Aerodynamic Outcomes of Four Common Voice Disorders: Moving Toward Disorder-Specific Assessment.

OBJECTIVES: The two goals of the present study were to (1) determine the ability of commonly used aerodynamic voice measures to capture change as a function of known interventions and (2) determine if certain aerodynamic measures demonstrate better responsiveness to change in specific disorder types than others. STUDY DESIGN: This is a retrospective, longitudinal, single-blinded, cross-sectional study. METHODS: Patients (n = 70) with a single voice disorder diagnosis of benign vocal fold lesions (lesions), unilateral vocal fold paralysis (UVFP), primary muscle tension dysphonia (MTD-1), or vocal fold atrophy (atrophy) underwent baseline testing, a single intervention (phonosurgery or voice therapy), and follow-up testing. Common aerodynamic measurements were completed in repeated syllables and an all-voiced sentence. RESULTS: Statistically significant improvements were observed for two outcome measures, average airflow in syllables, and average airflow in the all-voiced sentence. Patients with lesions, UVFP, and MTD-1 improved in average airflow in the all-voiced sentence. Patients with UVFP also improved in airflow in syllables. CONCLUSIONS: Average airflow in the all-voiced sentence changed as a function of treatment for the lesion, MTD-1, and UVFP groups, demonstrating a disorder-specific pattern. Laryngeal airway resistance, and estimates of average subglottal pressure did not show significant change. Average airflow in the all-voiced sentence measurements is recommended as a routine voice measure, and further investigation of other aerodynamic measures' sensitivity to change is warranted.

Phonatory aerodynamics in connected speech.

OBJECTIVES/HYPOTHESIS: 1) Present phonatory aerodynamic data for healthy controls (HCs) in connected speech; 2) contrast these findings between HCs and patients with nontreated unilateral vocal fold paralysis (UVFP); 3) present pre- and post-vocal fold augmentation outcomes for patients with UVFP; 4) contrast data from patients with post-operative laryngeal augmentation to HCs. STUDY DESIGN: Retrospective, single-blinded. METHODS: For phase I, 20 HC participants were recruited. For phase II, 20 patients with UVFP were age- and gender-matched to the 20 HC participants used in phase I. For phase III, 20 patients with UVFP represented a pre- and posttreatment cohort. For phase IV, 20 of the HC participants from phase I and 20 of the postoperative UVFP patients from phase III were used for direct comparison. Aerodynamic measures captured from a sample of the Rainbow Passage included: number of breaths, mean phonatory airflow rate, total duration of passage, inspiratory airflow duration, and expiratory airflow duration. The VHI-10 was also obtained pre- and postoperative laryngeal augmentation. RESULTS: All phonatory aerodynamic measures were significantly increased in patients with preoperative UVFP than the HC group. Patients with laryngeal augmentation took significantly less breaths, had less mean phonatory airflow rate during voicing, and had shorter inspiratory airflow duration than the preoperative UVFP group. None of the postoperative measures returned to HC values. Significant improvement in the Voice Handicap Index-10 scores postlaryngeal augmentation was also found. CONCLUSIONS: Methodology described in this study improves upon existing aerodynamic voice assessment by capturing characteristics germane to UVFP patient complaints and measuring change before and after laryngeal augmentation in connected speech. LEVEL OF EVIDENCE: 4.

Acoustic analysis of four common voice diagnoses: moving toward disorder-specific assessment.

OBJECTIVES: To assess treatment outcomes via acoustic voice laboratory measurements before and after intervention in patients with common voice problems and Determine if outcome sensitivity of certain voice laboratory measures varies with disorder type. STUDY DESIGN: Retrospective and single-blinded. METHODS: In this study, 40 patients with a single voice disorder diagnosis of either benign vocal fold lesions (lesions), primary muscle tension dysphonia (MTD-1), vocal fold atrophy (atrophy) or unilateral vocal fold paralysis (UVFP) underwent baseline testing, a single intervention-type (phonosurgery/voice therapy), and follow-up testing at uniform time points. Ten patients per diagnosis group were analyzed before and after treatment. Time- and frequency-based acoustic measures taken from vowels and sentences as well as patient-perceptual analysis (Voice Handicap Index-10) were reviewed. RESULTS: Statistically significant improvements were observed for three of four groups. Patients with muscle tension dysphonia displayed an improvement in Cepstral Spectral Index of Dysphonia speech (CSID) (P < 0.05). Patients with lesions had improved Voice Handicap Index-10 (P < 0.05), cepstral peak prominence (CPP) vowel standard deviation (P < 0.05), and CPP speech (P < 0.05). Patients with atrophy did not demonstrate significant improvement in any measure. Patients with unilateral vocal fold paralysis showed an improvement in CSID speech (P < 0.05) and CPP speech (P < 0.05). In addition, strong effect sizes were observed for many of the acoustic parameters studied. CONCLUSIONS: For all groups except atrophy, treatment was successful in improving patient perception of voice handicap and/or some acoustic voice parameters. A disorder-specific response to frequency-based acoustic measures was found.

Perceptions of voice therapy from patients diagnosed with primary muscle tension dysphonia and benign mid-membranous vocal fold lesions.

OBJECTIVES: Studies have established the role of behavioral therapy in treating voice problems. However, studies have also identified patient adherence as a limitation in voice therapy effectiveness. Accordingly, an understanding of patient preferences may help to improve adherence and increase voice therapy success. The primary aim of this study was to understand patient-perceived facilitators and barriers influencing voice therapy effectiveness in a group of treatment-seeking individuals with voice disorders. A secondary aim was to examine the relationship between self-reported improvement from voice therapy and the Voice Handicap Index-10 (VHI-10). STUDY DESIGN: Retrospective, observational study design. METHODS: One hundred ten patients enrolled in voice therapy at the University of Pittsburgh Voice Center completed a self-administered Patient Perception of Voice Therapy questionnaire on discharge. Data from 45 individuals who met study criteria were analyzed. RESULTS: Patient-reported improvement from voice therapy was correlated with changes in VHI-10 scores. A majority of patients identified specific voice therapy exercises and transfer of techniques to conversation as the most useful aspects of treatment. Few patients rated vocal hygiene education as most useful. Generalizing new vocal behaviors was also identified as a barrier to voice therapy success for many patients. CONCLUSIONS: In this study, patients valued direct voice therapy in which they worked on altering vocal behaviors more than indirect voice therapy that aimed to educate patients about their voice. Study findings suggest the importance of direct voice therapy and the need to incorporate carryover activities early on in the therapy process for greater treatment satisfaction and success.