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An urgent task of otorhinolaryngology (phoniatry) is the diagnosis and treatment of disorders of voice function in voice professionals or persons of voice-speech professions. An undiagnosed laryngeal disease worsens the quality of life of patients, creates difficulties in communication and can even lead to professional unfitness, because the patient does not withstand the necessary vocal load. The leading role in the modern diagnosis of laryngeal diseases belongs to endoscopic research methods video endoscopy and video endostroboscopy. All disorders of voice function are classified as functional and organic. Recent studies have shown that from 30.5 to 40% of voice professionals who have applied for phoniatric care suffer from functional disorders. Functional changes are understood to mean changes in which laryngoscopic examination does not always reveal any visible pathology. But with the help of special research methods, such as stroboscopy (videostroboscopy), spectral analysis of the voice, pathognomonic changes can be determined, and the patient presents characteristic complaints. More often than others, hypotonic and hypo-hypertonic dysphonia are diagnosed. Organic laryngeal diseases are characteristic of 69.5% of patients with dysphonia. They are represented by various nosological forms. Certain difficulties arise in the diagnosis of professional laryngitis and vascular pathology of the larynx. The lecture presents pathognomonic clinical changes of the larynx in voice professionals, knowledge of which is necessary for practical doctors to make a diagnosis.

Objective: Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. Materials and Methods: In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. Results: The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P<0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. Conclusion: Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value. [ABSTRACT FROM AUTHOR]

Studies show that functional dysphonia among teachers can lead to emotional stress, high rates of sickness and negative effects on their students' learning success. The study's aim was to examine the effects of using a silicone tube on both subjective and receptive voice assessment. The study had a pre-/post-test design and involved 36 primary school teachers. They performed daily vocal exercises with a flexible silicone tube for 6 minutes. The participants filled out the Voice Handicap Index (VHI) for subjective voice assessment and the RBH scale was used for receptive voice assessment. The results showed a significant improvement in the VHI results and the number of handicaps sank by 25 %. The scale value of the RBH scale improved in general. Based on the results, the exercises are suitable for daily use and could assist in preventing functional dysphonia among teachers. Further studies should look at objective acoustic changes in the voice and consider long-term effects. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to evaluate the efficacy and safety of lysozyme-based oral antiseptic in the therapy of non-infectious sore throat in teachers. Materials and Methods. A non-interventional, prospective, pilot study was conducted with two examinations. The first was performed as part of a general medical examination. If a non-infectious sore throat was confirmed by clinical checkup and all other inclusion and non-exclusion criteria confirmed, patients were offered to be enrolled in the study. After signing the informed consent form, patients were advised to use lysozyme-based lozenges, six times a day, for a period of five days. A telephone call follow-up examination was performed within 24 hours from the therapy completion. Results. This was a pilot study involving 25 adult patients of both genders. Lysozyme-based lozenges showed positive effects in relieving the symptoms of non-infectious sore throat in teachers. At the same time, the lozenges showed excellent tolerability, and no side effects were reported during the study. 92% of patients confirmed they would take the same medicine again due to the same problem. Conclusion. The results of this "proof-of-concept" study indicated that lysozyme-based antiseptic could be effective and safe in the treatment of non-infectious sore throat in teachers and should be further evaluated as treatment option in this condition. [ABSTRACT FROM AUTHOR]

Practitioners in the field of voice are often faced with patients who are 'dysphonic', but who do not have identifiable abnormalities of the vocal tract structures or any neural or hormonal alteration affecting the phonatory function. For lack of better nomenclature describing the origin of the disorder, this group of patients has been labeled as having 'non-organic' or 'functional' dysphonia. 'Non-organic' only states what the dysphonia is not, and 'functional' does not have any etiological implication. Hence 'functional disorder' as a determination of the origin is at best vague, imprecise and often misleading. In truth, the terms "functional" and 'non-organic' are by now so muddled and confused in everyday clinical usage and parlance that it is unclear what they mean in any given clinical setting or for any particular clinical case. Thus, the UEP Voice Committee (VC) has come to the conclusion that it is best to adopt a new term that is clearly defined, universally agreed to, and indicative of a different and more useful perspective. We have reviewed the literature relating to terminology of these phonatory disorders. We now propose replacement of the phrase 'functional dysphonia' with 'malregulative dysphonia', since the indication of faulty regulation represents an etiological connotation. We also propose a restructuring of the etiological terminology of phonation disorders. We believe this to be a biologically clearer framework for the labeling of 'non-organic' phonatory disorders, and hope that its routine use will allow for more clarity of presentation and discussion in the future. [ABSTRACT FROM AUTHOR]

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.

Objectives: Functional dysphonia (FD) is one of the possible presentations of chronic dysphonia. Defined as dysphonia without gross abnormality of the larynx, FD manifests as aberrant muscle contractions resulting in mild‐to‐severe dysphonia. Despite increasing clinical awareness, diagnosis, and treatment strategies for FD remain challenging. Study Design: Institutional review board. Methods: A retrospective review of videostroboscopic examinations and EMR data from 109 patients treated for FD was performed. Videostroboscopy was analyzed by two independent reviewers and classified by laryngeal posturing and observer‐rated quality of voice. Medical records were reviewed and patient characteristics, history of disease, and survey responses were collected. Statistics were calculated using JMP and SAS packages. Results: A total of 85.1% of subjects were female and the average voice handicap index (VHI30) score was 71.0/120. Average time to diagnosis of FD was 688 days and average time from diagnosis to treatment was 3.7 days. 44.0% of patients exhibited hyperadducted laryngeal posturing, 31.9% hypoadducted, and 24.2% showed a mixed posture. 98% of patient voices improved after treatment. 85% returned to normal voice and 10% maintained a mild residual dysphonia. Conclusion: We describe here a large cohort of patients affected by FD, including clinical presentation and videostroboscopic findings. Our data show that most individuals with FD improve after specialized voice therapy once correctly diagnosed but that correct diagnosis and proper treatment was often significantly delayed. Level of Evidence: 4—Case‐series Laryngoscope, 131:E1957–E1964, 2021 [ABSTRACT FROM AUTHOR]

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.

Abstract Background Medically unexplained loss or alteration of voice—functional dysphonia—is the commonest presentation to speech and language therapists (SLTs). Besides the impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aims of this research were the systematic development of a complex intervention to improve the treatment of functional dysphonia, and the trialling of this intervention for feasibility and acceptability to SLTs and patients in a randomised pilot study Methods A theoretical model of medically unexplained symptoms (MUS) was elaborated through literature review and synthesis. This was initially applied as an assessment format in a series of patient interviews. Data from this stage and a small consecutive cohort study were used to design and refine a brief cognitive behavioural therapy (CBT) training intervention for a SLT. This was then implemented in an external pilot patient randomised trial where one SLT delivered standard voice therapy or voice therapy plus CBT to 74 patients. The primary outcomes were of the acceptability of the intervention to patients and the SLT, and the feasibility of changing the SLT’s clinical practice through a brief training. This was measured through monitoring treatment flow and through structured analysis of the content of intervention for treatment fidelity and inter-treatment contamination. Results As measured by treatment flow, the intervention was as acceptable as standard voice therapy to patients. Analysis of treatment content showed that the SLT was able to conduct a complex CBT formulation and deliver novel treatment strategies for fatigue, sleep, anxiety and depression in the majority of patients. On pre-post measures of voice and quality of life, patients in both treatment arms improved. Conclusion These interventions were acceptable to patients. Emotional and psychosocial issues presented routinely in the study patient group and CBT techniques were used, deliberately and inadvertently, in both treatment arms. This CBT “contamination” of the voice therapy only arm reflects the chief limitation of the study: one therapist delivered both treatments. Trial registration Registered with the ISRCTN under the title: Training a Speech and Language Therapist in Cognitive Behavioural Therapy to treat Functional Dysphonia - A Randomised Controlled Trial. Trial Identifier: ISRCTN20582523 Registered 19/05/2010; retrospectively registered. http://www.isrctn.com/ISRCTN20582523

Objectives/hypothesis: Respiratory laryngeal dystonia (RLD) is poorly understood and rarely reported in the literature. Patients have atypical laryngeal movement resulting in airway obstruction. This motion is neurogenic in nature, is constant while awake, nonepisodic, and non-trigger dependent. Given its rarity, it is often misdiagnosed for inducible laryngeal obstruction; however, it is refractory to medical and behavioral management. Although this condition has been addressed in the literature, this report is the largest case series characterizing presenting symptomology, multimodal treatment outcomes, and longitudinal course of these patients, and proposes a set of diagnostic criteria to aid in clinical identification of RLD patients. Our objectives were to characterize RLD clinically and offer diagnostic guidelines to clinicians.Study Design: A prospective case series with a retrospective analysis at a tertiary referral center.Methods: A review of clinical records and videostroboscopic analysis of 16 patients treated for respiratory laryngeal dystonia from October 2005 to October 2018 was performed.Results: Sixteen patients with respiratory laryngeal dystonia were included. The common features of this group were persistent, nonepisodic dyspnea and stridor with laryngoscopic evidence of paradoxical vocal fold motion. Our patients had no structural neurologic abnormalities. These patients typically failed respiratory retraining therapy and medical management of laryngeal irritants. In our series, 100% of patients underwent respiratory retraining therapy, 68.8% received laryngeal botulinum toxin injection, and 31.3% required tracheostomy.Conclusions: RLD is a rare and challenging condition. The disorder can be severely disabling, and treatment options appear limited. A multidisciplinary approach may be helpful. Some patients responded to laryngeal botulinum injection and medical management, whereas others required tracheostomy for symptom control. Laryngoscope, 2020. [ABSTRACT FROM AUTHOR]

Der Larynx stellt eine bedeutsame Region für den Schluckvorgang und die Lautbildung dar. Mögliche Indikationen für eine osteopathische Behandlung sind Heiserkeit, Stimmstörungen, ventrale Halsschmerzen, im Weiteren auch laryngeale Krepitationen, Husten, Atemstörungen, Dysphagie, etc. In der Behandlung ist eine enge interdisziplinäre Zusammenarbeit, z. B. mit Logopäden und anderen medizinischen Berufsgruppen wesentlich. In diesem Beitrag werden mögliche Dysfunktionsmuster, Diagnostik, Inspektion, lokale bzw. regionale Tests und Behandlungsansätze dargestellt und diskutiert. Wesentlich ist hier neben medizinischer Differenzialdiagnostik ebenso ein osteopathisch spezifisches, systemisches Vorgehen (s. a. Liem 2020). Darüber hinausgehende globale Untersuchungs- und Behandlungsansätze würden hingegen den Rahmen sprengen und werden im vorliegenden Beitrag nicht diskutiert. The larynx is an important region for swallowing and sound formation. Possible indications for osteopathic treatment are hoarseness, voice disorders, ventral sore throat, and also laryngeal crepitations, coughing, breathing disorders, dysphagia, etc. In the treatment, a close interdisciplinary cooperation is necessary, e.g. with speech therapists and other medical professions. In this article, possible dysfunction patterns, diagnostics, inspection, local or regional tests and treatment approaches are presented and discussed. In addition to medical differential diagnosis, an osteopathically specific, systemic procedure is also essential here. [ABSTRACT FROM AUTHOR]

Introduction: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Functional dysphonia (FD) refers to an abnormality in voice quality in the absence of an identifiable lesion. In this paper, we propose an approach based on the tunable Q wavelet transform (TQWT) to automatically classify two types of FD (hyperfunctional dysphonia and hypofunctional dysphonia) from a healthy voice using the acoustic voice signal. Using TQWT, voice signals were decomposed into sub-bands and the entropy values extracted from the sub-bands were utilized as features for the studied 3-class classification problem. In addition, the Mel-frequency cepstral coefficient (MFCC) and glottal features were extracted from the acoustic voice signal and the estimated glottal source signal, respectively. A convolutional neural network (CNN) classifier was trained separately for the TQWT, MFCC and glottal features. Experiments were conducted using voice signals of 57 healthy speakers and 113 FD patients (72 with hyperfunctional dysphonia and 41 with hypofunctional dysphonia) taken from the VOICED database. These experiments revealed that the TQWT features yielded an absolute improvement of 5.5% and 4.5% compared to the baseline MFCC features and glottal features, respectively. Furthermore, the highest classification accuracy (67.91%) was obtained using the combination of the TQWT and glottal features, which indicates the complementary nature of these features. • Multi-class classification of functional dysphonia using Tunable Q wavelet transform (TQWT)- based features is studied. • The Synthetic Minority Over-Sampling Technique (SMOTE) is used to balance the training data. • TQWT-based features are combined with glottal features to enhance the performance. • The results show that the combination of TQWT-based and glottal features provided best performance in the classification of functional dysphonia. [ABSTRACT FROM AUTHOR]

