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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.

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.

SIn a recent survey study it was found that female army instructors were significantly more likely to suffer from symptoms of vocal attrition than new female recruits, supporting the clinical impression that those who are engaged in a vocally taxing vocation are at higher risk for vocal attrition than those who are not. In the present study we found that instructors who reported having rapid, excessive or loud speech, or a combination of these, were significantly more likely to report symptoms of vocal attrition than instructors who reported not having these speech habits. Difference in prevalence of vocal attrition symptoms among recruits with and without these speech habits was statistically non-significant. The present findings confirm the clinical impression that idiosyncratic dysphonia can increase the risk of vocal attrition, especially in people who are engaged in a vocally demanding profession or vocation.Les resultats d'une enquete slatistique recente avaient permis de conclure que les in...

Objective: Up to 40 000 dysphonic patients are referred for Speech and Language Therapy (SALT) annually in the UK.1[1 WIlson J.A., DEary I.J., SCott S. & MAcKEnzie K. (1995) Functional dysphonia. ] The referring otolaryngologist typically categorises the patient as functional/organic. The aim of this study was to assess the validity of that distinction. Method: One hundred and forty-seven dysphonic patients participated in the study. The patients were diagnosed as functional or organic at first medical examination. Subsequently independent socio-demographic, psychological (personality and psychological distress), and voice assessments were made. Results: Functional patients were significantly older than organic (P

For many years, laryngologists have described patterns of muscle misuse, notably hyperfunctional, as characteristic of functional dysphonia (FD), but all in uncontrolled, unblinded descriptive reports. This study aimed to compare the prevalence of traditional ‘hyperfunction features’ in FD patients and healthy volunteers. Methods: Forty consecutive patients with FD (17–75 years old; M : F = 14 : 26) and 25 hospital staff (26–69 years old; M : F = 8 : 17) underwent fibreoptic videolaryngoscopy and completed the Hospital Anxiety and Depression Questionnaire (HAD) and an inventory of previously unexplained physical symptoms (DSM-IIIR). Videotape copies of randomly ordered FD/control subjects, which had the sound deleted, were independently rated by a senior otolaryngologist and senior speech pathologist, blind to subject group, on: (1) six Van Lawrence features of vocal hyperfunction;1 (2) five Morrison and Rammage classes of muscle misuse;2 and (3) a ‘normal’/‘abnormal’ overall descriptor. Results: There was mild elevation of HAD anxiety and significantly higher somatization scores (P = 0.001) in FD. 1. Both assessors described an almost identical prevalence of Van Lawrence hyperfunction features in both normals and FD patients. 2. Morrison and Rammage: the common lateral (Type II) and anteroposterior supraglottic (Type III) hyperfunction patterns were noted in around half of the controls by both assessors. The ‘laryngeal isometric’ posture (Type I) was noted more often in patients (42%) than controls (20%, P = 0.02, χ2) by the speech pathologist. The rare ‘conversion aphonia’ and ‘psychogenic bowing’ patterns were noted almost exclusively in the patients. 3. Overall the speech pathologist classed 11 volunteers (44%) as abnormal, the otolaryngologist 15 (60%). Conclusion: The results show most ‘hyperfunction’ features are equally common in controls and patients with FD. The patients have diverse unexplained physical symptoms. Previous uncontrolled reports appear to have overinterpreted the significance of laryngeal hyperfunction features.

The hyperventilation syndrome and its clinical symptoms are presented. A project aimed at discovering whether hyperventilators were to be found among patients diagnosed as suffering from functional dysphonia and attending a speech therapy clinic is described. The existence of hyperventilators among this non-random sample of patients was verified. Case histories illustrate the clinical symptoms which identify the hyperventilator. Adaptation of relaxation and breathing therapy to the special needs of such patients is discussed.