Omalizumab discontinuation in children with severe allergic asthma: an observational real life study

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Data-Driven Classification of Dysarthria Profiles in Children With Cerebral Palsy

Purpose

The objectives of this study were to examine different speech profiles among children with dysarthria secondary to cerebral palsy (CP) and to characterize the effect of different speech profiles on intelligibility.

Method

Twenty 5-year-old children with dysarthria secondary to CP and 20 typically developing children were included in this study. Six acoustic and perceptual speech measures were selected to quantify a range of segmental and suprasegmental speech characteristics and were measured from children's sentence productions. Hierarchical cluster analysis was used to identify naturally occurring subgroups of children who had similar profiles of speech features.

Results

Results revealed 4 naturally occurring speech clusters among children: 1 cluster of children with typical development and 3 clusters of children with dysarthria secondary to CP. Two of the 3 dysarthria clusters had statistically equivalent intelligibility levels but significantly differed in articulation rate and degree of hypernasality.

Conclusion

This study provides initial evidence that different speech profiles exist among 5-year-old children with dysarthria secondary to CP, even among children with similar intelligibility levels, suggesting the potential for developing a pediatric dysarthria classification system that could be used to stratify children with dysarthria into meaningful subgroups for studying speech motor development and efficacy of interventions.

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Identification of Affective State Change in Adults With Aphasia Using Speech Acoustics

Purpose

The current study aimed to identify objective acoustic measures related to affective state change in the speech of adults with post-stroke aphasia.

Method

The speech of 20 post-stroke adults with aphasia was recorded during picture description and administration of the Western Aphasia Battery–Revised (Kertesz, 2006). In addition, participants completed the Self-Assessment Manikin (Bradley & Lang, 1994) and the Stress Scale (Tobii Dynavox, 1981–2016) before and after the language tasks. Speech from each participant was used to detect a change in affective state test scores between the beginning and ending speech.

Results

Machine learning revealed moderate success in classifying depression, minimal success in predicting depression and stress numeric scores, and minimal success in classifying changes in affective state class between the beginning and ending speech.

Conclusions

The results suggest the existence of objectively measurable aspects of speech that may be used to identify changes in acute affect from adults with aphasia. This work is exploratory and hypothesis-generating; more work will be needed to make conclusive claims. Further work in this area could lead to automated tools to assist clinicians with their diagnoses of stress, depression, and other forms of affect in adults with aphasia.

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School-Aged Children's Phonological Accuracy in Multisyllabic Words on a Whole-Word Metric

Purpose

The purpose of this study is to examine differences in phonological accuracy in multisyllabic words (MSWs) on a whole-word metric, longitudinally and cross-sectionally, for elementary school–aged children with typical development (TD) and with history of protracted phonological development (PPD).

Method

Three mismatch subtotals, Lexical influence, Word Structure, and segmental Features (forming a Whole Word total), were evaluated in 3 multivariate analyses: (a) a longitudinal comparison (n = 22), at age 5 and 8 years; (b) a cross-sectional comparison of 8- to 10-year-olds (n = 12 per group) with TD and with history of PPD; and (c) a comparison of the group with history of PPD (n = 12) with a larger 5-year-old group (n = 62).

Results

Significant effect sizes (η_p ²) found for mismatch totals were as follows: (a) moderate (Lexical, Structure) and large (Features) between ages 5 and 8 to 10 years, mismatch frequency decreasing developmentally, and (b) large between 8- to 10-year-olds with TD and with history of PPD (Structure, Features; minimal lexical influences), in favor of participants with TD. Mismatch frequencies were equivalent for 8- to 10-year-olds with history of PPD and 5-year-olds with TD. Classification accuracy in original subgroupings was 100% and 91% for 8- to 10-year-olds with TD and with history of PPD, respectively, and 86% for 5-year-olds with TD.

Conclusion

Phonological accuracy in MSW production was differentiated for elementary school–aged children with TD and PPD, using a whole-word metric. To assist with the identification of children with ongoing PPD, the metric has the ability to detect weaknesses and track progress in global MSW phonological production.

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Philtrum reconstruction in unilateral cleft lip repair

The philtrum is an important aesthetic structure in the midface. A number of philtrum reconstruction techniques have been advocated for secondary cleft lip revision procedures. Conventional surgical management involves end-to-end orbicularis oris muscle approximation during primary cleft lip repair, often resulting in a flat lip appearance that requires secondary revision surgery at a later stage. A novel modification of the approximation of the orbicularis oris muscle is described that may be implemented with any cleft lip technique in order to create an accentuated philtrum column for a natural looking philtrum.

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Fluorescence imaging of invasive head and neck carcinoma cells with integrin αvβ6-targeting RGD-peptides: an approach to a fluorescence-assisted intraoperative cytological assessment of bony resection margins

We assessed the use of peptides containing arginylglycylaspartic acid (RGD) that target integrin αvβ6 as a potential approach for a fluorescence-assisted intraoperative cytological assessment of bony resection margins (F-AICAB) in patients who had bone-infiltrating squamous cell carcinoma (SCC) of the head and neck. This was assessed to demarcate invasive carcinoma cells that stained for αvβ6. Specimens from bony resection margins (n=362) were defined as either malignant or benign according to the results of cytological and histological examinations.

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Induction of smell through transethmoid electrical stimulation of the olfactory bulb

Background

Anosmia has an estimated prevalence of 5% of the general population. Outside of inflammatory causes, therapeutic options are limited despite research advances. Bypassing peripheral neuronal damage through central stimulation is a potential therapeutic option that has shown success in other sensory systems, most notably with hearing. We performed a pilot study to determine the feasibility of inducing smell through artificial electrical stimulation of the olfactory bulbs in humans.

