Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients.

MATERIALS AND METHODS: Between March 2017 and February 2018, 27 newly diagnoses patients (about 2 months) were examined in the ENT Clinic of our University Hospital. The bulbar-onset of ALS was diagnosed by neurologists. RESULTS: According to the endoscopic and clinical results, patients were classified in 4 classes of dysphagia. Laryngology and speech pathology assessment with spectroacuostic analysis of speech using Praat software are fundamental for the proper evaluation of dysphonia of these patients. This study was the first attempt to find a vocal indicator of advancement in swallowing dysfunction in the patient population of ALS. Preliminary findings indicate that the reduction in the maximum fundamental frequency is associated with advancement of dysphagia. CONCLUSIONS: Monitoring the vocal parameters could be useful in order to give an early rehabilitation aid to these patients improving their quality of life and reducing aspiration risks.

Singing voice: acoustic parameters after vocal warm-up and cool-down.

Purpose: The aim of this study was to evaluate the effect of the vocal warm-up and cool-down on the singing voice through Fundamental Frequency (F0), Jitter, Shimmer and harmonics-to-noise ratio (HNR).Methods: Thirty-two female singing students were recorded four times while uttering the vowel [a] for at least 5''. The first two recordings were collected before and after a vocal warm-up session and the last two before and after a vocal cool-down session. Between those sessions the participants underwent an intense vocal activity.Results: Results showed significant variations in the average values of the parameters measured. The mean value of the F0 after intense vocal activity turned to be higher than the one measured before the warm-up session, as well as the mean F0 measured after singing compared to the one measured after the vocal warm-up. On the other end, the mean F0 after the vocal cool-down resulted to be lower than that measured before. After the vocal warm-up session Jitter and Shimmer decreased while HNR increased. In addition, a decrease was detected in comparison with the average value of Jitter and Shimmer before vocal warm-up and after vocal cool-down, whereas HNR increased. There was also a decrease between the Shimmer before the vocal warm-up and after an intense phonatory activity while HNR increased.Conclusions: Our study highlights the effect of the vocal warm-up on acoustic parameters. The reduction in F0 observed after the cool-down session confirms its positive effect in helping professional vocal recovery and reducing vocal fold tension.

Kinesio Taping Application in Dysphonic Singers.

INTRODUCTION: Kinesio Taping (KT) application in speech therapy has been studied in a few works about dysphonia, facial nerve palsy, sialorrhea, atypical deglutition, postsurgical recovery after thyroidectomy and laryngectomy. The aim of this study was the evaluation of the possible role of KT in supporting speech therapy in singers complaining of dysphonia using singing voice handicap index (SVHI), fundamental frequency (F0), shimmer, jitter and harmonic to noise ratio (mean H/N). MATERIALS AND METHODS: We enrolled consecutive singers and singing students complaining of dysphonia and voice problems. Control group (DG1) was composed of 15 individuals who underwent traditional speech therapy only, while Case group (DG2), also composed of 15 subjects, underwent traditional speech therapy associated with KT application. A computerized voice analysis was conducted using PRAAT software observing F0, jitter, shimmer and mean H/N before (t1), at mid (t2) and after (t3) the treatment. Moreover, each patient filled in the SVHI before (t1) and after (t3) the complete speech therapy treatment. RESULTS: The mean F0 and H/N measured before, during and after the logopedic treatment, showed a notable increase over time (P value <0.001) both for DG1 and DG2. However, no significant difference was found comparing the two groups. Jitter and Shimmer after treatment were clearly seen to be lower than before in both groups (P value <0.001), and followed a significantly different trend over time (P value <0.001). Moreover, unlike F0 and mean H/N, these parameters underwent a significantly greater decrease in DG2 compared to DG1. Lastly, SVHI improved at t3 and although these reductions were clear in both groups, it was greater in DG2 than in DG1. DISCUSSION AND CONCLUSIONS: Our findings are encouraging and suggest the possibility of using KT in case of vocal pathologies in singers. It is imperative to underline that the tape does not replace speech therapy, but could possibly enhance the effects of the treatment.

