Richard I. Zraick

Vocal fold augmentation with calcium hydroxylapatite: Twelve‐month report

To evaluate the long‐term effectiveness of calcium hydroxylapatite (CaHA) vocal fold injection for patients with glottal insufficiency.

Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis

Objective/Hypothesis: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the treatment of unilateral vocal fold paralysis.

The Use of Standardized Patients To Teach and Test Interpersonal and Communication Skills with Students in Speech-Language Pathology

The purpose of this study was to investigate the use of standardized patients (SPs) with aphasia to teach interpersonal and communication skills to new graduate student-clinicians in Speech-Language Pathology, and to test those skills via serial Objective Structured Clinical Examinations (OSCEs). This study had three phases: (1) clinical teaching using SPs, (2) mid-term evaluation via a single case OSCE, and (3) end-of-term evaluation via a multi-case OSCE. These phases were integrated with classroom teaching and testing components over a 16-week academic semester. Eighteen students participated while concurrently enrolled in a course on diagnosis and management of aphasia taught by the first author. One half of the class received initial instruction via a combination of didactic lecture and standardized patient interaction, while the other half of the class was taught initially via didactic lecture only. On OSCEI, there was no statistically significant difference between the two groups in their interpersonal and communication skills, with the class as a whole demonstrating less than acceptable competency. After targeting these skills in all students via additional class lectures, there was a statistically and clinically significant improvement in their competency in this area on OSCE II. Student feedback was positive.

Adult normative data for the KayPENTAX Phonatory Aerodynamic System Model 6600.

OBJECTIVESnThe primary purpose of the present study was to establish a preliminary adult normative database for 41 phonatory aerodynamic measures obtained with the KayPENTAX Phonatory Aerodynamic System (PAS) Model 6600 (KayPENTAX Corp, Lincoln Park, NJ). A second purpose was to examine the effect of age and gender on these measures.nnnDESIGNnProspective data collection across groups.nnnMETHODnA sample of 157 normal speakers (68 males and 89 females) were divided into three age groups (18-39, 40-59, and 60+ years). The PAS protocols of vital capacity, maximum sustained phonation, comfortable sustained phonation, variation in sound pressure level, and voicing efficiency were used to collect 41 phonatory aerodynamic measures. Comfortable pitch and loudness levels were used with each protocol requiring phonation.nnnRESULTSnA statistically significant main effect of age was found for seven measures, and a statistically significant main effect of gender was found for five measures. The remaining 29 measures did not reach statistical significance; however, 13 of these had high observed power. The remaining 16 measures did not reach significance and had low observed power.nnnCONCLUSIONSnBecause age- and gender-related changes were found for some measures, one must account for these two variables when assessing phonatory aerodynamics using the PAS Model 6600. The clinical implications of the findings for the assessment and treatment of individuals with voice disorders using the PAS Model 6600 are discussed.

The Effect of Task on Determination of Habitual Pitch

The purpose of this study was to investigate if there was an effect of task on determination of habitual pitch, or speaking fundamental frequency (SFF). Seven tasks commonly used to elicit habitual pitch in clinical voice evaluations were compared. Three groups of normal subjects (N = 36) were examined (adult males, adult females, and male and female prepubescent children). For the adult male (n = 12) and pediatric (n = 12) subjects, no significant effect of task was found. For the adult female (n = 12) subjects, a statistically significant (P < .001) effect of task was found. All tasks were found to have high (>0.90) test-retest reliability for all subjects. Implications of the use of one task for determination of habitual pitch are discussed, as is the possibility of a task effect on determination of other voice parameters.

The effect of task on determination of maximum phonational frequency range.

The purpose of this study was to investigate if there was an effect of task on determination of maximum phonational frequency range (MPFR). Two tasks commonly used to elicit MPFR in clinical voice evaluations were compared. Normal adult females (N = 30) were examined. No statistically significant effect of task was found. Both tasks (glissando and discrete-step) were found to have a high positive correlation (0.84). Implications of the use of one task for determination of maximum phonational frequency range are discussed, as is the possibility of a task effect on determination of other voice parameters.

Assessment of quality of life in persons with voice disorders.

