Biomedical subjects

P N Carding

Publications and source records attributed to P N Carding.

At least 19 recordsLinked to original sources

PubMed2006

Bioplastique injection laryngoplasty: voice performance outcome.

AIM: To compare voice performance following Bioplastique injection with that following Isshiki thyroplasty. MEASURES: A 12 item, self-reported voice performance questionnaire was completed and observer-rated perceptual voice analysis scores were also measured, before and after Bioplastique injection, for 14 patients. Results were compared with our previously reported outcomes for 28 thyroplasty patients. RESULTS: Only 14 of 30 patients had complete datasets. For these patients, the mean pre-operative voice performance questionnaire score improved significantly, from 40.3 to 18.9 (p=0.002, Wilcoxon test). All perceptual analysis parameters showed significant improvement. These results compare favourably with the thyroplasty cohort (mean voice performance questionnaire score: pre-operative 35; post-operative 18; p<0.001). One Bioplastique patient developed contralateral paresis, requiring partial removal of the material 18 months later. Two thyroplasty patients experienced complications and three required revision. CONCLUSIONS: Both Bioplastique injection and Isshiki thyroplasty resulted in a significant improvement in both subjective and perceptual voice performance. Our data suggest that the effect size of the two interventions is approximately similar (in nonrandomised cohorts of surviving patients). As in many similar studies, the incomplete follow-up data reflect severe comorbidity. Bioplastique injection is a quicker procedure associated with fewer complications, and thus appears superior to framework surgery in patients with limited life expectancy.

Aged↗

PubMed2006

Exploring the relationship between severity of dysphonia and voice-related quality of life.

OBJECTIVES: To explore whether severity and/or consistency of dysphonia are linked to voice-related quality of life. DESIGN: Cross-sectional study. SETTING: Specialist voice clinics, University Teaching Hospital. PARTICIPANTS: Sixty adult patients attending with a primary complaint of dysphonia. Exclusion criteria were those below 16 years of age, transexual patients and those with a persistent dysphonia of >2 years. MAIN OUTCOME MEASURES: Voice-related quality of life as assessed by VoiSS. EXPLANATORY FACTORS: Severity of dysphonia as judged by perceptual ratings of voice (GRBAS); a visual analogue scale to judge best, worst and today's voice. RESULTS: There was a highly significant correlation between perceptual dysphonia severity as assessed by GRBAS and the total, impairment and emotional subsets of the VoiSS questionnaire (r from 0.48 to 0.64). There was a similar and highly significant correlation between best, worst and today's self-rated voice and the total, impairment and emotional subsets of the VoiSS questionnaire (r from -0.40 to -0.60). However, none of the self-rated parameters was demonstrably better at explaining the effect on quality of life. CONCLUSIONS: An increasingly negative effect on quality of life appears to be associated with an increase in the severity of dysphonia. Further research on the role of quality of life measures in the assessment and treatment of dysphonia would be of value.

Adult↗

PubMed2004

The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content.

Self report measures of voice function are in frequent use, but have had inadequate psychometric evaluation. We aimed to perform a substantial factor analysis of two measures of voice impairment, the Voice Symptom Scale (VoiSS) and the Voice Handicap Index (VHI). Both the 30-item questionnaires were completed by 319 dysphonic voice clinic attenders (99M, 220F). Principal components analysis confirmed that both instruments reflected general voice abnormality. The VoiSS comprised three factors - impairment (15 items), emotional (8 items) and related physical symptoms (7 items) - each with a good internal consistency. Analysis of the VHI suggested that it contains only two subscales. When a three-factor solution was imposed on the data, analysis failed to support the currently advised three 10-item subscale interpretations. Instead, we found a physical (voice impairment) domain (8 items), a psychosocial domain (14 items) and a factor with 8 items related to difficulty in being heard. The VHI requires further statistical refinement to identify its subscale structure. The VoiSS was developed from 800 subjects and is psychometrically the most robust and extensively validated self report voice measure available.

Adult↗

PubMed2004

The reliability and sensitivity to change of acoustic measures of voice quality.

This study aimed to evaluate the reliability and sensitivity to change of three commonly used acoustic parameters as measured by the Multi-Dimensional Voice Programme (MDVP); jitter, shimmer and noise-to-harmonic ratio. A total of 231 subjects' voices were recorded and analysed. The sample comprised 145 dysphonic patients who received intervention (surgery or voice therapy), 36 dysphonic patients who received no intervention, and 50 non-dysphonic (normal) subjects. All voices were recorded and analysed on two occasions (before and after treatment, or test-retest assessment) using a standard procedure. These data were analysed using standard psychometric procedures for assessing reliability and responsiveness. The acoustic analysis measures demonstrated poor to moderate reliability and effect size with respect to their sensitivity to change. Caution should be exercised in the injudicious use of computer-based acoustic analysis systems as an isolated measure of voice outcome in any clinical trial of interventions aimed at improving voice quality.

Adolescent↗

PubMed2003

The reliability of three perceptual evaluation scales for dysphonia.

Perceptual rating scales are widely used in voice quality assessment, yet apart from the GRBAS scale, their reliability has been poorly demonstrated. There are no studies that have compared the optimal reliability of experienced judges using different auditory rating scales in a controlled experimental environment. This study aimed to assess the reliability of three common scales (The Buffalo Voice Profile, The Vocal Profile Analysis Scheme (VPA) and GRBAS. Sixty-five varyingly dysphonic and five normal voices were recorded onto CD in random order. Thirty voices were recorded twice. Seven experienced and trained speech and language therapists rated all voices on the three scales. Only the overall grade was found to be reliable for the Buffalo Voice Profile. The reliability of the VPA scheme was found to be poor to moderate. The VPA may have a use as a multi-dimensional and in-depth evaluation of voice types, but its greater scope is at the expense of reliability. The GRBAS was reliable across all parameters except Strain. Our detailed reliability analysis comparing performance of three commonly used rating scales provides further evidence to support the GRBAS as a simple reliable measure for clinical use.

Adolescent↗

PubMed2003

The dysphonic voice heard by me, you and it: differential associations with personality and psychological distress.

Voice production is subject to and indicative of psychological status. The precise relationships of voice disorders and psychological variables remain unclear. We compared the correlations of self-reported and more objective measures of voice quality in dysphonic patients with personality, coping, affect and somatization. Two hundred and four subjects participating in a randomized, controlled trial of speech therapy underwent self-report, observer rating and computer acoustic analysis of voice quality. These three indices of voice quality were compared with regard to their correlations with individual differences in neuroticism, alexithymia, negative emotion coping, anxiety, depression, neurotic symptoms, medically unexplained symptoms and quality of life. Significant correlations were observed between self-reported voice problems and all of the personality/coping and clinical psychological distress measures. People who reported more voice problems had: higher neuroticism and alexithymia; a tendency to use emotion-oriented coping; more psychological distress; poorer quality of life; and more past medically unexplained symptoms. Expert voice rating correlated weakly with neurotic disturbance, quality of life and previous medically unexplained symptoms. Objective voice assessment (amplitude perturbation) showed no significant associations with any psychological measure. The strongest associations of psychological variables and voice measures are with self-report measures. This suggests that it is in part the patients' perception of their own voice quality which accounts for the association of voice production and psychological factors in subjects presenting to voice clinics.

Adolescent↗

PubMed2001

The clinical features of functional dysphonia.

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

Adolescent↗

PubMed1999

A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia.

Forty-five patients diagnosed as having nonorganic dysphonia were assigned in rotation to 1 of 3 groups. Patients in group 1 received no treatment and acted as a control group. Patients in groups 2 and 3 received a program of indirect therapy and direct with indirect therapy, respectively. A range of qualitative and quantitative measures were carried out on all patients before and after treatment to evaluate change in voice quality over time. Results revealed a significant difference between the 3 treatment groups in the amount of change for the voice severity, electrolaryngograph, and shimmer measurements and on ratings provided by a patient questionnaire (P<0.05). However, other measures failed to show significant differences between the 3 groups. Most of the patients (86%) in group 1 showed no significant change on any of the measures. Some patients in treatment group 2 (46%) showed significant change in voice quality. Fourteen out of 15 patients (93%) in treatment group showed significant changes in voice quality.

Adolescent↗

PubMed1998

Thyroplasty for functional rehabilitation of the incompetent larynx.

Type I thyroplasty was performed in 12 patients with unilateral paralysis of the vocal fold. Subjective as well as objective improvement in vocal performance was reported in 11 patients. Aspiration was improved in six out of eight patients. Effort closure was evaluated by the ability of the patient to voluntarily raise his intra-abdominal pressure during Valsalva's manoeuvre. A comparison of pre- and post-thyroplasty measures, showed a statistically significant improvement in the efficacy of effort glottic closure (p < 0.05), indicating a better physical performance. We had one case of wound sepsis and another case of implant extrusion.

Abdomen↗

PubMed1998

The effectiveness of voice therapy for patients with non-organic dysphonia.

Forty-five patients diagnosed as having non-organic dysphonia were assigned in rotation to one of three groups. Patients in one group received no treatment and acted as a control group. Patients in the other two groups received a programme of either 'indirect' therapy or 'direct with indirect' therapy, respectively. A self-report questionnaire of vocal performance, observed ratings of voice quality, and computer-derived acoustic measurements (signal-to-noise ratio, pitch perturbation and amplitude perturbation) were carried out on all patients before and after treatment to evaluate the changes in voice quality over time. There was a significant difference between the three groups on the self-report questionnaire, voice quality ratings and pitch perturbation measurements (P = < 0.05). Thirteen out of 15 control patients showed no significant change on any of the measures. Seven patients who received indirect treatment showed significant improvement in voice quality following treatment. Fourteen out of 15 patients who received direct treatment showed significant improvement in voice quality.

Adult↗

PubMed1998

Vocim analysis of laryngeal images: is breathiness related to the glottic area?

