Gaviscon® Advance alone versus co-prescription of Gaviscon® Advance and proton pump inhibitors in the treatment of laryngopharyngeal reflux.

OBJECTIVES: Management of laryngopharyngeal reflux (LPR) typically comprises alginates and proton pump inhibitors (PPIs) alone or in combination, yet evidence to support any particular treatment regimen is lacking. We sought to evaluate the efficacy of Gaviscon® Advance alone versus co-prescription with a PPI in treating LPR. METHODS: One hundred consecutive LPR patients with a reflux symptom index (RSI) score > 10 attending our joint voice clinic (JVC) were studied prospectively. All were treated with Gaviscon® Advance four times daily. If patients had been started on a PPI prior to their JVC attendance, this was optimised to a twice-daily dosing regimen and continued. RSI scores were recorded at first attendance and 3 months post-treatment via postal questionnaire. Scores were analysed using t tests and Levene's test for equality of variances. RESULTS: Follow-up RSI scores were returned by 72 patients, 39 of whom were treated with Gaviscon® Advance only (group A) and 33 with Gaviscon® Advance + PPI (group B). Mean pre-treatment RSI scores were similar between groups [group A: 19.2, 95% confidence interval (CI) ± 2.4; group B: 21.3, 95% CI ± 3.2 (p = 0.65)]. No significant differences were observed with respect to 3-month post-treatment RSI scores [group A: 9.9, 95% CI ± 2.8; group B: 12.6, 95% CI ± 4.2 (p = 0.82)] and change in RSI scores [group A: 9.3, 95% CI ± 3.0; group B: 8.7, 95% CI ± 2.9 [p = 0.75]). CONCLUSIONS: Gaviscon® Advance alone is effective in treating symptoms of LPR, while co-prescription with a high-dose PPI offers no additional benefit.

Physiological changes in response to hearing female voices recorded at high fertility.

The human voice transmits pertinent information regarding health status and age, with recent evidence suggesting that it plays an important role in mate selection. However, the mechanism that drives preferences for voices of fertile females has yet to be elucidated. The current study examined the physiological changes that occur when listening to voices recorded from naturally cycling females at high and low fertility phases of the menstrual cycle, as well as from females using hormonal contraception. We found the voices of naturally cycling females recorded during a high fertility phase were rated as more attractive and produced the greatest increase in galvanic skin response (GSR). Heart rate (HR) also showed a trend towards the highest increase when listening to naturally cycling, high fertility female voices. There were no differences in ratings of voice attractiveness, GSR, or HR between the voices recorded from females using hormonal contraception. Analyzed separately, male and female listeners both showed a preference for naturally cycling, high fertility voices. Female listeners additionally showed increased GSR and HR responses to naturally cycling, high fertility voices. We discuss the adaptive benefits of detecting vocal changes for male as well as female listeners, and also discuss the role that the nervous system plays during human mate assessments.

Voice and physical appearance in female-to-male transsexuals.

The study aims to investigate if a similar interaction between physical appearance and voice could be found in female-to-male transsexuals as had been observed in male-to-female transsexuals. A panel of judges rated "maleness" of seven female-to-male transsexuals from video-recorded speech samples using three modes of presentation: auditory-only presentation, visual-only presentation, and audiovisual presentation. For the group of transsexuals as a whole, no significant differences were found between scores given in the auditory-only mode or the visual-only mode and those given in the audiovisual mode. Analysis of individual results, however, yielded significant differences in some individuals and there was some relation with hormone treatment. There was no significant correlation between the ratings of "maleness" in the auditory-only mode and fundamental frequency. Physical appearance in female-to-male transsexuals appears not to be a strong influencing factor in general, but may interact with gender recognition based on the voice in some individuals. The absence of a correlation between fundamental frequency and rating of maleness could mean that in female-to-male transsexuals, fundamental frequency is a relatively less important factor for gender expression or perhaps also that a higher voice in males is more accepted than a lower voice in females.

