Two-dimensional Scheme for Arranging Voice Disorders.

Importance: Prevalent schemes that have been used for arranging voice pathologies have shaped theoretical and clinical views and the conceptualization of the pathologies and of the field as a whole. However, these available schemes contain inconsistencies and categorical overlaps. Objective: To develop and evaluate a new approach for arranging voice pathologies, using 2 continuous scales, organicity and tonicity, which were used to construct a 2-dimensional plane. Design, Setting, and Participants: This survey study was conducted among experts in the fields of laryngology and/or voice disorders from 10 countries. The survey was conducted using an online platform from March to May 2021. The data were analyzed in June 2021. Of the 45 experts who were initially approached, 39 (86.7%) completed the survey. Main Outcomes and Measures: The primary outcome measures were group ratings on 2 rating scales: organicity and tonicity. On the organicity scale, 0 represented nonorganic and 10 organic. On the tonicity scale, 0 represented hypotonic and 10 hypertonic. Results: Participants included 16 laryngologists and 23 speech-language pathologists, of whom 27 (69.2%) were women and 12 (30.8%) men with a mean age of 55 years. The Cronbach α was high for organicity and tonicity (0.98 and 0.97, respectively). Interrater agreement (rwg) was moderate to very strong (rwg≥0.50) for most pathologies. The correlation between the 2 scales was moderate and negative (r = -0.38; P = .03). The pathologies were scattered across the full range of both scales and the 4 quadrants of the 2-dimensional plane, suggesting the continuity and bidimensionality of the new arrangement scheme. In addition, a latent profile analysis suggested that the 4-cluster solution is valid and roughly corresponded to the 4 quadrants of the constructed plane. Conclusions and Relevance: The findings of this survey study suggest the potential use of a 2-dimensional plane that was based on 2 continuous scales as a new arrangement scheme for voice disorders. The results suggest that this approach provides a valid representation of the field based on 2 basic measures beyond the specific etiology of each laryngeal pathology or condition. This simple and comprehensive organization scheme has the potential to facilitate new insights on the nature of voice pathologies, considering the interpathology similarities and differences.

Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery.

Objectives: High-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery. Methods: This study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient's answers on the IVST. Results: As the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV. Conclusion: The factors that affect a patient's subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.

The Normative Study of Acoustic and Aerodynamic Characteristics of Voice among Healthy Adult Turkish Speaker Population.

Phonatory Aerodynamic System (PAS Model 6600) is an evaluation instrument that assesses the effectiveness of surgical interventions, treatments, and therapy for voice disorders. It can be used for the assessment of voice disorders by supporting other perceptual and instrumental methods. It is important to establish normative data, because the use of appropriate norms is necessary for diagnostic and descriptive accuracy. Therefore, this study is aimed primarily at establishing adult normative databases for phonatory aerodynamic measures obtained with the KayPENTAX PAS Model 6600 among healthy adult Turkish speakers and then examining the effect of age, gender, and age-gender interaction variables on these measures. The contribution of the study is considered so important since it will generate normative data for all measurements-except the mean pitch-by the five protocols of PAS for the first time. Two hundred and six healthy Turkish speakers with normal voice (106 women and 100 men) were included in the study and stratified into three age groups. Forty-five phonatory aerodynamic measures across five PAS protocols (vital capacity, maximum sustained phonation, comfortable sustained phonation, variation in sound pressure level, and voicing efficiency) were collected. Age, gender, and age-gender interaction variables were analyzed for 45 PAS parameters. Significant gender and age effect was found for 30 and 19 variables, respectively. Gender-age interaction together was observed for only 6 parameters. Significant differences were not found for the remaining 10 parameters. Significant age and gender effects were observed for 35 phonatory and aerodynamic measures which are essential part of the objective clinical assessment of voice. Consequently, normative data used as reference in voice assessment should be generated according to age and gender differences.

Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis.