Voice and Pilates: the influence of Pilates on the singing voice / Voz y pilates: la influencia de pilates en la voz del canto

Introduction: those who use voice for professional purposes know how crucial it is to regulate posture, breath and voice to get the best vocal performance. Pilates, a fitness system that focuses on breathing and postural control, should be beneficial in optimizing singers' voice. The present study aims to demonstrate that the practice of Pilates improves the quality of artistic vocal production. Materials and methods: we collected a sample of 15 singing students that underwent ENT examination and filled in a first questionnaire. After that we proceeded to voice recording and acoustic analysis through software Praat. Next, together with a fully qualified Pilates teacher, we identified a few exercises acting on the respiratory muscles, that were explained and practiced during a Pilates lesson. These exercises were performed by each subject on his/her own at least three times a week for two months and together during other two Pilates group lessons. Finally, a second voice recording was performed, using the Praat software and under the very same condition of the first recording and a second self-assessment questionnaire was filled in. Results: the Kolmogorov-Smirnov test revealed that the Fo and Jitter parameters were not normally distributed, while the Shimmer and HNR resulted to be normally distributed. The averages of Shimmer and HNR parameters were thus analyzed through the T Test, while the F0 and Jitter parameters were analyzed through the Wilcoxon test. The analysis revealed that all the four parameters underwent statistically significant changes after the Pilates practice. Questionnaire results revealed that Pilates had a positive effect on voice production (15/15), especially on postural alignment (15/15) and respiratory capacity (13/15). Discussion: in our study the F0 increased after Pilates practice. This finding should be due to changes in the vocal folds length and tension, probably related to the postural exercises that had been performed, which conferred greater elasticity to the muscles. Contrariwise the Jitter parameter after exercising had decreased allowing us to conclude that Pilates helps to reduce vibratory perturbations of the vocal cords during vocal emission. This should have been obtained through a greater control of the respiratory dynamics provided by the exercises. The Shimmer parameter had also diminished, allowing us to hypothesize that the Pilates exercises, acting on the respiratory mechanisms, minimize intensity variations. On the contrary, HNR had increased suggesting that the amount of periodic signal in the voice after Pilates practice is greater than before. Since voices with a higher average HNR tend to be judged as more attractive, our results point to the fact that Pilates practice improves voice quality, as subjectively reported by the participants themselves. Conclusion: our study has highlighted the positive role of Pilates on vocal production in singing students: in a relatively short time, simple exercises - performed regularly - have shown a significant impact on vocal quality. It is likely that the very same positive effects could also be obtained by other occupational voice users

Introducción: los que usan la voz con fines profesionales saben lo importante que es regular postura, respiración y voz para obtener la mejor interpretación vocal. Pilates, un sistema de fitness que se enfoca en el control de la respiración y de la postura, puede ser beneficioso para optimizar la voz de los cantantes. El presente estudio tiene como objetivo demostrar que la práctica de pilates mejora la calidad de producción vocal artística. Materiales y métodos: recolectamos 15 estudiantes de canto que se sometieron a un examen otorrinolaringológico y rellenado en un primer cuestionario. Después de eso procedimos a la grabación de voz y análisis acústico a través del software Praat. A continuación, junto con un profesor de Pilates completamente calificado, se identificaron algunos ejercicios que actúan sobre los músculos respiratorios, que fueron explicados y practicados durante una lección de pilates. Estos ejercicios fueron realizados por cada sujeto por su cuenta en por lo menos tres veces por semana durante dos meses y juntos durante otras dos clases grupales de pilates. Finalmente, se realizó una segunda grabación de voz, utilizando el software Praat y bajo el mismo se completó la misma condición de la primera grabación y un segundo cuestionario de autoevaluación. Resultados: la prueba de Kolmogorov-Smirnov reveló que los parámetros de Fo y Jitter no fueron normalmente distribuidos, mientras que Shimmer y HNR resultaron ser distribuidos normalmente. Los promedios de los parámetros Shimmer y HNR se analizaron por medio de la prueba T, mientras que los parámetros F0 y Jitter fueron analizados a través de la prueba de Wilcoxon. El análisis reveló que todos los cuatro parámetros sufrieron cambios estadísticamente significativos después de la práctica de pilates. Los resultados del cuestionario revelaron que Pilates tuvo un efecto positivo en la producción de voz (15/15), especialmente en alineación postural (15/15) y capacidad respiratoria (13/15). Discusión: en nuestro estudio, el F0 aumentó después de la práctica de pilates. Este hallazgo se debe a cambios en la longitud y tensión de los pliegues vocales, probablemente relacionados con los ejercicios posturales que se han realizado, que confieren mayor elasticidad a los músculos. En cambio, el parámetro Jitter después del ejercicio había disminuido, lo que nos permite concluir que el pilates ayuda a reducir las perturbaciones vibratorias de las cuerdas vocales durante la emisión vocal. Esto debería haberse obtenido con mayor control de la dinámica respiratoria proporcionada por los ejercicios. El parámetro Shimmer también había disminuido, permitiéndonos hipotetizar que los ejercicios de pilates, actuando sobre los mecanismos respiratorios, reducen las variaciones de intensidad. En cambio, HNR había aumentado, lo que sugiere que la cantidad de señal periódica en la voz después de la práctica de pilates es mayor que antes. Dado que las voces con un HNR medio más alto tienden a ser consideradas más atractivas, nuestros resultados apuntan al hecho de que la práctica del pilates mejora la calidad de la voz, según lo informado subjetivamente por los propios participantes. Conclusión: nuestro estudio ha destacado el papel positivo del pilates en la producción vocal en estudiantes de canto: en un tiempo relativamente corto, ejercicios simples, realizados regularmente, han demostrado un impacto considerable en la calidad vocal. Es probable que los mismos efectos positivos también puedan ser obtenidos por otros usuarios de voz profesional

Nasal septum angiofibroma: a rare condition with an unusual onset.

The characteristics of extra-nasopharyngeal angiofibromas tend to be different from angiofibromas of the nasopharynx according to patient gender, patient age, prevalence, affected site, pathogenesis, and clinical and epidemiological features. We report a case of an extra-nasopharyngeal angiofibroma in a 28-year-old man referred to the ENT Clinic for right-sided epistaxis, airflow impairment and nasal swelling. The right nostril was completely occluded works by a reddish-yellow mass that bled easily. The computed tomography scan revealed an "inhomogeneous solid lesion in the nasal fossa". With the patient under general anesthesia, the formation in the anterior portion of the right side of the nasal septum was removed up to its vascular base. Although electrical cauterization efficiently controlled the bleeding, we abraded the sub-perichondral area to prevent further bleeding as well as recurrence. The histological exam report confirmed the diagnosis of angiofibroma. As in our case, epistaxis is commonly the presenting sign of angiofibroma. Yet its onset was peculiar, given that the bleeding started with a low impact trauma. The nasal swelling was also a relevant feature as well as the breathing impairment. Although uncommon, nasal septal angiofibromas should considered in patients with epistaxis.

Internal Laryngocele: Unusual onset in a 91-year-old female patient.

While internal laryngoceles rarely cause major clinical complaints, they may lead to airway obstruction and require emergency intervention on rare occasions. We report a 91-year-old patient who was referred to the Ear, Nose & Throat Clinic of the Policlinico Santa Maria alle Scotte, Siena, Italy, in 2017 due to recurrent episodes of severe dyspnoea. A flexible nasopharyngolaryngoscopic examination revealed an internal laryngocele of approximately 1.5 cm in diameter that moved up and down the glottic plane, occasionally invading the subglottic space during inspiration and impeding airflow. This caused cyanosis and dyspnoea so severe that an emergency tracheotomy was considered. Luckily, after considerable effort, the patient was able to cough, causing the mass to move above the vocal plane and allowing normal breathing. The laryngocele was subsequently removed via laryngomicrosurgery. Although the incidence of internal laryngoceles is quite rare, physicians should consider this potentially life-threatening condition among patients with dyspnoea.