Methods

Subjects with a history of sinus surgery, including total ethmoidectomy, with intact ability to smell were enrolled. The ability to smell was confirmed with a 40‐item smell identification test. Awake subjects underwent nasal endoscopy and either a monopolar or bipolar electrode was positioned at 3 areas along the lateral lamella of the cribriform plate within the ethmoid sinus cavity. A graded stimulation current of 1–20 mA at 3.17 Hz was administered while cortical evoked potential (CEP) recordings were collected. Subjective responses of perceived smell along with reports of discomfort were recorded. Subjects with artificially induced smell underwent repeat stimulation after medically induced anosmia.

Results

Five subjects (age, 43–72 years) were enrolled. Three subjects reported smell perception smell with electrical stimulation. This was reproducible after inducing anosmia, but CEP recordings could not provide objective support. All subjects tolerated the study with minimal discomfort.

Conclusion

This is the first report of induced smell through transethmoid electrical stimulation of the olfactory bulb. These results provide a proof of concept for efforts in development of an olfactory implant system.

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Therapeutic use of steroids in non–chronic rhinosinusitis olfactory dysfunction: a systematic evidence‐based review with recommendations

Background

Olfactory loss is a common and debilitating disease with limited treatment options, particularly for olfactory dysfunction not related to sinonasal inflammation. Both topical and systemic steroids have been used as treatments for olfactory loss. This study systematically reviews the literature on the efficacy of steroids for non–chronic rhinosinusitis (CRS)‐related olfactory loss and provides recommendations.

Methods

A literature search of PubMed, Ovid, EMBASE, and the Cochrane Database was performed according to Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines. Inclusion criteria included original data, English‐language articles on steroid treatment (topical and systemic) for olfactory loss unrelated to sinonasal inflammation. Data was collected on study design, olfaction dysfunction etiology, clinical outcomes, and level of evidence. Two investigators reviewed all articles independently, with a third acting as a mediator for any disagreements in recommendation.

Results

Of 866 abstracts identified, only 15 studies met inclusion criteria and were systematically reviewed. Level 4 evidence suggests oral steroids can improve olfactory loss. Level 1B evidence demonstrates topical steroid rinses improve olfactory dysfunction in a select group of patients. Topical steroid sprays show no improvement across several levels of evidence.

Conclusion

There is a paucity of high‐quality studies demonstrating efficacy of either topical or oral steroids for olfactory dysfunction unrelated to sinonasal disease. The only level 1 evidence suggests using steroid rinses to improve olfactory outcomes in select patients, with weaker evidence supporting use of oral steroids. Topical steroid sprays do not improve olfactory dysfunction in this patient population and are not recommended.

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Ivacaftor improves rhinologic, psychologic, and sleep‐related quality of life in G551D cystic fibrosis patients

Background

Ivacaftor is a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator that improves pulmonary function in cystic fibrosis (CF) patients with at least 1 copy of the G551D CFTR mutation. The purpose of this study is to evaluate the impact of ivacaftor on chronic rhinosinusitis (CRS) symptoms in this population.

Methods

The G551D Observational (GOAL) study was a multicenter prospective cohort study enrolling CF patients ≥6 years with at least 1 G551D mutation. Subjects were provided 20‐item Sino‐Nasal Outcome Test (SNOT‐20) questionnaires prior to ivacaftor therapy and at 1, 3, and 6 months afterward. The impact on rhinologic (R), psychological (P), sleep (S), and ear/facial (E) quality of life (QOL) domains was evaluated separately.

Results

Of 153 subjects, 129 (84%) completed all questionnaires. Typical baseline symptom burden was low (75% with scores <1) and degree of improvement (ie, reduced scores) was greater with higher baseline scores. SNOT‐20 decreased, reflecting improvement, at all follow‐up intervals (1 month: [mean change ± standard deviation] –0.25 ± 0.53, p < 0.01; 3 months; –0.29 ± 0.58, p < 0.01; 6 months: –0.21 ± 0.58, p = 0.02), but less than the prespecified minimal clinically important difference (0.8). Significant improvement was observed at 1, 3, and 6 months in the R domain (1 month: –0.24, p < 0.01; 3 months: –0.34, p < 0.01; 6 months: –0.25, p < 0.01) and P domain (1 month: –0.25, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.26, p < 0.01), and 1 and 3 months in the S domain (1 months: –0.35, p < 0.01; 3 months: –0.32, p < 0.01; 6 months: –0.18, p = 0.07). There was no improvement in the E domain at any time point.

Conclusion

Ivacaftor improves QOL in the R, P, and S domains in G551D CF patients, although QOL instruments validated for CRS may not translate well to CF CRS patients because symptom burden was surprisingly low.

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Interleukin‐4‒induced posttranscriptional gene regulation of CCL26 by the RNA‐binding protein HuR in primary human nasal polyp‒derived epithelial cells

Background

Much attention on the pathophysiology of nasal polyp (NP) has focused on eosinophils. Interleukin (IL)‐4 and eotaxin‐3 (C‐C motif chemokine ligand 26, or CCL26) levels have been reported to be increased in eosinophilic nasal polyps. The aim of this study was to characterize CCL26 posttranscriptional regulation by the RNA‐binding protein HuR in primary human nasal polyp‒derived epithelial cells (hNPDECs) challenged with IL‐4.

Methods

A prospective, observational study was conducted. Nasal polyp tissues were obtained from eosinophilic (n = 12) and non‐eosinophilic (n = 10) NP patients, and inferior turbinate (IT) tissues were taken from control subjects (n = 9) and cultured into hNPDECs. Expression of HuR and CCL26 were measured by immunohistochemistry, Western blot analysis, enzyme‐linked immunoassay, and real‐time polymerase chain reaction (PCR). The nucleocytoplasmic shuttling of HuR in hNPDECs was detected by immunofluorescence. Posttranscriptional regulation of CCL26 by HuR was tested by ribonucleoprotein immunoprecipitation assay (RIP) and dual‐luciferase reporter assay. CCL26 mRNA stabilization was measured by quatititative PCR after treatment with actinomycin D. Student's t test and one‐way analysis of variance were used.

