Paul K.Y. Lam

Cross‐cultural Adaptation and Validation of the Chinese Voice Handicap Index‐10

Objectives/Hypothesis: Recent developments in voice assessment propose the use of quality of life measurements. The Voice Handicap Index (VHI) is one of the most psychometrically robust and well‐studied instruments among the various instruments for measuring quality of life. Two versions of VHI (VHI‐30 and VHI‐10) have been shown to be valid instruments for distinguishing dysphonic from nondysphonic individuals and also for documenting treatment effect for dysphonic patients. The VHI has been used worldwide; however, the psychometric properties of the Chinese version of VHI remains untested. This study aimed to investigate such properties of the Chinese VHI‐30 and VHI‐10 in the Hong Kong Chinese population.

Rabeprazole Is Effective in Treating Laryngopharyngeal Reflux in a Randomized Placebo-Controlled Trial

BACKGROUND & AIMS There is controversy about the efficacy of treating patients with laryngopharyngeal reflux (LPR) using proton pump inhibitors (PPIs). We assessed the effects of high doses of the PPI rabeprazole in patients with LPR. METHODS Patients with LPR symptoms were assigned randomly to receive rabeprazole (20 mg, twice daily, n = 42) or placebo (n = 40) for 12 weeks. All patients completed symptom questionnaires; these provided demographic information and the reflux symptom index before, during, and 6 weeks after cessation of treatment. Videolaryngostroboscopy was used to document the laryngeal findings and determine the reflux finding score. RESULTS Twenty-four patients (57.1%) in the rabeprazole group and 27 patients (67.5%) in the placebo group had pH-documented LPR. The total reflux symptom index score decreased significantly in the group given rabeprazole, compared with patients given placebo, at weeks 6 and 12, but not at week 18. However, there were no significant differences in reflux finding scores between the rabeprazole and placebo groups at any of the time points. CONCLUSIONS Twelve weeks of treatment with rabeprazole (20 mg, twice daily) significantly improved reflux symptoms, compared with placebo, in patients with LPR. Relapse of symptoms was observed 6 weeks after stopping PPI therapy, indicating the requirement for longer treatment duration in patients with LPR.

Myxofibrosarcoma of the sphenoid sinus

Myxofibrosarcoma was originally described as the myxoid variant of malignant fibrous histiocytoma (MFH). It is uncommon in the head and neck region. We hereby report a case of myxofibrosarcoma in the sphenoid sinuses. The diagnostic and management difficulties are discussed. Close collaboration between surgeon, radiologist, histopathologist and clinical oncologist in makng accurate diagnosis and appropriate management of this rare tumour are emphasized.

Quality of Life in Patients with Laryngopharyngeal Reflux

Background: Laryngopharyngeal reflux (LPR) disease is an extraesophageal manifestation of gastroesophageal reflux disease (GERD). The impact of GERD-related LPR on the psychological well-being and quality of life (QOL) in Chinese is not known. Aim: To assess the QOL in patients with LPR disease. Methods: 76 LPR and 73 healthy subjects were recruited. Psychological well-being was assessed by the Hospital Anxiety and Depression Score and QOL was assessed by SF-36. Results: 51/76 (67.1%) patients had GERD-related LPR. More LPR subjects had taken sick leave (36.2 vs. 5.6%, p = 0.001) and reported adverse social life impact (60.5 vs. 38.9%, p = 0.013). LPR patients showed significantly worse results on the Voice Handicap Index (47.8 vs. 7.6, p = 0.001), were more anxious and had worse QOL in social functioning, pain and general health perception domains of SF-36. GERD-related LPR subjects had a higher depression score (4.8 vs. 3.8, p = 0.014) and a lower mental summary score (41.8 vs. 48.4, p = 0.01) in SF-36 compared with those without GERD. Conclusions: LPR had a negative impact on psychological status, social functioning and QOL. GERD symptoms appeared to be the main contributor to decrease QOL. GERD-related LPR patients had a significant impact on the mental component of their QOL.

Medialization thyroplasty for cancer-related unilateral vocal fold paralysis

Objective To justify the application of medialization thyroplasty in Chinese patients with symptomatic cancer-related unilateral vocal fold paralysis (UVFP). Study Design and Setting Retrospective chart review from February 2000 to March 2006. Results Eighty-seven Chinese patients undergoing medialization thyroplasty for UVFP were included; there were no significant differences between the cancer-related and benign groups in terms of the speech and swallowing rehabilitation outcome and the perioperative complication rate (P > 0.05). The median survival time of cancer-related UVFP patients from the date of medialization to death was 129 days. Age more than 65 years was identified as the only factor for a shorter survival period after medialization (P = 0.040). Conclusion Medialization thyroplasty restores satisfactory speech and swallowing and has a low perioperative complication rate in Chinese patients with cancer-related UVFP. Postmedialization survival period was also reasonable. Significance Medialization thyroplasty is a justifiable treatment option for cancer-related UVFP.

