RESUMO
OBJECTIVES/HYPOTHESIS: Vocal fold atrophy, scar, and sulcus reduce the vibratory function of the vocal fold mucosa, which causes severe refractory dysphonia. We have reported encouraging preliminary results using an intracordal injection of basic fibroblast growth factor (bFGF) and showed improvement in phonatory parameters and voice. The present study summarizes our experience with 100 cases of stiffened vocal folds that were treated with bFGF injections. STUDY DESIGN: Retrospective chart review with Interstitial Review Board (IRB) approval. METHODS: Local injection of bFGF was performed in 100 cases of vocal fold pathology, which included 43 cases of vocal fold atrophy, 41 cases with scar, and 16 cases with sulcus. Ten micrograms of bFGF were injected into the vocal folds under topical anesthesia 4 times in each patient. Therapeutic outcomes were examined with maximum phonation time (MPT), voice handicap index-10 (VHI-10), and GRBAS scale. RESULTS: MPT, VHI-10, and GRBAS scores significantly improved in all pathology groups. An improvement on the VHI-10 greater than five points was observed in 82% of atrophy cases, 78% of scar cases, and 67% of sulcus cases. Improvement on the VHI-10 was significantly better in the atrophy group than the scar or sulcus groups. The mild/moderate cases of scar and sulcus showed better improvement than severe cases. CONCLUSIONS: The current large case series indicates positive effects of intracordal injection of bFGF for improvement of voice with no severe adverse events. The effects appeared best for cases of atrophy, while the treatment of severe scar and sulcus requires further improvement. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2059-2064, 2021.
Assuntos
Disfonia/tratamento farmacológico , Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Rouquidão/tratamento farmacológico , Regeneração/efeitos dos fármacos , Prega Vocal/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Atrofia/diagnóstico , Atrofia/patologia , Estudos de Casos e Controles , Cicatriz/diagnóstico , Cicatriz/patologia , Disfonia/etiologia , Feminino , Fator 2 de Crescimento de Fibroblastos/efeitos adversos , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Rouquidão/etiologia , Humanos , Injeções Intralesionais/métodos , Doenças da Laringe/patologia , Masculino , Pessoa de Meia-Idade , Fonação/efeitos dos fármacos , Estudos Retrospectivos , Resultado do Tratamento , Prega Vocal/patologia , Voz/efeitos dos fármacosRESUMO
Adductor-type spasmodic dysphonia (ADSD) manifests in effortful speech temporarily relievable by botulinum neurotoxin type A (BoNT-A). Previously, abnormal structure, phonation-related and resting-state sensorimotor abnormalities as well as peripheral tactile thresholds in ADSD were described. This study aimed at assessing abnormal central tactile processing patterns, their spatial relation with dysfunctional resting-state connectivity, and their BoNT-A responsiveness. Functional MRI in 14/12 ADSD patients before/under BoNT-A effect and 15 controls was performed (i) during automatized tactile stimulus application to face/hand, and (ii) at rest. Between-group differential stimulation-induced activation and resting-state connectivity (regional homogeneity, connectivity strength within selected sensory(motor) networks), as well as within-patient BoNT-A effects on these differences were investigated. Contralateral-to-stimulation overactivity in ADSD before BoNT-A involved primary and secondary somatosensory representations, along with abnormalities in higher-order parietal, insular, temporal or premotor cortices. Dysphonic impairment in ADSD positively associated with left-hemispheric temporal activity. Connectivity was increased within right premotor (sensorimotor network), left primary auditory cortex (auditory network), and regionally reduced at the temporoparietal junction. Activation/connectivity before/after BoNT-A within-patients did not significantly differ. Abnormal ADSD central somatosensory processing supports its significance as common pathophysiologic focal dystonia trait. Abnormal temporal cortex tactile processing and resting-state connectivity might hint at abnormal cross-modal sensory interactions.
