RESUMEN
OBJECTIVES: This study examined the effects of a combination corticosteroid plus long-acting beta2 -adrenergic agonist inhaler (IC) on rabbit phonation. METHODS: White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2 O) and flow (PTF; L/min) were quantified. RESULTS: Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. CONCLUSION: Following 8-week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. LEVEL OF EVIDENCE: NA Laryngoscope, 133:2680-2686, 2023.
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Corticoesteroides , Trastornos de la Voz , Conejos , Masculino , Animales , Combinación Fluticasona-Salmeterol , Nebulizadores y Vaporizadores , Fonación , Administración por InhalaciónRESUMEN
Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.
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Percepción del Habla , Voz , Acústica , Adolescente , Adulto , Femenino , Humanos , Acústica del Lenguaje , Medición de la Producción del Habla , Adulto JovenRESUMEN
OBJECTIVE: To delineate research priorities for improving clinical management of laryngeal dystonia, the NIH convened a multidisciplinary panel of experts for a 1-day workshop to examine the current progress in understanding its etiopathophysiology and clinical care. METHODS: The participants reviewed the current terminology of disorder and discussed advances in understanding its pathophysiology since a similar workshop was held in 2005. Clinical and research gaps were identified, and recommendations for future directions were delineated. RESULTS: The panel unanimously agreed to adopt the term "laryngeal dystonia" instead of "spasmodic dysphonia" to reflect the current progress in characterizations of this disorder. Laryngeal dystonia was recognized as a multifactorial, phenotypically heterogeneous form of isolated dystonia. Its etiology remains unknown, whereas the pathophysiology likely involves large-scale functional and structural brain network disorganization. Current challenges include the lack of clinically validated diagnostic markers and outcome measures and the paucity of therapies that address the disorder pathophysiology. CONCLUSION: Research priorities should be guided by challenges in clinical management of laryngeal dystonia. Identification of disorder-specific biomarkers would allow the development of novel diagnostic tools and unified measures of treatment outcome. Elucidation of the critical nodes within neural networks that cause or modulate symptoms would allow the development of targeted therapies that address the underlying pathophysiology. Given the rarity of laryngeal dystonia, future rapid research progress may be facilitated by multicenter, national and international collaborations.
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Disfonía , Distonía , HumanosRESUMEN
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Disfonía , Voz , Acústica , Adolescente , Adulto , Femenino , Humanos , Acústica del Lenguaje , Medición de la Producción del Habla , Calidad de la Voz , Adulto JovenRESUMEN
Purpose This study examined differences in selected acoustic measures of speech and voice according to age and sex and across families. Method Participants included 169 individuals, 79 men and 90 women, from 18 families, ranging in age from 17 to 87 years. Participants reported no history of articulation disorders, stroke or active neurologic disease, or severe-to-profound hearing loss. They read aloud two passages to facilitate examination of the following speech and voice acoustic parameters: fricative spectral moments (center of gravity, standard deviation, skewness, and kurtosis), the proportion of time spent speaking, mean speaking fundamental frequency, semitone standard deviation (STSD), and cepstral peak prominence smoothed. Results The results indicated a significant age effect for fricative spectral center of gravity, spectral skewness, and speaking STSD. There was a significant sex effect for spectral center of gravity, spectral kurtosis, and mean fundamental frequency. Familial relationship was significant for spectral skewness, STSD, and cepstral peak prominence smoothed. Conclusions These findings revealed that certain speech and voice features change with age and some change differently for men and women. Additionally, speakers from the same family units may demonstrate similar patterns for prosody, voicing, and articulatory behavior. The results also demonstrated normal differences in speech and voice variation across age, sex, and family unit. Understanding patterns and differences across these demographic variables in healthy speakers is important to distinguishing more confidently between normal and disordered speech and voice patterns clinically.
