Vocal Training for Patients Post Vocal Cord Polyp Surgery Based on ICF and ICHI / 中国康复理论与实践

Objective:To explore the effect of vocal training based on International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI) on vocal function after vocal cord polyps. Methods:A framework of rehabilitation was developed with joint use of ICF and ICHI. From January, 2017 to December, 2018, 30 patients with vocal cord polyps and vocal dysfunction post operation were sampled. They accepted the therapy for a month, and assessed with Grade, Roughness, Breathiness, Asthenia and Strain scale (GRBAS), and measured acoustic parameters before and after operation, and after training, respectively. Results:The scores of GRBAS decreased after training, compared with those both before and after operation (F > 6.214, P < 0.05), as well as the acoustic parameters of fundamental frequency, fundamental frequency perturbation, normalized noise energy and amplitude perturbation (F > 9.655, P < 0.05). Conclusion:Vocal training based on ICF and ICHI is effective on vocal function after operation for vocal cord polyps.

Construction of System of Diagnosis, Assessment and Rehabilitation Interventions for Impairment of Speech and Voice Function Using WHO Family International Classificiations / 中国康复理论与实践

Results and Conclusion:Voice disorders are classified to Voice Disturbance (MA82), within the category of Symptoms or Signs Involving Speech or Voice. Voice disorders may be symptoms or signs of Speech Disturbance (MA80), Malignant Neoplasms of Larynx (2C23), Intracerebral Haemorrhage (8B00), Oedema of Larynx (CA0H.3), and the others. Voice disorder is impairment at body function, and influence activity and participation (d3, d7, d8 and d9), which may involve in environmental and personal factors. The evaluation of voice function involes in production of voice (b3100) and quality of voice (b3101). A structured rehabilitation solution has been developed with the interventions at body structure, body function, activities and participation, environmental factors and personal factors, including assessment (assessment, test, observation), training and treatment (training, assisting), educational counseling (education, advicing, counseling), and support (psychological and social). Objective:To explore diagnosis and assessment of voice function and develop a framework of rehabilitation for it based on International Classification of Diseases 11th Revision (ICD-11), International Classification of Functioning, Disability and Health (ICF) and International Classification of Health Interventions (ICHI). Methods:The diagnostic criteria of voice disorders and its complications were discussed with ICD-11 and ICF. The tools of assessment were analysed with ICF. A comprehensive intervention system was developed for the rehabilitation of voice function based on the joint use of ICF and ICHI.

Efectos del entrenamiento respiratorio aislado en las variables respiratorias y vocales / Effects of isolated respiratory training on breathing and voice variables

La implementación del entrenamiento respiratorio aislado en la rehabilitación y el entrenamiento de la voz es una práctica común en los países de habla hispana. Ac-tualmente, no existe ningún manuscrito en español que revise la información teórica y empírica del entrenamiento respiratorio en este contexto. El propósito de la presente revisión es entregar la evidencia actualizada del efecto del entrenamiento respiratorio aislado en la voz. El entrenamiento de la fuerza respiratoria ha demostrado tener consecuencias positivas en los parámetros medidos; no obstante, los datos disponibles hasta ahora no reporta efectos significativos en la voz, exceptuando los casos de personas con trastornos neurológicos de base y presbifonía. Si el entrenamiento respiratorio con el uso de dispositivos no ha demostrado impactar favorablemente sobre otras disfonías (no neurológicas ni presbifonía) ni en sujetos sanos profesionales de la voz, no existiría razón para esperar que los ejercicios respiratorios aislados que se suelen incluir en las rutinas de entrenadores vocales, fonoaudiólogos, logopedas y foniatras tengan un efecto positivo. Considerando que el entrenamiento de la fuerza muscular respiratoria parece actuar sobre algunos parámetros vocales en personas con alteraciones neurológicas y presbifonía, futuras investigaciones deberían considerar la exploración del posible efecto positivo en otros parámetros vocales no medidos aún en este tipo de población

Isolated breathing training in rehabilitation and voice training is a common prac-tice in Spanish-speaking countries. Currently, there are no documents in Spanish that study the theoretical and empirical information related to respiratory training in this context. The purpose of the present review is to provide updated information regarding the current evidence of the possible effect of isolated respiratory training on voice. Respiratory strength training has been shown to have positive effects on respiratory parameters, however, the available evidence does not report significant effects on the voice, except for people with underlying neurological disorders and presbyphonia. If respiratory training using devices designed for these purposes has not been shown to positively impact vocal characteristics of subjects with dyspho-nia (not neurological or presbyphonia) or of healthy professional voice users, there is no reason to expect that the isolated breathing exercises that are often included in the routines of vocal trainers and speech therapists will have a positive effect on voice variables. Considering that respiratory muscle strength training seems to positively affect some vocal parameters in people with neurological disorders and presbyphonia, future research should consider exploring the possible effect on other vocal parameters not yet measured in this type of population

Telepráctica de la Terapia Vocal: una ref lexión sobre su aplicación a partir del COVID-19 / Telepractice of voice therapy: a ref lection on its application from the beginning of COVID-19

El manejo de la pandemia por COVID-19 ha generado grandes cambios sociales y mundiales. Uno de ellos, debido al distanciamiento social, ha sido la incorporación de la telepráctica de la terapia vocal en países que tenían poco o nulo conocimiento de ella. Este artículo tiene el propósito de reflexionar sobre la aplicación de la teleprác-tica de la terapia vocal, considerando los beneficios, barreras y oportunidades que surgen de ella. Además, se plantea que la aplicación de la telepráctica requiere de una política, de un marco legislativo y de aspectos éticos para asegurar una terapia vocal exitosa. ¿Es efectiva la telepráctica? ¿es posible aplicarla? ¿qué requiere su aplicación?

