Myriam Piccaluga

Voice outcomes of laryngopharyngeal reflux treatment: a systematic review of 1483 patients

The aim of this study is to explore voice quality modifications in laryngopharyngeal reflux (LPR) disease and to understand better the pathophysiological mechanisms underlying the development of communicative disability. Biological Abstracts, BioMed Central, Cochrane database, PubMed and Scopus were assessed for subject headings using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. Relevant studies published between January 1990 and December 2015 describing the evaluation of voice quality in LPR disease were retrieved. Issues of clinical relevance, such as LPR diagnosis method, treatment efficacy and outcomes, were evaluated for each study. We determined the grade of recommendation for each publication according to the Oxford Centre for Evidence-Based Medicine evidence levels. The search identified 145 publications, of which 25 studies met the inclusion criteria for a total of 1483 LPR patients. Data were extracted by 2 independent physicians who identified 16 trials with a IIb evidence level, 7 trials with a IIa evidence level and 2 RCTs with a Ib evidence level where 4 patient-based instruments and 5 clinician-based instruments were used. The main voice assessment outcomes reported were hoarseness assessments by physicians or patients, followed by acoustic parameters; 15 and 14 articles, respectively, demonstrated significant improvements in subjective and objective voice assessments after treatment. The methodology used to measure acoustic parameters (i.e. sustained vowel duration, the sample portion choice for measurement, etc.) varied from one study to another. The majority of studies indicated that voice quality assessments (especially acoustic parameters) remain an interesting outcome to measure the effectiveness of treatment, but further studies using standardised and transparent methodology to measure acoustic parameters are necessary to confirm the place of each tool in the LPR disease evaluation.

Phonetic compliance: a proof-of-concept study

In this paper, we introduce the concept of “phonetic compliance,” which is defined as the intrinsic individual ability to produce speech sounds that are unusual in the native language, and constitutes a part of the ability to acquire L2 phonetics and phonology. We argue that phonetic compliance represents a systematic source of variance that needs to be accounted for if one wants to improve the control over the independent variables manipulated in SLA experimental studies. We then present the results of a two-fold proof-of-concept study aimed at testing the feasibility of assessing phonetic compliance in terms of gradient. In study 1, a pilot data collection paradigm is implemented on an occasional sample of 10 native French speakers engaged in two reproduction tasks involving respectively vowels and aspirated stops, and data are analyzed using descriptive statistics. In study 2, complementary data including L1-typical realizations are collected, resulting in the development of a first set of indicators that may be useful to appropriately assess, and further refine the concept of, phonetic compliance. Based on a critical analysis of the contributions and limitations of the proof-of-concept study, general discussion formulates the guidelines for the following stages of development of a reliable and valid test of phonetic compliance.

Gender differences in the presentation of dysphonia related to laryngopharyngeal reflux disease: a case-control study

ObjectiveTo investigate the voice quality impairments in patients with laryngopharyngeal reflux (LPR) according to the gender.DesignControlled multi-center study.Materials and methods80 LPR patients (40 males and 40 females) with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were included and clinically compared according to gender. To be considered as LPR patients, subjects responded to an empiric therapeutic trial based on pantoprazole intake and diet recommendations for 3 months or had positive pH/Impedance metry. Voice Handicap Index (VHI); Short Form Healthy Survey 36 (SF36), blinded Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI); aerodynamic and acoustic measurements were assessed in all patients and compared with 80 healthy controls (40 males and 40 females) according to gender.ResultsThe most common reasons for the consultation were, respectively, globus sensation in males (22.5%) and dysphonia (27.5%) in female who complained more of breathing difficulties and choking episodes related to LPR than males (p = 0.024). From a quality of life standpoint, female had increased significant impact of LPR disease on vitality and mental health than male. Compared to healthy subjects, both LPR male and female patients had stronger values of G, R, B, S, I, VHI, percent jitter, percent shimmer, and soft palate index than controls. In addition, LPR female had stronger values of lowest fundamental frequency and all aerodynamic measurements than controls.ConclusionAs showed in many other laryngeal conditions, voice quality of female could be more impaired by LPR than male. Some anatomical, histological and functional factors can be suspected and need additional future researches.

Voice quality outcomes of idiopathic Parkinson's disease medical treatment: A systematic review

To investigate voice quality (VQ) impairments in idiopathic Parkinsons disease (IPD) and to explore the impact of medical treatments and L‐Dopa challenge testing on voice.