Long-term average spectral characteristics of Cantonese alaryngeal speech

OBJECTIVE In Hong Kong, esophageal (SE), tracheoesophageal (TE), electrolaryngeal (EL), and pneumatic artificial laryngeal (PA) speech are commonly used by laryngectomees as a means to regain verbal communication after total laryngectomy. While SE and TE speech has been studied to some extent, little is known regarding the EL and PA sound quality. The present study examined the sound quality associated with SE, TE, EL, and PA speech, and compared with that associated with laryngeal (NL) speech by using long-term average speech spectra (LTAS). METHODS Continuous speech samples of reading a 136-word passage were obtained from NL, SE, TE, EL, and PA speakers of Cantonese. The alaryngeal speakers were all superior speakers selected from the New Voice Club of Hong Kong, which is a self-help organization for the laryngectomees in Hong Kong. TE speakers were fitted with Provox valve, and EL speakers used Servox-type electrolarynx. Speech samples were digitized at 20kHz and 16bits/sample by using Praat, based on which LTAS contours were developed. First spectral peak (FSP), mean spectral energy (MSE), and spectral tilt (ST) derived from the LTAS contours associated with different speaker groups were compared. RESULTS Data revealed all speakers generally exhibited similar LTA contours. However, PA speakers exhibited the lowest average FSP value and the greatest average MSE value. NL phonation was associated with a significantly greater ST value than alaryngeal speech of Cantonese. CONCLUSION The differences in FSP, MSE, and ST values in different speaker groups may be related to the different sound sources being used by the laryngectomees, and the difference in the way the sound source is coupled with the vocal tract system.

Pitch control in esophageal and tracheoesophageal speech of Cantonese.

Objective: Previous studies of English-speaking esophageal (SE) and tracheoesophageal (TE) speakers revealed a significantly lower voice fundamental frequency (F0) than normal laryngeal (NL) speakers. Studies of SE and TE speakers of a tone language, however, indicated discrepant findings. Tonal SE and TE speakers could produce comparable or even higher F0 than NL speakers. The present study examined the F0 characteristics associated with speech and nonspeech tasks produced by Cantonese SE and TE speakers. Subjects and Methods: Speech produced by 15 superior SE, 15 superior TE and 15 NL speakers was recorded while each was reading a short passage and performing a pitch scaling task. F0 values were calculated from the speech samples. Results: SE speakers had higher average F0 in reading tasks than TE and NL speakers, while the NL speakers exhibited the highest average F0 values followed by SE and TE speakers during pitch scaling. In addition, pitch scaling (nonspeech) tasks were associated with higher average F0 than passage reading tasks regardless of speaker type. Conclusion: The findings point to the fact that, despite the use of the new sound source, SE and TE speakers were still able to change F0 for specific speech tasks.

A Volumetric Analysis of the Vocal Tract Associated with Laryngectomees Using Acoustic Reflection Technology

Objective: Previous studies of the laryngectomized vocal tract using formant frequencies reported contradictory findings. Imagining studies of the vocal tract in alaryngeal speakers are limited due to the possible radiation effect as well as the cost and time associated with the studies. The present study examined the vocal tract configuration of laryngectomized individuals using acoustic reflection technology. Subjects and Methods: Thirty alaryngeal and 30 laryngeal male speakers of Cantonese participated in the study. A pharyngometer was used to obtain volumetric information of the vocal tract. All speakers were instructed to imitate the production of /a/ when the length and volume information of the oral cavity, pharyngeal cavity, and the entire vocal tract were obtained. The data of alaryngeal and laryngeal speakers were compared. Results: Pharyngometric measurements revealed no significant difference in the vocal tract dimensions between laryngeal and alaryngeal speakers. Conclusion: Despite the removal of the larynx and a possible alteration in the pharyngeal cavity during total laryngectomy, the vocal tract configuration (length and volume) in laryngectomized individuals was not significantly different from laryngeal speakers. It is suggested that other factors might have affected formant measures in previous studies.

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R062: Gore-Tex Medialization Laryngoplasty in Hong Kong Context

PROBLEM: Treatments for ADSD include botulinum toxin injections (botox), surgery, and/or voice therapy. Botox injections remain the gold standard treatment to reduce symptoms of ADSD. Improvements in vocal function have been reported after use of botox injections though a completely normal voice is rarely achieved. There is not a standardized, validated scale for measuring perceptual voice changes after botox injection. Problems arise when there is disagreement on the effectiveness of a treatment. The purpose of this phase one-study is to document clinician-patient agreement of the effects of botox injection on voice quality and quality of life in the ADSD population. METHODS: Retrospective chart review of 88 patients receiving botox injections. Clinicians’ perceptual ratings of vocal quality using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), a 100 mm VAS scale, were compared with patients’ ratings of voice quality using a 7 point EIS. Patient perception of the impact of the botox injection on quality of life utilizing the Voice Related Quality of Life (VRQOL) was compared with voice quality ratings from the CAPE-V and 7 point EIS. RESULTS: There was a weak correlation (r2 0.29) between the VRQOL and the CAPE-V. There was a weak correlation (r2 0.44) between the EIS and VRQOL. While the correlation was stronger between the CAPE-V and the EIS, it remained weak at (r2 0.49). CONCLUSION: The poor relationship among commonly used outcome measures leads the researchers to question how best to assess the effectiveness of botox in ADSD. Clinicians are required to document treatment outcomes making it important to utilize scales that are valid, reliable and sensitive to change. SIGNIFICANCE: This study is the first in a series of studies whose aim is to develop a valid, reliable, and accurate measurements of the effectiveness of botulinum toxin injections for the treatment of ADSD.