RESUMEN
This study investigates the effect of different mixers and the applicability of the mixing energy (ME) concept to dry powder formulations for inhalation. With the aim to step-wise build and expand this concept, adhesive mixtures of 2 % budesonide and lactose carrier were investigated, both with 1 % magnesium stearate (MgSt) added in a 'coating' step, and without, the latter referred to as 'naked' formulations. For high shear mixed formulations, the fine particle fraction (FPF) was found to increase with increasing ME up to 60 % and thereafter decreased, using the Novolizer device. The data could be well fitted to the modeling equation, thus confirming the validity of the ME concept. The naked formulations displayed a linear decrease in FPF with increasing ME, again showing the validity of the ME concept. For Turbula mixed formulations, FPF increased with increased mixing time (and mixing energy) for all batches. The naked (binary) composition reached to higher FPF values than for high shear mixing and the formulation with MgSt reached to FPF values around 60 %, demonstrating that it is possible to achieve the same high drug dispersibility with the Turbula mixer as for high shear mixer. An equation for calculation of mixing energy in Turbula mixing was set up in an analogous way to the equation for high shear mixing, which enabled direct comparison between the two mixers.
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Adhesivos , Química Farmacéutica , Portadores de Fármacos , Administración por Inhalación , Budesonida , Polvos , Tamaño de la Partícula , Lactosa , Inhaladores de Polvo SecoRESUMEN
OBJECTIVES: The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy. METHODS: A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis. RESULTS: Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments. CONCLUSIONS: The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning.
RESUMEN
The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.
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Formación del Profesorado , Trastornos de la Voz , Femenino , Humanos , Prevalencia , Factores de Riesgo , Estudiantes , Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/epidemiologíaRESUMEN
OBJECTIVE: A stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy. METHODS: A randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy. RESULTS: All VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up. CONCLUSIONS: This study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.
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Psicoterapia de Grupo , Trastornos de la Voz/terapia , Calidad de la Voz , Entrenamiento de la Voz , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recuperación de la Función , Suecia , Factores de Tiempo , Resultado del Tratamiento , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Adulto JovenRESUMEN
The aim of this study was to investigate voice function in patients with birch pollen allergy. Voice recordings for acoustic analysis were performed during pollen season and non-pollen season, with 30 patients and 30 controls, and all participants answered a questionnaire about voice symptoms. The results show that the patients reported more voice symptoms than controls during both seasons. In the non-pollen season the symptoms were decreased in the patient group but not in the controls. Speaking fundamental frequency was lower in patients compared to controls during both seasons. The results suggest chronic edema of the vocal folds in the patients. Laryngeal examination with stroboscope was not performed but is recommended for future patients diagnosed with an air-borne allergy.
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Betula/efectos adversos , Polen/efectos adversos , Rinitis Alérgica Estacional/epidemiología , Acústica del Lenguaje , Trastornos de la Voz/epidemiología , Calidad de la Voz , Acústica , Adulto , Betula/inmunología , Estudios de Casos y Controles , Edema/epidemiología , Edema/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polen/inmunología , Prevalencia , Rinitis Alérgica Estacional/diagnóstico , Rinitis Alérgica Estacional/inmunología , Estaciones del Año , Medición de la Producción del Habla , Encuestas y Cuestionarios , Suecia/epidemiología , Factores de Tiempo , Pliegues Vocales/fisiopatología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatologíaRESUMEN
OBJECTIVES: Teachers are at risk of developing voice disorders, but longitudinal studies on voice problems among teachers are lacking. The aim of this randomized trial was to investigate long-term effects of voice education for teacher students with mild voice problems. In addition, vocal health was examined prospectively in a group of students without voice problems. METHODS: First-semester students answered three questionnaires: one about background factors, one about voice symptoms (Screen6), and the Voice Handicap Index. Students with voice problems according to the questionnaire results were randomized to a voice training group or a control group. At follow-up in the sixth semester, all students answered Screen6 again together with four questions about factors that could have affected vocal health during their teacher education. The training group and the control group also answered the Voice Handicap Index a second time. RESULTS: At follow-up, 400 students remained in the study: 27 in the training group, 54 in the control group, and 319 without voice problems at baseline. Voice problems had decreased somewhat more in the training group than in the control group, but the difference was not statistically significant (P = 0.1). However, subgroup analyses showed significantly larger improvement among the students in the group with complete participation in the training program compared with the group with incomplete participation. Of the 319 students without voice problems at baseline, 14% had developed voice problems. CONCLUSIONS: Voice problems often develop in teacher students. Despite extensive dropout, our results support the hypothesis that voice education for teacher students has a preventive effect.
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Educación en Salud , Enfermedades Profesionales/prevención & control , Salud Laboral , Servicios Preventivos de Salud/métodos , Estudiantes , Formación del Profesorado/métodos , Trastornos de la Voz/prevención & control , Calidad de la Voz , Adulto , Curriculum , Evaluación de la Discapacidad , Femenino , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Enfermedades Profesionales/fisiopatología , Estudios Prospectivos , Factores de Riesgo , Estudiantes/psicología , Encuestas y Cuestionarios , Suecia , Factores de Tiempo , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Adulto JovenRESUMEN
The stumbling-block in voice therapy is the patient's generalization of the new voice behavior in everyday life. Traditionally voice therapy is based on demonstration, i.e. during the therapy session the speech therapist uses her own voice and body to demonstrate for the patient how to produce voice in different training tasks. During the last decade a new voice therapy strategy, the Verbal Instruction Model (VIM), has been developed by the author. In VIM the speech therapist uses verbal instructions instead of demonstration when conveying the training tasks to the patient. Our clinical experience has shown that VIM seems to help getting over the stumbling-block of generalization. However, evidence for VIM voice therapy outcome remains to be scientifically studied and confirmed. The purpose of this paper is to describe VIM voice therapy and to discuss therapy strategies in the light of motor learning principles.
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Aprendizaje , Modelos Teóricos , Actividad Motora , Patología del Habla y Lenguaje/métodos , Conducta Verbal , Trastornos de la Voz/rehabilitación , Entrenamiento de la Voz , Voz , Generalización Psicológica , Humanos , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicologíaRESUMEN
Teacher students seem to have low awareness of the vocal demands in their future professions, and students with vocal symptoms are at risk for developing voice disorders during their professional careers. The purpose of the present study was to determine the prevalence of voice problems in teacher students at the very beginning of their education at the university. Of 1636 students approached in the first couple of days, 1250 (76%) answered two questionnaires about voice symptoms, Screen6 and Swedish Voice Handicap Index (Sw-VHI), and one questionnaire about potential risk factors. A majority of the students were women, and their mean age was 23 years (range, 18-52 years). The results showed that 208 of 1250 students (17%) had voice problems, defined as at least two symptoms weekly or more often in Screen6. The proportion of women was larger in the group with voice problems than in the group without voice problems. Significant risk factors for voice problems were vocal fold problems in childhood and adulthood, frequent throat infections, airborne allergy, smoking, hearing problems, previous work as teacher or leader, voice demanding hobbies, and previous speech therapy or voice training. There was a clear association between the number of potential vocal risk factors and the number of voice symptoms. There was also a strong association between the scores of the two questionnaires, the Sw-VHI and the Screen6. Students with voice problems according to Screen6 scored 23.1 (mean Sw-VHI) compared with 7.8 for students without voice problems.
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Educación Profesional/estadística & datos numéricos , Docentes/estadística & datos numéricos , Enfermedades Profesionales/epidemiología , Estudiantes/estadística & datos numéricos , Trastornos de la Voz/epidemiología , Calidad de la Voz , Adolescente , Adulto , Distribución de Chi-Cuadrado , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/fisiopatología , Valor Predictivo de las Pruebas , Prevalencia , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios , Suecia/epidemiología , Universidades/estadística & datos numéricos , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Adulto JovenRESUMEN
Mean fundamental frequency (F(0)) values are often used in research on vocal load. In this study, we examine how the mean F(0) differs when evaluated through pronouncing a standard phrase as compared to the mean F(0) obtained in a real work/play environment. We also examine how the F(0) values change throughout the day. The study was performed in a preschool, nine adult female preschool teachers and 11 children participated. The participants wore a digital recorder equipped with an accelerometer, which was attached to the neck. In the study, the participant first pronounced a standard phrase in a controlled environment; thereafter, the voice was recorded in the environment where both children and adults normally reside throughout the day, denoted by the work/play environment. For each participant, the procedure was repeated four times throughout the day. Analyses showed that the F(0) values of the children's and adult's voices were significantly higher when recorded in the work/play environment as compared to the controlled environment. The average difference was 36 Hz for adults and 24 Hz for children. Previous studies have shown an increase of F(0) over the day for teachers. In this study, an increase between morning and afternoon values was found amounting to 8 Hz for adults and 24 Hz for children. For the child population, this increase was statistically significant. However, the total changes over the day revealed a somewhat more complex scheme, with an increase of F(0) in the morning, a decrease during lunch, and finally an increase in the afternoon. This pattern was verified statistically for the joint child-adult population.
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Ambiente , Docentes , Relaciones Interpersonales , Acústica del Lenguaje , Habla , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ocupaciones , Fotoperiodo , Juego e Implementos de Juego , Factores de Tiempo , Adulto JovenRESUMEN
The objective of this study was to evaluate a Swedish version of the voice handicap index questionnaire (Sw-VHI). A total of 57 adult, dysphonic patients and 15 healthy controls completed the Sw-VHI and rated the degree of vocal fatigue and hoarseness on visual analogue scales. A perceptual voice evaluation was also performed. Test-retest reliability was analyzed in 38 subjects without voice complaints. Sw-VHI distinguished between dysphonic subjects and controls (P<0.001). The internal consistency (Cronbach's alpha > 0.84) and test-retest reliability (intraclass correlation coefficient >0.75) were good. Only moderate or weak correlations were found between Sw-VHI and the subjective and perceptual voice ratings. The data indicate that a difference above 13 points for the total Sw-VHI score and above 6 points for the Sw-VHI subscales is significant for an individual when comparing two different occasions. In conclusion, the Sw-VHI appears to be a robust instrument for assessment of the psycho-social impact of a voice disorder. However, Sw-VHI seems to, at least partly, capture different aspects of voice function to the subjective voice ratings and the perceptual voice evaluation.
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Evaluación de la Discapacidad , Disfonía/diagnóstico , Voz , Adulto , Anciano , Anciano de 80 o más Años , Fatiga , Femenino , Ronquera , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Autoevaluación (Psicología) , Encuestas y Cuestionarios , Suecia , Adulto JovenRESUMEN
OBJECTIVE: To assess objective and subjective voice parameters among Turner syndrome (TS) women in relation to genotype, hearing, growth, and previous treatment with growth hormone (GH) and androgen given that lowering of speaking fundamental frequency (SFF) during treatment is regarded as a negative side effect. STUDY DESIGN: Cross-sectional, controlled for karyotype and age. METHODS: Voice function was studied objectively (SFF) and subjectively (questionnaire) in 117 women with TS. RESULTS: SFF did not differ between treated and nontreated participants or between patients with a spontaneous versus induced puberty. SFF was dependent on karyotype but not age. Subjective voice change was reported four times more often among treated compared with nontreated TS women (odds ratio [OR] = 4.4; 95% confidence interval [CI]: 0.9-20.10), whereas voice and articulation problems were reported three times more often among untreated compared with treated cases (OR = 2.9; 95% CI: 1.0-8.3). Voice symptoms were over-represented among patients having micrognathia (OR = 6.0; 95% CI: 1.6-22.3), hearing loss (OR = 8.6; 95% CI: 1.7-43.1), and monosomy (OR = 6.2; 95% CI: 0.8-36.2) but not among those with an arched palate. CONCLUSIONS: When given to TS girls, GH (33-66 microg/kg/d) and androgen (0.05 mg/kg/d) normalized SFF and reduced voice and articulation problems in adulthood. The TS phenotype includes important voice and speech problems, which in turn are associated with hearing problems, although genotypic, monosomic, and isochromosome patients have more voice problems and also more high-pitched voices than mosaic patients. Most TS women, despite their karyotype or age, exhibit a higher frequency of pitched voice than non-TS women.
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Andrógenos/uso terapéutico , Hormona del Crecimiento/uso terapéutico , Habla/fisiología , Síndrome de Turner/tratamiento farmacológico , Síndrome de Turner/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Audición/fisiología , Humanos , Cariotipificación , Persona de Mediana Edad , Mosaicismo , Encuestas y Cuestionarios , Síndrome de Turner/genética , Voz/fisiologíaRESUMEN
Voice problems are seldom reported in pollen allergy, although the allergic reaction involves the entire airways. The objective of this study was to investigate voice dysfunction during the pollen season in patients with allergic rhinitis. Thirty patients with verified birch pollen allergy and 30 controls were investigated twice, during the pollen season and outside the pollen season. Both times they scored respiratory and voice symptoms, the latter with the validated questionnaire Voice Handicap Index (VHI), and performed standardized voice recordings. These recordings were analyzed in a controlled manner by a professional voice therapist. During the allergy season, patients reported more respiratory and voice symptoms compared with controls. Those with blinded scored voice dysfunction scored their voice quality during springtime as 31 mm (95% confidence interval [CI] 20-42 mm), compared with 13 mm (95% CI 6-21 mm for participants without voice dysfunction (P<0.01). Furthermore, the group with experienced voice dysfunction scored significantly higher on the VHI in the functional and physical domains and in the total VHI score. Although voice problems during the pollen season are rarely discussed, in allergic rhinitis the larynx may also be involved. These findings support that some patients experience voice change, an experience which can be objectively confirmed.
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Rinitis Alérgica Estacional/epidemiología , Trastornos de la Voz/epidemiología , Calidad de la Voz , Adulto , Femenino , Humanos , Inmunoglobulina E/inmunología , Masculino , Rinitis Alérgica Estacional/inmunologíaRESUMEN
BACKGROUND: Human papillomavirus (HPV) in tonsillar carcinoma is correlated with favourable clinical outcome. Here, p16(INK4A), in situ HPV DNA hybridisation (ISH) and HPVL1 capsid detection were evaluated in tonsillar carcinoma to predict the response to radiotherapy (RT) and prognosis. MATERIALS AND METHODS: Fifty-one pre-treatment paraffin-embedded tonsillar cancer biopsies were analysed. Immunohistochemistry (IHC) was used for p16(INK4A) and HPVL1 capsid analysis and PCR and ISH for HPV detection. RESULTS: High-risk HPV DNA was detected by PCR in 49% of the tumours. P16(INK4a) staining was correlated to HPV In the high-grade p16(INK4a) staining group, 94% had a complete RT response. High p16(INK4a) staining as well as the HPV PCR-positive cases had a favourable prognosis. HPV DNA ISH and L1 IHC could not predict RT response or clinical outcome. CONCLUSION: P16(INK4a) overexpression was correlated to HPV in tonsillar carcinoma and is useful for predicting RT response and prognosis in tonsillar carcinoma patients.
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Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/virología , Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , Neoplasias Tonsilares/radioterapia , Neoplasias Tonsilares/virología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/metabolismo , ADN Viral/genética , Femenino , Humanos , Inmunohistoquímica , Hibridación in Situ , Masculino , Persona de Mediana Edad , Papillomaviridae/genética , Reacción en Cadena de la Polimerasa , Pronóstico , Neoplasias Tonsilares/metabolismo , Resultado del TratamientoRESUMEN
In about 50% of classical Hodgkin lymphomas, the Hodgkin/Reed Sternberg (H/RS) cells carry Epstein-Barr virus (EBV). The viral gene expression in these cells is restricted to EBNA-1, EBERs, LMP-1 and LMP-2 (type II latency). The origin of H/RS cells was defined as crippled germinal center B cells that escaped apoptosis. In spite of numerous attempts, only few typical Hodgkin lymphoma (HL) lines have been established. This suggests that the cells require survival factors that they receive in the in vivo microenvironment. If EBV is expected to drive the cells for growth in culture, the absence of EBNA-2 may explain the incapacity of H/RS cells for in vitro proliferation. In EBV carrying B lymphocytes, functional EBNA-2 and LMP-1 proteins are required for in vitro growth. For analysis of the interaction between EBV and the H/RS cells, we infected the CD21-positive HL line KMH2 with the B958 and Akata viral strains. Only EBNA-1 expression was detected in a few cells in spite of the fact that all cells could be infected. Using a neomycin-resistance-tagged recombinant EBV strain (Akata-Neo) we established an EBV-positive subline that was carried on selective medium. In contrast to the type II EBV expression pattern of H/RS cells in vivo, the KMH2 EBV cells did not express LMP-1. The EBV expression pattern could be modified in this type I subline. LMP-1 could be induced by the histone deacetylase inhibitors TSA and n-butyrate, by 5-AzaC, a demethylating agent, and by phorbol ester. None of these treatments induced EBNA-2. Importantly, exposure to CD40 ligand and IL-4 induced LMP-1 without EBNA-2 expression and lytic replication. The KMH2 EBV cells expressed LMP-2A, but not LMP-2B mRNAs. This result is highly relevant for the type II expression pattern of H/RS cells in vivo, since these stimuli can be provided by the surrounding activated T lymphocytes.