Nonpharmacologic effects of botulinum toxin on the life quality of patients with spasmodic dysphonia.

OBJECTIVE: Botulinum toxin (BT) injection improves objective and subjective voice measurements in spasmodic dysphonia; however, it is not clear whether the results are entirely caused by the neuromuscular blocking effects of BT or whether other factors (e.g., psychological or emotional) play a part. The aim of this study is to investigate whether nonpharmacologic factors contribute to the changes observed in the quality of life (QoL) after BT treatment of spasmodic dysphonia. STUDY DESIGN: Prospective cohort study. METHODS: Thirty-eight consecutive spasmodic dysphonic patients attending for repeat BT injections were investigated by recording their Voice Handicap Index (VHI) scores at three time points: 1) immediately prior to injection (baseline), 2) 1 day postinjection (when least pharmacologic change is expected), and 3) 2 weeks postinjection (when most pharmacologic change is expected). The changes in the total and domain VHI scores were compared between the two postinjection scores and the baseline value using two-way analysis of variance and the post hoc Bonferroni test. RESULTS: Most of the change in VHI score occurred between the baseline and first postinjection measurement. For two of the domains (total and emotional), the change was statistically significant. The change between the two postinjection assessments was minimal, and no domain showed statistically significant change. CONCLUSIONS: Our data indicate that the early improvements in QoL after BT injection can only in small part be attributed to the neurotoxic effects of the agent. We cannot say whether the reported effects in our study are attributable to a strong placebo response or are a real consequence of the patient's changing emotional state.

Perception of voice in the transgender client.

Fundamental frequency (F(0)) of speech is used to measure the success of voice therapy in male-to-female transgender clients. This study evaluates the relationship between F(0) and patients' happiness with their voice. The study design used was a cross-sectional evaluation of client satisfaction questionnaires and voice recordings from transgender clients. This study was a comparative evaluation of voice recordings by voice professionals and lay observers. Twelve male-to-female transgender participants completed visual analogue scales (VASs), rating happiness with self-perceived femininity of their voice. Fifteen speech and language therapists (SLTs) and 40 naïve observers evaluated the anonymized recordings, using the same rating system. The correlation between mean F(0) and participant happiness was established. Relationships between participant happiness and rater opinions were explored. A significant relationship between F(0) and participant happiness could not be demonstrated (r=0.32, P=0.32). There was a moderately strong positive correlation between self-perception of vocal femininity and perception of femininity by SLTs and naïve observers (r=0.76 and 0.68, P=0.003 and P=0.01, respectively). This study demonstrates that happiness with voice in male-to-female transgender clients is not directly related to F(0). Clients can assess femininity of their voice in the form of perceived pitch. This may not affect happiness scores. Voice satisfaction may not correlate with perceptions of supervising voice professionals. However, professionals can reliably evaluate how the voice will be received by the lay public. Subjective measures of patient satisfaction, including VASs, are reliable and valid tools in evaluating therapeutic success.