Reliability and Validity of Speech Evaluation in Adductor Spasmodic Dysphonia

Objectives. In order to establish a reliable diagnostic tool for adductor spasmodic dysphonia (ADSD), it is necessary to determine the proper terms representing its characteristic voice symptoms and to relate them to objective measures such as acoustic parameters or speech perturbation. The aim of this study was to evaluate speech in patients with ADSD by perceptual evaluations and acoustic measures, and to examine the reliability and validity of the measures by comparison with normal controls. Methods. Twenty-four patients with ADSD and 24 healthy volunteers matched to the ADSD patients with regard to age and sex participated in the study. Speech materials, consisting of three short sentences, were constructed from serial voiced syllables to elicit abductor voice breaks. Three otolaryngologists specializing in phoniatrics rated the degree of voice symptoms using a visual analog scale (VAS). VAS sheets with five 100-mm horizontal lines were given to each rater. The ends of the lines were labeled normal versus severe, and the five lines were labeled as overall severity and each of the four voice symptoms; strangulation, interruption, tremor and strained speech. Nine words were selected from the speech materials for acoustic analysis, and abnormal acoustic events were classified into one of the three categories; percentage of frequency shifts, percentage of aperiodic segments, or percentage of phonation breaks. Acoustic measures were performed by a speech-language-hearing therapist specializing in voice disorders and five healthy university students. To evaluate the intra- and inter-rater/measurer reliability of the VAS scores or acoustic measures, Pearson r correlations were calculated. To examine the validity of perceptual evaluations and acoustic measures, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results. Pearson r correlation coefficients for overall severity showed the highest intra- and inter-rater reliability, and reliability coefficients for one of the four voice symptoms, strangulation (r = 0.816-0.937), were slightly higher than those for the other symptoms. For acoustic events, intra-measurer reliabilities were r = 0.645 (frequency shifts), r = 0.969 (aperiodic segments), and r = 1.0 (phonation breaks), and inter-measurer reliability ranged from r = 0.102 to r = 1.0 (average r = 0.861). The Pearson r correlation coefficient for phonation breaks was higher than those for the other acoustic events. Perceptual evaluation using VAS showed high sensitivity (91.7 %) and specificity (100 %), and acoustic analysis showed low sensitivity (70.8 %) and high specificity (100 %). Eight of the 24 patients were judged to be within normal limits by one or both evaluation methods. Conclusions. Both perceptual evaluation and acoustic measures alone were found to be likely to miss true ADSD patients. It is important to obtain a range of speech materials and to use a combination of perceptual evaluation and acoustic measures based on our understanding of the advantages and disadvantages of both methods

Botulinum Toxin Therapy: A Series of Clinical Studies on Patients with Spasmodic Dysphonia in Japan

Spasmodic dysphonia (SD) is a rare voice disorder caused by involuntary and intermittent spasms of the laryngeal muscles. Both diagnosis and treatment have been controversial. Therefore, a series of clinical studies has recently been conducted in Japan. A nationwide epidemiological survey revealed that adductor SD predominated (90–95% of all cases; 3.5–7.0/100,000), principally among young women in their 20s and 30s. To facilitate early diagnosis, we created diagnostic criteria for SD and a severity grading system. The diagnostic criteria include the principal and accompanying symptoms, clinical findings during phonation, the treatment response, and the differential diagnoses. The severity grade is determined using a combination of subjective and objective assessments. Botulinum toxin (BT) injection is the treatment of choice; however, there have been few high-quality clinical studies and BT has been used off-label. We conducted a placebo-controlled, randomized, double-blinded clinical trial of BT therapy; this was effective and safe. BT treatment is now funded by the Japanese medical insurance scheme. Studies thus far have facilitated early diagnosis and appropriate therapy; they have fostered patient awareness of SD

The Influence of Phacoemulsification on Surgical Outcomes of Trabeculectomy with Mitomycin-C for Uveitic Glaucoma.

To evaluate the influence of phacoemulsification after trabeculectomy on the postoperative intraocular pressure (IOP) in eyes with uveitic glaucoma (UG).Kumamoto University Hospital, Kumamoto, Japan.A retrospective cohort study.The medical records of patients with UG who had trabeculectomy with mitomycin-C (MMC) were reviewed. Complete and qualified surgical failures were defined by an IOP of ≥21 mmHg (condition A), ≥18 mmHg (condition B), or ≥15 mmHg (condition C) without and with glaucoma eye drops, respectively. Kaplan-Meier survival analysis, generalized by the Wilcoxon test, and the Cox proportional hazards model analysis were conducted. Post-trabeculectomy phacoemulsification was treated as a time-dependent variable. In 24 (30%) of the included 80 eyes, phacoemulsification was included, and they were divided into two groups: groups I (8 eyes with phacoemulsification within 1 year after trabeculectomy) and group II (16 eyes after 1 year following trabeculectomy).Multivariable Cox proportional hazards model analysis showed post-trabeculectomy phacoemulsification was a significant factor in both complete success and qualified success based upon condition C (P = 0.0432 and P = 0.0488, respectively), but not for the other conditions. Kaplan-Meier survival analyses indicated significant differences in success probabilities between groups I and group II for complete success and qualified success based upon condition C (P = 0.020 and P = 0.013, respectively). There was also a significant difference for qualified success based upon condition B (P = 0.034), while there was no significant difference for the other conditions.Post-trabeculectomy phacoemulsification, especially within 1 year, can cause poor prognosis of IOP control of UG eyes after trabeculectomy with MMC

Mortality and prognostic factors for spontaneous pneumothorax in older adults.

Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax

“Pulmonary Actinomycosis attributable to Actinomyces meyeri presenting as cardiac tamponade: a case report”

Abstract Background Recently, it is reported that Actinomyces meyeri is the most common species causing actinomycosis. However, to our knowledge, there was no report about pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. Case presentation Hereby we describe a case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. At first, the patient was diagnosed with bacterial pericarditis with lung abscess in the left lower lung lobe and underwent pericardial drainage. Three days after the removal of the drainage tube, atrial fibrillation followed by cardiac arrest with asystole occurred and immediate cardiopulmonary resuscitation restored his circulation. Thereafter, he underwent pneumocentesis of the lung abscess and the culture grew A. meyeri. He was successfully treated with penicillin G. Conclusion This is the first case of pulmonary actinomycosis attributable to A. meyeri presenting as cardiac tamponade. We believe that an increased awareness of the disease is necessary to expedite diagnosis therefore minimizing morbidity and mortality

Results of the Cox Proportional Hazards Model Analysis for Condition B (Qualified Success).

<p>Results of the Cox Proportional Hazards Model Analysis for Condition B (Qualified Success).</p

Results of the Cox Proportional Hazards Model Analysis for Condition B (Complete Success).

<p>Results of the Cox Proportional Hazards Model Analysis for Condition B (Complete Success).</p

Results of the Cox Proportional Hazards Model Analysis for Condition A (Qualified Success).

<p>Results of the Cox Proportional Hazards Model Analysis for Condition A (Qualified Success).</p

Baseline Characteristics of All 80 Patients (80 Eyes).

<p>Baseline Characteristics of All 80 Patients (80 Eyes).</p