The ageing voice and voice therapy in geriatrics.

BACKGROUND: Although voice therapy is commonly used as an initial treatment for geriatric dysphonia, its role in the treatment for different organic voice disorder is less defined. AIMS: The goal of this study was to investigate dysphonia and therapy modalities in this cohort. METHODS: This study analyzes the demographics, Voice Handicap Index questionnaires, and acoustic voice measures including fundamental frequency, jitter and shimmer by using Kay Elemetrics Computerized Speech Lab Multidimensional voice program which were obtained in all patients before and after treatment. A total of 91 (55 men and 36 women) patients with voice complaints, age ranging from 50 to 91 years (mean 64.11 ± 7.2) diagnosed of any vocal fold pathology were made via strobovideolaryngoscopy. RESULTS: Vocal nodules in 23.9 % (N = 22) was the most common diagnosis associated with the voice complaints, followed by laryngopharyngeal reflux in 10.8 % (N = 10) and paresis in 9.78 % (N = 9). VHI scores varied greatly, ranging from 4 to 92, with an average score of 42.7. Multidimensional voice program scores showed that fundamental frequency (F0) tends to rise as a function of age in men (mean 283.66 ± 23.7). DISCUSSION: Fundamental frequency perturbation may be affected in ageing, both genders same values detected. Of these patients, 80 % received hygienic voice therapy and % 20 symptomatic voice therapies. This study identified fundamental frequency alteration for ageing voice and dysphonia in all elderly patients presenting with voice complaints. CONCLUSION: Additional research is needed to determine normative values for multidimensional voice program scores and other assessments in the elderly population.

Phagophobia: a case report.

Phagophobia is a form of psychogenic dysphagia. Although it is characterized by a fear and avoidance of swallowing food, fluids, or pills, physical examination and laboratory findings are normal. Here, we present a case of phagophobia, who at 13 years of age was brought to our hospital by his family because of his fear and avoidance of swallowing food and loss of weight. After psychiatric interview, the patient underwent an oral peripheral examination, stroboscopic laryngeal evaluation, the Bedside Swallow Evaluation, and the Modified Barium Swallow Study. His physical examination and all laboratory findings were normal. The management of this case included the combination of behavior therapy and a dysphagia management program. After approximately one month of utilizing these techniques, the case showed considerable improvement.

[The management of swallowing disorders through rehabilitation methods]. / Yutma bozuklugu olan hastalarda rehabilitasyon yöntemleri ve sonuçlari.

OBJECTIVES: Swallowing disorders are commonly encountered in ENT practice, and dysphagia may present a challenge with respect to diagnosis and management. This study aimed to examine patients with swallowing disorders. PATIENTS AND METHODS: The study included 280 patients (153 males, 127 females; mean age 53 years; range 3-98 years) who presented with complaints of swallowing difficulties between October 2000 and June 2002. The patients were examined according to the protocol of our department for swallowing disorders, which involved a detailed history taking, a patient questionnaire on swallowing disorders, cervical auscultation, and modified barium swallow studies. When further investigation was needed, fiber-optic endoscopic swallow studies, ultrasonic evaluation of the tongue base, neck CT, and 24-hour double-probe pH monitoring were also undertaken. RESULTS: A diagnosis of a swallowing disorder (premature spills, pulling in the vallecula and/or pyriform sinuses, penetration and/or aspiration, and delayed swallow reflex) was made in 164 patients. Dysphagia arose from a mechanical cause in 55%, and from a neurological cause in 32%. A multiphase rehabilitation program was initiated, which included positioning, adjusting bolus consistency, oral-motor range of motion exercises, use of palatal devices and swallowing techniques. Rehabilitation resulted in normal swallowing in 128 patients (78%). CONCLUSION: Mechanical causes should also be sought in patients with swallowing disorders.

[The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia]. / Yutma güçlügü olan hastalarin tanisinda fiberoptik endoskopiyle yutma degerlendirmesi ve modifiye baryumlu yutma testinin etkinlikleri.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow test (MBST) in patients with dysphagia. PATIENTS AND METHODS: Eighty patients with dysphagia were evaluated in three groups consisting of 27 patients with oral, pharyngeal, or esophageal masses; 26 patients with neurogenic dysphagia; and 27 patients with no distinct pathology. All the patients underwent FEES and MBST to examine elevation of the soft palate, nasal regurgitation, pharyngeal residue, penetration, aspiration, and pooling of secretions in the pyriform sinus and vallecula. RESULTS: In neurogenic dysphagia, MBST was more efficacious in detecting aspiration and pooling in the vallecula (p<0.05). Evaluation of the internal anatomy, visualization of masses, and laryngopharyngeal sensory discrimination were only possible with the FEES. On the other hand, evaluation of the elevation of the larynx and the hyoid, the relaxation of the upper esophageal sphincter, and the oral phase of swallowing, and the detection of esophageal pathologies were only possible with the MBST. CONCLUSION: The leading advantages of the two evaluation techniques seem to lie in the detection of aspiration for the FEES, and dynamic evaluation of the oral and esophageal phases of swallowing for the MBST.

