Polish Translation and Validation of the Voice Handicap Index (VHI-30).

Traditional voice evaluations, including imaging techniques, auditory-perceptual ratings, and acoustic and aerodynamic analyses, fail to assess the global handicap that a patient experiences as a result of a voice disorder. The Voice Handicap Index (VHI) is currently one of the most widely used and psychometrically robust instruments for measuring voice disability. The aim of the study is to translate and validate a Polish version of the VHI. The original English-language version of VHI-30 was translated into Polish. We enrolled 188 subjects-123 patients (91 women and 32 men) with voice disorders and 65 controls (53 women and 12 men) without voice disorders. Results obtained by the patients were significantly higher than those obtained by the controls on the Emotional subscale (U = 519.0; p < 0.001), Functional (U = 829.0; p < 0.001), Physical (U = 331.0; p < 0.001), and the global score (U = 390.0; p < 0.001). There were statistically significant negative correlations between maximum phonation time and global score (rho = -0.31; p < 0.01) as well as all three subscales. Shimmer and Smoothed Amplitude Perturbation Quotient were correlated positively with the global score (rho = 0.22; p < 0.05; rho = 0.25; p < 0.01, respectively) and with all three subscales. There were also statistically significant correlations between VHI scores and auditory perceptual evaluation. In the patient group, there was excellent internal consistency (α = 0.97) and strong test-retest reliability (intraclass correlation = 0.94). The cut-off value equal to 17 points was estimated. The Polish VHI showed excellent internal consistency, good test-retest reproducibility, and clinical validity. It is a useful tool for evaluating the voice disability perceived by a patient.

Mucosal wave measurements in the diagnosis of functional dysphonia.

ntroduction: The publication describes the characteristics of the glottis in FDs objectified by OQ, measured with VSK and EGG. AIM: The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. MATERIAL AND METHOD: The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. RESULTS: All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P < 0.05). Significant differences were found between patients with hypofunctional - 0.584 and hyperfunctional dysphonia - 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P < 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. CONCLUSIONS: Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

Objective measurement of mucosal wave parameters in diagnosing benign lesions of the vocal folds.

INTRODUCTION: The diagnostic procedure of phonation is dominated by subjective assessment tools. It seems reasonable to seek methods of quantitative glottal cycle assessment. OBJECTIVE: The aim of our study was the analysis of open quotients (OQ) of the glottis. METHODS: One hundred and twenty-four people were included in the study. Methodology was based on tools available in everyday phoniatrics practice - laryngovideostroboscopy (LVS) and electroglottography (EGG). There were statistically significant differences between control and studied group. Vocal fold polyps, nodules and edema influence glottal function in a different manner, what can be illustrated by objective glottal function parameters. Establishing Videostroboscopic Open Quotient values from three parts of glottis and Electroglottographic Quasi Open Quotient (QOQ) value, can help in dividing patients with benign lesions of vocal folds according to the type of disease. RESULTS AND CONCLUSIONS: Measurement of the open quotient from three parts of the glottis helps to differentially diagnose and localize glottal vocal fold lesions. Videostroboscopic Open Quotient and Electroglottographic QOQ values can be used to quantify the glottal cycle. Videostroboscopic Open Quotient, Electroglottographic QOQ and their ratio varies depending on the type of organic dysphonia.

Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx.

Introduction Laryngeal paralysis deteriorates all laryngeal functions. Therefore the therapeutic process must include restoration of respiratory, defensive and vocal function. Selection of a proper rehabilitation path plays a key role. Appropriate research protocol that includes objective methods of voice evaluation is an important element of monitoring the return of vocal efficiency. Voice efficiency is important for the patient particularly due to psychological and social reasons. Aim The aim of the study was the assessment of short-term functional voice therapy (FVT) in patients with unilateral paralysis of the larynx with the usage of objective parameters describing the glottis and voice quality. Material and Method During the last 10 years 355 patients with laryngeal paralysis were hospitalized in the Audiology and Phoniatrics Clinic due to dysphonia. All patients undergone 5-day FVT. From 2015 we unified diagnostic protocol measuring parameters obtained from videostrobokymography (VSK), electroglottography (EGG), perceptual and acoustic voice analysis before and after 5 day hospitalization. Results After FVT patients improved voice quality and glottal compensation. The majority of patients achieved a statistically significant improvement in the VSK, EGG, MDVP and perceptual analysis. Group of patients with unsatisfactory voice improvement after therapy required a prolonged rehabilitation or has been qualified for laryngeal microsurgery. Potential factors that could have cause insufficient effects of FVT were analysed. Conclusions The complexity of voice rehabilitation is crucial for the success of therapy. Interdisciplinary therapeutic team plays a significant role during voice rehabilitation in patients with vocal fold paralysis.

