RESUMEN
PURPOSE: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. MATERIAL AND METHODS: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. RESULTS: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. CONCLUSION: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.
Asunto(s)
Dieta Saludable , Reflujo Laringofaríngeo/terapia , Pantoprazol/uso terapéutico , Inhibidores de la Bomba de Protones/uso terapéutico , Conducta de Reducción del Riesgo , Acústica del Lenguaje , Trastornos de la Voz/terapia , Calidad de la Voz , Acústica , Femenino , Humanos , Reflujo Laringofaríngeo/complicaciones , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/fisiopatología , Masculino , Persona de Mediana Edad , Fonación , Estudios Prospectivos , Calidad de Vida , Recuperación de la Función , Medición de la Producción del Habla , Factores de Tiempo , Resultado del Tratamiento , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatologíaRESUMEN
OBJECTIVE: To compare symptoms, signs, and acoustical voice quality changes throughout the 6-month course of empirical treatment between laryngopharyngeal reflux (LPR) males and females. MATERIALS AND METHODS: Forty clinically diagnosed LPR females and 40 males with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations during 3 or 6 months according to their evolution. RSI, RFS, and acoustic parameters were assessed at baseline and 3 and 6 months posttreatment. A correlation analysis between videolaryngostroboscopic findings and acoustic measurements was performed. RESULTS: RSI, RFS, and many acoustic measurements (i.e., percent jitter, percent shimmer, phonatory fundamental frequency range, fundamental frequency variation, and peak-to-peak amplitude variation) significantly improved from baseline to 3 months posttreatment in male group. In female group, RSI and RFS total score significantly improved along the 3 first months of treatment. However, some clinical outcomes (i.e., RSI total score, hoarseness, cough, and globus) continued to improve from 3 to 6 months of treatment. We did not identify significant improvement of acoustic measurements in female group. The correlation study did not reveal significant correlation between videolaryngostroboscopic findings and acoustic measurements. CONCLUSION: This preliminary study suggests the occurrence of gender-related differences in the LPR therapeutic response. Further studies need to clarify whether females require a longer course of therapy than males.
Asunto(s)
Ronquera , Reflujo Laringofaríngeo , Pantoprazol , Inhibidores de la Bomba de Protones , Calidad de la Voz , Acústica , Femenino , Ronquera/tratamiento farmacológico , Ronquera/etiología , Humanos , Reflujo Laringofaríngeo/complicaciones , Masculino , Pantoprazol/uso terapéutico , Fonación , Inhibidores de la Bomba de Protones/uso terapéutico , Factores SexualesRESUMEN
OBJECTIVE: To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR). MATERIAL AND METHODS: Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted. RESULTS: Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters. CONCLUSION: Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement.
Asunto(s)
Dieta , Disfonía/etiología , Reflujo Laringofaríngeo/terapia , Pantoprazol/uso terapéutico , Fonación , Inhibidores de la Bomba de Protones/uso terapéutico , Conducta de Reducción del Riesgo , Calidad de la Voz , Disfonía/diagnóstico , Disfonía/fisiopatología , Femenino , Humanos , Reflujo Laringofaríngeo/complicaciones , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Recuperación de la Función , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the voice quality impairments in patients with laryngopharyngeal reflux (LPR) according to the gender. DESIGN: Controlled multi-center study. MATERIALS AND METHODS: 80 LPR patients (40 males and 40 females) with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were included and clinically compared according to gender. To be considered as LPR patients, subjects responded to an empiric therapeutic trial based on pantoprazole intake and diet recommendations for 3 months or had positive pH/Impedance metry. Voice Handicap Index (VHI); Short Form Healthy Survey 36 (SF36), blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI); aerodynamic and acoustic measurements were assessed in all patients and compared with 80 healthy controls (40 males and 40 females) according to gender. RESULTS: The most common reasons for the consultation were, respectively, globus sensation in males (22.5%) and dysphonia (27.5%) in female who complained more of breathing difficulties and choking episodes related to LPR than males (p = 0.024). From a quality of life standpoint, female had increased significant impact of LPR disease on vitality and mental health than male. Compared to healthy subjects, both LPR male and female patients had stronger values of G, R, B, S, I, VHI, percent jitter, percent shimmer, and soft palate index than controls. In addition, LPR female had stronger values of lowest fundamental frequency and all aerodynamic measurements than controls. CONCLUSION: As showed in many other laryngeal conditions, voice quality of female could be more impaired by LPR than male. Some anatomical, histological and functional factors can be suspected and need additional future researches.
