Effect of voice rehabilitation following radiotherapy for laryngeal cancer - a 3-year follow-up of a randomised controlled trial.

OBJECTIVES: This study aims to report on the effectiveness of voice rehabilitation following radiotherapy for laryngeal cancer in a long-term perspective, i.e., up to three years after completion of radiotherapy. METHODS: The study included a total of 74 patients that were randomised into an intervention group (n = 37) or a control group (n = 37). Voice recordings with blinded assessment of voice quality with the GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain) and acoustic analysis was performed at baseline, 12 and 36 months following radiotherapy. Voice rehabilitation was performed in 10 sessions immediately following completion of radiotherapy. Patients also filled out the Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer. RESULTS: The S-SECEL demonstrated statistically significant improvements in the intervention group when comparing baseline and 36 months, and no changes in the control group. Acoustic measures did not reveal any significant changes. The perceptual analysis demonstrated that when comparing the changes within the groups between baseline and 36 months there were statistically significant differences between the intervention and control group regarding the voice qualities Roughness, Breathiness and Strain. In the control group, 50% demonstrated deterioration in roughness, while in the intervention group only 7% deteriorated during this time. In Breathiness and Strain, 57 and 50%, respectively, improved in the intervention group, while only 32% and 23% improved, respectively, in the control group. CONCLUSION: Voice rehabilitation following radiotherapy for laryngeal cancer demonstrate positive effects in patient reported outcomes and perceptual measures of voice quality, and the effects remain up to three years following radiotherapy.

Posttraumatic Vernet syndrome without fracture: A case report and short literature review.

RATIONALE: The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms. PATIENT CONCERNS: A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department. DIAGNOSES: Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis. INTERVENTIONS: Intensive swallowing and speech exercises, assisted by a specialist, were performed. OUTCOMES: Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing. LESSONS: According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.

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.

Using Telepractice to Deliver Pediatric Voice Care in a Changing World: Breaking down Challenges and Learning from Successes.

For children with voice disorders, access to care has long been a challenge. Reasons for this include the challenge of qualifying children with isolated voice disorders for services within the public-school system as well as a family's geographic proximity to experienced clinicians who are in the healthcare system. Over the past decade, there have been both formal and informal investigations into the use of telepractice to deliver services to communicatively disordered children and adults, including those with voice disorders. Although barriers and obstacles existed, use of telepractice to deliver such services demonstrated both feasibility and, in some studies, effective outcomes. However, prior to spring of 2020, use of telepractice to deliver speech pathology services was not mainstream. This changed when the nation was forced to shut down many of its in-person healthcare and educational delivery due to the COVID-19 pandemic. This article summarizes select relevant literature pertaining to the use of telepractice in speech language pathology over the past decade and provides a case-based discussion of how it was and is currently being used to deliver pediatric voice care.

In the Zoom Where It Happened: Telepractice and the Voice Clinic in 2020.

Telemedicine-conveying medical information virtually for planning, diagnosis, or treatment-has been a part of the American medical system for over 100 years. A constantly evolving modality, telepractice was a supplemental care delivery system for most speech-language pathologists (SLPs) until March 2020 when the COVID-19 pandemic forced clinical operations to halt in-person activities and convert as much as possible to virtual platforms. The purpose of this article is to provide an overview of the need for telepractice prior to and beyond the current pandemic, the efficacy of telepractice for the voice-specialized SLP, limitations of telepractice, and best practices for providing care over telepractice with a specific focus on voice disorder diagnosis and treatment.

Voice rehabilitation after total laryngectomy with the infrahyoid musculocutaneous flap.

BACKGROUND: It is important for the patients to reconstruct the voice phonic function by surgery after total laryngectomy in the developing countries. AIMS/OBJECTIVES: To investigate the clinical outcomes of voice reconstruction using an infrahyoid musculocutaneous flap for patients after total laryngectomies. MATERIALS AND METHODS: Eighteen male patients recruited were laryngectomized. The infrahyoid musculocutaneous flap was designed. After total laryngectomy, the lower edge of the flap was sewed with the upper edge of the tracheostomy opening. Next, the lateral and medial edges of the flap were anastomosed to create a pronunciation tube. Finally, the remaining opening of the tube was sutured with the anterolateral wall of the hypopharynx to establish a communication with the pharyngeal cavity. RESULTS: A total of 17 cases of flaps were survived and only 1 necrosed. There were 17 patients without serious complications, except that 6 cases had mild irritable cough when gulping water. However, it could be relieved through blocking tracheostoma. One year after operation, all patients could more remarkably articulate clear, powerful, and consistent words. The articulatory configuration was existed under rigid laryngoscope and CT. CONCLUSIONS AND SIGNIFICANCE: The use of an infrahyoid myocutaneous flap is feasible for the voice restoration in the patients undergoing total laryngectomy.

Impacto en la calidad de vida del tratamiento de disfonía espasmódica aductora con toxina botulínica A / Impact on the quality of life of the treatment of adductor spasmodic dysphonia with botulinum toxin A

Introducción. La distonía laríngea o disfonía espasmódica se caracteriza por con-tracciones involuntarias de los músculos laríngeos internos que se desencadenan al hablar, siendo la forma aductora la más frecuente. La inyección de toxina botulínica es el manejo de elección. Para evaluar la respuesta a la terapia existen varios instru-mentos validados, uno de ellos es el cuestionario Voice Handicap Index-10 (VHI-10). El objetivo de este estudio es caracterizar a los pacientes con disfonía espasmódica aductora y evaluar el impacto de la toxina en su calidad de vida.Método. Éste se centró en un estudio retrospectivo descriptivo en pacientes adultos con diagnóstico de disfonía espasmódica aductora tratados con toxina botulínica A, en el Hospital Clínico Universidad de Chile (HCUC), en el periodo comprendido en-tre 2013 y 2021. El mismo permitió la obtención de los datos epidemiológicos de los pacientes, a quienes se les solicitó responder la encuesta VHI-10 previo y posterior a un mes de cada inyección de la toxina.Resultados. Se incluyeron 55 pacientes (218 procedimientos). La dosis promedio utilizada fue de 9,18 UI con un intervalo promedio de 7,4 meses. El puntaje VHI-10 promedio en la evaluación inicial fue de 29,4 y posinfiltración de 14,96, siendo esta diferencia significativa (p < 0,000001). En nuestra serie casi un tercio tiene asociada alguna patología neurológica, y se reportó un 3,67% de complicaciones leves y transitorias.Conclusión. La disfonía espasmódica aductora tiene un gran impacto en la calidad de vida de los pacientes, que se reduce significativamente mediante la inyección de toxina botulínica A, procedimiento que ha demostrado ser seguro y eficaz

Introduction. Laryngeal dystonia or spasmodic dysphonia is characterized by in-voluntary contractions of internal laryngeal muscles that are triggered when speak-ing, being the adductor form the most frequent. Botulinum toxin injection is the management of choice. There are several validated instruments to assess response to therapy, one of them is the Voice Handicap Index-10 (VHI-10) questionnaire. The objective of this study is to characterize patients with adductor spasmodic dysphonia and evaluate the impact of the toxin in their quality of life.Method. A descriptive retrospective study was carried out in adult patients with a diagnosis of adductor spasmodic dysphonia treated with botulinum toxin A, between 2013-2021 at the Hospital Clínico Universidad de Chile. The epidemiological data of the patients and the VHI-10 survey were obtained before and after one month of each toxin injection was requested.Results. 55 patients (218 procedures) were included. The average dose used was 9.18 IU with an average interval of 7.4 months. The average VHI-10 score in the initial evaluation was 29.4 and post-infiltration was 14.96, being this difference sig-nificant (p <0.000001). In our series, almost a third had an associated neurological pathology, and 3.67% of mild and transitory complications were reported.Conclusion. Adductor spasmodic dysphonia has a great impact on the quality of life of patients, which is significantly reduced by injecting botulinum toxin A, a pro-cedure that has been shown to be safe and effective

Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy / Alteración de la integración auditivo-vocal: nuevos retos y oportunidades para la evaluación y la terapia de la voz

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal in-tegration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice pro-duction and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associ-ated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assess-ment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person's auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders

Este artículo de reflexión aborda la importancia de la interacción entre la percepción y la producción de la voz, haciendo hincapié en los procesos de integración auditivo-vocal, los cuales aún no han sido muy divulgados en el contexto de los clínicos de voz. Dado lo anterior, este articulo busca: 1) destacar la importante relación entre la producción y la percepción de la voz y 2) considerar si esta relación pudiese explotarse clínicamente con fines diagnósticos y terapéuticos. Las teorías existentes sobre la producción de la voz y su interacción con la percepción auditiva proporcionan el contexto para discutir por qué la evaluación de los procesos auditivo-vocales podría ayudar a identificar los orígenes asociados a cierto tipo de disfonías e informar al clínico sobre las estrategias de abordaje adecuadas. La incorporación de la evaluación de la integración auditivo-vocal a través de la prueba del paradigma de adaptación sensoriomotora podría ser una importante adición a los protocolos de evaluación de la voz a nivel clínico. Además, si los estudios futuros pueden especificar los medios para manipular y mejorar la integración auditivo-vocal de una persona, la eficacia de la terapia de la voz podría aumentar, lo que llevaría a mejorar la calidad de vida de las personas con trastornos de la voz

Conocimiento de los factores de riesgo vocal y presencia de síntomas vocales en profesores universitarios / Knowledge of vocal risk factors and presence of vocal symptoms in university professors

Introducción: existen diferentes factores de riesgo que pueden llegar a generar alteraciones vocales en los profesores en el ejercicio de su labor. Esta investigación busca establecer la relación entre el conocimiento de los factores de riesgo vocal y la presencia de síntomas asociados a enfermedad vocal en profesores universitarios. Método: se llevó a cabo un estudio observacional descriptivo con un diseño trans-versal con 200 profesores seleccionados bajo criterios de exclusión y exclusión. Se aplicó una encuesta online de conocimiento de los factores de riesgo vocal y la subes-cala física del Índice de Incapacidad Vocal (VHI). Para el análisis estadístico se usó Stata 14. Resultados: se encontró que los docentes presentan conocimiento de los factores de riesgo vocal y la presencia de síntomas es leve. La relación entre estas dos variables fue negativa, es decir, a mayor conocimiento vocal menor presencia de síntomas. Conclusiones: a pesar de encontrarse relación entre las variables de estudio, el nivel de significancia es bajo. Las investigaciones que indagan el conocimiento de los factores de riesgo vocal son reducidas, por lo que se recomienda continuar investi-gando esta temática

Introduction: there are different risk factors that can generate vocal alterations in teachers in the exercise of their work. This research seeks to establish the relationship between knowledge of vocal risk factors and the presence of symptoms associated with vocal disease in college teachers. Method: a descriptive observational study was carried out with a cross-sectional design with 200 teachers selected under exclusion and exclusion criteria. An online survey of knowledge of vocal risk factors and the physical subscale of the Vocal Disa-bility Index (VHI) were applied. Stata 14 was used for statistical analysis.Results: it was found that teachers present knowledge of vocal risk factors and the presence of symptoms is mild. The relationship between these two variables was ne-gative, that is, the higher the vocal knowledge, the lower the presence of symptoms.Conclusions: despite finding a relationship between the study variables, the level of significance is low. The investigations that research the knowledge of the vocal risk factors are limited. Therefore, it is recommended to continue investigating this topic.

Orientaciones filosóficas en la intervención fonoaudiológica de voz. El desafío actual de dar el alta / Philosophical orientations in voice therapy. The current challenge of discharge

El presente artículo corresponde a una reflexión sobre las orientaciones filosóficas en la terapia vocal actual. Cuando existe alguna alteración o trastorno vocal, se habla comunmente de un desequilibrio entre los subsistemas involucrados en el proceso fonatorio, es decir, fuelle (sistema respiratorio), fuente (pliegues vocales) y filtro (tracto vocal). Si no hay un correcto balance, entonces el sistema no tiene un correcto funcionamiento y pueden aparecer síntomas como ronquera, sensación de cuerpo extraño, prurito, fatiga vocal o bien disfonía o incluso afonía. Como con-secuencia de estas dificultades, se generan compensaciones que durante el proceso de la intervención fonoaudiológica el profesional debe volver a "equilibrar". Para lograr este objetivo, se desarrollan y analizan las diversas herramientas que entregan las filosofías de pensamiento a lo largo de la historia de la rehabilitación vocal, don-de se encuentran la orientación higiénica, psicológica, sintomatológica, fisiológica y ecléctica. En este mismo sentido, el profesional debe buscar lo que percibe como más idóneo para cada paciente o grupo a intervenir, centrado en mejorar la calidad vocal y las necesidades actuales de estos, basándose en el contexto mundial actual, con el objetivo de lograr un buen proceso de entrenamiento o rehabilitación y final-mente lograr el alta.

The present article corresponds to a reflection about the philosophical orientations in the current vocal therapy. When there are some vocal alterations or disorders, we usually talk about an imbalance between the sub-sysmtems involved in the fonatory process, which are bellows (respiratory system), source (vocal folds) and filter (vocal tract). When there is not a correct balance, the system does not work properly and as a consequence, it is possible to experiment symptoms such as hoarseness, foreign body sensation, pruritus, vocal fatigue, dysphonia or even aphonia. As a result of these difficulties, it is possible to generate compensations through the intervention of speech therapy. By virtue of this therapy the professional must 'balance'. In order to achieve this, it is necessary to develop and analyze the different tools that philoso-phical studies offer through the history of vocal rehabilitation. Some of these tools are hygienic orientation, psychological, symptomatological, physiological and eclec-tic. Thinking on that, the professional must search what it is most suitable for every patient or group of people that he/she will be working with. This must be focus on improving vocal quality and the actual necessities of the patient, based on the current global context. The final purpose of the professional is to achieve a good and healthy process of training and/or rehabilitation to accomplish medical discharge.

Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit / Perfil de usuarios que reciben atención fonoaudiológica en una unidad de paciente crítico

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

RESUMEN Objetivo: describir el perfil de usuarios atendidos por fonoaudiólogos en una unidad de paciente crítico. Métodos: se realizó un estudio observacional descriptivo con temporalidad ex post facto. Se analizaron los resúmenes estadísticos mensuales de usuarios internados durante los meses de enero a diciembre de 2018, en la unidad de cuidados intensivos de un hospital público. Se describieron los datos a partir de análisis de frecuencia y medidas de tendencia central. La distribución de las variables se determinó mediante skewness-kurtosis test, considerando un nivel de significancia p<0,05. Resultados: 217 sujetos recibieron 868 atenciones fonoaudiológicas. Los hombres (57,26%) mayores de 65 años requirieron una intervención más frecuente. Los principales diagnósticos médicos de ingreso a la unidad correspondieron a patologías inespecíficas (57,14%), enfermedades respiratorias (15,21%) y cerebrovasculares (12,79%). Las funciones de fonoaudiología se relacionaron con la evaluación de la deglución (54,31%) y de la voz (32,4%). En cuanto a la intervención, el tratamiento de la disfagia (25,82%) y las funciones motoras orales (25,04%) dominaron la carga laboral. Las funciones asociadas con el lenguaje, el habla y la cognición fueron secundarias. Conclusión: el perfil del paciente crítico y las labores fonoaudiológicas en este ámbito representan un primer paso para caracterizar el rol profesional del fonoaudiólogo en el contexto de los equipos de medicina intensiva.

Multidimensional voice assessment: the immediate effects of Lax Vox® in singers with voice complaints / Avaliação multidimensional da voz: efeitos imediatos do Lax Vox® em cantores com queixas vocais

ABSTRACT Purpose: to multidimensionally assess the effect of the Lax Vox® vocal technique on singers with voice complaints. Methods: a comparative intrasubject study that assessed 30 singers - 13 males and 17 females, aged 18 to 55 years - who self-reported voice complaints and had voice problems symptoms. The participants were submitted to voice assessment with perceptive-auditory, acoustic, aerodynamic, and electroglottographic voice analysis, as well as laryngeal assessment with high-speed videolaryngoscopy. The participants were assessed at two moments: 1) at the beginning of the data collection; and 2) five minutes after performing the Lax Vox® vocal technique. The groups were compared with appropriate statistical tests, with a 5% significance level. Results: in the acoustic analysis, there was an increase in the fundamental frequency for males, after using the Lax Vox® vocal technique. In the aerodynamic assessment, there was an increase in the airflow mean values during vocalization, as well as in aerodynamic power after using the Lax Vox® vocal technique in both groups. Conclusion: the Lax Vox® vocal technique, in the studied singers with a complaint of dysphonia, promoted an increase in the fundamental frequency, for males. In the aerodynamic parameters, in both sexes, it promoted an increase in the airflow and aerodynamic power.

RESUMO Objetivo: avaliar, de forma multidimensional, o efeito da técnica vocal Lax Vox® em cantores com queixas vocais. Métodos: trata-se de um estudo comparativo intrassujeitos. Foram avaliados 30 cantores, sendo 13 homens e 17 mulheres, com idade entre 18 e 55 anos, que apresentaram queixa vocal autorreferida e presença de sintomas vocais. Os participantes foram submetidos à avaliação vocal pela análise perceptivo-auditiva, acústica, aerodinâmica e eletroglotográfica da voz, bem como à avaliação laríngea com a videolaringoscopia de alta velocidade. Os participantes foram avaliados em dois momentos: 1) no início da coleta; e 2) após cinco minutos de realização da técnica vocal Lax Vox®. Para comparação dos grupos foram utilizados teste estatísticos pertinentes, com nível de significância de 5%. Resultados: na análise acústica houve aumento da frequência fundamental dos homens após o uso da técnica vocal Lax Vox®. Na avaliação aerodinâmica houve aumento dos valores da média do fluxo aéreo durante vocalização e da potência aerodinâmica após o uso da técnica vocal Lax Vox® em ambos os grupos. Conclusão: a técnica vocal do Lax Vox® nos cantores com queixa de disfonia estudados promoveu um aumento da frequência fundamental nos homens. Nos parâmetros aerodinâmicos em ambos os sexos provocou um aumento do fluxo aéreo e da potência aerodinâmica.

[Voice disorder in children : what can be done ?] / Trouble de la voix chez l'enfant : que faire ?

A child having a hoarse, raspy or broken voice, is not normal. Child voice problems are too often ignored and neglected. Such problem should be treated as quickly as possible, as they have important academic and social consequences and significant implications for the choice of their future adult life. The problem must be solved before adolescence, because many professions and activities are not accessible to dysphonic children. Our society gives a lot of importance to the voice, but curiously without having sufficient knowledge of vocal hygiene. Information and awareness among doctors and parents is paramount so that school-aged children can benefit from adequate treatment.

Une voix d'enfant rauque ou cassée n'est pas normale. Les problèmes de voix chez l'enfant sont trop souvent ignorés et négligés alors qu'ils devraient être traités au plus vite, car ils peuvent avoir d'importantes conséquences scolaires et sociales à court terme et des répercussions non négligeables sur le choix de sa future vie d'adulte. Le problème doit être réglé avant l'adolescence. En effet, un grand nombre de professions et d'activités ne sont pas accessibles aux enfants dysphoniques. Notre société donne beaucoup d'importance à la voix, mais curieusement sans avoir une connaissance suffisante de l'hygiène vocale. L'information et la sensibilisation des médecins et des parents semblent extrêmement urgentes pour que les enfants d'âge scolaire puissent bénéficier d'un traitement adéquat.

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part II: Improving phonation to facilitate communicatio

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.

Complications associated with tracheoesophageal voice prostheses from 2010 to 2020: A MAUDE study.

PURPOSE: Tracheoesophageal puncture with voice prosthesis placement remains the gold standard for voice restoration following total laryngectomy, but may cause various complications. This study aims to summarize patient-related and device-related adverse events associated with tracheoesophageal puncture and voice prosthesis placement. MATERIALS AND METHODS: The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to tracheoesophageal puncture with voice prosthesis placement from January 1, 2010, to April 30, 2020. Data were extracted from reports pertaining to tracheoesophageal prostheses. RESULTS: Seventy-seven reports involving tracheoesophageal voice prostheses were identified, from which 111 adverse events were extracted. Of these, 58 (52.3%) were patient-related, while 53 (47.7%) were device-related. The most frequently reported patient-related adverse events were aspirated prosthesis (24 [41.4%]), foreign body during placement (11 [19.0%]), aspiration pneumonia (9 [15.5%]), and aspirated brush tip (8 [13.8%]). The most common device-related adverse events were detached brush tip (15 [28.3%]), leak (14 [26.4%]), and torn esophageal flange (11 [20.8%]). CONCLUSIONS: While tracheoesophageal puncture with voice prosthesis placement has revolutionized voice rehabilitation following total laryngectomy, the procedure may be associated with adverse events both at the time of placement and later. Interventions aimed at improving both physician and patient education may help reduce adverse events attributed to improper use. Further research is needed to clarify optimal approaches to education.

Speech and Language Therapy for Voice Problems in Parkinson's Disease: A Meta-Analysis.

Patients with Parkinson's disease (PD) commonly have speech and voice problems that affect their functional communication and that are not sensitive to pharmacological or neurosurgical treatments. The authors aimed to evaluate the effects of speech and language therapies (SLTs) on dysphonia in patients with PD by analyzing data from published randomized controlled trials (RCTs). Studies in English and Chinese that were related to speech and language treatment for patients with PD were retrieved from PubMed, Embase, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Literature Database, and Wanfang Database. On the basis of exclusion criteria, 391 records identified through the search were reduced to 10 studies that included 230 patients in the treatment groups and 205 patients in the control groups. A meta-analysis of data from the 10 studies was performed to examine the effects of SLTs on dysphonia in patients with PD. SLTs increased sound pressure level during sustained phonation, reading of the Rainbow Passage, and monologue 6 months after treatment, enhanced semitone standard deviation during reading of the Rainbow Passage more than 12 months after treatment, and reduced Voice Handicap Index scores among patients with PD with dysphonia problems at least 3 months after treatment. These findings demonstrate the efficacy of SLTs, especially Lee Silverman Voice Treatment, in increasing vocal loudness and functional communication among patients with PD. Further RCTs with large samples and multicenter participation are needed to validate the long-term effects and the efficacy of SLTs among patients with severe PD.

Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation.

OBJECTIVES: The study aimed to investigate the short-term and long-term effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer as measured by both the acoustic measure smoothed cepstral peak prominence (CPPS) and perceptual measures. A secondary aim was to investigate the relationship between acoustic and perceptual measures. METHODS: In total, 37 patients received voice rehabilitation post-radiotherapy and 37 patients constituted the irradiated control group. Outcome measures were mean CPPS for connected speech and ratings with the auditory-perceptual Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Outcome measures were analyzed 1 (baseline), 6, 12, and 24 months post-radiotherapy, where voice rehabilitation was conducted between the first two time-points. Additional recordings were acquired from vocally healthy participants for comparison. RESULTS: CPPS values of the voice rehabilitation group and vocally healthy group were not significantly different at 24 months post-radiotherapy. Ten out of 19 patients who received voice rehabilitation yielded a CPPS value above the threshold for normal voice 24 months post-radiotherapy, compared to 11 out of 26 in the irradiated control group. No statistically significant correlations were found between CPPS and perceptual parameters of GRBAS. CONCLUSION: Voice rehabilitation for irradiated laryngeal cancer patients may have positive effects on voice quality up to 24 months post-radiotherapy. The relationship between CPPS and GRBAS as well as the applicability of CPPS for evaluation over several points of measurement needs to be studied further.

A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial.

BACKGROUND: Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN: PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME: Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION: The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.

Evaluation of vocal changes after vestibular rehabilitation in patients with balance disorders.

BACKGROUND: Although there are articles and studies that associate postural changes with changes in vocal quality, to the best of our knowledge, this was the first study investigating the association between balance disorders and voice. OBJECTIVE: This study aimed to determine whether patients with balance disorders present any clinical, acoustic, or endoscopic vocal changes, and if the correction of balance impairments, such as through vestibular rehabilitation, lead to improvement in vocal quality. METHODS: This was a prospective cohort study that analyzed vocal differences (clinical, videoendostroboscopic, audio-perceptual, and acoustic vocal parameters) in a sample of 43 patients with vestibular dysfunction at three different time points (pre-treatment, post-treatment, and 3 months' post-treatment) diagnosed by videonystagmography with changes in computerized dynamic posturography who were treated with vestibular rehabilitation. RESULTS: In pre-treatment, all of the patients presented supraglottic hyperfunction during videoendoscopic examination and abnormal values in the audio-perceptual scale. After treatment for balance disorders, there was a statistically significant improvement in some parameters of the videoendoscopic and audio-perceptual measures. These improvements were detected immediately after treatment and remained present until at least three months after treatment. CONCLUSIONS: The results suggested that the treatment for balance disorders results in changes in posture and consequently in voice quality.

Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study.

INTRODUCTION: Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. MATERIAL AND METHODS: A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. RESULTS: The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 € (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 € (SEK 552,725) per gained QALY. CONCLUSION: From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 € per gained QALY, which is just above the threshold of the maximum willingness to pay level.