Left brachiocephalic vein stenosis and infectious aortitis: two unusual causes of Ortner's syndrome.

Ortner's syndrome (also known as cardiovocal syndrome) is defined as hoarseness due to compression of the left recurrent laryngeal nerve by an enlarged left atrium or enlarged thoracic vessels. We describe two cases of Ortner's syndrome with an unusual underlying vascular pathology. In the first patient, Ortner's syndrome was a consequence of left brachiocephalic vein stenosis resulting in collateral circulation filling the aorto-pulmonary window. The second patient developed a thoracic aortic aneurysm due infectious aortitis. Both patients required careful scrutiny in differential diagnosis because of their complex past medical history and concomitant diseases.

Comparison of voice quality in patients with GERD-related larynx and layngopharynx disorders before and after therapy.

OBJECTIVES: The aim of this study was to compare voice quality in patients with GERD-related changes in the larynx and laryngopharynx before and after treatment. MATERIAL AND METHODS: 249 consecutive patients diagnosed with GERD-related changes in larynx and laryngopharynx were involved in this retrospective study (166 females, 83 males). Patients completed the questionnaire RSI. The GRBAS scale was used for subjective voice evaluation. Objective voice analysis was performed with the use of KAY Elemetrics Model CSL 4300 (CSL 4305, MDVP). RESULTS: In women, the mean RSI score (by Belafsky) was 12.69, in men 12.6. In both analyzed groups, the laryngeal symptoms related to GERD diminished after treatment. Perceptual assessment of voice (GRBAS) revealed G2R1B0A0S1 in women and G2R2B0A0S1 in men. In both the male and female group before treatment, the dominant sonogram was type III in Remacle's scale, IInd degree of hoarseness in Yanagihara's scale, phonation time was shortened, and MDVP parameters were abnormal. After treatment there was statistically significant improvement in the following parameters: G, R, B, and S in sonogram, degree of hoarseness, some of MDVP parameters (Fhi, RAP and PPQ in females, and F0 and Flo in males), and less irregularity in tomogram. CONCLUSIONS: In all patients no restoration of normal voice was noted after treatment despite disappearance of the gastrological symptoms.

Chronic cough - assessment of treatment efficacy based on two questionnaires.

INTRODUCTION: Efficacy of chronic cough treatment is ambiguous. The aim of the study was to analyze chronic cough alleviation after specific treatment and the relationship between cough etiology and treatment efficacy. MATERIAL AND METHODS: A stepwise diagnostic approach was used to diagnose cough etiology in non-smoking adults with chronic cough. In all patients specific treatment was applied. Two different questionnaires - a visual analog scale and a 5-degree scale - were used to assess cough severity before and after 4-6 months of treatment. RESULTS: A significant correlation between pre-treatment and post-treatment results of both questionnaires was found (Spearman coefficient 0.43, p = 0.0003 and 0.73, p < 0.0001, respectively). Baseline questionnaire analysis revealed no differences in cough severity between patients with different cough causes or multiple cough causes. Although specific treatment resulted in a significant decrease of cough severity in the entire group, only partial improvement was noted. According to the visual analogue scale, a decrease of cough severity by at least 50% was achieved only in 54.4% of patients (37/68). Similarly, satisfactory improvement was noted in only 54.4% (37/68) of patients when using the 5-point scale. There were three sub-groups of patients, in whom no relevant decrease of cough severity was observed despite treatment: patients with 1. three coexisting cough causes, 2. non-asthmatic eosinophilic bronchitis, and 3. chronic idiopathic cough. CONCLUSIONS: Cough severity does not depend on its etiology. Efficacy of chronic cough treatment in non-smoking patients is only moderate.

Comparison of voice quality in patients with GERD-related dysphonia or chronic cough.

OBJECTIVE: The aim was to compare a voice quality in patients with GERD-related dysphonia or chronic cough and to determine whether there is a relationship between the main symptom reported and voice quality. MATERIAL AND METHODS: 249 consecutive patients diagnosed with GERD-related chronic cough or dysphonia were involved in this retrospective study and were divided into two main groups of men and women, and furthermore into groups of chronic cough and dysphonia. Laryngeal lesions were evaluated with videolaryngostroboscopy using Reflux Finding Score. Voice quality was assessed using GRBAS scale, sonograms, and multidimensional voice program (MDVP). RESULTS: All subjects were found to have vocal abnormalities both in subjective and objective voice analysis. Perceptual assessment of voice (GRBAS) did not reveal any differences between analyzed groups depending on the reported symptom. In MDVP analysis, the group of women with cough as the main symptom demonstrated significantly less abnormalities in VTI value. In men with cough as their main complaint, significantly less MDVP abnormalities were found in Jita, Jitt, RAP, PPQ, and sPPQ parameters. CONCLUSIONS: The comparison of voice perceptual assessment in patients with GERD-related dysphonia or chronic cough revealed no differences between analyzed groups. In objective voice analysis, the latter group presented lower degree of hoarseness in Yanagihara's scale. In objective MDVP analysis, the chronic cough group presented lower degree of abnormalities only in one of the noise related parameters in females and five frequency perturbation parameters in males.

[Warsaw A-E scale of endoscopic pharyngo-laryngeal findings associated with laryngopharyngeal reflux. Correlation with reflux finding score (RFS)]. / Skala Warszawska A-E oceny endoskopowych zmian w krtani zwiazanych z refluksem gardlowo-krtaniowym. Korelacja ze skala patologii refluksowej (RFS).

INTRODUCTION: Changes associated with laryngopharyngeal reflux (LPR) are usually related to the posterior part of the larynx and called "posterior laryngitis". Pathologic reflux-induced mucosal changes within the larynx are easily detected with the use of videolaryngoscopy (VLS). To the multitude of described changes within the larynx that are associated with the existence of LPR Belafsky introduced assessment with 26 scale points describing changes in the larynx (RFS; reflux finding score). AIM OF THE STUDY: The aim of this study was to introduce our proposal of a new scale of endoscopic pharyngo-laryngeal findings associated with laryngopharyngeal reflux named Warsaw A-E scale. For that reason the new scale was compared to the RFS scale of Belafsky. MATERIAL AND METHOD: A total of 249 patients were involved in this restospective study. The reflux disease was confirmed by gastroenetrologists. Larynx was evaluated with the use of videolaryngoscopy. Morphological changes within the larynx and pharynx were assessed using 1) the RFS scale according to Belafsky, 2) and using our proposed scale named Warsaw A-E scale. The results were compared. RESULTS: All patients received at least 7 points in RFS scale of Belafsky. Using Warsaw A-E scale, there were no patients found with the videolaryngoscopic image of the larynx classified as A type. In both the women's group, as well as the group of men prevailed type C. The comparison of the two scales showed correlation between them. CONCLUSIONS: The study showed a statistically significant correlation of Warsaw A-E scale of laryngopharyngeal changes with a commonly used scale of RFS according to Belafsky. It was found that the Warsaw A-E scale is easier to use and less time consuming.

[Vocal fold paralysis in the Medical University of Warsaw's Ambulatory of Phoniatry in years 2000-2011]. / Porazenia krtani w materiale Poradni Foniatrycznej Warszawskiego Uniwersytetu Medycznego w latach 2000-2011.

INTRODUCTION: Vocal fold paralysis it is an important problem in Phoniatrics' Ambulatory. There are a lot of difficulties in estimation a precise incidence of vocal fold paralysis in the population. As many as 50% of cases with paralysis might present nonspecific symptoms. AIM OF THE STUDY: The aim of the research it was to determine a vocal fold paralysis' epidemiology and etiology in material of the Medical University of Warsaw's Ambulatory of Phoniatry. MATERIAL AND METHODS: Authors present a group of 593 patients with vocal cord paralysis who were diagnosed and treated in The Ambulatory of Phoniatry from 2000 to 2011. The paralysis was observed in 439 women and in 154 men. In 488 patients paralysis was unilateral and in 105 - bilateral. RESULTS: In the study, surgery was responsible for most vocal fold paralysis (79.0%). In 357 patients, paralysis was caused by thyroid surgery. Other surgical causes of the paralysis there were: endarterectomy, thoracic surgery and skull base surgery. Of the total group, 1.2% of cases were diagnosed after intubation. In the review, in another 19.8% cases, paralysis was caused by thoracic, neck or brain tumors, by traumas and in 21 patients there was no obvious reason (idiopathic cases). CONCLUSIONS: Etiology of vocal fold paralysis seems to be affected by a character of institutions or hospitals who make a study and by geographic location. The most common etiology of vocal cord paralysis is iatrogenic.

[The complications after CO2 laser endoscopic surgery for early glottic cancer]. / Powiklania leczenia wczesnego raka glosni za pomoca lasera CO2.

