Factors associated with voice-related quality of life among patients with temporomandibular disorders.

BACKGROUND: Research would be important for obtaining a better understanding of voice complaints among patients with temporomandibular disorders (TMD). OBJECTIVE: The identification of predictors of voice disorders associated with TMD pain was made according to Diagnostic Criteria for TMD (DC/TMD) Axis I. METHODOLOGY: Functional limitations were measured using the Jaw Functional Limitation Scales for mastication (JFLS-M), jaw mobility (JFLS-JM), and verbal and emotional expression (JFLS-VEE). Patients also completed the Hospital Anxiety and Depression Scale (HADS). The primary outcome was social-emotional and physical functioning as indicated by scores on the Voice-Related Quality of Life (V-RQOL) questionnaire. Multiple linear regression was used to model the relationship between the domains on the V-RQOL questionnaire and scores on the HADS and JFLS after adjusting for age, gender, DC/TMD diagnosis, pain intensity, and time since pain onset. RESULTS: The HADS-D (B=-1.15; 95% CI, -1.718 to -0.587; p<.001) and JFLS-VEE (B=-0.22; 95% CI, -0.40 to -0.06; p=.008) were significant predictors of scores on the V-RQOL questionnaire. CONCLUSION: Higher scores on depression measures and limitations in verbal and emotional expression could exacerbate voice problems among TMD pain patients. Future research should promote multidisciplinary treatments for TMD pain-related voice disorders.

Prevalence of Voice Disorders in the United States: A National Survey.

OBJECTIVES: The prevalence of voice disorders has not been explored in the context of recent trends in voice use, including voice assistant technology and increased use of teleconferencing for remote work. The objective of this research is (1) to determine the prevalence of voice disorders in the adult population of the United States, and (2) to understand the association of voice disorders with demographic and voice use factors, including vocal demands, and use of teleconferencing and voice assistant technology. METHODS: A survey pertaining to voice disorders and voice use was developed and administered to a representative sample of US population. Demographics and information related to risk factors for voice disturbance, including high vocal demands, teleconferencing, and voice-assistant use were also analyzed. RESULTS: A total of 1522 responses were included. Of these, 20.6% reported having had a voice disorder at some point in their life. This rate was higher in employed respondents, singers, and teachers (all p < 0.0001) and was notably higher in those who used teleconferencing technology and voice assistant technology (both p < 0.0001). Approximately 60% of this subset reported seeking medical care for their voice, 12.6% reported a current voice disorder, and 9.5% reported a voice problem that had recurred multiple times. CONCLUSIONS: Approximately 1 in 5 Americans surveyed has had a voice disorder. Risk factors for voice disorders include use of teleconferencing technology, voice assistant use, and occupational factors. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:347-352, 2024.

Factors Associated With the Limitation at Work Because of the Voice: Study With Teachers of Basic Education In Brazil.