Correlation Between Dysphagia and Malocclusion in Rett Syndrome: A preliminary study.

OBJECTIVES: Rett syndrome (RS) is a severe neurological developmental disorder characterised by stereotypical hand movements, epileptic seizures, craniofacial dysmorphism and digestive dysfunction. This study aimed to examine the correlation between the severity of malocclusion and dysphagia in patients with RS. METHODS: This preliminary study was conducted at the Ear, Nose & Throat Clinic of the University Hospital of Siena, Siena, Italy, from January 2014 to December 2017. A total of 56 patients with RS were examined and grouped according to the severity of dysphagia (absent, mild, moderate or severe) and malocclusion (<2 mm, 2-3 mm, 3-4 mm or >4 mm). RESULTS: All of the patients were female and the mean age was 11.3 years. Eight (14.3%) patients had mild, 18 (32.1%) had moderate and 30 (53.6%) had severe dysphagia. Four (7.1%) patients had <2 mm occlusion, 10 (17.9%) had 2-3 mm occlusion, 26 (46.4%) had 3-4 mm occlusion and 16 (28.6%) had >4 mm occlusion. Mild dysphagia was observed in 100% and 40% of patients with <2 and 2-3 mm malocclusion, respectively, while moderate dysphagia was present in 60% and 38.5% of patients with 2-3 and 3-4 mm malocclusion, respectively. Severe dysphagia was observed in 28.6% and 87.5% of patients with 3-4 and >4 mm malocclusion, respectively. There was a significant correlation between dysphagia and malocclusion severity (P <0.001). CONCLUSION: A higher degree of malocclusion was associated with more severe dysphagia among a cohort of patients with RS.

Dysphagia in Rett Syndrome: A Descriptive Study.

OBJECTIVES: Rett syndrome (RS) is a neurodevelopmental disorder and the second major cause of mental retardation in females. The aim of this study was to evaluate swallowing problems of RS patients by endoscopic assessment and compile a list of suggestions for managing feeding and preventing complications. METHODS: The sample consisted of 61 female patients (mean age = 13.6 years, range, 2-33 years) admitted to the Department of Neuropsychiatry, where they had previously been diagnosed with RS. Speech evaluation associated with observation during mealtimes was useful to formulate suggestions for caregivers. RESULTS: Progressive deterioration of feeding was commonly noted by caregivers. Fifty-four patients had a history of recurrent episodes of bronchitis. Oral apraxia, dyskinetic tongue movements, prolonged oral stage, and poor bolus formation were the most common findings in all patients. CONCLUSIONS: Dysphagia was primarily limited to oral preparatory phases, while the pharyngeal phase was normal in most patients. The high percentage of dysphagia suggests the need to accurately monitor the feeding capability of RS children. It is critical to correctly inform caregivers about safe swallowing procedures to reduce the incidence of fatal complications.

Kinesio Taping in Dysphonic Patients.

OBJECTIVE: Kinesio taping (KT) is a method of elastic bandaging that produces a biomechanical effect on the organism. This study aims to evaluate its use in dysphonic patients tratment, as integrated part of speech therapy. STUDY DESIGN: Randomized controlled MATERIALS AND METHODS: Fifteen dysphonic patients were given the option to complement the speech therapy treatment with KT (DG1). 15 dysphonic patients suffering from similar conditions (DG2) who underwent traditional speech therapy were the control group. RESULTS: After treatment, both DG1 and DG2 obtained a statistically significant improvement for jitter and noise-to-harmonic ratio (P >0.05) and showed an improvement in Voice Handicap Index (VHI) total (VHIt), VHI functional (VHIf), VHI emotional (VHIe), and VHI physical (VHIp). However, the improvement was statistically significant for VHIt (P =0.0102), VHIe (P =0.0349), and VHIp (P =0.0366) in DG1, and only in VHIt (P =0.0466) in DG2. In DG1, P had a lower value than in DG2 for VHIt, VHIe, and VHIp. In DG2, there were a few patients who after therapy had a VHIt higher than before therapy, whereas this did not occur in DG1. CONCLUSIONS: As expected, this study confirms the benefits of speech therapy. Although KT is not a substitute for speech therapy, our preliminary results and patients' favorable response to KT encouraged us to continue with our studies on a larger scale. Further studies are required to better define the role of KT in speech therapy and evaluate its real effect over its placebo effect.

Objective Evaluation of Presbyphonia: Spectroacoustic Study on 142 Patients with Praat.

OBJECTIVES: Presbyphonia is the sequence of physiological events related to the process of senility of the vocal folds. The aim of our analysis was to provide deeper knowledge of presbyphonia, raising awareness of this condition as well as giving basic suggestions on how to treat related vocal alterations. STUDY DESIGN: This is a randomized study. METHODS: In 2015, we conducted a study on 182 subjects. Each participant underwent an ENT examination (video-laryngo-stroboscopy and subjective acoustic analysis using the General degree of dysphonia; degree of voice Instability; degree of voice Roughness; degree of voice Breathiness; degree of voice Asthenia; degree of voice Strain (GIRBAS) scale) and a logopedic examination (anamnesis, medical history, and acoustic voice analysis using the free software Praat). RESULTS: The comparison between the voice of young people and the seniors showed significant differences for the following Praat-analyzed acoustic parameters: modal fundamental frequency (F0) in women (P < 0,0001), fraction of locally unvoiced frames (P < 0,0001), number of voice breaks (P < 0,0001), jitter local (P < 0,0001), jitter local abs (P < 0,0001), jitter rap (P < 0,0001), jitter ppq5 (P < 0,0001), shimmer local (P < 0,0001), shimmer local dB (P < 0,0001), shimmer apq3 (P < 0,0001), shimmer apq5 (P < 0,0001), mean N/H (P < 0,0001), and mean H/N (P < 0,001), for both sexes. CONCLUSIONS: The Praat was confirmed to be a useful tool to detect the existence of the variation of the speech parameters in relation to aging and to quantify statistically significant differences that show a general deterioration in the voice quality, defined numerically. This might lead to a phoniatric treatment or speech therapy, which could improve patients' quality of life, leading to better vocal performance and social and communicative interaction.

Activity of coenzyme Q 10 (Q-Ter multicomposite) on recovery time in noise-induced hearing loss.

A potential consequence of exposure to noise is a temporary reduction in auditory sensitivity known as temporary threshold shift (TTS), which mainly depends on the intensity and duration of exposure to the noise. Recovery time is related to the amount of initial hearing loss, and the most recovery takes place during the first 15 min following exposure. This study evaluated the efficacy in otoprotection against noise-induced hearing loss of an orally administrated food supplement containing coenzyme Q 10 -Ter. This water-soluble formulation of coenzyme Q 10 shows better bioavailability than the native form and has been found to have a protective effect on outer hair cells after exposure to noise in animal models. Thirty volunteers were enrolled, and the right ear of each subject was exposed to a narrow-band noise centered at 3 kHz for 10 min at the intensity of 90 dB HL. In the 30 subjects enrolled, TTS was evaluated after 2, 15, and 30 min and the recovery time was recorded in each subject. The longest recovery time was 45 min. Among the 18 subjects who underwent a second test after treatment with Q-Ter, the mean recovery time was 31.43 min. The results of the present study show that 30 days' treatment with Q-Ter can aid faster recovery after exposure to noise (P < 0.0001). The reduction in the recovery time following treatment can be explained by Q-Ter-mediated improvement of the outer hair cells' response to oxidative stress.