Assuntos
Disfonia/fisiopatologia , Distúrbios Distônicos/fisiopatologia , Células Receptoras Sensoriais/fisiologia , Toxinas Botulínicas Tipo A/uso terapêutico , Mapeamento Encefálico/métodos , Disfonia/tratamento farmacológico , Distúrbios Distônicos/tratamento farmacológico , Feminino , Mãos/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Córtex Motor/efeitos dos fármacos , Córtex Motor/fisiopatologia , Fonação/efeitos dos fármacos , Fonação/fisiologia , Células Receptoras Sensoriais/efeitos dos fármacos , Fala/efeitos dos fármacos , Fala/fisiologiaRESUMO
INTRODUCTION: Sixty to 90% of patients with idiopathic Parkinson disease (IPD) developed early dysphonia and subtle speech impairment, which is usually related to orofacial muscular dysfunctions. The aim of this preliminary study is to assess the usefulness of voice quality and orofacial strength (involved in speech) as outcome of levodopa challenge test used for the IPD diagnosis. MATERIAL AND METHODS: A total of 20 patients with early IPD were recruited and evaluated for clinical findings (Hoehn and Yahr scale), voice handicap index, maximal phonation time, phonation quotient, percent jitter, percent shimmer, noise-to-harmonic ratio, and orofacial muscular strength (Iowa Oral Performance Instrument) at baseline, throughout the levodopa challenge test and after therapeutic stabilization. RESULTS: The intake of a standardized dose of levodopa (levodopa challenge test) significantly improved phonation quotient and percent shimmer. We did not find similar improvement after medical stabilization of patients (based on levodopa medication) despite an improvement of Hoehn and Yahr mean score. The intake of levodopa significantly improved cheeks and lips strength involved in speech quality both along the challenge test and after the therapeutic stabilization. CONCLUSIONS: These preliminary findings support a differential impact of levodopa on voice and speech functions in early diagnosed IPD and a mismatch between the clinical examination, orofacial strength, and voice quality improvements once the patient is medically stabilized.
Assuntos
Antiparkinsonianos/uso terapêutico , Disfonia/tratamento farmacológico , Músculos Faciais/efeitos dos fármacos , Levodopa/uso terapêutico , Força Muscular/efeitos dos fármacos , Doença de Parkinson/tratamento farmacológico , Fonação/efeitos dos fármacos , Qualidade da Voz/efeitos dos fármacos , Disfonia/diagnóstico , Disfonia/fisiopatologia , Músculos Faciais/fisiopatologia , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Dados Preliminares , Estudos Prospectivos , Recuperação de Função Fisiológica , Acústica da Fala , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Adductor spasmodic dysphonia (ADSD) is one of the most disabling voice disorders with no permanent cure. Patients with ADSD suffer from poor voice quality and repeated interruption of phonation that leads to limitations in daily communication. Botox (BT) injection, considered the gold standard treatment for ADSD, reduces the amount of voice breaks and improves voice quality for a limited period. In this study, patients with ADSD were followed after a single BT injection to track the changes in QOL and perceptual voice quality over a 6-month period. METHOD: This is a prospective and longitudinal study. Fifteen patients with ADSD were evaluated preinjection and 1, 3, and 6 months postinjection. They completed the Voice Activity and Participation Profile-Persian Version (VAPPP) and read a passage at each recording period. Perceptual assessment was done by three expert speech-language pathologists with knowledge of ADSD using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The data were analyzed using Friedman, Wilcoxon, and McNemar tests. The significance level was set at P < 0.05. RESULTS: The VAPPP total score and each of the domain scores reached their peak scores at 3 months postinjection. At 6 months postinjection, the VAPPP scores increased significantly in comparison with the 3-month scores and but were lower than preinjection scores. GRBAS results also indicated that patients' voices at 1 and 3 months postinjection were significantly less severe in terms of strain and roughness (P = 0.01; P < 0.001, respectively). CONCLUSION: BT injection resulted in improvement of subjects' QOL. The improvement was greatest at 3 months postinjection but remained above the preinjection values at 6 months after injection. The voice quality also improved but was not judged as normal.
Assuntos
Inibidores da Liberação da Acetilcolina/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Disfonia/tratamento farmacológico , Fonação/efeitos dos fármacos , Qualidade de Vida , Prega Vocal/efeitos dos fármacos , Qualidade da Voz/efeitos dos fármacos , Adulto , Idoso , Disfonia/diagnóstico , Disfonia/fisiopatologia , Feminino , Humanos , Injeções , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/fisiopatologiaRESUMO
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.
