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Ziel der vorliegenden Bachelorarbeit „Körpertherapeutisch orientierte Verfahren in der funktionellen Stimmtherapie und ihre Wirkfaktoren“ ist die Bearbeitung der Wirkfaktoren der Methoden Qi Gong, Feldenkrais-Methode, Yoga und Progressive Muskelentspannung sowie deren Einsatz in der logopädischen Stimmtherapie. Durch eine systematische Literaturrecherche in den Datenbanken PubMed, Academic Search Elite und Springer Link konnten elf geeignete Studien untersucht werden, die die genannten Methoden und ihre Effektivität anhand der in dieser Arbeit definierten Therapieprinzipien beleuchteten. Es wurden in den Studien vor allem die Aspekte „Bewegung/Haltung“, „Atmung“ und „Tonus“ bearbeitet. Dabei konnte festgestellt werden, dass die körpertherapeutisch orientierten Methoden eine positive Wirkung auf die Regulierung des gesamten Körpers zeigen. Sowohl subjektive als auch objektive Messungen zur Verbesserung der Wahrnehmungen konnten analysiert werden. Hinsichtlich der Aspekte „Sprechen/Artikulation“ und „Stimme/Phonation“ konnten ebenfalls begünstigende Faktoren ermittelt werden. Zusammenfassend haben körpertherapeutisch orientierte Verfahren einen positiven Einfluss auf die Therapie von funktionellen Dysphonien. Eine ergänzende Anwendung dieser wird weiterhin empfohlen, da es hinsichtlich dieser Methoden im stimmtherapeutischen Kontext noch an Forschungsarbeiten mangelt. The aim of this bachelor thesis "body- and movementbased methods in functional voice therapy and their factors of effectiveness " is to work on the effectiveness factors of the methods Qi Gong, Feldenkrais Method, Yoga and Progressive Muscle Relaxation and their use in voice therapy. Through a systematic literature search in the databases PubMed, Academic Search Elite and Springer Link, eleven suitable studies were examined, which illuminated the methods previously described and their effectiveness of the therapeutic principles defined in this thesis. The studies focused on the aspects of "movement/ posture", "breathing" and "tone". It is obvious that the body- and movementbased methods show a positive effect on the regulation of the whole body. Both, subjective and objective, measurements of perceptual improvement could be gained. With regard to the aspects "speech/ articulation" and "voice/ phonation", favourable factors could also be identified. As already mentioned earlier, body- and movementbased methods have a positive influence on the therapy of functional dysphonia. A complementary application of these treatments are still recommended, since there is still a lack of research regarding these methods in the context of voice therapy.

Resumen Introducción: El docente es un profesional que presenta riesgo para el desarrollo de patologías vocales consideradas enfermedades laborales. En Viña del Mar, el Instituto de seguridad del trabajo (IST) es un centro de referencia para las atenciones médicas de enfermedades laborales. El objetivo del estudio consiste en establecer la incidencia y prevalencia de profesores de Viña del Mar, Chile, que concurrieron al IST con quejas vocales entre 2012 y 2017. Metodología: Se adoptó un enfoque cuantitativo, retrospectivo, descriptivo, correlacional y de diseño no experimental. La muestra estuvo conformada por 186 profesores que presentaron quejas vocales relacionadas con su desempeño laboral. Resultados: 167 docentes mujeres y 19 docentes hombres consultaron por problemas vocales; 64.5% docentes de la muestra realizan clases en educación básica. Ningún docente universitario accedió al IST con este tipo de queja. El diagnóstico más recurrente fue de disfonías orgánico-funcionales (75,8%), de las cuales 69,5% fueron dirigidas a terapia vocal en el IST. 14,1% de los docentes fueron diagnosticados con disfonía funcional (también fueron enviados a terapia); sin embargo, 9,4% de los casos, al no cumplir con las características de origen exclusivamente laboral, no recibieron terapia fonoaudiológica en el IST. Conclusión: El docente chileno en la V Región presenta un bajo nivel de consulta por patologías vocales. Los docentes de educación básica son los que más buscan terapia profesional para su voz y la mayor cantidad de afecciones se relacionan con un deficiente conocimiento de técnicas y/o hábitos vocales inadecuados. Es necesaria una inversión mayor en promoción y prevención vocal para este grupo profesional. Abstract Introduction: Being a teacher presents a risk for the development of vocal pathologies, considered occupational diseases. In Viña del Mar, the Work Safety Institute (known by the acronym IST) is a reference center for medical care for occupational diseases. The objective of this study is to establish the incidence and prevalence of teachers from Viña del Mar, Chile, who attended the IST with vocal complaints between 2012 and 2017. Methods: A quantitative, retrospective, descriptive, correlational and non-experimental design approach was adopted. The sample was made up of 186 teachers who presented vocal complaints related to their job performance. Results: 167 female and 19 male teachers consulted with vocal problems; 64.5% teachers of the sample worked in primary school while there were no reports of university professors who accessed the IST with vocal problems. The most recurrent diagnosis was organic-functional dysphonia (75.8%), of which 69.5% was referred to vocal therapy at the IST. 14.1% Of the teachers were diagnosed with functional dysphonia, (and were also sent to vocal therapy). However, 9.4% of the cases did not meet the characteristics of being exclusively work related, for this reason they did not receive vocal therapy at the IST. Conclusion: Chilean teachers from V Region have a low level of consultation for vocal pathologies. Primary school teachers are the ones who seek most professional therapy for their voice and the greatest number of conditions are related to poor knowledge about voice techniques and/or vocal habits. A greater investment in promotion and vocal prevention is necessary for this professional group.

Background: Various voice assessment tools, such as questionnaires and aerodynamic voice characteristics, can be used to assess vocal function of individuals. However, not much is known about the best combinations of these parameters in identification of functional dysphonia in clinical settings. Methods: This study investigated six scores from clinically commonly used questionnaires and seven acoustic parameters. 514 females and 277 males were analyzed. The subjects were divided into three groups: one healthy group (N01) (49 females, 50 males) and two disordered groups with perceptually hoarse (FD23) (220 females, 96 males) and perceptually not hoarse (FD01) (245 females, 131 males) sounding voices. A tree stumps Adaboost approach was applied to find the subset of parameters that best separates the groups. Subsequently, it was determined if this parameter subset reflects treatment outcome for 120 female and 51 male patients by pairwise pre- and post-treatment comparisons of parameters. Results: The questionnaire “Voice-related-quality-of-Life” and three objective parameters (“maximum fundamental frequency”, “maximum Intensity” and “Jitter Percent”) were sufficient to separate the groups (accuracy ranging from 0.690 (FD01 vs. FD23, females) to 0.961 (N01 vs. FD23, females)). Our study suggests that a reduced parameter subset (4 out of 13) is sufficient to separate these three groups. All parameters reflected treatment outcome for patients with hoarse voices, Voice-related-quality-of-Life showed improvement for the not hoarse group (FD01). Conclusion: Results show that single parameters are insufficient to separate voice disorders but a set of several well-chosen parameters is. These findings will help to optimize and reduce clinical assessment time., In this study, we show that only a small set of four parameters is sufficient to differentiate between healthy subjects and patients with diagnosis of functional dysphonia. These four parameters also reflect treatment outcome for functional dysphonia and perceivable hoarse voices (success or failure). Thus, in future a functioning set of objective tools could be created that improves and accelerates assessment and therapy of voice disorders.

ntroduction: The publication describes the characteristics of the glottis in FDs objectified by OQ, measured with VSK and EGG. Aim: The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. Material and Method: The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. Results: All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P < 0.05). Significant differences were found between patients with hypofunctional – 0.584 and hyperfunctional dysphonia – 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P < 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. Conclusions: Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

Summary Objectives The validity and sensitivity to change of instrumental acoustic measurements in patients with functional dysphonia have been controversially discussed. This work examines combined voice therapy effects on standard acoustic measurements, and if these agree with perceptual and subjective voice outcomes. Study design Retrospective study. Methods Thirty-nine patients (26 women, 13 men) aged 20–70 years (mean: 46.3, standard deviation 12.8) with functional dysphonia were investigated before and after combined voice therapy. Instrumental parameters included mean and range of speaking fundamental frequency (fo) and intensity (SPL (dBA)); maximum SPL and mean fo of calling voice; minimum, maximum, range of singing voice fo and SPL, jitter (%), and the Dysphonia Severity Index. Voice Handicap Index-9 international was used for subjective and Grading-Roughness-Breathiness-Asthenia-Strain scale for perceptual assessment. Differences were investigated by Wilcoxon signed ranks test and coherences by Spearman rank correlation coefficient. Results After treatment, the speaking voice fo range (7–8.13 semitones) and SPL range (12.9–14.85 dB(A)) were significantly larger (P 0.05). Conclusions Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger fo and SPL speaking voice range after treatment indicate an altered voice technique. These instrumental measures may be clinical indicators of therapy success and transfer effects.