INTRODUCTION: The voice disorder can cause limitations at work, as it affects the communication and the performance of the teaching function. OBJECTIVE: To analyze the limitation at work because of the voice and to examine possible associations with sociodemographic characteristics, life and health habits and work conditions among Basic Education teachers in Brazil. METHODS: Cross-sectional epidemiological study, with a representative sample, carried out between October 2015 and March 2016, with 6,324 teachers working in Basic Education in Brazil. Data collection was carried out through the application of a questionnaire via telephone with questions regarding health and working conditions. The "limitation at work because of the voice" was considered a dependent variable, whose response options were a scale with four Likert items that varied from frequently to never. The independent variables were grouped in blocks for ordinal logistic regression analysis with hierarchical entry. The magnitude of the association was assessed by the Odds Ratio (OR) with the respective confidence intervals (95% CI). RESULTS: One third of Brazilian teachers (32.7%) reported some frequency of limitation at work (sometimes; rarely, frequently) because of the voice at some moment in the month before the survey and, of these, 5% declared high frequency. The factors that increased the chance of a greater frequency of limitation at work because of the voice were: being female (OR = 1.32; 95% CI = 1.15-1.51); teaching for elementary school (OR = 1.35; 95% CI = 1.02-1.78); use anxiolytic or antidepressant medications (OR = 1.46; 95% CI = 1.20-1.78); losing sleep due to concerns (OR = 1.69; CI = 95% = 1.46-1.95); high noise at school (OR = 2.09; 95% CI = 1.78-2.46); agitated environment by students' indiscipline (OR = 1.37; 95% CI =1.15-1.63); high demands at work (OR = 1.18; 95% CI = 1.02-1.36); not having social support (OR = 1.19; 95% CI = 1.04-1.38); having suffered verbal violence by the students (OR = 1.43; 95% CI = 1.23-1.67). On the other hand, the practice of regular physical activity (OR = 0.86; 95% CI = 0.75-1.00) and the fact of having enough time to complete work tasks (OR = 0.71; 95% CI = 0,62-0.82) decreased the chance of a higher frequency of limitation at work due to vocal problems. The perception that the work limits the teaching performance because of the voice was more frequent among teachers in the North (OR=1.41; 95% CI = 1.17-1.71) and Northeast (OR=1.46; 95% CI = 1.22-1.76) compared to the Southeast region. CONCLUSION: Factors associated with an increase in the chance of higher frequency of reporting work limitations due to the voice: being female, lack of physical activity, losing sleep due to concern, using anxiolytic or antidepressant medication, school location in the North and Northeast, teaching for the elementary school stage, high noise at school and psychosocial aspects of work organization. The Brazilian educational sector needs public policies that take into account regional inequalities and the health and work conditions of teachers.

Safety of Platelet-Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy.

OBJECTIVE: To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. METHODS: Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires. RESULTS: Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. CONCLUSION: This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:647-653, 2023.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease.

OBJECTIVE: To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease. METHOD: Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed. RESULTS: After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise. CONCLUSION: In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

Incidence of Common Mental Disorders in Teachers: Is There a Relationship with Voice Disorders?

OBJECTIVE: This study aims to evaluate the risk factors associated with the incidence of common mental disorders (CMD) in teachers, particularly the possible relationship with voice disorders. MATERIAL AND METHODS: A longitudinal quantitative study of 469 teachers of the municipal schools of Pelotas in Brazil was conducted over three years after a baseline interview. The symptoms of CMD were assessed with the Self-Reporting Questionnaire 20 items (SRQ-20 scale) and the voice disorder was assessed with the Voice Handicap Index Protocol with cutoff of 19 points. A bivariate analysis was performed using Poisson regression to verify the difference in proportion of the incidence of CMD in the different categories of independent variables. RESULTS: The incidence of CMD was 18% (N = 265). In the bivariate analysis, the risk for CMD was 77% higher for teachers who presented with a voice disorder (RR 1.77 95% CI 1.04 to 3.03). CONCLUSIONS: Teachers who reported a voice disorder had an increased risk of developing a CMD.

Association of voice and mental health diagnoses with differences in voice-related care utilization.

OBJECTIVE: To compare healthcare utilization in voice patients with versus without mental health (MH) diagnoses STUDY DESIGN: Retrospective study using electronic medical records from large regional healthcare system. METHODS: We examined data on sociodemographic characteristics, comorbidities, voice-related diagnoses, and patterns of healthcare utilization (including medication use, tests and procedures, and outpatient visits). The study period spanned January 2005 through June 2017. RESULTS: A total of 24,672 patients had at least one voice-related diagnosis. Of these, 11,483 (47%) also had at least one MH diagnosis compared to 14% in the overall repository (P < 0.0001). The most common voice-related diagnoses were nonspecific dysphonia (80%), acute laryngitis (30%), and vocal fold paresis/paralysis (7%). The 11,483 patients with both voice-related and MH diagnoses were more likely to have acute laryngitis and/or nonspecific dysphonia; less likely to have laryngeal cancer and/or paresis/paralysis; and more likely to have seen a primary care provider, to have received medications, and to have undergone radiology studies. In contrast, the 13,189 patients with only voice-related diagnoses had more overall voice-related visits, were more likely to have seen an otolaryngologist, and were more likely to have undergone a voice evaluation with a speech language pathologist. CONCLUSION: Voice patients with MH diagnoses were less likely to see otolaryngology and more likely to have radiology studies than voice patients without MH diagnoses. Further study is warranted to characterize temporal sequences of care in this group of patients and determine whether these differences are attributable to referral patterns from primary care. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1496-1502, 2020.