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Habla , Voz , Acústica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Acústica del Lenguaje , Medición de la Producción del Habla , Adulto JovenRESUMEN
OBJECTIVE:: People with subglottic stenosis (SGS) may experience laryngeal symptoms that pose significant challenges to management. This study surveyed the use and effects of nebulized treatments on laryngeal symptoms in a large cohort of adults with SGS. METHODS:: A survey of nebulized treatment practices was distributed to an online international community of over 2000 members; 316 individuals (298 female, 1 male, 17 declined to specify; age 25+ years) completed the survey. RESULTS:: Nearly half (144) of participants had tried a nebulizer in the past. Among those, half currently used nebulized treatments; the majority used these treatments regularly and for greater than 1 year. The most frequently reported treatments included isotonic saline (0.9% Na+Cl-) or hypertonic saline (3% Na+Cl-). Symptoms improved by these treatments included thick mucus (69%), cough (57%), throat dryness (31%), stridor (28%), and voice (15%). The most frequently reported limitations to nebulizer use included time, noise, and portability. CONCLUSION:: Among those individuals with SGS who have tried nebulized treatments, nearly half experienced relief from secondary laryngeal symptoms. Additional efficacy research is needed, particularly with respect to treatment type and dosage. The results are encouraging given the adverse impact these laryngeal symptoms can have on activities of daily living and quality of life.
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Tos , Disfonía , Disnea , Laringoestenosis , Nebulizadores y Vaporizadores , Calidad de Vida , Terapia Respiratoria , Solución Salina Hipertónica/uso terapéutico , Actividades Cotidianas , Adulto , Anciano , Tos/etiología , Tos/terapia , Disfonía/etiología , Disfonía/terapia , Disnea/etiología , Disnea/terapia , Femenino , Humanos , Laringoestenosis/fisiopatología , Laringoestenosis/psicología , Laringoestenosis/terapia , Masculino , Persona de Mediana Edad , Prioridad del Paciente/estadística & datos numéricos , Terapia Respiratoria/instrumentación , Terapia Respiratoria/métodos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: This investigation examined the prevalence, symptoms, risk factors, and quality-of-life burden of swallowing disorders in rheumatoid arthritis (RA), a chronic, progressive autoimmune inflammatory disease. METHODS: One hundred individuals with RA (84 women, 16 men; mean age = 61.1 years, SD = 13.1) were interviewed regarding the presence, nature, and impact of swallowing symptoms and disorders. Associations between swallowing disorders, medical factors, RA disease severity, and quality of life were examined. RESULTS: Forty-one percent of participants reported a current swallowing disorder that began gradually and was longstanding (most experiencing symptoms on a daily basis for at least 4 years). Symptoms compatible with solid food dysphagia contributed disproportionately to reporting a current swallowing disorder. Risk factors for dysphagia included a self-reported voice disorder, thyroid problems, esophageal reflux, and being physically inactive. Swallowing disorders increased with self-reported RA disease severity and contributed to a significantly greater burden on overall quality of life. CONCLUSION: Chronic, longstanding swallowing disorders are common in individuals with RA and appear to increase with disease severity. Those individuals with dysphagia reported greater reductions in quality of life as compared to those without, highlighting the need for improved awareness, exploration, and management of swallowing disorders in this population.
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Artritis Reumatoide/complicaciones , Trastornos de Deglución/epidemiología , Deglución/fisiología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/epidemiología , Trastornos de Deglución/etiología , Trastornos de Deglución/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection (CTR) procedure designed to minimize adverse effects on voice function. METHOD: Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected. Cepstral, signal-to-noise, periodicity, and fundamental frequency (F0 ) analyses were undertaken for connected speech and sustained vowel samples. Listeners made auditory-perceptual ratings of overall quality and monotonicity. RESULTS: Paired samples statistical analyses revealed that mean F0 decreased from 215 Hz (standard deviation [SD] = 40 Hz) to 201 Hz (SD = 65 Hz) following surgery. In general, VHI scores decreased after surgery. Voice disorder severity based on the Cepstral Spectral Index of Dysphonia (KayPentax, Montvale, NJ) for sustained vowels decreased (improved) from 41 (SD = 41) to 25 (SD = 21) points; no change was observed for connected speech. Semitone SD (2.2 semitones) did not change from pre- to posttreatment. Auditory-perceptual ratings demonstrated similar results. CONCLUSION: These preliminary results indicate that this revised CTR procedure is promising in minimizing adverse voice effects while offering a longer-term surgical outcome for SGS. Further research is needed to determine causal factors for pretreatment voice disorders, as well as to optimize treatments in this population. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2085-2092, 2017.
