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Biomedical subjects

Michael M Johns

Publications and source records attributed to Michael M Johns.

At least 19 recordsLinked to original sources
PubMed2006

Voice therapy improves quality of life in age-related dysphonia: a case-control study.

The objective of the study is to determine the efficacy of voice therapy in the treatment of age-related dysphonia. The study was conducted using a retrospective case-control chart review. The medical records of 54 patients older than 60 years diagnosed with age-related dysphonia without complicating diagnoses were reviewed. Patients who chose to undergo voice therapy were grouped as cases. Patients who chose not to undergo voice therapy were grouped as controls. The voice-related quality of life (VRQOL) measure was used to measure outcomes before and after treatment in cases and at a minimum 2-month follow-up in controls. Of the 54 patients, 19 (10 female, 9 male; mean age 73 years) chose to undergo voice therapy and filled in >1 VRQOL questionnaire. Six patients (3 female, 3 male; mean age 66 years) chose not to undergo voice therapy and filled in >1 VRQOL questionnaire. The 19 cases experienced a mean improvement in VRQOL score of 19.21 (2-tailed matched pairs t test P=0.00038) after a mean of 4.1 voice therapy sessions and 5.1 months. The six controls experienced a mean change in VRQOL score of 0.42 (2-tailed matched pairs t test P=0.96) after a mean of 3.3 months. Voice therapy leads to statistically significant improvement in the VRQOL life in elderly patients with age-related dysphonia. It is an efficacious noninvasive therapy for this disease.

Aged↗
PubMed2006

Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL).

The purpose of this study was to investigate the correlation between the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL), and to test conversion of scores between the two instruments. Understanding the relationship between instruments will facilitate comparison of voice outcome studies using different measures. A retrospective medical chart review of 140 consecutive patients with a chief complaint related to their voice presenting for speech pathology voice evaluation following laryngology evaluation and diagnosis was adopted. Each patient who filled out the VHI and V-RQOL within a 2-week period with no intervening treatment was included in the study. Correlation analysis for total scores was performed for the patients meeting inclusion criteria (n=132). Correlations were also performed as a function of diagnosis. Calculated VHI score based on measured V-RQOL score was compared to measured VHI score. Pearson correlation between scores on the VHI and V-RQOL was -0.82. There was no significant difference between the mean measured and mean calculated VHI scores. For individual scores, however, regression analysis did reveal a significant difference between calculated and measured VHI. The VHI and V-RQOL are highly correlated; however, this study suggests that the two instruments are not interchangeable for individuals.

Disability Evaluation↗
PubMed2006

Prevalence of perceived dysphonia in a geriatric population.

OBJECTIVES: To characterize geriatric dysphonia, including its prevalence, quality-of-life impairment, and association with overall health status. DESIGN: A validated survey-based study of geriatric dysphonia. SETTING: An independent living facility for geriatric individuals. PARTICIPANTS: The entire population of residents at the facility was offered the survey. The inclusion criterion was aged 65 and older. MEASUREMENTS: Two survey-based measures were used to characterize dysphonia: a direct question asking whether participants had problems with their voice and a voice-related quality-of-life (V-RQOL) measure. In addition, participants were administered the 12-item Medical Outcomes Study Short Form survey, U.S. version 2.0, a concise survey designed to evaluate overall health status. RESULTS: The prevalence of dysphonia was 20%. More than 50% of patients with voice problems incurred significant quality-of-life impairment resulting from their dysphonia as measured using V-RQOL scores. The mean total V-RQOL score+/-standard deviation was 89+/-20. Finally, general health measures did not reflect V-RQOL. CONCLUSION: There is a high prevalence of voice problems in older people, with a large proportion having significantly impaired quality of life related to their dysphonia. General health measures do not reflect V-RQOL, and many individuals may wrongly attribute dysphonia to age-related change alone. Administration of validated instruments for assessing dysphonia is encouraged, because direct questions regarding voice difficulties may not be sensitive to the severity of vocal impairment.

Aged↗
PubMed2006

Blinded evaluation of the effects of high definition and magnification on perceived image quality in laryngeal imaging.

OBJECTIVES: Advances in commercial video technology have improved office-based laryngeal imaging. This study investigates the perceived image quality of a true high-definition (HD) video camera and the effect of magnification on laryngeal videostroboscopy. METHODS: We performed a prospective, dual-armed, single-blinded analysis of a standard laryngeal videostroboscopic examination comparing 3 separate add-on camera systems: a 1-chip charge-coupled device (CCD) camera, a 3-chip CCD camera, and a true 720p (progressive scan) HD camera. Displayed images were controlled for magnification and image size (20-inch [50-cm] display, red-green-blue, and S-video cable for 1-chip and 3-chip cameras; digital visual interface cable and HD monitor for HD camera). Ten blinded observers were then asked to rate the following 5 items on a 0-to-100 visual analog scale: resolution, color, ability to see vocal fold vibration, sense of depth perception, and clarity of blood vessels. Eight unblinded observers were then asked to rate the difference in perceived resolution and clarity of laryngeal examination images when displayed on a 10-inch (25-cm) monitor versus a 42-inch (105-cm) monitor. A visual analog scale was used. These monitors were controlled for actual resolution capacity. RESULTS: For each item evaluated, randomized block design analysis demonstrated that the 3-chip camera scored significantly better than the 1-chip camera (p < .05). For the categories of color and blood vessel discrimination, the 3-chip camera scored significantly better than the HD camera (p < .05). For magnification alone, observers rated the 42-inch monitor statistically better than the 10-inch monitor. CONCLUSIONS: The expense of new medical technology must be judged against its added value. This study suggests that HD laryngeal imaging may not add significant value over currently available video systems, in perceived image quality, when a small monitor is used. Although differences in clarity between standard and HD cameras may not be readily apparent on small displays, a large display size coupled with HD technology may impart improved diagnosis of subtle vocal fold lesions and vibratory anomalies.

Equipment Design↗
PubMed2005

Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia.

OBJECTIVE: To review the safety of simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections. DESIGN: Retrospective case series review. SETTING: Tertiary care academic clinic. PATIENTS: Twenty-one patients with abductor spasmodic dysphonia. INTERVENTIONS: Patients received 100 simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period. MAIN OUTCOME MEASURES: Major and minor complications, injection dosing, and demographics. RESULTS: The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5% incidence of significant dyspnea and a 2% incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively. CONCLUSIONS: This case series demonstrates that simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injection is safe up to the highest doses reported. Complications with this approach are consistent with those previously reported using other methods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections to evaluate the efficacy of this technique.

Adult↗
PubMed2005

Burnout in academic chairs of otolaryngology: head and neck surgery.

BACKGROUND: Burnout can be characterized by a low degree of personal accomplishment and a high degree of emotional exhaustion and depersonalization using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). With increasing demands and constraints placed on academic department chairs, the risk of developing burnout may be increasing. The prevalence of burnout in chairs of academic departments of otolaryngology and the factors associated with it have not been previously described. OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the prevalence of burnout in otolaryngology chairs and to identify the factors that are associated with burnout development. Understanding these elements can lead to improved prevention, recognition, and treatment of professional burnout. STUDY DESIGN: A cross-sectional questionnaire-based study of 120 academic chairs of otolaryngology in the United States was performed. METHODS: A confidential questionnaire was mailed to U.S. otolaryngology chairs. The questionnaire consisted of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self efficacy survey, 5) a spousal support survey, and 6) the MBI-HSS. Statistical analyses were performed using Pearson correlation and analysis of variance, and burnout data were compared with previously reported data from other department chairs and physicians. RESULTS: Questionnaires were returned from 107 department chairs for a response rate of 89%. Chairs were on average 56 years of age, serving as chair for a mean of 11 years. Average work week was 68 hours and did not vary significantly with increasing duration as chair. Sixty-six percent of time was spent delivering patient care, 8% in research, and 26% performing administrative duties. MBI-HSS scores demonstrate 3% of chairs experiencing high burnout, 81% of chairs with moderate burnout, and 16% of chairs with low burnout. On average, chairs have low depersonalization scores, low-moderate emotional exhaustion scores, and low-moderate personal accomplishment scores. High emotional exhaustion or depersonalization was correlated with low self-efficacy, low spousal support, disputes with the dean, department budget deficits, working nights and weekends, Medicare audits, loss of key faculty, and being a malpractice defendant. High personal accomplishment was correlated with increased time spent performing administrative duties. When compared with other physician specialties, otolaryngology chairs demonstrate less sense of emotional exhaustion and depersonalization but also slightly less sense of personal accomplishment. Duration as chair, age, and hours worked per week were not associated with increased burnout. CONCLUSIONS: Most otolaryngology chairs experience moderate levels of burnout. The biggest risk factors for burnout include low self-efficacy, low spousal support, disputes with the medical school dean, department budget deficits, and nights/weekends worked. These findings may help department chairs identify and prevent burnout and may help in developing programs to minimize burnout in our field's academic leaders.

Academies and Institutes↗
PubMed2004

Length-tension relationship of the feline thyroarytenoid muscle.

Vocal fold tension during phonation is generated by coordinated contraction of the intrinsic laryngeal muscles. The thyroarytenoid muscle has been found to have increased stiffness at various levels of strain when compared with other intrinsic laryngeal muscles. The objective here is to test the hypothesis that the thyroarytenoid muscle exhibits high passive tension during maximal isometric tetanic force generation, and to test the hypothesis that the thyroarytenoid maintains the ability to generate contractile force at high levels of strain more effectively than other skeletal muscle. The thyroarytenoid muscles (n=9) and digastric muscle strips (n=7) were removed from adult random-bred cats. Maximal isometric tension and passive tension at optimum length were measured from each muscle in vitro. Active and passive length-tension curves were constructed for each muscle. The contractile properties of the thyroarytenoid group were compared with those of the digastric muscle group. The thyroarytenoid muscle group required on average 140 mN of passive tension to generate maximal isometric tetanic tension. This represented 39% of the average maximal isometric tetanic tension generated by the muscles. These results were significantly higher than the digastric muscle group, which required on average 28 mN of passive tension (9% of maximal isometric tetanic tension, p<0.05). At 110% of optimum length, the thyroarytenoid muscle maintained 89.8% of maximal isometric tetanic force, whereas the digastric muscle group maintained 67.7% of maximal isometric tetanic force (p<0.05). The thyroarytenoid muscle exhibits higher passive tension when generating maximal isometric tension than the digastric muscle control group. The thyroarytenoid muscle maintains higher levels of active tension at high strain than the digastric muscle control group. We conclude that these findings are related to the ability of the thyroarytenoid muscle to function as a fine tensor of the vocal fold in a high strain environment.

Animals↗