INTRODUCTION: CO(2) laser endoscopic surgery, introduction in the treatment of early glottic malignancies in the early seventies is the method has been well studied in such cases, and its utility for these lesions is well-established. Transoral resection with the CO(2) laser, open partial laryngectomy and radiotherapy are the main options for treatment of early laryngeal cancer. As all the therapies are all equally effective in controlling an early glottic cancer the choice of treatment must consider such factors as possible complications, functional outcome and patient compliance. For properly selected patients the laser therapy provides equivalent oncologic outcomes when compared to traditional surgical therapies while improving the functional aspects of postoperative speech, voice and swallowing. Its advantages over open surgery include quicker recovery, less morbidity, fewer side effects and greater cost-effectiveness too. The disadvantages of radiotherapy are: duration of treatment, loss of time for work and social activities, higher rate of other possible complications, and partial preclusion of further conservative salvage surgery. Some authors report radiotherapy offers the better quality of voice but further investigations are needed to compare the voice following endoscopic resections with that obtained after radiotherapy. AIMS: The aim of the study was to analyze the character of the peri- and postoperative complications after CO(2) laser endoscopic surgery for the early glottis cancer. MATERIAL AND METHODS: [corrected] This was a retrospective study of a files of 55 patients (7 female and 48 male) in age range 38-85 with early glottic carcinoma (Tis - T2) treated by cordectomy. Diagnosis was based on histopathological examination of the biopsy specimen of the lesion and ultrasonographical examination of the lymphonodules of the neck. Videolaryngostroboscopy and acustic analize of the voice was complicated. All of them underwent one of the types of cordectomy using a CO(2) laser, between 2007 and 2010. Cordectomies were categorized according to the classification of the European Laryngological Society (2000 and rev. 2007). In our series most cordectomies were type III 24 patients. Type IV - 2 patients, type Va - 18, type Vb - 4, type Vc - 6 and type VI - 1 patient. We observed peri-and postoperative complication and functional result of the treatment such as quality of voice and swallowing difficulties. CONCLUSIONS: Among 55 patient postoperative bleeding was the most commonly seen complication. It appeared in 34 of them (62%). All the cases of bleeding were easy to control. In 23 cases pain and mild laryngeal oedema were observed. It resolved in 3-4 day after medical treatment. None of our patient required tracheotomy. Eight patients needed revision procedures: four due to granulation tissue formation, two due to adhesion and another two due to laryngocele. This entire patient was manageable locally with repeated surgery. Our functional data, including stroboscopic findings and perceptual and objective voice evaluations, demonstrate that patients who underwent cordectomy and foniatric rehabilitation presents social efficient voice but with pathological components. All the patients have good long-term swallowing function.

Diagnosis and management of premature ventricular complexes-associated chronic cough.

BACKGROUND: Chronic cough frequently remains unexplained. Although various cardiac arrhythmias have already been reported as a cause of chronic cough, this phenomenon has not been evaluated prospectively. Therefore, we studied the incidence and management of cough associated with premature ventricular complexes (PVCs) in a population of patients with this condition. METHODS: Patients without organic heart disease who had been referred for the management of symptomatic PVC were evaluated prospectively. PVC-associated cough was recognized if cough episodes occurred just after spontaneous or induced PVC or observed in an ECG or a multichannel recording system that included ECG. A differential diagnosis of cough was performed according to the guidelines on cough. Afterward, antiarrhythmic therapy was instituted to eliminate PVC and cough. RESULTS: Of the 120 patients who were referred for the management of PVC, 10 had a chronic cough. After extensive workup for the cause of chronic cough, the cough was thought to be solely due to PVC in one patient, partially due to PVC plus another cause in five patients, and not due to PVC but to nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and chronic sinusitis in four patients. Patients with PVC-associated cough reported more severe perception of symptoms associated with arrhythmia than patients without cough (mean [+/- SD] visual analog scale score, 8.2 +/- 0.5 vs 5.7 +/- 1.6, respectively; p < 0.01). PVC-associated cough disappeared after antiarrhythmic treatment (radiofrequency ablation [n = 4], oral antiarrhythmic agent [n = 1]), or after spontaneous remission of PVC (n = 1). CONCLUSIONS: PVC may be a cause of chronic cough. Interdisciplinary cooperation is warranted for the proper diagnosis and management of PVC-associated cough.

[Management and therapy in functional aphonia: analysis of 500 cases]. / Postepowanie i leczenie w afonii psychogennej: analiza 500 przypadków.

INTRODUCTION: The article reviews current opinions on etiopathogenesis and management of functional total loss of the ability to produce loud voice. Psychogenic aphonia refers to involuntary whispering despite a basically normal larynx. MATERIAL AND METHODS: [corrected] The longitudinal study was carried out on 500 patients treated for psychogenic aphonia during 32 years (1972-2004). Of the facilitating techniques, the following were useful for phoniatric therapy: relaxation and respiration, gargle, chewing, pushing, inhalation phonation, masking, phonetic exercises. RESULTS: During the first day of vocal exercises the voice return to 410 patients (82%). The others required carrying on vocal therapy. CONCLUSIONS: The basic importance of phoniatric therapy is recovering the voice during the first day of vocal exercises. Sometimes the aphonic patient profits most from symptomatic voice therapy concurrent with psychotherapy.