Assuntos
Acústica , Edema/diagnóstico , Insuficiência Cardíaca/complicações , Fonação , Acústica da Fala , Medida da Produção da Fala , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Qualidade da Voz , Idoso , Idoso de 80 Anos ou mais , Diuréticos/uso terapêutico , Edema/tratamento farmacológico , Edema/etiologia , Edema/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação/efeitos dos fármacos , Projetos Piloto , Valor Preditivo dos Testes , Respiração , Resultado do Tratamento , Prega Vocal/efeitos dos fármacos , Distúrbios da Voz/tratamento farmacológico , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Qualidade da Voz/efeitos dos fármacosRESUMO
OBJECTIVES: Professional voice users, such as singers and teachers, are at greater risk of developing vocal fold injury from excessive use of voice; thus, protection of the vocal fold is essential. One of the most important factors that aggravates injury is the production of reactive oxygen species at the wound site. The purpose of the current study was to assess the effect of astaxanthin, a strong antioxidant, on the protection of the vocal fold from injury and inflammation due to vocal loading. STUDY DESIGN: This study is an institutional review board-approved human clinical trial. METHODS: Ten male subjects underwent a 60-minute vocal loading session and received vocal assessments prior to, immediately after, and 30 minutes postvocal loading (AST(-) status). All subjects were then prescribed 24 mg/day of astaxanthin for 28 days, after which they received the same vocal task and assessments (AST(+) status). Phonatory parameters were compared between both groups. RESULTS: Aerodynamic assessment, acoustic analysis, and GRBAS scale (grade, roughness, breathiness, asthenia, and strain) were significantly worse in the AST(-) status immediately after vocal loading, but improved by 30 minutes after loading. In contrast, none of the phonatory parameters in the AST(+) status were statistically worse, even when measured immediately after vocal loading. No allergic responses or adverse effects were observed after administration of astaxanthin. CONCLUSIONS: The current results suggest that astaxanthin can protect the vocal fold from injury and inflammation caused by vocal loading possibly through the regulation of oxidative stress.
Assuntos
Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Prega Vocal/efeitos dos fármacos , Distúrbios da Voz/prevenção & controle , Qualidade da Voz/efeitos dos fármacos , Acústica , Adulto , Anti-Inflamatórios/efeitos adversos , Antioxidantes/efeitos adversos , Percepção Auditiva , Citoproteção , Avaliação da Deficiência , Humanos , Julgamento , Masculino , Estresse Oxidativo/efeitos dos fármacos , Fonação/efeitos dos fármacos , Autoimagem , Estroboscopia , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/metabolismo , Prega Vocal/fisiopatologia , Distúrbios da Voz/etiologia , Distúrbios da Voz/metabolismo , Distúrbios da Voz/fisiopatologia , Xantofilas/efeitos adversos , Xantofilas/uso terapêutico , Adulto JovemRESUMO
OBJECTIVES: This study investigated the effect of menstrual cycle on vocal fold vibratory characteristics in young women using high-speed digital imaging. This study examined the menstrual phase effect on five objective high-speed imaging parameters and two self-rated perceptual parameters. The effects of oral birth control use were also investigated. METHODS: Thirteen subjects with no prior voice complaints were included in this study. All data were collected at three different time periods (premenses, postmenses, ovulation) over the course of one menstrual cycle. For five of the 13 subjects, data were collected for two consecutive cycles. Six of 13 subjects were oral birth control users. From high-speed imaging data, five objective parameters were computed: fundamental frequency, fundamental frequency deviation, harmonics-to-noise ratio, harmonic richness factor, and ratio of first and second harmonics. They were supplemented by two self-rated parameters: Reflux Severity Index and perceptual voice quality rating. Analysis included mixed model linear analysis with repeated measures. RESULTS: Results indicated no significant main effects for menstrual phase, between-cycle, or birth control use in the analysis for mean fundamental frequency, fundamental frequency deviation, harmonics-to-noise ratio, harmonic richness factor, first and second harmonics, Reflux Severity Index, and perceptual voice quality rating. Additionally, there were no interaction effects. CONCLUSIONS: Hormone fluctuations observed across the menstrual cycle do not appear to have direct effect on vocal fold vibratory characteristics in young women with no voice concerns. Birth control use, on the other hand, may have influence on spectral richness of vocal fold vibration.
