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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]

Objectives: The Nyquist plot provides a graphical representation of the glottal cycles as elliptical trajectories in a 2D plane. This study proposes a methodology to parameterize the Nyquist plot with application to support the quantitative analysis of voice disorders., Methods: We considered high-speed videoendoscopy recordings of 33 functional dysphonia (FD) patients and 33 normophonic controls (NC). Quantitative analysis was performed by computing four shape-based parameters from the Nyquist plot: Variability, Size (Perimeter and Area), and Consistency. Additionally, we performed automatic classification using a linear support vector machine and feature importance analysis by combining the proposed features with state-of-the-art glottal area waveform (GAW) parameters., Results: We found that the inter-cycle variability was significantly higher in FD patients compared to NC. We achieved a classification accuracy of 83% when the top 30 most important features were used. Furthermore, the proposed Nyquist plot features were ranked in the top 12 most important features., Conclusions: The Nyquist plot provides complementary information for subjective and objective assessment of voice disorders. On the one hand, with visual inspection it is possible to observe intra- and inter-glottal cycle irregularities during sustained phonation. On the other hand, shaped-based parameters allow quantifying such irregularities and provide complementary information to state-of-the-art GAW parameters., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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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]

In order to evaluate the effectiveness of the treatment in patients with functional dysphonia, the Cepstral Peak Prominence (CPP) test was used. Twenty dysphonic women aged from 18 to 47 years were under observation. The control group consisted of 20 healthy women of close age. Patients underwent 5-7 sessions electrostimulation of laryngeal muscles and phonopedic treatment, after which a complete restoration of the voice was noted. The Praat clinical program was used, installed on a Hewlett-Packard 630 laptop (Pentium B960, 2.2 GHz). A SHURE SM94 condenser microphone was used as well. In the control group, the results were as follows: M =7.49 ( SD =1.26) dB. In the main group before treatment: M =5.00 ( SD =1.07) dB, after treatment: M =7.95 ( SD =1.34) dB. Differences in KT values in the main group before and after treatment (5.00 dB and 7.95 dB, respectively) were significant at p <0.0001. Differences in KT values in the main group before treatment (5.00 dB) and in the control group (7.49 dB) were significant at p <0.0001. Differences in KT values in the main group after treatment (7.95 dB) and in the control group (7.49 dB) were not significant at p >0.05. The study showed high sensitivity of the method. The CPP data after treatment were higher than those before treatment and did not differ from the control ones. It is concluded that CPP is a highly sensitive method for evaluating the degree of periodicity of an acoustic signal and can be used to evaluate the effectiveness of treatment in patients with functional dysphonia.

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.