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Músculos Laríngeos/cirugía , Laringoestenosis/fisiopatología , Fonación/fisiología , Complicaciones Posoperatorias/fisiopatología , Tráquea/cirugía , Trastornos de la Voz/fisiopatología , Adulto , Anciano , Femenino , Humanos , Laringoestenosis/complicaciones , Laringoestenosis/cirugía , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Periodo Preoperatorio , Índice de Severidad de la Enfermedad , Habla/fisiología , Pruebas de Discriminación del Habla , Resultado del Tratamiento , Voz/fisiología , Trastornos de la Voz/etiología , Trastornos de la Voz/cirugíaRESUMEN
This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren's syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD = 14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4 %. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p < .05). Additional swallowing disorder risk factors included the presence of a self-reported voice disorder, esophageal reflux, current exposure to secondary tobacco smoke, frequent neck or throat tension, frequent throat clearing, chronic post-nasal drip, and stomach or duodenal ulcers. Swallowing disorders did not differ on the basis of primary or secondary SS. Swallowing disorders and specific swallowing symptoms were uniquely associated with reduced quality of life. Among those with swallowing disorders, 42 % sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.
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Trastornos de Deglución/epidemiología , Calidad de Vida , Síndrome de Sjögren/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVES: This study examined the effects of a laryngeal desiccation challenge and nebulized isotonic saline on voice production in young, healthy male singers and nonsingers. STUDY DESIGN: This is a prospective, double-blind, within-subjects experimental design. METHODS: Participants included 10 male university-trained singers and 10 age-matched nonsingers (mean age, 21.8 years; range, 18-26 years) who underwent a 30-minute oral breathing laryngeal desiccation challenge using medical grade dry air (<1% relative humidity) on two occasions in consecutive weeks. After the challenge, participants received either 3 mL or 9 mL of nebulized isotonic saline (0.9% Na+Cl-); order of administration was counterbalanced. Phonation threshold pressure (PTP), the cepstral spectral index of dysphonia (CSID) for sustained vowels and connected speech, and self-perceived vocal effort, mouth dryness, and throat dryness were measured at each recording (baseline, after challenge, and at 5, 35, and 65 minutes after treatment). RESULTS: Self-perceived effort and dryness measures increased (worsened) after desiccation challenge and decreased (improved) after nebulized treatment (P < 0.05). No consistent changes were observed for PTP or CSID over time. Overall, singers demonstrated significantly lower vocal effort and CSID as compared with nonsingers. CONCLUSIONS: Young, vocally healthy men may not experience physiologic changes in voice production associated with laryngeal desiccation and nebulized saline treatments; however, self-reported increases in vocal effort which are associated with dryness symptoms might improve with nebulized treatments. Future hydration research should consider age and sex variables.
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Acústica , Deshidratación/fisiopatología , Laringe/efectos de los fármacos , Fonación/efectos de los fármacos , Autoimagen , Canto , Cloruro de Sodio/administración & dosificación , Acústica del Lenguaje , Percepción del Habla , Calidad de la Voz/efectos de los fármacos , Administración por Inhalación , Adolescente , Adulto , Estudios Cruzados , Método Doble Ciego , Humanos , Soluciones Isotónicas , Laringe/fisiopatología , Masculino , Nebulizadores y Vaporizadores , Presión , Estudios Prospectivos , Medición de la Producción del Habla , Adulto JovenRESUMEN
OBJECTIVES: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which may adversely affect phonatory function. This study aimed to establish the prevalence, risks, and quality of life effects of voice disorders in RA. STUDY DESIGN: This is a cross-sectional, descriptive epidemiology study. METHODS: One hundred individuals with RA underwent a telephone interview to determine the frequency, severity, risks associated with, and quality of life burden of voice disorders. The results were analyzed using summary statistics, frequencies, chi-square tests, regression analysis, and risk ratios (P < 0.05). RESULTS: Thirty-five percent of participants with RA reported a current voice disorder which was chronic and long-standing in most cases. The prevalence of a current voice disorder did not significantly differ across age, sex, medication use, voice use patterns, medical history, or RA severity. These chronic voice disorders produced significant adverse effects on both voice-related quality of life and short form 36 health-related quality of life scales. Specific voice symptoms such as "voice-related discomfort" and "chronic throat dryness" contributed disproportionately to the quality of life burden. Of those participants with a voice disorder, only 37% had ever sought professional help to improve their voice. CONCLUSIONS: These results indicate that voice disorders are common in RA and produce significant adverse effects on quality of life. Further research is necessary to better understand the origin of these disorders and their potential response to treatment.
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Artritis Reumatoide/epidemiología , Calidad de Vida , Trastornos de la Voz/epidemiología , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/psicología , Distribución de Chi-Cuadrado , Costo de Enfermedad , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Utah/epidemiología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Adulto JovenRESUMEN
OBJECTIVES: This study examined quality of life burden of voice disorders in Sjögren's syndrome (SS). METHODS: Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders. RESULTS: Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders (P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement. CONCLUSIONS: Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.
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Costo de Enfermedad , Calidad de Vida , Síndrome de Sjögren/complicaciones , Trastornos de la Voz , Entrenamiento de la Voz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/fisiopatología , Estadística como Asunto , Encuestas y Cuestionarios , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Trastornos de la Voz/terapia , Calidad de la VozRESUMEN
OBJECTIVE: This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN: Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS: Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS: Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION: Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE: 2b.
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Síndrome de Sjögren/fisiopatología , Cloruro de Sodio/administración & dosificación , Pliegues Vocales/efectos de los fármacos , Voz/efectos de los fármacos , Adulto , Anciano , Deshidratación/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Sjögren/terapiaRESUMEN
OBJECTIVES/HYPOTHESIS: Sjögren's Syndrome (SS) is an autoimmune disease that causes sicca (dryness) symptoms by affecting secretions most notably of the lacrimal and salivary glands. Voice disorders have been documented in patients with SS, but the true prevalence and relationships among possible contributing factors remain unknown. This preliminary epidemiological investigation examined prevalence and risk factors for voice disorders in SS. STUDY DESIGN: Self-report epidemiological questionnaire. METHODS: One hundred and one (101) patients with SS (94 females, 7 males; M age = 59.4 years; standard deviation [SD] = 14.1 years) completed an extensive interview using a previously validated questionnaire involving the patient's medical, family, occupational, psychosocial, social/lifestyle, voice use, and general health histories. Summary statistics, chi-squares, risk ratios, and multiple logistic regression were used to determine the frequency and severity of voice disorders in individuals with SS, as well as associations with demographic, lifestyle, health, disease severity, and voice use factors. RESULTS: The prevalence of a current voice disorder in individuals with SS was 59.4%. In general, voice disorders began gradually; were chronic; and correlated with SS disease severity independent of age, sex, duration of the disease, comorbid autoimmune conditions, and use of SS-related medication. Specific voice symptoms including chronic throat dryness and soreness were significantly associated with SS disease severity. CONCLUSIONS: Voice disorders are relatively common in SS and are more frequent as disease severity worsens. These findings have important implications for evaluation and treatment of patients with SS. LEVEL OF EVIDENCE: 4.