Klasik iki-aşamalı dental implant konsepti, geçtiğimiz yıllardaki bir çokçalışmada olumlu sonuçlar ortaya koysa da, uzun osseointegrasyonsüresi, randevu sayısının fazla olması, geçici bir tam protez yapımı vebu protezlerin bir çok kez astarlama gerekliliği gibi bazı dezavantajlarıberaberinde getirmektedir. Dental implantların materyal, dizayn veyüzey işlemlerinde ortaya çıkan son dönemdeki yenilikler ve gelişmeler,klinik diş hekimliği için önemli bir konsept olan erken yüklemeprotokolünün ortaya çıkmasına ön ayak olmuştur. Erken yüklemeprotokolünü temel alan birçok yöntemde ortaya çıkan en önemlidezavantaj içerdikleri ölçü alma işlemleri sebebiyle operasyonbölgesinin zarar görebilmesidir. Son dönemde bu problemi ortadankaldırmak amacıyla ölçü alma prosedürlerini içermeyen Ohio StateUniversity (OSU) protokolü geliştirilmiştir. Ancak bu protokolde de,postperatif iyileşme gerçekleşmeden protetik işlemlerin tamamlanmasısebebiyle hastalarda konuşma problemleri baş gösterebilmektedir. Buçalışmada, OSU protokolü temel alınarak erken yükleme konsepti ileyapılan implant destekli bir mandibular hibrit protezde, postoperatifiyileşme sonrasında meydana gelen fonksiyonel konuşma probleminiortadan kaldıran alternatif bir yöntemin sunumu ve bu yöntemsonrasında ortaya çıkan neticenin gösterilmesi amaçlanmaktadır.62 yaşındaki erkek hasta, implant operasyonu sonrası OSU protokolüile oluşturulan alt hibrit protezinden kaynaklanan fonksiyonel konuşmaproblemi şikayeti ile kliniğimize başvurdu. Hastada, postoperatifiyileşme sonrasında protez ile mukoza arasındaki mesafe artışını telafietmek amacıyla akrilik rezin kullanılarak alternatif bir yaklaşımuygulanmaya 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 protokolübaz alınarak erken yükleme konsepti ile ağıza yerleştirilen dentalimplantdestekli hibrit protezlerde ortaya çıkabilecek fonasyonproblemlerinin çözümünde geçerli bir yöntem olabileceğigösterilmektedir. Bu yöntemle hastanın karşı karşıya kaldığıpsikososyal dezavantaj konforlu ve kısa bir sürede kolaylıkla ortadankaldırılmıştır.

Chronic tonsillitis contributes to the functional dysphonia emergence and voice acoustic characteristics deterioration. The study of larynx functional state in 42 occupational voice users with a compensated form of chronic tonsillitis included videolaryngostroboscopy, acoustic analysis of the voice using the "LingWaves Voice Program", and the Voice Handicap Index. After the washing course of palatine tonsil lacunas, the positive dynamics of the average values of the vibratory insufficiency index from 1.8 to 1.4 points (in patients with hypotonic dysphonia) and the dysphonia severity index from 3.2 to 4.3 points were noted. The tonal range of the speech voice has expanded by 5 semitones, and the vocal voice - by 3.5 semitones. The results of assessing the state of the voice apparatus using the Voice Handicap Index questionnaire showed a reliable positive tendency in all the criteria of the questionnaire. The duration of "S" and "Z" increased significantly, by 3.3 and 6.3 seconds, respectively. The frequency and dynamic ranges of spoken text increased by 1 semitone and 1 dB, respectively. The Maximum phonation time showed a positive tendency, having increased by 3.9 seconds, and jitter decreased by 0.05%. The irregularity coefficient of the vocal fold closure showed positive trend of 6% - from 0.83 to 0.78 according to the index. 42 patients underwent videolaryngostroboscopy, only in 8 (19%) patients no changes in the larynx were detected; in the remaining 34 the existing pathological changes were distributed among the nosological forms as follows: functional dysphonia was noted in 26 (61.9%) patients, of them, 2 patients (4.7%) had hypo-hypertonic dysphonia and in 24 (57.1%) hypotonic dysphonia; chronic laryngitis occurred in 8 (19%) patients. Chronic tonsillitis should be considered as one of the reasons for the functional dysphonia development. Sanitation of palatine tonsils lacunae improves the vocal functional state, which is confirmed by the results of acoustic analysis of the voice, videolaryngostroboscopy and Voice Handicap Index questionnaire. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Medically unexplained loss or alteration of voice--functional dysphonia--is the commonest presentation to speech and language therapists (SLTs). Besides the impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aims of this research were the systematic development of a complex intervention to improve the treatment of functional dysphonia, and the trialling of this intervention for feasibility and acceptability to SLTs and patients in a randomised pilot study Methods: A theoretical model of medically unexplained symptoms (MUS) was elaborated through literature review and synthesis. This was initially applied as an assessment format in a series of patient interviews. Data from this stage and a small consecutive cohort study were used to design and refine a brief cognitive behavioural therapy (CBT) training intervention for a SLT. This was then implemented in an external pilot patient randomised trial where one SLT delivered standard voice therapy or voice therapy plus CBT to 74 patients. The primary outcomes were of the acceptability of the intervention to patients and the SLT, and the feasibility of changing the SLT's clinical practice through a brief training. This was measured through monitoring treatment flow and through structured analysis of the content of intervention for treatment fidelity and inter-treatment contamination. Results: As measured by treatment flow, the intervention was as acceptable as standard voice therapy to patients. Analysis of treatment content showed that the SLT was able to conduct a complex CBT formulation and deliver novel treatment strategies for fatigue, sleep, anxiety and depression in the majority of patients. On pre-post measures of voice and quality of life, patients in both treatment arms improved. Conclusion: These interventions were acceptable to patients. Emotional and psychosocial issues presented routinely in the study patient group and CBT techniques were used, deliberately and inadvertently, in both treatment arms. This CBT "contamination" of the voice therapy only arm reflects the chief limitation of the study: one therapist delivered both treatments. [ABSTRACT FROM AUTHOR]