Asunto(s)
Disfonía/etiología , Reflujo Laringofaríngeo/complicaciones , Calidad de Vida , Calidad de la Voz , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adulto , Estudios de Casos y Controles , Femenino , Ronquera/etiología , Humanos , Reflujo Laringofaríngeo/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pantoprazol , Factores SexualesRESUMEN
OBJECTIVES: The study aimed to investigate the impact of chemoradiotherapy (CRT) on speech and voice quality according to the anatomic localization of the head and neck cancer. METHODS: Thirty-four patients treated by CRT for advanced suprahyoid (N = 17) or infrahyoid (N = 17) cancer were assessed for speech function, videolaryngostroboscopy, Voice Handicap Index, blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability, acoustic measurements, and aerodynamic measurements. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Head and Neck 35 (EORTC QLQ-H&N35) questionnaire. RESULTS: Patients treated for an infrahyoid tumor presented more severe values of Voice Handicap Index items, dysphonia, breathiness, asthenia, and some acoustic cues (Voice Turbulence Index, Soft Phonation Index, degree of unvoiced segments, and number of unvoiced segments) than patients treated for a suprahyoid tumor. The EORTC QLQ-H&N35 communication item was better in the suprahyoid patient group. CONCLUSIONS: Voice quality impairments associated with CRT are more severe in patients treated for advanced infrahyoid cancer, suggesting the need to develop specific posttherapy management of the dysphonia according to the tumor anatomical localization.
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Quimioradioterapia/efectos adversos , Irradiación Craneana/efectos adversos , Neoplasias de la Boca/terapia , Neoplasias de Oído, Nariz y Garganta/terapia , Fonación , Acústica del Lenguaje , Trastornos de la Voz/etiología , Calidad de la Voz , Acústica , Bélgica , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Laringoscopía , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/diagnóstico , Neoplasias de Oído, Nariz y Garganta/diagnóstico , Estudios Prospectivos , Calidad de Vida , Medición de la Producción del Habla , Estroboscopía , Encuestas y Cuestionarios , Resultado del Tratamiento , Grabación en Video , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatologíaRESUMEN
The objective is to assess the differences in the severity of symptoms, signs, voice quality, and quality of life before and after treatment according to age in suspected laryngopharyngeal reflux (LPR) patients. The design used in this paper is prospective multi-center study. Eighty clinically diagnosed LPR patients with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were treated with pantoprazole and diet recommendations for 3 months. Patients were subdivided into three groups according their age: group 1 (18-39 years, N = 21), group 2 (40-59 years, N = 31), and group 3 (≥60 years, N = 28). RSI, RFS, Voice Handicap Index (VHI), Short Form 36 questionnaire (SF36), aerodynamic, and acoustic measurements were evaluated at baseline and after treatment. The response to the empiric treatment was also assessed. Significant improvements in RSI, RFS, and VHI were found in all patient groups. The elderly patients showed a significantly lower RSI score than younger subjects (p = 0.035) without RFS difference among groups. At baseline, the SF36 score was better in group 3 with respect to social functioning (p = 0.049). At the 3-month follow-up, we found significant improvement of acoustic parameters only in the younger age groups (group 1 and group 2). The rate of resistant patients to the empiric treatment was higher in the younger group than in the elderly patient group (42.9 versus 28.6%). Age appears to reduce the subjective LPR symptom perception, leading to a lower rate of uncured patients. The utilization of acoustic parameters as an indicator of treatment effectiveness seems less useful for elderly subjects, probably due to an overlap between an aging voice and LPR.
Asunto(s)
2-Piridinilmetilsulfinilbencimidazoles , Reflujo Laringofaríngeo , Calidad de Vida , Trastornos de la Voz , 2-Piridinilmetilsulfinilbencimidazoles/administración & dosificación , 2-Piridinilmetilsulfinilbencimidazoles/efectos adversos , Adulto , Factores de Edad , Anciano , Monitorización del pH Esofágico/métodos , Esofagitis Péptica , Femenino , Humanos , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/fisiopatología , Reflujo Laringofaríngeo/psicología , Masculino , Persona de Mediana Edad , Pantoprazol , Estudios Prospectivos , Inhibidores de la Bomba de Protones/administración & dosificación , Inhibidores de la Bomba de Protones/efectos adversos , Encuestas y Cuestionarios , Evaluación de Síntomas , Resultado del Tratamiento , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Calidad de la VozRESUMEN
OBJECTIVE: To develop a French version of the Reflux Symptom Index (Fr-RSI) and to assess its internal consistency, reliability, and clinical validity. STUDY DESIGN: Controlled, prospective trial. MATERIALS AND METHODS: Forty-four patients with a reflux finding score > 7 and an Fr-RSI > 13 were enrolled and treated with 20 mg of pantoprazole twice daily and diet changes for 3 months. Ninety asymptomatic subjects were also included in the study. To assess reliability, Fr-RSI was completed twice within a 7-day period. Validity was assessed by comparing Fr-RSI scores with scores from the Voice Handicap Index (VHI) in 24 of 44 patients, at baseline and at 3 months posttherapy. RESULTS: The mean values of Fr-RSI at baseline and after 7 days were 20.17 ± 5.76 and 19.75 ± 7.08, respectively, for patients with laryngopharyngeal reflux (LPR) and 4.02 ± 3.49 and 3.71 ± 3.82, respectively, for controls. The test-retest reliability was high in patients with LPR (rBP = 0.78) and in healthy subjects (rBP = 0.80). Cronbach's alpha was 0.85, indicating high internal consistency. The mean Fr-RSI score significantly improved from a baseline of 20.17 ± 5.76 to 5.58 ± 3.65 after 3 months of treatment (P = 0.001), and the initial mean VHI total score significantly improved from 20.29 ± 19.62 to 12.87 ± 12.04 after treatment (P = 0.029), indicating validity of the results. However, of the subcategories of the VHI, only the mean physical score improved from a baseline of 11.19 ± 9.22 to 7.35 ± 5.96 after treatment (P = 0.016). CONCLUSION: The Fr-RSI developed in this study demonstrated both reliability and validity. It can be easily administered to assist in diagnosing and monitoring of LPR in French-speaking patients.
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Reflujo Laringofaríngeo/diagnóstico , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Francia , Humanos , Reflujo Laringofaríngeo/tratamiento farmacológico , Persona de Mediana Edad , Pantoprazol , Estudios Prospectivos , Inhibidores de la Bomba de Protones/uso terapéutico , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVES: The study aimed to explore the impact of the selection of the analyzed time interval on the significance of acoustic measurements used to investigate laryngopharyngeal reflux (LPR) treatment efficacy, and based on these results to develop an alternative statistical approach in data analysis focusing on individual patient vocal behavior. STUDY DESIGN: This is a prospective case series. METHODS: From September 2013 to July 2015, 41 patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for 3 months. Voice recordings were performed at baseline and after 3 months of treatment. Most stable time intervals of 1, 2, 3, 4, and 5 seconds, and a 1-second time interval positioned at mid-production, were subjected to acoustic analysis. Based on the latter, we developed an "informativeness coefficient" for each acoustic parameter that aimed at assessing its sensitivity to clinical resolution in the case of LPR disease. RESULTS: Significant clinical improvement (RSI and RFS) was observed after treatment (P < 0.05). The acoustic analysis revealed that acoustic parameters significantly improving from pre- to posttreatment varied across time intervals. The duration and the position of the analyzed time interval in the production yielded considerable differences in the results. Analysis of the informativeness coefficient indicated that jitter, jitter percent, relative average perturbation (RAP), pitch perturbation quotient (PPQ), shimmer (ShdB), shimmer percent (Shim), amplitude perturbation quotient (APQ), and smoothed amplitude perturbation quotient (sAPQ) were the indices most sensitive to medical treatment efficacy, with a coefficient ranging from 75.86% to 86.21%. CONCLUSIONS: Depending on the selection of the time interval over which the acoustic parameters are measured, the potential effect of the treatment may or may not be statistically demonstrated. Future studies are needed to establish standardized methodological procedures for acoustic data analysis.
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Acústica , Ronquera/diagnóstico , Reflujo Laringofaríngeo/complicaciones , Fonética , Acústica del Lenguaje , Medición de la Producción del Habla , Calidad de la Voz , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adulto , Anciano , Terapia Combinada , Femenino , Ronquera/dietoterapia , Ronquera/etiología , Ronquera/fisiopatología , Humanos , Reflujo Laringofaríngeo/diagnóstico , Reflujo Laringofaríngeo/dietoterapia , Reflujo Laringofaríngeo/fisiopatología , Laringoscopía , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Pantoprazol , Fonación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Inhibidores de la Bomba de Protones/uso terapéutico , Espectrografía del Sonido , Factores de Tiempo , Resultado del Tratamiento , Calidad de la Voz/efectos de los fármacos , Adulto JovenRESUMEN
BACKGROUND: Laryngopharyngeal reflux is a prevalent, not well-understood disease affecting a high proportion of patients who seek laryngology consultation. The objective of this prospective case series is to explore the subjective and objective voice modifications in Laryngopharyngeal reflux (LPR), especially the usefulness of acoustic parameters as treatment outcomes, and to better understand the pathophysiological mechanisms underlying the development of voice disorder. METHODS: Forty-one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily for three months. RSI, RFS, Voice Handicap Index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) were assessed at baseline and after three months post-therapy. Acoustic parameters were measured by selecting the most stable interval of the vowel /a/. A study of correlations between acoustic measurements and laryngoscopic signs was conducted in patients with roughness. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS). RESULTS: Significant improvement in RSI, RFS, VHI, jitter, percent jitter, relative average perturbation (RAP), shimmer, percent shimmer, and amplitude perturbation quotient (APQ) was found at 3 months of treatment (p < .05). A correlation analysis revealed significant correlations between the grade of dysphonia, breathiness, asthenia, instability and jitter, percent jitter, RAP, shimmer, percent shimmer and APQ. In dividing our cohort into two groups of patients according to the presence of roughness, shimmer, percent shimmer and APQ significantly improved in patients with roughness, but no positive correlation was found between acoustic parameters and laryngoscopic signs. CONCLUSION: Acoustic parameters can help to better understand voice disorders in LPR and can be used as treatment outcomes in patients with roughness.