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機能性発声障害は, 発声器官の濫用・誤用に起因する音声障害とされている.そのため治療方法は発声様式の再調整を行う音声治療が第一選択となる.患者の音声障害が, 声門の過閉鎖・声門上の過収縮を伴う型 (過緊張型) か, 声門閉鎖が不十分な型 (低緊張型) か, 声の高さの調節が障害された型 (ピッチ型) のいずれに該当するかによって選択すべき音声治療手技が大別される.そのなかから有効な音声治療手技を選択するためには, 耳鼻咽喉科医師とともに言語聴覚士も内視鏡下に発声時の喉頭動態を観察し, 試験的音声治療を実施することが有用である.本稿では診療と治療のポイント, および当院での治療成績について述べる.

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.

Resumen Objetivo Examen de la funcion vocal y analisis acustico de 905 docentes. Diseno Estudio de 576 casos y 329 controles. Pacientes 905 docentes de La Rioja: 589 mujeres y 316 hombres. Metodo Cuestionario estandarizado, examen ORL y de la funcion vocal, videolaringoestroboscopia y analisis acustico de la voz con MDVP. Resultados La prevalencia de los trastornos de la voz en el personal docente de La Rioja fue de un 57%. Las lesiones mas frecuentes fueron: la sobrecarga vocal (18%) las lesiones nodulares (14%) y la disfonia hiperfuncional (8%). El examen funcional de la voz fue mas patologico en los docentes disfonicos que en los docentes normales. Las perturbaciones de la frecuencia y de la amplitud eran mayores en los docentes disfonicos que en los docentes normales. Escasa relacion entre los algoritmos del analisis de la voz MDVP y la valoracion subjetiva de la voz GBRAS. Conclusiones La alta prevalencia de la patologia vocal en el personal docente aconseja realizar una revision anual de todos los docentes.

Summary Functional (nonorganic) dysphonia is often characterized by vocal instability. The purpose of the prospective study was to examine whether there is a difference in vocal instability of functional dysphonic voices compared with healthy ones, this means whether electroglottographic perturbation values differ (1) between healthy and dysphonic voices and (2) between two subgroups of the dysphponic voices (hpertonic and hypotonic dysphonic voices). Twenty-three patients with hypertonic functional dysphonia, 9 with hypotonic functional dysphonia and 31 healthy nonsmokers, were each examined electroglottographically before (Ex 1), immediately after (Ex 2), and 1 hour after (Ex 3) voice loading. Perturbations of frequency, amplitude, quasi-open-quotient, and contact-index were calculated from the EGG signal. At all three times of examination, hypertonic dysphonic voices showed higher perturbations than healthy voices, and they had higher perturbations than hypotonic dysphonic voices before and 1 hour after voice loading. Hypotonic dysphonic voices showed higher perturbations than healthy voices only 1 hour after voice loading. Voice loading induced different reactions in dysphonic voices: Some voices showed increased perturbations, and others exhibited normal or even decreased perturbation immediately after voice loading. Examination of electroglottographic-derived perturbations immediately after voice loading seems not to be useful. Differentiation of hypertonic and hypotonic dysphonic voices was possible with an estimated sensitivity of 88.9% and a specificity of 87.0% by using the sum of the amplitude-perturbation and the quasi-open-quotient-perturbation measured before voice loading.

Will der HNO-Arzt oder Phoniater die Weiteruberweisung von Patienten mit Stimmproblemen in die Wege leiten, ist die Stimmdiagnostik selbstverstandliche Voraussetzung. Diese sollte jedoch immer im ganzheitlichen Rahmen anderer Symptome und auch sozialer Konstellationen gesehen werden. Daraus leitet sich die Entscheidung uber eine Behandlung—z. B. stationar oder ambulant—ab. Das seit 1999 geltende Psychotherapeutengesetz hat fur die Klarung zur Psychotherapieindikation grose Erleichterungen mit sich gebracht. Durch das Erstzugangsrecht kann der gesetzlich versicherte Patient mit jedem zugelassenen Psychotherapeuten Kontakt aufnehmen, um dort die Psychotherapieindikation zu klaren. Im Falle einer Therapiebeantragung durch einen Psychologischen Psychotherapeuten wird der Arzt um einen Konsiliarbericht gebeten. Die Fixierung des Patienten auf seine Stimme als korperliches Symptom ist charakteristisch fur funktionelle und psychogene Stimmstorungen. Deshalb ist der empathische, angstabbauende und gleichzeitig sachliche Umgang bei der Uberweisung an einen Psychotherapeuten von Seiten des Arztes von eminenter Bedeutung.