Goniometer Measurements of Oral Labial Angle and Evaluation of Oral Motor Reflexes in Preterm Infants: Comparison to Findings in Term Infants.

To date, no study has evaluated changes in oral labial angle as preterm infants mature. The main purpose of this study was to document goniometer measurements of the labial angle of the mouth in preterm infants, to assess changes with development, to compare to findings in healthy term infants, and also evaluate oral motor reflexes in these groups. Seventy-eight preterm infants and 45 healthy term infants were recruited for the prospective study. Labial angle was assessed via goniometer, and oral motor reflexes and the volume of milk ingested were evaluated. There was significant difference between term and preterm infants' labial angles (P < .01). The distribution of preterm infants' angles were similar to term infants' by 36 to 40 weeks' postmenstrual age. Goniometer measurements of the oral labial angle may reveal oral motor performance in preterm infants and may be relevant for feeding skills assessment in this group of infants.

Effects of voice therapy in school-age children.

OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia in school-age children in two different cities in Turkey. STUDY DESIGN: Retrospective cohort study. METHODS: Ninety-nine outpatients aged 7-15 years with persistent hoarseness for at least 2 months as a primary symptom. Ratings of the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale, s/z ratio, and maximum phonation time (MPT). Voice therapy outcome data collected on three types of voice therapy (physiological, hygienic, and symptomatic). SETTING: Outpatient clinics in university hospitals in two different cities in Turkey. RESULTS: Voice therapy improved voice quality as assessed by an observer according to GRBAS rating system (P<0.0001). All the subjects demonstrated varying degrees of hoarseness (G1-G3) and strained (S1-S3) voices. Varying degrees of roughness (R1-R3) and breathiness (B1-B3) were also noted. In general, changes to the value of the grade (the measure of the overall degree of voice deviance) were statistically significant (t = -8.3; P<0.0001) before and after therapy. Significant changes were found in the s/z ratio when the values were compared before and after therapy sessions (t=11.08; P<0.0001). Changes in MPT were statistically significant for all types of voice therapy (P<0.0001). CONCLUSIONS: Vocal nodules were the main cause of the school-age children's voice problems, accounting for 62.6% of the cases. Different types of voice therapy techniques could be used in school-age children. Many of these techniques can successfully restore the normal voice. However, in this study, all subjective voice ratings such as GRBAS, s/z ratio, and MPT statistically changed by symptomatic voice therapy techniques. Symptomatic voice therapy was found to be a successful method of therapy.

Use of porous polyethylene implant for augmentation of the posterior pharynx in young adult patients with borderline velopharyngeal insufficiency.

In the current study, we evaluated the efficiency of using porous polyethylene implant to correct velopharyngeal insufficiency (VPI) in young adult patients. Ten male patients with VPI, aged 21 to 27 years, underwent posterior pharyngeal wall augmentation with porous polyethylene implant. The evaluations for VPI on all patients in the study included speech evaluation of nasality and articulation, mirror test, nasopharyngoscopy, and magnetic resonance (MR) imaging. Evaluation of the methods for correcting VPI was done preoperatively and 6 months after surgery, and the results were compared. According to preoperative speech evaluation, 7 patients had severe hypernasal speech and 3 patients had moderate hypernasal speech. Follow-up evaluations demonstrated that 7 patients had normal speech without hypernasal resonance. Although all patients had nasal escape on mirror test preoperatively, only 2 had nasal escape postoperatively. When the preoperative and postoperative results of the Multi-Dimensional Voice Programme were analyzed, there was a statistically significant improvement in all parameters. The distance between the posterior pharyngeal wall and the velum during phonation observed preoperatively had disappeared in the postoperative period in all of the patients' sagittal-plane MR scans. In the axial views of the MR scans, the velopharyngeal gap area calculated preoperatively was reduced in the postoperative period. We conclude that posterior pharyngeal wall augmentation with porous polyethylene implant is an effective method in the correction of mild VPI in adult patients.