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Objective: Considering the impact of dysphonia on public health and the increasing attention to patient-centred care, we evaluated sex-related differences in the prevalence of benign voice disorders, awareness of dysphonia and voice therapy (VT) results. Methods: One hundred and seventy-one patients, 129 females and 42 males, with functional or organic benign dysphonia underwent Voice Handicap Index (VHI), auditory-perceptual dysphonia severity scoring (GRBAS) and acoustic analysis (Jitter%, Shimmer%, NHR) before and after VT. Results: Prevalence of each voice disorder was significantly higher among females. Mean time-to-diagnosis (time elapsed until medical consultation) was not different between males and females. The refusal of therapy and VT adherence (mean number of absences and premature dropout) were similar in the two groups. Pre-VT VHI and "G" parameter were worse in women. The percentage of women with abnormal acoustic analysis was significantly higher. Post-VT VHI gain was higher in women, whereas "G" parameter improvement did not differ by sex. Conclusions: Our study showed a higher prevalence of voice disorders in females. Awareness of dysphonia was not gender related. Females started with worse voice subjective perception and acoustic analysis, but they perceived greater improvement after therapy.

The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.

Syfte: Studiens syfte var att kartlägga läkningsprocessen för stämveckspolyper efter invasiv eller icke-invasiv behandling. Metod: Pågående röstbesvär hos patienter (n=28) som tidigare hade haft stämveckspolyp bedömdes genom självskattningsformuläret voice handicap index 11 (VHI-11). För kompletterande bakgrundsinformation gällande samtliga patienter hämtades information från deras journaler och självskattningsformulär. Analys av patienternas larynxstatus gjordes också. Resultat: Polypens storlek hade en påverkan på utfallet där de mindre polyperna hade större sannolikhet att spontanläka än de större. Röstbesvären var större hos patienter vars stämveckspolyper spontanläkt än hos patienter som genomgått kirurgi. Hos patienter som fick en kombination av röstterapi och operation såg man mer betydande förbättringar i patienternas röster. Slutsatser: Studien visar att polyper som inte kräver operation har en läkningspotential. Patienter som får en kombination av operation och logopedbehandling pre- och postoperativt får bättre röster. Logopeder har en viktig roll inom denna patientgrupp och kan göra stora insatser för patienterna. Studien har även visat att polypstorleken har en påverkan när det kommer till behandlingsval.

The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI.Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.

Purpose To compare the prevalence and severity of depression and anxiety among patients with vocal fold (VF) nodules, polyps and edema. At the same time the aim was to analyse association between severity of distress and the level of vocal handicap as well as to identify other factors related to severity of depression and anxiety in these patients. Methods To all participants were given five questionnaires: (1) questionnaire on socio-demographic and some other characteristics of patient; (2) Beck's Depression Inventory (BDI); (3) State-Trait Anxiety Inventory (STAI) 1 (State Anxiety); (4) STAI 2 (Trait Anxiety); and (5) Voice Handicap Index (VHI)-10. Results A total of 205 patients were included in this study. Mild-to-severe depression, according to BDI was present in 79 (38.6%) patients. Mild-to-severe state anxiety and trait anxiety were present in 199 (97.1%) and 200 (97.6%) patients, respectively. Only 10 patients had VHI-10 score lt = 11. Multivariate analyses showed that there were no significant differences in the level of depression and anxiety between patients with VF nodules, polyps and edema. The VHI-10 score was significantly higher in patients with VF edema in comparison with VF nodule patients (p = 0.001), as well as in comparison with VF polyp patients (p = 0.001). Conclusion The present study identified a high prevalence of psychological and vocal distress among patients with vocal disorders. Severity of depression and anxiety did not differ between patients with VF nodules, polyps and edema, and it was not related to the level of vocal handicap.

