Clinical Features of Psychogenic Voice Disorder and the Efficiency of Voice Therapy and Psychological Evaluation.

OBJECTIVES: The aim of this study was to define the clinical features of psychogenic voice disorder (PVD) and explore the treatment efficiency of voice therapy and psychological evaluation. METHOD: Fifty-eight patients who received treatment following the PVD diagnosis and had no organic or other functional voice disorders were assessed retrospectively based on laryngoscopic examinations and subjective and objective assessments. Epidemiological characteristics, accompanying organic and psychological disorders, preferred methods of treatment, and previous treatment outcomes were examined for each patient. A comparison was made based on voice disorders and responses to treatment between patients who received psychotherapy and patients who did not. RESULTS: Participants in this study comprised 58 patients, 10 male and 48 female. Voice therapy was applied in all patients, 54 (93.1%) of whom had improvement in their voice. Although all patients were advised to undergo psychological assessment, only 60.3% (35/58) of them underwent psychological assessment. No statistically significant difference was found between patients who did receive psychological support concerning their treatment responses and patients who did not. Relapse occurred in 14.7% (5/34) of the patients who applied for psychological assessment and in 50% (10/20) of those who did not. There was a statistically significant difference in relapse rates, which was higher among patients who did not receive psychological support (P < 0.005). CONCLUSION: Voice therapy is an efficient treatment method for PVD. However, in the long-term follow-up, relapse of the disease is observed to be higher among patients who failed to follow up on the recommendation for psychological assessment.

Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience.

Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? • Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. • Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? • We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. • We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.

Laryngeal Verruca Vulgaris Presenting with Dysphonia: A Case Report.

Verruca vulgaris is a common skin lesion that is associated with human papilloma virus and is observed on the surface of skin. Verruca vulgaris is rarely seen in mucosal membranes. Atypical locations may be confused with verrucous carcinoma. The incidence of laryngeal verruca vulgaris has not yet been reported in the literature. Differential diagnoses in histopathological examinations include keratosis, squamous papilloma, verrucous hyperplasia, and verrucous carcinoma. Distinguishing disease from verrucous carcinoma is particularly important because the treatment approach can be altered. In this report, we present a rare case of laryngeal verruca vulgaris that was diagnosed on the basis of histopathological features.

Reliability and Validity of the Turkish Version of the Voice-Related Quality of Life Measure.

OBJECTIVES: This study aims to test the validity and reliability of the Turkish version of the Voice-Related Quality of Life (V-RQOL) questionnaire. STUDY DESIGN: This is a nonrandomized, prospective study with control group. METHODS: The questionnaire was administered to 249 individuals-130 with vocal complaint and 119 without-with a mean age of 37.8 ± 12.3 years. The Turkish version of the Voice Handicap Index (VHI) and perceptual voice evaluation measures were also administered at 2-14 days for retest reliability. The instrument was submitted to validity and reliability evaluation. RESULTS: The V-RQOL measure showed a strong internal consistency and test-retest reliability; the Cronbach's alpha coefficient for the overall V-RQOL was 0.969, the physical functioning domain was 0.949, and the social-emotional domain was 0.940. In the test-retest reliability test, the overall V-RQOL was found to be 0.989. The construct validity of the V-RQOL was determined based on the strength and direction of its relation to the VHI and the perceptual voice evaluation measure. The higher the VHI level, the lower the physical functioning, social-emotional, and overall score levels of the V-RQOL (r = -0.927, r = -0.912, r = -0.944, respectively; P < 0.001). Following the perceptual voice self-assessment, a statistically significant difference was found between the V-RQOL scores of individuals who defined their voices as good, very good, and perfect, and those who defined their voices as bad and very bad (P < 0.001). CONCLUSIONS: The results suggest that the Turkish version of the V-RQOL measure has reliability and validity and may play a crucial role in evaluating Turkish-speaking patients with voice disorders.

Influence of the macroscopic features of vocal fold polyps on the quality of voice: a retrospective review of 101 cases.

We conducted a study to examine six macroscopic features of vocal fold polyps and to investigate their influence on quality of voice. We retrospectively reviewed the records of 101 consecutive patients with vocal fold polyps who had undergone microlaryngeal surgery for polyp removal after conservative measures had failed. All patients had undergone videolaryngostroboscopy and perceptual and acoustic voice analyses. The six macroscopic features of these vocal fold polyps were morphologic type, location, position, shape, size, and the presence or absence of a reactive lesion on the contralateral vocal fold. Among our statistically significant findings were that gelatinous polyps tended to be broad-based; polyps located on the superior surface tended to be hemorrhagic; small polyps were mostly located on the middle one-third of the vocal fold, and most of them were broad-based; and all of the polyps that were accompanied by reactive lesions on the contralateral vocal fold were located on the free edge. Moreover, jitter was found to be low in small polyps. Finally, noise-to-harmonics ratios were significantly higher in patients with anterior polyps and in those with pedunculated polyps. We conclude that each of the six macroscopic features of vocal fold polyps affected vocal function to a certain degree. We believe that our study provides additional information to otolaryngologists and speech language pathologists who deal with vocal fold polyps.