Kristine Tanner

Vocal Function Exercises for Presbylaryngis: A Multidimensional Assessment of Treatment Outcomes:

Objectives Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis. Methods Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images. Results After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures, and laryngeal images did not reveal significant changes. Conclusions These preliminary data suggest that vocal function exercises produce significant functional and perceptual improvements in voice, and deserve further attention as a treatment for elderly patients with presbylaryngis.

An Evaluation of the Effects of Three Laryngeal Lubricants on Phonation Threshold Pressure (PTP)

Clinicians frequently offer advice to performers and voice-disordered patients aimed ostensibly to manipulate the water content and/or viscosity of the mucus blanket covering the vocal folds. To evaluate the relative effects of three potential laryngeal lubricants on phonatory function (ie, water, Mannitol--an osmotic agent, and Entertainers Secret Throat Relief (Kli Corp., Carmel, IN)--a glycerin-based product), phonation threshold pressure (PTP) was measured in 18 healthy, vocally normal female participants twice before (baseline) and then four times after 2 ml of each substance were nebulized. PTP is the minimum subglottal pressure required to initiate vocal fold oscillation, and the lowering of PTP is assumed to correspond to physiologically more efficient phonation and reduced phonatory effort. Over a 3-week period, participants were tested on three separate occasions (at 1-week intervals). On each occasion, a different nebulized treatment was administered. PTP for both comfortable and high fundamental frequency productions was measured using an oral pressure-flow system (Perci-Sars, MicroTronics Corp., Chapel Hill, NC). Analysis of the results revealed that Mannitol, an agent that encourages osmotic water flux to the luminal airway surface, lowered PTP immediately after its administration (ie, p = 0.071, for high-pitched productions only). However, the duration of its PTP lowering effect was less than 20 minutes. The other two substances did not demonstrate any significant postadministration effect on PTP.

Toward Validation of the Cepstral Spectral Index of Dysphonia (CSID) as an Objective Treatment Outcomes Measure

OBJECTIVES To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of dysphonia severity. METHOD Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic dysphonia, primary muscle tension dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. RESULTS CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. CONCLUSIONS The results confirm a robust relationship between listener perceived and CSID-derived dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure.

Gender differences affecting vocal health of women in vocally demanding careers.

Abstract Studies suggest that occupational voice users have a greater incidence of vocal issues than the general population. Women have been found to experience vocal health problems more frequently than men, regardless of their occupation. Traditionally, it has been assumed that differences in the laryngeal system are the cause of this disproportion. Nevertheless, it is valuable to identify other potential gender distinctions which may make women more vulnerable to voice disorders. A search of the literature was conducted for gender-specific characteristics which might impact the vocal health of women. This search can be used by health care practitioners to help female patients avoid serious vocal health injuries, as well as to treat better those women who already suffer from such vocal health issues.

Spasmodic Dysphonia: Onset, Course, Socioemotional Effects, and Treatment Response

Objectives: This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD). Methods: A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD. Results: Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor. Conclusions: The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.

Case-control study of risk factors for spasmodic dysphonia: A comparison with other voice disorders.

This epidemiology study examined risk factors uniquely associated with spasmodic dysphonia (SD).

Comparing nebulized water versus saline after laryngeal desiccation challenge in Sjögren's Syndrome

This study examined the effects of a laryngeal desiccation challenge and two nebulized hydration treatments on phonation threshold pressure (PTP), vocal effort, and throat dryness in patients with chronic airway dryness.

Quality-of-life scores compared to objective measures of swallowing after oropharyngeal chemoradiation.

To compare objective measures of swallowing function with patient reports of swallowing‐related quality of life 1 year after treatment of oropharyngeal cancer with chemoradiation therapy.

Risk and Protective Factors for Spasmodic Dysphonia: A Case-Control Investigation

OBJECTIVES Spasmodic dysphonia (SD) is a chronic, incurable, and often disabling voice disorder of unknown pathogenesis. The purpose of this study was to identify possible endogenous and exogenous risk and protective factors uniquely associated with SD. STUDY DESIGN Prospective, exploratory, case-control investigation. METHODS One hundred fifty patients with SD and 150 medical controls (MCs) were interviewed regarding their personal and family histories, environmental exposures, illnesses, injuries, voice use patterns, and general health using a previously vetted and validated epidemiologic questionnaire. RESULTS Odds ratios and multiple logistic regression analyses (α<0.15) identified several factors that significantly increased the likelihood of having SD. These factors included (1) a personal history of mumps, blepharospasm, tremor, intense occupational and avocational voice use, and a family history of voice disorders; (2) an immediate family history of meningitis, tremor, tics, cancer, and compulsive behaviors; and (3) an extended family history of tremor and cancer. CONCLUSIONS SD is likely multifactorial in etiology, involving both genetic and environmental factors. Viral infections/exposures, along with intense voice use, may trigger the onset of SD in genetically predisposed individuals. Future studies should examine the interaction among genetic and environmental factors to determine the pathogenesis of SD.

Vocal Fold Bowing in Elderly Male Monozygotic Twins: A Case Study

This case study examined case histories, diagnostic features, and treatment response in two 79-year-old male monozygotic (identical) twins with vocal fold bowing, exploring both genetic and environmental factors. DNA concordance was examined via cheek swab. Case histories, videostroboscopy, auditory- and visual-perceptual assessment, electromyography, acoustic measures, and Voice Handicap ratings were undertaken. Both twins underwent surgical intervention and subsequent voice therapy. Monozygosity was confirmed for DNA polymorphisms, with 10 of 10 concordance for STR DNA markers. For both twins, auditory- and visual-perceptual assessments indicated severe bowing, hoarseness, and breathiness, although Twin 1 was judged to be extremely severe. Differences in reference to root-mean-square amplitudes were observed for thyroarytenoid and lateral cricoarytenoid muscles, with smaller relative amplitudes observed for the Twin 1 versus Twin 2. No consistent voice improvement was observed after surgical intervention(s), despite improved mid-membranous vocal fold closure. Marked reductions in Voice Handicap Index total scores were observed after behavioral voice therapy, coinciding with increased mid-membranous and posterior laryngeal (interarytenoid) glottal closure. No substantive differences in acoustic measures were observed. Vocal fold bowing was more severe for Twin 1 versus Twin 2 despite identical heritability factors. Overall voice improvement with treatment was greater for Twin 2 than Twin 1. Environmental factors might partially account for the differences observed between the twins, including variability in their responsiveness to behavioral voice therapy. Voice therapy was useful in improving mid-membranous and posterior laryngeal closure, although dysphonia remained severe in both cases.