Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians.

peer reviewed[en] INTRODUCTION: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. METHODS: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. CONCLUSION: The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach

Acute Multiple Organ Failure in Adult Mice Deleted for the Developmental Regulator Wt1

There is much interest in the mechanisms that regulate adult tissue homeostasis and their relationship to processes governing foetal development. Mice deleted for the Wilms' tumour gene, Wt1, lack kidneys, gonads, and spleen and die at mid-gestation due to defective coronary vasculature. Wt1 is vital for maintaining the mesenchymal–epithelial balance in these tissues and is required for the epithelial-to-mesenchyme transition (EMT) that generates coronary vascular progenitors. Although Wt1 is only expressed in rare cell populations in adults including glomerular podocytes, 1% of bone marrow cells, and mesothelium, we hypothesised that this might be important for homeostasis of adult tissues; hence, we deleted the gene ubiquitously in young and adult mice. Within just a few days, the mice suffered glomerulosclerosis, atrophy of the exocrine pancreas and spleen, severe reduction in bone and fat, and failure of erythropoiesis. FACS and culture experiments showed that Wt1 has an intrinsic role in both haematopoietic and mesenchymal stem cell lineages and suggest that defects within these contribute to the phenotypes we observe. We propose that glomerulosclerosis arises in part through down regulation of nephrin, a known Wt1 target gene. Protein profiling in mutant serum showed that there was no systemic inflammatory or nutritional response in the mutant mice. However, there was a dramatic reduction in circulating IGF-1 levels, which is likely to contribute to the bone and fat phenotypes. The reduction of IGF-1 did not result from a decrease in circulating GH, and there is no apparent pathology of the pituitary and adrenal glands. These findings 1) suggest that Wt1 is a major regulator of the homeostasis of some adult tissues, through both local and systemic actions; 2) highlight the differences between foetal and adult tissue regulation; 3) point to the importance of adult mesenchyme in tissue turnover

What more can be done to popularize phonosurgical ideas in everyday handling of vocal folds?

This paper is focused on vocal fold surgery with phonosurgical intent. The aim of this review is to broaden phonosurgical knowledge, spread the ideas of the European Laryngological Society (ELS) on phonosurgery and translate the layered structure and physiology of the vocal fold described in Hirano's classic body-cover model into the graphic illustration of the "fluttering sleeve" created by Dikkers. In numerous countries, where phonosurgery is a relatively novel field of knowledge or still in its infancy, simple patterns and plain associations will serve the best in popularizing sophisticated vocal fold anatomy and preservation surgery and converting it into every day routine

Management of Chronic Laryngopharyngeal Neuropathy in the United States and Europe

Objective: This study aimed to analyze differences in the evaluation of laryngopharyngeal neuropathy by laryngologists in the United States and Europe. Methods: Members of the American Laryngological Association (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were ennailed to all 179 members of the ALA and all 324 members of the ELS. Results: Of the ALA members surveyed, 40 (23.3%) responded, compared to 72 members (22.2%) of the ELS group. Of the ALA respondents, 79.5% identified laryngology as their primary area of practice, whereas 56.9% of ELS respondents identified devoting more than 50% of their practice to laryngology. Of ELS laryngologists, 81.1% received training in laryngology or associated subspecialties. For diagnosing laryngopharyngeal neuropathy, the average comfort level on the Likert scale was significantly greater for ALA members than ELS members (P <.01). Furthermore, ALA laryngologists were less likely to consider laryngopharyngeal reflux as an overdiagnosed condition compared to ELS laryngologists (P <.05). Conclusion: Laryngologists in the United States and Europe vary significantly in their familiarity with laryngopharyngeal neuropathy. This could reflect either differences in awareness concerning this condition or a more critical perspective of European providers regarding the chronic laryngopharyngeal neuropathy (CLPN) diagnosis. As CLPN is still lacking definitive proof, the addition of European researchers could aid in validating CLPN and determining its overall effect on the chronic cough population

Management of Chronic Laryngopharyngeal Neuropathy in the United States and Europe

Objective: This study aimed to analyze differences in the evaluation of laryngopharyngeal neuropathy by laryngologists in the United States and Europe. Methods: Members of the American Laryngological Association (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were ennailed to all 179 members of the ALA and all 324 members of the ELS. Results: Of the ALA members surveyed, 40 (23.3%) responded, compared to 72 members (22.2%) of the ELS group. Of the ALA respondents, 79.5% identified laryngology as their primary area of practice, whereas 56.9% of ELS respondents identified devoting more than 50% of their practice to laryngology. Of ELS laryngologists, 81.1% received training in laryngology or associated subspecialties. For diagnosing laryngopharyngeal neuropathy, the average comfort level on the Likert scale was significantly greater for ALA members than ELS members (P <.01). Furthermore, ALA laryngologists were less likely to consider laryngopharyngeal reflux as an overdiagnosed condition compared to ELS laryngologists (P <.05). Conclusion: Laryngologists in the United States and Europe vary significantly in their familiarity with laryngopharyngeal neuropathy. This could reflect either differences in awareness concerning this condition or a more critical perspective of European providers regarding the chronic laryngopharyngeal neuropathy (CLPN) diagnosis. As CLPN is still lacking definitive proof, the addition of European researchers could aid in validating CLPN and determining its overall effect on the chronic cough population

Management of Chronic Laryngopharyngeal Neuropathy in the United States and Europe

Objective: This study aimed to analyze differences in the evaluation of laryngopharyngeal neuropathy by laryngologists in the United States and Europe.Methods: Members of the American Laryngological Association (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were ennailed to all 179 members of the ALA and all 324 members of the ELS.Results: Of the ALA members surveyed, 40 (23.3%) responded, compared to 72 members (22.2%) of the ELS group. Of the ALA respondents, 79.5% identified laryngology as their primary area of practice, whereas 56.9% of ELS respondents identified devoting more than 50% of their practice to laryngology. Of ELS laryngologists, 81.1% received training in laryngology or associated subspecialties. For diagnosing laryngopharyngeal neuropathy, the average comfort level on the Likert scale was significantly greater for ALA members than ELS members (P &lt;.01). Furthermore, ALA laryngologists were less likely to consider laryngopharyngeal reflux as an overdiagnosed condition compared to ELS laryngologists (P &lt;.05).Conclusion: Laryngologists in the United States and Europe vary significantly in their familiarity with laryngopharyngeal neuropathy. This could reflect either differences in awareness concerning this condition or a more critical perspective of European providers regarding the chronic laryngopharyngeal neuropathy (CLPN) diagnosis. As CLPN is still lacking definitive proof, the addition of European researchers could aid in validating CLPN and determining its overall effect on the chronic cough population.</p

Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians

Introduction: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. Methods: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. Results: Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. Conclusion: The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach