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Belching is the act of expelling air from the stomach or esophagus into the pharynx. Although the process is regarded as physiological, excessive belching might be associated with a significant burden for affected patients in the sense of a belching disorder. Diagnosis of a belching disorder is often challenging, and its differentiation from other conditions such as rumination syndrome, singultus, or aerophagia can be difficult. Treatment of these disorders also represents a challenge for otorhinolaryngologists. Hence, the aim of this review is to provide an interdisciplinary overview of these clinical syndromes and provide practical guidance for their diagnosis and treatment., (© 2024. The Author(s).)

Purpose: Vocal fatigue-related symptoms, frequent in patients with voice disorders, are reliably quantifiable with the Vocal Fatigue Index (VFI) in several languages. The main aim of this work was to investigate the content and construct validity of the German Vocal Fatigue Index (VFI-D) by comparison with the German Voice Handicap Index 9 international (VHI9i) and the Vocal Tract Discomfort Scale (VTD). Moreover, the scale and retest reliability were investigated., Method: In a prospective cohort study at two tertiary care hospitals, 93 adults with all types of voice complaints filled out the VFI-D, the VHI-9i, and the VTD. Eighty-one adults ( M age = 53.5 years, SD = 15.7) completed them one time, and additional 12 patients ( M age = 53.8 years, SD = 15.6) did a test-retest, completed them twice at an interval of 1 week. The validity was assessed by Spearman's rho and Mokken scaling and the reliability by a factor analysis and a two-tailed t test., Results: Mokken scaling has proven the VFI-D as one-dimensional questionnaire (one cluster, r = .95). All VFI-D items could be assigned to one of three factors according to principal component and principal axis factor analysis. Although Factor 1 related best to the VHI9i (∅ r s = .76) and Factor 2 to the VTD (∅ r s = .74), Factor 3 correlated moderately with the VHI9i ( r s = .34) and weakly with the VTD ( r s = .25). Results from the first and second VFI-D completion agreed strongly ( t = -1.78, p = .10)., Conclusions: In this study, the content and construct validity of the VFI-D were confirmed. Also, both scale reliability with identical factors as those in the original study and retest reliability were verified. The VHI9i and VTD were highly indicative of VFI-D Factors 1 and 2, respectively. No correlation between Factor 3 and the other questionnaires was determined. Future research should evaluate which characteristics are specific to vocal fatigue versus general voice disorder-related symptoms.

In this short communication, we discuss the recently described syndrome of retrograde cricopharyngeal dysfunction (R-CPD) with its first description in 2019 by the laryngologist Dr. Bastian. Diagnosis is generally based on typical clinical symptoms, e.g., the inability to belch, a bloated abdomen and retrosternal gurgling noises. We also describe high-resolution esophageal manometry as a new tool to further secure the diagnosis of R‑CPD, as well as therapeutic options such as botulinum toxin injections in the cricopharyngeal muscle or cricopharyngeal myotomy and the published data thereon., (© 2023. The Author(s).)

Introduction: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice., Methods: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected., Results: Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases., Conclusion: The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Standardized and validated patient surveys in the form of questionnaires are becoming increasingly important in otorhinolaryngology. Subjective symptoms and functional limitations but also health-related quality of life are assessed with so-called patient-reported outcome measures (PROMs). Besides patient history and objective findings, these questionnaires can be applied as another important source for ensuring the quality of patient-centered care. In German-speaking countries there are now several PROMs that specifically ask for the patient perspective on voice and swallowing disorders. For patients with voice disorders the following questionnaires based on the Voice Handicap Index (VHI), which are also used internationally, are mainly applied: VHI-30, VHI-12i, and VHI-9i. In the field of oropharyngeal dysphagia, the German versions of the Eating Assessment Tool-10 (EAT-10), des Sydney Swallow Questionnaire SSQ‑G, the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the MD Anderson Dysphagia Inventory (MDADI) are currently mostly used., (© 2023. The Author(s).)

Laryngopharyngeal reflux (LPR) is characterized by backflow of gastric or gastroduodenal content and gases into the upper aerodigestive tract, which can damage the mucus membranes of the larynx and pharynx. It is associated with a variety of symptoms such as retrosternal burning and acid regurgitation, or other unspecific symptoms such as hoarseness, globus sensation, chronic cough, or mucus hypersecretion. Due to the lack of data and the heterogeneity of studies, diagnosis of LPR is problematic and challenging, as recently discussed. Moreover, the different therapeutic approaches are also discussed controversially in the face of the poor evidence base, and include pharmacologic and conservative dietary measures. Hence, in the following review, the available options for treatment of LPR are critically discussed and summarized for daily clinical use., (© 2023. The Author(s).)

In addition to clinical and instrumental methods as well as medical history, questionnaires are well-established tools in the diagnosis of laryngopharyngeal reflux (LPR). Recently, the reflux symptom score (RSS) as well as the short version of it, the RSS-12, which are self-administered patient-reported outcome questionnaires, have been published as an alternative to the well-established reflux symptom index (RSI). The RSS-12 assesses severity and frequency of LPR symptoms as well as the impact on quality of life and has been shown to have high reliability and validity. However, so far, only French, English, and Portuguese versions of the RSS-12 have been published. Hence, the aim of this study was to prepare a transcultural German translation of the RSS-12 (G-RSS-12) to provide a new clinical and scientific tool for the diagnosis of LPR in German-speaking regions., (© 2022. The Author(s).)

Background: Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician., Objectives: Presentation of the current database to provide an overview of the etiology, progress and treatment for everyday clinical practice., Methods: Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature., Results: The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided., Conclusions: The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed., (© 2021. The Author(s).)

Background: The Sydney Swallow Questionnaire (SSQ) is a self-report inventory assessing subjective symptoms of oropharyngeal dysphagia with strong content, construct, discriminant, and predictive validity and test-retest reliability in a range of patient populations., Objective: The main aim of this work was to assess the validity and reliability of the German version of the SSQ (SSQ-G)., Materials and Methods: In a cross-validation study, 48 adult German-speaking patients (12 women, 36 men) with neurogenic (n = 16), structural (n = 16), and functional (n = 16) oropharyngeal dysphagia were assessed with the SSQ‑G and the MD Anderson Dysphagia Inventory (MDADI). Cronbach's α was applied to assess the reliability. Criteria and construct validity were investigated using the Spearman correlation coefficient., Results: With Cronbach's α = 0.94, the internal consistency of the SSQ‑G was excellent. The SSQ‑G questions 1 and 17 showed a moderately significant and highly significant correlation coefficient of -0.43 and -0.45, respectively, with MDADI question 1 (p < 0.5, p < 0.001). Between questions 8, 11, and 12 of the SSQ‑G and questions 7, 13, and 10 of the MDADI, coefficients of -0.48 to -0.55 showed a moderate to strong highly significant correlation (p < 0.001). Thus, the reliability and criterion and construct validity were statistically confirmed., Conclusion: The German version of the SSQ (SSQ-G) allows a reliable and valid assessment of functional swallowing difficulties. In combination with questionnaires on symptom-specific quality of life, such as the MDADI, a more differentiated clinical analysis of swallowing problems is thus possible., (© 2021. The Author(s).)

Laryngopharyngeal reflux (LPR) is defined as backflow of gastral or gastroduodenal content into the upper aerodigestive tract and characterized by a variety of unspecific symptoms such as chronic cough, globus sensation, or mucus hypersecretion. Due to the lack of a gold standard and the heterogeneity of studies, the diagnosis of LPR is still problematic and challenging. However, in patients with characteristic symptoms and endoscopic findings, with an increased reflux symptom index, a pathologic reflux finding score (RFS), pathologic 24 h esophageal or oropharyngeal pH monitoring, and without any other underlying condition, the diagnosis of LPR is probable. In the following review, we critically discuss the abovementioned methods as well as more recent tools such as measurements of pepsin concentrations in the saliva for diagnosis of LPR., (© 2021. The Author(s).)

Significant and new impulses regarding the treatment concept for outpatient phonosurgery on unsedated patients are currently coming from various Anglo-American authors. These "office-based procedures" have been propagated as an alternative to many conventional surgical interventions under anesthesia. The main reason for this remarkable development is the use of new endoscopic techniques in combination with photoangiolytic laser (KTP and blue laser), which allow safe and efficient phonosurgical procedures. Patient acceptance is high since outpatient procedures are considered to have a lower surgical risk. Despite the widespread euphoria, there is a lack of studies evaluating the medical decision criteria and safety management of office-based laryngeal surgery., (© 2021. The Author(s).)

Objective: Cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as reliable parameters to detect overall dysphonia in standardized connected speech samples. Recent studies indicate that vocal intensity (sound pressure level, SPL) and fundamental frequency (f o ) changes may influence cepstral measurement results in healthy speakers. The main aim of the present work was to investigate the effects of prosody related SPL and f o variations on cepstral measures in speech of adults with voice disorders., Study Design: Retrospective cross-sectional study., Methods: Recordings of CAPE-V sentences from 27 voice disordered Brazilian Portuguese speakers (19 women, eight men) with a mean age of 45 years (SD = 13) were investigated. Five /a/ vowels were manually extracted from stressed syllables in different positions. Voice f o (Hz), SPL (dBA), CPP (dB), and CPPS (dB) were computed using PRAAT. Statistical analysis included Linear Mixed Models with ANCOVA and Bonferroni post hoc tests., Results: Voice SPL as single factor and combined with f o had a highly significant effect (P ≤ 0.001), while f o alone had no significant impact on both CPP and CPPS (P ≥ 0.77). Voice f o , SPL, CPP, and CPPS of the first vowel were all significantly lower than of the last vowel (P ≤ 0.03)., Conclusion: In vowel samples from connected speech of adults with voice disorders, we observed better CPP and CPPS in higher voice SPL alone and combined with higher f o . Further, the vowel position influenced the present results. A larger clinical study should confirm how prosody related SPL and f o and vowel position effects could be controlled for in connected speech samples., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Cepstrum-based voice measures, such as smoothed cepstral peak prominence (CPPS), are influenced by voice sound pressure level (SPL) in vocally healthy adults. Since it is unclear if similar effects hold in voice disordered adults and how these interact with natural fundamental frequency (f o ) changes, this study examines voice SPL and f o effects on CPPS in women with vocal hyperfunction and vocally healthy controls., Study Design: Retrospective matched case-control study., Methods: Fifty-eight women with vocal hyperfunction were individually matched with 58 vocally healthy women for occupation and approximate age. The patient group comprised women exhibiting phonotraumatic vocal hyperfunction associated with vocal fold nodules (n = 39) or polyps (n = 5), and nonphonotraumatic vocal hyperfunction associated with primary muscle tension dysphonia (n = 14). All participants sustained the vowel /a/ at soft, comfortable, and loud loudness conditions. Voice SPL, f o , and CPPS (dB) were computed from acoustic voice recordings using Praat. The effects of loudness condition, measured voice SPL, and f o on CPPS were assessed with linear mixed models. Pairwise correlations among voice SPL, f o , and CPPS were assessed using multiple regression analysis., Results: Increasing voice SPL correlated significantly (P < 0.001) with higher CPPS in both patient (r 2  = 0.53) and normative groups (r 2  = 0.45). f o had statistically significant effects on CPPS (P < 0.001), but with a weak relation for the patient (r 2  = 0.02) and control groups (r 2  = 0.05)., Conclusions: In women with and without voice disorder, CPPS is highly affected by the individual's voice SPL in vowel phonation. Future studies could investigate how these effects should be controlled for to improve the diagnostic value of acoustic-based cepstral measures., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: The Clavien-Dindo classification is a broadly accepted surgical complications classification system, grading complications by the extent of therapy necessary to resolve them. A drawback of the method is that it does not consider why the patient was operated on primarily. Methods: We designed a novel index based on Clavien-Dindo but with respect to the surgical indication. We surveyed an international panel of otolaryngologists who filled out a questionnaire with 32 real case-inspired scenarios. Each case was graded for the surgical complication, surgical indication, and a subjective rating whether the complication was acceptable or not. Results: Seventy-seven otolaryngologists responded to the survey. Mean subjective rating and surgical complication grading for each scenario showed an inverse correlation ( r 2 = 0.147, p = 0.044). When grading the surgical complication with respect to the surgical indication, the correlation with the subjective rating increased dramatically ( r 2 = 0.307, p = 0.0022). Conclusion: We describe a novel index grading surgical complications with respect to the surgical indication. In our survey, most respondents judged a complication as acceptable or not according to its grade but kept in mind the surgical indication. This subjective judgment could be quantified with our novel index., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Morand, Anderegg, Kleinjung, Bohlender, Veraguth, Broglie, Holzmann, Huber, Röösli and Soyka.)

Objectives: Semi-occluded vocal tract exercises are widely applied to improve vocal performance in speakers, singers, and voice patients. This study investigates immediate lip trill effects on standard voice assessment measures including voice range profiles, jitter, maximum phonation time, and Dysphonia Severity Index in vocally healthy women., Study Design: Experimental study., Setting: Otolaryngology clinic within tertiary hospital., Subjects and Methods: Twenty-five vocally healthy women between 19 and 58 years (mean 38.4) were assessed before and after 3 minutes of standardized lip trill training combined with defined voice fundamental frequency and intensity modulations. Main outcome measures were fundamental frequency (F 0 ) during counting (F 0 counting), the singing voice range profile parameters minimum, maximum and range of F 0 and voice sound pressure level (voice SPL), jitter (%), maximum phonation time (MPT), and the Dysphonia Severity Index (DSI). Wilcoxon signed rank test was applied to determine significant changes after exercise., Results: After exercise the singing F 0 and SPL range significantly increased from 549 (SD 217) to 612 (238) Hz and 45.1 (10.1) to 47.3 (9.8) dBA, resepctively (P<0.05). Maximum voice SPL significantly increased from 90.9 (10.3) to 94 (9.7) dBA (P<0.05). Mean F 0 during counting showed a highly significant increase from 198 (SD 25.6) to 209 Hz (SD 25.4, P<0.01). No significant changes were found for all other parameters., Conclusions: In vocally healthy women, lip trill training immediately facilitates increases in mean F 0 during counting, and singing F 0 and SPL range. Future studies should investigate, if changes to these parameters indicate immediate responsiveness to voice exercise also in voice patients, and if these findings transfer to long-term effects through prolonged training., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose Smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR) are acoustic measures related to the periodicity, harmonicity, and noise components of an acoustic signal. To date, there is little evidence about the advantages of CPPS over HNR in voice diagnostics. Recent studies indicate that voice fundamental frequency (F0) and intensity (sound pressure level [SPL]), sample duration (DUR), vowel context (speech vs. sustained phonation), and syllable stress (SS) may influence CPPS and HNR results. The scope of this work was to investigate the effects of voice F0 and SPL, DUR, SS, and token on CPPS and HNR in dysphonic voices. Method In this retrospective study, 27 Brazilian Portuguese speakers with voice disorders were investigated. Recordings of sustained vowels (SVs) /a:/ and manually extracted vowels (EVs) /a/ from Consensus Auditory-Perceptual Evaluation of Voice sentences were acoustically analyzed with the Praat program. Results There was a highly significant effect of F0, SPL, and DUR on both CPPS and HNR ( p < .001), whereas SS and vowel context significantly affected CPPS only ( p < .05). Higher SPL, F0, and lower DUR were related to higher CPPS and HNR. SVs moderately-to-highly correlated with EVs for CPPS, whereas HNR had few and moderate correlations. In addition, CPPS and HNR highly correlated in SVs and seven EVs ( p < .05). Conclusion Speaking prosodic variations of F0, SPL, and DUR influenced both CPPS and HNR measures and led to acoustic differences between sustained and excised vowels, especially in CPPS. Vowel context, prosodic factors, and token type should be controlled for in clinical acoustic voice assessment.