Background and Objectives The Voice Handicap Index (VHI) is a widely recognized, self-administered questionnaire, designed to evaluate patients' perception of voice-related disability. It takes into consideration the physical, functional and emotional impacts of dysphonia. The VHI has been translated and validated in many languages, including European French. The purpose of our study is to translate, adapt and validate a new version of the VHI in Quebec French. Methods The original VHI was translated into Quebec French (QF) by forward and backward translations by four professional translators, including a speech-language pathologist. The content validity of the resulting VHI-QF was examined in focus groups with six patients and seven speech-language pathologists. Another sample of 154 patients with voice disorders and 150 healthy controls allowed evaluation of the new questionnaire's convergent and discriminant validity, and internal consistency. Satisfaction toward the questionnaire was also evaluated for all patients, as well Test-retest reliability and responsiveness for a sub-sample. Results The VHI-QF showed a moderate correlation with dysphonia severity level, indicating adequate convergent validity. Both total and subscale scores also exhibited adequate ability to discriminate between patients and controls (discriminant validity), high internal consistency, and good test-retest reliability. The analysis of pre- and post-treatment VHI-QF scores revealed adequate responsiveness to voice treatment. Patients were overall satisfied with the questionnaire. Conclusion The VHI-QF is a valid, reliable and clinically useful self-reported tool to evaluate the severity and change of voice disorders in Quebec French population. Therefore this questionnaire can be used in clinical and research contexts.

Purpose To compare the prevalence and severity of depression and anxiety among patients with vocal fold (VF) nodules, polyps and edema. At the same time the aim was to analyse association between severity of distress and the level of vocal handicap as well as to identify other factors related to severity of depression and anxiety in these patients. Methods To all participants were given five questionnaires: (1) questionnaire on socio-demographic and some other characteristics of patient; (2) Beck's Depression Inventory (BDI); (3) State-Trait Anxiety Inventory (STAI) 1 (State Anxiety); (4) STAI 2 (Trait Anxiety); and (5) Voice Handicap Index (VHI)-10. Results A total of 205 patients were included in this study. Mild-to-severe depression, according to BDI was present in 79 (38.6%) patients. Mild-to-severe state anxiety and trait anxiety were present in 199 (97.1%) and 200 (97.6%) patients, respectively. Only 10 patients had VHI-10 score lt = 11. Multivariate analyses showed that there were no significant differences in the level of depression and anxiety between patients with VF nodules, polyps and edema. The VHI-10 score was significantly higher in patients with VF edema in comparison with VF nodule patients (p = 0.001), as well as in comparison with VF polyp patients (p = 0.001). Conclusion The present study identified a high prevalence of psychological and vocal distress among patients with vocal disorders. Severity of depression and anxiety did not differ between patients with VF nodules, polyps and edema, and it was not related to the level of vocal handicap.

Background and Objectives: The Voice Handicap Index (VHI) is a widely recognized, selfadministered questionnaire, designed to evaluate patients’ perception of voice-related disability. It takes into consideration the physical, functional and emotional impacts of dysphonia. The VHI has been translated and validated in many languages, including European French. The purpose of our study is to translate, adapt and validate a new version of the VHI in Quebec French. Methods: The original VHI was translated into Quebec French (QF) by forward and backward translations by four professional translators, including a speech-language pathologist. The content validity of the resulting VHI-QF was examined in focus groups with six patients and seven speech-language pathologists. Another sample of 154 patients with voice disorders and 150 healthy controls allowed evaluation of the new questionnaire’s convergent and discriminant validity, and internal consistency. Satisfaction toward the questionnaire was also evaluated for all patients, as well Test-retest reliability and responsiveness for a sub-sample. Results: The VHI-QF showed a moderate correlation with dysphonia severity level, indicating adequate convergent validity. Both total and subscale scores also exhibited adequate ability to discriminate between patients and controls (discriminant validity), high internal consistency, and good test-retest reliability. The analysis of pre- and post-treatment VHI-QF scores revealed adequate responsiveness to voice treatment. Patients were overall satisfied with the questionnaire. Conclusion: The VHI-QF is a valid, reliable and clinically useful self-reported tool to evaluate the severity and change of voice disorders in Quebec French population. Therefore this questionnaire can be used in clinical and research contexts.

OBJECTIVE: The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective. DESIGN: The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long-term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed. SETTING: Multicentric study involving three tertiary European voice centres. PARTICIPANTS: Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study. MAIN OUTCOME MEASURES: The Voice Handicap Index-30 score. RESULTS & CONCLUSIONS: The median VHI was significantly different over time-points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.

Práce je věnována hodnocení hlasových obtíží u pacientů, kteří byli léčeni pro maligní onemocnění hrtanu. Je rozdělená na dvě hlavní části teoretickou a výzkumnou. V teoretické části jsou informace o samotném onemocnění hrtanu. Jsou zde popsány symptomy, terapie, ale i nezastupitelná role sestry v ošetřovatelské péči a prognóza pacientů, potýkajících se s malignitou hrtanu. Část práce je stručně zaměřena na kvalitu života a reedukaci hlasu. Kapitola o kvalitě hlasu se věnuje dotazníku Voice Handicap Index (VHI). Druhá, výzkumná část práce se zabývá subjektivním hodnocením hlasových obtíží. Pro sběr dat byl použit standardizovaný dotazník VHI a dotazník všeobecných identifikačních údajů. Na základě získaných údajů jsou zhodnoceny hlasové obtíže respondentů., The work is devoted to the evaluation of voice symptoms in patients who have been treated for malignant diseases of the larynx. It is divided into two main parts - theoretical and practical. The theoretical part about the disease itself larynx. Here they are described symptoms, therapy, but also irreplaceable role of nurses in nursing care and prognosis of patients suffering from laryngeal malignancy. Part of the work is briefly focused on the quality of life and reeducation voice. The chapter on voice quality dedicated questionnaire Voice Handicap Index (VHI). The second part, the research work deals with the subjective assessment of voice disorders. For data collection was used a standardized questionnaire VHI questionnaire and general identification data. Based on the data obtained are evaluated vocal difficulties respondents., Fakulta zdravotnických studií, Dokončená práce s úspěšnou obhajobou

Voice rehabilitation after transoral laser microsurgery to the larynx is challenging. We wait at least 6 months before surgical intervention. Only a few patients after total or extended cordectomy requested voice restoration. Subjective perception of voice using the Voice Handicap Index in medialization thyroplasty was significantly better. Medialization thyroplasty with elevation of the fibrous tissue from the inner surface of the thyroid cartilage is critical in achieving success. We preferred the Montgomery Thyroplasty Implant System. Transoral larynx anterior commissure stent placement after laser-assisted sectioning of anterior synechiae with application of mitomycin C is an effective procedure for anterior synechiae.

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten. Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelatio, Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems. Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems. Results There was a significant decrease of VHI points for the whole group after

Enligt Hälso- och sjukvårdslagens ska behandling systematiskt utvecklas och säkras (HSL, SFS 1982:763). Logopedisk röstbehandling är inte ett undantag. I ett samverkansprojekt mellan Linköpings Universitet och sydöstra sjukvårdsregionen deltog sex logopedmottagningar genom att låta patienter som erhöll röstbehandling att fylla i självskattningsformuläret Rösthandikappindex, RHI, vid behandlingsstart och behandlingsslut. Projektets mål var att fungera som en utgångspunkt för framtida, systematiska förbättringsarbeten beträffande röstbehandling. Denna studie har ett tvådelat syfte. Den ämnar undersöka om summan av deltagarnas RHI-skattningar förändrades efter genomgången röstbehandling och huruvida ålder, röstkrav inom yrket samt antalet behandlingstillfällen påverkade resultatet av skattningarna. Syftet med studien är också att, med hjälp av en enkät, undersöka yrkesverksamma logopeders inställning till RHI som verktyg för bedömning av röstproblematik och utvärdering av röstbehandling. Patientdata inkluderar resultaten från 350 patienters självskattningar. Enkätmaterialet innehåller svaren från 23 respondenter. Wilcoxon teckenrangtest visar en signifikant skillnad i RHI-poäng före (Md = 42) och efter (Md = 23) behandling med en genomsnittlig minskning av 19 medianpoäng i RHI-indexet med en observerat stor effektstyrka (.55). Den observerade differensen, både totalt och inom varje enskilt delområde, överstiger tidigare föreslagna gränsvärden för behandlingseffekt som angavs vid utvecklandet att VHI och RHI. Analyser av materialet visar att den vanligaste förekommande röstpatienten är en kvinna i 50-årsåldern med dysfoni. Förekomsten av olika diagnoser varierade stort mellan de deltagande regionerna. Hög ålder hos patienten påverkade medianvärdet på RHI vid behandlingsstart och behandlingsslut, men inte den observerade skillnaden mellan de två skattningarna. Beroende på vilken mottagning som tillhandahöll behandlingen observerades signifikanta skillnader i hur många be, In accordance to the Swedish law of Health- and medical treatments, every intervention should systematically evolve and be improved in terms of safety (HSL, SFS 1982:763). Voice therapy is no exception. Six voice clinics participated in a collaborative project between Linköping University and the south-east hospital region by letting every patient receiving voice therapy complete the Swedish version of the Voice Handicap Index, RHI, at the beginning and end of their treatment. This study has a two-parted aim. The first aim of this study was to examine whether the sum of the participants’ scores on RHI changed after completed therapy and if gender, age, vocal strain within the occupation or the number of therapy sessions had an effect on their score. The second aim of the study was to construct a survey to analyze working speech-language pathologist’s views on RHI as a tool for evaluating voice problems and voice therapy. The material from the survey consisted of the answers from 23 respondents. The patient data includes the results from 350 patients’ scores. Analysis of the data reveals that the typical voice patient is a woman in her fifties with the diagnosis dysphonia. The prevalence of certain diagnoses varies greatly between the participating voice clinics. Wilcoxon sign rank test points to a significant difference in RHI-scores before (MD = 42) and after (MD = 23) therapy with an average decrease of 19 median points in the RHI-index with a substantial observed effect size (.55). The observed difference surpasses the previously suggested threshold limit for clear intervention effect during the development of VHI and RHI. Age had a significant effect on the median score of RHI at the start and end of therapy, but the observed difference between the two measurements were not affected. Differences could be observed between the voice clinics regarding the average number of therapeutic appointments, the average length of the therapy and the average difference in RH