To explore the characteristics of functional dysphonia (FD) using multimodal methods. A total of 47 FD patients and a group of 22 normal controls were enrolled. Subjective auditory-perceptual assessment of the voice, Voice Handicap Index (VHI) 30, acoustic analysis, psychological scales assessment, surface electromyography (sEMG), nasal airflow and thoracoabdominal studies were performed. FD was mostly triggered by mood changes. Patient self-evaluation was more serious than auditory-perceptual evaluation and objective acoustic analysis. There was no obvious organic disorder observed under laryngoscope in patients with FD, but there were cases of glottic insufficiency and supraglottic compensation. With regards to sEMG, nasal airflow, chest, and abdomen examination results: (1) sEMG in the normal control group was symmetrical and stable on both sides during rest and phonation, and nasal airflow as well as the chest and abdomen were symmetrical and regular; (2) sEMG in the FD group showed increased recruitment of the sternocleidomastoid muscles, the infra- and suprahyoid muscles, and the cricothyroid muscle, accompanied by prephonation recruitment and postphonation persistence, mainly involving the infra- and suprahyoid muscles; (3) In the FD group, there was shortened inspiratory time, increased chest breathing amplitude, and reduced abdominal breathing, with predominantly chest breathing, and a "breath-holding" phenomenon was observed in some patients, with a significant increase in the number of breaths during the short text task. FD occurs mainly in middle-aged women, and there are many triggers. The Hamilton Anxiety/Depression Rating Scale scores were higher, and subjective symptoms were more serious than objective evaluation. No obvious organic changes were seen under laryngoscope, and features such as supraglottic compensation and glottic insufficiency were observed; muscle tension was significantly higher than that of the normal control group, and prephonation recruitment and postphonatory persistence were seen in some patients; the breathing pattern was mainly chest breathing, and the times of breaths during the short text task significantly increased. With identification of the characteristics of FD, the therapy could be focused them. [ABSTRACT FROM AUTHOR]

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Summary Background This crossover study compared the effects of two osteopathic treatments specific laryngeal manipulation (SLM) and postural manual therapy (PMT) on voice quality and pitch. Methods Twelve asymptomatic singers were measured acoustically immediately before and immediately after each intervention using a laryngograph. Fundamental frequency and the glottal closing quotient were used to determine any differences between groups before and after. Results Fundamental frequency showed a statistically significant change following both interventions (combined [ P = 0.007] and PMT and SLM individually ( P = 0.0143, P = 0.018, respectively). Although the benefit demonstrated using SLM was greater than that with PMT (2.4, 2.02, respectively), following Bonferroni correction there was no statistical significance demonstrated between the two groups. There was no statistically significant change with glottal closing time for any intervention or at any time ( P = 0.52). Conclusion This pilot study provides evidence of the benefit for both SLM and PMT in singers. A significant difference was found in the voice quality of the participants involved in both PMT and SLM. These results set the way for further larger scale studies to evaluate group interactions and potential benefits in symptomatic patients. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the effectiveness of the laryngostroboscopy for monitoring the evolution of patients with functional dysphonia before and after the logopedic vocal treatment. We performed a prospective observational study of 65 dysphonic patients diagnosed of functional dysphonia, where we analyzed four stroboscopic parameters (glottal closure, vocal fold vibration, mucosal wave and phase symmetry) by a protocol based on systematic subjective evaluation of the stroboscopic images before and after the rehabilitator treatment; and the results were stratified according to the clinical course. All patients, before the treatment, had some abnormality in at least one of the four analyzed aspects. After the vocal treatment, we found improvement of the four parameters in different degrees, and we just found a statistically significant relationship between the evolution of the glottal closure and the clinical course. We believe that the laryngostroboscopy, systematized through a protocol, is a useful technique for the diagnosis of functional abnormalities in patients with functional dysphonia but it is not a very useful technique for evaluating the results after the rehabilitator treatment, as there is not a statistically significant relationship between clinical course and the change in the most stroboscopic parameters, so it shouldn’t be the only technique used for these proposes. [ABSTRACT FROM AUTHOR]

The article presents a description of the voice rehabilitation in a 46-year old teacher, who was diagnosed with hyperfunctional dysphonia and soft nodules of vocal cords. As one of the elements of voice training we used, for the first time in Poland, manual therapy developed by L. Mathieson, intended to reduce the vocal tract discomfort by massage of neck muscle. Before and after the treatment, a comprehensive diagnosis was carried out: subjective self-assessment according to Voice Handicap Index (VHI), GRBAS perceptual evaluation, followed by videolaryngostroboscopy, acoustic voice analysis and maximum phonation time MPT) test. The battery of tests includes a new laryngeal palpation evaluation scale (LMTPE) developed from the English version (Laryngeal Manual Therapy Palpatory Evaluation). The use of manual therapy reduced tension of laryngeal muscles in our patient and improved her voice emission confirmed by the use of objective and subjective parameters. The reported case shows the advisability of including manual therapy in the rehabilitation of functional dysphonia. [ABSTRACT FROM AUTHOR]

BACKGROUND: We performed an epidemiologic study of patients suffering from functional dysphonia in relation to their age, sex, occupation, associated pathological background, vocal behaviour, tobacco consumption, and first features and duration of their condition. OBJECTIVE: To carry out an epidemiological study of the factors that can be considered triggering or predisposing patients to functional dysphonia, such as their age, sex, occupation, associated pathological background, prior vocal behavior, tobacco consumption, and first features and duration of their condition. MATERIAL AND METHODS: A systematized protocol was applied to 65 patients diagnosed with functional dysphonia in a five-year period. RESULTS: We found that the average age was 34 years; 87.7% were women; 95.4% were the hyperkinetic type. The majority had professions that involve facing the public or were voice professionals. The most frequent associated personal background was anxiety, depression, allergic rhinitis and gastroesophageal reflux. Previous vocal behaviour was characterized by vocal misuse and abuse, cervical tension, singing and hoarseness. 27.7% referred tobacco consumption. 66.2% referred a gradual beginning of the pathology and an average duration of 44.5 years. CONCLUSION: The functional dysphonias, frequent in women between 20 and 40 years of age, are most likely to affect people whose professions involve an excessive use of their voice. The personal background most related includes anxiety-depressive disorders, gastroesophageal reflux and allergic processes. The majority present a vocal behaviour characterized by misuse and abuse, singing cervical tension and hoarseness. Most of the patients show a gradual start of their symptoms. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aim of this study was to look for visual subjective and objective parameters of vocal fold dynamics being capable of differentiating healthy from pathologic voices in daily clinical practice applying endoscopic high-speed digital imaging (HSI). Study Design and Methods: Four hundred ninety-six datasets containing 80 healthy and 416 pathologic subjects (232 functional dysphonia (FD), 13 bilateral, and 171 unilateral vocal fold nerve paralysis) were analyzed retrospectively. Videos at 4000Hz (256×256 pixel) were recorded during sustained phonation. Subjective parameters were visually evaluated and complemented by an analysis of objective parameters. Visual subjective parameters were mucosal wave, glottal closure type, glottal closure insufficiency (GI), asymmetries of the vocal folds, and phonovibrogram (PVG) symmetry. After image segmentation, objective parameters were computed: closed quotient, perturbation measures (PMs) of glottal area, and left-right asymmetry values. Results: HSI evaluation enabled to distinguish healthy from pathologic voices. For visual subjective parameters, GI, symmetrical behavior, and PVG symmetry exhibited statistical significant differences. For 95% of the data, objective parameters could be computed. Among objective parameters, closed quotient, jitter, shimmer, harmonic-to-noise ratio, and signal-to-noise ratio for the glottal area function differentiated statistically significant normal from pathologic voices. Applying linear discriminant analysis by combining visual subjective and objective parameters, accurate classifications were made for 63.2% of the female and 87.5% of the male group for the three-class problem (healthy, FD, and unilateral vocal fold nerve paralysis). Conclusion: Actual acoustically applied PMs can be transferred to clinical beneficial HSI analysis. Combining visual subjective and objective basic parameters succeeds in differentiating pathologic from healthy voices. The presented evaluation can easily be included into everyday clinical practice. However, further research is needed to broaden our understanding of the variability within and across healthy and pathologic vocal fold vibrations for diagnosing voice disorders and therapy control. [Copyright &y& Elsevier]

