Isabel García-López

Validación de la versión en español del índice de incapacidad vocal (S-VHI) para el canto

UNLABELLED In the questionnaires that currently exist in Spanish to assess the impact on quality of life of voice pathology, there are no questions that refer specifically to the singing voice. We present the results of the validation of the Singing Voice Handicap Index (SVHI) in Spanish. MATERIALS AND METHODS The SVHI was translated into Spanish from the validated version in English. The questionnaire was completed by 29 dysphonic singers and 81 healthy singers. RESULTS There was good test-retest reliability (r=0.63, p=0.000). Regarding the item-total correlation, it was found that all samples had high correlations on individual items. Significant correlations were found between the severity of the score of the voice self-rated by the singer and the total scores of the SVHI (r=0.52, p=0.000). There were significant differences between the group of singers with dysphonia and the control group in the SVHI scores (ANOVA, F=10.9, p <0.002). CONCLUSIONS The Spanish version of the translated SVHI questionnaire is a validated tool with proper internal consistency and reliability. The average score of the SVHI singers in a healthy population is 20% of the maximum possible questionnaire score, well above the average score in a healthy population for the spoken voice with the 30-item specific VHI.

El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía

INTRODUCTION Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. MATERIAL & METHODS Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then, 6 months later, with anchors and a narrow band spectrogram as additional information. RESULTS The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. DISCUSSION This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram.

La voz cantada

Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist. The reason for this is probably that the field of voice has not received as much attention as others in our speciality. Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed. This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked.

Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis

OBJECTIVE This study aimed to determine the value of laryngeal electromyography in the prognosis of vocal fold paralysis. STUDY DESIGN This is a retrospective descriptive study. MATERIALS AND METHODS This study included 80 patients diagnosed with unilateral or bilateral vocal fold paralysis on flexible laryngoscopy between 2002 and 2014 in a tertiary medical center. Laryngeal electromyography using a standardized protocol was performed; the outcome measures were classified and analyzed into two groups according to the degree of injury. Group 1 included patients with mild to moderate injury, and group 2 included patients with severe to complete injury. Prognosis was correlated with vocal fold motion recovery status with a minimum of 6 months of follow-up since the symptoms onset using positive and negative predictive values. RESULTS Sixty patients showed acute or chronic recurrent laryngeal neuropathy in laryngeal electromyography. Twelve of 41 patients included in group 1 recovered motion, and 30 of 35 patients included in group 2 did not recover, resulting in 88.2% of positive predictive value and 35.7% of negative predictive value. CONCLUSIONS Our data confirm that laryngeal electromyography is a useful clinical tool in predicting poor recovery in patients with vocal fold paralysis. It allows identification of candidates for early intervention.

Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis

Laryngeal synkinesis is a vocal fold movement disorder produced by a misdirected reinnervation after a recurrent laryngeal nerve injury. Its symptoms differ greatly between patients, requiring diverse therapeutical approaches. We aim to describe our experience in the diagnosis and treatment of different laryngeal synkinesis presentations. 11 patients diagnosed between 2011 and 2014 in a tertiary referral center with laryngeal synkinesis confirmed by laryngeal electromyography were included in our study. All medical records and laryngoscopic and electromyographic data were reviewed retrospectively. Four patients had previous unilateral vocal fold palsy and seven had a bilateral palsy with different degrees of clinical involvement. All of them showed paradoxical movements during inhalation in videofibrolaryngoscopic examination. Laryngeal electromyography confirmed the diagnosis of laryngeal synkinesis. Dyspnea was the main presentation symptom. Three patients with mild symptoms were not treated. Patients with unilateral vocal fold immobility were successfully treated with periodic botulinum toxin injections. Patients with bilateral immobility had a good initial response to botulinum toxin, although in some of them, a posterior cordectomy had to be finally performed. In conclusion, laryngeal synkinesis is a heterogeneous clinic entity that appears in patients with unilateral or bilateral vocal fold paralysis. Videofibrolaryngoscopy and laryngeal electromyography are essential to a correct diagnosis. Botulinum toxin injections are the main treatment for symptomatic cases, even if in bilateral palsy cases more aggressive treatments are often required.

Adaptación fonética y validación del método de valoración perceptual de la voz CAPE- V al español

OBJECTIVE The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed.to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality. This tool was originally developed in English language and its Spanish version is still inexistent. The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version. METHOD To adapt the CAPE-V protocol to the Spanish language, we proposed 6 phrases phonetically designed according to the CAPE-V requirements. Prospective instrument validation was performed. The validity of the Spanish version of the CAPE-V was examined in 4 ways: intra-rater reliability, inter-rater reliability and CAPE-V versus GRABS judgments. RESULTS Inter-rater reliability coefficients for the CAPE-V ranged from 0.93 for overall severity to 0.54 for intensity; intra-rater reliability ranged from 0.98 for overall severity to 0.85 for intensity. The comparison of judgments between GRABS and CAPE-V ranged from 0.86 for overall severity to 0.61 for breathiness. CONCLUSIONS The present study supports the use of the Spanish version of CAPE-V because of its validity and reliability.

Parálisis laríngea en la población infantil

INTRODUCTION AND OBJECTIVES Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. METHODS All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. RESULTS The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. CONCLUSIONS The diagnosis of VFP may be suspected based on the patients symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation.

Electromiografía laríngea en el diagnóstico y tratamiento de los trastornos de la voz

INTRODUCTION AND OBJECTIVES Laryngeal electromyography, together with clinical evaluation, is a valuable tool in voice disorder management. It assesses the integrity of laryngeal nerves and muscles, contributing to the diagnosis of many diseases, especially laryngeal movement disorders. Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating voice disorders. METHODS A prospective study was designed to evaluate laryngeal movement disorders with laryngeal electromyography. Both the cricothyroid and thyroarytenoid muscles were tested routinely and, in some cases, the posterior cricoarytenoid muscle. The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist. RESULTS We included 110 patients, with the most common symptom being dysphonia. Laryngeal electromyography was performed in 85% of cases. Primary diagnosis before electromyography was laryngeal immobility. Positive predictive value for diagnosis in cases of paralysis was 88%. CONCLUSIONS Laryngeal electromyography is a useful adjunct, together with clinical evaluation, for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia.

Experiencia clínica en pacientes con síndrome de Meige primario y disfonía espasmódica

INTRODUCTION Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS. MATERIAL AND METHODS A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner. RESULTS Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire. CONCLUSION In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.

Tiroplastia tipo III para el tratamiento de la disfonía por elevación del tono

Type III thyroplasty is a surgical technique which diminishes the fundamental frequency of the voice. We present the case of a patient with dysphonia by tone elevation in relation to gender, treated by type III thyroplasty and an updated review of the surgical technique and its outcome.