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten. Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelatio, Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems. Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems. Results There was a significant decrease of VHI points for the whole group after

Enligt Hälso- och sjukvårdslagens ska behandling systematiskt utvecklas och säkras (HSL, SFS 1982:763). Logopedisk röstbehandling är inte ett undantag. I ett samverkansprojekt mellan Linköpings Universitet och sydöstra sjukvårdsregionen deltog sex logopedmottagningar genom att låta patienter som erhöll röstbehandling att fylla i självskattningsformuläret Rösthandikappindex, RHI, vid behandlingsstart och behandlingsslut. Projektets mål var att fungera som en utgångspunkt för framtida, systematiska förbättringsarbeten beträffande röstbehandling. Denna studie har ett tvådelat syfte. Den ämnar undersöka om summan av deltagarnas RHI-skattningar förändrades efter genomgången röstbehandling och huruvida ålder, röstkrav inom yrket samt antalet behandlingstillfällen påverkade resultatet av skattningarna. Syftet med studien är också att, med hjälp av en enkät, undersöka yrkesverksamma logopeders inställning till RHI som verktyg för bedömning av röstproblematik och utvärdering av röstbehandling. Patientdata inkluderar resultaten från 350 patienters självskattningar. Enkätmaterialet innehåller svaren från 23 respondenter. Wilcoxon teckenrangtest visar en signifikant skillnad i RHI-poäng före (Md = 42) och efter (Md = 23) behandling med en genomsnittlig minskning av 19 medianpoäng i RHI-indexet med en observerat stor effektstyrka (.55). Den observerade differensen, både totalt och inom varje enskilt delområde, överstiger tidigare föreslagna gränsvärden för behandlingseffekt som angavs vid utvecklandet att VHI och RHI. Analyser av materialet visar att den vanligaste förekommande röstpatienten är en kvinna i 50-årsåldern med dysfoni. Förekomsten av olika diagnoser varierade stort mellan de deltagande regionerna. Hög ålder hos patienten påverkade medianvärdet på RHI vid behandlingsstart och behandlingsslut, men inte den observerade skillnaden mellan de två skattningarna. Beroende på vilken mottagning som tillhandahöll behandlingen observerades signifikanta skillnader i hur många be, In accordance to the Swedish law of Health- and medical treatments, every intervention should systematically evolve and be improved in terms of safety (HSL, SFS 1982:763). Voice therapy is no exception. Six voice clinics participated in a collaborative project between Linköping University and the south-east hospital region by letting every patient receiving voice therapy complete the Swedish version of the Voice Handicap Index, RHI, at the beginning and end of their treatment. This study has a two-parted aim. The first aim of this study was to examine whether the sum of the participants’ scores on RHI changed after completed therapy and if gender, age, vocal strain within the occupation or the number of therapy sessions had an effect on their score. The second aim of the study was to construct a survey to analyze working speech-language pathologist’s views on RHI as a tool for evaluating voice problems and voice therapy. The material from the survey consisted of the answers from 23 respondents. The patient data includes the results from 350 patients’ scores. Analysis of the data reveals that the typical voice patient is a woman in her fifties with the diagnosis dysphonia. The prevalence of certain diagnoses varies greatly between the participating voice clinics. Wilcoxon sign rank test points to a significant difference in RHI-scores before (MD = 42) and after (MD = 23) therapy with an average decrease of 19 median points in the RHI-index with a substantial observed effect size (.55). The observed difference surpasses the previously suggested threshold limit for clear intervention effect during the development of VHI and RHI. Age had a significant effect on the median score of RHI at the start and end of therapy, but the observed difference between the two measurements were not affected. Differences could be observed between the voice clinics regarding the average number of therapeutic appointments, the average length of the therapy and the average difference in RH