BACKGROUND: People with cluster headache (CH) are frequently burdened by misdiagnosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experience, we noticed a typical voice quality with low and croaking tone in patients with CH. In this cross-sectional study, we evaluated, by digital voice analysis, whether it is possible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated. METHODS: After conducting digital recording of the voices from both patients with CH and HCs in a soundproof insulated cabin in the laboratory of the Audiology Department, a set of voice parameters was analyzed. We included the measures of fundamental frequency, calculations of jitter and shimmer, and noise-to-harmonics ratios as well as quantities related to the spectral tilt (i.e., H1-H2, H1-A1, H1-A2, and H1-A3) in 20 patients with CH and in 13 HCs. A videolaryngostroboscopy was performed in all subjects. RESULTS: Patients with CH, explored during the cluster bout period, showed significantly lower second harmonic (H1-H2) values compared with HCs (-6.9 ± 7.6 vs. 2.1 ± 6.7, p = 0.002), usually characterizing the so-called creaky voice. By using a laryngoscopy investigation, a significantly higher prevalence of mild to moderate vocal cord edema and laryngopharyngeal reflux signs were found in patients with CH (100% of patients with CH vs. 15% of HC, p < 0.001). CONCLUSION: Creaky phonation is a "physiological mode of laryngeal operation" usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mechanisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in-bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture.

Identifying individuals with recent COVID-19 through voice classification using deep learning.

Recently deep learning has attained a breakthrough in model accuracy for the classification of images due mainly to convolutional neural networks. In the present study, we attempted to investigate the presence of subclinical voice feature alteration in COVID-19 patients after the recent resolution of disease using deep learning. The study was a prospective study of 76 post COVID-19 patients and 40 healthy individuals. The diagnoses of post COVID-19 patients were based on more than the eighth week after onset of symptoms. Voice samples of an 'ah' sound, coughing sound and a polysyllabic sentence were collected and preprocessed to log-mel spectrogram. Transfer learning using the VGG19 pre-trained convolutional neural network was performed with all voice samples. The performance of the model using the polysyllabic sentence yielded the highest classification performance of all models. The coughing sound produced the lowest classification performance while the ability of the monosyllabic 'ah' sound to predict the recent COVID-19 fell between the other two vocalizations. The model using the polysyllabic sentence achieved 85% accuracy, 89% sensitivity, and 77% specificity. In conclusion, deep learning is able to detect the subtle change in voice features of COVID-19 patients after recent resolution of the disease.

OpenHSV: an open platform for laryngeal high-speed videoendoscopy.

High-speed videoendoscopy is an important tool to study laryngeal dynamics, to quantify vocal fold oscillations, to diagnose voice impairments at laryngeal level and to monitor treatment progress. However, there is a significant lack of an open source, expandable research tool that features latest hardware and data analysis. In this work, we propose an open research platform termed OpenHSV that is based on state-of-the-art, commercially available equipment and features a fully automatic data analysis pipeline. A publicly available, user-friendly graphical user interface implemented in Python is used to interface the hardware. Video and audio data are recorded in synchrony and are subsequently fully automatically analyzed. Video segmentation of the glottal area is performed using efficient deep neural networks to derive glottal area waveform and glottal midline. Established quantitative, clinically relevant video and audio parameters were implemented and computed. In a preliminary clinical study, we recorded video and audio data from 28 healthy subjects. Analyzing these data in terms of image quality and derived quantitative parameters, we show the applicability, performance and usefulness of OpenHSV. Therefore, OpenHSV provides a valid, standardized access to high-speed videoendoscopy data acquisition and analysis for voice scientists, highlighting its use as a valuable research tool in understanding voice physiology. We envision that OpenHSV serves as basis for the next generation of clinical HSV systems.

Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders.

Hyperfunctional voice disorders (HVDs) are the most common class of voice disorders, consisting of diagnoses such as vocal fold nodules and muscle tension dysphonia. These speech production disorders result in effort, fatigue, pain, and even complete loss of voice. The mechanisms underlying HVDs are largely unknown. Here, the auditory-motor control of voice fundamental frequency (fo) was examined in 62 speakers with and 62 speakers without HVDs. Due to the high prevalence of HVDs in singers, and the known impacts of singing experience on auditory-motor function, groups were matched for singing experience. Speakers completed three tasks, yielding: (1) auditory discrimination of voice fo; (2) reflexive responses to sudden fo shifts; and (3) adaptive responses to sustained fo shifts. Compared to controls, and regardless of singing experience, individuals with HVDs showed: (1) worse auditory discrimination; (2) comparable reflexive responses; and (3) a greater frequency of atypical adaptive responses. Atypical adaptive responses were associated with poorer auditory discrimination, directly implicating auditory function in this motor disorder. These findings motivate a paradigm shift for understanding development and treatment of HVDs.

Mitigating the Effects of Acute Vocal Exertion in Individuals With Vocal Fatigue.

OBJECTIVES/HYPOTHESIS: To investigate the effects of acute vocal exertion on individuals with vocal fatigue and to determine whether semi-occluded vocal tract exercises (SOVTEs) are more effective than vocal rest in mitigating acute effects. STUDY DESIGN: Prospective, repeated-measures design. METHODS: On consecutive days, 10 individuals (6 males, 4 females) with scores indicating vocal fatigue on the Vocal Fatigue Index completed two 10-minute vocal exertion tasks. Vocal rest or SOVTEs were interspersed in counterbalanced order between exertion tasks. Respiratory kinematic, acoustic, aerodynamic, and self-perceptual measures were collected at baseline, following vocal exertion, following SOVTE/vocal rest, and following the second exertion task. RESULTS: Acute vocal exertion worsened phonation threshold pressure (P < .001) and vocal effort (P < .001) and reduced maximum fundamental frequency (P < .001). Speech was terminated at lower lung volumes following vocal exertion (decreased lung volume termination [LVT], P < .001). Exertion-induced changes in vocal effort and LVT were significantly reversed by both vocal rest and SOVTE. Detrimental changes in voice measures reoccurred following the second vocal exertion task. SOVTE and vocal rest protected against changes in respiratory kinematics when vocal exertion was resumed. CONCLUSIONS: Vocal exertion impacted laryngeal, respiratory, and self-perceptual measures in individuals with vocal fatigue. Both SOVTE and vocal rest partially mitigated changes in voice measures and prompted more efficient respiratory strategies that were maintained when vocal exertion resumed. These data increase our understanding of how individuals with vocal fatigue respond to vocal exertion tasks and offer preliminary guidance for optimal clinical recommendations. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2732-2739, 2021.

Analysis of voice changes after thyroidectomy using the thyroidectomy-related voice and symptom questionnaire.

OBJECTIVE: After thyroidectomy, many patients suffer from voice problems and vague neck discomfort. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) is a self-administered questionnaire used to evaluate pre- and post-operative vocal status as well as throat and neck discomfort. We investigated voice conditions in thyroidectomy patients using the TVSQ as well as correlations between TVSQ responses and objective voice parameters. Also, we examined whether any clinicopathologic or surgical factors affect phonetic change after thyroidectomy. METHODS: We retrospectively reviewed the records of 242 patients who underwent total thyroidectomy to treat papillary carcinoma between January to December of 2019. Of these, we enrolled 232 who exhibited normal vocal cord mobility after surgery. TVSQ responses and acoustic voice analysis results were examined preoperatively and at 1, 3, and 6 months postoperatively. We subclassified patients into favorable and unfavorable TVSQ groups based on the increase in TVSQ score (△TVSQ ≥20) at 1 month postoperatively. We then investigated the difference of acoustic characteristics between two groups and analyzed the correlations between acoustic parameters and various clinical and surgical factors including pathologic results and lymph node status by subgroup. RESULT: All acoustic voice parameters except for the noise-to-harmonics ratio were significantly worse at 1 month postoperatively and recovered over time, but the TVSQ score did not recover from the 1-month value until 6 months postoperatively. In the subgroups, among the many clinicopathologic factors examined, advanced N stage (p = 0.002) and high positive total and central-and-lateral-neck lymph node ratios were significantly associated with an increased risk of an unfavorable TVSQ (p = 0.049, 0.027, <0.01, respectively). Among the acoustic parameters, only the changes in TVSQ total score and voice score were correlated with deterioration in jitter and shimmer at 1 month postoperatively. However, the correlations was not statistically significant and had disappeared at 6 months postoperatively. CONCLUSION: We figured out that TVSQ was able to capture the negative effects of lymph node status and lymph node dissection on vocal outcomes after thyroidectomy. Although there was a weak correlation between worsened perturbation value and TVSQ changes, no other acoustic analysis parameters were statistically significant correlated with the TVSQ score.