Objectives. Increased levels of fatigue and perfectionism were noted during evaluation of cognitive behavioral therapy for the treatment of functional dysphonia. The investigators thus aimed to explore levels of general fatigue and perfectionism in patients with functional dysphonia and controls.Study design. Case-control study.Setting. Teaching hospital, United Kingdom.Subjects and Methods. Patients recruited through speech therapy were asked to recruit a friend as a control, of the same sex and within 5 years of their age. An 11-point fatigue questionnaire, previously validated on a normal population, was analyzed using both Likert (0123) and bimodal (0011) systems, with a score greater than 4 on the bimodal system implying substantial fatigue. A 35-point perfectionism questionnaire was also completed and analyzed for “healthy” and “unhealthy” perfectionist traits.Results. There were 75 cases and 62 controls. The mean fatigue score in patients with functional dysphonia was 17.0 and 14.4 for the controls (Likert, P = .009). Under the bimodal scoring system, the mean fatigue scores in functional dysphonia (5.10) and controls (3.01) were also significantly different (P = .003). The mean perfectionism scores were 98.9 for patients with functional dysphonia and 91.2 for controls (P = 0.043).Conclusions. To the investigators’ knowledge, this is the first substantial report that fatigue and perfectionism scores are significantly elevated in functional dysphonia. Functional dysphonia is shown to be analogous to other medically unexplained physical symptoms that are also marked by generic somatopsychic distress and for which multiple factors are implicated in their onset and maintenance. This has implications for both research and treatment. [ABSTRACT FROM PUBLISHER]

Summary: Objective: Muscle tension dysphonia (MTD) is a clinical and diagnostic term describing a spectrum of disturbed vocal fold behavior caused by increased tension of the (para)laryngeal musculature. Recent knowledge introduced MTD as a bridge between functional and organic disorders. This review addresses the causal and contributing factors of MTD and evaluates the different treatment options. Methods: We searched MEDLINE (Pubmed, 1950–2009) and CENTRAL (The Cochrane Library, Issue 2, 2009). Studies were included if they reviewed the classification of functional dysphonia or the pathophysiology of MTD. Etiology and pathophysiology of MTD and circumlaryngeal manual therapy (CMT) were obligatory based on reviews and prospective cohort studies because randomized controlled trials (RCTs) are nonexisting. Concerning the treatment options of voice therapy and vocal hygiene, selection was based on RCTs and systematic reviews. Results: Etiological factors can be categorized into three new subgroups: (1) psychological and/or personality factors, (2) vocal misuse and abuse, and (3) compensation for underlying disease. The effective treatment options for MTD are (1) indirect therapy: vocal hygiene and patient education; (2) direct therapy: voice therapy and CMT; (3) medical treatment; and (4) surgery for secondary organic lesions. Conclusions: MTD is the pathological condition in which an excessive tension of the (para)laryngeal musculature, caused by a diverse number of etiological factors, leads to a disturbed voice. Etiological factors range from psychological/personality disorders and vocal misuse/abuse to compensatory vocal habits in case of laryngopharyngeal reflux, upper airway infections, and organic lesions. MTD needs to be approached in a multidisciplinary setting where close cooperation between a laryngologist and a speech language pathologist is possible. [Copyright &y& Elsevier]

Purpose: This study examined the effects of a manual tension reduction technique on acoustic and perceptual parameters of voice in a pediatric client diagnosed with functional dysphonia (FD). Method: A single pediatric client with FD was treated using circumlaryngeal massage (CM) for approximately 2 hr during a diagnostic evaluation. Acoustic and perceptual parameters of voice were taken before, after, and 1 year after treatment to determine the effects of the manual tension reduction treatment. Results: The participant demonstrated significant improvement in the perception of her overall vocal quality, strain, breathiness, pitch, and loudness after treatment. Acoustic measures of fundamental frequency and perturbation were normalized after treatment in both a sustained vowel production and a reading task. One-year follow-up demonstrated no change in the client's ability to maintain posttreatment vocal characteristics. Conclusion: A manual tension reduction technique was used successfully to treat a pediatric client's FD and return her voice to expected acoustic and perceptual values. [ABSTRACT FROM AUTHOR]

Introduction. The early diagnosis of functional voice disorders constitutes a serious challenge for phoniatricians. Formant analysis is considered for use in evaluating the quality of voice, particularly its harmonic structure. Aim. The aim of this study was to assess the applicability of formant analysis in the diagnosis of functional voice disorders. Materials and methods. The study comprised 41 female controls with normal voice and 18 female teachers with vocal fold prenodules. To detect the behaviour of the individual formants depending on age, the following subjects were included into the control group: 9 persons aged 23-30 years, 9 aged 31-39 years, 10 aged 41-49 years and 13 aged 51-58 years. The teachers age ranged from 25-53 years. The acoustic testing was performed in the study and control groups, and involved recording (three times) a sample of sustained vowels and a standarized sentence. Using formant analysis unit of the Iris software package, the mean value of frequency and its standard deviation of respective formants in vowels and sentence were estimated. Results. The analysis of the location of formants did not show significant differences between age groups of healthy individuals. However, when comparing the average frequencies and standard deviations of respective formants between the study group and control group, significant differences were found for the first formant (F1) of vowels: "a" (p=0.002) "e" (p=0.002), "o" (p=0.033). The groups differed significantly also in the second formant (F2) of vowel "a" (p= 0.019) and vowel "o" (p=0.050). Conclusions. Formant analysis may provide the information on subtle changes of voice, indicating the early symptoms of functional dysphonia in patients with prenodules vocal fold. Further studies on a larger group of subjects with functional voice disorders are required to corroborate these findings. [ABSTRACT FROM AUTHOR]

Summary: 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. [Copyright &y& Elsevier]

Clinical experience shows that children with functional dysphonia often present disorders that are associated with abnormal auditory and emotional development. These children also struggle with voice therapy, perhaps because of difficulties with auditory control during speech. It has been hypothesized that difficulties in auditory processing in children may be an important factor in the pathogenesis of childhood dysphonia. The study aimed to assess selected auditory functions in children with hyperfunctional dysphonia. The study group consisted of 331 children aged from 7 to 12 years suffering from hyperfunctional dysphonia. The control group consisted of 213 children aged 7–12 years. All patients underwent ENT and phoniatric examination. All children underwent two standardized psychoacoustic tests: the Frequency Pattern Test (FPT) and the Duration Pattern Test (DPT). In the examined material, 223 children had edematous vocal fold nodules. The largest statistically significant differences were seen in the acoustic parameters describing relative frequency changes. FPT and DPT showed statistically significant differences in children with hyperfunctional dysphonia compared to the control group. At all ages the percentage of correctly identified tone sequences was significantly lower in children with dysphonia. Children with hyperfunctional dysphonia have difficulties in judging the pitch and duration of auditory stimuli. Difficulties in auditory processing appear to be important in the pathomechanism of functional voice disorders. Impaired hearing processes in children with hyperfunctional dysphonia can make it difficult to obtain positive and lasting effects from voice therapy. [ABSTRACT FROM AUTHOR]

Background. Muscle tension dysphonia (MTD) is the cause of hoarseness in almost one half of the patients with voice disorders. The otorhinolaryngologic examination discovers no evident organic lesions in the larynx at least in the beginning of the voice problems. The reason for the hoarse voice is a disordered and maladjusted activity of the muscles taking part in phonation and/or articulation. In some patients, the irregular function of the larynx results in mucosal lesions on vocal folds. The factors participating in the development of MTD, directly or indirectly influence the quality of laryngeal mucosa, the activity of the phonatory muscles and/or increase of the vocal load. In the diagnostics and treatment of the MTD a phoniatrician, a speech and language therapist and a psychologist closely cooperate with the patient who must take an active role. The treatment is a long-lasting one but resulted in a high percentage of clinical success.Conclusions. Most likely, MTD is not a special disease but only a reflection of any disorder in the complicated system of regulation and realization of phonation. The prognosis of treatment is good when all unfavourable factors participating in development of MTD are eliminated and a proper professional voice- and psychotherapy started.

Summary: The purpose of the present study was to calculate the prevalence and incidence of voice disorders among teaching staff and find out the associated occupational risk factors. A case-control study was performed with 905 teachers, 579 cases and 326 controls; 492 were randomly selected and 413 volunteered. All teachers were asked to fill out a standard questionnaire. Next, a complete laryngeal exam was performed including a general ear, nose, and throat evaluation and videolaryngostroboscopy. The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were vocal overstrain (18%), nodular lesions (14%), and hyperfunctional dysphonia (8%). The incidence rate was 3.87 new cases per year per 1000 teachers. Women had organic lesions three times more than men (odds ratio [OR]: 3.52, confidence interval [CI]: 2.04–6.09). However, men had chronic laryngitis three times more than women (OR: 2.93, CI: 1.50–5.71) and functional dysphonia nearly twice more than women (OR: 1.81, CI: 1.21–2.69). We find a significant risk of suffering voice disorders in teachers who smoke daily (OR: 2.31, CI: 1.58–3.37) and who drink several cups of coffee or tea (OR: 1.87, CI: 1.36–2.56). It is advisable to carry out an annual evaluation of all teaching staff on account of the high prevalence of voice disorders among them. [Copyright &y& Elsevier]

Summary: In a previous study, female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls. This could not be confirmed for the male subgroup. The present study is to corroborate and nuance this observation by investigating larger groups, and to determine if, after voice therapy, the number of autonomic symptoms and complaints—particularly those ones that have no obvious relation to voice function—decreases. It is a prospective study with a matched control group; 184 patients with nonorganic dysphonia and 126 normal controls answered a questionnaire of 46 questions with 3 subsets and a consistency control. One hundred and one patients received functional voice therapy and completed the questionnaire before and after treatment. A matched control group of 42 normal subjects also filled in the questionnaire two times, with an interval of about 6 months. Neurovegetative symptoms and complaints—voice related and not related—are reported in highly significant excess by patients (especially but not exclusively females) with habitual nonorganic voice disorder. After therapy, there is a highly significant reduction in the number of autonomic symptoms and complaints (related or not related to voice), to such an extent that patients report on average no more general neurovegetative symptoms and complaints than healthy controls (even less). The number of neurovegetative symptoms and complaints connected with voice function is also strongly reduced in patients after therapy, but remains in significant excess when compared with controls. [Copyright &y& Elsevier]

Objectives: We sought to investigate whether a brief period of training in cognitive behavioral therapy (CBT) can improve the treatment of functional dysphonia by a speech and language therapist and ameliorate the psychological distress associated with this condition. Methods: In a consecutive cohort design, a speech and language therapist treated a small cohort (n = 15) of dysphonic patients with voice therapy alone. After a brief period of CBT training, she treated the next cohort of dysphonic patients (n = 13) with CBT-enhanced voice therapy. Pretreatment and posttreatment measures were taken of voice quality and voice-related quality of life. The General Health Questionnaire 28 and the Hospital Anxiety and Depression Scale were used to assess psychological distress and general well-being. Results: All voice measures improved significantly in both cohorts. Both groups improved significantly on the General Health Questionnaire 28, with the CBT group improving significantly more than the control group. Only the CBT group improved significantly on the Hospital Anxiety and Depression Scale (depression subscale). Conclusions: Despite limitations of size, design, and between-group baseline differences, the results support the hypothesis that the addition of CBT skills to existing voice therapy is both feasible and clinically effective in the treatment of functional dysphonia. [ABSTRACT FROM AUTHOR]