Anterior glottic webs are most frequently acquired and result in a major vocal handicap. Many treatment modalities have been reported in the literature. None of them achieves perfect morphological or functional results. We present our series treated by an endoscopic technique based on CO 2 laser section of the web, mitomycin application and placement of a temporary silastic stent. We retrospectively reviewed the charts of 18 consecutive patients with anterior webs treated at our university hospital between 2003 and 2010. The endoscopic technique consisted of the section of the web with the CO 2 Acublade system, immediate application of mitomycin C and placement of a silastic stent. No tracheostomy was required. The stent was removed 3 weeks later. Patients had a vocal evaluation pre and postoperatively. It consisted of a video-stroboscopic examination, the global score of the Voice Handicap Index, the global and roughness scores of the perceptive voice evaluation according to Hirano, acoustic and aerodynamic parameters. Eighteen patients were included in the study with a mean age of 46 years (min. = 5, max. = 76). Twenty-two percent were women. All patients had postoperative speech therapy. The mean follow-up is 48.4 months (3-87 months). At the last follow-up, none of the patients had recurrence of the laryngeal web. The grade G of dysphonia signiWcantly decreased from 2 to 1 (p = 0.035). CO 2 laser resection of anterior webs with mitomycin C application and placement of a silastic stent for 3 weeks induces a good morphological result with absence of web reformation but without substantial voice improvement observed in our series. © Springer-Verlag 2012.

Anterior glottic webs are most frequently acquired and result in a major vocal handicap. Many treatment modalities have been reported in the literature. None of them achieves perfect morphological or functional results. We present our series treated by an endoscopic technique based on CO 2 laser section of the web, mitomycin application and placement of a temporary silastic stent. We retrospectively reviewed the charts of 18 consecutive patients with anterior webs treated at our university hospital between 2003 and 2010. The endoscopic technique consisted of the section of the web with the CO 2 Acublade system, immediate application of mitomycin C and placement of a silastic stent. No tracheostomy was required. The stent was removed 3 weeks later. Patients had a vocal evaluation pre and postoperatively. It consisted of a video-stroboscopic examination, the global score of the Voice Handicap Index, the global and roughness scores of the perceptive voice evaluation according to Hirano, acoustic and aerodynamic parameters. Eighteen patients were included in the study with a mean age of 46 years (min. = 5, max. = 76). Twenty-two percent were women. All patients had postoperative speech therapy. The mean follow-up is 48.4 months (3-87 months). At the last follow-up, none of the patients had recurrence of the laryngeal web. The grade G of dysphonia signiWcantly decreased from 2 to 1 (p = 0.035). CO 2 laser resection of anterior webs with mitomycin C application and placement of a silastic stent for 3 weeks induces a good morphological result with absence of web reformation but without substantial voice improvement observed in our series. © Springer-Verlag 2012.

Objective: The recent Belgian adaptation for singers of the Voice Handicap Index (VHI) was translated and readapted in Swedish. This study’s aim was to evaluate the validity and reliability of a Swedish version. Method: In a parallel group design, 96 healthy singers and 30 singer patients with various diagnoses completed a Swedish version of the singer adapted VHI. A prospective evaluation of the Swedish voice health status instrument was carried out. In average, delays between test-retest were between 14 to 16 days. Validity and reliability as well as the internal coherence and group differences were assessed. Results: The singer-patient group scored significantly higher than the control group. Reliability was confirmed by high Cronbach’s alpha (>.78) for test-retest scores as well as each subscales. In particular, test-retest stability in both groups was confirmed by high values for Cronbach’s alpha (>.8). For both the control and patient groups, test and retest scores compared closely to previously reports with respect to overall scores. Retest results were slightly lower than initial test scores. Conclusions: The Swedish translation of the adapted VHI for singers (RHI-s) is valid and reliable and shows sensitivity to the singer's concerns. It can be considered a useful tool in the clinical assessment of Swedish healthy or pathological singers., QC 20100726