Can voice disorders matter as much as life-threatening comorbidities to patients' general health?

OBJECTIVE: National initiatives and funding agencies may deprioritize voice disorders relative to conditions such as malignancy, pulmonary, or cardiac disease. It is unknown whether the impact of voice problems is outweighed by other potentially more serious disease states. Our objective was thus to quantify the extent to which voice contributes to general health status when adjusting for concurrent, more life-threatening comorbidities. METHODS: Adults (n = 430) presenting to a tertiary care academic center with a primary voice complaint completed the Voice Handicap Index-10 (VHI-10) and the Patient-Reported Outcomes Measurement Information System global health short-form instrument (PROMIS). Medical comorbidities were categorized via the Deyo modification of the Charlson Comorbidity Index. The influence of voice and comorbid conditions on general health scores was assessed through multivariate ordinal regression. The potential for effect modification was also evaluated. RESULTS: VHI-10 mean scores were 11.4 (95% confidence interval [CI], 10.5 to 12.4). PROMIS physical and mental health t scores were 49.0 (95% CI, 48.0 to 49.9) and 51.6 (95% CI, 50.6 to 52.5), respectively. Global and social item scores were 3.4 (95% CI, 3.3 to 3.5) and 3.7 (95% CI, 3.6 to 3.8), respectively. The most prevalent comorbid conditions were pulmonary disease, malignancy, and connective tissue disorders. In all analyses, voice handicap was a significant predictor of general health, even when adjusting for comorbid conditions (VHI-10 ß = -1.349, P < 0.001 for physical health; ß = -1.278, P < 0.001 for mental health; ß = -1.691, P < 0.001 for social health; ß = -0.956, P < 0.001 for the global overview item). CONCLUSION: In the observed population, voice health has a significant, multi-dimensional impact on general health, which is not subsumed by the presence of comorbidities. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2405-2411, 2020.

Associations between Community-Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice-Disordered Population.

OBJECTIVES: To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. STUDY DESIGN: Retrospective cohort analysis. SETTING: Large national administrative US claims database. SUBJECTS AND METHODS: Patients were included if they were ≥18 years old; had outpatient treatment for a laryngeal/voice disorder from January 1, 2010, to December 31, 2014 (per International Classification of Diseases, Ninth Revision, Clinical Modification codes); had 12 months of continuous enrollment prior to the index date (ie, first diagnosis of laryngeal/voice disorder); had no preindex diagnosis of CAP; and had prescription claims captured from 1 year preindex to end of follow-up. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique preindex patient encounters, and CAP diagnoses during the postindex 3 years were collected. Two models-a time-dependent Cox regression model and a propensity score-based approach with a marginal structural model-were separately performed for patients with and without pre-index date PPI prescriptions. RESULTS: A total of 392,355 unique patients met inclusion criteria; 188,128 (47.9%) had a PPI prescription. The 3-year absolute risk for CAP was 4.0% and 5.3% among patients without and with preindex PPI use, respectively. For patients without and with pre-index date PPI use, the CAP occurrence for a person who had already received a PPI is 30% to 50% higher, respectively, than for a person who had not yet had a PPI but may receive one later. CONCLUSIONS: Patients without and with pre-index date PPI use experienced a roughly 30% to 50% increased likelihood of CAP, respectively, as compared with patients who had not had PPI prescriptions.

[Analyses of pathogenic factors and clinicopathological characteristics of vocal leukoplakia].

