Laryngological Complaint Prevalence in Hypermobile Ehlers-Danlos or Hypermobility Spectrum Disorders.

OBJECTIVE: The aim was to study laryngological complaints in patients with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD). METHODS: A total of 363 patients met inclusion for the study by completing questions related to voice, upper airway, and swallowing between July 7, 2020 and July 13, 2022. Demographic data, voice-related questions, and hypermobility diagnosis were analyzed retrospectively. From those, 289 patients were diagnosed with hEDS or HSD with 74 that did not meet the diagnostic criteria for either diagnosis serving as controls. RESULTS: There were no statistically significant differences between patients with hEDS and HSD regarding Voice Handicap Index (VHI-10) scores, voice, upper airway, or swallow complaints. However, more hEDS/HSD patients answered positively to the laryngeal dysfunction question versus controls (p = 0.031). 22.5% of hEDS/HSD patients (n = 65) reported hoarseness, of which 52.3% reported hoarseness >2 days/month. 33.9% (n = 98) with hEDS/HSD reported symptoms of dysphagia, and 27.0% (n = 78) reported laryngeal dysfunction symptoms. Controls demonstrated 20.3% prevalence of hoarseness, of which 46.7% reported hoarseness >2 days/month. 24.3% of controls had dysphagia and 14.9% laryngeal dysfunction symptoms. Of the 363 patients, VHI-10 scores >11 were more likely in patients reporting >2 days of hoarseness/month (p = 0.001) versus those with <2 days of hoarseness/month. There was an increased prevalence of voice, upper airway, and dysphagia symptoms in hEDS/HSD patients compared with previously reported prevalence data in the general population. CONCLUSION: A significant proportion of patients diagnosed with hypermobility due to hEDS or HSD were found to have voice, upper airway, and dysphagia symptoms. These rates are higher than those previously reported in the general population. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:773-778, 2024.

Quantitative Analysis of Unilateral and Bilateral Vocal Fold Immobility.

OBJECTIVE: To analyze the correlation between clinical and video laryngoscopy findings for 89 patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI), and healthy controls by quantitative analysis of normalized laryngeal outlet (NLO), bowing index (BI), and supraglottic compression (SGC). METHODS: Laryngoscope pictures were taken by two reviewers, and all pictures were standardized by scaling and calibrating to the same width and height in Image J. Three reviewers used quantitative measures to calculate BI, NLO, and SGC in Image J. We assessed reliability for each measurement by two-factor analysis of variance (ANOVA) without replication to calculate the interclass correlation coefficient. Analysis was broken down for each measurement in each group of interest by using a one-way test. The total glottic area was obtained by calculating the normalized glottal gap area from each image of maximum glottal closure during phonation. RESULTS: Overall reliability of all the measurements was 0.69 (IQ 0.58-0.83). Mean NLO from UVFI, BVFI, and control groups differed significantly. There was no significant difference between control and BVFI. The total glottic area did not consistently predict normalized laryngeal outlet values. Mean normalized laryngeal outlet values of UVFI and BVFI were significantly smaller in the BVFI groups compared with controls and UVFI. BI values consistently predicted total glottic area in the BVFI group. Static SGC measurement did not predict a difference between groups. CONCLUSION: This is a reliable novel technique, which can be utilized in clinical settings. These measurements have clinical relevance for managing voice disorders. NLO is the most accurate measurement correlating with glottal incompetence. BI findings are sufficiently specific to identify between UVFI and BVFI.

Vocal Fold Pathologies Among Undergraduate Singing Students In Three Different Genres.

OBJECTIVE: This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points. METHODS: This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres. RESULTS: During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers. CONCLUSION: No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre. LEVEL OF EVIDENCE: 2 Laryngoscope, 133:2317-2324, 2023.

Effect of Chronic Cough on Voice Measures in Patients With Dysphonia.

INTRODUCTION: Measuring the impact of chronic cough on voice quality can be difficult and challenging in daily practice. Evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We hypothesized that the presence of chronic cough plays a role in patients' perception of dysphonia severity, leading to a mismatch between the subjective, objective, and perceptual evaluations. METHODS: A retrospective chart review involving patients with a diagnosis of dysphonia and a complete speech voice evaluation was performed. A total of 311 patients were stratified into two different groups according to the presence of chronic cough. A total of 151 patients were assigned to the dysphonia and chronic cough group, while 160 patients were assigned to the dysphonia only group. During the initial evaluation, patients completed the Voice Handicap Index (VHI)-30, Glottal Function Index (GFI), and Reflux Symptoms Index (RSI). Voice evaluation also included aerodynamic/acoustic measures and the application of the GRBAS scale by a speech-language specialist. A paired t test and a linear regression analysis were used to compare subjective, perceptual, and aerodynamic/acoustic measures in both groups. RESULTS: The mean VHI-30 and GFI were elevated in both groups but significantly lower among patients with dysphonia and chronic cough when compared to patients with dysphonia only (P= 0.01). Additionally, a significantly higher RSI was found among patients with dysphonia and chronic cough (P< 0.01). No difference in aerodynamic/acoustic measures was found between groups (P> 0.05). Our linear regression model demonstrated a significant effect of the presence of chronic cough on the VHI-30, RSI, and GFI questionnaires (P< 0.05). Our model also found that the VHI-30 is a significant predictor for the (G), (B), (A), and (S) components of the GRBAS scale (P< 0.05). CONCLUSION: The presence of chronic cough has a significant impact on the different patient-reported outcome measures, including VHI-30, RSI, and GFI. The use of VHI-30 as a predictor for the GRBAS scale reinforces the importance of subjective and perceptual assessment among patients with voice disorders and establishes a new area for exploration.

Evaluation of Size, Laterality, and Location of Unilateral Vocal Fold Lesions on Voice Quality.

INTRODUCTION: The presence of a vocal fold mass implies high mechanical stress at the vocal fold base during vibration and an impaired glottic closure. However, evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We aimed to evaluate the impact of the location, laterality, and size of a unilateral unique vocal fold lesion on patient self-assessment questionnaires, acoustic-aerodynamic voice measures, and perceptual voice evaluation (GRBAS scale). METHODS: A retrospective chart review involving patients with a diagnosis of a unique unilateral vocal fold lesion and a complete voice evaluation was performed. A total of 58 patients were enrolled and demographics, characteristics of the vocal fold lesion (size, laterality, and location), self-assessment questionnaires, acoustic-aerodynamic measures, and perceptual evaluation (GRBAS scale) were analyzed. Pearson correlation and ANOVA analysis were completed to evaluate the correlation between the clinical characteristics of the vocal fold mass and self-assessment questionnaires, and to compare the level of significance for the differences between the continuous variables between groups of patients once stratified according to the location or laterality of the vocal fold mass. RESULTS: Glottal Function Index was found to correlate with the location of the vocal fold mass (P < 0.05), however, no correlation was found when evaluating the Reflux Symptom Index or the Voice Handicap Index (P > 0.05). Patients with a lesion located in the anterior-middle 2/3 of the vocal fold were found to have a higher mean Glottal Function Index and (G) component of the GRBAS scale (P < 0.05). No differences were observed when analyzing the remaining self-assessment questionnaires or the acoustic-aerodynamic voice measures according to size, location, or laterality of the vocal fold lesion (P > 0.05). CONCLUSION: The size and location of unilateral vocal fold lesions were found to have no effect on the majority of measures analyzed in this study. This is the first study we know of to assess the effect that laterality of the vocal fold lesion may have on the self-assessment questionnaires, audio-perceptual, and acoustic-aerodynamic measures included in this study. Our study found no significant differences in regard to laterality. This may indicate that other factors (eg, stiffness of lesion, amount of extraneous muscle tension, etc) could have more of an impact on audio-perceptual, self-assessment questionnaires, and acoustic-aerodynamic measures. Further research with larger cohort sizes and possibly prospective analysis is needed.