 2006Christine D. L. van Gogh M.D. Abstract BACKGROUND After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. METHODS Of 177 patients, 6,120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. RESULTS Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. CONCLUSIONS Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters. Cancer 2006. © 2005 American Cancer Society. [source] | ||||||||||