Clinical Features of Essential Voice Tremor and Associations with Tremor Severity and Response to Octanoic Acid Treatment.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to characterize the clinical features, tremor variability, and factors related to octanoic acid (OA) treatment response in essential voice tremor (EVT). STUDY DESIGN: Prospective, double blind, placebo-controlled, crossover study with secondary analysis. METHODS: Clinical tremor features in 16 individuals with EVT were comprehensively assessed, and correlations with acoustic tremor severity were determined. Intrasubject and intersubject variability measures were analyzed from 18 repeated measures for each acoustic tremor variable. Clinical correlates of treatment response were evaluated, and cumulative effects over a 2-week period of OA drug dosing were assessed. RESULTS: Participants with EVT were 90% female with a mean age of 70.31 (±8.68) years at the time of testing. Neurologist-rated body tremor beyond the vocal tract region was present in 69% of participants, and multiple vocal tract regions contributed to the voice tremor. The mean frequency of amplitude tremor was 4.67 Hz (±0.88). Respiratory tremor was evident in 50% of participants. Participants experienced moderate voice-related disability as assessed on the Voice Handicap Index-10 (19.38, ±8.50), and increased speaking effort. Acoustic tremor severity was significantly associated with severity of tremor affecting vocal tract structures. Overall intrasubject consistency was strong (single measures intraclass correlation coefficient = 0.701, P < .01), with high intersubject variability. Acoustic tremor severity was significantly, positively associated with treatment response, and results suggested a cumulative OA benefit for magnitude of amplitude tremor. CONCLUSIONS: This study identified common clinical correlates of EVT and demonstrated positive associations between acoustic tremor severity, severity of affected vocal tract structures, and response to treatment. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2792-E2801, 2021.

The Effect of the Mother's Participation in Therapy on Children with Vocal Fold Nodules.

OBJECTIVES: Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. METHODS: Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. RESULTS: The two groups' measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. CONCLUSIONS: Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family's involvement increases the child's motivation in therapy. The mother's presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother's involvement increases the child's compliance with and interest in therapy.

Prospective Evaluation of Safety of Singing on Steroids: Testing the Truth of Received Wisdom.

OBJECTIVES/HYPOTHESIS: Performing while on steroids is widely considered to increase risk of vocal injury. This study aims to determine incidence and type of injury, and changes in performers' voices after treatment of vocal fold edema (VFE) with glucocorticoids. STUDY DESIGN: Prospective Cohort. METHODS: Fifty-five performers (34 female; 21 male) treated for acute VFE with short-course oral glucocorticoids were prospectively evaluated pre- and post-treatment. Subjects underwent videostroboscopy, acoustic/aerodynamic assessment, and functional assessment with the Singing Voice Handicap Index-10 (SVHI-10) and Evaluation of the Ability to Sing Easily (EASE). Blinded reviewers rated videostroboscopic examinations and performed audio-perceptual assessment. Chi-square tests and Wilcoxon signed rank tests were applied for analyses of treatment changes. RESULTS: Following glucocorticoid treatment, two instances of vocal fold hemorrhage (3.6%) and three instances of glottic thrush (5.5%) were observed. These resolved without consequence. Mucosal wave dynamics and edema improved. Nearly all subjects completed scheduled performances, and significant improvement was noted on the EASE, reflecting improved function after treatment. These were further supported by statistically significant improvements in CAPE-V and some acoustic and aerodynamic outcomes (semitone pitch range for females, airflow measures for males). CONCLUSIONS: Oral glucocorticoids appear to be generally safe for performers presenting with acute VFE. The incidence of adverse effects, specifically hemorrhage and thrush, was low and the effects transient. Vocal fold examination should be considered obligatory before prescribing glucorticoids to working performers. A treatment strategy for acute VF edema incorporating glucocorticoids when appropriate appears to result in significant improvements in measures of glottal function including videostroboscopic appearance, subject perception, and auditory perception. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2298-2304, 2021.