Summary: Objective: We evaluated the efficacy of voice therapy according to Borragan''s method associated to S. Magnani''s vocal counselling in functional dysphonia in children. Patients and methods: We prospectively treated 16 patients with vocal fold nodules (10 males, 6 females). Age ranged from 6 to 11 years with a mean age of 9 years. We performed a full screening phoniatric evaluation. In addition psychological tests were carried out to investigate psychological background. Results: We lost three patients at follow-up; one patient received surgery, eight patients healed (43.75%), four improved (25%). There was no statistical difference in the analysis of electroacoustical parameters while MPT significatively raised after therapy. Conclusion: If patients have motivation voice therapy could improve functional dysphonia in children. It is also important psychological background. Further studies on bigger populations with long-term follow-up are needed. [Copyright &y& Elsevier]

Abstract: Psychological factors are considered for the predisposition and perpetuation of functional dysphonia. In the present study 61 patients with functional dysphonia were compared with 61 healthy controls, matched by age, sex, and occupation with respect to Cloninger’s personality model, mood, and anxiety. The patients with functional dysphonia presented significantly higher scores than the healthy controls with respect to “harm avoidance” (HA); depressive symptoms; symptoms of unspecific and general anxiety; symptoms of specific anxiety concerning “health”, “illness”, and “extraversion versus introversion”. No significant differences were found in “novelty seeking” (NS), “reward dependence” (RD), “persistence” (PE), or in state-anxiety and anxiety of social situations. These results were found considering univariate and multivariate analyses and confirm the relationship of psychological factors such as personality traits, mood, and anxiety on one hand and conversion disorder in general and functional dysphonia in particular on the other hand. This important relationship should be considered in the diagnostic and therapeutic interventions of functional dysphonia. [Copyright &y& Elsevier]

Summary: Speaking fundamental frequency (SFF) and its perceptual correlate “habitual pitch” have been considered important and contentious parameters in voice assessment and treatment. In clinical circles, disagreement exists regarding the role of habitual pitch in the development, maintenance, and treatment of disordered voices. Despite these divergent opinions, few studies have objectively evaluated SFF changes associated with voice improvement after therapy. To determine whether consistent directional and magnitude changes in SFF occur after management, pretreatment and posttreatment audio recordings of 40 women with functional dysphonia were analyzed. All subjects were treated with manual circumlaryngeal therapy, a treatment approach that does not directly target pitch as a perceptual entity to be manipulated. Results indicated that, as a group, no significant change in mean SFF was observed after successful management. Although no consistent directional pattern was identified, 80% of the subjects experienced pitch changes greater than one semitone; this suggests that voice improvement is often accompanied by a shift in SFF. Clinical implications of the data are discussed. [Copyright &y& Elsevier]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective This report aims to study the prevalence of features of laryngeal muscle tension in a population of patients with functional dysphonia (FD) and nondysphonic control subjects. Study Design Prospective control-blinded, cross-sectional study. Methods We reported on a prospective control-blinded, cross-sectional study of the prevalence of the six features described by Van Lawrence and the six features incorporated in the Morrison-Rammage classification. A senior laryngologist and senior speech pathologist independently rated sound-free, random-sequence video laryngoscopies of 51 patients with FD and 52 nondysphonic control subjects. Assessments were made of the presence or absence of the 12 laryngoscopic features of laryngeal dysfunction, and an overall rating made of the vocal technique as 'normal' or 'abnormal.' Results More than 60% of the control population demonstrated 1 or more of the 12 features of hyperfunction. There was no significant difference in the prevalence of the six Van Lawrence features, the six Morrison-Rammage features, or the total number of abnormal features between patients with FD and control subjects. On overall assessment, both assessors noted a high prevalence (50% and 36%, respectively) of abnormal vocal technique in the control population. There was no statistical difference in the total number of abnormal features observed between patients with FD and control subjects. Positive predictive value calculations showed that the presence of a clinical feature, at best, presented a 75% chance of correctly identifying a patient with FD and, at worst, a 50% chance. Conclusion The laryngoscopy features commonly associated with FD are frequently prevalent in the nondysphonic population and fail to distinguish patients with FD from normal subjects. [ABSTRACT FROM AUTHOR]

Muscle tension dysphonia (MTD) is a subtype of functional dysphonias that believed to be the result of misuse or abuse of an anatomically and neurologically intact larynx. MTD is usually seen in young to middle aged population who use his/her voice extensively in stressful situations. We had a 56-year-old female patient who underwent total thyroidectomy surgery and developed bilateral vocal fold paresis after the surgery. She had immediate tracheotomy and followed with tracheotomy tube for years. In our clinic examination, we found hyperadduction of the vocal folds and minimum activity and performed Botox® (Allergen, Irvine, California, USA) injection to the thyroarytenoid muscles. After 1 week, she decannulated. MTD is a rare and special disease. The disease can be primary without any organic pathology or secondary to a glottic closure problem. First treatment option must be speech therapy, but in resistant cases, surgery or Botox® (Allergen, Irvine, CA, USA) is suggested. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Muscle tension dysphonia (MTD) is generally diagnosed through clinical history and physical examination. Several diagnostic or classification systems exist, such as those of Van Lawrence, Morrison-Rammage, and Koufman, that delineate MTD and distinguish subtypes on the basis of laryngoscopic features. The aim of this study is to determine which of the clinical features included in these classifications are most related to the aerodynamic profile of MTD. This is an analytic retrospective study. This study evaluates a series of 30 consecutive patients, all over 18 years old, who attended the voice clinic consult of our department and were diagnosed with MTD. All subjects underwent fiberoptic nasal endoscopy, acoustic voice assessment, and aerodynamic voice assessment. The study only includes patients with a pathological aerodynamic profile. Presence or absence of each laryngoscopic feature in the full range of features in the Van Lawrence, Morrison-Rammage, and Koufman classification systems was evaluated independently by three experts. Cohen's kappa coefficient was calculated to indicate the degree of concordance between the experts. The chi-squared test was used to determine the degree of association between clinical features and mean value of the subglottic pressure peak (mmH 2 O). Clinical parameters that were found to have a statistically significant association (P < 0.05) with an alteration in mean subglottic pressure peak were those related to anteroposterior and lateral compression of the larynx in Van Lawrence, Morrison-Rammage, and Koufman classification systems. While several studies have sought to clarify the laryngoscopic features of MTD, the current study is the first to evaluate these features in subjects who have been objectively diagnosed by means of aerodynamic voice assessment. The laryngoscopic features most strongly related to an aerodynamic profile of MTD were anteroposterior compression of the larynx, lateral compression of the larynx, and vestibular fold contribution to phonation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary Objective The study aimed to examine the vocal behavior and self-assessed vocal health in women with varying everyday vocal load and functional voice problems, including patients with functional dysphonia, in three conditions: work, leisure, and a vocal loading task (VLT). Study Design This is a longitudinal controlled, clinical trial. Methods Fifty (n = 50) female subjects were tracked during 7 days' voice accumulation accompanied by a voice health questionnaire, containing general assessments with visual analogue scale and specific voice health questions. Subjects were divided into four vocal subgroups according to everyday vocal load and functional vocal complaints. Accumulation time was divided into three conditions: a VLT, work, and leisure. The following behavioral parameters were measured: (1) relative phonation time (%), (2) phonatory sound pressure/voice level (dB sound pressure level), (3) ambient noise level (dB sound pressure level), and (4) phonatory fundamental frequency (Hz). Results Patients with functional dysphonia reported significantly higher specific voice problems across conditions and worse general voice problems during work and leisure than other groups. Women with high everyday vocal load and voice complaints showed higher phonation times and fundamental frequency during work than voice healthy controls. They also reported the highest incidence of general voice problems in the VLT. Conclusions Vocal loading relates to prolonged phonation time at high fundamental frequencies. Patients with functional dysphonia experience general and specific voice problems permanently, whereas women with everyday vocal load and voice complaints recover during leisure. This may explain why the latter group does not seek voice therapy. [ABSTRACT FROM AUTHOR]

Summary Clinicians believe that psychosocial factors play a causal role in the etiology of many forms of functional dysphonia (FD). But for decades, all attempts to confirm such causation have failed. This paper aims to show the logic of this failure, to discuss the possibilities of employing psychology in therapy nonetheless, and to encourage clinicians to use their psychosocial knowledge and skills. The failure to confirm psychic and social factors as causal in the etiology of FD is basically a consequence of a principal shortcoming of evidence-based medicine (EBM). As the gold standard for validity, reliability, and objectivity in medical research, EBM is based on calculability and hence the processing of quantitative data. But life paths and life situations are best or sometimes only expressible in qualitative, experiential, and idiographic terms. Thus EBM-guided evaluation undervalues most psychosocial studies. This report of an experienced multidisciplinary voice team proposes alternative pathways for integrating psychosocial knowledge into the diagnosis and the treatment of FD. The difference between the fields of activity of psychotherapists and speech-language pathologists is discussed, and the latter group is shown the potential benefits of using more of their psychosocial knowledge and skills. [ABSTRACT FROM AUTHOR]

Summary Purpose The present study aimed to observe the effect of two types of tubes on vocal tract bidimensional and tridimensional images. Methods Ten participants with hyperfunctional dysphonia were included. Computerized tomography was performed during production of sustained [a:], followed by sustained phonation into a drinking straw, and then repetition of sustained [a:]. A similar procedure was performed with a stirring straw after 15 minutes of vocal rest. Anatomic distances and area measures were obtained from computerized tomography midsagittal and transversal images. Vocal tract total volume was also calculated. Results During tube phonation, increases were measured in the vertical length of the vocal tract, oropharyngeal area, hypopharyngeal area, outlet of the epilaryngeal tube, and inlet to the lower pharynx. Also, the larynx was lower, and more closure was noted between the velum and the nasal passage. Conclusion Tube phonation causes an increased total vocal tract volume, mostly because of the increased cross-sectional areas in the pharyngeal region. This change is more prominent when the tube offers more airflow resistance (stirring straw) compared with less airflow resistance (drinking straw). Based on our data and previous studies, it seems that vocal tract changes are not dependent on the voice condition (vocally trained, untrained, or disordered voices), but on the exercise itself and the type of instructions given to subjects. Tube phonation is a good option to reach therapeutic goals (eg, wide pharynx and low larynx) without giving biomechanical instructions, but only asking patients to feel easy voice and vibratory sensations. [ABSTRACT FROM AUTHOR]

Summary Objective The purpose of this study was to investigate the effect of phonation into tubes in air and tubes submerged in water on air pressure variables and vocal fold adduction in subjects with different voice conditions. Methods Forty-five participants representing four vocal conditions were included: (1) subjects diagnosed with normal voice and without voice training, (2) subjects with normal voice with voice training, (3) subjects with muscle tension dysphonia, and (4) subjects with unilateral vocal fold paralysis. Participants phonated into different kinds of tubes (drinking straw, 5 mm in inner diameter; stirring straw, 2.7 mm in inner diameter; silicon tube, 10 mm in inner diameter) with the free end in air and in water. Aerodynamic, acoustic, and electroglottographic signals were captured simultaneously. Mean values of the following variables were considered: glottal contact quotient (CQ) measured by electroglottograph, fundamental frequency, subglottic pressure (Psub), oral pressure (Poral), and transglottal pressure. Results All exercises had a significant effect on Psub, Poral, transglottal pressure, and CQ ( P  < 0.05). Phonation into a 55-cm silicon tube submerged 10 cm in water and phonation into a stirring straw resulted in the highest values for CQ, Psub, and Poral compared with baseline (repetition of syllable [pa:]) for all vocal status. Poral and Psub correlated positively. Conclusion During semioccluded exercises, most variables behaved in a similar way (same trend with a quite large individual variation) regardless of the vocal status of the participants. [ABSTRACT FROM AUTHOR]

Summary Background Functional dysphonias are commonly associated with reduced treatment attendance leading to variable treatment outcomes. Preliminary research has proposed that intensive treatment may improve client adherence and outcomes; however, further research into the application of intensive models in functional dysphonia in comparison with standard intensity models is warranted. Aims The present study evaluated the impact of intensive and standard treatments on functional, well-being, and service outcome measures in clients with functional dysphonia. Methods Participants with a functional dysphonia were randomly allocated to one of two treatment groups: (1) intensive treatment (n = 7) or (2) standard treatment (n = 9). Participants completed the voice handicap index (VHI) and the Australian therapy outcome measures voice assessment (conducted by a blinded assessor) before and after treatment and 4 weeks after treatment. Satisfaction questionnaires were completed after treatment and data pertaining to attendance and duration of intervention were collected throughout treatment. In addition to a vocal hygiene education session, all participants received a total of 8 hours of treatment; intensive treatment consisted of four 1-hour treatment sessions per week over 2 weeks, whereas the standard group received one 1-hour treatment session per week over 8 weeks. Results High satisfaction and statistically significant improvements on the VHI ratings were found after treatment in the intensive group. Significantly greater attendance rates were found in the intensive group. Intensive treatment is a potentially viable service delivery option for functional dysphonia and warrants further larger scale investigation. [ABSTRACT FROM AUTHOR]