Berufsbedingte Stimmstorungen nehmen insbesondere im Lehrberuf seit Jahren nachweislich zu. Ziel der Studie war es zu untersuchen, ob eine konstitutionelle Stimmhypofunktion als Risikofaktor fur eine Berufsdysphonie angesehen werden muss. Prospektiv wurden 15 Lehramtsstudentinnen mit normaler Stimmkonstitution und 18 mit konstitutionell kleiner Stimme hinsichtlich stimmlicher Merkmale in der Unterrichtssituation untersucht. Bereits nach 30-minutiger Unterrichtstatigkeit zeigten sich Unterschiede zwischen beiden Gruppen. Studentinnen mit konstitutioneller Hypofunktion tendierten zu erhohten Sprechstimmlagen. Stimmphysiologisch wird eine Stimmerhohung als Zeichen fur eine Stimmermudung gewertet, und die konstitutionelle Stimmhypofunktion ist als Risikofaktor fur Berufsdysphonien zu bewerten. Vor Ergreifen eines Sprechberufes werden phoniatrisch-logopadische Stimmtauglichkeitsuntersuchungen empfohlen, um rechtzeitig vor Auftreten stimmlicher Beschwerden praventive Masnahmen (stimmhygienische Beratung, Stimmubungstherapie) einleiten zu konnen.

Introduction: The objective of this paper is to discuss the different etiologic factors that affect the appearance and evolution of teachers' dysphonias, as well as to establish the main objectives of treatment. Material and Method: We considered 772 elementary and high school teachers, and evaluated their personal backgrounds, general clinical examination, psychological and audiological studies, phonatory system and environmental condition of the workplace. Results: We found that the most common pathology was the functional dysphonia or phonastenia, which is due among other factors to a functional breathing asynergy, while we detected few incidences of organic dysphonias. Discussion: This study discusses the different causes of dysphonia, especially the personal and institutional, and furthermore points out the specific labor disability and moral damage that generate in teachers, especially for women. Conclusions: Different measures for preserving and recuperating the teacher's voice in formative, such as professional, stages are proposed, and of special note is that the teacher must be considered a voice professional.

The purpose of this study is to examine the physiological characteristics of the Accent Method of voice therapy. To study the effect of accentuation in the Accent Method, the increase in airflow rate (Airflow), fundamental frequency (F0) and sound pressure level (SPL) caused by accentuation were simultaneously measured by means of the Nagashima Phonatory Function Analyzer PS-77H. Participants were five female patients with functional dysphonia, two normal professional subjects and two normal untrained subjects. The results are summarized as follows: (1) The five patients with functional dysphonia showed significantly greater increases in F0, SPL and Airflow in the accentuations after voice therapy than before voice therapy. (2) In the normal group, the professionally trained subjects showed significantly greater increases in F0 and SPL in the accentuations than untrained and pathological subjects before voice therapy. There was no difference in increases in Airflow in the accentuations among the professionally trained, untrained and pathological subjects after voice therapy. (3) The increases in F0 and SPL after voice therapy were greater than before voice therapy. All patients could increase the accentuations by means of abdominal breathing. This could be explained by the fact that the Accent Method caused a greater flexibility of controlling phonation. Furthermore, all patients showed efficient voice production after voice therapy.

Voice acoustic analysis is becoming more and more usefúl in diagnosis of voice disorders or laryngological pathologies. The facility to record a voice sigiial is an advantage over other invasive techniques. This paper presents the statistical analyzes ofa set of voice parameters like jitter, shimmer and HNR over a 4 groups of subjects vvith dysphonia, fünctional dysphonia, hyperfünctional dysphonia, and psychogenic dysphonia and a control group. No statistical signifícance differences over pathologic groups were found but clear tendencies can be seen between pathologic and control group. The tendencies indicates this parameters as a good features to be used in an intelligent diagnosis system, moreover the jitter and shimmer parameters measured over different tones and vowels. info:eu-repo/semantics/publishedVersion

Objectives: Functional dysphonias are disorders of the voice characterized by sound and efficiency disturbances of the voice without any organic changes of structures being detectable. At present, functional dysphonias are generally subclassified into hyper- and hypofunctional dysphonias in clinical practice. Study Design: The study was designed for a critical evaluation of the relevance of stroboscopy to the diagnostics and classification of functional dysphonias. Methods: 45 patients were examined (27 hyperfunctional, 15 hypofunctional and 3 mixed type) using videostroboscopy. Several stroboscopic parameters were taken into consideration. Three geometrical and three time-dependent parameters were first analyzed in a uni- and multidimensional way, then cluster analyses were performed. Results: We could not confirm the clinical subdivision into hyper- and hypofunctional dysphonias as based on anamnestic data, perceptual evaluation of voice sound, voice profile measurements and videostroboscopy. Quantitative measurements of selected parameters did not correlate with qualitative subjective stroboscopic assessment. In addition to this, it was not possible to identify separate clusters of stroboscopic findings. Conclusions: The results do not deny the clinical relevance of stroboscopy to the diagnostics of functional dysphonias as a very useful tool to exclude organic lesions. However, a reliable subclassification into different types of functional dysphonias was not possible.

