Laryngeal and respiratory patterns in patients with paradoxical vocal fold motion

SummaryThe purposes of this study were to determine the differences in spirometric measures obtained from patients with endoscopically-documented paradoxical vocal fold motion (PVFM) and to compare them to a group of normal subjects without endoscopically-documented paradoxical vocal fold motion during non-provocative breathing and following speech. Thirty eight subjects with documented paradoxical vocal fold motion using transnasal flexible laryngoscopy (TFL) and no history of asthma and 21 normal subjects with documented normal breathing patterns and normal findings on endoscopy underwent flow-volume loop studies. Endoscopic judgments of vocal fold motion from three breathing conditions were made by two observers. The results of the endoscopic judgments indicate that paradoxical motion occurs whether breathing through the nose or mouth in the PVFM subjects, mainly after speaking and inhalation. In addition, the spirometry results indicated that the inspiratory measure of FIVC%, FVC% and FIV0.5/FIVC were significantly lower in the PVFM group compared to the normal subjects. The data supports the hypothesis that in patients with PVFM, inspiratory spirometric values play a role in identifying patients with PVFM. The finding of vocal fold closure following a speech utterance in the majority of the PVFM subjects but not in the normal control group warrants further investigation

Vocal cord dysfunction diagnosis may be improved by a screening check list

Background: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. Methods: A prospective observational study involving 80 patients aged ≥18 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer “yes” counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. Results: The proportion of affirmative answers to the question “Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?” was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable “4 or more affirmative answers” was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma

Correlatos perceptivos e acústicos dos ajustes supraglóticos na disfonia Perceptive and acoustic correlates of supraglottis adjustments in dysfonia

OBJETIVO: avaliar os correlatos perceptivo-auditivos (ajustes supraglóticos) e acústicos (formantes) da qualidade vocal de indivíduos disfônicos com alterações glóticas, atendidos em ambulatório de fonoaudiologia de uma instituição hospitalar da cidade de São Paulo. MÉTODOS: o grupo estudado foi representado por amostras de voz de 20 indivíduos disfônicos com idades variadas entre 30 e 65 anos do sexo feminino (atendidos em um hospital da cidade de São Paulo) e julgamentos perceptivo-auditivos da qualidade vocal por amostras avaliadas previamente por um grupo de juízes em atividade clínica. As amostras foram exploradas quanto à freqüência dos três primeiros formantes (F1, F2 e F3). Os valores foram considerados de forma qualitativa (comparados aos dados da análise perceptivo-auditiva) e quantitativa (teste Qui-quadrado). RESULTADOS: os ajustes de qualidade vocal mais freqüentes foram laringe baixa, mandíbula fechada, lábios arredondados, corpo de língua abaixado, corpo de língua retraído, labiodentalização. Diferenças estatisticamente significantes foram encontradas para os valores de freqüência de F1 para os vocábulos "cata" (864 Hz) e "gata" (814 Hz), p=0 e F3 para os vocábulos "cata" (2598 Hz) e "gata" (2660 Hz), p=0,17 dos indivíduos do grupo estudado em relação aos valores de referência para o Português-Brasileiro. CONCLUSÃO: os ajustes de qualidade vocal identificados encontraram correspondência com a diminuição dos valores de F1 e F3 indicando tendências de ajustes do trato vocal.<br>PURPOSE: to evaluate auditory perception (supraglottic adjustments) and acoustic (formants) of vocal quality in dysphonic individuals with glotic disorders, attended in a clinic a hospital in the city of São Paulo. METHODS: the studied was represented by voice samples taken form from 20 dysphonic people aged between 30 and 65 of the female gender (attended in a hospital in the city of Sao Paulo) and the auditory perception judgment of the vocal quality was represented by samples previously evaluated by active judges in clinic activity. The samples were explored as for the frequency of the first three formants (F1, F2 and F3). The values were considered as for their quality (compared to the data of auditory perception analysis) and their quantity (Qui-square test) RESULTS: the more frequent adjustments of vocal quality were low larynx, closed jaw, lip rounding, lowered tongue body, retracted tongue body, labiodentalization. Statistically meaningful differences were found for the frequency value of F1 for the syllables "cata" (864 Hz) and "gata" (814Hz), p=0 and F3 for the syllables "cata" (2598 Hz) and "gata"(2660 Hz), p=0.17 for the subjects of the group studied with relation to the values of reference for Portuguese-Brazilian language. CONCLUSION: the identified adjustments of vocal quality met correspondence with the reducing of values of F1 and F3 indicating trends for vocal treat adjustments