Results

Immunohistochemical data show that both HuR and CCL26 were highly expressed in NP tissues, especially eosinophilic NP tissues (p < 0.05). IL‐4 stimulation increased CCL26 mRNA stability, and overexpression and knockdown of HuR affected CCL26 expression. Immunofluorescence data indicate that IL‐4 altered the subcellular distribution of HuR. The RIP and dual‐luciferase reporter assay results supply strong evidence for HuR binding to CCL26.

Conclusion

Our results provide strong support for the hypothesis that IL‐4‒induced expression of CCL26 in hNPDECs relies partly on CCL26 mRNA stabilization mediated by the interaction of HuR with CCL26 3'UTR.

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Skin disorders are prominent features in primary immunodeficiency diseases: a systematic overview of current data

Abstract

Primary immunodeficiency diseases (PIDs) are characterized by an increased risk of infections, autoimmunity, autoinflammation, malignancy and allergic disorders. Skin disorders are also common clinical features in PIDs and may be among the presenting manifestations. Recognition of specific PID‐associated skin conditions in combination with other clinical features as described in the currently used warning signs could raise suspicion of an underlying PID. We aimed to provide a systematically obtained overview of skin disorders and their prevalence in PIDs. Secondary, the prevalence of Staphylococcus (S.) aureus‐associated skin disorders and atopy were reviewed, as these are the most prominent skin features in PIDs. A systematic search was performed in Embase, Medline, Web of Science, Cochrane and Google Scholar (up to May 9^th 2018). All original observational and experimental human studies that address the presence of skin disorders in PIDs were selected. We rated study quality using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Sixty‐seven articles (5030 patients) were included. Study quality ranged from 18.2‐88.5%. A broad spectrum of skin disorders was reported in 30 PIDs, mostly in single studies with a low number of included patients. An overview of associated PIDs per skin disorder was generated. Data on S. aureus‐associated skin disorders and atopy in PIDs were limited. In conclusion, skin disorders are prominent features in PIDs. Through clustering of PIDs per skin disorder, we provide a support tool to use in clinical practice that should raise awareness of PIDs based on presenting skin manifestations.

This article is protected by copyright. All rights reserved.

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Distinct Lipid Transfer Proteins display different IgE‐binding activities that are affected by fatty acid binding

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Increased expression of L‐plastin in nasal polyp of patients with nonsteroidal anti‐inflammatory drug exacerbated respiratory disease

Abstract

Background

Most patients with nonsteroidal anti‐inflammatory drug exacerbated respiratory disease (NERD) suffer from recurrence of nasal polyps. However, little is known about the specific cellular and molecular mechanisms contributing to the pathogenesis of nasal polyp development in patients with NERD in particular, especially at baseline when cyclooxygenase 1 inhibitors are not present. The objectives of this study were to identify proteins involved in the pathogenesis of nasal polyps in patients with NERD.

Methods

We collected nasal polyp tissue from patients with NERD and from patients with aspirin‐tolerant chronic rhinosinusitis with nasal polyps (CRSwNP). Protein profiles were analyzed by 2‐dimensional electrophoresis and identified several proteins, including L‐plastin, as highly expressed. We examined L‐plastin and tissue factor (TF) expression by immunohistochemical and immunofluorescence analyses. To examine the role of L‐plastin in eosinophils, we knocked down L‐plastin expression in Eol‐1 cells by using siRNA transfection.

Results

L‐plastin protein levels in nasal polyp tissue were increased in patients with NERD relative to those in patients with aspirin tolerant CRSwNP. Immunofluorescence analysis revealed that L‐plastin was dominantly expressed in eosinophils and L‐plastin and TF were co‐expressed in eosinophils in NERD nasal polyp tissue. Knockdown of L‐plastin in Eol‐1 cells disrupted the cell surface distribution of TF by stimulation with granulocyte macrophage colony‐stimulating factor.

Conclusions

Increased expression of L‐plastin by eosinophils may contribute to abnormal fibrin deposition through TF translocation to the eosinophil cell surface in NERD nasal polyp tissue, which in turn may contribute to the pathogenesis of NERD.

This article is protected by copyright. All rights reserved.

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How to discontinue omalizumab in chronic spontaneous urticaria?

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Highlights and recent developments in airway diseases in EAACI journals (2017)

The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to supp...

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Genetic and environmental influences on third molar root mineralization

Publication date: Available online 26 November 2018

Source: Archives of Oral Biology

Author(s): Giedrė Trakinienė, Irena Andriuškevičiūtė, Loreta Šalomskienė, Arūnas Vasiliauskas, Tomas Trakinis, Antanas Šidlauskas

Abstract

Objective

To assess the genetic and environmental influences on the variability of human third molar (M3) root mineralization stages via a twin study.

Design

The study sample consisted of 162 same-sex twins (66 dizygotic and 96 monozygotic, mean age: 17.9 years) with normal growth and development. Panoramic radiographs were evaluated to assess root mineralization stages of the upper and lower third molars, using the method of Demirijian et al. (1973). Zygosity was established using 15 specific DNA markers.

Results

Females developed their third molar roots earlier in life than males. Monozygotic twins (MZ) demonstrated higher intra-pair correlations for M3 root development stages than did DZ twins. An ACE model with additive genes, as well as common and specific environmental factors, provided the best explanation of variation in M3 root development. The mineralization of M3 roots showed highly additive genetic determination, varying from 60 to 63%, whereas a common environment contributed from 25 to 27%, and a specific environment only accounted 14% of the total variation, at most.

Conclusions

A considerable proportion of the total variability of the third molar root mineralization rate can be attributed to additive genetic effects, while common and specific environmental effects have a smaller, yet significant, impact.

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Reviewers- an acknowledgement

Publication date: January 2019

Source: Medical Image Analysis, Volume 51

Author(s):

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Editorial Board

Publication date: January 2019

Source: Medical Image Analysis, Volume 51

Author(s):

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A Graph-Cut Approach for Pulmonary Artery-Vein Segmentation in Noncontrast CT Images

Publication date: Available online 26 November 2018

Source: Medical Image Analysis

Author(s): Daniel Jimenez-Carretero, David Bermejo-Pelaez, Pietro Nardelli, Patricia Fraga, Eduardo Fraile, Raul San Jose Estepar, Maria J Ledesma-Carbayo

Abstract

Lung vessel segmentation has been widely explored by the biomedical image processing community; however, the differentiation of arterial from venous irrigation is still a challenge. Pulmonary artery–vein (AV) segmentation using computed tomography (CT) is growing in importance owing to its undeniable utility in multiple cardiopulmonary pathological states, especially those implying vascular remodelling, allowing the study of both flow systems separately. We present a new framework to approach the separation of tree-like structures using local information and a specifically designed graph-cut methodology that ensures connectivity as well as the spatial and directional consistency of the derived subtrees. This framework has been applied to the pulmonary AV classification using a random forest (RF) pre-classifier to exploit the local anatomical differences of arteries and veins. The evaluation of the system was performed using 192 bronchopulmonary segment phantoms, 48 anthropomorphic pulmonary CT phantoms, and 26 lungs from noncontrast CT images with precise voxel-based reference standards obtained by manually labelling the vessel trees. The experiments reveal a relevant improvement in the accuracy ( ∼ 20%) of the vessel particle classification with the proposed framework with respect to using only the pre-classification based on local information applied to the whole area of the lung under study. The results demonstrated the accurate differentiation between arteries and veins in both clinical and synthetic cases, specifically when the image quality can guarantee a good airway segmentation, which opens a huge range of possibilities in the clinical study of cardiopulmonary diseases.

Graphical abstract

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Are antithrombotic agents necessary for head and neck microvascular surgery?

Publication date: Available online 26 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): W. Zhou, W.-B. Zhang, Y. Yu, Y. Wang, C. Mao, C.-B. Guo, G.-Y. Yu, X. Peng

Abstract

The aim of this prospective study was to determine the effect of antithrombotic agents in preventing thrombosis after head and neck reconstructive surgery. A randomized clinical trial of referred patients undergoing free flap surgery between February 2015 and July 2017 was conducted. Four hundred and fifty-four patients were randomly assigned to group A (n = 153), administered aspirin and low molecular weight dextran; group B (n = 150), administered low molecular weight heparin; and group C (n = 151), not administered any antithrombotic agent. Patient demographic characteristics, donor site, thrombosis, haematoma, and flap failure were recorded. Coagulation values including platelet count, prothrombin time, and activated partial thromboplastin time were measured during the perioperative period. Repeated-measures ANOVA and the χ² test were used for data comparisons. No significant inter-group differences were observed for postoperative microvascular thrombosis (P = 0.536) or flap failure (P = 0.615) among the three groups. There were more postoperative haematoma revisions in group B than in groups A and C (P = 0.032). It is concluded that postoperative antithrombotic agents neither provide a significant improvement in the free flap success rate nor decrease the risk of thrombosis and may increase the risk of haematoma.

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The dental monomer 2-hydroxyethyl methacrylate (HEMA) causes transcriptionally regulated adaptation partially initiated by electrophilic stress

Publication date: Available online 27 November 2018

Source: Dental Materials

Author(s): Rune Becher, Håkon Valen, Bergitte Pearl Olderbø, Anette Kocbach Bølling, Jan Tore Samuelsen

Abstract

Objectives

Cellular responses including cell death are induced by in vitro exposure to the un-polymerized dental monomer 2-hydroxyethyl methacrylate (HEMA). Activation of the Nrf2/ARE signaling pathway has been suggested to mediate the cellular responses. Activation of this pathway may occur either indirectly through generation of increased oxidative stress or through direct binding to cysteine thiols due to the electrophilic properties of HEMA. The objective of this study was to elucidate the potential mechanism of Nrf2/ARE pathway activation after HEMA exposure.

Methods

Global gene expression was investigated after exposure of the human bronchial epithelial cell line BEAS–2B to 2 mM HEMA for 4 h. After exposure to 0.5, 1 or 2 mM HEMA for up to 24 h, western analysis was performed for selected proteins. Finally, the levels of the same proteins were determined after treatment with either the antioxidants Vitamin C, Trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid) or BSO (L-buthioninesulfoximine), an inhibitor of GSH formation.

Results

Several of the 25 genes with the highest increase in gene transcription are related to oxidative stress responses. Increased levels of 5 corresponding proteins (HO-1, GCLC, GCLM, NQO1 and SQSTM1) were observed. Antioxidant treatment as well as inhibition of GSH did not affect upregulation of these proteins. Thus, increased ROS or reduced GSH levels appear to be of limited importance in the observed HEMA-induced changes.

Significance

Knowledge of the cellular responses to HEMA is important to evaluate the safety of HEMA-containing biomaterials. The results support that HEMA activates the Nrf2-ARE transcriptional pathway directly through its electrophilic properties.

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Multiway canonical correlation analysis of brain data

Publication date: Available online 27 November 2018

Source: NeuroImage

Author(s): Alain de Cheveigné, Giovanni M. Di Liberto, Dorothée Arzounian, Daniel D.E. Wong, Jens Hjortkjær, Søren Fuglsang, Lucas C. Parra

Abstract

Brain data recorded with electroencephalography (EEG), magnetoencephalography (MEG) and related techniques often have poor signal-to-noise ratios due to the presence of multiple competing sources and artifacts. A common remedy is to average responses over repeats of the same stimulus, but this is not applicable for temporally extended stimuli that are presented only once (speech, music, movies, natural sound). An alternative is to average responses over multiple subjects that were presented with identical stimuli, but differences in geometry of brain sources and sensors reduce the effectiveness of this solution. Multiway canonical correlation analysis (MCCA) brings a solution to this problem by allowing data from multiple subjects to be fused in such a way as to extract components common to all. This paper reviews the method, offers application examples that illustrate its effectiveness, and outlines the caveats and risks entailed by the method.

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In Memoriam: Francis Weill (1933–2018)

Publication date: Available online 27 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Michel Claudon, Hassen A. Gharbi, Barry B. Goldberg

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Medical Student Ultrasound Education: A WFUMB Position Paper, Part I

Publication date: Available online 27 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Christoph F. Dietrich, Beatrice Hoffmann, Jacques Abramowicz, Radu Badea, Barbara Braden, Vito Cantisani, Maria C. Chammas, Xin-Wu Cui, Yi Dong, Odd Helge Gilja, Roman Hari, Harvey Nisenbaum, Delwyn Nicholls, Christian Pállson Nolsøe, Dieter Nürnberg, Helmut Prosch, Maija Radzina, Florian Recker, Alexander Sachs, Adrian Saftoiu

Abstract

The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.

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Symptoms and Vocal Risk Factors in Individuals with High and Low Anxiety

Aims: To assess the frequency of vocal symptoms and risk factors in individuals with high and low anxiety and to investigate the relationships among vocal symptoms, risk factors, and anxiety levels. Patients and Methods: A total of 201 patients of both sexes with a mean age of 42.88 years (SD = 15.78) served as participants. The patients were divided into two groups according to the level of trait anxiety: a low-anxiety group (n = 108) and a high-anxiety group (HAG, n = 93). Data were collected using three self-assessment instruments: the Vocal Screening Protocol, the Voice Symptom Scale (VoiSS), and the State-Trait Anxiety Inventory (STAI). Results: The HAG presented higher scores in all VoiSS domains. There were positive correlations between the total and emotional scores on the VoiSS and the STAI Trait subscale. There were significant associations between 13 vocal risk factors and anxiety levels. Conclusion: Individuals with high anxiety present a higher frequency of vocal symptoms related to either vocal limitation, physical aspects, or the emotional impact of dysphonia. The higher the trait anxiety, the greater the total and emotional scores on the VoiSS. Anxiety levels are associated with certain vocal risk factors.
Folia Phoniatr Logop 2019;71:7–15

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Comparison of condylar size among different anteroposterior and vertical skeletal patterns using cone-beam computed tomography.

Comparison of condylar size among different anteroposterior and vertical skeletal patterns using cone-beam computed tomography.

Angle Orthod. 2018 Nov 26;:

Authors: Hasebe A, Yamaguchi T, Nakawaki T, Hikita Y, Katayama K, Maki K

Abstract
OBJECTIVES:: To compare condylar size among different anteroposterior and vertical skeletal patterns using cone-beam computed tomography (CBCT).
MATERIALS AND METHODS:: The study included 166 subjects (61 men, mean age: 27.2 ± 7.6 years; 105 women, mean age: 27.4 ± 9.2 years). The anteroposterior skeletal patterns of the subjects were classified into Classes I (-1° ≤ A point-nasion-B point angle [ANB] < 4°), II (ANB ≥ 4°), and III (ANB < -1°). The vertical skeletal patterns were classified into hypodivergent (mandibular plane [MP] ≤ 23°), normodivergent (23° < MP < 30°), and hyperdivergent (MP ≥ 30°) groups. The condylar length, height, and width were examined using CBCT images. Analysis of covariance was used to compare three condylar size measurements among the three anteroposterior groups and the three vertical groups using sex as a covariate. Both left and right sides were examined. Nine groups were further divided according to the anteroposterior and vertical groups, and two-way analysis of covariance (ANCOVA) was applied to estimate the composite effect of skeletal patterns in both directions.
RESULTS:: Sex as a covariate showed statistical significance in most examinations. The condylar height on both sides had statistically different anteroposterior skeletal patterns ( P < .001). The condylar width on both sides also had statistically different vertical skeletal patterns ( P < .001). After adjusting for sex, the condylar height and width on both sides increased from Class II, Class I, and Class III. The condylar width on both sides increased from the hypodivergent group, the normodivergent group, and the hyperdivergent group. No composite effect of skeletal patterns in both directions was observed.
CONCLUSIONS:: Condylar height and width considerably differed among subjects with different anteroposterior or vertical skeletal patterns. The anteroposterior or vertical skeletal patterns independently affected the condylar size.

PMID: 30475648 [PubMed - as supplied by publisher]

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Comparison of anterior retraction and anchorage control between en masse retraction and two-step retraction: A randomized prospective clinical trial.

Comparison of anterior retraction and anchorage control between en masse retraction and two-step retraction: A randomized prospective clinical trial.

Angle Orthod. 2018 Nov 26;:

Authors: Schneider PP, Gandini Júnior LG, Monini ADC, Pinto ADS, Kim KB

Abstract
OBJECTIVES:: The purpose of this two-arm parallel trial was to compare en masse (ER) and two-step retraction (TSR) during space closure.
MATERIALS AND METHODS:: Forty-eight adult patients with bimaxillary protrusion who were planned for treatment with extraction of four first premolars were enrolled. All patients were randomly allocated in a 1:1 ratio to either the ER (n = 24) group or the TSR (n = 24) group. The main outcome was the amount of posterior anchorage loss in the molars and the retraction of the incisors between ER and TSR; the difference in incisor and molar inclination was a secondary outcome. Lateral cephalometric radiographs and oblique cephalometric radiographs at 45° were taken before retraction (T1) and after space closure (T2). Cephalograms were digitized and superimposed on the anatomic best fit of the maxilla and mandible by one operator who was blinded to the treatment group.
RESULTS:: Neither incisor nor molar crown movements showed any significant differences between the ER and TSR. There were no significant differences in the tipping of incisors and molars between the two groups.
CONCLUSIONS:: No significant differences existed in the amount of retraction of incisors and anchorage loss of molars between ER and TSR. Changes in incisor and molar tipping were similar, with the crowns showing more movement than the apex.

PMID: 30475647 [PubMed - as supplied by publisher]

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Calendar Listings

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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Effectiveness of the Teacher's Vocal Health Program (TVHP) in the Municipal Education Network of Campo Grande, MS

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Paulo Roberto Haidamuss de Oliveira Bastos, Elisangela Carelli Hermes

Summary

Objective

This study aimed to implement and evaluate the effectiveness of the Teacher's Vocal Health Program in the Municipal Education Network in Campo Grande, MS, in the 2016 school year so as to reduce or extinguish the high prevalence of vocal symptoms among teachers.

Methods

This is an experimental research with convenience sampling of 48 teachers presenting with vocal symptoms. The Vocal Symptoms Scale was used to collect data, which according to the criteria of the Scientific Advisory Committee of the Medical Outcomes Trust, present proved psychometric properties and is specific to evaluate individuals with vocal alterations. The proposed Vocal Program is considered as a brief intervention one (3 months) and consists of qualification or instruction, as well as application of 5 daily vocal techniques and is controlled through individual monitoring spreadsheets.

Results

The total score average had statistically significant reduction in the experimental group when compared with the control group, which represents a positive effect concerning the program adhesion. The fact that there was no nullity in the subscales (limitations, physical, emotional) means that even submitted to the intervention, the teachers still present with vocal symptoms.

Conclusion

Teacher's Vocal Health Program represents an effective Vocal Health Program model for the teachers.

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The Influence of Occupation on Self-perceived Vocal Problems in Patients With Voice Complaints

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Barbara Ebersole, Resha S. Soni, Kathleen Moran, Miriam Lango, Karthik Devarajan, Nausheen Jamal

Summary

Objective

This study aimed to examine the relationships among patient occupation, laryngeal diagnosis, perceptual dysphonia severity, and patient-perceived voice impairment.

Methods

Adult patients presenting with a chief complaint of dysphonia over a 20-month period at a tertiary care, interdisciplinary voice center were included in this retrospective cohort study. Patients were categorized by profession: vocal performers, high occupational voice demand, low or no occupational voice demand, and retired. Associations between professional voice demand and clinician rating of dysphonia severity using the "Grade" score from the Grade, Roughness, Breathiness, Asthenia, and Strain scale and patient ratings of voice impairment using the Voice Handicap Index-10 (VHI-10) were tested using standard descriptive statistical methods.

Results

One hundred and sixty-three patients with a presenting complaint of dysphonia were evaluated. Significant associations were found on univariate and multivariable analysis among a patient's occupational voice demand, Grade, Roughness, Breathiness, Asthenia, and Strain grade, and VHI-10 score (P = 0.007 and P < 0.001, respectively). Patients subject to greater vocal demands as a result of their occupation had a greater perception of impairment, regardless of acoustic-perceptual severity, when compared with those with low or no occupational voice demand. Although voice diagnosis was significantly associated with VHI-10 score on univariate analysis, it failed to reach significance on multivariable analysis. Demographic measures such as gender and age also did not correlate with perceived vocal impairment.

Conclusion

Patient-perception of voice impairment is influenced by occupational demand, independent of acoustic-perceptual dysphonia. Performers and people with high occupational voice needs demonstrate a unique sensitivity to subtle voice changes.

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Contemporary Commercial Music Singing Students—Voice Quality and Vocal Function at the Beginning of Singing Training

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Ewelina M. Sielska-Badurek, Maria Sobol, Katarzyna Olszowska, Kazimierz Niemczyk

Summary

Objective

The purpose of this study was to assess the voice quality and the vocal tract function in popular singing students at the beginning of their singing training at the High School of Music.

Design

This is a retrospective cross-sectional study.

Methods

The study consisted of 45 popular singing students (35 females and 10 males, mean age: 19.9 ± 2.8 years). They were assessed in the first 2 months of their 4-year singing training at the High School of Music, between 2013 and 2016. Voice quality and vocal tract function were evaluated using videolaryngostroboscopy, palpation of the vocal tract structures, the perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, the Voice Handicap Index, and the Singing Voice Handicap Index (SVHI).

Results

Twenty-two percent of Contemporary Commercial Music singing students began their education in the High School, with vocal nodules. Palpation of the vocal tract structure showed in 50% correct motions and tension in speaking and in 39.3% in singing. Perceptual voice assessment showed in 80% proper speaking voice quality and in 82.4% proper singing voice quality. The mean vocal fundamental frequency while speaking in females was 214 Hz and in males was 116 Hz. Dysphonia Severity Index was at the level of 2, and maximum phonation time was 17.7 seconds. The Voice Handicap Index and the SVHI remained within the normal range: 7.5 and 19, respectively. Perceptual singing voice assessment correlated with the SVHI (P = 0.006).

Conclusions

Twenty-two percent of the Contemporary Commercial Music singing students began their education in the High School, with organic vocal fold lesions.

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The Vocal Tract Organ: A New Musical Instrument Using 3-D Printed Vocal Tracts

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): David M. Howard

Summary

The advent and now increasingly widespread availability of 3-D printers is transforming our understanding of the natural world by enabling observations to be made in a tangible manner. This paper describes the use of 3-D printed models of the vocal tract for different vowels that are used to create an acoustic output when stimulated with an appropriate sound source in a new musical instrument: the Vocal Tract Organ. The shape of each printed vocal tract is recovered from magnetic resonance imaging. It sits atop a loudspeaker to which is provided an acoustic L-F model larynx input signal that is controlled by the notes played on a musical instrument digital interface device such as a keyboard. The larynx input is subject to vibrato with extent and frequency adjustable as desired within the ranges usually found for human singing. Polyphonic inputs for choral singing textures can be applied via a single loudspeaker and vocal tract, invoking the approximation of linearity in the voice production system, thereby making multiple vowel stops a possibility while keeping the complexity of the instrument in reasonable check. The Vocal Tract Organ offers a much more human and natural sounding result than the traditional Vox Humana stops found in larger pipe organs, offering the possibility of enhancing pipe organs of the future as well as becoming the basis for a "multi-vowel" chamber organ in its own right.

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A Comparison of Indirect and Direct Methods for Estimating Transglottal Airflow Rate

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Ashwini Joshi, Christopher R. Watts

Summary

Objective

The purpose of this study was to compare indirect estimates of transglottal airflow rate using measures of phonation quotient with direct measures of mean airflow rate derived from a pneumotachograph.

Study design

This study used prospective, repeated measures design.

Methods

Nineteen male and female participants, matched for age, completed tasks for maximum phonation time and vital capacity in addition to the comfortable sustained phonation protocol of the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated from the vital capacity and phonation time measures, whereas actual transglottal airflow was obtained from the flow waveforms recorded on the PAS system. Statistical analyses compared transglottal airflow rate measures as a function of instrument and separately as a function of gender.

Results

Statistically significant differences were present only as a function of gender on airflow measures but not as a function of the instrument. There were no interaction effects present between instrument and gender.

Conclusions

Phonation quotient can be used as an estimate of transglottal airflow in the absence of a pneumotachograph-based system.

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The Effects of Exposure to Environmental Cigarette Smoke on the Vocal Folds of Rats

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Mahmut Babalık, İlhan Topaloğlu, Ziya Saltürk, Güler Berkiten, Yavuz Atar, Belgin Tutar, Şenol Baş

Summary

Objective

This study aimed to investigate histopathologically and immunohistochemically the effects of environmental smoke on the vocal folds.

Methods

This study examined 20 healthy Wistar albino rats, which were divided into four groups of five rats. Group 1 was exposed to smoke for 45 days and group 2 for 90 days. Groups 3 and 4 were the respective control groups. The rats in groups 1 and 3 were sacrificed on day 45 and those in groups 2 and 4 on day 90.

The larynx specimens were stained with hematoxylin and eosin, and the inflammation, hyperplasia, and metaplasia were evaluated. Ki-67 staining was used for the immunohistochemical analysis.

Results

There was no significant difference in mononuclear cell infiltration between the experimental and control groups (group 1 vs. group 3 P = 0.20, group 2 and 4 P = 0.41) (Table 3), but there was a significant difference between the two experimental groups (P = 0.007). Mild and moderate hyperplasia was seen in groups 1 and 2, respectively.

Conclusion

Environmental exposure to cigarette smoke has destructive effects on the vocal folds of rats.

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Regenerative Effects of Basic Fibroblast Growth Factor on Restoration of Thyroarytenoid Muscle Atrophy Caused by Recurrent Laryngeal Nerve Transection

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Mami Kaneko, Takuya Tsuji, Yo Kishimoto, Yoichiro Sugiyama, Tatsuo Nakamura, Shigeru Hirano

Summary

Objectives

Vocal fold atrophy following unilateral vocal fold paralysis is caused by atrophy of the thyroarytenoid (TA) muscle and remains a challenge. Medialization procedures are popular treatment options; however, hoarseness often remains due to the reduction in mass or tension of the TA muscle. Therefore, in addition to medialization procedures, TA muscle reinnervation is desirable. In vivo studies have shown the potential for basic fibroblast growth factor (bFGF) to affect muscular and nerve regeneration. The present study aimed to examine the regenerative effects of bFGF on restoration of TA muscle atrophy caused by recurrent laryngeal nerve transection.

Study design

Prospective animal experiments with controls.

Methods

TA muscle atrophy was induced by unilateral transection of the recurrent laryngeal nerve. One month after transection, different doses (200 ng, 100 ng, 10 ng) of bFGF in 50 µL were repeatedly injected into the TA muscle four times with an interval of 1 week between injections. Saline only was injected in the sham group. Larynges were harvested for histologic and immunohistochemical examination 4 weeks after the final injection.

Results

The cross-sectional TA muscle area was significantly larger in the bFGF-treated groups compared with the sham-treated groups. Immunohistochemistry indicated that bFGF significantly increases the number of neuromuscular junctions and satellite cells in the TA muscle.

Conclusions

These results suggest that local application of bFGF to the TA muscle may improve TA muscle atrophy caused by recurrent laryngeal nerve paralysis. Furthermore, bFGF may have regenerative effects on both nerves and muscles.

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Editorial Board

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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TOC

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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Subject Index

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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Instructions for Contributors

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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Author index

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s):

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Correlation between Voice and Auditory Processing

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Janine Santos Ramos, Mariza Ribeiro Feniman, Ingrid Gielow, Kelly Cristina Alves Silverio

Summary

Purpose

To compare and to correlate the performance of women with behavioral dysphonia and without voice disorders in auditory processing tests and in the Voice Tone Reproduction Test (VTRT).

Methods

Forty women aged from 18 to 44 years participated and were divided in two groups: dysphonic (DG) and non-dysphonic (NDG). The participants underwent interview, hearing, otorhinolaryngology and voice assessments (voice record, VTRT through phonetography), and auditory processing assessment—using the Pitch Pattern Sequence (PPS) test and the Duration Pattern Sequence (DPS) test. The statistical analysis compared both groups, and there was a correlation test (P < 0.05).

Results

The NDG had a better performance in the PPS test (P = 0.000), in the VTRT test in the first attempt (P = 0.025), and in the total of correct answers (P = 0.017). There was a positive correlation between the PPS and both the first attempt of the VTRT and the total number of attempts. Regarding the DPS, there was a positive correlation for the left ear with the total number of VTRT attempts.

Conclusions

Dysphonic women presented disorders in temporal auditory processing skills, revealing an important relation between vocal production and impairment of some central auditory functions. There was a positive correlation between the performance in the auditory processing assessment and the performance in voice tone reproduction in both groups. The VTRT may assist speech therapists and voice trainers in verifying difficulties of auditory perception of dysphonic women when the cause is due to behavioral tdysphonia.

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Estimating Vocal Effort from the Aerodynamics of Labial Fricatives: A Feasibility Study

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Yohann Meynadier, Anita El Hajj, Michel Pitermann, Thierry Legou, Antoine Giovanni

Summary

Objective and Hypothesis

Vocal effort in loud voice is produced with increased subglottal pressure during vowels and increased supraglottal pressure during consonants. In the paper, our main objective is to check whether it was supported by a parallel increase in the airflow resistance of the laryngeal articulator and of the supralaryngeal articulator, here the lips.