Introduction: Over the past few years, attention has been paid to the coexistence of dysphonia with dysphagia, in the context of functional disorders. The aim of this work was to objectify logopaedic examination of dysphonic patients with coexisting swallowing difficulties by surface electromyography. Methods: The material of the work included 58 patients with muscle tension dysphonia (MTD). Each patient underwent otolaryngologic, phoniatric and logopaedic examination. We collected information about medical history and asked patients to fill out Reflux Symptom Index (RSI), Eating Assessment Tool (EAT-10), Dysphagia Handicap Index (DHI) and Swallowing Disorder Scale (SDS). The algorithm of dysphagia diagnostics in our clinic assumes parallel surface electromyography (SEMG) during Functional Endoscopic Evaluation of Swallowing. Results: In comparison to patients suffering from atypical swallowing, patients with muscle tension dysphagia (MTDg) obtained higher values from almost all questionnaires. Logopaedic evaluation revealed abnormalities in the structure and efficiency of the articulatory organs and in the assessment of primary functions. Patients with more abnormalities in logopaedic examination had significantly higher infrahyoid muscle activity during swallowing observed in EMG. Patients with non-normative swallowing pattern had significantly greater asymmetry of the average and maximum amplitude of masseters, as well as submental muscles. Patients with higher percent of muscles asymmetry gained higher scores in questionnaires. Conclusions: Surface electromyography objectifies logopaedic examination of patients with swallowing difficulties. The results of this work showed that, apart from longer swallows, patients with MTDg differ from patients with non-normative swallowing patterns in the muscle activity measured by SEMG, abnormalities in logopaedic evaluation and the severity of complaints reported by patients.

In this paper, we present a study on the efficiency of neural networks for the hard problem of automatically classifying voice disorders. To this end, convolutional architectures combined with feed-forward neural networks are used for the classification of four types of voice disorders. Speech signals and data from medical records, collected by the Far Eastern Memorial Hospital (FEMH), involving four speech pathologies, (functional dysphonia, phonotrauma, laryngeal neoplasm and unilateral vocal paralysis), were analyzed and the proposed method participated at the FEMH Voice Data challenge 2019. The respective classification accuracy at the challenge’s testing dataset was 57% and the method ranked fifth with a small performance margin from the leading method.

Diese Arbeit gibt einen Überblick über stimmtherapeutische Manualverfahren und richtet den Fokus auf deren inhaltliche Ziele und Wirkungsweisen. Muskuläre Dysbalancen stehen in enger Verbindung mit der Stimmfunktion. Insbesondere bei funktionellen Dysphonien ist es bedeutend, in einer umfassenden Diagnostik die multifaktorielle Ätiologie zu eruieren und den Patient*innen eine individuelle Stimmtherapie zu ermöglichen. Manuelle Verfahren können hierbei einen ganzheitlichen Ansatz darstellen. Durch spezielle Ausbildungen haben Stimmtherapeut*innen die Möglichkeit, unterschiedliche Techniken der Manualtherapie zu erlernen und im Therapiesetting anzuwenden. Grundlage dieser Literaturarbeit bilden ausgewählte Studien und Fachliteratur, die in den folgenden Kapiteln zusammenfassend dargestellt werden. Darin beschriebene Analysen der manualtherapeutischen Wirkungsweise auf die Stimmfunktion zeigten Besserungen der subjektiven Stimmwahrnehmung bei den Patient*innen. Positive Veränderungen hinsichtlich des Muskeltonus konnten bei palpatorischen Ergebnissen beobachtet werden. Objektive Parameter wurden durch die manuelle Therapie ebenso beeinflusst, zeigten jedoch wenig signifikante Veränderungen. Stimmtherapeutische Ansätze mit manuellen Therapiemethoden zu kombinieren bietet eine vielversprechende Chance in der ganzheitlichen Behandlung von Dysphonien. Weitere Forschung ist notwendig, um fundierte Erkenntnisse für manuelle Interventionen im logopädischen Prozess zu erhalten. The following paper provides an overview of manual therapeutic procedures in the field of voice therapy and addresses their content aspects and efficacy. Muscular imbalance in different body parts is closely connected to the voice function. It is especially of great importance to determine possible causes of functional dysphonia in comprehensive clinical diagnostics in order to enable individually adjusted voice therapy. Manual therapy, therefore, can support a holistic therapeutic approach. Special training programs provide an opportunity for speech and language pathologists to learn about manual therapy methods and apply them in the therapeutic process. Relevant literature and selected studies, which will be closely described in the following chapters, constitute the basis of this paper. Analyses of manual therapeutic effects on the voice function have shown significant improvements of subjective perception of the voice in patients. Palpation results have led to positive outcomes regarding the muscle tone. Objective parameters of the voice function can be influenced through manual therapy, although no significant changes have been observed. Combining voice therapy with manual therapy methods seems to be a promising opportunity for the holistic treatment of functional dysphonia. Additional research is necessary in order to gain profound insights for further logopedic interventions.

Objectives: To confirm the data reported in our previous studies on the analysis of the variability of the electroglottographic signal in the pathological voice; to evaluate possible differences in variability between organic and functional pathologies; to identify any distinctive/typical EGG patterns for these pathologies. Methods: One hundred twenty-five subjects were enrolled (36 euphonic and 89 pathological: 24 functional dysphonia, 21 bilateral vocal nodules, 23 unilateral polyps and 21 unilateral cysts). All subjects were studied with videolaryngostroboscopy, spectrographic analysis of voice and electroglottography (EGG). The EGG signal variability was then investigated using amplitude-speed combined analysis, by means of a proprietary software algorithm. Amplitude and Speed variation were expressed as a new parameter, the Variability Index (VI), calculated both for the whole EGG signal recorded (VI-tot) and in each phase of the glottic cycle (VI-Q, absolute value; VI-Q%, percentage value). Results: In the comparison of VI values between pathological and normal groups, VI-tot and VI-Q2% (which corresponds to the final phase of vocal fold contact) were significantly greater in pathological subjects (P= 0.002). The comparison of VI values among subgroups of the various pathologies showed a difference for VI-tot (P< 0.0001) and VI-Q2% (P= 0.001); this difference was more marked in the cysts than in the functional dysphonia. The cut-off values of VI-tot and VI-Q2% were 0.191 and 18.17%, respectively (sensitivity and specificity 65.2% and 66.7% for VI-tot and 84.3% and 77.8% for VI-Q2%). Conclusions: The variability of the EGG signal investigated through the combined analysis of the amplitude and the speed of vibration using a proprietary algorithm software has proved useful not only to distinguish the normal voice from the pathological voice, but also to characterize which phases are more altered in the various voice pathologies studied, both functional and organic. Furthermore, the analysis of the VI parameter allowed to propose cut-off values characterized by a good sensitivity and specificity to discriminate dysphonia from the euphonic voice. Larger groups of patients will be needed to confirm these results.

