H2O2 Concentration in Exhaled Breath Condensate Increases After Phonotrauma: A Promise of Noninvasive Monitoring?

PURPOSE: The present study was designed to observe the concentration of hydrogen peroxide (H2O2) in exhaled breath condensate (EBC) after induced phonotrauma. METHODS: Thirty-five participants were randomly assigned to one of two conditions (1) Vocal demand and (2) Control. Participants in the experimental group (vocal demand) were asked to read aloud some texts during 1 hour, at 85-90 dB. Inflammation (H2O2 from exhaled breath condensate), acoustic, aerodynamic, and subjective measures were obtained at four time points: before vocal demand (baseline), immediately after baseline, 4-hour after baseline, and 24 hours after baseline. The same acquisition process was implemented for subjects in control group, except that they were not asked to engage in any vocal demand tasks at all. RESULTS: As for biological samples, a significant effect for group was observed. Higher values were found for participants in experimental condition. Significant differences were observed for within contrasts in the experimental group, namely 4 hours against baseline, 4 hours against immediately post, and 24 hours against 4 hours. Instrumental outcomes did not show significant differences across the different conditions at any time points. Self-reported measures (vocal fatigue and sensation of muscle tension) showed a significant main effect for group and main effect for condition. CONCLUSIONS: Intense vocal demand causes an increase in the concentration of H2O2 obtained from EBC at four hours after baseline, which is compatible with the generation of an inflammatory process in the vocal folds (phonotrauma). Moreover, the increase in the sensation of vocal fatigue and muscle tension after demand tasks seems to be an immediate reaction that did not match in time with the increment of H2O2 concentration.

Effectiveness of a physiologic voice therapy program based on different semioccluded vocal tract exercises in subjects with behavioral dysphonia: A randomized controlled trial.

PURPOSE: The present study aimed to assess the effectiveness of a physiologic voice therapy program based on different semioccluded vocal tract exercises in subjects with behavioral dysphonia. METHODS: Thirty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: 1) voice treatment with physiologic voice therapy plus vocal hygiene program (n=20), and 2) vocal hygiene program only (n=14). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic, electroglottographic, and acoustic assessment. The Voice Handicap Index (VHI), Voice symptom scale (VoiSs), Vocal tract discomfort scale (VTDS), and self-assessment of resonant voice quality were also performed. The treatment included eight voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with four different semioccluded vocal tract exercises (SOVTE). Comparison for all variables were performed between experimental group and control group. RESULTS: Wilcoxon test showed significant improvements for experimental group for VHI, VoiSs, VTDS (decrease), and self-perception of resonant voice quality (increase). Significant decrease for experimental groups was observed on subglottic pressure, phonation threshold pressure, and glottal airflow across the implemented tasks. CONCLUSION: Physiologic voice therapy based on semioccluded vocal tract exercises seems to be an effective tool to improve voice in subjects diagnosed with behavioral dysphonia. Apparently, most changes should be expected in variables related to physical and functional aspects compared to objective variables. Subglottic pressure and phonation threshold pressure seem to be the most change-sensitive parameters and they may reflect a reduction in phonatory effort reported by patients after voice therapy.

Chances of reversibility in early sensory deprivation of the Homo vulnerabilis: A 5-year (and ongoing) prospective study.

BACKGROUND: This prospective study evaluated the effectiveness of a rehabilitation program in vulnerable children with language deficits. AIMS/OBJECTIVES: Evaluating reversibility of a sensory understimulation. MATERIAL/METHODS: Two groups of five students, each, (sensory and not sensory deprived) were evaluated at ages 5 and 11. Both groups were taught the compulsory national educational program. The sensory deprived group also had a 5-year rehabilitation program. After that time, their language and vocabulary were reevaluated. RESULTS: Both groups became able to read, write and perform mathematical operations. Both groups took the compulsory elementary school national performance test and all of them performed above the national average. Despite these good performances the differences between both groups regarding language persisted. CONCLUSIONS: Deficits in children with early sensory deprivation are improved with rehabilitation programs. In order to achieve better restoration, intervention should be done earlier than at 5 years of age. Even if some deficits are not fully reversible, the improvement is significant and allows social inclusion and the possibility of breaking their circle of vulnerability. SIGNIFICANCE: Documenting the importance of early rehabilitation in sensory deficits.