Reflux symptoms and vocal characteristics in adults with non-organic voice disorders.

BACKGROUND:  Laryngopharyngeal reflux (LPR) is prevalent and can lead to voice disorders, but its diagnosis is difficult, because of limited correlations between clinical symptoms and organic pathology. Various tools and methods have been explored to aid a diagnosis of LPR. OBJECTIVE:  To investigate associations between reflux symptoms, acoustic-, perceptual-, and physical vocal characteristics, glottal function index (GFI), and vocal handicap index (VHI) in adults with non-organic voice disorders. METHODS:  Data of 51 adults with non-organic voice disorders were collected, using a retrospective cohort explorative research design, at a private ear, nose and throat specialist practice in Gauteng, South Africa. Quantitative outcomes were compared between reflux symptom index (RSI), acoustic characteristics (jitter, shimmer and fundamental frequency [F0]), maximum phonation time, perceptual- (GRBASI) and physical vocal characteristics, GFI and VHI. RESULTS:  The RSI showed positive fair correlations against GFI, VHIP and caffeine intake, indicating an increase in reflux symptoms with higher scores on the various measures. Moderate correlations were also found between GFI and VHIP, grade of hoarseness and jitter, strain and VHIP, strain and VHI total (VHIT) and between Asthenia and jitter. Very strong correlations were found within the various subsections of the VHI as well as between jitter and shimmer and between F0-male and physical symptoms of the VHI (VHIP). CONCLUSION:  Results indicated associations between reflux symptoms, vocal characteristics, the GFI and the VHI. Based on the correlations found these tools used in conjunction could improve clinical diagnosis of LPR. Implications of these findings are promising, but further research is recommended.Contribution: This study contributes to the body of knowledge to support the accurate clinical diagnosis of LPR using subjective measures to determine LPR symptoms, as well as acoustic analysis.

Vocal Characteristics of School-Aged Children With and Without Attention Deficit Hyperactivity Disorder.

OBJECTIVES: The aim of this study was to describe the laryngeal anatomy, perceptual, acoustic, and aerodynamic vocal characteristics of school-aged children with and without Attention Deficit Hyperactivity Disorder (ADHD). The predisposition that children with ADHD have for laryngeal injuries are recurrent in nature and are more often than not overlooked as laryngitis. Previous studies have reported varied results on the prevalence rates of pediatric vocal fold nodules within the school-aged ADHD population. STUDY DESIGN: A static, two-group comparison was used in the study to investigate the clinical, perceptual, acoustic, and aerodynamic vocal characteristics of children between 7 and 9 years old with and without ADHD. METHODS: The study replicated the protocol as executed by Barona-Lleo and Fernandez (2016) with additions. The Multidimensional Voice Program and the Voice Range Profile as additions to the assessment of vocal parameters were used with which comparable dysphonia severity index scores were calculated. Once-off clinical, perceptual, acoustic, and aerodynamic voice assessments were conducted on 20 age-gender matched participants (Control group mean age [months] = 98.80, standard deviation = 10.379; ADHD group mean age [months] = 108.00, standard deviation = 10.873). It was hypothesized that children with ADHD would have more hyperfunctional vocal characteristics; leading to laryngeal injuries, than their control group peers. RESULTS: Forty-five percent (n = 9) of the total sample population (both groups combined) had laryngeal pathology. Similar parent reported etiological voice symptoms and vocal habits were seen across both groups. Both groups performed similarly across both perceptual and aerodynamic voice assessments. Acoustically, the control group achieved significantly higher producible pitches than the ADHD group (P = 0.028) and were found to have more dysphonic dysphonia severity index scores than their ADHD group peers (P = 0.034). CONCLUSION: Prepubertal, school-aged children with or without ADHD may have similar vocal characteristics than previously thought. This is in support of the null hypothesis. The authors of the current study recommend that vocal screening in all school-aged children be carried out as an effective measure to monitor voice disorders in the pediatric population. Future research into larger sample sizes with this population with a special focus on the effect that central nervous system stimulants may have on the voice is recommended.