Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy / Alteración de la integración auditivo-vocal: nuevos retos y oportunidades para la evaluación y la terapia de la voz

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal in-tegration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice pro-duction and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associ-ated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assess-ment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person's auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders

Este artículo de reflexión aborda la importancia de la interacción entre la percepción y la producción de la voz, haciendo hincapié en los procesos de integración auditivo-vocal, los cuales aún no han sido muy divulgados en el contexto de los clínicos de voz. Dado lo anterior, este articulo busca: 1) destacar la importante relación entre la producción y la percepción de la voz y 2) considerar si esta relación pudiese explotarse clínicamente con fines diagnósticos y terapéuticos. Las teorías existentes sobre la producción de la voz y su interacción con la percepción auditiva proporcionan el contexto para discutir por qué la evaluación de los procesos auditivo-vocales podría ayudar a identificar los orígenes asociados a cierto tipo de disfonías e informar al clínico sobre las estrategias de abordaje adecuadas. La incorporación de la evaluación de la integración auditivo-vocal a través de la prueba del paradigma de adaptación sensoriomotora podría ser una importante adición a los protocolos de evaluación de la voz a nivel clínico. Además, si los estudios futuros pueden especificar los medios para manipular y mejorar la integración auditivo-vocal de una persona, la eficacia de la terapia de la voz podría aumentar, lo que llevaría a mejorar la calidad de vida de las personas con trastornos de la voz

Multidimensional voice assessment: the immediate effects of Lax Vox® in singers with voice complaints / Avaliação multidimensional da voz: efeitos imediatos do Lax Vox® em cantores com queixas vocais

ABSTRACT Purpose: to multidimensionally assess the effect of the Lax Vox® vocal technique on singers with voice complaints. Methods: a comparative intrasubject study that assessed 30 singers - 13 males and 17 females, aged 18 to 55 years - who self-reported voice complaints and had voice problems symptoms. The participants were submitted to voice assessment with perceptive-auditory, acoustic, aerodynamic, and electroglottographic voice analysis, as well as laryngeal assessment with high-speed videolaryngoscopy. The participants were assessed at two moments: 1) at the beginning of the data collection; and 2) five minutes after performing the Lax Vox® vocal technique. The groups were compared with appropriate statistical tests, with a 5% significance level. Results: in the acoustic analysis, there was an increase in the fundamental frequency for males, after using the Lax Vox® vocal technique. In the aerodynamic assessment, there was an increase in the airflow mean values during vocalization, as well as in aerodynamic power after using the Lax Vox® vocal technique in both groups. Conclusion: the Lax Vox® vocal technique, in the studied singers with a complaint of dysphonia, promoted an increase in the fundamental frequency, for males. In the aerodynamic parameters, in both sexes, it promoted an increase in the airflow and aerodynamic power.

RESUMO Objetivo: avaliar, de forma multidimensional, o efeito da técnica vocal Lax Vox® em cantores com queixas vocais. Métodos: trata-se de um estudo comparativo intrassujeitos. Foram avaliados 30 cantores, sendo 13 homens e 17 mulheres, com idade entre 18 e 55 anos, que apresentaram queixa vocal autorreferida e presença de sintomas vocais. Os participantes foram submetidos à avaliação vocal pela análise perceptivo-auditiva, acústica, aerodinâmica e eletroglotográfica da voz, bem como à avaliação laríngea com a videolaringoscopia de alta velocidade. Os participantes foram avaliados em dois momentos: 1) no início da coleta; e 2) após cinco minutos de realização da técnica vocal Lax Vox®. Para comparação dos grupos foram utilizados teste estatísticos pertinentes, com nível de significância de 5%. Resultados: na análise acústica houve aumento da frequência fundamental dos homens após o uso da técnica vocal Lax Vox®. Na avaliação aerodinâmica houve aumento dos valores da média do fluxo aéreo durante vocalização e da potência aerodinâmica após o uso da técnica vocal Lax Vox® em ambos os grupos. Conclusão: a técnica vocal do Lax Vox® nos cantores com queixa de disfonia estudados promoveu um aumento da frequência fundamental nos homens. Nos parâmetros aerodinâmicos em ambos os sexos provocou um aumento do fluxo aéreo e da potência aerodinâmica.

A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial.

BACKGROUND: Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION: The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.

Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study.

INTRODUCTION: Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. MATERIAL AND METHODS: A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. RESULTS: The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 € (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 € (SEK 552,725) per gained QALY. CONCLUSION: From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 € per gained QALY, which is just above the threshold of the maximum willingness to pay level.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation.

PURPOSE OF REVIEW: The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018-July 2019). RECENT FINDINGS: Our understanding of the prevalence of voice disorders and work-related vocal use, vocal load and vocal ergonomics (environmental and person influences) across different occupations is continuing to build. There is encouraging evidence for the value of intervention programs for occupational voice users, particularly of late with performers, teachers and telemarketers. Education and prevention programs are emerging for other 'at risk' occupations. SUMMARY: Occupational health and workforce legislation does not adequately acknowledge and guide educational, preventive and intervention approaches to occupational voice disorders. Voice disorders are prevalent in certain occupations and there is an urgent need for research to support occupational voice health and safety risk measurement, prevention and intervention. Large population-based studies are required with a focus on the health and economic burden of occupational voice disorders.

Design and Implementation of an Interactive Website for Pediatric Voice Therapy-The Concept of In-Between Care: A Telehealth Model.

Purpose: This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). Methods: A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Results: Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9-14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. Conclusion: The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.

The Americans With Disabilities Act and Voice Disorders: Practical Guidelines for Voice Clinicians.

OBJECTIVE: The Americans with Disabilities Act Amendments Act of 2008 (ADAAA) resulted in changes to the legal definition of disability and substantially affected how those with voice disorders may qualify for reasonable accommodations under the law. However, there has been little guidance and a lack of awareness about these changes within the voice literature. This article examines the Americans with Disabilities Act of 1990 (ADA), the changes made in 2008 (ADAAA), and how the law applies to individuals with voice disorders. STUDY DESIGN: This is a review article. METHODS: The ADA and ADAAA are summarized with a particular focus on individuals with voice disorders. Types of reasonable accommodations within the workplace are suggested, and online resources are provided which outline the disclosure and accommodation process. Practical examples are used to provide guidance for clinicians who may be involved in counseling this clinical population. RESULTS/CONCLUSIONS: Many individuals with voice disorders may not realize that their conditions can be classified as disabilities under the law, entitling them to workplace accommodations and time off to pursue medical treatment. However, disclosure laws such as the right to refrain from mentioning a disability during a job interview may not be protective of individuals with severe voice impairments, as symptoms are often difficult to conceal. Clinical implications and directions for future research are discussed.

Assessment of a method for the automatic on/off control of an electrolarynx via lip deformation.

OBJECTIVES: To reduce the inconvenience caused by operating a button-electrolarynx (EL) by hand, we proposed a method for the automatic control of an EL via lip deformation and applied the method to a video-based experimental system (video-EL). The purpose of this study was to validate the method and assess its performance in producing Mandarin Chinese. STUDY DESIGN AND METHODS: Eight subjects, including one laryngectomee, were invited to participate in the assessment. First, the empirical parameters of phonation onset/offset estimation were compared with the optimal parameters obtained by minimizing simulation errors during video-EL. Second, a reaction time test was used to evaluate the ability of subjects to pronounce a single word with video-EL. Third, the fluency of subjects in producing long sentences with video-EL was calculated. Finally, the intelligibility of speech produced with video-EL was compared with that produced with button-EL. RESULTS: The empirical parameters were not significantly different from the optimal parameter and resulted in fewer interruptions during voicing. Video-EL resulted in slower voice initiation and termination when compared with button-EL, which affected the intelligibility of an isolated word. However, video-EL provided a sufficiently fluent voice source so that the intelligibility of speech produced with video-EL was not significantly different from speech produced with button-EL when producing sentences. CONCLUSIONS: The method proposed in this study is effective in the automatic on/off control of an EL. Subjects produced fluent speech with video-EL that was as intelligible as that produced with button-EL when Mandarin sentences were produced continuously.

Update on pediatric voice and airway disorders: assessment and care.

