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Objectives: To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR)., Methods: Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements., Results: From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients., Conclusion: Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients., Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis., Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough., Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Acoustic parameters are widely used as voice quality therapeutic outcomes in many laryngological diseases. The aim of this study is to explore the impact of changes in the nature and duration of the analyzed time interval and the vowel choice on the significance of the acoustic measurements used as therapeutic outcomes in two different diseases., Study Design: A prospective case series., Material and Methods: From September 2013 to January 2018, patients with laryngopharyngeal reflux (LPR) disease were recruited and treated with pantoprazole, diet, and behavioral changes for 3 months. The reflux symptom index and reflux finding score were used for both diagnosis and assessment of treatment effectiveness. Simultaneously, patients with early idiopathic Parkinson's disease (IPD) were enrolled and benefited from a levodopa challenge test. An Iowa Oral Performance Instrument was used for objective outcomes in the assessment of levodopa effectiveness on muscular strength of IPD patients. Acoustic measurements were performed in both groups pre- and postmedication intake at different time intervals, including the "most stable" time intervals of 1 second, 2 seconds, 3 seconds, 4 seconds, and 5 seconds and a 1 second-time interval positioned at mid-production. We also measured acoustic parameters on the entire signal of three vowels and on the signal of each vowel being taken separately., Results: A total of 80 LPR and 19 IPD patients met our inclusion criteria and completed the study protocol. LPR and IPD patients had significant clinical improvements throughout treatment, according to reflux symptom index, reflux finding score, and Iowa Oral Performance Instrument scores. The acoustic analysis revealed that acoustic parameters significantly improved from pre- to post-treatment and varied across methods used for measurement. The duration and position of the analyzed time interval in the production and the vowel on which the acoustic measures were made yielded considerable differences in the results., Conclusion: Depending on the time interval over which the acoustic parameters are measured, the clinically demonstrated effect of the medication may or may not be statistically demonstrated irrespective of the disease. According to the results of this study and regarding the lack of standardization of acoustic measurement methods, a line of thought is proposed to bypass the interval selection problem., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease., Material and Methods: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted., Results: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations., Conclusion: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR)., Material and Methods: Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted., Results: Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters., Conclusion: Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Sixty to 90% of patients with idiopathic Parkinson disease (IPD) developed early dysphonia and subtle speech impairment, which is usually related to orofacial muscular dysfunctions. The aim of this preliminary study is to assess the usefulness of voice quality and orofacial strength (involved in speech) as outcome of levodopa challenge test used for the IPD diagnosis., Material and Methods: A total of 20 patients with early IPD were recruited and evaluated for clinical findings (Hoehn and Yahr scale), voice handicap index, maximal phonation time, phonation quotient, percent jitter, percent shimmer, noise-to-harmonic ratio, and orofacial muscular strength (Iowa Oral Performance Instrument) at baseline, throughout the levodopa challenge test and after therapeutic stabilization., Results: The intake of a standardized dose of levodopa (levodopa challenge test) significantly improved phonation quotient and percent shimmer. We did not find similar improvement after medical stabilization of patients (based on levodopa medication) despite an improvement of Hoehn and Yahr mean score. The intake of levodopa significantly improved cheeks and lips strength involved in speech quality both along the challenge test and after the therapeutic stabilization., Conclusions: These preliminary findings support a differential impact of levodopa on voice and speech functions in early diagnosed IPD and a mismatch between the clinical examination, orofacial strength, and voice quality improvements once the patient is medically stabilized., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The study aimed to investigate the impact of chemoradiotherapy (CRT) on speech and voice quality according to the anatomic localization of the head and neck cancer., Methods: Thirty-four patients treated by CRT for advanced suprahyoid (N = 17) or infrahyoid (N = 17) cancer were assessed for speech function, videolaryngostroboscopy, Voice Handicap Index, blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability, acoustic measurements, and aerodynamic measurements. Quality of life was evaluated using the European Organization for Research and Treatment of Cancer Head and Neck 35 (EORTC QLQ-H&N35) questionnaire., Results: Patients treated for an infrahyoid tumor presented more severe values of Voice Handicap Index items, dysphonia, breathiness, asthenia, and some acoustic cues (Voice Turbulence Index, Soft Phonation Index, degree of unvoiced segments, and number of unvoiced segments) than patients treated for a suprahyoid tumor. The EORTC QLQ-H&N35 communication item was better in the suprahyoid patient group., Conclusions: Voice quality impairments associated with CRT are more severe in patients treated for advanced infrahyoid cancer, suggesting the need to develop specific posttherapy management of the dysphonia according to the tumor anatomical localization., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this paper is to shed light on the pathogenesis and pathophysiological mechanisms underlying the development of hoarseness related to laryngopharyngeal reflux disease (LPRD)., Material and Methods: PubMed, Embase, and The Cochrane Library were searched for the terms reflux, laryngopharyngeal, laryngitis, voice, and hoarseness. Experimental and clinical studies providing substantial information about the occurrence of voice disorders, laryngeal histologic changes, or any pathophysiological processes related to LPRD were included by two independent investigators., Results: Of the 104 studies reviewed, 47 studies that met our inclusion criteria were analyzed. LPRD leads to significant macroscopic and microscopic histopathologic changes in the mucosa of the vibratory margin of the vocal folds. More and more studies suspect that epithelial cell dehiscence, microtraumas, inflammatory infiltrates, Reinke space dryness, mucosal drying, and epithelial thickening are probably responsible for the hoarseness related to reflux and the impairment of the subjective and objective voice quality evaluations., Conclusion: Future clinical studies examining the pathophysiology of hoarseness related to LPRD should take into consideration all potential mechanisms involved in the development of hoarseness., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To develop a French version of the Reflux Symptom Index (Fr-RSI) and to assess its internal consistency, reliability, and clinical validity., Study Design: Controlled, prospective trial., Materials and Methods: Forty-four patients with a reflux finding score > 7 and an Fr-RSI > 13 were enrolled and treated with 20 mg of pantoprazole twice daily and diet changes for 3 months. Ninety asymptomatic subjects were also included in the study. To assess reliability, Fr-RSI was completed twice within a 7-day period. Validity was assessed by comparing Fr-RSI scores with scores from the Voice Handicap Index (VHI) in 24 of 44 patients, at baseline and at 3 months posttherapy., Results: The mean values of Fr-RSI at baseline and after 7 days were 20.17 ± 5.76 and 19.75 ± 7.08, respectively, for patients with laryngopharyngeal reflux (LPR) and 4.02 ± 3.49 and 3.71 ± 3.82, respectively, for controls. The test-retest reliability was high in patients with LPR (r BP  = 0.78) and in healthy subjects (r BP  = 0.80). Cronbach's alpha was 0.85, indicating high internal consistency. The mean Fr-RSI score significantly improved from a baseline of 20.17 ± 5.76 to 5.58 ± 3.65 after 3 months of treatment (P = 0.001), and the initial mean VHI total score significantly improved from 20.29 ± 19.62 to 12.87 ± 12.04 after treatment (P = 0.029), indicating validity of the results. However, of the subcategories of the VHI, only the mean physical score improved from a baseline of 11.19 ± 9.22 to 7.35 ± 5.96 after treatment (P = 0.016)., Conclusion: The Fr-RSI developed in this study demonstrated both reliability and validity. It can be easily administered to assist in diagnosing and monitoring of LPR in French-speaking patients., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The study aimed to explore the impact of the selection of the analyzed time interval on the significance of acoustic measurements used to investigate laryngopharyngeal reflux (LPR) treatment efficacy, and based on these results to develop an alternative statistical approach in data analysis focusing on individual patient vocal behavior., Study Design: This is a prospective case series., Methods: From September 2013 to July 2015, 41 patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for 3 months. Voice recordings were performed at baseline and after 3 months of treatment. Most stable time intervals of 1, 2, 3, 4, and 5 seconds, and a 1-second time interval positioned at mid-production, were subjected to acoustic analysis. Based on the latter, we developed an "informativeness coefficient" for each acoustic parameter that aimed at assessing its sensitivity to clinical resolution in the case of LPR disease., Results: Significant clinical improvement (RSI and RFS) was observed after treatment (P < 0.05). The acoustic analysis revealed that acoustic parameters significantly improving from pre- to posttreatment varied across time intervals. The duration and the position of the analyzed time interval in the production yielded considerable differences in the results. Analysis of the informativeness coefficient indicated that jitter, jitter percent, relative average perturbation (RAP), pitch perturbation quotient (PPQ), shimmer (ShdB), shimmer percent (Shim), amplitude perturbation quotient (APQ), and smoothed amplitude perturbation quotient (sAPQ) were the indices most sensitive to medical treatment efficacy, with a coefficient ranging from 75.86% to 86.21%., Conclusions: Depending on the selection of the time interval over which the acoustic parameters are measured, the potential effect of the treatment may or may not be statistically demonstrated. Future studies are needed to establish standardized methodological procedures for acoustic data analysis., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

In this study are reported the laryngeal and vocal results obtained after a microflap excision of benign vocal fold (VF) lesions and immediate implantation of esterified hyaluronic acid (EHA) in the surgical wound. In a previous pilot study on 11 cases, we have shown an excellent tolerance of this bioimplant. The objectives are to confirm the innocuity of the technique, to demonstrate the laryngeal and vocal evolution at short and long term, and to evaluate the eventual positive impact of EHA implantation on the pliability of the superficial layer of the lamina propria (SLLP) and on voice. This is a prospective and comparative study on 83 patients suffering from various benign VF lesions. Thirty-three patients were implanted with EHA, whereas 50 patients did not undergo implantation at the end of the microsurgical procedure. All patients undergo rigid laryngoscopy and microflap excision procedure under general anesthesia. After freeing up of the Reinke's space and creation of a mucosal microflap, a few fibers of EHA are inserted in the surgical wound, before closure of the incision with fibrin glue. Serial laryngeal and vocal assessments are performed in all patients using videostroboscopy (Wolff and Xion), perceptual and objective voice evaluation (MDVP software, Kay Elemetrics), and phonatory function measurements (Aerophone II). Pre- and early postoperative means are compared by analysis of variance. Delayed and long-term evolution of laryngeal and vocal data are compared by means of nonparametric statistical methods. The longest follow-up in the implanted group is 4 years. Early postoperative results are similar in both groups: a significant improvement of a majority of laryngeal and vocal data is observed after microsurgery. In the long term, the two groups exhibit a different behavior: further improvement of voice, as an ongoing process, is only observed in the EHA implanted group, together with improvement of some videostroboscopic characteristics. The nonimplanted group remains stable, with no further improvement of the voice quality obtained after microsurgery. Excellent short- and long-term tolerance of EHA implantation is confirmed by this larger series. The use of EHA implant in microdissected SLLP is safe and leads to good laryngeal and vocal outcomes in the treated patients. More interestingly, treated cases exhibit a continuous improvement over a long period of time., (2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)