La disfonía por tensión muscular es uno de los diagnósticos comunes en la clínica de voz y el fonoaudiólogo o vocólogo es parte fundamental del equipo multidisciplinar encargado de su manejo. El propósito de este artículo es realizar una descripción de la disfonía por tensión muscular dentro del espectro de las denominadas disfonías funcionales. En la primera parte se presentan las diversas denominaciones, clasificaciones y características de las disfonías por tensión muscular que pueden servir como guía para el terapeuta en el proceso de evaluación e intervención terapéutica de las personas con alteraciones vocales por tensión muscular. En la segunda parte se presenta un caso para el cual se describe la intervención terapéutica realizada analizando los factores asociados, se discuten los resultados y la eficacia del tratamiento. La terapia basada en la coordinación y balance de los sistemas fisiológicos vocales puede ser una herramienta efectiva en la resolución de casos de disfonía por tensión muscular

Diagnosis and treatment of diseases of the larynx in patients with dysphonia are an urgent task of modern otorhinolaryngology. The reason for this is the constant growth of professions with high requirements for voice quality. The modern methods of diagnosis in diseases of the larynx are based on endoscopic diagnostic techniques. The article provides detailed description of the clinical and endoscopic signs of functional and organic diseases of the larynx that are significantly more prevalent in voice professionals: hypotonic and hypo-hypertonic functional dysphonia, soft and hard vocal fold nodules, acute and chronic occupational laryngitis, and vascular pathology of vocal cords. The article presents the main approaches to the treatment of diseases of the larynx, including using the drug Homeovox. The article will be useful to the otorhinolaryngologists of the outpatient network to establish the diagnosis and assign а therapy to the voice and speech professionals.

Objective To update our knowledge regarding the effectiveness of voice therapy for the treatment of vocal disturbance associated with benign vocal fold lesions, including vocal polyps, nodules and cysts, and for determining the utility of voice therapy in treating organic voice disorders, while highlighting problems for the future development of this clinical field. Methods We conducted a review of the most recent literature on the therapeutic effects of voice therapy, vocal hygiene education or direct vocal training on vocal quality, the lesion appearance and discomfort felt by patients due to the clinical entity of benign vocal fold mass lesions. Results Although voice therapy is principally indicated for the treatment of functional dysphonia without any organic abnormalities in the vocal folds, a number of clinicians have attempted to perform voice therapy even in dysphonic patients with benign mass lesions in the vocal folds. The two major possible reasons for the effectiveness of voice therapy on vocal disturbance associated with benign vocal fold lesions are hypothesized to be the regression of lesions and the correction of excessive/inappropriate muscle contraction of the phonatory organs. According to the current literature, a substantial proportion of vocal polyps certainly tend to shrink after voice therapy, but whether or not the regression results from voice therapy, vocal hygiene education or a natural cure is unclear at present due to the lack of controlled studies comparing two groups with and without interventions. Regarding vocal nodules, no studies have investigated the effectiveness of voice therapy using proper experimental methodology. Vocal cysts are difficult to cure by voice therapy without surgical excision according to previous studies. Evidences remains insufficient to support the use of voice therapy against benign vocal fold lesions. Conclusion Evidences at present is therefore still insufficient to support the use of voice therapy for the treatment of benign vocal fold lesions.

Introduction Electroglottography (EGG) is the most commonly used method of indirect visual examination of vocal fold vibration. Aim The study was conducted with an aim of assessing EGG quasi open quotient (QOQEGG) in different functional dysphonias to develop a differential diagnosis. The second aim was to check the influence of articulation on QOQEGG values. Material and methods There were 20 people without voice problems, 20 patients with hypofunctional dysphonia and 20 patients with hyperfunctional dysphonia included in the study. Electroglottography was recorded during comfortable sustained phonation of [a], [e], [i], [o], [u]. Results There were no statistically significant differences in QOQEGG observed during phonation of different vowels in the control group and patients with hyperfunctional dysphonia. In patients with hypofunctional dysphonia, significantly higher values of QOQEGG were observed during [a] and [e]. Both in the control and in studied groups vowel [i] was vocalized significantly quieter. Conclusions To conclude, EGG can be useful in differential diagnosis of functional dysphonia. QOQEGG is a parameter differentiating hypofunctional dysphonia from hyperfunctional dysphonia. Dissimilarities in articulation of different vowels in patients with various types of dysphonia influence values of QOQEGG. EGG study protocol in cases of functional dysphonia should include a comparison of [a], [e], [i] vowels.

Summary The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.

Summary Objectives Voice therapy with semioccluded vocal tract exercises (SOVTE) has a long history of use in singers and nonsingers with dysphonia. SOVTE with increased vocal tract impedance leads to increased vocal efficiency and economy. Although there is a growing body of research on the physiological impact of SOVTE, and growing clinical sentiment about its therapeutic benefits, empirical data describing its potential efficacy in singers and nonsingers are lacking. The objective of the current study is to evaluate vocal tract function and voice quality in singers and nonsingers with dysphonia after undergoing SOVTE. Methods Patients who were diagnosed with functional dysphonia, vocal fold nodules and age-related atrophy were assessed (n = 8 singers, n = 8 nonsingers). Stroboscopic examination, aerodynamic assessment, acoustic analysis, formant frequency, and self-assessments were evaluated before and after performing SOVTE. Results In the singer group, expiratory lung pressure, jitter, shimmer, and self-assessment significantly improved after SOVTE. In addition, formant frequency (first, second, third, and fourth), and the standard deviation (SD) of the first, second, and third formant frequency significantly improved. In the nonsinger group, expiratory lung pressure, jitter, shimmer, and Voice Handicap Index-10 significantly improved after SOVTE. However, no significant changes were observed in formant frequency. Conclusions These results suggest that SOVTE may improve voice quality in singers and nonsingers with dysphonia, and SOVTE may be more effective at adjusting the vocal tract function in singers with dysphonia compared to nonsingers.

RESUMO: Objetivo: verificar a presença de alterações do sistema estomatognático e sua associação com o sexo, profissão, relato de alergias e diagnóstico fonoaudiológico do tipo de disfonia em indivíduos disfônicos que procuraram atendimento em uma clínica-escola fonoaudiológica. Métodos: estudo quantitativo e retrospectivo, por meio de banco de dados. Amostra de 69 prontuários de sujeitos de ambos os sexos, com idades entre 19 e 44 anos. Coletaram-se dados sobre faixa etária, sexo, profissão, relato de alergias, diagnóstico fonoaudiológico do tipo de disfonia, tipo respiratório e dados da avaliação antroposcópica do sistema estomatognático: oclusão, alterações horizontais e transversais de mordida, largura e profundidade do palato duro, modo respiratório e tensão de lábios, língua e bochechas. Resultados: 28,99% (n=20) eram profissionais da voz; 33,33% (n=23) relataram alergias; tipo respiratório misto com 75,36% (n=52), seguido pelo superior com 20,29% (n=14) e costodiafragmaticoabdominal com 4,35% (n=3); tipo de disfonia funcional (n=42; 66,67%), seguido pelo organofuncional (n=19; 23,54%) e orgânico (n=8; 11,59%). Nas associações de alterações do sistema estomatognático com tipos e modos respiratórios, tipos de disfonia, profissionais da voz e relato de alergias não houve significâncias, apenas do sexo feminino com ausência de alterações verticais de mordida. Conclusão: os pacientes estudados eram predominantemente mulheres; adultos; não profissionais da voz; com disfonia funcional; sem relato de alergias ou alterações de sistema estomatognático; com tipo e modo respiratórios adequados, havendo associação apenas do sexo feminino com ausência de alterações verticais de mordida. ABSTRACT: Purpose: verifying the presence of the stomatognathic system changes and its association with gender, profession, allergies report and speech diagnosing the type of dysphonia in dysphonic individuals who sought care in a speech therapy school clinic. Methods: quantitative and retrospective study, through the database. Sample of 69 subjects records of both genders, aged between 19 and 44 years. Data were collected on age, gender, profession, report of allergies, speech therapy diagnosis of the type of dysphonia, respiratory type and data of anthroposcopic evaluation of the stomatognathic system: occlusion, horizontal and transverse bite changes, width and depth of the hard palate, breathing mode and lips, tongue and cheeks tension. Results: 28.99% (n=20) were voice professional; 33.33% (n=23) reported allergies; mixed respiratory type with 75.36% (n=52), followed by the superior with 20.29% (n=14) and diaphragmatic breathing with 4.35% (n=3); type of functional dysphonia (n=42; 66.67%), followed by organofunctional (n=19; 23.54%) and organic (n=8; 11.59%). There were not significances in the stomatognathic system changes associations with types and breathing techniques, types of dysphonia, voice professional and allergies report, there were only significances in female with no vertical bite changes. Conclusion: studied patients were predominantly women; adults; not voice professionals; with functional dysphonia; no history of allergies or stomatognathic system changes; with proper type and mode breathing, with only female association with no vertical bite changes.

Background There are no reliable outcome predictors for functional dysphonia (FD) patients. Objectives To investigate if any clinical or phoniatric characteristics could identify FD patients at risk of negative outcome after speech therapy. Methods We retrospectively reviewed the results of 78 FD patients treated with the proprioceptive elastic method. Before and one-month after therapy, patients underwent endoscopy, acoustic analysis with Multi-Dimensional Voice Program, and Voice Handicap Index-10 questionnaire (VHI-10). Negative outcome was the persistence of VHI-10 ≥ 13. Results 26 FD patients had negative outcome (i.e. VHI-10 ≥ 13) after speech therapy. At univariate analysis, clinical variables (i.e. sex, age, comorbidities, dysphonia duration, and professional voice use) were not associated with the outcome. Elevated Jitter% (Jitt; p = 0.03), Shimmer% (Shim; statistical trend, p = 0.06), and Noise to Harmonics Ratio (statistical trend, p = 0.06) were found in patients with poor results. At multivariate analysis, higher Jitt was an independent negative prognostic factor (p = 0.02), while a statically trend was identified for Shim (p = 0.06). A panel of Jitt >1.5 and Shim >5.1 showed an acceptable discriminatory power (AUC [ROC] = 0.76) according to Hosmer and Lemeshow scale. Conclusion A panel of two acoustic analysis parameters could help in identifying FD patients at risk of speech therapy failure. Further studies in these patients are needed to evaluate the most efficient treatment protocol.

Confronto dell’indice di variabilità EGG nella voce eufonica e patologica.In un recente lavoro abbiamo presentato un nuovo approccio allo studio del tracciato elettroglottografico; il metodo di studio si basava sulla valutazione della variazione del segnale EGG e della sua derivata prima, mediante un nuovo software ideato dalla scuola foniatrica pisana. Tale software permette di ottenere indici quantitativi relativi alle fasi di contatto e decontatto delle corde vocali durante la fonazione, mediante lo studio della variabilità combinata dell’ampiezza e della velocità di vibrazione (derivata prima del segnale EGG). La voce patologica presenta un segnale EGG più variabile rispetto alla voce normale: la vibrazione cordale è resa irregolare dalla presenza di patologia del piano glottico. Al fine di dimostrare differenze tra voce normale e patologica relative alla variabilità combinata tra ampiezza e velocità di vibrazione, abbiamo introdotto un nuovo parametro quantitativo denominato “variability index, VI”. Abbiamo studiato 95 soggetti (35 normali e 60 con voce patologica); tra i patologici, 15 mostravano disfonia disfunzionale e 45 disfonia organica. I soggetti affetti da disfonia organica presentavano: 15 noduli vocali bilaterali, 15 polipi unilaterali e 15 cisti unilaterali. Tutti i soggetti venivano studiati con videolaringostroboscopia, i parametri elettroacustici della voce venivano analizzati attraverso il sistema KayPENTAX CSL (Model 4500). L’esame EGG veniva effettuato attraverso il KAY Model 6103 collegato al sistema CSL. Il nuovo software di analisi del segnale EGG permette non solo di ottenere un VI totale (VI-total) relativo alla variabilità durante tutta la registrazione, ma anche VI parziali relativi alle varie fasi del ciclo glottico. Applicando la variazione di ampiezza e della derivata prima su un grafico di Lissajous, è possibile dividere l’intero ciclo glottico in 4 fasi (rappresentate da 4 quadranti nel grafico): la fase iniziale di contatto delle corde vocali (VI-Q1), la fase finale di contatto delle corde vocali (VI-Q2), la fase iniziale di de-contatto delle corde vocali (VI-Q3) e la fase finale, fino al completo de-contatto delle corde vocali (VI-Q4). Per ciascun quadrante, inoltre, è possibile calcolare l’indice di variabilità percentuale. Comparando gli indici di variabilità nei gruppi normali e patologici, abbiamo ottenuto i seguenti risultati: il VI totale era significativamente maggiore nel gruppo di soggetti patologici (0,25 vs 0,18; p = 0,01); il valore assoluto di VI in 3 quadranti era maggiore nei patologici anche se non in maniera statisticamente significativa (VI-Q2, 0,041 vs 0,029; VI-Q3, 0,065 vs 0,058; VI-Q4, 0,054 vs 0,052). La variabilità percentuale del quadrante Q2 (VI-Q2%), era significativamente più elevata nei soggetti patologici rispetto ai normali (0,22 vs 0,16) (p = 0,01). I risultati di questo studio hanno confermato che il nostro nuovo software di analisi del tracciato EGG permette di distinguere la voce normale da quella patologica sulla base di un nuovo parametro quantitativo, il VI. Lo studio mette in evidenza come la fase che più caratterizza la differenza tra voce normale e patologica è quella relativa alla fase finale di contatto delle corde vocali, che presenta una maggiore variabilità di ampiezza e velocità di vibrazione. Ulteriori studi, con un numero maggiore di soggetti, saranno necessari per confermare questi risultati e per dimostrare eventuali differenze di variabilità del segnale EGG nelle diverse patologie delle corde vocali.In a recent study we introduced a new approach for analysis of the electroglottographic (ECG) signal. This method is based on the evaluation of variation of the EGG signal and its first derivative, through new software developed by the Pisan phoniatric school. This software is designed to extract quantitative indices related to the contacting and decontacting phases of the vocal folds during phonation. The software allows us to study the combined variability of vibration amplitude and velocity (i.e. the first derivative of the EGG signal). Pathological voices show a much more variable EGG signal compared to normal voices, since cordal vibration is made irregular due to the presence of glottis plane pathologies. With the aim of demonstrating the differences between normal and pathological voices relevant to combined vibration amplitude and velocity variability, we have introduced a new quantitative parameter named “variability index, VI”. We studied 95 subjects (35 normal and 60 with pathological voice); among pathologic subjects, 15 showed functional dysphonia and 45 showed organic dysphonia. Subjects affected by organic dysphonia presented: 15 bilateral vocal nodules, 15 unilateral polyps and 15 unilateral cysts. All subjects were studied with videolaryngostroboscopy; electro-acoustic parameters of the voice were analysed with the KayPENTAX CSL (Model 4500) system. The EGG signal was recorded using KAY Model 6103 connected to the CSL system. The new software for the analysis of the EGG signal allows us to obtain not only a VI total value relevant to variability during all the recording, but also partial VI values relevant to the different glottis cycle phases. In fact, plotting the amplitude variation and its first derivative on a Lissajous graph, it is possible to divide the whole glottis cycle into four phases (each represented by four quadrants on the graph): the initial vocal folds contacting activity (VI-Q1), the last phase of vocal folds contacting (VI-Q2), the first phase of vocal folds decontacting (VI-Q3) and the last phase, up to the complete decontacting of vocal folds (VI-Q4). For each quadrant, it is also possible to work out the percent variability index. By comparing the variability indices in the normal and pathological groups, we obtained the following results: the total VI was significantly higher in the pathological subjects (0.25 vs 0.18; p = 0.01); the absolute value of VI was higher in pathological subjects, although the difference was not significant (VI-Q2, 0.041 vs 0.029; VI-Q3, 0.065 vs 0.058; VI-Q4, 0.054 vs 0.052). The percent variability in the Q2 quadrant (VI-Q2%) was significantly higher in pathological subjects compared to normal subjects (0.22 vs 0.16) (p = 0.01). The results of this study confirm that our new software for analysis of EGG signal can distinguish normal voice from pathological voice based on the new quantitative parameter VI. Moreover, this study emphasises that the final contact phase of vocal folds is the most representative of the difference between the normal and pathological voice and shows a wider variability in terms of amplitude and vibration velocity. Further studies on larger groups of subjects will be required to confirm these results and assess differences in the EGG signal among the various vocal fold pathologies.