Voice-Related Quality of Life Is Associated with Postoperative Change in Subglottic Stenosis.

OBJECTIVES: To characterize the impact of subglottic stenosis (SGS) on voice-related quality of life (V-RQOL) and quantify the effect of treatment on voice outcomes. STUDY DESIGN: Case series. METHODS: Retrospective review of SGS patients treated from 1996 to 2018 at a single institution to assess for 1) V-RQOL association with individual patient cumulative treatment number and 2) V-RQOL correlation with treatment type, time between treatments, and degree of stenosis. Analysis included both parametric and nonparametric statistical comparison across treatment types and multivariable and univariate linear regression. RESULTS: Sixty-one patients, predominantly white (93%) and female (93%), were included. Etiology of SGS included idiopathic (61%), iatrogenic (16%), granulomatosis with polyangiitis (16%), and other (7%). The plurality of patients had four or more treatments (44%), with the remainder having one (28%), two (13%), or three treatments (15%). Analysis of change between pre- and postoperative V-RQOL scores was completed for 130 treatments. These included dilation with laser incision (52%), in-office injection (34%), dilation without division (8%), cricotracheal resection (1%), and all other treatment (8%). For every 10% improvement in airway caliber postoperatively, there was a 1.3-point improvement in calculated V-RQOL (r = 0.27, P = .02). After adjustment for treatment type, age, sex, and SGS etiology, this association held (beta = 1.5, P = .02). Change in V-RQOL was not associated with treatment type, treatment number, or time between treatments. CONCLUSION: Patients with subglottic stenosis who have greater degree of change in airway caliber experience greater improvement in V-RQOL scores following treatment. V-RQOL scores are not associated with treatment type or time between individual treatments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:360-365, 2021.

Voice Quality After Radiotherapy and Cordectomy in Early-Stage Glottic Carcinomas.

Laryngeal carcinomas are the most common upper respiratory tract cancers and most commonly involve the glottic region. The aim of this study is to evaluate the voice quality after radiotherapy (RT) and microsurgical cordectomy (MC) treatments using Voice Handicap Index (VHI) and Grade, Roughness, Breathiness, Astenicity, and Strain (GRBAS) perceptual evaluation scale in patients with early-stage glottic carcinoma. A total of 37 patients with early-stage glottic carcinomas, 19 patients had RT and 18 patients with MC, were included in our study. The patients were evaluated in terms of their sound quality by using VHI-10 and GRBAS perceptual assessment scale 3 months after the treatment was completed. Although the findings were better in favor of RT according to GRBAS perceptual assessment scale of patients who received RT (n = 19) and MC (n = 18), no statistically significant difference was found between the 2 groups (P = .613). Patients in both groups were evaluated with VHI-10, emotional (P = .036) and physiological (P = .038) scores were significantly higher in MC group and no significant difference was found in functional scores (P = .192). However, there was no statistically significant difference between the 2 groups in terms of voice quality (P = .185). In early-stage (Tis, T1a, T1b) glottic carcinoma, there was no significant difference between RT and MC in terms of voice quality. Therefore, the choice of treatment modality in patients with early-stage glottic carcinoma should be taken into account in terms of the patient's occupation, comorbid diseases, cost of treatment, hospital stay, and, most importantly, patient preference.

Patient-Reported Factors Associated with the Onset of Hyperfunctional Voice Disorders.

