Clark A. Rosen

Development and validation of the voice handicap index-10.

Objectives/Hypothesis: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI).

Voice handicap index change following treatment of voice disorders

Outcome measurements of voice disorders is an important new area for both the evaluation of voice-disordered patients and evaluation of treatment efficacy. The Voice Handicap Index (VHI) measures the patients perception of the impact of his or her voice-disorder. The VHI was used in this study to measure the changes of the patients perception following treatment for four different voice disorders. The VHI showed a significant change following treatment for unilateral vocal fold paralysis, vocal cyst/polyp, and muscle tension dysphonia. Results of this paper indicate that the VHI is a useful instrument to monitor the treatment efficacy for voice disorders.

PRELIMINARY RESULTS OF THE USE OF INDOLE-3-CARBINOL FOR RECURRENT RESPIRATORY PAPILLOMATOSIS

OBJECTIVE: We report the preliminary results of a phase I trial using indole-3-carbinol for the treatment of recurrent respiratory papillomatosis. Indole-3-carbinol is a chemical that is found in high concentrations in cruciferous vegetables and has been shown to alter the growth pattern of recurrent respiratory papillomatosis cell cultures and to be effective in an in vivo animal model of recurrent respiratory papillomatosis. METHODS: Eighteen patients were treated with oral indole-3-carbinol and had a minimum follow-up of 8 months and a mean follow-up of 14.6 months. All patients received indole-3-carbinol, and outcome measures included a change in papilloma growth rate and the need for surgery during treatment compared with before treatment. All patients had serial examinations with videoendoscopy to document papilloma location and growth rate. RESULTS: Thirty-three percent (6 of 18) of the study patients had a cessation of their papilloma growth and have not required surgery since the start of the study. Six patients have had reduced papilloma growth rate, and 6 (33%) patients have shown no clinical response to indole-3-carbinol. Indole-3-carbinol affects the ratio of hydroxylation of estradiol; changes in the ratios of urinary 2-hydroxylation and 16-hydroxylation of estradiol caused by indole-3-carbinol correlated well with clinical response. No major complications or changes in the childrens growth curve were noted. CONCLUSIONS: The preliminary results of treating recurrent respiratory papillomatosis with indole-3-carbinol holds promise. Longer follow-up of this patient group and a blinded, controlled trial are required. We conclude that indole-3-carbinol appears to be safe and well tolerated and may be an efficacious treatment for recurrent respiratory papillomatosis. (Otolaryngol Head Neck Surg 1998;118:810–5.)

Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications

To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.

The Frequency of Perceived Stress, Anxiety, and Depression in Patients with Common Pathologies Affecting Voice

The studys objectives were to investigate (1) the frequency of perceived stress, anxiety, and depression for patients with common voice disorders, (2) the distribution of these variables by diagnosis, and (3) the distribution of the variables by gender. Retrospective data were derived from self-report questionnaires assessing recent stress (Perceived Stress Scale-10), anxiety, and depression (Hospital Anxiety and Depression Scale) in a cohort of new patients presenting to a voice clinic. Data are presented on 160 patients with muscle tension dysphonia (MTD), benign vocal fold lesions, paradoxical vocal fold movement disorder (PVFMD), or glottal insufficiency. Pooled data indicated that average stress, anxiety, and depression scores were similar to those found for the healthy population. However, 25.0%, 36.9%, and 31.2% of patients showed elevated stress, anxiety, and depression scores, respectively, compared to norms. Patients with PVFMD had the most frequent occurrence-and patients with glottal insufficiency had the least frequent occurrence of elevated stress, anxiety, and depression. Stress and depression were more common with MTD than with lesions, whereas reverse results were obtained for anxiety. More females than males had elevated stress, anxiety, and depression scores. The data are consistent with suggestions that stress, anxiety, and depression may be common among some patients with PVFMD, MTD, and vocal fold lesions and more common for women than men. However, individual variability in the data set was large. Further studies should evaluate the specific role of these conditions for selected categories of voice disorders in susceptible individuals.

Recommendations of the Neurolaryngology Study Group on laryngeal electromyography

The Neurolaryngology Study Group convened a multidisciplinary panel of experts in neuromuscular physiology, electromyography, physical medicine and rehabilitation, neurology, and laryngology to meet with interested members from the American Academy of Otolaryngology Head and Neck Surgery, the Neurolaryngology Subcommittee and the Neurolaryngology Study Group to address the use of laryngeal electromyography (LEMG) for electrodiagnosis of laryngeal disorders. The panel addressed the use of LEMG for: 1) diagnosis of vocal fold paresis, 2) best practice application of equipment and techniques for LEMG, 3) estimation of time of injury and prediction of recovery of neural injuries, 4) diagnosis of neuromuscular diseases of the laryngeal muscles, and, 5) differentiation between central nervous system and behaviorally based laryngeal disorders. The panel also addressed establishing standardized techniques and methods for future assessment of LEMG sensitivity, specificity and reliability for identification, assessment and prognosis of neurolaryngeal disorders. Previously an evidence-based review of the clinical utility of LEMG published in 2004 only found evidence supported that LEMG was possibly useful for guiding injections of botulinum toxin into the laryngeal muscles. An updated traditional/narrative literature review and expert opinions were used to direct discussion and format conclusions. In current clinical practice, LEMG is a qualitative and not a quantitative examination. Specific recommendations were made to standardize electrode types, muscles to be sampled, sampling techniques, and reporting requirements. Prospective studies are needed to determine the clinical utility of LEMG. Use of the standardized methods and reporting will support future studies correlating electro-diagnostic findings with voice and upper airway function.

OUTCOME MEASUREMENTS AND QUALITY OF LIFE IN VOICE DISORDERS

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patients perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patients perceived severity and need to recover vocal function may determine treatment.

Normative values for the Voice Handicap Index-10.

OBJECTIVES The objective of this study was to elucidate the normative values for the Voice Handicap Index-10 (VHI-10) questionnaire. METHODS VHI questionnaires were completed by 190 subjects without voice complaints. The results were then analyzed for mean, standard error of the mean (SEM), and standard deviation (SD) for both the original VHI and VHI-10 subset questionnaires. Outliers were defined as being more than three standard deviations above the mean. RESULTS Analysis of 156 VHI questionnaires revealed a mean of 6.86 (SEM=0.79, SD=9.88) for the normative values. One hundred fifty-eight VHI-10 questionnaires were analyzed to show a mean of 2.83 (SEM=0.31, SD=3.93) for the normative values. CONCLUSIONS This study offers normative data for the VHI-10 that has been missing in the literature. A VHI-10 score >11 should be considered abnormal.

Stroboscopy as a research instrument : Development of a perceptual evaluation tool

Laryngeal stroboscopy is arguably the most important clinical tool for the evaluation and treatment of patients with voice disorders. Unfortunately, at present, laryngeal stroboscopy is strictly a clinical tool and has no definitive use in the area of voice research. The limitation with laryngeal stroboscopy is the subjective nature of the interpretation of the video examination. A video stroboscopy research tool was developed using 10 stroboscopic parameters selected from the literature and clinical practice. The stroboscopy research tool was validated with the results of 18 reviewers using the instrument to rate 21 unique “cases” and 6 repeated “cases.” The results of this video perceptual analysis study identified which parameters were the most robust and reliable across a wide range of reviewers and validated power analysis curves for future similar research. Furthermore, findings from this study revealed that a greater than 80% intra‐rater reliability is the preferred method for the selection of a valid and reliable reviewer. Future research using this instrument will most likely increase the reliability and utility of the instrument with the use of prestudy reviewer training and/or the use of video examples to serve as anchors or external references.

Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar). A review of materials available and different vocal fold injection approaches is performed. A comparison of vocal fold injection to laryngeal framework surgery is also undertaken. With proper patient and material selection, vocal fold injection now plays a major role in the treatment of many patients with dysphonia.