PURPOSE OF REVIEW: To investigate the status of the recent literature focused on studying the assessment and treatment of pediatric voice and airway disorders using both established and novel techniques. RECENT FINDINGS: Recent research regarding voice assessment and treatment reveals the use of systematic and innovative approaches when collecting instrumental and perceptual voice data. There are recent advancements in certain surgical interventions designed to minimize complications. Wider use of functional endoscopic imaging of the pediatric larynx is improving our understanding of childhood voice production and airway management. There is also an important emerging focus on quantifying the impact of having a childhood voice disorder through the use of new tools. Although there is an increase in pediatric voice and airway research, many studies tend to be entirely descriptive rather than quantitative. There continues to be little specific research that uses prospective, longer-term and formal voice outcomes before and after behavioral and surgical interventions. SUMMARY: Pediatric voice and airway disorders are an important childhood health problem. Voice assessment in children should include formal perceptual and instrumental evaluations, including sophisticated acoustic, aerodynamic and imaging modalities. The care of these children requires a collaborative approach that includes systematic and innovative treatment methods.

Comparison of quality of life between voice rehabilitated and nonrehabilitated laryngectomies in a developing world community.

CONCLUSIONS: Quality of life (QOL) scores were significantly higher among voice rehabilitated patients although this was accompanied by significant immediate and long-term morbidity and a cost implication for the patient. OBJECTIVE: We present a prospective and cross-over study of overall QOL and morbidity related to voice restoration in laryngectomees. METHODS: The EORTC QOL questionnaire (QLQ-C30 and QLQ-H&N-35) was distributed among all the consenting patients alive after laryngectomy from January 2008 to October 2009. In patients who had secondary voice rehabilitation, post-rehabilitation QOL scores were collected separately. Comparison of QOL between the non-rehabilitated and rehabilitated cohorts was done and a cross-over study of pre-rehabilitation and post-rehabilitation scores were done in the second cohort. RESULTS: A total of 113 patients were studied. QOL scores were significantly higher among voice rehabilitated patients.

[Assessment of speech and linguistic disorders in patients with cochlear implant--preliminary results]. / Ocena mowy i zaburzen jezykowych u chorych z implantem slimakowym--doniesienie wstepne.

UNLABELLED: Cochlear Implant (CI) is the most advanced technical solution in the treatment of profound hearing loss and deafness in patients of all age groups. The aim of the study was to analyse the speech and linguistic disorders in adults with pre- and postlingual deafness rehabilitated with Cochlear implant (CI). MATERIAL AND METHODS: 21 adults with pre- (I group) and postlingual (II group) deafness deriving no benefit from hearing aids participated in this study. Phonatory organ was examined by endoscopy (VLS) and stroboscopy (VLSS). Test of Auditory Perception (TSS) was conducted directly after the activation of speech processor and after rehabilitation. The logopedic assessment before and after CI was based on the examination of motoric activity of articulatory organs, type of respiration, loudness of speech and the assessment of articulation. The linguistic assessment of grammatical and lexical aspect was carried out. The prosodic elements of speech were also analysed. RESULTS: Stroboscopic examination pointed to hypofunction of larynx in patients with prelingual deafness and hyperfunction--in postlingual deafness. The values of TSS were improved after CI, especially in patients with postlingual deafness. The most severe disorders of the efficiency of articulatory organs were observed in patients with prelingual deafness before CI. In the group of prelingually deaf patients disorders of the articulation of vowels and consonants as well as the lexical and grammatical aspect of speech were improved after CI. The correctness of syntax and inflection, development of active vocabulary, improvement of prosodic elements of speech were noticed in patients with postlingual deafness after CI. CONCLUSIONS. Patients with postlingual deafness achieved better results of rehabilitation in auditory perception than prelingually deaf patients. The linguistic improvement of grammatical and lexical aspect was noticed especially in prelingually deaf patients after implantation. This group of patients achieved also the significant progress in prosodic elements of speech in comparison with the results before implantation.

Vocal function exercises for presbylaryngis: a multidimensional assessment of treatment outcomes.

OBJECTIVES: Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis. METHODS: Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images. RESULTS: After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures, and laryngeal images did not reveal significant changes. CONCLUSIONS: These preliminary data suggest that vocal function exercises produce significant functional and perceptual improvements in voice, and deserve further attention as a treatment for elderly patients with presbylaryngis.

Use of botulinum toxin in voice restoration after laryngectomy.

BACKGROUND: Following laryngectomy, a distinct population of patients fails to achieve successful tracheoesophageal voice. These patients' voices range from strained and effortful to none at all. Such patients may present with severe hypertonicity or spasm of the pharyngoesophageal segment. Botulinum toxin has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this article is to review the evidence for using botulinum toxin to achieve an improvement in post-laryngectomy voice. METHODS: A Medline literature review (1966 to January 2009) and a search of the Cochrane database were performed. Foreign language articles and those not pertaining to post-laryngectomy voice restoration were excluded. RESULTS: Nine articles reporting a total of 134 patients were identified. Although there were differences in the outcome measures used, objective improvement in voice production occurred in between 70 and 100 per cent of cases. CONCLUSION: Botulinum toxin can be used as a safe and cost-effective treatment in patients with confirmed pharyngoesophageal segment hypertonicity and/or spasm following laryngectomy, to obtain an improvement in voice quality.

[Assessment of speech quality in patients with resected larynx].

The organ salving treatment of laryngeal neoplasms including their surgical resection at one of the stages was given to 25 patients. They were further followed up for the assessment of vocal function. Analysis of speech was performed by a group of 5 auditors. They counted how many times each patient heard a consonant as a sonant and vice versa. Based on the analysis of mistakes, the patients were divided into the following three groups: group 1 (many mistakes), group 2 (moderate number of mistakes), an group 3 (practically no mistakes). The most common mistake was devocalization of voiced sounds. Postoperative analysis of speech quality characteristics revealed their dependence on the extent of surgical intervention, the presence of tracheostoma, the type of plastic correction, and the dose of radiation therapy. It was shown that extensive and combined frontal-lateral resection leads to voice impairment. Tracheostoma also have negative effect on speech discrimination.

Aerodynamic and acoustic assessment in children following airway reconstruction: an assessment of feasibility.

OBJECTIVE: The purpose of this study was to examine the feasibility of conducting aerodynamic and acoustic assessment in children following airway reconstruction. Underlying etiologies, co-morbidities and age related factors can present challenges for meaningful instrumental data collection in this population. METHODS: A chart review of 100 children who were seen for a complete voice evaluation at the Center for Pediatric Voice Disorders at the Cincinnati Children's Hospital Medical Center was conducted. Children who completed full or partial aerodynamic and acoustic protocols were identified. Data regarding the ability to participate in the assessment was tabulated, and vowel samples taken from the acoustic data were subjected to signal type classifications (e.g., Type I, II, III). RESULTS: Fifty-three children met the inclusion/exclusion criteria of the chart review. Of those children, 58% (n=31/53) were able to complete the full acoustic and aerodynamic protocols without any modification. In regards to the aerodynamic protocol alone, 64% (n=34/53) could complete protocol. In regards to the acoustic protocol alone, 75% (n=40/53) could complete the entire acoustic protocol without any modification. There were 32% (n=17) who provided a Type I acoustic signal which was appropriate for measurement of F(0). There was a significant correlation between age and ability to complete the protocol for both the aerodynamic (p=.007) and acoustic (p=.004) protocols. CONCLUSIONS: This study demonstrated that a majority of children were capable of completing aerodynamic and acoustic protocols. A significant proportion of children in this study had severe dysphonia, precluding the ability to extract fundamental frequency. Although aerodynamic and acoustic measures are feasible for many patients in this population, the severity of dysphonias observed in these patients causes the use of these measures to be limited in some cases for documenting behavioral and surgical outcomes measures.

Voice assessment: updates on perceptual, acoustic, aerodynamic, and endoscopic imaging methods.

PURPOSE OF REVIEW: This paper describes recent advances in perceptual, acoustic, aerodynamic, and endoscopic imaging methods for assessing voice function. RECENT FINDINGS: We review advances from four major areas. PERCEPTUAL ASSESSMENT: Speech-language pathologists are being encouraged to use the new consensus auditory-perceptual evaluation of voice inventory for auditory-perceptual assessment of voice quality, and recent studies have provided new insights into listener reliability issues that have plagued subjective perceptual judgments of voice quality. ACOUSTIC ASSESSMENT: Progress is being made on the development of algorithms that are more robust for analyzing disordered voices, including the capability to extract voice quality-related measures from running speech segments. AERODYNAMIC ASSESSMENT: New devices for measuring phonation threshold air pressures and air flows have the potential to serve as sensitive indices of glottal phonatory conditions, and recent developments in aeroacoustic theory may provide new insights into laryngeal sound production mechanisms. ENDOSCOPIC IMAGING: The increased light sensitivity of new ultra high-speed color digital video processors is enabling high-quality endoscopic imaging of vocal fold tissue motion at unprecedented image capture rates, which promises to provide new insights into the mechanisms of normal and disordered voice production. SUMMARY: Some of the recent research advances in voice function assessment could be more readily adopted into clinical practice, whereas others will require further development.

