Wendy J. Huinck

Risk Factors for Voice Problems in Teachers

In order to identify factors that are associated with voice problems and voice-related absenteeism in teachers, 1,878 questionnaires were analysed. The questionnaires inquired about personal data, voice complaints, voice-related absenteeism from work and conditions that may lead to voice complaints and absenteeism. Different factors play a role in the development and consolidation of voice problems. Physical and psycho-emotional factors appear to be the most important risk factors. Remarkably, voice load and environment seem to be less important as risk factors in the development and consolidation of voice complaints. Teachers who experienced voice problems during their training reported more voice problems during their career. The results of this study stress the importance of a multifactorial approach in the diagnosis and treatment of voice problems, whereby physical and psycho-emotional aspects should be considered as sensitive to the risk of developing voice problems. Moreover, this study shows the crucial importance of adequate voice training during the teacher training programme.

Epidemiology of Voice Problems in Dutch Teachers

In order to assess voice complaints and absence from work due to voice problems among teachers of primary and secondary education, as well as among a control group, 2,117 questionnaires were analysed. The total group consisted of 1,878 teachers and 239 controls. Female teachers more frequently reported voice complaints and absence from work due to voice problems than their male colleagues. No unequivocal relationship between age on the one hand and voice complaints and absence from work due to voice problems on the other hand was observed. Therefore, the percent of cases was corrected for gender but not for age. More than half of the teachers reported voice problems during their career and about one fifth had a history of absence from work due to voice problems. These numbers are relatively high compared to those of the controls with as well as to those without a vocally demanding profession. More than 20% of the teachers sought medical help or had been treated for a voice problem. Remarkably, more than 12% of the teachers had experienced voice problems during their training and this group reported significantly more voice complaints and absence from work due to voice problems in their career than the colleagues without voice problems during the training. The results of the Voice Handicap Index scores followed these trends. These findings point at voice problems during education as a risk factor for getting voice problems during the career. The results of this study clearly demonstrate that teaching is a high-risk profession for the development of voice problems, which is in accordance with other studies and support the contention that voice is a worldwide problem in the teaching profession. Furthermore, this study indicates the importance of voice care not only during training for the profession but also during the career.

Muscular tension and body posture in relation to voice handicap and voice quality in teachers with persistent voice complaints.

The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.

Cochlear implantation in late-implanted prelingually deafened adults: changes in quality of life.

Background With expanding inclusion criteria for cochlear implantation, the number of prelingually deafened persons who are implanted as adults increases. Compared with postlingually deafened adults, this group shows limited improvement in speech recognition. In this study, the changes in health-related quality of life in late-implanted prelingually deafened adults are evaluated and related to speech recognition. Methods Quality of life was measured before implantation and 1 year after implantation in a group of 28 prelingually deafened adults, who had residual hearing and who used primarily oral communication. Patients completed 3 questionnaires (Nijmegen Cochlear Implant Questionnaire, Glasgow Benefit Inventory, and Health Utility Index 3). Postoperative scores were compared with preoperative scores. Additionally, phoneme recognition scores were obtained preimplantation and 1 year postimplantation. Results Quality of life improved after implantation: scores on the Nijmegen Cochlear Implant Questionnaire improved significantly in all subdomains (basic speech perception, advanced speech perception, speech production, self-esteem, activity, and social interaction), the total Glasgow Benefit Inventory score improved significantly, and the Health Utility Index 3 showed a significant improvement in the utility score and in the subdomains “hearing” and “emotion.” Additionally, a significant improvement in speech recognition scores was found. No significant correlations were found between gain in quality of life and speech perception scores. Conclusion The results suggest that quality of life and speech recognition in prelingually deafened adults significantly improved as a result of cochlear implantation. Lack of correlation between quality of life and speech recognition suggests that in evaluating performance after implantation in prelingually deafened adults, measures of both speech recognition and quality of life should be used.