The main aim of this study was to describe the changes in acoustic analysis in diagnosing voice disorders in children. The secondary goal was the attempt at differentiation of organic and functional disorders by means of acoustic analysis. The study included 112 children in treated due to laryngeal papilloma, gastro-esophageal reflux, atopic disease and noduli vocales. The following values have been determined: basic frequency F(o), jitter, shimmer, F(o) tremor and the harmonics to noise ratio (HNR). The study results confirmed that the HNR value was the most sensitive indicator of changes in the voice organ.

OBJETIVOS:Identificar a relação entre o tipo de disfonia, o grau de desvio vocal autoavaliado e a presença de sintomas vocais em indivíduos adultos.MÉTODOS:Participaram do estudo 164 indivíduos de ambos os gêneros (58 homens e 106 mulheres, média de idade de 42,89 anos) com diagnóstico médico otorrinolaringológico de disfonia, divididos em três grupos, de acordo com o tipo de disfonia. Ao todo 87 indivíduos com disfonia funcional, 35 com disfonia organofuncional e 42 com disfonia orgânica responderam a versão validada para o Brasil da Voice Symptom Scale (VoiSS) (Escala de Sintomas Vocais - ESV), composta por 30 questões, com quatro escores: Limitação, Emocional, Físico e Total, e autoavaliaram suas vozes em excelente, muito boa, boa, razoável ou ruim.RESULTADOS:Houve diferenças na ESV de acordo com o tipo de disfonia para as médias dos resultados nos escores Limitação, Emocional e Total, o que não foi verificado no escore Físico. As médias dos resultados nos escores Limitação, Emocional e Total da ESV foram maiores nas disfonias orgânicas, seguidas pelas organofuncionais e pelas funcionais. Quanto pior a autoavaliação, maior o desvio nos escores Limitação, Emocional e Total da ESV.CONCLUSÕES:Indivíduos com disfonias orgânicas relataram maior percepção de sintomas vocais, seguidos pelos sujeitos com disfonias organofuncionais e com disfonias funcionais. De forma geral, os indivíduos disfônicos apresentaram sintomas vocais físicos independente do tipo da disfonia. Por fim, existem correlações diretas entre os escores Limitação, Emocional e Total da ESV com a autoavaliação vocal. PURPOSE:To identify the relationship among the type of dysphonia, vocal deviation self-assessed and the presence of voice symptoms in adults.METHODS:One hundred sixty-four subjects of both genders (58 males and 106 females, mean age 42.89 years) diagnosis of dysphonia, divided into three groups according to the type of dysphonia: 87 individuals with functional dysphonia, 35 individuals with organofunctional dysphonia and 42 individuals with organic dysphonia, answered the Brazilian validated version of Voice Symptom Scale (VoiSS) (Escala de Sintomas Vocais - ESV), that consists of 30 questions with four scores: Impairment, Emotional, Physical and Total, and self-assessed their voices as excellent, very good, good, fair or poor.RESULTS:According to the dysphonia type, there were differences in ESV Impairment, Emotional and Total mean scores, which was not found in the Physical score. The Impairment, Emotional and Total mean scores were higher in organic dysphonia, followed by organofunctional dysphonia and finally functional dysphonia. When the vocal self-assessment is poor, the higher are the deviations in the Impairment, Emotional and Total ESV scores.CONCLUSIONS:Individuals with organic dysphonia reported higher perception of voice symptoms, followed by subjects with organofunctional dysphonia and finally individuals with functional dysphonia. In general, individuals with dysphonia presented physical voice symptoms, regardless of the type of the dysphonia. Finally, there are direct correlations between Impairment, Emotional and Total ESV scores and the vocal self-assessment. Universidade Federal de São Paulo (UNIFESP) Department of Speech-Language Pathology and Audiology Sindicato dos Professores de São Paulo UNIFESP, Department of Speech-Language Pathology and Audiology SciELO