Objective: To investigate the pathogenic factors of vocal leukoplakia and its clinical and pathological features. Methods: Eighty-one patients with vocal cord leukoplakia who underwent surgery between February 2010 and December 2016 and 160 volunteers without pharyngeal symptoms designed as controls were included in this case control study. The clinicopathological characteristics of 81 patients were summarized and analyzed synthetically. Results: There was statistical significance in reflux symptom index(RSI), reflux finding score(RFS), smoking index, and drinking index between case group and control group(Z=-5.35, -4.82, -4.76, -2.44, P<0.05). The voice-using duration per day in case group was significantly longer than that of control group.There was no statistical significance in hospital anxiety and depression scale for anxiety(HADA) scores、hospital anxiety and depression scale for depression(HADD) scores between case group and control group(P>0.05). In 42 patients who received 24-hour dual probe pH monitoring the prevalence of pathologic LPR was 42.8%. In 81 patients, 39(48%)patients were pathologically diagnosed as squamous cell hyperplasia, 18(22%)patients as mild dysplasia, 12(15%)sides as moderate dysplasia , 10(12%)patients as severe dysplasia and 2(2%)patients as carcinoma in-situ. The average age of high-risk pathological vocal leukoplakia was significantly higher than that of low-risk leukoplakia(t=-2.73, P<0.01). The propotion of speckled leukoplakia in high-risk leukoplakia was significantly higher than that of low-risk leukoplakia(χ(2)=23.81, P<0.01). There was no statistical significance between high-risk leukoplakia and low-risk leukoplakia in the prevalence of pathologic LPR(P>0.05). The bilateral lesions, speckled leukoplakia were more likely to relapse(χ(2)=4.27, 12.17, P<0.05). The more serious the pathology, the more likely it was to relapse (Z=-2.168, P=0.03). There was no statistical significance between recurrence group and non-recurrence group in the prevalence of pathologic LPR(P>0.05). Conclusions: LPR, smoke constitute the risk factors of vocal cord leukoplakia. Drinking, voice abuse are related to vocal cord leukoplakia. Senile, speckled leukoplakia are more likely to be malignancy. A speckled leukoplakia, bilateral leukoplakia, severe pathological degree are important factors to predict recurrence.

Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract / Trastornos de la voz en paracoccidioidomicosis residual en las vías respiratorias superiores y el tubo digestivo

Background. Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. Aims. The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. Methods. We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. Results. The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. Conclusions. The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed (AU)

Antecedentes. La paracoccidioidomicosis (PCM) es una micosis sistémica de evolución aguda y crónica causada por especies que pertenecen al género Paracoccidioides. Se considera que es la micosis sistémica endémica de mayor prevalencia en América Latina, con casos en las regiones tropicales y subtropicales. La PCM residual se refiere a las secuelas de las cicatrices fibróticas que provoca el tratamiento de la enfermedad; cuando se asocia con la acumulación de colágeno, conduce a alteraciones funcionales y anatómicas en los órganos. Objetivos. El objetivo de este estudio fue evaluar la función vocal de los pacientes con PCM residual en las vías respiratorias superiores y el tubo digestivo. Métodos. En 2010 se realizó un estudio transversal con una cohorte de 21 pacientes con PCM residual en las vías respiratorias superiores y el tubo digestivo. Resultados. La media de edad fue 49,48±9,1 años y solo dos pacientes (9,5%) eran mujeres. El estudio se realizó durante un período entre 1 y 113 meses (mediana: 27) después de finalizado el tratamiento farmacológico. Cinco pacientes (23,8%) presentaban alteraciones en la laringe como secuela de la enfermedad. Sin embargo, se encontró que todos los pacientes tenían alteraciones vocales en el análisis de percepción auditiva vocal por la escala GRBASI. El análisis acústico computarizado con el software Vox Metria mostró que 11 pacientes (52,4%) presentaron alteraciones en la variación ciclo a ciclo de la frecuencia fundamental (parámetro denominado jitter), 15 (71,4%) en la variación ciclo a ciclo de la amplitud de la señal vocal (shimmer), 8 (38,1%) en la frecuencia fundamental (F0), 4 (19%) en la relación señal-ruido (glottal to noise excitation - GNE), 7 (33,3%) en la existencia de ruido y 12 (57,1%) en la existencia de irregularidad vibratoria. Conclusiones. La gran frecuencia de alteraciones en la PCM residual indica que los pacientes en dicha fase podrían beneficiarse de un tratamiento multidisciplinario con vigilancia integral de la enfermedad que incluyera la rehabilitación del habla tras la curación de la PCM (AU)

A quantitative method for the assessment of dysarthrophonia in myasthenia gravis.