The aim of this study was to determine the relationship between glottic space and breathy voice. Using a new computerized method of analysing the glottic area of video images with the Vocim computer system, 16 patients with a vocal cord palsy and 31 with non-organic dysphonia were examined. The quality of the breathy voice was assessed and correlated with the size of the glottic space during phonation. There was a positive (r = 0.70) correlation between glottic area and breathy voice in vocal cord palsy. There was no correlation (r = 0.002) in non-organic dysphonia. Therefore in this study population, for vocal cord palsy, glottic area is the dominant feature in determining voice quality. This relationship is not maintained in non-organic dysphonia.

Glottis↗

PubMed1998

Is a 'safe swallow' really safe?

The aim of this study was to look at whether full vocal cord adduction is achieved in 45 normal subjects when asked to hold their breath, as in the supraglottic safe swallow technique. Fiberoptic nasendoscopy was used to assess vocal cord adduction. Results show that 57.7% of normal subjects do not fully close their vocal cords for the complete duration of breath holding. This finding has implications for the efficacy of teaching methods of the supraglottic safe swallow technique.

Adult↗

PubMed1996

Vocim--a system for measuring the larynx endoscopically.

Examination of the larynx with a flexible endoscope has been a standard procedure for over 20 years. Although excellent images have been obtained there has not been a method for achieving any objective measurements and there are clearly both research and clinical applications for this. The reason for this is firstly because of the inherent distortion of the lens and secondly because of an absence of a reliable method of assessing the relative position of the endoscope within the larynx. This paper illustrates the theory of how these problems have been overcome and describes the equipment used in the clinical situation. The first clinical trial of the Vocim system is detailed, demonstrating an error of only 4%.

Computers↗

PubMed1995

An analysis of vocal cord paralysis before and after Teflon injection using combined glottography.

Combined glottography shows clinical potential but has only had limited use in monitoring laryngeal function before and after surgery. Eight patients undergoing Polytetrafluoroethylene (Teflon) injection for unilateral vocal cord palsies had pre- and post-operative combined glottography performed. Grossly abnormal waveforms pre-operatively confirmed poor glottic closure and irregular vibratory cycles. Analysis was difficult. Post-operatively all patients had a marked improvement in voice. Combined glottography showed a clear recovery of the waveforms towards normal with resumption of the two-mass model of glottal movement. Analysis was greatly simplified. Objective records were produced.

Adult↗

PubMed1993

An assessment of the reproducibility of combined glottography in a clinical setting.

Although combined glottography has potential as a clinical tool, it has had limited use in the monitoring of laryngeal function before and after treatment. There is no data about the standardization nor reproducibility of the procedure. An indication of the reproducibility of combined glottography is paramount if changes in laryngeal function are to be measured accurately. Using a standardized technique, two complimentary studies examined the reproducibility of combined glottography within one sitting (Study 1) and over time (Study 2). The components of variance were analysed (ANOVA). In Study 1 the variance under controlled conditions for Open Quotient (OQ) and Speed Quotient (SQ) was only 13% and 18% respectively of the total, whilst in Study 2 the variance over time for OQ and SQ was 55% and 58% respectively. Under controlled conditions combined glottography is a reproducible technique.

Adult↗

PubMed1993

A comparison of combined glottography in men and women.

Out-patient combined glottography has shown potential in the assessment of the vocal cord cycle in laryngeal abnormality. We compared this technique in men and women with normal laryngeal function, to evaluate the influence of patient sex on the results. Ten adult men were compared with 10 age matched women. The open quotient was significantly greater in women. This indicates the woman's glottis is open for a greater proportion of the glottic cycle, as a result of the anatomical and physiological differences of the larynx between the sexes. Analyses are made of the glottic cycle differences which may account, in part, for the different quality of the female voice. Interpretation of results using this technique must take account of the patient's sex.

Adult↗

PubMed1992

Combined glottographic measurement of vocal cord paralysis in the outpatient clinic.

Recordings by combined glottography of vocal cord movements in patients with a vocal cord palsy were compared with a control group. In paralysis of the vocal cord the open quotient (OQ) is increased and the speed quotient (SQ) decreased. This system may have potential in the diagnosis and continued assessment of laryngeal abnormalities as well as providing a permanent objective record in medico-legal cases.

Adult↗

PubMed1992

An evaluation study of voice therapy in non-organic dysphonia.

Thirty patients diagnosed as suffering from non-organic dysphonia were assigned to one of three treatment groups: direct therapy, indirect and no treatment for a period of 8 weeks. Therapeutic outcome was evaluated by independent judges, patient self-evaluation, electrolaryngograph ratings and measures of fundamental frequency. The direct treatment group showed the most significant improvement in the return to normal voice functioning followed by the indirect treatment group. One patient in the control group showed improvement without any intervention. This study provides evidence in support of the effectiveness of both direct and indirect therapy in the treatment of non-organic dysphonia and raises questions concerning individual patient responses to these approaches.

Adult↗