Assuntos
Laringoscopia/métodos , Ciclo Menstrual , Fonação , Gravação em Vídeo , Prega Vocal/fisiologia , Qualidade da Voz , Adulto , Fenômenos Biomecânicos , Anticoncepcionais Orais Hormonais/administração & dosagem , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Ciclo Menstrual/efeitos dos fármacos , Fonação/efeitos dos fármacos , Valor Preditivo dos Testes , Fatores de Tempo , Vibração , Prega Vocal/diagnóstico por imagem , Prega Vocal/efeitos dos fármacos , Qualidade da Voz/efeitos dos fármacos , Adulto JovemRESUMO
OBJECTIVE: The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. STUDY DESIGN: This is a prospective cohort study. METHODS: Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. RESULTS: Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. CONCLUSIONS: Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time.
Assuntos
Acústica , Percepção Auditiva , Disfonia/fisiopatologia , Disfonia/psicologia , Músculos Laríngeos/fisiopatologia , Fonação , Autoimagem , Qualidade da Voz , Inibidores da Liberação da Acetilcolina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas/administração & dosagem , Avaliação da Deficiência , Disfonia/diagnóstico , Disfonia/tratamento farmacológico , Emoções , Feminino , Humanos , Julgamento , Músculos Laríngeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fonação/efeitos dos fármacos , Valor Preditivo dos Testes , Estudos Prospectivos , Processamento de Sinais Assistido por Computador , Software , Espectrografia do Som , Inquéritos e Questionários , Resultado do Tratamento , Qualidade da Voz/efeitos dos fármacosRESUMO
BACKGROUND: Vocal impairment is one of the main debilitating symptoms of Parkinson disease (PD). The effect of levodopa on vocal function remains unclear. OBJECTIVE: This study aimed to determine the effect of levodopa on electromyographic patterns of the laryngeal muscle in patients with PD. STUDY DESIGN: This is a prospective interventional trial. METHODS: Nineteen patients with PD-diagnosed by laryngeal electromyography-were enrolled. Cricothyroid and thyroarytenoid (TA) muscle activities were measured at rest and during muscle contraction (phonation), when participants were on and off medication (12 hours after the last levodopa dose). RESULTS: Prevalence of resting hypertonia in the cricothyroid muscle was similar in the off and on states (7 of 19, P = 1.00). Eight patients off medication and four patients on medication had hypertonic TA muscle at rest (P = 0.289). No electromyographic alterations were observed during phonation for either medication states. CONCLUSION: Despite a tendency for increased rest tracings in the TA muscle when participants were on medication, no association was found between laryngeal electromyography findings and levodopa + carbidopa administration.
Assuntos
Antiparkinsonianos/administração & dosagem , Carbidopa/administração & dosagem , Eletromiografia , Músculos Laríngeos/efeitos dos fármacos , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Fonação/efeitos dos fármacos , Qualidade da Voz/efeitos dos fármacos , Idoso , Antiparkinsonianos/efeitos adversos , Brasil , Carbidopa/efeitos adversos , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Músculos Laríngeos/fisiopatologia , Levodopa/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: This study aims to assess voice changes and laryngeal abnormalities in asthmatic patients using inhaled corticosteroids (ICSs). PATIENTS AND METHODS: This study included 30 patients (15 females; mean age 21.3±2.6 years; range, 17 to 26 years and 15 males; mean age 20.7±2.3 years; range, 16 to 27 years) with bronchial asthma treated with ICSs between May 2013 and December 2013. A speech sample from each patient was evaluated by two phoniatricians and the degrees of dysphonia were scored. Each patient's voice was acoustically analyzed using the multidimensional voice program software. Videolaryngoscopy was used to detect laryngeal abnormalities including the vocal folds. RESULTS: A total of 53.3% of ICSs users had dysphonia; most of them had a mild degree dysphonia. Of patients, vocal folds erythema was present in 56.7%, interarytenoid thickening in 56.7%, vocal folds bowing in 5.3% and vocal fold atrophy in 5.5%. A total of 36.7% patients had manifestations of laryngopharyngeal reflux. The presence of vocal fold bowing and atrophy was significantly related to the duration of ICS use (p=0.048). Soft phonation index values were positively associated with the duration of the ICS use (p=0.013). CONCLUSION: Inhaled corticosteroids have abnormally adverse effects both on the function and the structure of the vocal folds.