The management of the COVID-19 pandemic has generated huge changes socially and worldwide. One of these, due to social distancing, has been the incorporation of telepractice to voice therapy in countries where the knowledge of it was very little or there was none. The purpose of this article is to reflect about the usage of tele-practice in voice therapy by considering the benefits, barriers and opportunities that emerge from it. The paper also poses that the application of telepractice requires po-licies, a legislative framework and ethical aspects to ensure a successful voice therapy. Is the telepractice effective? Can it be implemented? What does its appliance require?

Alternative technique in secondary tracheoesophageal puncture using flexible endoscope and overtube in patients with difficult post-laryngectomy abnormalities

Background: Functional speech rehabilitation after total laryngectomy remains one of the most challenging issues in head and neck multidisciplinary care. Tracheoesophageal puncture for voice prosthesis insertion performed as a secondary procedure with a rigid esophagoscope and trocar can be technically difficult in certain patients due to post-treatment cervical abnormalities, such as reduced hyperextension, stenosis, and trismus. Methods: This study presents an improved method of secondary tracheoesophageal prosthesis insertion using a flexible endoscope in association with a plastic pliable overtube to keep the virtual esophageal lumen open. By this method, the puncture can be performed easily and safely with the avoidance of unexpected lesions. Results: From 2005 to 2015, 12 (16,9%) out of 71 patients who underwent secondary voice prosthesis placement at our institution required this alternative technique due to anatomical alterations that hindered the execution of the procedure following the standard technique. Conclusion: The procedure was successfully performed in all patients with no related complications (AU)

Factors influencing the longevity and replacement frequency of Provox voice prostheses

<p><b>INTRODUCTION</b>This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement.</p><p><b>METHODS</b>The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated.</p><p><b>RESULTS</b>All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01).</p><p><b>CONCLUSION</b>The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.</p>

Microbial colonization of Provox voice prosthesis in the Indian scenario.

INTRODUCTION: Tracheoesophageal speech using the voice prosthesis is considered to be the “gold standard” with success rates as high as 90%. Despite significant developments, majority eventually develop dysfunction due to microbial deterioration. We did a pilot study of 58 laryngectomy patients who developed prosthesis dysfunction. MATERIALS AND METHODS: A total of 58 laryngectomy patients who had their dysfunctional prosthesis removed were included in this study. Dysfunctional prostheses were removed and examined. Esophageal and tracheal flanges were examined separately. After obtaining pure fungal and bacterial cultures, the yeast strains were identified. Bacteria were identified with the light microscope and gram staining. We analyzed prosthesis lifespan and probable factors affecting it. RESULTS: Central leak was found in 43% cases while in 57% peri‑prosthetic leakage was the most common reason for prosthesis replacement. Microbial analysis revealed a combination of yeast and bacteria in approximately 55% culture samples. Out of these, almost 90% had the presence of single yeast species with bacteria. Pure fungal culture was identified in rest of the 45% cultures while none detected pure bacterial forms. Candida tropicalis was the solitary yeast in 81% while Candida albicans was seen in 10% as the solitary yeast. Bacterial isolates revealed Klebsiella pneumonia in 19%, Escherichia coli in 8% while Staphylococcus aureus was grown in 1% cultures. The consumption of curd (P = 0.036, 95% confidence intervals [CI]: 2.292‑64.285) to have a significant correlation of the mean prosthesis lifespan. Consumption of curd (P = 0.001, 95% CI: 0.564‑2.008) and history of prior radiotherapy (P = 0.015, 95% CI: 0.104‑0.909) had a significant bearing on the Provox prosthesis lifespan. CONCLUSIONS: Candida is the most common organism grown on voice prosthesis in Indian scenario. Consumption of curd and history of prior radiotherapy significantly affect Provox prosthesis lifespan.

Imaging and Acoustic Study of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.

Mechanism of Vocal Phonation in T-E Shunt Patients after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Total laryngectomy has become a usual treatment for any advanced carcinoma of the larynx, but most patients who have undergone total laryngectomy have shown permanent disability in voice production. To solve this problem, studies of voice rehabilitation after total laryngectomy have been done. MATERIALS AND METHODS: We have developed an accurate method to measure the vocal tract shape along its length from magnetic resonance images acquired during the sustained phonation of Korean vowels by T-E shunt patients and normal subject. We estimated the accuracy of MRI and also compared the vocal tract spape of the normal and T-E shunt patients by comparing the first three formant frequencies estimated from MRI to those measured directly from speech data of the T-E patients and the normal subject. RESULTS: The length of T-E shunt patient's vocal tract is 17-18.5 cm. T-E shunt patients phonated strained voice. The length of resonant chamber of T-E shunt patients are shorter than that of the normal subject. The vocal tract is shortened during the phonation by T-E shunt patients. In cases of /e/ and /i/, front cavities are constricted while back cavities are shortened. The pseudoglottis of the T-E shunt patients is located at the region 14-15 cm from lip. CONCLUSION: Acoustic characteristics and vocal tract shapes of the T-E shunt patients are relatively similar to those of the normal subject. To achieve normal voice, reconstruction of pharyngeal and superior glottal resonant chamber will be desirable.