To describe teachers treated for dysphonia and vocal cord nodules by the public health system in Navarra (Spain), to describe associated factors and to identify the proportion of these cases registered as occupational diseases.Cases of dysphonia occurring in persons between the age of 18 and 65 years, registered between May 2010 and June 2011, and treated in a specific unit (Speech Unit) of Otorhinolaryngology Services were identified. Information on occupation, sex and clinical diagnosis was collected. For teachers, additional information was obtained on smoking habits, teaching level and prior training in speech disorders and their prevention. Cases declared as occupational diseases were identified from the official Register of Occupational Diseases of Navarra.135 teachers (18% of all dysphonia patients in the sample) were treated for dysphonia in the Speech Unit (87% women). Being female was 3-fold higher among teachers than other occupations (crude prevalence odds ratio = 3.5; 95% confidence interval, 95%CI, 2.1-5.9). Female teachers were also 6.5 years (95%CI, 1.7-11.4) younger than male teachers. No association was found between smoking and risk of vocal cord nodules or dysphonia. Only 20% of teachers treated had received training on speech disorders and their prevention. Nine out of 83 cases of vocal cord nodules diagnosed in professional voice users were officially declared as occupational diseases; in all cases, these were teachers.Dysphonia in teachers is a frequent reason for visiting a specialty clinic. Among these professionals, women showed a higher risk of suffering from vocal cord nodules. Most cases of vocal cord nodules in our sample were not reported as occupational diseases.Describir a los docentes que son atendidos por disfonía y los que son diagnosticados con nódulos de las cuerdas vocales en las consultas especializadas del Servicio Público de Salud de Navarra, identificar factores relacionados en la aparición de estas dolencias y valorar la declaración de los nódulos de las cuerdas vocales como enfermedad profesional. MÉTODOS: A partir de los registros de consultas externas de atención especializada de la Comunidad de Navarra (España) de mayo de 2010 hasta junio de 2011, se identificaron los casos de disfonía, con edades entre 18 y 65 años, entre los atendidos en las consultas de laringe del Servicio de Otorrinolaringología del Servicio Navarro de Salud y posteriormente derivados a la Unidad de Voz de dicho servicio. Se obtuvo información sobre ocupación, sexo y diagnóstico de los casos. En los docentes se disponía también de datos acerca de hábito tabáquico, nivel de enseñanza en el que trabajan y formación sobre trastornos foniátricos y su prevención, entre otros. La identificación de los casos que habían sido declarados como enfermedad profesional se llevó a cabo mediante búsqueda de sucesos coincidentes en el Registro de Enfermedades Profesionales en Navarra.135 docentes (18% del total de pacientes en la muestra) fueron atendidos por disfonía en la Unidad de Voz del Servicio de Otorrinolaringología del Servicio Navarro de Salud (87% mujeres). En pacientes con disfonía, ser mujer es 3 veces más frecuente en los docentes que en el resto de ocupaciones (odds ratio de prevalencia cruda ORp=3,5; intervalo de confianza al 95%, IC95% 2,1-5,9). Adicionalmente, los casos entre docentes mujeres tienen una media de edad inferior en 6,5 años (IC95% 1,7-11,4) que los casos entre docentes varones. Fumar no se asoció a mayor riesgo de padecer disfonía o nódulos. Un 20% de los docentes tenía formación sobre trastornos fonatorios y su prevención. De 83 casos de nódulos diagnosticados entre profesionales de la voz sólo nueve (11%) fueron declarados como enfermedad profesional, todos ellos en docentes.Las disfonías en los docentes son motivo frecuente de consulta en las clínicas especializadas. Entre estos profesionales, las mujeres presentan mayor riesgo de padecer nódulos que los hombres. La mayoría de los casos de nódulos identificados no se declaran como enfermedades profesionales.

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.

This article describes the nature and treatment of functional voice disorders in adolescents. It summarizes physiological and psychological changes that occur in adolescence, the types of functional voice disorders common to that period, and the incidence and possible causes, including high-risk factors. Three case studies illustrate the importance of obtaining accurate laryngeal data, typical symptoms and signs, and the use of voice probes in diagnosis and treatment. The use of intensive treatment and carryover is stressed. The role of the school clinician in management is discussed, as is the need for screening programs and further research.

Time consuming is an important aspect in assessing dysphonic patients. So, the English version of the Voice Handicap Index (VHI-30), a self-administered questionnaire consisting of 30 items used to evaluate patients' self-perception of voice problems, was reduced to 10 items (VHI-10) for clinical purposes. In 2010, an Italian version of VHI-30 was validated, now the aims of this study were to analyze the psychometric properties of an Italian version of VHI-10 and to evaluate its validity in a cohort of patients affected by organic or functional dysphonia.Cross-sectional study.The Italian version of the VHI-30 was submitted to 372 dysphonic participants and 120 healthy control subjects and was conducted again 2 weeks later. The 10 items constituting the VHI-10 were extracted from the VHI-30. For 73 dysphonic patients, the questionnaire was also administered after treatment.The scores of the control group were significantly lower with respect to all diagnostic subgroups (P0.001). The Cronbach's α, test-retest, and Pearson's correlation index demonstrated high reliability and validity of the Italian VHI-10. The ratio of the VHI-10 and VHI-30 scores was higher than 0.333 in all subgroups.This study demonstrated that the Italian VHI-10 is a robust tool that can adequately represent and replace the VHI-30. The reported results support the use of the VHI-10 for the Italian population in clinical settings owing to its validity and rapid and simple use.

Self-reported Improvement with Voice Therapy via Translation for Muscle Tension Dysphonia: A Pilot Study Purpose: Voice therapy is essential to caring for millions of Americans with vocal problems. However, for immigrants who are non-English speakers (NES), native-language therapists may not be available. Treatment is often provided via translator, but little data support the efficacy of this modality. We hypothesized that voice therapy would improve subject self-ratings of voice impairment, both with and without translation. Materials/Methods: We surveyed both NES and English-speakers (ES) before and two months after receiving voice therapy at our institution for functional dysphonia. NES received therapy via translation. The survey instrument was the 30-item Voice Handicap Index (VHI). NES subjects were provided with a professionally translated version of the VHI in their native language. Results: Change scores were calculated for the 20 subjects (12 NES and 7 ES) who completed both pre- and post-treatment surveys, and were normalized to a maximal score of 120 to account for incomplete questionnaires. ES improved from a baseline mean of 49.1 to 30.5 (p=0.015), and NES from 56.9 to 47.3 (p=0.065). The mean for the entire group improved from 54.0 to 41.1 (p=0.002). No significant between-group difference was found. Conclusion: Overall, this mixed population showed improvement in the VHI with voice therapy. Analyzed individually, English-speakers had significant improvement, while non-English speakers did not. Further studies of voice therapy via translation are warranted.

Objective: To measure the handicap that functional dysphonia may cause on patients.Patients and Methods: We present the results of the subjective evaluation - the vocal handicap index (VHI-30) adapted to Spanish language and the evaluation of symptoms associated with dysphonia - in 65 patients diagnosed of functional dysphonia.Results: We found a significant degree of handicap showed by high values of VHI-30 (55,74) its three subscales - organic (24,82), functional (19,28) and emotional (11,65) - and a significant degree of impairment caused by the associated symptoms. We compare our results with control groups of our environment and the results were stratified according to the profession of patients.Discussion and conclusion: The literature on the measurement of vocal handicap is briefly reviewed. We conclude that the presence of functional dysphonia cause a significant grade of disability for social and professional activities and a considerable emotional impact for the patient. Objetivo: Analizar el grado de discapacidad que suponen las disfonías funcionales para los pacientes. Pacientes y métodos: Presentamos los resultados de la valoración subjetiva (el índice de discapacidad vocal - .H.I.- 30 adaptado al español - y valoración de la sintomatología asociada a la disfonía) en 65 pacientes diagnosticados de disfonía funcional.Resultados: Encontramos un grado importante de discapacidad reflejado por unos valores elevados del V.H.I.-30 (55,74), sus tres subescalas - orgánica (24,82), funcional (19,28) y emocional (11,65) - y importante grado de afectación por los síntomas asociados. Se comparan nuestros resultados con los grupos de control de nuestro entorno y se estratifican los resultados según la profesión de los pacientes.Discusión y conclusión: Se revisa la literatura sobre la valoración de la discapacidad vocal. Concluimos que la presencia de la disfonía funcional supone una discapacidad importante a nivel de las actividades sociales y laborales del paciente y un impacto emocional considerable.

Introducción: La medición de la discapacidad vocal en los pacientes con disfonía funcional es un tema de gran relevancia. Objetivo: Analizar los resultados de dos medidas subjetivas (el índice de discapacidad vocal (VHI) y el índice de calidad de vida (QLI)) y calcular el grado de discapacidad que suponen las disfonías funcionales para los pacientes. Material y método: Sesenta y cinco pacientes diagnosticados de disfonías funcionales contestaron un cuestionario que incluye el índice de discapacidad vocal y el índice de calidad de vida. Resultados: Encontramos un grado importante de discapacidad reflejado por unos valores elevados del VHI (55,74), sus tres subescalas (orgánica (24,82), funcional (19,28) y emocional (11,65) y del QLI (11,42). Discusión: Se realiza una revisión exhaustiva de la literatura, constatando la escasez de estudios sobre la discapacidad que producen los trastronos vocales y se comparan nuestros resultados con los de otros autores. Conclusión: La presencia de disfonías funcionales supone una discapacidad importante a nivel de las actividades sociales y laborales del paciente y un impacto emocional considerable. Introduction: Functional dysphonia is a major issue. Aim: To analyse the results of two subjective measures (Vocal Handicap Index (VHI) and Quality Life Index (QLI)) and to calculate the impact that functional dysphonias suppose for the patients. Material and Method: 65 patients diagnosed of functional dysphonia answered a questionnaire that includes the Vocal Handicap Index and the Quality Life Index. Results: We found an important degree of handicap indicated by high values of the VHI (55,74), of its three subscales (organic (24,82), functional (19,28) and emotional (11,65)) and of the QLI (11,42). Discussion: We made a wide literature review, noting that there are a few studies of the handicap of voice disorders; and compared our results with those of other authors. Conclusion: The presence of functional dysphonias supposes an important level of handicap in the patient's social and laboral activities and a considerable emotional impact.

Psychische Einflusse bei der Entstehung und Aufrecht-erhaltung funktioneller Stimmstorungen verlangen eine psychotherapeutische Behandlung von Stimmstorungspatienten. Die Stimmstorungssymptomatik wird als eine kreative Ich-Leistung zur Bewaltigung eines inneren Konfliktes unter Einsatz der Ich-Funktion des Sprechens und der Stimme im sozialen Kontext verstanden. Fur einen grossen Teil der Dysphoniepatienten ist eine Konzentration der Psychotherapie auf das Symptom erforderlich. Die symptomzentrierte Kurzpsychotherapie auf psychoanalytischer Grundlage stellt den Symptomfokus in den Mittelpunkt der psychotherapeutischen Behandlung, der als generalisierte Beschreibung der kognitiven, affektiven und verhaltensmassigen Elemente der Sprechkonfliktsituationen die Arbeit mit Material der Manifestationen der Stimmbeschwerden im psychosozialen Kontext strukturiert. Die Erarbeitung der der Stimmsymptomatik zugrundeliegenden psychodynamischen Konfliktkonstellation ermoglicht den Patienten die Entwicklung von Alternativen der Bewaltigung des inneren affektiven Konflikts und der Gestaltung der psychosozialen Interaktionsmuster mit emotional bedeutsamen Personen.

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.Case-control study.Teaching hospital, United Kingdom.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.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).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.

During a 2-year period, 17 patients with "functional dysphonia" were assessed and managed in a hospital setting. A single treatment approach, known as manual laryngeal musculoskeletal tension reduction, was employed. The effects of the therapy regimen were analyzed using perceptual and acoustical measures of vocal function. The results indicated a significant change in the direction of "normal" vocal function in the majority of patients within one treatment session. Perceptual measures of severity were consistently more likely to be rated as normal following treatment. Acoustic measures of voice confirmed significant improvements in jitter, shimmer, and signal-to-noise ratio (SNR). Results are discussed in terms of the clinical utility and effectiveness of this treatment approach for functional dysphonia.

Functional dysphonia is a term applied to voice disorders for which there is an absence of apparent structural change in the larynx. The aim of this work was to investigate how functional dysphonia may differ acoustically from other types of dysphonia. Fundamental frequency profiles for steady vowels were generated using a software program called GLIMPES (Glottal Imaging by Processing External Signals). The fundamental frequency variations were found to be unimodal in normal individuals. In contrast, the variations for dysphonic patients were sometimes bi-modal or multi-modal due to the presence of subharmonics or low-frequency modulations. The appearance of these patterns was generally related to the severity of the dysphonia rather than to its etiology.

Psychogene Faktoren spielen in der Atiologie funktioneller Dysphonien zweifellos eine mitentscheidende Rolle. In der vorliegenden Untersuchung wird versucht, mittels eines empirisch-psychologischen Ansatzes eine Differenzierung psychogener und nicht psy-chogener Dysphonien anhand relevanter psychologischer Dimensionen vorzunehmen. Bei funktioneUen Aphonien konnte anhand mehrerer Dimensionen (Beanspruchung, Offenheit, Allgemeinbeschwerden, Bela-stungsfaktoren) eine psychologische Auffalligkeit im Vergleich zur Kontrollgruppe nachgewiesen werden und die Psychogenese somit nachvollzogen werden. Bei den funktioneUen Dysphonien dagegen ist dies nur partiell gelungen. Daraus kann geschlossen werden, dass bei funktioneUen Dysphonien nicht zwangslaufig psychogene Aspekte im Vordergrund stehen. Es konnte zu einer Uberschatzung der Psychogenese bei funktionellen Dysphonien kommen, da die psychologisch gut abgrenzbaren Gruppen der funktionellen Dysphonien und Aphonien manchmal unter einer no-sologischen Einheit subsumiert werden.

The study was designed as a two-stage project. In the first phase a sample dysphonia patients were examined thoroughly in respect of important etiopathogenetic factors mentioned in the relevant literature. In the second phase presented here a total of 45 patients with functional dysphonia were examined by means of standardized questionnaires and a newly-constructed interview. The results were compared to a group of normals matched for age, sex and voice strain. As hypothesized, these results suggest that functional dysphonia is correlated with less openmindedness, intensive voice strain, an array of psycho-physiological complaints and psycho-social strain factors.

Tape recordings before and after successful voice therapy from 174 subjects with non-organic voice disorders (functional dysphonia) were analysed by long-time averaged voice spectrograms (LTAS). In female as well as in male voices there was a statistically significant increase in level in the first formant region of the spectra. In the female voices there was also an increase in level in the region of the fundamental. The LTAS were compared to the results of a perceptual evaluation of the voice qualities by a small group of expert listeners. There was no significant change of the LTAS in voices with negligible amelioration after therapy. In the voices, where the change after therapy was perceptually rated to be considerable, the LTAS showed only an increase in intensity, but the general configuration of the spectral envelope remained unchanged. There was only a weakly positive correlation between the quality ratings and parameters of the spectra.