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Síndrome de Sjögren/complicaciones , Trastornos de la Voz/epidemiología , Trastornos de la Voz/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: The purpose of this study was to investigate the effect of emotional expression on several acoustic measures of vibrato, including its rate, extent, and steadiness. We hypothesized that singing a passage with emotional content would influence these variables. STUDY DESIGN: This study used a within-subjects, repeated-measures design. Singer performance under different conditions was analyzed. METHODS: Ten graduate student singers (eight women, two men) completed a series of tasks including sustained sung vowels at several pitch and loudness levels, an assigned song that was judged to have relatively neutral emotion, and a personal selection that included passages of intense emotion. Vowel tokens were extracted from the recordings and averaged for each task. Dependent measures included the mean fundamental frequency (F0), mean intensity, frequency modulation (FM) rate, FM extent, and measures of FM rate and extent variability. RESULTS: The FM rate and extent were higher and the modulation variability was lower for the more emotional song than for the sustained vowels. Mean F0 and intensity were higher for the emotional song than for the neutral song. CONCLUSIONS: Singing an emotional passage influences acoustic features of vibrato when compared with isolated, sustained vowels. The wider dynamic and pitch ranges for emotional passages only partly explain vibrato differences between emotional and neutral singing.
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Emociones/fisiología , Canto/fisiología , Calidad de la Voz , Voz/fisiología , Adulto , Femenino , Humanos , Masculino , Espectrografía del Sonido , Acústica del LenguajeRESUMEN
BACKGROUND: The purpose of this study was to determine if persistent changes in the duration of bolus movement through the pharynx and bolus movement coordination with pharyngeal swallowing gestures occur after treatment of oropharyngeal carcinoma with chemoradiation therapy. METHODS: The timing of bolus movement and coordination with swallowing gestures was evaluated in 30 patients using a modified barium swallowing study at least 1 year after completion of treatment. Patients were recruited irrespective of any swallowing complaints. The mean of each measure from the study subjects was compared to those from a group of age-matched controls. RESULTS: Bolus transit duration in the study population was unchanged compared with normal controls. Unlike normal controls, the patients were found to allow the bolus to arrive in the vallecula before the initiation of swallowing gestures that resulted in a swallow. Earlier opening of the upper esophageal sphincter was found for a 1-cc bolus (p = .004). For the 20 cc bolus size, the onset of hyoid and aryepiglottic fold elevation was delayed (p = .029 and .037, respectively). Gesture timing did not change to accommodate larger bolus sizes, as it normally does, resulting in a delay in airway protection for the 20-cc bolus. CONCLUSION: Patients are able to move a liquid bolus through the pharynx in a timely manner. However, patients are unable to modify swallowing gestures to safely protect the airway.
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Carcinoma/terapia , Quimioradioterapia/efectos adversos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Deglución , Neoplasias Orofaríngeas/terapia , Anciano , Sulfato de Bario/farmacología , Estudios de Casos y Controles , Medios de Contraste/farmacología , Fluoroscopía , Humanos , Masculino , Manometría , Persona de Mediana Edad , Medición de Riesgo , Factores de Tiempo , Grabación en VideoRESUMEN
OBJECTIVE: This study examined voice, speech, and laryngeal characteristics in primary Sjögren's syndrome (pSS). METHODS: Eleven patients (10 female, 1 male; mean [SD] age = 57 [14] years) from The University of Utah Division of Rheumatology provided connected speech and sustained vowel samples. Analyses included the Multi-Dimensional Voice Profile, the Analysis of Dysphonia in Speech and Voice, and dysphonia severity, speech clarity, and videolaryngostroboscopy ratings. RESULTS: Shimmer, amplitude perturbation quotient, and average fundamental frequency differed significantly from normative values (P < .01). Cepstral Spectral Index of Dysphonia values indicated mild-to-moderate dysphonia in connected speech (mean [SD] = 20.26 [8.36]) and sustained vowels (mean [SD] = 16.91 [11.08]). Ratings of dysphonia severity and speech clarity using 10-cm visual analog scales suggested mild-to-moderate dysphonia in connected speech (mean [SD] = 2.11 [1.72]) and sustained vowels (mean [SD] = 3.13 [2.20]) and mildly reduced speech clarity (mean [SD] = 1.46 [1.36]). Videolaryngostroboscopic ratings indicated mild-to-moderate dryness and mild reductions in overall laryngeal function. Voice Handicap Index scores indicated mild-to-moderate voice symptoms (mean [SD] = 43 [23]). CONCLUSION: Individuals with pSS may experience dysphonia and articulatory imprecision, typically in the mild-to-moderate range. These findings have implications for diagnostic and referral practices in pSS.