Objective: Neck muscle dysfunction has been considered as risk factor or consequence of voice disorders. This study investigates the correlation between neck and voice-related subjective symptoms in patients with voice disorders., Study Design: Retrospective case-control study., Methods: 100 adult patients (59 female and 41 male) over 18 years with a mean age of 50.01 years (SD 16, range 24-87), of which 68 were under 60 years, were included. 50 patients had organic voice pathologies and 50 functional dysphonia. Outcome measures were the Voice Handicap Index 9 international (VHI-9i) and the Neck Disability Index (NDI-G). Spearman rank order coefficient was applied to determine the correlation between overall and single item VHI and NDI results. Subanalyses were done for functional vs. organic disorder, gender and age ± 60 years., Results: Mean overall VHI-9i (13.93, SD = 7.81, range = 0-31) and mean NDI-G (6.07, SD = 7.71, range = 0-43) showed a significant mild correlation (r s  = 0.220, P = 0.02). Split into subgroups the relation was stronger in patients with organic pathologies (r s  = 0.297, P = 0.03), but not significant in functional disorders (r = 0.148, P = 0.30). There was a moderate relation in men (r s  = 0.317, P = 0.04). Single item correlation was highest between VHI-9i item P4 (physiological) and NDI-G item reading (cognitive functioning) (r s  = 0.480, P = 0.002)., Conclusion: Specifically patients with organic voice disorders showed increased voice symptoms with the presence of neck dysfunction. This indicates a risk for a functional imbalance of the muscles surrounding the larynx, which in extreme cases may hinder functional voice rehabilitation even after phonosurgery. Therefore, neck dysfunction should be considered in voice diagnostics., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In clinical routine, vocal fatigue is a common symptom in patients with dysphonia., Objective: The aim of this study was to conduct a transcultural translation of the Vocal Fatigue Index (VFI), a standardized subjective questionnaire. Furthermore, pretesting and prevalidation were performed in 20 subjects, with comparison to the Voice Handicap Index (VHI‑9i) and the Vocal Tract Discomfort Scale (VTD)., Materials and Methods: The translation, content review, and pretest of the German Vocal Fatigue Index (VFI-D) was divided into four sections: 1. transcultural translation, 2. expert voting on comprehensibility, 3. test of comprehensibility through cognitive interviews in 15 participants, 4. pretest of the VFI‑D with cross validation compared to VHI‑9i and VTD in 20 subjects. This process corresponds to current standards for transcultural translation and adaptation of questionnaires., Results: According to expert voting and cognitive testing, the VFI‑D is correct and comprehensible (intercoder reliability κ = 0.66). The factor analysis revealed three distinguishable parts: VFI‑D part 1 correlates strongly with VHI‑9i and VTD, VFI‑D part 2 with VTD only (rho ≈ 0.800 each), and VFI‑D part 3 correlates only weakly with VHI‑9i and VTD (rho ≈ 0.585). Thus, convergence and divergence validity are proven., Conclusion: The first German version of the VFI‑D might be a base for further research on symptoms, causes, and treatment options in vocal fatigue. Particularly patients in voice-intensive professions may benefit.

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 (f o ) and intensity (SPL (dBA)); maximum SPL and mean f o of calling voice; minimum, maximum, range of singing voice f o 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 f o range (7-8.13 semitones) and SPL range (12.9-14.85 dB(A)) were significantly larger (P < 0.05). Both parameters were highly correlated (P < 0.001). Subjective symptoms were significantly reduced from a mean Voice Handicap Index-9 international of 15.6-8.6, and all perceptual Grading-Roughness-Breathiness-Asthenia-Strain scale parameters were significantly improved (G: 1.05-0.51) after therapy (P < 0.05). These findings were not associated with any acoustic parameter (P > 0.05)., Conclusions: Significantly improved subjective and perceptual findings verify positive combined voice therapy effects in patients with functional dysphonia. The larger f o 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., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status., Study Design: This is a matched case-control study., Methods: We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests., Results: In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR., Conclusions: The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Current pediatric voice assessment guidelines include instrumental measurements of fundamental frequency (F0) and the perturbation indices jitter and shimmer. In children below 10 years, gender, age, height and weight effects on these parameters have been inconsistently characterized. Recent research in healthy children showed, that differences in habitual speaking voice intensity (voice SPL) under the usual assessment procedure significantly affect jitter and shimmer. These effects were reduced in phonations with controlled voice SPL >80dBA. Reliable measurement methods and description of physiologic influencing factors are essential to identify pathologic voices., Objective: This cross-sectional single cohort study investigates in children between 5;0 and 9;11 years how gender, age, height and weight affect voice F0, jitter and shimmer in phonations at individually "medium" voice intensity (modeling the usual clinical practice) and with controlled voice SPL >80dBA., Subjects and Methods: 68 vocally healthy children (39 f/29 m) aged 5;0-9;11 years provided 3 prolonged phonations of/a/at individually "medium" and controlled voice intensity at ">80dBA" (visual feedback, 10cm distance). F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were determined with PRAAT. Gender, age, height and weight effects without and with controlled voice SPL were assessed by descriptive statistics, Analysis of Variance and Linear Mixed Models., Results: F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were significantly different in medium voice compared to >80dBA (p<0.01). In medium phonations girls had a higher F0 than boys (girls: 276.7(50.7), boys: 261.5(33.7)), but with >80dBA this difference was only minimal (girls: 328.9(52.2), boys 327.9(51.2)). Mean jitter (0.27(0.10)) and shimmer (4.34(1.68)) were smaller and showed less spread (jitter: 0.5(0.26); shimmer: 9.47(3.47)) with >80dBA. Gender, age, height and weight had no significant effects on F0, jitter, shimmer and voice SPL in both phonation types (p-range=0.42-0.99)., Conclusions: Neither without nor with controlled voice SPL there were systematic gender, age, height or weight effects on voice F0, jitter and shimmer. Gender related F0 discrepancies were equalized in phonations with >80dBA. In children below 10 years gender related acoustic voice differences may be mainly linked to behavior, which should be considered in future works regarding physiologic voice development., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Current voice assessment recommendations for dysphonic children comprise instrumental acoustic measurements of the perturbation parameters jitter and shimmer. In healthy adults and children changes in speaking voice sound pressure level (voice SPL) have significant confounding effects on both parameters. In adults these effects were considerably reduced in phonations with controlled voice SPL >80dBA (10cm distance). However, it is unclear if these findings apply to children and if children are able to control for their own voice intensity., Objective: This cross-sectional single cohort study investigates voice SPL effects on jitter and shimmer in children between 5;0 and 9;11 years phonating at individually "medium" (modeling "comfortable" loudness of the usual clinical protocol), "soft" and "loud" voice and a prescribed intensity level of ">80dBA" (10cm distance, with visual control). Further both their ability to phonate at a prescribed voice intensity level and the effect on SPL related confounding effects were studied., Subjects and Methods: A total of 68 healthy children (39 f/29m) aged 5;0 to 9;11 years were included. All phonated the vowel/a/for 5s, three times at four defined voice intensity levels (soft/medium/loud/>80dBA) each. Jitter (%), shimmer (%) and voice SPL (dBA) were determined using PRAAT. Voice intensity level effects were assessed by descriptive statistics, Analysis of Variance (ANOVA) and Linear Mixed Models (LMM)., Results: There were significant differences for jitter and shimmer between all voice tasks (p<.01). Jitter and shimmer were lowest and showed the smallest spread in controlled phonations ">80dBA". 19 children below 7;0 years could not perform the voice tasks and were excluded from the study., Conclusions: This practical study demonstrated a significant effect of voice loudness and task on jitter and shimmer in children. Since the observed confounding effects were large compared to treatment effects, jitter and shimmer may not be meaningful without adequate control of voice SPL. In phonations at ">80dBA" (10cm distance) voice SPL related effects were considerably reduced. However, this assessment protocol was suitable only for children above 7;0 years. Application of this task to future studies of dysphonic children may yield clinically valuable information., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: The X-linked McLeod syndrome belongs to the group of neuroacanthocytosis syndromes and has a Huntington-disease-like phenotype with a choreatic movement disorder, cognitive alterations, and psychiatric symptoms. Another neuroacanthocytosis syndrome, the autosomal recessive chorea-acanthocytosis, has a similar presentation, but distinct clinical features, believed to be characteristic, such as tongue protrusion dystonia, feeding dystonia, and rubber-man-like appearance., Methods: This work comprised a case series of 3 patients with McLeod syndrome., Results: The 3 patients with McLeod syndrome developed severe feeding dystonia and tongue protrusion as well as rubber-man-like appearance in 1 patient during the course of the disease., Conclusion: These observations indicate that there is an extended phenotypic overlap between McLeod syndrome and chorea-acanthocytosis., (Copyright © 2011 Movement Disorder Society.)

Background: Though one of the most important investigations in paediatric audiology, brainstem evoked response audiometry (BERA) often necessitates sedation or general anaesthetics, especially in newborn and infants. In paediatric neurology, melatonin has been successfully used for some years to induce sleep prior to EEG investigations. Melatonin as a hormone regulating the circadian rhythm induces natural sleep without the risks of sedation. Side effects are not known., Methods: Click-induced BERA was first performed in 10 adults with normal hearing with and without previous melatonin administration, and click thresholds and latencies of evoked potentials were compared. 50 children then underwent BERA in melatonin-induced sleep., Results: Click thresholds in adults were mostly identical (r = 0,88), while the mean latencies of evoked potentials seemed to be minimally prolonged (r from 0,82 to 0,95). Click-induced BERA was successful in 45 of the 50 children, and notched-noise BERA in at least 2 frequencies in 38 of 43 children., Conclusions: Offering a high success rate with no side effects, melatonin-induced sleep seems to be a good alternative to sedation. This method is widely accepted by parents and permits earlier diagnosis of hearing impairment in the routine clinical setting.

Thin section arrays of 20 head and neck squamous cell carcinomas were studied by I-FISH for gains (including amplification) and losses of specific genomic segments. These arrays allow the examination not only of a number of tumor sections but also of the surrounding margins and of inconspicuous control tissue in one experiment. All tumor sections examined significantly differed from the inconspicuous control tissues by containing more or less extensive cell populations with aberrant signal constitutions. In no case, however, did the aberrant population constitute the whole area of the section. Gains of signals were strikingly more frequent than were losses. All tumors showed significant gains of the segments examined, the highest differences between tumor and control sections were found for the segments 9q34 and 8q24, followed by 5p15.3 and 11q13. Amplifications were most frequently found of 11q13: 8 of the 20 tumors showed amplifications in more than 20% of the nuclei, while no nucleus with more than four signals was found in any of the control tissues (control: 0%). Amplifications of the target sequences on chromosomes 8 (14 tumors) and 9 (8 tumors) were observed in low but significant percentages of nuclei, no significant cell population was detected with an amplification of 5p15.3. Fourteen tumors exhibited a significant loss of 13q14, and only 8 tumors a significant loss at any other site. In the tumor margin sections, in most cases, the margins apparently were also affected by the one or the other of the genomic changes of the pertinent primary tumor. Nevertheless, there were, in some cases, also large differences depending on the way of analysis, but also on the specific signal constitution considered. Tumor stages T3 and T4 tended to have higher frequency of nuclei with gains of 5p15.3, 8q24, and 11q13 as compared to T2 tumors and less gains of 9q34 and loss of 13q14. With the exception of 8q24 and 13q14 alterations there was also a trend to higher percentages of aberrant nuclei in the margin of T3-4 tumors vs. T2 tumors.

Multiple chromosomal aberrations have been reported in head and neck squamous cell carcinoma (HNSCC). But less information is available on specific patterns of chromosomal amplifications which distinguish different areas of head and neck tumors. To elucidate genetic mechanisms causing the aggressive growth and high proliferation of hypopharyngeal squamous cell carcinoma (SCC), we performed reverse chromosome painting (RCP) on a total of eight hypopharyngeal SCC including invasive carcinoma and preinvasive tissue. Five hypopharyngeal invasive carcinomas showed amplifications on chromosome 3q. Furthermore, we detected gains on chromosomes 11q and 6p. Compared to the histologically classified preinvasive tissues, we found amplified alterations on chromosome 6p, 11q and 12q, but none of them showed gains on chromosome 3q. This observed heterogeneity in hypopharyngeal SCC might reflect a specific role of chromosome 3q as a late event in the highly invasive capacity of these SCC.

The clinical use of distortion product otoacoustic emissions (DPOAE) stems from the observation that the outer hair cells are the most vulnerable part of the cochlea, and damage to these cells is associated with hearing loss and loss of DPOAE. The purpose of this study is to evaluate the applicability of DPOAE in predicting hearing thresholds under clinical conditions. DPOAE measurements (L1 = L2 = 70 dB SPL. f2/f1 = 1.20) of 219 hearing-impaired and normal hearing ears were analyzed. Recordings were acquired for DPOAE at 2 f1-f2 varying from 635 to 4052 Hz. The detectability of DPOAE in hearing-impaired subjects exhibited a strong hearing threshold dependence. Receiver operating characteristic (ROC) analysis yielded the highest sensitivity and specificity for threshold levels of about 30 dB at low frequencies and for threshold levels of about 60 dB at high frequencies. In addition, the separability of groups with different hearing status was more reliable at high frequencies as compared to low frequencies. The DPOAE provide an objective assessment of cochlear function. However, prognosis of hearing thresholds on the basis of DPOAE measurements depends strongly on the test frequency and is associated with large errors. Hence, the clinical use of DPOAE in predicting hearing thresholds is limited.