Barbara Weinrich

Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population.

The prevalence of laryngeal pathology in a treatment-seeking population of southwestern Ohio underwent a 15-year reexamination. Relationships between pathology and demographic variables of age, gender, and occupation were investigated. Data were collected from 1,158 new patients seen by participating otolaryngologists between 1996 and 1998. The most frequent pathologies were reflux laryngitis, functional (including diagnoses of laryngeal myasthenia and hoarseness), vocal fold paralysis, nodules, and laryngitis. Pathologies were found to occur more often in females, with some pathologies more common to one gender. Pathologies occurred more often in the older age categories. The most common occupations found in the sample were retired persons, executives/managers, and homemakers. Comparisons were made to an earlier investigation of laryngeal pathology in the same otolaryngology practices. Differences from the previous study were noted in the prevalence of pathology and the distribution of demographic variables. Relationships between pathology and demographic variables reported by the two studies were examined for consistency.

Aerodynamic changes as a result of vocal function exercises in elderly men.

Objectives/Hypothesis: Voice therapy can improve the vocal quality of elderly patients with voice problems, but the changes in vocal aerodynamics associated with physiologic voice therapy are not well documented. The purpose of the present study was to determine the changes in vocal aerodynamics as a result of the management program known as Vocal Function Exercises (VFEs).

Perceptual Evaluation of Severe Pediatric Voice Disorders: Rater Reliability Using the Consensus Auditory Perceptual Evaluation of Voice

The purpose of this nonrandomized prospective study was to quantify the inter- and intrarater reliability of experienced speech-language pathologists perceptual ratings of voice in pediatric patients post-laryngotracheal reconstruction (LTR). Moderate to severe dysphonia is common in this population. Using the sentence portion of the Consensus Auditory Perceptual Evaluation-Voice (CAPE-V) rating scale, three experienced speech-language pathologists independently rated randomized voice samples of 50 participants ages 4-20 years, who had acquired or congenital airway conditions requiring at least one LTR on the six salient perceptual vocal attributes. Data collection and listening conditions were carefully controlled. Seventeen (34%) of the samples were randomly selected for rerating at a later time. Estimates of interrater reliability were strongest for perceptual ratings of breathiness (intraclass correlation coefficient [ICC]=71%), roughness (ICC=68%), pitch (ICC=68%), and overall severity (ICC=67%). Reliability was lower for ratings of loudness (ICC=57%) and strain (ICC=35%). For each rater, the intrarater reliability on all but one parameter (strain) was moderate to strong (ICC=63-93%). There was a strong interrater eliability for four of six vocal parameters rated using the CAPE-V in a population of children and adolescents with marked dysphonia. The parameter of strain, when rated by auditory sample alone and apart from the clinical context, was difficult to rate.

Comparison of Pediatric Voice Handicap Index Scores with Perceptual Voice Analysis in Patients following Airway Reconstruction

Objectives We performed a retrospective review to compare a subjective parental proxy-derived voice handicap survey to an observer-derived method of measuring voice perturbation in children who have undergone airway reconstruction. The main outcome measures were the Pediatric Voice Handicap Index (pVHI) total score and the Overall Severity score on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Methods The percent Overall Severity CAPE-V score (score divided by 100) and the percent pVHI score (score divided by 92) were calculated. A Wilcoxon signed rank test was used to compare CAPE-V scores with the pVHI total scores. The relationship between the pVHI scores and the CAPE-V scores was investigated with a Spearman correlation. Subgroup analysis was performed to determine the relationship of surgery type to CAPE-V and pVHI scores. Results Fifty subjects with a history of airway surgery who were evaluated between 2005 and 2008 were identified. Forty-two of the 50 subjects had complete data for review. Their median age was 7.1 years (range, 3.3 to 17.9 years). Their pVHI total scores had a median of 30 (range, 1 to 80). Their Overall Severity CAPE-V scores had a median of 50.5 (range, 0 to 98). Their median CAPE-V percent was higher than their median pVHI percent (50.5% versus 32.6%; p = 0.0003). A weak correlation was found between the Overall Severity CAPE-V score and the pVHI total score (rho = 0.41; p = 0.0003). There was a trend toward higher Overall Severity CAPE-V scores in patients who underwent cricotracheal resection. The total number of airway surgeries was significantly correlated with the Overall Severity CAPE-V score (rho = 0.6; p < 0.0001) but not with the pVHI score. Conclusions Children who undergo airway reconstruction often have a resulting voice disturbance that can affect their lives in multiple dimensions. The results of this study revealed a weak-to-fair correlation between the parent-reported pVHI total score and expert ratings of voice quality using the CAPE-V. In this patient population, both of these tools provided important information regarding the relationship of the severity of voice disturbance to its handicapping effects.

Characterization of supraglottic phonation in children after airway reconstruction.

Objectives We examined select acoustic (signal type), aerodynamic, and perceptual measures and associated surgical data in a cohort of children who were endoscopically identified as using supraglottic phonation after undergoing airway reconstruction. Methods Twenty-one children (4 to 18 years of age) who were seen in the Cincinnati Childrens Hospital Medical Center for Pediatric Voice Disorders and identified as using supraglottic phonation were included in this study. According to standard protocol, each of these children underwent acoustic, aerodynamic, and perceptual analyses and laryngeal imaging. Their medical records were reviewed for surgical history. Results Four primary supraglottic compression patterns and 3 distinct sound sources for voice were identified. Signal type classification revealed that 20 of 21 voice signals were either type II or type III. Signal type was moderately associated with compression pattern (p = 0.01). No statistically significant findings were found in testing the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) Overall Severity score against compression patterns and vibration source. The mean Strain scores for participants who used a combined source of vibration were significantly higher than for those who used their ventricular folds. Conclusions The compensatory compression patterns and alternate sources of vibration used by these children resulted in moderate to severe dysphonias. How children compensate after undergoing airway reconstruction has important implications for behavioral and surgical interventions aimed at improving voice quality. Not all aspects of traditional voice evaluation are suitable for this population.

The effect of task type on fundamental frequency in children

OBJECTIVE The purpose of this study was to examine the influence of task type on the fundamental frequency (F(0)) produced by young children. Fundamental frequency is a parameter which describes the rate of vocal fold vibration. The influence of task type on F(0) values is important for health professionals designing and implementing assessment protocols for children with voice disorders. METHODS Forty-eight healthy children between the ages of 5.0 and 7.11 years were evaluated in this study. Each child completed four tasks used to elicit a voice sample for subsequent analysis of F(0). The tasks included: (a) sustaining the vowel/a/(Vowel), (b) sustaining the vowel embedded in a word at the end of a phrase (Phrase), (c) repeating a sentence (Sentence), and (d) counting from 1 to 10 (Counting). Each child was evaluated by one of two clinicians who had an equal number of years of training and were the same age and gender. RESULTS A repeated measures analysis of variance (ANOVA) was used to examine the influence of task type on F(0) values. The results revealed a significant difference in F(0) between the four elicitation tasks (p=.002). Pair wise comparisons revealed that Counting elicited higher F(0) values compared to Phrase (p=.018) and Sentence tasks (p=.001). There were no significant interaction effects for task by age, gender, or clinician who evaluated the child (p>.05). CONCLUSIONS The results of this study revealed that task type does significantly influence F(0) values in young children. This finding is clinically important as it indicates that the same task should be used to monitor changes in the voice over time in relationship to surgical or behavioral interventions.

Voice outcomes following adult cricotracheal resection.

Cricotracheal resection (CTR) is an effective treatment for moderate‐to‐severe laryngotracheal stenosis (LTS) in adults. However, one of the potentially significant sequela of this procedure is postoperative dysphonia and permanent voice alteration. The objective of this study is to characterize voice changes in adult patients with subglottic stenosis who have undergone CTR.

