Exploring impact of recombination landscapes on breeding outcomes.

Plant breeding relies on crossing-over to create novel combinations of alleles needed to confer increased productivity and other desired traits in new varieties. However, crossover (CO) events are rare, as usually only one or two of them occur per chromosome in each generation. In addition, COs are not distributed evenly along chromosomes. In plants with large genomes, which includes most crops, COs are predominantly formed close to chromosome ends, and there are few COs in the large chromosome swaths around centromeres. This situation has created interest in engineering CO landscape to improve breeding efficiency. Methods have been developed to boost COs globally by altering expression of anti-recombination genes and increase CO rates in certain chromosome parts by changing DNA methylation patterns. In addition, progress is being made to devise methods to target COs to specific chromosome sites. We review these approaches and examine using simulations whether they indeed have the capacity to improve efficiency of breeding programs. We found that the current methods to alter CO landscape can produce enough benefits for breeding programs to be attractive. They can increase genetic gain in recurrent selection and significantly decrease linkage drag around donor loci in schemes to introgress a trait from unimproved germplasm to an elite line. Methods to target COs to specific genome sites were also found to provide advantage when introgressing a chromosome segment harboring a desirable quantitative trait loci. We recommend avenues for future research to facilitate implementation of these methods in breeding programs.

Use of portable air purifiers to reduce aerosols in hospital settings and cut down the clinical backlog.

SARS-CoV-2 has severely affected capacity in the National Health Service (NHS), and waiting lists are markedly increasing due to downtime of up to 50 min between patient consultations/procedures, to reduce the risk of infection. Ventilation accelerates this air cleaning, but retroactively installing built-in mechanical ventilation is often cost-prohibitive. We investigated the effect of using portable air cleaners (PAC), a low-energy and low-cost alternative, to reduce the concentration of aerosols in typical patient consultation/procedure environments. The experimental setup consisted of an aerosol generator, which mimicked the subject affected by SARS-CoV-19, and an aerosol detector, representing a subject who could potentially contract SARS-CoV-19. Experiments of aerosol dispersion and clearing were undertaken in situ in a variety of rooms with two different types of PAC in various combinations and positions. Correct use of PAC can reduce the clearance half-life of aerosols by 82% compared to the same indoor-environment without any ventilation, and at a broadly equivalent rate to built-in mechanical ventilation. In addition, the highest level of aerosol concentration measured when using PAC remains at least 46% lower than that when no mitigation is used, even if the PAC's operation is impeded due to placement under a table. The use of PAC leads to significant reductions in the level of aerosol concentration, associated with transmission of droplet-based airborne diseases. This could enable NHS departments to reduce the downtime between consultations/procedures.

Voice Disorders and Personality: New Steps on an Old Path.

OBJECTIVES: This study examined the association between voice disorders and personality by comparing a heterogenic group of dysphonic patients to non-dysphonic speakers using the NEO-FFI big-five personality inventory. METHODS: A group of 100 dysphonic patients diagnosed with 24 different pathologies was compared to 149 non-dysphonic speakers. Inter-group differences on the five NEO-FFI scales were evaluated using three analysis approaches, a general comparison between the dysphonic and non-dysphonic groups and arranging pathologies using a categorical and a continuous approach. RESULTS: Of the five NEO-FFI scales, Openness emerged as the single personality trait that yielded a statistically significant difference between the dysphonic group and the non-dysphonic group (P < 0.001). Moreover, when the 24 pathologies were arranged categorically, people with structural pathologies were lower on the Openness scale than non-dysphonic speakers (P < 0.001). Similarly, when pathologies were arranged continuously, people with pathologies characterized by high organicity were low on the Openness scale compared to the non-dysphonic group (P < 0.001). CONCLUSIONS: This study represents a new approach to examining the association between voice disorders and personality. Openness emerged as the single personality trait that repeatedly and consistently differentiated between dysphonic and non-dysphonic people and among specific pathologies, using all analysis approaches. Our findings suggest that examining a spectrum of pathologies, rather than focusing on a particular pathology, provides a new perspective and sheds light on the complex association between voice disorders and personality.

Development and Validation of the Children's Voice Questionnaire (CVQ).

OBJECTIVES: This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability. STUDY DESIGN: Observational, prospective, cross-sectional study. METHODS: The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability. RESULTS: High reliability was found for the CVQ (Cronbach's α = 0.94). Test-retest revealed strong and statistically significant reliability (r = 0.79, P < 0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25] = 6.22, P < 0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59 < r < 0.66, P < 0.01). CONCLUSIONS: The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings.

Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises.

INTRODUCTION: Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient. OBJECTIVE: To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy. METHODS: We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task. RESULTS: All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition. CONCLUSIONS: Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.

Voice Related Coping in Professional Voice Users-A Systematic Review.

OBJECTIVES: This systematic review explored coping with voice problems in professional voice users. The objectives were to: 1) evaluate how voice-related coping is assessed in professional voice users 2) investigate how they cope with voice problems, and 3) identify factors associated with voice-related coping. DESIGN: Systematic review. METHODS: A systematic literature search of ten electronic databases using both EBSCOhost and OVID online platforms was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Only peer-reviewed articles which assessed coping in the context of voice problems in professional voice users were included. Methodological quality was assessed using Johanna-Briggs Institute Critical Appraisal checklists. Data analysis was conducted using narrative synthesis. RESULTS: Following deduplication, abstract and full-text screening, seven articles were included in the review. All participants (n=2484) were teachers; no other professional voice users were covered. 98% of the cases studied were females. The tools used to assess voice-related coping were Utrecht Coping List (UCL) and Voice Disability Coping Questionnaire (VDCQ). Studies which used UCL reported a passive coping pattern in teachers with high vocal handicap whereas VDCQ showed increased use of social support. Factors associated with coping were not examined by any of the studies. CONCLUSION: Seeking social support was highlighted as a frequently used coping strategy across studies and measures. Teachers with high vocal handicap used a passive coping pattern and active coping styles were not significantly used. Current evidence does not sufficiently specify factors affecting coping in professional voice users. More research on voice-related coping involving all professional voice users is warranted to identify associated factors and further ascertain its influence on vocal health.

Quantification of Respirable Aerosol Particles from Speech and Language Therapy Exercises.

INTRODUCTION: Voice assessment and treatment involve the manipulation of all the subsystems of voice production, and may lead to production of respirable aerosol particles that pose a greater risk of potential viral transmission via inhalation of respirable pathogens (eg, SARS-CoV-2) than quiet breathing or conversational speech. OBJECTIVE: To characterise the production of respirable aerosol particles during a selection of voice assessment therapy tasks. METHODS: We recruited 23 healthy adult participants (12 males, 11 females), 11 of whom were speech-language pathologists specialising in voice disorders. We used an aerodynamic and an optical particle sizer to measure the number concentration and particle size distributions of respirable aerosols generated during a variety of voice assessment and therapy tasks. The measurements were carried out in a laminar flow operating theatre, with a near-zero background aerosol concentration, allowing us to quantify the number concentration and size distributions of respirable aerosol particles produced from assessment/therapy tasks studied. RESULTS: Aerosol number concentrations generated while performing assessment/therapy tasks were log-normally distributed among individuals with no significant differences between professionals (speech-language pathologists) and non-professionals or between males and females. Activities produced up to 32 times the aerosol number concentration of breathing and 24 times that of speech at 70-80 dBA. In terms of aerosol mass, activities produced up to 163 times the mass concentration of breathing and up to 36 times the mass concentration of speech. Voicing was a significant factor in aerosol production; aerosol number/mass concentrations generated during the voiced activities were 1.1-5 times higher than their unvoiced counterpart activities. Additionally, voiced activities produced bigger respirable aerosol particles than their unvoiced variants except the trills. Humming generated higher aerosol concentrations than sustained /a/, fricatives, speaking (70-80 dBA), and breathing. Oscillatory semi-occluded vocal tract exercises (SOVTEs) generated higher aerosol number/mass concentrations than the activities without oscillation. Water resistance therapy (WRT) generated the most aerosol of all activities, ∼10 times higher than speaking at 70-80 dBA and >30 times higher than breathing. CONCLUSIONS: All activities generated more aerosol than breathing, although a sizeable minority were no different to speaking. Larger number concentrations and larger particle sizes appear to be generated by activities with higher suspected airflows, with the greatest involving intraoral pressure oscillation and/or an oscillating oral articulation (WRT or trilling).

Spatiotemporal droplet dispersion measurements demonstrate face masks reduce risks from singing.

COVID-19 has restricted singing in communal worship. We sought to understand variations in droplet transmission and the impact of wearing face masks. Using rapid laser planar imaging, we measured droplets while participants exhaled, said 'hello' or 'snake', sang a note or 'Happy Birthday', with and without surgical face masks. We measured mean velocity magnitude (MVM), time averaged droplet number (TADN) and maximum droplet number (MDN). Multilevel regression models were used. In 20 participants, sound intensity was 71 dB for speaking and 85 dB for singing (p < 0.001). MVM was similar for all tasks with no clear hierarchy between vocal tasks or people and > 85% reduction wearing face masks. Droplet transmission varied widely, particularly for singing. Masks decreased TADN by 99% (p < 0.001) and MDN by 98% (p < 0.001) for singing and 86-97% for other tasks. Masks reduced variance by up to 48%. When wearing a mask, neither singing task transmitted more droplets than exhaling. In conclusion, wide variation exists for droplet production. This significantly reduced when wearing face masks. Singing during religious worship wearing a face mask appears as safe as exhaling or talking. This has implications for UK public health guidance during the COVID-19 pandemic.

A Pilot Study Assessing the Therapeutic Potential of a Vibratory Positive Expiratory Pressure Device (Acapella Choice) in the Treatment of Voice Disorders.

INTRODUCTION: Semioccluded vocal tract exercises (SOVTEs) can involve a single source of vibration (eg, vocal folds in the straw exercise) or a dual source of vibration (eg, vocal folds and water bubbling in tube phonation) in the vocal tract. Oftentimes, this secondary source of vibration causes large oscillations in intraoral pressure and has been likened to a "massage effect." This study assesses the implementation of a positive expiratory pressure device (Acapella Choice) as a possible alternative SOVTE, which presents a secondary source of vibration without the need of a water container. METHODS: Twenty-two normophonic participants underwent acoustic, electroglottographic, and aerodynamic assessment before, during, and after phonation with two different established SOTVEs (silicone tube in water and straw in air) in addition to Acapella Choice. RESULTS: Acapella Choice produced the largest peak-to-peak amplitudes of intraoral pressure oscillation. Straw in air produced the largest static intraoral pressure. Straw in air and Acapella Choice presented significantly larger ranges of static pressures than tube in water phonation. Post-exercise condition showed a statistically larger sound pressure level for Acapella Choice. CONCLUSIONS: Positive expiratory pressure devices, such as Acapella Choice, may be a promising alternative to established SOVTEs as it promotes large oscillatory pressures in the vocal tract without the need for a water container. This exercise also produces larger sound pressure level with no significant changes in glottic contact quotient, indicating improved vocal economy.

Validation of the Brazilian Version of the Voice Disability Coping Questionnaire.

PURPOSE: To perform the validation of the Brazilian version of the Voice Disability Coping Questionnaire (B-VDCQ) using procedures according to the Scientific Advisory Committee of Medical Outcomes Trust and psychometric analyses to determine the scales validity and reliability. METHODS: In the preliminary procedures, the VDCQ was administered to 14 patients to determine if items were culturally valid and propose possible adaptations for a B-VDCQ. The sample of this study consisted of a data set of 178 individuals, 87 with vocal complaint, comprising 19 men and 68 women, with mean age of 34.1 years and 91 without vocal complaint, comprising 29 men and 62 women, with mean age of 32.4 years. To demonstrate validity, the B-VDCQ scores were compared to vocal self-assessment and perceptual analysis. To determine the reliability and test-retest reproducibility, 14 voice patients repeated the measurement between 3 and 14 days after the first administration. RESULTS: Principal component analyses of the patients with vocal complaint yielded four coping strategies: venting, support seeking, minimisation, and avoidant acceptance. Subscales of the questionnaire showed acceptable internal consistency and reproducibility values, apart from the minimisation subscale. B-VDCQ validity was demonstrated through relationships with perceptual analyses and vocal self-assessment and subscale score differences between the two groups. CONCLUSIONS: The B-VDCQ has been submitted to essential steps necessary for cultural adaptation and validation. It is a simple instrument to administer and shows to be specific for evaluating patients with voice problems. The B-VDCQ can be an important addition to the voice evaluation of patients with dysphonia.

Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.