Speech and voice symptomatology (dysarthrophonia) are often reported by patients with myasthenia gravis (MG). However, they have been poorly investigated despite their significant impact on quality of life. Quantitative methods for the assessment of dysarthrοphonia could facilitate the evaluation of these common MG symptoms. The goal of this study was to investigate the phonatory (sustained phonation and reading) and speech (diadochokinesis) function in MG patients using quantitative measures. The voice/speech of 12 MG patients (7 with anti-AchR and 5 with anti-MuSK antibodies) and 24 age-matched healthy controls was recorded and analyzed using electroglottography (EGG) and speech acoustics. For the analysis of voice, the variables that were found to distinguish MG patients compared to healthy controls were a higher average fundamental frequency (P<0.05), a higher standard deviation of the average fundamental frequency (P<0.001), a higher mean fundamental frequency of the vibrating vocal folds (P<0.005) and a higher fundamental frequency range (P<0.005). The analysis of diadochokinesis showed that MG patients had a higher mean duration of the silent interval between a series of repetitive /pa/ syllables (P<0.05), of the sound /t/ (P=0.05) and of the silent interval between a series of repetitive /ka/syllables (P<0.05). No statistical differences were found in any of these variables between the MG subgroups with anti-AchR or anti-MuSK antibodies. This study demonstrates that non-invasive physiological methods (EGG and speech acoustics) offer essential tools for the assessment of dysarthrophonia in MG patients.

Musculoskeletal Pain and Occupational Variables in Teachers With Voice Disorders and in Those With Healthy Voices-A Pilot Study.

PURPOSE: This study aimed to compare musculoskeletal pain perception in teachers with voice disorders and in those with healthy voices, and to investigate the relationship between musculoskeletal pain and occupational variables (ie, work journey per week and working period). METHOD: Forty-three classroom teachers were divided into two groups: dysphonic group (DG), 32 classroom teachers with voice complaints and voice disorders; and non-DG, 11 classroom teachers without voice complaints and who are vocally healthy. The musculoskeletal pain investigation survey was used to investigate the frequency and intensity of the pain. Occupational variables, such as work journey per week and working period, were investigated by the Voice Production Condition-Teacher questionnaire. The statistical tests used were the Spearman correlation (P ≤ 0.05) and the Mann-Whitney U test (P ≤ 0.05). RESULTS: There was no difference between the frequency and the intensity of musculoskeletal pain regarding dysphonia. Work journey per week was positively related to the frequency and the intensity of laryngeal pain in the DG. The working period had a negative relationship to the frequency and the intensity of musculoskeletal pain in the submandibular region in the DG. CONCLUSION: Classroom teachers with voice disorders and those with healthy voices do not have differences regarding the frequency and the intensity of musculoskeletal pain. Besides dysphonia the pain is an important symptom to be considered in classroom teachers. The occupational variables contributed to the presence of musculoskeletal pain in the region near the larynx, which appears to be directly proportional to work journey per week and inversely proportional to the working period.

Epidemiology of Voice Disorders in Latvian School Teachers.

OBJECTIVES: The prevalence of voice disorders in the teacher population in Latvia has not been studied so far and this is the first epidemiological study whose goal is to investigate the prevalence of voice disorders and their risk factors in this professional group. METHODS: A wide cross-sectional study using stratified sampling methodology was implemented in the general education schools of Latvia. The self-administered voice risk factor questionnaire and the Voice Handicap Index were completed by 522 teachers. Two teachers groups were formed: the voice disorders group which included 235 teachers with actual voice problems or problems during the last 9 months; and the control group which included 174 teachers without voice disorders. RESULTS: Sixty-six percent of teachers gave a positive answer to the following question: Have you ever had problems with your voice? Voice problems are more often found in female than male teachers (68.2% vs 48.8%). Music teachers suffer from voice disorders more often than teachers of other subjects. Eighty-two percent of teachers first faced voice problems in their professional carrier. The odds of voice disorders increase if the following risk factors exist: extra vocal load, shouting, throat clearing, neglecting of personal health, background noise, chronic illnesses of the upper respiratory tract, allergy, job dissatisfaction, and regular stress in the working place. CONCLUSIONS: The study findings indicated a high risk of voice disorders among Latvian teachers. The study confirmed data concerning the multifactorial etiology of voice disorders.