OBJECTIVES: Prevention, diagnosis, and treatment of hyperfunctional voice disorders would be improved by better understanding their etiological contributing factors. Therefore, this study estimated the prevalence of etiological factors using self-reported data about disorder onset from a large cohort of patients with Phonotraumatic Vocal Hyperfunction (PVH) and Non-Phonotraumatic Vocal Hyperfunction (NPVH). METHODS: Retrospective chart review extracted the self-reported rate (gradual, sudden) and events associated (voice use, anxiety/stress, upper respiratory infection [URI]) with disorder onset from 1,577 patients with PVH and 979 patients with NPVH. RESULTS: Both patient groups reported a gradual onset more than a sudden onset. Voice use was the most frequently reported event for PVH and the NPVH group self-reported all three events at equal frequency. The largest PVH subgroups were associated with voice use while the NPVH subgroups were associated with only voice use, only URI, or only anxiety/stress. CONCLUSION: The results support the general clinical view that PVH is most strongly related to the gradual accumulated effects of phonotrauma, while NPVH has a more heterogeneous etiology. The identified PVH and NPVH subgroups may have clinical relevance and future work could investigate differences in treatment and outcomes among these subgroups.

Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson's disease.

Diets that have effects on health problems can vary in their composition. Whilst following a regular diet (RD) a person typically consumes about 30% of calories from fat. Ketogenic diet (KD) is a form of diet whereby a person consumes as much as 90% of calories from fat. KD has been trialed as a treatment for neurological diseases and obesity. Parkinson's disease (PD) is a neurologic disease that impacts the quality of voice. Voice Handicap Index (VHI) is a test that gives information to clinical and physiological assessment about voice. We assessed the impact of KD and RD on voice quality (VQ). Seventy-four patients with PD who reported a voice disorder related to their disease were randomly assigned to the KD or RD groups. We investigated the VHI change of subjects before and 3 months after diet. Sixty-eight PD patients completed the study. Baseline VHI values did not differ significantly between groups. All mean VHI parameters improved in KD group (p˂ 0.001). Currently there are different therapies that address speech and voice disorders in patients with PD. As such KD may be an alternative therapy to improve VQ of patients with PD. A larger sample size is necessary to determine the role and pathophysiology of KD on VQ of PD patients.

Transoral management of adult benign laryngeal stenosis.

PURPOSE: Management of benign laryngeal stenosis (BLS) remains challenging even though transoral treatments in selected cases have shown satisfactory results, at least comparable to open-neck approaches, with reduced invasiveness. To date, no overall consensus has been reached on many issues. The aim of this study is to assess the effectiveness of a purely transoral treatment in a cohort of patients affected by BLS. METHODS: We evaluated 40 patients affected by BLS, treated by transoral surgery between 2013 and 2017. The European Laryngological Society classification for laryngotracheal stenosis was applied for the staging. Improvement in airway patency and quality of life was assessed by decannulation rate, Airway-Dyspnea-Voice-Swallowing (ADVS) score, Voice handicap index (VHI)-30, and Eating assessment tool (EAT)-10 questionnaires. RESULTS: Mean age was 61 years and M:F ratio was 1.4:1. Previous laryngeal surgery was the most common cause of stenosis (50%), followed by radiotherapy (20%), idiopathic etiology (12%), granulomatosis with polyangiitis (10%), and prolonged intubation (8%). Transoral treatment entailed an improvement in quality of life with a significant decrease in the VHI score (p < 0.0001) and improvement in Airway (p = 0.008), Dyspnea (p < 0.0001), and Voice (p < 0.0001) scores. No major perioperative complications were observed. The decannulation rate among patients with a tracheostomy in place (N = 16) was 63%. CONCLUSIONS: Transoral treatment of selected BLS managed by a team with high-level expertise in surgery and anesthesiology is associated with significant improvement of quality of life, especially with regard to voice and breathing functions.

Voice disorders in teachers and the International Classification of Functioning, Disability and Health (ICF) / Trastornos de la voz en docentes y Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF)

Introduction. Contemporary occupational diseases are increasingly expressed by function disorders, which include voice disorders, forcing workers to request a leave of absence from work and leading to an incapacity to perform their work activities. Teachers have the higher prevalence of vocal disorders among the professionals who use their voices professionally, which is reported as the second cause of teaching work absences in Brazil. Objective. To analyze the environment and organization aspects of the teaching work associated with the development of voice disorder of teachers, according to the International Classification of Functioning, Disability and Health (ICF). Method. This study consisted of two steps. Initially, an integrative bibliographic review was performed to search for references related to the topic in the LILACS, MEDLINE and SCIELO databases, using the health descriptors "voice disorders" and "teachers". Then, the selected articles were read in full in order to identify the work factors associated with the voice disorder and compared with the theoretical framework of the ICF, in order to identify possible indicators of loss of functioning and capacity for teaching work resulting from voice disorders. Results. The presence of dust and noise were the most prevalent environment as-pects. In turn, the high demand for work and the lack of autonomy to perform the work were identified as factors related to the organization of the work of the teaching work, as well as stress at work and the presence of situations of violence at school as the most reported work absences.Conclusion. As shown, the factors of teaching work described impact all compo-nents of functioning and lead to the incapacity of the teacher to work. The use of the ICF may contribute to systematize and quantify, in a standardized way, the loss of functioning and work capacity resulting from voice disorders, in addition to assis-ting in the development of public health promotion policies and in the prevention of vocal disorders in teachers.

Introducción. Las enfermedades ocupacionales contemporáneas se expresan cada vez más en trastornos funcionales, que incluyen trastornos de la voz, y que obligan a los trabajadores a solicitar una excedencia del trabajo, provocando la incapacidad para realizar sus actividades laborales. Los docentes tienen la mayor prevalencia de trastornos vocales entre aquellos que usan su voz profesionalmente, lo que se reporta como la segunda causa de ausencias laborales docentes en Brasil.Objetivo. Analizar los aspectos ambientales y organizativos de la labor docente asociados al desarrollo del trastorno de la voz de los docentes, según la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF).Método. Este estudio consta de dos pasos. Inicialmente se realizó una revisión bi-bliográfica integradora para buscar referencias relacionadas con el tema en las bases de datos Lilacs, Medline y SciELO, utilizando los descriptores de salud "trastornos de la voz" y "docentes". Luego, se leyeron íntegramente los artículos seleccionados con el fin de identificar los factores laborales asociados al trastorno de la voz y se com-pararon con el marco teórico de la CIF, con el fin de identificar posibles indicadores de pérdida de funcionamiento y capacidad para el trabajo docente derivados de los trastornos de la voz.Resultados. La presencia de polvo y ruido fueron los aspectos ambientales más prevalentes. A su vez, la alta demanda de trabajo y la falta de autonomía para reali-zarlo fueron identificados como factores relacionados con la organización del trabajo de la labor docente, así como el estrés en el trabajo y la presencia de situaciones de violencia en la escuela como las ausencias laborales más reportadas.Conclusión. Como se muestra, los factores del trabajo docente descritos impactan todos los componentes del funcionamiento y conducen a la incapacidad del maestro para trabajar. El uso de la CIF puede contribuir a sistematizar y cuantificar, de mane-ra estandarizada, la pérdida de funcionamiento y capacidad laboral derivada de los trastornos de la voz, además de ayudar en el desarrollo de políticas de promoción de la salud pública y en la prevención de los trastornos vocales en los docentes.

Alcohol-Responsive Hyperkinetic Movement Disorders-a Mechanistic Hypothesis.

Patients with essential tremor, vocal tremor, torticollis, myoclonus-dystonia and posthypoxic myoclonus often benefit in a surprisingly rapid and robust manner from ingestion of a modest amount of alcohol (ethanol). Despite considerable investigation, the mechanism of ethanol's ability to produce this effect remains a mystery. In this paper, we review the pharmacology of ethanol and its analogue GHB (or sodium oxybate), summarize the published literature of alcohol-responsive hyperkinetic movement disorders, and demonstrate videos of patients we have treated over the last fifteen years with either an ethanol challenge or with chronic sodium oxybate therapy. We then propose a novel explanation for this phenomenon-namely, that ingestion of modest doses of ethanol (or sodium oxybate) normalizes the aberrant motor networks underling these disorders. We propose that alcohol and its analogues improve clinical symptoms and their physiologic correlate by restoring the normal firing pattern of the major outflow pathways of the cerebellum (the Purkinje cells and deep cerebellar nuclei), We present evidence to support this hypothesis in animal models and in affected patients, and suggest future investigations to test this model.