Secondary airway lesions in laryngomalacia: a different perspective.

OBJECTIVE: To document the prevalence of secondary airway lesions (SALs) among children with laryngomalacia (LM). STUDY DESIGN: A cross-sectional observational study. SETTING: Single practice in a tertiary care pediatric facility. SUBJECTS AND METHODS: Patients diagnosed with LM were initially identified from a prospectively kept surgical database. Patients with cardiac/large-vessel malformations, prematurity, repeated or prolonged intubations, acute infections, or prior airway surgery were excluded. Only children who had a full examination of the airway were included. Other associated diagnoses along with demographics, surgical intervention, and type of LM were included. RESULTS: Over an 8-year period, 1112 patients underwent laryngoscopy and bronchoscopy. A total of 108 consecutive cases were diagnosed with LM (78 primary diagnosis and 30 secondary diagnosis). After excluding 17 with disorders associated with large airway disease, 91 LM patients were included. The mean age was 553.23 days (ranging between 5 days and 15 years); 60 were boys and 31 were girls. The prevalence of SALs was 7.7% (95% confidence interval, 7.65-7.76; 7 children; 4 subglottic stenosis, 4 tracheomalacia, 1 bronchomalacia, and 1 choanal atresia). Fifty-nine patients underwent supraglottoplasties, while 1 patient had a tracheostomy. CONCLUSIONS: After accounting for conditions known to be associated with large airway lesions, the prevalence of SALs associated with laryngomalacia was much less than previously reported. The authors hypothesize that the upper-end figures are a reflection of highly select cohorts and the inclusion of patients with other pathology known to be associated with subglottic stenosis, tracheomalacia, and bronchomalacia and low thresholds for diagnosing mild subglottic stenosis.

Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis.

Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a significant decrease in the fundamental frequency, habitual pitch and maximum phonation time with a significant increase in Shimmer. In the female group, there was a significant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which significantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symptoms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more common than hoarseness.

Vocal characteristics in children with attention deficit hyperactivity disorder.

The aim of this study was to evaluate vocal changes in patients with attention deficit hyperactivity disorder (ADHD). Nineteen children diagnosed to have ADHD according to the Diagnostic and Statistical Manual of Mental Disorders criteria and 19 controls were enrolled in this study. They underwent vocal perceptual evaluation and acoustic analysis. Hoarseness, breathiness, strain, and loudness were graded on a scale of 0-3. The following acoustic parameters were recorded: Fundamental frequency, Shimmer, Relative average perturbation, Noise-to-Harmony ratio, Voice Turbulence Index, and Habitual pitch. Children with ADHD were perceived to have significantly more hoarseness, breathiness, and straining in their voice. They were also louder compared to controls. There were no significant changes in the acoustic parameters except for the Fundamental frequency, which was lower in the ADHD group. The vocal behavior in children with ADHD is different than controls. Early diagnosis of such behavior in this group of children is important.

Vocal changes in patients using nasal continuous positive airway pressure.

The aim of this prospective study is to assess the vocal changes in patients using nasal continuous positive airway pressure (CPAP). A total of 18 subjects using nasal CPAP were assessed by grading their voice perceptually as G0 for normal voice and G3 for severe hoarseness. Acoustic analysis was also performed and the following parameters were measured: fundamental frequency, habitual pitch, shimmer, relative average perturbation, voice turbulence index, and noise-to-harmonic ratio. The same was done for a control group matched according to age and gender. There was a statistically significant difference in the perceptual evaluation between the CPAP group and controls, with more patients in the former group having moderate hoarseness. There was also an increase in the perturbation parameters and a decrease in the fundamental frequency and habitual pitch in the CPAP group compared to controls. The increase in shimmer was statistically significant. The usage of nasal CPAP seems to induce vocal changes that are perceived as mild to moderate hoarseness, together with an increase in the perturbation parameters. These seem to be secondary to the upper airway dryness reported in these patients. The hypothetical effect of nasal CPAP on the sol layer of the vocal folds is discussed.

Vocal technique in a group of Middle Eastern singers.

OBJECTIVE: We aimed to report on the vocal technique in a group of Middle Eastern singers. SUBJECTS AND METHOD: A total of 78 Middle Eastern singers were assessed. Demographic data included age, gender, training status and number of years of singing. All singers had laryngeal videoendostroboscopy. Description and grading of posture, tension, type of breathing, type of phonation, resonance and tone quality are reported. Proportions and means (+/- SD) were used to describe the sample for categorical and continuous variables respectively. Associations between endostroboscopy and voice technique were determined by chi(2) or Fisher's exact test. RESULTS: There were 43 males and 35 females with an age ranging between 16 and 32 years and a mean of 23 +/- 4 years. Of these, 88.5% were nontrained singers and 50% had more than 3 years of singing experience. Around 80% of Middle Eastern singers rely on either thoracic or clavicular breathing. Posture was average in 68% and moderate tension was present in 63% of the cases. Two thirds had a bright voice, 61% were hypernasal and almost 46% had a strained phonation. There was a significant correlation between posture and tension. CONCLUSION: Middle Eastern singing relies more on thoracic breathing and is characterized by tension.

Formant frequencies in Middle Eastern singers.

PURPOSE: This work was conducted to describe the formant frequencies in a group of Middle Eastern singers and to look for the presence of the singer's formant described in operatic singers. MATERIAL: A total of 13 Middle Eastern singers were enrolled in this study. There were 5 men and 8 women. METHOD: Descriptive analysis was performed to report the various formants (F1, F2, F3, and F4) in both speaking and singing. The Wilcoxon test was used to compare the means of the formants under both conditions. RESULTS: For both sexes combined, for the /a/ vowel, F1 singing was significantly lower than F1 speaking (P = .05) and F3 singing was significantly higher than F3 speaking (P = .046). For the /u/ vowel, only F2 singing was significantly higher than F2 speaking (P = .012). For the /i/ vowel, both F2 and F3 singing were significantly lower than F2 and F3 speaking, respectively (P = .006 and .012, respectively). There was no clustering of the formants in any of the Middle Eastern sung vowels. CONCLUSION: Formant frequencies for the vowels /a/, /i/, and /u/ differ between Middle Eastern singing vs speaking. There is absence of the singer's formant.