Dysphonia plica ventricularis (DPV) is a type of functional dysphonia (FD) which can be caused by several reasons. DPV-emotional type is seen secondary to emotional crisis which is equivalent to psychogenic/dissociative dysphonia. Here we describe a case of DPV secondary to emotional dysregulation with an underlying emotionally unstable personality disorder. Crisis intervention and emphasis on regular compliance to treatment has been discussed.

Objective: to verify the correlation between vital capacity and maximum phonation times of /ė/ (unvoiced) and /s/, as well as compare and relate them with the professional voice use and age in women with functional or organic-functional dysphonia. Methods: a retrospective research with 524 records of dysphonic patients from a school clinic, including young adult women with a speech-language diagnosis of functional or organic-functional dysphonia based on medical reports. Neurological and psychiatric alterations, previous speech therapy treatment, symptoms of flu or allergies on the day of evaluation, pulmonary disease, organic dysphonia diagnosis, and hearing loss, were excluded. The sample resulted in 14 women with functional dysphonia and 21 with organic-functional dysphonia. Data on professional voice use, as well as results for vital capacity and maximum phonation times were collected. The data were statistically analyzed at a 5% significance level. Results: There was a positive correlation for both groups of dysphonic patients between the maximum phonation times of /ė/ and of /s/, as well as the maximum phonation times of /ė/, /s/, and vital capacity. Higher values for vital capacity and maximum times of /s/ and /ė/ for voice professionals were seen. The maximum phonation times of /ė/ were lower than those of /s/. Conclusion: as the maximum phonation times of /ė/ increased, the maximum phonation times of /s/ and the vital capacity also augmented in both groups, demonstrating the interrelation among these variables; there was no relation with the other variables studied.

OBJECTIVES/HYPOTHESIS This is a retrospective study investigating the prevalence of globus pharyngeus in patients with dysphonia. STUDY DESIGN Retrospective chart review. METHODS The study examined the prevalence of globus pharyngeus in patients presenting with history of dysphonia at the American University of Beirut Medical Center Voice Center was performed. The etiology of dysphonia was categorized as organic in the presence of laryngeal pathology versus functional in the absence of any laryngeal pathology on laryngeal videostroboscopic examination. Functional dysphonia was further stratified as muscle tension dysphonia (MTD) and non-MTD based on the presence or absence of supraglottic muscle tension patterns. RESULTS The medical records of 300 patients were reviewed. Total prevalence of globus pharyngeus was 14.33%. There was a significant difference in the prevalence of globus pharyngeus between patients with organic dysphonia and patients with functional dysphonia (P < .001). Out of 43 patients with globus, 41.86% had organic voice disorders versus 58.14% who had functional voice disorders. Among those with functional voice disorders, globus pharyngeus was more prevalent in patients with MTD versus non-MTD patients (P = .19). Out of 25 patients with functional voice disorders and globus, 72% had MTD versus 28% who had no MTD (P = .19). CONCLUSIONS Globus pharyngeus is significantly more prevalent in patients with functional dysphonia versus patients with organic dysphonia. Moreover, in patients with functional dysphonia, the prevalence of globus was higher in those with MTD despite not reaching statistical significance. Globus pharyngeus may be either the cause or the result of laryngeal aberrant functional behavior. LEVEL OF EVIDENCE 4 Laryngoscope, 129:930-934, 2019.

Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM). In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic–aerodynamic analysis, and patients’ self-assessment (e.g., Singing Voice Handicap Index). While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p

Summary Objective Functional dysphonia refers to a voice disorder without organic laryngeal disease. In this article, the clinical features and therapeutic strategies of functional dysphonia in children were investigated. Method Retrospective analysis of 595 cases of children with dysphonia 3–18 years of age, including 42 patients diagnosed with functional dysphonia. The patients were distributed by age into four groups:3–6, 7–10, 11–14, 15–18 years. The clinical features, laryngeal signs, voice characteristics, pediatric voice handicap index, and therapeutic effects were analyzed. Result In this study, 7.1% of the patients were struck with functional dysphonia. 7 (16.7%) patients aged 7–10 years, 16 (38.1%) aged 11–14 years, and 19 (45.3%) patients aged 15–18 years, and there were 23 males and 19 females. Thirteen (31.0%) patients had no cause identified, while some were triggered by upper respiratory tract infection (16 cases, 38.1%), voice overuse (9 cases, 21.4%), or other factors (4 cases, 9.5%). Thirty-four (80.9%) patients had prominent hoarseness, with aphonia in 25 (73.5%) patients, and other 7 (16.7%) patients (15-18 years) showed vocal breaks or vocal effort (4 patients), and high pitch or pitch instability (3 patients). Some patients were accompanied by reduced mucosal waves, supraglottic compensations, and glottal insufficiency. Twelve patients received voice therapy, and their voice was improved after treatment. Conclusion In our study, functional dysphonia characterized 7.1% of the patients with voice disorders in children. All patients were 7–18 years of age, particularly 11–18 years. The main triggers of the disorder were upper respiratory tract infection, unknown and voice overuse. Other than apparent hoarseness, some 15–18 years patients experienced vocal breaks, vocal effort, or abnormal pitch. Supraglottic compensations and glottal insufficiency were observed in more than half of the patients. Symptomatic voice therapy obtained significant effects.

OBJECTIVE: To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).DESIGN: Cross sectional questionnaire study.SETTING: Tertiary referral centre voice clinic.PARTICIPANTS: 210 consecutive voice clinic patients.MAIN OUTCOME MEASURES: Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver operating characteristic (ROC) curve analysis.RESULTS: 177 returned complete datasets. 96 patients (54.2%) had functional dysphonia and 81(45.8%) had organic laryngeal disorders. Mean total VoiSS score =39.7/120 (standard deviation (SD) 22.2). Mean emotional VoiSS subscale =7.6/22 (SD 7.5). Mean HAD anxiety =6.5/21 (SD 5.2) and depression mean =7.1/21 (SD 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for "caseness". There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho= 0.68, p < .001) and HADS depression (Spearman's Rho= 0.62, p < .001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS "caseness" (area under curve =0.88). In addition functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.CONCLUSION: The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders. This article is protected by copyright. All rights reserved.

Die Atiopathogenese funktioneller Dysphonien ist komplex; es reicht nicht aus, nur auf vokale Verhaltensaspekte zu schauen. Die dispositionelle Basis fur eine funktionelle Dysphonie kann konstitutionell, Sprechberufs-, Sprechverhaltens- und/oder personlichkeitsbedingt sein. Ausloser konnen (chronischer) Stress, stimmliche Uberbeanspruchung, ungunstige Sprechgewohnheiten, Infekte der oberen Luftwege, entzundliche Prozesse im Kehlkopf, belastende Lebensereignisse und COSO events sein. Die Interaktion von pradisponierenden und kausalen Faktoren ist unbekannt. Stress, Erschopfung, Angst, Depressivitat und/oder Personlichkeitsmerkmale, die Krankheitsbewaltigung (Coping) erschweren oder verhindern, gelten als aufrechterhaltende Faktoren. Stets ist eine Uberlagerung der Stimmsymptomatik durch reaktive psychische und soziale Auffalligkeiten zu berucksichtigen (z. B. Leidensdruck, depressive Verarbeitung, Sprechangst, sozialer Ruckzug). Da die Assoziation multipler psychosozialer Faktoren mit funktionellen Dysphonien nicht trennscharf ist – eine solche ist stets bei organmedizinisch nicht begrundbaren Symptomen anzutreffen – sind funktionelle Dysphonien psychodiagnostisch zu differenzieren. In Anlehnung an den ICD-10 Kpt V (F00-F99) wird ein diagnostischer Pfad vorgestellt. Unbekannt ist bislang, welche psychosozialen Faktoren eine psychogene Dysphonie von einer „Muscle Tension Dysphonia“ unterscheiden.

RESUMO Professores são profissionais com alta prevalência de disfonia, para a qual os principais fatores de risco são as longas jornadas de trabalho em salas de aula com presença de ruído ambiental. O objetivo da pesquisa foi calcular o tempo de fonação e a dose cíclica de professoras com disfonia e de professoras sem alteração de voz durante a atividade letiva. Para o estudo, dois grupos foram analisados: cinco professoras com disfonia funcional constituíram o grupo de professores disfônicos, e cinco professoras sem alteração de voz constituíram o segundo grupo. Para a coleta dos dados foi utilizado o dosímetro marca VoxLog® e os parâmetros analisados foram: intensidade; frequência fundamental; tempo de fonação e dose cíclica. Na análise estatística foram utilizados os testes Anova, T de Student e Kruskal-Wallis. Observou-se que professores disfônicos apresentaram um maior tempo de fonação e de dose cíclica quando comparados com professores sem alteração vocal. A disfonia associa-se com um tempo maior de fonação e uma exposição maior do tecido da prega vocal a fonotraumas.

The main purpose of the research is to model the cognitive processes that occur when the physician determines the severity of the dysphonia, and to build an IT system that can substitute the subjective severity diagnosis used by a clinician. In this preliminary study the relationship between acoustic parameters and the speech defect severity determined by a clinician is investigated. Being limited in the number of pathological speech samples, it is very important to choose the effective parameters. After a phoneme level segmentation, acoustic parameters were measured at a predetermined fixed points in continuous speech. Parameters were grouped according to the phonetic classes (classes according to the manner of articulation), and the correlation of the grouped parameters with the severity of dysphonia given by the RBH scale was examined, where R stands for roughness, B for breathiness, H for overall hoarseness. The analysis was carried out on a database containing several pathological disease types, the most frequent being recurrent paresis and functional dysphonia. It was found that beyond the initial acoustic parameters such as jitter(ddp), shimmer(dda), Harmonics-to-Noise Ratio (HNR) and mel-frequency cepstral coefficients (mfcc) measured on vowels, it is worth measuring Soft Phonation Index (SPI) and Empirical mode decomposition (EMD) based frequency band ratios on different phonetic classes. These measures were found to correlate with the severity of dysphonia, determined by the clinician (RBH). They provide useful information and could be useful to differentiate different types of dysphonia like functional dysphonia and recurrent paresis.

Summary Purpose The purpose of this study was to determine if voice amplification influenced vocal dose in female teachers with dysphonia. Material and Methods This was an experimental study with comparative intrasubjects in which 15 individuals were compared in two different moments: condition 1 (C1) without voice amplification and condition 2 (C2) with voice amplification. All of them were female, kindergarten and elementary school teachers who presented organic or functional dysphonia. The search was carried out at the school where the teachers work. The professional voice use was considered the teachers' activity for a continuous period of two classes (average recording time of 96 minutes, with no difference in time between C1 and C2). To measure the dose we used the vocal dosimeter composed of a microphone, an accelerometer fixed to the neck, and a portable unit that stores the vocal data. The phonation data (intensity, fundamental frequency, phonation percentage, cycle dose, and distance dose) were analyzed by the equipment software (VoxLog). Results The use of vocal amplification in teachers promotes a reduction of the fundamental frequency (295.6–267.7 Hz), the voice intensity (96.2–93.3 dB sound pressure level), the cycle doses (489.4–345.2 thousand cycles per second), and distance doses (3,800–2,300 m). Conclusion The vocal amplification allows the teacher to maintain the same phonation time (phonation percentage) but decreases the number of vocal fold oscillations (cycle dose) and the total distance traveled by the vocal fold tissue during phonation (distance dose), reducing the exposure of the vocal folds to voice trauma.

Voice pathologies, caused either by functional dysphonia or organic lesions, or even by just an inappropriate emission of the voice, may lead to vocal abuse, affecting significantly the communication process. The present study is based on the case of a single patient diagnosed with myasthenia gravis (Erb-Goldflam syndrome). In this case, this affection has caused, among other disruptions, a dysarthria. For its treatment, a technique for the education and re-education of the voice has been used, based on a resonator element: the cellophane screen. This article shows the results obtained in the patient after applying a vocal re-education technique called the Cimardi Method: the Cellophane Screen, which is a pioneering technique in this field. Changes in the patient’s voice signal have been studied before and after the application of the Cimardi Method in different domains of study: time-frequency, spectrum, and cepstrum. Moreover, parameters for voice quality measurement, such as shimmer, jitter and harmonic-to-noise ratio (HNR), have been used to quantify the results obtained with the Cimardi Method. Once the results were analyzed, it has been observed that the Cimardi Method helps to produce a more natural and free vocal emission, which is very useful as a rehabilitation therapy for those people presenting certain vocal disorders. Las patologías vocales, ya sean debidas a disfonías funcionales o a lesiones orgánicas o, simplemente, a una emisión de voz inadecuada, pueden dar lugar a un forzamiento vocal que afecta de manera importante al proceso de comunicación. El estudio que se presenta se basa en el caso de una única paciente con un diagnóstico de miastenia gravis (enfermedad de Erb-Goldflam). En este caso concreto, dicha afección ha dado lugar, entre otras perturbaciones, a una disartria. Para tratarla, se ha utilizado una técnica de educación y reeducación vocal basada en un elemento resonador: una pantalla de celofán. En el presente artículo se muestran los resultados obtenidos en la paciente tras aplicar una técnica pionera en el campo de la reeducación vocal denominada método Cimardi: Pantalla de Celofán. Se han estudiado los cambios en la señal de voz de la paciente antes y después de la aplicación del mencionado método Cimardi, utilizando para ello diferentes dominios de representación: el temporal, el espectral y el cepstral. Además, se han usado distintos parámetros para medir la calidad de la voz, como por ejemplo el shimmer, el jitter o el harmonic-to-noise ratio (HNR), con el fin de poder cuantificar los resultados obtenidos con el método Cimardi. Una vez analizados los resultados, se ha observado que la técnica empleada por el método Cimardi ayuda a producir una emisión vocal más natural y libre, lo que resulta muy útil como terapia rehabilitadora para aquellas personas que sufren ciertos trastornos vocales.

The prevalence of functional dysphonia in teachers is high therefore vocal cords nodules have been recognized as a professional disease. Prevention actions are often development by voice experts but not by professors. However professors can play a relevant role in functional dysphonia prevention. The author suggests some basic contents to be included in a teacher college subject. In the conceptual level epidemiology notions, vocal system functioning and voice disease process are bring up. In procedure level student way of life style and voice use in class are point out. Class oral participation is use to enhanced students voice use. In the attitudinal level professors efforts are guided to make students recognized voice worth for professional career.

Summary Type of Study This is a longitudinal, case-control clinical trial. Objectives This study aims to track recovery time following a vocal loading task (VLT) imposing vocal fatigue and to explore if patients with functional dysphonia (FD) are worse affected by vocal loading, and if these patients take longer than others to recover. Methods Fifty (n = 50) female participants in four vocal subgroups on a spectrum of everyday vocal loading and functional voice complaints, including n = 20 patients with FD, took part in a clinical VLT, inflicting vocal fatigue through loud speech in ambient noise. Short-term recovery was explored through self-assessment of unspecified voice problems every 15 minutes for 2 hours following loading. Long-term recovery was tracked through self-assessments of specific voice symptoms during 3 days following vocal loading. Effects of heavy vocal loading were evaluated through voice recordings, long-time-average spectrum, perceptual assessments, and assessments of digital imaging performed pre- and post vocal loading. Results Patients with FD did not return to baseline for unspecified voice problems within 2 hours of vocal loading and were worse affected by vocal loading than other groups. Women with high everyday vocal loading with no voice complaints identified vocal loading more evidently than other groups. Long-term recovery took 7–20 hours for all groups. Conclusions Short-term recovery is slower for patients with FD and these patients are worse affected by a VLT than others.