Effects of topical anesthetic and flexible fiberoptic laryngoscopy on professional sopranos.

This study examined the acoustic and perceptual effects of topical anesthetic and flexible fiberoptic laryngoscopy (FFL) against a control condition on the singing voices of ten professional sopranos. Recordings of a section of an aria, various scales, and a messa di voce exercise were obtained in the three experimental conditions. Acoustic analyses of the same aria section recorded during the three conditions were similar with respect to the distribution of energy across the spectrum (LTAS) and vibrato rate and extent. The ability of the participants to achieve their highest and lowest notes or to complete the messa di voce was also not affected by the anesthetic or FFL. Perceptual ratings of a variety of parameters by experienced singing teachers also revealed little difference across conditions with only "appropriate velopharyngeal closure" found to differ in one comparison. These results indicate that highly experienced operatic sopranos are either not affected by or appear to have the ability to compensate for the presence of anesthetic and the FFL. The most likely explanation is that this group of singers relied on a solid vocal technique. Results will need to be replicated on less accomplished singers before concluding that this medical procedure does not affect the operatic singing voice.

Effect of chronic electrical stimulation of laryngeal muscle on voice.

Conventional surgical therapies for bilateral laryngeal paralysis sacrifice voice to enlarge the airway. Electrical pacing of the posterior cricoarytenoid (PCA) muscle to restore glottal opening and allow ventilation offers a new treatment approach. The purpose of this investigation was to determine whether long-term stimulation of the PCA muscle altered perceptual, acoustic, and aerodynamic parameters of voice. Two patients underwent implantation of a Medtronic Itrel II laryngeal pacemaker. Voice evaluation was performed before surgery and at monthly postoperative sessions with the pacemaker off. Months of PCA stimulation did not change perceptual descriptors of voice quality. Measures of fundamental frequency and intensity, upper and lower limits of the dynamic frequency and intensity range, and phonatory flow rates were largely unaltered. The results indicated that there was no effect of laryngeal pacing on voice.

An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice.

Seven patients with Parkinson's disease were implanted with deep brain stimulators to provide chronic electrical stimulation to the subthalamic nucleus bilaterally. Acoustic recordings and neurologic assessments were undertaken before surgery in the medication-off and medication-on conditions and after surgery with and without electrical stimulation in the medication-off and medication-on conditions. The data showed significant improvements in limb motor performance in response to medication before surgery and when the subthalamic nucleus was stimulated after surgery. Six months after surgery, there were small but statistically significant increases in sound pressure level and fundamental frequency variability in response to stimulation in the medication-on condition. No other statistically significant speech changes were measured. These findings are consistent with several other studies that have reported disparity between limb and speech improvements after neurosurgical intervention for Parkinson's disease.

Vocal shadowing under conditions of normal and altered laryngeal sensation.

Five adult male subjects vocally matched the pitches of tones in a steady-state tone matching task (SSTMT) and vocally shadowed frequency changes in a frequency modulated tone matching task (FMTMT). Matching was done in both a normal condition and a condition of topical anesthesia of the laryngeal mucosa. Pitch matching accuracy was not seriously altered in the anethesia condition, but anesthetized subjects required more time and had slower velocities in effecting transitions between tones on the FMTMT, as compared to normal. In both conditions there was a direct proportionality between interval size and each of the time and velocity variables examined, while frequency lowering was generally faster than frequency raising. Analysis of subject response strategies on the FMTMT revealed recurring patterns, described here as Overshoot, Undershoot, Oscillate and Hit. Fewer Hit, and more Oscillate, patterns were observed for the anesthesia condition as compared to normal. It was concluded that the FMTMT, as compared to the SSTMT, required finer and more rapid laryngeal control to coordinate respiratory driving pressures and glottal resistance, and hence was more susceptible to impairment of the laryngeal mucosal reflexogenic system. Implications of the data for modeling certain mechanical and physiological aspects of laryngeal control are discussed.