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study

PURPOSE To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. MATERIAL AND METHODS A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. RESULTS Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. CONCLUSION Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.

Impact of Laryngopharyngeal Reflux on Subjective, Aerodynamic, and Acoustic Voice Assessments of Responder and Nonresponder Patients

OBJECTIVE To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR). MATERIAL AND METHODS Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted. RESULTS Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters. CONCLUSION Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement.

The perception of anticipatory labial coarticulation by blind listeners in noise: A comparison with sighted listeners in audio-only, visual-only and audiovisual conditions

Abstract This study investigates the time course of the perception of the /i-y/ contrast by French-speaking blind listeners using a gating paradigm. The performances of the blind listeners in discrimination and identification are compared with the range of performances exhibited by sighted perceivers when stimuli are presented auditorily, visually and audiovisually, whether in acoustically non degraded or in noisy conditions. Results provide evidence in favor of partial compensation for visual deprivation in speech perception. Blind listeners outperformed sighted participants in discriminating between auditorily-presented gated stimuli, particularly in noisy conditions. But this small advantage allowed them to compensate only partially for their inability to exploit visual information in order to process coarticulated speech as quickly and efficiently as sighted controls.

The Effect of the Speech Task Characteristics on Perceptual Judgment of Mild to Moderate Dysphonia: A Methodological Study

Objective: To study the differences in perceptual ratings of mild and moderate dysphonia related to the speech task, and their impact on intrarater and interrater reliabilities. Patients and Methods: Voice recordings of 15 outpatients with mild or moderate dysphonia related to laryngopharyngeal reflux were presented to 6 female experienced judges blinded to the clinical state of the patients. From these, the GRBASI (Grade, Roughness, Breathiness, Asthenia, Strain, and Instability) evaluations were performed on connected speech and sustained vowel of the pretreatment voice recordings and absolute agreement, and both intrarater and interrater reliabilities were assessed. Results: The average GRBASI scores were significantly worse when performed on sustained vowel. Intrarater reliability substantially varied according to the judge and the task. Good interrater reliability was broadly found for the evaluations of all GRBASI components irrespective of the speech task. Concerning agreement, we only found absolute agreement between judges for G and R items assessed on text. Conclusion: Average grade of perceptual voice impairment, intrarater reliability, and agreement vary according to the speech task.

Impact of Chemoradiation After Supra- or Infrahyoid Cancer on Aerodynamic, Subjective, and Objective Voice Assessments: A Multicenter Prospective Study

OBJECTIVES The study aimed to investigate the impact of chemoradiotherapy (CRT) on speech and voice quality according to the anatomic localization of the head and neck cancer. METHODS Thirty-four patients treated by CRT for advanced suprahyoid (N = 17) or infrahyoid (N = 17) cancer were assessed for speech function, videolaryngostroboscopy, Voice Handicap Index, blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability, acoustic measurements, and aerodynamic measurements. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Head and Neck 35 (EORTC QLQ-H&N35) questionnaire. RESULTS Patients treated for an infrahyoid tumor presented more severe values of Voice Handicap Index items, dysphonia, breathiness, asthenia, and some acoustic cues (Voice Turbulence Index, Soft Phonation Index, degree of unvoiced segments, and number of unvoiced segments) than patients treated for a suprahyoid tumor. The EORTC QLQ-H&N35 communication item was better in the suprahyoid patient group. CONCLUSIONS Voice quality impairments associated with CRT are more severe in patients treated for advanced infrahyoid cancer, suggesting the need to develop specific posttherapy management of the dysphonia according to the tumor anatomical localization.

The production of intervocalic glides in non dysarthric Parkinsonian speech

In the context of a research project aiming at investigating the relationships between speech disorders, quality of life and social participation in Parkinsons Disease (PD), we report here on an acoustic study of glides and steady vowels by non dysarthric parkinsonian and control speakers. Our specific aim is to explore the dynamics of supra-laryngeal articulators in PD. Results suggest that non dysarthric Parkinsonian speakers maintain an accurate production of glides in VC[glide]V pseudo-words at the expense of articulatory undershoot in the surrounding vowels, and some asymmetry between the V1-toglide and glide-to-V2 articulatory movements. We discuss how these results both support and challenge the accuracytempo trade-off hypothesis (Ackermann and Ziegler, 1991).