Summary Introduction Thanks to videostrobokymography the vocal fold vibration from particular area of glottal chink, can be assessed in an objective way. Aim Evaluation of objective parameters of vocal fold vibration with the usage of videostrobokymography in patients with different voice disorders. Material and Methods Material of the study included patients treated in the Institute of Physiology and Pathology of Hearing, Audiology and Phoniatrics Clinic. 82 patients with normal voices, vocal fold nodules, polyps, Reinke edema, vocal cord paralysis and functional dysphonia were enrolled into the study. Open Quotient (OQ) from frontal, middle and dorsal third of vocal folds were measured. T-Student test was used for statistical analysis. Results The study revealed differences of OQ in control group and patients with organic or functional dysphonia. Differences in parameters were calculated for each vocal fold region. The mean value of OQ in control group was 0.56 (frontal third), 0.55 (middle third), 0.597 (dorsal third). Statistical significant differences of OQ calculated from separate glottal chink areas, were observed in Reinke edema (from frontal and middle third) and vocal cord paralysis (from frontal third). Conclusions Videostrobokymography is an useful complement to classical stroboscopy. Objective parameters enables the objectification of vibratory activities. Videostrobokymography is helpful in differential diagnosis of voice disorders.

Objectives/Hypothesis: No studies to date have examined the clinical safety and efficacy of carboxymethylcellulose (CMC) for vocal fold injection. The current study investigates the voice outcomes and complications of CMC injection. Study Design: Retrospective review. Methods: All patients who underwent CMC injection from three independent sites in a 1-year period were reviewed. Voice outcomes in the form of voice handicap index-10 (VHI-10) and complications from injection were recorded. Results: Seventy-eight patients with VHI-10 results from 1 to 8 weeks after CMC injection were evaluated. Thirty-eight patients were treated for vocal fold immobility, and 15 patients underwent treatment for hypomobility, 15 for vocal fold atrophy, seven for scar/sulcus, one for previous laryngeal fracture, one for functional dysphonia, and one for persistent granuloma. In 60 patients with available VHI-10 data, overall improvement in voice was seen. There was a mean decrease in VHI-10 of 7.48 (26.4 to 18.9, P < .05), correlating to a 19.9% decrease. Forty-five patients (75%) showed a decrease in VHI-10, nine (15%) showed an increase, and six (10%) showed no change. Statistically significant differences were seen for patients with immobility (decrease of 8.6, or 31%) and hypomobility (decrease of 10.7, or 37.8%). There were no complications of vocal fold stiffness, inflammatory reaction, or scar in the 78 patients during the total follow-up period. Conclusions: CMC is a viable, safe, and efficacious material for the temporary treatment of glottic insufficiency in vocal fold immobility and hypomobility, with minimal risk of permanent adverse voice outcomes.

To describe the opinion of undergraduate health sciences students in the Basque Country universities (UPV/EHU) regarding ethical issues related to HIV-positive persons in schools, workplaces and health centers.Our population consisted of medical, nursing and dental undergraduate students attending UPV/EHU. An opinion survey was conducted among students attending lectures, on a randomly selected date in 2002-2003. The questionnaire included several items on ethical conflicts related to HIV-positive persons in different settings. Item responses consisted of a Likert-type scale with five possible levels of agreement (from "strongly disagree" to "strongly agree"), as well as the option "I do not want to answer/I have no opinion about this".529 completed questionnaires were collected. 69% of respondents reported total disagreement with refusing to admit HIV+ students to primary schools, and 77% with dismissal of HIV+ workers. Approximately 90% of respondents felt managers should be aware of the HIV+ status of their employees. 78% of the students did not report disagreement with having HIV+ schoolmates in classrooms. Respondents generally disagreed with employment limitations for HIV+ health care workers, 60% strongly disagreed with health workers refusing to treat HIV+ persons, 69% considered that HIV testing should be compulsory for health workers, and 55% that health workers should know their patients' HIV status.In general terms, our students are against social and employment limitations targeting HIV+ persons, but favor disclosure of HIV status in schools and health centres.Objetivos: Conocer la opinión de estudiantes de carreras sanitarias de la Universidad del País Vasco (UPV/EHU) acerca de conflictos éticos relacionados con las personas VIH+ en centros docentes, de trabajo y sanitarios. Métodos: La población de interés eran estudiantes de Medicina, Odontología y Enfermería de la UPV/EHU en todos los cursos de dichas titulaciones. A los alumnos presentes en el aula en fecha escogida aleatoriamente en el curso académico 2002-2003, se les ofreció rellenar una encuesta en la que se recogía su opinión sobre situaciones conflictivas relacionadas con la presencia de personas seropositivas (VIH+) en lugares de trabajo y centros públicos. Las opciones de respuesta eran cerradas, sobre una escala de cinco grados de acuerdo desde “Totalmente en desacuerdo” hasta “Totalmente de acuerdo”, incluyendo también las opciones “No deseo opinar” y “No tengo opinión formada sobre el tema”. Resultados: Se obtuvieron un total de 529 cuestionarios cumplimentados. Un 69% de los encuestados se manifiesta en total desacuerdo con no admitir niños VIH+ en colegios, y un 77% con el despido de trabajadores seropositivos. Un 90% acepta que la dirección de un colegio conozca si un alumno es VIH+. Un 78% está de acuerdo en tener compañeros de clase VIH+. Los encuestados no aceptan limitaciones laborales a los trabajadores sanitarios VIH+. Un 60% está totalmente en desacuerdo con que los sanitarios puedan rechazar el tratamiento de un paciente VIH+. Un 69% está de acuerdo con la obligatoriedad de la prueba VIH a los trabajadores sanitarios, y un 55% con que éstos puedan conocer la situación VIH de los pacientes. Conclusiones: En general, nuestra muestra se manifiesta en contra de limitaciones sociales o laborales a personas.

Objective To assess the degree of vocal handicap in patients with dysphonic disorders. Patients and methods Ninety-seven patients with a diagnosis of vocal nodules and 65 patients with a diagnosis of functional dysphonia completed a questionnaire which included the Vocal Handicap Index (VHI) and the Quality of Life Index (QLI) (a measure of voice-related quality of life). Results We found a high degree of incapacity reflected by high scores on the VHI (mean score 61 in patients with vocal nodules, 56 in patients with functional dysphonia), on the individual subscales of the VHI (organic: 26, 25; functional: 22, 19; emotional: 13, 12), and on the QLI (13, 11). Conclusion Vocal nodules and functional dysphonias often imply significant incapacity in terms of social functioning and work performance, with associated emotional impacts.

To review the recent literature since the 2009 Cochrane review regarding the effectiveness of voice therapy for patients with functional dysphonia.A range of articles report on the effects of voice therapy treatment for functional dysphonia, with a wide range of interventions described. Only one study is a randomized controlled trial. A number of excellent review articles have extended the knowledge base. In primary research, methodological issues persist: studies are small, and not adequately controlled. Studies show improved standards of outcome measurement and of description of the content of voice therapy.There is a continued need for larger, methodologically sound clinical effectiveness studies. Future studies need to be replicable and generalizable in order to inform and elucidate clinical practice.

STROBOSCOPY FINDINGS: A COMPARISON OF FLEXIBLE CCD-VIDEOSTROBOSCOPY AND RIGID STROBOSCOPYOBJECTIVE: After exclusion of morphologic laryngeal alterations by laryngoscopy the prospective study compared stroboscopy findings using a flexible distal charge-coupled device chip-optic (CCD-optic) and a rigid 70°- or 90°-laryngoscope. MATERIAL AND METHODS: 52 patients with functional dysphonia and 47 candidates for speech therapy education were checked with both examination methods. The stroboscopy results were rated randomized and pseudonymized by 3 experts assessed by a study protocol according to the European laryngological society basic protocol 2001. RESULTS: The interrater-reliability was moderate to good. Using the flexible videolaryngoscopy less gaging, less supraglottic contraction during phonation, more often a complete glottal closure and more often a normal mucosal wave movement were found. CONCLUSION: To get an optimal endoscopy result the combination of rigid laryngoscopy and flexible videolaryngoscopy and -stroboscopy will be recommended. Because of the variety of stroboscopic findings for the diagnosis of functional dysphonia additional the case history and functional voice examinations are necessary.