Purpose of reviewTo present the current state of knowledge regarding health-related quality of life in persons with voice disorders and to describe voice-disordered quality of life instruments. Recent findingsThe present study discusses the concept of health-related quality of life as it relates to persons with voice disorders, and reviews current voice-disordered quality of life instruments for use in persons with dysphonia. The health-related quality of life in persons with voice disorders is not particularly well understood, due to a paucity of investigations. A variety of voice-disordered quality of life instruments are, however, available. Most of these instruments have been validated and are routinely used as outcome measures in clinical and research settings. SummaryThe available instruments for assessing health-related quality of life in persons with voice disorders are limited. The available instruments for assessing voice-disordered quality of life are greater, and the choice of which instrument to administer is largely based on clinicians preference. Regardless of which instruments are selected, inclusion of health-related quality of life and/or voice-disordered quality of life as a therapy outcome measure is vital to the establishment of an evidence base for clinical interventions aimed at lessening the impact of dysphonia.

Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis: follow-up at six months.

OBJECTIVE/HYPOTHESISnTo determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the treatment of unilateral vocal fold paralysis.nnnSTUDY DESIGNnA retrospective study of patients with unilateral vocal fold paralysis who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and March 8, 2005.nnnMETHODSnThe data analyzed included patient characteristics and type of intervention, along with the pretreatment and posttreatment voice parameters of videostrobolaryngoscopy, perceptual analysis, and patients subjective voice assessment.nnnRESULTSnNineteen patients were evaluated. The average time from intervention to posttreatment evaluation was 3 (range, 1-9) months. Improvements were demonstrated in all three voice parameters in both the injection and the medialization groups. No significant differences were found in the degree of improvement between the two groups. Videostrobolaryngoscopy and the perceptual analysis, both rated by the authors, correlated well with each other, but they both correlated poorly with the patients subjective voice analysis.nnnCONCLUSIONSnInjection and medialization laryngoplasty were comparable in their improvement of subjective and objective voice outcomes. Both treatment modalities should be included in the otolaryngologists armamentarium for managing unilateral vocal fold paralysis.

Readability of patient-reported outcome questionnaires for use with persons with swallowing disorders.

The purposes of this study were to examine the readability of published patient-related outcome (PRO) questionnaires for persons with swallowing problems, and to compare the readability results to existing data about average reading levels of English-speaking adults living in the United States. A search was conducted to identify published PRO questionnaires related to swallowing problems that traditionally are completed by patients in a self-administered format. Reading grade levels were analyzed separately for four different swallowing-related PRO questionnaires using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were also computed across the questionnaires. The results of this study demonstrate that all four PRO questionnaires exceeded the fifth- to sixth-grade reading levels recommended by health literacy experts regardless of the formula applied. In the demand for standardization of swallowing-related quality-of-life assessment tools, developers should consider readability as another testable construct, since poor readability may affect validity, reliability, and sensitivity. The swallowing clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or his or her proxy. Developers of PRO questionnaires should consider the reading level of respondents and include information about this when reporting psychometric data.

Readability of Patient-Reported Outcome Questionnaires for Use With Persons With Dysphonia

OBJECTIVESnThe purpose of this study was to examine the readability of several published patient-reported outcome (PRO) questionnaires for persons with dysphonia, and to compare the readability results with existing data about average reading levels for English-speaking adults living in the United States.nnnDESIGNnA search was conducted to identify published PRO questionnaires related to dysphonia that are traditionally completed by patients in a self-administered format.nnnMETHODnReading grade levels were analyzed separately for 12 different voice-related PRO questionnaires using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were also computed across the questionnaires.nnnRESULTSnThe results of this study demonstrate that most PRO questionnaires exceeded the fifth- to sixth-grade reading levels recommended by health literacy experts regardless of the formula applied.nnnCONCLUSIONSnIn the demand for standardization of voice-related quality of life assessment tools, developers should consider readability as another testable construct because poor readability may affect validity, reliability and sensitivity. The voice clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or their proxy. Developers of PRO questionnaires should consider reading level of respondents and include information about this when reporting psychometric data.