Functional Voice Disorders: The Importance of the Psychologist in Clinical Voice Assessment.

OBJECTIVES: The etiopathogenesis of functional voice disorders (FVDs) is multifactorial. The purpose of this study was to analyze the severity of depression and anxiety, and the incidence of affective and anxiety disorders, in patients who presented different types of FVDs and were followed at the University Clinic of Otolaryngology. DESIGN: This is a cross-sectional study. METHODS: After ENT observation, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). A psychologist assessed the severity of depression and anxiety using the Hamilton rating scales, and screened for affective and anxiety disorders using the Mini International Neuropsychiatric Interview. RESULTS: Significant differences in the mean values were found between the groups, with the MTVD1 group having higher levels of depression and anxiety. In affective disorders (current major depression and current mood disorder with psychotic symptoms) and in anxiety disorders (lifetime panic disorder, current generalized anxiety, and current panic disorder with agoraphobia), significant differences in association were found between groups. CONCLUSIONS: Groups presented with significant differences in depression and anxiety levels, and in some psychiatric diagnoses. Patients with FVDs should be independently assessed regarding their voice disorder classification. The integration of a psychologist in the clinical voice assessment team is essential, as findings have corroborated an important incidence of psychiatric disorders in FVDs patients.

Description of patients consulting the voice clinic regarding gender, age, occupational status, and diagnosis.

The purpose of this paper was to describe the gender, age, occupational status, and diagnosis of dysphonic patients. We retrospectively analyzed the medical records of 1079 patients examined at the Voice clinic of the University hospital of Liège in French-speaking Belgium. Overall, seven out of ten patients who attended the voice clinic for dysphonia were females. The patients' ages ranged from 4 to 93 (mean = 43.5). Females predominantly consulted at the age of 54 and males at the age of 9. Regarding the occupational status, workers represented more than half of our patients (53 %), while 11.2 % were unemployed, 15.4 % were students, and 19.9 % were retired. Regarding the diagnoses of the 1079 patients, nodules were the most common pathologies (n = 182, 16.9 % of the patients), prevailing in females (n = 142, 18.8 % of the females), and encountered in 16.8 % of the workers and 42.8 % of the students consulting the voice clinic. Following nodules, laryngeal mobility disorders were diagnosed in 16.4 % of the patients (n = 177), mainly females (n = 115), and was the most frequent diagnosis in retirees (n = 75, 34.9 %). The majority of the patients consulting the voice clinic for dysphonia were adult females, in their workforce, diagnosed with vocal nodules. The identification of the patients' characteristics and diagnoses is important to develop treatments and prevention of dysphonia, estimate their costs, and allow comparisons across referral centers.

Relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux and voice disorders in teachers. / Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras.

OBJECTIVE: To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. METHODS: this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. RESULTS: We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). CONCLUSION: There was no association between VD and LPR, but between age and VHI score.

Alteraciones en la voz de las pacientes con anorexia nerviosa restrictiva: un estudio piloto / Alterations in tone of voice in patients with restrictive anorexia nervosa: A pilot study

Se realiza un estudio sobre el tono (percepción acústica) de la voz en la anorexia nerviosa restrictiva (ANR). El objetivo es valorar la alteración en la voz de las pacientes con ANR cuando el trastorno se inicia en la pubertad. La muestra total son 148 sujetos distribuidos en dos grupos: grupo control (n=102) y ANR (n=46). Se determinó la frecuencia fundamental de la voz (F0) utilizando dos fonemas ('a' e 'i') mediante un micrófono Plantronic 300 y grabador digital. Se analiza la voz con el programa Praat. Se presentan los primeros datos para la lengua española de los valores normales de la F0 de voz en población femenina sana de 9 a 17 años. Posteriormente se muestran los datos comparativos con el grupo de pacientes con ANR

This article is about the tone of voice (acoustic perception) in patients with restrictive anorexia nervosa (AN-R). Our goal was to study whether or not there is an alteration of the tone in restrictive anorexia nervosa when the disease has started in the puberty. The total sample consisted of 148 subjects divided in two groups: control (n=102) and AN-R (n=46). The voice's fundamental frequencies (F0) were determined based on the repetition of two phonemes ('a' and 'i') and measured by a microphone Plantonic 300 and a digital recorder. We analyzed the voice's F0 using Praat software. We present the first data for the normal range of the F0 in Spanish healthy women from 9 to 17 years old who were Spanish native speakers. Finally, we show a comparison of data between AN-R patients and control group

Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras / Relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux and voice disorders in teachers

RESUMO Objetivo Analisar a relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo (RLF) e distúrbio de voz (DV) em professoras. Métodos Pesquisa de natureza transversal, com amostra por conveniência que teve, como critérios de inclusão, ter mais de 18 anos, ser professor do sexo feminino, procurar atendimento com queixa de DV e/ou de RLF. Os fatores de exclusão foram: ser fumante e apresentar alterações respiratórias. Todos os sujeitos preencheram os seguintes instrumentos: Condição de Produção Vocal – Professor (CPV-P), inclusive o Índice de Triagem para Distúrbio de Voz (ITDV), e o Índice de Desvantagem Vocal (IDV). Fez-se coleta de amostra de fala para avaliação perceptivo-auditiva da voz e todas foram submetidas à avaliação otorrinolaringológica. Resultados Foram avaliadas 121 professoras, com média de idade de 43 anos e de 7,8 horas-aula por dia. Somente 24% das professoras não apresentaram lesões em pregas vocais e 42,1% apresentaram sinais videolaringoscópicos sugestivos de RLF. No grupo de professoras com presença de sinais de RLF, os sintomas do ITDV mais relatados foram garganta seca, rouquidão, pigarro, e a média do IDV foi de 17,9 pontos. Não houve associação entre distúrbio de voz e presença de sinais videolaringoscópicos sugestivos de RLF. Na análise de regressão logística binária múltipla, os fatores independentes para o RLF foram idade e escore (tercil: 13-20) do IDV. Conclusão Não houve associação entre o DV e o RLF e sim entre idade e escore IDV.

ABSTRACT Objective To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. Methods this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. Results We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). Conclusion There was no association between VD and LPR, but between age and VHI score.

Voice problems and depression among adults in the United States.

OBJECTIVES/HYPOTHESIS: Prior studies have observed a high prevalence of psychosocial distress, including depression, in patients with voice problems. However, these studies have largely been performed in care-seeking patients identified in tertiary care voice clinics. The objective of this study was to examine the association between depression and voice problems in the U.S. STUDY DESIGN: Cross-sectional analysis of National Health Interview Survey (NHIS) data. METHODS: We identified adult cases reporting a voice problem in the preceding 12 months in the 2012 NHIS. Self-reported demographics and data regarding healthcare visits for voice problems, diagnoses given, severity of the voice problem, and depression symptoms were analyzed. RESULTS: The total weighted sample size was 52,816,364. The presence of depressive symptoms was associated with a nearly two-fold increase (odds ratio = 1.89, 95% confidence interval = 1.21-2.96) in the likelihood of reporting a voice problem in the past year. Patients who reported feeling depressed were less likely to receive care for the voice problem and less likely to report that treatment had helped than those who did not feel depressed. CONCLUSION: These findings indicate that the co-occurrence of voice problems and depressive symptoms is observed in the general population, not only in care-seeking patients, and that depressive symptoms may influence reported likelihood of receiving voice treatment and effectiveness. This suggests that voice care providers should take mental health symptoms into account when treating patients, and also indicates a need for further investigation. LEVEL OF EVIDENCE: NA. Laryngoscope, 126:1859-1864, 2016.