Floris L. Wuyts

Test-retest study of the GRBAS scale: Influence of experience and professional background on perceptual rating of voice quality

Perceptual evaluation was performed by means of the GRBAS scale for a series of nine pathological voice samples that were presented twice to a group of 23 judges, consisting of experienced and inexperienced otolaryngologists (ENTs) and speech-language pathologists (S/LPs). The time interval between ratings was 14 days. Test-retest reliability was moderate. The best agreement between the observers was obtained for the G (grade) parameter and the worst for the S (strained) parameter. Considering the medians of the GRBAS ratings, no significant influence was measured for level of experience or professional background. Yet, based on means, the results show that professional background has a greater impact on perceptual rating than experience.

Clinical assessment of balance: Normative data, and gender and age effects

The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second time limit).

Quality-of-life benefit from cochlear implantation in the elderly.

Objective: To compare the audiologic results of geriatric patients receiving cochlear implants with younger age groups and to evaluate the quality of life after cochlear implantation in the geriatric population by means of validated quality-of-life questionnaires. Study Design: Cross-sectional study involving 89 postlingually deafened cochlear implant subjects. Setting: Tertiary referral center. Patients: A total of 89 postlingually deafened patients were included in the study, among which were 25 patients who were aged 70 years or older. Interventions: All patients received a cochlear implant. Subjects were implanted with either the Laura, Nucleus 24, or Med-el Combi 40+ cochlear implant systems implementing the SPEAK, ACE, CIS, or CIS+ coding strategies. Mean Outcome Measures: Speech recognition was determined by means of phonetically balanced monosyllabic word lists. The Hearing Handicap Inventory for Adults, the Glasgow Benefit Inventory, and the scale for the prediction of hearing disability in sensorineural hearing loss were used to quantify the quality of life. Results: Mean audiologic performance for the three groups increased significantly after implantation (p < 0.001). Postoperative audiologic performance of the geriatric population led to useful hearing, but these scores were significantly lower than for the younger age groups (p = 0.002). However, the quality-of-life outcomes for the geriatric group were similar to those of the younger age groups (p = 0.411 for the Hearing Handicap Inventory for Adults; p = 0.886 for the Glasgow Benefit Inventory). Conclusion: The results of this study prove that cochlear implantation in the elderly provides improvements in quality of life and speech understanding, similar to those for younger adult cochlear implant recipients.

Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for the perceptual evaluation of dysphonia.

Perceptual evaluation of 14 pathological voices was performed by 29 listeners using the GRBAS scale. To evaluate scale effects on the judgments, 2 versions of the scale were presented: the original 4-point scale and a visual analog scale. Each listener used the same voice samples for both versions of the scale with an interval of 2 weeks. Agreement was found to be higher with the original 4-point scale than with the visual analog version for all scale items G, R, B, A and S. Although a visual analog scale seems to enable a finer judgment of voice quality, this study showed that, with increased freedom of judgment, the interrater agreement decreased considerably. Therefore, we recommend the use of the original 4-point version of the GRBAS scale.

Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study

AIMS This study was designed to compare the effects of combined endurance-resistance training (CT) with endurance training (ET) only on submaximal and maximal exercise capacity, ventilatory prognostic parameters, safety issues, and quality of life in patients with chronic heart failure (CHF). METHODS AND RESULTS Fifty-eight CHF patients (NYHA class II-III) were randomized either to 6 months CT [n = 28, 58 years, left ventricular ejection fraction (LVEF) 26%, VO(2)peak 18.1 mL/kg/min] or ET (n = 30, 59 years, LVEF 23%, VO(2)peak 21.3 mL/kg/min). The increase in steady-state workload (P = 0.007) and the decrease in heart rate at SSW (P = 0.002) were significantly larger in CT- compared with ET-trained patients. Maximal exercise capacity (i.e. VO(2)peak, maximal workload) and work-economy (Wattmax/VO(2)peak) evolved similarly. VO(2)peak halftime was reduced following CT (P = 0.001). Maximal strength in upper limbs increased significantly (P < 0.001) in favour of the CT group. CT also had a beneficial effect on health-related quality of life, i.e. 60% of CT-trained patients vs. 28% of ET-trained patients reported a decrease in cardiac symptoms (OR = 3.86, 95% CI 1.11-12.46, P = 0.03). There were no differences with regard to improved LVEF, evolution of left ventricular dimensions, nor outcome data (mortality and cardiovascular hospital admissions during follow-up). CONCLUSION In CHF patients, CT had a more pronounced effect on submaximal exercise capacity, muscle strength, and quality of life. The absence of unfavourable effects on left ventricular remodelling and outcome parameters is reassuring and might facilitate further implementation of this particular training modality.

High-Dose Folic Acid Pretreatment Blunts Cardiac Dysfunction During Ischemia Coupled to Maintenance of High-Energy Phosphates and Reduces Postreperfusion Injury

Background— The B vitamin folic acid (FA) is important to mitochondrial protein and nucleic acid synthesis, is an antioxidant, and enhances nitric oxide synthase activity. Here, we tested whether FA reduces myocardial ischemic dysfunction and postreperfusion injury. Methods and Results— Wistar rats were pretreated with either FA (10 mg/d) or placebo for 1 week and then underwent in vivo transient left coronary artery occlusion for 30 minutes with or without 90 minutes of reperfusion (total n=131; subgroups used for various analyses). FA (4.5×10−6 mol/L IC) pretreatment and global ischemia/reperfusion (30 minutes/30 minutes) also were performed in vitro (n=28). After 30 minutes of ischemia, global function declined more in controls than in FA-pretreated rats (&Dgr;dP/dtmax, −878±586 versus −1956±351 mm Hg/s placebo; P=0.03), and regional thickening was better preserved (37.3±5.3% versus 5.1±0.6% placebo; P=0.004). Anterior wall perfusion fell similarly (−78.4±9.3% versus −71.2±13.8% placebo at 30 minutes), yet myocardial high-energy phosphates ATP and ADP reduced by ischemia in controls were better preserved by FA pretreatment (ATP: control, 2740±58 nmol/g; ischemia, 947±55 nmol/g; ischemia plus FA, 1332±101 nmol/g; P=0.02). Basal oxypurines (xanthine, hypoxanthine, and urate) rose with FA pretreatment but increased less during ischemia than in controls. Ischemic superoxide generation declined (3124±280 cpm/mg FA versus 5898±474 cpm/mg placebo; P=0.001). After reperfusion, FA-treated hearts had smaller infarcts (3.8±1.2% versus 60.3±4.1% placebo area at risk; P<0.002) and less contraction band necrosis, terminal deoxynucleotidyl transferase–mediated dUTP nick-end labeling positivity, superoxide, and nitric oxide synthase uncoupling. Infarct size declined similarly with 1 mg/d FA. Conclusions— FA pretreatment blunts myocardial dysfunction during ischemia and ameliorates postreperfusion injury. This is coupled to preservation of high-energy phosphates, reducing subsequent reactive oxygen species generation, eNOS-uncoupling, and postreperfusion cell death.

Comparison of different voice samples for perceptual analysis.

Choice of voice sample material can influence perceptual judgments by a jury. The twofold purpose of this study was first to validate the pertinence of a sustained vowel for perceptual voice analysis in French speakers and second to test the hypothesis that use of only the stabilized portion of the vowel would lead to underestimation of dysphonia. Voice samples were recorded in 60 dysphonic patients and 20 normal controls. Three different sample materials were obtained for each subject, i.e. connected speech, a sustained vowel including both the initial and stable portion (complete sustained vowel), and a sustained vowel including only the stable portion (stabilized sustained vowel). The jury was composed of 7 experienced listeners. Jury consistency was measured as a percentage of agreeing judgments for the same subject. No difference in consistency was observed using the three sample materials. Judgments on stabilized sustained vowels were confirmed as less severe than judgments on connected speech. Judgments on complete sustained vowels were comparable to judgments on connected speech.