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Síndrome de Sjögren/complicaciones , Trastornos del Habla/etiología , Trastornos de la Voz/etiología , Femenino , Humanos , Laringoscopía/métodos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Medición de la Producción del Habla , Estroboscopía/métodos , Grabación en Video , Escala Visual AnalógicaRESUMEN
OBJECTIVES/HYPOTHESIS: To compare objective measures of swallowing function with patient reports of swallowing-related quality of life 1 year after treatment of oropharyngeal cancer with chemoradiation therapy. STUDY DESIGN: Patients seen for follow-up at least 1 year after treatment of oropharyngeal carcinoma with chemoradiation therapy were sequentially approached and asked to participate in the study. METHODS: Maximum pharyngeal constriction, hyoid elevation, upper esophageal sphincter opening size, and bolus pharyngeal transit time were measured from modified barium swallowing studies in a group of 31 patients at least 1 year after chemoradiation therapy for the treatment of oropharyngeal carcinoma. Measures were made for a liquid 1-mL, 3-mL, and 20-mL bolus. Objective measure results were compared to scores from the MD Anderson Dysphagia Inventory and The University of Washington Swallowing Quality of Life Questionnaire results from the same patients. RESULTS: No strong correlation was identified between any of the objective measures of swallowing physiology and quality-of-life scores. CONCLUSIONS: Patient perception of the impact of swallowing function on quality of life does not correlate well with actual physiologic functioning.
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Carcinoma de Células Escamosas/terapia , Trastornos de Deglución/diagnóstico , Deglución/fisiología , Neoplasias Orofaríngeas/terapia , Calidad de Vida , Autoevaluación (Psicología) , Anciano , Carcinoma de Células Escamosas/patología , Quimioradioterapia/efectos adversos , Quimioradioterapia/métodos , Estudios de Cohortes , Trastornos de Deglución/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Medición de Riesgo , Perfil de Impacto de Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The purpose of this study was to examine the prevalence of voice disorders in college students and their effect on the students as shown by quality-of-life indicators. METHODS: A cross-sectional survey was completed by 545 college students in 2012. The survey included 10 questions from the Voice-Related Quality of Life (V-RQOL), selected voice symptoms, and quality-of-life indicators of functional health and well-being based on the Short Form 36-item Health Survey (SF-36). RESULTS: Twenty-nine percent of the college students (mean age, 22.7 years) reported a history of a voice disorder. Hoarseness was the most prevalent voice symptom, but was not correlated with V-RQOL scores. A wobbly or shaky voice, throat dryness, vocal fatigue, and vocal effort explained a significant amount of variance on the social-emotional and physical domains of the V-RQOL index (p < 0.05). Voice symptoms limited emotional and physical functioning as indicated by SF-36 scores. CONCLUSIONS: Voice disorders significantly influence psychosocial and physical functioning in college students. These findings have important implications for voice-care services in this population.
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Calidad de Vida , Estudiantes/psicología , Trastornos de la Voz/epidemiología , Trastornos de la Voz/psicología , Calidad de la Voz , Adolescente , Adulto , Factores de Edad , Anciano , Estudios de Cohortes , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Autoinforme , Adulto JovenRESUMEN
OBJECTIVES: To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of dysphonia severity. METHOD: Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic dysphonia, primary muscle tension dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. RESULTS: CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. CONCLUSIONS: The results confirm a robust relationship between listener perceived and CSID-derived dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure.