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Objective: Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. Materials and Methods: In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. Results: The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P<0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. Conclusion: Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value. [ABSTRACT FROM AUTHOR]

Studies show that functional dysphonia among teachers can lead to emotional stress, high rates of sickness and negative effects on their students' learning success. The study's aim was to examine the effects of using a silicone tube on both subjective and receptive voice assessment. The study had a pre-/post-test design and involved 36 primary school teachers. They performed daily vocal exercises with a flexible silicone tube for 6 minutes. The participants filled out the Voice Handicap Index (VHI) for subjective voice assessment and the RBH scale was used for receptive voice assessment. The results showed a significant improvement in the VHI results and the number of handicaps sank by 25 %. The scale value of the RBH scale improved in general. Based on the results, the exercises are suitable for daily use and could assist in preventing functional dysphonia among teachers. Further studies should look at objective acoustic changes in the voice and consider long-term effects. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to evaluate the efficacy and safety of lysozyme-based oral antiseptic in the therapy of non-infectious sore throat in teachers. Materials and Methods. A non-interventional, prospective, pilot study was conducted with two examinations. The first was performed as part of a general medical examination. If a non-infectious sore throat was confirmed by clinical checkup and all other inclusion and non-exclusion criteria confirmed, patients were offered to be enrolled in the study. After signing the informed consent form, patients were advised to use lysozyme-based lozenges, six times a day, for a period of five days. A telephone call follow-up examination was performed within 24 hours from the therapy completion. Results. This was a pilot study involving 25 adult patients of both genders. Lysozyme-based lozenges showed positive effects in relieving the symptoms of non-infectious sore throat in teachers. At the same time, the lozenges showed excellent tolerability, and no side effects were reported during the study. 92% of patients confirmed they would take the same medicine again due to the same problem. Conclusion. The results of this "proof-of-concept" study indicated that lysozyme-based antiseptic could be effective and safe in the treatment of non-infectious sore throat in teachers and should be further evaluated as treatment option in this condition. [ABSTRACT FROM AUTHOR]

Functional dysphonia (FD) refers to an abnormality in voice quality in the absence of an identifiable lesion. In this paper, we propose an approach based on the tunable Q wavelet transform (TQWT) to automatically classify two types of FD (hyperfunctional dysphonia and hypofunctional dysphonia) from a healthy voice using the acoustic voice signal. Using TQWT, voice signals were decomposed into sub-bands and the entropy values extracted from the sub-bands were utilized as features for the studied 3-class classification problem. In addition, the Mel-frequency cepstral coefficient (MFCC) and glottal features were extracted from the acoustic voice signal and the estimated glottal source signal, respectively. A convolutional neural network (CNN) classifier was trained separately for the TQWT, MFCC and glottal features. Experiments were conducted using voice signals of 57 healthy speakers and 113 FD patients (72 with hyperfunctional dysphonia and 41 with hypofunctional dysphonia) taken from the VOICED database. These experiments revealed that the TQWT features yielded an absolute improvement of 5.5% and 4.5% compared to the baseline MFCC features and glottal features, respectively. Furthermore, the highest classification accuracy (67.91%) was obtained using the combination of the TQWT and glottal features, which indicates the complementary nature of these features. • Multi-class classification of functional dysphonia using Tunable Q wavelet transform (TQWT)- based features is studied. • The Synthetic Minority Over-Sampling Technique (SMOTE) is used to balance the training data. • TQWT-based features are combined with glottal features to enhance the performance. • The results show that the combination of TQWT-based and glottal features provided best performance in the classification of functional dysphonia. [ABSTRACT FROM AUTHOR]

Background: Medically unexplained loss or alteration of voice--functional dysphonia--is the commonest presentation to speech and language therapists (SLTs). Besides the impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aims of this research were the systematic development of a complex intervention to improve the treatment of functional dysphonia, and the trialling of this intervention for feasibility and acceptability to SLTs and patients in a randomised pilot study Methods: A theoretical model of medically unexplained symptoms (MUS) was elaborated through literature review and synthesis. This was initially applied as an assessment format in a series of patient interviews. Data from this stage and a small consecutive cohort study were used to design and refine a brief cognitive behavioural therapy (CBT) training intervention for a SLT. This was then implemented in an external pilot patient randomised trial where one SLT delivered standard voice therapy or voice therapy plus CBT to 74 patients. The primary outcomes were of the acceptability of the intervention to patients and the SLT, and the feasibility of changing the SLT's clinical practice through a brief training. This was measured through monitoring treatment flow and through structured analysis of the content of intervention for treatment fidelity and inter-treatment contamination. Results: As measured by treatment flow, the intervention was as acceptable as standard voice therapy to patients. Analysis of treatment content showed that the SLT was able to conduct a complex CBT formulation and deliver novel treatment strategies for fatigue, sleep, anxiety and depression in the majority of patients. On pre-post measures of voice and quality of life, patients in both treatment arms improved. Conclusion: These interventions were acceptable to patients. Emotional and psychosocial issues presented routinely in the study patient group and CBT techniques were used, deliberately and inadvertently, in both treatment arms. This CBT "contamination" of the voice therapy only arm reflects the chief limitation of the study: one therapist delivered both treatments. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the effectiveness of the laryngostroboscopy for monitoring the evolution of patients with functional dysphonia before and after the logopedic vocal treatment. We performed a prospective observational study of 65 dysphonic patients diagnosed of functional dysphonia, where we analyzed four stroboscopic parameters (glottal closure, vocal fold vibration, mucosal wave and phase symmetry) by a protocol based on systematic subjective evaluation of the stroboscopic images before and after the rehabilitator treatment; and the results were stratified according to the clinical course. All patients, before the treatment, had some abnormality in at least one of the four analyzed aspects. After the vocal treatment, we found improvement of the four parameters in different degrees, and we just found a statistically significant relationship between the evolution of the glottal closure and the clinical course. We believe that the laryngostroboscopy, systematized through a protocol, is a useful technique for the diagnosis of functional abnormalities in patients with functional dysphonia but it is not a very useful technique for evaluating the results after the rehabilitator treatment, as there is not a statistically significant relationship between clinical course and the change in the most stroboscopic parameters, so it shouldn’t be the only technique used for these proposes. [ABSTRACT FROM AUTHOR]

The article presents a description of the voice rehabilitation in a 46-year old teacher, who was diagnosed with hyperfunctional dysphonia and soft nodules of vocal cords. As one of the elements of voice training we used, for the first time in Poland, manual therapy developed by L. Mathieson, intended to reduce the vocal tract discomfort by massage of neck muscle. Before and after the treatment, a comprehensive diagnosis was carried out: subjective self-assessment according to Voice Handicap Index (VHI), GRBAS perceptual evaluation, followed by videolaryngostroboscopy, acoustic voice analysis and maximum phonation time MPT) test. The battery of tests includes a new laryngeal palpation evaluation scale (LMTPE) developed from the English version (Laryngeal Manual Therapy Palpatory Evaluation). The use of manual therapy reduced tension of laryngeal muscles in our patient and improved her voice emission confirmed by the use of objective and subjective parameters. The reported case shows the advisability of including manual therapy in the rehabilitation of functional dysphonia. [ABSTRACT FROM AUTHOR]

BACKGROUND: We performed an epidemiologic study of patients suffering from functional dysphonia in relation to their age, sex, occupation, associated pathological background, vocal behaviour, tobacco consumption, and first features and duration of their condition. OBJECTIVE: To carry out an epidemiological study of the factors that can be considered triggering or predisposing patients to functional dysphonia, such as their age, sex, occupation, associated pathological background, prior vocal behavior, tobacco consumption, and first features and duration of their condition. MATERIAL AND METHODS: A systematized protocol was applied to 65 patients diagnosed with functional dysphonia in a five-year period. RESULTS: We found that the average age was 34 years; 87.7% were women; 95.4% were the hyperkinetic type. The majority had professions that involve facing the public or were voice professionals. The most frequent associated personal background was anxiety, depression, allergic rhinitis and gastroesophageal reflux. Previous vocal behaviour was characterized by vocal misuse and abuse, cervical tension, singing and hoarseness. 27.7% referred tobacco consumption. 66.2% referred a gradual beginning of the pathology and an average duration of 44.5 years. CONCLUSION: The functional dysphonias, frequent in women between 20 and 40 years of age, are most likely to affect people whose professions involve an excessive use of their voice. The personal background most related includes anxiety-depressive disorders, gastroesophageal reflux and allergic processes. The majority present a vocal behaviour characterized by misuse and abuse, singing cervical tension and hoarseness. Most of the patients show a gradual start of their symptoms. [ABSTRACT FROM AUTHOR]

Introduction. The early diagnosis of functional voice disorders constitutes a serious challenge for phoniatricians. Formant analysis is considered for use in evaluating the quality of voice, particularly its harmonic structure. Aim. The aim of this study was to assess the applicability of formant analysis in the diagnosis of functional voice disorders. Materials and methods. The study comprised 41 female controls with normal voice and 18 female teachers with vocal fold prenodules. To detect the behaviour of the individual formants depending on age, the following subjects were included into the control group: 9 persons aged 23-30 years, 9 aged 31-39 years, 10 aged 41-49 years and 13 aged 51-58 years. The teachers age ranged from 25-53 years. The acoustic testing was performed in the study and control groups, and involved recording (three times) a sample of sustained vowels and a standarized sentence. Using formant analysis unit of the Iris software package, the mean value of frequency and its standard deviation of respective formants in vowels and sentence were estimated. Results. The analysis of the location of formants did not show significant differences between age groups of healthy individuals. However, when comparing the average frequencies and standard deviations of respective formants between the study group and control group, significant differences were found for the first formant (F1) of vowels: "a" (p=0.002) "e" (p=0.002), "o" (p=0.033). The groups differed significantly also in the second formant (F2) of vowel "a" (p= 0.019) and vowel "o" (p=0.050). Conclusions. Formant analysis may provide the information on subtle changes of voice, indicating the early symptoms of functional dysphonia in patients with prenodules vocal fold. Further studies on a larger group of subjects with functional voice disorders are required to corroborate these findings. [ABSTRACT FROM AUTHOR]

Clinical experience shows that children with functional dysphonia often present disorders that are associated with abnormal auditory and emotional development. These children also struggle with voice therapy, perhaps because of difficulties with auditory control during speech. It has been hypothesized that difficulties in auditory processing in children may be an important factor in the pathogenesis of childhood dysphonia. The study aimed to assess selected auditory functions in children with hyperfunctional dysphonia. The study group consisted of 331 children aged from 7 to 12 years suffering from hyperfunctional dysphonia. The control group consisted of 213 children aged 7–12 years. All patients underwent ENT and phoniatric examination. All children underwent two standardized psychoacoustic tests: the Frequency Pattern Test (FPT) and the Duration Pattern Test (DPT). In the examined material, 223 children had edematous vocal fold nodules. The largest statistically significant differences were seen in the acoustic parameters describing relative frequency changes. FPT and DPT showed statistically significant differences in children with hyperfunctional dysphonia compared to the control group. At all ages the percentage of correctly identified tone sequences was significantly lower in children with dysphonia. Children with hyperfunctional dysphonia have difficulties in judging the pitch and duration of auditory stimuli. Difficulties in auditory processing appear to be important in the pathomechanism of functional voice disorders. Impaired hearing processes in children with hyperfunctional dysphonia can make it difficult to obtain positive and lasting effects from voice therapy. [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate whether a brief period of training in cognitive behavioral therapy (CBT) can improve the treatment of functional dysphonia by a speech and language therapist and ameliorate the psychological distress associated with this condition. Methods: In a consecutive cohort design, a speech and language therapist treated a small cohort (n = 15) of dysphonic patients with voice therapy alone. After a brief period of CBT training, she treated the next cohort of dysphonic patients (n = 13) with CBT-enhanced voice therapy. Pretreatment and posttreatment measures were taken of voice quality and voice-related quality of life. The General Health Questionnaire 28 and the Hospital Anxiety and Depression Scale were used to assess psychological distress and general well-being. Results: All voice measures improved significantly in both cohorts. Both groups improved significantly on the General Health Questionnaire 28, with the CBT group improving significantly more than the control group. Only the CBT group improved significantly on the Hospital Anxiety and Depression Scale (depression subscale). Conclusions: Despite limitations of size, design, and between-group baseline differences, the results support the hypothesis that the addition of CBT skills to existing voice therapy is both feasible and clinically effective in the treatment of functional dysphonia. [ABSTRACT FROM AUTHOR]

Summary: Objective: We evaluated the efficacy of voice therapy according to Borragan''s method associated to S. Magnani''s vocal counselling in functional dysphonia in children. Patients and methods: We prospectively treated 16 patients with vocal fold nodules (10 males, 6 females). Age ranged from 6 to 11 years with a mean age of 9 years. We performed a full screening phoniatric evaluation. In addition psychological tests were carried out to investigate psychological background. Results: We lost three patients at follow-up; one patient received surgery, eight patients healed (43.75%), four improved (25%). There was no statistical difference in the analysis of electroacoustical parameters while MPT significatively raised after therapy. Conclusion: If patients have motivation voice therapy could improve functional dysphonia in children. It is also important psychological background. Further studies on bigger populations with long-term follow-up are needed. [Copyright &y& Elsevier]

Abstract: Psychological factors are considered for the predisposition and perpetuation of functional dysphonia. In the present study 61 patients with functional dysphonia were compared with 61 healthy controls, matched by age, sex, and occupation with respect to Cloninger’s personality model, mood, and anxiety. The patients with functional dysphonia presented significantly higher scores than the healthy controls with respect to “harm avoidance” (HA); depressive symptoms; symptoms of unspecific and general anxiety; symptoms of specific anxiety concerning “health”, “illness”, and “extraversion versus introversion”. No significant differences were found in “novelty seeking” (NS), “reward dependence” (RD), “persistence” (PE), or in state-anxiety and anxiety of social situations. These results were found considering univariate and multivariate analyses and confirm the relationship of psychological factors such as personality traits, mood, and anxiety on one hand and conversion disorder in general and functional dysphonia in particular on the other hand. This important relationship should be considered in the diagnostic and therapeutic interventions of functional dysphonia. [Copyright &y& Elsevier]

Muscle tension dysphonia (MTD) is a subtype of functional dysphonias that believed to be the result of misuse or abuse of an anatomically and neurologically intact larynx. MTD is usually seen in young to middle aged population who use his/her voice extensively in stressful situations. We had a 56-year-old female patient who underwent total thyroidectomy surgery and developed bilateral vocal fold paresis after the surgery. She had immediate tracheotomy and followed with tracheotomy tube for years. In our clinic examination, we found hyperadduction of the vocal folds and minimum activity and performed Botox® (Allergen, Irvine, California, USA) injection to the thyroarytenoid muscles. After 1 week, she decannulated. MTD is a rare and special disease. The disease can be primary without any organic pathology or secondary to a glottic closure problem. First treatment option must be speech therapy, but in resistant cases, surgery or Botox® (Allergen, Irvine, CA, USA) is suggested. [ABSTRACT FROM AUTHOR]