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 4000 Hz (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.

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...

After a head or a cervical injury dysphonia and its accompanying globus syndrome are often ignored, even if the existence of these traumatic sequelae are repeatedly reported. Till now there is no coherent idea about their pathogenesis, wherefore in the individual case wide differences exist in the diagnosis, treatment and in the expert opinion. It could be shown in this paper, that a posttraumatic dysphonia, due to a minor trauma, is a well defined disease with an uniform pathogenesis. The diagnosis results from the typical anamnesis of the accident, from the prove of the functional dysphonia and last not least from the prove of a functional deficit of the cervical spine, especially in the height of C 2/3. The right diagnosis allows a causal treatment and enables a just expert opinion.

A total of 160 voice-trained and untrained subjects with functional dysphonia were given a "clinical rating" according to their clinical findings. This was a certain value on a scale that recorded the degree of functional voice disorder ranging from a marked hypofunction to an extreme hyperfunction. The phonetograms of these patients were approximated by ellipses, whereby the definition and quantitative recording of several phonetogram parameters were rendered possible. By means of a linear combination of phonetogram parameters, a "calculated assessment" was obtained for each patient that was expected to tally with the "clinical rating". This paper demonstrates that a graduation of the dysphonic clinical picture with regard to the presence of hypofunctional or hyperfunctional components is possible via computerised phonetogram evaluation. In this case, the "calculated assessments" for both male and female singers and non-singers must be computed using different linear combinations. The method can be introduced as a supplementary diagnostic procedure in the diagnosis of functional dysphonia.

Purpose: The study aims to observe whether any systematic change in vocal fold configuration occurs during and after phonation into a tube using computerized tomography (CT). Materials and Methods: Ten participants diagnosed with functional dysphonia were included in the study. CT was performed when participants produced the sound (a:), phonated into a drinking straw and when repeating (a:) after the exercise. Similar procedure was performed with a stirring straw after 20 min of vocal rest. Anatomic variables included: (1) glottal area, (2) glottal width, (3) vertical vocal fold thickness, (4) vocal fold area, and (5) vocal fold length. Each vocal fold was separately analyzed. Results: Only glottal area for stirring straw was statistically different throughout the three time points. This variable increased during tube phonation compared to conditions pre- and post-tube. Discussion: Since vocal fold length did not change during tube phonation, the increment in glottal area was likely due to increased amplitude of vibration. Increased vibratory amplitude has been found in previous studies with high-speed imaging, suggesting an increased subglottic pressure. From the physiologic point of view, transglottal pressure plays an important role in vocal fold amplitude of vibration. Conclusions: Tube phonation seems to cause increased glottal area during exercise. This change is more prominent during exercise with a higher degree of airflow resistance. Therefore, the degree of flow resistance is an important clinical variable to be considered when choosing the right voice exercises regarding the voice status/phonatory pattern of patients during voice therapy.

Summary The aim of this study was to investigate the prevalence of acid reflux in patients complaining of hoarseness where no organic disease or functional dysphonia could be found. We also aimed to determine whether anti-reflux treatment improved their symptoms. Patients were not selected on the basis of symptoms of reflux. Fifty patients with hoarseness took part in a prospective study that sought to establish objectively whether acid reflux was present. All patients were given a 6-week course of ranitidine and Gaviscon. Patients were asked to score their voice quality before and after treatment. Although 72% of patients complained of heartburn more than once a week, only 40% proved to have acid reflux. Although subjective improvement after anti-reflux treatment was found in a larger proportion of those with than without proven reflux, the conclusions that can be drawn are limited as there were no satisfactory objective measurements of voice or controls.

Objectives: Laryngopharyngeal reflux (LPR) may be a contributing factor in chronic hoarseness. The association of LPR with functional dysphonia (FD), the most common voice clinic diagnosis, is unknown. We attempted to determine whether patients with FD have a higher rate of laryngeal exposure to acidic stomach contents than do healthy volunteers. Methods: We recruited through the voice clinic 23 patients who had had persistent dysphonia for 3 months. Pregnancy, major structural laryngeal abnormality, and vocal fold paralysis were exclusion criteria. Eight healthy volunteers were recruited. The subjects gave informed consent to enter the study, which had the approval of our hospital ethics committee. The patients and control subjects underwent 24-hour dual-probe pH-metry. Results: Twenty-two patients and 6 control subjects completed the study. Overall, there seemed to be no statistical differences between patients and controls on all but 2 channel 1 pH-metry parameters. These were the longest reflux episode (seconds) in a supine position, and the fraction of time the pH was less than 4 in a supine position. Both of these time periods were longer in patients than in the controls (p Conclusions: Our study demonstrated an association between LPR and FD for 2 pH parameters. Larger studies are required to assess the potential relationship between nonorganic dysphonias and reflux. Furthermore, the presence of a multifactorial causation of FD, including “medical” and psychological causes, should be addressed in future studies.