Objective: The aim of the study was to assess the applicability of the Voice Handicap Index (VHI) in the screening diagnostics of voice dysfunction and in the evaluation of the level of handicap due to dysphonia. Patients andMethods: A total of 165 patients with voice disorders (vocal paresis, benign vocal fold masses, and functional dysphonia) and 65 healthy controls completed the VHI questionnaire. All the participants were subjected to maximum phonation time (MPT) assessment, the patients also to laryngovideostroboscopy. Results: The VHI scores for the patients and controls differed significantly (p < 0.001). A significant correlation (p < 0.05) was found when MPT and VHI were compared. The cutoff point, at which VHI sensitivity (for distinguishing between subjects with voice dysfunction and with vocal health) reached its maximal value (98%) at the highest level of specificity (95%), was assumed to be 12. Conclusions: The study revealed that the VHI is a reliable tool for identifying patients who experience vocal dysfunction and should be used in multidimensional diagnostics of voice disorders. The level of 12 points in the VHI test should be considered to be a threshold for rating the biopsychosocial impact of dysphonia.

Objective: This study focuses on the relation between objective voice quality and the self-perception of a voice handicap. Patients and Methods: The study group consisted of 86 German-speaking patients (51 women, 35 men) suffering from benign dysphonia. The test persons completed the German version of the Voice-Related Quality of Life (V-RQOL) Questionnaire without prior information about their diagnosis and underwent voice analysis with the Dysphonia Severity Index (DSI) being the parameter of this study. Results: No correlation between V-RQOL and DSI could be found (p > 0.05). On the V-RQOL, women scored worse than men, but not at a significant level. Patients with dysphonia of organic origin scored significantly worse than patients with functional dysphonia (p = 0.026). On the DSI, men’s values were significantly lower than women’s (p = 0.001). Organic dysphonia caused significantly lower DSI values than functional dysphonia (p = 0.011). Conclusion: Objective voice quality and the individual perception of voice quality by the patient are independent parameters. Both need to be assessed in clinical practice.

Locus of Control (LoC) refers to an individuals' perception of whether they are in control of life events. Health Locus of Control refers to whether someone feels they have influence over their health. Health Locus of Control has not been studied in any depth in voice-disordered patients. The objective of this study was to examine Health Locus of Control in three patient groups: (1) Spasmodic Dysphonia, (2) Functional Dysphonia and (3) a nondysphonic group with Nonlaryngeal Dystonia. LoC was measured and compared in a total of 57 patients using the Multidimensional Health Locus of Control Scales (diagnostic specific) Form C. Internal, Chance, and Powerful others LoC were measured and comparisons were made using one-way analysis of variance. Contrary to expectations Internal LoC was found to be significantly higher in the Functional Dysphonia group when compared to the other two groups. There was no significant difference between the groups in Chance or Powerful others LoC. The two organic groups, Spasmodic Dysphonia and Nonlaryngeal Dystonia, were more alike in Internal Health Locus of Control than the Functional Dysphonia group. The diagnostic nature of the groups was reflected in their LoC scores rather than their voice loss. These results contribute to the debate about the etiology of Spasmodic Dysphonia and will be of interest to those involved in the psychology of voice and those managing voice-disordered patients.

The Multi-Dimensional Voice Program (MDVP) and Praat are computer programs commonly used for acoustic analysis of voice in clinical and research settings. Both softwares extract a set of acoustic parameters, many of which are defined similarly. The purpose of this study was to compare results obtained by both programs, and examine whether they can clinically distinguish among pathological groups differently. Fifty-eight women participated in the study. Of these women, 28 were diagnosed with functional dysphonia and 30 were diagnosed with benign mass-lesions (10 nodules, ten polyps and 10 cysts). Six productions of the vowels /a/ and /i/, were analyzed using MDVP and Praat. Results show similar mean fundamental-frequency (mF0) values for both programs (P > 0.05). However, values of jitter, shimmer, noise-to-harmonic ratio (NHR) and degree of unvoiced (DUV) segment were significantly lower using Praat, in comparison with MDVP. Jitter values obtained using MDVP, for the vowel /i/, revealed a significant group difference between the nodule and cyst groups (P

Klasik iki-aşamalı dental implant konsepti, geçtiğimiz yıllardaki bir çok çalışmada olumlu sonuçlar ortaya koysa da, uzun osseointegrasyon süresi, randevu sayısının fazla olması, geçici bir tam protez yapımı ve bu protezlerin bir çok kez astarlama gerekliliği gibi bazı dezavantajları beraberinde getirmektedir. Dental implantların materyal, dizayn ve yüzey işlemlerinde ortaya çıkan son dönemdeki yenilikler ve gelişmeler, klinik diş hekimliği için önemli bir konsept olan erken yükleme protokolünün ortaya çıkmasına ön ayak olmuştur. Erken yükleme protokolünü temel alan birçok yöntemde ortaya çıkan en önemli dezavantaj içerdikleri ölçü alma işlemleri sebebiyle operasyon bölgesinin zarar görebilmesidir. Son dönemde bu problemi ortadan kaldırmak amacıyla ölçü alma prosedürlerini içermeyen Ohio State University (OSU) protokolü geliştirilmiştir. Ancak bu protokolde de, postperatif iyileşme gerçekleşmeden protetik işlemlerin tamamlanması sebebiyle hastalarda konuşma problemleri baş gösterebilmektedir. Bu çalışmada, OSU protokolü temel alınarak erken yükleme konsepti ile yapılan implant destekli bir mandibular hibrit protezde, postoperatif iyileşme sonrasında meydana gelen fonksiyonel konuşma problemini ortadan kaldıran alternatif bir yöntemin sunumu ve bu yöntem sonrasında ortaya çıkan neticenin gösterilmesi amaçlanmaktadır. 62 yaşındaki erkek hasta, implant operasyonu sonrası OSU protokolü ile oluşturulan alt hibrit protezinden kaynaklanan fonksiyonel konuşma problemi şikayeti ile kliniğimize başvurdu. Hastada, postoperatif iyileşme sonrasında protez ile mukoza arasındaki mesafe artışını telafi etmek amacıyla akrilik rezin kullanılarak alternatif bir yaklaşım uygulanmaya karar verildi. Bu yaklaşım sayesinde hibrit protez ile mukoza arasındaki mesafe, hijyeni ve fonasyonu etkilemeyecek şekilde azaltılmış oldu. Bu olgu sunumunda ortaya konan alternatif tekniğin, OSU protokolü baz alınarak erken yükleme konsepti ile ağıza yerleştirilen dentalimplant destekli hibrit protezlerde ortaya çıkabilecek fonasyon problemlerinin çözümünde geçerli bir yöntem olabileceği gösterilmektedir. Bu yöntemle hastanın karşı karşıya kaldığı psikososyal dezavantaj konforlu ve kısa bir sürede kolaylıkla ortadan kaldırılmıştır., Although classic two-step concept for dental implants has presented encouraging outcomes, treatment protocol requires a lengthy period for osseointegration. The other disadvantage of conventional implant therapy is the need for several appointments and temporary complete dentures with multiple relines. Along with continuous improvements in implant materials, designs and surface treatment techniques, immediate/early loading protocol has become one of the most remarkable achievements in clinical dentistry. Immediate loading procedures may increase the possibility of damage to the surgical site during the impression procedures. The Ohio State University (OSU) protocol has been developed to compensate for previous early loading techniques’ inadequacy. However, this protocol may cause phonation difficulty to the patient due to postoperative healing. The aim of this study was to describe an alternative technique to eliminate the cause of the functional dysphonia in a patient with early load mandibular hybrid prosthesis via the OSU protocol and to evaluate the outcomes of this technique. A 62-years-old male patient reported to our department with a complaint of functional dysphonia after the prosthetic rehabilitation with implant-retained mandibular hybrid prosthesis via OSU protocol. Acrylic resin applied to the metal framework of mandibular hybrid prosthesis decrease the distance between hybrid prosthesis and mucosa. Result: This alternative technique has led to eliminate the cause of dysphonia in a short period of time and resulted in patient satisfaction in terms of hygiene and phonation. So it may be an appropriate technique for functional dysphonia patient with early load mandibular hybrid prosthesis and may further psychosocially motivate patients in the social environment.