Risk Factors for Hyperfunctional Voice Disorders Among Teachers

The aim of the study was to assess the prevalence of voice problems among teachers, and identify risk factors for developing voice pathology. In this study we evaluated 448 teachers (400 females and 48 males) between the age range of 25 to 55 years, from primary school as well as secondary school which were selected randomly. A questionnaire was given to them to find out how many of them had a voice problem. All the positive cases were further evaluated by an Otorhinolaryngologist, an Audiologist and a Speech Language Pathologist. Out of the 448 teachers, 39 of them(9%) had an indication of voice disorder based on the positive respose got from the questionnaire. Among the 39 cases identified 11 were males (28%) and 28 were females (71%). We tried to investigate on the factors that would have contributed to voice problem in the identified 9% of cases .Detailed history was taken and was examined by an otorhinolaryngologist, an audiologist and a Speech Language Pathologist.Out of the 39 cases identified 26% had history of recurrent allergic rhinitis and laryngitis, 18% had sinusitis and post nasal drip, 18% had asthma, 26% had gastoesophageal reflux disorder, (8%) had minimal sensori neural hearing loss and hypothyroidism was found in 8%. Interaction of multiple factors like hereditory, behavioral, lifestyle, medical and environmental can contribute to voice disorders in occupational voice users. Teachers need to be educated regarding vocal mechanism, vocal hygiene and effective voice use , dust free and noise free work environment, diet modification like drinking adequate water, avoiding spicy and deep fried food, regularizing meals and avoiding sleeping immediately after food. The underlying medical issues like allergy, sinusitis, laryngitis, hypothyroidism, gastroesophageal reflux, hearing loss etc also need to be addressed , since vocal hygiene alone will not help until and unless the underlying cause is taken care of

Creation of a 13-Item Bedside Dysphagia Screening Test

Dysphagia is a common problem that affects people with many health conditions and that can have serious complications. Various dysphagia screening tests exist; however, their creation was associated with certain weaknesses, e.g. none of them used “objective” instrumental tests (e.g., videofluoroscopy or flexible endoscopic examination of swallowing, FEES) in all patients to verify the results. In addition, most dysphagia screening tests were developed for stroke patients. The purpose of this study was to fill this gap. Our research included not only patients with stroke but also patients with other neurological and otorhinolaryngologic conditions. We tested 33 physical examination items in 44 patients and analyzed the results by comparing them to FEES results. Our study is the first one that performed this kind of comparison in all the patients enrolled in the study. Data mining was used to create a 13-item dysphagia screening test that has 88.2% sensitivity

Aerodynamic Analysis Of Voice In Persons With Laryngopharyngeal Reflux

Objectives of the study: The individuals with laryngopharyngeal reflux are prone for aspiration of refluxed contents and so there is a need for aerodynamic evaluation in these individuals. Hence, the present study investigated the aerodynamic characteristics in individuals with Laryngopharyngeal reflux. Study design: Prospective control group design. Method: Thirty laryngopharyngeal reflux subjects and 30 normal subjects participated in the study. Aerodynamic parameters such as vital capacity, mean air flow rate, maximum phonation duration and phonation quotient were measured using Aero Phone Instrument ((Model 6800). Independent t test was employed for statistical inference. Results: The results revealed that the vital capacity and maximum phonation duration values were lower for laryngopharyngeal reflux subjects when compared to normal controls. No significant differences were observed for mean air flow rate and phonation quotient. Conclusions: The results revealed that the laryngopharyngeal reflux individuals showed significant deviations in aerodynamic parameters when compared to normal individuals. Thus study confirms aerodynamic abnormalities in laryngopharyngeal reflux subject

Validity of the Reflux Symptoms Index for post-pubescent female vocalists

The Reflux Symptoms Index (RSI), a nine-item self-rated questionnaire, has been suggested as a way of monitoring severity of laryngopharyngeal reflux (LPR) symptoms during treatment. However, limited research has been conducted to assess the validity of the RSI as a way of identifying severity of laryngopharyngeal reflux (LPR) symptoms as differentiated from gastroesophageal reflux (GER) symptoms. Twenty-five post-pubescent female vocalists participated by completing a one-hour voice evaluation, including a Voice Handicap Index (VHI), an RSI, a Reflux Finding Score (RFS) completed with videostroboscopy for visualization of the laryngeal cavity, and analysis of an acoustic sample with the Multi-Dimensional Voice Profile for noise to harmonic ratio (NHR) and perceptual ratings of hoarseness and breathiness. The investigation placed each participant into one of three groups based upon symptoms reported in her case history form. In an effort to evaluate the validity of the RSI as a tool for differentiating LPR from GER and the absence of reflux, these scores were analyzed for correlations or group relationships. Predictions were that, if the RSI were an indicator of severity of LPR, the RSI raw score would correlate with type of symptoms, RFS raw score, NHR, and/or perceptions of hoarseness. Results failed to reveal statistically significant group differences; however, informal inspection of the data indicated that the RSI scores were generally higher for the GER group than the LPR and asymptomatic groups. Also, RSI scores correlated with VHI raw scores, as both were self-rated items, and the NHR values and the perceptual ratings of hoarseness correlated with the VHI raw scores

Exploiting Nonlinear Recurrence and Fractal Scaling Properties for Voice Disorder Detection

Background: Voice disorders affect patients profoundly, and acoustic tools can potentially measure voice function objectively. Disordered sustained vowels exhibit wide-ranging phenomena, from nearly periodic to highly complex, aperiodic vibrations, and increased "breathiness". Modelling and surrogate data studies have shown significant nonlinear and non-Gaussian random properties in these sounds. Nonetheless, existing tools are limited to analysing voices displaying near periodicity, and do not account for this inherent biophysical nonlinearity and non-Gaussian randomness, often using linear signal processing methods insensitive to these properties. They do not directly measure the two main biophysical symptoms of disorder: complex nonlinear aperiodicity, and turbulent, aeroacoustic, non-Gaussian randomness. Often these tools cannot be applied to more severe disordered voices, limiting their clinical usefulness.

Methods: This paper introduces two new tools to speech analysis: recurrence and fractal scaling, which overcome the range limitations of existing tools by addressing directly these two symptoms of disorder, together reproducing a "hoarseness" diagram. A simple bootstrapped classifier then uses these two features to distinguish normal from disordered voices.

Results: On a large database of subjects with a wide variety of voice disorders, these new techniques can distinguish normal from disordered cases, using quadratic discriminant analysis, to overall correct classification performance of 91.8% plus or minus 2.0%. The true positive classification performance is 95.4% plus or minus 3.2%, and the true negative performance is 91.5% plus or minus 2.3% (95% confidence). This is shown to outperform all combinations of the most popular classical tools.

Conclusions: Given the very large number of arbitrary parameters and computational complexity of existing techniques, these new techniques are far simpler and yet achieve clinically useful classification performance using only a basic classification technique. They do so by exploiting the inherent nonlinearity and turbulent randomness in disordered voice signals. They are widely applicable to the whole range of disordered voice phenomena by design. These new measures could therefore be used for a variety of practical clinical purposes.
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Development and validation of a comprehensive assessment questionnaire for Cantonese alaryngeal speakers' speech performance

The study devised and validated the perceptual assessment questionnaire for evaluating the speech performance of Cantonese alaryngeal speakers. Forty-eight male alaryngeal speakers participated in the study: 10 electrolaryngeal, 10 esophageal, 9 tracheoesophageal, 9 pneumatic artificial and 10 normal laryngeal speakers. Five speech therapists also participated in the perceptual rating procedures. Results indicated moderate to strong inter-rater reliability in all parameters that involve only auditory judgment except that of rating electrolarynx noise. Assessment parameters that require both auditory and visual judgment might require further modification. For tone perception, moderate to strong inter-rater reliability was also noted. High intra-rater reliability of the assessment questionnaire was also found. In addition, the parameters adopted were reported to have significant correlation with the acoustic correlates except that for pitch rating. The assessment questionnaire suggested appeared to be valid for evaluating auditory dependent speech characteristics of the four types of alaryngeal speech.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Is voice therapy an effective treatment for dysphonia? A randomised controlled trial

OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia. DESIGN: Single blind randomised controlled trial. SETTING: Outpatient clinic in a teaching hospital. Participants: 204 outpatients aged 17-87 with a primary symptom of persistent hoarseness for at least two months. INTERVENTIONS: After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12-14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. MAIN OUTCOME MEASURES: Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF-36. RESULTS: Voice therapy improved voice quality as assessed by rating by patients (P=0.001) and rating by observer (P<0.001). The treatment effects for these two outcomes were 4.1 (95% confidence interval 1.7 to 6.6) points and 0.82 (0.50 to 1.13) points. Amplitude perturbation showed improvement at six weeks (P=0.005) but not on completion of the study. Patients with dysphonia had appreciable psychological distress and lower quality of life than controls, but voice therapy had no significant impact on either of these variables. CONCLUSION: Voice therapy is effective in improving voice quality as assessed by self rated and observer rated methods