Background. The goal of this study was to assess and compare voice handicap in patients with benign organic and functional dysphonia. Patients and methods. Voice handicap was assessed using a German version of the Voice Handicap Index. A total of 108 German speaking patients, 64 women and 44 men aged 45.3±15.1 years with benign organic (n=69) or functional (n=39) voice disorders completed the questionnaire immediately after clinical examination and without knowing their individual diagnosis. Fifty individuals without voice complaints and normal voice status, 28 women and 22 men aged 47.1±15.5 years, served as controls. Results. Significant differences (P

The categorization of voice into quality type (ie, normal, breathy, hoarse, rough) is often a traditional part of the voice diagnostic. The goal of this study was to assess the contributions of various time and spectral-based acoustic measures to the categorization of voice type for a diverse sample of voices collected from both functionally dysphonic (breathy, hoarse, and rough) (n=83) and normal women (n=51). Before acoustic analyses, 12 judges rated all voice samples for voice quality type. Discriminant analysis, using the modal rating of voice type as the dependent variable, produced a 5-variable model (comprising time and spectral-based measures) that correctly classified voice type with 79.9% accuracy (74.6% classification accuracy on cross-validation). Voice type classification was achieved based on two significant discriminant functions, interpreted as reflecting measures related to "Phonatory Instability" and "F(0) Characteristics." A cepstrum-based measure (CPP/EXP ratio) consistently emerged as a significant factor in predicting voice type; however, variables such as shimmer (RMS dB) and a measure of low- vs. high-frequency spectral energy (the Discrete Fourier Transformation ratio) also added substantially to the accurate profiling and prediction of voice type. The results are interpreted and discussed with respect to the key acoustic characteristics that contributed to the identification of specific voice types, and the value of identifying a subset of time and spectral-based acoustic measures that appear sensitive to a perceptually diverse set of dysphonic voices.

Two vocal tract postures commonly identified as hallmarks of nonorganic dysphonia are anterior-posterior and medial compression of the supraglottis. However, insufficient data exist to support their diagnostic utility. The purpose of this study was to compare these two postures in patients with nonorganic dysphonia and normal controls using interval data derived from quantitative measures of videostroboscopic images obtained with an oral endoscope. Retrospectively, 40 patients with nonorganic dysphonia and 40 normal controls were selected. Relative anterior-posterior compression (LO(AP)) was calculated as the laryngeal outlet (LO) (the view of the true vocal folds during phonation) normalized to the anterior-posterior dimension in pixels. Relative ventricular fold medial compression (LO(w)) was calculated as the laryngeal outlet normalized to the medial dimension in pixels. Results were as follows: (1) LO(AP) was significantly greater for the dysphonic group, (2) the range of LO(AP) values between the two groups overlapped considerably, (3) no significant difference was found between groups for LO(w), (4) the correlation between LO(AP) and LO(w) within each subject yielded r values of 0.71 and 0.67 for the nonorganic dysphonia and normal control groups, respectively. It is concluded that medial compression of the ventricular folds can be a normal laryngeal posture, and that although anterior-posterior compression is present in greater degree in dysphonics, it is sufficiently common in normals to question its utility as a diagnostic sign of phonatory dysfunction.

An approach is given to extract parameters affecting phonation based upon digital high-speed recordings of vocal fold vibrations and a biomechanical model. The main parameters which affect oscillation are vibrating masses, vocal fold tension, and subglottal air pressure. By combining digital high-speed observations with the two-mass-model by Ishizaka and Flanagan (1972) as modified by Steinecke and Herzel (1995), an inversion procedure has been developed which allows the identification and quantization of laryngeal asymmetries. The problem is regarded as an optimization procedure with a nonconvex objective function. For this kind of problem, the choice of appropriate initial values is important. This optimization procedure is based on spectral features of vocal fold movements. The applicability of the inversion procedure is first demonstrated in simulated vocal fold curves. Then, inversion results are presented for a healthy voice and a hoarse voice as a case of functional dysphonia caused by laryngeal asymmetry.

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.

OBJECTIVES: To assess the overall efficacy of voice therapy for dysphonia. DESIGN: Single blind randomised controlled trial. SETTING: Outpatient clinic in a teaching hospital. Participants: 204 outpatients aged 17-87 with a primary symptom of persistent hoarseness for at least two months. INTERVENTIONS: After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12-14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. MAIN OUTCOME MEASURES: Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF-36. RESULTS: Voice therapy improved voice quality as assessed by rating by patients (P=0.001) and rating by observer (P