Assuntos
Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Glucocorticoides/administração & dosagem , Voz/fisiologia , Administração por Inalação , Adolescente , Adulto , Asma/complicações , Atrofia , Beclometasona/administração & dosagem , Budesonida/administração & dosagem , Disfonia/etiologia , Eritema/etiologia , Feminino , Humanos , Doenças da Laringe/etiologia , Laringoscopia/métodos , Masculino , Nebulizadores e Vaporizadores , Fonação/efeitos dos fármacos , Fala/efeitos dos fármacos , Gravação em Vídeo/métodos , Prega Vocal/efeitos dos fármacos , Prega Vocal/patologia , Voz/efeitos dos fármacos , Adulto JovemRESUMO
OBJECTIVES: This study examined the effects of a laryngeal desiccation challenge and nebulized isotonic saline on voice production in young, healthy male singers and nonsingers. STUDY DESIGN: This is a prospective, double-blind, within-subjects experimental design. METHODS: Participants included 10 male university-trained singers and 10 age-matched nonsingers (mean age, 21.8 years; range, 18-26 years) who underwent a 30-minute oral breathing laryngeal desiccation challenge using medical grade dry air (<1% relative humidity) on two occasions in consecutive weeks. After the challenge, participants received either 3 mL or 9 mL of nebulized isotonic saline (0.9% Na+Cl-); order of administration was counterbalanced. Phonation threshold pressure (PTP), the cepstral spectral index of dysphonia (CSID) for sustained vowels and connected speech, and self-perceived vocal effort, mouth dryness, and throat dryness were measured at each recording (baseline, after challenge, and at 5, 35, and 65 minutes after treatment). RESULTS: Self-perceived effort and dryness measures increased (worsened) after desiccation challenge and decreased (improved) after nebulized treatment (P < 0.05). No consistent changes were observed for PTP or CSID over time. Overall, singers demonstrated significantly lower vocal effort and CSID as compared with nonsingers. CONCLUSIONS: Young, vocally healthy men may not experience physiologic changes in voice production associated with laryngeal desiccation and nebulized saline treatments; however, self-reported increases in vocal effort which are associated with dryness symptoms might improve with nebulized treatments. Future hydration research should consider age and sex variables.
Assuntos
Acústica , Desidratação/fisiopatologia , Laringe/efeitos dos fármacos , Fonação/efeitos dos fármacos , Autoimagem , Canto , Cloreto de Sódio/administração & dosagem , Acústica da Fala , Percepção da Fala , Qualidade da Voz/efeitos dos fármacos , Administração por Inalação , Adolescente , Adulto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Soluções Isotônicas , Laringe/fisiopatologia , Masculino , Nebulizadores e Vaporizadores , Pressão , Estudos Prospectivos , Medida da Produção da Fala , Adulto JovemRESUMO
OBJECTIVE: Basic fibroblast growth factor promotes wound healing by accelerating healthy granulation and epithelialization. However, the duration of the effects of a single intracordal injection of basic fibroblast growth factor has not been established, and administration intervals and timing have yet to be standardized. Here, we administered a single injection to patients with insufficient glottic closure and conducted follow-up examinations with high-speed digital imaging to determine the duration of the treatment response. STUDY DESIGN: Case series. METHODS: For treatment, 20 µg/mL recombinant human basic fibroblast growth factor was injected into two vocal cords. The following examinations were performed before the procedure and at 3-month intervals for 12 months starting at 1 month postinjection: Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale assessment, maximum phonation time, acoustic analysis, high-speed digital imaging, glottal wave analysis, and kymographic analysis. RESULTS: Postinjection, the GRBAS scale score decreased, and the maximum phonation time was prolonged. In addition, the mean minimum glottal area and mean minimum glottal distance decreased. These changes were significant at 12 months postinjection compared with preinjection. However, there were no significant changes in the vibrations of the vocal cord margins. CONCLUSIONS: The intracordal injection of basic fibroblast growth factor improved insufficient glottic closure without reducing the vibrations of the vocal cord margins. This effect remained evident at 12 months postinjection. A single injection can be expected to yield a sufficient and persistent long-term effect.
Assuntos
Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Doenças da Laringe/tratamento farmacológico , Fonação/efeitos dos fármacos , Prega Vocal/efeitos dos fármacos , Distúrbios da Voz/tratamento farmacológico , Qualidade da Voz/efeitos dos fármacos , Acústica , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Humanos , Injeções , Quimografia , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Medida da Produção da Fala , Fatores de Tempo , Resultado do Tratamento , Vibração , Gravação em Vídeo , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologiaRESUMO
OBJECTIVE: The aim of this study was to illustrate the risk of vocal fold atrophy in patients who receive serial subepithelial steroid injections for vocal fold scar. METHODS: This study is a retrospective case report of two patients who underwent a series of weekly subepithelial infusions of 10 mg/mL dexamethasone for benign vocal fold lesion. Shortly after the procedures, both patients developed a weak and breathy voice. The first patient was a 53-year-old man with radiation-induced vocal fold stiffness. Six injections were performed unilaterally, and 1 week later, he developed unilateral vocal fold atrophy with new glottal insufficiency. The second patient was a 67-year-old woman with severe vocal fold inflammation related to laryngitis and calcinosis, Raynaud's phenomenon, esophagean dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. Five injections were performed bilaterally, and 1 week later, she developed bilateral vocal fold atrophy with a large midline glottal gap during phonation. In both cases, the steroid-induced vocal atrophy resolved spontaneously after 4 months. OUTCOMES & IMPORTANCE: Serial subepithelial steroid infusions of the vocal folds, although safe in the majority of patients, carry the risk of causing temporary vocal fold atrophy when given at short intervals.
Assuntos
Corticosteroides/efeitos adversos , Cicatriz/tratamento farmacológico , Dexametasona/efeitos adversos , Fonação/efeitos dos fármacos , Prega Vocal/efeitos dos fármacos , Distúrbios da Voz/tratamento farmacológico , Qualidade da Voz/efeitos dos fármacos , Corticosteroides/administração & dosagem , Idoso , Atrofia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/fisiopatologia , Dexametasona/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Injeções , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estroboscopia , Fatores de Tempo , Resultado do Tratamento , Gravação em Vídeo , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologiaRESUMO
BACKGROUND: Parkinson's disease (PD) is one of the most common diseases of the central nervous system (CNS). It is frequently heralded by speech disturbances, which are one of its first symptoms. AIM: The aim of this paper is to share our own experience concerning the correlation between the severity of speech disorders and the PD duration, its severity and the intake of L-dopa. MATERIAL AND METHODS: The research included 93 patients with idiopathic PD, aged 26-86 years (mean age 65.1 years). Participants were examined neurologically according to the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale. They were also assessed by Frenchay Dysarthria Assessment. RESULTS: Considerable and severe disorders were concurrent with impairments in the mobility of the tongue, lips, the jaw as well as the pitch and loudness of the voice. The strongest correlation but at a moderate level was found to exist between the severity of labial impairment, voice loudness and the length of the disease. There was also a positive correlation between lip movement while the motions were being diversified, lip arrangement while speaking and the intake of L-dopa. CONCLUSIONS: As PD progresses a significant decline in vocal articulation can be observed, which is due to reduced mobility within the lips and the jaw. Exacerbation of articulation disorders resulting from progression of the disease does not materially influence the UPDRSS scores. L-dopa has been found to positively affect the mobility of the lips while the patient is speaking and their arrangement at rest.
Assuntos
Antiparkinsonianos/uso terapêutico , Transtornos da Articulação/etiologia , Levodopa/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/administração & dosagem , Antiparkinsonianos/farmacologia , Transtornos da Articulação/tratamento farmacológico , Transtornos da Articulação/fisiopatologia , Progressão da Doença , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Arcada Osseodentária/fisiopatologia , Levodopa/administração & dosagem , Levodopa/farmacologia , Lábio/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Fonação/efeitos dos fármacos , Fonética , Amplitude de Movimento Articular/efeitos dos fármacos , Reflexo Anormal , Respiração/efeitos dos fármacos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Voice abnormalities are among the symptoms occurring in patients with amyotrophic lateral sclerosis (ALS). They are divergent and range from hoarseness, through the excessive adduction of false folds, up to the weakness of the vocal folds. The aim of the study was to analyze the phonatory function of the larynx in ALS patients. METHODS: Seventeen patients with ALS were evaluated with subjective perceptual voice assessment (including the GRBAS scale), videolaryngostroboscopy including voice range and maximum phonation time (MPT), and objective acoustic voice analysis with IRIS software (including evaluation of jitter, shimmer, mean fundamental frequency, and noise-to-harmonics ratio (NHR)). Examinations were performed three times at 6-month intervals. RESULTS: Hoarseness, roughness, and breathiness of voice were all found more frequently in the majority of these patients. Voice range, amplitude of vibration, mucosal wave, and glottal closure showed significant abnormalities with repeated examinations. MPT was shortened especially among women with ALS. Acoustic analysis of voice among men showed increased jitter value in the first examination only, while jitter, shimmer, and NHR in women with ALS were increased in all examinations. CONCLUSIONS: Analysis of voice qualities among patients with ALS allows for the detection of various abnormalities associated with the natural progression of the disease.
Assuntos
Esclerose Lateral Amiotrófica/fisiopatologia , Laringe/fisiopatologia , Fonação , Qualidade da Voz/fisiologia , Adulto , Idoso , Esclerose Lateral Amiotrófica/complicações , Feminino , Rouquidão/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Fonação/efeitos dos fármacosRESUMO
PURPOSE OF REVIEW: This article aims to review previous research reports and to summarize current strategies for the treatment of the aging vocal fold using regenerative medicine and tissue engineering, with a particular focus on growth factor therapy. RECENT FINDINGS: Previous studies have elucidated age-related histological and gene expression changes in key extracellular matrix components, such as collagen and hyaluronan, in the lamina propria of the aging vocal fold. On the basis of these findings, our research group has focused on growth factor therapy to restore extracellular matrix distribution in the aging vocal fold to a younger state. Results from recent studies with basic fibroblast growth factor and hepatocyte growth factor provided preliminary evidence of the regenerative effects of growth factor therapy on treatment of the aging vocal fold. In addition, a clinical trial using basic fibroblast growth factor revealed improvements of maximum phonation time, mean flow rate, and acoustic parameters in atrophied vocal folds. These positive findings suggest that the administration of basic fibroblast growth factor may become a useful tool for the treatment of the aging vocal fold. SUMMARY: Regenerative medicine and tissue engineering are innovative strategies for the treatment of aging vocal folds, and recent reports have also confirmed the therapeutic potential of growth factor therapy for the treatment of the aging vocal fold. More recently, the clinical application of basic fibroblast growth factor was reported with encouraging outcomes. Continued basic research and clinical investigations will be required to develop strategies to overcome age-related voice disorders.
Assuntos
Envelhecimento/patologia , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Fator de Crescimento de Hepatócito/uso terapêutico , Engenharia Tecidual/métodos , Prega Vocal/patologia , Distúrbios da Voz/patologia , Distúrbios da Voz/terapia , Qualidade da Voz , Animais , Matriz Extracelular/patologia , Humanos , Fonação/efeitos dos fármacosRESUMO
G. Paul Moore influenced the study of spasmodic dysphonia (SD) with his 1960 publication that examined the neurological, medical, and vocal fold behavior in a group of patients with adductor spasmodic dysphonia (ADSD). This review of advances in the diagnosis and treatment of SD follows a time line of research that can be traced in part to the early work of Moore et al. This article reviews the research in ADSD over the past 50 plus years. The capstone events that brought SD to its present day level of management by laryngologists and speech-language pathologists are highlighted. A look to the future to understand more of the disorder is offered for this debilitating disorder.
Assuntos
Disfonia , Músculos Laríngeos/fisiopatologia , Fonação , Espasmo , Acústica da Fala , Qualidade da Voz , Toxinas Botulínicas/uso terapêutico , Disfonia/diagnóstico , Disfonia/história , Disfonia/fisiopatologia , Disfonia/psicologia , Disfonia/terapia , História do Século XX , História do Século XXI , Humanos , Músculos Laríngeos/efeitos dos fármacos , Fármacos Neuromusculares/uso terapêutico , Fonação/efeitos dos fármacos , Prognóstico , Espasmo/diagnóstico , Espasmo/história , Espasmo/fisiopatologia , Espasmo/psicologia , Espasmo/terapia , Patologia da Fala e Linguagem/métodos , Qualidade da Voz/efeitos dos fármacosRESUMO
OBJECTIVE: The objective of this study was to obtain initial reactions and suggested modifications to two existing presenteeism scales: the Stanford Presenteeism Scale 6 (SPS-6) and the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP) among a cohort of employed individuals with a focal laryngeal dystonia, spasmodic dysphonia (SD). STUDY DESIGN: The study design is a qualitative study. METHODS: Nine speakers with SD underwent cognitive interviews, during which they were asked to evaluate the relevance of statements and clarity of wording on the SPS-6, the WPAI-SHP, and an additional set of voice-related statements designed by the researchers. Participants were asked to complete the scales, rank order statements in terms of perceived importance, and suggest additional statements of relevance. RESULTS: Although all participants noted that their SD did have an effect on their jobs, there were suggestions for modifying both the WPAI-SHP and the SPS-6. Participants regarded specific voice-related statements that were generated by the researchers to be of greater importance than the majority of the statements on the SPS-6. Minor changes in the wording of the instructions on the WPAI-SHP were recommended. CONCLUSIONS: Presenteeism is an important construct to measure in individuals with a chronic voice disorder such as SD. However, existing presenteeism scales might best be administered in conjunction with additional statements that are more voice related so that clinicians can be made aware of specific difficulties encountered in the workplace.
Assuntos
Cognição , Disfonia/psicologia , Eficiência , Entrevistas como Assunto , Saúde Ocupacional , Fonação , Qualidade da Voz , Local de Trabalho , Absenteísmo , Adulto , Idoso , Toxinas Botulínicas Tipo A/uso terapêutico , Efeitos Psicossociais da Doença , Disfonia/diagnóstico , Disfonia/tratamento farmacológico , Disfonia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , Percepção , Fonação/efeitos dos fármacos , Pesquisa Qualitativa , Licença Médica , Inquéritos e Questionários , Fatores de Tempo , Qualidade da Voz/efeitos dos fármacosRESUMO
This study investigates rhythmic features based on the short-time energy function of speech signals with the aim of finding robust, speaker-independent features that indicate speaker intoxication. Data from the German Alcohol Language Corpus, which comprises read, spontaneous, and command&control speech uttered by 162 speakers of both genders and various age groups when sober and intoxicated, were analyzed. Energy contours are compared directly (Root Mean Squared Error, statistical correlation, or the Euclidean distance in the spectral space of the contour) and by parameterization of the contour using the Discrete Cosine Transform (DCT) and the first and second moments of the lower DCT spectrum. Contours are also analyzed by Principal Components Analysis aiming at fundamental "eigen contour" changes that might encode intoxication. Energy contours differ significantly with intoxication in terms of distance measures, the second and fourth DCT coefficients, and the first and second moments of the lower DCT spectrum. Principal Components Analysis did not yield interpretable "eigen contours" that could be used in distinguishing intoxicated from sober contours.
Assuntos
Intoxicação Alcoólica/diagnóstico , Etanol/efeitos adversos , Fonação/efeitos dos fármacos , Distúrbios da Fala/induzido quimicamente , Percepção da Fala/fisiologia , Interface para o Reconhecimento da Fala , Qualidade da Voz , Adulto , Intoxicação Alcoólica/sangue , Intoxicação Alcoólica/fisiopatologia , Algoritmos , Testes Respiratórios , Discriminação Psicológica , Etanol/análise , Etanol/sangue , Feminino , Humanos , Modelos Lineares , Masculino , Fonética , Análise de Componente Principal , Espectrografia do Som , Acústica da Fala , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/fisiopatologia , Inteligibilidade da FalaRESUMO
Voice and speech impairments are frequent in Parkinson's disease, particularly when the disease is at an advanced stage. These impairments affect spoken communication and may become a serious disability for someone with Parkinson's disease. Many studies based on auditory-perceptual or acoustic methods have been carried out to characterize dysarthria. The heterogeneity of evaluation methods and experimental bias however make results difficult to understand. For instance, in terms of phonatory impairments and with regard to F0, results are contradictory: PD speech may be characterized by either higher F0 or lower F0 compared to control subjects, or there may be no difference at all between the two population. In this study, we aim to provide a conceptual and methodological framework which allows for interpreting the results obtained from 44 speakers (29 PD and 15 control subjects) in relation to physiological (gender, age, PD subjects' pharmacologic state) and linguistic (speech production tasks) constraints. For the present corpus, we did not observe any F0 mean difference between the two groups. Our results however reveal a significant increase in F0 mean in PD subjects under L-dopa. We assume a double and opposite effect on F0 mean during drug withdrawal: low sub-glottal pressure, due to PD, results in a decrease in F0, while laryngeal rigidity leads to an increase in F0. These two effects thus mutually annihilate. Under L-Dopa, however, the drug effect increases sub-glottal pressure, which combined with an increase in F0 due to rigidity, leads to a global increase in F0.