Thomas Murry

Development and validation of the voice handicap index-10.

Objectives/Hypothesis: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI).

Voice handicap index change following treatment of voice disorders

Outcome measurements of voice disorders is an important new area for both the evaluation of voice-disordered patients and evaluation of treatment efficacy. The Voice Handicap Index (VHI) measures the patients perception of the impact of his or her voice-disorder. The VHI was used in this study to measure the changes of the patients perception following treatment for four different voice disorders. The VHI showed a significant change following treatment for unilateral vocal fold paralysis, vocal cyst/polyp, and muscle tension dysphonia. Results of this paper indicate that the VHI is a useful instrument to monitor the treatment efficacy for voice disorders.

Targeted chemoradiation for advanced head and neck cancer: Analysis of 213 patients

To determine the survival results, patterns of relapse, and organ preservation effects of a targeted chemoradiation protocol for patients with advanced (stage III–IV) carcinoma of the head and neck.

Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: The Memphis experience

PURPOSE/OBJECTIVE To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. METHODS AND MATERIALS Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly x 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. RESULTS Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. CONCLUSION Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.

Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer.

Health‐related quality of life (QOL) provides a measure of the patients perception of his life after treatment. This study was undertaken to assess changes in QOL and swallowing in patients undergoing concurrent chemoradiotherapy (CR) for head and neck cancer. The assessment tools consisted of the Head and Neck Radiotherapy Questionnaire (HNRQ) and a swallowing questionnaire (SQ).

OUTCOME MEASUREMENTS AND QUALITY OF LIFE IN VOICE DISORDERS

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patients perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patients perceived severity and need to recover vocal function may determine treatment.

Combined-Modality Treatment of Adductor Spasmodic Dysphonia with Botulinum Toxin and Voice Therapy

A combined-modality treatment program consisting of botulinum toxin injection (Botox) and voice therapy was used to treat 17 subjects diagnosed with adductor spasmodic dysphonia (ADD SD). Ten subjects with ADD SD served as the control and were given Botox only. Voice therapy after Botox injection was directed toward reducing the hyperfunctional vocal behaviors, primarily glottal overpressure at voice onset and anterior-posterior squeezing. The results indicated that subjects who underwent combined-modality treatment maintained significantly higher mean airflow rates for significantly longer periods. Moreover, there was a carryover effect in these patients when they received Botox only. Adductor spasmodic dysphonia is treated most effectively when intrinsic laryngeal muscle spasms are reduced or eliminated by Botox injection and extrinsic hyperfunctional vocal behaviors are treated with voice therapy.

Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Greek

The objective was to culturally adapt and validate the Voice Handicap Index (VHI) to the Greek language. The study design used was a psychometric analysis. The VHI was translated into Greek with cultural adaptations to accommodate certain words. The translated version was then completed by 67 subjects with various voice disorders and by a control group of 79 subjects. All the participants also completed a self-rating scale regarding the severity of their voice disorder. Statistical analyses demonstrated high internal consistency and high test-retest reliability both for the overall VHI score and for the functional, physical, and emotional domains of the VHI. A moderate correlation was found between the VHI and the self-rating severity scale. The subjects in the control group had lower scores compared to the subjects with voice disorders for the overall VHI score and for the three domains. Based on the internal consistency values and the test-retest reliability, the Greek version of VHI is a valid and reliable measure for use by Greek subjects with voice disorders.

Multidimensional analysis of male and female voices

This paper is a sequel to a study which showed that the dominant dimension for perceptual discrimination among normal voices was the male-female categorization and which also suggested that discrimination within the male-female categories utilized distinct dimenisons. The present study eliminates the male-female axis by treating the gender groups separately and making the within-category dimensions available for more sensitive analysis. The purpose was to determine the number and nature of perceptual parameters needed to explain judgments of voice similarity depending on talker sex and whether the stimulus sample was a sustained vowel or a short phrase. The similarity judgments were submitted to multidimensional analysis via INDSCAL and the resulting dimenisons were interpreted in terms of available acoustic measures and unidimensional voice-quality ratings of pitch, breathiness, hoarseness, nasality, and effort. The decisions of the listerners appeared to be influenced by both the sex of the speaker and the stimulus sample, although fundamental frequency (fo), was important for all judgments. Aside from the fo dimensions, judgments concerning male voices were related to vocal tract parameters, while similarity judgments of female voices were related to perceived glottal/vocal tranct differences. Formant structure was apparently important in judging the similarity of vowels for both sexes while perceptual glottal/temporal attributes may have been used as cues in the judgments of phrases.

Multidimensional classification of abnormal voice qualities

This study demonstrates the application of a multidimensional scaling technique, known as INDSCAL, to determine the perceptual attributes of a group of non‐normal voices. In this study, equal‐appearing interval scale was used to obtain judgments of similarity for 20 speakers sustaining a vowel. For each speaker, six physical and three psychophysical measures were also obtained and used to interpret the INDSCAL solution. A five‐dimensional solution was found to be the most appropriate solution for explaining the variance. The findings of the INDSCAL analysis suggest that there exist distinct perceptual features of the abnormal voice which have physical and psychophysical correlates. The strengths of the underlying dimensions of the voices appear to indicate that multidimensional scaling will be a valuable tool in the diagnosis of voice abnormalities.