Training outcome in future professional voice users after 18 months of voice training.

The goal of this study is to define the long-term influence of vocal hygiene education and the effectiveness of voice training in 46 students. Half of the subjects, called the trained group (n = 23), received vocal hygiene education during 1 school year and voice training during 2 school years (18 months). The other half, also 23 subjects, received neither vocal hygiene education nor voice training as such (called the untrained group). The voice training is made up of technical workshops (30 h a year in groups of 5–8 subjects) and vocal coaching in the radio and drama projects (30 h whole class). In the lectures (30 h) a theoretical background on breathing, articulation, voicing and vocal hygiene was discussed. A multidimensional test battery containing the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, Dysphonia Severity Index (DSI) and Voice Handicap Index (VHI) was applied before and after 18 months to evaluate the effect of voice training over time. A questionnaire on daily habits was presented before the lectures, and after 18 months to detect the long-term effect of the lectures. The objectively measured voice quality (DSI) of the trained group improved significantly over time (p < 0.001) due to training (p = 0.008), which was not the case in the untrained group. The self-assessed VHI, on the other hand, changed over time (p < 0.001) in both groups. For the trained group the VHI changed from 18.4 to 14.4 and in the untrained group from 20.1 to 15.3. It is important to note that the VHI scores of both groups remained high. The interpretation of the results of the daily habit questionnaire is disturbing: the initial high degree of smoking, vocal abuse, stress and late meals was not influenced by the lectures or training and remained high. This study proves the positive outcome and emphasizes the need for a well-organized voice training program in future professional voice users. However, the lectures and training on vocal hygiene failed to improve voice-conserving habits.

Adverse ventricular remodeling and exacerbated NOS uncoupling from pressure-overload in mice lacking the beta3-adrenoreceptor.

Stimulation of the beta-adrenergic system is important in the pathological response to sustained cardiac stress, forming the rationale for the use of beta-blockers in heart failure. The beta3-adrenoreceptor (AR) is thought to couple to the inhibitory G-protein, G(i), with downstream signaling through nitric oxide, although its role in the heart remains controversial. In this study, we tested whether lack of beta3-AR influences the myocardial response to pressure-overload. Baseline echocardiography in mice lacking beta3-AR (beta3(-/-)) compared to wild type (WT) showed mild LV hypertrophy at 8 weeks that worsened as they aged. beta3(-/-) mice had much greater mortality after transverse aortic constriction (TAC) than WT controls. By 3 weeks of TAC, systolic function was worse. After 9 weeks of TAC, beta3(-/-) mice also had greater LV dilation, myocyte hypertrophy and enhanced fibrosis. NOS activity declined in beta3(-/-)TAC hearts after 9 weeks, and total and NOS-dependent superoxide rose, indicating heightened oxidative stress and NOS uncoupling. The level of eNOS phosphorylation in beta3(-/-)TAC hearts was diminished, and nNOS and iNOS expression levels were increased. GTP cyclohydrolase-1 expression was reduced, although total BH4 levels were not depleted. 3 weeks of BH4 treatment rescued beta3(-/-) mice from worsened remodeling after TAC, and lowered NOS-dependent superoxide. Thus, lack of beta3-AR signaling exacerbates cardiac pressure-overload induced remodeling and enhances NOS uncoupling and consequent oxidant stress, all of which can be rescued with exogenous BH4. These data suggest a cardioprotective role for the beta3-AR in modulating oxidative stress and adverse remodeling in the failing heart.

Improving Vestibular Evoked Myogenic Potential Reliability by using a Blood Pressure Manometer

Objective/Hypothesis: To improve the reliability of vestibular evoked myogenic potentials (VEMP), we propose a feedback method making use of a readily available blood pressure manometer with inflatable cuff to control the sternocleidomastoid muscle (SCM) contraction.