Study Design and Method

For this comparison, our choice fell on the fricative consonants, as their production allows perfectly synchronous air pressure and airflow measurements. Also, the calculation of the real instantaneous aerodynamic resistance is possible with fricatives—as it is with vowels—whereas it is not possible with plosives. The present feasibility study on a healthy subject is based on direct subglottal and intraoral pressures and airflow measured for /f/ or /v/ and from the contiguous vowel produced in VCVCV nonsense words at different levels of intensity.

Results and Conclusion

The results support that the airflow resistances at the lips and that at the larynx are quite parallel. The airflow resistance at the lips during labial fricative production could provide a good picture of the laryngeal resistance during the production of continuous speech. This suggests clinical applications using both noninvasive inferred measurements of subglottal pressure variation and direct noninferred airflow measurements from more natural speech production tasks.

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The Influence of Sleep Disorders on Voice Quality

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Bruna Rainho Rocha, Mara Behlau

Summary

Objectives/Hypothesis

To verify the influence of sleep quality on the voice.

Study Design

Descriptive and analytical cross-sectional study.

Methods

Data were collected by an online or printed survey divided in three parts: (1) demographic data and vocal health aspects; (2) self-assessment of sleep and vocal quality, and the influence that sleep has on voice; and (3) sleep and voice self-assessment inventories—the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Voice Handicap Index reduced version (VHI-10). A total of 862 people were included (493 women, 369 men), with a mean age of 32 years old (maximum age of 79 and minimum age of 18 years old).

Results

The perception of the influence that sleep has on voice showed a difference (P < 0.050) between measures of sleep quality and vocal self-assessment. There were higher scores on the ESS, PSQI, and VHI-10 protocols if sleep and vocal self-assessment were poor. The results indicate that the greater the effect that sleep has on voice, the greater the perceived voice handicap. The aspects that influence a voice handicap are vocal self-assessment, ESS total score, and self-assessment of the influence that sleep has on voice. The absence of daytime sleepiness is a protective factor (odds ratio [OR] > 1) against perceived voice handicap; the presence of daytime sleepiness is a damaging factor (OR < 1).

Conclusions

Sleep quality influences voice. Perceived poor sleep quality is related to perceived poor vocal quality. Individuals with a voice handicap observe a greater influence of sleep on voice than those without.

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Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Hassan Khoramshahi, Ahmad Reza Khatoonabadi, Seyyedeh Maryam Khoddami, Peyman Dabirmoghaddam, Noureddin Nakhostin Ansari

Summary

Objectives

This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia.

Study Design

Prospective, within-participant repeated measures.

Method

Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients.

Results

The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r _Pearson = −0.1–0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1).

Conclusion

This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.

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Vocal Evaluation of Children with Congenital Hypothyroidism

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Ana Paula Dassie-Leite, Mara Behlau, Suzana Nesi-França, Monica Nunes Lima, Luiz de Lacerda

Summary

Objective

To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles.

Matherial and Methods

Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination).

Results

In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data.

Conclusion

Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

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The Impact of Double Source of Vibration Semioccluded Voice Exercises on Objective and Subjective Outcomes in Subjects with Voice Complaints

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Marco Guzman, Gabriela Acuña, Fernanda Pacheco, Francisca Peralta, Constanza Romero, Cecilia Vergara, Camilo Quezada

Summary

Purpose

The present study reports the effects of double source of vibration semioccluded vocal tract exercises (SOVTEs) on subjective and objective variables in subjects with voice complaints.

Methods

Eighty-four participants with voice complaints were randomly assigned to one of four treatment groups: (1) water resistance therapy, (2) tongue trills, (3) lip trills, and (4) raspberry (tongue and lip trills at the same time). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, and acoustic assessments. Measures for the Vocal Tract Discomfort Scale (VTDS), self-assessment of resonant voice quality, and sensation of muscle relaxation were also obtained. Three assessment sessions were conducted: (1) before the therapy session (Pre), (2) immediately after the voice therapy session (Post 1), and (3) 1 week after home practice (Post 2).

Results

Significant differences between baseline (Pre) and both post measures were found for the perception of muscle relaxation and resonant voice quality. No significant differences between Post 1 and Post 2 for any exercises were observed. This indicates that all voice exercises improved subjective self-perceived voice quality immediately after exercises and that improvement remained stable after 1 week of practice. Water resistance therapy and raspberry attained the highest effect. A significant decrease for all exercises was also observed for VTDS values after 1 week of practice. Although some significant changes were observed in objective variables, no clear patterns could be detected.

Conclusions

SOVTEs with secondary source of vibration may reduce vocal symptoms related to physical discomfort in subjects with voice complaints. Objective variables apparently do not fully reflect subjective positive outcomes, or they are not sensitive enough to capture changes. No significant differences between four observed SOVTEs were observed.

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Idiopathic Supraglottic Stenosis Refractory to Multiple Interventions Improved With Serial Office-based Steroid Injections

Publication date: November 2018

Source: Journal of Voice, Volume 32, Issue 6

Author(s): Matthew R. Hoffman, Johnny P. Mai, Seth H. Dailey

Summary

Purpose

The objective of this study was to describe a patient with idiopathic supraglottic stenosis who experienced persistent disease despite multiple office-based and operative interventions, whose disease is now better controlled with scheduled serial office-based steroid injections.

Methods

This is a case report and literature review.

Results

A 42-year-old female was referred for worsening supraglottic stenosis despite systemic steroids. She underwent awake tracheotomy. A thorough historical, histologic, and laboratory workup did not reveal an etiology to her stenosis. She later underwent endoscopic partial laryngectomy and was able to be decannulated. She underwent a second endoscopic partial laryngectomy two years later for worsening disease and then was managed over the next seven years with intermittent systemic steroids. Over the last year, she has undergone eight office-based steroid injections with improvement in her degree of stenosis and symptom burden.

Conclusions

There are only four prior reported cases of idiopathic supraglottic stenosis, none of which has been managed with serial office-based steroid injections. This case report adds to the small body of literature on the management of this rare disease and proposes a new office-based treatment pathway that may help induce regression of stenosis.

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