Aerodynamic and acoustic assessment in children following airway reconstruction: An assessment of feasibility

OBJECTIVE The purpose of this study was to examine the feasibility of conducting aerodynamic and acoustic assessment in children following airway reconstruction. Underlying etiologies, co-morbidities and age related factors can present challenges for meaningful instrumental data collection in this population. METHODS A chart review of 100 children who were seen for a complete voice evaluation at the Center for Pediatric Voice Disorders at the Cincinnati Childrens Hospital Medical Center was conducted. Children who completed full or partial aerodynamic and acoustic protocols were identified. Data regarding the ability to participate in the assessment was tabulated, and vowel samples taken from the acoustic data were subjected to signal type classifications (e.g., Type I, II, III). RESULTS Fifty-three children met the inclusion/exclusion criteria of the chart review. Of those children, 58% (n=31/53) were able to complete the full acoustic and aerodynamic protocols without any modification. In regards to the aerodynamic protocol alone, 64% (n=34/53) could complete protocol. In regards to the acoustic protocol alone, 75% (n=40/53) could complete the entire acoustic protocol without any modification. There were 32% (n=17) who provided a Type I acoustic signal which was appropriate for measurement of F(0). There was a significant correlation between age and ability to complete the protocol for both the aerodynamic (p=.007) and acoustic (p=.004) protocols. CONCLUSIONS This study demonstrated that a majority of children were capable of completing aerodynamic and acoustic protocols. A significant proportion of children in this study had severe dysphonia, precluding the ability to extract fundamental frequency. Although aerodynamic and acoustic measures are feasible for many patients in this population, the severity of dysphonias observed in these patients causes the use of these measures to be limited in some cases for documenting behavioral and surgical outcomes measures.

Use of acupuncture for the treatment of adductor spasmodic dysphonia: a preliminary investigation

Ten subjects with adductor spasmodic dysphonia participated in a study examining the effects of an acupuncture treatment protocol on their voice disorder. Treatment consisted of eight sessions, and it was designed and performed by two physicians certified in acupuncture. Voice characteristics were evaluated pretreatment and posttreatment using the CSL Motor Speech Profile (MSP), Unified Spasmodic Dysphonia Rating Scale, and Voice Handicap Index (VHI). Subjects also answered a posttreatment questionnaire regarding their experience. Significant pretreatment and posttreatment differences occurred for some MSP measures. Significant differences were found on all three subtests of the VHI, and the average total scores pretreatment and posttreatment differed by 17 points (considered significant according to VHI standardization). Seven of 10 subjects reported improvements in voice production, although expert raters did not detect perceptual changes in voice quality. Possible reasons for the discrepancies between objective measures and self ratings, and implications for further research, are discussed.

An Examination of Elicitation Method on Fundamental Frequency and Repeatability of Average Airflow Measures in Children Age 4:0–5:11 Years

OBJECTIVE The purpose of this study was to determine the effect of task type on fundamental frequency (F(0)) and the short-term repeatability of average airflow values in preschool/kindergarten-age children. STUDY DESIGN Prospective, experimental. METHODS Thirty healthy children (age 4.0-5.11 years) were included in this study. Participants completed three tasks (sustained vowel, counting, and storytelling) used to elicit measurements of F(0). With a 10-minute interval, participants also completed two trials of sustained /a/ at a comfortable pitch and loudness level for the measurement of average airflow rate. F(0) and intensity of the vowel production were recorded for both trials. RESULTS A repeated measures analysis of variance revealed a significant main effect for task type elicitation on F(0) values (P=0.0003). A significant difference between elicitation tasks for F(0) was observed in the comparison of the counting and storytelling task (P<0.0001). A paired t test revealed no significant difference in average airflow rate across two trials (P=0.872). The change in F(0) and intensity was measured across the trials, and separate analyses of covariance revealed that these changes did not significantly influence average airflow values, (P=0.809) and (P=0.365), respectively. CONCLUSIONS The results of this study demonstrated that F(0) may be influenced by task type in young children. Average airflow values appear to be stable over a short time period. This information is important in determining methods of evaluation and the reliability of instrumental measures in young children with voice disorders.