INTRODUCTION: Semi-occluded vocal tract exercises (SOVTE) are often used in voice clinics. SOVTE change the acoustic vocal tract impedance in relation to the glottis impedance, improving voice quality. However, differences among SOVTE, such as the number of vibration sources into the vocal tract, are often disregarded by clinicians. Some SOVTE present single, whereas others double source. This study aims at investigating changes in voice production pattern for a series of SOVTE. A combined exercise (tongue-trill coupled with hand-over-mouth) was implemented to illustrate the effect of a secondary source of vibration in the vocal tract. METHOD: Twenty-three healthy volunteers performed a series of SOVTE: LaxVox, straw, lip-trill, tongue-trill, hand-over-mouth, humming, and tongue-trill combined with hand-over-mouth. Comfortable phonation served as control exercise. The dependent variables were electroglottography contact quotient (CQ), contact quotient range (CQr), fundamental frequency (F0), fundamental frequency range, and difference between the first formant frequency and F0 (F1 - F0). RESULTS: A significant difference for CQr scores compared with comfortable phonation was found for the combined tongue-trill with hand-over-mouth, lip-trill, LaxVox, and tongue-trill exercises. The F1 - F0 acoustic analysis showed significant differences in scores for exercises with one versus two sources of vibration. DISCUSSION AND CONCLUSION: The results indicate that SOVTE should be divided into two groups, as follows: (a) steady (single sourced) with lower CQr and F1 - F0 difference (hand-over-mouth, humming, and straw) and (b) fluctuating (dual source) with larger CQr and F1 - F0 difference (tongue-trill, lip-trill, and LaxVox). Because of these differences, also different therapeutic effects can be expected. Tongue-trill combined with hand-over-mouth exhibited mixed effects of both the exercise groups.

Coping strategies in voice disorders of a Brazilian population.

The purpose of this research is to explore coping strategies of individuals with and without vocal complaint and to examine relationships between the type of coping and vocal complaint; vocal symptoms; vocal self-assessment; perceptual analysis and states of depression, anxiety, and aspects related to self-esteem; and locus of control. One hundred seventy-eight subjects with (n=87) and without vocal (n=91) complaint completed the following analysis: identification and characterization questionnaire, vocal self-assessment, perceptual analysis, Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version, Beck Depression Inventory, Rosenberg Self-esteem Scale, Spielberger State-Trait Anxiety Inventory, and Health Locus of Control Scale. Age (P=0.219) and sex (P=0.132) were similar for both groups. The groups were statistically different for the following vocal characterization: number of symptoms, voice complaint, vocal self-assessment, and perceptual analysis. Conversely, the groups did not differ on states of depression, anxiety, and aspects related to self-esteem; and locus of control. Mean coping scores for the group with vocal complaint was 51.86 and for the group without vocal complaint was 23.18. Furthermore, men and women did not differ on the coping strategies reported (P=0.750); however, individuals with vocal complaint reported statistically more strategies than the individuals without vocal complaint (P<0.001). Problem-focused strategies were more frequently reported by individuals with vocal complaint (46.7%). Coping results correlated (Spearman's r) positively with vocal perceptual analysis (P=0.036), depression (P=0.006), and anxiety (P=0.022), and correlated negatively with locus of control (P=0.001). No correlation was found between coping and the other variables studied. These findings indicate that people with vocal complaint use a variety of coping strategies, problem focused in particular, to deal with their voice problems. Coping results appear to be associated with perceptual characteristics of voice and some traits, such as depression, anxiety, and locus of control.

An investigation of abdominal muscle recruitment for sustained phonation in 25 healthy singers.

OBJECTIVES: The purpose of this study was to investigate the baseline muscle thickness and recruitment patterns of the transversus abdominis muscle (TAM) and the internal oblique muscle (IOM) during semisupine phonation in a group of healthy performers. STUDY DESIGN: This was a 2 × 3×2 within-group, repeated-measure study in which 25 professional vocalists--12 male and 13 female performed a series of sustained pitches in differing vocal qualities. Measurements were taken with ultrasound (Sonosite Micromaxx Ultrasound System) of the baseline thickness and % recruitment during voicing, of two deep abdominal muscles--TAM and the IOM. Correlations between TAM and IOM absolute change scores, TAM and IOM percentage change scores, and changes in muscle thickness (absolute and percentage) and age were examined using Spearman's correlations. Gender differences in the four types of change scores within each combination of pitch and quality were conducted with one-way analysis of variances. Differences in muscle thickness change 1) absolute scores and 2) percentage change in TAM and IOM, by pitch and quality (and their interactions) were analyzed using linear mixed models, using restricted maximum likelihood estimations, employing a Toeplitz variance-covariance matrix structure in SPSS (IBM, 2011). Post hoc analyses for independent variable group differences used Sidak's correction for multiple comparisons. Alpha level was set to 0.05. RESULTS: In terms of absolute contractions (changes in the actual millimeter thickness of the muscle), the IOM was greater than the TAM. However in terms of percentage changes in muscles during phonation, the TAM was always greater than the IOM. The TAM as a percentage change was recruited preferentially and significantly in most vocal qualities tested. Although there were differences in muscle mass and recruitment patterns between genders, and males had thicker muscle mass at rest, differences due to muscle mass were not conclusive. CONCLUSIONS: Overall this study supports the argument that the peri-abdominal muscles do indeed play a role in supporting the "performing" or athletic voice in healthy subjects, and will hopefully act as a database for further research in individuals with healthy and injured voices.

Investigation of the impact of thyroid surgery on vocal tract steadiness.

INTRODUCTION: Subjective nonspecific upper aerodigestive symptoms are not uncommon after thyroid surgery. These are postulated to be related to injury of an extrinsic perithyroid nerve plexus that innervates the muscles of the supraglottic and glottic larynx. This plexus is thought to receive contributing branches from both the recurrent and superior laryngeal nerves. PATIENTS AND METHODS: The technique of linear predictive coding was used to estimate the F(2) values from a sustained vowel /a/ in patients before and 48 hours after thyroid or parathyroid surgery. These patients were controlled against a matched pair undergoing surgery without any theoretical effect on the supraglottic musculature. In total, 12 patients were recruited into each group. Each patient had the formant frequency fluctuation (FFF) and the formant frequency fluctuation ratio (FFFR) calculated for F(1) and F(2). RESULTS: Mixed analysis of variance (ANOVA) for all acoustic parameters revealed that the chiF(2)FF showed a significant "time" main effect (F(1,22)=7.196, P=0.014, partial eta(2)=0.246) and a significant "time by group interaction" effect (F(1,22)=8.036, P=0.010, eta(p)(2)=0.268), with changes over time for the thyroid group but not for the controls. Similarly, mean chiF(2)FFR showed a similar significant "time" main effect (F(1,22)=6.488, P=0.018, eta(p)(2)=0.228) and a "time by group interaction" effect (F(1,22)=7.134, P=0.014, eta(p)(2)=0.245). CONCLUSIONS: This work suggests that thyroid surgery produces a significant reduction in vocal tract stability in contrast to the controls. This noninvasive measurement offers a potential instrument to investigate the functional implications of any disturbance that thyroid surgery may have on pharyngeal innervations.

A single-centre retrospective review of unilateral and bilateral Dysport injections in adductor spasmodic dysphonia.

We reviewed the results and side-effect profile of the Dysport preparation of botulinum toxin A (BTA) in the management of the adductor spasmodic dysphonia. We performed 272 injection episodes in 68 patients, 42 (62%) female, 26 (38%) male. A total of 116 of these injections were unilateral, and 156 were bilateral; 94% of the injections were considered to have been successful with a voice score of 2 or higher. The mean duration of effect (injection intervals) was 128.8 days in the unilateral cohort and 118.7 days in the bilateral (P > 0.05). We injected a relatively lower dose of BTA for unilateral injection episodes in our institution compared to those reported by others to produce comparable results and side-effect profiles.

How do individuals cope with voice disorders? Introducing the Voice Disability Coping Questionnaire.

Coping is a key concept in psychological medicine, which refers to the way in which people deal with the stress of illness. Voice disorders may have pervasive effects upon the individual's life beyond the vocal impairment yet, there is little reference in current literature as to how people cope with voice problems. This study explored and validated the Voice Disability Coping Questionnaire (VDCQ), a newly developed disease-specific coping measure, which elicits how patients cope with voice problems. Eighty subjects presenting with muscle tension dysphonia (MTD) and adductor spasmodic dysphonia (ASD) completed a 28-item VDCQ as part of an initial assessment protocol before intervention, within a longitudinal study. Principal component analyses were used to investigate the underlying structure of this questionnaire; analyses of variance were used to determine group differences in coping strategies. The principal component analyses generated four coping subscales: "social support," "passive coping," "avoidance," and "information seeking" measured over 15 items. The subscales revealed logical correlations between them. Avoidance and passive coping were found to be used by the ASD group significantly more than the MTD group. This study provided initial evidence for the validity and reliability of the VDCQ; it differentiated between clinical groups and may facilitate a patient-centered approach, which enhances the understanding of voice disorders.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study.

OBJECTIVES: In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. METHOD AND MATERIALS: Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. RESULTS: Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. CONCLUSION: Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.