Voice dysfunction in hypothyroidism: An objective multidimensional acoustic study

Hypothyroidism [HT] is a well-recognized cause of voice disorders, although the mechanism is not fully understood. Much deeper understanding of the effect of hormones on the voice is imperative, so that enhanced management of the symptoms may be addressed. Acoustic analysis of voice can be informative because it affords quantitative analyses that carry potential for subsystem description and inference of the underlying mechanism of vocal breakdown. To date, available reports concerning objective analysis of voice characteristics in hypothyroidism are still lacking. This paper considers acoustic analysis of voice disorder in hypothyroidism to provide a quantitative description of voice characteristics that may contribute to our wider standing of the associated vocal deviations, and to assess the efficiency of computer-based acoustic waveform analysis in detecting such vocal dysfunction. Twenty-five patients with hypothyroidism were subjected to; auditory perceptual assessment using a modified GRBAS scale, videolaryngoscopy to exclude any laryngeal pathology, and acoustic voice analysis by Multi-Dimensional Voice Program [MDVP; Kay Elemetrics, NJ, USA]. These data were compared with age and sex matched 30 normal subjects. Dysphonia grade II, associated with increased roughness, breathiness, asthenic character, voice breaks, and reduced pitch are specific characteristics of the voice in hypothyroidism. In comparison to normal subjects, the F[o] related measures [F[o] F[o] standard deviation], perturbation measures [short and long term parameters], noise measures [harmonic to noise ratio] and voice irregularity measures [degree of unvoiced] showed statistically significant different values. The other acoustic parameters [soft phonation index, voice turbulence index and tremors measures], although showed a clinical difference, they did not reach level of significance. The perceptual and acoustic findings are indicative of laryngeal hypofunction in most patients with hypothyroidism. This incurred from a widespread influence of thyroid hormone deficiency on cortical motor and sensory processes which may result in changes of the motor and sensory control involved in the laryngeal phonatory mechanism. Moreover, good vocal production requires good physical condition and integrated control of physical and mental processes. Such processes are ultimately lost in hypothyroidism

Ultrasonography versus laryngoscopy in assessment of laryngeal pathologies

This study was designed to investigate the potential role of ultrasound in the diagnosis of laryngeal pathologies and to evaluate its reliability and validity as compared to the standard of video-laryngoscopic assessment. Gray-scale, B-mode real-time ultrasound of the larynx was carried out in 35 patients with a variety of laryngeal lesions and 21 subjects with no detectable laryngeal lesions. Ultra sonographic findings correlated with laryngoscopic findings in 66% of cases [37/56]. Laryngeal ultrasound correctly predicted the laryngoscopic findings in only 20 of 35 cases with various lesions [i.e. sensitivity = 57%], it also correctly identified that no lesion was present in 17 of 21 normal cases [i.e. specificity = 81%]. Such sensitivity of laryngeal ultrasound varied with the lesion type and size. The sensitivity was 77.7% in laryngeal paralysis, 44% in cases with minimal vocal fold pathologies, and 60% in cases with infiltrating laryngeal lesions. The technique had a positive predictive value of 83% [20/24] and a negative predictive value of 53% [17/32] for detected laryngeal pathology as compared to the standard of videolaryngoscopy. Ultrasonography identified presence of an infiltration of the thyroid cartilage, presence of cervical lymph nodes, and thyroid gland disorder, otherwise no additional advantages were available. This study indicated that ultrasound is a safe and non-invasive tool that may have some role in investigation of laryngeal pathology, but further fine-tuning of the technique may be necessary

Audiological, cognitive and communicative assessment of patients with Down syndrome

Outline the hearing and cognitive profile of children with Down syndrome in relation to speech and language aptitudes in order to recognize other underlying etiological factors of communicative disability beside mental handicap that would improve the rehabilitation of those children. Twenty children with Down syndrome and 20 age and sex-matched normal subjects were subjected to comprehensive audiological evaluation including pure tone audiometry, tympanometry, Auditory brainstem response [ABR], and Event-related potentials [ERPs] in addition to vocal tract examination, and communicative and psychometric evaluation. Conductive hearing loss was detected in 5 [25%] as a complication of recurrent otitis media and repeated insertion of ventilation tubes. ABR wave V detection thresholds were compatible with behavioural pure tone audiometry. Shortened absolute latency of waves I, III and V as well as interpeak latency of I-III, III-V and I-V was observed in 10 patients [50%]. In 8 patients [40%] ERPs showed delay in latency of N[1], P[2], N[2] and P[3] components. In comparison to normal subjects, all patients showed variable degrees of subnormal mentality and social immaturity [p<0.001] as well as delayed language [language age] development [p<0.001]. Auditory dysfunction in patients with Down syndrome can occur at many levels either middle ear, brainstem and higher cortical cognitive progressing. Such findings may contribute to lower functioning of those patients in cognitive, linguistic and social aptitudes. Early audiological screening specific management and well-tailored rehabilitation strategy may allow improved prognosis and good quality of life in patients with Down syndrome

Role of genetic factor in specific language impairment; evidence from pedigree analysis

Genetic factors account for much of the variance in linguistic abilities among people with language disorders and some of the variance in linguistic abilities among normal people. There has been rapid growth of evidence indicating that genetics play an important role in the etiology of specific language impairment [SLI]. In the present study, pedigree analysis was performed for 25 probands of SLI order to determine the possible mode of inheritance of such heritable disorder that can provide additional knowledge about the genotype of normal and affected individuals that may be helpful in genetic counseling. The results revealed transmission pattern consistent with an autosomal mode of transmission. The probability of the SLI in the offspring of an affected parent and normal spouse is approximately 0.5, exactly as would be predicted if a single dominant gene is implicated in the etiology. The currents state of the art of genetic studies related to SLI such as family aggregation studies, twin studies, adoption studies, pedigree analysis and molecular genetic studies was reviewed. It appears that the genetics underlying this disorder are complex, involving, several loci that interact with each other and the environment to produce an overall susceptibility to disease onset

Influence of zinc supplementation on thyroid function and intelligence in children with down syndrome

This study was conducted to evaluate some factors that may affect the cognitive abilities of children with Down syndrome [DS] including hypothyroidism; zinc and selenium deficiency; and the oxidative five stress and additionally, to study the effect of zinc supplementation on the mental state of such cases. Sixty Down syndrome patients were enrolled together with 20 apparently healthy controls with matched age and sex. Estimation of the IQ scores, evaluation of the thyroid function tests, measurement of the serum levels of zinc and selenium, as well as plasma levels of superoxide dismutase activity [SOD] and hydrogen peroxide [H[2][O]2] were done to all cases and controls, Cases with severe mental retardation [IQ 25-39] were received oral zinc sulfate supplementation. A follow up study was done to reevaluate all the above-mentioned studied parameters after 3, and 6 months. Results showed that, in comparison with the controls, DS patients had significantly lower serum levels of both zinc and selenium and significantly higher serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. There were significant positive correlations between the IQ scores and each of T3, T[4], zinc and selenium serum levels, while significant negative correlations were found between the IQ scores and serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. The follow up study showed significant rise of serum zinc level after 3 months of zinc supplementation. Progressive improvement of the IQ scores and thyroid function tests were noticed. This improvement was significant after 6 months of zinc supplementation. In conclusion, cognitive abilities in DS patients may be affected by multiple factors as hypothyroidism, oxidative stress as well as zinc and selenium deficiency. Zinc supplementation for 6 mo may help these abilities to be improved