The Validity of a Simple Outcome Measure to Assess Stuttering Therapy

Objective: The validity of a simple and not time-consuming self-assessment (SA) Scale was tested to establish progress after or during stuttering therapy. Patients and Method: The scores on the SA scale were related to (1) objective measures (percentage of stuttered syllables, and syllables per minute) and (2) (self-)evaluation tests (self-evaluation questionnaires and perceptual evaluations or judgments of disfluency, naturalness and comfort by naïve listeners). Data were collected from two groups of stutterers at four measurement times: pretherapy, posttherapy, 12 months after therapy and 24 months after therapy. The first group attended the Comprehensive Stuttering Program: an integrated program based on fluency shaping techniques, and the second group participated in a Dutch group therapy: the Doetinchem Method that focuses on emotions and cognitions related to stuttering. Results: Results showed similar score patterns on the SA scale, the self-evaluation questionnaires, the objective measures over time, and significant correlations between the SA scale and syllables per minute, percentage of stuttered syllables, Struggle subscale of the Perceptions of Stuttering Inventory and judged fluency on the T1-T2 difference scores. Conclusion: We concluded that the validity of the SA measure was proved and therefore encourage the use of such an instrument when (stuttering) treatment efficacy is studied.

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A Prospective Study.

To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.

Stable benefits of bilateral over unilateral cochlear implantation after two years: A randomized controlled trial

To investigate hearing capabilities and self‐reported benefits of simultaneous bilateral cochlear implantation (BiCI) compared with unilateral cochlear implantation (UCI) after a 2‐year follow‐up and to evaluate the learning effect of cochlear implantees over time.

Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial

Objective: To study the cost–utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. Study Design: Randomized controlled trial (RCT). Setting: Five tertiary referral centers. Patients: Thirty-eight postlingually deafened adults eligible for cochlear implantation. Interventions: A cost–utility analysis was performed from a health insurance perspective. Main Outcome Measures: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. Results: Direct costs for unilateral and bilateral CI were &OV0556;43,883 ± &OV0556;11,513(SD) and &OV0556;87,765 ± &OV0556;23,027(SD) respectively. Annual costs from the second year onward were &OV0556;3,435 ± &OV0556;1,085(SD) and &OV0556;6,871 ± &OV0556;2,169(SD), respectively. A cost–utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. Conclusion: This is the first study that describes a cost–utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5–10 years or longer.

Development of a Squelch Effect in Adult Patients After Simultaneous Bilateral Cochlear Implantation

Objectives: To investigate whether a squelch effect occurs in the first 3 years after simultaneous bilateral cochlear implantation and to investigate whether this effect increases during follow-up. Study Design: Prospective study as part of a multicenter randomized controlled trial that compares simultaneous bilateral cochlear implantation to sequential and unilateral cochlear implantation. Setting: Tertiary referral center. Patients: Nineteen postlingually deafened adults. Intervention: Simultaneous bilateral cochlear implantation. Main Outcome Measure: The squelch effect, measured yearly with a speech-intelligibility-in-noise test with spatially separated sources. Bilateral results were compared to unilateral results in which the cochlear implant at the noise side was turned off. The squelch effect was investigated for the patients’ best performing ear and for the left and right ears separately. Results: In 13 individual patients, a squelch effect was present after 1 year. This number increased during follow-up years. On group level, a squelch effect was present in patients’ best performing ear after 2 and 3 years (1.9 dB). A squelch effect was present in both ears after 3 years (AS: 1.7 dB, AD: 1.3 dB). Conclusion: Patients who underwent simultaneous bilateral cochlear implantation developed a measurable benefit from the squelch effect after 2 years in their best performing ear and after 3 years in both ears. These observations suggest that the brain learns to use interaural differences to segregate sound from noise after simultaneous bilateral cochlear implantation. The squelch effect increased over time which suggests a growth in cortical integration and differentiation of inputs from bilateral CIs due to brain plasticity. Trial Registration: Dutch Trial Register NTR1722. Level of evidence: 1b.

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A randomized controlled trial

To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation.