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At least 19 recordsLinked to original sources
PubMed2005

Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia.

OBJECTIVES: Adductor spasmodic dysphonia (ADSD) has been characterized as a "task specific" laryngeal dystonia, meaning that the severity of dysphonia varies depending on the demands of the vocal task. Voice produced in connected speech as compared with sustained vowels is said to provoke more frequent and severe laryngeal spasms. This study examined the diagnostic value of "task specificity" as a marker of ADSD and its potential to differentiate ADSD from muscle tension dysphonia (MTD), a functional voice disorder that can often masquerade as ADSD. STUDY DESIGN: Case-control study. METHODS: Five listeners, blinded to the purpose of the study, used a 10 cm visual analogue scale to rate dysphonia severity of subjects with ADSD (n = 36) and MTD (n = 45) producing either connected speech or a sustained vowel "ah." RESULTS: In ADSD, dysphonia severity for connected speech (M = 6.22 cm, SD = 2.56) was rated significantly more severe than sustained vowel productions (M = 4.8 cm, SD = 2.8 [t (35) = 3.67, P < .001]). In MTD, however, no significant difference in severity was observed for the connected speech sample (M = 5.98 cm, SD = 2.83 versus the sustained vowel M = 5.86 cm, SD = 2.87 [t (44) = 0.378, P = .707]). The receiver operating characteristic (ROC) curve, an index of the accuracy of task specificity as a diagnostic marker, revealed that a 1 cm difference criterion correctly identified 53% of ADSD cases (sensitivity) and 76% of MTD cases (specificity) (chi2 (1) = 6.88, P = .0087). CONCLUSIONS: Reduced dysphonia severity during sustained vowels supports task specificity in ADSD but not MTD and highlights a valuable diagnostic marker whose recognition should contribute to improved diagnostic precision.

Adult↗
PubMed2000

Adductor spasmodic dysphonia and muscular tension dysphonia: acoustic analysis of sustained phonation and reading.

Acoustic phonatory events were identified in 10 women diagnosed with adductor spasmodic dysphonia (ADSD) and compared to 5 women and 5 men diagnosed with muscle tension dysphonia (MTD). The three acoustic parameters examined during sustained vowel production and reading included phonatory breaks, aperiodicity, and frequency shifts. Intra- and intermeasurer correlations showed high reliability for the measures. Findings indicated that those with ADSD produced a greater number of aberrant acoustic events than those with MTD. The results suggested that: (1) only those with ADSD show evidence of phonatory breaks during vocalization, albeit a sustained vowel or voicing during reading; (2) those with ADSD demonstrate greater variation in the type of aberrant acoustic events produced as a function of speech task. The latter point suggests that control of the larynx varies as a function of task demand, a finding not evident in the functionally based disorder of MTD. MTD is a disorder that often presents itself in a similar clinical manner to ADSD because of its perceptual commonalties and resembling laryngoscopic characteristics. The acoustic analysis presented in this study could be used as a method to assist in distinguishing between the two disorder types.

Acoustics↗
PubMed1999

Phonatory air flow characteristics of adductor spasmodic dysphonia and muscle tension dysphonia.

The purpose of this study was to determine if phonatory air flow characteristics differed among women with adductor spasmodic dysphonia (AdSD), muscle tension dysphonia (MTD), and normal phonation. Phonatory air flow signals were gathered during [pa] syllable repetitions. Mean phonatory air flow, coefficients of variation, and the presence of large air flow perturbations (75 ml/s or more) were examined for the three groups of speakers. There was no significant difference in mean phonatory air flow across groups, and very large intersubject variation in mean phonatory air flow occurred for both the AdSD and MTD groups. Coefficients of variation were similar for the groups of women with MTD and normal phonation but were significantly larger for the group with AdSD. Air flow perturbations were common with AdSD and rare with MTD. Relatively large coefficients of variation and air flow perturbations of at least 75 ml/s did occur for some women with normal voices who were 70 years of age or older. It appears that intrasubject variability in phonatory air flow may aid in the differentiation of AdSD and MTD when used in conjunction with other elements of a thorough voice evaluation. However, the potential contribution of aging to increased intrasubject variability in phonatory air flow must be considered when interpreting findings.

Adult↗
PubMed1996

Muscle tension dysphonia and spasmodic dysphonia: the role of manual laryngeal tension reduction in diagnosis and management.

Excessive activity of the extralaryngeal muscles affects laryngeal function and contributes to a spectrum of interrelated symptoms and syndromes including muscle tension dysphonia and spasmodic dysphonia. Recognition of the role of extralaryngeal tension is helpful in ensuring proper diagnosis and selection of appropriate treatment. This report demonstrates the application of manual laryngeal musculoskeletal tension reduction techniques in the diagnosis and management of laryngeal hyperfunction syndromes. The manual technique consists of focal palpation to determine 1) extent of laryngeal elevation, 2) focal tenderness, 3) voice effect of applying downward pressure over the superior border of the thyroid lamina, and 4) extent of sustained voice improvement following circum-laryngeal massage. The clinical utility of this innovative approach is discussed.

Adult↗
PubMedDate not supplied

[Classification of dysphonias based on the primary etiologic factor (part I)].

INTRODUCTION: Phonation is a complex integral function of the organism. Regular phonation is characterized by: clarity and adequate pitch. Dysphonia is a disorder of phonation. It may have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena are caused by: aperiodicity of vocal vibration, turbulent air flow in the glottis and incomplete glottis closure. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: organic dysphonias and functional dysphonias. On the 8th Congress of Union of European Phoniatricians, in Koszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification, made according to the primary etiologic factor in dysphonias. In this paper, we shall consider the first four. I DYSPHONIAS CAUSED BY PRIMARY FUNCTIONAL DISORDERS: This group includes: 1. Hyperkinetic dysphonia grade I 2. Hyperkinetic dysphonia grade II 3. Hypokinetic dysphonia 4. Contact hyperplastic dysphonia 5. Dysodic dysphonia II DYSPHONIAS CAUSED BY PRIMARY NEUROGENIC DISORDERS: This group includes: 1. Central dysphonias 2. Spasmodic (spastic) dysphonia 3. Dysphonia caused by myasthenia gravis 4. Dysphonia within skull base syndromes 5. Dysphonia caused by unilateral palsy of the inferior laryngeal nerve 6. Dysphonia caused by bilateral palsy of the inferior laryngeal nerve 7. Dysphonia caused by palsy of the superior laryngeal nerve III DYSPHONIAS CAUSED BY PRIMARY PSYCHOGENIC DISORDERS: This group includes: 1. Psychogenic aphonia 2. Psychogenic dysphonia 3. False mutation IV DYSPHONIAS CAUSED BY PRIMARY SOMATIC DISORDERS: This group includes: 1. Dysphonia caused by insufficiency of vocal cords 2. Dysphonia caused by oedema of vocal cords 3. Dysphonia caused by laryngitis (secondary functional) 4. Cord-ventricular voice 5. Posttraumatic dysphonia 6. Arthrogenic dysphonia 7. Presbyphonia CONCLUSION: Dysphonia is a disorder of phonation which originates at the glottis level. When disorders of phonation are concerned it is necessary to study the organism as a whole as well as all mechanisms which take part in voice production. In that case the damaged part of the phonation system can be diagnosed, which enables efficient medical treatment of the disorder.

Humans↗
PubMedDate not supplied

[Classification of dysphonias based on the primary etiologic factor (part II)].

INTRODUCTION: Phonation is a complex integral function of an organism. Regular phonation is characterized by: clearness and adequate pitch. Dysphonia is a disorder of phonation. It can have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena in regard to voice are caused by: irregularities in vocal cord vibration, turbulent airflow in the glottis and obstruction of glottis. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: 1. organic dysphonias and 2. functional dysphonias. On the 8th Congress of the Union of European Phoniatrists, in Köszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification according to the primary etiologic factor of dysphonias. In this paper, we shall consider four gropus: from the fifth to eighth. V DYSPHONIAS CAUSED BY PRIMARY ENDOCRINE DISORDERS: This group includes: 1. Dysphonia caused by pituitary disorders 2. Dysphonia caused by thyroid gland disorders 3. Dysphonia caused by parathyroid glands disorders 4. Dysphonia caused by pancreatic function disorders 5. Dysphonia caused by suprarenal function disorders 6. Dysphonias caused by sexual glands function disorders 7. Intersexuality. VI DYSPHONIAS CAUSED BY COMPLEX PROFESSIONAL REASONS: This group includes: 1. Permanent hyperkinetic dysphonia 2. Permanent hyperkinetic dysphonia with vocal cord nodules 3. Dysphonia caused by myogenic imperfect closure of vocal cords 4. Phonastenia. VII DYSPHONIAS CAUSED BY PRIMARY DISPLASTIC DISORDERS: This group includes: 1. Dysphonia caused by laryngeal hypoplasia 2. Dysphonia caused by laryngeal asymmetry 3. Dysphonia caused by epiglottal anomalies 4. Dysphonia caused by laryngeal diaphragm. VIII DYSPHONIAS CAUSED BY LARYNGEAL TUMORS: This group includes: 1. Dysphonia caused by benign tumors 2. Dysphonia caused by malignant tumors. CONCLUSION: Dysphonia is a disorder of phonation which originates from glottal level. Disorders of phonation require observation of an organism as a whole and studying all mechanisms which take part in voice production. This provides examination of voice disorders, their establishment and adequate treatment.

Endocrine System Diseases↗
PubMed2002

Risk factors and demographics in patients with spasmodic dysphonia.

OBJECTIVES: Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia. STUDY DESIGN: Retrospective patient survey of 168 patients with a known diagnosis of spasmodic dysphonia who completed questionnaires at the time of interval botulinum toxin injection. METHODS: Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first-degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of chi2 values. RESULTS: In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty-five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P =.0001). Thirty percent of patients directly associated onset of spasmodic dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic dysphonia. Twenty-six percent of patients had an essential tremor compared with 4% of first-degree relatives (P =.0001), and 11% had associated writer's cramp compared with 2% of relatives (P =.02). Less than 1% of patients described a history of toxic exposure or electrical injury. CONCLUSIONS: The majority of patients with spasmodic dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic dysphonia. Patients with spasmodic dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.

Adolescent↗
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

What are the illness perceptions of people with dysphonia: a pilot study.

BACKGROUND: Patients do not respond to treatment in a predictable manner. Individual preconceptions determine help seeking, compliance and treatment outcome, yet clinicians rarely explore these issues. The illness perception approach sees the patient as an active participant in the healthcare process. AIMS: The aim of this study was to investigate the illness perceptions of people with dysphonia. The subsidiary aims were to correlate the Illness Perception Questionnaire with any psychological distress identified and a self-report measure of dysphonia, and to consider any potential implications for patient management. DESIGN: Prospective, cross-sectional observation. SETTING: Primary and secondary care, two general and four community hospitals. PARTICIPANTS: Fifty adult patients with dysphonia due to benign disease completed three self-administered questionnaires, which investigated their illness perceptions, psychological distress and perceptions of the impact of the presenting 'illness'. MEASURES: The dysphonia was categorised as being due to functional (n=40) or organic (n=10) causes. All the voices were rated by an expert listener according to the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale. PARTICIPANTS completed the Illness Perception Questionnaire, the Vocal Performance Questionnaire and the Hospital Anxiety and Depression scale. RESULTS: Patients showed a wide variation in perception of causation. They had no strong perceptions about the causes, consequences or duration of the presenting dysphonia. Functional dysphonics reported greater consequences, lower perceived control and increased anxiety when compared to patients with organic dysphonia. In terms of cure/control, all patients expected treatment to be helpful but this expectancy reduced as time increased. Anxiety was more associated with functional dysphonia, however, only 17 per cent of the subjects in this group showed clinically significant levels of signs of psychological distress. CONCLUSIONS: Lay illness representations often diverge from the clinician's understanding of the presenting problem and strongly influence treatment behaviour. Early exploration of illness perceptions may enhance health behaviour and maximise the impact of intervention.

Adult↗
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↗
PubMedDate not supplied

The relevance of stroboscopy in functional dysphonias(1).

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

Adolescent↗
PubMed2002

Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy.

OBJECTIVE: To describe a condition that is referred to as steroid inhaler laryngitis, a clinical entity that is caused by the use of inhaled fluticasone propionate and manifested by dysphonia, throat clearing, and fullness. DESIGN: Case series. SETTING: An outpatient clinic of an academic referral center. PATIENTS: The study population consisted of 20 patients with reactive airway disease and dysphonia who were receiving inhaled fluticasone therapy and who were diagnosed as having steroid inhaler laryngitis during the period from January 1998 to June 2000. INTERVENTION: Cessation of inhaled fluticasone therapy when possible, as well as treatment of other underlying causes of dysphonia, such as laryngopharyngeal reflux and infectious processes. MAIN OUTCOME MEASURE: The resolution of dysphonia with cessation of inhaled fluticasone therapy. RESULTS: Patients with steroid inhaler laryngitis were found to have laryngeal findings ranging from mucosal edema, erythema, and thickening to leukoplakia, granulation, and candidiasis. Patients with more severe mucosal findings were more likely to have laryngopharyngeal reflux as well. Resolution of dysphonia occurred only after discontinuation of the inhaled fluticasone therapy. CONCLUSIONS: Steroid inhaler laryngitis is a form of chemical laryngopharyngitis induced by topical steroid administration. Symptoms and physical findings mimic laryngopharyngeal reflux, but only respond completely to discontinuation of the inhaled steroid therapy. The otolaryngologist should be familiar with this cause of dysphonia.

Administration, Inhalation↗
PubMed2006

Prevalence and relative risk of dysphonia in rheumatoid arthritis.

SUMMARY: Laryngeal involvement in rheumatoid arthritis is not uncommon and may include cricoarytenoid arthritis or vocal fold lesions such as vocal fold rheumatoid nodules or bamboo nodes. Dysphonia or voicing problems can be the result of such laryngeal involvement. This cohort study investigates the prevalence and the relative risk of dysphonia when suffering from rheumatoid arthritis compared to that of healthy subjects. One hundred and sixty-six subjects with rheumatic arthritis and 148 healthy control subjects completed two quality-of-life questionnaires: the Voice Handicap Index and a three-item outcome scale. Both instruments measure the quality of the voice itself and the extent of impairment resulting from dysphonia as experienced by the patient in social and occupational settings. Patients proved to have statistically significant higher prevalence and relative risk of dysphonia. Depending on the questionnaire being used, prevalence data of dysphonia in patients varied between 12% and 27%, whereas the healthy subjects showed prevalence data varying from about 3% to 8%. A patient's relative risk varied from about 3 to 4 when compared to healthy subjects. Patients suffering from rheumatoid arthritis have a clearly higher risk of dysphonia compared to healthy subjects.

Adolescent↗
PubMed2003

Ventricular dysphonia: clinical aspects and therapeutic options.

OBJECTIVE/HYPOTHESIS: Ventricular dysphonia, also known as dysphonia plica ventricularis, refers to the pathological interference of the false vocal folds during phonation. Despite its low incidence and prevalence, Vd is a well-known phenomenon in voice clinics. The present report reviews symptoms, etiology, diagnosis, and therapeutic options regarding this voice disorder. STUDY DESIGN: Literature review and case studies. METHODS: The literature pertaining to all clinical aspects of V(D) was reviewed to define diagnostic and therapeutic clinical decision making. RESULTS: Ventricular dysphonia is characterized by a typical rough, low-pitched voice quality resulting from false vocal fold vibration. Ventricular dysphonia may be compensatory when true vocal folds are affected (resection, paralysis). Noncompensatory types may be of habitual, psychoemotional, or idiopathic origin. Because perceptual symptoms may vary considerably, diagnosis should rely on a meticulous voice assessment, including laryngeal videostroboscopic, perceptual, aerodynamic, and acoustic evaluation. Various therapeutic approaches for the noncompensatory type of ventricular dysphonia may be considered: voice therapy, psychotherapy, anesthetic or botulinum toxin injections, or surgery. CONCLUSION: The study presents the state of the art with respect to ventricular dysphonia and may be helpful in diagnosis and therapeutic decision-making.

Adolescent↗