This study evaluates a Swedish version of the Voice Handicap Index adapted for singers. A total of 96 healthy singers and 30 singer-patients completed the questionnaire. Validity and reliability, internal coherence, and group differences were assessed. The singer- patient group had significantly higher scores than the control group. Reliability was confirmed by high Cronbach's (> 0.78) for test-retest scores, and for each of the sub-scales. Test-retest stability in both groups was confirmed by high correlation values alpha (> 0.8). Overall scores compared closely to those from previous reports. The Swedish translation of the adapted VHI for singers (RHI-s) is valid and reliable and shows sensitivity to the singer's concerns. It can be considered a useful tool in the clinical assessment of Swedish healthy or pathological singers., authorCount :4

Diplomová práce pojednává o kvalitě hlasu u pacientů, kteří prodělali chirurgickou či onkologickou terapii pro karcinom hrtanu. Je rozdělena do dvou hlavních částí - teoretické a výzkumné. První, teoretická část, pojednává o samotném onemocnění, jsou zde popsány nejen symptomy, diagnostika a terapie, ale i historie onemocnění a hlasové změny před i po léčbě s kvalitou hlasu. Druhá je výzkumná. Pomocí dotazníkového šetření byla zjišťována kvalita hlasu a na základě získaných údajů pak zhodnoceny nejčastější problémy, se kterými se pacienti po operaci, anebo po aktinoterapii, musí potýkat, a které jejich celkovou kvalitu hlasu ovlivňují v negativním slova smyslu. Zkoumaný vzorek tvoří ženy i muži dospělého věku, kteří byli léčeni v Krajské pardubické nemocnici a.s., Diploma thesis deals with the quality of the voice at the patients after surgery or oncology therapy. It's divided into two parts - a theoretical part and a practical part. The first, theoretical part, contains description of carcinoma of the larynx with symptoms, diagnostic procedures, therapy and the history of disease and voice changes before and after the therapy with the quality of the voice. The second part is experimental. The quality of voice at the patients with carcinoma of the larynx was uncovered through the question blank. The data were evaluated and the results are described in the second part of the diploma thesis. Physical effort was researched on men and women hospitalizated in the hospital of Pardubice., Katedra ošetřovatelství, Hodnocení vedoucího: výborně mínus Hodnocení oponenta: výborně mínus Doplňující otázky k obhajobě: Myslíte si, že samotné provedení testu VHI by mohlo být dostačující k vyloučení hlasové poruchy? Myslíte si, že v léčbě malignit hrtanu má své místo psychoterapie? Obhajoba diplomové práce s prezentací velmi dobrá., Dokončená práce s úspěšnou obhajobou

A commercial phonetograph was complemented with a response button, such that presses resulted in marked regions in the voice range profile (VRP). This study reports the VRP data of 16 healthy female professionally trained singers (7 mezzosopranos and 9 sopranos). Subjects pressed the button to indicate sensations of vocal instability or reduced control during phonation. Each press thereby marked potential areas of difficulty. A method is presented to quantify the consistency of button use for repeated tasks. The pattern of button presses was significantly consistent within subjects. As expected, the singers pressed at the extremes of VRP contours as well as at register transitions. These results and the potential of the method for the assessment of vocal problems of singers are discussed., QC 20150623

The voice is arguable still the most important tool of communication despite the growing importance of e-mails and text messaging (SMS) in daily contact. Indeed in modern society people are probably even more dependent on their voice than in the rural societies of old. Approximately one third of the working population nowadays need their voice to earn money1. And it goes without saying that most people need their voice for daily social activities. Any impairment of the voice therefore will have large impact both on daily work and social activities for many people. Diagnosis and treatment of voice disorders is by that of great importance. The voice has a variety of characteristics and so have any of its disorders. The complaints of the patient are the starting point in any diagnosis. These complaints usually consist of ‘my voice is hoarse’. They may also concern the consequences of professional activities, like a teacher whose voice does not reach the back of the classroom, especially in a noisy one. The sound of the voice may have changed and, finally, we have to pay attention to the cause of the problems, the aetiology of the voice disorder. All these aspects need to be assessed in a description of any voice disorder. The complaints of the patient may be collected with a self-evaluation form by the patient him/herself. The character of the sound of the voice (voice quality) can be assessed subjectively with the listening ear of the diagnostician and objectively by instruments. The aetiology is determined by the thorough history taking and physical examination. The form and function of the larynx is examined with, for example, (video)laryngostroboscopy. The outcome of these examinations together leads to a diagnosis, which is the basis for decisions about any modality of treatment including intervention like surgical procedures, voice therapy, medication or any combination of these. The results of these interventions need to be evaluated.

The present study is the outcome of 5 former studies aiming at adapting the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singers, dysodic or not. The reliability, validity and internal coherence were evaluated on a population of 192 classical singers and 27 non singers. The comparison of the mean scores at the test and the retest shows that the results at the retest are significantly inferior in both the functional scale (p= 0.013) and the global score (p= 0.006). The test/re-test stability is good (ICC: Functional scale (F): 0.869, Emotional scale (E): 0.846, Physical scale (P): 0.85, Global score (G): 0.878/ Spearman's rho F: 0.855, E: 0.834, P: 0.858, G: 0.886). The internal coherence of each sub scale is good (Cronbach's alpha: > 0.80). The correlation between the 3 subscales is quite high (FvsE: 0,613 /EvsP: 0,737/ FvsP: 0,693) which means that each scale measures a specific dimension but that they are still homogeneous. The test/re-test difference between the singers and the controls are not significant but the control group has a greater variability in their answers (Levene test: F: p<0.001; P: p= 0.009; G: p= 0.02). Three variables increase the results: being a solist (F: p= 0.046; E: p= 0.002; P: p= 0.056; G: p= 0.006), being an amateur (F: p< 0.001; E: p= 0.019; P: p< 0.001; G: p= 0.001), having a vocal complaint (F, E, P et G: p< 0.001). This version of the V.H.I. is reliable, valid and adapted to the population of classical singers.

Objective: The present study is the outcome of 5 former studies aiming at adapting the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singers, dysodic or not. Material and methods: The reliability, validity and internal coherence were evaluated on a population of 192 classical singers and 27 non singers. Results: The comparison of the mean scores at the test and the retest shows that the results at the retest are significantly inferior in both the functional scale (p= 0.013) and the global score (p= 0.006). The test/re-test stability is good (ICC: Functional scale (F): 0.869, Emotional scale (E): 0.846, Physical scale (P): 0.85, Global score (G): 0.878/ Spearman's rho F: 0.855, E: 0.834, P: 0.858, G: 0.886). The internal coherence of each sub scale is good (Cronbach's alpha: > 0.80). The correlation between the 3 subscales is quite high (FvsE: 0,613 /EvsP: 0,737/ FvsP: 0,693) which means that each scale measures a specific dimension but that they are still homogeneous. The test/re-test difference between the singers and the controls are not significant but the control group has a greater variability in their answers (Levene test: F: p<0.001; P: p= 0.009; G: p= 0.02). Three variables increase the results: being a solist (F: p= 0.046; E: p= 0.002; P: p= 0.056; G: p= 0.006), being an amateur (F: p< 0.001; E: p= 0.019; P: p< 0.001; G: p= 0.001), having a vocal complaint (F, E, P et G: p< 0.001). Conclusion: This version of the V.H.I. is reliable, valid and adapted to the population of classical singers., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's reliability and coherence. In order to obtain this first scale, we went through three stages. Material et method: The first consisted in the modification of the existing items and the creation of new ones. The second was to measure the stability by a test - retest and the coherence of the adapted and the new items. This was done on groups of dysodic singers and professional voice users. The third stage consisted in evaluating the reliability and the coherence of 31 items on a homogeneous population of 132 classical singers with and without vocal impairment. The subjects were divided in three groups. The first group was composed of 95 normophonic singers, the second included 37 dysphonic singers and the third group was the control group, composed of 20 non singers without vocal complaints. Results: The statistical results show a good stability of the test - retest (ICC=0.949; Rho: 0.912; Bland et Altman [-010.19, +13.23]). The internal coherence of each sub scale (Cronbach's alpha) is good (>0.70). The correlations between the three sub scales are moderate between the functional and the emotional sub scale: 0.58; between the emotional and the physical: 0.64; and between the functional and the physical: 0.78). Each sub scale is measuring a specific dimension; still they are homogeneous between one another. Four variables have a significative influence on the results: the pathology (p<0.001), being a professional singer (p<0.001), the repetition (p = 0.003), being a chorister (p = 0.002). Conclusion: The V.H.I, adapted to the singers, appears to be reliable, valid and adapted to the population of dysodic classical singers., SCOPUS: cp.j, info:eu-repo/semantics/published