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Biomedical subjects

P Carding

Publications and source records attributed to P Carding.

12 recordsLinked to original sources
PubMed2005

Quality of life and voice following endoscopic resection or radiotherapy for early glottic cancer.

OBJECTIVES: To assess whether proposed voice and quality of life (QoL) outcome measures were likely to be acceptable to patients previously treated for early glottic cancer by either radiotherapy or endoscopic resection, as well as looking for differences in QoL and voice between treatments. DESIGN: Questionnaire-based cohort study. SETTING: Secondary care, three centres. PARTICIPANTS: All patients treated for T1a or in situ glottic carcinoma between 1997 and 2003. Fifty-three patients were identified; those who had undergone salvage surgery or radiotherapy were excluded. A proportion refused to participate or could not be contacted and two patients had died of unrelated causes. Thirty-six patients completed the trial with 18 from each treatment arm. MAIN OUTCOME MEASURES: Quality of voice as assessed by three questionnaires, Voice Handicap Index (VHI), Vocal Performance Questionnaire (VPQ), Voice Symptom Score (VoiSS) and perceptual analysis of voice by Grade, Roughness, Breathiness, Asthenia and Strained (GRBAS) assessment of vocal recordings. Quality of life as assessed by the Hospital Anxiety and Depression Scale (HADS), University of Washington Quality of Life Questionnaire (UW-QoL), and the Functional Assessment of Cancer Therapy (FACT) questionnaire. RESULTS: All patients included in the trial were able to complete the questionnaires; however, 19% required assistance of some kind. GRBAS assessment showed no difference between groups for any criteria. All QoL questionnaires gave equivalent good scores. All of the voice questionnaires showed no statistical difference between groups except for the emotional subscale of the VoiSS which showed a significantly better score for the radiotherapy arm (P = 0.04). CONCLUSION: All outcome measures were applicable and acceptable to the patient group. Overall QoL and voice appears similar despite treatment arm, apart from the emotional subscale of the VoiSS. A randomized controlled trial is required to further assess this question.

Aged↗
PubMed2005

The reliability and validity of patient self-rating of their own voice quality.

OBJECTIVES: To provide preliminary data on the reliability and validity of dysphonic patients rating their own voice quality. DESIGN: Prospective reliability/validity assessment of voice ratings in dysphonic patients. SETTING: The Royal Free Hampstead NHS Primary Care Trust. PARTICIPANTS: Thirty-five adult dysphonia patients recruited from ENT referrals to a speech and language therapy department. Exclusion criteria were (i) a hearing impairment which may affect auditory discrimination and (ii) a diagnosis of cognitive impairment which may affect task comprehension. MAIN OUTCOME MEASURES: Patient intra-rater reliability was assessed by test-retest ratings, using G (Grade), R (Rough), B (Breathy), A (Asthenic), S (Strained) (GRBAS). Validity was assessed by comparing (i) patient-clinician inter-rater reliability, (ii) patients' GRBAS ratings with their Vocal Performance Questionnaire (VPQ) responses. RESULT: (i) Patients had lower intrarater reliability than clinicians (for G of GRBAS, kappa = 0.51 versus 0.74); (ii) patients consistently rated their voices more severely than clinicians (for G of GRBAS, mean rating = 1.4 versus 1.0); (iii) clinician-patient inter-rater agreement was no better than chance (paired t-test, all P < 0.05); (iv) patient ratings correlated significantly with vocal performance scores (r > 0.4, P < 0.05). CONCLUSIONS: Patients appear to have good validity and consistency using GRBAS as a self-perception tool. However, validity measured in terms of agreement with clinician ratings is poor. Voice patients may rate what they perceive rather than what they hear. Disagreement between patient and clinician ratings has implications for therapy aims, prognosis, patient expectations and outcomes. Where disagreement persists, the clinician may have to determine whether therapy priorities need redesigning to reflect patients' perceived needs, or to evaluate whether patient perceptions and expectations are unrealistic.

Adult↗
PubMed2000

The effect of Isshiki type 1 thyroplasty on quality of life and vocal performance.

Type 1 thyroplasty for unilateral vocal cord palsy improves many vocal outcome measures but there is little information on quality of life despite its increasingly recognized importance. Our prospective study examined its effect on a range of subjective and objective measures and quality of life. Twenty-seven patients underwent thyroplasty. Before and after surgery they completed a vocal performance questionnaire and the Nottingham Health Profile (NHP); instrumental analyses of jitter, shimmer and noise-harmonic ratio (NHR); and perceptual analyses of grade, roughness, breathiness, aesthenia and strain (GRBAS) were also performed. Significant improvements were found in instrumental, perceptual and self-assessment of voice and the energy, social and emotional dimensions of the NHP. Three patients had initially poor results but were successfully revised. These results of type 1 thyroplasty compare favourably with those previously published. The improvement in quality of life appears to result directly from improved voice. Many thyroplasty patients have limited life expectancy: early surgical intervention should be considered.

Adult↗
PubMed2000

Formal perceptual evaluation of voice quality in the United Kingdom.

This document is a position statement on the formal perceptual evaluation of voice quality in the United Kingdom (UK). It addresses a number of clinical issues pertaining to the complexity of voice quality analysis. There is also a brief description of the three formal perceptual protocols most commonly used in the UK: The Vocal Profile Analysis (VPA), GRBAS and The Buffalo III Voice Profile. Potential clinical problems with perceptual voice quality evaluation are highlighted. Problems associated with the lack of defined terminology, limitless variety of voice quality, general lack of reliability data and difficulties in determining specificity and sensitivity are discussed. A practical guide for selecting an evaluation scheme is described. The conclusion is that the GRBAS scheme should be recommended as the absolute minimum standard for practising UK voice clinicians. However, there is a clear need to develop a more satisfactory perceptual rating scheme that is clinically realistic, theoretically sound, internationally acceptable and has proven reliability.

Female↗
PubMed1999

Tracheo-oesophageal puncture by retrograde passage of a gastroscope via mini-laparotomy and gastrotomy.

Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.

Carcinoma, Squamous Cell↗
PubMed1993

Mean airflow rates in laryngeal polyposis.

This study assesses the laryngeal airflow characteristics in 10 patients with laryngeal polyposis before and after surgical excision. The results indicate that mean airflow rates in the presence of polyps are a reflection of two mechanical processes. Narrow based polyps splint the glottis open during phonation, thus increasing flow rates, whereas large broader based polyps tend to obstruct the glottis and reduce the airflow. The results suggest that mean airflow rates may be used to measure the improvement in laryngeal function following surgical intervention in individual patients.

Adult↗