The voice handicap index as a tool for assessment of the biopsychosocial impact of voice problems.

BACKGROUND: Objective measurements do not evaluate the biopsychosocial impact of a voice disorder. The Voice Handicap Index (VHI) measures the influence of voice problems on a patient's quality of life. OBJECTIVE: To investigate if the VHI can monitor biopsychosocial impact of voice disorders and to provide a frame of reference for use of the VHI in general ENT practice. METHODS: VHI scores and subscores were analysed in 272 controls, 237 patients with initial voice complaints ("new patients") and 92 patients before and after microsurgery ("operated patients"). RESULTS: The VHI scores of the controls were not normally distributed (Kolmogorov-Smirnov test: < .001). The total VHI scores for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were, respectively, 0.0, 0.0, 2.0, 6.0, 12.0, 23.0 and 32.8. In the controls, there was not a significant effect of gender on either VHI totals or subscores (p = 0.060-0.858). In the "new patients" group, males scored significantly higher on the functional subscore (p = 0.004). There was a very weak negative correlation between age and VHI totals and subscores in controls (correlation coefficient: -0.092 to -0.187). There was a significant difference in VHI totals and subscores between subjects with and without voice complaints (p < 0.001). In the patient group, VHI scores of professional voice users (PVUs) were not significantly different from those of non-PVUs (p = 0.112-0.753). In controls, a significantly higher score was found for PVUs in the P domain of the VHI (p = 0.017). After microsurgical treatment, 82.0% of patients had a lower total VHI score, and 93.3% reported an improvement in voice. In the patient group, the median postoperative VHI score was almost halved. CONCLUSION: Gender and profession did not have a significant influence on the total VHI score. There was a weak tendency for VHI to decrease with age. The VHI is a useful instrument for quantifying the biopsychosocial impact of a voice disorder, and is able to monitor changes in self-perception of voice handicap after treatment.

[Subjective assessment of voice functions among teachers taking part in the rehabilitation program]. / Subiektywna ocena czynnosci glosowej u nauczycieli uczestniczacych w programie rehabilitacyjnym.

INTRODUCTION: In daily phoniatric practice, apart from laryngoscopy, another simple and useful method of examining the voice organ is perceptual voice assessment based on the GRBAS scale. An extension to this examination can be the Voice Handicap Index test (VHI). MATERIALS AND METHODS: 79 female teachers taking part in a 7-week-long rehabilitation course on voice emission techniques. Before and after the course the participants were subject to phoniatric examination including laryngovideostroboscopy, GRBAS scale assessment and determining the voice handicap index (VHI). RESULTS: After the course, a substantial improvement has been observed in voice emission, perceptual assessment and the VHI test. It has been observed that there is a statistically significant correlation between GRBAS and VHI results and mean phonation time (MPT) measured before and after the course. CONCLUSIONS: The VHI test should be included in complex analysis of the effects of intensive rehabilitation.

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine]. / "Voice Handicap Index" (VHI) in der stationären Stimmrehabilitation.

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

[Assessment of rehabilitation of teachers' voice disorders]. / Ocena skutecznosci rehabilitacji zaburzen glosu u nauczycieli czynnych zawodowo.

Results of treatment of teacher's voice disorders were presented. Patients except pharmacological treatment and physiotherapy realised the course of voice emission exercises under speech therapist supervision. Ninety teachers were examined before and after treatment. Laryngological, phoniatric and laryngostroboscopic studies were carried out. In most patients phoniatric assessment revealed elongation of phonation time, changing of breathing route from cleidocostal to phrenocostal and voice creation without neck muscle tension after completing of treatment. 6 weeks lasting period of exercises was determined to be sufficient in most patients to learn correct breathing and phonation but to establish normal voice emission patient strong motivation, discipline and regularity during several months lasting exercises is needed.